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Connected Care and Patient Experience Survey Results

Posted on September 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Surescripts recently put out the results of a survey they did on Connected Care and the Patient Experience. If you’re like me, whenever you see a survey, you want to see the questions and raw data from the survey. The good news is that Surescripts has shared the survey result data here.

We could dig into a lot of the data, but this chart was the one that really stood out to me:
Patient Engagemnt and Healthcare Information

No doubt Surescripts has a bit of bias when it comes to wanting to get organizations to share healthcare data. They started with sharing prescription data, but they’re working on sharing much more data. This Surescripts bias aside, aren’t we all biased towards wanting the right information to be shared in the right place at the right time? That’s the nirvana of healthcare data that all of us as patients want.

Put another way, can I please fill out a health history form one time and never have to fill one out again?

This is a feeling that resonates with so many patients. It’s felt particularly strong when you fill out essentially the same paperwork possibly on the same day for 2 specialists that both work for the same company. Brutal to even consider, but it’s the reality of healthcare data sharing today.

I understand many of the reasons why this isn’t happening and it is a very complex problem with no easy solutions. There are a lot of organizations and people involved and many of them aren’t motivated to change. Change is hard when you’re motivated. Change is almost impossible when you’re not motivated.

Back to the graphic above, I love how it frames the issue. The challenge of poor information is bad on multiple levels including: slowing down the patient visit and improper care. The graphic above illustrates so well how much better we can do at getting the right information to the doctor. Doing so will make a doctor more efficient and help them provide better care.

Beyond the Buzz: The Myths and Realities of Consumer and Patient Engagement

Posted on September 29, 2015 I Written By

The following is a guest blog post by Peter Edelstein, MD, is the Chief Medical Officer at Elsevier.
Peter Edelstein, MD
Today’s healthcare reform world is filled with buzzwords.  “Population Health Management.”  “Value-Based Care.”  “Patient Engagement.”  I am in no way suggesting that these topics do not play critical roles if we are to realize the enormous potential of healthcare reform.  However, if you ask ten people to define any one of these buzzwords, you’ll receive twelve different definitions.  And in a world of threatening reimbursement penalties and expanding healthcare legislation, the sooner that we come to some consensus on the basic meaning of these terms, the sooner we can understand the associated myths and realities.

Relative to the patient population (that is, the general population), the population of providers (doctors, nurses, and other clinicians) represents a fairly homogeneous and small group to target with initial reform efforts.  In addition, we are all painfully aware of the unacceptable number of preventable deaths and complications which occur at the hands of providers each and every day.  Thus reform legislation has first focused on reducing variability, elevating quality, and controlling the cost of care delivery through programs focused on providers (hospitals and healthcare systems, as well as the physicians, nurses, other clinicians who work in such institutions). 

Again, this makes sense as a starting point.  That said, to believe that we will achieve our ultimate goals of evolving into a system dominated by preventative care and outpatient and home health maintenance (leaving hospitals to serve only those whose chronic conditions can no longer be controlled in the outpatient setting) solely by changing how providers deliver care is a myth of epic proportions.  Far-and-away our greatest opportunity to shift our population’s health from reactive, acute, and expensive to proactive, preventative, and cost-efficient is by directly engaging and educating and empowering the general population of patients and future patients themselves. 

This perspective is based on two major realities.  First, studies (as well as our own experience) confirms that even individuals with chronic conditions spend on average only a handful of hours annually in front of a professional care provider.  (How many hours did you or your spouse spend under the direct care of a provider in the previous twelve months?  For the overwhelming majority of you, the answer is less than a couple.)  Second, patients who demonstrate interest in and ownership of their health have better clinical outcomes and reduced costs of care.  In a nutshell, people spend virtually all of their lives away from doctors, nurses, and hospitals, and as with virtually any complex processes, those who are more involved and knowledgeable have better outcomes.

