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How to Build an Effective Rural Virtual Care and Telehealth Strategy

Posted on October 10, 2018 I Written By

The following is a guest blog post by Lee Horner, CEO of Synzi.

Rural healthcare organizations are increasingly interested in implementing virtual care and telehealth solutions in order to better meet the needs of their facilities, staff, and patient population. In danger of closing their doors, rural hospitals are struggling to survive and thrive in a healthcare environment with razor-thin margins.

iVantage’s 2017 Rural Relevance Study reports that 41 percent of rural hospitals operate at a negative margin. Poor financial performance is impacting these hospitals’ ability to keep their doors open and serve rural communities. In fact, the National Rural Health Association (NRHA) reported that the number of rural hospital closures has risen to 87 in the last 8 years.

A rural hospital closure has significant impact to its community. These facilities provide fundamental healthcare services to nearly 57 million people across the country and are often an integral part of the local economy, providing jobs and a tax base for the community. John Henderson, CEO of the Texas Organization of Rural and Community Hospitals (TORCH) stated that hospitals are a critical element of a town’s survival: “Hospitals, schools, churches. It’s the three-legged stool. If one of those falls down, you don’t have a town.”

Virtual care technology can be a viable delivery option for healthcare facilities and residents in rural communities. To best build an effective virtual care strategy, rural healthcare organizations should short-list solutions which solve for limited bandwidth in rural areas, patient preference for mobile devices and communications, an organization’s current infrastructure and workflow, and security concerns.

Addressing Bandwidth Issues: Rural healthcare organizations may initially think that limited Wi-Fi and broadband availability will restrict telehealth adoption by a facility, a medical practice and/or the patients themselves. However, rural healthcare organizations can identify and implement solutions which work across any level of connectivity (whether cellular or Wi-Fi) to ensure that the providers and the patients can use the solution without issues. Various entities are actively pushing for continued investment in our nation’s broadband infrastructure and rural communities are a priority for future build-out.

Reflecting Patient Preferences: Patients are already using many devices – including smartphones, tablets, and/or computers – which also provide them with more convenient access to healthcare without requiring significant travel time and costs. Moving forward, rural healthcare organizations should prioritize solutions which are device-agnostic and should also ensure their patient communications work across any type of modality. Providers and patients already own many of these devices; a flexible virtual care platform will help organizations and individuals reap more benefits out of the investments they have already made in technology.

Optimizing Current Workflows: Healthcare organizations have ongoing clinical workflows, and may be wary of technology’s role in automating these processes. However, rural healthcare organizations’ existing workflows can be optimized by using a virtual care platform which ensures that the virtual care protocols are consistent with in-person protocols in terms of engaging at-home patients and/or reaching offsite specialists for a needed consult. The ideal solution should be intuitive and easy to use; providers will then be able to quickly incorporate virtual care into their practices.

Addressing Security Concerns: When exploring new technology, most healthcare organizations will initially question if a net-new solution meets safety and privacy standards. Rural healthcare organizations should prioritize solutions which are HIPAA-compliant and HITRUST-certified to ensure security, privacy and compliance. Although rural health providers will immediately understand the need to adopt a virtual care platform, IT departments and champions will also need to realize that the adoption of this new technology will benefit providers, patients, and ultimately, the sustainability of the healthcare organization. Virtual care technology is essential to rural healthcare as it helps close the time and distance gap in terms of providing patients with the care they need, when they need it – regardless of where the patients or the providers are located.

The rural population has noted gaps in both access and quality. An estimated one in five Americans live and work in rural areas across the nation, yet, there are 2,157 Health Professional Shortage Areas in rural areas compared to 910 in urban areas. Moreover, the Rural Health Information Hub reports that 19.5 percent of rural adults describe their health status as fair/poor vs. 15.6 percent of their urban counterparts. Virtual care technology can help address the gap in care by providing access to additional physicians and needed specialists at the click of a button. By leveraging external and/or associated hospitals and physician groups, rural hospitals strengthen their care within the vast populations and geographies they support.

