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Health Data Tracking Is Creeping Into Professional Sports

Posted on October 27, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Pro athletes are used to having their performance tracked minutely, not only by team owners but also by legions of fans for whom data on their favorite players is a favored currency. However, athletic data tracking has taken on a shape with the emergence of wearable devices.

For example, in spring of last year, Major League Baseball approved two devices for use during games, the Motus Baseball Sleeve, which tracks stress on elbows, and the Zephyr Bioharness, which monitors heart and breathing rates, skin temperature and sleep cycle.

In what must be a disappointment to fans, data from the devices isn’t available in real time and only can be downloaded after games. Also, clubs use the data for internal purposes only, which includes sharing it with the player but no one else. Broadcasters and other commercial entities can’t access it.

More recently, in April of this year, the National Football League Players Association struck a deal with wearables vendor WHOOP under which its band will track athletes’ performance data. The WHOOP Strap 2.0 measures data 100 times per second then transmits the data automatically to its mobile and web apps for analysis and performance recommendations.

Unlike with the MLB agreement, NFL players own and control the individual data collected by the device, and retain the rights to sell their WHOOP data through the Players Association group licensing program.

Not all athletes are comfortable with the idea of having their performance data collected. For example, as an article in The Atlantic notes, players in the National Basketball Association included the right to opt out of using biometric trackers in their latest collective-bargaining agreement, which specifies that teams requesting a player wear one explain in writing what’s being tracked and how the team will use the information.  The agreement also includes a clause stating that the data can’t be used or referenced as part of player contract negotiations.

Now, it’s worth taking a moment to note that concerns over the management of professional athlete performance data file into a different bucket than the resale of de-identified patient data. The athletic data is generated only during the game, while consumer wearables collect data the entire time a patient is awake and sometimes when they sleep. The devices targeting athletes are designed to capture massive amounts of data, while consumer wearables collect data sporadically and perhaps not so accurately at times.

Nonetheless, the two forms of data collection are part of a larger pattern in which detailed health data tracking is becoming the norm. Athletic clubs may put it to a different purpose, but both consumer and professional data use are part of an emerging trend in which health monitoring is a 24/7 thing. Right now, consumers themselves generally can’t earn money by selling their individual data, but maybe there should be an app for that.

Is It Time To Redefine Interoperability?

Posted on October 26, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Recently, an article appearing in healthcare journal HealthAffairs argued that hospitals’ progress toward interoperability has been modest to date. The article, which looked at the extent to which hospitals found, sent, received and integrated information from outside providers in 2015, found that they’d made few gains across all four categories.

Researchers found that the percent of hospitals engaging in all four activities rose to 29.7% that year, up from 24.5% in 2014. The two activities that grew the most in frequency were sending (growing 8.1%) and receiving (8.4%). Despite this expansion, only 18.7% of hospitals reported that they used this data often. The extent to which hospitals integrated the information they received didn’t change from 2014 to 2015.

Interesting, isn’t it, how these stats fail to align with what we know of hospitals’ priorities?  Not only did the rate hospitals sent and received data increase slowly between those two years, hospitals don’t seem to be making any advances in integrating (and presumably, using) shared data. This doesn’t make sense given hospitals’ intense efforts to make interoperability happen.

The question is, are hospitals still limping along in their efforts, or are we failing to measure their progress effectively? For years now, looking at the extent to which they sent/received/found/integrated data has been the accepted yardstick most quarters. To my knowledge, though, those metrics haven’t been validated by formal research as being the best way to define and capture levels of interoperability.

Yes, hospital health data interoperability may be moving as slowly as the HealthAffairs article suggests. After all, I hardly have to tell readers like you how difficult it has been to foster interoperability in any form, and how challenging it has been to achieve any kind of consensus on data staring standards. If someone tells progress toward health data exchange between hospitals hasn’t reached robust levels yet, it probably won’t surprise you in the least.

Still, before we draw the sweeping conclusions about something as important as interoperability, it probably wouldn’t hurt to double-check that we’re asking the right questions.

