Leadership's Role in Organizational Change
PHARMACY FORECAST 2017 HEALTH INFORMATION TECHNOLOGY
36 AM J HEALTH-SYST PHARM | VOLUME 74 | NUMBER 2 | JANUARY 15, 2017
Health Information Technology: Integration, Patient Empowerment, and Security
Kevin C. Marvin, B.S.Pharm., M.S., FASHP, FHIMMS, Informatics Pharmacist Consultant, Swanton, VT.
Address correspondence to Mr. Marvin (kevin@marvinusa.com).
Copyright © 2017, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/17/0102-0036.
EVOLVING FOCUS OF ATTENTION
With the 2015 enactment of the Medicare Access and CHIP Re- authorization Act, beginning in 2018, there will be a shift from meaningful- use payment adjustments that em- phasize use of an electronic health record (EHR) toward a merit-based incentive payment system (MIPS) that requires measurable improve- ments to care quality.1 Integration of health information technologies is es- sential in meeting MIPS goals. Contin- ued advancements in technology and interoperability will expand health- care device utilization in all care set- tings. At the same time, increased data security will require attention.
INTEGRATION OF HEALTH INFORMATION TECHNOLOGY
Consolidation of health systems has led to increased integration of health information technologies. A large majority (89%) of Forecast Pan- elists (FPs) predicted that at least half of health systems will significantly re- organize their information technology infrastructure to achieve true system- wide integration in the next five years (Figure 1, item 1). For pharmacy de- partments, such integration requires standardization of medication order- ing, distribution, monitoring, docu- mentation, and related processes.
Without such standards, simple differ- ences (e.g., with i.v. medication con- centrations) will compromise integra- tion by forcing the need for different order sets, smart pump libraries, and configurations of other automated systems. The integration of patients into the decision-making process for their care will be facilitated through EHR portals and secure messaging among care team members.2
ADVANCES IN MEDICAL DEVICES
Beyond patient EHR portals, am- bulatory care data sources are evolv- ing quickly. Wearable devices provide real-time data and encourage patient self-monitoring and therapy adherence. In addition, medication dispensing and reminder devices provide real- time medication adherence informa- tion. Sixty-five percent of FPs agreed that in at least 25% of health systems, health data generated by ambulatory care patients (such as from wearable devices) will be integrated into the pa- tient’s EHR in real time (Figure 1, item 3). The design of patient-connected devices must be optimized, based on human factors and interoperability, to ensure safe and accurate diagnoses and appropriate treatments.3,4
ACHIEVING INTEROPERABILITY
Integration of patient physiologi- cal data (e.g., vital signs) into the EHR through monitoring devices is com- monplace. Opportunities abound to integrate these data into automated decision-support systems, but there is limited experience in achieving in- teroperability with medication admin- istration devices. About three fourths of FPs predicted that at least 50% of hospitals will realize measurable im- provements in patient outcomes and staff productivity through interoper-
ability between EHRs and medical de- vices (Figure 1, item 2). This prediction may be too optimistic, with a recent study finding an error rate of 60% as- sociated with the use of smart infusion pumps.5 Thus, caution must be exer- cised so that errors are not introduced or magnified in the pursuit of EHR- to-pump interoperability. Careful de- sign of i.v. medication ordering and administration workflows is needed to address multiple pump-use variables, including medication concentrations, weight-based dosing, dose rounding, loading dose and bolus administra- tion, titrations, and pump setup. EHR- to-device interoperability can support improved patient care but requires accurate configuration and coordina- tion of all components.
SUPPORTING PATIENT CARE PLANS
Most EHR systems support the creation and sharing of care plans, but updating by the patient and all care team members is not universally available. Almost two thirds of FPs predicted that patients in at least 25% of health systems within five years will have a single plan of care that is readily accessible at all points of care and can be updated by all healthcare professionals and the patient (Fig- ure 1, item 4). Electronic care plans should support a team-based consen- sus process that includes the patient and provides access appropriate to the caregiver or patient. Pharmacists should be incorporated into the care planning process.6
TRANSPARENCY THROUGH PROVIDER REPORT CARDS
Patient empowerment requires the provision of more information to patients to support their decision- making process. Public entities, pay- ers, and employers will create elec-
PHARMACY FORECAST 2017HEALTH INFORMATION TECHNOLOGY
AM J HEALTH-SYST PHARM | VOLUME 74 | NUMBER 2 | JANUARY 15, 2017 37
Figure 1 (Health Information Technology). Forecast Panelists’ responses to the question, “How likely is it that the fol- lowing will occur by the year 2021 in the geographic region where you work?”
80%
60%
40%
20%
0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
55%
34%
9% 1%
1 At least 50% of health systems will have significantly reorganized their information technology infrastructure (including electronic health records) to achieve true systemwide integration.
80%
60%
40%
20%
0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
25%
49%
21%
5%
2 In at least 50% of hospitals, interoperability between electronic health records and medical devices (e.g., infusion pumps, physiological monitoring systems) will lead to measurable improvements in patient outcomes and staff productivity.
