In a public health report by the Centers for Disease Control (CDC), the state of the U.S. public health technology was likened to “puttering along the data superhighway in our Model T Ford.”
While the healthcare industry has talked about improving data interoperability with the noble goal of breaking down data silos to better coordinate care and turn data into information, the business of healthcare resisted meaningful change. The status quo that traps data in its silos helped to serve the interests of big, incumbent vendors by locking provider customers into their proprietary tech stacks. In turn, some providers believed they too could protect against patient leakage by holding medical data captive.
Data interoperability is stuck in the past
Even though patients have had, since 1996, a right to access their own information under HIPAA, the healthcare system made it really, really hard to obtain that data. Life Image recently conducted a survey of 1,300 patients and found that 40% of patients had to go to their provider’s office in person to submit requests for medical records. Additionally, 40% received those medical records on a CD, a 1980s technology that is obsolete in the modern consumer world.
In all other industries except healthcare, data requests, collection, storage and exchange are commonplace, and available at your fingertips at any hour and any day of the week. While patient satisfaction and convenience seemed to be worthwhile healthcare goals, they weren’t enough to drive significant, wholesale change and conversion from protectionism, managing resources to optimize the physician rather than the patient, or stubbornly persistent operational practices using CDs.
Nothing happens until something happens
The federal government recognized this inertia and promulgated a lengthy set of interoperability rules in March 2020. Just days later, the force and fury of COVID-19 started hitting the U.S. and created a public health emergency that exposed the significant operational risks and clinical dangers created by the lack of interoperability. Frictionless data sharing was no longer an existential threat. All of a sudden, the hazards became tangible.
The paradox is that COVID-19 has manifested the critical need for exactly what the new federal rules require: advancement of interoperability and digital online access to clinical data and imaging, at scale, for care coordination and infection control. Now more than ever, healthcare needs to be able to digitize, visualize, virtualize, and curate all types of medical data at scale including diagnostic and pathology information without physical exchange. No more CDs, no more faxes, no more film or slides.
Not just data – advanced data
COVID-19 is a respiratory illness with corresponding impacts to the heart, liver, kidney and other organs. People with underlying health conditions such as obesity, diabetes, chronic lung disease and cardiovascular disease appear to be at higher risk for hospitalization and death. Out of the 122,653 U.S. COVID-19 cases reported to CDC, only 5.8% of patients had data available pertaining to underlying health conditions or potential risk factors.
Advanced data such as imaging data are critical to diagnosis, treatment, recovery, and post-care monitoring. The typical structured data found in an electronic health record (EHR) or claims data are easier to access but have limited clinical value. With chronic or complex conditions, advanced data such as medical imaging, pathology and genomics are critical components of the longitudinal patient record that must be easily accessed and shared. However, imaging data has historically been among the most technically challenging to exchange.
While the industry has made some gains in imaging interoperability between large tertiary hospitals and their primary referral sites, patient sharing of digital images online is dismally small.
Response from Oliver Lignell, vice president, virtual health, AVIA
Providers have a new tool to help them combat COVID-19: digital. Health systems are proactively leveraging digital assets to help triage, navigate, and treat cases in ways that address concerns and also reduce the spread of the virus to other patients and providers.
Virtual assistants and chatbots can help consumers explore symptoms, accurately triage their needs, and navigate them to the appropriate site of care. These solutions can both reduce consumer worries and potentially inappropriate use of EDs and urgent care clinics.
Virtual visits are another critical digital tool because they allow patients to complete a visit from the safety and comfort of their home without exposing them to crowded and potentially infectious clinical locations and, just as importantly, reduces wait times and crowds at in-person care sites.
Asynchronous virtual visits (store and forward, text/chat) can also be an important (and low-cost) solution. Consumers can initiate a low acuity visit on-demand, when convenient, ensuring their concerns are addressed when desired – with the added benefit of decreasing wait times, creating a more efficient patient flow, and freeing up provider capacity. Such solutions further reduce the pressure on health systems while improving the responsiveness to patients.
Response from Andrea Tait, vice president of Client Value, Orion Health
Digital tools can play a key role as healthcare providers across the globe struggle to maintain the health of their workforce and the capacity of their organizations. Pandemic response is best supported through triaging, testing and treating the affected. Tools like public-facing screeners, pandemic information sites and chatbots can help evaluate millions of people with little to no clinician support.
By triaging individuals, tools like remote patient monitoring and telehealth can be used to monitor patients from their homes and assure others that sheltering in place is sufficient. Remote monitoring tools allow clinicians to monitor more patients and make decisions about who may require testing. Designated testing sites minimize the need for direct interaction between healthcare providers and patients, preserving both the health and capacity of health service providers.
Integrated care pathways and telehealth tools can help clinicians treat more patients at home and discharge those in hospitals who may be safer receiving treatment for other conditions remotely, all while minimizing their own risk. Home and community delivered care is an increasingly essential component of healthcare system sustainability. Now, more than ever, these tools and strategies are fundamental to the future of the healthcare system.
