On August 1st, I was an attendee at a high level Health Information Technology (HIT) meeting in Washington DC, as an invited guest of the National eHealth Collaborative. The National eHealth Collaborative (NeHC) is a public-private partnership that accelerates effective use of health IT to create a more patient and family centered healthcare system with better outcomes and greater value. The NeHC works closely with the Office of the National Coordinator for Health IT in the U.S. Department of Health and Human Services and is led by some of the nation’s most respected thought leaders in healthcare and health IT. The NeHC partnered with InfoComm last November to put together a conference in Washington, DC focused on AV and IT in the healthcare realm, attended by the CEO of the NeHC as well as executives from InfoComm and AV and IT industry leading solutions providers. My attendance at that AV/IT event led to my company becoming a member of the NeHC.
This Health IT meeting was attended by health professionals from across the country. David Muntz, CHCIO, principal deputy of the U.S. Dept. of Health and Human Services, Office of the National Coordinator for Health Information Technology, was one of three speakers at the meeting. Along with health IT, two portions of Muntz’s discussion piqued my interest — one point focused on comparative technology costs vs. overall advantages (he compared landline to cellular service) and the other, on parallel with that discussion, included an approach to Return on Investment (ROI) as a value proposition or VOI. I asked a question of Muntz during the Q&A session focused on BYOD and telepresence. His answer as well as his panel discussion were enlightening, so much so I decided to introduce myself to him at the end of the conference. We discussed BYOD, telepresence and telemedicine as well as one of the focus subjects of the meeting, which was the quality of healthcare in rural areas. I asked him if he would allow me to interview him for an industry blog article, he agreed and here it is.
Corey Moss: Mr. Muntz, I’d like to thank you very much for your participation in helping to put together this article. To begin, in your discussion you mentioned a focus on a Return on Investment by the organization’s CIO, which you posed as more of what should be viewed as a value proposition or Value of Investment. Could you please elaborate on that as applies to mobility within a healthcare (or any) organization?
David Muntz: Sure, too many people follow the traditional and very limiting idea of Return on Investment which relies on a variety of arithmetic based formulae. I agree that ROI as a measure is still good and very important, but not broad enough to consider the other implications of an investment. I use the term VOI to focus on the Value of Investment. VOI takes into account ROI and other factors associated with the investment — for example, flexibility, and a bunch of capabilities that you really have a tough time quantifying for what some call intangibles. It’s easier to use an example rather than discuss a model in detail. The easiest illustration is a smart phone versus the traditional land line for voice. If you did a traditional ROI, you’d stick with the relatively less costly land line, but when you think about the smart phone, you get all kinds of other advantages: safety, which is why I bought not only my smart phone, but three others for my wife and daughters, plus instant access to a world of knowledge (just last night I looked up several words and checked my calendar at dinner with my wife), location assistance and commerce. There certainly isn’t an app store for my landline. I’m sure you can think of many others.
CM: When you talk about investing in HIT, you also have to consider all of the values of your investment, not just a revenue and expense based return. When you apply this to BYOD, you have to think about the value in much broader terms. First, and my list will not be complete, there is the soft side of employee recruitment and retention, customer satisfaction — which in healthcare means the ability of healthcare professionals from outside using equipment they already know, and convenience. What hard value can you place on convenience? The training curve for BYOD is virtually flat. Since we’re already headed toward a wireless world, and I’m assuming that most BYOD devices are wireless, there isn’t additional cost of wiring except for expanding access and bandwidth, physically securing, tracking or upgrading these hard assets. BYOD isn’t without challenges, however, such as enforcing security policies to protect data and intellectual property, what to do when a device is compromised, either lost or stolen, how to manage printing and help desk support. BYOD is here; we’ll have to embrace it rather fight against it. There are products, policies, and processes than can help us manage them.
Please tell me about your experience in terms of implementation of BYOD in the realm of healthcare.
DM: BYOD is already a topic we’re addressing in our Agency. Again, you have to not only accept it, but also create policies and processes to protect and promote the interests of the Agency. We look at the same products, policies and approaches used in all sectors, such as mobile device management which you know as MDM, training and education with competency testing to enforce those policies, and consistent reminders about our responsibilities to protect sensitive information.
CM: I heard a statistic in another panelist’s discussion that one in six people live in rural areas of the United States. Can you apply that statistic to rural healthcare and the inherent deficiencies?
DM: Rural is a critical focus area for HHS and ONC. We have a program dedicated to the promotion of HIT in rural areas and we’re working with other agencies and departments such as the USDA and FCC to address the disparity. To answer your question, one of our staff members reports that the rural population is in the range of 46 to 59 million, depending on which definition of rural you use. About 10 percent of physicians practice in rural areas, but that’s heavily weighted towards primary care. An even smaller proportion of specialists practice in rural areas. Without wanting to comment on the quality of care, it is clear that access to care in rural areas is tougher than in urban areas.
Another factor that complicates access to care resources, from an HIT perspective, is the lack of adequate bandwidth for communications to facilitate information sharing and access to telemedicine. Too often, patients are forced to abandon their work in rural areas and travel with family and friends to urban centers to get care. It is impossible to ignore time as a factor, which does directly impact the patient and all with whom they interact. Even if the health problem is minimal, the time for worrying is exacerbated by the distance one must travel to understand the situation. The challenges, therefore, are not just to health status and morale, but to economic status. When members of the rural community have to come to urban areas, their work is often delayed or abandoned. One way to expand that access to health resources is via telemedicine, which would allow patients to access a broader array of experts, which has benefits for everyone. And let’s not make the assumption that all the healthcare expertise is in the cities. There are many wonderful experts who want the quality of life found in the rural community and access to them could benefit the urbanites. We can and we must overcome the barriers presented by distance.
CM: In your opinion, how can mobility/BYOD and telepresence affect remote medical assistance to these areas?
DM: I’m not sure that BYOD is different regardless of geography. I have already addressed my interest in telemedicine, though I like your term telepresence better. It seems more comprehensive. Maybe telehealth would be better for our purposes.
CM: In closing, where do you see this approach to technology in telemedicine within the next five years?
DM: I’m hopeful that the joint efforts I mentioned earlier will improve the infrastructure that must be in place to facilitate telehealth; that access to the best resources whether physical or intellectual will be the same regardless of geography. I’m confident that video visits will be commonplace, that we’ll use a variety of what used to be called physician extenders, but I’ll call medical professional extenders to provide on-site, hands-on assistance when required. I’m hopeful that our new payment models will encourage telehealth. I’m hopeful that patients will be better able to participate in their own care by generating data for monitoring, reacting to data that is reported by those monitors, and that a closer partnership between patients and caregivers will exist. In summary I am hopeful that geography will be interesting but irrelevant for care.
I would like to thank David Muntz very much for his time and participation in helping to put together this very important industry article. I hope those in the AV industry are able to come away with some thoughts about BYOD, telepresence and telehealth, along with the notion of a value of investment as a revised concept to replace ROI. It’s an education that just continues for me.