CEO SUMMARY: Healthcare’s shift away from fee-for-service medicine and toward integrated clinical care is widely recognized. However, few lab administrators and pathologists are aware of the even faster transformation underway in healthcare informatics. Presented here are the “Top 10 Tech Trends” identified last month by Healthcare Informatics. A common theme is the need for information technology and healthcare informatics to serve patient care organizations, a new term that describes care models such as accountable care organizations (ACO) and medical homes. In similar ways, clinical labs and pathology groups will need to deploy robust informatics capabilities to serve providers.
EVERY CLINICAL LABORATORY and anatomic pathology group in the world produces the same end product: information. Yet many lab organizations fail to stay up-to-date with their use of information technology (IT).
Bad news is coming to those laggard laboratories. In the United States, healthcare is poised for a deep transformation of existing care delivery models. Gone will be the solo practitioners and the many self-standing specialist providers of recent decades.
In their place will be wholly-integrated provider organizations. This integration will be visible in two ways. First, clinical care will be thoroughly integrated within the self- contained organization. Think Kaiser Permanente, Mayo Clinic, and Geisinger Health as useful examples.
Second, the coming generation of integrated provider organizations will fully consolidate all the operational and service functions required to deliver integrated clinical care. In particular, these providers will establish a seamless and all-digital informatics backbone to support both operations and the delivery of clinical care to patients. Because clinical laboratories and pathology groups are essentially “information factories,” these major healthcare trends put all labs at risk—if they fail to advance their use of information technology in parallel with the organizational and clinical integration of the physicians and providers they serve.
Lab administrators and pathologists have fair warning of this about-to-unfold transformation of the American healthcare system. Time remains for every lab organization to develop a robust IT strategy that anticipates these developments and positions their laboratory to be an essential, added-value resource to physicians, patients, and payers.
Last month, Healthcare Informatics Magazine published its annual list of the “Top Tech Trends for 2012.” This list of trends turns out to be chock-full of valuable insights on how hospitals, health systems, and major physician groups are prioritizing their information technology projects.
The list developed by Healthcare Informatics (HI) will surprise many lab administrators and pathologists. Of the 10 trends it deems most significant, none involve adoption of a specific type of information technology, such as offering wireless access or moving to cloud-based solutions.
To the contrary, each of the 10 health technology trends presented by HI represents a clinical or operational strategy of hospitals and health systems that must be supported by a different IT structure and capability. This is a significant development. Among other things, it is evidence that deeply-transformative forces are already in play.
To help lab directors and pathologists come up to speed on these important trends, THE DARK REPORT offers its insights about HI’s “Top Tech Trends for 2012.” Sprinkled throughout HI’s description of these trends is the use of a new term: “patient care organization.” This term recognizes that the range of integrated clinical care organizations will not be limited to hospitals and health systems, but will include multi-provider arrangements owned and operated by physicians, by health insurers, by employers, and by not-for-profit organizations.
Top Tech Trend #1
PERFORMANCE IMPROVEMENT IMPERATIVES
The editors of Healthcare Informatics place this trend at the top of their list for 2012. It recognizes the essential role that Lean, Six Sigma, and similar process improvement methods will play in healthcare moving forward.
Mark Hagland, Editor-in-Chief at HI, wrote “…More patient care organization leaders now recognize that deep process change will be required to prepare their organizations for healthcare-reform related mandates.”
More specifically, Hagland identifies Lean, Six Sigma, and similar continuous performance improvement methodologies as cornerstones of this trend. It means hospital CIOs are recognizing that, to support this culture of deep process change, their organization’s information technology must deliver accurate, complete data in real time.
Mark Van Kooy, M.D., is Director of Clinical Informatics at Aspen Advisors, in Pittsburgh, Pennsylvania. He minced no words in his advice to CIOs and CMIOs when he stated, “Learn process improvement methodologies, and become fluent in the subject.” Only in this way, observed Van Kooy, can healthcare IT leaders understand care delivery processes at a deep level so as to help their parent organization leverage its informatics capabilities in support of continuous process change.
As HI’s number one tech trend, the recognition of the essential role of Lean, Six Sigma, and performance improvement methods should be an equally powerful statement to lab administrators and pathologists. It is time to fully engage your own laboratories in ongoing process improvement at a deep level.
