Memorial Healthcare budgets to implement Intelligent Observations' sensor-driven approach systemwide.
As the COVID-19 pandemic rages on, a small but growing number of hospitals are investigating or installing automated technology that promises to reduce hospital-acquired infections through a new internet of things approach to hand hygiene.
The technology alternative uses near-field magnetic induction (NFMI) technology to verify that clinicians are washing or sanitizing their hands the proper amount of time, every time, at appropriate transitions of care. Due to its location accuracy, NFMI is able to do this with a far greater precision than previous technologies that rely upon RFID wireless technology.
The system pairs NFMI-powered sensors with NFMI-powered badges, upgrading badges already typically worn by clinicians. If clinician don't wash or sanitize their hands when approaching a patient to touch them, or after touching them, Intelligent Observation sensors can silently record the fact that hands weren't washed for a sufficient amount of time.
The technology can also provide an auditory signal before the clinician touches the patient or the next patient, to prompt the clinician to wash or sanitize their hands. Implementation of this option is left up to hospital and health system management.
If the clinician does stop for an adequate period of time at a hand-washing station or hand sanitizer dispensers, other Intelligent Observation sensors record that as well to ensure hand hygiene compliance.
The new technology "facilitates something we've been doing manually today," says Jeffrey Sturman, senior vice president and chief information officer of Memorial Healthcare System, which owns the 226-bed Joe DiMaggio Children's and numerous other hospitals in south Florida. "We’re going to be able to see the dividends of this pretty quickly."
In fact, Sturman says, the entire 2000-bed Memorial Healthcare System has budgeted installation of Intelligent Observation throughout the entire system during the next fiscal year, which begins on May 1. Sturman hopes to begin the pilot at Joe DiMaggio in February, March, or April.
Jeffrey Sturman, senior vice president and CIO, Memorial Healthcare System (Image courtesy Memorial Healthcare System)
Technology Also Enables Data-Driven Contact Tracing
"I'm capturing data in a very specific manner, down to the centimeter or millimeter level, knowing who's been in a room," Sturman says. In fact, not only can the technology determine hand hygiene compliance, but it also enables a more data-driven form of contact tracing for COVID-19, MRSA, or any other infectious disease, he adds.
The Intelligent Observation tech also tackles two huge problems with traditional visual-observation methods of verifying hand hygiene compliance.
The first is that healthcare institutions conduct a bare minimum number of visual observations to comply with regulations. That number amounts to between 1% and 2% of all hand hygiene events in hospitals, says Seth Freedman, CEO of Intelligent Observation.
Freedman says the fact that these data are extrapolated from the small sample means they are not statistically accurate. Intelligent Observation's always-on monitoring of compliance provides, for the first time, a reliable representation of all hand hygiene data, he says.
The second problem with visual observation is the Hawthorne Effect, a well-researched phenomenon that humans do what they are supposed to do when they know they are being watched, but when they are not, they resume their typical behavior.
Sturman says rather than pushing back or resisting the new technology, Memorial Healthcare clinicians are helping to improve the product to adhere to the World Healthcare Organization's "My 5 Moments for Hand Hygiene" protocol.
"Most hospitals in the United States actually don't do this, whereas most hospitals in Europe and Asia do follow these moments through the WHO process," Sturman says.
U.S. hospitals follow the simpler "entry and exit" guidelines of checking that clinicians wash or sanitize their hands before and after touching patients in part because they are easier to visually observe, Freedman says.
Still, some U.S. hospitals, including Memorial Healthcare, are already committed to the WHO protocol, and think Intelligent Observation gives them, for the first time, a way to adhere to the 5 Moments protocol.
"We're proud of it, and we think it's the safest and most clinically effective thing to do," Sturman says.
When Intelligent Observation goes into Joe DiMaggio and other Memorial Healthcare hospitals, the sensor in each room will be placed not in the doorway typical for entry and exit sensing, but instead will be right next to the bed, creating a zone around the bed where the full WHO protocol can be recorded.
