CAMBRIDGE, Mass. -- The format of the inaugural New England eHealth Innovation Conference -- bringing to mind a hardcore American Idol-like talent show in which 10 startup health IT vendors did a song-and-dance as audience members voted on their favorites and a panel of CIOs critiqued the vendors (see sidebar) -- showed a gulf between what's being offered in the marketplace and what health care CIOs actually need.
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Ten vendors, selected from a larger pool of applications by an advisory panel including CIOs and physicians from New England hospitals, demonstrated cutting-edge applications of workflow management, telehealth, home patient monitoring and natural language processing to track elderly patients or those vulnerable to depression.
While the panel generally gave those vendors high marks for attempting to solve specific workflow problems with next-generation technology, enable better quality care or fill information gaps in health care, they were quick to offer a laundry list of more immediate needs in health IT.
First on their list was anything to extend their present network software to phones and tablets, especially iPad electronic health record (EHR) systems. Several mentioned the lack of well-conceived interfaces -- which they need immediately. Another top concern is security and HIPAA compliance for wired and mobile devices.
"If you have a data breach, your credibility is shot. The next time you need patients to opt-in in order to mode their data around, what are they going to do? Probably not opt in, depending on how bad the breach is," said Charles Podesta, CIO at Fletcher Allen Health Care in Burlington, Vt. "We've seen it in the credit card industry, and we're starting to see it now -- the bad guys know there's identity information in electronic health records."
Don't waste our time, CIOs implore health IT vendors
The CIOs -- while not quite as pithy as Simon Cowell and Paula Abdul -- gave health IT vendors pragmatic advice for getting their foot in the door at a health care facility and their products seriously considered by IT and clinical leadership for pilot projects and potential purchase.
- First, be completely honest on where a particular piece of software is in its development cycle. Don't come too early with half-developed vaporware.
- Second, have some outcomes data that can help set clinical expectations and aid the decision-making process.
- Third, give the hospital or health system an "out" for terminating the project easily if it doesn't work out because of time, budget or workflow constraints. Prepare ahead of time for a possible parting of ways with an amicable handshake that doesn't penalize either side.
CIO panel moderator Larry Garber, M.D., medical director for informatics at the Reliant Medical Group in Worcester, Mass., said he'd like to see more practical applications of natural language processing (NLP) technology to help physicians track the most vulnerable patients. Home monitoring data piped into EHR systems, he said, is becoming practical among Reliant's patients. Along with that data, though, comes a need to filter the constant messaging it entails.
NLP, he feels, is the filter that can route more urgent messages to a physicians' device -- most importantly, smartphones -- so they can act on the data and not just read the constant flow of reports from all patients. He'd like to see it cheap, he added with a smile, addressing the vendor-heavy audience.
Figuring out how to share information such as continuity of care documents is a high priority for health systems that mix inpatient, outpatient and specialty health care, said David Briden, CIO for Exeter (N.H.) Health Resources. His system is always looking for better interoperability among its various EHR systems that serve those disparate groups.
"The more information they have," Briden said wryly of his physicians, who are constantly figuring out deeper ways to integrate EHR-based patient data into their care workflows, "the more they'd like to have."
Deane Morrison, CIO at Capital Region Health Care in Concord, N.H., said that what he and his peers need from health IT vendors -- now -- are tools that enable participation in new health care coordination models, such as accountable care organizations and their ilk, as well as tools that can gather data for quality reporting programs such as meaningful use.
We've seen it in the credit card industry, and we're starting to see it now -- the bad guys know there's identity information in electronic health records.
Charles Podesta, CIO, Fletcher Allen Health Care
"Most of our IT systems have not been designed to work in an ACO," Morrison said. Health care systems will be looking to purchase new applications that enable patient risk measurement, predictive modeling and other activities that support outcomes-based care, he added.
Tools enabling patient engagement will soon rise to the top of CIO purchasing lists, too, Podesta said. His peer, Richard Kubica, CIO of Hartford Hospital, agreed, predicting that social media will be a new platform that can create patient engagement.
Podesta said patient engagement means more than setting appointments or electronically messaging their caregivers, but getting patients to take charge of their own health. "If we can't get the diabetic to stop eating Paula Deen recipes, all this technology we put in place won't matter."
Technology enabling patient follow-up to major procedures and delivering context-specific education is high on his list, he said, citing a current program in which Fletcher Allen phones heart patients five days after their procedures -- half of them are doing something wrong in their aftercare, with medication adherence being the most frequent problem. Fixing those issues, he said, will directly lead to reduced admissions.