The statistics are terrifying. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol poisoning kills six people every day. Of those, 76 percent are adults ages 35 to 64, and three of every four people killed by alcohol poisoning are men. The group with the most alcohol poisoning deaths per million people is American Indians/Alaska Natives (49.1 per one million). More than 15 million people struggle with an alcohol use disorder in the United States, but less than eight percent of those receive treatment.
Almost 72,000 Americans died last year from drug overdoses, a record high acknowledging an increase of about 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes and even U..S. gun deaths.
Treating addiction is not a simple process and the current treatment of 90-day detox programs works well if you have thousands of beds, staff and other resources. Meanwhile the actual behavioral health treatment of addition is not much better. It is still a time-consuming process requiring individual diagnosis, but largely driven by paper and trial and error guesswork.
Meanwhile heroin, fentanyl and other synthetic drugs addictions were surpassing alcoholism. In Gallup, New Mexico, last year 104 people died from drug and alcohol abuse in McKinley County while the state suffered 1,952 deaths, the 13th highest in the US.
One of the nation’s epicenters of addiction is Gallup, New Mexico, where 22,000 addicts await a behavioral healthcare fix. While there are many tech solutions in healthcare, behavioral health does not receive the same level of attention as physical health, despite mental, behavioral and physical health being inextricably linked, as the World Health Organization noted in a 2014 report.
One of the widest chasms between the two began in U.S. healthcare in 2010 with the transition from paper to electronic patient medical records. However, these electronic health record (EHR) systems have been focused on the physical side of medical recording, leaving the behavioral side with little support.
While care collaboration through interoperability remains one of the major challenges in the healthcare industry, collaboration between physical and behavioral health has is also behind the curve. Behavioral health services (BHS) operate and are updated based on paper records, leaving challenges around efficiency, communication and the ability to scale treatment operations.
Historically, clinicians have directly performed assessments of people for the purposes of diagnosis, monitoring the progression of an illness, or evaluating responses to treatment. For example, a person’s mental state can be evaluated by examining movement patterns, mood states, social interactions (e.g., number of texts and phone calls made, content of interactions), behaviors or activities at different times of day, vocal tone, speed, word choices, facial expressions, biometric and heath measures.
While assessing an individual’s symptomatology, large quantities of behavioral data can provide vital information for researchers to increase their understanding of mental illnesses and mental wellbeing, help develop better interventions and better health outcomes, and potentially predict who may be at risk of developing behavioral health problems.
Providers addicted to records and files
A physical health issue can require visits to a primary care physician, specialists, and possibly x-ray technicians along with the records and paper trails that go along with it, the treatment of behavioral health is often much more complex. If a patient requiring behavioral care shows up at an urgent care facility and receives treatment, that data doesn’t get back to the patient’s primary care provider. The primary care provider only learns of the visit if the patient decides to give them that data. The PCP can’t pull information from possible business partners in the area to know when there’s been a change.
A substance abuse patient needs a physical and mental examination before they can check into the behavioral health center. An intake coordinator starts that process, then the patient sees a nurse, and then a counselor. But the person also has depression and needs to see a psychiatrist and they also need to go to the detox center at the hospital. Chances are they also have social problems to worry about such as child support, perhaps a bankruptcy case, or they’re headed to jail.
In addition, different behavioral treatment centers may have operational differences such as the number of treatment phases and the ability to track, monitor and anticipate recidivism after patients graduate from treatment centers. There are also differing manual processes and types of tracking documentation used by facilities while training programs may or may not be part of treatment centers as well.
In a typical BHS treatment center, their process and workflow comprise admission and treatment which includes assigning a treatment counselor, nurse for withdrawal, case manager and training program coordinator. There is also a program for job training, an aftercare phase along with monitoring, tracking, reporting and progress improvement or non-progress on treatment programs against the outcome of the overall program.
However, this phase is cumbersome because of the lack of an electronic recording system for behavioral health as most records are stored as PDFs in EHR systems. In addition to these limitations, there is lack of support to track progress or non-progress on patient outcomes.
Unlike the ‘physical’ medical approach, behavioral care treatments tend to be more subjective to each care provider and require a longer time to monitor and record positive outcomes from treatment. Behavioral treatment depends more on data analytics from patients to determine the best approach for patient engagements. There are also additional data categories required for BHS such as chemical dependency assessment, a treatment plan, social service related data, a training program and related data and mental health assessments.
