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Healthcare has become too expensive for most entities to afford (state and federal governments, private industry, and private citizens). So, how do you dramatically lower (50% or more) the cost of “producing” an encounter?  We clearly need to think and act differently than we are now. There has to be an admission that the current workflow is broken and simply automating it will not help.


One mechanism might be more closely matching the healthcare issue with venue and resources spent on the encounter. Currently our default is seeing patients in the clinic or sending them to the hospital via the emergency room.


In many cases, if a simple communications tool, along with streaming medical data, were available in real time it might be more convenient and less costly to treat the patient in place. This concept, while not new, has never been widely deployed as currently the most likely way a provider or system is paid is by face-to-face encounters. Treating patients with remote, non-face-to-face technology is often not reimbursable. However, with the advent of payment reform and pay for outcomes (vs. volume), I believe it will be increasingly likely that treating patients in the lowest cost setting consistent with their illness needs to become standard practice. In many cases the best option will be home-based care and not facility-based care.


We need to begin a national discussion about when it is both safe and effective to treat patients (not just give advice, but diagnose and treat) in non-face-to-face settings. “Virtual” care is a technical reality and very disruptive to the current face-to-face, facility-based care delivery model.  “Virtual” care holds out the promise of more convenient and timely care (immediate care when you need it, without having to travel).


Furthermore, because the overhead of producing a “virtual” visit is much less (maybe as much as 50%) than a face-to-face visit, we need to consider this alternative for care delivery as we run out of funds to deliver care to our citizens. The alternative might be drastic rationing/queuing and service delivery cutbacks due to lack of adequate funding.


The time has come for providers, government officials and citizens to consider this next “evolutionary” step in service delivery reform for routine ambulatory care services.


What do you think?

Below is a guest blog post from Tee Green, president and chief executive officer of Greenway Medical Technologies, Inc.


Should every health system, hospital or group practice CIO know that to do interoperability right they need to consider XDS or PIX at the core of functionality? That these cross enterprise document sharing and patient identifier cross reference protocols can reach into another EHR?


Health IT solution providers should, and it’s clear from a survey of CIOs commissioned by Greenway that CIOs want leaders who will partner in their pursuit of the data liquidity that fits their needs. Right now education outranks selling, as interoperability is arguably the most important factor in addressing the range of care coordination programs every healthcare entity is facing. Tee Green new headshot.jpg


It’s also clear that the growing EHR replacement market is being fueled by a reassessment of original platforms lacking in comprehensive data exchange at a point when the improvement of population health should not take any backward steps.


The survey specifically found that the primary concern CIOs have about utilizing technology in their healthcare system is of course interoperability. Twenty-six percent voiced it in basic terms, and another 18 percent specifically in terms of medical staff alignment, which is itself a function of interoperability through the alignment of hospitals and clinics on EHR platforms capable of seamlessly exchanging data. That’s 44 percent overall, which outweighed cost at 22 percent.


Who should carry the burden of interoperability? Forty-nine percent chose a shared process between health IT solution providers and the healthcare system. Thirty-three percent chose a shared approach additionally led by health IT. Taken together that’s 82 percent voicing the need for a shared partnership. That’s an overwhelming result the industry needs to listen to.


And don’t think that today’s patient-consumers are not aware that technology matters. We surveyed them too, and 56 percent notice when technology is used at the point of care, and believe it helps their doctors do a better job. They also realize, by a 3-to-1 margin, that technology beats paper when it comes to sharing data.


Where do we go from here?


National organizations like the EHR/HIE Interoperability Workgroup - a coalition of state agencies, EHR companies, HIEs and certification experts - are solidifying standards, from PIX to C-CDA, and must also foster and project a sense of selfless collaboration with CIOs and doctors and nurses.


This is a key example of how together health IT leaders can create a smarter and sustainable healthcare system, and takes away any skepticism that the industry is not in it for population health. And the movement to national interoperability must be led by the industry, not by external policy, to further assure CIOs that motivations are in the right place.


Our survey did not reflect an overly negative attitude, and that’s because health IT leaders are already showing the willingness to partner with each other.


Development agreements and data exchange pilots by perceived market competitors are starting to emerge that align hospitals and clinics and integrate with HIEs, and select EHR-to-EHR exchange has become a staple of an interoperability showcase near you.


