An annual study by the internet security firm White Hat Security found that the average website had 230 "serious vulnerabilities"—those that could lead to breach or data loss—in 2010. The good news is that healthcare websites were among the most secure, with an average of 35 serious vulnerabilities in 2010, edging out even banking and financial services sites.
The bad news? It doesn't matter how many or how few times a healthcare organization's data is breached or even if it is only potentially breached. In the healthcare industry, it takes just one event—a lost laptop, a misfired e-mail, or a website that leaks sensitive, user-specific data—to make headlines.
Healthcare leaders are rightly concerned about it. In the 2011 HealthLeaders Media annual industry survey, we asked technology leaders to rank their top three concerns about electronic medical records and/or patient portals: privacy and security was the number one ranked choice.
(On a side note, tech leaders were less concerned about data security in health information exchanges—only six percent said it was the biggest roadblock to HIEs. Respondents could only choose a single answer to this question, however; funding, interoperability, and lack of standards were cited as more pressing and immediate concerns.)
Data privacy and security was—as always—a hot topic at this year's HIMSS conference. Amidst the usual debates about voluntary social security identifiers and tech-talk about algorithms, one voice suggested a low-tech way of countering some of those headlines.
There will never be support for better access to electronic health data without a consumer voice to drive it—but they need motivation to speak up, says Matthew Bates, Sr. VP of Innovation at Thomson Reuters—one of the many industry folks I talked to in Orlando last month.
"The only consumer voices we're really seeing consistently right now are the ones saying 'Hey, I don't really want a giant database controlled by the feds with all my info in it,'" he says.
Stories in the media about the exchange of healthcare information are dominated by data breaches and medical errors. Those stories are tragic, he says, but they're just one side of the story.
One way to counter that negative press is to publicize some of the positive stories about how health information data can improve care, prevent errors, and save lives, he says.
There are stories of patients and docs who have had some great experiences because of interoperability—and healthcare leaders should make sure that patient-consumers hear them, Bates says. He suggests the government sponsor public service announcements on the topic. That celebrities share testimonials. The more stories patient-consumers hear about the power of medical information to impact outcomes, he says, the more they'll demand that the information be shared.
"I think there are some heartfelt stories out there."
Last week my pedometer called to alert me to suspicious activity on my count—I'd logged so many steps over the course of four days at the CHIME and HIMSS conferences in Orlando that the device assumed someone else was using it. If you don't get the joke, you've never been to HIMSS. The number two topic of conversation there (second only to healthcare technology) is whether or not you wore the right shoes. As a friend said, at HIMSS there's no such thing as the "right shoe."
By the way, although the steps on my pedometer were all me, I assure you I had nothing to do with the emails that someone in Turkey sent to everyone in my address book after I used the hotel's free wireless Internet access.
Here are a few other notes and observations from the show (mostly of a more serious nature than shoes and Turkish malware).
1.The only guarantee: There are no guarantees
The healthcare field faces plenty of uncertainty—what will future stages of meaningful use require? Will healthcare reform survive legal and political challenges? What will accountable care organizations look like? How will we share health data securely? There are lots of questions and even more answers.
Despite the old saw, there really are some guarantees about the future of healthcare, says Nate Kaufman, managing director of Kaufman strategic advisors in San Diego, who spoke at the conference.
He says he guarantees the industry is not going to get huge increases in reimbursements, payers aren't going to make up for Medicare and Medicaid shortfalls, accountable care organizations aren't going to be getting big bonus checks in the mail in the next few years, and Republicans are not going to repeal healthcare reform—because if they did they'd have to come up with a whole 'nother way to keep the healthcare bubble from bursting.
One last guarantee from Kaufman: "2016 is when all the fun starts."
2.There's one in every crowd
One of my favorite moments in the show came when Kaufman was asking his audience of a few hundred people true or false questions.
"True or false?" he asked. "By 2016 most records will still be paper-based."
