Louisiana is known for a lot of great things—think seafood and southern Hospitality—but the state is also becoming a hotbed of healthcare IT development. The nickname Silicon Bayou has been tossed around a few times to describe the great innovation going on in the region.

 

For example, the second CajunCodeFest kicks off tonight in Lafayette and will be the largest healthcare developer forum in the United States. Last year, more than 275 people attended the event, with 115 participants from 15 states and three countries. This year, teams from all over the country are expected to participate in the 27-hour coding competition that provides participants the opportunity to transform “data” into healthcare solutions. The data released will be used to create solutions that encourage patients to "Own your Own Health” to make knowledgeable and informed decisions about their healthcare.

 

Heavy hitters from the health IT world will be on hand, including Dr. Farzad Mostashari, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

 

Intel is proud to be a sponsor and it should be a great event that moves healthcare information technology forward. Follow us on Twitter @IntelHealthIT as we will be live tweeting and sharing photos, and watch for a recap after the event that will hightlight the winners and innovative technology. The hashtag is #CCF2.

 

What questions do you have?

Middle East oil producers have accumulated handsome budget surpluses thanks to sustained oil prices during the last decade and governments are doing the right thing by spending these on social development. Healthcare and education are the key sectors that are benefiting from this boon and information technology is claiming a fair share of government spending.

 

Qatar has already been spending a good part of its oil wealth in education and the Kingdom of Saudi Arabia is investing heavily into healthcare services including large IT deployments which include setting up three data centres and one of the largest national PACS deployments in the world. All these initiatives are tapping on cutting edge cloud solutions which offer seamless access to patient data across the care continuum as well as securely and cost effectively storing patient data.

 

Intel and our technology partners are increasingly shifting focus to healthcare IT projects in the region. We recently held a workshop in Riyadh with Dell on mobile healthcare to learn from leading healthcare providers how they are planning to improve care coordination with technology. Hamad Medical Corporation in Qatar has just delivered a Clinical Information System (CIS) Conference in Doha to more than 1,400 clinicians which offered CME, CNE and CPD credits to participants. How is that for a change that awards our caregivers for learning effective use of technology?

 

While the region is on a fast track preparing their health workforce for improved patient care, we have been researching how the Middle East is faring with respect to mobility and care coordination vis-à-vis the developed world. We have just completed a regional survey with HIMSS Analytics and the results are fairly surprising.

 

In some aspects, the region is way ahead and in some respects catching up. Among mobile devices provided to clinicians, tablets specifically for healthcare use is expected to rise to 41 percent this year from about 24 percent, while all types of cellular phones and pagers are on decline. This does not mean clinicians won’t be using them. They will simply become Bring Your Own Devices, a big challenge for device manageability. Only 3 percent of the health workforce is expected to get a smartphone or feature phone compared to as high as 45 percent procured by the healthcare institutions before.

 

I will present the survey details at a HIMSS Middle East Regional Event in Riyadh next week, and have the honor of addressing distinguished participants from regional governments, healthcare industry and the IT sector. I would like to share one worry that keeps me awake at night. A recent report from Bank of America is forecasting that the oil price will halve within two years due to a number of factors including yet again greater use of technology. Should this occur, would the Middle East governments have the same enthusiasm to continue with the social investments in healthcare and education or start to cut back just like the developed world is doing today?

 

How do we keep the momentum going to finally reap the benefits of current investments in healthcare IT? What do you think?

 

Rick Cnossen is the Worldwide Director, Healthcare IT, at Intel Corp.

At a certain point in the lifecycle in any business, the predominant business model gets exhausted.

 

Medicine is a case in point. The dominant U.S. business model—visit based, fee-for-service—is slowly buckling under the crushing cost burden it is imposing our society.

 

Although it will take awhile to transform this $2 trillion bloated behemoth into a system that offers better care at a lower cost, there are flurry of movements under way that are both interesting and promising. One of the most interesting and most promising is the patient centered medical home (PCMH).

 

What is it? It is a primary care practice that puts together a mix of people, process, and technology so that patients get better care and better customer service.  It also intended to help increasingly burnt-out providers step off the 30 visit a day rat-race and reconnect them to a more satisfying and less frantic patient care model.

 

At the people level, the PCMH emphasizes teams of care providers vs. strict reliance on the physician for all clinical and patient decision making. The teams consist of doctors, PAs, nurses, medical assistants—and even administrative staff. This does not mean that the receptionist is making diagnoses, but rather provides the basis for a more coordinated effort to meet patient needs both before and after the visit. A simple example: a patient is referred to a cardiologist. Did they go? Has the practice received the documentation of the visit? Physicians are not going to track this, but a team member certainly can.