Top 5 Ways Healthcare Applications Slow Down and What To Do About It

Posted on October 4, 2018 I Written By

The following is a guest blog post by Jeff Garbus and  Alvin Chang from Soaring Eagle Consulting.

We spend a lot of our lives tuning applications that people complain are too slow. In no particular order, here are some of our findings.

Poor indexing #1 – Unused Indexes, Missing Indexes can cause problems

While I’ve said, “in no particular order,” I do have to say this one is usually first. When applications go through Q/A / Stress test, there is often a lot more horsepower than there is data. As a result, the memory and CPU combination mask the otherwise bad performance. Once the application hits production, larger volumes of data are not managed as effectively.

On the plus side, you can almost always add an index (or indexes) without causing other application side effects.

Warning: Do NOT automatically add indexes as recommended by a DBMS’ tuning advisor; they often miss opportunities, and also often significantly over index by recommending multiple similar indexes rather than one enveloping one.

Be wary of overindexing as too many indexes can also create overhead that will cause processes to slow.

Bad queries #2 – Too much data returned by a query

Sometimes you are simply bringing too much data back from the database to the front end. I saw a search recently that brought about a half million rows of data back to the end user. I asked, “What is the user going to do with that much data?” Answer: “They are going to look at the first few rows and refine the search.”

This unnecessarily stresses the disk CPU, memory, and the network.

Easiest solution: Bring back only the data the user is going to work with. Perhaps the first few hundred rows. Save time, disk resources, and network resources.

Bad queries #3 – Overuse of temporary tables

Many applications use temporary tables incorrectly or are wasteful with them. For example, they are used

  • When the programmer wants to avoid joins (which the server is very good at!);
  • Are filled with lots of data, then rows are deleted (why load them in the first place?);
  • Or too many columns are used (why select * when the columns aren’t being used?) – this increases network bandwidth, as well as making the table unnecessarily big
  • Joining temp tables is another way developers often misuse server resources. Without indexes, this is very costly

Avoid temporary tables

Bad Queries #4 – Attempting to do it all in one Giant Query. 

Sometimes the opposite can also be true. When attempting to write a query for a process, Developers can get stuck in the mindset that a single query can solve all possible conditions of a query.  This leads to large complicated queries that in addition to being difficult to decipher. Can also generate excessive numbers of worktables as it attempts to place large subsets of data into worktables.

Large Reports #5 Combine reporting and transactional activity

It is very common to allow reporting off highly transactional databases. The problem is that reporting creates shared locks on resources, and transactions can not modify the data while the locks are held. In addition, reports are often ad hoc, so that the load on the server is unpredictable.

Easy solution: replicate production data to a reporting server. If replication or other high availability is unavailable, use dump/load to keep day old data for reporting purposes (this is often sufficient).

Allow direct downloads of data

Some companies allow “super users” (also sometimes called “analysts”) to download production data, real time, to applications like Microsoft Access. In addition to being a likely security violation, this also creates blocking issues for the online users.

Solution: Data replication, as above.

If you’d like to learn more about how to improve slow applications, sign up for our webinar “Are your Servers, Apps, and EHR systems ready for a spike in website traffic?

About Jeff Garbus and Alvin Chang
Jeff Garbus founded Soaring Eagle Consulting 20 years ago, and Alvin has been his right hand for almost 30 years now. Together they have authored or coauthored 20 books and dozens of articles on Database Management. Soaring Eagle Consulting is an On Shore HIPPA and PCI compliant remote database management company that is available for projects and consulting work on Architecture, Performance and Tuning, Scalability, application development, migrations and 24×7 full operational support. Do your DBAs need a best friend? Jeff, Alvin, and the On Shore GURU level database team are here to help you!

Soaring Eagle is a proud sponsor of Healthcare Scene.

MGMA 2018 Keynotes Hit Back-to-Back Home Runs

Posted on October 2, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Not far from legendary Fenway Park, MGMA hit back-to-back home runs with their opening keynotes: Simon Sinek and Mel Robbins. Both had us completely enthralled and hanging on their every word. It was an incredible way to start a conference.

