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.
It is no secret that health systems are under intense pressure to deliver better outcomes at lower costs, and standardizing acute care workflow will only carry providers so far. Truly moving the needle on cost and outcomes will require a fundamental redesign in care delivery; otherwise, health systems may well find themselves left out. Care keeps shifting to environments in which hospitals have less influence: what was once critical care can now be managed in an in-patient unit; what was once in the hospital is now in an office; what was once in the office is now at home.
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.
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.
The pace of mHealth innovation shows no signs of slowing down. New technologies are not only improving the lives of patients, but also empowering clinicians. However, healthcare is a highly regulated space dominated by major vendors, and it is vital that the regulatory environment keep up with the changing world. Specifically, it’s time for the Department of Health and Human Services (HHS) to take a fresh look at the Health Insurance Portability and Accountability Act (HIPAA) to ensure it better fits today’s mobile world.
Current HIPAA guidelines – while critical – need to be revised to support smaller companies that can transform the space. Leading app developers across the industry are working together to seek clearer guidelines that will encourage innovation. The App Association recently joined with AirStrip, CareSync, and other mHealth companies urging government representatives to look at this issue so we can better align our practices with theirs and together work towards the goal of improved patient care.
The Office of the National Coordinator for Health Information Technology (ONC) just released what it calls “A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.” The directive generating the most attention calls for “a common set of electronic clinical information…at the nationwide level by the end of 2017.” According to ONC, the common data set would consist of about 20 basic elements, such as patient demographics and lab test results.
At first blush, the ONC directive is a small step in the right direction, but sets the bar awfully low. Rest assured that vendors will consider 20 basic elements the maximum data set, not the minimum. A more effective approach would, for example, specify vocabularies (LOINC, RxNORM), document types (JSON, XML) and transport mechanisms (HTTPS or other TLS) to be used when sending or receiving data instead of focusing on the data elements themselves.
The key to successful health care technology is making sure it improves both the patient experience and the quality of care. While technology is sometimes seen as a barrier to human connection and interaction, the right tools can transform the health care experience for the patient. At Dignity Health, our focus for 2015 is centered on making population health a reality by looking toward the ambulatory side of care. The mobility strategy we put in place in 2014 is enabling us to empower our providers and care teams with telehealth solutions so they can have alternate ways to connect with and care for their patients.