HIMSS 2016, the largest IT conference in the industry, was once again a bellwether of what happened, what’s happening, and what’s about to happen. This year it reminded me of the aftermath of Y2K—the chaos and anxiety have subsided somewhat, and now we’re trying to figure out what happens next.
Of course some of the Big Topics were on display: ICD-10, Meaningful Use, patient engagement, value-based reimbursement. Interoperability, a Big Topic from about five years ago, once again was near the top of the agenda. This is a good thing. Although some progress has happened, it needs to be more widespread to help all the other puzzle pieces fit together.
Streamlining our communications is what will foster efficiency, cost-effectiveness, and better healthcare delivery overall. It seems strange today that only a few years ago there was an effort on the part of software developers not to make their product compatible with others. Now that paradigm has been flipped on its head, driven partly by regulation and partly by (I hope) common sense.
Moving this along is the Direct Project, launched in 2010 as part of the National Health Information Exchange. It helps support a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. In short, a way for your cardiologist to get your primary care records in record time. It’s all about standards, not content. There are now more than 200 participants across 50 organizations, including EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, and federal, state and regional health information organizations.
Many vendors at HIMSS were pitching solutions for “population health” and “value-based reimbursement.” But many were offering different solutions and using different definitions. (The one disappointing aspect: Fewer provider-side colleagues seemed to be in attendance. Instead, it appeared that more vendors participated, talking to other vendors or consultants.)
Population Health Intelligence and Predictive Analytics
Population health intelligence needs predictive analytics. We have to get a handle on how many patients need to get scripts renewed, or which women need to come in for mammograms. We are gathering the data, and we know which patients we want to target, but the Big Topic to be addressed: How do we engage them? Part of the answer is through wider use of patient portals and apps.
But those are only the platforms. What about the incentives, education, and persuasion that will get patients on board? Consider that many of the patients who need the most care are the Baby Boomer generation, and even some of their parents. This population, unfortunately, is the least likely to be comfortable with computers and smartphones. They also aren’t used to taking charge of their own healthcare in the same way as their children and grandchildren. They depend on the doctor to insist on appointments and follow up with instructions.
So it’s not the technology, but the process that needs work now. Patient portals will help, but only if a clinic’s staff is dedicated to helping patients learn how to use them. Even reaching the 5% mark of patients using portals has been a struggle for many practices. The goal here is to widen our scope of outreach. We have to use the tools that those older patients are familiar with, such as phone calls, snail mail reminders, and in-office conversations during the annual exam.
Signs indicate that “population health” will segment into some discrete strategies, like “narrow network strategy,” “quality management (analytics and registries),” etc., with products to match.
A related Big Topic: The major change in perspective in the healthcare ecosystem—preventive care rather than treating the already sick. Moving the needle on this initiative will obviously save billions of dollars, but first we have to change the mindset of many physicians.
Doctors Still Resist EMR/EHR
Another issue related to changing mindsets is that many docs still resist the move to EMR/EHR. This is more problematic in small markets and older practices that may not have the trained, aware staff common to urban environments. The path to finding the right software, spending the money, training staff, and doing data entry is a steep climb. HIMSS held an EHR-related patient safety symposium—although many organizations are still struggling with basic implementation and utilization. Only the very mature ones are worried about EHR-related safety. Dr. Joe Schneider, SVP and Chief Health Information Officer at Indiana University, spoke on ways to avoid and manage EHR downtime that focused heavily on the ONC’s SAFER guides.
Finally, much discussion focused on personalized medicine and adherence. Getting the right drug to the right patient on the right schedule is another area where technology helps, but human interaction is the key. How do we make sure that the patient fills the script the first time (a big hurdle), takes that first pill and every subsequent pill on time, and then refills? Having the data available on non-adherence has been a wake-up call.
Non-adherence rates are estimated to be between 30% and 60%. This is not just about reluctance or forgetfulness on the part of patients, but also related to errors in taking medicine and a lower percentage of preventive medication adherence than curative medication adherence. The fact that non-adherence now affects reimbursability is helping convince HCPs to focus more on this major problem.
A lot of specific Big Topics, all interrelated. It’s true we are in the midst of a sea change in the industry, the size and effect of which we’ll be able to assess only in hindsight. But what HIMSS seemed to be saying this year is that we’ve stopped complaining about how high the mountain is, and started celebrating our progress toward the summit.