On Tuesday, March 26, the Senate health committee will hold a hearing on implementation of the electronic health information provisions in the 21st Century Cures Act.
In the Cures Act, Congress took steps to help improve the exchange of electronic health information. Last month, the Department of Health and Human Services (HHS) released two rules to define information blocking—so it is clear when one system is purposefully not sharing information with another—and to give patients more control over their records and providers more information so they can better treat their patients. This hearing will be about the proposed new rules and efforts to improve electronic health records and make health information more accessible.
Chairman Lamar Alexander (R-Tenn.) said of the new proposed rules: “These proposed rules remove barriers and should make it easier for patients to more quickly access, use, and understand their personal medical information. It should also unleash new ways of helping doctors and other medical providers to make sense of that information in ways that lead to better health care experiences, better outcomes, and lower costs for patients. Our committee will continue careful oversight of these new rules which affect almost every American and are an important result of the bipartisan 21st Century Cures Act.”
The Senate health committee had six hearings in 2015 to explore ways to get our nation’s system of health information technology out of a ditch and make it useful for doctors and patients. The committee then authored the 21st Century Cures Act which directed HHS to make proposals to improve electronic health records.
The 2019 HIMSS Annual Conference may be over, but that doesn’t mean an end to the pressing challenges and trends discussed at Orlando’s Orange County Convention Center. More than 42,500 people attended the conference — the majority of whom were C-suite executives and HIT professionals taking full advantage of the healthcare IT industry’s largest opportunity for networking, product promotions, continuing education and major announcements.
As always, there were a few subjects during HIMSS19 that generated significant buzz. Here are four of those trends that will remain key topics throughout the next year:
Healthcare data exchange
The release of two long-anticipated proposed rules on information blocking came just as HIMSS19 convened. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) unveiled proposals that would require healthcare providers and plans to implement open data sharing technologies to support transitions of care. The first focuses on standardized application programming interfaces (APIs) and carries forward provisions from the 21st Century Cures Act.
Those associated with Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Advantage and Qualified Health Plans in the federally-facilitated exchanges would have to provide patients with immediate electronic access to medical claims and other health information by 2020. Under a latter proposal, health information exchanges (HIEs), health IT developers and health information networks (HINs) can be penalized up to $1 million per information blocking violation, but providers are not subject to fines.
The goal of the proposals is to consider care across the entire continuum, giving patients greater control and understanding of their health journeys. This is interesting, given that HIMSS attendees who responded to Stoltenberg Consulting’s seventh annual HIT Industry Outlook Survey noted “lack of system interoperability” as one of their biggest operational burdens, and “leveraging meaningful patient data” as the IT team’s most significant hurdle this year. Thus, overcoming these challenges to meet the newly proposed mandates will likely dominate discussions during the remainder of 2019.
Much has been written about the prospect of using blockchain technology as a key component of achieving EHR interoperability. It has been widely reported that 55 percent of surveyed hospitals indicated a desire to initiate some sort of blockchain program within the next two years.
However, as with many game-changing approaches, the devil is in the details. Blockchain technology presents a huge challenge when it comes to impact on the data center–whether that data center is on premises, in the cloud or a hybrid cloud configuration. The tsunami of data added to the already overwhelming amount of required information could swamp a healthcare organization. In addition, the performance decline from this mass of information may negate the positive aspects of using blockchain for EHR interoperability.
Let’s first look at the positives. Defined by the Office of the National Coordinator for Health Information Technology (ONC), interoperability under the health information technology arm includes three specific functions. First, it involves the secure exchange of electronic health information without special user effort. Second, it “allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable state or federal law.” Third, it prohibits specific information blocking, the act of “knowingly and unreasonably” interfering with the exchange and use of electronic health information. If implemented properly, blockchain can meet these requirements exceptionally well.
Now for the challenge. Blockchain is slow. In the most recently available study, the Bitcoin network — the largest and most widely tested application of blockchain technology — achieved maximum throughput nearly 50 times slower than PayPal and 14,000 times slower than VisaNet. If blockchain-based applications come in on top of the already staggering load of data handling required of IT in the healthcare sector today, the danger of major system slowdowns, and even system crashes, will increase dramatically. In the healthcare environment, these IT disasters could have life-or-death consequences.