Now we come up against another reality:  limited resources.  Hospitals and healthcare systems have limited staff and finances, and Patient Engagement often draws the short straw when competing with electronic health records, computerized order sets, and other provider-specific support solutions.  But, as I’ve suggested, de-prioritizing Patient Engagement as “less important” or “less impactful” is a myth which greatly limits our potential to increase the value (elevate quality/reduce costs) of healthcare delivery.  Thus, the most important first step for healthcare stakeholders to accept is the reality that assigning resources to Patient Engagement must be as great a priority (if not greater) as allocating staff and money to products and solutions which target only traditional providers.

Once healthcare leaders accept the critical importance of Patient Engagement, they again have to consider their limited resources.  It is another common and perilous myth when trying to allocate resources and develop and implement Patient Engagement strategies to consider all patients within a healthcare system’s catchment area as a homogeneous population.  The reality here is that not all individuals have the same potential for or barriers to becoming engaged patients.  And understanding with which patient subpopulations you can get “the most bang for your buck” is a necessity which is often overlooked. 

For example, any of us who have directly cared for a large cohort of patients knows that there are some individuals (comprising a patient subpopulation) who simply have no intention of ever lifting a finger to care for themselves.  I think about the roughly 50% of Americans with chronic conditions who fail to take their medications as prescribed.  Or the diabetics who simply cannot be troubled with checking their blood sugars.  Every provider can immediately call to mind dozens of patients who, understanding how to better their own health, simply refuse to do so.  The reality is that as in all areas of life, there are simply some people who just will not engage, be accountable, take ownership.  To waste valuable resources trying to engage this patient subpopulation is foolish, disillusioning for staff, and wasteful, and it is best to quickly identify these individuals and accept that all you can do is provide reactive care when they become ill.

A second and large patient subpopulation is well worth the resources and efforts to engage.  These are the folks with limited literacy and numeracy skills.  Multiple studies have demonstrated the inverse relationship between literacy and healthcare outcomes.  Thus, assigning resources to clearly engage and educate these individuals so that they have the knowledge and understanding necessary to engage is worthwhile.

The third large patient subpopulation worth targeting is comprised of people whose upbringing or culture serves as a barrier to engagement.  Perhaps the largest of these cohorts is elderly Americans, many of whom were raised never to question a physician or ask for clarification.  Such patients are unable to engage because they refuse to address their lack of understanding of recommendations for their self care.  Another large faction are those who were raised in cultures (often outside of the United States) where, as with elderly Americans, the provider is God, never to be questioned.  Thus, these folks don’t really understand what they can do to improve their health, and they refuse to ask for further clarification.

The reality for these two large patient subpopulations is that the appropriate use of resources to understand and directly address the obstacles to true engagement and education can result in great successes.

In the end, our ability to achieve truly dramatic and impactful healthcare reform depends to a great extent on engaging and educating the patients of today and tomorrow.  Appreciating this reality, and understanding the realities related to identifying patient subpopulations which can truly be engaged and educated is the best approach to achieving successful reform.

About Peter Edelstein, MD
Peter Edelstein, MD, is the Chief Medical Officer at Elsevier. Edelstein is board certified by the American College of Surgeons and the American Society of Colon and Rectal Surgery. He has more than 35 years of experience practicing medicine and in healthcare administration. Edelstein was in private practice for several years before serving on the surgical faculty at Stanford University, where he focused on gastrointestinal, oncologic and trauma surgery. He then spent more than a decade as an executive in the Silicon Valley medical device industry. Edelstein’s most recent role was as Chief Medical Officer for the healthcare business at LexisNexis Risk Solutions, a Reed Elsevier company. He is also the author of the recently published book, ‘Own Your Cancer: A Take-Charge Guide for the Recently Diagnosed & Those Who Love Them’.

ICD-10 Animation Training Videos

Posted on September 28, 2015 I Written By

The following is a post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
Last month we wrote about the need to use more video animation in healthcare. As we’ve ventured into the video animation space, we’ve realized the power of a really well done video animation. In just a few minutes a video animation can educate someone on a complex concept in a fun and entertaining way.

