Guest post by Donald M. Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University; and Thanh Tran, CEO, Zoeticx, Inc.
The ECRI Institute released in May a survey outlining the top 10 safety concerns for healthcare organizations in 2015. The second highest concern is incorrect or missing data in EHRs and other health IT systems.
HIEs? The latest Black Book survey in the U.S. finds that 90 percent of hospitals and 94 percent of independent physicians don’t trust the business model of public HIEs and have concerns over how much of the cost payers will be fronting, causing a contraction in the HIE market. Even the ONC and medical industry are at odds on how to address the interoperability issue. The ONC does not even mention middleware in any of its plans.
Even HL7 does not provide the seamless connection of middleware and is only capable of connecting one medical facility to another, requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, HL7 is really a point-to-point customized interface requiring extra steps. A middleware platform does not tie developers to specific hospitals or EMRs and allows universal access.
Meanwhile, yet another survey cites the tragedy of a lack of interoperability. A new survey of nurses nationwide, taken by the Gary and Mary West Health Institute, find that some 60 percent of registered nurses say medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Also, 74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices and 93 percent agreed that medical devices should be able to seamlessly share data with one another automatically.
Half of them claim they actually witness medical mistakes because of lack of interoperability of these devices. Some 46 percent of RN respondents also noted that when it comes to manual transcription from one device to another, an error is “extremely” or “very likely to occur.”
From a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests. Meanwhile physicians and surgeons struggle with interoperability on a daily basis.
According to data published on HealthIT.gov, 173 health IT vendors are supplying certified EHR products to more than 4,500 hospitals. Despite wide penetration of EHR’s in hospitals, clinics and physician offices, access to patient information between systems continues to plaque our healthcare system.
Alan Portela, CEO of AirStrip, has more than 25 years of experience in bringing medical technology solutions to market. Portela originally joined AirStrip as a senior advisor and member of the board of directors prior to his appointment as CEO in 2011. Prior to joining AirStrip, he was CEO and principal of Hybrid Clinical Transformation, LLC, where he developed EHR adoption strategies for the U.S. Military Health System and much of the Veterans Health Administration. He also served as president and chief strategist at CliniComp, Intl., and in senior executive roles in several innovative healthcare technology and service organizations.
AirStrip provides a vendor and data source-agnostic, enterprise-wide mobile interoperability platform that advances care collaboration and serves as a catalyst for health system innovation. Here he discusses mHealth trends; why and how it needs to change; interoperability; security and protecting against breach;and the biggest issues facing healthcare in the next year.
Can you tell us about yourself and your background prior to starting AirStrip? Why healthcare?
Prior to joining AirStrip, I was the president at CliniComp and responsible for the implementation of high acuity EHR systems at the U.S Military Health System, Veterans Health Administration (VA) and a number of prestigious healthcare organizations in the private sector. In my more than 25 years of experience in the healthcare industry, I have held several senior executive roles with innovative healthcare technology vendors and helped pioneer an mHealth company more than a decade ago that came out of UCLA Medical Center Department of Neurosurgery (Global Care Quest). Leading the industry via disruptive and continuous innovation has become a true passion. Each day I see how technology improves patient care, and I enjoy being an active part of that transformation.
What do you think the mHealth industry needs to change to better support doctors and patients today?
Mobile technology and clinical decision support tools will undoubtedly be the biggest contributors to the needed clinical transformation revolution, providing physicians with a means to deliver proactive quality care to millions of patients throughout the continuum of care. However, for clinical transformation to occur, the industry needs to establish – and enforce – interoperable standards so that data and technology can move seamlessly across systems and provide clinically relevant patient information at the moment of care regardless of where the caregivers and the patients are. Interoperability will remove the data silos that currently impede access to information, and allow for clinical decision support that lets clinicians provide the best care, improving overall patient outcomes and well-being. The fact that legacy vendors are not sharing data means that innovation is being stifled. Unfortunately, both the federal government and a handful of legacy vendors seem to be driving us deeper into the crisis by carrying the flag of interoperability, but only limiting requirements to minimal clinical data sets, which do not contribute to the move from volume to value-based reimbursement.
