Strategy More Important Than Technology in Post-COVID-19 Wave of Innovation

Healthcare IT will play a leading role in bridging the gaps the pandemic revealed, says HIMSS president and CEO Hal Wolf.

For a man who's had a front row seat on a roller coaster ride, Hal Wolf, president and CEO of the Healthcare Information and Management Systems Society (HIMSS), seems amazingly composed. The internationally renowned healthcare and informatics leader has led the organization since September 2017, overseeing possibly the most dramatic era in the history of healthcare IT.

In February 2019, the U.S. Department of Health and Human Services issued two proposed rulings to improve the interoperability of electronic health information. The many tentacles of those regulations included a need to address information blocking; promote patient access to their own data, while enhancing security; and foster healthcare innovation. HIMSS played a leading role in shaping these rulings, working in concert with its constituents.

This March, as the coronavirus pandemic began its trek across the United States, for the first time in its history, HIMSS closed down its annual conference, the largest healthcare IT convention in the nation. It issued the notice three days before the official start of the gathering, more than 40,000 people were expected to attend, and President Donald Trump was set to take the stage. Instead of delivering the HIMSS keynote on March 9, Trump declared a national public health emergency, while The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services simultaneously released their final interoperability rulings.

What's happened since has been terrifying and thrilling, much like a carnival park ride. COVID-19 tested the resiliency of the healthcare industry and the virus, says Wolf, and inspired unprecedented innovation that has accelerated the transformation of healthcare. "We'd love the circumstances to have been as progressive as they have been in the last six months without a pandemic," he says.

Yet COVID-19 also revealed deep cracks in the health system. Once again, HIMSS is playing a leading role, determined to help close those gaps, Wolf says. "If there is a silver lining in a terrible, terrible dark cloud, it's that the spotlight is on these gaps, and we have a chance to make long-term improvements."

Prior to joining HIMSS in September 2017, Wolf worked as a healthcare consultant for The Chartis Group and his own consulting company. He previously held executive positions at Kaiser Permanente’s The Permanente Federation, MTV Networks, and Time Warner, and served as senior advisor to McKinsey & Company.

Before the election, HealthLeaders spoke with Wolf over Zoom about how the healthcare industry should move forward, and the role HIMSS is playing in these endeavors. Our discussion shines a light not only on what's next for healthcare IT, but also on the broader stage of healthcare. Following are excerpts from the interview, edited for space and clarity.

HealthLeaders: The pandemic has revealed significant gaps in our healthcare system, particularly related to obtaining real-time information to address population health needs. What's your perspective on this issue?

Hal Wolf: The recognition of gaps inside the United States started before COVID-19. It's quite apparent both in the U.S. and the World Health Organization (WHO)—and all around the globe—that from a population health perspective, we take far too long and have far too many manual processes to get health status information [on a timely basis].

When you have a pandemic or a rising national crisis, our ability to understand where we are, starting at a population health level, is critical. Where do resources go, how does it impact the supply chain, where do we need to send clinicians? How quickly do we need to make adjustments, what are the reimbursement models, and when do we begin to execute across border accreditation practices? This is really basic blocking and tackling that every country needs, and the U.S. is absolutely no exception.

Hal Wolf, president and CEO of HIMSS (Photo courtesy of HIMSS)

HL: How does an individual's access to their health information factor into this dynamic?

Wolf: About 50% of people might have had their record with them or had access to it through the facility they walked into, but too many did not. We were putting people's lives at risk because we're not putting ourselves in a position to have individual information.

Our gaps are pretty straightforward. There's an economic toll that takes place, and there's a toll on human life. It doesn't have to be that way. Because of COVID-19, it's an incredibly important time for us to shore up our healthcare systems in the United States and globally as well.

HL: What role is HIMSS playing to close these gaps?

Wolf: Before COVID, HIMSS had been focusing on the collection of data and having unified national databases, especially at the level of the Centers for Disease Control and Prevention (CDC), supporting investment and development on backend systems. [In addition]:

• We were leading the fight on changing [telehealth] reimbursement levels and getting those set during the pandemic.
   
• We're in Congress working from a government relations standpoint to make as many of these changes as permanent as possible.
   
• We work with ONC on a regular basis on understanding interoperability standards and supporting the rules that came out last March, which we hope to get implemented. A lot of them—and rightfully so—were put on the back burner during the pandemic, but they're coming back again.

These fundamentals are very much part of the HIMSS mission, which is to reform the global health ecosystem through the power of information and technology. We're having the same conversations at the EU, and we support the WHO initiatives on data gathering as well.

HL: What message do you have for hospital and health system executives?

Wolf: First of all, nothing gets done without the three key points of people, process, and technology. The technology is the least of your worries. Implementation and processes need to be updated in order to take care of the patients, consumers, and citizens who are walking through your doors. Their expectations are changing because they have now shifted to digital health and telehealth. Each and every one of them saw massive change in a very short period of time—a huge disruption.

As we go back to the new normal, there will be a [transitional period] where executives should:

1. Change processes to ensure the long-term inclusion of telehealth and digital health capabilities is step one.
    
2. Secondly, they've got to train their workforce. How do you get people to understand those full capabilities? How do we train them what to listen for? How do we know when a clinician is needed versus a full physician? How do we [address] scope of practice challenges inside their facilities? They need to understand that implementation vehicle.
    
3. Finally, on the technology side, don't try and over-understand it, but understand its capability because that will come back and help your operations. It's going to help [improve] satisfaction with your physician and clinician community. And it's going to give you an advantage in attracting patients and taking care of them in the method that they [prefer].
    

HL: Your comments mirror my recent discussions with innovation executives, which focus more on strategy and processes than technology.

Wolf: On that point [at the outset of the pandemic], some of the more progressive health systems were able to scale up rather quickly. But the majority of them had to grab a lot of technologies thrown against the wall, see what would stick, and go with it. Now that everyone's caught their breath just a little bit, hospital executives are looking up and saying, "That was a really good reflex action, but I need a longer-term strategy. I know what I need to scale up. I need to understand where I'm going and how I get my workforce ready to go there." If you stiff-armed it or didn't feel like it was a pressing need before, guess what? You just got a really great awakening.

Across the country executives are taking a very strong strategic approach and recognizing the moment for change has arrived. It is one of the largest change management efforts that we will see in healthcare in such a short period of time because of the pandemic.

Related: The Unexpected Side Effect of COVID-19: Collaboration

HL: How does collaboration fit into the path forward?

Wolf: This is a phenomenon that came out of necessity. It started with supply chain management—sharing masks and protective gear. Then it was overloaded ERs and bed capacity. Suddenly there was this exchange of ideas, and personnel—all hands on deck. It wasn't about rivalry. … It was about taking care of the patients that were coming in everyone's facilities, and it went to the absolute heart of what makes healthcare so important to each and every one of us. I think you're going to see more of that occurring. It won't necessarily be huge and widespread right out of the gate, but the level of cooperation and the need that is presented are going to create opportunities.

Because of COVID-19, it's an incredibly important time for us to shore up our healthcare systems in the United States and globally as well.

In part 2 of this interview, Wolf explores how interoperability and a national patient identifier are key elements in paving the way forward, and he peers into the future, offering his predictions about how healthcare will change in the next three years.