In just a few short days healthcare is going to be hit by one of the biggest changes it has seen in a long time. If you’re like me, you’ve started to see many of your colleagues and friends on Facebook posting about not being prepared for ICD-10. Prepared or not, ICD-10 is coming on October 1st.

As part of the preparation for ICD-10, we’ve been working with a number of companies and providers to create ICD-10 video animation training. We’ve created some broad ICD-10 training videos like this video on ICD-10 implementation steps and highly focused training videos like this video on ICD-10 Codes for Acute Bronchitis. We’ve also created the top 20 ICD-10 codes for Pulmonary, Gastroenterology, Family/Internal Medicine, Podiatry, Cardiology, and Radiology.

When you start hearing your colleagues complaining about all the “funny” ICD-10 codes, you might want to share with them this video:

These videos have been a great way to educate people on ICD-10 in a fun and interesting way. Next up we’re working on videos that educate healthcare on our PQRS registry. PQRS is becoming more and more important in healthcare and many people still don’t understand it well. We believe these PQRS videos will help those working on PQRS.

Where would you like to see more video animations in healthcare? We’d love to hear your thoughts on where you think video animation could be effective.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. ClinicSpectrum offers a video animation service that will take your healthcare education and marketing to the next level. Connect with Clinic Spectrum on social media: @ClinicSpectrum.

The 3rd Annual Health IT Marketing and PR Conference (#HITMC)

Posted on September 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We take a short break from our regularly scheduled programming to talk about the announcement of the 3rd Annual Health IT Marketing and PR Conference. For those not familiar with the event, it brings together the leading marketing and PR professionals working in healthcare. It’s an extraordinary group of people even if I’m quite biased since I organize the conference.

My own bias aside, each year I’m amazed at the community that’s formed around the Health IT Marketing and PR Conference. It’s a really unique event since there’s no other place for health IT marketing and PR professionals to get together and talk about the unique challenges of marketing to healthcare.

This year we decided to move the conference out of Las Vegas to Atlanta. It made sense to try an east coast location in 2016 since HIMSS and ANI are both in Las Vegas next year. We’ve got a great venue at the Loews hotel in midtown Atlanta. The conference center at the Loews is on the 14th floor and has floor to ceiling windows with amazing views of Atlanta which will make for a really nice event.

As per usual, we’re holding the Healthcare IT Marketing and PR Conference about a month after HIMSS on April 6-8, 2016.

If you have some expertise in healthcare marketing and/or PR, then the call for speakers is open for the event as well. We always get a lot of great submissions, but we particularly love those who provide some real life case studies of their experience marketing to healthcare and those that think outside the box in how and what they present. We’re always trying to implement new ways to create unique conference engagement.

We’ve already gotten a lot of support from sponsors for the event, but there is still room for more if you offer something valuable for healthcare IT marketing and PR professionals. You can check out the HITMC sponsorship options if you’re interested in the options we have available.

The early bird registration for the Healthcare IT Marketing and PR Conference will save you $500 if you register between now and November 30th. Plus, since you’re a reader of a Healthcare Scene blog, you can get an additional $100 off by using the promo code: HITRocks when registering for the conference.

We’re excited to see many of you at HITMC 2016, but if we don’t see you there we hope to see you at one of the other healthcare IT events we attend.

John Doerr’s Excitement for Digital Health

Posted on September 24, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John Doerr, a venture capitalist in many of the most famous tech companies, was onstage at the TechCrunch Disrupt conference where he was asked which of his latest investments he was most excited in. He replied that his most exciting investment was still in stealth mode, but that it was a healthcare startup and that “They aim to do for healthcare what Google did for health.”

Here’s the video of John Doerr talking about this investment and investing in healthcare:

I always love when billionaires like John Doerr are spending some of their time focused on healthcare. Certainly many of them have underestimated the complexity of healthcare and the entrenched system. Certainly many of them have made some bad investments. However, I think the more entrepreneurs and investors that focus on improving healthcare the better. So, I’m pleased he’s spending some time and energy with healthcare.

