Healthcare Information Exchange: Transformation During Crisis

The COVID-19 pandemic introduced the most significant threat to worldwide health since the 1918 Spanish Flu outbreak, making the ability to quickly gather, share, analyze, and act on healthcare data more important than ever. Organizations that had focused on health information management since the adoption of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 were already familiar with these needs. Many healthcare providers have been focused on digitally transforming their information management processes to help improve the accuracy and efficiency of healthcare information exchange and, ultimately, to help improve healthcare service delivery across a patient’s continuum of care. 

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The primary objective for most healthcare professionals is improving the quality of patient care to achieve successful health outcomes. Meeting that objective requires effective healthcare information exchange, and that calls for the acquisition, management, sharing, analysis and protection of the patient’s healthcare information. Electronic healthcare records (EHR) are a foundational part of healthcare information exchanges. They contain clinical and non-clinical patient information that caregivers need to provide diagnoses, treatment, and ongoing care for their patients. Spread across various systems and functions, this information can be difficult to consolidate into a centralized EHR system. Key challenges remain in interoperability, accessibility of information for patients and caregivers and security of the information to not only deal with regulations such as HIPAA, but also to help protect the various IT systems used to store, manage and share it.

These challenges have only become more complicated in the age of COVID – first with the incredible burden placed on the healthcare system in caring for patients, and then with testing and, now, vaccine distribution. Trying to keep up with technology demands, as well as meeting the needs of a population in crisis, has kept the industry on its toes. How can technology vendors help the healthcare industry keep up and overcome challenges?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was a milestone in the healthcare industry, giving patients more control over their health information. Since health records were mainly paper-based at the time, though, searching and sharing documents was a time-consuming and often expensive process. The HITECH Act, passed to promote the expansion of EHR systems and compliance with HIPAA Privacy and Security rules helped make EHR systems a foundational part of efficient healthcare information exchanges.

However, adoption of EHRs was uneven and often involved disparate systems that in some instances did not easily lend themselves to interoperability. When the COVID-19 pandemic put increased pressure on healthcare information management systems, it highlighted the challenges in interoperability, accessibility and security.

Problem 1: EHR interoperability challenges

A patient’s EHR is created from information found in data points scattered across multiple systems. Sources of this data can include digitized paper records, computerized healthcare records, diagnostic imaging devices, medical monitoring equipment, patient wearables, emails and more. Together, they build a valuable single-source record of a patient’s diagnoses, treatment and medical history.

The ability to simply and efficiently share EHRs between providers is a key to telehealth services, which ranked No. 1 in top-of-mind priorities of healthcare IT professionals as the COVID-19 pandemic unfolded in 2020. A HIMMS/Forrester survey asked a group of healthcare IT professionals, “What is the most pressing technology issue you are facing now that you need the vendor community to prioritize?” The top two answers involved integrating new solutions like virtual care and remote collaboration with existing clinical workflows, and sharing data across an increasingly fractured continuum of care.

Meeting these challenges will not be easy, as most EHR systems have proprietary architectures, but the message is clear: Technology vendors must prioritize interoperability between healthcare data systems, content management systems, clinical analysis, business process systems, and other systems that work together to create EHRs.

It may be difficult to find one technology vendor with the answer for all interoperability challenges. Instead, healthcare IT professionals can seek technology providers that work together to provide whole coverage. Look for providers that are best in their practice, whether in the field of content management, process management, or data analytics, and who have a deep understanding of requirements and standards such as DICOM, IHE, HL7, and FHIR for interoperability. 

Paper and printing continue to be a large part of healthcare information management, so print management is also an important part of the equation. Vendors should be able to demonstrate that their solutions can seamlessly integrate with other systems and healthcare processes already in use, and work across a variety of data formats. The result for the healthcare provider should be a holistic EHR strategy with robust interoperability that delivering cost-effective solutions that can help healthcare professionals in their daily work.