I have never been more excited for a set of keynotes than I have for the 2018 MGMA Annual Conference #MGMA18Annual. When the agenda for the conference was officially released I was pleasantly surprised to see not one, but TWO well-known keynote speakers.

Simon Sinek is best known for his TEDTalk – “How great leaders inspire action” which became one of the most popular ever produced. In it Sinek talks about getting past WHAT you offer and HOW you offer it in order to reach the crucial WHY you do what you do. It is one of my favorite videos to watch.

Sinek’s #MGMA18Annual keynote was based on his latest work on Finite vs Infinite Games of Leadership. For a preview you can watch this video of his presentation at Google.

According to Sinek a finite game is one where there known players, fixed rules and an agreed upon objective. Baseball, football and hockey are classic examples of finite games. Infinite games, have known and unknown players, changeable rules and the objective is to keep the game going. With infinite games there are no winners or losers. The only way the game ends is when the second-to-last player loses the will or the resources to continue playing the game.

Sinek used the Cold War as an example of an infinite game. The Soviet Union was the second-to-last player and they dropped out when they lost the will and the resources to keep playing. Sinek warns that when you pit a finite player vs an infinite player you are in fact playing an infinite game and inevitably the finite player loses. That is because the finite player is playing to WIN whereas the infinite player is playing to keep playing. Sooner or later the finite player will drop out – not prepared to dedicate as much resources to the game as the infinite player.

Sinek applied this finite vs infinite game analogy to business and found that too many companies are finite players in an infinite game. “We talk about being number 1.” said Sinek. “We boast about beating the competition, but in fact that isn’t the case at all in business. There is no winner. You are either ahead or behind, but you can’t actually win in the game of business. You just have to keep playing.”

According to Sinek, one of the keys to succeeding in an infinite game is to have a Just Cause. Such a cause will help you rally the necessary resources and will to keep playing the game. Ending child poverty, and making the sum total of human knowledge searchable are examples of Just Causes.

Healthcare clearly has a Just Cause – to help people live longer, healthier lives. So why is healthcare in such a quagmire? (something Sinek claims is typical of finite players in an infinite game). This was one of the questions posed by a member of the audience at #MGMA18Annual. Sinek’s answer was brilliant.

“I believe that the problem in healthcare is that many organizational leaders have mistakenly taken the industry’s Just Cause and made it their own. Healthcare as industry is supposed to keep people healthy. However, the job of the leaders of healthcare organizations isn’t to make people healthy. No! Their job is to take care of the people who deliver care to patients.”

Imagine how different healthcare would be if administrators, healthcare leaders and government officials all had the same goal: taking care of the physicians, nurses and support staff under their influence. Think about the level of care a patient would receive if the doctor and the nurse felt that the organization they worked for had their back? How different would the patient experience be?

Home Run #1.

Mel Robbins, #MGMA18Annual’s second keynote speaker, kicked off Day 2 of the conference with a rousing session centered on her transformative 5 second rule. Her simple rule has helped people stay sober, save their marriages and turn-around failing careers. The rule is so simple that she felt obligated to call it out in her opening: “After I tell you the secret of the 5 second rule, most of you will likely say to yourself – that can’t possibly work, but trust me it does. And that’s the beauty of it, it’s simple.”

In a nutshell, Robbins method involved counting down from 5 whenever you find yourself starting to have a negative thought or when you feel yourself making an excuse NOT to do something you know you should.

Roll out of bed and see your running shoes, but then look outside and see that a few dark clouds. Don’t let the excuse fully form in your mind. Instead, change your mental soundtrack by counting down 5 – 4 – 3 – 2 – 1 and then do it. See a task that you’ve been putting off all day, 5 – 4 – 3 – 2 – 1 and dive in. Sounds too simple right?

Robbins spent much of her time on stage giving scientific evidence and examples of how this 5 second rule actually works. She talked about being on “autopilot” – a mental state where your brain falls back on learned behaviour to guide the actions you take. Procrastination and self-doubt are the autopilot settings for most of us. According to Robbins, in order to break free of autopilot, you need to engage your frontal cortex – which is what happens when you count down from 5.

