ICD-10 and Meaningful Use continue to be two of the hottest topics in health IT. For more informatoin on these subjects, we caught up with Brenna Quinn, Sr. VP, Solutions Development, Health Services, at Siemens Healthcare. In the below video, she talks about ICD-10 and Meaningful Use and how these requirements weigh on the workflows of healthcare CIOs. Watch and also see the company’s new health IT solutions that fit in with healthcare reform.

What questions do you have?

Intel spent a day recently with nurse practitioner Ginger Harris as she went on home visits with a new Intel-inspired Ultrabook. As our population grows older, technology plays a significant role in providing home-based care for people who have trouble getting to the doctor's office. Critical for "on-the-go" clinicians is a reliable computer that is lighter, faster, and "instant-on."

Watch the video to see what Intel-inspired Ultrabooks can bring to mobile health workers. What questions do you have?

The best medicine is collaborative. Particularly with specialization and increasingly complex and powerful therapeutic technologies, providers have to work with each other and with patients and families to get the best outcomes.

And the lifeblood to any effective healthcare collaboration is information.

A number of organizations, like Kaiser or Mayo, with healthcare IT systems crossing both ambulatory and inpatient environments, do a pretty good job of moving information between members of the care team—making collaboration efficient and useful.

However, for the majority of our currently fragmented healthcare system, the state of art of provider collaboration is surprisingly 20th century with a touch of 19th century thrown in. The most common collaboration methods are face to face and phone. For routine communications and reporting between providers, fax still remains prominent. E-mail, which is ubiquitous in the business world, is relatively rare in healthcare, particularly when it comes to provider to patient discussions.

Why the lag? There are a couple of good reasons; personal health information (PHI) is both sensitive and highly regulated and therefore requires careful handling (hence the reluctance to use unsecured email).

Secondly, healthcare information is locked into disparate computer systems or on paper, making it labor intensive and inefficient to share with other providers that don’t work at your shop.

Fortunately, we are starting to see some of this change. The technology is generally ready. Encrypted, secure email systems are now available and designed for both provider to provider and provider to patient communication. Standards for healthcare data communication have been established that cover lab data, images, patient summaries, and prescriptions. Health information exchanges (HIEs), which would provide a pipe for all of this data to be moved between separate organizations within a community are being built across the country.

Since technology is no good if no one uses it, the government is providing incentives through the Meaningful Use program for providers to actively use these information sharing tools. Examples: in the latest draft of the Stage 2 Meaningful Use guidelines, providers are required to electronically submit summaries of care for >10 percent of their patients when they are referred to another provider. There is a requirement that practices are able to electronically communicate with their state immunization registry. Sixty five percent of prescriptions have to be sent electronically. Providers are required to provide tools (i.e. patient portals) so that 10 percent of their patients can communicate with them electronically.

This is great start. Stage 3 Meaningful Use requirements (which have not yet been defined) will continue to up the ante, with additional requirements designed to incentivize electronic communication and collaboration.  Improvements in hardware and infrastructure will help make powerful tools such a video-conferencing more practical and widespread.

The way we pay for health care will also drive collaboration. The recent flurry of activity around accountable care organizations (ACO) provides a model that rewards provider groups that carefully managing patient welfare throughout the care process. ACOs can’t succeed without collaborative tools.   

At a certain point, the network effect kicks in, and information rich collaboration becomes the standard of care. Although it has been a painfully slow process that has been 20 years in the making, we are getting much, much closer.

What do you think?

Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel.

One of the most important decisions that a doctor will make when in transitioning to an electronic health record (EHR) is their personal computing device. By personal computing device, I simply mean piece of hardware they use to enter data, review patient charts, run reports and all the other IT stuff that they will need perform in the era of Meaningful Use.

The good news: there are lots of choices.
The bad news: there are lots of choices.

Let’s break it down into two simple paths: tablets and PCs (such as laptops or “convertibles” that can be used as tablet but offer a keyboard too).

Here’s a simple checklist that you can use in making your choice.

