COVID-19 has amplified troubling pain points in the healthcare sector. Forced to scale delivery of care beyond hospital walls at an accelerating pace, providers are experiencing the limitations of outdated legacy technology and siloed lines of communication. And in full ICUs across the nation, weary frontline workers are stretched thin, summoned from crisis to crisis by an unrelenting chorus of alerts, alarms and pages.
Better communication and collaboration tools, like those deployed in most other industries today, could help beleaguered frontline teams perform their jobs more efficiently and with less stress. In fact, some hospitals already provide their staff with technology that helps them better prioritize nurse call alerts, manage workflows and assignments, and collaborate with physicians, technicians and others involved in each patient’s treatment.
But those are the exceptions to the norm in one of the last industries to undergo a digital transformation. In fact, some 90% of hospitals still rely on faxes, and 80% still use pagers. In many cases, physicians using pagers must carry several at the same time. Communications between care team members and with the patient occur over outdated systems and can delay the exchange of vital information and timely scheduling of treatments. These antiquated communication systems decrease the quality of care and make it harder for healthcare workers to do their jobs.
Healthcare leaders seeking improved efficiency and productivity in their organization’s patient outcomes, financial performance, staff satisfaction, or patient experiences should look first to the quality of their communications. A health system’s communications network provides the channels for critical collaboration between physicians, technicians, nurses and others as they pursue the shared goal of delivering quality patient care.
Platforms that prioritize data integration, patient engagement and collaboration among caregivers not only deliver the best care, but also enable doctors and nurses to do their jobs easier, improve the patient experience and realize the lowest operating expenses.
As physicians, nurses and administrators grow increasingly dissatisfied with the legacy systems still in use at their organizations, more and more hospitals and hospital systems are augmenting or replacing traditional IT infrastructure with cutting-edge technologies. What follows are key features to look for while planning improvements and evaluating available solutions.
Much like the formation of New Year’s Resolutions, the prediction of technology trends for the coming year has become a tradition among pundits, analysts and vendors alike. As the calendar turned to 2020, Hyland, like many, took the opportunity to look into a crystal ball to predict what the future might hold for the software industry at large, as well as many of the key vertical markets in which it operates.
For example, Hyland leadership revealed six overarching trends for enterprise technology as well as key trends to watch for health IT. At the time, none of us could have foreseen that a global pandemic was coming that would turn all of these predictions on their collective ears.
Of course, the healthcare industry has been particularly impacted by COVID-19. Provider organizations have justifiably focused their attention on responding to the new patient care and staffing needs brought about by the virus. That said, all of the health IT trends Hyland outlined at the beginning of 2020 (interoperability, artificial intelligence and cloud adoption) still have relevance in today’s unprecedented landscape. Although, admittedly, the reasons these topics are trending are for vastly different reasons than we originally anticipated.
I want to revisit these trends under the lens of COVID-19 as well as add a few more to the list in light of current circumstances.
Original insight: Secure access to patient information at any facility throughout a care continuum is an imperative for delivering a longitudinal digital record that travels with the patient. The key is to ensure tight integration between disparate IT systems, and to include unstructured data in the interoperability equation. As much as 80% of essential patient information is in an unstructured format – such as digital photos and videos, or physician notes – and not natively included in an electronic medical record (EMR) system. When removed from a clinician’s view, the patient record is incomplete.
New relevance: Health IT interoperability was important prior to COVID-19, and it’s even more critical now. Providers, patients and public health officials need all-encompassing data in a standardized format to better understand this evolving illness and develop guidelines. The effort to identify risk, control spread and manage the treatment of afflicted patients is a coordinated effort among multiple healthcare providers and external care partners. The easier information can be shared among these varied stakeholders, the better equipped we’ll be to combat the virus.