Artificial intelligence is transforming the healthcare industry – it is creating opportunities that have been never thought possible while opening up the realm of new possibilities beyond human capabilities.
Powered by increasing availability of healthcare data and advances in machine learning, artificial intelligence aims to mimic human cognitive functions, assisting physicians to make better clinical decisions or even replace human judgement in certain functional areas of healthcare. A major part of AI involves the use sophisticated algorithms to ‘learn’ features from a large volume of healthcare data, and then use the obtained insights to assist clinical practice. It can also be equipped with learning and self-correcting abilities to improve its accuracy based on feedback. It can assist physicians by providing up-to-date medical information from journals, textbooks and clinical practices which can help to reduce diagnostic and therapeutic errors that are inevitable in the human clinical practice.
Here are some recent advances of artificial intelligence in practical use.
Cardiac Intervention “Mapping” the heart and, in many cases, mapping the signal of the heart allows physicians to understand specific problems before deciding on a solution. Taking arrhythmia as an example, by using AI, you can use the mapping to get much clearer understanding of what is the exact problem that causes the irregular heartbeat. Another example involves planning interventions with a catheter. Mapping provides the exact anatomical structure of the arteries so you make decisions on the exact kind of catheter to be used and the exact behavior of the arteries at the specific point where you have to do the intervention. Mapping usually occurs prior to an operation but sometimes it can be used during the operation itself, when you have images from the fluoroscopy; then you can do analysis of the images and get precise information about the location and the structure of the arteries.
Spinal Surgery This is a very interesting and challenging application where you have to be very precise, especially when you are putting in screws into the vertebrae. Precision cannot be gained very easily just by what the surgeon sees because, in many cases, it’s a percutaneous procedure. It’s difficult to see exactly where the vertebra line up. Artificial intelligence assists in the navigation by utilizing pre-op scanning, along with information provided by the x-ray in the operating room. Algorithms can combine those two sources of information which allows the surgeon to accurately navigate to the exact point of insertion.
This also holds true for hip or knee replacement. Using AI algorithms, during the planning phase, you can decide on a specific implant that will be for a particular patient. Mapping also provides very good segmentation of the bones prior to the operation. This helps avoid doing generic work with an implant that might not fully fit the knee or hip and the patient will suffer from future problems.
The Department of Health and Human Services (HHS) filed its annual year-end report to Congress at the start of 2019. The 22-page report summarized nationwide trends in health information exchange in 2018, including the adoption of EHRs and other technologies that support electronic access to patient information. The most interesting takeaway has to do with the ever-elusive healthcare interoperability.
According to the report, HHS said it heard from stakeholders about several barriers to interoperable access to health information remain, including technical, financial, trust and business practice barriers. “These barriers impede the movement of health information to where it is needed across the care continuum,” the report said. “In addition, burden arising from quality reporting, documentation, administrative, and billing requirements that prescribe how health IT systems are designed also hamper the innovative usability of health IT.”
To better understand these barriers, HHS said it conducted multiple outreach efforts to engage the clinical community and health IT stakeholders to better understand these barriers. Based on these takeaways, HHS said it plans to support, through its policies, and that the health IT community as a whole can take to accelerate progress: Focus on improving interoperability and upgrading technical capabilities of health IT, so patients can securely access, aggregate, and move their health information using their smartphones (or other devices) and healthcare providers can easily send, receive, and analyze patient data; increase transparency in data sharing practices and strengthen technical capabilities of health IT so payers can access population-level clinical data to promote economic transparency and operational efficiency to lower the cost of care and administrative costs; and prioritize improving health IT and reducing documentation burden, time inefficiencies, and hassle for health care providers, so they can focus on their patients rather than their computers.