 

At the process level, the PCMH require practices to think about their practices not as a visit factory organized around the availability of overworked providers, but as a patient-centric service center, where it is easy for patients to make last minute appointments and communicate with the care team as question arise.

 

A PCMH also brings an element of practice accountability to patient care: Am I managing my diabetics effectively?  Are my cardiac patients adhering to the recommended meds? This is a distinct switch from the predominant model of reactive medicine to a proactive approach. This can have a big payoff for the management of chronically ill patients that consume much of our health care dollars.

 

It is impossible to implement these people and process changes without technology. The technology centerpiece of the medical home is the electronic health record (EHR), which provides not only a repository for patient information, but can also trigger preventative reminders based on the patient’s condition, plus practical tools such as e-prescribing. The EHRs make the patient record universally available to anyone with access to a workstation—a critical requirement for team based care.

 

While EHRs are very well suited to individual record keeping, they may not be as well suited at looking at populations of patients (i.e. How many of my diabetic patients are well controlled for HgA1c?). To help answer these questions some PCMHs may use a disease registry (more technology) to track patients.  Finally, since patient engagement and easy access to providers is a core element of the patient centered medical home, many are adopting patient portals and secure messaging to provide an alternative to traditional phone and fax communication.

 

Does the PCMH work? At least one study suggests that they do. Research done by Seattle-based Group Health’s medical home pilot (published in Health Affairs in May of 2012) indicated that medical home patients (when compared to patients in traditional Group Health practices) had 29 percent fewer ER visits and 6 percent fewer hospitalizations, with a net savings of about $10 per patient per month. The data also suggest improved patient satisfaction and happier providers.

 

The downside: setting up a PCMH is hard work and expensive (team based care means more practice FTEs per patient). However, the PCMH model that is not going away and is fully aligned with the necessary shift from quantity to quality in American medicine. It is the right approach.

 

What questions do you have?

 

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

To provoke some thinking about what the future holds for healthcare IT professionals—as well as all of us as individuals—there’s  a new TED talk I highly recommend.

 

Intel fellow Eric Dishman, GM for healthcare at Intel, distills his difficult and confusing journey through the healthcare system – and how technology can improve such journeys for future patients. You can see the video here.

 

This talk is inspiring on at least two different levels. It’s inspiring to see how computing innovation can help solve big problems, and make our lives safer and more convenient. And it’s an inspiring story of how human compassion from a stranger saved Eric’s life, giving him the kidney that he needed.

 

In the presentation, Eric demonstrates an example of how patients will be more involved in their own care, something that he has worked on for more than a decade at Intel. He conducts a live online conversation with his nephrologist while, using a handheld device, projecting a live ultrasound image of his newly transplanted kidney for the audience.

 

The talk weaves together three themes of “personal health” aided by new technology and emerging models of care:

 

Care anywhere – the infusion of mobile devices and communications technologies that let clinicians and patients stay on track – beyond wires and organizational walls.

 

Care networking – the shift from solo-based practice to true team-based care. He says, “We have got to go beyond this paradigm of isolated specialists doing parts care to multi-disciplinary teams doing person care.” Eric contrasts the efficient and comprehensive care he received from the kidney transplant team with the scattered and unconnected care he received for many years when no one knew precisely how to treat him.

 

“The sacred and somewhat over-romanticized doctor-patient 1-on-1 is a relic of the past. The future of healthcare is smart teams – and you better be on that team for yourself,” he says.

 

Care customization – the development of a care plan for the individual, taking into account everything from one’s needs and personal wishes to one’s unique genomic variations. He tells the audience how he is living proof that we are living at the cusp of a revolution in personalized medicine. He challenges the medical research community to “experiment on my avatar in software, not my body in suffering,” he says.

 

But he saves the best for last. You need to see how his 15-minute TED talk ties it all together at the end. It’s a tribute to people who make a difference, and an inspiring call to action.

 

What questions do you have?

Below is a guest blog from Mathew Taylor, ICT Solutions Strategist & Architect at Intel Corporation, who will be speaking at next week’s Hospital Cloud Forum in New York City.

 

We live in a mobile world, and healthcare technology is moving in that direction as well. Access to laptops, tablets, smart phones, and electronic medical devices, can play a key role in enabling better care with improved efficiency.

 

Virtual collaborative services, chronic disease management, and patient education are just three examples of how mobility shifts the healthcare delivery model towards higher quality care at lower cost.

 

The ability for health professionals to have remote access from anywhere to health data and to be able to share that data securely with patients AND other providers has great value. The latest personal mHealth app may inspire, but the ability for patients and health workers of varying skill levels to collaborate to achieve coordinated care is needed to support long-term improved outcomes, reducing office visits, admissions, and readmissions.

