11 most interesting developments in health IT this year

From an unprecedented number of data breaches to new regulatory guidelines to one of the costliest EHR implementations to date, 2015 has been an active year in the health IT sphere. The year is only halfway through, but here are 11 of the most interesting developments in health IT so far.

1. Data breach overload. In 2014, health technology experts predicted 2015 would be the "Year of the Healthcare Hack." Unfortunately, that prediction has largely held true. A March 20, 2015 Washington Post article carried the headline "2015 is already the year of the health-care hack — and it's only going to get worse."

In early February, Indianapolis-based Anthem reported hackers gained access to the payer's network, compromising the information of 78.8 million individuals. In March, Mountlake Terrace, Wash.-based Premera Blue Cross reported an attack affecting 11 million individuals. More recently, the U.S. Office of Personnel Management announced a breach in April that at the latest count compromises the sensitive information of 21.5 million people.

It isn't just the number and severity of breaches that is increasing; the root cause of the majority of breaches has taken an ominous turn. According to the Ponemon Institute, criminal attacks are now the main cause of healthcare data breaches for the first time. Over the past five years, the occurrence of healthcare breaches caused by criminal attacks increased 125 percent.

The bad news doesn't stop there. The cost of handling a data breach is also on the rise, increasing 23 percent from 2013, according to the Ponemon Institute. The average consolidated cost of a single breach is roughly $3.8 million, and breaches could cost the U.S. healthcare industry overall $6 billion a year.  

2. Meaningful use forges on. This spring, CMS released two separate proposed rules; one outlining meaningful use stage 3 and one outlining changes to the EHR incentive program for the next two years before stage 3 sets in. Key proposed changes from both the proposed rules include a calendar year reporting schedule, removing "topped-out" measures that are no longer useful in gauging performance and requiring all providers to start attesting to stage 3 in 2018 regardless of their current progress in the program.

CMS' proposed changes come at a time when many providers are still working through stage 2 of meaningful use. The American Hospital Association has been a vocal opponent to the meaningful use program, and in May 2015, AHA Executive Vice President Rick Pollack (and CEO- and president-elect) asked CMS to suspend implementing stage 3 rules until stage 2 is more ironed out, as 2015 will be the first year of stage 2 for most providers.

"The transition to new technology supporting stage 2 has been a challenge for providers due to lack of vendor readiness, mandates to use untested standards, insufficient infrastructure to meet requirements to share information and compressed timelines," Mr. Pollack wrote. "We greatly appreciate the changes CMS has proposed in a separate modification rule for 2015 to 2017 that would accommodate some of the challenges, such as a shorter reporting period in 2015. However, the need for those changes in the middle of a program year underlines the importance of ensuring that policies are feasible before they are finalized in regulation."

However, not everyone is vehemently opposed to the proposed rules. Richard (Dick) Daniels, executive vice president and CIO of Oakland, Calif.-based Kaiser Foundation Hospitals and Health Plan, simply stated, "The bar continues to be raised. These are tough things we'll need to deliver on, but I think it will be good for the industry."

3. Epic gets vocal. The Verona, Wis.-based EHR is often accused of being a closed system that is not willing to interoperate with other vendors. In recent months, Epic has spoken up about its interoperability initiatives. At a March 2015 hearing for the U.S. Senate Committee on Health, Education, Labor & Pensions, Peter DeVault, director of interoperability at Epic, illustrated Epic's history with interoperability.

"There's been a lot of focus on the need for interoperable EHRs over the last couple of years, and a lot of confusion and misinformation in terms of what Epic's software will support," Mr. DeVault said in his written testimony. "Epic does not own or claim rights to our customers' patient data. We do not interfere with their ability to access patient data and we do not re-sell patient data. We give our customers access to our source code and developer support. We also provide tools that support the free flow of information between different system [sic] and different organizations."

An exchange at this hearing flared tensions between Epic and EHR vendors Cerner and athenahealth. When asked why Epic had not joined the CommonWell Alliance, a group of health IT vendors seeking to foster interoperability and data exchange, Mr. DeVault called the alliance an "aspiring" network that would cost millions of dollars achieve, and he questioned how the alliance intended to use the data.

