A week after the craziness that is HIMSS (there’s a reason the #HIMSSanity hashtag has done so well), I’m kicking around an idea that came to my mind on my flight home from HIMSS. Overwhelmed by the 5 days of in depth discussions, I closed out my HIMSS talking about healthcare IT with the lovely lady sitting next to me. It just so happened that she was a HIE coordinator at a hospital in California and was heading home from HIMSS as well.
We had a far reaching discussion on the 5 or so hour flight home from Orlando. At one point we started the discussion of personalized medicine. I think I freaked her out a little bit when I mentioned the concept of every organ having an IP address.
Our discussion prompted to me to consider this really interesting an important question:
Can we abolish a disease because we’re so good at predicting that disease that we prevent it from ever happening?
When I considered this idea, it reminded me of Bill Gates (and many others) efforts to literally eradicate Polio from off the face of the earth. They’re doing so using vaccines and I can’t remember the exact timeline, but they’re only a few years out from this goal. It’s so empowering to think about eradicating a disease. Could health IT have a similar impact?
I haven’t thought through all the diseases and all the technology that could benefit from this concept, but I’m quite certain this is the real future of healthcare IT. How wonderful would it be to work on a project that determined the cause of diabetes early enough that we no longer had diabetics? What if we no longer had coughs and colds because we could identify the warning signs early enough that we could stop them from ever happening? We just need to get past the beauracracy and regulation and on to solving these major problems. No doubt this will take an enormous effort and resources and people beyond the traditional health IT.
This is a lofty concept indeed. However, I don’t think these ideas are that far away. What do you think? Could healthcare IT be used to abolish a disease?
One of the most interesting things I wrote about thanks to the HIMSS conference was what I called the real cause of hospital readmissions. I’m still interested in working with more hospitals to verify the data that’s presented in that blog post, but I’ll be surprised if it doesn’t play out as an important finding when it comes to reducing hospital readmissions.
In the post, I probably was a little aggressive in my statements about how the hospital can reduce readmissions through their own actions versus depending on home health, primary care doctors, or post-acute care providers. The good news is that my great readers always hold me accountable when I step too far over the line. In this case, Richard D. Tomlinson, RN, BSME, CMUP and Founder & CEO of Nuclei Health Consultancy, offered up a deeper perspective on the complexities associated with solving the hospital readmission problem.
I would like to take a moment to provide some perspective relative to your blog post today.
Hospital readmissions are, of course, clinically complex at times. In actuality, the risk for readmission can be influenced/increased due to lack of or missed opportunity for interventions prior to patient discharge. Effective quality measures, and robust analytics, with effective data feedback and clinical governance, can be deployed as components to an overall readmission reduction strategy; more on that later.
When we discuss readmissions we must consider the fact every case is unique; the circumstances, follow up care, coordination with 3rd party caregivers/providers (e.g. home health), level of transitional intervention, cultural influences, income levels, environment, stress levels. These factors are difficult to quantify, yet I do believe there is a way to translate these factors into reasonable algorithms.
I mentioned readmission as a strategy. Hospital readmission with most health systems I have worked with do not view it in strategic terms, and they must in my opinion in order to be effective (it could be argued Very often, initiatives are tactile in their core and therefore do not have a genesis of the strategic perspective when planning/implementing. As such, critical components such as clinical governance and workflow changes within the readmioften fall by the wayside or are missed completely. Add to that BI tools in the market today are not addressing predictive analysis for readmission risk as a dynamic in the overall care plan. A future-state, effective, model in my opinion would incorporate all the aforementioned factors, and in real-time track these factors and provide the care team with dynamic risk for readmission. That, combined with robust strategic tools and models in place, would have in my view significant outcomes.
Readmission engineering must be redesigned and retooled before any ROI level discussion can take place. Thank you for your fine Site and information exchange. All the Best, RDT.
I agree completely that the hospital readmission problem is not a simple problem. However, I still think a lot of people are looking in the wrong place. I look forward to digging into this problem a lot more. Reducing hospital readmissions is great for everyone involved.
In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.
Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?
Quick update on my IDN’s progress towards Stage 2 attestation, with $MM in target incentive dollars at stake. We must meet ALL measures; there is no opportunity to defer one. The Transition of Care (both populating it appropriately, and transmitting it via Direct) is the primary point of concern.
The hospital EHR is ready to generate and transmit both Inpatient Summary and Transition of Care C-CDAs. The workflow to populate the ToC required data elements adds more than 4 minutes to the depart process, which will cause operational impacts. None of the ambulatory providers in the IDN have Direct, yet; there is no one available to receive an electronic ToC. Skilled resources to implement Direct with the EHR upgrades are not available until 6-12 weeks after each upgrade is complete.
None of the 3 remaining in-scope ambulatory EHRs have successfully completed their 2014 software upgrades. 2 of the 3 haven’t started their upgrades. 1 has not provided a DATE for the upgrade.
None of the ambulatory EHRs comes with a Clinical Summary C-CDA configured out-of-the-box. 1 creates a provider-facing Transition of Care C-CDA, but does not produce the patient-facing Clinical Summary. (How did this product become CEHRT for 2014 measures?) Once the C-CDA is configured, each EHR requires its own systems integrator to develop the interface to send the clinical document to an external system.
Consultant costs continue to mount, as each new wrinkle arises. And with each wrinkle, the ability to meet the incentive program deadlines, safely, diminishes.
