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.
At the HIMSS Annual Conference and Exhibition in Chicago, HIMSS released the results of the 2015 Impact of the Informatics Nurse Survey – a survey of nearly 600 participants including C-suite executives, clinical analysts and informatics nurses. The survey examined the growing technology-driven healthcare ecosystem and the role nursing informatics – a specialty that integrates knowledge, data and wisdom – is playing in this evolving environment. The results indicated that the role of informatics nurses has expanded greatly and is having immense impact on patient safety and overall care, as well as notable workflow and productivity improvements.
This year’s survey, supported by the HIMSS Nursing Informatics Community, found that 60 percent of respondents believe that informatics nurses have a high degree of impact on the quality of care provided to patients. The survey also showcased that the majority of respondents claim that their organization had hired an informatics professional in a leadership capacity. Moreover, 20 percent of respondents reported employing a Chief Nursing Information Officer (CNIO) at the leadership helm.
“The 2015 Impact of the Informatics Nurse Survey showcases the positive influence informatics nurses are having on improved quality and efficiency of patient care,” said Joyce Sensmeier, vice president of informatics for HIMSS. “We are going to continue to see the role and use of technology expand in healthcare and the demand for nurses with informatics training will grow in parallel. As clinicians further focus on transforming information into knowledge, technology will be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to this transformation.”
As healthcare provider organizations look to build upon their electronic health record (EHR) solution in order to leverage data analytics and population health management tools to transition to a true learning health system, nurses will continue to play an important role in the process. Key findings from the survey reinforce that participants believe that informatics nurses bring value to the implementation phase (85 percent) and optimization phase (83 percent) of clinical systems processes. These numbers are a clear indicator that the informatics specialty is a critical part of evolving healthcare organizations.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Apervita, the fastest-growing health analytics community, empowers health professionals from around the globe to collaboratively share expertise and content through evidence-based point-of-care analytics. Apervita is a secure, self-service platform that enables health professionals and enterprises to author, publish and subscribe to a market of evidence-based algorithms, quality and safety measures, pathways, and protocols, easily connecting them to data and workflow. Available to every health professional and powerful enough for the entire health enterprise, Apervita provides health analytics at a tenth of today’s cost, in a hundredth of the time.
Apervita is the leading health analytics community, where together with health professionals from around the globe, Apervita is transforming the world’s health knowledge into thousands of point of care health analytics. Apervita is a secure self-service platform that enables any health professional to connect health data to a market of trusted algorithms, protocols, assessments, pathways and measures, published by leading authors.
Paul Magelli is co-founder and Chief Executive Officer of Apervita, Inc. An accomplished entrepreneur, he brings together a pioneering vision for computable health with seasoned leadership and experience building global ecosystems. Paul brings together a broad range of leadership qualities, an acute focus on customers and a pioneering vision for digital health strategies.
Apervita believes health researchers and practitioners have already created the greatest wealth of health knowledge that has ever existed and it is just waiting to be unleashed to improve health.
Today, the majority of this knowledge is paper-based or locked into proprietary systems. Apervita’s market is already unlocking them, turning them into computable and shareable analytics and putting them to work to improve health. They are addressing some of the biggest health challenges, such as the 100,000s of patients that die prematurely every year in the United States from chronic disease, complications and preventable adverse events.
CHIME and HIMSS are in the news again, and this time you’ve got to love that they are — for sticking up for what they, as organizations, believe in. Their flexing of a little muscle is for telling ONC that its leadership and its current efforts just are not good enough; referring to the announcement that Dr. Karen DeSalvo, current national coordinator for health information technology, is splitting here duties between ONC and HHA, where she’s battling Ebola.
CHIME, especially, is known for its bravado, one of the reasons I find it such an intriguing organization to watch. Its messages are always loud and clear, and unadulterated; just what we need in an overly PC public where “the folks” are supposed to take what’s given to them.
CHIME and HIMSS’ letter is more about the overall leadership changes taking place at ONC and the organizations’ apparent difficulty keeping leadership in place; DeSalvo has led the organization for less than a year. “We are concerned with leadership transitions currently occurring within the Office of the National Coordinator for Health Information Technology (ONC); changes which could have a detrimental effect on ONC’s role in HHS’ charge to positively transform our nation’s health system,” CHIME and HIMSS’ letter to ONC states.
