Guest post by LeRoy E. Jones, chief executive officer, GSI Health, LLC.
The health IT revolution is here and 2016 will be the year that actionable data brings it full circle.
Opportunities to achieve meaningful use with electronic health records (EHRs) are available and many healthcare organizations have already realized elevated care coordination with healthcare IT. However, improved care coordination is only a small piece of HIT’s full potential to produce a higher level synthesis of information that delivers actionable data to clinicians. As the healthcare industry transitions to a value-based model in which organizations are compensated not for services performed but for keeping patients and populations well, achieving a higher level of operational efficiency is what patient care requires and what executives expect to receive from their EHR investment. This approach emphasizes outcomes and value rather than procedures and fees, incentivizing providers to improve efficiency by better managing their populations. Garnering actionable insights for frontline clinicians through an evolved EHR framework is the unified responsibility of EHR providers, IT professionals and care coordination managers – and a task that will monopolize HIT in 2016.
The data void in historical EHR concepts
Traditionally, care has been based on the “inside the four walls” EHR, which means insights are derived from limited data, and next steps are determined by what the patient’s problem is today or what they choose to communicate to their caregiver. If outside information is available from clinical and claims data, it is sparse and often inaccessible to the caregiver. This presents an unavoidable need to make clinical information actionable by readily transforming operational and care data that’s housed in care management tools into usable insights for care delivery and improvement. Likewise, when care management tools are armed with indicators of care gaps, they can do a better job at highlighting those patients during the care process, and feeding care activities to analytics appropriately tagged with metadata or other enhanced information to enrich further analysis.
Filling the gaps to achieve actionable data
To deliver actionable data in a clinical context, HIT platform advancements must integrate and analyze data from across the community—including medical, behavioral, and social information—to provide the big picture of patient and population health. Further, the operational information about moving a patient through the care process (e.g., outreach, education, arranging a ride, etc.) is vital to tuning care delivery as a holistic system rather than just optimizing the points of care alone. This innovative approach consolidates diverse and fragmented data in a single comprehensive care plan, with meaningful insights that empowers the full spectrum of care, from clinical providers (e.g., physicians, nurses, behavioral health professionals, staff) to non-clinical providers (e.g., care managers, case managers, social workers), to patients and their caregivers. Armed with granular patient and population insights that span the continuum, care teams are able to proactively address gaps in patient care, allocate scarce resources, and strategically identify at-risk patients in time for cost-effective interventions. This transition also requires altering the way underlying data concepts are represented by elevating EHR infrastructures and technical standards to accommodate a high-level synthesis of information.
Looking back at 2015, we see significant trends impacting inpatient telemedicine that will gain strength through 2016. Here are the Top Five: How they impacted healthcare, and how they will change hospital medicine moving forward.
More Legislation and Regulation Activity
A recent report from the National Conference of State Legislatures showed there were 200 telemedicine bills introduced in all but eight states in 2015. The federal government also introduced the TELEMedicine for MEDicare Act of 2015 and the Veteran’s E-Health and Telemedicine Support Act of 2015, which are aimed at creating an interstate license for those practicing telemedicine for these patient populations. Last year, 32 states and the District of Columbia enacted telemedicine parity laws, requiring health plans to reimburse telemedicine the same way—and at the same cost—as in-person service. We expect to see more of this activity as telemedicine becomes an increasingly integral part of healthcare in America.
Easier Licensure Across States
Currently, if you have a group of physicians caring for patients in hospitals in four or five states, they must become licensed in each of those states. As noted above, recent legislation (along with new telehealth licensing compacts between states) will make it easier for physicians to get a license across state lines. This will clearly help facilitate the use of telemedicine services
Growing Financial Support
Today, the payer response can best be described as a patchwork. Medicare typically doesn’t reimburse for inpatient telemedicine (except in rural areas as Medicaid), and the commercial payers tend to vary from state to state. There isn’t a uniform basis for reimbursements. Many hospitals end up financing most of the costs of inpatient physician services delivered with telemedicine?and we all know healthcare dollars are tight for everybody. However, the physician reimbursement is moving, albeit slowly. The state parity laws will help. So, too, will having more commercial payers recognize the value of telemedicine services. For example, UnitedHealth Group announced plans to expand coverage for virtual physician visits to employer-sponsored and individual plan participants, increasing those covered from approximately 1 million to well more than 20 million. Better reimbursement structures will help fortify hospitals’ financial underpinnings and alleviate some of the burden they’ve been forced to bear.
