Data has long been a popular topic in healthcare and is even more so after this year’s HIMSS. The industry is buzzing about the joint CMS and ONC announcement, which proposes a framework to improve interoperability and support seamless and secure access of health information. The pressure is on for healthcare to tackle their data as the two organizations strive to provide patients with the ability to leverage personal information in various applications. And, this pressure will only increase as we look into the future, making it even more imperative that payers and providers address the issue now.
Look more closely, and you will see that with their recent announcement CMS and the ONC are focusing on healthcare organizations’ ability to manage data across the enterprise. Historically, healthcare has worked from siloed applications and data sources with light integration using interface engines. Recently, healthcare organizations have pinned their hopes on leveraging data effectively through huge investments in new EHR platforms. The reality, pointed out by government officials at HIMSS in Orlando, is that this still results in significant challenges for healthcare organizations to manage information across the data value chain.
Although not part of their proposed framework, CMS and the ONC point out the need for better patient mastering across data sources. Organizations hoped their investment in a centralized EHR platform would solve this but that has proven to not be the case. In addition to patient data, healthcare organizations face challenges in mastering physician data, which can have wide impact, including on value-based care initiatives. The joint proposal also highlights that the ability to push back accurate, cleansed data to source systems is critical.
Healthcare needs a unified approach
Using FHIR to stop data blocking and push the industry towards a standards-based approach will help, but it’s not sufficient for the data challenges facing healthcare organizations. In addition to tackling the issues pointed out at HIMSS, healthcare organizations must:
The megalithic healthcare conference, HIMSS19, has come and has gone from the vast former swampland of central Florida. While I’m a relative newcomer to the show’s trajectory – I’ve been to four of the annual tradeshows since 2011 – this year’s version was, for me, the most rewarding and complete of them all. This could be for one of several reasons. Perhaps because I no longer represent a vendor so sitting in the exhibit hall in a 30×30 booth with a fake smile wondering when the day’s tedium would end and the night’s socials would begin may impact my rosy outlook.
Or, maybe I was simply content to engage in the totality of the experience, attend some quality sessions, meet with many high-class people and discuss so-called news of the day/week/year. Doing so felt, well, almost like coming home. Or, perhaps my experience at the conference this year was so good because of running into former colleagues and acquaintances that drove me to such a place of contentment while there. No matter the reason, I enjoyed every minute of my time at the event.
Something else felt right. An energy – a vibe – something good, even great, seems/ed about to happen. Something important taking place in Orlando, and I was blessed to be a part of it. Kicking off the week, CMS created news – like it does every year at about this time – with its announcement that it will no longer allow health systems and providers to block patients from their data. This was a shot across the bow of interoperability and the industry’s lack of effort despite its constant gibberish and lip service to the topic.
Another fascinating thing that finally occurred to me: no matter the current buzzword, every vendor has a solution that’s perfect for said buzzword. Be it “patient engagement,” “interoperability,” “artificial intelligence,” “blockchain”; whatever the main talking point, every organization on the exhibit floor has an answer.
But, no one seems to have any real answers.
For example, after nearly a decade, we still don’t have an industry standard for interoperability. Patient engagement was once about getting people to use patient portals for, well, whatever. Then it was apps and device-driven technologies. We’re now somewhere in between all of these things.
AI? Well, hell. It’s either about mankind engineering the damnedest algorithms to automate the hell out of everything in the care setting (an over exaggeration) or that AI/machine learning will lead to the rise of machines, which will help care for and cure people – before ultimately turning on us and killing or enslaving us all (again, I’m overly exaggerating).
By George Mathew, M.D., chief medical officer for the North American Healthcare organization, DXC Technology.
In mid-February, nearly 45,000 health information and technology professionals, clinicians, executives and suppliers gathered to explore healthcare’s latest innovations at the annual Health Information and Management Systems Society (HIMSS) conference in Orlando, Florida.
These “champions of healthcare” examined the greatest challenges facing the industry — including an aging population, chronic disease, a lack of actionable information and increasingly demanding consumers. They also explored how new solutions are being enabled by technologies such as predictive analytics, artificial intelligence (AI), machine learning and telemedicine.
The following four trends drove much of the conversation at HIMSS19 and will continue to shape the next wave of healthcare transformation.