Additionally, HHS said it plans to leverage the 21st Century Cures Act to enhance innovation and promote access and use of electronic health information. The Cures Act includes provisions that can: promote the development and use of upgraded health IT capabilities; establish transparent expectations for data sharing, including through open application programming interfaces (APIs); and improve the health IT end user experience, including by reducing administrative burden.
“Patients, healthcare providers, and payers with appropriate access to health information can use modern computing solutions (e.g., machine learning and artificial intelligence) to benefit from the data,” HHS said in its report. “Improved interoperability can strengthen market competition, result in greater quality, safety and value for patients, payers, and the healthcare system generally, and enable patients, healthcare providers, and payers to experience the promised benefits of health IT.”
Interoperability barriers include:
Technical barriers: These limit interoperability through—for example—a lack of standards development, data quality, and patient and health care provider data matching. Addressing these technical barriers by coordinating to establish the technological foundation for standardizing electronic health information and by promoting exchange of that information can considerably remove these barriers.
Financial barriers: These relate to the costs of developing, implementing, and optimizing health IT to meet frequently changing requirements of health care programs. The cost to adjust health IT to meet these requirements can impact innovation and the timeliness of technical upgrades. Specific barriers include the lack of sufficient incentives for sharing information between health care providers, the need for enhanced business models for secondary uses of data, and the current business models for health systems or health care providers that do not adequately focus on improving data quality.
Trust barriers: Legal and business incentives to keep data from moving present challenges. Health information networks and their participants often treat individuals’ electronic health information as an asset that can be restricted to obtain or maintain competitive advantage.
Elsewhere, the Center for Medical Interoperability, located in Nashville, Tenn., is an organization that is working to promote plug-and-play interoperability. The center’s members include LifePoint Hospitals, Northwestern Memorial Healthcare, Hospital Corporation of America, Cedars-Sinai Health System, Hennepin Healthcare System, Ascension Health, Community Health Systems, Scripps Health, and UNC Health Care System.
Its mission is “to achieve plug-and-play interoperability by unifying healthcare organizations to compel change, building a lab to solve shared technical challenges, and pioneering innovative research and development.” The center stressed that the “lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars a year.”
More interoperability barriers identified
In a separate study, “Variation in Interoperability Among U.S. Non-federal Acute Care Hospitals in 2017,” showed additional difficulty integrating information into the EHR was the most common reason reported by hospitals for not using health information received electronically from sources outside their health system. Lack of timely information, unusable formats and difficulty finding specific, relevant information also made the list, according to the 2017 American Hospital Association (AHA) Annual Survey, Information Technology Supplement.
Among the explanations health systems provided for rarely or never using patient health information received electronically from providers or sources outside their health system:
Difficult to integrate information in EHR: 55 percent (percentage of hospitals citing this reason)
Information not always available when needed (e.g. timely): 47 percent
Information not presented in a useful format: 31 percent
Information that is specific and relevant is hard to find: 20 percent
Information available and integrated into the EHR but not part of clinicians’ workflow: 16 percent
Hospitals, when asked to explain their primary inability to send information though an electronic exchange, pointed to: Difficulty locating providers’ addresses. The combined reasons, ranked in order regardless of hospital classification (small, rural, CAH or national) include:
Difficult to find providers’ addresses
Exchange partners’ EHR system lacks capability to receive data
Exchange partners we would like to send data to do not have an EHR or other electronic system to receive data
Many recipients of care summaries report that the information is not useful
Cumbersome workflow to send the information from our EHR system
The complexity of state and federal privacy and security regulations makes it difficult for us to determine whether it is permissible to electronically exchange patient health information
Lack the technical capability to electronically send patient health information to outside providers or other sources
The report also details other barriers related to exchanging patient health information, citing the 2017 AHA survey:
Greater challenges exchanging data across different vendor platforms
Paying additional costs to exchange with organizations outside our system
[Need to] develop customized interfaces in order to electronically exchange health information
“Policies aimed at addressing these barriers will be particularly important for improving interoperable exchange in health care,” the report concluded. “The 2015 Edition of the health IT certification criteria includes updated technical requirements that allow for innovation to occur around application programming interfaces (APIs) and interoperability-focused standards such that data are accessible and can be more easily exchanged. The 21st Century Cures Act of 2016 further builds upon this work to improve data sharing by calling for the development of open APIs and a Trusted Exchange Framework and Common Agreement. These efforts, along with many others, should further improvements in interoperability.”
