On Sep. 16, the Detroit-based Covisint, a healthcare IT vendor specializing in cloud-based solutions, will release the results of a study conducted by the Atlanta-based Porter Research and sponsored by Covisint, and which was based on interviews with 49 senior healthcare executives, 20 of whom were CIOs and other senior IT executives.
Among those senior healthcare executives interviewed for the study, 58 percent rated their confidence in cloud computing to access information from disparate locations, on a scale of 1 to 5. That finding is significant, despite the limited size of the survey cohort, since, at the same time, 72 percent of respondents stated that they plan to submit reporting to the Physician Quality Reporting System (PQRS) to obtain reimbursements and avoid penalties in the value-based purchasing program under the Affordable Care Act (ACA). Meanwhile, a majority of respondents (60 percent) also report that their physicians access a community view of patients’ care plans via electronic health records (EHRs), while about half (49 percent) of respondents will use their current EHR vendors to address their secure-messaging needs within the next year.
In assessing the results of the study, Cynthia Porter, president of Porter Research, noted in a statement that “Healthcare is changing with a vengeance, and companies who excel at improving the cost and quality of care will benefit from these findings. We set out to determine where the true, industry game-changers were,” Porter added, “and the results were-eye-popping. For instance, how revealing was it that 59 percent of the nation’s leading healthcare execs place a high importance in cloud-based technologies, even though the industry is still greater than 70-percent paper-based?” Significantly, one-third of respondents said that their EHRs lacked critical population health management and reporting capabilities.
One week prior to the public release of the full study, John Haughton, M.D., Covisint’s CMIO, gave HCI Editor-in-Chief Mark Hagland an industry-first interview regarding the study’s findings and his perspectives on where cloud computing to support population health management and healthcare reform, stands right now. Below are excerpts from that interview.
How would you characterize attitudes towards the cloud right now among healthcare and healthcare IT leaders? We at HCI continue to hear a variety of opinions on the subject.
I found it interesting that [the Orem, Utah-based] KLAS [Research] found that, among those healthcare IT executives whose organizations are already using the cloud, those using the cloud gave cloud vendors an average score of 4.5 on a scale of 5 in terms of their satisfaction with data security. At the same time, 66 percent of those not yet using the cloud cited concerns over data security and operational control as reasons for their continued hesitation. I think those findings from KLAS put our findings into some perspective.
Is there any particular result in the study you’d like to highlight?
I think that the result of the fact that we’re now sitting at nearly 60 percent of senior executives saying that all this stuff is OK and works and is trustworthy from the cloud means, we’re on the downhill side now. And I think it’s a marker. So it’s not, do I need to go to the cloud? But rather, how can I make the cloud work for me?
What is the key thing that our readers should be aware of, overall?
I think that this research helps to validate that we’re moving from the initial phase of electronic records in healthcare, which really was implementation of islands or individual-facility-centric, to a hunger in the market for access to real-time information at the point of care, and across the care team and across organizations. And the real key is the real-time update. So we get obtain that information and bring it forward, and I think the business drivers are also lining up, as more organizations move forward. One person has talked about having one foot in the fee-for-service canoe, and one foot in the risk canoe, and the idea of having real-time, trusted information becomes critical.
And the idea of the cloud broker, which isn’t fully embedded in healthcare yet, emerges. The idea is that everything becomes a network of networks, and the data becomes the application. When it’s put together into a usable fashion, then that’s the application that can be rendered inside an EHR or a device and possibly become available to the patient; the critical piece is having the information available to use. And to do that, you need the cloud; and it also lines up with some of the deeper partnerships between payers and providers.
At Covisint, we’re seeing payers asking, how do we connect with this real-time engagement with the provider and the patient? We call that the last mile. And the original disease management involved call centers at the plan; but now, you can get data in real time on both the analytics sides, but also, Mrs. Smith is leaving the hospital, and the hospital uses hospitalists, and so Dr. Jones in the community didn’t even know that Mrs. Smith was in the hospital. And what’s valuable to get into the community is the real-time sharing of information to the physician in the community, and both providers and payers want that. For the physicians, they’re trying to improve their star rating; and for the payer, they’re trying to reduce costs.
And this may be healthcare’s version of crowd-sourcing. In healthcare, there’s already a payment occurring for an office visit. So if the payer can end up getting key information to the provider at the time of the visit, whether after a hospital stay or for chronic care, then that visit is that much more valuable. So the value proposition might be, that physician knows that patient, and you may be able to tweak the medications to stop a hospital stay. Or, by talking with the patient while also having access to data, the physician may be able to find out that the patient has had a flu vaccination, but needs a mammogram. So the physician can improve their HEDIS or star scores. And the health plan can start to notify people or get in touch with people who need to be brought in. So the payer and provider are helping each other by sharing information back and forth.
What is your answer to healthcare IT leaders who still don’t trust the cloud because of the PHI data security issue?
In the early iterations of the cloud, there was a lack of security control. But in the newer versions, the CIO does have control over the data. And there are big enough companies in the cloud where the contractual relationships are such that they carry a business lever. A decade ago we saw it in the auto industry, and now see it in travel and other industries, and that is that you need trust that a competitor won’t get at your information, that it will be secure and safe, and that you can rely on it from a business perspective. Neutrality is an important element in that.
And it’s important that the CIO have control over it, but also that the CIO can get the value out of having the information available in the community, for the patient. You used to have to choose one or the other—security or availability—but now you don’t anymore, when everyone’s a sender or receiver. In some situations, we’re sending data as a source for an EMR, or a source for health information exchange; but we’re also receiving in the same way.
Given that the executives interviewed cited increasing operational efficiency, reducing unnecessary readmissions, and improving the management of chronic conditions, as their top operational priorities, what would your advice be for healthcare and healthcare IT leaders right now?
I think it is, start with what you have, and figure out who a trusted partner is in your community. If you’re a provider, it may be that you need reliable data from multiple payers, and that may require the cloud. Or maybe you’re hosting the information on Citrix. So wherever you can, use data standards in data communication. But it’s better to get a document that’s an electronic image to the point of care today, than perhaps waiting for all wiring and standards ready—it might be more important to get the information out to the provider today.
So watch for data standards and use them when you can, but get the data out in a trusted way as quickly as you can. And all of this will change, in terms of how you render it, in terms of the software and in terms of the devices you use, and how it all mixes and matches. Whatever you do, it’s got to get out into the community—the information does. And any information technology used has to be safe, trustworthy, and scalable. And now there are business and clinical reasons to do it.
What will happen in the next couple of years, with regard to the emerging new forms of healthcare reimbursement and organizations, and this topic?
I think that organizations will take on more risk, so that the coordination and organization of services will happen at a more local level, even as individual providers will still be paid primarily under fee-for-service. So we’ll see a shift from health plans to hospital organizations in terms of taking on risk, but still with some fee-for-service payment mixed in. The end result will be more local control, more sharing, and more distribution of information.