Organizing and innovating around patients
As patients gain access to more information about their health and new technologies empower them to be proactive consumers of healthcare, the industry is focusing on how patients as consumers will drive new models of care. Topics such as patient engagement, patient-centric health information exchanges, personalized care and the consumerization of health were prominent during HIMSS19 learning sessions and conversations around the expo hall.
By Rom Eizenberg, vice president, Bluvision segment of the identification technologies business within HID Global.
A doctor or a nurse can find themselves under duress in an instant. A patient unexpectedly attacks a doctor in a room. A nurse, who is leaving her shift at 3 a.m., is jumped by a masked assailant in the hospital parking lot. A patient’s angry family member confronts a doctor about the care protocol or frustration over a lack of response to the treatment. Each of these examples can create threatening situations that generate concern and could pose a risk to the safety of hospital personnel.
Hospitals and other healthcare organizations have a responsibility to protect not only patients but also clinical staff. Growing concern about the dangers that doctors, nurses and other caregivers face on a regular basis is increasing dialogue in the healthcare industry about what is needed to ensure that staff get the support from hospital security teams and law enforcement when they need it – and at exactly the location where they need it.
About 25 percent of nurses experienced workplace violence each year. While the healthcare sector makes up just 9 percent of the overall U.S. workforce, it experiences nearly as many violent injuries as all other industries combined. Between 2005 and 2014, the rate of healthcare workplace violence increased by 110 percent in private-sector hospitals, according to a U.S. Bureau of Labor Statistics report.
According to a 2015 study published in the Journal of Emergency Nursing, 76 percent of nurses at a private hospital system in Virginia said they had experienced physical or verbal abuse from patients in the previous year. Hospitals can utilize technology more effectively to reduce these violence rates and protect their caregivers, especially if such incidents escalate.
To trigger a duress signal that catapults security forces or police officers to the rescue, healthcare leaders must understand the five key things about an effective response system to address real-time duress during a high-risk situation:
By Donald 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.
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”
Guest post by Michael Leonard, director of product management, healthcare, Commvault.
Once a year, the healthcare community gathers to discuss the hottest healthcare trends. This year, the event took place in Sin City, and the turnout was staggering. Topics of choice at the show ranged from EHR best practices to the rising need for telehealth services.
Now that I’ve had a chance to step back and digest, there are a few key moments that jumped out from the event. Here are my top two:
The HIMSS survey showed healthcare organizations are ready for telehealth.
During the show, HIMSS released a survey that had some exciting results around connected technology in the healthcare field. The results showed that 52 percent of hospitals are currently using three or more connected health technologies. Technologies being used by that group that stood out to me include mobile optimized patient portals (58 percent), remote patient monitoring (37 percent) and patient generated health data (32 percent). It’s fascinating to see these results, and important for healthcare and health IT professionals to know that the telehealth wave is here to stay.
The U.S. Department of Health and Human Services’ (HHS) made a key interoperability announcement.
At the show, the HHS Secretary Sylvia M. Burwell made a major announcement around interoperability that was backed by the majority of the top electronic health record (EHR) vendors and is supported by many of the leading providers. This news will enhance healthcare services and allow doctors and patients to make better informed decisions. It certainly has the potential to catapult the industry forward, allowing healthcare partners to increase accessibility by improving their clinical data management solutions.
As always, the conversation at HIMSS was engaging and educational and I left with some great takeaways and predictions for the future of health IT including:
With the yearly bluster and promise of HIMSS, I still find there have been few strides in solving interoperability. Many speakers will extol the next big thing in healthcare system connectivity and large EHR vendors will swear their size fits all and with the wave of video demo, interoperability is declared cured. Long live proprietary solutions, down with system integration and collaboration. Healthcare IT, reborn into the latest vendor initiative, costing billions of dollars and who knows how many thousands of lives.
Physicians’ satisfaction with electronic health record (EHR) systems has declined by nearly 30 percentage points over the last five years, according to a 2015 survey of 940 physicians conducted by the American Medical Association (AMA) and American EHR Partners. The survey found 34 percent of respondents said they were satisfied or very satisfied with their EHR systems, compared with 61 percent of respondents in a similar survey conducted five years ago.
