Lessons in Health IT

John Paganini, MBA, CPHIMS, CIIP

Sr. Manager

Interoperability Initiatives

HIMSS Innovation Center

Health Care Initiatives

Emerging Technologies

HIMSS’s Strength in Innovation

• 52 years of global health IT leadership

• Unmatched convening power

• Highly-credible and respected thought

leadership, tools, resources, and

publications to equip all in their

transformational role

• The recognized international leader in

interoperability, standards, and

harmonization initiatives

•Serves as an international Center of Excellence

•Enables innovation that improves the value of information technology in healthcare

•Convenes industry stakeholders to solve real-world clinical workflow and financial transactional challenges

Components of the HIMSS Innovation Center

• Technology Showcase

• Conference Center

• Bookstore/Resources

• Welcome Center

• Immersion Theater

• Learning Center

HIMSS Innovation Center Collaborators

Interactive Health Journey

HIMSS Mobile Application

Marketing Exposure and Product Visibility

HIMSS Marketing and Ad Campaigns

HIMSS Websites

Technology Showcase

• Connects Technology Innovations with Healthcare Industry

• Designed to Enhance Discussion and Extend Education

• Establish Awareness and Visitor Connections

• Collaborator Demonstrations

– Year Round

– Attended or Unattended

• Exhibition Environment

• Collaborator Exposure and Visibility

• Beacon Technology Facilitates Lead Management

Conference CenterHost meetings of up to 150 people in the epicenter of innovation

Fully wired audio/visual environment. Splits into 3 separate rooms.

Immersion Theater

Describes the Importance of Health IT

Highlights Collaborator Products and Services

Theater messaging can be customized for Events and Meetings

Learning CenterVisitors learn about healthcare initiatives from their point of view

What‟s your point-of-view?

Make a choice to start.

Healthcare Consumer

Healthcare Professional/Provider

Health IT Vendor

Academic

Government

LEFT SCREEN

CONSOLE SCREEN

RIGHT SCREENCENTER SCREEN

Looping pictureHealthcare Professional story

Healthcare

Professional/Provider

Looping picture

Interoperability & Standards

Select a HOT TOPIC and learn

how it effects your point-of-view.

Interoperability & Standards

Health Business Solutions

Privacy & Security

Patient Engagement

Analytics

LEFT SCREEN

CONSOLE SCREEN

RIGHT SCREENCENTER SCREEN

Looping pictureLooping picture

Healthcare

Professional/Provider

Interoperability & Standards story

CONSOLE SCREEN

Over 6000 Attendees

Over 130 EVENTSEvents

Visitors

HIMSS Innovation Center infrastructure and services to advance interoperability

Technical

Demos

IHE USA Certification

HIMSSInteroperability

Services

Host Toolsets for Custom testing projects

Plugfests, and “hack-a-thons”

HIMSS Interoperability ShowcaseTM

Technical Support

EMR, HIE and HISP vendors

Patient Care Devices Vendors

(Infusion Pumps)

Special

Projects

• Neutral Environment for Testing and Certification

• IHE USA Certification Program

• „Newly Branded‟ Interoperability Certification Program (IWG)

– launching at HIMSS15

• Gazelle and other Open Source Tools (e.g. EMR)

HIMSS Interoperability Services Program

HIMSS Innovation Center

Health Care Initiatives

Emerging Technologies

Privacy and Security

Information security and patient privacy are fundamental components of a well-functioning healthcare environment.

HIMSS provides resources to assist healthcare organizations and business associates with their privacy and security initiatives.

Privacy and SecurityPrivacy and Security is one of the first and most crucial steps in expediting care in Sara‟s health journey.

When the ambulance arrives at the scene, EMTs quickly access Sara‟s condition and call ahead to the Emergency Department to let them know that Sara Brown, a 45-year old woman, was coming in with stroke symptoms. A consent form, signed by Sara, allows hospital admissions to use a Health Information exchange (HIE) to request Sara Brown‟s medical information. Now, with Sara‟s consent, all of her correct vital information and patient records are present in the Emergency Department Electronic Medical Record before she even arrives.

