CEO SUMMARY: During the 1990s, hospital spending on information technology was devoted primarily to acquiring upgraded versions of software systems for clinical services such as laboratory, pharmacy, and radiology. That’s no longer true. As the following nine key trends in healthcare informatics demonstrate, hospitals, physicians, and other types of healthcare providers are moving aggressively to acquire and deploy a surprisingly wide range of IT solutions. From wireless to handhelds, clinical laboratories will be challenged to maintain the ability to connect and feed laboratory test data into these new informatics channels.
HEALTHCARE INFORMATICS continues to evolve at a rapid pace. Each generation of software and hardware technology provides clinical laboratories with capabilities and opportunities to further enhance the contribution of laboratory medicine.
Because laboratories are essentially information factories, these swift changes in information technologies (IT) can have huge impact on both labs and the end users of the laboratory test data they generate.
To help lab directors and pathologists stay informed about these important developments, THE DARK REPORT provides this briefing about nine major trends in healthcare IT recently identified by the editors of Healthcare Informatics, a publication widely-read by hospital CIOs. These nine trends represent informatics initiatives now occurring in the nation’s leading hospitals, physicians’ offices, and other types of providers.
Nine healthcare IT trends were identified, based on four criteria. Technologies needed: 1) to support improved efficiencies in the delivery of healthcare services; 2) to be compatible with HIPAA compliance; 3) to be effective in use; 4) and to have mature products established and working successfully in the healthcare marketplace. Of equal importance, these nine trends reflect demand within the hospital industry and vendor’s market responses to fill that demand.
Health Informatics Trend #1
• BIOMETRICS •
CONTROLLING ACCESS to information systems and confirming the identity of users is a high-priority task as the healthcare industry struggles to comply with HIPAA.
Biometrics links some form of access control to a human attribute, something which can’t be lost, stolen, or duplicated. Fingerprints and retinal scans are the most familiar forms of biometric access controls.
In the 36-month period from 2002 through 2004, annual spending on biometric systems will increase from $110 million to $302 million, according to a report issued last fall by Allied Business Intelligence, located in Oyster Bay, New York.
One pilot project in retinal scan bio- metrics is now taking shape at the University of South Alabama Hospitals, a three-hospital system in Mobile, Alabama. Blue Cross Blue Shield of Rhode Island is implementing an integrated system that integrates a fingerprint sensor with the company’s internal network.
Health Informatics Trend #2
• COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) •
RECOGNIZED AS ONE of the fast-growing product segments in healthcare IT, computerized physician order entry (CPOE) is widely viewed as a way to reduce medical errors and improve patient safety.
CPOE is one of the first three standards selected by the Leapfrog Group to measure patient safety across different hospitals. In a 2002 poll of 517 hospitals, the Leapfrog Group reported that 25% intended to implement a CPOE system by 2004.
The new generation of CPOE products incorporate capabilities such as clinical decision support tools, alerts, clinical pathways, and ordering rules. These complement and support the basic function of computer order entry for pharmacy, lab, radiology, and other services. It is recognized that the best performance of CPOE comes when it is integrated with an electronic medical records (EMR) system.
CPOE is still in its earliest stages. Products are not yet robust. Early adopters tend to be inpatient settings, particularly in academic medical centers. Vanderbilt University Medical Center developed a home-grown CPOE, called “WizOrder.” It is designed to reduce variation in how healthcare is delivered. Among other benefits, it is reducing laboratory test utilization by as much as 40% in individual departments. McKesson Corp. licensed this product and now markets under the name Expert Orders™ .
Health Informatics Trend #3
• DISEASE MANAGEMENT •
DISEASE MANAGEMENT PROGRAMS should be on every hospital CEO’s strategic radar screen. It is a fast-growing trend, fueled by employers’ interest in controlling healthcare costs.
The scale of this surging interest is revealed in statistics released by Hewitt Associates, the large human resources consulting firm. Last fall, Hewitt announced that, in just five years, the number of large corporations supporting disease management programs had doubled, from 9.5% in 1997 to over 19%. It predicted that, by year’s end 2003, 30% of the nation’s large corporations would have disease management programs in place.
Most of these programs are administered through insurance plans and concentrate on the three major chronic diseases: congestive heart failure, diabetes, and asthma. In 2002, it is estimated that $580 million was spent on disease management programs in the United States.