Specifically, the survey found:
42 percent of respondents described their EHR system’s ability to improve efficiency as difficult or very difficult;
43 percent of respondents said they were still addressing productivity challenges related to their EHR system;
54 percent of respondents said their EHR system increased total operating costs; and
72 percent of respondents described their EHR system’s ability to decrease workload as difficult or very difficult.
Whether in the presidential election campaign or at HIMSS, outside of the convention center hype, our abilities are confined by real world facts. Widespread implementation of EHRs have been driven by physician and hospital incentives from the HITECH Act with the laudable goals of improving quality, reducing costs, and engaging patients in their healthcare decisions. All of these goals are dependent on readily available access to patient information.
Whether the access is required by a health professional or a computers’ algorithm generating alerts concerning data, potential adverse events, medication interactions or routine health screenings, healthcare systems have been designed to connect various health data stores. The design and connection of various databases can become the limiting factor for patient safety, efficiency and user experiences in EHR systems.
Healthcare, and the increasing amount of data being collected to manage the individual, as well as patient populations, is a complex and evolving specialty of medicine. The health information systems used to manage the flow of patient data adds additional complexity with no one system or implementation being the single best solution for any given physician or hospital. Even within the same EHR, implementation decisions impact how healthcare professional workflow and care delivery are restructured to meet the constraints and demands of these data systems.
Physicians and nurses have long uncovered the limitations and barriers EHRs have brought to the trenches of clinical care. Cumbersome interfaces, limited choices for data entry and implementation decisions have increased clinical workloads and added numerous additional warnings which can lead to alert fatigue. Concerns have also been raised for patient safety when critical patient information cannot be located in a timely fashion.
Solving these challenges and developing expansive solutions to improve healthcare delivery, quality and efficiency depends on accessing and connecting data that resides in numerous, often disconnected health data systems located within a single office or spanning across geographically distributed care locations including patients’ homes. With changes in reimbursement from a pay for procedure to a pay for performance model, an understanding of technical solutions and their implementation impacts quality, finances, engagement and patient satisfaction.
Guest post by Linda Lockwood, solutions director and service line owner, health solutions, CTG.
With HIMSS 2016 fast approaching, the hunt for the perfect Population Health tool will be underway. Whether you’re a HIMSS veteran or a first-time attendee, expect to be caught in a jungle of vendors, each promising the latest and greatest Population Health tools.
HIMSS seems to grow each year, and with so many vendors, solutions and offerings, and the buzz happening during the event, it can be a challenge to carefully evaluate Population Health tools to help inform a decision.
HIMSS can make you excited for the future of your organization, but can also be overwhelming with so many Population Health options to consider. These six tips can help you separate fact from fiction and select a tool that best meets the population health needs of your organization:
Identify organizational goals for population health and match your tool choice to those goals: It’s important to understand what your organizational goals are, as they will drive the selection of tools. If you have not entered into risk bearing agreements, but want to be prepared, perhaps you may want to start off with a tool that supports development of registries and profiles physician performance. You will also want to identify your high risk, high cost patients, and be sure you have the ability to track this performance over time. This information may be available from your financial systems, but you also will need to have the ability to drill down to the device, and supply level—as well as use of medications and supplies including blood products—to identify opportunities for improvement.
How does joining an ACO impact your decision? If you have plans to join an ACO, your needs may include the ability to perform Care Management and Care Coordination and Patient Engagement. You will want to be sure that there is interoperability between the hospital, physician offices and care managers as well as the payers. Reporting becomes critical with an ACO as certain metrics must be reported on a regular basis. As you evaluate tools, ask if they have pre-build reports that include some of the standard measures that a MSSP requires, as well as CMS.
Think about mergers and acquisitions: If you are in the process of a merger or acquiring physicians, you must ensure whatever tool you include has the ability to aggregate data from multiple EHRs and formulate a plan to support interoperability for sharing and exchanging key data. If you are self insured, your organization will have access to data about your population. If you are focusing on wellness and prevention, you will want tools to support patient engagement, health and wellness. Alternately, if have high risk patients, you require Population Health tools to support care coordination, outreach, pharmacy and lab adherence and wellness reminders.