Since Sara‟s vital information is only entered once the results is: reduced errors, increased patient safety and improved quality of care.

What does Cyber look like now?

• Hacktivists

• Nation state actors (e.g., N. Korea, China, Iran, Russia,

etc.)

• Malicious & negligent insiders (a complex problem)

• Destructive malware (not just adware)

• Mainstream media & trade press reports

• Hollywood

– Movies & TV

The Evolving Threat Space

Threats

- Multi-dimensional

- The equation to be solved is

complex

– Malicious insiders + phishing

attacks + nation state activity

Occam's Razor

The scientific principle that, all things

being equal, the simplest answer is

usually the right one.

When trying to explain or prove

something, we should refrain from

making more assumptions than are

necessary.

The Evolving Threat Space

Occam’s razor

– Unencrypted data

– Very weak passwords

– Unsecured wireless connections

– Significant, well-known vulnerabilities + effective exploits

– Phishing (exploit the human)

– Elicitation (befriend the human)

– Aging IT infrastructure (exploit the tech)

Pathways to Solutions

Public-private partnerships

– Secure the human & technology

– Know & predict the threats

– Cross-sector engagement

– Work with the government

Innovation

– Stay ahead of the threat with automation/AI

– Current threats, predicted threats

Train & prepare for the event (even if it never happens)

Cyber Threat Intelligence in Health Care

As a result of these sophisticated cyber threats, health care

organizations are realizing that their current cybersecurity

programs are not sufficient to prevent, detect, respond and

recover from the current level of cyber attacks.

Healthcare organizations are working hard to make needed

improvements. One resource healthcare organizations

should make use of is cyber threat intelligence (CTI).

Lee Kim JD, FHIMSS

Cyber Threat Intelligence in Health Care

Specific, detailed, actionable data about cyber

threats, cyber threat actors, malware, vulnerabilities,

and indicators of compromise (IOC).

Simply put, cyber threat intelligence is all about

helping the healthcare organization improve its

security posture based on accurate, detailed

information on the current cybersecurity threats.

Lee Kim JD, FHIMSS

Cyber Threat Intelligence in Health Care

In light of increasingly sophisticated cyber

threats, healthcare organizations should evaluate the

effectiveness of their cybersecurity program and make

improvements where appropriate.

Consider how cyber threat intelligence can help your

healthcare organization to improve the ability to prevent,

detect, respond and recover from cyber attacks.

Lee Kim JD, FHIMSS

Health Business Solutions

Identifies and promotes the effective use of financial and administrative systems for healthcare organizations.

Health Business SolutionsFinancial management of healthcare is an important concern for Sara and her family.

In addition to worrying about Sara‟s care, Mike wanted to ensure they could manage the financial costs. Through Health Business Solutions the hospital was able support Mike and Sara by getting them real time financial information on the costs of the care she was receiving.

Helping the family finding financial solutions allowed them to focus on Sara‟s healthcare and not the cost.

Health Business Solutions CommitteePurpose Statement

Health Business Solutions Committee identifies and promotes the

effective use of financial and administrative systems for healthcare

organizations. Building on the historical work of the Medical Banking

and Financial Systems Committee, the Committee will work

collaboratively with others to understand and define the points of

intersection of finance and administrative systems across the

healthcare continuum.

Health Business Solutions Areas of Focus ICD-10: Concentrates on the development of tools and resources (ICD-10 Playbook)

that will equip HIMSS membership with preparation for and implementation of ICD-10.

The targeted HIMSS audience for these tools may include but is not limited to

ambulatory providers, hospital/enterprise providers, payers, software vendors and

clearinghouses. .

Financial Privacy and Security: Examines the current deployment of risk

management and security controls within the financial services industry and analyzes

how these could be leveraged to facilitate the nation‟s goals for eHealth.