I predict that by the time meaningful use Stage 2 gets underway in 2014, the thresholds for data exchange being tied to incentives - electronically transmitting 10 percent of care transitions, at least one to a different EHR platform - will be eclipsed. The healthcare industry expects it. It’s the primary concern, the primary need for partnership, and the primary way for health IT to deliver.


What do you think?


View the entire survey, “Healthcare Information Technology: Trends and Transformations,” at

The experience of flipping through clean, colorful presentations of vital patient data drew enthusiastic visitors to the Intel booth at HIMSS this week.


In a demonstration created by Intel, Microsoft and Cleveland Clinic (pictured), visitors were able to explore the value of next-generation touch interfaces on Intel-powered tablets and devices. The Windows* 8 proof-of-concept application showed the potential of developing useful new presentation layers that automatically surface key pieces of clinical data for a set of patients being treated:  risk status, vitals, recent labs, medications, notes and visit information, images, etc. Cleveland Clinic Booth_lowres.jpg


“This effort is deeply grounded in the needs of clinical teams to access the latest and most relevant patient information as they move throughout their shifts,” said Mark Blatt, MD, worldwide medical director for Intel’s health IT team.


“We are excited to show how Windows 8 apps have the potential to push critical information from the enterprise EHR to the clinician,” Dr. Blatt said. “Windows 8 and new Intel-powered mobile devices also allow clinicians the flexibility to use touch to enter data in tablet mode and keyboard and mouse to enter data in laptop mode. This offers a two-in-one benefit, a tablet when you want it and a laptop when you need it.”


The demonstration application allows clinicians to view a risk-stratified list of patients based on their health status via a live Windows 8 interface tile. Users can then select a patient and view the updated medical record in the Windows 8 touchscreen experience. 


“Innovation has always been the cornerstone of Cleveland Clinic's pursuit of providing the best patient care,” said Will Morris, MD, associate chief medical information officer at Cleveland Clinic. “With our long history of integrating health information technology into clinical practice, we are always looking for new opportunities, like this one, that allow us to explore and develop the latest tools and technologies.”


“Healthcare organizations need a no-compromise mobile productivity solution to help manage the multiple workflows and improve the collaboration of teams,” said Michael Robinson, vice president, U.S. Health and Life Sciences, Microsoft. “We believe that Windows 8 can help empower mobile teams to be more productive and secure, while complementing existing EHR systems.”


What questions do you have?

Evernote says security has been breached by hackers. Dropbox password breach highlights cloud security weaknesses. These recent headlines are just two in a long list of examples of popular apps being compromised, putting sensitive data stored in their respective clouds at risk.


In an earlier blog, What cloud is your healthcare data in?, I explored the impacts of healthcare workers using apps with sensitive healthcare data, and the often undesirable side effect of moving the sensitive data into “side clouds” that are relatively insecure and add significant privacy and security risk.


A recent HIMSS global security survey of 674 frontline healthcare workers, Workarounds in Healthcare, a Risky Trend, HIMSS media, March 2013, shows that when solutions are unusable, security is cumbersome, or IT departments too slow or too restrictive in enabling new technologies, healthcare workers use workarounds. This survey revealed that this happens every day (22%) or sometimes (30%).


Personal apps for file transfer, note sharing, communications or other purposes where identified by 20 percent of healthcare workers as key tools to do workarounds. When sensitive healthcare data is used in workarounds this adds risk from a confidentiality / breach standpoint, as well as an integrity (completeness / accuracy) standpoint since the patient record often does not get updated with data moving in these workaround “side channels.”


To mitigate this risk we need a multi-pronged strategy including improving the usability of healthcare solutions and security to avoid compelling healthcare workers to use workarounds. IT departments in healthcare organizations need to be responsive and avoid being overly restrictive in enabling new technologies, or face being bypassed by healthcare workers in their use of workarounds. Administrative controls need to be bolstered, including policy, risk assessment (and proactively addressing deficiencies) and effective security training.


What kinds of apps are your healthcare workers using, and where do you see the risks?

Much of the chatter coming out of HIMSS13 hinges on the concept of integration. Specifically, this idea that integrating physicians with other community care givers will naturally foster a better, less expensive quality of care. It’s an idea whose time has come. So, what are healthcare CIOs doing to facilitate better communications among clinicians working inside and outside the hospital? The short answer: not much.


Sure, the innovative ones are trying. But as a group, most are still thinking in terms of individual activities performed by individual actors in individual silos. We’re seeing push-back around data sharing. We even have people pronouncing the HIEs dead, declaring that data exchange is too hard, too complex. Yet this vital communication at the point of care is too useful and too necessary to disregard.


