Interview With Stephen Lieber

IMG_2778In June, the 10th eHealth week brought together minister delegations, entrepreneurs, industry leaders as well as other healthcare advocates under one roof in Amsterdam. The conference was focused on 3 topics: empowering people, social innovation & transition and trust & standards. During this time we had the opportunity to have a conversation with Stephen Lieber, President, and CEO of HIMSS, about the current progression of technologies in healthcare in both Europe and the US.

Aline Noizet: Hi Stephen, nice to have you here. In your opening remarks this morning, you talked about adoption of digital health in Europe and the U.S.  You said that, although new technologies seem quite advanced in the U.S. the adoption is not as fast paced as we expect it to be by now. What do you think is the reason for this gap?

Stephen Lieber: It’s not system-wide. I can find examples of the most sophisticated level of medical care supported by the most sophisticated technology. At the same time, I can find many many hospitals that don’t operate at that level, same with physician practices. My physician, for instance, has electronic medical records. All my records are digitized, yet she doesn’t communicate with me electronically; she calls me up and I have to come in for results. You can find examples in the United States of sophisticated technology in adoption and use, but you’ll find other countries where it’s more widespread. I don’t think you’ll find anything in the United States that you can’t find in Europe, especially in the Nordic region, in Scandinavia. The Northern European area has a very long history of digitizing records and using electronic record keeping for healthcare.

AN: Telemedicine is a good example of technology that is more adopted in the U.S. than in Europe.

SL: One of the things that we have to deal with that you don’t in Europe, for example, is distance. People here may think they have distances but they don’t. What I mean is that the ability to get to a specialist when you need a specialist or you need any kind of care is not affected by how far they are. Whereas, in the United States, there are many places where there are no medical facilities for miles and miles and miles. So you have to use telehealth, telemedicine in order to deliver care, especially specialized care to very remote areas.

AN: What do you think of the role of education in the adoption of those new technologies?

SL: Yes, we are really trying to bring a common level of education and knowledge to all parts of the world by bringing in faculty from Asia, Europe, U.S., etc. The whole idea is that there’s an exchange of knowledge so that everyone has a good understanding of what others are doing. I think there are a couple of things you’re trying to accomplish with the educational programming.  One is to share new ideas.  The other is you’re trying to change the mindset from, “This is the way we’ve always done it” to “Oh, there are different ways to do it.”  People who sit in our educational programs may not take that exact approach and do it that exact way they are being taught, but it will at least open their eyes up to different ways that it can be done. Our hope would be that, when they go back into their usual setting, they will ask questions like, “Why are we doing that?  Why aren’t we utilizing these tools that we know are available?” and then, “How do we incorporate them?”

AN: Let’s talk about interoperability. It was the central topic in the previous editions of ehealth week. Could you give us an update on where interoperability stands now?

SL: The issue of interoperability  really boils down to standards. Meaning that there are technical standards written into the products, so that when the data comes out, it comes out in a format that can be read and incorporated into somebody else’s product with ease.  That’s what interoperability is. The problem we have is that healthcare is very complex.  There are so many different devices and people involved using many different kinds of electronic tools.  A cardiologist has an information system that’s very focused around cardiology. That’s different than an information system that the pharmacist has around prescription drugs. Yet, they’ll still need to communicate because the cardiologist issues a prescription out of his or her information system that needs to feed into the pharmacist information system. That’s just one example.

It’s estimated that in a typical hospital setting they run hundreds of different systems because there are so many different departments, so many different functions all of which are associated with all of the possible things you could do in health care. The achievement of absolute universal interoperability so that everything talks to everything else on every level of detail, is an objective that is probably not reachable.  Now, what we focus on are the most critical components of health information that we need to make sure gets communicated: allergies, drug interactions, things like that. What has been developed is a fairly, globally recognized set of data elements that we all agree on.  Every system has got to be able to read that.  We’re making great progress towards the issue of interoperability because there is that common understanding that there’s a high-level sort of umbrella set of data that we all agree needs to be shareable and exchangeable.  As a result, four years ago, we talked a lot about interoperability and interoperability standards.  We still touch on it, but we really are moving on and communicating the message to the commercial side.  That’s non-negotiable.  You got to be able to do that.  Now, we’re focused on a higher level and more sophisticated level of what we can do with the data versus just getting to the point of being exchangeable.

AN: The cloud is helping a lot in that respect too.

SL: It helps, absolutely.  It provides standardization of data storage.  You also have a significantly more secure and lower cost of investment, because everybody is not buying their own storage or is able to share. I think that some advantages of cloud computing that will be brought to interoperability.

AN: HIMSS organizes conferences all year long. What do you learn from each of those conferences? What do you learn in Europe to apply to U.S., and U.S. to apply to Europe?

SL: The thing that I’ve learned and that I get reminded of is how similar we all are in our healthcare systems.  When HIMSS first started doing events outside the United States 10 years ago, everybody said, “You don’t understand.  Our healthcare system is so different than yours.” Well, people get sick or get injured, they get treated by doctors and nurses, and hopefully they get better.  That’s the same everywhere.  Are there differences in who owns the hospital or how it’s paid for?  But that’s not what we’re talking about. We’re talking about the use of technology to improve quality.  The thing that I take away from all of these events is that we are talking about the same things. We are talking about cloud computing.  We are talking about analytics.  We are talking about interoperability.  That’s one takeaway, that the commonality and the similarity. The other thing that I learn is a better appreciation for the barriers that exist in settings that are preventing doctors and hospitals and other care delivery professionals and organizations.  What is preventing them from getting to that higher level of quality, that safer care?  In Germany, for instance, it’s actually a low level of financial investment.  They’re just not investing in the information technology. In the Netherlands, the barrier, the complaint is the products need to leapfrog and jump and become even more sophisticated because they’ve been adopted already and people are using them.  Now, it’s like, “Okay, what’s next?  What’s the next thing that we’re going to able to do?”  I think that’s the other thing that I take away is understanding what we are faced with in different countries, in different parts of the world.

AN: Before HIMSS, you were the CEO of Emergency Nurses Association.  We recently held a very successful session during Health 2.0 Europe on how the new technologies are impacting the role of nurses.  From your point of view, you’ve seen that evolution, so how do you think it evolved and what’s left to do?

SL: I was the CEO of that association from 1989 to 1998.  It was a time when there were just the very early discussions around datasets in emergency nursing.  There were very few to know actual information system tools.  There was no electronic medical record, and it was the early conversations about recognizing that computerization was coming to healthcare and coming up with standard terminology in datasets.  Twenty years plus later, it has come to the point where nursing is probably the biggest advocate for digital health records and electronic tools in helping make decisions and advise clinicians. What I’ve seen is really going from the Stone Age to the Modern Age in healthcare, especially with nursing. Today, they are one of our bigger communities that are engaged with us at HIMSS across most of the world.  It’s not true in all countries that nursing is recognized as the constant, the professional that’s always there at the bedside or in a physician’s office, the professional that spends the most amount of time with the patient.  And so, nursing has recognized that technology absolutely is their friend and their tool. They are just huge supporters and a great advocate for the use of technology in healthcare.

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