The growing preference for outpatient orthopedic surgery is much more than another pandemic-inspired trend. Recent advances in medicine over the past few years have made procedures, even those as intensive as total joint replacements (TJR), safe to conduct in the outpatient or ASC setting.
Now, surgeons can capitalize on regional anesthesia and tranexamic acid to minimize blood loss and GPS software to improve the precision of implant positioning, all factors which ensure the patient can recover comfortably in their own home, not the hospital.
While these advances make outpatient TJR procedures possible, the digital transformation in healthcare makes it preferable. Specialty-specific digital tools are crucial for the transition to outpatient surgery, reducing the burden on physicians, limiting a patient’s time spent out of the home, and lowering costs for both patients and physicians.
As has been widely reported, inefficient electronic health record software can intensify burnout instead of mitigating it. Physicians that spend extensive time documenting, especially after hours, report higher rates of burnout, and programs that are click-intensive and data-heavy contribute to this phenomenon as well.
These pitfalls are especially burdensome in the ASC setting because it is a site of care that may be separate from a patient’s primary care office or hospital system. In order to best understand a patient’s medical history and effectively communicate with their other physicians and specialists, ASCs need interoperable EHR systems that minimize manual data entry.
EHR adoption is already especially challenging within orthopedics, as this is a specialty that covers a wide age range, from children to older adults, and encompasses integumentary, neurovascular, and musculoskeletal systems across the entire body. Therefore, on top of the challenges of finding software that mimics the workflow of outpatient care, it must also capture the nuances of the orthopedic specialty. It should streamline workflows and predict and suggest codes, reducing overall clicks and time spent within the system, so that the physician can dedicate that time to the patient.
The cornucopia that is the annual HIMSS conference and tradeshow – healthcare technology’s biggest event – is behind us, but what’s left in the wake is wonderful, inspiring even, if not a bit overwhelming. The reactions to this year’s event have been overwhelmingly positive. Interoperability in the form of data sharing and a ban on patient health information blocking by CMS (through proposed rules released the first day of HIMSS) set the tone.
This was followed by CMS administrator Seema Verma taking a strong tone in all of her presentations at HIMSS, with the media and during her keynote speech. The federal body made it clear that data generated from patient care is, unequivocally, their data. While these themes heavily influenced the show, there were other takeaways.
There are many other diverse opinions about what came out at HIMSS19 and the themes that will affect healthcare in the year ahead. For some additional perspective, I turned to healthcare’s thought leaders; people who are a lot smarter than I. Their responses follow. That said, did we miss anything in the following?
Dr. Geeta Nayyar, Femwell Group Health and TopLine MD
After spending a week surrounded by some of the most intellectual and innovative minds globally in healthcare at HIMSS19, I’m even more confident that the shift toward patient engagement mass adoption is well underway and ON FHIR. The new CMS/ONC proposed law around interoperability and penalties for “information blocking,” are both touchdowns for the quarterback, which remains to be patient engagement. The robust discussions during the pre-conference HIMSS patient engagement program, reflected a move to a consumer-centric approach evidenced by the presence of Amazon, Google and Microsoft at the show. The keynote by Premier’s CEO Susan Devore shared a consumer-centered, provider led vision, “with data flowing seamlessly and being analyzed and effectively leveraged to guide decision making at the point of care.” Collaboration in healthcare is the key to everyone’s success. I was inspired to see her and so many women coming together to support each other in HIT, as Dr. Mom remains the healthcare decision maker in the households, we are all ultimately trying to reach.
Andrew Schall, Modernizing Medicine
Physician burnout continues to be a hot topic coming out of HIMSS19 and many feel that EHR platforms may be a part of the burnout epidemic. There were several sessions that focused on user-centered design at HIMSS this year including one that focused on the iterative approach to software development and user experience. First, I think that the industry is recognizing that one-size-fits doesn’t work for EHRs. Additionally, I believe that improvements will come in large part from the greater involvement of practicing physicians in designing specialty-specific EHR workflows and interfaces. A combination of powerful technology like AI and augmented intelligence, as well as well-designed EHR solutions with an intuitive user interface and user experience, will help ease the physician burden and automate time-consuming and administrative tasks like coding and billing – ultimately reducing burnout.
