Servers and storage are a primary focus for one hospital’s support upgrades.
Healthcare organizations increasingly are taking responsibility for more lives. At the same time, there’s mounting pressure to provide value-based care with the best clinical outcomes at the lowest possible cost. To that end, technology advancements present both opportunities and challenges for providers.
The patient data resulting from all these changes is integral to the future state of healthcare. But how can it best be managed, accessed and securely stored? And how is it helping to meet patient-care goals? Those are the questions HealthTech asked George Conklin, senior vice president and CIO of Irving, Texas-based CHRISTUS Health. In this interview, Conklin talks about how his organization is approaching patient data-management practices, tackling interoperability challenges and improving population health.
CONKLIN: First, there’s our own effort to take responsibility for managing more lives through our health insurance plans. Population health is a significant, developing strategy for us. I’ve previously noted that we had some 30,000 associates under care management. Today that is a much larger number with well more than 100,000 lives under some form of management. The other main driver is the pressure to provide value-based care, where value is defined as the best clinical outcomes for the lowest possible cost. As we take on greater risks for people, we also believe we have a greater responsibility for engaging them in their own care. It’s up to us to figure out how to do that.
CONKLIN: One of our big areas of effort focus is on providing patients and their caregivers with valuable information that aligns with their treatment plan. For example, if patients have diabetes, we want to collect as much information as possible and share that with clinicians, care managers, and the patients and their family members to alert them to potential problems. To accomplish that, patients need easy access to their information through all the available technologies, including smartphones, tablets and PCs. Since there’s no one-size-fits-all approach, we want to be able to deliver data through the Internet using HTML5-based application services that can run on any device. An increasing number of vendors are beginning to provide technology-agnostic tools and platform-independent capabilities, and those are the ones we’re looking at.
CONKLIN: Every one of us has a different set of triggers that we respond to in order to do the right things for our health. Historically, being coercive hasn’t worked well. The “Field of Dreams” concept where “if you build a patient portal, they will come” hasn’t worked that well either. Although we’ve met federal requirements relating to patient portal utilization, we’re not satisfied with the uptake. We want to figure out what motivates various individuals to use the products and tools we make available so they can stay healthier. We’re starting to explore novel ways to increase engagement and portal use, like gaming technologies that engage those people interested in those technologies in their care.
CONKLIN: Many find the technology and applications challenging or intrusive to their daily workflow. We’re looking at how we can use technologies to help physicians be more productive. For example, voice recognition applications can reduce both the transcription and data-entry workload. As more millennials become doctors, their technology demands and receptiveness will be much higher, because it’s been part of their lives from day one.
CONKLIN: We’ve begun doing outreach into patient homes, including a very successful project for patients with diabetes and COPD [chronic obstructive pulmonary disease]. Using remote data captured from scales, blood pressure pumps and medication compliance reporting, we’ve dramatically reduced the number of readmissions. We’re also exploring opportunities to extend our outreach, including partnering with other entities in our communities to provide services such as remote pharmacy support and centralized ICU [intensive care unit] monitoring capabilities. A recently published study we conducted shows significant impacts of these technologies on length of stay and mortality, both recognized indicators of care quality.
CONKLIN: We’re trying to move to a more prospective or real-time interaction with patient information rather than retroactively doing ad hoc analyses. We’re collecting data from a wide array of sources, including our ambulatory and acute care systems, electronic health records (EHRs), physician offices and patient homes. We provide feedback to clinicians and patients based on population self-management analytics best practices and treatment protocols that we continue to refine based on our experience. Eventually, we want to be able to search our data warehouse and analyze data across specific conditions, age groups or other factors, so we can prospectively identify potential issues. But to do this, you usually have to outsource to the cloud, which can raise security concerns.
CONKLIN: When you hear numbers like 40 percent of the breaches last year being healthcare-related, it worries people. Most of us are going to be able to point to someone we know who’s had a bad experience. Security is a very serious concern for us. We implement all our technologies, including mobile ones, within secure frameworks and have significantly expanded our security organization and its interactions with others, including law enforcement and other providers.
CONKLIN: First of all, you need to look carefully at the particular application or technology you’re going to be using for its ability to interface with the rest of your data and applications portfolio. For example, we have some stand-alone applications, where we struggle to get the information out, that we need to incorporate into the larger data warehouse so it’s available for analytics. Second, and probably more important, think very carefully about what I call “semantic interoperability.” You may be able to get the applications to technically talk to each other, but if you get gibberish when you pool the data, it means you lack an enterprise data-management strategy that can normalize the information you capture.
CONKLIN: It’s our experience that technology variability is going to be a fact of life. That means as organizations continue to grow, merge and consolidate, the focus should remain on semantic interoperability — not on replacing information systems. For example, if you acquire a health system operating a perfectly good EHR that’s well used by clinicians but is different from the one you have, why go through the pain and expense of replacing it? Instead, you should focus on how to get data out of those applications in a way that will be useful and will enable you to do the analytics you need to improve patient care and population health. Our focus as service providers needs to be on making sure our vendors provide truly interoperable applications. We are engaged in a number of these efforts through our work in Washington with the American Hospital Association’s Interoperability task force and the Council for Affordable Quality Healthcare’s Committee on Operating Rules for Information Exchange.