By Susan DeCathelineau, vice president of global healthcare sales and services, Hyland Healthcare.
Healthcare interoperability continues to be a critical topic facing healthcare technology leaders. There’s no question that achieving true healthcare interoperability is key to moving the industry forward by enabling the type of information exchange that can streamline workflows, inform clinical decision making and enable precision medicine.
However, much of the current interoperability discussion is focused on ensuring core systems, i.e. Electronic Medical Records (EMRs) are compatible with one another. Yet there is one issue that is largely overlooked: the crucial role of integrating structured data with unstructured patient information.
For example, EMRs are designed to capture and manage structured patient data, and they do that job well. That is to say, they capture content using controlled vocabulary rather than narrative text. But the lack of structured data and standardization in the healthcare industry today creates major issues when sharing EMR content within and across healthcare organizations.
EMRs are not built to natively ingest the plethora of unstructured information that exists on a patient. This unstructured content includes things like diagnostic medical images, clinical documents and notes, visible light images and more. According to many industry estimates, as much as 75 percent of the information that exists on a patient lives outside of core applications like EHRs. Instead, this unstructured content is scattered in a multitude of legacy data silos.
Manage your unstructured clinical content
A recent whitepaper by Signify Research illustrates just how pervasive ineffective management of unstructured content is in today’s health systems, and just how vital this effort is to interoperability initiatives. In the paper, author Steve Holloway explains how the growth of healthcare networks resulting from merger and consolidation activity is driving the need for true interoperability. These ever-larger healthcare enterprises are increasing demand for incoming and outgoing information exchange between a diverse ecosystem of providers, patients and payers.
He continues to say that EMRs and health information exchanges have had “limited success in addressing the myriad of nuanced applications and unstructured content outside of core administrative patient records and financial billing processes.”
Holloway proposes that support for multi-disciplinary care and robust, multi-node interoperability will never be achieved without a more holistic approach to integrating structured and unstructured data.
Make the connection, see your whole patient
Providing a “holistic approach” to integrating structured and unstructured healthcare content is a core focus at Hyland Healthcare. Experience has shown that providing a suite of connected healthcare solutions allows healthcare providers to harness the unstructured content in every corner of their enterprise — whether it be a diagnostic medical image, clinical document, video file or audio recording — and link it to the core clinical or business applications they use every day. Addressing unstructured content needs is made possible by combining both a full suite of content services and enterprise imaging tools.
In short, healthcare providers – and by extension the entire healthcare enterprise – work best when it is possible to see your whole patient. By enhancing the EHR or other core clinical application with unstructured content that currently resides in disparate data silos, provider organizations can complete the patient picture. This delivers a truly comprehensive medical information repository at the fingertips of key healthcare stakeholders.
America’s healthcare system is notoriously disjointed, with patchwork information technology and disparate data. The quest for interoperability as an answer – the ability to easily share health records between sites of care – has had varying levels of success. But it’s a solution that is crucial to healthcare’s value-based transformation and can’t be allowed to fail, especially by going too slow to be meaningful.
The challenges associated with interoperability – from fragmented sources of patient information to data being kept in varied formats, to difficulties using an electronic health record (EHR) as a secure central “home” for a patient’s data – were highlighted in a recent American Hospital Association (AHA) report on “The Hospital Agenda for Interoperability.”
The report highlighted challenges for providers and underscored that a collaborative approach is necessary for improving the lives of families and their caregivers for the long-term. The AHA report not only represents frustrations with EHR and Health Information Exchange (HIE) but calls for extending efforts at digital transformation that logically layer on top of that.
As the debate and progress inches forward to 2020, it is vital to return to what hospitals are telling us.
Beyond technical challenges
The difficulty in interoperability goes beyond technicalities. For example, while healthcare providers generate clinical data and payers create claims data, their current structures are not conducive for synchronization and insight generation. Payers and providers have different objectives (whether it’s clinical notetaking, billing, clinical decision support, etc.) so there’s more to the underlying friction than just a variety of data formats.
The AHA calls out additional reasons for issues with interoperability and the high costs that result. That includes expensive workarounds, overcomplicated user interface design, lack of documentation consistency, unrealistic expectations for technical solutions, issues with regulatory compliance for data security, privacy and use, and pricing models that “toll” information sharing. It’s also clear that business and technical challenges with interoperability should not be conflated – each technology Band-Aid further burdens healthcare organizations with ad hoc, un-intuitive technology that will cost more over time and fail to solve interoperability challenges.