When considering all this additional data versus data requirements for physical care, it seems like a process that is almost designed to be slow and cumbersome. So if the parameters of treatment can’t be changed to accommodate the surge in addicts, the only other consideration is the treatment process.
Interoperability, as it was envisioned, should be built on transparency and connectivity, allowing a patient’s critical health information to be easily accessible, regardless of where treatment is being administered. By creating an infrastructure that supports the sharing of patient data along the care continuum, hospitals, skilled nursing facilities (SNF) and long-term post-acute care (LTPAC) facilities can offer the best care possible. As a result, organizations that participate in interoperability best practices are positioned to become preferred providers.
Unfortunately, interoperability is still a work in progress for many organizations. While more than 95 percent of hospitals and 90 percent of office-based physicians are now utilizing electronic health record (EHR) platforms, many struggle with — or have reservations around — sharing information outside of their facility. As such, silos represent a great barrier to realizing a fully implemented state of interoperability.
The current data gap can drastically impact care. For example, a patient experiences a serious medical incident — such as a fall or stroke — and arrives at the hospital where staff may not have access to existing patient data which could inform the best delivery of care. Or perhaps they’re able to access that data, but not right away. Care is now delayed, which can be additionally concerning depending on the time-sensitivity of the patient’s condition.
Taking this example a step further, let’s explore what happens after care at the hospital has concluded. The patient requires rehabilitation, and a continuation of care document (CCD) is issued to a post-acute care facility. From there, the patient’s information is transferred by less-than-foolproof methods such as fax, for example. A glitch as simple as a jammed paper feed could prevent critical information from reaching the appropriate caregiver.
As value-based care and payment-care models are moving toward the forefront, blind handoffs of patient information are no longer viable, as they drastically increase the financial risks hospitals and payer groups are subject to — not to mention the clear detriment the system has on delivery of care.
Closing the gap
The larger question is how does the industry get from Point A to Point B? The easy answer is to liberate the data through a cloud-based infrastructure that supports an efficient, easy-to-access data exchange between all caregivers. An integrated solution would connect stakeholders across the care continuum, providing accurate insights when needed, eliminating data silos between care partners, and enabling more confident decision-making.
These systems would promote:
Optimized transitions: Data needs to travel with the patient — or before movement — discretely across all systems.
Patient visibility: Data should reflect the most current ADT information, identifying and sharing where a patient is and from where they’ve been discharged.
Central view of LTPAC patients: This facility-agnostic feature should offer automated updates of a patient’s functional progress.
Ongoing status and monitoring: Maintaining continued care is facilitated through alerts and notifications to caregivers regarding any change to their status or well-being and meaningful feedback on care pathway progress.
Facility performance: Beyond understanding a patient’s status, it’s also helpful to understand how facilities in and out of their PPN have performed.
The concept of interoperability, in some ways, seems contradictory to traditional best practices. Healthcare organizations are charged with protecting patient data at all costs, and the idea of sharing data in a way that opens access to a wider group of stakeholders could give pause. Regulatory infractions for data loss in the healthcare industry can be steep, and the number of well-publicized data breaches in recent years reinforces how valuable health records are to both the organizations who keep them and those who try to steal them.
So, it should go without saying that an EHR “superhighway” must be developed with security in its DNA, taking stringent regulatory requirements into account. The good news is that the newest breed of information exchange platforms is being built with security roles in mind, drastically reducing the possibility of data loss.
Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions in need of solving, obstacles and the most important hurdles that must be overcome. And how solving these problems might alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes: For everyone you ask, you’re likely to receive a different answer. What must first be addressed? In this series (see part 2 and part 3), we ask. We also examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
So, without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities — healthcare’s most pressing questions, problems, hurdles, obstacles, things to overcome? How can they be best addressed?
Nick Knowlton, VP of strategic initiatives, Brightree
Throughout the healthcare ecosystem, patient-centric interoperability has historically been a huge challenge, specifically throughout post-acute care. This problem results in poor outcomes, unnecessary hospital re-admits, patients not getting the treatment they deserve, excessive cost burden and poor clinician satisfaction. This challenge can be solved through creating better standards, adapting existing interoperability approaches to meet the needs of post-acute care, implementing more scalable interoperable technologies, and involvement with national organizations, such as CommonWell Health Alliance and DirectTrust, amongst others.
