According to Damo Consulting’s 2019 Healthcare
IT Demand Survey, when it comes to spending money on information
technology (IT), healthcare executives believe AI and digital healthcare
technologies—though promising—need more development.
Damo’s report notes that 71% of healthcare providers
surveyed expect their IT budgets to grow by 20% in 2019. However, much of that
growth will be allocated to improving EHR functionality, Healthcare Purchasing News reported
in its analysis of Damo survey data.
As healthcare executives plan upgrades to their EHRs,
hospital-based medical laboratories will need to take steps to ensure
interoperability, while avoiding disruption to lab workflow during transition.
The survey also noted that some providers that are considering
investing in AI and digital health technology are struggling to understand the
market, the news release states.
“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic about their technology needs versus their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” explained Paddy Padmanabhan (above), Chief Executive Officer of Damo Consulting, in a news release. (Photo copyright: The Authors Guild.)
Providers More
Positive Than Vendors on IT Spend
Damo Consulting is a Chicago-area based healthcare and
digital advisory firm. In November 2018, Damo surveyed 64 healthcare executives
(40 technology and service leaders, and 24 healthcare enterprise executives). Interestingly, healthcare providers were more
positive than the technology developers on IT spending plans, reported HITInfrastructure.com, which
detailed the following survey findings:
79% of healthcare executives anticipate high
growth in IT spending in 2019, but only 60% of tech company representatives
believe that is so.
75% of healthcare executives and 80% of vendor
representatives say change in healthcare IT makes buying decisions harder.
71% of healthcare executives and 55% of vendors say
federal government policies help IT spending.
50% of healthcare executives associate
immaturity with digital solution offerings.
42% of healthcare providers say they lack
resources to launch digital.
“While information technology vendors are aggressively
marketing ‘digital’ and ‘AI,’ healthcare executives note that the currently
available solutions in these areas are not very mature. These executives are
confused by the buzz around ‘AI’ and ‘digital,’ the changing landscape of who
is playing what role, and the blurred lines of capabilities and competition,” noted
Padmanabhan in the survey report.
The survey also notes that “Health systems are firmly
committed to their EHR vendors. Despite the many shortcomings, EHR systems
appear to be the primary choice for digital initiatives among health systems at
this stage.”
Some Healthcare
Providers Starting to Use AI
Even as EHRs receive the lion’s share of healthcare IT
spends, some providers are devoting significant resources to AI-related
projects and processes.
For example, clinical
pathologists may be intrigued by work being conducted at Cleveland Clinic’s Center for
Clinical Artificial Intelligence (CCAI), launched in March. The CCAI is using
AI and machine learning in pathology, genetics, and cancer research, with the
ultimate goal of improving patient outcomes, reported Becker’s Hospital Review.
“We’re not in it because AI is cool, but because we believe
it can advance medical research and collaboration between medicine and
industry—with a focus on the patient,” Aziz Nazha, MD, Clinical
Hematology and Oncology Specialist and Director of the CCAI, stated in an
article posted by the American Medical Association (AMA).
AI Predictions Lower
Readmissions and Improve Outcomes
Cleveland Clinic’s CCAI reportedly has gathered data from
1.6 million patients, which it uses to predict length-of-stays and reduce
inappropriate readmissions. “But a prediction itself is insufficient,” Nazha told
the AMA. “If we can intervene, we can change the prognosis and make things
better.”
The CCAI’s ultimate goal is to use predictive models to “develop
a new generation of physician-data scientists and medical researchers.” Toward
that end, Nazha notes how his team used AI to develop genomic biomarkers that identify
whether a certain chemotherapy drug—azacitidine (aka,
azacytidine and marketed as Vidaza)—will work for specific patients. This is a
key goal of precision
medicine.
CCAI also created an AI prediction model that outperforms
existing prognosis scoring systems for patients with Myelodysplastic
syndromes (MDS), a form of cancer in bone marrow.
Meanwhile, at Johns
Hopkins Hospital, AI applications track availability of beds and more. The
Judy Reitz Capacity Command Center, built in collaboration with GE Healthcare Partners, is a
5,200 square feet center outfitted with AI apps and staff to transfer patients
and help smooth coordination of services, according to a news release.
Forbes described the Reitz command
center as a “cognitive hospital” and reports that it has essentially enabled
Johns Hopkins to expand its capacity by 16 beds without undergoing bricks-and-mortar-style
construction.