With HIE technology becoming dated and outpaced by newer technologies – and the added challenge that many EMRs certified as interoperable don’t really interoperate – one approach being advocated by health IT experts is the use of mobile tools for real-time voice and video communication.


Collaboration using video conferencing and real-time streaming medical data makes tremendous sense at the point of care. But it’s a hard leap for many healthcare CIOs, a destination they’re striving for but haven’t yet reached.


Atlantic Health System’s Linda Reed, RN, MBA, FCHIME, vice president and CIO, and president of her regional HIE, is among those CIOs tasked with balancing physician demands for rapid communications inside and outside the hospital against her organization’s need to maintain security and compliance.


Right now, the Morristown, N.J.-based health system, which has 2,852 physicians and 1,310 licensed beds spanning three locations, limits the use of real-time video to its telemedicine stroke program — but Reed anticipates the technology’s inevitable arrival as a widespread mobile communications tool.


“Whether it’s through Facetime, or Skype, or what have you, the real-time video wave is coming, especially with more people having iOS and Android applications,” Reed says. “For the moment though, in hospitals, we try to discourage all that because we don’t want people sending photos of patients. Everything comes back to compliance.”


Like most healthcare CIOs, Reed has embraced the BYO phenomenon, implementing Citrix and VMWare solutions that enable physicians to use their own devices while maintaining access to legacy applications that are still client/server-based.


To better facilitate rapid communication among physicians, Atlantic has begun piloting a secure text messaging app that appears promising. Currently, about 60 physicians are using the PIN-protected app, enabling them to receive PHI on-the-fly without violating any privacy rules. It took a while to find the right vendor because some of the apps were just too cumbersome to use, but it’s proven a reliable, safe tool for time sensitive communications.


“These are the things we’re doing now, but who knows,” adds Reed. “As healthcare changes and hospitals become smaller as the ambulatory side grows, what other tools will we need to support patients in their homes?”


Intel’s Worldwide Medical Director, Mark Blatt, M.D., is among those convinced that that’s where real-time voice and video technologies increasingly will come into play, enabling true POC collaboration among clinicians.


Although it will likely be another two quarters before he has the proof points he needs to offer examples of healthcare organizations that are effectively and creatively using IA mobile tools in this manner, he’s convinced we’re getting close.


Proactive CIOs who want to position their organizations accordingly, he says, should embrace three key concepts: choose the right device for the task; rearrange workflows to move toward collaboration; and, think about the compute model and how information is delivered to a mobile device.


“The mobile form factors are slate computers when you want them, laptops when you need them,” Dr. Blatt says. “And if I’m thinking about it from an operating perspective, consider that Windows* 8 is backward compatible with all your legacy equipment. All your peripherals and drivers just work, and you have the trusted security and manageability tools you’ve become comfortable with.”


What steps is your healthcare organization taking to better integrate clinicians and community-based care givers?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

As expected, HIMSS13 is abuzz with new offerings. Mobility, of course, is a central focus, and while devices and apps should garner a good deal of any healthcare CIO’s attention, don’t overlook the fact that Microsoft’s latest upgrade delivers a game-changing approach to the Windows* operating system.


Yes, it’s early. Maybe your organization is still running XP, or you’re just getting Windows 7 off the ground. Maybe you always prefer to wait on future versions. But proactive CIOs are looking at Windows 8 now because it enables them to incorporate the BYO phenomenon with all of their legacy software.


“From the CIO’s perspective, the challenge is keeping everything in synch at all times,” says Stanley Crane, CTO at Allscripts. “In Windows 8, the same management tools they use today to manage Windows 7 and XP environments translate exactly. There’s no new tool kit to get, the mechanisms are in place, you can keep everyone in synch. That, to me, is a huge plus.”


Thanks to backward compatibility, Windows 7-based healthcare organizations that may not have a lot of touch enablement (yet) can still run all of their applications in desktop mode within the Windows 8 environment without making any changes.


But in a move to accommodate the newer platforms that are touch-enabled, Windows 8 offers a choice: compute traditionally with a keyboard and mouse, or compute the way our collective consumer experience has been guiding us: with touch. Users can go back and forth seamlessly between both compute models.


