lessons in health it - northeast ohio hfma · 2019-02-20 · lessons in health it john paganini,...
TRANSCRIPT
HIMSS’s Strength in Innovation
• 52 years of global health IT leadership
• Unmatched convening power
• Highly-credible and respected thought
leadership, tools, resources, and
publications to equip all in their
transformational role
• The recognized international leader in
interoperability, standards, and
harmonization initiatives
•Serves as an international Center of Excellence
•Enables innovation that improves the value of information technology in healthcare
•Convenes industry stakeholders to solve real-world clinical workflow and financial transactional challenges
Components of the HIMSS Innovation Center
• Technology Showcase
• Conference Center
• Bookstore/Resources
• Welcome Center
• Immersion Theater
• Learning Center
Interactive Health Journey
HIMSS Mobile Application
Marketing Exposure and Product Visibility
HIMSS Marketing and Ad Campaigns
HIMSS Websites
Technology Showcase
• Connects Technology Innovations with Healthcare Industry
• Designed to Enhance Discussion and Extend Education
• Establish Awareness and Visitor Connections
• Collaborator Demonstrations
– Year Round
– Attended or Unattended
• Exhibition Environment
• Collaborator Exposure and Visibility
• Beacon Technology Facilitates Lead Management
Conference CenterHost meetings of up to 150 people in the epicenter of innovation
Fully wired audio/visual environment. Splits into 3 separate rooms.
Immersion Theater
Describes the Importance of Health IT
Highlights Collaborator Products and Services
Theater messaging can be customized for Events and Meetings
What‟s your point-of-view?
Make a choice to start.
Healthcare Consumer
Healthcare Professional/Provider
Health IT Vendor
Academic
Government
LEFT SCREEN
CONSOLE SCREEN
RIGHT SCREENCENTER SCREEN
Looping pictureHealthcare Professional story
Healthcare
Professional/Provider
Looping picture
Interoperability & Standards
Select a HOT TOPIC and learn
how it effects your point-of-view.
Interoperability & Standards
Health Business Solutions
Privacy & Security
Patient Engagement
Analytics
LEFT SCREEN
CONSOLE SCREEN
RIGHT SCREENCENTER SCREEN
Looping pictureLooping picture
Healthcare
Professional/Provider
Interoperability & Standards story
CONSOLE SCREEN
HIMSS Innovation Center infrastructure and services to advance interoperability
Technical
Demos
IHE USA Certification
HIMSSInteroperability
Services
Host Toolsets for Custom testing projects
Plugfests, and “hack-a-thons”
HIMSS Interoperability ShowcaseTM
Technical Support
EMR, HIE and HISP vendors
Patient Care Devices Vendors
(Infusion Pumps)
Special
Projects
• Neutral Environment for Testing and Certification
• IHE USA Certification Program
• „Newly Branded‟ Interoperability Certification Program (IWG)
– launching at HIMSS15
• Gazelle and other Open Source Tools (e.g. EMR)
HIMSS Interoperability Services Program
Privacy and Security
Information security and patient privacy are fundamental components of a well-functioning healthcare environment.
HIMSS provides resources to assist healthcare organizations and business associates with their privacy and security initiatives.
Privacy and SecurityPrivacy and Security is one of the first and most crucial steps in expediting care in Sara‟s health journey.
When the ambulance arrives at the scene, EMTs quickly access Sara‟s condition and call ahead to the Emergency Department to let them know that Sara Brown, a 45-year old woman, was coming in with stroke symptoms. A consent form, signed by Sara, allows hospital admissions to use a Health Information exchange (HIE) to request Sara Brown‟s medical information. Now, with Sara‟s consent, all of her correct vital information and patient records are present in the Emergency Department Electronic Medical Record before she even arrives.
Since Sara‟s vital information is only entered once the results is: reduced errors, increased patient safety and improved quality of care.
What does Cyber look like now?
• Hacktivists
• Nation state actors (e.g., N. Korea, China, Iran, Russia,
etc.)
• Malicious & negligent insiders (a complex problem)
• Destructive malware (not just adware)
• Mainstream media & trade press reports
• Hollywood
– Movies & TV
The Evolving Threat Space
Threats
- Multi-dimensional
- The equation to be solved is
complex
– Malicious insiders + phishing
attacks + nation state activity
Occam's Razor
The scientific principle that, all things
being equal, the simplest answer is
usually the right one.
When trying to explain or prove
something, we should refrain from
making more assumptions than are
necessary.
