As we focus this month on the topic of Leadership Fundamentals for Digital Transformation, we wanted to ask one healthcare leader – Hal Wolf, CEO of HIMSS, parent company of Healthcare IT News – for his thoughts on the fundamental transformations that have taken place around the globe as health systems innovate their approaches to information and technology in response to the COVID-19 emergency.
In a precarious moment, with novel coronavirus numbers spiking once again to new heights in the U.S. and in Europe, there’s still a sense of urgency about this current moment. But looking ahead, it’s worth taking stock of what lasting digital health changes might emerge from this ongoing crisis.
As Wolf sees it, there are some big imperatives. Interoperability has to be improved and expanded, with data silos broken down and easier cross-system communication. A national patient identifier is a must for effective care coordination and population health management. On those fronts and many others, HIMSS has been working hard, he says.
“The role that HIMSS has been playing across the globe has really been accentuated because of the pandemic,” said Wolf. “The marketplace has turned to digital health solutions very quickly. They didn’t have any choice.”
“And a number of organizations and systems may not have all the processes in place. They may not have had the culture quite ready for it. They might have had some pieces; some health systems were large and ready to scale. But I don’t think there’s a single system, really, that we’ve talked to, that didn’t see exponential growth in terms of the number of uses of telehealth and other digital health solutions,” Wolf continued.
As they manage this burst of innovation, he said, they’re turning to HIMSS for help – whether that’s with HIMSS Analytics’ many maturity models, or to stay informed about what’s happening from a legislative, regulatory or reimbursement standpoint.
Beyond that, said Wolf, HIMSS has been working with public health agencies around the world to help ensure that “organizations like the CDC and even in the EU have the proper backend systems and data environments, working with the WHO on their data strategy.”
All of that, he said, is part and parcel of HIMSS’ vision: “to ensure the best health for every human everywhere. This is what we’re after. And it’s been a very busy time for us.”
A key must-have toward that pop health goal, of course, is interoperability.
“How are we collecting that information, how are we aggregating that information, and how are we turning that information into policy and quick responsiveness on the part of governments and systems?” said Wolf.
“The problem is at the point of care, and this is where interoperability becomes so significantly important. Because I need to be able to walk into an emergency room, or if I’m in an ICU, I want to make sure they’re getting my record. I want to make sure that all the data that needs to be associated with me is being associated,” Wolf added.
Right now, he said, “there are just too many fundamental gaps. We’ve done a great job, the United States, of developing components of HIE. But there’s an underlying dependency that we’re missing, you know, and that’s the individual patient identifier.”
Toward that end, HIMSS has helped spearhead new initiatives such as the Patient ID Now coalition and has lobbied Washington policymakers – where there has been some movement on the issue recently – on the issue of accurate patient identification.
“That’s a big gap in the United States, and when we look globally, it’s the same problem,” said Wolf. “People have records, but they’re pockets. They’re not necessarily sitting there, one in a hospital, one in primary care. It might be across town. it might be across the country. It might be on another floor in the same building.
“But if they can’t get to that information, if they can’t connect to it, we’re duplicating tests, we’re wasting time and we’re running a huge risk at the individual level,” he said.
Thankfully, “I think for the first time we’re really getting the traction that we need,” said Wolf. “We’re hearing positive comments coming out of the Senate.”
But the reality is, “until we know who a person is walking into a particular door, and their record, we’re creating vulnerabilities for them,” he said.
“And here we are across the country right at the moment, you and I are talking 80%-plus capacities in ICU all across the country. This is a huge [COVID-19] surge we’re seeing right now. So patient ID is incredibly important. I don’t know how you achieve true interoperability without it.”
Looking further ahead, Wolf says he’s interested in how to maintain digital health’s momentum. As health systems adopt new digital health tools and scale up existing ones, he asked, “how are they going to take those opportunities and then turn it back into the new normal?”
On the interoperability front, he’s encouraged by the potential of the information blocking and patient access rules – even if they take effect a few months later than first planned – to set some new rules of the road.
“Continued compliments to ONC, Dr. Rucker and the team,” said Wolf. “They had a huge task in front of them, which was to get those rules together and put them out when they were ready. And I think we would all agree that there was so much anxiety and interest in those rules. But they make a lot of sense. People are recognizing it’s needed. When we talk about population health, all the way down to the individual, how the heck do we do that if we don’t put these rules in place?”