This simple brain hack puts you back in control of your actions and suddenly the excuses melt away and you get on with the necessary task. That essay suddenly gets written, the house gets painted, the phone call gets made and the important email gets sent.

Robbins was quick to point out that her 5 second rule did not apply to life-or-death medical decisions, nor should it be used to make important financial or life-altering decisions. It was meant to be used when we start hearing the voice of our inner doubts.

I must admit that when I first watched Robbin’s TEDTalk I did not internalize her message. I fell into the trap and thought it was too simple to be effective. Hearing her deliver her message live at #MGMA18Annual changed my mind. It’s only been a day but already I’ve used Robbin’s 5 second rule to climb the stairs instead of using the escalators at the convention center, opt for water instead of soda,  and write this blog before going to bed.

Home Run #2

Thank you MGMA organizers.

Patient Billing And Collections Process Needs A Tune-Up

Posted on October 1, 2018 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 from a patient payments vendor suggests that many healthcare organizations haven’t optimized their patient billing and collections process, a vulnerability which has persisted despite their efforts to crack the problem.

The survey found that while the entire billing collections process was flawed, respondents said that collecting patient payments was the toughest problem, followed by the need to deploy better tools and technologies.

Another issue was the nature of their collections efforts. Sixty percent of responding organizations use collections agencies, an approach which can establish an adversarial relationship between patient and provider and perhaps drive consumers elsewhere.

Yet another concern was long delays in issuing bills to patients. The survey found that 65% of organizations average more than 60 days to collect patient payments, and 40% waited on payments for more than 90 days.

These results align other studies that look at patient payments, all of which echo the notion that the patient collection process is far from what it should be.

For example, a study by payment services vendor InstaMed found that more than 90% of consumers would like to know what the payment responsibility is prior to a provider visit. Worse, very few consumers even know what the deductible, co-insurance and out-of-pocket maximums are, making it more likely that the will be hit with a bill they can’t afford.

As with the Cedar study, InstaMed’s research found that providers are waiting a long time to collect patient payments, three-quarters of organizations waiting a month to close out patient balances.

Not only that, investments in revenue cycle management technology aren’t necessarily enough to kickstart patient payment volumes. A survey done last year by the Healthcare Financial Management Association and vendor Navigant found that while three-quarters of hospitals said that their RCM technology budget was increasing, they weren’t necessarily getting the ROI they’d hoped to see.

According to the survey, 77% of hospitals less than 100 beds and 78% of hospitals with 100 to 500 beds planned to increase their RCM spending. Their areas of investment included business intelligence analytics, EHR-enabled workflow or reporting, revenue integrity, coding and physician/clinician documentation options.

Still, process improvements seem to have had a bigger payoff. These hospitals are placing a lot of faith in revenue integrity programs, with 22% saying that revenue integrity was a top RCM focus area for this year. Those who would already put such a program in place said that it offered significant benefits, including increased net collections (68%), greater charge capture (61%) and reduced compliance risks (61%).

As I see it, the key takeaways here are that making sure patients know what to expect financially and putting programs in place to improve internal processes can have a big impact on patient payments. Still, with consumers financing a lot of their care these days, getting their dollars in the door should continue to be an issue. After all, you can’t get blood from a stone.

Healthcare AI Could Generate $150B In Savings By 2025

Posted on September 27, 2018 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.

Is the buzz around healthcare AI solutions largely hype, or can they deliver measurable benefits? Lest you think it’s too soon to tell, check out the following.

According to a new report from market analyst firm Frost & Sullivan, AI and cognitive computing will generate $150 billion in savings for the healthcare business by 2025.  Frost researchers expect the total AI market to grow to $6.16 billion between 2018 and 2022.

The analyst firm estimates that at present, only 15% to 20% of payers, providers and pharmaceutical companies have been using AI actively to change healthcare delivery. However, its researchers seem to think that this will change rapidly over the next few years.

One of the most interesting applications for healthcare AI that Frost cites is the use of AI in precision medicine, an area which clearly has a tremendous upside potential for both patients and institutions.