“Health IT is a dynamic field; to successfully address the needs of patients, providers and developers, ONC’s leadership team must be in place over the next two years. Such constancy will pay huge dividends in navigating all the changes that must occur for positive transformation.”
CHIME and HIMSS point out the obvious in their missive: That ONC faces a public that perceives its leadership as not wanting to be at the organization, much in the same vein as what’s going on at the White House amid reports that a disengaged Obama is counting down his last days as President.
As ONC’s leadership publically takes a willy-nilly approach, CHIME, HIMSS and others are done looking on wondering what’s up and are starting to demand some action. A half-hearted approach to leadership is not going to work, not now, not after so many of its programs that ONC lobbied for and put in place while practices and health systems looked on wondering how to deal with the swarm of new mandates and regulations.
Healthcare leaders from across the nation are renewing calls for the Centers for Medicaid and Medicare Services (CMS) to shorten the meaningful use (MU) reporting period in 2015 and provide more program flexibility, citing concerns with lower-than-expected Medicare numbers and continued reports detailing nationwide difficulty in meeting federal guidelines for electronic health records (EHR) requirements.
According to newly released CMS numbers, less than 17 percent of the nation’s hospitals have demonstrated Stage 2 capabilities. Further, less than 38 percent of eligible hospitals (EHs) and critical access hospitals (CAHs) have met either stage of meaningful use in 2014, highlighting the difficulty of program requirements and foretelling continued struggles in 2015. And while eligible professionals (EPs) have until the end of February to report their progress, only 2 percent have demonstrated Stage 2 capabilities thus far.
Officials from the American Medical Association (AMA), College of Healthcare Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS) and Medical Group Management Association (MGMA) called the results disappointing, yet predictable.
“Meaningful use participation data released today have validated the concerns of providers and IT leaders. These numbers continue to underscore the need for a sensible glide-path in 2015,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO. “Providers have struggled mightily in 2014, in many instances for reasons beyond their control. If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use.”
CMS data required by Congress indicate that more than 3,900 hospitals must meet Stage 2 measures and objectives in 2015 and more than 260,000 eligible professionals (EPs) will need to be similarly positioned by January 1, 2015. Given the low attestation data for 2014 and the tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015, healthcare leaders have pressed for a shortened reporting period in 2015, mirroring the policy of 2014.
HIMSS released the following infographic that summarizes the findings of 25 years of health IT from its annual leadership surveys. It’s a pretty good depiction of how health IT has changed in the last quarter century. Looking back on the past twenty five years in healthcare, something are fairly interesting. For example, physicians in 1993 said they would not adopt their use in healthcare until they became easier to use. The sentiment still remains, to a certain degree, especially in regard to systems like electronic health records.
Another interesting factoid, is that in 1994, 14 percent predicted that digital patient information would be shared nationwide in one to three years.
Finally, the number of health IT priorities that has changed in the course of the last 25 years is either alarming or inspiring, based on the level of change in the space and how quickly things continue to change. However, the number of changes and their frequency remind me of a dog on a trail stalking down one scent after another without a real sense of purpose – Y2K, HIPAA, patient safety, reducing medical errors, financial survival, meaningful use, etc.
Today, healthcare organizations are being challenged to provide quality care while improving accuracy, efficiency and accountability. With the additional strain of staff reductions, space constraints, budget cuts and technological advancements all competing with new regulations, there is almost a perfect storm of workflow changes for clinicians to address and adopt. While most focus on the immediate challenges of electronic health records, they may not think through all the implications when implementing the technology used to access it.
Amid the widespread adoption of EHRs, caregivers are equipped with a multitude of devices to access electronic reports – including tablets, handhelds, wall mounts and mobile carts. Furthermore, the logistics governing electrical, phone and network cabling, not to mention physical “real estate,” can stretch the ability to cope for some facilities. It’s not surprising to find cutting-edge IT equipment being used in cramped, stuffy rooms with inadequate furniture, mounting surfaces and storage. At the recent HIMSS conference, we presented to dozens of clinicians and explored how the enterprise-wide application of ergonomic principles within a hospital setting can help manage and sustain all of the often overlooked aspects of clinical workflow.
