The patient was prepped and ready on the operating table when the surgeon realized he only had a report of a CT scan and would need the actual images that were taken by another health system to successfully perform the procedure. Normally, this would either delay the surgery or tempt the doctors to try the procedure without all the relevant information.
Luckily for everyone involved, the hospital was a participant of a health information exchange (HIE). Within a few minutes, the surgeon had access to the necessary images through our secure portal and began a successful operation.
Interoperability is critical for planned and unplanned procedures. Today, COVID-19 patients often enter a hospital short of breath in desperate need of emergency attention – yet, as many hospitals work now, that patient is expected to produce their extensive medical record of allergies, conditions, medications, and previous operations while gasping for air.
Although medicine continues to greatly advance, most care providers still dwell in the world of dinosaurs: faxing, printing, burning CD-ROMs, and relying on the patient’s ability to produce medical histories.
A recent report by the National Academy of Medicine found that workflow and inadequate technology usability were major factors contributing to America’s alarming medical staff burnout rate. Customers who use modern network technology greatly benefit from seamless access to patient files that used to lie beyond their health system’s servers, easily communicating between other healthcare providers and patients themselves. Patient care is hard enough today without technical and communication failures.
While the federal government is ushering the medical records system into the 21st century through new interoperability and patient access rules going into effect in 2021, providers would do well to stay ahead of mandated changes before it’s too late.
The U.S. Department of Health and Human Services (HHS) issued a Notice of Funding Opportunity to expand and accelerate innovative uses of electronic health information via health information exchanges (HIEs) to support state and local public health agencies. Strengthening health data exchange and use between HIEs and state and local public health agencies will help communities to better prevent, respond to, and recover from public health emergencies, including disasters and pandemics such as COVID-19.
With $2.5 million in funding from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) signed by President Trump on March 27, 2020, the HHS Office of the National Coordinator for Health Information Technology (ONC) will award up to five (5) cooperative agreements under the Strengthening the Technical Advancement and Readiness of Public Health Agencies via Health Information Exchange (STAR HIE) Program.
Award recipients will focus on improving HIE services (such as last-mile connectivity and data services) in support of state and local public health agencies. The STAR HIE Program aims to strengthen existing state and local HIE infrastructure so that public health agencies are able to better access, share, and use health information as well as support communities that have been disproportionately impacted by the COVID-19 pandemic.
“State and local HIEs play a unique role in their communities by uniting health information from many different sites of service, including providers, hospitals, nursing homes, clinical laboratories, and public health departments, making them a natural fit to deliver innovative, local ‘last mile’ approaches to strengthen our overall public health response,” said Don Rucker, M.D., national coordinator for health information technology. “The funding opportunity we announced today will invest in infrastructure and data services for HIEs that provide critical real-time information to communities at the frontlines of responding to the COVID-19 pandemic.”
Award recipients will be required to deploy services that can enable, enhance, or increase the use of health information exchange at the state and local levels among relevant entities, and be inclusive of a diverse set of participating providers, including those who care for vulnerable or at-risk populations. They also will be required to engage in activities that address communities disproportionately impacted by the COVID-19 pandemic, considering factors such as age, race, ethnicity, disability, and sex.
By Dr. Chris Hobson, chief medical officer, Orion Health.
Dr. Chris Hobson
Health information exchanges (HIEs) represent a key piece of health information technology and are ideal tools to assist providers and managers in flattening the COVID-19 case count and fatality curves. HIEs were designed from the start to enable “right care to the right patient at the right place.”
Getting real-time, complete clinical information to where it’s needed, when it’s needed assists clinicians in the delivery of individual patient care. By virtue of the high-quality data held on every patient across a population, HIEs are also rapidly becoming essential tools in population health management. Real-time, high-quality data is essential for clinical and public health decision making.
The emergence of COVID-19 illustrates how high-quality individualized data can be leveraged to help a population level effort.
COVID-19 offers the challenge and opportunity to apply HIE capabilities in a flexible way to the management of a novel infectious disease where public health measures of social distancing, contact tracing, testing and isolation are so far the only real options for management.
A range of HIE functionalities and capabilities add value here. One is the ability to generate configurable notifications to providers based on new information arriving in the HIE. The first notification type tells providers when their patients have tested positive. This can be achieved easily based on the arrival of a positive test for COVID-19 into the HIE. Providers can subscribe to alerts for specific patients, or all of their patients.
By Abhinav Shashank, co-founder and CEO, Innovaccer.
Abhinav Shashank
U.S. healthcare is nowhere near what technology made us dream of a decade back. Healthcare technology was meant to act as a means of reducing costs, eliminating burnout, and making care delivery patient-centric. Cut to today, where a broken leg can cost a patient as much as $7,500, seven out of 10 physicians do not recommend their profession to anyone, and we rank poorly among other developed countries in terms of the number of preventable deaths.
Why did technology fail?