The Evolving Threat Space
Occam’s razor
– Unencrypted data
– Very weak passwords
– Unsecured wireless connections
– Significant, well-known vulnerabilities + effective exploits
– Phishing (exploit the human)
– Elicitation (befriend the human)
– Aging IT infrastructure (exploit the tech)
Pathways to Solutions
Public-private partnerships
– Secure the human & technology
– Know & predict the threats
– Cross-sector engagement
– Work with the government
Innovation
– Stay ahead of the threat with automation/AI
– Current threats, predicted threats
Train & prepare for the event (even if it never happens)
Cyber Threat Intelligence in Health Care
As a result of these sophisticated cyber threats, health care
organizations are realizing that their current cybersecurity
programs are not sufficient to prevent, detect, respond and
recover from the current level of cyber attacks.
Healthcare organizations are working hard to make needed
improvements. One resource healthcare organizations
should make use of is cyber threat intelligence (CTI).
Lee Kim JD, FHIMSS
Cyber Threat Intelligence in Health Care
Specific, detailed, actionable data about cyber
threats, cyber threat actors, malware, vulnerabilities,
and indicators of compromise (IOC).
Simply put, cyber threat intelligence is all about
helping the healthcare organization improve its
security posture based on accurate, detailed
information on the current cybersecurity threats.
Lee Kim JD, FHIMSS
Cyber Threat Intelligence in Health Care
In light of increasingly sophisticated cyber
threats, healthcare organizations should evaluate the
effectiveness of their cybersecurity program and make
improvements where appropriate.
Consider how cyber threat intelligence can help your
healthcare organization to improve the ability to prevent,
detect, respond and recover from cyber attacks.
Lee Kim JD, FHIMSS
Health Business Solutions
Identifies and promotes the effective use of financial and administrative systems for healthcare organizations.
Health Business SolutionsFinancial management of healthcare is an important concern for Sara and her family.
In addition to worrying about Sara‟s care, Mike wanted to ensure they could manage the financial costs. Through Health Business Solutions the hospital was able support Mike and Sara by getting them real time financial information on the costs of the care she was receiving.
Helping the family finding financial solutions allowed them to focus on Sara‟s healthcare and not the cost.
Health Business Solutions CommitteePurpose Statement
Health Business Solutions Committee identifies and promotes the
effective use of financial and administrative systems for healthcare
organizations. Building on the historical work of the Medical Banking
and Financial Systems Committee, the Committee will work
collaboratively with others to understand and define the points of
intersection of finance and administrative systems across the
healthcare continuum.
Health Business Solutions Areas of Focus ICD-10: Concentrates on the development of tools and resources (ICD-10 Playbook)
that will equip HIMSS membership with preparation for and implementation of ICD-10.
The targeted HIMSS audience for these tools may include but is not limited to
ambulatory providers, hospital/enterprise providers, payers, software vendors and
clearinghouses. .
Financial Privacy and Security: Examines the current deployment of risk
management and security controls within the financial services industry and analyzes
how these could be leveraged to facilitate the nation‟s goals for eHealth.
Revenue Cycle Improvement: Create a vision for the next generation of revenue
cycle management business processes and tools that will keep administrative cost
containment, interoperability and consumer engagement front and center. Task Force
members include a cross-section of representatives from provider organizations, payer
organizations, financial institutions, retail clinics, and a variety of revenue cycle
vendors and consultants.
Patient Engagement
Patients can take control of their health and health information by leveraging capabilities and connectivity of a personal health record and utilize the work of an alliance of health device manufacturers.
Patient EngagementUnderstanding her medical care and treatments was an important step in making the right healthcare decisions for Sara and Mike.
While Sara was recovering in the hospital Mike, with Sara‟s permission, was following her care through an app on his iPad. Through a private and secure patient portal, Mike was able to see her labs, tests, and plans of care through the hospital stay.
When it was documented that Sara was allergic to a medication, Mike was able to correct it quickly, which helped keep the record accurate. When Sarah went home, they shared the patient portal with their primary care provider to collaborate on Sara‟s recovery path.
Healthcare providers working together with Sara and Mike contributed to a quicker recovery time and a better outcome for all.
Consumers are Demanding a LOT from Health IT
•Cloud access to their detailed patient records
•Email accessibility to their providers and staff
•Ability to use their personal health record (PHR)
Control access
Maintain records
Import data from pharmacy and labs
Pay bills
This is our goal, is it happening now?
Friend is being treated at two health systems,
both have the same EHR, PHR
• When he logged into the second PHR, it prompted him, asking if he
agreed to integrate his two medical records. He agreed.