In short, medical laboratory leaders may want to interact
with IT colleagues to ensure uninterrupted workflows as EHR functionality evolves.
Furthermore, AI developments suggest opportunities for clinical laboratories to
leverage patient data and assist in improving the diagnostic accuracy of providers
in ways that improve patient care.
Despite the widespread adoption of electronic health record (EHR) systems and billions in government incentives, lack of interoperability still blocks potential benefits of digital health records, causing frustration among physicians, medical labs, and patients
Clinical laboratories and anatomic pathology groups understand the complexity of today’s electronic health record (EHR) systems. The ability to easily and securely transmit pathology test results and other diagnostic information among multiple providers was the entire point of shifting the nation’s healthcare industry from paper-based to digital health records. However, despite recent advances, true interoperability between disparate health networks remains elusive.
One major reason for the current situation is that multi-hospital health systems and health networks still use EHR systems from different vendors. This fact is well-known to the nation’s medical laboratories because they must spend money and resources to maintain electronic lab test ordering and resulting interfaces with all of these different EHRs.
Healthcare IT News highlighted the scale of this problem in recent coverage. Citing data from the Healthcare Information and Management Systems Society (HIMSS) Logic database, they note that—when taking into account affiliated providers—the typical health network engages with as many as 18 different electronic medical record (EMR) vendors. Similarly, hospitals may be engaging with as many as 16 different EMR vendors.
The graphics above illustrates why interoperability is the most important hurdle facing healthcare today. Although the shift to digital is well underway, medical laboratories, physicians, and patients still struggle to communicate data between providers and access it in a universal or centralized manner. (Images copyright: Healthcare IT News.)
The lack of interoperability forces healthcare and diagnostics facilities to develop workarounds for locating, transmitting, receiving, and analyzing data. This simply compounds the problem.
Pressure from Technology Giants Fuels Push for Interoperability
According to HITECH Answers, the Centers for Medicare and Medicaid Services (CMS) has paid out more than $38-billion in EHR Incentive Program payments since April 2018.
Experts, however, point out that government incentives are only one part of the pressure vendors are seeing to improve interoperability.
“There needs to be a regulatory push here to play referee and determine what standards will be necessary,” Blain Newton, Executive Vice President, HIMSS Analytics, told Healthcare IT News. “But the [EHR] vendors are going to have to do it because of consumer demand, as things like Apple Health Records gain traction.”
Another solution, according to TechTarget, involves developing application programming interfaces (APIs) that allow tech companies and EHR vendors to achieve better interoperability by linking information in a structured manner, facilitating secure data transmission, and powering the next generation of apps that will bring interoperability ever closer to a reality.
TechTarget reported on how University of Utah Hospital’s five hospital/12 community clinic health network, and Intermountain Healthcare, also in Utah, successfully used APIs to develop customized interfaces and apps to improve accessibility and interoperability with their Epic and Cerner EHR systems.
Diagnostic Opportunities for Clinical Laboratories
As consumers gain increased access to their data and healthcare providers harness the current generation of third-party tools to streamline EHR use, vendors will continue to feel pressure to make interoperability a native feature of their EHR systems and reduce the need to rely on HIT teams for customization.
For pathology groups, medical laboratories, and other diagnosticians who interact with EHR systems daily, the impact of interoperability is clear. With the help of tech companies, and a shift in focus from government incentives programs, improved interoperability might soon offer innovative new uses for PHI in diagnosing and treating disease, while further improving the efficiency of clinical laboratories that face tightening budgets, reduced reimbursements, and greater competition.
Future EHRs will focus on efficiency, machine learning, and cloud services—improving how physicians and medical laboratories interact with the systems to support precision medicine and streamlined workflows
When the next generation of electronic health record (EHR) systems reaches the market, they will have advanced features that include cloud-based services and the ability to collect data from and communicate with patients using mobile devices. These new developments will provide clinical laboratories and anatomic pathology groups with new opportunities to create value with their lab testing services.
Proposed Improvements and Key Trends
Experts with EHR developers Epic Systems, Allscripts, Accenture, and drchrono spoke recently with Healthcare IT News about future platform initiatives and trends they feel will shape their next generation of EHR offerings.