Digital solutions can be employed in seemingly non-traditional ways to both prepare and respond to the impact of the coronavirus. For healthcare organizations, traditional pre-access telephone dialing metrics can be modified. Hospital registration staff, in addition to financial guidance and scheduling, can screen patients for COVID-19 and obtain additional clinical information in advance of arrival.
By identifying potentially infected patients, even before they enter the hospital, hospitals and clinics are able to communicate effectively within the facility and plan for appropriate patient care, monitor and manage potential for healthcare personnel COVID-19 exposure, and inhibit the spread of the disease both within the facility and community.
Equally important and sometimes forgotten, back-end services provided by both hospital staff and revenue cycle vendors yields the same patient communication opportunities. Discharged patient follow up and screening post-discharge keeps the patients connected and engaged with the hospital as well as preserves an open communication line between the hospital and discharged patient.
Response from Matthew A. Michela, president and CEO, Life Image
The coronavirus has manifested the importance of digital solutions and interoperability in a heightened way. The lack of digital connections to community referral sites will impact the safety of patients and healthcare staff. It is imperative during this public health crisis that attending healthcare workers have as much relevant clinical data in advance as possible through digital connections.
Unfortunately, many healthcare organizations are still deploying outdated technology, such as imaging CDs, and the last thing a provider or hospital should want is a patient who is symptomatic or potentially a carrier of a virus to show up with a CD in hand. This presents a problem on multiple levels, from the lack of care coordination to the risk of disease spread.
The technology is available and many large health systems are set up to support digital exchange, so they need to mandate protocols to exchange information in this manner. In the same way that the public is asked to wash their hands and frontline workers are urged to wear masks, healthcare professionals should insist that medical data is received digitally for fast, efficient care.
As we face the COVID-19 pandemic, it is important for hospital organizations to ensure information is delivered in real time, accurately, and highly customized to the intended audience (patients, visitors, clinicians, etc.). It can be beneficial for hospitals to automatically deliver COVID-19 patient education videos tailored for each patient’s demographics, language, and clinical circumstances.
This also includes educational content and notifications (visitor restrictions, live updates, social distancing practices, etc.) on digital signage locations in public areas throughout hospitals. That content can be delivered in notifications or in response to Real-Time Location System (RTLS) triggers (for example, if a clinician enters the room, the patient’s TV will display hand washing reminders).
RTLS integration can also track and report staff entries into patient rooms so hospital leaders have real-time data about potential exposures, isolation violations, or interactions with non-approved staff. Interactive surveys with branch logic can help guide patients to provide vital feedback and report any hand hygiene breaches. Digital meal ordering, service requests, and virtual visits decrease human-to-human contact while helping patients get the food, care, services, and items they need. Live streaming (either soothing content like an aquarium or information sources) can also provide distraction therapy and education for patients in isolation.
Baystate Health, the premier integrated health system serving more than 800,000 patients in western New England, announced a partnership with Life Image, the largest medical evidence network providing access to points of care and curated clinical and imaging data, to develop novel artificial intelligence tools that would help advance technical innovations in radiology, neurology and oncology.
Specifically, TechSpring, the innovation arm for Baystate, will work with Life Image to evaluate a number of AI solutions including those that promise to improve speed and accuracy in diagnosing blood clots in stroke patients; improve clinical pathways for physicians treating or diagnosing a patient by finding and comparing clinical criteria against a group of de-identified patients with similar clinical characteristics; and identify potential patient matches to oncology clinical trials in order to advance cancer research, as well as give western New England residents better access to potentially life-saving treatments.
Baystate and Life Image began working together 10 years ago when the health system became one of the company’s first customers. Life Image created the image exchange category when it developed solutions more than a decade ago to help solve the many technical and structural barriers that prevented the seamless exchange of medical images.
With its beginnings in image exchange, Life Image is now a global medical evidence network that offers ‘living’ datasets of novel imaging data that’s linkable to other clinical information and provides network access to points-of-care to enable improved care delivery, novel research and innovation.
By Janak Joshi, senior vice president, chief technology officer and head of strategy, Life Image.
In December 2018, the FDA announced its new framework for the real world evidence (RWE) program, which would require including imaging data alongside claims, electronic health records (EHRs) and other datasets in clinical research. In issuing this new framework, regulators underlined the continued importance of using contextualized, quality datasets to make drug development faster, safer, more efficient and less expensive.
Because of this move to include authentic patient data in the drug development process, imaging data has become an essential part of RWE as it can accelerate the development cycle and improve the confidence in the final clinical arguments in support of drugs going to market.
Imaging data plays such a leading role in clinical decision-making because it is the most advanced diagnostic evidence for several diseases, and it can clearly show disease progression and drug impact across a variety of therapeutic areas, among other reasons. While EHRs and medical claims are the predominate sources of data, because they were initially designed for billing and payment purposes they do not have the depth and breadth needed to accurately capture the nuances of a patient’s full clinical history – nor do they contain imaging information.