 

However, mobility requires you to think carefully about your target usage scenarios, like being able to view medical records and imaging data while securely sharing screens. Ensuring devices have the needed performance, security, and manageability to deliver a productive and secure user experience is critical. The 2012 Ponemon Institute survey on Patient Privacy & Data Security shows that the average organization in its study has lost $2.4 million over the last two years due to data breaches, so look for the latest encryption and anti-theft features.

 

So, as you continue to explore the best uses of mobility, educate yourself to understand what devices can best meet your needs. I encourage you to learn how to choose the right mobile point of care device, protect hand-held devices, and protect data on stolen laptops with anti-theft technology.

 

Next week on April 16, I’ll be participating in a panel discussion about mobility. If you are in the New York area, come be a part of the Hospital Cloud Forum at the Union League Club in New York City and sit in on the panel, mHealth: Balancing the Benefits and Risks.

 

What questions do you have about mobility in healthcare IT?

The road to personalized medicine is paved with a whole series of big data challenges, as the emphasis shifts from raw sequencing performance to mapping, assembly and analytics. The need to transmit terabytes of genomic information between different sites worldwide is both essential and daunting, including:

 

Collaboration with research and clinical partners worldwide to establish statistically significant patient cohorts and leverage expertise across different institutions.

Reference Genomes used to assemble sequences, perform quality control, identify and annotate variants, and perform genome-wide association studies (GWAS).

Cloud-based Analytics to address critical shortages in bioinformatics expertise and burst capacity for HPC cluster compute.

Data Management and Resource Utilization across departments in shared research HPC cluster environments, analytics clusters, storage archives, and external partners.

Medical Genomics extends the data management considerations from research to clinical partners, CLIA labs, hospitals and clinics.

 

Most institutions still rely upon shipping physical disks due to inherent problems with commodity 1 Gigabit Ethernet (GbE) networks and TCP inefficiencies. When the goal is to reduce the analytics time from weeks to hours resulting in a meaningful clinical intervention, spending days just to transport the data is not a viable option. The transition from 1GbE to 10GbE and beyond has been unusually slow in healthcare and life sciences, likely due to an overemphasis on shared compute resources, out of context from the broader usage, system architecture, and scalability requirements.

 

Data centers in other industries have been quick to adopt 10GbE and unified networking due to impressive cost savings, performance and manageability considerations. Adopting a balanced compute model – where investments in processor capacity are matched with investments in network and storage – yields significant performance gains while reducing data center footprint, power and cooling costs. Demand for improved server density and shared resource utilization drives the need for virtualization. While I/O optimization historically has addressed jumbo packet transmissions on physical infrastructure, a more realistic test is that of regular packets, comparing physical and virtualized environments over both LAN/WAN traffic conditions. Aspera and Intel are working together to address these critical challenges to big data and personalized medicine.

 

Aspera develops high-speed data transfer technologies that provide speed, efficiency, and bandwidth control over any file size, transfer distance, network condition, and storage location (i.e., on-premise or cloud). Aspera® fasp™ Transfer Technology has no theoretical throughput limit and can only be constrained by the available network bandwidth and the hardware resources at both ends of the transfers. Complete security is built in, including secure endpoint authentication, on-the-fly data encryption, and integrity verification.

 

Intel has incorporated a number of I/O optimizations in conjunction with the Intel® Xeon® E5 processor and the Intel® 10Gb Ethernet Server Adapters:

 

Intel® 10 Gigabit Ethernet (Intel® 10GbE) replaces and consolidates older 1GbE systems, reducing power costs by 45 percent, cabling by 80 percent and infrastructure costs by 15 percent, while doubling the bandwidth.  When deployed in combination with Intel® Xeon® E5 processors, Intel 10GbE can deliver up to 3X more I/O bandwidth compared to the prior generation of Intel processors.

Intel® Data Direct I/O Technology (Intel DDIO) is a key component of Intel® Integrated I/O that increases performance by allowing Intel Ethernet controllers and server adapters to talk directly with cache and maximize throughput.

PCI-SIG* Single Root I/O Virtualization (SR-IOV) provides near-native performance by providing dedicated I/O to virtual machines and completely bypassing the software virtual switch in the hypervisor. It also improves data isolation among virtual machines and provides flexibility and mobility by facilitating live virtual machine migration.

 

Aspera® fasp™ demonstrated superior transfer performance when tested in conjunction with Intel® Xeon® E5-2600 processor and Intel® 10Gb Ethernet Server Adapter, utilizing both Intel® DDIO and SR-IOV. The real-world test scenarios transmitted regular packet sizes over both physical and virtualized environments, modeling a range of LAN/WAN traffic latency and packet loss:

 

• 300 percent throughput improvement versus a baseline system that did not contain support for Intel® DDIO and SR-IOV, showing the clear advantages of Intel’s innovative Intel® Xeon® E5 processor family.