They include:
Automation analytics and human-centered designs for increased efficiency and to help reduce physician burnout;
Improved feature parity across mobile and computer EHR interfaces to provide patients, physicians, and medical laboratories with access to information across a range of technologies and locations;
A shift toward cloud-hosted EHR solutions with support for application programming interfaces (APIs) designed for specific healthcare facilities that reduce IT overhead and make EHR systems accessible to smaller practices and facilities.
Should these proposals move forward, future generations of EHR platforms could transform from simple data storage/retrieval systems into critical tools physicians and medical laboratories use to facilitate communications and support decision-making in real time.
And, cloud-based EHRs with access to clinical labs’ APIs could enable those laboratories to communicate with and receive data from EHR systems with greater efficiency. This would eliminate yet another bottleneck in the decision-making process, and help laboratories increase volumes and margins through reduced documentation and data management overhead.
Cloud-based EHRs and Potential Pitfalls
Cloud-based EHRs rely on cloud computing, where IT resources are shared among multiple entities over the Internet. Such EHRs are highly scalable and allow end users to save money by hiring third-party IT services, rather than maintaining expensive IT staff.
Kipp Webb, MD, provider practice lead and Chief Clinical Innovation Officer at Accenture told Healthcare IT News that several EHR vendors are only a few years out on releasing cloud-based inpatient/outpatient EHR systems capable of meeting the needs of full-service medical centers.
While such a system would mean existing health networks would not need private infrastructure and dedicate IT teams to manage EHR system operations, a major shift in how next-gen systems are deployed and maintained could lead to potential interoperability and data transmission concerns. At least in the short term.
Yet, the transition also could lead to improved flexibility and connectivity between health networks and data providers—such as clinical laboratories and pathologist groups. This would be achieved through application programming interfaces (APIs) that enable computer systems to talk to each other and exchange data much more efficiently.
“Perhaps one of the biggest ways having a fully cloud-based EHR will change the way we as an industry operate will be enabled API access.” Daniel Kivatinos, COO and founder of drchrono, told Healthcare IT News. “You will be able to add other partners into the mix that just weren’t available before when you have a local EHR install only.”
Paul Black, CEO of Allscripts, believes these changes will likely require more than upgrading existing software or hardware. “The industry needs an entirely new approach to the EHR,” he told Healthcare IT News. “We’re seeing a huge need for the EHR to be mobile, cloud-based, and comprehensive to streamline workflow and get smarter with every use.” (Photo copyright: Allscripts.)
Reducing Physician Burnout through Human-Centered Design
As Dark Daily reported last year, EHRs have been identified as contributing to physician burnout, increased dissatisfaction, and decreased face-to-face interactions with patients.
Combined with the increased automation, Carl Dvorak, President of Epic Systems, notes next-gen EHR changes hold the potential to streamline the communication of orders, laboratory testing data, and information relevant to patient care. They could help physicians reach treatment decisions faster and provide laboratories with more insight, so they can suggest appropriate testing pathways for each episode of care.
“[Automation analytics] holds the key to unlocking some of the secrets to physician well-being,” Dvorak told Healthcare IT News. “For example, we can avoid work being unnecessarily diverted to physicians when it could be better managed by others.”
Black echoes similar benefits, saying, “We believe using human-centered design will transform the way physicians experience and interact with technology, as well as improve provider wellness.”
Some might question the success of the first wave of EHR systems. Though primarily built to address healthcare reform requirements, these systems provided critical feedback and data to EHR developers focused not on simply fulfilling regulatory requirements, but on meeting the needs of patients and care providers as well.
If these next-generations systems can help improve the quality of data recording, storage, and transmission, while also reducing physician burnout, they will have come a long way from the early EHRs. For medical laboratory professionals, these changes will likely impact how orders are received and lab results are reported back to doctors in the future. Thus, it’s worth monitoring these developments.
January’s press release confirmed the tech company is working to integrate critical medical data into its mobile devices, while further promoting interoperability and patient access
While interoperability has improved since the earliest electronic health record (EHR) systems, today’s active patients often need to sort through multiple healthcare portals—including those of clinical laboratories and anatomic pathology groups—to get a comprehensive view of their medical history. Not only can this be time consuming, but also inconvenient if the patient lacks access to a computer.
Thus, it’s no surprise that in a January 24 press release, mobile technology giant Apple announced plans to enter the development ring and create an improved EHR for its mobile device users by updating its existing “Health” mobile application (app). The iOS 11.3 update, among other things, is designed to enable Apple iPhone owners to receive critical medical data, such as medical laboratory test results, directly on their devices.
