Tag Archives: clinical integration

Telehealth Brings Non-Stress Tests to the Home

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Non-stress tests (NSTs) are the current standard of care for monitoring high-risk pregnancies. Intended to reduce the risk of stillbirths, these tests are for those who have one or more risk factors, whether they be maternal, fetal or obstetric complications.

Currently, these tests can be very time-consuming for patients. NSTs involve attaching the mother to fetal and contraction monitors to watch the fetal heart rate tracing and uterine activity. However, many rural and remote areas don’t have ready access to NSTs. Consequently, mothers sometimes travel up to several hours each way to get to our facility for their NST appointments once or twice a week. Once they arrive, there’s the usual wait time, the 30-60 minute testing process, plus an additional wait time for the test to be interpreted by a staff member and a clinician. These appointments, on top of any additional prenatal visits the mothers have scheduled, can therefore add up to a considerable amount of time, even for patients who live nearby.

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Why 2015 is the Worst Time to be a Physician

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With the ONC’s recent release of their 10-year interoperability vision, it might seem like the industry is starting to make things easier for clinicians. In reality, 2015 is starting off to be one of the worst times ever to be a physician. Interoperability is a critical issue to support a transition from fee-for-service to value-based care. Physicians will eventually be reimbursed around their ability to impact clinical outcomes, so the need for clinically relevant information at their fingertips is mission critical.

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Creating a Friendly Environment for Adoption of Clinical Decision Support

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In recent years, our ability to stream large amounts of data in real-time has improved dramatically. This enhancement can transform how clinicians offer care by sourcing unprecedented opportunities for clinical decision support. However, the capability to process, store, and display data in and of itself does not transform care. Rather, it is how the clinicians adopt and apply decision support that will make all the difference to patients. However, the current environment must be altered to create a clinical decision support-friendly climate.

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Embracing Security Challenges

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 Over the past year, the perception of mobile technology in healthcare has changed dramatically.  mHealth is now being recognized as a tool that can help address the challenges our healthcare system is facing, including a shortage of caregivers, an influx of newly insured patients, decreased reimbursements and readmission penalties.  Historically, there have always been barriers that kept hospitals from making the leap to mobility – lack of infrastructure, costs, or the fear of security breaches, among other reasons. Yet as mobile technology becomes deeply ingrained in our day-to-day work and social lives, healthcare is following suit and migrating toward mobility as a component of care delivery.

However, concerns about security remain at the forefront.   According to data from the Department of Health and Human Services (HHS), more than 41 million people have had their protected health information compromised in a reportable HIPAA privacy or security breach.  Additional data from the 2014 Healthcare Breach Report from Bitglass suggests that 68 percent of all healthcare data breaches are due to device theft or loss and 48 percent of breaches involve a laptop, desktop or mobile device.

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Data, Data Everywhere and Not a Drop to Drink

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Clinicians want two things from data. On an individual patient level, they need to be able to see the data whenever and wherever they want – in a clean at-a-glance format and with essentially zero lag time. And at a cohort (population) level, they want the data presented as meaningful information in a way that enables conclusions, decisions, and actions about a group of patients.

These statements may seem like self-evident  Data 101 to many of you, but in my decades of experience working clinically as an emergency physician and being responsible for operations of multiple emergency departments, it is clear that we have not delivered on this vision. In fact, the healthcare world lags other industries by 15-20 years in the availability, presentation, and use of information. Although our industry is catching up, there is still more effective use of information technology in banking, aviation, on-line retail, and a multitude of other industries. Even though many of the concepts of optimum presentation and use of data have been around for decades – the quest for electronic health records began in the 1980s – their breadth of execution and the realization of their value propositions have not been sufficient to become the norm. Healthcare has moved at a glacial speed of change, at least until recently.

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The Evolution of Health IT

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Health IT is often considered a silent partner in healthcare – not seen by patients, but a critical part of the system. As we celebrate National Health IT Week, it’s important to realize that although health IT already has a long history, the constant and rapid evolution of this space continues to transform the market. Information has been collected and stored for years, but the promise of clinical decision support has us at the cusp of all this information becoming valuable in new and innovative ways.

Just a decade ago, I was documenting patient encounters in paper charts. Although the transition to electronic medical records (EMRs) has been perceived as slow, in the grand scheme of medicine it actually happened almost overnight. These systems were not designed with our continuously changing workflow in mind, with user interfaces and workflows that aligned to our practices. They served as repositories for patient information, but did little else. In fact, our workflow changed to support the EMR, sometimes to the detriment of the patient. Instead of focusing directly on the patient, we often must split our time and attention between the patient and the computer terminal.

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Staying Ahead in a Technology-Driven Field

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Since patient care and well-being is at the center of Rockdale’s mission, attracting the best and brightest clinicians in the region is an important effort for us. Part of distinguishing ourselves from our competitors is providing the resources and advanced technological support clinicians want. In fact, to support this shift, we formed the Information Technology Physician Engagement Group in 2013 to identify exactly what were the technology priorities for our physicians:

  • Improved cellular service
  • Improved physician Wi-Fi
  • Single sign-on access
  • Mobile technology for better efficiency

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Cerner/Siemens and Blue Shield/Blue Cross: What Happens Next?

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The industry is buzzing over the news that Cerner is buying the health information technology business unit of Siemens. The Siemens acquisition is the most recent high-profile example of consolidation that is taking place in all sectors of healthcare.

The consolidation trend is not new, of course. Providers reacted first, by aligning as Accountable Care Organizations (ACOs) and clinical integration (CI) networks during the past five years. Then the passing of the Affordable Care Act (ACA) accelerated the need for collaboration, forcing providers to acquire additional acute care and post-acute care facilities as well as physicians’ offices. This consolidation trend was the first to expose the obvious lack of interoperability amongst vendors.

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CommonWell Health Alliance – Big Stride or Baby Steps?

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baby-steps1You’ve all heard my thoughts on mobility as the critical lynchpin for healthcare to achieve true clinical transformation. And, that one of the longest standing and most stubborn barriers to mobility is the lack of true interoperability across systems and devices from multiple vendors in any health system.

So during HIMSS13 back in March, I was interested to hear that some EMR vendors were joining together in the CommonWell Health Alliance to integrate their systems. It was encouraging to see these EMR vendors talk about opening up and becoming more compatible with each other – something that health systems have demanded, but that vendors’ proprietary attitudes and competition for market share have prevented. Like most of the industry, I’ve been curious to see how the Alliance would unfold and if the outcome could be experienced immediately since healthcare organizations cannot afford to wait. The need for action is NOW. Continue reading →

Are We There Yet?…Almost

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Road_14The interoperability challenge has plagued hospitals and health systems for longer than any of us care to admit. The topic still elicits eye-rolls and cringes from everyone from health care reporters to CIOs – and who can blame them? The industry has largely over-promised and under-delivered when it comes to vendors “playing nice in the sandbox,” integrating systems and making data across the continuum available in a simple and cost-effective way. Continue reading →