After years of underinvestment, CIO’s in healthcare may have something to cheer about this year. The biggest trend seems to be the increased focus and investment in IT in healthcare enterprises. With more than $30 billion invested in electronic health record (EHR) systems, and meaningful use (MU) requirements out of the way, we are seeing enterprises turn toward the more strategic aspects of IT in the ongoing transformation of the healthcare sector.
These investments, however, will follow the money. In other words, funding will focus on initiatives that have the biggest impact in terms of revenues, cost avoidance, and transformative potential. A recent survey by technology provider Healthedge suggests that investments among payers will be targeted at selective enhancements to the most critical systems that support business development, and not a wholesale upgrade of IT. Here are a few of the top investment areas across healthcare:
Population Health Management (PHM): Everybody is on board with the concept of PHM as the defining principle in an outcomes-based business model. However, PHM has eluded a consistent definition, other than that its desired impact is to reduce overall costs of patient populations, and improve clinical outcomes. Analytics has been an important aspect of this discussion, however standalone analytics solutions have struggled to demonstrate value, and progress on advanced analytics involving predictive models and cognitive sciences has been slow. This year may change all of that. Many standalone analytics companies are likely to be acquired, and IBM Watson will gain more traction. M & A in healthcare will drive PHM as well.
Information Security: With healthcare data breaches at over 112 million in 2015, including high-profile breaches at Anthem, Premera, and Excellus, IT security is now a CEO level issue. There is no doubt what this means – investments in data security technologies are going to increase. However, there is no guarantee that data breaches will not increase.
Healthcare Consumerism: Changing demographics and unexpected increases in the costs of health insurance are driving the consumerization of healthcare today. Silicon Valley startups, flush with VC money, are coming up with direct-to-consumer approaches that are making traditional healthcare firms sit up and take notice. At the same time, the newly awakened healthcare consumer is also demanding information and price transparency. New York Presbyterian has launched a patient-first marketing strategy aimed at improving engagement with patients through information sharing, and is revamping its website completely. BCBS of NC has already released the cat among the pigeons by publishing price data (and is facing pushback from its provider network). IT investments will now be focused on maximizing the reach and value of the information to empower consumers to make the right choices.
Last year, 2015, was a year of buildup, anticipation, and finally some bold moves to propel healthcare technologies forward, specifically regarding interoperability of data. The Office of the National Coordination, under the auspices of the department of Health and Human Services, released the long-awaited and much-debated meaningful use Stage 3 requirements in October. All the players in the health tech space were awaiting the final verdict on how Application Programming Interface (API) technology was placed into the regulations, and the wait was worth it, regardless of which side of the fence you were on. Before we get into the predictions, though, a little background knowledge about these technologies, and their benefits, will be helpful.
API Overview
An API is a programmatic method that allows for the exchange of data with an application. Modern APIs are typically web-based and usually take advantage of XML or JSON formats. If you are reading this article, you almost inevitably have used apps that exchange data using an API. For example, an application for your smartphone that collects data from your Facebook account will use an API to obtain this data. Weather apps on phones also utilize an API to collect data.
HL7 Overview
Next let’s take a look at the history of interoperability of healthcare data. HL7 2.x is a long standing method to exchange healthcare data in a transactional model. The system is based on TCP/IP principles and typically operates with Lower Layer Protocol (LLP) which allows for rapid communication of small delimited messages. The standard defines both the communications protocol and the message content format. No doubt about it, HL7 2.x is incredibly effective for transactional processing of data, but it has been limited in two key areas:
A pioneering developer of a successful HL7 interface engine once said: “Once you have developed one HL7 interface … you have developed one HL7 interface.” The standard exists, but there is nowhere near enough conformity to allow this to be plug-and-play. For example, a patient’s ethnicity is supposed to be in a specific location and there is a defined industry standard list of values (code set) to represent ethnicity. In reality, the ethnicity field is not always populated and if it is, it rarely follows the defined code set.