Cerner, one of the seven founding members of CommonWell, issued a statement responding to Mr. Devault's comments, calling them "a slap in the face to many parties working to advance interoperability."

Jonathan Bush, founder and CEO of athenahealth, another founding member of CommonWell, took to Twitter, suggesting Epic was unfounded in saying the alliance would be to costly. Cerner chimed in via Tweet as well, providing calculations that place Epic's earnings just from data exchange fees alone at $40 million.

Additionally, Mr. DeVault said in his testimony that Epic has exchanged more electronic records and patient data through its Care Everywhere record exchange platform than any other vendor, including more than 1,000 hospitals and 26,000 clinics using the platform. He also mentioned Care Everywhere was launched in 2005, four years before the HITECH Act was enacted.

Providers using a platform other than Care Everywhere were still able to exchange records with those using Care Everywhere, though until April 1, 2015 they were required to pay a fee. At HIMSS15, Epic announced it would waive the record sharing fee for non-Epic users, something the company had been considering for several years, according to Eric Helsher, vice president of client success at Epic.

"We felt the fee was small and, in our opinion, fair and one of the least expensive, but it was confusing to our customers and others in understanding how it worked," he told Becker's Hospital Review. "There was logic to it, but it confused people, so we decided to end the fee until at least 2020 when we'll consider reevaluating."

4. Telemedicine takes off. A couple of recent studies suggest consumers are still hesitant about using telemedicine services and virtual visits, but that hasn't stopped the industry from adopting this technology and lawmakers from addressing its prevalence. Currently, 28 states and Washington, D.C. have telemedicine parity laws, with Delaware, Indiana, Minnesota and Nevada being the latest to pass such legislation, according to the American Telemedicine Association.

Retail clinics and payers have also been keen on the uptake. UnitedHealthcare shared plans to extend telemedicine coverage to 20 million members and partnered with three telemedicine providers to do so. Most recently, Walgreens reported plans to extend telemedicine services to 25 states.

Despite telemedicine's acceptance in healthcare and policy circles, some patients and consumers remain skeptical of this form of care. A recent study from TechnologyAdvice found 65 percent of individuals would be somewhat or very unlikely to choose a virtual appointment, and 75 percent would not trust, or would trust less, a diagnosis made via telemedicine.

On the reimbursement front, a study in Telemedicine journal and e-Health found Medicare spent just 65.2 percent of its allotted funds for telemedicine on telemedicine-related charges in 2012. This breaks down into just $0.09 per Medicare enrollee per year. What's more, a lack of interstate licensing prevents providers who reside in one state from delivering care through telemedicine to patients in another.

To address the licensing issue, a group of lawmakers introduced the Interstate Medical Licensure Compact to streamline the process of licensing physicians to practice in multiple states. Currently, 11 states have signed on to the compact: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia and Wyoming.

5. The talent gap widens as a need for IT leaders emerges. As hospitals and health systems seek IT talent, they may come to find an insufficient supply. A report from Burning Glass Technologies found job postings for health informatics positions remain open longer than the average job posting — 35 days versus 33 days, respectively. Additionally, higher-level health IT jobs like medical coding supervisors and health information managers tend to stay open 10 to 11 days longer than the national average.

However, the IT sector seeks to hire individuals more quickly than others. According to the 2015 Midyear U.S. Job Forecast report from CareerBuilder, 56 percent of employers in the information technology sector plan to hire full-time, permanent employees within the next six months, compared to the national average of 49 percent.

This growth is even more pronounced in healthcare as the industry is still arguably in the novice stages of its digital evolution. Most hospitals and health systems now have an EHR, but after the EHR implementation comes data exchange and cloud computing and data analytics. And, as data breaches become more common and severe, hospitals and health systems are considering more cybersecurity positions to augment their teams.

