By Robert Barras, vice president of health solutions, CTG Inc.
Robert Barras
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.
Improved scalability
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.
Enabling interoperability
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.
Founders’ story
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.
Marketing/promotion strategy
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.
Market opportunity
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.
By Rahul Patel, EVP of digital products and services, Persistent Systems.
Rahul Patel
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.
Big data has arrived, and in healthcare, it has landed on our desks with a resounding thud. The challenge ahead lies in discerning how to analyze information and use it to effectively improve patient outcomes, costs and efficiencies.
Many of us are already influenced by machine learning and artificial intelligence (AI). For example, if buying hiking boots online, items of a similar nature also appear as suggested purchases, like bug spray or sunscreen. The data analytics behind those recommendations includes a wealth of information about the user, including demographics, such as age, gender, education and income level, as well as location and other factors that influence buying decisions. It will only be a matter of time until we are able to apply the same principles to healthcare data.
Imagine a doctor who can review operational and clinical data in real time for a patient who had knee replacement surgery. After the patient goes home, she is given a Fitbit to monitor her step count. If her steps trend downward, it is probably time for someone to intervene because she is potentially in pain or not ambulating correctly. That same physician could also see where she has received care, the cost of the care, and who performed the surgery. Then, the physician could compare her progress against others with similar demographic and health backgrounds by using machine learning and streaming analytics that not only gather relevant data across the entire care continuum—from hospital to rehab facility to home—but draw inferences from that information in real time to truly influence cost and care outcomes. In addition, if the patient had three MRIs that cost $2,000 each and someone with similar demographics and health conditions had one MRI that cost $500—caregivers can explore why that happened and work toward more uniformity.
This idea is inspiring, but a more practical look can be taken for how AI can support the business operations of healthcare as an achievable first step, along with connecting that operational data with remote care, device data and patient EHRs. Here are next steps for creating efficiencies with the power of AI and interoperability:
Step 1: Unlock Human Potential
As a recent Advisory Board report states, “AI works best when paired with humans.” The goal is to use this technology to create efficiencies across the care continuum that not only help staff in their roles, but that free clinicians, caregivers and office staff to focus on more valued activities. AI can help augment and automate human tasks and functions where appropriate, and sooner rather than later it may be able to offer advice, ultimately allowing caregivers to focus entirely on patient care.
Step 2: Optimize the Supply Chain
AI can quickly answer employee queries, buy supply, such as bandages from a certain supplier, and can also track unused supplies to minimize excess inventory. In addition, AI can help alleviate the amount of time—and frustration—nursing and clinical staff spend searching for supplies by not only providing location, but automating future order and delivery.
Step 3: Enhance and Expand Employee Self-Service
For those healthcare employees without regular access to a computer, such as lab technicians, AI can quickly and accurately empower cross-functional self-service. All employees need to do is ask for answers about anything, from paid time off (PTO) balances to company holidays.
Step 3: Automate Financial Processes
AI can augment the payment process, detecting payment, vendor and invoice patterns, and suggesting automating payments for a specific invoice that is approved 99 percent of the time.
By Donald Voltz,MD, Aultman Hospital, department of anesthesiology, medical director of the main operating room, assistant professor of anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr. Donald Voltz
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”
Guest post by Fizzah Iqbal, content writer, Incubasys.
After a number of initial coin offerings being launched in the cryptocurrency market, blockchain development companies plan to introduce blockchain technology to the health records (EHR) industry. The Electronic Health Record (EHR) is a digitised version of patient’s medical history maintained by their doctors over a period of time. It includes information on demographics, diagnosis, vital signs, past medical history, progress over time, lab tests and more.
Owing to the de-centralised nature of blockchain system, it securely stores health records and maintains a single version of the truth that cannot be tampered with. This is of significant importance to different medical organisations and individuals like doctors, hospitals, labs, and insurers who can request permission to access a certain patient’s record from the blockchain without involving an intermediary. It offers two-way benefits; first, doctors and medical organisations get access to patients’ details and history without losing any precious time waiting for approvals from any intermediary and provide better patient care based on more accurate data, second, patients have more control over who sees their data.
The Challenge?