As for this company in stealth mode, I’m pretty sure Wolters Kluwer might argue that they’ve been doing that with health information for a long time. It will be interesting to see what a new startup tries to offer when it comes to making the world’s health knowledge available in a consumable format.

How Will Quick Labs Change Healthcare?

Posted on September 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was struck by the news that HealthSpot was planning to bring the 7 minute blood test to their retail pharmacy clinics. For those not familiar with HealthSpot, they provide a kind of kiosk setup that allows for a telemedicine visit with a doctor. However, what makes them unique is that the kiosk is staffed by an MA who can assist the patient. Plus, the kiosk has a bunch of medical devices which the remote doctor can make available to the patient as part of their treating the patient.

While I find it fascinating that HealthSpot is taking this all to the next level with a 7 minute blood test, it also made me start to think about the impact of these quick lab tests on healthcare in general. We’re seeing much of this work pioneered by Theranos’ lab efforts. The HealthSpot announcement above seems to indicate that a whole wave of new quick labs are heading to the market.

We like to talk about the lab result workflow when it comes to EHR software. If you have an interface between your EHR and the lab, then the results can automatically appear in the EHR. Over the years I’ve heard a lot of debate and discussion around whether the lab results should be automatically shared with the patient or not. The arguments against sharing revolve around the patient misreading the diagnosis or the patient getting a bad result without a medical provider there to help them deal with the bad result and put it in context.

On the other side of the coin is the patients who say that it’s there data and they should have access to their data. Plus, they argue that waiting a few extra days for a normal result causes days of extra worrying while the patient waits for the doctor to get back to them with the normal result. The most common thinking is that normal results are fine to share in real time and the abnormal results are best delivered by someone to the patient. Of course, smart patients realize that if they don’t hear from the doctor soon, then it’s bad news which means the doctors have to stay on top of calling back even the abnormal results.

Now let’s reframe this discussion when it only takes 7 minutes to get the lab results. All of the above discussion doesn’t matter. The patient waits at the office for 7 minutes, the doctor has the results and can share the results with the patients immediately with the doctor present. No more phone tag. No more worrying while the patient waits for the results. No more issues with automatically sharing the results with the patients electronically. It’s really quite beautiful.

Of course, we won’t be able to do this for all lab results. Some lab results just take time. However, these quick labs are going to change a lot of things about how we interact with patients and that’s a good thing.

Top 10 Healthcare CIO Budget Priorities

Posted on September 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those on the email list that can’t see the image that Charles Webster, MD shared, here are the list of top technology priorities:
1. BI/Analytics
2. CRM
3. Digitalization/Digital Marketing
4. Legacy Modernization
5. Industry-Specific Applications
6. Enterprise Applications
7. Infrastructure and Data Center
8. Application Development
9. Architecture
10. BPM
11. Cloud
12. Collaboration

Sure makes the life of a CIO look pretty easy, doesn’t it? (That was my sarcasm font in case you don’t have that font installed on your computer)

As I chew on this list, I’m processing Will Weider, CIO at Ministry Health Care’s response to me asking him what would he consider the 3 key focus areas for healthcare CIO’s:

10.5 Million Person Healthcare Hack Revealed 19 Months Later

Posted on September 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As we (and pretty much everyone) predicted, the number of healthcare breaches continues to grow. In the latest case, Rochester New York based Excellus BlueCross BlueShield and related companies were hacked. As per usual, the hackers mounted a “sophisticated cyberattack” which compromised data including names, addresses, telephone number, social security numbers, financial account information, and some medical information from “shadowy groups in China.”

Here’s a description of the 10.5 million records that were affected:

Affected parties include about 7 million people who are insured by Excellus, patients covered by those policies and Blue Cross Blue Shield members from other parts of the country who received medical care that was billed through Excellus, Redmond said. Excellus is the largest health insurer in the Rochester area.

The records of an additional 3.5 million people who receive services through five Lifetime units — Lifetime Health, Lifetime Care, Univera Healthcare, MedAmerica and Lifetime Benefits Solutions — also were breached by the hackers.