• Similar results across both LAN and WAN transfers, confirming that Aspera® fasp™ transfer performance is independent of network latency and robust to packet loss on the network.

• Approximately the same throughput for both physical and virtualized computing environments, demonstrating the combined I/O optimizations effectively overcomes the performance penalty of virtualization.

 

International collaboration, cloud-based analytics, and data management issues with terabytes of genomic information will continue to pose challenges to life science researchers and clinicians alike, but working with I/O solutions driven by Aspera and Intel, we will get there faster.

 

Read the joint Intel-Aspera whitepaper, Big Data Technologies for Ultra-High-Speed Data Transfer in Life Sciences, for details of the I/O optimization results. Explore Aspera case studies with life science customers. Watch videos about the benefits of Intel DDIO and Intel Virtualization for Connectivity with PCI-SIG* SR-IOV.

 

How do you manage transport of your large medical genomics payloads?  What big data challenges are you working to overcome?

In a 2013 HIMSS global security survey of 674 frontline healthcare workers (Workarounds in Healthcare, a Risky Trend), too many layers of login was cited by 36 percent as a key driver compelling the use of risky workarounds, which are out of compliance with policy, to get their jobs done. An example of a workaround could be a file transfer app on a personal device used to transfer sensitive healthcare data unencrypted.

 

Single Sign-On (SSO) is a natural solution to this, reducing the total number of logins required for healthcare workers to do their job “the right way,” in compliance with policy, avoiding compelling them to resort to risky workarounds. However, as more healthcare systems are integrated behind a single sign-on solution, the risk and specifically the business impact of a compromised set of credentials increases. For this reason single-sign on is often combined with stronger multi-factor authentication.

 

A key take-away from the HIMSS survey is that usability is more than a “nice to have,” directly impacting non-compliance and risk. BYOD, social media, apps and other trends are empowering healthcare workers with more tools than ever before, and this research shows that if IT departments, solutions or security gets in the way, healthcare workers can and do use workarounds to get their job done.

 

Usability issues with multi-factor authentication, and specifically separate hardware tokens are well known. People lose them, break them, don’t like them (especially if they need multiple of them), and separate hardware tokens are often associated with increased TCO (Total Cost of Ownership) due to support and provisioning costs. Intel® Identity Protection Technology provides a strong 2-factor authentication solution without a separate hardware token, thereby avoiding the usability, support and TCO issues with separate hardware tokens.

 

The “what you have” in this case is the Intel® IPT capable mobile device that gets provisioned by the healthcare worker as a secure terminal for accessing healthcare solutions and sensitive patient information. Here’s how this works: in the event that the healthcare worker’s username/password credentials are compromised, and an impersonator tries to use these stolen or lost credentials to access the healthcare solution, the login will fail and they will be blocked since they don’t have the Intel® IPT capable mobile device that was previously provisioned by the healthcare worker as a secure terminal.

 

Combining SSO with Intel® IPT combines both the usability benefits of a reduced number of logins, as well as the usability benefits of a multi-factor solution that does not require a separate hardware token, for a stronger and more usable healthcare security solution.

 

What issues are you seeing with too many layers of login in your healthcare organization, and are you looking at single sign on solutions with multi-factor authentication?

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 www.meetgreenway.com.

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.

 

HIMSS_2013_Banner.jpg

Healthcare workers are increasingly being empowered with many powerful technologies, from BYOD, to social media, texting, and even personal email and USB sticks that have been around for a while. These tools provide new options to healthcare workers to get their jobs done.

 

Download a new white paper on risky security workarounds

 

Where healthcare solutions or security get in the way, or IT departments are perceived as being slow or overly restrictive, healthcare workers often use these options in workarounds that achieve the immediate goal, perhaps transferring a patient record unencrypted to a co-worker using a file transfer app on a personal device, but often add significant risk from a privacy and security standpoint.

 

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 (22%), or sometimes (30%). In a recent blog series, we shared some early highlights of this survey including what is driving the use of workarounds, what specific types of workarounds are being used, and where privacy and security is challenged.

 

Download the white paper with many more details on the results of this survey and what they mean. Learn practical strategies for how to mitigate risks associated with workarounds, within a holistic, multi-layered approach:

1. Improving usability of solutions and security,

2. Improving responsiveness and agility of your IT department,

3. Choosing the right device, compute model and communication method for your tasks,

4. Improving the effectiveness of your administrative controls including policy, enforcement and effective training.

 

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