HL7 is an unsolicited push method, which means when a connection is made, messages simply flow from one system to another. If you are attempting to build a collection of cumulative data over time, this is a mostly sufficient method, but what you cannot do is ask a question and receive a response. Although some query/response methods have existed for years, their adoption has been very sparse in the industry.
2016: Year of the Healthcare API
If you are a physician with an electronic health record (EHR) system and you accept Medicare patients, you likely have gone through the process of becoming meaningful use (MU) certified, which means you have purchased an EHR software solution certified by the ONC. This EHR must follow guidelines of technical features, and physicians must ensure they utilize those features in some manner. In October 2015, the ONC released MU Stage 3 criteria (optional requirement in 2017, mandatory in 2018) which includes this game changer: A patient has a right to their electronic health information via an API.
Guest post by James Carder, CISO of LogRhythm, VP of LogRhythm Labs.
James Carder
This year’s biggest health data breach victims include insurers Premera and Anthem, where incidents affected nearly 100 million patients combined. It’s clear that healthcare organizations must strengthen their cyber security programs to protect themselves and their patients, or they’ll be targeted again and again. Strategically, healthcare organizations must change the way they have operated for the past 30+ years with regard to their behaviors and their use of IT. Cyber security is now a key business differentiator as both patient care and safety are paramount to a hospital’s ability to remain a trusted provider. The hospital of the future is one that incorporates these protection measures into its business brand, thereby recruiting, retaining and reinvesting in patients.
As we start out 2016, here’s what I think we’ll see going forward:
Healthcare IT security will continue to fall further and further behind the rest of the industry verticals
Healthcare IT security will continue to fall further behind the rest of the industry verticals. Healthcare organizations are focusing on functionality for patient care (rightfully so), and security is an afterthought. Many organizations are overly dependent on antiquated hardware and software, with inherent vulnerabilities, that could inadvertently put patients in danger. There has never been a real investment in information security, so the cost to catch up to industry standards and shed the label of being the hackers’ “low hanging fruit” is that much more expensive. The industry will continue to be targeted by sophisticated and organized attackers until a serious investment is made in both technological and human capital.
The medical record is a relative goldmine of information and, as such, a highly valuable target for all classes of attackers, ranging from financial crime groups to nation state threat actors. The number of items a hacker has access to and the way in which the information can be used is more extensive. Stolen data can be re-used by a hacker over and over again. So, in addition to this general prediction, I also think that at least one of the U.S. News and World Report top 10 hospitals will go public with a breach through outside channels.
Healthcare IT (security) spend will be the highest it has ever been, doubling the spend of 2015
Despite my first prediction, healthcare organizations will invest a lot of money in IT security technology and human resources, doubling the spend of 2015. Although the executives may fund the security department, a security culture might not trickle down to the rest of the organization. The person in charge of security might be accountable for security, but the buy-in must come from the board of directors down through every level of the organization. Staff and the clinicians must understand what they are doing is making the organization a safer place for them and their patients–their effective security behaviors allow clinicians to do their job in treating patients better.
At least one major medical device manufacturer will have to go public with a vulnerability that could fatally affect patients
Medical device vendors and manufacturers have never taken security seriously. They are primarily looking for functionality for patient care and ease of administration and maintenance. A medical device is a computer system with one end attached to the patient, providing critical patient care, and the other end attached to the corporate network or Internet. Just like most devices on the network, a medical device runs a known operating system; vulnerable to the myriad exploits that effect any computer. Based on the risk profile of a medical device, it should be subject to the highest security standards in the industry but unfortunately they are not. If someone can hack into a Windows XP box that is unpatched with exploitable vulnerabilities, someone can hack into an XP-based medical device. I predict that another medical device manufacturer will disclose an easily exploitable vulnerability that could patients at direct risk. I also predict that an attacker will exploit a medical device and use it as a bridge into a company’s corporate network to facilitate a breach.