Revenue Cycle Improvement: Create a vision for the next generation of revenue

cycle management business processes and tools that will keep administrative cost

containment, interoperability and consumer engagement front and center. Task Force

members include a cross-section of representatives from provider organizations, payer

organizations, financial institutions, retail clinics, and a variety of revenue cycle

vendors and consultants.

Patient Engagement

Patients can take control of their health and health information by leveraging capabilities and connectivity of a personal health record and utilize the work of an alliance of health device manufacturers.

Patient EngagementUnderstanding her medical care and treatments was an important step in making the right healthcare decisions for Sara and Mike.

While Sara was recovering in the hospital Mike, with Sara‟s permission, was following her care through an app on his iPad. Through a private and secure patient portal, Mike was able to see her labs, tests, and plans of care through the hospital stay.

When it was documented that Sara was allergic to a medication, Mike was able to correct it quickly, which helped keep the record accurate. When Sarah went home, they shared the patient portal with their primary care provider to collaborate on Sara‟s recovery path.

Healthcare providers working together with Sara and Mike contributed to a quicker recovery time and a better outcome for all.

Frost & Sullivan

estimates that patient

portals will grow 221%

through 2017.

Consumers are Demanding a LOT from Health IT

•Cloud access to their detailed patient records

•Email accessibility to their providers and staff

•Ability to use their personal health record (PHR)

Control access

Maintain records

Import data from pharmacy and labs

Pay bills

This is our goal, is it happening now?

Friend is being treated at two health systems,

both have the same EHR, PHR

• When he logged into the second PHR, it prompted him, asking if he

agreed to integrate his two medical records. He agreed.

• The next time he saw his specialist at the first facility, she noticed that

his records from the other system had been integrated into his record

• Lessons:

– Health information exchange (HIE) works

– Should be driven by the patient‟s consent

– Leads to a more engaged patient

– This is what Meaningful Use is about

Patient Engagement Further Defined

We define engagement as

“actions individuals must take to obtain the greatest

benefit from the healthcare services available to

them”

This definition focuses on behaviors of individuals

Relative to their healthcare

That are critical and proximal to health outcomes

Rather than the actions of professionals or policies

of institutions

Meaningful Use Stage 2

• Provide patients the ability to view online, download and transmit their

health information within four business days of the information being

available to the EP (for EPs only) More than 50% of all unique patients seen

by the EP are provided timely online access to their health information

• Provide patients the ability to view online, download and transmit their

health information within 36 hours after discharge from the hospital (for

Eligible Hospitals/CAHs only)

• Use secure electronic messaging to communicate with patients on relevant

health information (for EPs only) More than 5% of all unique patients seen

Patient Engagement fit with Strategy

New Payment Models

•Patient Centered Medical Home

•Accountable Care Organizations

•To achieve these successfully, patient engagement essential

The Future of Patient Engagement

The Future of Patient Engagement

•Patient Engagement is key to

Meaningful Use Stage 2

•Reaching the 5% participation threshold is a

challenge

• Integration of patient engagement into a

strategic initiative is the key

•There is growing evidence that patient

engagement impacts medical outcomes

Interoperability

HIMSS is continually working to provide crucial tools for achieving interoperability and implementing standards in all areas of Health IT integration, including clinical and non-clinical information.

InteroperabilityHealth information exchange was an important factor in ensuring the right information was available to all providers working on Sara‟s care.

The hospital Sara was admitted to had implemented standards in all areas of Health IT integration, including clinical and non-clinical information. This infrastructure allowed for a seamless flow of information between physicians, hospital systems and Sara‟s own electronic medial record.

Health IT interoperability help Sara and her doctors achieve crucial health information exchange.

Interoperability

The Connected Healthcare System

http://3.bp.blogspot.com/-fmSY89ejjUY/TpenyfestBI/AAAAAAAAA7s/Y7slQnSh8HI/s1600/20101205-0873LKFHC10_creationnation-S.jpg

Interoperability Defined

In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.

For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.

Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor.

“Foundational” interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.