Top Tech Trend #2
POPULATION HEALTH MANAGEMENT & RE-ADMISSIONS
AT THE MOMENT, this trend is rooted in new health initiatives designed to reduce and prevent hospital re-admissions. But it is wrong to characterize this trend as simply aimed at re-admissions.
Rather, reducing hospital re-admissions is the spear point for the overriding goal of lifting the health of the entire population being managed by a patient care organization.
In the short term, hospitals and health systems will be under direct pressure to measurably reduce hospital re-admissions. Medicare and private payers are instituting programs designed to focus patient care organizations and hospitals to reduce re-admissions in order to maximize their reimbursement as participants in these programs.
Jane Metzger, Principal Researcher at the Global Institute for Emerging Healthcare Practices at CSC in Falls Church, Virginia, told HI that “reducing avoidable re-admissions has become one of the most pressing issues for hospitals as they look to become accountable care organizations (ACOs).”
Further, Metzger noted that hospitals and health systems are scrambling to improve quality metrics and their publicly-available rates of re-admissions because there are now “first time, high financial stakes” to reward them for success in this effort. Of course, lab administrators and pathologists understand that laboratory testing has an essential role in reducing hospital re-admissions.
What HI emphasized about this top tech trend is that providers are actively taking steps to improve real-time access to population health analytics. This information is required to guide physicians when providing care.
Similarly, access to this same information is essential for care team members who regularly contact individual patients to implement the proactive care management protocols. These medical professionals also need real-time access to laboratory test data to fulfill these types of care initiatives.
Top Tech Trend #3
PRIVATE HIES ON THE UPSWING
ONE PHENOMENON that gets little public attention is the steady increase in the number of private health information exchanges (HIEs).
This is a response to the American Reinvestment and Recovery and Health Information Technology for Economic and Clinical Health (ARRA, HITECH) Acts. Healthcare Informatics noted that “hospitals and health systems, as well as payers, are fueling HIE growth as they build the information backbones necessary to support care coordination and accountable care organization (ACO) development.”
Health plans and managed care companies are building HIEs as an extension of their patient portals and as a way to deliver additional services to both patients and physicians. It is also a way that insurers can help in coordinating patient care.
This trend has direct consequences for clinical laboratories and pathology groups. To remain a viable provider of lab testing services in a region, labs will need to participate in these HIEs.
Further, it seems that the emergence of private HIEs alongside public HIEs would create market competition between these organizations. Whether such competition might benefit local laboratories remains to be seen.
Top Tech Trend #4
TURNING HEALTHCARE’S BUSINESS MODEL INSIDE OUT
IT IS LOGICAL that the fourth tech trend on Healthcare Informatics’ list centers upon the use of information technology as a necessary tool for accountable care organizations (ACOs) and similar patient care organizations.
This goes beyond the central data warehouse containing patients’ electronic health records (EHR). It is a trend that describes how hospitals and providers are developing the capability to analyze healthcare data, then guide the activities of care givers.
HI illustrated how this trend is unfolding by using an example provided by Jim Adams, who is Managing Director, Research and Insights, at the Advisory Board Company in Washington, DC. Adams identifies three phases in his “IT maturity model for accountable care.”
Phase one incorporates 12 foundational elements. These range from establishing ambulatory EHRs and health information exchanges (HIE), to disease registries, physician and patient engagement, and components focused on quality improvement (such as Lean and Six Sigma).
Phase two for Adams happens when reimbursement models incorporate performance risk and bundled payments for end-to-end acute care episodes (i.e. surgeries) and for ambulatory episodes (i.e. chronic diseases).
In phase three, Adams says that patient care organizations will accept utilization risk for a population of patients. Providers will achieve this by employing preventative medicine to reduce unnecessary utilization and improve patient outcomes.
One expert told HI that the purely technological challenge for patient care organizations will be to harness “discreet data across the continuum of care, coming from various care settings and various IT systems, to really understand the health of the population.”
Clinical laboratories and pathology groups will also be feeding data to these same patient care organizations. The patient lab test data they produce needs to flow seamlessly into the data repositories of these patient care organizations.
Top Tech Trend #5
BRIDGING THE CARE TRANSITION GAP
HEALTH INFORMATICS has an important role in managing the problem of transitioning patient care from one provider to another. IT collaboration tools are being developed to meet these needs.