Cybersecurity is one of the most pressing hurdles in the healthcare industry. The life and death nature of healthcare and the shift to electronic health records (EHR) creates an environment where hackers that successfully deploy ransomware and other cyberattacks can extort large sums of money from healthcare entities and steal highly sensitive data. To address this challenge, healthcare entities need to continue to increase their investment in cybersecurity and focus on improving their overall security posture by implementing tools and processes that will monitor all devices and assess their compliance with security policies; stop phishing attacks; keep all servers patched and current; ensure third party vendors comply with policies; and train employees on proper security hygiene.
Cyberattacks continue to expose the security vulnerabilities of healthcare institutions, keeping many industry stakeholders awake at night. This is why every organization handling protected health information (PHI) needs to build security frameworks and risk sharing into their infrastructure by implementing risk-mitigation strategies, preparedness planning, as well as meet industry standards for adhering to HIPAA requirements. Hospitals and healthcare systems must keep their focus on strategies and tactics that ensure business continuity in the event of an attack as it’s clearly not a matter of if a breach can happen but when.
The core problem for healthcare isn’t science, technology or caregiving intervention. It’s making sure that the systems of delivery and communications are thought through and actually respond to the way patients need and expect healthcare to be delivered. This means it doesn’t matter how advanced and perfected your health system may be — unless it conforms to culture — the way people think and behave — it will do nothing but confuse and frustrate patient needs, which are psychological and social, as well as physical and mental.
Health Level Seven(HL7) International, the global authority on interoperability of health information technology with members in 55 countries, announced election results for its board of directors at the 32nd Annual Plenary and Working Group Meeting in Baltimore, Maryland. The 2018 class of HL7 Fellows and the 2018 recipients of the W. Edward Hammond, Ph.D. volunteer of the year awards were also recognized at the event.
Incoming Board Chair
Walter Suarez, M.D., M.P.H., executive director, health IT strategy and policy, Kaiser Permanente, was selected by the membership to serve as the chair-elect in 2019 and as the board chair, 2020-2021.
HL7 Board Member Elections
Four members were elected to the HL7 board of directors for the 2019-2020 term:
Director — Kensaku Kawamoto, M.D., Ph.D., associate chief medical information officer, University of Utah Health Care
Director — Janet Marchibroda, fellow, Bipartisan Policy Center
AffiliateDirector — Diego Kaminker, owner, Kern-IT SRL and member, HL7 Argentina
2018 HL7 Fellows
The HL7 Fellow Award was presented to five individuals during HL7’s 32nd Annual Plenary and Working Group Meeting in Baltimore. The award was established to recognize HL7 members with at least 15 years of active membership as well as outstanding service, commitment and contributions to HL7. The 2018 recipients of the HL7 Fellowship Award include:
David Hay, M.D.
Rob McClure, M.D.
HL7 Volunteers of the Year
HL7 honored three members with the 22nd annual W. Edward Hammond, Ph.D. Volunteer of the Year Award. Established in 1997, the award is named after Dr. Ed Hammond, one of HL7’s most active volunteers and a founding member as well as past board chair. The award recognizes individuals who have made significant contributions to HL7’s success. The 2018 recipients include:
Brett Marquard, principal, WaveOne Associates, Inc.
Ulrike Merrick, lead specialist, informatics terminology, APHL – Association of Public Health Laboratories and public health information specialist, Vernetzt, LLC
Bryn Rhodes, owner, Database Consulting Group and chief technology officer, HarmonIQ Health Systems Corporation
About the Volunteers:
Brett Marquard, has been a member of HL7 since 2008. Brett has held several positions throughout his 10-year tenure at the organization. For seven years, he co-chaired the HL7 Structured Documents Work Group. In addition, Marquard has served as the vice chair of the HL7 US Realm Steering Committee since 2016 and has chaired the newly established CDA Management Group since 2017. He is active in the effort to advance HL7 Fast Healthcare Interoperability Resources (FHIR®) and works with the ONC within the context of addressing their HL7 requests. Finally, Marquard been instrumental in the standards development process as the primary editor of the Consolidated CDA (C-CDA) and US FHIR Core implementation guides.
