If you want to learn and experience the latest developments and trends in health IT, the annual Healthcare Information and Management Systems Society (HIMSS)1 is the place to be. With over 40,000 healthcare professionals and vendor representatives, it’s North America’s largest and most important healthcare IT conference. This year’s conference was held during the first week of March in Las Vegas. It had more than 1,300 vendors that demonstrated their product and over 300 educational sessions and panels spread out over 5 days.
Here are the five biggest trends and takeaways from HIMSS16.
Health IT’s most elusive goal, interoperability, is on everyone’s mind. It describes the extent to which systems and devices can exchange data and interpret that shared data. This is true for not only hospital organizations that are trying to figure out how their different EHRs will talk to each other, or new companies that are trying to address population health challenges with EHR data, but also for the U.S. government.
HIMSS16 was kicked off with a motivating vibe on day 1, with an industry-wide pledge for interoperability. The Department of Health and Human Services (HHS) Secretary Sylvia Burwell announced a major commitment from the healthcare industry to improve interoperability across all EHRs and healthcare systems. The pledge has been signed by 90% of the industry’s EHR vendors, five of the largest healthcare systems in the U.S. and multiple professional organisations. The objective of the pledge is to improve consumer access to health data, eliminate intentional data blocking and implement federal standards for health data interoperability.
A commitment to interoperability is not sufficient. The industry must work together on standards and find innovative ways to share data. The industry’s commitment was reflected in the FHIR movement gaining momentum. It was one of the most popular topics at the conference in both the number of sessions and the lack of empty seats. FHIR is the latest in data standards by the HL7 healthcare standards organization, describing data formats and elements, and an API for exchanging Electronic Health Records (EHRs). It’s built on previous standards, but is easier to implement using modern web-based open architecture technologies.
Finally, the industry is catching up to the latest technologies adopted by tech startups. The API technologies include a HTTP-based RESTful protocol, HTML and CSS for user interface integration, JSON/XML for data representation, OAuth for authorization and Atom for results. FHIR is suitable for use in a wide variety of contexts - mobile phone apps, cloud communications, EHR-based data sharing, server communication in large institutional healthcare providers, and more.
However, the challenge is often not the technology itself, but its wide adoption and implementation. There are a few signs that we’re heading in the right direction with this standard. In 2014, the US health IT policy and standards committee endorsed recommendations for more public APIs, so the US government is on board. What surprised many was the support and collaboration from the industry, as all major EHR vendors are taking part in the industry-driven public APIs standards task force called the Argonaut Project. This is a first for the industry, adding to the optimism behind FHIR.
Although U.S. based organizations and companies are leading the initiative, it is spreading like fire all over the world, including Canada. For example, James Agnew, an architect at the University Health Network (UHN) in Toronto is a big proponent of open technologies in healthcare, and leads the HAPI project, a free platform for exchanging medical data used in projects around the world. Further, the government of Ontario has started a few projects implementing FHIR, including a Public Health Delivery Platform, Mobile Mass Immunization iOS application built on PHDP, and a Public Health Immunization Exchange.
Now that we have the EHR data, the next question is how do we leverage this data to improve patient outcome? The U.S. Meaningful Use certification aims to solve this problem with financial incentives for healthcare organizations. While stage 1 and 2 centered around expanding capabilities of EHR technology, the latest, stage 3, focuses on achieving improvements in health quality, safety and decision support for high priority health status problems such as obesity and diabetes. This improves population health outcomes as a whole while engaging the patient. Finally, moving away from a fee or service based model to an outcome-based model allows providers to focus on the continuum of care.
Driven by these standards, not only are major EHR vendors adding new modules to comply, but new companies are popping up. These new analytics-driven and mobile-first systems focus on integrating EHR data to solve specific population health challenges and engage with the patient. The early successes of pilots for these initiatives were clear at HIMSS16, with plenty of vendor/provider case studies to show for it. Some examples:
A healthcare CIO recently blogged: “Manu Tandon, CIO of Beth Israel Deaconess Medical Center shared his notes with me and with his permission, I’d like to share them with you:
“Population health conversation last year was about maximizing revenue for the organization. Now it's about identifying and managing cohorts of patients using patient generate data as a source. The best thinking we saw aligns very well with ours. A workflow oriented EHR centric model that closes the gap between operations and analytics is the way to go. Separate big data platform based approaches are fading away.”
An audience poll asking what their #1 communication concern was identified EHR integration and care team communication as the top priority. This is not surprising, as hospitals are getting bigger in size and healthcare organisations are spanning many locations and technology systems, making communications between clinicians more difficult. Thus, the focus of many organisations is on coordinating activities and existing staff to use the resources more efficiently.
Some ways that technology facilitates care coordination are:
For example, the New York Presbyterian hospital presented a case study of a clinical communication and collaboration pilot in one of their buildings. With the objectives to improve patient safety, clinician productivity and coordinated care, the pilot tested a single device to manage the clinician’s workflow and communication for the entire team: physicians, nurses, assistants and technicians. The pilot resulted in improved outcomes. It is interesting to note the types of messages sent between the care team: 50% confirmation, 40% social support, and 10% task/question related.
There was a real sense of urgency that health IT leaders had concerning data and network security issues. Recent large-scale data breaches and the rise of interoperability in the industry has forced healthcare cybersecurity to the top of every major hospital organization and medical device manufacturer’s priority list.
In 2015 alone, Patient Health Information (PHI) data breaches affected 113 million patients, and governmental fines are becoming more expensive. HIPAA compliance used to be a checkbox item; comply with these edicts and you get a passing grade. Today, in light of the increase in breaches, compliance is the absolute minimum with additional security applied to ensure that a patient’s information remains their own.
Thus, the need for a hospital-wide enterprise-level secure messaging is clear. It’s a well-known secret in the industry that physicians text each other patient information, so there’s a real movement to get physicians off SMS and to use a secure messaging communication platform across hospitals. The app would allow clinicians to reach each other in real-time no matter which department they work in or which building. The best way to do this is to have an app that integrates with current hospital systems already being used by staff and clinicians and for it to become a natural part of their workflow.