There was a brief silence and then one lone voice shouted out.
"True!" she said.
The rest of the room chuckled. It was mostly a nervous chuckle. Because that's one more guarantee: Everyone knows that one doctor who insists that things will never change.
3.Someone better pull over and ask for directions
The industry has come a long way in the past few years—getting closer to achieving meaningful use, hammering out interoperability issues, kicking around ideas about the privacy and security and other perennial bugbears. But there's still a long way to go and healthcare technology leaders have a lot of different ideas about just how to get there.
One CIO I talked to said she has absolutely no problem sharing her data with other organizations—even competitors. Come one, come all and let's get going for the patient's sake, she said. When I repeated this comment to others throughout the course of the show, reactions were mixed. Some CIOs agreed. Others blanched at the idea. A few said it's a lovely but impossible dream.
The reaction from vendors? Mostly they wondered if I would give them her email address.
4. What's the opposite of sexy? ICD-10
The semi-looming ICD-10 coding changes have definitely been overshadowed by meaningful use. And, frankly, they're just not a lot of fun to talk about. Still, the ICD-10 sessions at this year's conference were well-attended—standing room only in at least one case. It might not be the sexiest topic, but it looks like healthcare IT leaders might be getting ready to move it off the back burner. Is there such a thing as a middle burner?
A colleague of mine—an HIMSS first-timer—decided to hit one of the ICD-10 sessions. Regardless of how in-vogue the topic is, he said he decided it was time to leave the room when the audience started making insider jokes about coding … that he didn't get.
5. Can you hear me now?
I conducted a lot of interviews at HIMSS, and recorded most of them, so I was very interested in what John Umekubo, MD, from St. Mary's Medical Center in San Francisco had to say about advances in voice recognition technology and how it can help physicians write their clinical notes. I can't tell you what he said just yet—I haven't had time to transcribe the interview.
Healthcare reform, meaningful use, interoperability, and privacy and security are hot topics among attendees at the annual CHIME and HIMSS conferences in Orlando this week, of course. But this year there seems to be an increased emphasis on secure and accurate exchange of healthcare data—whether among members of local or regional cooperatives, private for- and non-profit exchanges, state-run HIEs, or individual systems that just want the hospitals, clinics, specialists, and primary care physicians in their network to do a better job of communicating electronically (and no, faxing doesn't count).
At one point, Kaiser Permanente had 2,000 systems that were barely communicating, said John Mattison, MD, CMIO of Kaiser Permanente Southern California during a CHIME town hall on health information exchange. "I couldn't solve the problem locally without solving it globally," he said. Solutions, he explained, include open-source collaboration and standardized terminology.
The benefits to quality, safety, and continuity of care are obvious—and the main impetus for eHealth initiatives. But there are other perks as well. Systems that take simple steps such as coordinating and tracking referrals electronically, for example, can help primary care physicians ensure that their patients are getting the care they need. They also boost revenue for the simple reason that more patients are getting—and showing up to—appointments.
But while the good news is that getting everyone speaking the same IT language can improve care, increase efficiency, and boost the bottom line, the challenge is that change is still, well, change. Change management might be a bit of a hackneyed phrase, but there's no doubt that it's a key to success. Giving up phone calls and faxes means creating new procedures that many different people in many different organizations must implement in exactly the same way—otherwise everything falls apart.
That holds true on a larger scale, as well—individual HIEs won't be able to communicate across state lines, for example, without a common framework and standards. Creating such standards will require organizations (including competitors) to trust one another, but it's a critical aspect of success, Mattison says.
Not an easy task.
Still, the buzz in Orlando this week suggests that healthcare organizations are willing to tackle it. And HealthLeaders Media's recently released annual industry survey backs that up. Among healthcare technology leaders, 28% said they already participate in some kind of data exchange or share data with one or more competitors and another 61% said they plan to do so.
