The bigger lesson of the past year is the need for widely deployed health IT tools …
… that will help the industry leverage the massive amounts of data available to address the new challenges that the future will inevitably bring.
HIMSS
by Andrew Kanter, MD, MPH, FACMI, FAMIA, Chief Medical Officer, Intelligent Medical Objects; a HIMSS Diamond Member
March 1, 2021
As we enter a new year, it important to reflect on some of the lessons the healthcare industry has learned from the previous challenging year, and how we can move forward in the future.
The pandemic has emphasized the needs about patient data
The pandemic has emphasized the need for patient data to be easily shared and has revealed gaps in the way data is recorded, aggregated, normalized and interpreted.
This has again become clear as we determine how, when and to whom the COVID-19 vaccines will be administered.
To do so quickly and accurately requires automated tools to normalize the data and identify specific cohorts.
The pandemic has emphasized the need for patient data to be easily shared and has revealed gaps in the way data is recorded, aggregated, normalized and interpreted.
To do so quickly and accurately requires automated tools to normalize the data and identify specific cohorts.
The 21 st Century Cures Act, is intended to improve interoperability, data sharing, and patient engagement.
When the rules were finalized, we expected big changes on the horizon for how healthcare could share data and information more seamlessly.
However, the COVID-19 pandemic brought these issues into immediate relief.
The 21 stCentury Cures Act, is intended to improve interoperability, data sharing, and patient engagement
… we expected big changes on the horizon for how healthcare could share data and information more seamlessly
However, the COVID-19 pandemic brought these issues into immediate relief.
As we now attempt to vaccinate the globe, we have learned that the healthcare industry was underprepared to aggregate, normalize and share information that was critical to containing and managing the disease.
As we now attempt to vaccinate the globe, we have learned that the healthcare industry was underprepared to aggregate, normalize and share information that was critical to containing and managing the disease.
Clinicians, despite being under tremendous pressure, must be able to record sufficient details about their patient’s conditions, treatments, and outcomes so that the resulting data can help manage the pandemic going forward.
Clinicians, despite being under tremendous pressure, must be able to record sufficient details about their patient’s conditions, treatments, and outcomes so that the resulting data can help manage the pandemic going forward.
The unprecedented global collaborations that arose to research this novel disease, as well as help healthcare systems respond to the pandemic, relied heavily on data, much of which was incomplete or of undetermined quality.
The unprecedented global collaborations that arose to research this novel disease, as well as help healthcare systems respond to the pandemic, relied heavily on data, much of which was incomplete or of undetermined quality.
This made it hard to draw firm conclusions about which treatments were working and which were not.
We did not understand how many people were infected, nor did we know what the priority areas would be.
It took much more effort and time to extract value from the data than was necessary.
True, some of the issues were wrapped up in politics and technological challenges such as the availability of testing, but many issues were related to how we record, aggregate, normalize and interpret the data we did collect.
Some of issues that arose included the lack of standardized terminology to capture details of COVID-19 infections and conditions.
Some of issues that arose included the lack of standardized terminology to capture details of COVID-19 infections and conditions
- Rapidly changing coding recommendations put burdens on health information systems and created analytics challenges, particularly during the start of the pandemic.
Large-scale observational research undertaken concurrently with controlled trials relies on existing health system data.
Unfortunately, much of the data needed to understand the severity of illness or likely comorbid factors were either not captured or captured in heterogeneous ways.
A great deal of iteration and collaboration was required to determine the best ways to classify patients and extract data for analysis.
Large-scale observational research undertaken concurrently with controlled trials relies on existing health system data.
Unfortunately, much of the data needed to understand the severity of illness or likely comorbid factors were either not captured or captured in heterogeneous ways.
There are many reasons for these gaps, including incentives for electronic documentation remaining tied to financial and quality reporting metrics.
There are many reasons for these gaps, including incentives for electronic documentation remaining tied to financial and quality reporting metrics.
EHRs differ in their ways of collecting and storing information.
Additionally, new interoperability standards, such as FHIR and the U.S. Core Data for Interoperability, have not been fully implemented and do not yet have the necessary specificity to address these important research questions.
Additionally, new interoperability standards, such as FHIR and the U.S. Core Data for Interoperability, have not been fully implemented and do not yet have the necessary specificity to address these important research questions.