The WHO protocol adds three events to simple entry and exit. The three additional events are: performing an aseptic task, body fluid exposure risk, and contact with patient surroundings.
"Every U.S. hospital we've spoken to has talked about having a transition plan to be able to move from entry and exit [only] to the five moments," Freedman says. "Intelligent Observation gives them a tool to be able to do that."
Like any technology, Intelligent Observation comes with a price tag, but in addition to fully meeting hand hygiene compliance, this technology also can free up scarce nurse resources previously devoted to visual observation of hand hygiene.
"Most healthcare systems right now have a priority to figure out how to get nonessential nursing activities off of nurses' plates," Freedman says.
"The average 250-bed hospital spends about $60,000 to $70,000 a year in [visual observation] costs, and that's approximately what Intelligent Observation costs per year for a 250-bed hospital," Freedman says.
Memorial Healthcare is starting with Joe DiMaggio Children's because of interest by executives to adopt innovative technology there first, Sturman says. This will serve as a jumping-off point for more widespread adoption.
Federal warning in October prompted Rush Memorial to rethink protection of backups.
While no one was entirely ready for the hellish year that was 2020, few healthcare IT leaders have been at it longer than Jim Boyer, MBA, CIO and executive vice president of Rush Memorial Hospital in Rushville, Indiana, who assumed his position in 2002.
"For many years we've been working off of our security audits and just trying to be innovators of how do we take a small hospital and tighten security," Boyer says. "It's the same challenge as with any hospital."
But that challenge keeps mutating and growing. Back in October, the Cybersecurity and Infrastructure Security Agency, the Federal Bureau of Investigation, and the U.S. Department of Health and Human Services released a joint advisory warning hospitals and health systems about an "increased and imminent cybercrime threat."
At a time when COVID-19 has overloaded hospitals and made downtime inconceivable, the October warning is forcing CIOs such as Boyer to rethink traditional IT designs.
Toward that end, Rush Memorial now has replaced its traditional on-premises backup technology with cloud-based backup technology that locks down its data backups separately from the rest of its network.
"Our whole strategy was to be able to be air gapped, so that we would have immutable backups," says Dan Matney, Rush Memorial's director of information services. To do so, it moved online backups to a cloud-based service known as Clumio. "It was the only vendor we knew that we would rely on to be able to give us that," Matney says.
Air Gapping Makes Backup Files Unavailable to Intruders
"Air gapping" is the practice of taking a snapshot of a set of data and placing it in a non-LAN-attached network. When intruders launch a ransomware attack, the first thing they look for is the enterprise's backup files. By air gapping, those files are simply not available anywhere on the enterprise's servers—they exist only as files on Clumio's cloud-based servers, Boyer says.
Rush Memorial implemented Clumio with a policy to back up everything that had changed within the past four hours, Matney says.
"If we get hit, we lose no more than four hours of work," he says. "While that still might be a fair amount of work, especially if it were to occur during the day, that would be a pretty minimal hit."
According to Clumio, hackers cannot access the backend infrastructure. In traditional air gap solutions, customers have to manage network security, purchase additional hardware at a secondary site, and ensure that no network access is available once the backup is completed.
Clumio not only manages all the security and moves the infrastructure access outside the reach of the hackers, but also takes the constant security upkeep off the customers hands. Clumio completes quarterly penetration testings, and has completed certification and compliance testing for ISO 27001, and 27701, HIPAA compliance, PCI DSS, and SOC 2 Type I and Type II.
Prior to working at Rush Memorial, Matney worked at a managed services provider who had four "rather large" clients that had gone through ransomware attacks. Fortunately, they had backups on tape drives that had not been encrypted by the ransomware, and only a couple of days of data were lost, he says.
The October government ransomware alert was a reminder that all IT organizations need to be proactive, not reactive, Boyer says.
