Access and Outcomes

Patient-centric healthcare may hasten embrace of content management systems

By Aine Cryts

According to a recent survey by EHealth, a private health insurance exchange, six in 10 Americans are increasingly feeling pressured about the cost of expensive medical emergencies and paying for healthcare.¹ “More people have deductibles than ever before,” Sara Collins, vice president of healthcare coverage and access at the nonprofit Commonwealth Fund told The Los Angeles Times. “From 2004 to 2013, the size of deductibles has grown nearly 150%.”

At the same time that healthcare CIOs are trying to meet the needs of these more cost-conscious patients, they’re also under pressure to comply with Meaningful Use requirements such as the proposed Stage 3 requirement that all healthcare providers share health information with patients within 24 hours.

Enter content management systems. While each vendor may call this solution something different, the problem they’re all trying to solve is the same: How to provide clinical data to healthcare providers in a way that’s meaningful for patients and the physicians and nurses who care for them. Providing a holistic view of the patient within the EHR will become increasingly important as pressure increases to manage patients for a fixed cost, rather than within the current fee-for-service model.

Responding to Increased Patient Expectations

The way consumers receive content on their iPhones and tablets has changed their expectations of how they receive healthcare information. “Consumers expect to have instant access to relevant data at the right time,” said Cynthia Hardin, executive director of infrastructure product management at San Francisco-based McKesson Health IT.

There are no “four walls” for healthcare organizations when they’re thinking about healthcare information access needs, says Hardin. “The healthcare enterprise can have thousands of users. It’s scalable to provide the ability for patient care teams to look at any patient folder. Now the expectation is that hundreds of thousands of patients will be able to access their health information. This needs to be kept in the vision and requirements of a healthcare’s content management strategy. Security is also important when you’re thinking about giving [healthcare information] access at the patient level.”

Providing a complete view of the patient is also essential for care teams. The need for real-time access to patient-specific information is immediately clear in oncology, says Cristine Kao, global healthcare information solutions marketing director at Rochester, NY-based Carestream Health. “Oncology is one of the most complex areas of medicine,” said Kao. “It includes an integrated team of radiologists, oncologists, surgery, and home care. The entire care team needs to have access to the patient. But they don’t have systems that are interoperable and enable them to see the comprehensive patient record in one place.”

That difficulty often leads to the need to reimage patients, since images aren’t being shared in the right place at the right time. Kao says that this results in approximately 8% to 10% of all retakes. She notes that the challenge becomes even more difficult when providing appropriate access to surgery videos, pathology slides, and cardiology images, for example.

Technology to Achieve Meaningful Use, Coordinated Goals

The reality isn’t always quite so dire for patients, though the need to provide patients and healthcare teams with access to patients’ records does keep CIOs up at night. CIOs are also wrestling with the Meaningful Use Stage 3 recommendations recently announced by the Office of the National Coordinator for Health Information Technology. One of the proposed requirements would hold healthcare providers accountable for providing patients with access to the health information about their visit with a clinician within 24 hours. The proposal further states that labs and other artifacts generated as a result of the healthcare encounter will need to be available within 4 days.

Access to clinical content is often linked to the specialty that generates that data, says Tim Kaschinske, healthcare solutions consultant at Woburn, Mass-based Bridgehead Software. However, as healthcare organizations start to transition to a more patient-centric care model, it will become increasingly important for everyone in the patient’s care team to have access to that clinical data, whether that’s an x-ray of an ankle or a photo of a wound captured by an ED physician.

Here’s how Kaschinske describes the way a physician would typically search for a wound image that arrives on a disk provided by his patient during their appointment: The physician goes to the folder with the patient ID on it, then fishes around the folder to find out if there’s anything relevant to their current health situation. He may find it; he may not. What’s key here is that he doesn’t know what he doesn’t know.

What the physician needs, according to Kaschinske, is the ability to query for patient metadata. In order to provide this level of information to physicians, CIOs need to figure out how their content management system can use data extractors to meaningfully understand the information available about a patient—whether that’s by IHE (Integrating the Healthcare Enterprise) profiles or XDS (Cross-Enterprise Document Sharing) or PDQ (National Cancer Institute’s Physician Data Query) or another system for understanding that piece of data, such as DICOM.

Content Management Systems: New Technology?

Kao says that a healthcare organization’s content management strategy really needs to happen in phases. The vendor-neutral archive is the foundation, but she says that healthcare leaders can’t manage content without a consolidated view of that data.

“Twenty-five percent of healthcare providers have some kind of [vendor-neutral archive],” said Kao. Other pressures driving the adoption of content management systems include the federal government’s focus on quality of outcomes and interoperability, she says.

Because radiology has long embraced DICOM as a standard, Kao says that radiology can “take on a leadership role to educate about the benefits” of this standard. “Radiology has been able to take advantage of the DICOM infrastructure for PACS and image sharing. Content management in radiology has been done.”

“Content management systems aren’t a new concept,” said McKesson’s Hardin, who insists that they’ve been in use in healthcare and in other industries for a long time. “It comes down to data types,” says Hardin, who insists that healthcare organizations need to address specific needs within their enterprises.

“EMRs were going to store all of this data, but they don’t provide an easy workflow path. EMRs don’t provide a physician with what he needs at the moment in time when he’s working with a patient and needs to access a particular piece of data,” she said. When a hospital is using a content management system, the intelligence of that system can serve up the type of data a doctor needs when they need it—regardless of data type.”

With a content management system, a hospital can branch out beyond imaging and other clinical content even to include business content, which is essentially non-patient-centric data such as legal records and payroll for employees.

CIOs will need to make a decision if they want to include exclusively patient-centric data or if they want to be able to use the content management system to store such business data, says Hardin. Much of the calculation is about the need to balance good clinical workflows with the need to have a large repository for the healthcare organization’s data that delivers a lower cost of ownership.

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Aine Cryts is a contributing writer for AXIS.

 

Reference

1. Rising healthcare costs are pressuring patients. Los Angeles Times. March 29, 2015.