Data entry flexibility: Are you comfortable with the data entry method of the device? Does it offer you options of different ways of entering data (i.e. real keyboard, virtual keyboard, digital pen, mouse, voice recognition, and handwriting recognition)? Flexibility not only gives you the ability to determine the method that you feel most comfortable with, but also allows you to mix and match in a given encounter (i.e. use digital pen for  a drop down problem list and voice recognition to record the subjective portion of the note). Tablets are very sexy, but in terms of sheer flexibility, PCs have the advantage.

Versatility: Is the device that you are using to go mobile from exam room to exam room equally useful when you are wrapping up at the end of the day in your office?  Or when you go home? Note: tablets are great mobile devices, but tend to less optimized when you aren’t mobile for routine tasks like printing that PCs do well.

EHR compatibility: There are very few applications that are built specifically or “native” to the tablet environment. That doesn’t mean that client server or web based EHRs won’t work on a tablet, but it may mean that it doesn’t work quite as well as a PC; it is worth checking before you commit.

Battery life/Battery management: Keeping your mobile devices fully charged is critical to smooth operation at the clinic; battery life of the device is important (the longer the better), but  having the flexibility to swap out the old for a fresh battery (so you don’t have to wait for the recharge) is also a plus. This is standard feature for most PCs—and not for tablets.

Screen size/display: Is your device the right size for you? Is it the right size for your patients? Providers need to balance size vs. weight. There is a right answer here—just what ergonomically works for you.

Final thoughts: For any practice that exceeds one physician, hardware decisions have a group element as well, which means that there has to be some compromises and trade-offs to meet the greater good of the practice as a whole. In this context, flexibility is king, since physicians are highly variable in their data entry preferences. In the flexibility argument, PCs always win.

Watch the below video for more information on selecting the right healthcare device. What questions do you have?

Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel

At HIMSS12, Doug Cusick, vice president and general manager of Health and Life Sciences at HP, spoke about information technology and how it supports the delivery of healthcare. In particular, he summarized how big data is the essence of where healthcare will be going forward in the next few years, and how data is gathered, exchanged and disseminated so clinicians can make informed decisions.

As you can see in the below video, he covers how patients are being more active in the decision making process, are at the center of the healthcare ecosystem, both in the hospital and in the community, and how technology enables them to be a part of the system.

What questions do you have?

Risk assessments are often driven by regulations such as HIPAA Security Rule, incentives such as Meaningful Use (see Core Objective 15) or compliance with standards such as ISO 27001 for Information Security Management Systems. Risk assessments can also be a valuable tool to allocate limited budget to reduce the most business risk, as discussed in my previous blog on Maximizing the Value of Risk Management in Healthcare. Risk assessments identify highest priority risks, in terms of likelihood and business impact, and safeguards required to mitigate these risks. However, just doing risk assessments doesn’t improve the organizations security posture. Actually reducing risks, and improving security posture, requires addressing privacy and security deficiencies identified in the risks assessment, by implementing administrative, physical and technical safeguards.

However, in practice there are many things that can get in the way of successfully improving the security posture of a healthcare organization, as shown by the survey results below sourced from the HIMSS Industry Solution Webinar titled “Embrace Healthcare Change Safely: Practical Strategies for Security Risk Management,” currently available free on demand.

Healthcare is driven by the key goals of improving the quality and reducing the cost of patient care. This translates into cost reduction pressure, and limited budget for privacy and security as a top of mind fundamental obstacle to implementing security. Making the best use of limited resources is key to reducing the most business risk, and risk assessments done well and regularly (at least annually) can meet this need well by guiding allocation to reduce the most business risk, and in a measured way that avoids over-securing in some areas, under-securing in others, weakest links and significant residual risk.

Lack of available staff with the necessary expertise to do privacy and security is identified by these survey results as the second greatest obstacle to implementing security. Engaging external professional services for privacy and security, and risk assessment is a practical best practice to overcome this obstacle. Hiring or making existing staff available to participate in privacy and security initiatives together with external professional services can help better guide these initiatives, and build this key expertise within healthcare organizations longer term.

Gaining executive buy-in by reporting regularly on compliance and risk management are critically important in the success of privacy and security initiatives. ROI (Return On Investment) analysis for highest priority risks identified in risk assessments can also help influence positive decisions from executives and financial stakeholders. Having the right audit framework around risk management can help overcome obstacles associated with security initiatives stalling in implementation due to higher priority initiatives. For example, establishing a process that requires an IT Manager tasked with implementing a security control to formally signoff on implementation, or waive risk associated with not implementing a security control can help move such initiatives up in priority on task lists. Of course, there are the usual project management best practices that apply to implementing security, including assigning owners and dates, and managing through to final implementation of security safeguards.

