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.
Dr. Donald Voltz
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.
Michael Leonard
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 Evolving
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.
Linda Lockwood
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.
Craig D. Richardville
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.
At HIMSS this year, multiple speakers laid out visions for a future where parents could consult with a pediatrician via a telemedicine encounter during the middle of the night, take their children to receive immunization shots at a retail clinic, and have all of this information aggregated in their primary care provider’s record so that providing an up to date immunization record at the start of the next school year is as simple as logging into the PCP’s patient portal and printing out the immunization record. In short, multiple speakers presented visions of a truly interoperable future where patient information is exchanged seamlessly between providers, healthcare applications on smartphones, and insurers.
While initiatives such as the CommonWell Health Alliance, Epic’s Care Everywhere, and regional health information exchanges attempt to address the interoperability challenge, these fall short of fully supporting the future vision described above. Today’s solutions do not address smartphone applications and still require manual intervention to ensure that suggested record matches truly belong to the same patient before the records are linked. This process is costly but manageable in an environment where a low volume of patient records are matched between large provider organizations. In a future world where patient data is available from a multitude of websites, smartphone applications and traditional healthcare organizations, it would be cost prohibitive to manually review and verify all potential record matches.
Of course, one solution to this dilemma would be to improve patient matching algorithms and no longer require manual review of records before they are linked. However, for this to be possible, a standard set of data attributes would need to be captured by any application that would use or generate patient data. In a 2014 industry report to the Office of the National Coordinator for Health Information Technology, first name, last name, middle name, suffix, date of birth, current address, historical address, current phone number, historical phone number, and gender were identified as data attributes that should be standardized. Many of the suggestions in this report were incorporated into the Shared Nationwide Interoperability Roadmap that the ONC released in January 2015.
HIMSS released the results of the 26th Annual HIMSS Leadership Survey of more than 300 participants, examining key trending issues impacting the business of healthcare including patient considerations, security concerns, insurance models and policy mandates. This survey revealed that 72 percent of respondents report that consumer and patient considerations, such as patient engagement, satisfaction and quality of care will have a major impact on their organization’s strategic efforts over the next two years.
The strategic value of information technology (IT) continues to be top of mind with healthcare leaders as 81 percent of respondents indicated IT is considered a highly strategic tool at their organizations and 76 percent noted that their IT plan fully supports their overall business plan. Participants also answered questions related to how IT was being used to facilitate the goals of the Triple Aim – a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. While more than two-thirds of respondents (68 percent) indicated an improvement within the patient health experience, more than half also felt that IT was reducing the cost of healthcare (53 percent) and improving population health (51 percent).
“This year’s survey showed that more than one-third of participants report that their organization was able to demonstrate improvement in all three areas covered in the Triple Aim as a result of their IT use,” said John H. Daniels, vice president, strategic relations for HIMSS. “These numbers are critical as they prove the continued progress healthcare is making as IT integrates with value-based care strategies and the growing influence of the patient in health encounters. It will be important for providers to capitalize on this momentum to ensure improved patient satisfaction as the sector begins the transition from Stage 2 to Stage 3 of meaningful use.”
The Leadership Survey also indicated that IT is supported from the top down– 79 percent of respondents indicated their organization’s executive team is highly supportive of IT and 72 percent of respondents indicated their organization’s board of directors was also on board with IT growth within their organizations.
