Hardly a day goes by without some new revelation of a US IT mess that seems like an endless round of the old radio show joke contest, “Can You Top This”, except increasingly the joke is on us. From nuclear weapons updated with floppy disks to needless medical deaths, many of which are still caused by preventable interoperability communication errors as has been the case for decades.
According to a report released to Congress, the Government Accountability Office (GAO) has found that the US government last year spent 75 percent of its technology budget to maintain aging computers where floppy disks are still used, including one system for US nuclear forces that is more than 50 years old. In a previous GAO report, the news is equally alarming as it impacts the healthcare of millions of American’s and could be the smoking gun in a study from the British Medical Journal citing medical errors as the third leading cause of death in the United States, after heart disease and cancer.
The GAO interoperability report, requested by Congressional leaders, reported on the status of efforts to develop infrastructure that could lead to nationwide interoperability of health information. The report described a variety of efforts being undertaken to facilitate interoperability, but most of the efforts remain “works in progress.” Moreover, in its report, the GAO identified five barriers to interoperability.
Insufficiencies in health data standards
Variation in state privacy rules
Difficulty in accurately matching all the right records to the right patient
The costs involved in achieving the goals
The need for governance and trust among entities to facilitate sharing health information
CMS Pushing for “Plug and Play” Interoperability Tools that Already Exist
Meanwhile in a meeting with the Massachusetts Medical Society, Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services’ (CMS) acknowledges in the CMS interoperability effort “we are not sending a man to the moon.”
“We are actually expecting (healthcare) technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care,” Slavitt stated. “Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of (Electronic Health Records) EHR’s which will spur innovation by allowing for plug and play capability. The private sector has to essentially change or evolve their business practices so that they don’t subvert this intent. If you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice.”
He claims that CMS has “very few higher priorities” other than interoperability. It is also interesting that two different government entities point their fingers at interoperability yet “plug and play” API solutions have been available through middleware integration for years, the same ones that are successfully used in the retail, banking and hospitality industries. As a sign of growing healthcare middleware popularity, Black Book Research, recently named the top ten middleware providers as Zoeticx, HealthMark, Arcadia Healthcare Solutions, Extension Healthcare, Solace Systems, Oracle, Catavolt, Microsoft, SAP and Kidozen.
Medical Errors Third Leading Cause of Death in US
The British Medical Journal recently reported that medical error is the third leading cause of death in the United States, after heart disease and cancer. As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine. However, accurate, transparent information about errors is not captured on death certificates which are the documents the Center for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, but causes such as human and EHR errors are not recorded on them.
According to the World Health Organization (WHO), 117 countries code their mortality statistics using the ICD system. The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it. “Top-ranked causes of death as reported by the CDC form our country’s research funding and public health priorities,” says Makary in a press release. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves. It boils down to people dying from the care that they receive rather than the disease for which they are seeking care.”
The Root Cause of Many Patient Errors
Better coding and reporting is a no-brainer and should be required to get to the bottom of the errors so they can be identified and resolved. However, in addition to not reporting the causes of death, there are other roadblocks leading to this frighteningly sad statistic such as lack of EHR interoperability. Unfortunately, the vast majority of medical devices, EHRs and other healthcare IT components lack interoperability, meaning a built-in or integrated platform that can exchange information across vendors, settings, and device types.
Various systems and equipment are typically purchased from different manufacturers. Each comes with its own proprietary interface technology like the days before the client and server ever met. Moreover, hospitals often must invest in separate systems to pull together all these disparate pieces of technology to feed data from bedside devices to EHR systems, data warehouses, and other applications that aid in clinical decision making, research and analytics. Many bedside devices, especially older ones, don’t even connect and require manual reading and data entry.
Healthcare providers are sometimes forced to mentally take notes on various pieces of information to draw conclusions. This is time consuming and error-prone. This cognitive load, especially in high stress situations, increases the risk of error such as accessing information on the wrong patient, performing the wrong action or placing the wrong order. Because information can be entered into various areas of the EHR, the possibility of duplicating or omitting information arises. Through the EHR, physicians can often be presented with a list of documentation located in different folders that can be many computer screens long and information can be missed.
The nation’s largest health systems employ thousands of people dedicated to dealing with “non-interoperability.” The abundance of proprietary protocols and interfaces that restrict healthcare data exchange takes a huge toll on productivity. In addition to EHR’s physical inability, tactics such as data blocking and hospital IT contracts that prevent data sharing by EHR vendors are also used to prevent interoperability. Healthcare overall has experienced negative productivity in this area over the past decade.
Interoperability will be healthcare IT’s biggest trend in 2016 as the industry finally sees momentous forward movement.