In these programs, nurses contact patients and provide support and information. In contacting patients, nurses are supported with IT-based capabilities for electronic communication between patients and providers. Features such as automation of home care monitoring and the ability to mine clinical data repositories are also on the “want list” of disease management programs.
Health Informatics Trend #4
• HANDHELD DEVICES •
IT IS BECOMING INCREASINGLY COMMON to see a physician, nurse, or healthcare worker using a PDA (personal display appliance) or tablet computer. Early users are enthusiastic supporters of the concept.
The growth of this trend will be in tandem with the installation of wireless networks. (See “Wireless”, below.) Already experts agree that a “strong plurality of hospital-based organizations nationwide are at some stage of handheld development.
Handheld devices represent the intersection of efforts to enable CPOE, reduce prescription errors, allow access to clinical data such as lab test results, checking patient wristband bar codes for positive identity verification, and a host of other uses. The arrival of handheld PDAs with color screens will accelerate this process, since many clinical applications use color to flag important information.
One early adopter is 508-bed Abington Hospital in Abington, Pennsylvania. For the past two years, it has operated an 802.11b wireless local wide area network that links 60 mobile wireless workstations. These, along with another 300 stationary wireless workstations, are connected with the hospital’s EMR.
And, surely a sign that the “hand- held” era has arrived is news that the University of Louisville School of Medicine is distributing handhelds to each of its 600 undergraduate medical students. It is first medical school in the nation to do this. Among the medical students, a common use of the handhelds is to use them for reference access to the PDR and Lippencott Williams & Wilkins Publishers’ “Five Minute Clinical Consult.”
Health Informatics Trend #5
• NATIONAL CONNECTIVITY •
REMEMBER CHINS–Community Health Information Networks? These were regional healthcare data repositories much discussed in the early 1990s, but which failed to become a reality.
The need to share healthcare data never diminished. What rendered the CHIN concept obsolete was the development of the Web, along with enabling hardware and software.
In the private hospital sector, projects like the Winona Health Project in Winona, Minnesota and Healthbridge (pooling clinical data from 25 regional hospitals) in Cincinnati, Ohio have attracted national attention. Both are pioneering attempts to connect hospitals, physicians, patients, and payers in some type of network arrangement.
Further impetus to electronically connect healthcare centers has come from various levels of government following the 9/11 terrorist attacks and the anthrax attacks a month later. Federal money is now funding projects to link public health agencies and laboratories as a phase one, with further connections to hospitals as a subsequent goal.
The benefits can be substantial. In Vermont, THE DARK REPORT is tracking a statewide collaboration involving all the state’s hospital laboratories. They’ve connected their lab test data repositories and normalized test results across all sites. Through data mining, it is now possible to identify undiagnosed adult-onset diabetics by comparing the multi-year test results of a single patient’s HbA1c testing. Much of the funding to establish the connections between these hospital labs came from a federal NIH grant administered through the Vermont Department of Health.
Health Informatics Trend #6
• STORAGE •
IF BRUCE A. FRIEDMAN, M.D. IS RIGHT, the healthcare system will be overwhelmed by the sheer volume of clinical data generated from genetic, proteomic, and molecular-level healthcare technologies.
Dr. Friedman is Director of Ancillary Information Systems at the University of Michigan Health System in Ann Arbor, Michigan. His area of informatics expertise is clinical laboratory and pathology.
“Laboratory directors should consider how the impact of three converging trends will affect laboratory operations,” he said. “First, about 70% of a patient’s medical record retained over time is comprised of laboratory test data. Second, newer generations of lab testing produce proportionately huge amounts of data. Third, radiology, as it digitizes images, is generating significant volumes of data.”
Dr. Friedman rightly identifies the coming “storage crunch” facing hospitals and health systems. One expert says that the volume of reference data requiring storage is increasing 70% per year!
“We see that any hospital of a decent size may generate between 10 and 12 terabytes of information annually,” observed Robert Burgess, Senior Manager at First Consulting Group in Long Beach, California. A terabyte is 1,024 gigabytes.
Healthcare Informatics identifies five technologies as crucial in creating the capability to store and access clinical data. Hospitals are actively moving to acquire them:
1) Disk arrays, computers optimized for single-purpose storage. Each can cost $1 million and hold 30 terabytes of data.
2) Network-attached storage (NAS), which attaches disk arrays to computers throughout departments.
3) Storage area network, lays on top of an NAS and uses fiber channel to create communications bandwidths of one to two gigabytes.