Problem 2: Accessibility of patient healthcare information

Increased use of EHRs and advancements in digital information delivery platforms have also allowed patients to take a more active role in managing their health. Reports show as many as 93% of patients reported that they can view their health records online, although only 64% reported that they use digital devices and mobile apps to manage their health. COVID-19 exacerbated the need for patient access to records and for telehealth services, as ease of access for both patient and provider can help organizations deliver virtual healthcare – a need that is projected to grow even as COVID-19 subsides.

Interoperability issues also impact access to information shared across patient portals, which must support a variety of data and file formats. Information access sites such as patient portals need to support the variety of data that make up a patient’s EHR. This can include text documents, spreadsheets, emails, PDF, DICOM images and multiple video, audio, image and other file formats. It is also important for systems to support chat, teleconferencing and videoconferencing. Of course, it is helpful if this functionality is available and properly formatted for use across all platforms a patient or other caregiver might use to access this information, including PCs, laptops, smartphones, and tablets. Healthcare providers accessing health information can benefit from all of the above as well as systems that use artificial intelligence (AI) to transform information into“smart data” that can be used to provide improved diagnoses and treatment services.

A technology vendor should be able to provide solutions that can integrate with multiple healthcare information exchange access systems, support the various viewing platforms a patient or caregiver may use, and provide convenient access and viewing of health information as a health organization pursues a holistic healthcare information exchange strategy.

Problem 3: Information security

Before the impact of COVID-19, an American Medical Association (AMA) survey showed 83% of physicians had experienced a cyberattack. That number has only increased as hackers take advantage of an overworked, overstressed medical system. The ease with which EHR and digital healthcare information exchanges allow patients and healthcare organizations to have access to private health information has also introduced potential data breach points and vulnerabilities that can be left open by unwitting patients.

As the pandemic progressed, the increased reliance on telehealth, while essential to healthcare in the COVID era, became an area of vulnerability as well. According to a joint guide from the AMA and American Hospital Association,  “Remote Virtual Private Networks (VPN), and other cloud telehealth services have quickly expanded to support telework, telehealth, and for remote monitoring of medical devices. However, this expansion also dramatically increased the ‘attack surface’ for cyber adversaries who quickly adapted and began probing hospital and physician office networks.” 

As 2020 came to an end, the AMA noted physican practices and hospitals had to confront cybercrime on three fronts: a dramatic rise in phishing campaigns, targeted attacks on the VPNs and cloud services used for telehealth and remote-monitoring devices, and an increase in ransomware attacks.

Not only do patients expect sensitive medical information to be kept private, accurate, and secure, HIPAA states this as one of a patient’s rights. Health organizations must have appropriate security mechanisms and standards in place to not only help safeguard patient information but help protect the organization from cyber threats that can use healthcare information exchange endpoints to attack the broader IT infrastructure. Organizations should look for technology vendors that can demonstrate their content management, process management, data analytics, and print solutions incorporate security by design with features that can help protect healthcare information and IT infrastructure.

With the digitization of data systems, information and network security has extended from just putting measures in place to help protect patient privacy rights to putting measures in place to help safeguard the complete healthcare information exchange system from cyberattacks. The COVID-19 crisis has accelerated this transformation in healthcare information exchange throughout all these areas and its impact will be felt well into the future. 

As hospitals and other health organizations navigate through the current COVID-19 crisis and beyond, the selection of technology vendors in support of healthcare information exchange and the use of EHR is more important than ever. Selecting vendors that meet the requirements outlined here can help put a healthcare organization on track to creating a holistic and efficient digitally transformed healthcare information exchange.  

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Brad Arrington is senior manager, integrated marketing, federal and special account channel, Business Information Communications Group, Canon U.S.A., Inc. Throughout his 18+ year career with Canon, he has been responsible for managing the business and technical relationships with strategic partnerships that broaden the reach of Canon’s business-focused product and services portfolio, which includes serving as the lead on FedRAMP product development and certification processes, as well as coordinating cross-company FedRAMP activities.