Playing devil’s advocate, I’d say the IDN should have negotiated its vendor contracts to include penalty clauses sufficient to cover the losses of a missed incentive program deadline – or, worst case scenario, to cover the cost of a rip-and-replace should the EHR vendor not acquire certification, or have certification revoked. The terms and conditions should have covered every nuance of the functionality required for Stage 2 measures.
But wait, CMS is still clarifying its Stage 2 measures via FAQs. Can’t expect a vendor to build software to specifications that weren’t explicitly defined, or to sign a contract that requires adherence to unknown criteria.
So, what COULD CMS and the ONC do about it? How about finalizing your requirements BEFORE issuing measures and certification criteria? Since that ship’s already sailed, change the CEHRT certification process.
1. Require vendors to submit heuristics on both initial implementation and upgrades, indicating the typical timeline from kick-off to go-live, number of internal and external resources (i.e., third-party systems integrators), and cost.
2. Require vendors to submit customer-base profile detailing known customers planning to implement and/or upgrade within calendar year. AND require implementation/upgrade planning to incorporate 3 months of QA time post-implementation/upgrade, prior to go-live with real patients.
3. Require vendors to submit human resource strategy, and hiring and training program explicitly defined to support the customer-base profile submitted, with the typical timeframes and project resource/cost profiles submitted.
4. Require vendor products to be self-contained to achieve certification – meaning, no additional third-party purchase (software or professional services) would be necessary in order to implement and/or upgrade to the certified version and have all CMS-required functionality.
5. Require vendor products to prove the CEHRT-baseline functionality is available as configurable OOTB, not only available via customization. SHOW ME THE C-CDA, with all required data elements populated via workflow in the UI, not via some developer on the back-end in a carefully-orchestrated test patient demo script.
6. Require vendor products adhere to an SLA for max number of clicks required to execute the task. It is not Meaningful Use if it’s prohibitively challenging to access and use in a clinical setting.
Finally, CMS could redefine the incentive program parameters to include scenarios like mine. Despite the heroic efforts being made across the enterprise, this IDN is not likely to make it, with the fault squarely on the CEHRT vendors’ inability to deliver fully-functional products in a timely manner with skilled resources available to support the installation, configuration, and deployment. Morale will significantly decline, next year’s budget will be short the $MM that was slated for further health IT improvements, and the likelihood that it will continue with Stage 3 becomes negligible. Vendor lawsuits may ensue, and the incentive dollar targets may be recouped, but the cost incurred by the organization, its clinicians, and its patients is irrecoverable.
Consider applying the hardship exemption deadline extension to the incentive program participants.
As a former system administrator that worked in a number of data centers, it’s been really interesting for me to watch the evolution of healthcare data centers and the concept of healthcare cloud solutions. I think we’re seeing a definite switch by many hospital CIOs towards the cloud and away from the hassle and expense of trying to run their own data centers. Plus, this is facilitated greatly by the increased reliability, speed, and quality of the bandwidth that’s available today. Sure, the largest institutions will still have their own data centers, but even those organizations are working with an outside data center as well.
I had a chance to sit down for a video interview with Jason Mendenhall, Executive Vice President, Cloud at Switch Supernap to discuss the changing healthcare data center and cloud environment. We cover a lot of ground in the interview including when someone should use cloud infrastructure and when they shouldn’t. We talk about the security and reliability of a locally hosted data center versus an outside data center. We also talk a little about why Las Vegas is a great place for them to have their data center.
If you’re a healthcare organization who needs a data center (Translation: All of you) or if you’re a healthcare IT company that needs to host your application (Translation: All of you), then you’ll learn a lot from this interview with Jason Mendenhall:
As a side note, the Switch Supernap’s Innevation Center is the location for the Health IT Marketing and PR Conference I’m organizing April 7-8, 2014 in Las Vegas. If you’re attending the conference, we can also set you up for a tour of the Switch Supernap while you’re in Vegas. The tour is a bit like visiting a tech person’s Disneyland. They’ve created something really amazing when it comes to data centers. I know since a secure text message company I advise, docBeat, is hosted there with one of their cloud partners Itrica.
A new study suggests that an increase in healthcare provider use of cloud technology plus a decrease in the cost of IT implementation could lead to big changes in the US healthcare IT market.
According to market research consulting firm RCNOS, between now and 2018, the health IT market will grow at a compound annual growth rate of close to 10 percent. Innovation in the market and government support for health IT tools will help the market along as well, the researchers report.
Technologies likely to have this effect include EMRs, clinical decision support systems, medical imaging information systems and lab information systems. The researchers say personal health records, telemedicine and ICD-10 systems are also growth areas.
To realize this potential, however, it will take widespread cooperation across many sectors of the healthcare industry, including providers, payers, plan sponsors, the pharmas and more, writes health blogger Jane Sarasohn-Kahn.
That being said, health IT market growth is not an absolutely sure thing. According to investor and entrepreneur Anne DeGheest, who recently spoke with the Wall Street Journal, the intense activity around health IT resembles the technology bubble of the 1990s.
Whether you share Sarasohn-Kahn’s enthusiasm or DeGheest’s caution, it’s difficult to argue that this is a golden time for health IT innovation and entrepreneurship. What makes today’s health IT activity different than bubbles of previous generations is that it solves real problems, rather than creating apps in search of a problem. I’d argue that health IT’s explosive growth will run well beyond 2018.