by Anni Mekhail
The March 2018 Healthcare Information and Management Systems Society (HIMSS) annual conference in Las Vegas provided a wealth of insight into the products, investments, and innovations hitting the healthcare industry. The convention included over 1000 exhibitors, from global tech giants and health focussed incumbents, to numerous academic and research centres, healthcare investors, incubators, and start-up companies. As a doctor working in management consulting, I enjoyed my first experience of HIMSS and came away with some valuable ideas and insights, including my top five takeaways which I highlight below.1. Interoperable electronic health records and devices
The move from paper to electronic health records has been one of the biggest generational shifts in the delivery of healthcare. The adoption of electronic health records enables clearer note taking, easier record searches, more accurate coding, and the ability to review patient records without being at their bedside. However, to date, the lack of transparency and interoperability between systems has led to both patient and provider frustration. Information has to be recorded multiple times over as patients move between neighbouring healthcare providers.
Health Level Seven International was founded in 1987 to produce a set of international standards (HL7) for transfer of clinical and health administrative data between software applications by various healthcare providers.1 Since then, the standards have undergone a number of iterations and improvements and have been widely adopted as international health informatics good practice. The HL7 standard has allowed for the exchange of information across hospital departments, providers and geographies. More recently, HL7 has produced the Fast Healthcare Interoperability Resources (FHIR), an evolution of HL7 intended to further support interoperability capability.2 This is leading to the development of system agnostic patient record software, healthcare apps, and medical devices, enabling providers to share and aggregate data across organisations and geographies and enabling the development of population health management (PHM) solutions. Indeed, PHM solutions are attracting a lot of serious attention from healthcare providers wishing to move away from the break-fix model of healthcare and proactively manage the health of their patients in the future.
2. Patients owning their health reports and wellbeing
Traditionally, electronic health records, and the data therein, have been the domain of healthcare providers. Patients can request their own data, but this is not actively encouraged, and the process is time consuming and difficult for both patients and providers. Electronic patient records are held by the hospital as a record of an admission instance rather than a patient instance. Metaphorically, this is akin to sorting emails by which room one is in when an email is sent, rather than by who is sending or receiving the email. This hinders record interoperability, leads to fragmentation of records related to a single event in the patient’s care history, is disempowering for the patient, impedes patient education, and causes issues in data transfer, as information is assigned to episodes rather than patients. A number of players have come into the market intending to reverse this model by putting the record in the hands of the patient and allowing them to choose what information to release to providers.
3. Augmented/virtual reality and telemedicine enabling remote treatment and learning
Remote healthcare provision originated in Australia, where two-way radio systems were set up to provide care to remote areas. By the middle of the 1900’s NASA had made significant advances on this concept as a result of needing medical care and medical research on space flights. However, it is only recently, with rising health demand and improvements in secure conferencing software functionality, that the delivery of satellite medicine has gained significant traction. Pilot studies in particular specialities in several countries have demonstrated increased patient throughput, increased patient satisfaction, and reduced patient and provider cost,3 and in certain settings can demonstrate similar standards of care.4
Augmented and virtual reality provide further opportunities to improve medical training, patient education, and telemedicine. Indeed, ventures to support medical training are enabling medical students globally to learn surgical procedures remotely using live-streaming video glasses, and patient education has been facilitated by curated content production using virtual reality. Telemedicine capability is being enhanced by devices such as the HoloLens, a holographic computer and head-mounted display which allows interaction with holograms.
4. Data visualisations driving intuitive insights for healthcare professionals and patients
Medical record keeping has its roots in either handwritten paper charts or unwieldy database structures. For quality medical care, the accessibility of data is as important as the existence of the data. All patient interactions involve hundreds of decisions by care providers. To make good decisions, providers need access to clear snapshots of relevant patient information at a glance.
However, as enterprise software for health informatics has traditionally required higher upfront investment and therefore much lower churn, the industry has generally been less motivated or incentivised to respond rapidly to user preferences. To date, the software used has been focussed more on product functionality than product design. Nonetheless, as competition increases amongst medical informatics companies, medical software is adopting the principles of elegant and simple design from the consumer software industry. This includes techniques such as iconography, colour signalling, and shadowing. Patient information displayed in an easy to interpret dashboard can speed up medical workflows, reduce the risk of ‘system blindness’, with increasing evidence that this is helping to improve patient outcomes.5
5. Predictive analytics enabling more efficient diagnostic pathways
No technology blog would be complete without referencing technologies such as predictive analytics and machine learning. Healthcare’s progress to digitisation, codification, and advanced natural language processing, together with cloud computing, have created enormous datasets. Ways of predicting outcomes based on data range from simple statistical stratification, segmenting patients by risk category, to machine learning algorithms such as very complex artificial recurrent neural networks. These techniques have been augmented by the development of machine vision using graphics processing units, allowing us to convert unstructured data formats (pictures) into structured data. This is particularly relevant to medicine, given that a significant proportion of our diagnoses is based on radiological imaging.
Predictive analytics and machine learning have implications for traditional research methods, diagnostics, precision medicine, and population health interventions. Most products in the market currently only focus on triaging patient risk. However, numerous companies are working to develop diagnostic and prognostic products which impact the roles of healthcare providers in the near future.
It is an exciting time for digital transformation in healthcare, with a lot of opportunities to redesign the model of delivery by fully utilising the stored information available to us and by working to empower the patient to be in charge of their well-being. For healthcare providers, the HIMMS conference offers valuable insight into understanding how the health technology landscape is developing and allows organisations to choose technology partners aligned to their goals. Moving forward, healthcare organisations need to work with companies who put carers and patients at the top of their priority list and approach healthcare in a collaborative manner. Only by doing this, and by working with clinicians in change management transformation, will the healthcare industry be able to move towards a service that provides seamless interoperability, efficiency, and value that focuses on carer and patient experiences.
1 Health Level 7 International, "Health Level Seven INTERNATIONAL,". See also: http://www.hl7.org/.
2 Health Level 7 (HL7), "FHIR Overview," 19 April 2017. See also: https://www.hl7.org/fhir/overview.html.
3 M. Berman and A. Fenaughty, "Technology and managed care: patient benefits of telemedicine in a rural health care network," Health Economics, vol. 14, no. 6, pp. 559-73, 2004.
4 D. Wirthlin, S. Buradagunta, R. Edwards, D. Brewster, R. Cambria, J. Gertler, G. LaMuraglia, D. Jordan, J. Kvedar and W. Abbott, "Telemedicine in vascular surgery: Feasibility of digital imaging for remote management of wounds," Journal of Vascular Surgery, vol. 27, no. 6, pp. 1089-100, 1998.
5 S. Kherterpal, A. Shanks and K. Tremper, "Impact of a Novel Multiparameter Decision Support System on Intraoperative Processes of Care and Postoperative Outcomes," Anaesthesiology, vol. 128, pp. 272-82, 2018.