Electronic Health Reporter

Guest post by Justin Sotomayor, pharmacy informatics director, CompleteRx.

The field of health informatics has grown exponentially over the past 50 years. From Robert Ledley’s work paving the way for the use of electronic digital computers in biology and medicine in the 1950s, to the founding of the American Medical Informatics Association in the 1990s, to the launch of the Medicare/Medicaid Electronic Health Record Incentive Program in the 2000s, it continues to mark new milestones at an astounding pace, presenting both challenges and opportunities for the healthcare industry.

Three trends – in particular – will have a marked impact on patients and practitioners, and are certain to define health informatics in the near future, if not for years to come.

The end of Meaningful Use

In 2009, with the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act, came the launch of the Meaningful Use program – and the related requirement that healthcare providers show “meaningful use” of a certified EHR to qualify for incentive payments. With both Stage 1 (adoption) and Stage 2 (coordination of care and exchange of information) behind them, hospitals are fully responsible for Stage 3 (improved outcomes) by 2018. While, undoubtedly, the program has improved EHR adoption – in many cases, streamlining and enhancing patient care – it has been widely criticized. In a 2015 news release, the American Medical Association regarded Stage 2 as a “widespread failure,” suggesting it monopolized staff attention without commensurate benefit to patients, and hampered innovation.

Most recently, following highly-publicized remarks in January by CMS Acting Administrator Andy Slavitt that Meaningful Use would be replaced, the U.S. Department of Health and Human Services has proposed transitioning Meaningful Use for Medicare physicians to the “Advancing Care Information (ACI)” program under the Medicare Access and CHIP Reauthorization Act (MACRA). According to Mr. Slavitt, this program is designed to be “far simpler, less burdensome, and more flexible,” primarily by loosening the requirements to qualify for extra payments, and incentivizing providers based on treatment merit, known as Merit-based Incentive Payment System (MIPS). While this update doesn’t yet affect hospitals or Medicaid providers, and these groups should continue to prepare for full Meaningful Use implementation, it’s an indication that industry concerns over meaningful use are being heard and responded to, and that additional changes may be forthcoming.

The rise in cybersecurity threats

Meaningful use and other mandated health information technology advancements were introduced with the stated objective to improve care delivery and efficiency; however, many hospitals – which are already navigating unprecedented budget cuts and closures as a result of other industry realities – have struggled to commit the resources necessary for compliance. Even those that have, may not have had the time or budget to sufficiently recognize new vulnerabilities – specifically, the increase in security threats – and put systems and protocols in place to mitigate them. Criminals have noted this gap in preparedness, and unfortunately, increasingly taken advantage of it. For example, ransomware attacks – in which hackers trick employees into downloading malware, restricting whole systems or operating systems through encryption, and then extort money to reinstate access – have plagued dozens of hospitals this year, compelling Hollywood Presbyterian Medical Center in Los Angeles, in one example, to shell out $17,000 to reclaim its data.

In addition to such immediate financial loss, victims of ransomware and security attacks face myriad other risks: dangerous and costly disruption to clinical and financial operations, long-term damage to hospital reputation, potential HIPPA fines for leaked patient information, and in a worst case scenario, patient deaths (for example, if a nurse were unable to access life-saving heart medication from an automatic dispensing machine). In the face of challenges like these, awareness and education, as well as proactive crisis planning, are crucial. Many best practices, such as daily EHR backups, are easily implemented, and may greatly reduce operational disruption in the event of a crisis.

The growth in pharmacy informatics

With the growth in health informatics, has come the rise of sub-specialties, such as pharmacy informatics. While there has been some concern over whether technological advancements in the field – such as robotic prescription dispensing systems, or Computerized Physician Order Entry (CPOE) – have the potential to replace pharmacists, in reality, they’re more likely to elevate the roles of those professionals, as they spend less time on tasks that could be automated and more time on the patient floor. In this time of rapid change, many pharmacists have successfully supplemented traditional educations with on-the-job training for these tools; however, as such technologies get more complex, there is increasing demand for professionals who have been cross-trained on pharmacy and informatics from the outset – a trend exemplified by the expansion of health informatics degree programs across the country.