"You have to get the culture of your organization to trust that the IT leaders of your organization are going to do what's necessary to keep things locked down, but also keep things operational," Boyer says.
It's all about simplifying the stack of software on Rush Memorial computers, which will help improve security.
"We try to get rid of a lot of different layers of vulnerability and simplify the process, so it's manageable," Boyer says. "We're a small hospital, so we want to keep things manageable for our teams, because if you have too many systems, the patching, securing, and whatnot becomes a landslide for the IT staff."
"We're able to isolate a workstation very quickly, and keep operations running without it being a threat," Boyer says.
Many organizations are also placing enormous emphasis on educating employees to recognize suspicious emails. "You have to educate the workforce, not to the realm of paranoia, because you wouldn't get anything done," Boyer says. "If they see something that smells or looks 'phishy,' then it is phishy."
Even when email initially enters Rush Memorial, systems in place to educate recipients about red flags, such as a questionable hyperlink. "It's going to pop up and say, this link is not safe," Boyer says. "It'll educate them on why it's not safe."
But of all the measures taken since October, it's the air-gapped backup that stands above the rest.
Guide to key dates, reference documents, and API Resource Guide released ahead of April 5 deadline.
As the April 5 deadline approaches for implementation of the information blocking, Application Programming Interfaces (API) condition and maintenance certification, and other provisions of the 21st Century Cures Act, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) is offering additional resources to providers.
In a January 4 blog post, Rob Anthony, director of the certification and testing division in ONC's Office of Technology, described the new resources, including key dates, an application program interfaces (API) deep dive guide, and other reference materials.
The new resources augment the ONC's growing library of educational materials and explanations for health IT developers, Anthony said.
The 21st Century Cures Act: Information Blocking, Interoperability, and the ONC Health IT Certification Program Final Rule, known for short as the ONC Cures Act Final Rule, was issued in March 2020, and the deadlines were extended last October. A major goal is to provide all U.S. patients with fingertip access to their medical information on their smartphones.
The new resources include:
The 2015 Edition Cures Update Key Dates assembles all important dates so health IT developers can not only track these dates, but also understand the various requirements they must meet.
For developers seeking ONC certification on any of ONC's API certification criteria, or compliance with API Conditions or Maintenance of Certification requirements, ONC now provides its latest Application Programming Interfaces Resource Guide. The new guide includes ONC clarifications from the ONC Cures Act Final Rule preamble.
"We hope the health IT developer community finds these useful as important compliance dates approach," Anthony wrote in the blog post.
Last October, other 2015 edition health IT certification criteria and conditions and maintenance of certification requirements were extended to December 31, 2022.
Almost $250 million will support providers, building on the initial program. Comments are due January 19.
Leaders of Round 2 of the Federal Communication Commission's COVID-19 Telehealth Program, newly boosted by $249.95 million of funding, wants your opinion.
The FCC will be considering a lot of applications for how to use this funding, bestowed by the Consolidated Appropriations Act , passed by the Congress in December and effective as of December 27.
In particular, the FCC wants input on the metrics the FCC will use to evaluate applications in this funding round.
After the COVID-19 pandemic began, the FCC established its COVID-19 Telehealth Program. The initial funding of $200 million, awarded to 539 applicants from 47 states plus Washington, D.C., and Guam, enabled telehealth and connected care services to patients at home or who may be in a mobile location, due to the pandemic.
"Telehealth has been a critical factor in helping us address the COVID-19 pandemic, which continues to have a devastating impact on the health of the American people," said FCC Chairman Ajit Pai as part of the Round 2 announcement.
Pai said the initial program has expanded access to telehealth services throughout the U.S., including to record numbers of remote patients who have received bilingual telehealth services from health clinics providing service to rural hospitals.
The initial funding was exhausted in July 2020, after the FCC had evaluated and awarded funding commitments on a rolling basis. Areas hardest hit by COVID-19 received top priority during that round.