Ulrike Merrick, has been an active member of HL7 since 2008. She has served as a co-chair of the Orders and Observations Work Group since 2014 and was recently appointed to HL7’s newly established Version 2 Management Group. In addition, Merrick was elected to serve on the HL7 Technical Steering Committee beginning in January 2019 as the co-chair of the Administrative Steering Division. Much of her involvement in HL7 is focused on lab testing and reporting, and she has used her background in this area to engage the CDC in HL7 initiatives. Merrick has leveraged her broad network in the laboratory community to provide input from subject matter experts in relevant HL7 specifications, such as the HL7 Specimen Domain Analysis Model.
Bryn Rhodes, has participated in HL7 for several years and joined as a member in 2018. He serves as an interim co-chair of the Clinical Decision Support Work Group. Rhodes has also been involved in the efforts to extend HL7 FHIR into the clinical decision support and clinical quality measurement domains. He is the co-author of several HL7 specifications including the following: Clinical Quality Language (CQL), FHIRPath, FHIR Clinical Reasoning Module, QI Core/Quick and the CQL-based HQMF. In addition, Rhodes oversaw the transfer of the CMS electronic quality measure (eCQM) work using the CQL across multiple measure developers. Finally, he was instrumental in the Centers for Disease Control and Prevention (CDC) Adapting Clinical Guidelines for the Digital Age project’s incorporation of FHIR clinical reasoning and FHIR resources into the CDS L3 output and operationalizing the process by use in a CDC opioid management clinical guide.
Included amongst the segments of healthcare such as post-acute care that until recently had been mostly overlooked, specialty pharmacy now is in the spotlight as a key area of healthcare utilization and spend in the U.S. Critical, expensive and often life-sustaining medications for high complexity disease states, as well as care management programs that help patients through their healthcare journey, are at the core, driving nearly $175 billion in drug spend for the 2 percent to 3 percent of the U.S. population considered medically complex. Specialty pharmacy operations typically involve a cross-functional staff of insurance experts, patient care coordinators, nurses and pharmacists that interact with patients and stakeholders to ensure therapeutic success in a historically fragmented, manual process-driven model.
Challenges in specialty pharmacy operations
As with many aspects of the healthcare system, specialty pharmacy operations are fraught with many pragmatic, economic, and clinical care challenges.
Operational, pragmatic challenges include:
Multiple fax and phone communications between prescriber and specialty pharmacy supporting referrals, prescriptions, authorizations and patient care coordination
Challenging and fragmented patient engagement combining traditional phone-based communication with other methods such as texting with mixed results
Overlapping prescriber and patient communications among health plan, pharmaceutical manufacturer patient service hubs, prescribers and specialty pharmacy
These process challenges are creating an economic strain for the pharmaceutical industry, the payer, the provider, and most importantly the patient – where insurance benefit and funding source determinations often create confusion between overall coverage and patient out-of-pocket costs. This is compounded by complex coordination of benefits, billing and payment processing of medical and pharmacy claims, as well as other sponsored funding sources. Increasing patient cost share can make specialty drugs unaffordable for many patients which impacts medication adherence and ultimately patient outcomes.
The resulting clinical challenges make it difficult for critical patient care information to be easily shared (e.g. labs, patient assessments, medication profiles, side-effects, etc.). Additionally, treatment objectives often overlap among specialty pharmacy channel providers, resulting in crossed communications and patient confusion. In the end, key success metrics (both economic and clinical) are not easily measured, and often not operationally and clinically aligned.
The power of data accessibility and real-time analytics
Compressed specialty pharmacy margins require significant technology investment to offset operating costs and increasing service expectations. Technological advances help to address several of these challenges and as a result drive improvement in patient care and satisfaction, lower operating costs and more informed clinical decision-making.