Other parts of the health information ecosystem required to respond to the pandemic would benefit from improved interoperability and strong data normalization.
Other parts of the health information ecosystem required to respond to the pandemic would benefit from improved interoperability and strong data normalization.
These include integrated delivery networks, enterprise data warehouses, Health Information Exchanges (HIEs), and health analytics vendors
These include integrated delivery networks, enterprise data warehouses, Health Information Exchanges (HIEs), and health analytics vendors.
HIEs and immunization registries, for example, manage vast amounts of patient data which could be used to understand the pandemic, help with prioritizing/administering vaccines, and over the long term, address population health challenges.
The COVID-19 vaccine rollout
The COVID-19 vaccine rollout is just the latest example of our problematic response to the pandemic and has raised concerns about maintaining an equitable distribution of vaccine.
The COVID-19 vaccine rollout is just the latest example of our problematic response to the pandemic and has raised concerns about maintaining an equitable distribution of vaccine.
Health IT has a major role to play in the dissemination and evaluation of the coronavirus vaccine.
There is a need to prioritize who should receive the vaccine, report on who was missed, and follow up.
There is a need to prioritize who should receive the vaccine, report on who was missed, and follow up.
This requires data from disparate sources (e.g., EHRs, facility-based registries, state and jurisdictional immunization information systems, etc.) that will need to be standardized and integrated into a single system.
- To do so quickly and accurately will require automated tools to normalize the data and identify specific target populations.
- Well-defined terminology value sets can be designed to stratify the population based on risk, likelihood of benefit, and need.
- These cohort definitions could then be used prospectively by decision support algorithms to help in the implementation of best practice guidelines for vaccination as well as for population health reporting, ensuring that the correct target populations receive the vaccines as intended.
Unfortunately, the likelihood that all this will be accomplished without a significant investment in data systems is low.
Unfortunately, the likelihood that all this will be accomplished without a significant investment in data systems is low.
It requires the proper capture, aggregation, normalization and summarization of patient data in a manner that does not add further burden to the providers and the delivery networks.
The confusion so far about how to equitably administer 330 million doses of different COVID-19 vaccines has raised serious concerns about whether we are up to the task.
The confusion so far about how to equitably administer 330 million doses of different COVID-19 vaccines has raised serious concerns about whether we are up to the task.
There is plenty reason to be optimistic that sometime this year we will see an end to quarantines and stay-at-home advisories.
But the bigger lesson of the past year is the need for widely deployed health IT tools that will help the industry leverage the massive amounts of data available to address the new challenges that the future will inevitably bring.
But the bigger lesson of the past year is the need for widely deployed health IT tools that will help the industry leverage the massive amounts of data available to address the new challenges that the future will inevitably bring.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates. Read the Five Strategic Actions
Originally published at https://www.himss.org on March 1, 2021.
COVID-19 Global Policy Call to Action Report (2020)
HIMSS
October 27, 2020
The top priority of all governments and healthcare organizations has to be addressing the current crisis and how to mitigate the further spread of COVID-19 through global policy efforts.
However, with governments and those in the private sector quickly implementing changes for different healthcare organizations and granting flexibilities to providers to deliver care in novel and innovative ways, the healthcare sector should also think about the opportunities that these changes offer and how they could be sustained post the current crisis.
Some of the adjustments made will only be appropriate for treatment and research purposes during this crisis, but there will be many potential options for leveraging pandemic-related care practices in future-facing policy structures.
HIMSS — as a global thought leader which supports governments, along with the private sector and other healthcare stakeholders — recommends the following strategies in combating the COVID-19 pandemic and future public health emergencies that can further transform our global healthcare system.
Governments, businesses, and civil society leaders and elected officials are called to recognize the important role and value of health information and technology during a health emergency …
… and to work across government agencies and with communities and businesses to prioritize actions that leverage sound health data, the tools of informatics and the innovative solutions outlined in this Global Policy Call to Action.