“Structural” interoperability is an intermediate level that defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered.

“Semantic”interoperability provides interoperability at the highest level, which is the ability of two or more systems or elements to exchange information and to use the information that has been exchanged.

Interoperability and standards ensures that your

health information moves seamlessly and in a

standardized manner between all of your

healthcare providers.

Your information follows you wherever you go, allowing your provider to have the

right information at the right time to make informed

clinical decisions.

CONSUMER

Interoperability aims to create a common framework

for information sharing designed to optimize clinical workflow and improve patient

care.

Electronic health record systems implemented using interoperable technology and

standards can streamline your flow of clinical

information, reduce errors and improve efficiency.

PROVIDER

Interoperability product testing and certification

programs will enable you to achieve optimal levels of

interoperability, accelerating the alignment of healthcare

provider needs with regulatory requirements.

VENDOR

Over $30 Billion to be saved by achieving Medical Device Interoperability

Source: http://www.himss.org/files/images/room.png

The Connectathon

Source: http://www.himss.org/files/images/room.png

An IHE Connectathon is a cross-

vendor, live, supervised, and

structured testing event with over 100

participating vendors and 600+

engineers and IT architects. All these

organizations and IT experts converge

on-site in Cleveland, OH, for one full

week of interoperability testing and

problem resolution. Participants test

their products against multiple

vendors using real-world clinical

scenarios contained in IHE's

Integration Profiles.

IHE NA Connectathon

Moves to Cleveland, OH

http://m.19actionnews.com/19action

news/db_330498/contentdetail.htm?

contentguid=BlRLfHKj

http://www.cleveland.com/business/index.ssf/

2015/01/clevelands_first_connectathon.html#

incart_related_stories

Analytics

HIMSS Analytics supports improved decision making for healthcare organizations, healthcare IT companies and consulting firms by delivering high quality data and analytical expertise.

AnalyticsHaving the right information, at the right time, available to Sara‟s doctors helped improve decision making in her overall care.

There were many treatments for Sara‟s stroke. The physicians used the information available to them through analytics to see what would be the best care for her by comparing her demographics to large databases of patient information, or population health.

Using analytics to help support Sara‟s doctor make informed medical decisions, improved the quality of care she received.

The HIT industry has enjoyed a

positive history during the past few

years.

54.7% 57.7% 61.4% 64.6% 65.4% 62.3%54.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2008 2009 2010 2011 2012 2013 2014

Acquired/Installed at least one HIT application

All

U.S

. H

ospitals

The percentage of U.S. hospitals acquiring and/or

installing HIT applications each year is back to 2008

levels…

Percent of US Hospitals Acquiring/Installing at least one HIT application

All

U.S

. H

ospitals

…with the level of activity (number of applications

acquired) in 2014 are lower than in 2008.

27.2% 33.3% 36.0% 36.3% 39.1% 40.1% 36.9%

14.5%14.4% 15.6% 16.0% 13.2% 12.7%

9.3%13.0%

10.0%9.8% 12.3% 13.1% 9.5%

8.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2008 2009 2010 2011 2012 2013 2014

1 - 3 Applications 4 - 9 Applications 10+ Applications

Percent of US Hospitals Acquiring/Installing HIT applications

The market seems to be shifting in

significant ways.

The market continues to be focused on EMR

applications…with their buying patterns shifting in a

predictable way.

Higher market demand Lower market demand

Application 2009 2010 2011 2012 2013 2014

Physician Documentation 3 2 2 2 2 1

Computerized Practitioner Order Entry (CPOE) 1 1 1 1 1 2

Patient Portal 72 56 38 32 32 3

Electronic Medication Administration Record (eMAR) 2 3 3 3 3 4

Clinical Decision Support System (CDSS) 9 6 6 8 8 5

Top Five Most Frequently Acquired/Implemented HIT Applications

Leading us to conclude that the hospital HIT market will

continue to constrict…

$7.27 $7.14 $7.05 $6.99 $6.96 $6.95

$6.00

$6.20

$6.40

$6.60

$6.80

$7.00

$7.20

$7.40

$7.60

$7.80

$8.00

2014 2015 2016 2017 2018 2019

In $

Bill

ions

Projected Total U.S. Hospital HIT Application Spend (2014 – 2019)

…reflecting both a notable shift in buyer interests...

