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