For Andy Nieto, health solution manager at Lenovo Health, care collaboration is "the pinnacle of the art of care and the science of care together."
"Clinicians and care providers of all kinds have an inherent talent in the art of care — in making patients feel better, in listening to them and in being part of their healing process," he said. "Technology in care collaboration brings the diagnostics information, the personal information and the pertinent treatment information together to facilitate the delivery of the art of care."
Advances in technology, namely virtual desktop infrastructure (VDI), enable care teams to seamlessly work together, regardless of their geography or IT system. VDI provides a standardized interface — not just of the desktop itself, but of the entire information ecosystem.
In this way, individual users scattered throughout a single hospital or a care team comprised of individuals working across multiple health systems can interact with the same software, applications and patient data in the same format.
As part of the Becker's Virtual Health IT Summit, a three-day online conference on the trends, topics and technologies that empower better care delivery, Becker's Hospital Review spoke with Mr. Nieto to learn how VDI technology is revolutionizing care collaboration.
Editor's Note: Responses have been lightly edited for clarity and length.
Question: What are some of the biggest barriers hospitals face when it comes to collaboration among care teams?
Andy Nieto: From a technical perspective, the biggest barrier to care collaboration is that disparate systems are unable to accurately exchange patient information. There's been a big push in the last several years to improve data sharing for care collaboration and care management, but it has all been under the guise of ACOs and value-based care.
The concept is this: If I know what my patient's other physicians are doing, then we can collaborate and all be on the same page for that patient's care. The challenge is if a care team has one doctor on Allscripts, one doctor on Cerner, one doctor on Epic, a hospital on Epic and specialists on specialty EHRs, the information they share isn't always exchanged in a way that makes sense. For example, one EHR may document coding with very, very specific structured language. Another EHR may communicate the same information using a natural language, or even just verbatim what the physician wrote or dictated. When it comes to aggregating that information, some systems rely on statistical or accurate aggregation, while others simply give you the note in text form and rely on the physician to ingest and digest the information presented to them.
There are also political challenges to care collaboration. If I'm a primary care doctor within a health system and employed by the hospital, then my focus is on improving outcomes and reducing readmissions. But, if I'm an independent rheumatologist, then my motivation is specifically treating the patient's rheumatic disease. While my focus is on my specific specialty, I still need to understand their hypertension, their diabetes or their other comorbidities. So, we start using technology to facilitate this important consultative relationship between primary care physicians, specialists and other care team members. That's collaboration. That's care coordination toward a good outcome, but it requires interaction between providers who typically don't have enough time to get through their documentation today as it is.
Q: How are hospitals and health systems leveraging current IT systems such as VDI to support improved care?
AN: From a care collaboration perspective, VDI can be leveraged by saying, "Hey Dr. Smith, I know you're using Cerner, but we have Epic at our hospital. II can give you a virtual session, in which you visit a webpage, type in this information and you can actually see the same record I'm looking at. Would that facilitate us digesting the same information at the same time toward an improved outcome?"
Now take the "D" out of VDI, and we are talking about virtualized information that can be shared so a group collaborating on a patient's care can view a consistent set of information, and each care team member can digest the same input at the same time and render a clinical opinion, a clinical recommendation or a plan that is inclusive of all of these participants.
Q: Elaborate further on VDI technology and how it can elevate the ways physicians collaborate.
AN: Holistically, VDI is this concept of a virtualized infrastructure that shares information, provides consistent and concurrent access to the same information, and removes obstacles or barriers when care teams are operating on multiple, disparate EHR systems to create virtualized instances of a universally accepted solution.
Here is a great example: I used to live in Louisville, Ky. My parents lived in Denver. My dad came for a visit, during which he fell down my stairs and dislocated his shoulder, broke his ankle, broke his wrist, and, since he has heart issues and landed on his chest, was transported by ambulance to the nearest hospital. Clinicians there were able to use a web-based version of his hospital in Denver's system so that the care providers in Louisville could understand all of his comorbidities and ensure he didn't have any problems. They even changed some pain medication they intended to prescribe in order to fit his other medication regimen.
When he returned home to Colorado and scheduled his follow up appointments, his primary care physician knew he had fallen and had a cast on his ankle and a brace on his wrist. Because of VDI, everyone on his care team was able to collaborate effectively, even though he was hundreds of miles from his home. But, he could've been local — the geography doesn't matter. Virtualization allows us to remove geography as a barrier.
Q: What are the key benefits and risks to VDI?
AN: The first benefit is data security. By not storing patient data externally, such as on a laptop, the data is stored internally to the managed system, so the users can protect and control it. Conversely, the risks associated with VDI are small and revolve around access, since everything is stored in a central location. Nonetheless, it's a whole lot easier to put a security perimeter, audit tools and investigation on a single location or managed location than on the periphery of [each individual device].
The second benefit is consistent user interfaces. One example I love to use is nurses in the nurse pool. If I am a nurse, maybe today I'm on floor three west in oncology. Tomorrow, I might be on four south in orthopedics. On Monday, I might end up on two east in the surgical wing. Regardless, every time I log in to my hospital's system — a VDI environment — I have a consistent interface. It doesn't matter where I may be assigned to, I'm familiar with the system, so there's no need for additional staff training. Once I learn it, it's the same no matter where I go in the hospital.
Q: How is the cost justification for implementing a VDI solution measured?
AN: VDI usually can be justified when it comes to management, IT systems standardization and risk benefit. The trade-off of having data disseminated all over versus storing it in a tightly controlled, managed environment, is a risk most hospitals are willing to pay for. Moreover, the risk of violating HIPAA is a lot lower if I can say, "I don't care if you steal a laptop or a desktop, you're not going to get any data," versus, "I'm going to let all my doctors manage all the data for all their patients on their own laptops, which can be stolen from their cars or lost in public places." With all the data hosted on a consolidated environment, it's more manageable and hospitals can set unique audit controls on it, which ultimately lowers the risk of a breach. VDI also cuts down on staff training. The system environment drives efficiency and efficacy, since all the tools staff need maintain a consistent format and are found directly at their fingertips. They don't have to learn all these different, disparate systems.
Q: So, is security a consideration when leveraging VDI for improved care collaboration?
AN: Absolutely. Especially in North America and the U.S., security and privacy concerns are actually a motivation to move to VDI. In fact, Lenovo recently surveyed its Healthcare Customer Advisory Council, and security was the No. 1 reason healthcare leaders said they moved to VDI. Healthcare organizations prefer an environment where they can control their data, yet still access it, use it and leverage it however they please.
To access additional information from the summit on advances in care collaboration for improved outcomes, click here.