For example, is the extent to which providers send data to outside organizations as important as the extent to which they receive such data?  I know, in theory, that health data exchanges would be just that, a back and forth between parties on both sides. Certainly, such arrangements are probably better for the industry as a whole long term. But does that mean we should discount the importance of one side or the other of the process?

Perhaps more importantly, at least in my book, is the degree to which hospitals integrate the data into their own systems a good proxy for measuring who’s making interoperability progress? And should be assumed that if they integrate the data, they’re likely to use it to improve outcomes or streamline care?

Don’t misunderstand me, I’m not suggesting that the existing metrics are useless. However, it would be nice to know whether they actually measure what we want them to measure. We need to validate our tools if we want use them to make important judgments about care delivery. Otherwise, why bother with measurements in the first place?

Patient Portal Use Rising Rapidly

Posted on October 25, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

A new study has concluded that patient portal use has shot up over the past few years, with a substantial majority of patients reporting that they use provider portals if possible.

The purpose of the study, results of which was published in Perspectives in Health Information Management, was to examine how healthcare consumers saw their interactions with provider portals, their use of personal health records and their take on the process of releasing health data.

According to a 2015 study cited by the article’s authors, 53% of HIM professionals reported charging consumers for both electronic and paper copies of their health information. Thirty-eight percent said they had a patient portal, but less than 5% of patients were using it.

Over the last two years, however, the picture has changed a great deal. Researchers conducting the current study found that only 10% of consumers were charged for their health information. In addition, 49% reported that they maintained a personal health record. Eighty-three percent of respondents said that their providers had portals, and 82% said that they were taking advantage of their provider’s portal where available.

Patient uses for portals included viewing lab results (35%), requesting medication refills (19%), requesting appointments (22%), secure messaging (19%) and other (5%). Among portal users, 53% were very satisfied and 38% were satisfied with their experiences.

Meanwhile, 49% of respondents said they maintained PHRs, with top record format being combined paper and electronic (46%), followed by paper only (35%), electronic only (18%) and other (1%).

It’s important to note that the study population was especially healthcare-savvy. Participants chosen were campus-based and online students enrolled in a College of Health Professions course, alumni of BA programs in HIM at the researchers’ university, local AHIMA members and the researchers’ family and friends.

The article argues that because the participants were all current healthcare consumers, they were qualified participants. That may be so, but the high concentration of HIM-friendly respondents probably stacked the deck somewhat. (To be fair, the authors admit this.)

That being said, even these relatively sophisticated respondents weren’t completely comfortable with the health data access they had. Complaints cited by consumers included a lack of interoperability between physicians’ offices and electronic PHI, as well as the difficulty of getting data into the portal or updated when already present. Others reported having concerns about health data security.

All told, it looks like the hoped-for growth in patient health data use is taking place over time. I suspect that a direct comparison between less-informed consumers from 2015 and today would show less pronounced changes, though.

 

Health IT Continues To Drive Healthcare Leaders’ Agenda

Posted on October 23, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

A new study laying out opportunities, challenges and issues in healthcare likely to emerge in 2018 demonstrates that health IT is very much top of mind for healthcare leaders.

The 2018 HCEG Top 10 list, which is published by the Healthcare Executive Group, was created based on feedback from executives at its 2017 Annual Forum in Nashville, TN. Participants included health plans, health systems and provider organizations.

The top item on the list was “Clinical and Data Analytics,” which the list describes as leveraging big data with clinical evidence to segment populations, manage health and drive decisions. The second-place slot was occupied by “Population Health Services Organizations,” which, it says, operationalize population health strategy and chronic care management, drive clinical innovation and integrate social determinants of health.

The list also included “Harnessing Mobile Health Technology,” which included improving disease management and member engagement in data collection/distribution; “The Engaged Digital Consumer,” which by its definition includes HSAs, member/patient portals and health and wellness education materials; and cybersecurity.

Other hot issues named by the group include value-based payments, cost transparency, total consumer health, healthcare reform and addressing pharmacy costs.

So, readers, do you agree with HCEG’s priorities? Has the list left off any important topics?