Make data quality a priority: The ability to have accurate, reliable data is crucial with any Population Health or reporting tool. If a data governance system is in place, it’s important to understand what source data you will need to populate the tool. Be sure you know where key data is entered in the system and the common values for that data. In tandem with this, the organization should identify data stewards and business owners. Data governance must have organization-wide commitment, and business owners who are actively engaged.
Recognizing that healthcare providers need to transition from sick care to well care, Carolinas HealthCare System has been aggressively pursuing a technology strategy that powers more effective patient engagement, virtual care delivery and interoperability amongst providers in the Carolinas. At the Charlotte, NC-based healthcare system, information technology professionals, clinicians, analysts and operational leaders collaborate on executing a strategy that delivers tools and technology to improve patient care, easily.
Spearheading these initiatives has been Craig D. Richardville, MBA, FACHE, FHIMSS, senior vice president and chief information officer. In recognition of his efforts to bring better care to patients in North and South Carolina, Richardville has been named the 2015 John E. Gall, Jr. CIO of the Year.
The award, sponsored by the College of Healthcare Information Management Executives (CHIME) and HIMSS, recognizes healthcare IT executives who have made significant contributions to their organization and demonstrated innovative leadership through effective use of technology. The boards of directors for both organizations annually select the recipient of the award, which is named in honor of the late John E. Gall Jr., who pioneered implementation of the first fully integrated medical information system in the world at California’s El Camino Hospital in the 1960s. Richardville will receive the award on March 3, 2016, at the HIMSS Annual Conference & Exhibition in Las Vegas.
“I’m honored and humbled to be recognized for this award,” Richardville said. “I credit the team at Carolinas HealthCare System who has the commitment and talent to serve our patients. With this team, we’ve been able to leverage technology to improve and support the care delivered.”
Richardville has been instrumental in advancing innovative technologies for patient care. In 2013, the health system deployed one the nation’s largest virtual ICU practices. Currently, nearly 300 ICU beds in North and South Carolina were being monitored virtually. Clinicians cans also conduct virtual psychiatric visits, as well as provide care for stroke and other complicated conditions to rural communities.
On May 28, HIMSS submitted comments to the Department of Health and Human Services on the meaningful use Stage 3 proposed rule and the 2015 Edition Health IT Certification Criteria. The two letters, sent to Acting CMS administrator, Andrew Slavitt, and National Coordinator for Health IT, Dr. Karen DeSalvo, respectively, strongly urge CMS and ONC to:
Decrease the prescriptive nature of the EHR Incentive program,
Increase focus on the substantial capabilities established earlier in the program, and
Reduce complexity in the 2015 Certification Criteria.
HIMSS voiced its continued support for the meaningful use program as a tool to positively transform health and healthcare in the United States. Identifying meaningful use as a “critical tool for enabling healthcare transformation,” the response cites HIMSS Analytics data – collected annually on all non-federal US hospitals, and more than 30,000 tethered US ambulatory facilities – that “70 percent of hospitals have made a positive progression in the advancement of their EHR capabilities over the last five years, with more than 60 percent of ambulatory facilities showing similar progress in the last three years.”
HIMSS reiterated its long-standing commitment to interoperability: “HIMSS is committed to a culture in which IT is fundamental to transforming healthcare; improving quality of care, enhancing the patient experience, containing cost, improving access to care, and optimizing effectiveness of public payment.”
HIMSS remains strongly committed to making the Electronic Health Record Incentive program less prescriptive and more focused on encouraging and assisting providers to take advantage of the substantial capabilities established in Meaningful Use Stages 1 and 2, including interoperability.
HIMSS applauds a proposal in the NPRM for a single definition of Meaningful Use starting in calendar year 2018, no matter when a provider began to participate in the EHR Incentive Program.
HIMSS supports the work being done by CMS to align the EHR Incentive Program with other CMS quality reporting programs that also use certified health IT. HIMSS believes such efforts will lessen the burden on providers.
HIMSS is committed to ensuring patient safety remains paramount to the development, implementation, and wide-spread use of health IT systems.
HIMSS reiterates its long-standing assertion that 18 months is the minimum length of time needed between the final rules on Meaningful Use, certification, and standards, and the start of any stage of Meaningful Use. An 18-month timeline allows stakeholders to help educate and prepare providers on the upcoming new stage. The current timeline for transitioning to Meaningful Use, Stage 3 in 2017 and 2018 does not include 18 months.