Electronic Health Reporter

As someone passionate about patient engagement and using health IT and other technologies to improve care, I continue hear a great deal about how solutions can actually benefit population health. Even at the most recent HIMSS conference, “patient engagement” as a term clearly has become one of this year’s biggest buzz phrases.

Conference sessions were dedicated to the topic, vendors marketed their services to solving some of the issues associated with it and seemingly everyone in attendance had an opinion for what needs to be done or at least has some strategies for bringing more patients — or their data — directly into the care sphere.

Problem is, from my perspective, that, unfortunately, too much is still being said about population health and not nearly enough about individual health. In theory, I understand why this must be, but in practicality, I don’t understand the seemingly lack of attention individuals are receiving. Obviously, if population health outcomes improve then that must logically mean individual health outcomes are improving.

And while I understand that not everyone or every need can possibly be addressed, that doesn’t mean we shouldn’t be trying to fill those needs. The current conversations about improved population health remind me of a common business/life solution when addressing a major problem: How does one eat an elephant? One bite at a time. Likewise, it would seem the same approach could be taken to achieve improve population health outcomes: One individual patient at a time.

That said, I asked some folks within the health IT community how technology affects individual patient outcomes. Though some of the ideas here are still high level, perhaps they are a step in the right direction. Here are some of the responses I received:

Ben Quirk, CEO, Quirk Healthcare Solutions

What are the real-world benefits of electronic health records, for example, to a specific individual? To answer that question, let’s take a look at a fictional person we’ll call “Bill.” Bill is quite elderly and has a variety of age-related illnesses. He lives in Ohio, and decides spend the winter with his daughter in Florida.

Bill’s daughter, Susan, arranges for her father to be seen by a local specialist during his stay. Susan tries to get a voluminous paper file transferred from Ohio to the new doctor in Florida, but there are delays: phone messages are missed, handwriting is misread, and no one has time to copy and mail 100 pages of medical records.

In the end, Susan is unable to get her father’s records transferred in time for the appointment with the new physician. As a result, an unnecessary test is performed, and a drug is prescribed that had caused an allergic reaction in the past.

In the future, EHRs will enable the Florida clinic to have electronic access to the same records available in Ohio. Already, Medicare and some commercial carriers have websites that list physician visits, patient complaints, diagnoses made, lab/diagnostic tests performed, and drugs prescribed. Eventually, such websites may include a full medical profile, including doctor’s notes, lab results, x-ray images and more.

We no longer drive to a video store to rent a movie, or wait for a bank to mail a monthly statement to check our finances. With EHRs, we will no longer be dependent on paper locked in an office when we need access to important medical records. Whether its transferring records from one clinic to another, availability of records following a disaster, or simply the desire of a patient to stay informed, EHRs have practical advantages for each of us.

Jim Gerrity, director of global industry marketing, Ciena

Telehealth services are one of the fastest growing areas in healthcare. Market drivers include an aging population, lack of clinical specialists, a pro-active vs. reactive approach to care, proven results, cost savings and advancements in telecommunications networks.

One of the more advanced telehealth applications is telesurgery.

In telesurgery, doctors leverage the latest HD video, state-of-the-art robotics and high capacity, low latency networks to perform remote surgical procedures. This technology brings surgical expertise to remote areas and underserved populations, and helps healthcare providers improve surgical outcomes, reduce costs, and make better use of expert surgeons. However, the quality of the video, available network bandwidth, network latency and jitter (variation of latency), are the obstacles to the widespread use of this technology remotely.

Of great importance to the success of telesurgery is the round-trip latency from the issuing of a robotic control signal to the resulting video displayed at the surgeon’s site – this essentially determines the safety of telesurgery. If the robotic control signal gets delayed, it will result in a delayed action of the surgical robot, which could lead to catastrophic consequences.

The quality of video transmission from the patient site to the surgeon site is also important, as the ability to clearly see the result of a robotic control command on a patient helps a surgeon to make a decision on the next movement.