- Global Policy Strategic Action 1:
Establish a Flexible and Adaptable Healthcare Environment
- Global Policy Strategic Action 2:
Build a Foundation of Interoperable Platforms To Facilitate Broad-Based Data Exchange
- Global Policy Strategic Action 3:
Ensure That Privacy Security and Cybersecurity Protocols Meet the Needs of Current or Pending Crises
- Global Policy Strategic Action 4:
Enhance Global Disease Surveillance and Data Analytics Capacity
- Global Policy Strategic Action 5:
Visualize Future Permanent Health System Changes
Global Policy Strategic Action 1:
Establish a Flexible and Adaptable Healthcare Environment
The global healthcare community has been proactive in implementing new processes and protocols in response to the COVID-19 pandemic. In order to continue to best equip the community in responding to this crisis and future public health emergencies, we must maintain a care delivery environment that can quickly adapt and evolve based upon lessons learned.
This added flexibility will help catalyze innovation across the care delivery environment, thus improving our capabilities. This can be enhanced by recognizing our continued push toward value in healthcare. Focusing on innovation and value will lead to a greater infusion of innovative technologies into the care delivery environment, which needs to be embraced, including virtual services like telehealth and remote patient monitoring.
Priorities
- Create an environment where innovation can continue to flourish across delivery systems
- Reinforce the importance of the push to value in healthcare
- Infuse innovative technology into care processes
- Broaden access to virtual services that can be delivered safely and securely
- Telehealth
- Remote patient monitoring
- Ensure appropriate resource allocation and compensation for COVID-19 care delivery
Global Policy Strategic Action 2:
Build a Foundation of Interoperable Platforms To Facilitate Broad-Based Data Exchange
The ability to securely share and use health data is imperative in the fight against infectious disease outbreaks such as COVID-19 and it is also vital to enhanced care management.
HIMSS stresses the importance of leveraging open data or cross-sector health data sharing platforms to collect and use needed data across sectors, including laboratory information management systems, EHR data, emergency department encounters, emergency medical services data and public health surveillance data from public health and commercial laboratories during public health emergencies.
The ability to securely share and use health data is imperative in the fight against infectious disease outbreaks such as COVID-19 and it is also vital to enhanced care management.
HIMSS stresses the importance of leveraging open data or cross-sector health data sharing platforms
The COVID-19 pandemic has emphasized the need for interoperability of systems for healthcare providers who need comprehensive data in order to make informed decisions about appropriate treatment for patients.
The COVID-19 pandemic has emphasized the need for interoperability of systems for healthcare providers who need comprehensive data in order to make informed decisions about appropriate treatment for patients.
The pandemic has also catalyzed creative solutions for policymakers who must now work with the healthcare community to create laws, regulations, and guidance that expand and improve care delivery options, address social determinants of health, public health research and epidemiological investigation, and that better address the needs of patients, especially for vulnerable populations.
The pandemic has also catalyzed creative solutions for policymakers who must now work with the healthcare community to create laws, regulations, and guidance that expand and improve care delivery options, address social determinants of health, public health research and epidemiological investigation, and that better address the needs of patients, especially for vulnerable populations.
Priorities
- Harness clinical data to develop safe and effective treatment paradigms and facilitate vaccine-related research
- Promote greater data exchange across the care continuum to improve research capabilities
- Improve public health infrastructure to facilitate appropriate testing and promptly identify new outbreaks
- Empower communities to leverage social determinants of health data to inform policy action
- Ensure the equitable distribution of treatment protocols and address any disparities
Global Policy Strategic Action 3:
Ensure That Privacy Security and Cybersecurity Protocols Meet the Needs of Current or Pending Crises
With the expansion of the use of technology and typical safeguards loosened, as well as more personal, individually identifiable data being available to combat COVID-19, widespread concerns about privacy and security are mounting.
The privacy and security of an individual’s healthcare data remains a major concern while there is a need to strike a balance that allows for proper response to the crisis. HIMSS leadership joined with a number of international leaders in calling on governments to mitigate cyberattacks that target the healthcare sector. The healthcare community, led by the government, must make it a priority to provide cybersecurity education to all in the sector by discussing new and existing threats and mitigation efforts in a manner that must be understandable to people at all levels of the healthcare community.
Robust data privacy and security controls must be developed that are resilient and rigorously safeguard personally identifiable information, or PII, while being flexible enough to support current the needs of the public health community. In a public health crisis, it is essential to realize actual and potential primary and secondary uses of data. As such, it is important to ensure that the necessary privacy and security controls are used to safeguard the data throughout its lifecycle.
