Embracing Security Challenges

 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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What stage of “Meaningful Interoperability” are you?

interoperable-600x300The 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.

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Harnessing the Power of Big Data with Digital Health Partnerships

KWard_dataIn today’s digital world, electronic patient data is growing exponentially and moving faster than healthcare organizations can imagine.  At the same time, clinicians suffer from information overload, and high-volume and increasingly complex clinical patient loads, alongside dwindling time and resources.

Now more than ever, the pressure is building to harness the power of big data and digital technologies to help clinicians make faster, patient-centric decisions that increase quality of care and enhance health outcomes all while decreasing costs.

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Data, Data Everywhere and Not a Drop to Drink

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

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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The Partner Approach to Implementing Change

imagesTechnology is created and designed to make life simpler. For physicians, mobile technology offers the ability to review data more immediately and conveniently. It also helps provide the patient with better, more holistic care. All sounds great, right?

Almost.

Implementing any change in an organization is tricky. It requires effort from all parties involved to transform the “new thing” into “the norm.” Physicians need to see the value of the solution and be encouraged to use it regularly. The vendor needs to tweak its solutions to meet the needs and expectations of the customer. And the customer needs to adopt new workflows to support the technology. It’s a cycle of trust, encouragement and adjustment.

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The Promise of Mobility: A Cardiac Surgeon’s Perspective

ImageWhen I talk to fellow clinicians at Sequoia Hospital who are now using mobility to monitor labor and delivery patients, or view ECGs in near real-time, the reactions are uniformly positive. They praise the ability to make faster, informed assessments based on the information they access on their smartphones or tablets and the workflow improvements.

However, from a surgeon’s point of view, the most exciting developments are just starting to happen. Incorporating mobility throughout the cardiac care continuum and providing constant monitoring of patients anytime or anywhere is the real game-changer. Because we are most interested in the total care of the patient, continuity is crucial – and mobility enables this in ways that were never possible before.

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Making it Real: A Physician’s Pathway to Clinical Transformation

PathwayEveryone in the industry would likely agree that “clinical” or “care transformation” has been a popular buzz-term for the past several years. Most also agree that interoperability barriers and data silos need to be broken down to achieve it. But there are several issues that are critical to improve the way physicians work before hospitals and health systems will see the kind of transformational change that’s necessary to make the most of technology enhancers while preserving the human element of patient care. Continue reading