EXCLUSIVE - Moving from an age of foundational IT to a new era of information in healthcare

Information and communication technologies (ICTs) are transforming all facets of our lives at an increasingly rapid pace today. Healthcare is no exception. To take a few examples, Electronic Medical Records (EMRs) have changed the way patient information is stored and exchanged. Telehealth and mobile apps are bringing quality healthcare to remote communities. Sensor technologies are altering patient monitoring. Cutting edge artificial intelligence, enabled by big data and machine learning, is supporting diagnosis and decisions on treatment options and it could potentially usher in a new era of personalised medicine.  

OpenGov spoke to Mr. Harold Wolf, President and CEO of HIMSS (Healthcare Information and Management Systems Society), about this rapidly changing healthcare landscape. Headquartered in Chicago, HIMSS is a global, cause-based, not-for-profit organisation focused on better health through information and technology. HIMSS leads efforts to optimise health engagements and care outcomes using IT. 

Mr. Wolf assumed his current position in July 2017. He has nearly 35 years of experience as a healthcare and informatics executive with areas of expertise in mhealth, product development, integrated care models, marketing, distribution, information technology and innovation implementation,

You just started your role as the new President and CEO of HIMSS. Could you tell us about your aspirations and what you hope to achieve in the coming years?

I am looking forward to bringing an operational and international perspective. We also look forward to bringing an expanded relationship with the clinical and provider communities. Healthcare is moving from an age of foundational IT, which is a critical part of HIMSS’ identity, to a new era of information based on the technical foundation. With all the investments that have gone into IT we now have a platform by which we can utilise the information being captured and impact the clinical, consumer, patient and administrative components of the health eco-system. I think that’s the next phase we’re moving towards and I hope my experience will lend to that, both my domestic and international experience.

I’ve been very fortunate through the years to have high-profile opportunities to contribute to health IT, from being CIO in in the initial stages of application development to thinking through both the business architecture and impact of large-scale systems. Not just at Kaiser Permanente, but in the UK, Australia, Denmark, full end-to-end country developments, thinking about the impact both information and technology have on daily lives and all the way up through the policies necessary to support innovation.

Has the healthcare sector kept pace with other industries in terms of taking advantage of the benefits of ICT?  What are the major trends and opportunities/ threats that you see in the area of healthcare transformation in the context of ICT?

Number of industries have been transforming - automotive, banking, retail and travel to name a few. 

Healthcare has been behind the curve of transformation not because healthcare has been stubborn but due to the nature of healthcare as an appropriately risk concerned environment.

Additionally, healthcare had the model of a local entities not always connected with other systems or organisations around them.  But now healthcare has grown into larger scale operations. In short, rapid or aggressive innovation has not been comfortable or necessarily required as it is now.  But healthcare can learn from other industries. 

Look at automotive - the industry shares information to better serve the consumer and provide products based on identified customer needs.  Automotive uses advanced analytics to understand performance, auto makers look at segmentation analysis to understand the consumer’s needs and what products should be develop. Car makers share supply chain information. Look at how the banking industry has transformed by delivering information to the consumer when they want it and how they want it. They have taken information and applied to new technologies (mobile banking, for example) to help transform how the industry interacts with the consumer - which allows the banking industry to continue to grow and prosper.

Finally, if you examine how retail and travel have transformed, those industries have looked at the extenders of information and technology to gain a greater understanding of the consumer and therefore being able to provide consumer-focused solutions to then lead to an industry transformation.  

In terms of opportunities and threats, healthcare needs to be prepared for and be able to address the Silver Tsunami of retiring baby boomers and the economic challenges that healthcare is facing. This is where our focus needs to be immediately as are headed toward significant impacts on our systems within the next 5 to 10 years.

The opportunity for the industry and for HIMSS, is to understand how we can use information and technology to provide care for our aging population as well as be able to meet the economic demand being faced by healthcare. We need to understand how to take care of a population who is living longer, with more chronic disease— often due to living longer, and understand that treatment will extend beyond the clinic or the hospital walls. That is where information and technology can play a role. Relationship of connectivity to the patient and the provider is what we need to manage and grow.

Finally, we have to recognise that changes are coming at us very fast—systems will be overwhelmed very quickly.  We need to build a culture of healthcare to innovate faster than ever before.