In the quest to use technology to save money, improving interoperability between healthcare systems and using powerful data analytics to extract insights from systems working in concert appears to be an expensive and elusive goal. But the cost of not committing to a more universal approach is far greater, because it prevents clear and effective insights on where improvements are needed. Insights are only ever as good as the data that feeds them, and if there isn’t a clearly defined data analytics and data governance strategy aligned with industry best practices, the results will be half-baked.
The need for leadership
Leaders who may have not been exposed to technology outside of healthcare may not be aware of open source, cloud-based tools to rapidly and more cost effectively meet interoperability needs. As they implement piecemeal or outdated, point-to-point solutions, technology costs rise significantly, while perception of technology’s efficacy goes out the window. Worse, paying to ship data to third-party vendors instead of focusing on an internal and overarching connectivity strategies involving every vertical means opportunities to maximize their data’s potential will be lost.
In other words, healthcare organizations might find that they are ironically spending immense amounts of money on technology intended to reduce costs under a value-based payment system. But they might not be spending it wisely. And as other industries steam ahead with movements akin to interoperability on a national scale, leaders in healthcare need to stay focused on the larger task of consistency as not to fall even further behind. Unlike industries like retail, the quality of lives for patients and their caregivers are at stake.
Technology – and business – challenge
As the AHA report emphasizes, the challenges involved go beyond technology and land firmly in the realm of business. Healthcare organizations need to be open to making health data available, whether it’s a secure transfer to another provider, or to the patients. CMS recently renamed “meaningful use” to “promoting interoperability” in efforts to provide a model and further incentives for “advancing care information.”
In a drive for standardization, the proposed U.S. Core Data for Interoperability1, mandated by the 2015 21st Century Cure Act2, calls for the identification and refinement of a basic set of clinical data to be required for all electronic health records. The American Medical Informatics Association, however, recommends that healthcare researchers and providers concentrate on sharing data as quickly as possible, deferring the creation of standards until sometime in the future.3 “This is a false choice and a distraction,” said James D’Arezzo, CEO of Condusiv Technologies.
D’Arezzo, whose company is the world leader in I/O reduction and SQL database performance, adds, “What the healthcare industry really needs to focus on is enabling its heavily overburdened IT infrastructure to do the job it’s being asked to do.”
The industry’s preoccupation with interoperability and standardization, notes D’Arezzo, is perfectly understandable. Turf wars over proprietary interfaces and protocols are having a major impact on healthcare IT budgets.4 Non-compatible electronic health records contribute significantly to the fact that computerized record keeping consumes more than 50 percent of the average physician’s workday, which now stretches to more than 11 hours.6 Healthcare organizations struggling to process this tsunami of data are frustrated by the number and variety of analytics tools they are forced to use.6
Supporting all this activity, however—unnoticed and, says D’Arezzo, dangerously neglected—is the basic computational machinery itself. Data analytics requires a computer system to access multiple and often far-flung databases, pulling information together through millions of individual input-output (I/O) operations. The system’s analytic capability is dependent on the efficiency of those operations, which in turn is dependent on the efficiency of the computer’s operating environment.
According to experts, the most widely used operating system, Microsoft Windows, is in many ways the least efficient. In any storage environment, from multi-cloud to a PC hard drive, Windows penalizes optimum performance because of server inefficiencies in the handoff of data to storage. This is a problem that, untreated, worsens with time. The average Windows-based system pays a 30 percent to 40 percent penalty in overall throughput capability because of I/O degradation.7
By Karen Way, global practice lead for data and intelligence, NTT DATA Services.
A recent study conducted by NTT DATA Services and Oxford Economics highlighted the top three challenges identified by healthcare executives and consumers: standardizing and sharing of data across the healthcare spectrum, preparing for and adapting to regulatory changes and recruiting or retaining the right resources. It’s understandable that these challenges rise to the top of the list, as trying to meet rising consumer demands for access to their healthcare data while maintaining regulatory compliance with limited resources is a bit like juggling raw eggs. If your timing or skills are just a bit off, you end up with egg on your face.
How can a healthcare organization address these challenges? First, it’s important to understand exactly which challenges are present within your own organization, and how they are impacting the patient experience.
Study results showed that only 24 percent of healthcare organizations share data across the business. Why? There are several reasons:
Interoperability – Even though this concern has been expressed since the inception of the EHR/EMRs, there are still barriers to being able to communicate data between different systems in a consumable, usable format. For example, several years ago, I had a CT scan due to the sudden onset of a continuous migraine headache. After the scan, I was referred to a neurologist that practiced out of another hospital system. I took a copy of the scan (on a DVD) to my specialist appointment, but the doctor was unable to view it on her system. As a result, I had to have another CT scan for the neurologist to see what may have been happening. Data already collected could not be used due to lack of standardization across systems. As noted in Dr. Eric Topol’s book Deep Medicine, “Your ATM card works in Outer Mongolia, but your electronic health record can’t be used in a different hospital across the street.”
