Governance and Workforce: The Core of a Digital Health Ecosystem

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By Neil Patel, President, Healthbox; Executive Vice President, HIMSS

Digital transformation is transitioning from a nice-to-have to a mission-critical element of any healthcare provider’s strategy. The HIMSS Digital Health Indicator (DHI) objectively measures a provider organization’s progress toward a digital health ecosystem that enables consumers to manage their health and wellness using digital tools—supported by connectivity with clinicians and provider teams—in a secure and private environment whenever and wherever care is needed. The DHI is the only comprehensive tool to assess and advise health system leaders on how to achieve outcomes using digital health, not just to use technologies or achieve other more specific measures. This blog series dives into each of the four dimensions of the DHI: governance and workforce, interoperability, predictive analytics, and person-enabled healthcare.

In April 2020, nearly half (43.5%) of Medicare primary care visits were provided through telehealth, compared with less than one percent (0.1%) in February 2020. Telehealth visits have remained steady since, showing both the benefits of rapid digital adoption and the need for more work on the fundamental dimensions of digital health.

The foundation of digital health delivery is governance and workforce. While some providers are ready and advancing thanks to their strong foundations, most are struggling to align and train people while revising or creating policies.

Effective digital transformation requires digital leadership and accountability. Governance and workforce are highly interdependent—so having the right policies and leadership in place is the first step toward creating a robust digital health workforce. Access to personal health data presents new privacy and ethical considerations. As tightly guarded data becomes more accessible, its application must be regulated by the right policy frameworks.

What does governance and workforce mean in this context?

Governance and workforce refers to the vision and system-level strategy to guide the implementation of digital health across global health systems. Governance ensures the policy and regulatory environment of health systems guard privacy, security, stewardship and accountability. Strongly linked to performance and strategy is the integrity, capacity and sustainability of the health workforce—which is critical to ensuring people and populations have secure connectivity to care teams, and data is accessible across the journey of care.

This breaks down into four subdimensions:

Data stewardship describes the leadership, culture, vision and objectives required to support digital health by how data is managed, gathered and mobilized.

Policy and decision-making describe the measurement, learning, resource allocation and coordination used for digital health governance.

Transparency supports connectivity and relationships with consumers, including digitally enabled communication and transparency of quality, safety and performance outcomes.

Workforce capacity and competency policies support and retain a high-performing workforce that is incentivized to design, adopt and scale digitally enabled care processes.

For further explanation, please see Digital Health: A Framework for Healthcare Transformation by Anne Snowdon, RN, PhD, FAAN, director of clinical research, HIMSS.

Why does it matter?

Data stewardship has a growing practical urgency because of the increase in the availability of electronic health data—and the increase in risk that comes with it.

Data stewardship is critical to securing healthcare data, and the consequences of not being a good steward are steep: over the past decade, there have been 2,550 data breaches in the healthcare industry, impacting 189 million medical records. 89% of providers and 41% of Americans have been impacted by data breaches in recent years, costing providers about $6.45 million per breach.

More data breaches are the result of human error rather than brute force. 59% of data breaches are associated with internal actors—a bigger threat than external attacks. Data stewardship must set up internal actors for success through appropriate safeguards, as well as training to reduce instances of misdelivery and HIPAA transgression.

The workforce should also be supported through training on new technologies in the digital health ecosystem. There are large gaps in readiness today for some of the most critical new healthcare developments such as telemedicine, personalized medicine and genetic screening.

According to Stanford Medicine’s 2020 Health Trends Report, nearly half of all physicians (47%) are seeking additional training to better prepare themselves for innovations in healthcare. Lack of training can lead to medical errors, inefficiency and burnout. Physician burnout is a systemic issue: in 2019, 44% of physicians indicated that they are burnt out—and 32% said that computerization, primarily EHRs, is contributing.

As digital technology utilization expands far beyond just EHR use, the workforce will continue to require better training and support to leverage new tools so as not to repeat EHR implementation distress. Clinical and non-clinical staff need these tools and the training to use them within their own workflow, as well as to enable patients to leverage them in their health journey.

