Legislation, Trends, & Our Current
Healthcare System:
Key Factors Affecting the Future of Healthcare Technology
By: Donald E. Kinser, PE, MBA, President & CEO – EDI, Ltd.
The future of healthcare in the US, at least through 2015 or so, will be shaped in a fundamental way by the healthcare industry’s mad dash to achieve “meaningful use” of a “certified” electronic health record (EHR) mandated by the 2009 ARRA/HITECH legislation. As a result of HITECH, the focus on healthcare IT has never been stronger and healthcare organizations everywhere are scrambling to cash in on the incentives and, more importantly, avoid the penalties that the ARRA/HITECH legislation mandates. Now that HHS has issued the “interim final rule” regarding meaningful use, the race is on before the penalties kick in. Based on the HIMSS Analytic EMR Adoption model (EMRAM) scores at the end of 2009, less than 15% of US hospitals have achieved Stage 4 on the EMRAM scale. HIMSS believes that a Stage 4 hospital can meet most, if not all, of the HHS’ meaningful use criteria. The healthcare industry clearly has a long way to go and most are working furiously to get there.
The increased use of HIT, now mandated by HITECH, has profound implications for hospital buildings and facilities including:
- The diversion of scarce capital away from construction and toward IT projects
- The need for high reliability networks and data access and related IT infrastructure
- The explosion in data server and storage needs.
Many, if not most, US hospitals are ill prepared for these impacts.
There was a great deal of discussion about the diversion of capital from buildings and facilities during the 2010 ASHE Planning, Design, and Construction conference (PDC) in San Diego, CA. Nearly every keynote or plenary speaker at the PDC conference listed access to capital as the number one issue facing the hospital construction industry today. The need to invest in healthcare IT to avoid significant penalties mandated by the HITECH legislation is consuming a much larger share of healthcare provider’s capital and is squeezing out needed investment in plant and facilities. This has caused many hospital building projects across the country to be postponed or canceled. In conversations during networking breaks at the PDC conference, I heard many predict that 2010 will be bad and 2011 even worse for the hospital design and construction community. I hope this is not the case. Clearly, the significant HIT investments mandated by HITECH are hurting the hospital design and construction industry.
“Meaningful use” will require that clinical care information be collected, communicated, and stored digitally. The communication of orders, lab results, images, medications administration, and clinical documentation all rely on the network and servers/storage in the data center. The same is now true of most, if not all, clinical communications including nurse call, voice, alerts, alarms, etc. Furthermore, most medical equipment, including monitors, pumps, vents, etc., are now directly attached to the network and report results directly into the medical record. Given this, one can understand why networks and data centers are now so vital to a hospital’s ability to provide care. Put simply: a hospital can no longer function as a hospital without access to both the network transport infrastructure and the data servers and storage.
As a result, efforts are underway to classify a healthcare provider’s enterprise network as a medical device (IEC 80001) and for the first time, technology concerns regarding space and building system infrastructure are now part of the recently published 2010 Edition of the FGI Guidelines for Design and Construction of Health Care Facilities. The newly revised guidelines establish minimum requirements for the quantity, size, and location of technology spaces throughout a hospital facility. The guidelines also establish basic mechanical, electrical, and security requirements for these technology spaces. These physical requirements include UPS power, 24/7 HVAC, and other requirements aimed at increasing the reliability of the network systems.
Another significant facility impact will be the need for robust and reliable wired network connectivity in existing patient care areas. The problem is that the majority of existing hospitals today lack any wired connectivity in patient care areas. Wireless was an easy, relatively inexpensive, and quick way to deploy network connectivity in existing patient care areas where no such connectivity existed, and this is why healthcare has been such an early adopter of wireless 802.11 technologies. This was fine when the amount of data and the number of users accessing the wireless network was low; but with the increased demands on the network resulting from meaningful use, the 802.11 network quickly becomes inadequate. Hospitals will be required to make significant investments in re-cabling existing hospital facilities, further diverting capital away from new construction.
The explosion of digital data in healthcare today is unlike anything the industry has ever experienced. The increased use and sophistication of various imaging modalities is one driver. Today, medical imaging is estimated to account for 30% of the world’s data storage capacity. This is predicted to grow to 50% within the decade. This prediction was made prior to passage of the HITECH Act, and the increased use of electronic medical records resulting from the legislation will only accelerate the need for storage in healthcare.
Estimates are that we receive 80% of our healthcare during the last 20 years of our lives. In 2011, the leading edge of the baby boomer generation reaches age 65 and enters the prime years as healthcare consumers. The resulting demand for medical information storage from this demographic will be massive.
Together these trends drive the need for data centers; many, if not most, hospital data centers are not up to the task. They are obsolete, unreliable, lack sufficient power and cooling, and are inadequately sized. Many are stuck in basements or other constrained locations where they cannot be expanded. Most are a disaster waiting to happen, and in many cases there are no real plans for disaster recovery. I view the data center issue as a “train wreck” headed for the healthcare industry (certainly not the only train wreck in healthcare today). This is one of the major reasons why EDI recently expanded our Data Center Services capabilities to better serve the healthcare industry.
EDI has the expertise and experience to help you assess the ability of your network and data center to support your HIT efforts and then design and engineer solutions that meet your needs. We can also help you access the needed capital for required IT investments through partners that offer creative and flexible financing structures and programs. Please give us a call if you would like to learn more about how we can help you achieve meaningful use and meet the challenges.
Donald E. Kinser, PE, MBA, is Chairman, President & CEO of EDI. He is an active participant in the American Society of Hospital Engineers (ASHE) and the Health Information Management Systems Society (HIMSS). He can be reached at dkinser@ediltd.com.