He also sees continuing progress on telehealth – not just how it’s used, but how it’s regulated and reimbursed.
“It’s here. Let’s just put it that way. Once you change the rules, it might go backwards a little bit. But the reality is the demand is here. When you open a new channel of communication, it stays,” he said.
As Wolf explained: “We’ve had a lot of pent-up demand sitting in healthcare that was fundamentally in a corral because of the encounter-based paradigm. When we shifted to telehealth during the pandemic, because we cut off encounter-based discussions, it all went to telehealth. So we saw these 300-fold increases.”
Sure, the volume of virtual care visits has been reduced a bit with more in-person visits, but “the fact of the matter is there’s a consumer push to have this happen,” said Wolf. “It’s patient-friendly, it’s staff-friendly, because you’re not burning up a 20-minute slot for something that might be easily answered through an email, as an example, or quick five-minute Zoom call.”
There’s just a “fundamental demand,” he said, “and the recognition that we live in an environment right now where we have a shrinking number of primary care doctors, we have an increased gap in the number of nurses and clinicians that we need in order to care for an aging population … it just cannot be solved in the old paradigm.”
Enabling durable digital transformation
Even as policies around data exchange and telehealth reimbursement change, however, lasting digital transformation will come from the ground up, said Wolf. And it’s going to demand new workforce development efforts as the roles of people, process and technology continue to evolve.
In some areas, that change is long overdue.
“One of the things that we’re just building some momentum on right now is the supply chain. We have some major gaps in supply chain at the hospital level, and our care delivery systems in the United States and globally have usually been based upon, ‘How much did I pay for that widget?'” Wolf said.
“Now suddenly we’ve seen supply chains broken. We don’t necessarily track the quality at the individual level of an item. We’re starting to do that more effectively,” he explained.
“I mean, just look at the studies that were coming out about the quality of N95 masks,” he continued. “So tracking the source, understanding the quality, getting the volumes out, ensuring supply chain isn’t interrupted – and then thinking about the price and then inventory control, all of these pieces. We have really under-focused on supply chain. So this is something that I’m really thrilled to see coming around. I think that’s a huge leap.”
A renewed focus on social determinants of health is also welcome, said Wolf, as the pandemic – and the economic devastation it has caused – exacerbate inequities in underserved communities.
“The pandemic has put a huge spotlight on it. And I think people are now more focused on social determinants of health than ever before. I’ve seen the dialogue in the United States in particular – because, frankly, in Europe they’ve been talking about it a while – at new levels. So we have a ways to go. But we’ve got to solve for social determinants of health to have a long-lasting impact on the health of the country as a whole.”
Asked about the post-pandemic innovations he’s seen so far that are most encouraging, Wolf mentioned the “extended use of clinical decision support tools – getting it in the hands of clinicians and getting them the right guidance.”
“People are recognizing that information has been changing so rapidly and this is not something you can wait six months to take a course on. So the whole improvement in knowledge management and exchange.”
“Secondly, the backend systems: We recognize we have a broken reporting system,” he added. “We’re starting to shore that up. And [with] the money that’s been passed by Congress and the efforts that are going on at this point, we recognize now where to start placing those hundreds of millions of dollars … for the backup and exchange of information.”
“We’ve also started to see consolidations in HIEs. Right here in the state of Colorado we’ve seen two really terrific HIEs say they’re going to be collaborating together in a space where they were working together before, but this is a whole new level. And that’s just going to help patients in the exchange,” he continued.
Even though these are exceedingly challenging times – “I’m never going to walk away without again praising the incredible efforts of frontline workers here and around the globe,” said Wolf – some of the advances in public and population health that have occurred since the start of the pandemic hold the promise of lasting benefit when an effective vaccine, hopefully, is eventually released.
“I’m really thrilled with the ability of HIMSS to be able to support the global ecosystem at this incredible hour of need,” said Wolf. “We’re thrilled with the development of our chapters, thrilled with the development of our communities – we have 83,000 members now that are deeply engaged and we talk to so many of them every day. So just a just a huge thank you to all of them, and to all the frontline workers that are just making a big difference.”
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Healthcare IT News is a HIMSS publication.
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