Health professionals will use information technology to help coordinate care teams, identify the responsibilities of providers, and avoid duplication of care while backstopping providers to ensure that nothing needed by the patient is dropped or overlooked by a caregiver.
Further, these are new uses for healthcare IT. “In the past, discharge summaries were focused on what happened, as opposed to here are the goals, here is what needs to be done and this is what has been done so far, and what information needs to be handed off to make the transition successful,” stated Harry Greenspun, M.D., Senior Adviser for Healthcare Transformation and Technology at the Deloitte Center for Health Solutions in Washington, D.C.
Consistent with this need, Pat Rutherford, R.N., Vice President of the Institute for Healthcare Improvement, in Cambridge, Massachusetts, told HI that she sees “the hospital’s role as a ‘pay it forward’ dynamic of providing the information that the next provider of care needs, and what it can do to make that transfer of information successful.”
This affirms the need for real-time access to lab test results, such as when the patient is about to be discharged. Transmitting the patient’s lab test data generated during the hospital stay as part of the transition to the next care setting will be important if that next team of care givers is to be effective at reducing or preventing a re-admission of this patient.
Using informatics to support the transition of patient care is likely to involve both clinical laboratories and pathology groups in new ways. It will create different interactions between laboratories and providers.
Top Tech Trend #6
PRIVACY AND SECURITY DURING THE YEAR OF THE CSIO
HERE’S A HEALTH IT TREND that has yet to be recognized by most lab administrators and pathologists. Healthcare Informatics believes that 2012 is the year of the Chief Information Security Officer (CISO).
In other words, healthcare organizations across the United States are giving more attention and funding to patient privacy and IT security than at any time in the past. Current developments explain part of this heightened interest.
For one thing, this year will see the release of the final rules for the privacy and security regulations specified by the Health Information Technology for Economic and Clinical Health (HITECH) Act. These are modifications to the Health Insurance Portability and Accountability Act (HIPAA).
The second factor is increased provider audits by the HHS Office for Civil Rights (OCR). OCR contractors will conduct as many as 150 provider audits between May and December this year.
At the same time, provider IT departments are working to minimize the risk of data breaches from unsecured mobile devices, like smart phones and iPads. More than 60% of respondents to one survey said that their institutions had increased the portion of the IT budget devoted to security.
The appearance of this trend in the tech top 10 list is a timely reminder to laboratories that more attention should be devoted to beefing up IT security and creating employee awareness about the risk of privacy breaches involving sensitive patient information.
Top Tech Trend #7
SECOND-GENERATION CLINICAL DECISION SUPPORT
IT IS WIDELY-ACCEPTED that the first generation of clinical decision support (CDS) systems have not performed to expectations. For that reason, considerable investment is flowing into the development of second-generation CDS.
HI described the existing deficiencies in CDS as follows: “what has become clear in the past few years is that the first generation of CDS tools, as embedded in commercial healthcare IT vendors’ core EHR systems, has not lived up to expectations; and indeed, has required continuous customization work on the part of healthcare IT leaders seeking to avert alert fatigue and truly optimize the workflow of physicians and other clinicians. So, what’s next?”
Healthcare Informatics answered its own question by quoting Jerry Osheroff, M.D., Principal at TMIT Consulting in Cherry Hill, New Jersey, who said, “‘…there are care delivery organizations and others who are drawn very strongly to this notion of measurably improving high-priority outcomes through the use of second-generation clinical decision support.”
“Major learning number two,” noted Osheroff, “is that there is a relatively small handful of relatively high targets [for broad performance improvement] of interest to care organizations. That’s why folks have locked onto issues such as optimizing VTE [venous thromboembolism] prophylaxis and hemoglobin A1C management; and the next big target will be re-admissions.”
HI noted that Osheroff believes that success with implementing second-generation clinical decision support “will require creating consensus around concrete performance improvement targets the physicians can embrace.”
Of course, developing care algorithms and evidenced-based medicine (EBM) guidelines that incorporate laboratory tests is a core competency of pathologists, clinical chemists, and laboratory scientists. THE DARK REPORT sees this as an opportunity for local clinical labs and pathology groups to engage early with patient care organizations and participate in developing the protocols that will be built into the second-generation clinical decision support systems now actively under development.
Top Tech Trend #8
IMAGING INFORMATICS AND THE ENTERPRISE
HOSPITALS ARE DEALING with an explosion of digital images across a variety of medical specialties. These images are produced in medical specialties ranging from radiology and cardiology to dermatology, gastroenterology, and pathology.