Projected Five Year CAGR of HIT Application Categories (2014 – 2019)

6.3%

1.5%

-1.2%

-2.5%-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

Hospital Tethered Applications

Other Clinical Applications EMR Applications Operational Applications

Fiv

e Y

ear

CA

GR

…and buyer motivations.%

of Tota

l H

ospital H

IT S

pen

d

Projected Hospital HIT Application Spend (2014 – 2019)

60.3% 59.0% 56.7% 54.0% 50.9% 49.0%

39.7% 41.0% 43.3% 46.0% 49.1% 51.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2014 2015 2016 2017 2018 2019

First Time Buyers Replacement Buyers

The growth in this market has led to

advanced EMR capabilities in the US

hospital market.

HIMSS Analytics Electronic Medical

Record Adoption Model (EMRAM)

incorporates methodology and

algorithms to automatically score the

more than 5,400 U.S. and

approximately 650 Canadian hospitals

in the HIMSS Analytics database

relative to their EMR capabilities.

Ranging from limited ancillary

department systems through a

paperless EMR environment, EMRAM

scores provide peer comparisons for

hospital organizations as they

strategize their path to implementing a

complete EMR and participation in an

electronic health record (EHR).

EMRAM Distribution: All US Hospitals

Q4 2007

19.3%

14.0%

37.2%

25.1%

2.2% 1.4% 0.8% 0.0%0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

0 1 2 3 4 5 6 7

Perc

en

t o

f H

osp

itals

EMRAM Stage

EMRAM Distribution: All US Hospitals

Q4 2014

3.8%2.0%

5.1%

21.0%

14.0%

32.7%

17.9%

3.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

0 1 2 3 4 5 6 7

Perc

en

t o

f H

osp

itals

EMRAM Stage

The advanced EMR capabilities of

hospitals has notable implications for

providers.

3.8%

2.3%2.5%

3.5%

2.3%

4.4%

5.5%

6.4%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

0 1 2 3 4 5 6 7

Op

era

tin

g P

rofi

t M

arg

in

EMRAM Stage

Hospitals with advanced EMR capabilities tend to be more

profitable

Average Operating Margin : U.S. Hospitals (2014)

The number of information system employees increases

as the hospital’s EMR capabilities advance

Average IS FTEs: U.S. Hospitals (2014)

1.3 9.0 14.0

54.2

33.4 32.6

80.0

207.2

0

50

100

150

200

250

0 1 2 3 4 5 6 7

Nu

mb

er

of

FT

E I

S S

taff

EMRAM Stage

• How do we know

Health IT works?

• How does Health IT

improve patient care?

• Can we duplicate the

type of value others

have achieved?

Health Information Technology

Improving patients‟ experience of care within the Institute of Medicine‟s

6 domains of quality: Safety, Effectiveness, Patient-

Centeredness, Timeliness, Efficiency, and Equity.

Better healthcare

Keeping patients well so they can do what they want to do. Increasing

the overall health of populations: address behavioral risk factors; focus

on preventive care.

Better health

Lowering the total cost of care while improving quality, resulting in

reduced monthly expenditures for Medicare, Medicaid, and CHIP

beneficiaries.

Reduced costs

$

Source: http://www.healthpartners.com/public/about/triple-aim/

HIMSS Innovation Center

Health Care Initiatives

Emerging Technologies

- Advanced Medical Imaging- Computer-Aided Diagnostics

- Wireless Telemedicine- Noninvasive Health Monitoring

- Teleradiology- Personal Medical Devices

- Implantable Sensors- Medication Adherence

- Asset Tracking and Monitoring- Mobile Diagnostics

- Implantable Prosthetics