To overcome these challenges and ensure successful telesurgery, healthcare providers increasingly are adopting optical networking technologies to transport bandwidth-intensive ultra HD and stereoscopic video without latency and jitter, to ensure patient data is delivered quickly and reliably.

Life-saving applications of telesurgery are creating headlines and bringing a new “digital” form of treatment for some patients, but providers must plan now to provision for their increasing use, as well as other bandwidth-intensive emerging eHealth applications.

April Sage, CPHIMS, director healthcare IT, Online Tech

There are many health IT applications available to patients on the web and through their phones that will help them connect and communicate with their professional and family or care providers, remind them to take their medications, or connect with other patients who have information to share. But health issues can be frightening, private issues and attending to patient concerns that their information is secure and protected is paramount for any beneficial outcome. One key example is being able to tightly control the visibility of your information. Example: http://www.caringbridge.org/what-we-offer/the-privacy-you-choose

If health IT apps hope to successfully impact patient outcomes, they need to address patient privacy concerns, and obligations to protect sensitive data under regulations like HIPAA and HITECH. These suggestions can help:

Provide patients with a clear understanding of what information is collected, who has access, and how it will be used.

Patients are more concerned with their privacy when they understand the scope of data collected. This is especially true when linked to location data, which raised privacy concerns far more than other types of data. This issue can be especially sensitive for women, or others that might feel personally vulnerable.

Embrace your responsibility to protect patient data.

Diligence at the inception of a project can save tremendous costs of fines, remediation, and losing the confidence of customers if patient data is breached. Limit data stored on devices, require strong passwords, and take care to encrypt any stored data as well as data in transit between devices and servers. If you don’t already have a health IT attorney, now would be a good time to find one.

Design for privacy.

Health IT application designers need to account for privacy and security as part of their design constraints. In addition to requiring strong login credentials and using some method of two-factor authentication, such as an additional PIN code, app designers can consider metaphors for health information. For example, achieving a health goal might be represented by an image instead of descriptive health information as in UbiFit’s activity “garden.” Such metaphors can create a more aesthetically pleasing experience with the added bonus of increasing patient privacy to the casual observer.

Accomplishing improved patient outcomes while protecting privacy is possible when this becomes part of the guiding design principles of Health IT apps.

Nilesh Chandra, managing consultant, PA Consulting Group

Improved integration through health information exchanges allows sharing of data for patients seeking care while they’re traveling, working with a new doctor or seeking emergency attention. With electronic health records, medications can be cross checked, allergies can be tracked, past reactions to medications are detailed, and dosage requirements are displayed in a central location. For doctors, this is an advantage as they can access patient records quickly.

The availability of large data sets of patient health data in a structured record format enables large scale analysis of the data in a manner that wasn’t possible before, allowing clinicians and researchers to identify new insights based on patterns in data.

Additionally, we see further opportunities with the possible integration of data collected by wearable devices. If that data is able to be incorporated into a patient’s health records, healthcare providers will be able to more easily assess treatment options for patients based on their individual lifestyles.

Dr. Andrew Litt, chief medical officer, Dell Healthcare and Life Sciences

We know that technology can increase efficiency and reduce costs in the healthcare system, but it can also allow us to customize care at the individual level. Connecting healthcare information currently locked in silos can enable multiple caregivers to synchronize care around the whole patient. Longitudinal electronic medical records data supplemented with genomic, proteomic and other unique individual data can reduce the time and expense of bringing new drugs to market and direct targeted treatments for patients who do not respond to today’s drugs. High-performance computing and cloud-based interoperable data storage are making genomic information more accessible to physicians and medical researchers by collapsing the cost and time of analyzing, storing and using this personalized data. The rapid availability of this data in a form that physicians can use to make personalized and precision medical treatment plans will dramatically improve our ability to treat diseases that have been refractory to therapy and to do so at a lower cost.