80%
60%
40%
20%
0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
24%
41%
26%
9%
3 In at least 25% of health systems, health data generated by ambulatory patients (such as from wearable devices) will be integrated into the patient’s electronic health record in real time.
80%
60%
40%
20%
0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
21%
43%
30%
6%
4 Patients in at least 25% of health systems will have a single plan of care that is readily accessible at all points of care and can be updated by all healthcare professionals in the system and by the patient.
80%
60%
40%
20%
0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
38% 41%
17%
4%
5 At least 10% of health systems will be the victim of a major cyberattack or unauthorized information system access that seriously compromises patient safety.
80%
60%
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0% Very
Likely Somewhat
Likely Somewhat
Unlikely Very
Unlikely
31%
47%
21%
1%
6 At least 50% of healthcare consumers will use an online provider report card to help decide where to seek medical care.
PHARMACY FORECAST 2017 HEALTH INFORMATION TECHNOLOGY
38 AM J HEALTH-SYST PHARM | VOLUME 74 | NUMBER 2 | JANUARY 15, 2017
STRATEGIC RECOMMENDATIONS FOR PRACTICE LEADERS
1. Assertively pursue systemwide integration of medication- related information tech- nology using sound project management techniques (e.g., clear goals, accountability, deadlines). Establish system- wide standards for safety-related facets of medication use (e.g., i.v. drug concentrations) and workflow.
2. Through the pharmacy and therapeutics committee, estab- lish policies that clearly assign responsibilities for i.v. pump configuration, user training, support, and maintenance. Ensure that the formulary and all medication-use process- es are consistent with the i.v. pump configuration.
3. Ensure that pharmacy has a voice in your health system’s preacquisition assessment of devices that would affect
medication use and monitor- ing. In those assessments, take into account human factors and interoperability with elec- tronic health records.
4. If your health system has cen- tralized patient care plans, ensure clarity in the process for pharmacists accessing and en- tering information into those plans.
5. Give priority to reviewing the access security of all pharmacy-managed technology systems. Test downtime work- flow processes and procedures for each system, and make improvements as indicated.
6. Identify the pharmacy-specific metrics displayed (or likely to be displayed) on your health system’s provider report card and develop a continuous quality-improvement plan for those measures.
tronic tools to display quality and cost data to support patient selection of providers and therapies. Most health- care consumers, according to 78% of FPs, are likely to use an online provid- er report card to help decide where to seek medical care (Figure 1, item 6). These report cards can be an excellent tool to support patient decision-mak- ing when they properly balance quality and cost measures. Opportunities exist for pharmacy departments to monitor and improve report card measures that could affect patient demand for am- bulatory care and specialty medica- tion services. A feedback mechanism for patients to comment on the report card’s usefulness (with subsequent ad-
justments based on this input) is also an important consideration.7
MAINTAINING SECURITY
Healthcare data integration re- quires enhanced data access, which can increase susceptibility to hack- ing. Cyberattacks on health-system computers have occurred and can be costly due to downtime and the loss or release of patient data.8 Indeed, 79% of FPs predicted that at least 10% of health systems will be the victims of a major cyberattack or unauthor- ized information system access that seriously compromises patient safety (Figure 1, item 5). Electronic systems across the organization must be eval-
uated to ensure that they are secure from unauthorized access, are prop- erly backed up, and have appropri- ately tested downtime processes.
Disclosures The author has declared no potential conflicts of interest.
References 1. Medicare Access and CHIP Reau-
thorization Act. www.congress.gov/ bill/114th-congress/house-bill/2/text (accessed 2016 Oct 13).
2. Royal Philips. Breaking the cycle of reactive healthcare: analysis of the U.S. Future Health Index results. https://s3-eu-west-1.amazonaws. com/philips-future-health-index/ report/2016/Future_Health_Index_ Report_2016_US.pdf (accessed 2016 Jul 10).
3. Harte RP, Glynn LG, Broderick BJ et al. Human centred design consider- ations for connected health devices for the older adult. J Pers Med. 2014; 4:245-81.
4. Food and Drug Administration. Guid- ance for industry: applying human factors and usability engineering to medical devices (February 2016). www.fda.gov/downloads/MedicalDe- vices/.../UCM259760.pdf (accessed 2016 Jul 10).
5. Schnock KO, Dykes PC, Albert J et al. The frequency of intravenous medi- cation administration errors related to smart infusion pumps: a multihos- pital observational study. BMJ Qual Saf. Epub ahead of print. 2016 Feb 23.
6. Joint Commission of Pharmacy Prac- titioners. Pharmacists’ patient care process (May 2014). www.ashp.org/ DocLibrary/BestPractices/JCPPCare- Process2014.aspx (accessed 2016 Jul 10).
7. Friedberg M, Damberg C. A five-point checklist to help performance reports incentivize improvement and effec- tively guide patients. Health Aff. 2012; 31:612-8.
8. Moriarty-Siler E. Cyberattacks: the next health care epidemic (May 2016). www.benefitspro.com/2016/05/26/ cyberattacks-the-next-health-care- epidemic?page_all=1 (accessed 2016 Jul 10).
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