4) Storage virtualization, capable of pooling data across widely-dispersed storage devices and even across multiple computing platforms and different types of storage media.
5) Storage management software, the prime tool for coping with huge quantities of data. Predictions are that up to 80% of the cost of new data repositories will be spent on storage management software.
Health Informatics Trend #7
• TRANSACTION PROCESSING •
ONE FREQUENTLY-OVERLOOKED ASPECT of HIPAA is its mandate that clinical transactions, claims, and other administrative functions move toward standardized formats.
This will accelerate efforts by payers and providers to improve transaction processing. The goal is to reduce costs and speed payment of claims. Gartner Group, of Stamford, Connecticut, aptly describes the existing gap between reality and ideal. In a study released last fall, Gartner says that, of the $1 trillion spent on healthcare in 2000, about $250 million went to administration. At the same time, 80% of the nation’s hospitals had yet to even test whether their network can handle basic electronic transactions!
Despite the recent, and well-publicized, failure of MedUnite to establish an economically-sustainable Web-based transaction clearinghouse of large scale, a number of regional efforts have made substantial progress. In Buffalo, New York, four providers and three major insurers launched WYNHealthENet in 2001. From a first effort in 1994, the Utah Health Information Network (UHIN) has enrolled nearly every payer and provider in the state.
Health Informatics Trend #8
• WEB SERVICES •
GONE ARE THE MUCH-HYPED consumer health Web portals of the late 1990s. The Web is now a serious tool for enabling all types of business and service transactions.
The operative word is “integration.” Accenture Partner James Hall of London, England says CIOs tell him that 40% of the cost to deploy a new application is spent to connect it to existing applications.
The Web is now used by hospitals to help with internal integration. Outside the hospital environment, the architecture of healthcare enterprise-to-enterprise Web services needs further development, particularly the interoperability glitches between Java and Microsoft’s .NET.
Another issue is legacy software used by hospitals, physician groups, and payers. Because much legacy software has yet be upgraded as fully Web-enabled, it requires considerable time and expense to program workable solutions. However, informatics experts now consider the Web to be the future of healthcare informatics. In response, both vendors and providers have aligned their strategies to maximize compatibility with the Web.
Health Informatics Trend #9
• WIRELESS •
WIRELESS IS ANOTHER AREA of healthcare informatics where consensus exists across the entire spectrum of healthcare. Vendors report rapid growth in wireless system sales to healthcare entities.
“Probably 25% to 30% of hospitals have fairly large-scale wireless implementations under way now,” stated Bruce Kantelis, Vice President, Mobile Computing at McKesson Corporation. “Another significant percentage have spot applications already installed.”
Wireless is already supporting a wide range of mobile devices in hospital settings. But experts recommend that hospitals establish an overall wireless strategy first, to help insure that all wireless devices subsequently purchased are compatible with the overall goals of the hospital.
Erie County Medical Center (ECMC) in Buffalo, New York developed its wireless strategy first. Only then did it install a backbone wireless system from Cisco Systems. It next took a unique approach to purchasing its wireless devices.
ECMC created a multidisciplinary team of IT and clinical leaders to lead the wireless installation. This team then held “internal hardware fairs.” Vendors were invited to show their wares. Physicians, nurses, and other staff members could test and manipulate the devices themselves. Staff preference guided the final mix of wireless devices that were purchased.
Nine Trends Shaping Health IT
THESE NINE TRENDS are driving changes to healthcare informatics in hospitals and physicians’ offices.
1. Biometrics: Using unique human attributes to allow access to a secure system.
2. CPOE: Computerized physician order entry viewed as a way to improve patient safety, raise healthcare outcomes, better control costs.
3. Disease Management: Corporate America’s solution to controlling the cost of healthcare while improving outcomes.
4. Handhelds: Tablet computers and PDAs (personal display appliances) fast-becoming a favorite among physicians, nurses, and hospital staff.
5. National Connectivity: Need to exchange data continues to drive private efforts to link providers and payers. Government response to 9/11 and anthrax attacks generates money to link public health resources.
6. Storage: Watch out! Exponentially- growing volumes of healthcare data will tax the capacity of health system IT departments.
7. Transaction Processing: Nationwide push to speed up payments and reduce administrative costs complements HIPAA requirements for standardized formats.
8. Web Services: Consensus is that the Web provides a better and faster way to integrate new IT services.
9. Wireless: Convenience of cell phones comes to a multitude of healthcare services and tasks—while maintaining continuous contact with the host computer.