Clinical researchers looking to achieve a holistic view of each patient’s healthcare journey by incorporating medical imaging into their RWE programs should avoid these three things.
Institutional bias stems from using data from a single health system, which tends to follow a uniform set of treatment protocols, leading to homogenous evidence data. A diverse dataset includes variation, for instance in geography, which can influence socioeconomic and environmental factors, level of education, healthcare access, payer mix and demographics.
The most effective RWE incorporates medical data, including imaging, from varied populations that include both research and non-research settings, AMCs and community hospitals, publicly and privately funded institutions, and a mix of highly insured and uninsured patients. The ultimate goal of RWE is to be representative of any and all patients across the globe.
A limited, siloed data pool
Small datasets do not accurately reflect the “real world,” therefore RWE requires very large databases with various datasets in order to ensure data integrity and credibly match patients to appropriate clinical trials. This poses a challenge since much of today’s data is siloed. To make RWE representative of outcomes and context, clinical researchers must break down siloes to achieve a large, interoperable pool of quality data from a breadth of sources, which they can normalize and match across sets for optimal results.
Take, for example, a new drug trial that needs to involve 500 individuals meeting specific real-world data standards. For each participant, researchers may require four years of prescription details, four years of imaging data, five years of blood test results, as well as genomics and other relevant data. However, consider that over the years many of these patients likely went to various pharmacies, switched health plans and/or providers, and had imaging and blood tests performed at various facilities or out-of-network sites. As a result, each patient’s information may be spread out over multiple EHR systems and may even be in non-digital, fax or CD formats.
Life Image and swyMed announce a new strategic partnership to enhance telestroke capabilities. This engagement will improve the ability for physicians to collaborate and coordinate care while using swyMed’s offering by seamlessly integrating relevant clinical and imaging data into the telemedicine encounter. The agreement also deepens swyMed’s ability to connect to neurologists and primary stroke centers, which are already part of the Life Image network. Life Image is currently supporting more than 140 stroke centers within its U.S. network.
This new partnership will advance swyMed’s telestroke solution by combining the exceptional bandwidth management capabilities in its videoconferencing platforms, which are highly beneficial for rural area hospitals, with access to all relevant medical records, diagnostic imaging, and other critical clinical data.
This data is made available through the Life Image clinical image exchange, which is integrated into the workflows of 80 percent of all large health systems and academic medical centers in the U.S. The engagement will also provide Life Image hospital customers with a value-added telestroke solution as part of the Life Image Interoperability Suite, to extend neurology departments’ reach beyond the walls of the organization and deliver timely, high-quality care for patients affected by stroke.
“Despite widespread knowledge that every moment counts when it comes to treating acute ischemic stroke, a majority of stroke patients do not receive adequate treatment in time due to lack of access to primary stroke centers and appropriate specialists,” said Evie Jennes, CCO, swyMed. “We have dedicated extensive efforts to innovating solutions to overcome these challenges and optimize outcomes among stoke patients. By engaging with Life Image, we can now provide immediate access to imaging and clinical data to speed up diagnosis and treatment, as well as connect swyMed users to premier neurology centers and leading research facilities through Life Image’s extensive provider network.”
There are several access-related challenges associated with acute stroke treatment, which are further compounded by the fact that diagnosis and treatment are incredibly time-sensitive and require a specialist. Unfortunately, research shows a severe lack of stroke specialists in the U.S.: only 55 percent of Americans reside within 60 miles of a primary stroke center, and there are only an estimated 1,100 neurologists specializing in stroke nationwide.
This new strategic partnership between swyMed and Life Image will address these data access and specialist shortage issues by offering immediate connectivity, even in the most bandwidth-challenged areas, to stroke specialists across the U.S., and integrating all relevant medical data into the telemedicine encounter to allow diagnosis and treatment to begin before the patient arrives at the hospital.
“Providers have long struggled with interoperability and data-integration issues across systems and locations, and these issues come to a head when caring for a stroke patient. Paramedics and emergency room doctors especially need to immediately reach stroke specialists and provide them with the patient’s neurological exam and other imaging and clinical data in order to achieve the best-possible outcome for the patient,” said Matthew A. Michela, president and CEO, Life Image.
“We see this partnership with swyMed as an important opportunity to advance the clinical practice of telestroke. Whether it’s a rural hospital with poor bandwidth or a hospital without stroke specialists, this new engagement will benefit all providers dealing with stroke management by uniting swyMed’s cutting-edge telemedicine platform with our powerful global network of data and integration into thousands of provider workflows nationwide.”
Life Image’s interoperable solution, which integrates into existing workflows, orchestrates the flow of more than 10 million clinical encounters per month. The network connects 1,500 U.S. facilities, 8,000 affiliated sites, 150,000 U.S. providers and 58,000 global clinics with a broader ecosystem of patients, life sciences, medical device companies and telemedicine companies.