It's clear they also recognize the challenges, however, including those perennial hot topics mentioned above. Most of the IT leaders in our survey said it will take anywhere from four to 10 years to realize the ultimate goal of an interoperable healthcare system where providers, payers, patients, and public health entities can exchange health information.
But Mattison is more optimistic. As more and more organizations begin working together and accessing and using health information data, he said, there will be a "tipping point" in the next year or two, he said.
It might take years for everyone to have unfettered access to data—there may never be one perfect system. But providers and vendors are working to overcome obstacles—from managing change to implementing standards to keeping data secure. That's good news for the 61% of organizations that are starting to investigate their exchange options.
For this month's HealthLeaders magazine cover story I interviewed a number of healthcare organizations that are using remote health technologies to improve efficiency, respond quickly to emergencies, and open up new streams of revenue. Many of those I interviewed said telemedicine isn't just as good as being there—it's better. And although the technology is hardly widespread, it does show signs of growth, according to HealthLeaders Media's annual industry survey. Nearly half (46%) of respondents said they have one or more telemedicine programs in place. Another 41% say they'll have one in place in one to five years.
Advancing technology—the availability of faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquity of mobile devices—is creating a foundation for a system of virtual healthcare where neither patient nor caregiver need be in the same place—or even in a clinical setting at all.
The organizations featured in the article include Loyola University Medical Center in Maywood, IL, where Kathleen Webster, MD, director for pediatric critical care and the medical director for the pediatric ICU, can consult on cases from home on her laptop computer. A high-definition monitor and digital stethoscope allow her to see and hear better than she could if she were in the room. "I see a lot of the studies that say telemedicine is equivalent to being there. But I actually think there is a case for saying at times telemedicine is better than being there," she says.
But there are still barriers to adoption: spotty reimbursement, questions about credentialing and other legal and administrative issues, a sometimes sizeable up-front capital investment unlikely to bring an immediate return, and that they can get concrete evidence that remote care is significantly better than care delivered in person.
And while enthusiasm for and anecdotal evidence of telemedicine's potential abound, some say there is simply not enough research to show the effectiveness of telemedicine compared to in-person treatment, especially when it comes to the use of mobile devices.
Texting health reminders to patients and similar tactics have potential and are popular with consumers, but simply sending out text messages doesn't mean that recipients will change their behavior, says Patricia Mechael, PhD, director of strategic applications of mobile technology at Columbia University. "We need to move away from research on user satisfaction and actually look at the impact on outcomes," she said at a recent m-health summit in Washington, DC. There is "a lot of hype around m-health and we need to come back to the reality of what works, what doesn't, and how to integrate mobile technology in a realistic fashion."
Rest assured, researchers are on the case.
For example, in a randomized trial of a home monitoring program at the Wenatchee (WA) Valley Medical Center, the organization showed the program saved 5% net of costs. The number of clinic visits went up—and because patients had already been triaged by case managers, those visits were more productive. At the same time, hospitalizations and emergency room visits declined.
Of course, home monitoring is just one aspect of remote healthcare—the potential for the technology is great. But for telehealth programs to become varied and widespread, payers and healthcare leaders must work to quantify the financial and clinical return on investment. If that happens, expect to see a rise not only in the number of organizations making tentative strides toward remote healthcare technologies but also the number that are planning to invest in the technology to rise in future HealthLeaders Media industry surveys.
In the meantime, leaders at organizations that do have telemedicine programs say it may not be the best strategy to wait for indisputable proof of the technology's worth.
"There is a financial barrier to entrance" to telemedicine, says Yadin David, founder and past president of the nonprofit Center for Telemedicine and eHealth Law and assistant professor at the University of Texas School of Public Health. But healthcare leaders should balance investment with expected ROI.
"Definitely do not wait, because your market share, I believe, will [suffer] if you don't have this type of program available to you. If you're not participating, you might be late for the train. It definitely will not wait."
The annual HealthLeaders Media industry survey includes individual reports on responses from a variety of c-suite titles, including technology leaders.