While disruptive technology solutions did flood healthcare in the last couple of decades, many of them required physicians to go the extra mile to comprehend those sophisticated systems. Today, physicians are still crunching large data files day in and day out, nurses are doubling up as technical executives, and patients are perplexed by the fact that their providers hardly have time for them.
It’s time for technology to care
If a technology solution is not assisting organizations in improving care quality, reducing costs, and optimizing utilization levels, then its very relevancy is questionable. Healthcare organizations need technologies that can help them actuate their data, realize their strategic goals, and bring patients closer to their providers.
Health IT solutions should make the lives of providers easier. Any health IT solution that puts an additional burden on providers is unjustified and unacceptable. Providers are not data analysts, and expecting them to train tirelessly to understand an IT system and spend a couple of hours each day navigating through complex interfaces can drastically reduce physician-provider time and pave the way for physician burnout.
In with ultimate integration. We need to bring together EHRs, PHMs, payer claims and HIEs and put it all in the palm of the providers’ hands. Whether it’s quality management or data management, it should be simple.
In with relevant insights right at the point of care. Providers are tired of wading through complicated EHRs and excel sheets. What we need now is to seize the nanosecond and realize truly automated care delivery that helps boost the clinical outcomes.
In with 100 percent transparency and bi-directional interoperability. Healthcare providers are often forced to access bits and pieces of electronic healthcare analytics and referrals on disparate applications. Physicians need to capture real-time care gaps, coding opportunities, patient education opportunities, and more; the only problem is that they don’t know how exactly to accomplish this. Providers should be able to capture the gaps in patient care right when they need to and enhance the patient experience of care.
In with true patient-centric care. Healthcare is not just providing episodic care to patients, it is about building relationships with them. In a world where the quality of care directly influences the financial success of an organization, providers should look forward to aligning the needs of their patients to their treatment procedures.
Healthcare of the 2020s needs reliable data activation platforms
“If you can’t explain it simply, you don’t understand it well enough.” — Albert Einstein
Buzzwords like innovation, intelligence, and analytics make sense in today’s time; however, unless the user experience is seamless, the charisma of back-end development does little good for healthcare professionals.
We’re moving into an age of intelligence, and in this age, successful organizations do one thing right- they know the worth of their data. This is the same thing that we need to do in healthcare. Organizations have to switch from a makeshift approach to engage patients and find a concrete strategy that is suited to their advantage, but this needs to be done with the support of data.
With more than 4 million nurses, the largest segment of the U.S. healthcare sector, nurses have indisputably demonstrated an ability to improve healthcare outcomes. We are just beginning to utilize Healthcare IT data and AI to improve patient outcomes. One of the key benefits of AI will be the ability to leverage the data from nursing care plans and nursing diagnoses to perform work load balancing for nursing staff. This is a key solution to future management of the problem of the shortage of nurses.
Another problem that needs attention is the possible disconnects which can result from nurse to nurse hand offs with the use of virtual nurses who remotely monitor patients. They enter data into their own EHR system – not the same one in use by the hospital where the patient is located. We will discuss here the nature of the data, technologies and frameworks, the nursing information model and the structure of the data elements needed to provide care needed to implement solutions for staffing, interoperability and workflow improvements.
The National Academy of Medicine’s committee background report on the Future of Nursing 2020-2030, Activating Nursing to Address Unmet Needs in the 21st Century, found the worsening health profile in the United States requires “more than a traditional medical response.” As professionals in the care team, nursing documentation requires a standardized framework to achieve consistent data quality in healthcare communications about the work of nurses. This standardized framework recognized for professional nursing documentation is the American Nurses Association (ANA) Nursing Process. This ANA framework is essential to nurses for managing and improving healthcare outcomes, safety and reimbursement as proposed by the Institute for Healthcare Improvement (IHI).
In most electronic health information record systems, the standard nursing data implemented (sometimes called the system terminology, data dictionary, or nomenclature) is proprietary with a pre-existing data structure/framework. The proprietary framework acts as a barrier to nursing documentation by constraining the available concepts for nursing documentation and the nursing care plan fields.
Without interoperable electronic data concepts available for documentation, nursing care notes become unstructured free-text and are not included in coded health information exchanges. Due to the highly structured design of EHR systems, nursing practice is determined by the system’s terminology and ontology framework configuration. If nurses do not select the ANA framework; nursing care data takes on the sedentary shape of the local proprietary data structures, rather than nesting in a flexible, portable and universal tool to enable nurses and other episodic care providers to improve future nursing interventions, practice and care outcomes.
The American Nurses Association (ANA) describes the common nursing framework of the documentation of professional nursing practice as the Nursing Process. The Nursing Process is the foundation for the documentation of nursing care. Yet, in the EHR, nursing documentation is reused during the patient’s stay, over and over, with the documentation being done from the nursing assessment as if the documentation was a template. The Nursing Process is the framework and essential core of practice for the registered nurse to deliver holistic, patient-focused care.”