6. Mayo Clinic pick makes Epic more epic. In January 2015, Rochester, Minn.-based Mayo Clinic announced it was dropping its contracts with GE and Cerner, which at the time operated three systems in Mayo hospitals, to implement a single EHR and RCM system through Epic.

The move puts Mayo, the first and largest integrated nonprofit medical group practice in the world, in the league of healthcare giants partnered with Epic, such as Oakland, Calif.-based Kaiser Permanente, Cleveland Clinic, Baltimore-based Johns Hopkins Medicine and Mount Sinai Health System in New York City. CVS MinuteClinic, a leader in retail health, also uses the EpicCare EHR platform.

Although the company's implementations are often associated with hefty price tags, Epic says it currently has 315 customers. Additionally, a May 2015 CMS report found that Epic is the No. 1 EHR vendor among providers attesting to meaningful use, with nearly 186,000 Epic users having done so.

Epic is currently teamed up with IBM and Impact Advisors in a bid for the Department of Defense's EHR contract, an $11 billion deal that would include the health records of nearly 10 million people. Cerner and Allscripts lead two other groups awaiting word on the history-making deal.

7. IBM ventures into health IT. Much has changed for Armonk, N.Y.-based IBM's artificially intelligent computer system, Watson, since its days in the limelight on Jeopardy!, where it won a $1 million prize in 2011. Now Watson is making its foray into healthcare.

At HIMSS15, IBM announced a new healthcare unit, IBM Watson Health, which will collect clinical, research and social data from a range of health services to create a more complete picture of personalized health. Also established was Watson Health Cloud, a secure and open platform for physicians, researchers, insurers and other healthcare companies to access individualized insights and an overall picture of the factors that can influence a person's health.

IBM's entrance into the health IT landscape is informed in part through collaborations with Apple, Johnson & Johnson and Medtronic to create new offerings that collect and leverage information from health monitoring and tracking devices and applications.

One key component IBM's health IT transition is the company's acquisition of Cleveland-based data aggregation company Explorys, which will work with partners in the IBM Health Group to advance analytics and care with a focus on wellness and prevention. IBM also acquired Phytel, a population health management software platform.

In May, IBM Watson Health announced a partnership with Epic Systems and Rochester, Minn.-based Mayo Clinic to apply Watson's cognitive computing capabilities to EHRs.

8. ICD-10 upheaval. ICD-10, endorsed by WHO in 1990 and used since 1994, is set for U.S. adoption beginning Oct. 1, 2015. ICD-10 was initially set to come into play in 2013 but was delayed twice.

Although the U.S. has used a clinical modification of ICD-10 since 1999, the full suite of ICD-10 codes includes nearly five times as many diagnosis codes as ICD-9, many of which are more specific. Considering that ICD-10 is already under revision and the next version, ICD-11, is expected to be released in 2017, there is mounting pressure for ICD- 10 adoption.

Reactions to the impending implementation vary. Some feel it is overdue while others call for further delays, like American Medical Association President Steven Stack, MD. On one hand, there is concern over how ICD-10 will impact small physician practices. On the other, the lack of ICD-10 implementation thus far may have prevented healthcare providers in the U.S. from responding to national health threats as efficiently as possible.

In July 2015, CMS released additional ICD-10 guidelines in partnership with the AMA that allow for greater flexibility in claims auditing and quality reporting to help providers transition to the new coding and billing sets. These changes include allowing providers a one-year transition period wherein providers' Medicare claims will not be denied or audited solely based on the specificity of diagnoses codes as long as they still come from the appropriate family of codes. Similarly, physicians will not face penalties for the Physician Quality Reporting System based on the specificity of diagnoses codes as long as the code is from the correct ICD-10 family.

9. EHR-related lawsuits skyrocket. An analysis from The Doctors Company, the nation's largest physician-owned medical malpractice insurer, found the number of EHR-related lawsuits doubled from 2013 to 2014.

EHR-related cases include faulty or flawed system factors such as failure to ensure EHR security, lack of EHR alert/alarm/decision support, insufficient scope/area for documentation, system failure, electronic systems/technology failure or lack of integration/incompatible systems.