Data Volume – The volume of data being generated daily in the healthcare industry has been estimated to be approximately 30 percent of the world-wide total. With the estimates of data generation rates of at approximately 2.5 quintillion (that’s 1, followed by 30 zeros) bytes/day, that’s a lot of healthcare related data. Healthcare organizations aren’t even beginning to tap the depths of this data, simply due to the data volume.
Disparate Data – Like patients, healthcare data comes in many different shapes, sizes and languages. Even if interoperability issues didn’t exist, sharing of data across the healthcare business is hard because of these differences. Data can be an image, a PDF, a written note, a prescription label, etc. Historically, each type of data requires different mechanisms for managing it, often using different tools or systems.
These three factors combined can be overwhelming for healthcare organizations whose main goal is to provide the best healthcare possible.
Another leading challenge identified in the study is that of recruiting and retaining skilled resources. Of the healthcare executives surveyed, only 51 percent stated that they were able to recruit and retain resources with the required skills and knowledge. There are two components to this issue:
Upskilling resources – With the continual advancements in technology, it is important to ensure that resources can take advantage of training opportunities and professional growth. This is often a delicate balance for organizations; time spent in training is often seen as time away from projects with deadlines.
Healthcare experience – While there may be a pool of qualified resources with the required technical skills, it can be hard to find resources with knowledge and/or experience in the healthcare sector. For example, several years ago, a client brought in resources to support their enterprise data warehouse that had extensive experience in data warehousing. There were high expectations of new and improved functionality due to the technical depth of these resources. Unfortunately, the project did not deliver as expected. Why? None of the resources had knowledge of healthcare data or business processes. One resource posed the question to the client: “what is a healthcare claim?”
Just as important as reviewing the patient experience for ways technology can solve the problem, it helps to treat your workforce like your customer and improve the experience of transforming the organization into a digital-first enterprise. A recent article in the Wall Street Journal highlights the difficulty in recruiting resources and approaches to solving this challenge. The article also reinforces that in today’s data economy, it is no longer enough that a resource be technically skilled, they must also have knowledge of the business environment in which they are applying the technology.
Most of us know someone who has been diagnosed with cancer and understand first hand the tidal wave of emotions and questions that come immediately after diagnosis. One question that sticks out to providers is the seemingly simple: “How many patients have you seen who are just like me?” and perhaps even more important: “Why are you confident that I can reach the magical five year survival rate?”
Unfortunately, with systems of record like the electronic health record, neither of these questions is easy for the provider to answer. The challenge is, in today’s oncology world there is both a combination of clinical confidence based on peer-reviewed data and the artistic necessity to understand what could work based on perceived comparable patients. Oncologists do incredible work to save lives, however, there is more to be done to help support the people who are making the most important decisions at the most critical inflection points.
Meaningful data to improve cancer care
Prior to the creation of EHRs, physicians stressed that they did not have enough access to data. While data is now being stockpiled within the depths of EHRs, physicians still do not have access to everything the data has to offer. The available data in EHRs is often fragmented, disorganized, and sometimes simply incomplete, making it difficult to glean any real value from this information after it is collected.
Essentially, the EHR can be compared to a messy bureau in your bedroom. While bureaus are intended to organize your clothes — socks in one drawer, t-shirts in another, etc. — sometimes socks windup in the pants drawer. All of the valuable information and data is in the EHR, but is sometimes lost in the wrong “drawers,” making it hard for clinicians to find the important information and make sense of it to impact patient care. While physicians are doing the best they can by adding information into EHRs, technology has not caught up to allow physicians to extract insights and put that data to use.
Fortunately, with the use of outside technology, we can pull real-world data (RWD) and real-world evidence (RWE) from the EHRs. This can unlock the insights hidden within the available data and uncap the potential for improving and personalizing cancer care, while reducing overall costs.
Unlocking hidden insights
The technology available today knows how data should be arranged. It knows when something is misplaced, and knows how to make sense out of it. Through advanced algorithms and clinical input, technology can essentially sort and gather RWD from EHRs and then group together similar patients based on their own biology, disease states, and other phenotypic factors, allowing for insight into treatment plans and potential outcomes.
The U.S. Department of Health and Human Services (HHS) today issued for public comment draft two of the Trusted Exchange Framework and Common Agreement (TEFCA) that will support the full, network-to-network exchange of health information nationally. HHS also released a notice of funding opportunity to engage a non-profit, industry-based organization that will advance nationwide interoperability.