Artificial Intelligence (AI)
Original insight: Realistic applications of AI are coming into focus in healthcare, showing where the technology will help providers optimize workflows and better analyze the vast amounts of information needed to support improved decision making. Experts view AI technology as complementary and a true asset when it comes to helping physicians analyze the overwhelming amount of patient data they receive daily. Physicians can implement AI to streamline or eliminate tedious tasks, such as manual documentation and data search, or cull information to help them focus on a key area of interest.
The medical imaging space in particular provides a tremendous area for the growth of AI and machine-learning technologies. Clinicians can use them to analyze thousands of anonymized diagnostic patient images to identify and detect indicators of everything from lung cancer to liver disease. These technologies are also being used to accelerate research.
New relevance: AI is being used in a number of ways to address the challenges of COVID-19. For example, AI algorithms have been used to identify the spread of new clusters of unexplained pneumonia cases. Other AI applications are being used to spot signs of COVID-19 infections in chest X-rays and identify patients at high-risk of coronavirus complications based on their pre-existing medical conditions. Still others are scanning the molecular breakdown of the virus itself as well as those of existing drug compounds to identify medications that can potentially target the virus and shorten the span of the illness or lessen the severity of the symptoms. In all of these scenarios, AI is quickly analyzing large segments of data to accelerate research and treatment. This automation is indispensable in an environment where medical staff are stretched to their limits, and the act of saving time could save lives.
Rising healthcare promises have been tied to cloud technology in the most recent tech-talks of the town. While the majority of care providers are not holding their breath due to previous disappointments, we wanted to translate the often vague statements made into discrete simplified processes for healthcare.
Healthcare is riding a wave of digital transformation that has brought about revolutionary processes of data management and care delivery. Moving from paper-based records to a digital format, the first wave took us from disconnected facility-based care to integrated smart care with increased coordination and population health activity.
The second wave enabled better patient experience with omnichannel communications and interoperable data sharing applications. Empowering patients and clinicians with analytics, the recent wave has health organizations leveraging real-time data-driven solutions, artificial intelligence, and cloud services to align with the culture of preventive and wellness-centric care.
The cloud will be central to future digital transformations in healthcare. What is uncertain for many is what specific, new cloud services will be developed and why are healthcare organizations now – and foreseeable future continuing – to opt for cloud-based technologies.
Why are health organizations leveraging the cloud?
We have been in the process of transitioning from fee-for-service to value-based care over the past decade. The industry is further planning to move from disease-based episodic care to preventive care in future years. To achieve that goal, several additional factors need to progress.
The healthcare system of the future will be more consumer-centric and value-driven. It will use real-time data to generate actionable insights, and data technology will play a crucial role. Cloud technology promises to improve performance enhancement and healthcare data analytics overall.
Health systems have a need for increased data capacity, and the cloud promises almost unlimited data storage, easy accessibility, and enhanced cybersecurity. As health organizations are expanding into a variety of digitized services such as virtual care, wearable devices, telemedicine, and smart AI assistance, the data per patient expands.
The cloud is a single point of access to patient information, to multiple doctors and medical services at the same time, that boosts not only real-time coordination but also ensures data security for hospitals and patients.
Gartner, in a recent healthcare cloud services report, highlighted how provider leadership has moved from skepticism to acceptance of the cloud as a service delivery model. In what ways is the cloud benefiting the healthcare industry?
The healthcare industry remains at a crossroads as providers and healthcare IT professionals confront a rapidly changing business and regulatory landscape. With factors like rising patient cost obligations, growing payer complexity, and the inevitable shift to a value-based payment environment weighing on them, medical practices nationwide are in search of new IT solutions to support them. The rapid pace of cloud adoption across all sectors is a prominent example. The market for cloud solutions is one of the fastest growing areas within healthcare, but it’s not solely a private sector phenomenon; the federal government’s cloud-first strategy finally gained traction in 2015, prompting a FCW analyst to predict accelerating momentum for federal cloud initiatives over the next three to five years.