In my case, I’d probably add a few items to list. For example, I may be getting ahead of the industry, but I’d argue that healthcare AI-related technologies might belong there. While there’s a whole separate article to be written here, in short, I believe that both AI-driven data analytics and consumer-facing technologies like medical chatbots have tremendous potential.

Also, I was surprised to see that care coordination improvements didn’t top respondents’ list of concerns. Admittedly, some of the list items might involve taking coordination to the next level, but the executives apparently didn’t identify it as a top priority.

Finally, as unsexy as the topic is for most, I would have thought that some form of health IT infrastructure spending or broader IT investment concerns might rise to the top of this list. Even if these executives didn’t discuss it, my sense from looking at multiple information sources is that providers are, and will continue to be, hard-pressed to allocate enough funds for IT.

Of course, if the executives involved can address even a few of their existing top 10 items next year, they’ll be doing pretty well. For example, we all know that providers‘ ability to manage value-based contracting is minimal in many cases, so making progress would be worthwhile. Participants like hospitals and clinics still need time to get their act together on value-based care, and many are unlikely to be on top of things by 2018.

There are also problems, like population health management, which involve processes rather than a destination. Providers will be struggling to address it well beyond 2018. That being said, it’d be great if healthcare execs could improve their results next year.

Nit-picking aside, HCEG’s Top 10 list is largely dead-on. The question is whether will be able to step up and address all of these things. Fingers crossed!

Health Data Standardization Project Proposes “One Record Per Person” Model

Posted on October 13, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

When we sit around the ol’ HIT campfire and swap interoperability stories, many of us have little to do but gripe.

Is FHIR going to solve all of our interoperability problems? Definitely not right away, and who knows if it ever will? Can we get the big EMR vendors to share and share alike? They’ll try, but there’s always a catch. And so on. There’s always a major catch involved.

I don’t know if the following offers a better story than any of the others, but at least it’s new one, or at least new to me. Folks, I’m talking about the Standard Health Record, an approach to health data sharing doesn’t fall precisely any of the other buckets I’m aware of.

SHR is based at The MITRE Corporation, which also hosts virtual patient generator Synthea. Rather than paraphrase, let’s let the MITRE people behind SHR tell you what they’re trying to accomplish:

The Standard Health Record (SHR) provides a high quality, computable source of patient information by establishing a single target for health data standardization… Enabled through open source technology, the SHR is designed by, and for, its users to support communication across homes and healthcare systems.

Generalities aside, what is an SHR? According to the project website, the SHR specification will contain all information critical to patient identification, emergency care and primary care along with background on social determinants of health. In the future, the group expects the SHR to support genomics, microbiomics and precision medicine.

Before we dismiss this as another me-too project, it’s worth giving the collaborative’s rationale a look:

The fundamental problem is that today’s health IT systems contain semantically incompatible information. Because of the great variety of the data models of EMR/EHR systems, transferring information from one health IT system to another frequently results in the distortion or loss of information, blocking of critical details, or introduction of erroneous data. This is unacceptable in healthcare.

The approach of the Standard Health Record (SHR) is to standardize the health record and health data itself, rather than focusing on exchange standards.

As a less-technical person, I’m not qualified to say whether this can be done in a way that will be widely accepted, but the idea certainly seems intuitive.

In any event, no one is suggesting that the SHR will change the world overnight. The project seems to be at the beginning stages, with collaborators currently prototyping health record specifications leveraging existing medical record models. (The current SHR spec can be found here.)

Still, I’d love for this to work, because it is at least a fairly straightforward idea. Creating a single source of health data truth seems like it might work.

New Service Brings RCM Process To Blockchain

Posted on October 6, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Much of the discussion around blockchain (that I’ve seen, at least) focuses on blockchain’s potential as a platform for secure sharing of clinical data. For example, some HIT experts see blockchain as a near-ideal scalable platform for protecting the privacy of EHR-based patient data.

That being said, blockchain offers an even more logical platform for financial transactions, given its origins as the foundation for bitcoin transactions and its track record of supporting those transactions efficiently.

Apparently, that hasn’t been lost on the team at Change Healthcare. The Nashville-based health IT company is planning to launch what it says is the first blockchain solution for enterprise-scale use in healthcare. According to a release announcing the launch, the new technology platform should be online by the end of this year.