In this scenario, the AI integrates a patient’s genomic, clinical, financial and behavioral data, then cross-references the data with the latest academic research evidence and regulatory guidelines. Ultimately, the AI would create personalized treatment pathways for high-risk, high-cost patient populations, according to Koustav Chatterjee, an industry analyst focused on transformational health.

In addition, researchers could use AI to expedite the process of clinical trial eligibility assessment and generate prophylaxis plans that suggest evidence-based drugs, Chatterjee suggests.

The report also lists several other AI-enabled solutions that might be worth implementing, including automated disease prediction, intuitive claims management and real-time supply chain management.

Frost predicts that the following will be particularly hot AI markets:

  • Using AI in imaging to drive differential diagnosis
  • Combining patient-generated data with academic research to generate personalized treatment possibilities
  • Performing clinical documentation improvement to reduce clinician and coder stress and reduce claims denials
  • Using AI-powered revenue cycle management platforms that auto-adjust claims content based on payer’s coding and reimbursement criteria

Now, it’s worth noting that it may be a while before any of these potential applications become practical.

As we’ve noted elsewhere, getting rolling with an AI solution is likely to be tougher than it sounds for a number of reasons.

For example, integrating AI-based functions with providers’ clinical processes could be tricky, and what’s more, clinicians certainly won’t be happy if such integration disrupts the EHR workflow already in existence.

Another problem is that you can’t deploy an AI-based solution without ”training” it on a cache of existing data. While this shouldn’t be an issue, in theory, the reality is that much of the data providers generate is still difficult to filter and mine.

Not only that, while AI might generate interesting and effective solutions to clinical problems, it may not be clear how it arrived at the solution. Physicians are unlikely to trust clinical ideas that come from a black box, e.g. an opaque system that doesn’t explain itself.

Don’t get me wrong, I’m a huge fan of healthcare AI and excited by its power. One can argue over which solutions are the most practical, and whether AI is the best possible tool to solve a given problem, but most health IT pros seem to believe that there’s a lot of potential here.

However, it’s still far from clear how healthcare AI applications will evolve. Let’s see where they turn up next and how that works out.

Will The Fitbit Care Program Break New Ground?

Posted on September 21, 2018 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.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.

 

Execs Say Silicon Valley Has The Jump On Healthcare Innovation

Posted on September 12, 2018 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, it’s begun to look as though the leading lights of Silicon Valley might bring the next wave of transformation to healthcare. But can they work big changes in the industry on their own, or are they more likely to succeed by throwing their extremely considerable muscle behind existing healthcare players? That’s one of the many questions at issue as companies like Google, Amazon (Yes, I know they’re in Seattle), and Facebook shoulder their way into the business.

According to a new survey by Reaction Data, many healthcare execs think Amazon, in particular, has the potential to change the game.  When asked which outside entrants were most likely to disrupt the healthcare industry, two-thirds of respondents said the that the online retailing giant topped the list. “Amazon is ahead of the game in many ways compared to the other companies,” a chief nursing officer told Reaction Data.

There’s little doubt that there’s an opening for a company like Amazon to solve some pressing problems. As an industry outsider – unless you count its recent big-ticket acquisition of PillPack, which happened about a minute ago – Amazon may be able to bring fresh eyes to some of healthcare’s biggest problems. For example, what health exec wouldn’t kill to benefit from the e-retailer’s immense logistics capabilities? The mind boggles.

Facebook and Google aren’t making as many healthcare headlines, but they too are moving carefully into the business. For example, consider Google’s partnership with Stanford aimed at creating digital scribes. The digital scribe initiative may not seem like much, but I wouldn’t underestimate what Google can learn from the effort and how effectively it can operationalize this knowledge. It isn’t 2010 anymore, and I think the search giant has come a long way since its Google Health PHR effort collapsed.