Shane Whitlatch, FairWarning
HIMSS 2019 showcased the ongoing digital transformation to make healthcare responsive to patients across a continuum of care. Enabling patients to be able to access, use and own their personal health data, while ensuring privacy and security was the central takeaway of this year’s HIMSS. Notable, critical moves to support this goal included: the Department of Health and Human Services announced proposed rules to enhance interoperability and data access with payor data; ongoing security and privacy efforts to ensure appropriate patient access to their data while mitigating emerging risks from items including medical devices to nation-state attackers; and artificial intelligence and machine learning initiatives to effectively manage the tsunami of data in healthcare while promoting optimal healthcare.
Tripp Peake, LRVHealth
The best part of HIMSS this year was we seemed to get away from a single buzzword. Healthcare is hard, there’s no silver bullet. The Precision Medicine Summit got into the weeds about how to really roll out a program in a provider system. The AI companies stopped talking about AI for AI sake and were more focused on ROI. Everyone seemed more balanced about VBC: yes, inevitable, but also gradual. Consumerism was probably as close to a central theme as existed. And I continue to be excited about the energy, creativity, and commitment of the entrepreneurs in this market.
Don Woodlock, InterSystems
Anytime you bring 43,000 healthcare professionals together in one location, you will never have a shortage of opinions on the future of the industry. We are at the cusp of a revolution in healthcare, driven by technological advancements. Some key trends we saw at HIMSS19 were, no surprise, around artificial intelligence, where people are trying to enhance predictive risk scoring and improve patient engagement. Additionally, there were profound announcements around mandating application programming interface (APIs) to improve the flow of healthcare data across the ecosystem. As interoperability becomes liquid, it will become the critical component of every healthcare system, driving the industry to new heights.
Paddy Padmanabhan, Damo Consulting
On day one of the conference, the HHS sucked the oxygen out of the room by dropping a proposed 800-page rule on data and interoperability. The rule aims to aggressively expand interoperability by making it mandatory for providers and health plans participating in government programs such as Medicare Advantage, CHIP and others to make patient data available to patients as a condition for business. CMS head Seema Verma and ONC Chief Don Rucker drove the message home repeatedly during the conference. Indeed, Seema Verma declared it an epic misunderstanding that patient data can belong to anyone other than the patient. A somewhat sobering counterpoint was voiced by Epic Systems CEO Judy Faulkner in a media interview where she suggested that interoperability challenges go well beyond data sharing by EHR vendors. Regardless of where it may fall, interoperability will continue to dominate healthcare IT agenda for some time to come. Related issues around new and emerging data sources, especially social determinants of health, will gain prominence in the coming months.
Erin Benson, LexisNexis Health Care
The proposed rule on interoperability of health information influenced most conversations at HIMSS. In the context of cybersecurity, the rule served as a reminder that it’s just as important to let “good guys” in quickly and seamlessly as it is to prevent unauthorized access. We want to enable value-based care and give patients the ability to manage their own health by having access to their records. We also want to keep costs low and efficiency high by enabling interoperability and giving partners, vendors and employees necessary access to systems. Therefore, a cybersecurity strategy needs to strike a balance between user engagement and data security.
Mike Morgan, Updox
The power of consumerism is really impacting healthcare and the need for patient engagement is alive and well. Providers across the board must look at new technologies and ways to redefine patient engagement to better communicate with patients and partners but do it via channels that are easy for staff and customers to use. New applications, such as telehealth and secure text messaging, have changed how healthcare communicates and consumers are demanding that immediate, convenient engagement.
Vince Vickers, KPMG
HIMSS19 seemed to have the most decision makers at the conference in five-plus years when a lot of healthcare organizations were still looking at implementing electronic health records. We might be ready for another wave of healthcare IT investment after healthcare organizations digested those investments made in electronic health records. The key is now around optimizing EHRs – interoperability, improving ease of use, enhancing analytics — or dedicating resources to enterprise resource planning (ERP) systems to make themselves more efficient in the back office. We’re also seeing healthcare organizations position themselves to be more consumer-oriented, partly to address new entries from some of the tech companies, such as Google, Amazon, Microsoft, and a multitude of others, that wanted to make a big splash at HIMSS.