Several of these technological advances that are showing early evidence of changing the historical paradigm include:
Interoperability with EHRs and other critical patient history data sources providing access to holistic views of patient medical records which can improve patient engagement, therapeutic interventions and reduce unnecessary procedures
Sophisticated workflow software driven by data-informed electronic protocols to support overall multi-party process efficiencies
Robust and timely analytics that provide comparative and predictive insights that influence optimal patient care at the lowest cost as well as provide more timely, accurate patient insights that drive patient success, including medication adherence
Integrated patient engagement technologies that improve patient interactions when and how the patient wishes to engage
Impact across the continuum
The application of advanced capabilities in connectivity and analytics in the specialty pharmacy space creates a more efficient system and a better result for all involved. Successful implementation of these technologies accelerates patients onto the most appropriate therapy, optimizes patient treatment plans and improves the overall patient experience which support medication adherence goals. It can also help establish innovative and more productive relationships between health plans, employers, providers, specialty pharmacies, pharmaceutical manufacturers and patients.
There are many uses of information technology in healthcare. In the previous years, these implementations have developed more than anyone could anticipate. They boost efficiency, improve the quality of care and security and control costs. These advancements have created many benefits for the patients and medical facilities in both the public and the private sector. When asked, experts say that these are some of the biggest health IT issues that should be considered:
Interoperability, when it comes to healthcare is one of the processes that make it easier for medical services to share information on patients. It makes the healthcare more efficient — it prevents doing the same tests multiple times on one patient and it helps specialists communicate quickly through the system.
This is why it’s so crucial that this technology continues advancing and moving further while making the job of doctors all over the world as simple and as focused on the problem as possible.
Of course, with so much data which exists in healthcare field, security of that data is one of the top priorities. In recent years we have come across so many examples of how not to handle patient data but now that we are dealing with population Healthcare, we need to be even more careful. That’s why cyber security of the data became an imperative at so many companies.
“Security is something that you should definitely keep an eye on. Whenever you see that there is a new update, make sure that your healthcare organization has it. People are getting more and more skilled at hacking and obtaining data that this has to be a priority,” said Gina Petrelli, a data analyst from OriginWritings and WriteMyX
Because there is such a shortage of trained medical personnel in the world, big data will have to become the main source for point-of-care information. This can improve the current state of health in certain groups as well as establish customization so that every technology can be unique to each culture. It will also help develop safer and more efficient systems across the world.
Big data means that there are many sources and a lot of data to be taken from them — medical professionals will have the kind of information that they usually can’t easily get.
Over the years, there have been some big investments made towards the healthcare technology industry. However, those investments are noticeable now more than ever — technologies are advancing fast and this progress is visible in many areas.
Investments in healthcare information technology has mostly been aimed at technologies that improve efficiency, technology that supports decision making and personalized medicine, technology that empowers patients, technology that protects against cyber attacks and technology that enables remote health monitoring.
Why most investments are made towards these areas is understandable — they contribute to the overall health and safety of populations.
Improvements of EHR
Electronic health records are something that is already in place and has been for some time now. While there are many benefits to this, it can sometimes be a nuisance and a burden to medical professionals. They are often not inter-operable and that causes a lot headaches to doctors across the world. Any technology that allows for easier use and interoperability is going to be well-accepted.
“While we’ve had these technologies for years now, you’ll have to notice that they caused many troubles – security, operating, transitioning from paper to digital. New improvements could change that,” said Dennis Marks, a communication manager at 1Day2Write.
Growth of telemedicine has been steady over the years but the growth will speed up in the future years. This will enable doctors to examine patients using wearables and use that data to assist them in diagnostics, management and prevention later. This is all thanks to MACRA, value-based demands placed upon the providers and so on.
By Robert Barras, vice president of health solutions, CTG Inc.
There’s nothing like a good bandwagon to get everyone excited. Whether it’s the success of your favorite sports team, or a hot new restaurant in town, or a movie that’s breaking box office records, once something gets hot it seems everyone wants a piece of it.
For healthcare IT, one of the loudest and most visible bandwagons in the last few years has been the cloud. The idea of being able to hand off the expense and resource-intensive hassle of purchasing, implementing, and maintaining hardware and software is very attractive to healthcare organizations continuously being challenged to “do more with less.” Yet that expediency is often offset by continuing concerns about security, especially as it relates to protected health information (PHI), speed of access, and other issues.
The reality is the cloud is the right choice for some organizations, or even some specific applications, but it’s not a panacea for HIT. Following are some things to consider as you make the choice of whether to move to the cloud at all, and what makes sense to move to it.