The new public notice asks for public input on how to address applications that did not receive funding in the initial round. This input period will also address the definition of what comprises a hardest-hit area.
Comments are due by January 19, 2021. Comments can be filed in WC Docket No. 20-89 through the FCC's electronic filing system.
MIT team-developed app, derived from Alzheimer's research, expected to seek FDA approval
Massachusetts Institute of Technology (MIT)-based researchers have found the way that someone coughs can reliably determine if they have COVID-19, according to a recently published study.
Moreover, these coughs can be recorded by Web browsers and devices such as cell phones and laptops.
In the paper, published in the IEEE Journal of Engineering in Medicine and Biology, the research team describes an artificial intelligence model distinguishing asymptomatic COVID-19 individuals from a healthy person by the way they cough.
Gathering tens of thousands of samples of coughs, as well as spoken words, the research team trained the model. This model identified 98.5% of coughs from individuals who were verified to have COVID-19, including 100% of coughs from asymptomatic individuals – those who had tested positive for the virus, but reported they had no symptoms.
The next step, post-study, will be distributing an easy-to-use app. If approved by the Food and Drug Administration, it could potentially be a free, convenient, noninvasive prescreening tool, which could identify those who are likely to be asymptomatic for COVID-19.
App users could log in daily, cough into their phone, and get back information instantly on whether they might be infected. They could confirm the finding by taking a formal test.
"The effective implementation of this group diagnostic tool could diminish the spread of the pandemic if everyone uses it before going to a classroom, a factory, or a restaurant," says Brian Subirana, PhD, a research scientist in MIT's Auto-ID Laboratory and a co-author of the study.
The algorithm originated in models the MIT team had previously developed to analyze forced-cough recordings to see if they could detect signs of Alzheimer's, one symptom of which is neuromuscular degradation such as weakened vocal cords.
Through a series of further tests, the team determined that the kinds of vocal degradation experienced by Alzheimer's patients was similar to the vocal degradation experienced by those with the COVID-19 virus.
Vaccination registries, social determinants of health, and patient matching advance the HIE mission.
2021 will continue one positive trend begun in 2020: maturing and increasingly cloud-based health information exchange, driven by the COVID-19 pandemic, but yielding benefits across the continuum of care.
Lisa Bari, SHIEC Interim CEO (Photo courtesy of SHIEC)
"If you're waiting for the burning platform, people need information critically right now to deliver care in COVID," Bari says. "In some cases, we see we're still dealing with paper bridges or digital silos as well, but at the very minimum, the importance of sharing health information has jumped to the front of the line."
Complicating that imperative was the White House directive that hospital reporting of COVID-19 data go directly to the U.S. Department of Health and Human Services (HHS) and the White House, Bari says. "A lot of hospitals, HIEs, and states had a lot of concern with that, and they still do," she says.
"The future solution will probably be a mix of the new system that was set up, and expanding the previous reporting system, whereby hospitals send their information to the Centers for Disease Control [and Prevention] (CDC)," she says.
The Role of HIEs in Sharing COVID-19 Vaccination Data
SHIEC supported many of the provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed by Congress and signed into law on March 27, 2020. SHIEC also supported many of the provisions of the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, though that legislation was blocked by the U.S. Senate and replaced by different continuing resolution legislation last month.
The new year tilts health information exchange in an additional direction, as providers now begin to share registries of those who have been vaccinated from COVID-19.
"It varies by HIE, but some HIEs already have connections to immunization registries," Bari says. Until recently, these registries have been focused on children, and according to Bari, HIEs are part of the conversation of getting adult immunization registries rolling.
As an umbrella organization for HIEs, SHIEC plays a role. At its annual conference in August 2020, Phil Beckett, PhD, CEO of Healthcare Access San Antonio moderated a session titled, "The Power of Public HIEs to Deliver Optimized Adult Vaccinations to Safety," and presenters from the University of Texas at Austin described an operational adult vaccination registry for Texas. "presenters from the University of Texas at Austin describedImmTrac2, an operational adult vaccination registry for Texas."