For robust privacy and security it is critically important that implemented safeguards continue to be effective. Monitoring existing controls for effectiveness is essential. This includes user acceptance, since if users don’t accept security, or seek alternatives that circumvent or disable security (and there are many eg from consumerization/BYOD), this can lead to ineffective security, non-compliance issues, and significant residual risk. See my previous blog on Healthcare User Experience, Compliance and Risk for more on this, and how vertically integrated security solutions that make use of Intel hardware assisted security can provide technical security safeguards that are performant, robust, usable and cost effective.

What challenges do you see with implementing security within your organization?

Learn more about improving your healthcare organization's security posture in this concise interactive narrated presentation

I recently had the privilege of delivering the keynote at Duke University’s Third Annual Informatics Conference, “Business Transformation Through Informatics” in North Carolina, followed by a congressional staff briefing organized by Health IT Now in Washington D.C. I thought I would summarize the key takeaways here since the presentations and discussions which followed seemed to achieve a degree of resonance with the respective audiences.

I should preface this to say that each of these observations are my own, based on exhaustive research of different models worldwide. I regularly work with regional and national governments around the world to design their national healthcare architectures, establish a shared services strategy, and leverage cloud computing to cost-effectively share essential infrastructure and expertise across a region.

Care coordination realistically models health information exchange as a network of participants rather than as a point-to-point exchange
Health information exchange is better modeled as a complex network of participants rather than a simplified point-to-point exchange of information. Each exchange of health information requires numerous supporting utility services – to check authorization, lookup clinician and patient registries, normalize terminology, aggregate patient health information across disparate sources, etc. Healthcare itself more closely follows a document-centric model of workflows such as that modeled by HL7 CDA (Health Level 7 Clinical Document Architecture), embodied as standard healthcare documents such as encounter and discharge summaries, request for consult, etc. Care coordination requires timely and secure access to a shared patient record across a region, inclusive of the patient, the caretakers, the clinicians and the institutions all participating in the patient’s care.

Care coordination, quality metrics and clinical decision support require a standard informatics model
A key success factor in health reform is the establishment of a shared summary care record built upon a standard informatics model, leveraging HL7 CDA and terminology standards including SNOMED CT, LOINC, ICD10, and for medications, RxNorm or ATC. The Consolidated CDA represents a harmonized set of recommendations across HL7 balloted CDA implementation guides, IHE Implementation Guides, Health Story Project and S&I Framework. HL7 CDA has been proven worldwide, including the use of HL7 CDA for epSOS (Smart Open Systems for European Patients) transborder exchange of summary health records and medication histories. A standard informatics model enables doctors to pose queries like “Tell me which of my patients have a particular condition and are taking a particular medication” – perhaps there is a new potential drug interaction or a change in recommended treatment procotol.  Clinical decision support, population health, quality metrics, comparative effectiveness research all depend on a standardized informatics model.

Care coordination, quality metrics and clinical decision support require a critical mass of shared patient health information across all participants in the region
Countries that require electronic submission of encounter and discharge summaries within 24-48 hours of care episodes, have significantly accelerated their progress towards health reform. This protected health information is then aggregated, normalized and made accessible as a shared patient health record through a regional HIE using web-based service APIs. Patients and clinicians alike are given immediate access that is both secure and transparent. Patients are able to directly consent and authorize access to health professionals, as well as audit specific disclosures, thereby establishing trust in the system. Independent audits are conducted to ensure “need to know” and “least privileged” access to protected health information. A critical mass of shared patient health information is established because all healthcare participants in a region are included. Goals for patient safety and improved care delivery at reduced costs are met because patient care can be coordinated across each of the specialists and institutions in a region.

