How technology and data will help guide physician decisions in the future

Michael NissenbaumEditor’s Note: Aprima’s CEO and President Michael Nissenbaum recently spoke with Medical Economics about the present and future of health information technology (HIT). Here is the full interview. Excerpts of this interview were published in the October 25, 2013 issue as part of the publication’s Top 100 EHR company ranking.

Medical Economics: In what ways is technology transforming medicine?

Nissenbaum: We have just seen a truly disruptive change in the traditional patient-physician data paradigm. It’s making for smarter patients going to the Internet, understanding their symptoms, understanding who they need to speak with before they make the first call. From the physician’s side, they have access to more data and will have even better data in the future when you start talking about the use of genomics resulting in better outcomes.

Ultimately, with patients getting healthier faster or cured faster, you have physicians being able to aggregate information and use it in their practice. You have more efficient practices and you are able to delegate more within the practice using midlevel providers to do more work. It’s to everyone’s benefit. For instance, electronic prescriptions, they are more accurate and more targeted. With genomics and new cancer therapies, it’s opening new possibilities. In the past, we could only dream about a time that we could target medicines to the specific needs of patients.

Medical Economics: Are there other ways that you feel like technology has changed medical delivery?

Nissenbaum: On a personal level, my kids’ pediatricians are losing their charts. Think about the amount of time practices spend trying to track paper charts. Now, it’s readily accessible, and that has an enhanced efficiency for everybody. When you start using patient portals, [the parents are] able to interact on a proactive basis with the physician’s office. Isn’t that so much better than calling the office and hoping the physician gets back to you that day?

Medical Economics:If you could think about the delivery of medicine in the next 5 years, how will it change? How important will technology be in helping to guide this evolution?

 Nissenbaum:  Everyone is facing heavy bets that technology is going to be the catalyst for much of the change, whether you are talking about the ability to interface with more devices and more instrumentation or to interface with other applications that have information that can be shared.

From my perspective, the whole idea of setting a data standard amongst the different EHRs should have been the very first item coming out of the box of CMS [the Centers for Medicare and Medicaid Services] for Meaningful Use 1 and 2 (MU1 and MU2). Because once you do that, you literally set a common denominator throughout our entire healthcare delivery system that people can communicate, share, and ultimately have better outcomes or better patient care.

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Going forward, again with a potential reduction in the number of primary care providers, you are going to need technology to step in and fill some of the void. If you have 32 million new patients coming into the healthcare system, you are going to have to be able to train and use physician extenders in the practice and able to share information online. A patient will be able to consult with his or her physician face to face or in video conferencing, for example, and this will continue to push the evolution.

Medical Economics:We are 3 years into Meaningful Use. Our government continues to incentivize and will ultimately penalize physicians for not adopting EHR systems. Why has it taken such a massive push to get physicians to adopt?

Nissenbaum: Previous to the incentives, there really was no benefit; there was no carrot to adopt. When they put a stimulus out there, all of a sudden the carrot was in place. People tend to fly to carrots especially when there is an alternative sitting there if they don’t. We are looking at the penalty starting to kick in next year. With their health budgets taking up so much of our GNP, it’s inevitable that the government is going to use the penalties to help control some of the cost of healthcare. We are seeing the audits now into the meaningful use adopters, and physicians are being asked to pay back MU1, MU2 dollars in some cases. The great thing about the next phase of the EHR and MU2 is the commonality of shared data. When you start sharing data and setting up Patient-Centered Medical Homes, you have better outcomes for the patient. If you have better outcomes, ultimately your cost of maintaining a healthy population is reduced.

Medical Economics: Will we see more consolidation? What happens in the HIT market when the government incentives to adopt EHRs run out?

Nissenbaum: There were something like 1,300 complete ambulatory certified products for MU1. As of yesterday, there were 23 products that were complete EHR ambulatory products certified for MU2. The bar has been raised, and many of those shops that met MU1 do not have the resources whether its personnel, capital, the understanding to meet stage 2. If I am a physician and I am hosted, I want to make sure I have access to my medical records, so that when I do find a replacement or substitute, I have the ability to migrate the existing data to the new system. I think that’s going to be a huge consideration going forward. It’s going to change the world. 

Medical Economics: How important is mobile technology for physicians?

Nissenbaum: Mobile technology is good, and I think it’s going to become great. I think almost any physician would agree that you (currently) cannot document an encounter on a cell phone. These devices are changing quickly. I saw a tablet recently that also doubles as a cell phone. We are going to have this confluence of devices and more powerful technology that can sit on those devices that will enable more flexibility to provide care to patients in all settings. It will make healthcare much more viable.

Medical Economics: What are some of the most exciting technological developments?

Nissenbaum: We can do so much more today with data. Big data is a great resource for better evidence-based medicine. Whether you want to take it on a macro basis as you look at the efficacy of drugs, or you can do something such as disease tracking. Think about if you are able to monitor influenza as it migrates across a population and get in front of the problem instead of trying to catch up with it. Having this type of technology and data will be invaluable to help reduce the overall cost of healthcare in the future.

Also I think the field of genomics is very exciting as it relates to the delivery of care, and the delivery of specific care to that patient, to that patient’s family and future generations.

Medical Economics: In the next 5 years or so, what do you think HIT vendors will be talking about as it relates to technology platforms and applications?

Nissenbaum: I think lowering the proprietary barriers is paramount. It’s not company A versus company B, because then the patient is the one who suffers. I don’t think patients are going to tolerate that perpetually, because they want to see their doctor. They don’t want their data or their healthcare held hostage because of proprietary knowledge.

Medical Economics: Do you think there is a reality and that’s kind of evolution as we move forward?

Nissenbaum: If data sharing turns out to be the catalyst for being able to reduce overall healthcare costs, there is going to be a mandate to make sure everybody can share data. When we start realizing the benefits of longitudinal data share, the outcomes are going to be spectacular.

Michael Nissenbaumis president and chief executive officer of Aprima. He joined the company in 2004 after stints at Millbrook Corp. and GE Healthcare. During his tenure as president of Millbrook, the company grew from 24 employees to more than 140 employees, supporting over 10,000 physicians in 65 specialties and sub-specialties, across the country. At GE, Nissenbaum led the commercialization of GE Healthcare–Clinical Data Services. He received an MBA from the University of Chicago and is a certified public accountant and chartered financial analyst.