Shortly after David Blumenthal, MD, announced he would resign his post as national coordinator for health IT (a move that was planned when he was appointed two years ago) healthcare leaders began talking about what made him such an effective champion of electronic health systems and health information exchanges.
Two clear themes emerged. First, although has helped to set tough standards for healthcare organizations to achieve meaningful use of electronic health systems, he has also spent a lot of time listening to healthcare leaders, weaving their suggestions into those policies. And that MD after his name? That’s part of what makes him effective, too.
“He was open to having discussions with CIOs, discussing issues with us,” said Pamela McNutt, senior vice president and CIO at Methodist Health System and chair of the College of Healthcare Information Management Executives’ policy steering committee. “He was very engaged in the topic and sensitive to our concerns,” she said in a CHIME release.
“His real-world experience as a physician who adopted the technology enabled him to speak with experience about the challenges and rewards,” added David Muntz, senior vice president and CIO at Baylor Health Care System, who also serves on CHIME’s Board of Trustees and policy steering committee. “It was also his personal style, approachability, and interest as a listener that contributed to his success. You knew that he heard your point of view and trusted him to exercise good judgment in the face of many competing factors.”
The story Blumenthal tells of his early encounters with clinical technology are a good illustration of the power of having a doctor who listens driving the nation’s health IT agenda. At first skeptical about EMRs, he listened when his younger colleagues urged him to try the technology, and quickly recognized that it would make him a better doctor. He often tells the story of the day an EMR alerted him to the fact that he was about to prescribe a sulfur-based medication to a patient who was allergic to the ingredient, preventing a potentially fatal error.
In a memo to staff, Secretary of Health and Human Services Kathleen Sebelius said that during the past two years, the nation has “finally turned the corner” in its journey to the use of health information technology and the adoption of EHRs. “David will leave his post having built a strong foundation, created real momentum for HIT adoption, charted a course for the meaningful use of EHRs, and launched a new phase of cooperative and supportive work with the healthcare community, states, and cities across the nation,” she wrote.
That may be true, but let’s face it—there are a lot more corners to turn.
As HHS begins its search for Blumenthal’s replacement, it would do well to remember the quality that made Blumenthal respected in the health IT community and effective in his role: He understands the doctors and leaders he’s trying to reach—because he is the doctor and leader he’s trying to reach.
As healthcare organizations begin to explore accountable care models, one thing is clear—technology will play a huge role. Organizations that are leading the way toward ACOs talked about how they'll use technology to reach their goals in the most recent HealthLeaders Media breakthroughs report, The Bridge to Accountable Care Organizations.
In a roundtable event that is part of the multi-media report, leaders talked about electronic medical records and health information exchanges—the foundation for identifying gaps in care and for housing data that will be used to guide physicians.
"Clearly, health IT is the backbone, the enabler to an ACO," says Warren Skea, PhD, director, health industries advisory practice at PricewaterhouseCoopers, which sponsored the report. "There won't be success unless information is free flowing between all entities. What we've heard is that it is critical to have one system within the organization.
Health information exchanges are critical but not every market has one, and I think that's going to be a significant hurdle for many markets. One of the challenges is that patients' cost and their care will be counted regardless of whether they receive in-network or out-of-network care. So if you've got patients who go outside the network to receive care, outside of your IT framework, it will be critical to get that out-of-network information as quickly as possible, making it interoperable and managing it in the most cost effective way and in the most timely manner."
"In a managed care system with referrals we know where the patient is headed before the cost is incurred and that gives our care management infrastructure a chance to help," says Nancy Boerner, chief medical officer at Monarch Healthcare, a 20-hospital system in Irving, CA. "In this system where choice will still be present, waiting for claims information—even if it's timely claims information—is a bit too late.
We're looking at an idea of having a care navigator that is an extension of the office practice to really be an adjunct to help the patient when something happens that we know could use some additional coordination because in this population that's really the challenge for us. Now we're trying to figure out how we can get involved with the information even before the claim hits."