The federal government should play a role by increasing funding for HIEs' efforts in this area, and optimizing funding already budgeted for HIEs, Bari says.
"The federal government and the CDC should be funding broad public health use cases for HIE across the country," she says. "HIEs are probably best positioned to deliver it in a way that aggregates across states, regions, and communities, and there's a real need for that."
With such a reporting system in place, public health officials could much more easily see where COVID-19 hot spots may arise next, Bari says.
Expanding Into Social Determinants of Health
Another front-burner priority for SHIEC participation in 2021 is the Gravity Project, an effort by HL7 to expand social determinants of health (SDOH) core data for standard, interoperable use in electronic health records.
HL7 is hosting the Gravity Project FHIR accelerator, developing SDOH use cases, common data elements, recommendations on how best to capture and share data, and create an HL7 FHIR Implementation Guide for software developers.
Additionally, companies such as Unite Us, who are building SDOH software, are working to build connections between communities and providers, as well as tracking referrals and obtaining feedback on them, Bari says.
"The first thing that we and HIE members can do is be part of these standards development organizations and start to build that into our work," she says.
Already, the Nebraska Health Information Initiative (NEHII) partnered with Unite Us to build Unite Nebraska, a community information exchange of health and social care providers that could serve as a model SDOH community information exchange for other states, Bari says.
In October 2020, Unite Us and NEHII announced they were expanding their partnership to six additional states, including Iowa, Missouri, South Dakota, North Dakota, Kansas, and Minnesota.
Bari says healthcare will see final versions of SDOH interoperability standards this year. "They've made some great progress," she says.
Patient Matching Benefits From New ONC Project Built on USPS Addresses
One other technology accelerated by the pandemic is patient matching, Bari says.
"Lots of labs stood up really quickly—the ones who hadn't been doing reporting on public health before," she says. "It showed that HIEs are important for patient matching, and that we still have huge gaps.
"The great news is ONC [Office of the National Coordinator for Health Information Technology] just announceda new project to build an address standard, basically using the person-matching capabilities of the U.S. Postal Service."
Still, Congress needs to act to remove bans on HHS studying and working on patient identifiers and patient matching, Bari says.
"We need to stop being scared of this idea of a patient ID or patching matching," she says. "We need Congress to come to the table and commit to getting this done at the national level, whatever the solution is."
Editor's Note: This story has been changed to correct acronymns.
Remote work leads the list of dramatic changes resulting from the pandemic. The survey of 600 C-level executives finds that before the pandemic, an average of only 8% of workforces worked remotely on a regular basis. After the pandemic began, the percentage rose to 27%.
Executives participating in the survey span six global industries—financial services, healthcare, manufacturing, retail, government, and telecommunications.
Three-quarters of those surveyed believe COVID-19 accelerated digital transformation in their companies. One third anticipate budget increases, but healthcare, government, and communications are most likely to sustain or expand their digital investments, the survey found.
"We thought we were being pretty bold with our 10-year plan, and what we've realized is we probably weren't bold enough—that we actually do need to accelerate this even more," said Mark Wehde, chair of engineering at Mayo Clinic in Rochester, Minnesota. "Our 10-year plan was now a two-year plan."
As sick patients present in pop-up and overflowing hospitals, healthcare IT orgs are transitioning to digital technologies quickly, while keeping healthy patients safe.
More than half of healthcare organizations surveyed have boosted their technology investments in patient experience, particularly telehealth services. Despite this, most essential healthcare providers continue to work in physical locations, the report says.
Other key findings include:
Public cloud workloads in healthcare are increasing, the report says. Prior to COVID-19, 13% of healthcare applications were cloud-hosted. In the next 18 months, healthcare survey respondents expect that number to jump to 21%.