• The next time he saw his specialist at the first facility, she noticed that
his records from the other system had been integrated into his record
• Lessons:
– Health information exchange (HIE) works
– Should be driven by the patient‟s consent
– Leads to a more engaged patient
– This is what Meaningful Use is about
Patient Engagement Further Defined
We define engagement as
“actions individuals must take to obtain the greatest
benefit from the healthcare services available to
them”
This definition focuses on behaviors of individuals
Relative to their healthcare
That are critical and proximal to health outcomes
Rather than the actions of professionals or policies
of institutions
Meaningful Use Stage 2
• Provide patients the ability to view online, download and transmit their
health information within four business days of the information being
available to the EP (for EPs only) More than 50% of all unique patients seen
by the EP are provided timely online access to their health information
• Provide patients the ability to view online, download and transmit their
health information within 36 hours after discharge from the hospital (for
Eligible Hospitals/CAHs only)
• Use secure electronic messaging to communicate with patients on relevant
health information (for EPs only) More than 5% of all unique patients seen
Patient Engagement fit with Strategy
New Payment Models
•Patient Centered Medical Home
•Accountable Care Organizations
•To achieve these successfully, patient engagement essential
•Patient Engagement is key to
Meaningful Use Stage 2
•Reaching the 5% participation threshold is a
challenge
• Integration of patient engagement into a
strategic initiative is the key
•There is growing evidence that patient
engagement impacts medical outcomes
Interoperability
HIMSS is continually working to provide crucial tools for achieving interoperability and implementing standards in all areas of Health IT integration, including clinical and non-clinical information.
InteroperabilityHealth information exchange was an important factor in ensuring the right information was available to all providers working on Sara‟s care.
The hospital Sara was admitted to had implemented standards in all areas of Health IT integration, including clinical and non-clinical information. This infrastructure allowed for a seamless flow of information between physicians, hospital systems and Sara‟s own electronic medial record.
Health IT interoperability help Sara and her doctors achieve crucial health information exchange.
The Connected Healthcare System
http://3.bp.blogspot.com/-fmSY89ejjUY/TpenyfestBI/AAAAAAAAA7s/Y7slQnSh8HI/s1600/20101205-0873LKFHC10_creationnation-S.jpg
Interoperability Defined
In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.
For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.
Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor.
“Foundational” interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.
“Structural” interoperability is an intermediate level that defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered.
“Semantic”interoperability provides interoperability at the highest level, which is the ability of two or more systems or elements to exchange information and to use the information that has been exchanged.
Interoperability and standards ensures that your
health information moves seamlessly and in a
standardized manner between all of your
healthcare providers.
Your information follows you wherever you go, allowing your provider to have the
right information at the right time to make informed
clinical decisions.
CONSUMER
Interoperability aims to create a common framework
for information sharing designed to optimize clinical workflow and improve patient
care.
Electronic health record systems implemented using interoperable technology and
standards can streamline your flow of clinical
information, reduce errors and improve efficiency.
PROVIDER
Interoperability product testing and certification
programs will enable you to achieve optimal levels of
interoperability, accelerating the alignment of healthcare
provider needs with regulatory requirements.
VENDOR
Source: http://www.himss.org/files/images/room.png
The Connectathon
Source: http://www.himss.org/files/images/room.png
An IHE Connectathon is a cross-
vendor, live, supervised, and
structured testing event with over 100
participating vendors and 600+
engineers and IT architects. All these
organizations and IT experts converge
on-site in Cleveland, OH, for one full
week of interoperability testing and
problem resolution. Participants test
their products against multiple
vendors using real-world clinical
scenarios contained in IHE's
Integration Profiles.
IHE NA Connectathon
Moves to Cleveland, OH
http://m.19actionnews.com/19action
news/db_330498/contentdetail.htm?
contentguid=BlRLfHKj
http://www.cleveland.com/business/index.ssf/
2015/01/clevelands_first_connectathon.html#
incart_related_stories
Analytics
HIMSS Analytics supports improved decision making for healthcare organizations, healthcare IT companies and consulting firms by delivering high quality data and analytical expertise.
AnalyticsHaving the right information, at the right time, available to Sara‟s doctors helped improve decision making in her overall care.
There were many treatments for Sara‟s stroke. The physicians used the information available to them through analytics to see what would be the best care for her by comparing her demographics to large databases of patient information, or population health.
Using analytics to help support Sara‟s doctor make informed medical decisions, improved the quality of care she received.
54.7% 57.7% 61.4% 64.6% 65.4% 62.3%54.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2008 2009 2010 2011 2012 2013 2014
Acquired/Installed at least one HIT application
All
U.S
. H
ospitals
The percentage of U.S. hospitals acquiring and/or
installing HIT applications each year is back to 2008
levels…
Percent of US Hospitals Acquiring/Installing at least one HIT application
All
U.S
. H
ospitals
…with the level of activity (number of applications
acquired) in 2014 are lower than in 2008.