Monarch CEO Bart Asner, MD, adds, "It's been an enormous amount of work to figure out who the patients are, get information and data on these patients, and figure out ways that will make the information flow smoothly through the system going forward."
In the ACO model, a variety of organizations must find ways to share information—that can be a challenge, says James Canedy, MD, a board member at the Nebraska Medical Center in Omaha, NE, which has partnered with the Methodist Health System to create an accountable care alliance. "We have a lot of different groups coming together: two health systems, an academic practice plan, independent physicians and health system employed population. And it's not hard to believe that they're all on different systems. So we are fortunate we have the Nebraska Health Information Exchange so we can pull data from any health system in the state. Most hospitals are enrolled in this, so we have access to data … but then how do you match that data with the other system data? So there are processes in place but it's a tough expensive, expensive model."
Getting the most out of an organization's information technology backbone is one of the crucial differences between now and previous efforts to manage population health, says Skea.
"Information technology and the willingness to share information among disparate groups will help to integrate care as well as support the ability to measure success and reach consensus on quality goals and metrics," he adds. "Early adopters are well on their way to positioning their organizations for an era of ACOs."
One of the "five pillars" of meaningful use is to engage patients and their families in electronic health data. But engaging patients and families with electronic health data isn't just about HITECH requirements and stimulus money - - it's also a way to foster collaborative decision-making between provider and patient, which, in turn, improves the patient experience, leads to better outcomes, and can reduce readmissions.
Americans pay more attention and become more engaged in their health and medical care when they have easy access to their health information online, according to a 2010 California HealthCare Foundation survey. For example, patients who use a personal health record say they take steps to improve their own health, know more about their healthcare, and ask their doctors questions they say they would not otherwise have asked.
But consumer adoption is still low—just 7%, according to the survey. The questions facing the healthcare industry are how best to get those numbers up and whose job it is to do so.
"We need to find better ways to tap into the skills of the consumer. There's hardly anyone more motivated to manage their own health or that of a family member," says Donna DuLong, RN, cochair of the American Health Information Management Association's Personal Health Information Practice Council. "The trick is finding the right tools and helping educate them and raise awareness."
Here are five ways to engage patients in their personal health records:
1. Address privacy concerns. About 75% of the people currently not using a PHR who responded to the CHCF survey call it "a significant barrier" to participation. Providers should stress that electronic data is more secure than paper charts, which might be lying out on a desk where anyone can see them instead of behind a firewall in a password-protected computer.
2. Use patient-centered design principles. To engage patients in online health records, make access and navigation as easy as possible. Arrange data in ways that make sense to a layperson—organizing content by condition, for example, rather than by date of service.
3. Offer familiar services. Patients who do any kind of online business—from banking to shopping (and, really, who doesn't?) will feel comfortable with healthcare services such as online appointment scheduling, appointment reminders, and medication refill requests.
4. Reach out to digital natives. Interactive and relevant content is important to tech-savvy consumers, so build communities and create intelligent tools and searches for them. "Engagement matters," DuLong says.
5. Reach patients through a trusted source. People trust their personal docs—and so it should fall primarily to the primary care physician to "sell" patients on the idea of personal health records. "We need physicians and patients to start talking about how these tools can improve their communication and assist patients to be more in control of their own health," says Sam Carp, CHCF vice president of programs. Quick access to lab tests and results is a big selling point for patients, says vice president and chief innovation and technology officer at the Palo Alto (CA) Medical Foundation, part of the Sutter Health System.
Meanwhile, if the healthcare industry will be looking to docs to get patients engaged in personal health records, that means docs must also be on board. Busy doctors—or those who are reluctant adopters—need an incentive to do so, whether through government incentives or penalties for failing to embrace electronic health records. "The more successful the current federal effort is to promote EHR adoption among physicians and other providers, the easier it will be for patients to access their health information from their most trusted source," says Mark D. Smith, MD, CHCF president and CEO.