With physicians often needing to access three or four different viewers to see images, hospitals are seeking a way to handle digital images with a single enterprise solution. In this sense, these institutions are outgrowing the capabilities offered by PACS (picture archiving and communications system).
The additional complication is that many electronic medical record (EMR) systems are not able to handle the variety of image types that are produced by different medical specialties.
According to HI, digital archiving solutions “must address the workflow and management issues that typically do not match up across departments.” Vendor- neutral archive (VNA) systems have yet to gain favor with providers. One expert observed that “VNA solutions ignore the need for standards-based visualization tools that can be applied to an archive.”
Another issue is that existing standards for managing and accessing digital images exist. However, there are no mandates by government. Nor is there consensus by industry on how providers should adopt and use these standards.
All of this confusion may be a benefit to anatomic pathology groups. It provides them time to acquire and use digital pathology systems during that window of time when hospitals and health systems have yet to settle on universal solutions for storing and accessing the multiple types and formats of digital images that are part of a single patient health record.
Top Tech Trend #9
MOBILE HEALTH, OR BYOD— “BRING YOUR OWN DEVICE!”
PROBABLY NO SINGLE ELEMENT of healthcare informatics has evolved as rapidly as the acceptance of mobile devices by physicians, nurses, and other clinicians. This might be called the smartphone/tablet revolution because of its speed and scale.
Not surprisingly, Healthcare Informatics reports that a study of healthcare CIOs conducted by Health Information and Management Society (HIMSS) determined that “while approximately 75% of those surveyed said their organization allows clinicians to access clinical data via a mobile device, only 38% have a policy in place that regulates the use of mobile devices and outlines a mobile strategy.”
Essentially, this is a health informatics trend that has outrun the ability of health CIOs to establish policies and provide robust support for the mobile devices in use by their clinicians. Furthermore, this may be a mobile device cat that is already be out of the bag! One CIO declared, “If I told physicians they couldn’t bring their own mobile devices, I’d be shot.”
Clinical labs report that they are already fielding many requests from referring physicians to establish capabilities which allow the physicians to order lab tests and view lab test results via a mobile device. This creates the opportunity for first-mover and early adopter lab organizations to meet this need of their referring physicians and gain competitive advantage in their regional markets.
Top Tech Trend #10
PERSONALIZED MEDICINE: THE GAME CHANGER
PERSONALIZED MEDICINE was selected as one of the top 10 tech trends—not because health IT departments are spending money today on solutions—but because they should be!
It was the opinion of the editors at Healthcare Informatics that “the convergence of emerging genetic medicine and electronic health records” is a development that requires immediate attention by hospital and healthcare CIOs.
The common element in this advice and warning was the need for electronic medical record (EMR) systems to handle genetic data. A number of health systems already provide services that incorporate genetic medicine.
For example, the Coriell Institute for Medical Research, Camden, New Jersey, and the Ohio State University Medical Center in Columbus, Ohio, are collaborating on a clinical study. It involves 1,800 patients diagnosed with congestive heart failure or hypertension who are under the care of OSU cardiologists and primary care physicians.
At this time, the electronic health record system has no fields ready to be populated by genetic data. As a work-around, Coriell and OSU put the genetic risk reports in PDF files. These files are then attached to the patients’ records in the same fashion that imaging files are currently attached.
Hospitals Need TC Services
As presented above, the 10 top tech trends identified by Healthcare Informatics magazine offer an invaluable window into the key issues that dominate spending by hospitals, health systems, and other providers on information technology. Lab leaders will find great value in using THE DARK REPORT’S assessment of these trends as part of their strategic planning process.
Healthcare Informatics Picks Top IT Trends
PRESENTED BELOW are the “Top Tech Trends for 2012” that were identified by the editors of Healthcare Informatics magazine in the March 2012 issue. Each of these 10 health IT trends has a component that involves clinical laboratory test data.
- Performance Measurement
- Population Health Management & Re-Admissions
- Private HIEs on the Upswing
- Healthcare’s New Business Model
- Bridging the Care Transition Gap
- Privacy and Security During Year of CSIO
- Clinical Decision Support
- Imaging Informatics and the Enterprise
- Mobile Health, or BYOD—“Bring Your Own Device!”
- Personalized Medicine: Game Changer