One of the strongest factors driving cloud momentum among medical practices today remains security concerns: with growing IT complexity increasing security risks, cloud options remain an attractive plug-and-play alternative to on-site servers that allows healthcare providers to minimize vulnerabilities. But modern cloud solutions also allow providers to maximize practice management capabilities and offer faster time to value. And, with features like pay-as-you-go pricing, cloud solutions don’t require a big upfront investment, making them a popular choice with budget-conscious healthcare organizations.
Another key factor driving practice adoption of modern, cloud-based solutions is the need more efficient workflows to support effective patient billing. The patient share of healthcare costs is growing rapidly in the US. According to a Kaiser Family Foundation report, out-of-pocket costs have grown three times as fast as overall healthcare costs. And, the average deductible has skyrocketed from $584 in 2006 to $1,318 in 2015. Practices need solutions that can help them implement controls and analytics as patients become responsible for a greater share of costs.
As a result of these and other factors, cloud technology now plays a pivotal role in healthcare, and cloud-based healthcare IT solutions are becoming increasingly important in helping practice successfully navigate this new environment. So what’s in store for 2016? Here are some healthcare IT trends to watch:
A more modern, intuitive software experience: The consumerization of healthcare IT has begun in earnest, and that means practices are looking for design-centered products that deliver intuitive solutions. Cloud-based healthcare IT solutions that move beyond Web 1.0 to provide a consumer-focused user experience (UX) will be the clear winners.
Can you remember how you operated without a cell phone at your disposal 24/7? If you’re like most people today, braving the outside world without a cell in hand probably gives you palpitations. The healthcare industry has seen a comparable shift as a result of technology innovation over the past couple decades. So much so that healthcare practitioners who are somewhat new to the industry may not be accustomed to the manual practices that were in use just a few years ago.
As for today, we know that healthcare companies are using cloud. Perhaps most prominently, electronic health records (EHR) are widely adopted. In fact, the Healthcare Information and Management Systems Society (HIMSS) reports that a majority (83 percent) of healthcare organizations are using cloud services today. With adoption spanning nearly the entire industry, cloud technology has transformed how healthcare is administered.
Given the scale of cloud adoption, a few questions remain. Namely, how is healthcare using cloud today? Now that the industry has adopted the cloud, what does the future hold?
How Is Healthcare Using Cloud?
To start, let’s explore one specific use case. Medicalodges, a post-acute healthcare organization based in Kansas, was looking to get away from managing its own infrastructure. By moving to the cloud, it was able to improve collaboration, security, and set up a business continuity/disaster recovery (BC/DR) solution. Today, the organization has virtualized its servers with dinCloud’s Hosted Virtual Server (dinServer) solution. As a result, Medicalodges reports benefits including: improved collaboration, security, disaster recovery, cost savings, and scalability. Looking ahead, Medicalodges has future plans to run a mix of browser-based thin clients and continue to expand its cloud infrastructure.
In its 2014 Analytics Cloud Survey, HIMSS found that 43.6 percent of surveyed healthcare organizations are currently hosting clinical applications and data. Meanwhile, 35.1 percent are using the cloud for BC/DR, 14.9 percent have virtualized servers, and 8.1 percent are using hosted virtual desktops (HVDs). In another case, a medical organization needed to run several versions of a specific testing application. However, they could not run it on the same computer because of compatibility conflicts of running the same application in multiple instances. They leveraged application publishing from dinCloud to virtualize the application. The application sits in the cloud and can be opened in multiple instances on the same computer now.
Healthcare is not without its issues. Seemingly, for each source asked what the biggest problem the sector faces, there is a differing opinion on what’s most important. I’m often perplexed by the lack of cohesiveness shown toward the industry’s leading issues, too, and sometimes wonder how many of us could name the most pressing threats to the industry, as agreed upon by the community. There are clear problems – interoperability, lack of transparency, disparate systems working against each other — to name a few. So, in the following series, I’ve asked some insiders for their opinions on health IT’s greatest problems, and as you’ll see, they responses received vary greatly.