“Our goal is to help consumers live a better day. We’ve worked closely with the health community to create an experience everyone has wanted for years—to view medical records easily and securely right on your iPhone,” said Apple COO Jeff Williams in the press release.
Jeff Williams (above), COO at Apple, notes that, “By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.” (Photo copyright: Apple.)
The new features are already available to developers in the latest iOS 11.3 beta 3 release. However, release to the public is expected soon with the issuance of the iOS 11.3 final release. This means that patients will not need to download extra apps—or remember to use them—to take advantage of the feature.
New Way to Improve Patients’ Access to Health Data or Just Another Data Silo?
The Apple Health Records platform adheres to Fast Healthcare Interoperability Resources (FHIR) protocols for transmission of data. Providers send information to Apple which then aggregates the information, transmits it to patients’ iPhones and notifies them of the updates.
All information stored on the device is encrypted in storage and protected from unauthorized access by the user’s password.
Through the new Health Records interface, users view this aggregated data as a timeline, conduct searches, and share information with other parties as they deem appropriate.
Current medical information listed in the press release includes:
Allergies;
Conditions;
Immunizations;
Clinical laboratory results;
Medications;
Procedures; and,
Vitals.
Currently, the platform integrates data from three major EHR developers:
Epic;
Cerner; and,
AthenaHealth
Apple’s update to the Health app makes it easier for people to access and control of all of their health records and data. This included medical laboratory tests. (Image and caption copyright: Apple.)
Apple is also working with 12 health institutions across the US in the first phase of the project, including:
In the Apple press release, Stephanie Reel, CIO at John Hopkins Medicine in Baltimore, stated, “Streamlining information sharing between patients and their caregivers can go a long way towards making the patient experience a positive one. This is why we are excited about working with Apple to make accessing secure medical records from an iPhone as simple for a patient as checking email.”
Previous Attempts at Mobile Health Record Devices Got Mixed Results
This isn’t the first time a major technology company has attempted to enter the mobile health market. Google Health was shuttered in 2011 citing low adoption. Wearable fitness trackers, such as Fitbit (NYSE:FIT) enjoyed a bubble, but are now seeing mixed success in terms of long-term adoption and use, according to The Motley Fool. More to the point, they’ve never quite become the holy grail of monitoring and data collection that some experts predicted, Huffington Post reported.
Larry Dignan, Editor-in-Chief at ZDNet, builds a compelling case for why this could be the attempt that succeeds in providing a consolidated platform for clinical laboratories, physicians, and other care providers to push data directly to patients and—with the patient’s permission—to each other, regardless of the platforms healthcare facilities use to store and transmit data.
He notes that much of Apple’s newest features build on foundations laid by the healthcare industry to create scalable, functional EHR systems. By working with existing protocols, Apple’s Health Records platform is already positioned for compatibility with many healthcare providers.
Furthermore, Apple is already known for partnering at the enterprise level with major businesses and industries, while also holding the trust of millions of Americans who store their personal information on Apple devices.
Is Apple the Future of EHRs?
Despite this, until the platform—and adoption by the public—is proven a success, it will be yet another walled garden of medical information. Even then, Apple is only one segment of the global mobile market.
Unless Apple provides access to other platforms (such as Android), those patients—and the medical communities serving them—are left consolidating information on their own through a sprawl of various portals. This also means that medical laboratories, pathology groups, and other service providers must continue to invest time and funding into communicating data in ways compatible with a plethora of internal and external systems and software.
Still, the platform offers an intriguing glimpse at the future of medical records and heralds a shift toward empowering patients with easy, comprehensive access to their own data, which would be a boon to the medical laboratory industry.
All hospital laboratories will be part of these programs, and it is an opportunity for medical laboratory professionals to deliver considerable value, as hospitals take steps to improve the utilization of antibiotics
Overuse and inappropriate use of antibiotics is now considered one of the biggest problems in medicine. “Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” stated Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention (CDC) and Administrator, Agency for Toxic Substances and Disease Registry (ATSDR), in a press release issued by the CDC last May. “Losing these antibiotics would undermine our ability to treat patients [who have] deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”
Much publicity is devoted to the rise of the increase of antibiotic-resistant organisms. In recognition of this problem, the Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (TJC), took steps to add antimicrobial stewardship program requirements to their respective hospital accreditation programs. (more…)
