With the rapid adoption of audiovisual technology into healthcare, healthcare CIOs and other healthcare IT leaders face the difficult decision of how to balance their organizations’ investment dollars against budgetary constraints, security, and selection of technology that is appropriate to the provider organization’s  IT infrastructure. At a roundtable discussion, “Balancing Innovation, Budget Constraints, and Network Security,” part of the Technology Crossroads Conference that was put on by the National eHealth Collaborative in Washington, D.C., last week, expert panelists discussed wide-raging topics confronting provider organizations against the backdrop of the fast-changing technology landscape, including technology investments, cost pressures, health information exchange, network security, cloud computing, and the Health Insurance Portability and Accountability Act.

Providers’ Perspective: Balancing Priorities

Bill Spooner, CIO of Sharp HealthCare in San Diego, who has been with the organization for 30 years, offered a unique perspective as someone who started in finance before moving to IT. “I get to work with people who are introducing all sorts of fantastic innovations, and we try to make sense of it and determine which pieces of innovation we really want to bring in,” he said. He noted that at Sharp HealthCare, the potential technology investments, which come from various areas, are balanced against various criteria, such as financial and quality targets and patients’ needs, and are assigned scores. That information is used to create a prioritized list of technologies the organization is considering for adoption.

Spooner said the IT department in his organization is brought into the process early on. As an IT person, he said he is responsible for ensuring that whatever technology is chosen, will sit on the health system’s network without compromising security, and he relies on security experts to evaluate the products and vendors of the technologies under consideration.

He noted that AV technology that is part of the many elements of the health system’s technology planning, has often been implemented in other industries before making a transition into healthcare. While he sees vendors as coming in as part of larger initiatives, “we have to look at each one to see how they have leveraged their unique capabilities, such as video conferencing or video conferencing, to see if we can work with them more closely.” It’s important for technologies to fit in with the workflows of practitioners, he said.

Scott Whyte is vice president of IT connectivity at San Francisco-based Dignity Health, with 40 hospitals operating primarily in California, Arizona and Nevada. “We continue to grow and plan to be a national healthcare organization rather than a regional hospital organization,” he said. As building blocks for that growth, the health system has about 5,000 physicians and 30 hospitals connected to a health information exchange (HIE), and it has started a patient portal effort. He said Dignity has pockets of IT innovation, including telemedicine, telestroke, e-ICU, video teleconsults, and real-time monitoring feeds over the iPhone.

Nonetheless, budgetary constraints have made technology innovations difficult to implement at the healthcare system, despite their promise, he said. As healthcare pivots from a fee-for-service reimbursement model to one in which they are paid for quality outcomes, healthcare systems are caught in a quandary, between the need to satisfy bondholders who control capital and the need to prepare for future reimbursement models, he said. Profit margins are small in healthcare, and investments are tight, he noted. Provider organizations will be more likely to invest in technologies that are relevant to their strategic issues and immediate pain points, such as alleviating cost pressures, aligning workflows, or helping to close the shortage of physicians and other caregivers, he said.

Healthcare Reform Relies on Trust

William R. Braithwaite, M.D., Ph.D., the head of Braithwaite Consulting, Washington, D.C., said his vision of the future of healthcare is the best care at lower cost. He said that clinicians and patients need to interact directly with computers, and the drivers of that are health information exchanges, electronic health records and clinical decision support systems. Making reference to the report, “Best Care at Lower Cost: The Path to Continuously Learning in America,” released In September by The Institute of Medicine, he said the combination of those three drivers can save healthcare $765 billion a year. “There is money to be made in all aspects of healthcare,” he said.

Braithwaite noted that trust (or lack of it) is the Achilles’ heel to healthcare reform. Without trust in the system by both physicians and patients, the healthcare reform effort will fail, he said. “The black hole in this whole approach is that trust in the system requires that who is sending the information and who is receiving it, and who it is about, is done in a way that assures us that the records are accurate and appropriate,” he said.

Braithwaite, who is referred to by many as the “father of HIPAA,” said the security rule requires that providers manage their risk, which involves considering the size, complexity, infrastructure, hardware and software capabilities, and cost of doing it. This means educating and training people to document and monitor what is going on in a reasonable and appropriate way.

The level of trust in healthcare is challenging to maintain, given technological strides such as mobile health, the “bring your own device” trend, and wireless access allowing caregivers to work from anywhere, at any time, he said. To ensure the level of trust in this fast-changing environment, healthcare leaders need to federate identity management to build a trust network, so physicians need only logon once. Patients need to be assured of secure access to their records, which is especially important at a time when healthcare providers have been increasingly targeted as a source of information in fraud. Cost pressures are there, and providers should consider the use of cloud services for lowering costs and standardized services in a way that includes the security and functionality of those systems, he said.

Robert Wah, M.D., is chief medical officer and vice president of Falls Church, Va.-based CSC, as well as a practicing endocrinologist. Prior to CSC, he served as acting deputy national coordinator at the Office of the National Coordinator for Health Information Technology. He noted that under healthcare reform providers are in a progression from paper records to the digital records and, finally, to digital networks, a step that will enable providers to analyze data in ways they haven’t been able to do before. “That’s when we are going to be able to reap the investments we have made in healthcare,” he said. “Technology is bringing us information where we need it and when we need it; that’s going to save lives and save money,” he said.

Wah described a healthcare information platform, the center of which is a rapidly growing pool of information. He envisions all of the participants in healthcare—patients, doctors, hospitals, payers, government, researchers—contributing to the pool and extracting out of the pool the information they want. “We’re hopeful that we’re getting close to that now,” he said.

Wah also sees an intersection of HIT, cloud computing and cyber security occurring in healthcare. He put particular emphasis on security, noting that the human element is the weakest link in the chain. Whoever is hired to take care of security should not only have the best technology, but should have the human element in control as well, by proper training, education, and third-party certifications, he said. “You don’t want to go to a mom and pop shop to secure your data. You need to have industrial strength security,” he said.

He said security should not be viewed as a burden, but rather as the enabler to make the whole system work; and it should be designed in from the start of any system, not as something that is bolted on later. Reiterating Braithwaite’s point, he said that if patients do not trust the system, they will not participate, and it will fail. The biggest worry patients have about the HIT revolution is a breach of their information, he said. “They are rightly concerned. If you are diagnosed with HIV or take psychiatric medications or have sexually transmitted disease that is a bell you cannot unring. Patients know that, so all of us who work in this area have to be very concerned about the worry our patients have,” he said.