Although, the irony of this story is that the initial hack seemed to have occurred on Dec 23, 2013, but wasn’t discovered by the staff until much later. The report suggests that the hack wasn’t discovered until they did an investigation into their own systems after the 78.8 million person Anthem breach. What’s not clear to me is why it took them so long after that breach which occurred in February 2015 to finally announce their own breach.

The company is offering the standard 2 year’s of identity and credit card protection to affected individuals. Does this all feel somewhat routine now? I’m sorry to say that it’s become so common that it almost feels like a non-event. It probably doesn’t feel that way to the millions of patients who got a notice in the mail. Although, with breaches of Google, Amazon, Target, etc, I think we’re all becoming somewhat numb to breaches of our personal data.

Sharing Medical Records Cartoon

Posted on September 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday! Time for a little healthcare IT humor courtesy of The New Yorker:

Sometimes reality has to make you laugh even if it’s a sad situation. Or as Health IT Policy wonk Steven Posnack said:

CMS Redefines Telemedicine by Bringing Better Care to 15 Million Patients and Huge Profitability to Medical Facilities

Posted on September 17, 2015 I Written By

The following is a guest blog post by Donald Voltz, MD.
Donald Voltz - Zoeticx
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CCM) which would fundamentally change telemedicine as it is practiced.

CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.

The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings.  Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.

The time has come for a paradigm shift to reengineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained system. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment.  This needs to be an area of focus for hospital CEOs, CIOs and CMOs.

Huge Market Opportunity

According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million.  With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.

The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggling to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.

CMS’ CCM guidelines are as follows:

  • 24×7 access to clinical staff
  • Patient care continuum
  • Collaboration, coordination between primary care providers and other care services
  • Electronic management of care transition among care providers
  • Coordination between home and community care services
  • Patient engagement

Here is how these guidelines are now being addressed:

The Patient-Centric Model

While each patient has a primary care provider who is responsible for CCM service, they are not confined to receiving care in a single practice or institution. The primary care provider assumes the role of care coordinator, but care is likely to be distributed between multiple care providers, often across different care locations. In a patient-centric care model, care services can come from any care providers – geographically and organizationally diverse, necessitating an accountable provider to coordinate and orchestrate high-quality care across multiple chronic conditions.

Secure Electronic Care Transition

CMS clearly states these CCM care plans must be electronically available at all times to all care providers who will be delivering care to these patients, not available by faxing, or scanning as patient data is currently shared. The chronic care management plan must be available to all healthcare providers who might take care of these patients 24×7. In addition, the primary care provider who assumes the care coordinator responsibility for a patient is expected to follow-up on the care delivered, additional needs of the patient and changes in chronic condition that may have been addressed by a healthcare professional remote to the patients’ primary practice.

CMS neither authorizes how such a CCM system is designed nor enforces how efficient the implemented care service is. The monthly reimbursement limits the time and additional resources physicians are able to allocate for the development, implementation and daily operations of a CCM program in their practice. The manual implementation of a system that meets all of the requirements defined by the CMS will far exceed the reimbursement recovered. It is also likely to be inferior to one with some degree of automation coupled with messaging when a patient’s condition changes or their chronic care management plan is accessed by other providers. Efficiency along with automated logging of time spent on care coordination are critical requirements for a service to be effective.

A CCM service solution must meet the requirements defined by CMS while integrating into the current operational structure of primary care practice and integrate with current health IT systems and manage the secure documentation flow.  It must also offer a built-in notification system to alert physicians to changes in patient status and/or access to the care plan while maintaining an efficient operation in clinics with a lower overhead and no need for additional infrastructure.

While CMS does not enforce the efficiency of a CCM care service, the monthly payment must represent an increase of revenue to care providers. Care providers cannot implement a new potential code while increasing its cost due to manual labor increase. So, efficiency must be part of the solution requirements.

The answer to CCM service would be a new healthcare application offering secure documentation flow, built-in notification and collaboration services to support a low cost, efficient operation for clinics.