One of the top reasons in favor of moving data and/or applications to the cloud is the ability to scale them on an ad hoc basis – especially as healthcare data continues to grow exponentially. A report from EMC and research firm IDC projects the volume of healthcare data will grow from 153 exabytes in 2013 to 2,314 exabytes by 2020.
Of course, the growth won’t come in a steady stream. At some points, healthcare organizations will need to be able to manage a high volume of data. At others, they may need to boost their computing power temporarily to drive a specific objective.
Rather than trying to manage data or computing needs internally and ending up with over- or under-capacity, the cloud provides a convenient way to scale up or down quickly. It’s also more cost-efficient, as healthcare organizations only pay for what they consume, significantly reducing costs. Finally, expanding capacity through the cloud ensures processing-heavy analytics applications aren’t slowing down the performance of critical clinical applications.
All of that data won’t be coming from a single source, either. As more of healthcare shifts to being value-based, providers of all types and sizes need to populate their population health management (PHM) and other analytics applications with data drawn from a variety of sources inside and outside of the organization.
Most organizations, especially those hyper-concerned with security, will not want all of that outside data flowing into their core systems or internal data centers. The cloud presents an ideal alternative.
It can create a clean separation between the main storage of PHI and all other data by treating PHI as a source that feeds applications housed in the cloud. With the help of a partner, all the incoming data can be cleaned and normalized so it can be used within analytics or other applications, providing better, more complete answers to PHM, patient engagement, trends, and other questions than can be obtained with internal data alone.
As the use of data in this manner grows, it will simplify the exchange between providers – especially as standards such as FHIR proliferate throughout the industry. The result is interoperability almost becomes a byproduct of the use of data in the cloud, avoiding the need for expensive, time-consuming special projects just to send electronic health records from one provider to another.
Ivenix, Inc., a medical technology company with a vision to eliminate infusion-related patient harm, was founded in 2012 to develop innovative solutions that transform infusion delivery. Designed from the ground up to streamline medication delivery and bring legacy technology into the digital age, the Ivenix Infusion System includes a large-volume infusion pump supported by a robust infusion management system designed to set new standards in usability, medication precision and interoperability.
Today’s IV smart pumps rely on technology developed more than a decade ago and continue to put patients at risk. At Ivenix, we believe it’s more important than ever to empower clinicians with the most effective infusion equipment, training and processes to ensure they do no harm. No hospital wants to wonder: “Are we doing enough? Are we making every effort to prevent infusion mistakes?” We are all patients. And Ivenix is dedicated to the belief that infusion technology should put patients first with enhanced outcomes and a better patient experience, while dramatically improving clinical workflow and efficiency. It’s what inspires us, motivates us, and brings us together for the shared purpose of delivering groundbreaking infusion innovation to healthcare.
Ivenix is generating awareness through a number of channels, and has partnered with industry associations, such as HIMSS, IHE and AAMI, which has an Infusion Safety Therapy Coalition, to address current market issues in infusion safety, interoperability and innovation. Ivenix is also testing its infusion pump system with a number of integration partners, including leading EMR, alarms management and clinical communication vendors to provide interoperability solutions.
Ivenix is addressing the $9 billion global infusion pump market, with first targeted efforts on the U.S. large volume pump market, a $2..6 billion market segment that represents the majority of infusion pumps used in the U.S. hospital and ancillary clinic market.
Who are your competitors?
Braun, BD, ICU Medical, Baxter
How your company differentiates itself from the competition and what differentiates Ivenix?
Ivenix has developed an infusion platform to address an industry fraught with medication errors. Infusion-related errors account for more than 50 percent of the 1.5 million adverse drug events reported annually to the U.S. Food and Drug Administration (FDA). Between 2015 and 2017, more than 23,000 pump malfunctions, including subsequent injuries, were reported to the FDA. With today’s pumps, infusion errors are attributed to error-prone programming tasks, usability issues and clinical use, inaccurate flow, hardware failures and outdated designs with limited information. Currently, less than 1 percent of IV pumps are fully integrated with electronic medical records. Ivenix is rethinking infusion delivery to set new standards in safety, simplicity, and interoperability, Ivenix designed its infusion system on three fundamental dimensions:
Patient-centered design: Intuitive design enables faster bedside setup and lowers risk of programming errors, benefiting patients because clinicians spend less time troubleshooting pumps or resolving nuisance alarms.