Facebook, too, has made some tentative steps toward building a healthcare business, such as its recent agreement to collaborate with the NYU School of Medicine on speeding up MRI scanning using AI. The social networking giant hasn’t shown itself capable of much diversification to date, but I wouldn’t count it out, if for no other reasons than the massive profits to be made. Even for Facebook, we’re talking about serious money here.

If you’re wondering what these companies hope to accomplish, it’s not surprising. There are so many possibilities. One place to start is rethinking the EHR. Maybe I’m a starry-eyed dreamer, but I agree with observers like Dale Sanders, an executive with HealthCatalyst, who argues that Silicon Valley disrupters might be poised to bring something new to the table. “I keep hoping that the Googles, Facebooks and Amazons of the world will quietly build a new generation EMR,” Sanders writes in a recent column.

EMR transformation is just one of many potential targets of opportunity for the Silicon Valley gang, though. There’s obviously a raft of other goals healthcare leaders might like to see realized, The truth is, though, that it matters less what the Silicon Valley giants do than the competitive scramble they kick off within the industry. Even if these behemoths never succeed in leading the charge, they’re likely to spur others to do so.

Does NLP Deserve To Be The New Hotness In Healthcare?

Posted on August 30, 2018 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, I’ve been seeing a lot more talk about the benefits of using natural language processing technology in healthcare. In fact, when I Googled the topic, I turned up a number of articles on the subject published over the last several weeks. Clearly, something is afoot here.

What’s driving the happy talk? One case in point is a new report from health IT industry analyst firm Chilmark Research laying out 12 possible use cases for NLP in healthcare.

According to Chilmark, some of the most compelling options include speech recognition, clinical documentation improvement, data mining research, computer-assisted coding and automated registry reporting. Its researchers also seem to be fans of clinical trial matching, prior authorization, clinical decision support and risk adjustment and hierarchical condition categories, approaches it labels “emerging.”

From what I can see, the highest profile application of NLP in healthcare is using it to dig through unstructured data and text. For example, a recent article describes how Intermountain Healthcare has begun identifying heart failure patients by reading data from 25 different free text documents stored in the EHR. Clearly, exercises like these can have an immediate impact on patient health.

However, stories like the above are actually pretty unusual. Yes, healthcare organizations have been working to use NLP to mine text for some time, and it seems like a very logical way to filter out critical information. But is there a reason that NLP use even for this purpose isn’t as widespread as one might think? According to one critic, the answer is yes.

In a recent piece, Dale Sanders, president of technology at HealthCatalyst, goes after the use of comparative data, predictive analytics and NLP in healthcare, arguing that their benefits to healthcare organizations have been oversold.

Sanders, who says he came to healthcare with a deep understanding of NLP and predictive analytics, contends that NLP has had ”essentially no impact” on healthcare. ”We’ve made incremental progress, but there are fundamental gaps in our industry’s data ecosystem– missing pieces of the data puzzle– that inherently limit what we can achieve with NLP,” Sanders argues.

He doesn’t seem to see this changing in the near future either. Given how much money has already been sunk in the existing generation of EMRs, vendors have no incentive to improve their capacity for indexing information, Sanders says.

“In today’s EMRs, we have little more than expensive word processors,” he writes. “I keep hoping that the Googles, Facebooks and Amazons of the world will quietly build a new generation EMR.” He’s not the only one, though that’s a topic for another article.

I wish I could say that I side with researchers like Chilmark that see a bright near-term future for NLP in healthcare. After all, part of why I love doing what I do is exploring and getting excited about emerging technologies with high potential for improving healthcare, and I’d be happy to wave the NLP flag too.

Unfortunately, my guess is that Sanders is right about the obstacles that stand in the way of widespread NLP use in our industry. Until we have a more robust way of categorizing healthcare data and text, searching through it for value can only go so far. In other words, it may be a little too soon to pitch NLP’s benefits to providers.

Can Providers Survive If They Don’t Get Population Health Management Right?

Posted on August 27, 2018 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.

Most providers know that they won’t succeed with population health management unless they get some traction in a few important areas — and that if not, they could face disaster as their volume of value-based payment share grows. The thing is, getting PHM right is proving to be a mindboggling problem for many.