Healthcare IT struggles mightily with patient information that is not in the medical record system, but has leaked into other locations in the healthcare organization (cell phone emails, USB drives, employee desks, etc.). Healthcare organizations have moved Protected Health Information (PHI) into HIPAA compliant electronic health records (EHRs) systems, patients maintain electronic copies of their health information, which they give to their different providers as they move between appointments. This “patient distributed information” becomes PHI, with all its associated compliance and legal burdens for the health care organization.
There is liability associated with this, and information governance strategies available that reduce the associated risks. Patient distributed information is present on smartphones, tablets, laptops, and the like are not sanctioned EHR (such as email, file directories, etc.). These devices are not part of the organization’s HIPAA compliant system, and never can be. Most healthcare providers ignore the problem, which eventually leads to catastrophic security failures resulting in patient privacy breaches, and career damaging incidents for the healthcare IT department.
To eliminate the problem, IT needs to look to integrate an information governance framework that can:
Interview employees to understand how they deal with and understand this issue.
Audit, usually done with software systems, to provide objective evidence and quantification of the presence of PHI on your digital systems.
Set specific policies and procedures employees can follow in each and every situation when they come into contact with “patient distributed information.”
Provide raining and review of policies and procedures work.
Automate the policies and procedures with software systems to ensure compliance.
Surveil your digital systems is the best way to monitor and review your program, as well as seek to improve it.
Acknowledge the increasing presence of patient distributed information on your digital systems, and have a plan for how to address it. Look to information governance to establish a strategy and program to address patient distributed information. With the proper policies, procedures, training, and systems in place your organization will be able to effectively handle and mitigate the risks.
Joe Petro is senior vice president of healthcare research and development, where he provides leadership for all of the research and development required to bring Nuance Healthcare products to market, including: Dragon Naturally Speaking, eScription, Dictaphone (Enterprise Express/iChart), Radiology Platform, Radiology Reporting & Decision Support, SpeechMagic, Critical Test Results Reporting and innovations such as cloud offerings, CLU, and CAPD. Prior to joining Nuance, Joe was SVP of product development at Eclipsys Corporation. While at Eclipsys, he also served on the executive staff and was a reporting officer, where he was responsible for the development of more than 30 products from ADT, departmental, inpatient, ancillaries, patient financial management and outpatient products. Petro received a Bachelor of Science in Mechanical Engineering from University of New Hampshire and a Master’s Degree in Mechanical Engineering from Kettering, graduating both with Summa Cum Laude accolades.
Here he discusses Nuance, the evolution of technology in health IT, trends and changes, the patient response, meaningful use’s hamstringing and the biggest obstacles patients face.
Describe Nuance Communications and your role.
Nuance is the market leader in creating clinical understanding solutions that drive smart, efficient decisions across the health information technology industry. More than 500,000 clinicians and 10,000 healthcare facilities worldwide use our technology and solutions. Nuance clinical speech and understanding products are deeply embedded in EHR solutions, such as Cerner, Epic, Meditech, etc., enabling them to deliver innovations that provide a seamless user experience to their clinicians.
I’m the senior vice president of engineering, Research and Development, for Nuance’s healthcare division. I am responsible for the research and development of the entire Nuance Healthcare product portfolio. When not leading the engineering teams, I spend time with clients trying to understand how to improve existing products and devise brand new ideas that someday will become part of our extensive product portfolio.
How is Nuance changing healthcare today and in the future? Where do you see the company, and health IT going?
I think the health IT industry is approaching an inflection point where technology shifts from being viewed as a mandated requirement to more of a ”necessity that I must have in order to get my job done.” We are finally reaching a point where the cloud is enabling the kind of form-factor agnostic experience that we all thought made a lot of sense from the very beginning, but which was challenging to deliver because all of our “things” were not connected.