Of those surveyed, 46% are allocating a significant share (defined as more than 25%) of their IT budgets to security and threat management.
Business-continuity plans were already a priority for survey respondents, with 63% of them already having had such plans in place before the pandemic.
KLAS Cybersecurity Readiness Assessment ratings will start in April.
A new partnership promises to reduce the effort required for healthcare providers to perform security assessments and help technology vendors focus on dealing with new security issues through a common security preparedness rating system for their products and services.
KLAS Research, a healthcare research and insights firm, announced that product and service security risk assessments from Censinet will be the source of new quarterly KLAS ratings on those products and services. KLAS and Censinet will also collaborate in other ways, such as research, insight sharing, special report access, and cybersecurity best practices.
The prospect has energized CIOs who find the technology risk assessments they conduct annually or more frequently to be a mountain of work desperately in need of pooled provider efforts.
Already, these CIOs consult KLAS when considering the interoperability, pricing, product availability, and other aspects of more than 900 healthcare IT products and services. Starting in April 2021, KLAS will add its new Cybersecurity Readiness Assessment service, which it calls the first comprehensive security risk assessment purpose-built for healthcare and accessible on a network.
"Cybersecurity is not getting any easier," says Aaron Miri, MBA, CHCIO, chief information officer at the University of Texas at Austin, Dell Medical School and UT Health Austin. "We're being attacked more and more, particularly given COVID."
Aaron Miri MBA, CHCIO, chief information officer, University of Texas at Austin, Dell Medical School and UT Austin Health
Censinet, a two-year-old company, has a large swath of giant healthcare systems already participating in its network. Censinet sends out a standardized questionnaire to 440 vendors of products and services, covering security practices as defined in the National Institute of Standards and Technology (NIST) Framework for Improving Critical Infrastructure Cybersecurity Version 1.1.
"It allows me as a CIO to start having conversations with vendors in a very normalized conversational manner, even if I wasn't an expert in security," Miri says.
Centralizing Vendor Risk Assessment Creates Transparency for Providers
The new service also relieves pressure on vendors by creating a mechanism that centralizes their standardized security assessments for view by all Censinet customers, as well as simplified scores to be published by KLAS and viewable at no charge by any provider.
It also reduces the customary overhead of various providers comparing notes with each other, as each one performs their own cycle of security assessments, prompted by annual compliance needs, or reassessments when systems are upgraded.
"Providers have been doing this via email or calling each other or texting forever, and we're sick of it," Miri says. "So there's a lot here that's of value. For UT Austin specifically, we're growing so fast, as a city and what we're doing here to provide medical services, I can't take any risks anymore. I can't just wing it and say, I hope my small army of people catches X, Y, and Z in time."
The HHS Office for Civil Rights has put providers on notice that they face major penalties if they are found to be in violation of regulations requiring security assessments of their own systems and those of business associates, Miri says.
Miri advises those health systems just getting up to speed to break assessment work up into pieces, identifying the health IT vendors they work with, and prioritize so that those vendors who deal with protected health information are top priority.
"Every system has that one analyst with a giant Excel sheet on their computer" tracking security assessments, Miri says. "Why not take all that in there and just apply it to something like Censinet? That's where the value is. Now you're able to share best practices and learn from each other."
All this is in response to a vast increase in the number and sophistication of cyberattacks on healthcare systems in recent years. The COVID-19 pandemic only increased reliance on healthcare IT systems, boosting the incentive for attackers to target different technology components of digital health today.
Yet to be seen: How long it will take for efforts such as this to bend the curve on ransomware and other cyberattacks.
UT Austin's Miri likens it to the trajectory that adoption of interoperability technology has taken since 2015.
"In 2016, people didn't even know how to explain the issue with interoperability," Miri says. "Then laws got passed, and Congress got involved and started mandating certain things, because visibility was brought to the problem."