Healthcare providers are marching toward certification and meaningful use of their electronic health systems and thinking about how they'll spend the financial rewards for doing so. But are they doing it for the love of e-health technology? Or are they doing it because the government is all but forcing them to?
A recent survey conducted by the HealthLeaders Media Intelligence Unit, E-Health Systems: Opportunities and Obstacles, suggests healthcare leaders are feeling positive that they'll meet meaningful use requirements. In fact, 91% said they will be ready by 2016 at the latest. And 41% said their systems are already certified by an approved ONC certifying body.
That jibes with data from the Office of the National Coordinator for Health Information Technology, which found about 80% of the nation's hospitals and 41% of office-based physicians plan to cash in on as much as $27 billion in federal incentives for adoption and meaningful use of electronic health records technology.
And while this all sounds like good news, one question remains—are electronic health systems everything that the industry had hoped for?
Perhaps not so much.
In the HealthLeaders report, hospital and health system leaders rate their satisfaction with the cost, value, interoperability, ease of use, speed, responsiveness, and downtime of their systems. They also rated their satisfaction with functions such as chart review, patient portals, physician portals, decision support, and the ability to conduct data-driven research. In every category fewer than 57% of respondents were either strongly or somewhat satisfied.
The satisfaction rates were a little better at physician practices and clinics—but not by a whole lot.
(Check out page 14 and 16 of the report for all of the data on leaders' satisfaction with a variety of EHS components, broken down by setting.)
And that begs the question—are providers pushing forward with electronic health systems just to get the money and to avoid penalties for failing to meet meaningful use? Or do they believe that the technology will ultimately get better and have a positive impact on outcomes? A sampling of provider responses shows that some are motivated by the financial carrots and sticks, but others believe it is the right thing to do.
"The penalties [for failing to achieve meaningful use] would close our practice," wrote one respondent, the administrator of a physician organization.
"Failure is not an option," said the VP of finance at a small hospital. "We must achieve meaningful use if we are to keep our doors open and to remain a viable business."
On the other hand, 89% of leaders say that e-health systems will improve quality of care industrywide within 10 years, and many talked about the benefits to patients and quality of care.
"The importance of knowing the patient's entire story outweighs 'competition,'" said the CNO of a midsized hospital. "It is also important to better aggregate statistical and demographic information for our area to better address and provide appropriate preventive care and education."
You can read the full HealthLeaders Media Intelligence Unit report, E-Health Systems: Opportunities and Obstacles, online here.
One of the "five pillars" of meaningful use is to engage patients and their families in electronic health data. The stage one requirements of the HITECH Act, already in place, include the relatively simple tasks of sharing discharge instructions and providing patient education—electronically or by printing out the information from the patient's electronic health record. But it's clear that in future stages hospitals will be required to do much more, such as using remote monitoring devices and communicating with patients electronically to help them manage chronic conditions and to intervene before they require emergency care.
But engaging patients and families with electronic health data isn't just about HITECH requirements and stimulus money—it's also a way to foster collaborative decision-making between provider and patient, which, in turn, improves the patient experience, leads to better outcomes, and can reduce readmissions.
Americans pay more attention and become more engaged in their health and medical care when they have easy access to their health information online, according to a 2010 California HealthCare Foundation survey. For example, patients who use a personal health record say they take steps to improve their own health, know more about their healthcare, and ask their doctors questions they say they would not otherwise have asked.
But even though PHR use has doubled since 2009, consumer adoption is still low—just 7%, according to the national CHCF survey. The questions facing the healthcare industry are how best to get those numbers up and whose job it is to do so.
"We need to find better ways to tap into the skills of the consumer. There's hardly anyone more motivated to manage their own health or that of a family member," says Donna DuLong, RN, cochair of the American Health Information Management Association's Personal Health Information Practice Council. "The trick is finding the right tools and helping educate them and raise awareness."