Specifically, the documents being released for comment are: (1) a second draft of the Trusted Exchange Framework (TEF), (2) a second draft of the Minimum Required Terms and Conditions (MRTCs) for trusted exchange, and (3) a first draft of a Qualified Health Information Network (QHIN) Technical Framework. These documents will form the basis of a single Common Agreement that QHINs and their participants may adopt. This Common Agreement will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale across disparate networks.
“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” said HHS Secretary Alex Azar. “The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far and look forward to continued engagement.”
In developing a TEFCA that meets industry’s needs, HHS’ Office of the National Coordinator for Health Information Technology (ONC) has focused on three high-level goals:
Provide a single “on-ramp” to nationwide connectivity;
Ensure electronic information securely follows you when and where it is needed; and
Support nationwide scalability for network connectivity.
ONC will maintain the TEF, while a non-profit, industry-based organization, known as the Recognized Coordinating Entity (RCE), will be awarded funds to develop, update, implement, and maintain the Common Agreement. Through this effort, ONC will define the minimum required terms and conditions needed to bridge the current differences among data sharing agreements that are preventing the flow of electronic health information. The industry-based RCE will be tasked with developing additional required terms and conditions necessary to operationalize the Common Agreement and meet the interoperability requirements of the 21st Century Cures Act.
Bridge Connector, a technology company offering data-driven workflow automation to solve health IT interoperability challenges, has secured an additional $10 million in funding from Axioma Ventures. This brings its total capital raise to $20 million in 13 months of being in business.
Bridge Connector is working to change the way healthcare communicates by connecting disparate data systems quickly and cost-efficiently with their integration-platform-as-a-service (iPaaS) and other solutions, and it plans to close on a series B in fourth quarter 2019. Its business model aims to create an ecosystem where all healthcare organizations, regardless of size, can equitably reap the benefits of connected data systems.
“Bridge Connector is growing at a fast pace because of their unique and specialized solutions to our partners’ needs,” says Howard Jenkins, founding partner of Axioma Ventures and former CEO and president of Publix. “Bridge has exceeded all expectations in quality and in growth, and we fully support the great work that is taking place.”
After being in business just over a year, Bridge Connector has been recognized for their work through several awards, recent ones being the Ohana Partner Award from Salesforce at HIMSS19, the 2019 South Florida Business Journal H. Wayne Huizenga Start Up Award, and they were named to the 2019 Nashville Business Journal‘s Best Places to Work.
“We launched with five people. And in our first year of business, we have grown to 70 team members, with plans to be over 100 strong by the end of this year. ‘Growth’ has been our motto driving everything,” says Bridge Connector founder and CEO, David Wenger.
Wenger is referring to a shared sense of urgency to achieve data interoperability in healthcare, because it has been identified repeatedly by health care executives as one of the most critical areas for improvement as the market shifts to value-based payments, and the lack of interoperability is one of the most pressing issues facing providers and payers today.
Instead of taking months to deploy a traditional integration, Bridge Connector’s products can connect disparate data systems in a matter of days, with a “no-code” platform. Their solutions enable workflow automation in business and clinical use cases, and transparency and true interoperability among providers, payers and most importantly, patients, who increasingly desire more control over their own data to make better-informed care choices and improve outcomes.
“Interoperability is within reach when we re-think health IT integrations from a ‘workflows’ problem-and-solution standpoint,” said Wenger. “This results in a quicker time to value that the market is demanding. We partner with the largest health care organizations in the world, and we are just getting started.”
Bridge Connector will use the new round of funding to further their technology advancements, differentiate product verticals, and continue growing their teams in sales, technology and product.
InTouch Health, ranked 2019 Best in KLAS for Virtual Care Platforms, announced the release of the industry’s first fully integrated, end-to-end virtual care platform. Solo by InTouch delivers enterprise solutions to provide scalable, patient-centric telehealth for any use case in any setting – with packages enabling compelling price points for every situation.
“We’ve spent a lot of time listening to our customers and we heard their need for a truly integrated solution that allows a physician to have a virtual, everyday interaction with patients whether they are in the home, clinic, emergency room, inpatient in a hospital – anywhere on the care continuum locally or anywhere in the world with one platform,” said Joseph M. DeVivo, InTouch Health CEO. “Coming off the heels of winning Best in KLAS for Virtual Care Platforms, we want to continue solving our customer’s problems by delivering the most comprehensive capability on the market. The latest KLAS analysis further proved that there was an industry-wide need for EHR and third-party software integrations across platforms. In order to fill that gap, we created the next generation of our software platform to provide clinicians with an intuitive, web-based interaction that allows access to all of the tools they need through a single interface.”
