Improving the Communication Infrastructure: Healthcare’s Next Big Wave?

With access to patient health information now commonplace among providers, the next core investment could be in communication channels with patients, according to CHIME’s 2018 HealthCare’s Most Wired survey.

The survey findings, released on October 31 at the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego, included more than 600 participants, and revealed an array of findings related to interoperability and integration, data security, value-based care and population health, and patient engagement.

This is the first year that CHIME conducted the Most Wired survey and the first year a trends report based on survey data has been made available for the industry, according to the associations’ officials.

Many organizations reported that they do have the capability to consume data from outside entities such as an external hospital system or a retail pharmacy, although less so with home health agencies, skilled nursing homes and chronic care facilities.

Meaningful use has helped drive the development and use of patient portals, and progressive providers have adopted several additional capabilities, according to the analysis. And, many patients have readily transitioned to mobile apps offered by most portals. Regulations on application programming interfaces (APIs) under Promoting Interoperability, the Centers for Medicare and Medicaid Services’ renaming for meaningful use, will expand engagement opportunities with patients but also pose security challenges for providers, according to officials who presented the findings at the CIO Forum.

The report specifically noted, “As healthcare adopts and leverages new technologies, it is becoming increasingly complex to maintain an ecosystem in which data can be reliably shared. Poor communication between disparate systems can be one of the greatest impediments to clinicians being able to access the information necessary to provide effective patient care. Communication technologies, like remote access capabilities and emergency alerting, can improve the speed at which critical data is delivered to caregivers.”

Indeed, nearly all of the survey’s participating organizations reported that at least 95 percent of their clinicians regularly access clinical information electronically. This includes medical history, nurse notes, order sets, care plans, diagnostic study results, operative reports, medication reconciliation, discharge instructions, care plans, and clinical summaries. Similarly, almost all physicians can electronically access their organization’s EHR, CPOE, clinical guidelines, medical images, and evidence references while in the hospital or clinic.

However, only about half of physicians can access these same resources via mobile applications. Adoption of secure messaging also lags behind other remote-access functions; both represent opportunities for the industry to advance the current communication infrastructure, according to the analysis.

What’s more, over three-fourths of participating organizations send the following patient-monitoring data directly to the EHR: blood glucose, bedside blood pressure, bedside pulse oximetry, and EKG data. But there are still significant gaps in the integration between EHRs and patient-monitoring equipment—only 25 percent of participating organizations send data from their IV pumps directly to their EHR, and only 10 percent send data directly from in-bed scales. Furthermore, when tracking hospital-acquired infections, 59 percent integrate this data with their EHR, 33 percent store the data electronically, and 8 percent use manual processes.

Regarding security, few organizations (29 percent) have a comprehensive program in place, which CHIME outlines as doing all of the following: reporting security deficiencies and security progress to the board; having a dedicated CISO (chief information security officer) and cybersecurity committee; providing security updates to the board at least annually; and having a board-level committee that provides security oversight.

Indeed, having a dedicated CISO and regularly reporting security updates to an executive committee are some of the first steps to mitigating cybersecurity vulnerabilities. However, for most organizations, establishing these security foundations is still a work in progress, the report revealed.

When it comes to value-based care and population health, data aggregation is the first step toward effectively leveraging population health management technology, and while the industry has made progress, there is still room to improve data aggregation across the continuum of care, according to the report. About 57 percent of healthcare organizations are using clinical and billing data as well as an HIE to identify gaps in care. However, only one-quarter of organizations are using these tools and have the ability to access registry data at the point of care.

The analysis noted that care-management practices for areas outside of the inpatient setting are still maturing, especially for home management of chronic diseases. While most provider organizations’ population health strategies target diseases like COPD, congestive heart failure, diabetes, heart disease, and hypertension, few are tracking behavioral health, sickle cell anemia, or end-stage renal disease. Additionally, few organizations currently allow patients at home to do things like manually submit self-test results or report their medication management compliance via email.

The survey also asked participants about their patient engagement and telehealth capabilities. Within the hospital setting, adoption of patient engagement capabilities is shallow. Less than one-third of organizations support patient and family functions for ordering meals based on dietary restrictions, planning for discharge processes, controlling environments, reporting non-clinical problems, and accessing traditional whiteboard information. And roughly one-third support patient engagement–related staff functions for initiating patient pathways, while one-quarter have adopted real-time engagement.

Obstacles remain in order to truly engage patient communities, with one example being that price transparency is still emerging—only 27 percent of participating organizations provide the public with cost calculations for common procedures.

Virtual care is gaining traction, with over one-third of participating organizations offering virtual visits in a non-clinical setting. While this may seem low compared to adoption of other capabilities, it is actually high given that virtual care is still developing, and few patients have participated in it, according to the report’s analysts.

And while barriers such as reimbursement limitations and evolving regulations currently prevent healthcare organizations from harnessing the full potential of telehealth services, 89 percent of participating organizations offer some form of telehealth services. Most of these organizations are still early in their telehealth journey; few offer focused telehealth services such as eICU, rehabilitation, genetic counseling, or skilled nursing services.