Change Healthcare already processes 12 billion transactions a year, worth more than $2 trillion in claims annually.  Not surprisingly, the new platform will extend its new blockchain platform to its existing payer and provider partners. Here’s an infographic explaining how Change expects processes will shift when it deploys blockchain:

Change_Healthcare_Intelligent_Healthcare_Network_Workflow_Infographic

To build out blockchain for use in RCM, Change is working with customers, as well as organizations like The Linux Foundation’s Hyperledger project.

Hyperledger encompasses a range of tools set to offer new, more-standardized approaches to deploying blockchain, including Hyperledger Cello, which will offer access to on-demand “as-a-service” blockchain technology and Hyperledger Composer, a tool for building blockchain business networks and boosting the development and deployment of smart contracts.

It’s hard to tell how much impact Change’s blockchain deployment will have. Certainly, there are countless ways in which RCM can be improved, given the extent to which dollars still leak out of the system. Also, given its existing RCM network, Change has as good a chance as anyone of building out blockchain-based RCM.

Still, I’m wondering whether the new service will prove to be a long-term product deployment or an experiment (though Change would doubtless argue for the former). Not only that, given its relatively immature status and the lack of broadly-accepted standards, is it really safe for providers to rely on blockchain for something as mission-critical as cash flow?

Of course, when it comes to new technologies, somebody has to be first, and I’m certainly not suggesting that Change doesn’t know what it’s doing. I’d just like more evidence that blockchain is ready for prime time.

FDA Announces Precertification Program For Digital Health Tools

Posted on October 5, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

The FDA has recruited some the world’s top technology and medical companies to help it pilot test a program under which digital health software could be marketed without going through the through the agency’s entire certification process.

The participants, which include Apple, Fitbit, Johnson & Johnson, Samsung and Roche, will give the agency access to the measures they’re using to develop, test and maintain their software, and also how they collect post-market data.

Once armed with this information, the FDA will leverage it to determine the key metrics and performance indicators it uses to see if digital health software meets its quality standards.

Companies that meet these new standards could become pre-certified, a status which grants them a far easier path to certification than in the past. This represents a broad shift in the FDA’s regulatory philosophy, “looking first at the software developer digital health technology developer, not the product,” according to a report previously released by the agency.

If the pilot works as planned, the FDA is considering making some significant changes to the certification process. If their processes pass muster, pre-certified companies may be allowed to submit less information to the FDA than they currently must before marketing a new digital health tool.  The agency is also considering the more radical step of allowing pre-certified companies to avoid submitting a product for premarket review in some cases. (It’s worth noting that these rules would apply to lower-risk settings.)

The prospect of pre-certifying companies does raise some concerns. In truth, the argument could be made that digital health software should be regulated more tightly, not less. In particular, the mobile healthcare world is still something of a lawless frontier, with very few apps facing privacy, security or accuracy oversight.

The fact is, it’s little wonder that physicians aren’t comfortable using mobile health app data given how loosely it can be constructed at times, not to mention the reality that it might not even measure basic vital signs reliably.

It’s not that the healthcare industry isn’t aware of these issues. about a year ago, a group of healthcare organizations including HIMSS, the American Medical Association and the American Heart Association came together to develop a framework of principles dressing app quality. Still, that’s far short of establishing a certification body.

On the other hand, the FDA does have a point when it notes that a pre-certification program could make it easier for useful digital health tools to reach the marketplace. Assuming the program is constructed well, it seems to me that this is a good idea.

True, it’s pretty unusual to see the FDA loosen up its certification process – a fairly progressive move for a stodgy agency – while the industry fails to self-regulate, but it’s a welcome change of style. I guess digital health really is changing things up.

 

Why Should Patients Control Their Health Data? Here Are A Few Ideas.

Posted on September 29, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Lately, healthcare organizations have begun working to give patients more access to their personal health data. They’ve concluded that the more control patients have, the more engaged they become in your care, which in turn leads to better outcomes.