What healthcare leaders are saying about interoperability
While HHS said it conducted outreach efforts to engage health IT stakeholders to better understand these barriers, we did too. To further understand what’s currently going on with healthcare interoperability, read the following perspectives from some of the industry’s leaders. If there’s something more that you think must be done to improve healthcare interoperability, let us know:
InterSystems announces it has been selected by the eHealth Exchange, the largest nationwide health information network connecting the public and private sectors, as the technology partner powering the network’s latest expansion plans. The network will implement InterSystems HealthShare suite of connected health solutions to help deliver the initial enhancements.
The eHealth Exchange enables federal agencies, 75 percent of U.S. hospitals, and tens of thousands of clinics to share patient records to better treat patients and coordinate care. The eHealth Exchange also supports public health reporting, quality reporting, and disability and insurance determinations. The network celebrated its 10-year anniversary by adopting InterSystems HealthShare to power its information exchange, accelerating network expansion, and introducing new use cases, such as population-level exchange, push notifications, discrete data-level queries using HL7 Fast Healthcare Interoperability Resources (FHIR), prescription drug monitoring programs (PDMP), and more.
HealthShare is a suite of connected health solutions that unites providers, patients, and payers with a unified health record and analytics that span the care continuum. HealthShare integrates data from a variety of health information systems and pulls it into one place to give care teams a complete view of the patient, creating a unified, community-wide health record.
“InterSystems is thrilled that HealthShare will power the ever-expanding ecosystem for the eHealth Exchange,” said Don Woodlock, vice president of HealthShare for InterSystems. “As the participants in eHealth Exchange continue to grow – in number and members — the scalability, durability, and performance of HealthShare are perfectly suited to enable the national network to grow. Providing better connectivity between providers of all types and the patients they serve gets us all to a shared common objective: a unified view of the patient and a more engaged and engaging healthcare system.”
InterSystems partners with some of the nation’s largest health information exchanges (HIEs) to serve as the underlying technology behind the networks, including Healthix, the largest public HIE in the U.S.; Manifest MedEx, California’s largest nonprofit health data network; New York Care Information Gateway, a health information organization covering 6.5 million patients across the five boroughs of New York and Long Island; and North Carolina Department of Information Technology’s NC HealthConnex, the state’s designated health information exchange supporting 4,500 healthcare facilities across the state.
Heal announced the results of its 2019 first-time patient user survey. Having delivered more than 110,000 house calls since February 2015, Heal shared a voluntary survey with more than 6,000 patients who used Heal for the first time in 2018. Findings from the survey reveal substantial reduction in ER and urgent care overuse and pointed to a corresponding increase in timely care delivery. A highlight of those results includes:
55.78 percent of first-time Heal users admit they would have gone to urgent care or an emergency room if Heal was not available
37.4 percent would have waited an extended period of time to see their doctor or would have passed on seeking treatment at all if Heal was not available
1.96 percent would have tried a telemedicine service if Heal was not available
According to a study in 2016 from the Health Care Cost Institute, the national median cost of emergency room visits for patients was nearly $1,917, while some states, such as California, range $2,268 or higher. As an ever-increasing number of patients choose Heal over avoidable trips to the ER or urgent care, Heal has delivered more than $65 million in healthcare cost savings to patients and insurance companies.
However, cost savings isn’t the only benefit Heal patients are claiming to experience.In a recently published academic paper, authored by Dr. Eric Topol and his team, “Characteristics of the modern-day physician house call.” They independently performed a retrospective observational analysis on data collected on Heal house calls made to 13,849 patients over one year from August 2016 to July 2017.
Imagine you could safely wield your medical data the same way you can use an ATM card at any store or cash machine anywhere, anytime.