The government line is that patients love the idea of electronic health data. "In my personal experience of providing care with an electronic health record I never found a patient who wasn't either intrigued or supportive of the use of an electronic health system, says David Blumenthal, MD, HHS' national coordinator for health information technology.
But there are many consumer concerns and barriers to patient adoption.
Privacy and security of data is a big one: About 75% of the people currently not using EHR/PHR who responded to the CHCF survey call it "a significant barrier" to participation. Right or wrong, some patients think that if they release their personal health information, insurers might use it to deny coverage, employers might use it to decide whether to hire or fire them, hospitals might sell the data to marketers, or careless employees might release the records to a nosy neighbor or an identity thief.
Concerns about misuse of data are legitimate, says U.S. Surgeon General Regina Benjamin, MD. "And that's where government comes in, to protect the information, [to ensure] that your information isn't shared with anyone unless you want it to be. That's important."
In fact, she says, physicians should stress to patients that electronic data is more secure than paper charts, which might be lying out on a desk where anyone can see them instead of behind a firewall in a password-protected computer. "We're trying to explain to people that it's easier to protect electronic data than it was to protect that paper chart," she says.
Benjamin's comment aligns with conventional wisdom among healthcare leaders: that the task of engaging patients in their electronic health data should fall primarily to primary care physicians.
"While there is still a lot of work to be done to overcome concerns about privacy, as more physicians adopt EHRs, their patients will have easier access to their health information. Most important, we need physicians and patients to start talking about how these tools can improve their communication and assist patients to be more in control of their own health," says Sam Carp, CHCF vice president of programs.
But busy doctors—or those who are reluctant adopters—need an incentive to do so. Partnerships will play a role in giving both docs and their patients a push toward embracing electronic health data, Blumenthal says.
"There's a shared responsibility across the government and the private sector. In a very direct and intimate way, physicians and nurses can help patients understand the value of EHRs," he says. "As in everything in our society, the private sector can't do it alone and the government can't do it alone."
Mark D. Smith, MD, MBA, CHCF president and CEO, agrees that physicians need that government push. "The more successful the current federal effort is to promote EHR adoption among physicians and other providers, the easier it will be for patients to access their health information from their most trusted source."
Online portals are one way providers are reaching out to help their patients become meaningful users. Sutter Health, a 24-hospital integrated system in Northern California, has an online portal that allows patients to send secure e-mails to their doctor's office about nonurgent health questions, view and chart test results, request a prescription renewal, view instructions from a recent doctor's visit, and request an appointment.
Sutter uses a number of tactics to protect health information and reassure patients with security and privacy concerns, including 128-bit SSL encryption, session timeouts, page expirations, and disabled data caching. Sutter also monitors the Web server for evidence of unauthorized break-in attempts. "In the unlikely event that the Web server is compromised, no health information would be exposed because it is not stored on the Web server. Patient information is stored only in the EHR, behind a firewall," according to the organization's privacy and security statement, part of a concerted effort to educate patients about the PHR.
More than half of the patients at the Palo Alto (CA) Medical Foundation, a multispecialty group practice that's part of the Sutter Health System, have accessed their personal health records. Quick access to lab tests and results is a big selling point for patients, says Vice President and Chief Innovation and Technology Officer Paul C. Tang, MD.
"Most of the people sign up at the time they are in the office," he says. "If we are going to order lab tests—or any tests, for that matter—I'll look up and see [if the patient] is online. Because it's on the EHR. And if they're not I'll say, 'You know, you can look at these results electronically. Would you like to sign up for that?' That's the most important time to approach a patient because then they will get the results oftentimes the same day, and they love that."
In the paper-based model, the time it took a physician to send out the tests, get back the results, and then pass them on to the patient was "horrible," Tang says. And, in fact, sometimes patients didn't get their results at all.
