By Tom Bizzaro, vice president, health policy and industry relations, First Databank
Tom Bizzaro
Healthcare delivery is changing drastically. Demographics, technology, economics, societal forces and many other factors are prompting the industry’s transformation as we head into 2016 and beyond. And, while change is always a bit jarring, sometimes it actually makes sense.
Here are eight emerging trends that are changing healthcare for the better:
The move toward telemedicine
Is there anyone out there who can honestly admit they are thrilled about traveling to a provider’s facility for their care? In today’s world, time has value and patients are much less willing to spend their time waiting for care. Now, in some cases, it is critical to be face-to-face with your caregiver. However, in many cases, it is just an inconvenience. I am pretty sure that surgery and treating a broken bone won’t lend themselves to a virtual visit, but think about all those things that do. Using Skype for virtual doctor visits; reading medical images taken in Indianapolis by a physician in Australia; and using a kiosk to get access to a nurse consultation have become commonplace — and much more is expected as telemedicine continues to expand.
The adoption of evolving electronic communication tools
I read recently that people under the age of 25 prefer texting as a means of communication with their doctors. It seems that phone calls and even emails are too intrusive and time consuming. In a world where email is too slow, where people are cutting the cord to cable TV, and newspapers are the last place young people get their news, healthcare organizations must stay on top of their constituents’ constantly changing communication preferences. Even those that aren’t young enjoy electronic communication tools like a medical guardian, these devices provide peace of mind for their owners and they in turn can save lives when necessary.
The return of home care
While patients are pushing healthcare providers to adopt the latest technologies, at the same time “what is old is new again.” Home healthcare services are growing as aging Americans want to stay in their homes as long as possible. Pharmacists are making home visits to the most at-risk patients to manage medication therapy. Doctors are making house calls to help improve care and decrease hospital readmissions. Nurses are performing all types of infusion therapy in patients’ homes.
HIMSS organizers, in preparation of the annual conference and trade show, and as a way to rally attendees around several trending topics for the coming event, are once again asking the healthcare community how it feels about several key issues that are likely to resonate. As is often the case with this ongoing experiment, the folks in my position — those with a venue to voice their opinions who tell the rest of us what they think — pontificate on the potential impact of these trends.
Certainly, some of my fellow journalists are far better qualified than I to answer the questions posed by HIMSS with any level of authority. Therefore, I’ve given my small microphone to readers of this site so they can voice their opinions of the topics that conference goers are likely to hear about dozens of time while in Chicago.
This year HIMSS is asking what we feel will be the future of: the connected healthcare system, big data, security, innovation and patient engagement. Today, here, we focus on the future of the connected healthcare system, and what several insiders believe that future to be.
With that, enjoy and let me know if you agree with the following thoughts. If not, why; what’s missing?
Tom Bizzaro, vice president of health policy, First Databank
Tom Bizzaro
We’re hoping that the electronic health records (EHR) interoperability movement follows a trajectory similar to that of e-prescribing. To start, as an industry, we have to universally acknowledge the value of interoperability within healthcare IT systems. Indeed, sharing data across systems can help to improve care quality and efficiency in the country’s health system and lead to success of value-based reimbursement models. However, all players – providers, payers, patients and vendors alike – need to truly embrace the value EHR interoperability, putting it above any proprietary concerns.
Then, we need to get to work. We must continue to develop and implement a wide range of standards and vocabularies. Through these, we will ensure that our data is in synch and that systems will always be speaking the same language. Perhaps most important, we need a National Patient Identifier, which will make it possible to match information to specific patients as they traverse the health system. And, while it might seem like doing all this work will take a long time, if we roll up our sleeves and do what’s required, the EHR interoperability story will be on its way to its own happy ending soon enough.
Jonathan Isaacs, executive vice president and general manager, surgery solutions, SourceMedical
Jonathan Issacs
It’s 3:00 a.m. and you wake up with an acute pain in your side that won’t go away — you head to the ER. The CT scan shows nothing — you head to the GI specialist. The doctor says to get an endoscopy — you head to the ASC. The endoscopy says you have a chronic condition that will need to be managed by you, your PCP, and even more specialists. Where does all that data live? Everywhere!
It’s a changing world out there. From cancer centers to freestanding Emergency Departments, healthcare organizations must deliver quality care at lower prices. But information collected at different points can fall through the cracks, putting the patient at risk. That’s why data interoperability is a critical issue.
The solution is not to put every entity in the healthcare value chain on the same closed, monolithic EHR that tries to do everything. We have seen time and again what happens when innovation is stifled and vendors become “too big to fail.” But by embracing connectivity standards, providers and patients alike can leverage best-in-class tools purposely built for specific treatments and outcomes. The easier it is, the higher the likelihood of success. And isn’t that the whole point?
George Robinson, RPh, senior product manager, First Databank.
Approximately $20 billion is lost annually in the United States because of medication errors, with the average hospitalized patient subject to at least one medication mistake per day.Alert fatigue is often cited as a reason for these errors—even though alerts generated by clinical decision support (CDS) systems call attention to important information (such as potential drug interactions), excessive alerts wear clinicians down, resulting in boy-who-cries-wolf scenarios. The result: clinicians instinctively override the alerts instead of implementing an override monitoring plan.
Consider the following:
In 2009, researchers at the Boston-based Beth Israel Deaconess Medical Center and the Dana-Farber Cancer Institute looked at the safety alerts generated by 2,872 clinicians through 3.5 million electronic prescriptions over a nine-month period. Of the 233,537 alerts, 98 percent were drug-drug interaction issues, and more than 90 percent were overridden.
A more recent 2013 study, published in the Journal of the American Medical Informatics Association, showed improved override rates with only about half of alerts overridden by providers, with half of those overrides classified as appropriate. Authors concluded that further refinement of these alerts could improve relevance and reduce alert fatigue.
A Driver in Need of a Clearer View
The afore-mentioned studies conclude that clinicians are indeed overriding medication alerts at alarming rates. Although the industry has made significant progress in addressing alert fatigue during the time the data from these studies was being analyzed, these studies clearly support what most healthcare professionals already suspect: The practice of ignoring and overriding medication alerts is widespread and can potentially lead to undesirable consequences.