The biggest challenge faced by healthcare systems throughout the world is how to share medical data with known and unknown parties for different reasons without violating patients’ rights and ensuring data security. Creating a trusted environment for decision-making regarding EHRs is challenging for medical community since each EHR stores data using different workflows which makes tracking data recording rather ambiguous. The growing focus on care coordination and EHR access across the care continuum has raised questions about ways to ensure that multiple providers can view, edit and share patient’s data without violating their rights and privacy in any way.
It’s not only about the problem of data sharing logistics in HER instead every solution that requires serious contemplation in a national healthcare system needs to put patient’s privacy and rights first in their list of priorities. And although laws have made health care data more accessible, vast majority of hospitals and doctors still cannot share data safely and securely. The time has arrived where solutions are needed in which patients themselves control whom to share their data with and where to remain pseudonymous.
The Solution?
Healthcare data is inherently sensitive in nature. Besides that the constant challenges of interoperability, patient record matching, and health information exchange have created opportunities for blockchain development companies to come up with a blockchain-based solution.
Once a blockchain solution is deployed to manage EHRs, it becomes a unified and common backbone for digital health. The biggest advantage of using this backbone is that each hospital or care provider no longer needs a specific version of databases or software to access patient data. Any information presented by EHR on the distributed ledger of a permissioned blockchain would be perfectly reconciled community-wide with the assured integrity throughout without any human intervention.
The use of blockchain technology to manage EHRs reduces the time it takes any medical representative to access patient’s information, enhance system interoperability and improve data quality. It also enables a reduction in overhead costs especially for development and maintenance of legacy health record systems. What blockchain does for everyone in healthcare system is that instead of relying on a designated intermediary for information exchange the de-centralised nature of blockchain allows any approved party to join in and either access information, share or exchange without the need to build data exchange channels between certain organisations.
In just a few short years, we’ve witnessed the smartphone’s rise from bleeding-edge innovation to household fixture. We’ve watched it permeate every industry, establishing itself as essential to how we interact and operate, to the point where we’ve come to define our times by it—this is the smartphone age.
But mobile technology’s diffusion into the mainstream hasn’t been uniform. Some industries have greeted the mobile revolution with open arms, while others have resisted this paradigm shift (to varying degrees of success).
The healthcare sector falls somewhere in between, and that’s a cause for serious concern. After all, the purpose of technology is to improve the quality of our lives, our society, and our human experience, and it’s alarming that health care—arguably the most direct way to do just that—isn’t leveraging mobile tech to its full potential.
Hospitals, clinics, and other care facilities are facing challenges when it comes to successful mobile health (or mHealth) solutions. And as a mobile app development company with an extensive background in the medical sector, Codal has a few ideas about how to cure this smartphone affliction.
Is There A Doctor In The House?
Just like a doctor diagnosing a patient, let’s start by ruling out what isn’t the issue.
This year, popular medical publication Physicians Practicesurveyed 187 doctors, nurses, and other healthcare workers to find that a massive 75.9 percent of them said their facility used some form of mHealth on weekly basis. Safe to say, adoption isn’t the problem here.
But the same survey found that the majority of those care facilities were using those solutions between just 0 and 5 hours a week. They might have access to mHealth solutions, but they certainly aren’t using them in their day-to-day practices. The question is why.
The brass of these hospitals certainly doesn’t need to be convinced— not if over 75 percent of them are willing to invest in mHealth solutions. But perhaps we need to dig deeper. Perhaps it’s the physicians themselves who aren’t willing to implement these smartphone tools in their workflows.
But another recent study, this one conducted by the American Medical Association, found that 85 percent of 1300 physicians surveyed believed that digital health solutions gave them an advantage in their ability to care for their patients. The figure attached illustrates a more in-depth breakdown of these findings.
The AMA’s study went even further, attempting to identify exactly what attracted these physicians to digital tools like mHealth. The primary reasons cited were improving work efficiency, enhancing diagnostic ability, and most importantly, increasing patient safety. And these were just the most popular factors—the full responses are a laundry list of the benefits mHealth solutions offer.
Another notable conclusion was the high amount of younger physicians that were especially optimistic about the impact digital tools could have. This finding suggests that these solutions are indeed the future of medical practice in the healthcare sector.
So if everything is pointing towards mHealth dominating hospitals and clinics across the country, why isn’t it? If it’s not the higher-ups or the users themselves, what’s left? The quality of the mHealth solutions themselves.
Ivenix, Inc.