In a select sample of lawsuits between 2007 and 2013, approximately 1 percent of lawsuits were related to EHRs. While seemingly low, the number is deceptive, as lawsuits often take up to five years to close. In that same time frame, the number of cases also grew as hospitals and health systems were increasingly using information systems, according to Politico.

What's more, as use of EHRs continues to pick up, to the healthcare industry can likely expect the number of related lawsuits to grow.

The reasons for EHR-related lawsuits comprise both human and computer error. Physicians or medical staff with access to a record may enter information incorrectly due to time constraints or improper system training, or a system's design can prompt error-prone entries.

The federal government may eventually need to entertain the idea of a fund to be used to pay the victims of injuries in which EHR errors are implicated, Michael Victoroff, MD, told Politico.

10. Hospitals and health systems shift IT priorities. Following the mandatory implementation of EHRs brought about by the HITECH Act of 2009, the focus for many hospitals and health systems has shifted from sifting through vendors to select a system for implementation to optimizing the systems they now have in place. Although EHRs were rapidly adopted in small practices and large healthcare organizations across the country, the standards and requirements to make them interoperable and highly efficient are still lacking overall.

This priority change toward making those systems function at as close to peak performance as possible has opened the floodgates for startups and established industry giants alike to offer add-on programs, software expansions and tech-based solutions in the hopes of improving workflow and outcomes. Providers are seeking these technologies not only to better connect care teams and enable secure information sharing, but to contend with the low levels of clinician satisfaction with EHRs reflected in surverys and statistics.

Through its Health IT Dashboard, the ONC has provided a resource that offers strategies and tips for EHR optimization. At the Becker's Hospital Review CIO/Health IT + Revenue Cycle Management Summit in Chicago on July 21, a panel of experts including vendor and hospital CIOs and CMOs discussed how for many systems, add-on programs are an increasingly popular strategy as they work to increase continuity in their EHRs.

But in addition to tech-based solutions, the roundtable addressed the need for policy and cultural changes surrounding EHRs. Some resistance to health IT and inconsistencies in its use within a system can be attributed to a need for guidelines on who inputs what information and when. In other instances it may be helpful for IT leaders or EHR-point people to demonstrate that the technology can actually make the lives of care team members easier, rather than complicating patient care with clerical work.

With a handful of top vendors dominating the majority of the EHR market and challenges with interoperability, the emergence of new tech companies and solutions will likely continue. Experts agree that striving toward IT optimization will involve adopting software accessories to better power larger, existing platforms, and getting to know the technology better so that staff members at all levels experience its benefits.

11. Health IT becomes a core competency. Hospitals and health systems are investing more and more into their IT departments, establishing them as pillars of critical support instead of the department that keeps computers running. The evolution of this mindset can partially be attributed to government regulations and mandates. But as healthcare organizations venture into big data, analytics, clinical decision support tools and even telemedicine, health IT is becoming more embedded in hospital operations.

In a previous interview with Becker's Hospital Review, John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center, said his role has significantly evolved from when he joined BIDMC. "When I started in 1996, being a CIO was keeping the bits and bytes flowing," Dr. Halamka said. "Now, it's strategy, tactic and budgets." To keep up with the evolution, Dr. Halamka appointed three other leaders, a CMIO, CTO and CISO, to help tackle the growing responsibilities and reach of the IT department.

Additionally, as health IT becomes more central to the organization's strategy, the question of whether to outsource certain functionalities becomes more pressing. The 2014 HIMSS Workforce Survey did identify a "notable decline" in organizations' plans to outsource IT functions, which could signify a shift to more in-house IT operations. According to the survey, 70 percent of respondents said they planned to outsource at least one area of IT operations, compared to 93 percent in the previous year's survey.

More articles on health IT:

How to create a culture of innovation: 6 lessons from Edward Marx
'Think, build and run': 4 IT leaders discuss the future of the industry
UMass Memorial to switch to Epic EHR

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