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Like in all other industries, data is abound in healthcare. However, the challenge lies in deriving meaningful insights from this vast reserve of information and making it available at the point of care. Information systems within the healthcare space are currently systems of record and oftentimes fail to offer actionable insights and care recommendations. Dr. Ahmad Sharif, SVP and Chief Medical Information Officer at Fresenius Medical Care is all set to bridge this gap between the clinical and IT technology world. Dr. Sharif brings extensive experience in health information technology, having worked with over 25 health systems across the country and abroad. He holds expertise in implementing and optimizing electronic health records, clinical practice management and technology solutions for multi-facility large academic institutions and smaller community and critical access hospitals. In conversation with Embedded Advisor, Dr. Sharif throws light on the present EMR/EHR space, what are the avenues for growth, and what’s the future of clinical data.
Could you give a brief overview of the current scenario of the EMR/EHR space?
The reach of technological innovation continues to grow, changing the healthcare space industry. Technology is playing an incremental role in almost all processes, and hospitals are adopting new technologies to increase patient care. To this end, a lot of hospitals and healthcare providers have adopted some form of EHR. While the EHRs have made significant strides in the centralization and efficiency of patient information, it can also be used as a data and population health tool for the future. However, there are still a few areas—which are not necessarily governed by that meaningful use framework—that will ensure more adoption. Initially, we did not have a lot of data; with the transaction system being in a place where we are now generating swaths of data. However, the challenge here is that we do not know whether the data that we have is structured in the right way to lock or unlock its full potential. So now, we are refocusing on data governance, as it is the underpinning for the value you generate out of your data to have robust data governance models. There are multiple organizations, which are trying to figure out different mechanisms in terms of style guides and nomenclatures and so on and so forth.
"Data governance, analytics, and interoperability are going to take us into the future"
Once this is done, the next piece is carrying out analytics in parallel. We glean that data to get more insightful wisdom out of that and based on multiple factors, determine if it is individual or population-specific. As well as depending on what you intend to do at that point of time, it allows you for a closed-loop decision making as well. There are other administrative factors around, which expand operation analytics that you can run. However, as a clinician, my chief concern is how we can bring it back all that data to the point of care, which is more important.
I would hope that we would have declared victory on this front a few years ago, but unfortunately, we still haven’t been able to do that as an industry that is ‘Interoperability.’ We have the transactional systems and also despite having the CCD or CDA architecture, which is proposed in the regs as well, we still see that there is a deficit of the information being seamlessly exchanged between one provider to the another. Whether, it’s a hospital system or the industry which leads to a little bit less desirable outcomes in the Care Coordination ward. Especially when the rest of the industry today is going towards value-based services and we have to improve the quality with cost and efficiency at the same point.
What would be your piece of advice for other organizational leaders and other CIOs and shed some light on the security aspect as well.
As your footprint increases, your exposure to the surface also increases. I think there should be a structured approach and one should be clear on the objectives of the project such as what they want the outcome of the project to be. Because that will determine what inputs you have to put in place. There are some standards which should be taken into account when talking about data or analytics to invoke the adage ‘garbage in garbage out.’ When you are moving towards new projects, you should have a solid base which is built because of data governance. For instance, in large organizations and multi-tenant hospital system, if everybody is writing the data terms in a different format, you will have to end up doing a lot of data massaging and spending a lot of time and effort just to get to the right parameters. So it is better to start with a vision as to what do you want to achieve for your organization and then start building these blocks which are data governance such as data stewardship and data provenance, and data security.
Finally, do not forget the user aspect. In my view, usability is key. You can design and create models, which could be mathematically, or technologically the best of breed. But they are not easily consumable by your customers such as your providers, patients, and staff. And if they are not easy to use and flexible, then you would not see a good adoption and outcomes out of that. Otherwise, I think data is the power; it allows you to make informed decisions. Many organizations have adopted a data-driven approach wherein the decisions are not based on emotions or anecdotes. Instead, the facts you can glean from the data allows you to focus, prioritize, and invest in the highest value areas. Hence, data and the insights from the data are important from anybody who is a CEO to a patient or staff taking care of the patients on the floor.
What are the new technologies that you’re witnessing out there that you believe would have an impact in the next 18 to 24 months?
I’m excited about the social determinants of health in particular. We are talking about integrating them into with all the clinical data and using that insight for overall care delivery and creating a plan of care. With the advent and proliferation of the sensors, we would be provided with the platforms where, again, we will have more data points to analyze and make more informed decisions.
Also, we are experiencing advancements in the deep learning side and its application in medicine as well. The combination of smartphone sensors and deep learning is going to be the future, which will enable us to leverage the potential of the machines to its fullest. Their function in my view beyond anything else is that simple healing human touch which is the essence of the provider-patient relationship. Through this, the provider let’s say a physician, nurse, or anybody the better menial tasks are taken away from them, and they can focus on the key for care delivery aspect. I think all of this would allow us to have more sophisticated platforms in the healthcare world as well. We have made wonderful strides and progress within the EHR report until the fourth. But if you take a deeper look, the healthcare is archaic and is behind in adopting the consumer technologies which we see in other industries. But with all of this seeping into the health care world now, we can provide tools to all of the constituents of health care on the provider side giving them the ability to interact with patients. And automatically be in the back end and be quantified and they don’t have to be the data entry clerics and spend most of their time reading the peace price that they are typing it away. Thus, advancements occurring concerning to technology, would save us a lot of time and effort and let us refocus on that interaction between the patients and the providers.
Another aspect which excites me is price transparency. This is a major issue, maybe not a technology issue, but the technology can make it simple and available as well. Also, the development in the virtual scanner and its adoption in telemedicine will bring in a tremendous amount of potentials for keeping patients in low acuity care areas which are also more cost-efficient and more personal for the patients as well. For instance, in our case, we want patients to be dialyzed at home, but obviously, they have a little fear of dialyzing themselves. Imagine that you have to recycle all of your blood and you see that in front of you. They want somebody to be there and help them with tools and medicine. This can be comforting and reassuring for the patients with video conferencing as they can have warmer interaction than just a difficult phone call. So I think the telemedicine or the virtual care also has huge potential and I’m looking forward to it.
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