Producing effective EHR systems for nursing requires a deep understanding of how nurses create and conduct cognitive documentation as well as task-oriented documentation. Most EHR systems dictate rather than adapt to nursing workflows and nursing information is not organized to fit the ANA model of care. The EHRs often assume a nursing care delivery model that is represented as algorithmic sequences of choices, yet nursing care is iterative with reformation of patient goals, revising interventions and actions and updating care sequences with individual patients based on encountered condition changes and constraints. In the dictated workflow of EHRs, nursing data is collected as care assessments with nursing diagnoses, interventions and actions in formats used to create single patient encounters.
It should come as little surprise to me that no matter the healthcare sector — long-term care, ambulatory or in patient, for example – most of the worries faced are the same or very similar. Many of the same levels of attention is given to many of the highly complex usual suspects – interoperability, health information exchange, accountable care, HIPAA and even mandates like meaningful use. The murmurs of those working here are often similar and there is a fairly deep collective holding of the breath in regard to advancements or developments in these areas regarding the blowing winds of how these and other issues sway constituents throughout the marketplace.
The general sentiment of individuals, those leading large hospitals and multi-location care facilities, who express their opinions and concerns to organizations like HIMSS, to name one, are the same as the concerns voiced by many of the attendees at PointClickCare’s annual user meeting, to name one, in Orlando Nov. 2-5, 2014. These same sentiments also are expressed at variety of other meetings of the minds throughout the US in similar constituent groups or with vendor and other allegiances.
Educational and work sessions held at these gatherings always have the same look and feel; the same as those expressed at PointClickCare’s Summit 2014. Engagement, connection, care; ACOs, HIEs, and managing their relationships; EHRs, interoperability, and managing this relationship and the flow of information (or doing so when the information does begin to flow); and change management strategies that provide guidance and advice for … managing change.
The information exchanged in venues such as these and the sessions themselves are valuable, of course, and needed to fill an enormous information void. Most importantly, these healthcare education sessions draw together folks seeking guidance and those needing insight, as well as provide a dash of leadership at times when much seems to be lacking. Finally, these educational sessions – quick and concise as many of these sessions may be – alleviate fear during a scary and tumultuous time in healthcare.
By Stephen Cobb, senior researcher, ESET North America.
The benefits of making health records available electronically would seem to be obvious. For a start, faster access to more accurate patient information – which is one of the promises of EHRs (electronic health records) and HIEs (health information exchanges) – could save lives. The author of a recent report on the many thousands of lethal “patient adverse events” that occur in America every year, Dr. John T. James, pointed to “more accurate and streamlined medical recordkeeping” as a top priority in the effort to reduce these deadly medical errors. Yet headlines about healthcare facilities exposing confidential patient data to potential abuse have been all over the media this year. So, will security issues and privacy concerns stymie EHR adoption or slow down HIE rollouts?
Today, more than half of all Americans probably have at least some part of their medical record stored on computer. In January, the CDC reported that roughly four out of five office-based physicians are now using some type of EHR system, up from one in five in 2001. A few months later, in a Harris poll sponsored by ESET, only 17 percent of adult Americans said that, to their knowledge, their health records were not in electronic format.
During that same survey of 1,734 American adults, we asked “are you concerned about the security and privacy of your electronic patient health records” and 40 percent said they were. Slightly more of them, 43 percent said they were not. However, if we take out the 17 percent whose records were not in electronic format, the “concerned or not?” question breaks down as 48 percent Yes, versus 50 percent No, a statistical tie.
Guest post by Judy Chan, president, HealthPro Consulting.
Burgeoning EHR implementations nationwide attributable to the meaningful use incentive program have created a surge in HIO and electronic health information exchange (eHIE).
Having health information available for electronic exchange is generally accepted as beneficial to patients, providers and payers. Providers can access patient information from other providers when they need it where they need it. Providers are able to avoid duplicating lab tests, scans and x-rays that save the payers dollars. Additionally, patients don’t need to remember what treatments were administered or drugs prescribed and can avoid unnecessary exposure to radiation.
In emergency situations, the benefits of having a patient’s health information available to emergency room staff are obvious. Patients who have experienced referrals in the course of diagnosis and treatment also readily see the advantage of not having to hand-carry all of their medical records from one doctor’s office to the next. The electronic exchange of health information among providers eliminates faxes, paper work and phone calls.
Patient’s perspective
What makes the exchange of health information frightening to patients?
1. Your health information is available to others who have a legitimate need.
2. Consent must be given by the patient to share their information
3. You must trust the distributor of your information
4. You should monitor your data on a regular basis and make corrections when necessary
5. Information could be accidentally released without your permission.
6. Your consent is electronically recorded by multiple systems.
Do these risks sound familiar? They should because they are not very different from the risks that credit rating agencies that have recorded your financial transactions for years.