We find clinicians complaining sometimes that digital solutions are adding to their workload, instead of making their work easier. What are the reasons for this disconnect and how can this be resolved? 

Without question a number of systems, starting with EMRs, are adding to the workload, often asking clinicians for more information and input than with paper. Additionally, we often hear of alert fatigue. A lot of these issues are tied up in configuration management of the system and can be addressed within the applications.

I think the bigger question for all clinicians is to understand what the extra data input or care management workflow/pathway requirements are gaining for their practice and patient short and long term. EMRs are tools and it’s very important to use the tool to benefit and thus be clear on the value add.

In your many years of experience in the industry, what kind of roles do you think that governments can play in the digital transformation of healthcare services, as regulators, facilitators or providers of healthcare? 

Nearly all governments play a role in digital transformation through one or more of the three you mentioned. I would also add that governments must play a role in sponsoring innovation and investment in digital care capabilities. It’s a large responsibility due to the impact health has on a general population, productivity, overall citizens expectations and of course national budgets.  Digital transformation helps set the course for countries to support the changing demands of healthcare and health.  It is to that end that governments are picking and choosing where to engage based on their own needs and timelines.

Interoperability and security of patient data/information are integral aspects in the development of integrated healthcare systems, and often are quite challenging to tackle and address for healthcare providers around the world, especially when they have to deal with existing legacy systems. What do you think are some ways healthcare providers could approach revamping or updating healthcare systems? Could you give us some examples? What role can HIMSS play in this?  

Security needs to go hand in hand with interoperability. The reality is one has to complement the other for very obvious reasons. If I’m creating an environment where information can, will and needs to be exchanged—not just in bulk, but transactionally as well, in order to get the right information to the right person or clinician at the right time—it has to be done in a secure manner. I think it’s a critical dependency. Both security and interoperability are critical focal points of HIMSS in support of global healthcare. Think about any critical use of technology, use of information, whether it’s in the home, whether it’s in an ICU, a hospital bed, a virtual setting, between providers or whether it’s on your device; interoperability and security have to go hand in hand for ease of secure access of information.

The bottom line is that organisations need secure solutions to connect their platforms across the eco-system.

There are multiple steps in securing legacy environments.  First and foremost is understanding the network that the health systems have built.  Is the network itself secure with adequate firewalls and protocols for the exchange of information both internally and externally? Understand the impact of devices that need network connectivity and internal integration and insure that they are deployed in a secure fashion.

Many systems have used white hat hackers to test their network platform to find the vulnerabilities before the black hats take a run.  Finally, be focused on using applications and capabilities that meet international standards of interoperability and this will work well with each other through for secure data exchange. 

HIMSS works to support, innovate and encourage the use of interoperability standards on a global basis.  We convene experts and conduct webinars on security on a regular basis and are happy to work with systems to help evaluate their innovation and interoperability needs.  

SINGAPORE: In 2015, Ng Teng Fong General Hospital (NTFGH) completed Project OneCare, overhauled its legacy systems and implemented a fully integrated system with one record for each patient and a single source of truth within a “4-less” Environment: Chartless, Scriptless, Filmless, Paperless. The hospital interfaced 976 devices directly with the EMR system Real Time Location System (RTLS) tracking of inpatient and critical assets across the 3 hospital towers and achieved HIMSS Analytics EMRAM Stage 7, the first in Singapore to do so.

Prior to this, the legacy systems from its earlier holding site at Alexandra Hospital comprised many disparate data sources and multiple interfaces which could not provide care providers with a single view of patient records. In addition, some applications had complicated order entry screens, limited clinical documentation capabilities and inadequate analytical capabilities. There was also limited device integration.

There is increased pressure for healthcare providers worldwide to create better and more customised services for clients/patients while working with very limited resources. How can healthcare providers balance between adding value for patients while maintaining good financial growth and profitability? 

We live in a consumer-oriented world and the demands on healthcare to be more segmented toward different patient groups and to be more user friendly will only go up.  Providers need to find the opportunities and innovations that allow the connectivity for patients/consumers that both address the need for personalisation as well as meet financial pressures. 

This is where digital health and corresponding process innovations in care come into play.  There are many in the growing market and I believe clinicians are seeing better values by the day. Deploying them judiciously into the daily process will remain the difference between success and failure.

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