"In the electronic world they know they can get it reliably. They will get it [because] we have systems in place so that even if the doctor doesn't release it in time, the system will automatically release it at a certain point. That's one of our fail-safe mechanisms," he says. "You can look at it as what we owe the patient or you can look at it as a patient safety issue, because it's not going to fall through the cracks."
There are signs that there will come a time when patient access to health records is the norm. Patients are not only used to accessing data—they're demanding it. "They're using information they can glean off the Web right now; I think if we make more information that's pertinent to them available they will use it more effectively and they'll achieve better outcomes," Tang says. "That's the end goal, here."
The PHR will benefit outcomes by delivering healthcare that is personalized and appropriate for each individual, Tang says. "By partnering with patients we'll be more effective in dealing with diabetes, heart failure, coronary disease" and other chronic conditions.
Tang, who is also a vice chair of the federal HIT Policy Committee, says engaged patients and families will have a "big payoff" as the population of Medicare-eligible patients rises. Many say that engaging caregivers—those family members or friends who are often volunteering their time to care for their loved ones—will help ease the impact the aging population will have on the healthcare industry.
"We will need to partner with patients and their families in order to address the health needs of aging baby boomers," Tang says.
Imaging has been all over the news lately—but the articles aren’t all about the technological wonders of modern radiology. Imaging is a service line that generates profits without which most healthcare organizations would suffer. The technology has improved dramatically in the past 15 or so years. But lately public attention has been focused on so-called combination scans—and some are wondering whether healthcare organizations are rightly reaping those profits.
A study in the this month’s issue of Radiology found that from 1995 to 2007 the number of emergency department visits that included a computed tomography (CT) exam increased from 2.7 million to 16.2 million, an increase of 16% per year. In and of itself the study, led by David B. Larson, MD, from the Cincinnati Children’s Hospital Medical Center in Ohio, isn’t exactly scandalous. One simple explanation is that there are more uses for the technologies today, researchers noted.
And research by heart imaging specialists at Johns Hopkins found that a combination of CT scans to detect coronary artery disease and its severity,
by measuring how much blood is flowing through the heart and the amount of plaque in surrounding arteries, are just as good as tests that are less safe, more complex, and more time-consuming.
“The newer, state-of-the-art CT scans are just as good as established older technologies in diagnosing the presence and severity of coronary artery disease,” said cardiologist and lead study investigator Richard George, MD. “In addition, the newer CT scans have the added advantages of being easier on the patient, taking less time to perform, using less radiation, and providing physicians with all the information they need in one test.”
But the public might not see it that way. An enterprising reporter in Connecticut used CMS’ Hospital Compare data to ferret out the fact that patients at the University of Connecticut’s John Dempsey Hospital are getting combination CT scans of the chest 48% of the time—nearly 10 times the national average. And more than 72% percent of patients who were sent for CT scans of the abdomen received double scans—also much higher than the national average of 19%.
“The data collected by CMS’ ‘Hospital Compare’ system shows that Dempsey, part of the UConn Health Center, has the highest rate of double chest and abdomen scans among all hospitals in the state, most of which are in line or have lower rates than national averages,” wrote Lisa Chedekel for the Connecticut Health Investigative Team website.
For its part, the hospital did conduct an internal review last year that flagged a high incidence of the multiple scans. It is taking a number of steps to address what radiology chair Douglas Fellows, MD, concedes is a “staggering” number of combination scans.
Clinicians with expertise in abdominal and chest imaging are working with physicians to encourage single scans, for example. And in cases where outpatients come to Dempsey with orders for double scans, Fellows’ staff is contacting doctors to push for single scans, according to the article.
Soon after Chedekel’s article was published, The Association of Healthcare Journalists, a professional organization for healthcare reporters, picked up the story. No doubt reporters will be checking CT scan rates at their own local hospitals, too.
It might be a good time to assess the number of combination scans at your own facility—and at the very least be prepared to talk to the press about the benefits of modern imaging.