Guest post by Kirk Larson, national CIO, healthcare, NetApp Inc.
Kirk Larson
As we start a new year, let’s take a moment and take stock of the past 12 months. Like an annual physical, it gives us a chance to take a pulse check on the industry and see what the next year has in store – the opportunities and the obstacles.
During 2015, we had the opportunity to chat candidly with CIOs, healthcare technology partners and healthcare providers to discuss the big questions affecting the industry:
— What are the big topics the industry will be focused on?
— What changes do you see coming?
— What new challenges lay ahead and what new technologies will help us overcome them?
Based on these discussions, here are some of the key trends healthcare CIOs can expect in 2016:
Electronic Health Record (EHR) Optimization
As healthcare organizations move beyond implementation phase of EHRs, CIOs and IT are refocusing their efforts towards enhancing care workflow and benefits realization by way of optimizing the IT infrastructure. Basically, the status quo on overspending on legacy hardware is no longer being tolerated.
While the high availability, performance and security requirements for IT infrastructure certainly aren’t lessening anytime soon, IT is feeling greater cost pressures to run EHRs more efficiently. As a result, organizations are looking to simplify IT operations for running on-premises data centers with improved data management solutions, with the end-goal of moving toward building their own private clouds.
In addition to greater cost efficiency, we are seeing a growing demand for increased agility of IT services. As such, organizations are looking to advanced analytics capabilities as a means of achieving greater responsiveness. But before they can reap the benefits of employing a population health management system, IT needs to shift from tired legacy IT environments to highly agile IT infrastructure.
Population Health Management
Population health management programs have long been used by healthcare insurers to increase wellness and decrease claims cost. Organizations leverage multiple data sources such as EHRs, pharmaceutical data, insurance claims, etc.; to enhance and preserve wellness, as well as, programs that anticipatory and pre-emptive in design.
Guest post by Jean Van Vuuren, regional vice president, Alfresco.
Jean Van Vuuren
Hospitals, clinics and other healthcare organizations are constantly evolving due to the proliferation of technology, the increasingly digital workforce and advancing patient expectations. In addition to evaluating the constant flow of new technologies in the healthcare market, they must be nimble to meet the technological needs of healthcare workers and patients. In addition, the increasingly multigenerational workforce has varying requirements when it comes to technology, organizational culture and career progression. Finally, it is becoming more important for healthcare organizations to deliver a consistent patient experience. Today’s patient is better informed, more in sync with their health and expects a superior healthcare experience. To address these somewhat competing forces, healthcare organizations will focus on consolidation, integration and digitization in 2016.
Consolidation
Shared services is a growing model across industries, and healthcare organizations will follow this trend in 2016. This model allows organizations to consolidate tools and processes to meet a number of needs across their organizations. Hospitals, clinics and other healthcare facilities will look to take existing services and the tools that support them, and coalesce them into a more agile and flexible platform for IT solutions that support their entire organizations. For example, hospitals that have a system to manage EHRs and a different system to manage employee records may be able to use one, the other or an entirely new system to address both needs (and, potentially, others across the organization). The latter would obviously involve the decommissioning of legacy applications in favor of more robust tools that are open, have flexible deployment options and support mobility.
Integration
Similarly, healthcare facilities will only be able to meet the technological, organizational and clinical needs required today by employing tools that integrate not only with the systems they already have in place, but also with the tools that employees and patients use both personally and professional. And, in 2016, they will focus on integration, bringing in technology that can work with many other tools now and into the future. Using the example above, if a healthcare organization has an EHR system that they plan to keep, but they also want to get another system to manage employee records, they will seek to purchase a tool that integrates with their current EHR system. And for good reason.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
Robert Williams
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Help wanted
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider
community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example)
providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
The health IT revolution is here and 2016 will be the year that actionable data brings it full circle.
