[Editor's note: Updated October 30, 2015]
Each industry has its own type of information technology and a particular group of terms that goes along with it. Healthcare is no exception in this regard. In fact, healthcare has even more industry-specific terms than most other business sectors do. That's partly because of its complexity and also because it's going through a radical change in how products are delivered and paid for.
Healthcare has a large number of moving parts that include many kinds of care providers, each of which has its own type of information systems. The systems that a hospital uses are different from those of a physician practice, and both kinds of systems differ greatly from the IT used by pharmacies, home health agencies and nursing homes. Moreover, a large medical center may have dozens or even hundreds of different systems across its departments and medical equipment.
Healthcare is also very fragmented. While there are huge healthcare systems that encompass everything from soup to nuts (think Kaiser Permanente), there are myriad healthcare providers of every stripe in the country's metropolitan areas. A large number of IT vendors supply this giant market. Just in ambulatory care – care provided outside of the hospital – there are hundreds of electronic health records (EHR) vendors, although about a dozen of them divide most of the market.
While healthcare has a reputation for being resistant to IT, physicians and nurses are not technophobes. Even before EHRs came along, they welcomed medical advances that depended heavily on new technology. A small but enthusiastic cadre of physicians pioneered the early EHRs. But healthcare providers want IT to support them in providing better care without increasing their workload. Unfortunately, the systems that have been developed up to now require them to spend more time on documentation than they used to, reducing their productivity. EHRs also change their workflow. So even though there is some evidence that health IT has improved the quality of care, many physicians are frustrated and unhappy with their EHRs.
This brief overview of the health IT landscape only begins to convey the breadth and complexity of the field. The following glossary provides more information on what health IT is all about.
Accountable care organizations (ACOs)
The centerpiece of the Obama Administration's efforts to control healthcare costs, ACOs are groups of hospitals and physicians or just physicians that are committed to improving the quality and lowering the cost of care. Some ACOs have contracted with the Medicare Shared Savings Program, the Medicare Pioneer Program, or state Medicaid programs; others have commercial insurance contracts; and some have both government and private-sector business. There are about 600 ACOs, of which the majority are physician-led. Most ACOs today split the savings they achieve with their payers. But some are starting to take downside financial risk as well, and more are expected to follow suit in coming years.
Activity-based cost accounting
A new type of application known as activity-based cost accounting software gives healthcare organizations the ability to calculate the cost of each episode of care. While few hospitals and healthcare systems use this approach today, more are expected to adopt it because of the growth of value-based reimbursement and payment bundling. Instead of drawing inferences from billing or claims data, the new software allows organizations to analyze every cost element in the episode, including hospital, physician, medication, and ancillary expenses. This is going to be important for hospitals going forward as more of them accept bundled payments and global payments, both of which involve multiple providers of care.
Admission-transfer-discharge (ADT) systems
ADT systems, the core of hospital financial systems, track the admissions, transfers, and discharges of patients. They allow hospitals to know how many patients they have at any particular time and how long they have been in the hospital. Not only is this information important for operational purposes, but it enables management to calculate the average length of stay – a crucial metric for determining the rate of bed turnover. In the last year or two, some accountable care organizations (ACOs) and HIEs have been given access to hospital ADT systems. This enables them to tell primary care doctors when their patients have been discharged so that they can pick up their care right away.
Ambulatory care EHRs
EHRs in physician practices run the gamut from fairly simple systems designed for small offices to very sophisticated EHRs used mainly by large groups, many of them owned by hospitals. There are hundreds of these systems, but a dozen of them control 75 percent of the market. Government certification rules for EHRs have narrowed the field, forcing vendors with weak products to drop out. Ambulatory care EHRs typically integrate the clinical modules with billing and scheduling systems, making it easy to send billing codes to the financial side. Many ambulatory care EHRs are cloud-based, especially those that target small practices.
A mobile data aggregation platform, HealthKit is interfaced with some widely used EHR systems. Patients can send their mobile data to HealthKit, view it there, and authorize sharing of the data with their providers. Healthcare organizations have begun to use HealthKit in different ways. For example, Cedars-Sinai is asking patients to tell their physicians what they’re interested in using the data for. Duke Medicine, in contrast, is focusing on specific conditions, starting with heart failure. Duke has connected HealthKit with the mobile app for its patient portal. When a doctor wants to monitor a patient, he or she sends that patient a message saying that HealthKit is available. The patient can then authorize access to the data on his or her smartphone, and the physician pulls it into the EHR.
ResearchKit is an open-source framework that allows developers to create smartphone apps for medical research. The initial apps enabled researchers to gather data from smartphone users participating in studies of diabetes, asthma, Parkinson’s disease, cardiovascular disease, and breast cancer. By the fall of 2015, 50 researchers had developed ResearchKit apps available in the Apple store. More than 100,000 people have enrolled in ResearchKit studies being conducted in such academic centers as Duke University, Johns Hopkins University, Oregon Health and Sciences University, the University of Southern California, and Boston Children’s Hospital. ResearchKit is integrated with HealthKit, allowing researchers to use data collected from a variety of app-enabled monitoring devices.
Automation tools are designed to prompt or execute actions that can contribute to better health. For example, most EHRs have "health maintenance alerts" that pop up in electronic charts when providers see patients, and standalone registries generate more comprehensive alerts. Some registries are combined with clinical protocols to generate automated messaging to patients who are overdue for office visits or tests. Registries can also be used in automated online campaigns to educate people who have specific kinds of chronic diseases. And PHM software populates dashboards that care managers can use to determine which patients most need their help on a daily basis.
Big data, which has made an impact everywhere as computers have grown faster and more powerful, is becoming a major factor in healthcare. The three main characteristics of big data – volume, velocity and variety – increasingly challenge healthcare organizations as EHRs, financial systems,and imaging systems spew out ever more data. Population health management requires the capability to risk-stratify populations, track and intervene with patients, and predict which patients will get sicker or sicker. To do that, organizations must aggregate, normalize and analyze a wide variety of data across many care settings. The advent of genomic sequencing and personalized medicine is starting to add a new level of complexity and giant data sets that only big data techniques are capable of addressing.
Business & clinical intelligence
Business intelligence (BI) applications address financial and operational aspects of healthcare systems, such as contract negotiations, facility management, measurement of resource utilization, and cost analysis. Clinical intelligence (CI) software supports activities such as quality improvement, care management, and population health management. BI and CI overlap in a number of areas, such as an organization’s staffing needs. Both are needed to evaluate the efficiency and quality of care provided by an organization or an individual provider. Measures of efficiency include average length of stay and readmission rates, both of which are affected by the quality of care.
BYOD (Bring Your Own Device)
Since the advent of smartphones and tablets, more and more clinicians have been bringing them to work. BYOD has created concern among hospital administrators because of its security risks. Some healthcare systems allow doctors and nurses to use only hospital-supplied mobile devices when they are on the hospital campus. Others allow people to bring their own devices but prohibit them from storing protected health information on them. Nevertheless, clinicians have discovered that the easiest way to get one other’s attention quickly is by texting their colleagues. To address that trend, a growing number of hospitals have adopted secure texting systems.