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.
par8o is named after the 19th Century Italian economist, Vilfredo Pareto, who first defined the powerful economic concept of “Pareto Optimization” in which a system is able to maximize benefits for each and every participant. When applied to the healthcare industry, Pareto Optimization holds the promise of being able to improve overall access to healthcare while lowering costs.
The par8o Healthcare Operating System allows healthcare organizations to optimize their networks of providers and other resources to deliver quality care by applying Pareto Optimization. This approach, and the technologies par8o has developed to implement it, are well-suited to the complex, multi-constituency nature of healthcare because they achieve continuous efficiency improvements while balancing the needs of all parties.
Simply put, par8o helps organizations match the right patient to the right resource at the right time.
Much like iOS or Android operating systems that tie together the user experience on your phone, par8o ties together payers, providers and patients to eliminate interoperability excuses to create a simple user experience.
par8o is a venture-backed, EHR-agnostic platform that creates a common point for coordinating care delivery and plan design, a technology that connects providers, payers, and patients. par8o is a cloud-based healthcare operating system enabling all parties to improve care and optimize towards several clinical and business goals in parallel rather than to the detriment of one another. par8o helps clients succeed by applying Pareto Optimization, a powerful economic principle that succeeds because it is well suited to the complex, multi-constituency nature of healthcare. Simply put, par8o helps organizations match the right patient to the right resource at the right time, ensuring that patients successfully transition to the next step in their care.
As we head into Christmas, and 2015, millions of Americans have hopes for a bright holiday willed with hope, health and happiness. And while America’s consumer engine is in full force, presents are getting bought, wrapped and covered with ribbons and bows, it’s hard to image that there’s little that can’t be bought and given in the spirit of good cheer for the betterment of man and for the greater good. But, as in all areas of life there are a few things that won’t fit nicely in the stocking or under the tree.
If only everything we wanted and needed could be placed in our stocking to be unwrapped on Christmas morn, but there’s just too much on the list. The list would be long for those in healthcare – interoperability, improvement of policies, better communication with care providers, and even more, qualified employees to join healthcare-related ventures.
If only some of these Christmas wishes could be packaged and stuffed in the stocking. Here are a few ideas from several healthcare folks who wish they could make the world’s dreams come true.
Common language between all healthcare electronic health records (EHR) systems, such that they can communicate with each other and patient notes may be accessed between all providers. We have gone digital, but none of the systems communicate with one another. This does not make any sense. Patients should be able to elect to have their records “shared” between systems when they visit other physicians, and more so to have their accounts sync’d between systems so that all physicians are up to date with all tests, procedures and visits. For now, the only thing EMRs have provided for is more legible notes that are inundated with information required by national standards regulations. Healthcare is far beyond the rest of the IT world. Indeed, it functions in the pre-internet era – we have electronic systems, but they do not communicate in any meaningful way. Healthcare IT is still functioning as if we are in the 1990s.
Bill Marvin, president, chief executive officer and co-founder, InstaMed
Health IT Christmas wish: Interoperability. By integrating technology and processes across heterogeneous environments, providers automate administrative processes and simplify compliance requirements, resulting in lower operational costs.
I would love to see a fully functional telemedicine capability in every hospital and office across the country. What I mean by fully functional is that reimbursement hurdles have been cleared, apps are standard, we have a maturity and adoption model in place all so that patients are receiving the best care from the right clinician in the most optimal manner possible.
Charles A. Settles, product analyst, TechnologyAdvice
There are a myriad of things I’d like to find in my figurative “stocking” come Christmas morning, but perhaps the one I’d like to see the most is more widespread patient, provider and payer use of health wearable devices or fitness trackers, i.e. Fitbit, FuelBand, Jawbone, etc. The spread of these devices is something we are keeping a close eye on here at TechnologyAdvice; we recently surveyed nearly 1,000 adults about their use of fitness trackers and uncovered several key insights. Perhaps the most actionable of those insights was that nearly 60 percent of adults would use a fitness tracking device if it would help reduce their monthly health insurance premiums. Of course, there are potential benefits to payers and providers as well — in the push to switch the healthcare reimbursements from a fee-for-service to a outcomes-based model, these devices could provide invaluable information to physicians that would aid in health maintenance, preventative care, and overall population health modeling. As these devices evolve and are able to track more and more biometrics, they could enable less expensive and higher quality telemedicine.