Given the tremendous and on-going changes currently taking place in health IT, especially the recent delay in ICD-10, and the ever on-going issues surrounding meaningful use, we remain in a turbulent, yet revolutionary time in the industry. As changes continue to come and behaviors, habits, further reform is activated and enforced, there will only be more of a focus on where we are headed from a technology standpoint.
Given the multiple balls health IT leaders are currently juggling and the rapid changes they are facing from new technology and managing tools that were once thought to be saviors of the sector – patient portals come to mind – I and they are left to wonder what’s next for health IT. With that lingering question, I asked a few folks working directly in the space what they think will occupy the minds of health IT leaders for the short term.
The delay in ICD-10 implementation was met with equal parts relief and frustration. As the healthcare IT industry is evolving, government and regulatory authorities have come up with several certifications to enhance the quality of care for patients. For example, meaningful use incentives have created an artificial market for dozens of immature EHR products. Many EHR vendors have been preoccupied with backlogged implementations and have neglected the usability and innovation of their EHR products. Most concerning to current EHR users are unmet pleas for sophisticated interfaces with other practice programs and complex connectivity, pacing with accountable care progresses and the rapid EHR adoption of mobile devices. Many popular “one size fits all” EHR products have failed to meet the needs of several medical specialties.
Distracted by the process of certifying their EHR products for Stage 2 of meaningful use, not all software vendors have been able to deliver on their Meaningful Use 2 promises to anxious providers; 40 percent of the practices are replacing their EHR systems, as their current systems are cumbersome to use, not integrated, not able to meet regulatory compliance, outdated, have interoperability challenges, inefficient customer support, lacks specialty specific workflow and are not mobile enabled.
Stacy Leidwinger, vice president of product marketing, RES Software
A top concern in healthcare right now is securing patient health records. Although the clinical details themselves contain little financial value, the records contain personal patient details that can easily result in stolen identity or credit card information.
In the US, nearly 3 trillion dollars per year is spent on healthcare, which translates to everyone from physicians and pharmacists to well-organized crime syndicates targeting healthcare, usually through the use of stolen patient records and identities.
Two of the weakest points in healthcare security are 1) people tending to underestimate security risks, therefore, becoming vulnerable to social engineering, and 2) the fact that endpoints can’t be physically secured in many cases while continuing to provide needed value. Patients need to take a more serious approach in choosing a healthcare organization by making it clear that they “trust” their provider.
Guest post by Michael Sherling, MD, MBA, co-founder and chief medical officer, Modernizing Medicine.
At most hospitals and academic medical centers, physicians come together once a month to learn new approaches to treatment, to exchange ideas and to debate the possibilities of a challenging diagnosis. We call this Grand Rounds.
Grand Rounds keeps physicians up to date and helps patients too. Instead of relying on one doctor’s opinion, patients get a collective experience of several doctors. Through open debate, a more thoughtful approach to disease treatment is generated. Unfortunately, 80 percent of physicians do not practice in a hospital or academic medical center where Grand Rounds happen. They practice in private practice. While there are opportunities for physicians in private practice to maintain continuing medical education through journals, online courses and annual meetings, most of these practitioners are on their own, so to speak.
When physicians in private practice see a challenging case, they can read about it in a medical textbook, phone a friend (another specialist) or refer the patient to another physician. They don’t have the luxury of calling a “time out” and presenting the case to five other physicians. Pressured by time constraints of increased documentation and decreasing reimbursement, many doctors opt to refer out the more challenging cases, or shy away from newer treatments simply because they don’t have the same access or shared experiences as doctors practicing in hospitals and academic medical centers.
Today, innovative cloud-based electronic health record (EHR) systems can present an opportunity to break down the barriers in private practice so that physicians can make more informed decisions at the point of care. Cloud-based systems rely on one instance of the software where all de-identified medical data is stored. These systems are HIPAA compliant and patient information is protected and secured. Yet, to advance medicine and improve healthcare outcomes for patients and physicians alike, the cloud-based systems can provide physicians access to de-identified patient data. Instead of relying on underpowered clinical control trials for common diseases, outdated studies for rare diseases and anecdotal evidence for orphan diseases, cloud based systems can reveal to physicians which treatment patterns are used for any given disease.