In fact, interoperability is not a new trend. It has been an important mission (and a challenge) for healthcare administrators for decades, but the past couple of years have been game-changing:
First, the U.S. Department of Health and Human Services (HHS) wants interoperability to be a common feature in all EHRs by 2024 so that patient data can be shared across systems to provide better care at a lower cost. Since the 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), a $30 billion initiative to accelerate EHR adoption, more than 433,000 professionals (95 percent of eligible hospitals and 60 percent of eligible professionals in Medicare and Medicaid programs) have received incentive payments.
Second, the HHS’s ambitious announcement that mandates moving 50 percent of Medicare payments from fee-for-service-based to value-based alternatives by 2018 puts care coordination and interoperability at center stage. This historic initiative is transformational for patient-centered care based on accountability and outcomes and is the first step toward achieving better health overall with lower cost.
Third, there’s been significant industry momentum with more than 40 organizations coming together to work on HL7 FHIR (Fast Healthcare Interoperability Resource), dubbed “Project Argonaut,” an industry-wide effort to create a modern API and data services sharing between the EHR and other healthcare IT systems based on Internet standards and architectural patterns. Project Argonaut began in December 2014 and has made impressive progress. And while still evolving, the recently released Stage 3 meaningful use rules have emphasized interoperability — more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2.
Guest post by Karen Holzberger, vice president and general manager, diagnostic solutions, Nuance Healthcare.
Karen Holzberger
A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also has another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
It is important that when a radiologist sees a nodule and it has certain characteristics, he or she makes recommendation for follow-up imaging, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering standard clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
This is a great step forward for the industry, but some hospitals are taking it one step further. Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding. For instance, if the node is a certain size, it should be tested further.
The results of having this information at the radiologists’ fingertips are impressive. In fact, studies show that when these clinical guidelines are built into existing workflows, 90 percent of radiologists align with them, as opposed to alternative methods, such as paper print outs, which result in 50 percent concordance.
Is your hospital or healthcare organization actually a technology company in disguise? Lots of companies are. After all, to win and hold onto customers, organizations have to make huge investments in IT and technology. At some point if, say, a financial services organization spends most of its money on technology, hasn’t it actually become a technology company that happens to deliver financial services? Are hospitals and health care organizations any different?
The thing is, while businesses are becoming tech companies, successful tech companies have realized it’s not about technology at all. It’s about experiences. Think about Uber or AirBnB: What they’re really selling is an experience enabled by technology.
Welcome to the experience economy. At Mad*Pow, the design firm where I lead experience design, we’re always trying to help hospitals and healthcare companies think about the patient experience as they travel through their healthcare journey.
It’s not easy work. The healthcare industry has gotten more than its fair share of disruption to deal with. Things like electronic medical records and the Affordable Care Act have unleashed waves upon waves of new technology into the clinical setting—none of which plays very well together. Meanwhile, doctors and clinicians have become data entry specialists, sacrificing important patient time for screen time. As a result, healthcare is behaving a bit too much like “sick care,” treating problems rather than treating people. It’s more about the transaction, less about the patient experience.
On the bright side, the industry is responding in exciting ways. Today, more and more hospitals are acting like tech start-ups. They’re sponsoring hack-a-thons to crowdsource innovation within their own walls. They’re incubating ideas from doctors and clinicians to build and test new devices and technologies. They’re partnering with universities and entrepreneurs and private business to fuel and fund and focus their innovation.
Guest post by Donald M. Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University; and Thanh Tran, CEO, Zoeticx, Inc.
The ECRI Institute released in May a survey outlining the top 10 safety concerns for healthcare organizations in 2015. The second highest concern is incorrect or missing data in EHRs and other health IT systems.
HIEs? The latest Black Book survey in the U.S. finds that 90 percent of hospitals and 94 percent of independent physicians don’t trust the business model of public HIEs and have concerns over how much of the cost payers will be fronting, causing a contraction in the HIE market. Even the ONC and medical industry are at odds on how to address the interoperability issue. The ONC does not even mention middleware in any of its plans.
Even HL7 does not provide the seamless connection of middleware and is only capable of connecting one medical facility to another, requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, HL7 is really a point-to-point customized interface requiring extra steps. A middleware platform does not tie developers to specific hospitals or EMRs and allows universal access.
Meanwhile, yet another survey cites the tragedy of a lack of interoperability. A new survey of nurses nationwide, taken by the Gary and Mary West Health Institute, find that some 60 percent of registered nurses say medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Also, 74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices and 93 percent agreed that medical devices should be able to seamlessly share data with one another automatically.
