A notable year for IT advancements
Each month in this space, we speak to HIMSS Analytics Executive Vice President Hoyt and HIMSS Analytics Senior Director of Research Jennifer Horowitz to get their perspective on provider uptake of health IT. From basic EHRs to advanced clinical and business analytics, the industry has made huge strides in the past five years or so, and this most recent year was as eventful as any.
In January, we asked Hoyt kick off 2014 to take part in a lightning round, of sorts, offering quick assessment of where healthcare is – and where it needs to be – with regard to each one.
With ambulatory EHRs, "We still have a long way to go. We are just at the very beginning. And that's where there's some world leadership that the U.S. needs to listen to. Especially to the small countries that have wealth, such as Singapore.
"We all know that some 80 percent of the volume of healthcare consumption takes place on the ambulatory side. What they've done – and this is part of their culture; they've got less entrepreneurialism in medical care delivery, and more of a government or corporate influence; frankly we're moving in that direction as hospitals buy practices, and we're positioning ourselves to be more like them and take advantage of economies of scale. But ambulatory EHRs need to get out there more ubiquitously. We're low on that."
As for inpatient EHRs, "I think the most prominent change in 10 years is that medical staff has become – or is about to become – highly active users," said Hoyt.
Later this year, Hoyt had a bit more perspective on hospital EHRs – specifically the huge difficulties so many organizations were having using them to meet meaningful use measures.
When the year dawned, "I was more optimistic," said Hoyt. View/download/transmit and transitions of care are the most notoriously difficult measures, of course, but many providers are also reporting trouble with electronic clinical quality reporting.
When they do it electronically, their success percentage is lower than if they do it electronically and also do chart abstraction, according to anecdotal evidence gathered by HIMSS.
"That tells us that their system is not collecting the data that they need to report," said Hoyt. "And if they're not totally automated they can go find it on paper. So that is either a) a vendor issue, or b) an implementation and process redesign issue."
When it comes to health information exchange? "Continuing struggles. We recognize the importance of it, and frankly I'm very happy that the stimulus program includes HIE. But we continue to struggle and we can not take our foot off the pedal of that."
And the interoperability so essential to that data exchange? “Same thing,” said Hoyt. “And the federal government's role, I think, has been appropriate: Stimulate the industry to develop and implement standards."
One exciting area of early progress is analytics. "We're at the beginning. We have now gotten to the point where the early adopters and the advanced organizations are collecting huge sums of data, and we're just beginning to become skilled at using the data to improve quality safety and efficiency,” said Hoyt.
Hospitals of all shapes and sizes should be making more advanced use of their data, but it doesn’t have to be “Star Wars,” he added. Since the great EHR implementation wave of the past five years, "you've got data that you've never had before,” even in the smallest critical access hospital. “Are you analyzing it? Are you finding anything profound?”
It's incumbent on providers to start making the most of it, says Hoyt. "We now have the data," he says. "We have the responsibility to begin using it."
One smart use of analytics is to bolster clinical decision support. “That subset of the industry has had some interesting changes going on,” said Hoyt. “I've noticed when I do these Stage 7 visits over the past two years, I ask them, do you use – and I mention a couple brand names – and more than two out of three times, the big places, notably Epic clients, say, 'Nope, we don't use them any more. We used to, but we've got the skills in-house. We don't need to pay $50,000 a year for order sets, we can build them ourselves.
“We all expect the systems to give us clinical advice. But other than pharmacy, which is a necessity, I'm getting a sense that the bigger organizations, for order sets and protocols, are saying, I don't need to pay that kind of money,” he added. “Which was not always the case. When I was a CIO, I remember buying all that stuff and putting it on PCs.”
With regard to mobile health, “it’s exploding,” said Hoyt. “And it's a challenge for the CIOs, with bring your own device and security. But clearly it has a public health benefit, and clearly it has third world implications that we aren't even thinking of; when you hear these people who have been to Africa, which has sort of skipped the landline phenomenon and gone straight to mobile, I think it's very, very helpful for underdeveloped nations.
As for imaging, “We're at the saturation point, and clearly at the expectation point,” said Hoyt of the PACS market. “Making film is just ludicrous."
In another conversation on the same topic later this year, he said, "I think we of course have a saturated market, and I think the activity, if it's occurring, is driven out of mergers and acquisitions," says Hoyt. Where new system replacements are happening, that's because "two systems merged and they had two different PACS and they eventually consolidated into one."
The other big trend for image management, of course, is vendor-neutral archiving. “People don't want to have two different vendors (for viewing non-DICOM images),” said Hoyt. “I think VNAs are going to pick up and eat into some of the traditional PACS market."
And when it comes to privacy and security – a benchmark that affects nearly every type of health IT, "We're treading water, but mobility is adding a new layer of stress,” said Hoyt. “One new phenomenon that we weren't even talking about 10 years ago is patient involvement in chronic disease management, enabled by technology. Patient portals, etc. That's a whole new subject that wasn't even on the agenda 10 years ago."
Another new wrinkle is cybercrime, which has increasingly set its sights on the healthcare industry.
"My biggest concern is that there are just so many more threats against our space," says HIMSS Director of Privacy and Security Lee Kim. "Hackers have been in the news, and all the various breeds of malware that have been cranked out, programs that can build customized malware to a specific target … the worry is that there are so many sources of threat intelligence that need to be scooped up from various sources."
The good news is that a HIMSS survey from earlier this years shows that basic security technologies are pretty well-ensconced at most hospitals. Single sign-on authentication may still has some ground to make up – installed at 48.9 percent of providers, compared to 46.9 percent who don't have it – but it's gained a considerable foothold since 2009, when barely more than one quarter of facilities (26.3 percent) were making use of it.
As for other protections, such as firewalls and spam/spyware filters, majorities of hospitals have them in place: 89.3 percent and 85.2 percent, respectively. Even encryption, – which has long been underused in healthcare for such a relatively simple safeguard that's so commonplace in other industries – shows impressive, some might say surprising, uptake: 78.1 percent of hospitals use it, versus 20.5 percent who don't.
The value of technology to safeguard privacy and security is obvious. But for other species of health IT, gauging that value can be an elusive business. There's been a whole lot of capital invested in health information technology these past few years. And some people – especially those in charge of spending more of it – want to know whether it's money well spent.
"People understand that IT can create value,” said Hoyt. The catch? "It's not automatic."
This year, we discussed HIMSS’ Health IT Value Suite, a trove of quantitative and anecdotal data meant to help healthcare stakeholders assess technology's value. Its 1,000 case studies are meant to offer evidence that health IT works – even if the notion of value could have 80 different meanings.
That fact is illustrated by the Value Suite's STEPS taxonomy – the acronym stands for satisfaction, treatment/clinical, electronic information/data, prevention/patient education and savings – which lays out dozens of documented real-world examples of the myriad ways health IT has led to improved care and financial gains.
One of the challenges, of course, is that different types and different sizes of providers arrive at value in different ways. A fully tricked-out academic medical center is in a different position, after all, than a tiny rural physician practice.
"The leading-edge institutions are investing the effort to measure before they implement and after they implement, and they've got demonstrable evidence," says Hoyt.
"Quality has a measure of value, financially, but it's harder to derive," says Hoyt. "It's not mathematical. That's why we use the term 'value,' and not ROI."