National Health IT Week: Where will we be in 5 years?
Imagine the state of healthcare and healthcare information technology in five years. What will it look like? Will healthcare provide more – or less – value? Will care be better coordinated? Will patients be more engaged? What about interoperability?
Those were just a few of the complicated issues a panel at the HIMSS Public Policy Summit tackled Wednesday in the nation's Capitol as part of National Health IT Week, observed each year across the country.
Michael Zaroukian, MD, vice president and CMIO at Sparrow Health System in Lansing, Mich., the moderator for the panel, opened with the five-year question, and Brian Jacobs, MD, vice president, CMIO and CIO of Children's National Health System in Washington D.C., took it on.
"I think we're in an unprecedented time now," Jacobs said. "We've converted a lot of our paper-based, inaccessible data and information – essential health data – into information that can be harvested to start to address all of those unique opportunities that we have to improve."
For example, he said, the data might be used to identify the deficits in a patient's preventive care, to improve the outcomes for a group of diabetics, or indeed, any group or population.
[See also: HIMSS names National Health IT Week award winners.]
"There's a lot of work ahead of us," he warned. "The information has to be integrated into the workflow of doctors and nurses, and it has to be data that's actionable."
Over the last decade, healthcare evolved the technology, implemented it and got docs and nurses to use it, Jacobs noted.
"But we didn't necessarily think in 1999 or 2002 about transforming that into value that's going to be actionable," he said.
Pat Wise, RN, and vice president, healthcare information systems at HIMSS, knows a thing or two about value. At HIMSS, she is responsible for directing initiatives that use technology to drive the quality, efficiency, effectiveness and safety of patient care. Also, Wise leads a group working on fine-tuning the HIMSS Health IT Value Suite, which HIMSS describes as "a comprehensive knowledge repository that classifies, quantifies and articulates the clinical, financial and business impact of health IT investments."
"It was not that many years ago that we went to organizations and they were proudly telling us that they had hit the 75 percent mark or the 80 percent mark in e-prescribing, or that they had conquered CPOE or that they had conquered documentation," Wise said.
Cutting edge organizations were proud to call attention to the functionality of their technology, she recalled.
"Indeed, that was often more than enough to win them an award," she said. "We've moved, in a short period of time, so much beyond that. Now when we go to potential Davies Award winners, they're talking to us about what they found in the data – how they used the data to drive quality, how they optimized the care."
[Related: HIMSS names two new Davies Award winners.]
"We're no longer talking about the success of the functionality," Wise said. "We're talking about optimization."
Moderator Zaroukian asked the panel for public policy suggestions that might help patients to engage more with their data and also to consider provider engagement.
The upshot: There has to be more to engagement than patient portals. Providers are finding it difficult to engage many of their patients, especially via portals.
"Patient engagement, yes; how to get there? Challenging," said Jacobs, of National Children's Hospital. "In our own environment, we're seeing the challenges every single day. Certainly, it's something we're going to have to do better."
"What are we going to do to manage the issues around the elderly that can't master the technology, the pre-verbal child, the mentally ill, the patient that has developmental delay?" he asked. "These are real problematic patients in our population who, when we try to engage them, we struggle. When we try to engage them through their family members, we sometimes struggle as well."
"I think that reaching the patient where they are is an important part of it today," said Leslie Kelly Hall, senior vice president at Boise, Idaho-based Healthwise, a not-for-profit organization with the stated mission to help people make better health decisions.
"This is an evolution."
Von Nguyen, senior advisor at the Centers for Medicare and Medicaid Services' Innovation Center, introduced the notion of "warm handoffs," the idea that providers help one another better care for patients by making sure they share information, making sure that vital information isn't lost from provider to provider, between primary care provider and cardiologist, from hospital to health center, or back to the hospital.
"The world we're moving into is less about warm handoffs and more about painless integration," he said. "It's about continuously coordinating care for the patient."
"We have so many venues of care," Jacobs said, and it's not just the clinic. It's not just the hospital or the emergency department. It's the home, it's the school, it's the workplace, it's the wearable device."
As he sees it, the data is overwhelming, and it's dirty. "It has quality issues," he said. "Omitted data, redundant data, data with different units – the weight that's measured in kilograms and the weight that's measured in pounds. The movement of that data around systems and the availability of it, while critical for diagnosis and treatment, present some real challenges there. So, interoperability, standards, integrated systems are really very, very important for a clinician, for a patient for an administrator to be able to understand where those opportunities are to improve the health of the individual or the group."
So, while there are many challenges on the interoperability front, Jacobs said, overcoming them is critical in moving forward.
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