Time to Value:  health reform must be accelerated
The time to build out the necessary infrastructure must proceed aggressively, such that the collaborative economic model can be established before the stimulus funds are exhausted. The collaborative economic model depends on achieving a critical mass of normalized health information. Once a minimum set of normalized health information is established, local business innovation can develop value-add services, which further drive value in the network. Examples of value-add services include drug interaction checks, clinical trial patient recruitment, clinical decision support, and comparative effectiveness of particular treatment protocols, institutions, clinicians, even patient-focused wellness and behavior modifications. Time to Value is the single biggest cause of failed HIEs worldwide – they took too long to establish a sustainable business model, ran out of funds before completing the necessary infrastructure, and ignored the importance of a standard informatics model.

Regional HIEs form the backbone of a shared services strategy
A Shared Services model is a means to cost-effectively share the necessary infrastructure for health information exchange, while creating a collaborative economic model that drives local innovation and accelerates adoption of advanced healthcare usage models. Regional HIEs become the logical organizing point to collect, host and store the normalized health information, to centrally monitor and enforce patient consent and authorization, to offer value-add services which drive further value in the network. Regional HIEs provide necessary infrastructure which must be must be organized, monitored and enforced similar to transportation and utilities, to ensure interoperability at both national and regional levels. Health reform which follows a balanced approach across business drivers and metrics, policy and standards, architecture, and reimbursement and investment models demonstrate the highest levels of maturity and return on investment.

What challenges do you face with accelerating health reform?  What are your key learnings in the journey thus far?

Healthcare enterprise organizations have been exercising caution with cloud adoption due to the regulated nature of the industry and desire to maximize return on existing (on-premises) IT investment. However, I am seeing accelerated adoption of SaaS (software-as-a-service) applications and expect this trend to continue.

In previous blogs (here and here), I’ve described some of Intel’s collaborative efforts with healthcare cloud providers working on medical imaging solutions.  Let’s take a closer look at some of the key reasons why medical imaging lends itself especially well to the benefits enabled by cloud computing:

•  Exponential Growth of Imaging Data: The amount of data stored by healthcare organizations is doubling every 18-24 months, and in large part this is driven by medical imaging.  As higher image resolutions are supported and richer media becomes more commonplace (e.g. video, 3D), the problem gets worse. Although medical images are rarely accessed more than a few months after they are captured, they are stored for many years to satisfy retention requirements, further increasing demand for storage capacity. The need to manage and scale the infrastructure to support medical imaging is putting significant time/cost pressure on Health-IT departments.

•  Loosely-Coupled Nature of PACS (Picture Archiving and Communication System): There are a lot of PACS vendors out there.  Most EMR (electronic medical record) applications treat PACS as a loosely coupled system and have mechanisms to support integration with various solutions.  Consuming PACS via the SaaS model will be much more straightforward and less disruptive to clinical end users than would be the case if PACS was tightly integrated with the EMR.

•  Pressure on Health-IT Departments to do More with Less: The healthcare industry is anything but static. Demands resulting from healthcare legislation & regulations coupled with trends such as BYOD (Bring your own device) are definitely keeping Health-IT departments busy. Evaluating applications against organization-defined criteria for SaaS suitability, and outsourcing where it makes sense to do so can enable IT to focus more time on strategic investment areas rather than “keeping the lights on”.

•  Need for Improved Access & Mobility: There is an increasing desire to access images anywhere, anytime, on any device in order to support a wide range of clinical workflows (e.g. diagnostic imaging on a workstation, reviewing an image with a patient on a mobile device at the point of care, etc.). SaaS applications are typically very mobile and support a wide range of client devices.

•  Technology Innovation: Several technology innovations have enabled medical imaging solutions to be delivered efficiently from the cloud.  Virtualized, highly-scalable, servers and storage platforms enable large pools of computing resources that can be shared across applications. This reduces the solution cost (economies of scale) and improves agility (applications can respond automatically to fluctuations in demand). Converged networking solutions can manage network and storage traffic over the same unified fabric, reducing cables, complexity and cost. Improvements in server-side graphics capabilities enable images to be rendered in the cloud and streamed to client devices over low-bandwidth network connections.

Intel works closely with the software vendors, industry partners and organizations like the Open Data Center Alliance to ensure that our cloud solutions arescalable, secure, and meet the needs of the healthcare industry. If you have any thoughts to share on the application of cloud technologies to medical imaging or other healthcare systems, please add to the discussion below.  You can also follow me @CGoughPDX on Twitter.

Watch the below video for some additional information from me on medical imaging and cloud computing.