Let’s start with some numbers which give us at least one perspective on the situation.

According to a survey by Health Leaders Media, 87% of respondents said that improving their population health management chops was very important. Though the article summarizing the study doesn’t say this explicitly, we all know that they have to get smart about PHM if they want to have a prayer of prospering under value-based reimbursement.

However, it seems that the respondents aren’t making nearly as much PHM progress as they’d like. For example, just 38% of respondents told Health Leaders that they attributed 25% or more of their organization’s net revenue to risk-based pop health management activities, a share which has fallen two percent from last year’s results.

More than half (51%) said that their top barrier to successfully deploying or expanding pop health programs was up-front funding for care management, IT and infrastructure. They also said that engaging patients in their own care (45%) and getting meaningful data into providers’ hands (33%) weren’t proving to be easy tasks.

At this point it’s time for some discussion.

Obviously, providers grapple with competing priorities every time they try something new, but the internal conflicts are especially clear in this case.

On the one hand, it takes smart care management to make value-based contracts feasible. That could call for a time-consuming and expensive redesign of workflow and processes, patient education and outreach, hiring case managers and more.

Meanwhile, no PHM effort will blossom without the right IT support, and that could mean making some substantial investments, including custom-developed or third-party PHM software, integrating systems into a central data repository, sophisticated data analytics and a whole lot more.

Putting all of this in place is a huge challenge. Usually, providers lay the groundwork for a next-gen strategy in advance, then put infrastructure, people and processes into place over time. But that’s a little tough in this case. We’re talking about a huge problem here!

I get it that vendors began offering off-the-shelf PHM systems or add-on modules years ago, that one can hire consultants to change up workflow and that new staff should be on-board and trained by now. And obviously, no one can say that the advent of value-based care snuck up on them completely unannounced. (In fact, it’s gotten more attention than virtually any other healthcare issue I’ve tracked.) Shouldn’t that have done the trick?

Well, yes and no. Yes, in that in many cases, any decently-run organization will adapt if they see a trend coming at them years in advance. No, in that the shift to value-based payment is such a big shift that it could be decades before everyone can play effectively.

When you think about it, there are few things more disruptive to an organization than changing not just how much it’s paid but when and how along with what they have to do in return. Yes, I too am sick of hearing tech startups beat that term to death, but I think it applies in a fairly material sense this time around.

As readers will probably agree, health IT can certainly do something to ease the transition to value-based care. But HIT leaders won’t get the chance if their organization underestimates the scope of the overall problem.

The Cultural Nuances of Communication

Posted on August 23, 2018 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 amazing some of the insights you can get from Twitter. This is especially true when someone puts together a series of tweets (most people call them a tweetstorm) that shares a story or insights on a specific topic. Today, I gained some new insight into the cultural nuances of communication in this Twitter thread:

Why we need more black men in medicine. I had a patient this week who came in with left leg weakness over the last week. Younger black guy in his 30s. Brain MRI clearly indicates multiple sclerosis. So we all go in during morning rounds to give my man his diagnosis.

He has a bit of blank stare as he listens to my attending try to explain what he has. He was told earlier he mightve had a stroke, and now we’re telling him he doesnt have a stroke. But he’s clearly processing what he does have and just says “nah” to having any questions.

So we’re running the patient list after rounding, and as we get to him my attending says somn like “idk if apathy is the word, seems like he doesnt care”. Laughs and so does the rest of the team. I’m sitting there like, this aint it. And yes, I was the only one.

So after running the list, I don’t even stick around with the team. I go straight back to dude’s room and the code switch was automatic. “Look mane, I know all that was a lot. Did you really get what the doc was sayin?” Mans looked at me with a face of relief.

Now I’m goin into detail on MS, how it’s different from a stroke, and what it means for him long term. The real validation came when he interrupted me early on and said “OH so it’s a BRAIN thing I got?” “Yes my man it’s a brain thing.”

And now my dude understands what he has, why we need the tests we need, and what the rest of his life might look like. All because I could recognize what everyone else seemed to miss, from a cultural perspective. He’s not apathetic. