Transcript Physicians in an IT World

Physicians in an IT
World: A Year in
Review
Patricia Hale, MD, PhD, FACP,
FHIMSS
Albany Medical Center
November 12, 2015
Physician Community Webinar Series
#DrHIT @HIMSS
Key Points or Objectives
• What have been the major health IT topics in 2015 that
are of most interest to physicians?
• How do they impact physicians in various practice
settings?
• What might we expect in 2016?
#DrHIT @HIMSS
There have been two main areas of
health IT focus in 2015…
•Usability
•Interoperability
No …wait…..
#DrHIT @HIMSS
There have been THREE main areas of
health IT focus in 2015
• Usability
• Interoperability
…And Patient engagement….
…No…wait… that really isn’t right either…
let’s start again…
#DrHIT @HIMSS
Top 10 Countdown….
Focus areas of Health IT for Physicians in 2015
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#10 CYBERSECURITY
• Over 153 million patients have been affected by breaches
since 2009 costing over $31 Billion
• 56% of consumers said privacy and security of their
medical data would influence how much they tell their
doctors about their conditions
• 81 percent of health care executives say that their
organizations have been compromised by at least one
malware, botnet, or other cyber-attack during the past two
years
• only 50% feel that they are adequately prepared in
preventing attacks
• 24% of hospitals plan to increase security protocols and
systems this year.
#DrHIT @HIMSS
#10 Cybersecurity - continued
• Health information is 10 times more valuable on the black
market than social security and credit card information
– Not easily changed
– Basis for insurance and credit fraud
– Target for overseas intelligence
– High quality and deeply personal resulting in blackmail
possibilities
– Can be used to obtain illicit prescription drugs
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians
#9 Telemedicine
• Fastest growing sector and expected to triple from 2010 to 2016
• Remote physician consults increased by more than double from 2011 to 2013 (40-50K in
2013)
• There are over 425K telehealth providers in the US and 90% are expanding telehealth
offerings
• A trial using remote video conferencing between nurses and recently discharged patients
delivered a 97% success rate in preventing readmissions (This could result in 17Billion of
savings)
• In 2015 Medicare will cover 7 new telehealth reimbursement codes for services like
wellness visits and mental health consultations and more than 3 million patients will be
monitored via mobile networks by 2016
• 70% of patients are comfortable with communicating with their healthcare providers via
text, e-mail or video and 71% of millennials would like their doctor to use a mobile app
• 66% of doctors use tablets or iPads (increase from 45% in one year) and 50% said evisits could replace over 10% of their in-office visits. With 44% of the physician workforce
aging and nearing retirement this increase in options for patient care is considered critical
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#8 Patient Derived Data
• 86% of physicians agree mobile apps will be important for
managing patient health over the next five years
• 49% of patients wear (or would be willing to wear) tech health
measurement devices
• 51% of patients say that health monitoring is the #1 reason they
use mobile phone apps
• 47% of physicians would be comfortable prescribing
medications based on the results of a home urinalysis device
and 20% of patients said they would be comfortable using such
a device
• 80% of daily clinical tasks - such as blood pressure, glucose
monitoring and other measures - will soon be handled by tech
systems
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians
#7 “Big Data”
• More than 26% of hospitals are planning on purchasing or extending analytics
tools- 35% will stay with current vendor, 25% will leave and 40% are unsure
• 80% of healthcare data currently is unstructured as images, text, etc.
• Big data is getting BIGGER –
– Average of 665TB of information per hospital …and that is increasing by
more than 20-40% every year
– 36.6Million total admissions in US hospitals per year
• Currently the most common use of analytics is to assist in more accurate diagnostic
coding, streamlining cost of care, increasing revenue reimbursement outcomes and
business analysis for managing populations
• Over 80% of clinical data is still unstructured and remains in image or txt files with
natural language processing gradually improving and being applied for data
extraction and analysis but clinical dashboards and performance monitoring are all
of increasing interest.
• What about the looming challenge of data reconciliation? We already see this
issue with medication and problem lists….
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#6 Replacement of EHRs
Over 30% of outpatient physician practices plan to replace their EHR
Over 25% of hospitals plan to invest or reinvest in EHRs
– 63% plan to stay with current vendor
– 31% will leave current vendor
– 6% unsure
• Reasons for replacement include
• Joint ventures and mergers requiring change to same systems
• Usability issues
• Interoperability issues with other systems
• Vendor obsolescence as the EHR market changes
• Concerns about ability to meet MU and other state and federal initiatives and
requirements
• Major concerns with the process of replacement include
– Resource requirements for conversions
– Management of disruption to patient care during conversions
– Archiving and access to previous patient records
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#5 Population Health
• >50% hospitals plan on prioritizing investment in population
health IT and it is the top priority for hospitals >251 beds
• 70% of providers say they see tangible benefits to patient
care - especially in the areas of improved outcomes, cost
savings and better prevention and care planning
• 2/3 of the US population live in areas covered by ACOs and
75% of hospitals have ACO participation plans
• Improved referral management and management of complex
patients to decrease readmissions are major areas of
success.
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#4 ICD 10 (and beyond)
• 60% of hospitals plan to change over
to ICD10 this year with most (85%)
staying with their current vendors
• Although the initial conversion in
October has seemed “quiet” many are
concerned that denials and
reimbursement issues will not
become obvious until past 90 days.