But patient engagement isn’t the only reason for giving patients the keys to their PHI. In fact, organizational control of patient health data can cause problems for everyone in the healthcare data exchange chain.

An item found on the Allscripts blog does a nice job of articulating issues that can arise.  According to the blog item, those issues include the following:

  • The patient is in the best position to address inconsistencies in their medical record. For example, if one doctor diagnoses the patient with asthma, then another physician conclusively demonstrates the patient is not asthmatic, the patient can reconcile the two physicians’ conclusions.
  • Patients have a better overview of their care than most doctors. When a chronically ill patient sees multiple clinicians, their impressions may conflict with one another, but the patient can provide context on their overall conditions.
  • If a patient consents to multiple uses of their health data, and the consents seem to be in conflict, only the patient can articulate what their intentions were.
  • If the master patient indexing process generates a false match with someone else’s records, the patient will recognize this immediately, while physicians may not.
  • Giving patients control of the record allows them to decide how long those records should be maintained. Otherwise, HIEs — or other entities not bound by record retention laws — might destroy the data prematurely.
  • When patients have control of their data, they can make sure it gets to whomever they choose. On the other hand, patient data may not make it to other care settings if providers drop the ball.

To be sure, delegating control of their PHI to patients can go too far.

For example, if they’re transmitting most or all of their health data between providers, it could pose a significant administrative burden.  Patients may not have the time or energy to route the data files between their providers, assure that data has been received on the other end and make certain that the data was formatted in a way their clinicians can use.

Also, if the patient is chronically ill and sees multiple providers, they may end up having to manage a large body of data files, and not everyone can do so effectively. Ultimately, they may get too overwhelmed to send their records to anyone, or send the wrong records, which can create complications of its own.

Still, on the whole, healthcare organizations are giving patients more control of their health data for good reasons. When patients take responsibility for their health data, they’re far more likely to understand their condition and take steps to address problems. Establishing a balance between patient and provider control may be tricky, but it can and should be done.

NY-Based HIE Captures One Million Patient Consents

Posted on September 28, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

One of the big obstacles to the free exchange of health data is obtaining patient consent to share that data. It’s all well and good if we can bring exchange partners onto a single data sharing format, but if patients don’t consent to that exchange things get ugly. It’s critical that healthcare organizations solve this problem, because without patient consent HIEs are dead in the water.

Given these issues, I was intrigued to read a press release from HEALTHeLINK, an HIE serving Western New York, which announced that it had obtained one million patient consents to share their PHI. HEALTHeLINK connects nearly 4,600 physicians, along with hospitals, health plans and other healthcare providers. It’s part of a larger HIE, the Statewide Health Information Network of New York.

How did HEALTHeLINK obtain the consents? Apparently, there was no magic involved. The HIE made consent forms available at hospitals and doctors’ offices throughout its network, as well as making the forms available for download at whyhealthelink.com. (It may also have helped that they can be downloaded in any of 12 languages.)

I downloaded the consent form myself, and I must say it’s not complicated.

Patients only need to fill out a single page, which gives them the option to a) permit participating providers to access all of their electronic health information via the HIE, b) allow full access to the data except for specific participants, c) permit health data sharing only with specific participants, d) only offer access to their records in an emergency situation, and e) forbid HIE participants to access their health data even in the case of an emergency situation.

About 95% of those who consented chose option a, which seems a bit remarkable to me. Given the current level of data breaches in news, I would’ve predicted that more patients would opt out to some degree.

Nonetheless, the vast majority of patients gave treating providers the ability to view their lab reports, medication history, diagnostic images and several additional categories of health information.

I wish I could tell you what HEALTHeLINK has done to inspire trust, but I don’t know completely. I suspect, however, that provider buy-in played a significant role here. While none of this is mentioned in the HIE’s press release or even on its website, I’m betting that the HIE team did a good job of firing up physicians. After all, if you’re going to pick someone patients would trust, physicians would be your best choice.

On the other hand, it’s also possible patients are beginning to get the importance of having all of the data available during care. While much of health IT is too abstruse for the layman (or woman), the idea that doctors need to know your medical history is clearly beginning to resonate with your average patient.