If one took the prevalence of analytics at HIMSS at face value, sophisticated implementation of population health management is already a done deal. This is obviously not the case. However, this year, it was relatively easy to see real progress and momentum in the alignment of IT to innovative care and business processes. By Charlie Davies, Lead Analyst, Healthcare & Life Sciences, Ovum
By Charlotte Davies, Lead Analyst, Healthcare & Life Sciences, Ovum
If one took the prevalence of analytics at HIMSS at face value, sophisticated implementation of population health management is already a done deal. This is obviously not the case. However, this year, it was relatively easy to see real progress and momentum in the alignment of IT to innovative care and business processes. Hillary Clinton’s over-generosity about the aggregate achievements of EHRs was balanced by her emphasis on the importance of evidence-based medicine and evidence-based health policy making to the future of healthcare. This is significant, as effective use of analytics will be key to achieving this. There was clear evidence of more proactive clinical leadership, better governance and working relationships with vendors to maximize tech ROI, the latter helped somewhat by cloud and competition. The challenges were also on show. Interoperability and connecting health information systems remain daunting hurdles. There is growing pressure to streamline IT infrastructure and application portfolios, if only to free up the required investment in health informatics and pervasive mobility solutions. Finally, HIMSS also underlined the extent to which privacy, identity authentication and consent management requirements have become make or break factors.
Healthcare system change is shining the light on tech’s potential
Concerted collaboration between healthcare providers, payers, governments and research institutions is starting to bear fruit. IBM’s Smarter Care conversations are taking place with the heads of health and human services or nursing or criminal justice systems. There is growing disruption to the fee for service model, via new reimbursement mechanisms like bundled payments, which is driving investment in payment innovation and in RCM and analytics from payers in particular such as Wellpoint and Humana. There is more development and dissemination of best practice in care pathways and change management, particularly in the area of patient safety.
Vendors adept at supporting these multifarious and often complex processes are gaining the best results and the best feedback. Boston University Medical Center’s Project RED (Re-Engineered Discharge) is improving the hospital discharge process in a way that promotes patient safety and reduces re-hospitalization rates. CareinSync had this firmly in mind when it developed its mobile Carebook service designed to support virtual care team co-ordination in acute settings and to enable better hand-off between acute and post-acute. Results are encouraging: a 22 percent reduction in 30-day all-cause readmission rates and a half- day reduction in the average length of hospital stay for over 65s.
There are encouraging developments to address its interoperability shortcomings
However, the challenge in achieving data liquidity between primary, acute and social care settings is shining a light on the limitations of existing healthcare IT systems, developed with a limited core set of functionalities in mind. This is particularly apparent in the EHR segment where wider usability and interoperability were not an original development priority. It’s significant that cloud-based AthenaHealth won KLAS’ best overall healthcare software rating in January this year, beating serial winner EPIC. It’s also a reason why more progressive vendors like Allscripts are gaining traction with new EHR deployments internationally.
Last year, the eHealth Initiative's 2013 data exchange survey rated interoperability as the number one priority facing providers. This year, HIMSS had significantly expanded its Interoperability Showcase and launched a new benchmarking Continuity of Care Maturity model to complement the HIMSS EMRAM model. This is focused on collaboration capabilities to support dynamic coordinated patient care, patient engagement and advanced analytics. We also had discussions with InterSystems, Oracle and CGI on their fruitful work with public healthcare systems in Sweden, Spain and Finland respectively to implement cross-organizational projects to facilitate much more effective care co-ordination.
Finally, we noted that Harvard’s SHARP team has developed their latest set of SMART tools (www.smartplatform.org) on FHIR, the new standard from the HL7 consortium, which we have previously commented on as holding substantial promise (see TTW in Healthcare 2014).
Isolated islands of insight will give way to greater orchestration
The big data and analytics firepower on show from SAP, IBM, HP’s Autonomy, Oracle was much more in evidence this year as well as a more prominent presence from Tier 2 vendors like Information Builders and Qliktech, plus a growing number of collaborative efforts, for example, the developing Actian and Opera relationship. Multiple EHR and RCM companies have also added analytics components to their portfolios. There are a growing number of proof points testifying to the value of advanced big data/analytics products, which mesh disparate unstructured and structured datasets together, such as IBM Watson’s fast developing capabilities and those emerging such as SAP’s Hana for Healthcare and Autonomy’s IDOL. From a patient/clinician perspective, initial results are particularly interesting are they often point towards diagnosis and treatment pathways significantly different to those anticipated.
Prepare for a marathon journey
However, the reality is that the majority of health providers continue to make progress with ‘small data’, gradually amassing incremental business and clinical value delivered through individual departments. MD Andersen and UPMC’s observations on an IBM user panel were particularly illustrative in this respect. The former’s journey from the creation of a predominately financial and operational data warehouse in 2002 to today’s cross department initiative incorporating clinical, social and genomic data was a substantial undertaking which required big changes in governance and painstaking internal selling. UPMC, which is undertaking a similar journey to harness business intelligence and analytics across the organization referred to the difficulty in finding a balance between retaining hard-won best practice and introducing new more standardized and cross-departmental initiatives. Another panel member, Amedisys, which delivers home care services, highlighted both the challenge in driving value from aggregated data and in finding good health informatics staff.
The fact that these larger and often well-funded organizations are really only starting to see the benefits of a more orchestrated approach to information underlines how the use of BI and analytics to transform care and efficiency is very much a marathon journey, just as dependent on effective leadership, governance and implementation as the underlying technology.
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