• There is increasing challenges for
physician documentation with the
requirements for more extensive
documentation for ICD 10 combined
with problem list requirements for MU
that must be documented in SnoMed
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#3 Patient Engagement
Patients are ready to be engaged…
• The 2013 Accenture Consumer Survey on Patient Engagement showed that
more than three fourths of Medicare recipients access the Internet at least
once a day for email (91%) or to conduct online searches (73%) and a third
access social media sites at least once a week.
• It also reported that 67% of Americans 65 and older say that accessing their
medical information online is very or somewhat important, and 83% of U.S.
seniors think that they should have full access to their electronic health records
…but only 28% actually do.
• In an AMA study, patients over 65 adopted portals at a rate greater than
patients aged 18 to 35.
• The Pew Internet & American Life Project shows Internet use between 2000
and 2012 tripled for those 65 and older and doubled among those 50 to 64
years old.
http://www.athenahealth.com/whitepap
ers/patient-engagement-strategies/
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#3 Patient Engagement
Patient Portal..SSSSSSSSS!
Which one?
How do they work?
Who sees my info?
How will it help me?
?
?
?
Choose ME!
…For many providers they are still a “box”
implemented for MU that offer little
functionality in them for patients…
?
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#3 Patient Engagement
• 52% of patients want access to EMR data related to physician
notes
• EHR services for patients increased from 2012-2015
– ability to request refills for prescriptions 43% to 58%
– Secure e-mail from 41% to 56%
– Access of medical information online 30% to 55%
• 50% of hospitals plan to increase IT efforts for patient
engagement (but over 40% have yet to implement any system
at all.)
• Most will be looking towards new vendors.
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#2 = Interoperability
• There has been a 45% to 51% increase in routine access by physicians of clinical data of
a patient who has been seen by a different health organization in the past 3 years
• There has been a 19% to 32% routine electronic notification of patients’ interactions with
other health organizations in the past 3 years
• “Locked” data and “interoperability issues” have become a federal concern as there have
been many recent news items describing examples of vendor dominated health data
exchanges causing market competition concerns.
• Patient matching and recommendations for a national unique patient identifier or matching
algorithm are again a popular topic
• RHIOs (regional health information exchanges) have had varying success in the US.
Some statewide systems are successful, some have closed down. NYS recently linked
the NYS RHIO system after many years of efforts.
• The issue of data reconciliation will become an increasing challenge as more data
exchange occurs
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#1 = USABILITY
• EHR system USE has continued to
increase in the past 2 years:
– 79% of physicians say they are
more proficient using EHRs
than 2 yrs. ago – 82% enter
patient notes, 72% e-prescribe
ad 65% receive electronic
results that populate the patient
chart
– Secure communication with
patients increased from 13% to
30%
– Notification of patient
interaction with other health
care organizations increased
from 19% to 32%
– Use of clinical decision support
increased from 24% to 34%
– 60% of physicians agree that
there is increased accuracy of
the patient record
• BUT 58% of physicians say their system is hard
to use and 70% say their system has decreased
the amount of time they spend with patients
• Physician are increasingly frustrated with hard
to read electronic physician notes that have
“note bloat” to meet regulatory and coding rules
obscuring meaningful clinical communication
• There has also been a dramatic decrease in
physician opinion on positive impact since 2012
– 62% down to 46% believe it has improved
quality of treatment decisions
– 72% down to 64% believe there has been
a reduction in medical errors
– 58% down to 46% believe that it improved
health outcomes of their patients
#DrHIT @HIMSS
Top 10 focus areas of Health IT for physicians in 2015
#1 = USABILITY
• “Usability” is a very popular topic …but not often well defined
• Vendors have been shown to not consistently implement
usability testing as required by MU and little data is available
comparing vendors on how usable their systems really are
• We need to develop and implement better tools for workflow
analysis and documentation of workflow to better target design
• We also need formal healthcare specific usability testing models
• NIST usability guide is a start...
#DrHIT @HIMSS
Summary - Top 10 focus areas of
Health IT for physicians in 2015:
#10 Cybersecurity
#5 Population Health
#9 Telemedicine
#4 ICD10 and beyond
#8 Patient derived data
#3 Patient engagement
#7 “Big data”
#2 Interoperability
#6 Replacement of EHR
#1 Usability
#DrHIT @HIMSS
So…What about 2016?
• Usability – will continue to be an increasingly discussed issue
• Interoperability – will remain a hot topic with potential increased
confusion and lack of coordination between initiatives and government
oversight
• Patient engagement – device connectivity – “personalized medicine” –
Most likely many more promises but ?? delivery
• Vendor replacement projects and “optimization” projects are likely to
increase as organizations form joint ventures and mergers to meet
ACO needs
• Will we begin to discuss advancement of ICD 10 to ICD 11/SnoMed?
• Your thoughts???
#DrHIT @HIMSS
2015 Recommended Resources
New Books in 2015
1. “Cognitive Informatics
for Biomedicine” –
Patel, Kannampallil
and Kaufman
2. “Healthcare
Information
Management
Systems” 4th Edition –
Weaver, Ball, Kim,
Kiel
3. “Medical Informatics:
An Executive Primer,
Third Edition” – Ken
Ong
Blogs/web sites and News feeds to
follow
1. HIMSS newsletters/web site and
groups
2. HisTalk blog
3. EHRScience blog
4. KevinMD blog
5. Politico’s Morning eHealth (e-mail
news feed)
6. AMDIS list serv
7. AMIA list servs
#DrHIT @HIMSS
Continuing Education Credit
• This program has been designated for 1 hour of
CAHIMS credit.
• This program has been designated for 1 hour of
CPHIMS credit.
• Download forms at www.himss.org/physician.
#DrHIT @HIMSS