27.2% 33.3% 36.0% 36.3% 39.1% 40.1% 36.9%
14.5%14.4% 15.6% 16.0% 13.2% 12.7%
9.3%13.0%
10.0%9.8% 12.3% 13.1% 9.5%
8.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2008 2009 2010 2011 2012 2013 2014
1 - 3 Applications 4 - 9 Applications 10+ Applications
Percent of US Hospitals Acquiring/Installing HIT applications
The market continues to be focused on EMR
applications…with their buying patterns shifting in a
predictable way.
Higher market demand Lower market demand
Application 2009 2010 2011 2012 2013 2014
Physician Documentation 3 2 2 2 2 1
Computerized Practitioner Order Entry (CPOE) 1 1 1 1 1 2
Patient Portal 72 56 38 32 32 3
Electronic Medication Administration Record (eMAR) 2 3 3 3 3 4
Clinical Decision Support System (CDSS) 9 6 6 8 8 5
Top Five Most Frequently Acquired/Implemented HIT Applications
Leading us to conclude that the hospital HIT market will
continue to constrict…
$7.27 $7.14 $7.05 $6.99 $6.96 $6.95
$6.00
$6.20
$6.40
$6.60
$6.80
$7.00
$7.20
$7.40
$7.60
$7.80
$8.00
2014 2015 2016 2017 2018 2019
In $
Bill
ions
Projected Total U.S. Hospital HIT Application Spend (2014 – 2019)
…reflecting both a notable shift in buyer interests...
Projected Five Year CAGR of HIT Application Categories (2014 – 2019)
6.3%
1.5%
-1.2%
-2.5%-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Hospital Tethered Applications
Other Clinical Applications EMR Applications Operational Applications
Fiv
e Y
ear
CA
GR
…and buyer motivations.%
of Tota
l H
ospital H
IT S
pen
d
Projected Hospital HIT Application Spend (2014 – 2019)
60.3% 59.0% 56.7% 54.0% 50.9% 49.0%
39.7% 41.0% 43.3% 46.0% 49.1% 51.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2014 2015 2016 2017 2018 2019
First Time Buyers Replacement Buyers
HIMSS Analytics Electronic Medical
Record Adoption Model (EMRAM)
incorporates methodology and
algorithms to automatically score the
more than 5,400 U.S. and
approximately 650 Canadian hospitals
in the HIMSS Analytics database
relative to their EMR capabilities.
Ranging from limited ancillary
department systems through a
paperless EMR environment, EMRAM
scores provide peer comparisons for
hospital organizations as they
strategize their path to implementing a
complete EMR and participation in an
electronic health record (EHR).
EMRAM Distribution: All US Hospitals
Q4 2007
19.3%
14.0%
37.2%
25.1%
2.2% 1.4% 0.8% 0.0%0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
0 1 2 3 4 5 6 7
Perc
en
t o
f H
osp
itals
EMRAM Stage
EMRAM Distribution: All US Hospitals
Q4 2014
3.8%2.0%
5.1%
21.0%
14.0%
32.7%
17.9%
3.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
0 1 2 3 4 5 6 7
Perc
en
t o
f H
osp
itals
EMRAM Stage
3.8%
2.3%2.5%
3.5%
2.3%
4.4%
5.5%
6.4%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
0 1 2 3 4 5 6 7
Op
era
tin
g P
rofi
t M
arg
in
EMRAM Stage
Hospitals with advanced EMR capabilities tend to be more
profitable
Average Operating Margin : U.S. Hospitals (2014)
The number of information system employees increases
as the hospital’s EMR capabilities advance
Average IS FTEs: U.S. Hospitals (2014)
1.3 9.0 14.0
54.2
33.4 32.6
80.0
207.2
0
50
100
150
200
250
0 1 2 3 4 5 6 7
Nu
mb
er
of
FT
E I
S S
taff
EMRAM Stage
• How do we know
Health IT works?
• How does Health IT
improve patient care?
• Can we duplicate the
type of value others
have achieved?
Health Information Technology
Improving patients‟ experience of care within the Institute of Medicine‟s
6 domains of quality: Safety, Effectiveness, Patient-
Centeredness, Timeliness, Efficiency, and Equity.
Better healthcare
Keeping patients well so they can do what they want to do. Increasing
the overall health of populations: address behavioral risk factors; focus
on preventive care.
Better health
Lowering the total cost of care while improving quality, resulting in
reduced monthly expenditures for Medicare, Medicaid, and CHIP
beneficiaries.
Reduced costs
$
Source: http://www.healthpartners.com/public/about/triple-aim/
- Advanced Medical Imaging- Computer-Aided Diagnostics
- Wireless Telemedicine- Noninvasive Health Monitoring
- Teleradiology- Personal Medical Devices
- Implantable Sensors- Medication Adherence
- Asset Tracking and Monitoring- Mobile Diagnostics
- Implantable Prosthetics