Ergonomics is the application of scientific knowledge to a workplace to improve the well-being and efficiency of workers. Ergonomic design considerations begin with human abilities and limitations and how they affect the work process. An ergonomic workplace increases workers’ efficiency and productivity, while helping to reduce fatigue, exertion, and musculoskeletal disorders.
Studies have shown that a good ergonomics program also favorably influences reduction of workplace injuries and absenteeism, and contributes to overall employee wellness.
As someone passionate about patient engagement and using health IT and other technologies to improve care, I continue hear a great deal about how solutions can actually benefit population health. Even at the most recent HIMSS conference, “patient engagement” as a term clearly has become one of this year’s biggest buzz phrases.
Conference sessions were dedicated to the topic, vendors marketed their services to solving some of the issues associated with it and seemingly everyone in attendance had an opinion for what needs to be done or at least has some strategies for bringing more patients — or their data — directly into the care sphere.
Problem is, from my perspective, that, unfortunately, too much is still being said about population health and not nearly enough about individual health. In theory, I understand why this must be, but in practicality, I don’t understand the seemingly lack of attention individuals are receiving. Obviously, if population health outcomes improve then that must logically mean individual health outcomes are improving.
And while I understand that not everyone or every need can possibly be addressed, that doesn’t mean we shouldn’t be trying to fill those needs. The current conversations about improved population health remind me of a common business/life solution when addressing a major problem: How does one eat an elephant? One bite at a time. Likewise, it would seem the same approach could be taken to achieve improve population health outcomes: One individual patient at a time.
That said, I asked some folks within the health IT community how technology affects individual patient outcomes. Though some of the ideas here are still high level, perhaps they are a step in the right direction. Here are some of the responses I received:
What are the real-world benefits of electronic health records, for example, to a specific individual? To answer that question, let’s take a look at a fictional person we’ll call “Bill.” Bill is quite elderly and has a variety of age-related illnesses. He lives in Ohio, and decides spend the winter with his daughter in Florida.
Bill’s daughter, Susan, arranges for her father to be seen by a local specialist during his stay. Susan tries to get a voluminous paper file transferred from Ohio to the new doctor in Florida, but there are delays: phone messages are missed, handwriting is misread, and no one has time to copy and mail 100 pages of medical records.
In the end, Susan is unable to get her father’s records transferred in time for the appointment with the new physician. As a result, an unnecessary test is performed, and a drug is prescribed that had caused an allergic reaction in the past.
In the future, EHRs will enable the Florida clinic to have electronic access to the same records available in Ohio. Already, Medicare and some commercial carriers have websites that list physician visits, patient complaints, diagnoses made, lab/diagnostic tests performed, and drugs prescribed. Eventually, such websites may include a full medical profile, including doctor’s notes, lab results, x-ray images and more.
I wasn’t wowed by Hillary Clinton’s presentation at HIMSS14. Perhaps it was her overly polished nature or the fact that she really didn’t seem to say anything more than catch phrases arranged by her speech writer, which were obviously meant to garner “oohs” and “ahs” from the Clinton-friendly crowd.
Perhaps I was put off by the campaign-style stump that she delivered or that, once again, she claimed credit for being at the forefront of healthcare and working across the isle from her days in the White House and Senate. Or, perhaps it was her seemingly misplaced reference to Alexis DeTocqueville, the 19th century French historian.
The reference to the French observer of this country seemed trite and overly simplified, especially for such a sophisticated group.
“Lots of places were grander and richer,” Clinton stated, referring to the chronicler, “yet what did he say we have that he found unique? He said we were distinguished by the habits of our hearts. What did he mean by that? He meant that we worked with one another. In those days it might have been putting up a barn for a farmer who lost his to a fire. Or forming a volunteer police or fire department, or starting the first hospital.”
To a point she’s right, of course. As a society, Americans tend, for the most part, to be a people of full and giving hearts. We as a people come together, in a connected manner, much the same as we should and are in healthcare. However, her reference did little more for me than stir up memories of the man from conversations that took place in my political science class years ago.