For CIOs, having this capability means not having to bolt on a consumer BYO approach to their legacy environments. No need to use virtualization software in cases where it doesn’t make sense, simply because it’s the only way to prevent information from sitting on devices. They can compute natively in Windows on a mobile device.


“It’s not a forklift upgrade where I have to switch everything to touch; I don’t have to,” adds Mark Blatt, M.D., Worldwide Medical Director at Intel. “I can migrate to touch in a natural manner as makes sense. And I can let the consumer, or enduser, add their own BYO touch to the platform, fully knowing I have all the manageability and security tools that I’ve always had available to me. I’m not compromising anything.”


In addition, Windows 8 offers three interesting capabilities over the existing touch mobile device platforms currently on the market:


Live Tile: an environment in which users can communicate bi-directionally with the application that sits below it. It’s a nice innovation worthy of a little effort. For example, in the Live Tile environment, the icon could say, “You have stat lab values.” And after a certain amount of time, it could change from green to yellow to red, or it could buzz; it’s a live, interactive environment that’s pushing information to the tile, rather than telling you to go pull it from the store. Think of the possibilities here. FYI, users can right-click to turn off active tiles and make them static.


Picture password: a sign-on capability completely unique to the user, so they don’t have to remember pins or passwords. It frees users from some of the legacy constraints without sacrificing security. A welcome addition in health care settings.


Snap mode: a feature that offers the ability to run two different applications at the same time. Not just two different windows, but two applications on the screen at the same time. A physician could, for example, open a neuroanatomy program from the store that shows pictures of the brain and nervous system. On the other half of the screen, she could be running a DICOM viewer in desktop mode that shows an actual CAT scan of the patient’s brain. Having this ability to multi-task and bring up multiple apps in live environments is critical to the way health care providers think and work—and Snap mode allows this flexibility.


For functionality and flexibility, healthcare CIOs could do worse than consider a Windows 8 upgrade, given the overall gains. Is it on your organization’s radar yet? Why or why not?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.


In my last blog, What Types of Workarounds Are Your Healthcare Workers Using?, I explored the types of tools healthcare workers are using to circumvent solutions or security that gets in the way, driving non-compliance issues and additional privacy and security risk. An example of a workaround could be copying unencrypted patient records onto a personal USB key in order to transfer them.


A global survey of frontline healthcare workers completed January 2013 by HIMSS and Intel, with 674 respondents, reveals that more than half of respondents use workarounds either every day, or sometimes. In this blog we look at results from the survey that highlight to what extent healthcare workers are aware of the risks associated with using workarounds, why they are doing workarounds anyway, and why workers may not be adequately aware of risks.


In order to gauge awareness of risks associated with workarounds we asked in the survey, “Do you think people using workarounds are aware of the associated privacy and security risks?” Almost evenly split, 36 percent indicated yes while 35 percent indicated no, and another 20 percent indicated they don’t know. Clearly there is much work to be done in increasing awareness of risks associated with workarounds, a basic first step to mitigating this type of risk. To dig a little deeper we surveyed respondents with two further questions on why those that are aware of risks use workarounds anyway, and where things may be breaking down for those that aren’t aware of risks.


To understand why healthcare workers that are aware of risks use workarounds anyway, we asked, “If people are aware of risks, why do you think they use workarounds anyway?" Of the major categories of response to this question, 53 percent indicated frustration with currently system, 53 percent that workarounds make their job easier, 38 percent indicated risks were insignificant, and 29 percent indicated that improving the quality, improving efficiency, and reducing the cost of patient care takes priority over security. These results suggest that current healthcare solutions are in many cases viewed as more difficult to use that workarounds. Many healthcare workers are also clearly making a decision to do workarounds that improve healthcare while waiving the associated risks as insignificant or lower priority.


To explore why some healthcare workers lack awareness of risks, we asked, “If people are not aware of risks, why might they not be aware?" Forty-five percent indicated lack of oversight or enforcement of policy, 43 percent indicated lack of effective security awareness training, and 19 percent indicated lack of privacy and security policy. It seems that while most organizations have a policy, often it is not adequately enforced, and security awareness training is in many cases ineffective.


Stay tuned for the finale of this blog series next week with the release of a HIMSS/Intel whitepaper on this recent security survey. We’ll also be releasing these survey results and the HIMSS /Intel whitepaper at a workshop at HIMSS 2013. If you will be at HIMSS13 in New Orleans, join us for this complementary workshop panel to explore these concepts further. RSVP and reserve your spot.