The CCM application must address the following requirements:

  • No disruption of existing services. The application must operate and integrate seamlessly with any existing EHR so to not change provider workflow or disrupt current processes; defining a very stringent requirement to keep the existing EHR systems untouched and unchanged while allowing for this new service to co-exist.
  • Secure electronic care transition with CCM care plan sharing. Patients can engage with this new care service even when the service may not be contained within the same network as the primary care provider. Patients ultimately maintain control of what information and with whom this information is shared. The primary care provider is responsible for maintaining the CCM care plan, as well as the patient, and should expect any information shared will be used for a single care session and not beyond it. Although the CCM care plan is expected to contain the most up-to-date medication information, primary care providers are not interested in opening up their entire system to others, but instead need to maintain control and secure access while allowing for access to these protected documents.
  • Automation, automation and automation. Efficiency of the whole CCM service must be at the core so that primary care providers can enhance patient care without adding expense and resources to implement it. Consider a patient with Congestive Heart Failure (CHF) where continuous monitoring of weight is critical for early intervention and the avoidance of hospitalizations. To engage patient’s in their care, they must be given a mechanism to report daily weight to their primary care provider. The primary care provider must have a solution where attention is given if the patient’s condition so it not has exceeded a certain threshold. Automation is required so that primary care providers can be efficient and only given attention when attention is required. Automation must be in place so that no activities such as follow-up would be omitted.
  • An EHR-agnostics solution. Implementation of a CCM service must address the constraints of a non-homogeneous environment. Healthcare organizations and physician practices are not able to control the EHR environments when patients receive care outside of their primary practice. The requirement for electronic document exchange along with the expectation of the latest patient health data being contained in the CCM care plan goes beyond a static solution offered by a data duplicated HIE (Health Information Exchange) infrastructure.
  • Visible value to a patient. A critical requirement for CMS reimbursement is a patient’s opting into a CCM management program that includes out-of-pocket monthly co-pay for the service of 8 dollars per month. A patient must see the value for CCM services which can be demonstrated through enhanced engagement, access to providers and the assurance that their condition is being overseen each month by their chronic care coordinator. Anticipation of an early intervention for potential problems along with the ability to inquire and receive feedback on their condition(s) brings added value to patients and their loved ones. This value can only be delivered if such a service can be developed in an efficient manner with a low cost of operating and a limited expansion of personal to bring it about.
  • Documentation of discontinuous time spent on care coordination. CMS requires at least 20 minutes are spent on care coordination activities each month in order to bill for this for patients enrolled in the program. Without a seamless component to log such activity, the efficiency of the overall process comes into question. A comprehensive CCM application must address the practice management side to account for and generate monthly reports of the CCM activities completed.

Future of Healthcare Impacted by Integration, Patient Data and New Modes of Delivery

The future of healthcare will be impacted by the integration of technology, patient collected data, and enhancement of healthcare professionals’ ability to deliver care in modes not yet imaged. With respect to management of chronic medical conditions, leveraging technology to coordinate the care delivered so these patients can lead productive lives at a reduced cost with less time in the hospital for exacerbations of their disease is a goal that is now possible.

Development of tools to coordinate care without additional health IT expense, in either time spent learning a new workflow or cost of such an application, is now available. Finding such an innovate model that works for patients, healthcare professionals and health systems for chronic care management will likely spread into other areas of healthcare. CCM services and care coordination allow remote, discontinuous, non-face-to-face management of patients with complex health conditions when it meets stringent requirements – a quiet, continuous monitor of health status and interventions, collaboration of all care delivered to the patient, an ability to anticipate, engage and alert patients and care professionals of impending issues, along with the administrative side of billing and logging such activity.

This ability not only changes the direction of the chronic care cost curve, it also increases care provider bandwidth, giving them the ability to successfully manage more patient, with better efficiency while delivering high quality, valuable care.

About Donald Voltz, MD
Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.

Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Thanh Tran, CEO of Zoeticx, also contributed.