The American Medical Association (AMA) believes that one of the biggest challenges in healthcare today is securing, sharing, and using trusted health data in real time. The AMA’s integrated innovation enterprise, Health2047, created Akiri to transform how everyone does it.
Akiri is partnering with healthcare leaders to solve real-world business problems. Akiri is already collaborating with the life sciences industry to solve data challenges related to drug safety and clinical trials.
In addition to the life science industry, Akiri plans to collaborate with payers, physicians, and health systems to improve the quality and efficiency of care delivery.
Who are your competitors?
Akiri leverages a unique combination of technologies and optimizes them for healthcare, so at this time, Akiri does not have any direct competitors.
How your company differentiates itself from the competition and what differentiates Akiri?
Akiri Switch is unlike any other solution for managing healthcare data. It is not a health information exchange (HIE); an extract, transform, load (ETL) process; or an electronic medical record (EMR) system. Instead, Akiri Switch is an invitation-only, subscription-based, ultra-secure private network. Rather than store any health data, it transmits it through a standardized system of codes.
VirtualHealth recently announced that WellCare Health Plans, Inc. is now live on its next generation Helios solution. Helios is the first comprehensive care management platform purpose-built to power the entire ecosystem of value-based care. It provides intelligent workflows based on a 360° view that encompasses all aspects of a member’s health. With Helios, care teams can finally work collaboratively using smart algorithms to pinpoint interventions and reduce avoidable issues between medical visits.
WellCare is leveraging Helios as a linchpin in its broader strategy to optimize health for its 5.5 million Medicare and Medicaid members in 20 states. The company is leveraging Helios’ care management capabilities, including multi-source integration, risk stratification, trigger-based tasking, clinical automation, care planning, service management and real-time analytics.
“This deployment of the Helios platform sets the stage for the future of care management at WellCare, equipping our teams with the data and tools needed to drive improved patient outcomes,” said Darren Ghanayem, executive vice president and chief information officer, WellCare. “We look forward to working closely with the innovators at VirtualHealth as we optimize care for our members.”
WellCare’s launch comes on the heels of a year of record-breaking customer wins for VirtualHealth, including partnerships with Chimes, Inter Valley Health Plan and other industry leaders. The Helios solution currently optimizes care for nearly 7 million members of the highest-risk patient populations across Medicare, Medicaid, and LTSS programs. VirtualHealth’s rapid growth also earned it a ranking of 39 on the Deloitte 2018 Technology Fast 500.
“By connecting the entire care team across one integrated ecosystem, our clients can go beyond traditional care management and be proactive about their members’ health.” said Adam Sabloff, founder and CEO of VirtualHealth. “We’re excited to be working with WellCare to create a world in which technology’s promise finally meets the challenge of comprehensive care management across all patient populations.”
By Ilia Sotnikov, vice president of product management, Netwrix.
On February 21, UConn Health reported that personally identifiable information (PII) from 326,000 patients was compromised. A malicious third party illegally gained access to several employee email accounts that contained patient names, dates of birth, Social Security numbers, addresses, and limited medical information, such as billing and appointment information.
What is most important about this data breach is that the hackers were not necessarily looking for patient medical records — they seem to have been looking for any personal information they could steal. That vividly illustrates the importance of having stringent policies to protect PII, supported by employee training on best security practices. Specifically, there are three lessons to learn from this event if you want to mitigate your risk of suffering a similar breach.
Lesson #1. Classify your sensitive data
The 2018 Netwrix IT Risks Report shows that healthcare organizations generally lack proper data governance practices and rarely check what data they store and how sensitive it is. The majority of respondents classify data based on its sensitivity (61 percent) and clear up unnecessary data (67 percent) only once a year or even less often.
It’s estimated that by 2020, each person will generate 1.7 MB of data every second. However, not all of that data needs special protection. Therefore, an effective strategy is to develop a data classification policy to discover all the data you have and classify it according to your organization’s needs. That way, you can prioritize your security efforts on the data that deserves it the most. At the same time, you can eliminate duplicate and unneeded files, which will reduce your attack surface area and lower your storage and backup costs.