In the same way, Miri says, visibility will be brought to the security risk assessment problem "in a very conversational manner" through the KLAS ratings. Miri also expects "rigorous carrots and sticks, whatever is necessary, is going to be coming out from the various legislative bodies, both state and federal, that say, enough is enough, vendor X."
Censinet does not charge vendors for participating in its risk assessment service, says Taylor Davis, MBA, executive vice president of analysis and strategy at KLAS. "The goal is to have a complete catalog of cybersecurity preparedness across all major vendors and services firms in healthcare technology, and see high-level ratings around some of the core elements of the NIST 1.1 framework of cybersecurity preparedness."
Neither the KLAS ratings nor the deeper analysis available to Censinet customers take the place of the full cybersecurity due diligence process for healthcare organizations. But they offer the kind of higher-level view of vendor security preparedness that can be digested by more non-technical portions of healthcare C-suites.
"They're still going to have to do the risk assessments themselves, based on the data that's in the [Censinet] platform," says Ed Gaudet, CEO and founder of Censinet. "The vendor has complete control of that data, so the provider has to request it. the vendor gets to update their answers, and they get to provide supporting evidence, like data flow diagrams, certificates of insurance, SOC 2 or HITRUST audits. The nice thing is, vendors do it one time," but facilitate assessments with numerous providers through the Censinet platform.
When vendors do update their answers, KLAS ratings will reflect whatever changes those answers trigger as part of Censinet's analysis, Gaudet says.
On the provider side, the ratings will be provided at no charge to any provider who registers with KLAS and asks for them. For non-providers, KLAS makes the ratings and deeper analyses available for a fee. This information is requested by educational institutions, investment firms, and governments who are interested in the results of KLAS assessments. Vendors are also able to determine the frequency of reassessments by KLAS.
All healthcare providers who participate by meeting with KLAS and providing feedback about their vendors can view the preparedness of all healthcare vendors and service firms on the KLAS website. Those healthcare organizations that provide a list to KLAS of all their healthcare solutions in use will receive back a personalized report of their vendors' cybersecurity preparedness, KLAS says.
Data now streaming in around vaccines, their administration, and efficiency will need to move past previous practices, consultant says.
New federal rules on interoperability between healthcare information systems are poised to make a substantial impact in 2021. On October 30, the U.S. Department of Health and Human Services publishedthe final 2020-2025 Federal Health IT Strategic Plan. Patient-centered aspects of the plan describe the goal of having patient care information follow patients from any provider to any other provider, and to be accessible from their smart phones.
HealthLeaders spoke with Seth Hirsch, chief operating officer of SES Corp., a consulting firm to commercial and government organizations, about interoperability and other major trends impacting healthcare and healthcare IT in the coming year.
HealthLeaders: Healthcare data interoperability has been promised for several years. Why do you think 2021 will be the inflection-point for widespread adoption of enabling technologies?
Seth Hirsch: The pandemic has served as a huge forcing function—essentially the old saying about necessity being the mother of invention, writ large by the scope and urgency of the problem. This coming year is going to be even more pivotal for data interoperability because—after a year of getting to know the disease and the health metrics that are most relevant—we’ve got more health data and context to work with. On top of that, we’ve now got data streams flooding in around newly approved vaccines, their administration, and efficacy.
HL: Disease surveillance, including clinical trials, has trailed the rest of healthcare by not being automated, repeatable, and scalable. How does the industry move past previous practices to more state-of-the-art tools and results?
Hirsch: Complexity has been a stumbling block, since we’re dealing with huge volumes of COVID-19 data of a diverse nature from diverse sources, often with strict privacy limitations. That can make it hard to know where to begin. Part of the answer is to look at the nature of clinical trials and see what parts lend themselves most readily to innovation, and then focus on that as a starting point. For instance, some longitudinal studies last for years, during which time you have strict limits about changing participants or drawing conclusions too soon. So you can see how it may be hard to automate and scale your management of data in that case.