Half of them claim they actually witness medical mistakes because of lack of interoperability of these devices. Some 46 percent of RN respondents also noted that when it comes to manual transcription from one device to another, an error is “extremely” or “very likely to occur.”
From a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests. Meanwhile physicians and surgeons struggle with interoperability on a daily basis.
According to data published on HealthIT.gov, 173 health IT vendors are supplying certified EHR products to more than 4,500 hospitals. Despite wide penetration of EHR’s in hospitals, clinics and physician offices, access to patient information between systems continues to plaque our healthcare system.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Elevator Pitch
In a market where healthcare organizations are constantly challenged to do more with less, Panasonic provides a broad range of hardware and software solutions that make it easier for clinicians and healthcare facilities to provide every individual with the best patient experience possible.
About Statement
The Panasonic Healthcare Solutions team focuses on operational areas of patient care and provider support, including mobility, imaging, IT services, document management and unified communications.
Services and Products Offered
Mobile computing, security solutions, digital signage/way-finding solutions, audio visual solutions, internal communication systems, document imaging systems, and medical vision systems.
Problems Solved
Panasonic can equip clinicians and healthcare facilities with the tools they need to operate smoothly and efficiently – from tablets that enable doctors to pull up patient information on-the-spot to interactive kiosks that direct visitors on where to go. Technology that promotes productivity within a healthcare facility – from maintaining a digitally based record system to giving clinicians more face time with their patients – are steps that can improve the patient experience and overall health outcomes.
Value Proposition
Healthcare systems must ensure that they not only provide a safe place for quality care but also offer advancements that can deliver a great patient experience, increasing patient satisfaction and improving outcomes. Panasonic offers a wide range of products and customizable solutions that can help hospitals deliver a connected continuum of care.
Guest post by John Olajide, president and CEO, Axxess.
The home health delivery model has become more prevalent in recent years as a cost-effective, patient-preferred alternative to traditional hospital and skilled nursing settings. Approximately 12 million U.S. individuals receive care from more than 33,000 agencies for acute illness, long-term health conditions, permanent disability, or terminal illness — according to a survey by the National Association for Home Care & Hospice (NAHCH).
Demand for home health services is seeing an increase as more baby boomers turn 65 daily and choose to receive their health care services at home. Recent surveys of older adults are showing a preference to receive healthcare in the dignity and comfort of their homes. As an example, surveys by the American Association of Retired Persons (AARP) consistently show that over 80 percent of older adults want to remain in their homes and communities throughout their lives. Several surveys show the same trend in the wider patient populations; and technology innovations are making it possible to deliver quality healthcare services to patients at home.
While the increased awareness in and recent growth of the home healthcare sector is promising for home health agencies, critical to their success is the adoption and integration of the right cloud-based technology to increase operational efficiency, ensure compliance with stringent regulatory requirements and improve patient outcomes.
Technology can also assist in preventing home healthcare fraud. While fraud can occur in all sectors of healthcare, home health is unique in that the caregiver visits the patient in the home. A common example of fraud in home health is when a caregiver submits documentation for visits that were not made and the home health organization, in turn, submits claims to insurance providers for such services without obtaining proof that such service was actually rendered. Home health agencies would be wise to protect themselves from the possibility of this type of fraudulent activity by a disreputable employee.
Guest post by James Bindseil, president and CEO, Globalscape.
Health IT has reached a pivotal crossroad: On one end, consumers’ expectations for more timely care and instant access to health files and records continue to skyrocket; on the other, security and compliance risks are more complex and threatening than ever before.
This leaves health providers in a precarious position: should they prioritize security and compliance, or productivity and care?
In a perfect world, the answer would be all four. Unfortunately, today’s health IT landscape — which is going through a rapid and significant transformation to keep up with evolving compliance mandates, new demands around access to patient files, changing government policies, sophisticated security threats and new technologies — is far from perfect.
One of the most pressing issues lies within the policies and technologies provided by today’s IT teams. In fact, in many instances, the policies and tools implemented by IT to keep patient data safe and secure often end up having the opposite effect: they make it incredibly difficult for providers to deliver fast and efficient care in a secure, compliant manner.
For example, let’s imagine a day-in-the-life of a hospital care provider, who faces immense pressure to deliver top-notch care to as many people, and in as little time, as possible. On day one, an off-duty doctor is called at home to provide his take on the best care plan for a specific patient. How will he review the pertinent information while working remotely? In another scenario, the doctor is running from patient to patient, and is unable to take the necessary time to record his actions. Taking the work home on a USB drive seems like the best option. The next day, the hospital needs to quickly share files with the patients’ previous provider to care for an urgent medical issue.
In a market where healthcare organizations are constantly challenged to do more with less, 