Priorities
- Provide cybersecurity education awareness campaigns to educate all communities about new and existing threats and mitigation efforts
- Develop a resilient data privacy system that prioritizes personally identifiable information but is flexible enough to support current public health needs
- Ensure the appropriate privacy safeguards are in place to facilitate primary and secondary uses of data for public health purposes
- Secure cloud-based resources are critical for consistent data sharing and transfer around a pandemic or emergency response
Global Policy Strategic Action 4:
Enhance Global Disease Surveillance and Data Analytics Capacity
Disease surveillance is foundational to public health response to pandemics. The use of timely, evidence-based information supports informed public health and safety policy decisions. Thus, the global healthcare community is encouraged to prioritize disease surveillance and data analytics in order to quickly respond to COVID-19 and future public health crises.
Health authorities at all levels and across public and private healthcare systems must work together to modernize coordinated disease surveillance and data analytics. As a first approach, governments and non-governmental organizations alike are urged to support a global examination of the obstacles to a modernized system. This research should help countries and localities alike determine where does surveillance information transfer fail? What are the reasons for that failure? Then we have identified tasks that drive toward solving the issues, thereby ending up closer to the goal of enhanced capacity to collect and analyze data. This is quintessential to help enable reopening of economies and society at large.
“At the same time that we confront the current crisis, we must plan for the future by putting in place tools to enhance our ability to conduct effective surveillance, containment, and case management… There is no time to lose,” noted the authors of a report by the Duke-Margolis Center for Health Policy. The authors included two former U.S. Food and Drug Administration commissioners, Mark McClellan, MD, PhD, and Scott Gottlieb, MD; and Farzad Mostashari, MD, MSc, former national coordinator for health information technology at the Department of Health and Human Services.
Priorities
Heath organizations are urged to prioritize syndromic surveillance, which looks at health data such as spikes in COVID-19 related symptoms as well as admission, discharge, and transfer, or ADT, notifications from medical facilities.
- Develop a disease surveillance system that capitalizes on technology and innovation and supports:
- Accurate and transparent daily electronic reporting on the number of cases
- Informs preventative actions and coordination with human services and social support systems to assist the most vulnerable
- Developing quality measurement standards and protocols to support continuous quality improvement in COVID-19 care delivery
- Supports data analytics for informed policymaking at all levels of government
- Build cross-sector funding, technical assistance and demonstrations using the latest surveillance and data analytics tools to expedite outbreak management actions
- Ensure public health surveillance practices and policies safeguard individual protections
- Build on lessons learned from well-established, present-day public health surveillance efforts
Global Policy Strategic Action 5:
Visualize Future Permanent Health System Changes
Fundamental to conquering COVID-19 and future health threats is to push toward an improved public health infrastructure including the expansion of modernized public health surveillance, consideration of social determinants of health, and use of mobile and digital solutions that support public health contact tracing efforts. Moreover, COVID-19 is pressing health systems and health authorities closer to formulating new definitions and policies that include not only traditional forms of in-person healthcare, but also virtual health interactions.
Charles Alessi, MD, chief clinical officer with HIMSS, recommends that by using technology and data, healthcare can more effectively plan for a second wave of the pandemic and beyond. He encouraged that a proper discussion about the role that data can play is needed, and that it will be essential to incorporate digital modalities in the care of non-communicable disease.
Priorities
- Participate in worldwide data collection and sharing to accelerate the implementation of short-term measures during the crisis to determine effectiveness of treatment and care
- Advance new reforms to benefit patients and the broader care delivery environment
- If and where barriers exist, prioritize the permanent expansion and relaxation of current restrictions on telehealth services, and where applicable, billing or reimbursement for telehealth encounters compared to face to face encounters
- Strengthen the medical supply chain now with the necessary infrastructure to be well-positioned for the next COVID-19 wave and future disease pandemics
- Leverage HIMSS Digital Health Indicator to assess overall emergency preparedness of country, municipal or community health systems
- Reinforce the use of mapping and data sharing technologies to inform risk strata algorithms for health systems and public health interventions
Originally published at https://www.himss.org