When it comes to tech adoption, particularly in healthcare, there needs to be a catalyst—we saw that with CMS regulations and meaningful use. Now, we are starting to see perspectives shift: Physicians are asking seemingly obvious questions like “Why can’t I access this data on my smart phone…?” or “Why can’t I do the same things on my phone as I can using the computer on wheels in the hospital?” This kind of shift is creating massive opportunities for a company like Nuance because the ability to get data into the mobile device (and easily access it) can be profoundly impacted by the technologies that we build. And sure there are plenty of challenges, but the industry is becoming more adroit and agile, creating solutions that serve the specific needs of the individual physician – and not just the technology to address government imposed regulations.
Guest post by Mitchell Goldburgh, cloud clinical archive product manager, Dell.
Stage 2 meaningful use criteria require providers to make diagnostic reports and associated images accessible through a certified electronic health record. That presents a difficult hurdle for many hospitals, especially community hospitals that are not connected to a large health system. And with the plethora of EHRs in use across healthcare, the task may be difficult for some multi-hospital systems.
This is a watershed moment for many imaging practices, and Stage 2 requirements may be the factor that sends most imaging files to a vendor-neutral archive (VNA).
Knowing that Stage 2 will require facilities to integrate their medical images with EHRs, the best VNA providers have in place automated tools that can integrate these files with all of the major EHRs and with many of the smaller EHR vendors. The value of a VNA comes from local and remote content brought to EHRs with a consistent presentation of results and images at the point of clinical care. VNA solutions offer a global viewer with a common toolset to navigate documents and imaging content, thus simplifying the access and freeing users from the need to learn multiple application navigations.
As technology in imaging increases the complexity of data, the presentation of information consistently for non-imaging specialists within the accountable care group becomes crucial to “customer” satisfaction with the imaging services. But VNA software is only a part of the solution – an integrated model that simplifies delivery of content can best be achieved with a service delivery model enabled with cloud content management.
Archiving-as-a-serviceis the model for the future
So what does this model entail? A good vendor-neutral archiving solution enters the scenario once a clinical exam is reported. At that point, the job of the PACS is done. The exam file is transmitted to an on-site server (supported by your archiving service provider) that transforms it into a vendor-neutral format. Current files are stored on site for fast access and also uploaded to a secure cloud platform. At this point content notification occurs, informing external systems that the report and clinical imaging data are available. In this model clinicians can view content anywhere, from any device, either as a stand-alone application from the VNA or through the web-enabled EHR accessing the VNA.
Results of the inaugural 2014 HIMSS Cloud Survey show the widespread adoption of cloud services among healthcare organizations across the U.S., with 80 percent of the 150 respondents reporting they currently use cloud services. The top three reasons for adopting cloud services include lower maintenance costs, speed of deployment and lack of internal staffing resources. The survey shows a positive growth outlook for cloud services as almost all healthcare organizations currently using cloud services plan to expand their use of these tools.
Half of the cloud adopters are hosting clinical applications in the cloud, primarily using Software as a Service (SaaS). Other typical cloud services include health information exchange (HIE), hosting human resources applications and data as well as backup and disaster recovery.
“Cloud services have been long praised as a tool to reduce operating expenses for healthcare organizations. The data presented in our inaugural survey demonstrates the healthcare industry’s eagerness to leverage this resource,” said Lorren Pettit, Vice President of Market Research for HIMSS Analytics. “With such a positive market outlook, we hope vendors will leverage the business intelligence gleaned from this report, continue working with providers to meet their needs, and help healthcare organizations provide the most cost-efficient care.”
Healthcare organizations take into consideration a number of factors when selecting a cloud services provider. The top concerns for healthcare organizations seeking cloud services are the cloud services provider’s willingness to enter into a business associate agreement (BAA) as well as physical and technical security.
Even after a cloud services provider has been selected and the cloud services have been adopted by the healthcare organization, there are still challenges. Two-thirds of healthcare organizations have challenges, including a lack of visibility into ongoing operations, customer service, as well as costs and fees.
Half of the respondents also identified performance issues, such as slow responsiveness of hosted applications as a problem, but were willing to work with their existing cloud service provider to resolve their issues, rather than switch to a new one.