Integrated data-driven insights: Advanced IT platform integrates with the EMR and other hospital information systems, securely manages data and connects clinicians with patient-specific knowledge to be better informed – and therefore make better decisions – at the bedside.
Adaptive fluid delivery: Advanced pump technology reduces clinical variability of medication delivery to help improve patient outcomes.
Federal healthcare organizations, such as CMS, have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with interoperability requirements and data integration, the mesh used to try and bridge the gap. Many government rules have been written to address the type of mesh needed and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes, such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
Anyone for A Slice Of PI?
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
CMS announced the change as part of a proposed rule that will transform the EHR Incentive Programs commonly known as meaningful use under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed policies are part of the MyHealthEData initiative, which prioritizes patient health data access and interoperability improvements.
But this time the name change wasn’t just that. For the first time a new CMS rule specifically requires providers to share data to participate in the life blood of hospital reimbursement—Medicare and Medicaid. The rule also floats the idea of revising Medicare and Medicaid co-pays to require hospitals to share patient records electronically with other hospitals, community providers and patients — a clear-cut demand for interoperability.
PI also reduces hospital interoperability requirements from 16 to six, revamping the program to a points-based scoring system and is requiring that hospitals make patients’ EHRs available to them on the day they leave the hospital beginning in 2019.
Does Your EHR Have the Right Stuff?
While this news from CMS appears to be a step in the right direction to solve a problem that has plagued the healthcare industry for many years, it must first be made a reality by those ultimately responsible for its implementation—hospital HIT organizations. The days of data obstruction and silo logic must end with a focus on new EHR markets built on interoperability.
Interoperability requires multiple layers to demonstrate an EHR system can be accessed. Meanwhile, every EHR system claims to support some form of interoperability, ranging from web interfaces to API protocols or to the lowest and highest cost HL7. However, healthcare systems will have to demonstrate their operability to CMS to abide by PI and therefore allow access of their EHR systems. Hospitals and clinics can encounter many challenges with this, such as HIPAA compliance and support for their infrastructure for open secure access, requiring an HIE and the funds to support data synchronization and IT support.
There is a growing interest among healthcare organizations to leverage actionable analytics solutions to derive valuable insights from data. Advanced, AI-driven predictive modeling is working to build healthier populations that meet the demands of value-based care, and new digital experiences are reaching providers and patients through a diverse array of touchpoints. Digital health solutions, driven by new and emerging data sources, are creating a unique combination of high-touch care management complemented by automated, virtual care.
This digital transformation in healthcare is being driven by the changing nature of the healthcare landscape, as well as the demands from consumers for more say in their care. The healthcare industry is making significant investments in IT to engage and empower patients, enable caregivers and improve operating efficiencies. However, the industry is also facing pushback from the caregiver community, with many physicians feeling that interacting with an EMR reduces their productivity. Physician burnout and unrealized expectations from technology investments have created a mood of caution in digital investments.
However, the digital transformation wave is still coming, since the proven patient health benefits, as well as industry improvements, are simply too great to ignore. Given the abundance of software-driven tools, technology professionals face the crucial task of integrating applications and data among the various players in the healthcare ecosystem including doctors, hospitals, government, device makers, insurers, employers, pharmaceutical companies and patients. Seamless transitions of care between these constituencies, however, are still a major hurdle, and positive patient experience is decided by the totality of patient care carried out by all those — both within and outside — of a health system. Shared processes between clinical entities are only possible if the data can journey smoothly from one system to another.
The problem today is that there is over-engineering in healthcare with overlapping and rich data standards and formats, and implementations that stay locked tightly in proprietary strongholds.
How to Make Interoperability Work
It is imperative that digital transformation initiatives focus on interoperability and integrations through well-defined application programming interfaces (APIs). APIs are designed so that systems with validated credentials can query and access systems widely available on the internet. Systems are then designed to respond to queries from programs with data that is machine-readable.
APIs deliver the ability to securely and efficiently access repositories of big data from wearable devices, social media, curated public datasets, research, and episodic care. They are the key to better understanding patients’ financial, social and behavioral context, and through predictive and prescriptive analytics can reveal trends across populations and micro-populations. With the explosion of disparate technologies, it will be about connecting them all quickly and efficiently to gain a competitive edge in healthcare.