Health IT pain points seem to be lingering long despite the never ending promises and hope eternal new technology innovation seems to offer. Every sector has its prickles, no doubt, and much is left to overcome in healthcare, but given the complexity and the copious amount of change and development here, it’s of little surprise that pain is being felt.
What may be surprising, though, is that like patient engagement, there seems to be a different type of pain, and severity of pain, depending on who you ask.
With that, for greater clarity, I decided to ask some of health IT industry insiders what they’re pain points were and why. Their responses follow:
Dr. Trishan Panch, chief medical officer, Wellframe
One of the biggest pain points for hospitals is that we’ve come across a health system’s inability to scale care management resources. They are effective in improving outcomes when patients are engaged, but because of limitations around existing models (i.e. human interaction via phone or in-person) only a small proportion of the patient population can be engaged. That’s why organizations are turning to technology solutions to scale care management resources to reach more people.
One of the biggest pain points for physicians today is the lack of interconnectivity between different IT systems. Participation in the meaningful use program has helped create some common standards for communication but, for a variety of reasons, these have not yet lead to widespread, effective clinical data sharing. Few physicians can operate in the ecosystem of a single electronic medical record, since they often work in systems that are different, from practice, various hospitals and other places of care.
Interoperability is a pain point in healthcare IT, particularly when it comes to transitions in senior care. Connecting the care delivery ecosystem to provide safer transitions of care is critical to long-term care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individual will be available when he arrives at his new destination. However, this is not always the case. Healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care; interoperability plays a vital role. Connecting healthcare providers across the care continuum will allow for better health outcomes, help reduce unnecessary hospital re-admissions, as well as keep healthcare costs down.
There are various statistics about the negative impact paperwork has upon providing healthcare. The AHA has estimated it adds at least 30 minutes to every hour of patient care provided. A main pain point continues to be the ability for IT to implement efficient EHR systems. At the core of any EHR system are its image capture capabilities. It must be simple to use throughout the workflow process. This includes image capture, editing, saving and sharing. The capture, or scanning, must be speedy. Editing features must be clear in how to use. This minimizes learning curves at the start. It also optimizes the speed of processing documents during the life of its use. Easy saving to local or network locations should also enable simple and secure sharing too. When one, some or all of these areas stall, it can cripple the realization of benefits from digital document management.
If for no other reason, the following open letter seems worthy of publication. It was sent by HIMSS to HHS’ secretary Sylvia Mathews Burwell on Sept. 30, 2014. The four-page letter, published below for your review, lays out the organization’s professional and political goals for the near term.
HIMSS makes three specific recommendations to HHS, suggesting to the feds where their attention should focus. HIMSS’ recommends immediately pulling three key policy levers: the EHR incentive program, interoperability leading to secure electronic exchange of health information, and electronic reporting of clinical quality measures (CQMs).
HIMSS also makes the strong recommendation for one three-month reporting period in 2015 for meaningful use, as well as publicly reminding HHS that there continues to be support efforts for interoperability. The letter does little than offer a pat on the back to HHS for its efforts, and says that HIMSS offers its support for everything HHS is doing, but the letter also serves as a real reminder that HIMSS is willing to flex a little muscle on behalf of its members if HHS doesn’t listen up or do a little falling in line.
To be clear, I have nothing against HIMSS; if they can get away with telling a federal organization how it is, that’s admirable. However, the letter is soaked with arrogance and bullishness, as if HIMSS is intentionally telling all in healthcare just how big and powerful it is, dammit. No doubt, this is the type of thing that’s gone on for years. I understand how lobbyists work; in fact, I’ve worked with them and understand their game. This is probably just the first time in a while I’ve seen such a blatant outreach effort. After all, it’s not like HHS doesn’t know who or what HIMSS as an organization is, but it seems strong in a nuanced way.