What are best practices?

To deliver care in a leading digital health ecosystem, there are key requirements that governance policy must support:

Reimbursement models that incentivize outcomes, not transactions. 
Just as in the principles of sales compensation, incentivize what matters. Health systems should be engaged in value-based care, and physicians should be evaluated based on outcomes instead of RVUs. This is key to motivating the adoption of digital health solutions that help improve outcomes.

Focus on value of outcomes, as defined by people and populations. 
Promoting health at the population level starts with encouraging healthy behavior at the individual level. The workforce should be set up to support the individual in digital environments—and policy should support a digitally engaged population.

Care delivery processes and pathways that prioritize health and wellness.
An individual’s care team must be digitally enabled to extend its connection and resources beyond the in-person setting, utilizing digital solutions to monitor and improve health habits even before getting sick.

Remote patient monitoring to expand the reach of care teams.
Several health systems have been able to improve their nurse-patient staffing ratios dramatically and open inpatient beds for those in duress through monitoring.

Provider roles that support consumer self-management. 
Providers who are partners can help organizations become more accountable for supporting consumer-centric care. Leadership should prioritize resource allocation and learning opportunities for staff to build digital health capabilities.

Data that is secure, private and used to proactively identify risk and track outcomes to inform care decisions.
Data governance ensures privacy and security is maintained at all times. Teams receive performance analytics reports regularly, and the culture embraces data-informed decision-making.

Good governance starts with aligning an organization’s priorities, strategies and metrics. Intermountain Healthcare, a health system in Salt Lake City, uses daily huddles to drive accountability at all levels of the organization. The highly structured process uses data-driven decision making to resolve issues in real time, as well as escalate larger issues up to leadership.

Penn Medicine’s Information Security team, a 35-person unit that oversees employees and patients across six hospitals, was recognized for its effort in cybersecurity. The team maintains close relationships with corporate and operational leaders by bringing security to the field. It has several programs in place to make sure its workers are operating at their highest level—including certification training and the Penn Test Challenge, which uses gamification to improve diagnostic and mitigation skills. These programs have been effective at both building security skills and improving employee retention.

Final Thoughts

With every day that a new digital technology is adopted, governance policies and the workforce must adapt. Many organizations are lagging significantly behind technology advancements—especially in the inconsistent use of standards (e.g., FHIR, HL7), inconsistent application of policies, siloed health information systems, digital platforms and technologies that are not interoperable, and IT systems that do not interface or work together.

During the COVID-19 pandemic and beyond, access to virtual care has proven to be a necessity. Even health systems slow to respond to change were forced to find solutions to antiquated policies quickly. If existing governance policies support data privacy regulation, compliance and security, then the rapid deployment of new technology in a pandemic is possible. Cleveland Clinic activated a rapid transition plan toward remote care even before the first COVID-19 case was confirmed in Ohio. The clinic created a digital health playbook, including elements on how to expand telehealth privileges, leverage digital platforms and train the workforce. It is a great example of creating a process to enable technology quickly and effectively.

“Adoption of digital health solutions actually starts in the boardroom,” said Hal Wolf, president and CEO, HIMSS. “Governance policies reflect CEO and board commitment to a digital health ecosystem. However, to apply policy to practice, a strong and robust digital health workforce is critical. Digital health is emerging as a priority, and governance and workforce are at the foundation of its success.”

As digital technologies are adopted, it is important to implement technology to serve caregivers and patients, instead of setting it up with only administrative workflows in mind. The healthcare workforce requires expertise and guidance to be included in identifying problems, evaluating new technologies and using processes grounded in real-world evidence. Digital technologies can provide solutions to health workforce challenges—allowing the workforce to spend more time and communicate more effectively with patients, improve diagnostic skills, enhance the clinician/consumer relationship, and provide more equitable means of providing healthcare.

Identify your organization’s strengths and opportunities to inform a comprehensive digital health strategy with the complimentary HIMSS Digital Health Indicator Rapid Assessment.

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