With prominent healthcare leaders projecting that upwards of 50 percent of care can be delivered virtually, Solo by InTouch powers the first of its kind platform that healthcare providers can leverage for every type of user and use case, including direct-to-consumer, direct-to-patient, provider-to-provider, clinics, worksites, EDs, and more.
“Healthcare providers are facing an immense amount of pressure to retain and attract new patients from both inside the system and the external, new market entrants,” said Steve Cashman, chief commercial officer at InTouch Health. “Virtualizing their practices as appropriate creates an opportunity for providers and patients to connect in ways that can meaningfully improve quality, access, and cost. Solo by InTouch is the first of its kind integrated platform that considers health systems’ large investments in EMR systems and can offer capabilities to every user from simple follow ups, to ambulatory clinics, to emergent care.”
The new software platform runs through the proactively monitored InTouch Network and will provide the same clinical reliability InTouch customers know and trust. It will include an updated user interface for seamless virtual visits, IT integration capabilities designed for interoperability, and end-to-end care coordination, with newly-scaled pricing. Additional capabilities will also allow for the basic audio/video connections clinicians need to facilitate telehealth for low-acuity interactions, such as post-op follow-up with a patient and getting a second opinion from a colleague during a virtual visit. These new capabilities are designed to deliver the flexibility for all healthcare providers — from small practices to large health systems — to scale their telehealth services across basic, low-acuity interactions to life-saving, emergent consultations.
Healthcare technology is advancing quickly and this is precisely why executives need to be aware of all new technologies that can make their healthcare organisation more efficient and more impactful. This may seem difficult – staying on top of things and implementing new technologies always is, but it brings immense benefits and great results. While many technology advancements come with all that fame that is often not necessary, it can make patient satisfaction better. It can also improve cost savings and this is really important for the future of your organisation.
So, in this spirit, here are some of the most amazing tech advancements that can help your healthcare organisation become better and take another step towards the future.
Blockchain can make interoperability ai reality. You can solve many problems between healthcare organisations and it’s a solution that healthcare industry has been looking for for many years. It can decentralize the record systems and have multiple locations that can be shared with more stakeholders. This will help the healthcare system immensely and it can operate within different stakeholders in the healthcare systems. Instead of having a single client database, you can include both clinical and financial data on one server and in an independent, transparent database.
“Blockchain technology can share data in a safe system and put the clients and their needs at the center of the attention. Still, healthcare industry is a decade away from implementing blockchain in a meaningful way,”says Ingrid Fulton, a tech editor at Draft beyond and ResearchPapersUK.
Artificial intelligence can help with better oncology. Veterans Affairs is helping with this as a part of their precision oncology program which supports patients that have stage 4 cancer and that have tried all other methods of getting better. They are using AI to help use cancer data in the treatment of these patients. They are also veteran.
They treat more than 3.5 percent of patients in the US and this is the largest group of patients with cancer within any healthcare groups. This includes veterans from rural areas where it has been hard for them to implement better technology, especially something of this value.
The FDA released guidance last year noting that electronic health records (EHRs) have the potential to improve clinical trials, leading to greater safety and efficacy. But tapping that potential, according to the agency, requires interoperability — the ability of two or more products, technologies or systems to 1) exchange information, and 2) to use the information that has been exchanged without special effort on the part of the user.
The healthcare industry, driven by meaningful-use requirements, is focused on wider efforts to promote interoperability. Many of them emphasize technology, including advances such as Fast Healthcare Interoperability Resources (FHIR) tools and Substitutable Medical Applications, Reusable Technologies (SMART) standards. But while the technology is crucial, it is equally as important to recognize the group of stakeholders who could play a critical role in making systems more interoperable, and thus improve the clinical trials process:
The patients themselves.
Interoperability has the potential to help increase care coordination, improve safety, support patients in making the most informed healthcare decisions, reduce costs, and help public health and health promotion efforts. In addition, interoperability can have a role in drug development, as the 21st Century Cures Act mandates that the FDA include Real-World Data (RWD) — data gathered during routine clinical care – in regulatory decision making. This RWD can be in part derived from the EHR-generated data, standardized and shared through the interoperability process.
The growing availability of information (digital health data is increasing by 48 percent each year) creates the potential for better patient care, including improved clinical trials. Unfortunately, despite strides made in interoperability, data in medical records are still too often packaged in ways (i.e., handwritten notes and medical device feeds) that are hard to share or standardized.