Judge for yourself and read the letter below. Are you a HIMSS member? What do you think of the organization’s power push?
Another interesting infographic, from Dell, that I thought worthy of sharing. It’s comprehensive, as you can see. Essentially, it asks and answers the question of how is healthcare IT changing through and because of its relationship with technology.
Without a doubt, the change we’re seeing, especially in the last 10 years, is monumental. Take a look at some of the figures below. In a nutshell: social media, which truly did not exist a decade ago is changing healthcare, especially consumer engagement with the industry. According to this data, more than 40 percent of patients are affected by the use of social media in the care space and it drives their decision when deciding which facility to give business to. Does this suggest that they want their physicians using social media platforms or to simply have a profile to interact with the office? The data doesn’t say, but it likely implies that they want the ability to be able to communicate through their own channels rather than the more archaic means like the phone and static websites. Patients want the ability to communicate somehow through the use of social and likely want to own more of the relationship with their providers. It is their health after all and they want the process of care to be efficient. This trend will likely only increase.
Another interesting point here is that more than 75 percent of healthcare CIOs believe that their health systems don’t have the infrastructure to support their technological advancement. This is a major issue as these leaders look to make long-term adjustments, keep up with reform and employ systems to drive efficiencies. However, in an ever-changing technological world where advancement never ends, I think this is likely to be an ongoing trend/problem/dissatisfaction. For example, over the last five years so much attention has been given the the use of and functionality of EHRs and how they will improve healthcare as a whole, but many say that the systems are antiquated and simply don’t meet the needs of modern practices and hospitals and more needs to be done to improve them and make them more robust and useful.
On its face, the CommonWell Health Alliancee really seems to hit the mark. A collection of the top EHR vendors coming together, sharing a stage and shaking hands; smiling; snapping photos of smiling happy CEOs. All together for one cause, or so the story goes: healthcare data interoperability. According to the “organization’s” website, interoperability is the cornerstone of healthcare’s future.
“Interoperability helps improve quality, reduce costs, enable regulatory compliance and ensure better access to healthcare for millions of people,” and so on and so forth.
Finally, CommonWell’s call to action: moving the healthcare industry beyond just recognizing the importance of interoperability, but moving the industry forward. CommonWell is supposed to be the health IT superhero that moved this giant boulder up the hill and positions it so eloquently on the top.
For those of us who didn’t know this already, CommonWell sums it up: “It’s time for healthcare IT organizations to come together and commit to achieving interoperability for the common good,” and so on and so forth.
So glad it took the giants of the industry to tell us as much.
Okay, so admittedly, this is a step in the right direction. It’s like putting big money behind a good cause. For everyone who has ever worked in the nonprofit trenches who spend their days begging the haves for the have nots, this a dream come true.
Those in the spot light can move us forward to a point where we must be. Allowing private enterprise to bear this mantle means we might finally make the move forward instead of being held back by the shackles of the federal reform and imposition.
After all, wasn’t interoperability a staple of meaningful use; an “industry consortium to adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data,” if you will?
Because of meaningful use, we were supposed to be singing in circles by now, discussing all of the advancements we’ve made; our coming together and our ascending to the precipice. Alas, little has been attained through federally funded meaningful use except implementation and wars of words.
We waited, didn’t we? Long enough? Perhaps, perhaps not; depends on who you ask. Farzad Mostashari says we should wait a bit longer for the results to role in. The boys at Allscripts, athenahealth, Cerner, Greenway, McKesson and Relay Health (imagine the feelings of all the other vendor’s CEOs who were left out of this pre-arranged agreement; I guess there’s mincing words anymore) decided private enterprise is the way for things to actually get done.
And while it’s an interesting experiment, I think I agree with some of the other more intelligent folks in the field. Until we see some sort of actual forward movement with this initiative and until there’s some proof of life, this is really nothing more than a stake in the ground. A happy public relations move designed to flex a little corporate muscle on the industry’s largest stage.