Worries about security, interoperability and patient rights are complicating the health care industry's transition to digital health care applications and electronic medical records.
HALF MOON BAY, Calif.—The need to move to modern computer technology including cloud computing to enable the transition to digital health care and medical records was a hot topic during a session here at the Constellation Research Connection Enterprise conference.
While many new technologies offer ways for hospitals and other health care institutions to improve payment systems and streamline patients' access to their medical records, panelists said the transition is hampered by a reluctance to invest in new systems.
"The challenge is how do we catch up to and leapfrog to where consumers are today, while still trying to fix, for example, payment systems" running on aging mainframe systems, said Anne Kao, chief digital officer and CIO at MedAmerica.
But as with enterprises in general, some health care providers are moving more aggressively to new technology. Shawn Wiora, CIO at Creative Solutions in Healthcare, an operator of hospice and elder care facilities based in Fort Worth, Texas, says his company has moved entirely to cloud-based platforms and challenged other health care providers to follow suit.
Holding up a thick bound volume of Health Insurance Portability and Accountability Act regulations, Wiora declared, "There is nothing in HIPAA that prevents you from going to the cloud, but a lot of companies say they can't."
Security is one of the primary reasons companies state for rejecting a move to the cloud, along with concern about the lack of control that comes with not having the data center on premises, Wiora said. The vast majority of health care breaches, he noted, have happened at companies with on-premises systems.
In a follow-up interview with eWEEK,
Wiora said he was "putting every CIO and board of directors on notice that if they are not going to the cloud, they are doing a disservice to patients because no one can say they have better IT security infrastructure than the cloud providers. Their ability to attract and retain top security personnel is second to none."
Another technology concern is interoperability. Panelists discussed the challenge of trying to communicate between health care facilities and labs as part of treating patients. "We don't have a clear standard for interoperability, and that's where the disruption comes in," said David Chou, digital health advisor and former CIO at Academic Medical Center. "It's going to happen with the emergence of standards, but the health care vertical is really risk-averse."
Kao discussed new areas in digital health that MedAmerica is experimenting with including telehealth services that let patients get advice directly from a doctor via their smartphone or tablet in video chat sessions.
But Chou said bottom line concerns can hold back some technology and preventative care advances.
“The future of hospitals is keeping patients out, but the reimbursement model is based on how many patients you see,” he said. “How do you go to the CEO or the board of directors and say ‘We’re losing money, but we’re doing the right thing’" by providing free or low cost preventative care services?
In a later interview with eWEEK Chou said profit and budget concerns have a lot of influence on the policies and investment decisions hospitals make.
Peter Nichol, former head of information technology at Access Health CT, which operates Connecticut's health insurance marketplace, said there has been huge progress in digitizing medical records thanks to the High Tech Act in 2009. "It's considered a wide success, but they didn't take into account anything about interoperability. We need to get better at connecting organizations and [transforming] the billing cycle."
Jonathan Rende, CIO and CISO at Castlight Health, which provides a software-as-a-service (SaaS) platform to enable employees to compare and shop for health care coverage, said patients are still largely defined by paper-based forms. "We have to take that in and ingest that, but there are no standards; it's a mess."
Meanwhile, employees have to manage increasingly complex benefits in their health plans.
Rende said that "70 percent of employees don't understand their health care records." Technology can accelerate that, he said, "but it's a major transformation to get to where people can understand their options. Most push it off to their partner or someone else. I think technology offers an amazing opportunity to simplify that in ways people can understand."
There was also discussion of patients' rights to their health care records. Chou said some medical institutions are wrestling with who owns patient records or the best way to make it available.
But Wiora said there is no question as to what constituency has clear rights to patient data. "There is no dispute, the patient owns their data," said Wiora. "We've talked for years about interoperability and it hasn't happened. I think the discussion has to be more driven by consumers to say, 'These are my records and I want online access to all my records since the day I was born."