But repeatability is something you can definitely innovate on right way, in that the principles of reproducible research in data science that dovetail fairly well with the scientific method of clinical trials. If you standardize management of clinical trial data, including how you categorize, cleanse, and analyze the data, then even the most advanced algorithms or AI analysis will have the data lineage to ensure your methods are reproducible. And that’s a foundation for being able to scale over time.
HL: Specifically, how can analysis of COVID-19 data be supercharged to answer an ever-changing short list of questions about the disease and its treatments?
Hirsch: We need to enhance adoption of common health IT data standards—such as the ANSI-accredited Fast Healthcare Interoperability Resources (FHIR) framework— to break down silos between health-related data sources like mobile phone apps, cloud communications, EHR-based data sharing, and data stored on institutional servers. There’s also a cultural component in that we need to break down the silos between technologists and the business users, in this case medical professionals, in managing data around the disease and its treatments. The more each side understands the other’s world, the more seamless, secure, and proactive the analysis will be.
HL: To what degree is Big Tech (Apple, Google, Microsoft) able to answer some of these questions to an extent unachievable by other health IT? If so, where does health IT fit into their emerging big data initiatives in healthcare?
Hirsch: I'm not sure how fully I can answer this question. But one observation is that COVID-19 is a global challenge that involves many public systems and datasets in the U.S. and internationally. That means even the most advanced and well-funded innovations by big tech need to ultimately deal with the regulatory realities, such as HIPAA restrictions on health data, orATOs for anything that interacts with government data or systems. And by the same token, big tech companies should look to balance their proprietary interests with the need to collaborate together on the bigger mission where it make sense—not unlike how we’re seeing FedEx and UPS put their competitive instincts aside temporarily when it comes to coordinating the massive task of distributing COVID-19 vaccines.
Tech aims to overcome vaccine hesitancy and provide self-scheduled vaccinations, travel directions, and digital proof of vaccination.
With the arrival of COVID-19 vaccinations, comes a new twist in the saga of the pandemic. The World Health Organization lists "vaccine hesitancy" as one of the top 10 threats to world health.
Could chatbots help overcome some people's objections?
The founder of QliqSOFT, which recently announced a chatbot called Quincy, says that the company's innovation not only helps healthcare providers with COVID-19 vaccine distribution, but also helps educate recipients about the safety and benefits of the medication.
“The COVID-19 vaccines will only be effective if people take them,” says Krishna Kurapati, founder and chief executive officer of QliqSOFT. “This new chatbot allows healthcare organizations to automate education and follow-up to alleviate vaccine hesitancy, while also providing multiple touch points to remove hurdles and ensure follow-through.”
Chatbots are AI-driven conversational agents that can respond dynamically to input and responses from recipients of invitations to chat via a simple text interface. QliqSOFT can be branded and customized for each healthcare organization using it.
The chatbot provides Centers for Disease Control and Prevention-originated education about the vaccines to answer frequently asked questions posed by patients to the chatbot.
Quincy also allows patients to schedule their immunizations. This ability for patients to schedule their own appointments will lead to fewer no-shows, QliqSOFT says. Patients that schedule their own appointments are 94% more likely to show up, the company says.
In addition, the chatbot offers options on patients' mobile devices for transportation to and from vaccination locations, providing in-chat directions, including public transportation and ride-share options.
CPSI, a provider of healthcare solutions and services for community hospitals, their clinics and post-acute care facilities, announced it was making the QliqSOFT chatbot available in early 2021 for its customers.
The chatbot is also able to capture necessary consents and digital proof of vaccination. Such proof may be required for access to facilities, places of employment, and events in 2021. QliqSOFT does this by capturing documentation and images containing protected health information through an embedded HIPAA-compliant camera technology in the chatbot app.
Quincy is integrated into Epic's App Orchard set of application programming interfaces, which will help Epic customers get up and running within days, QliqSOFT says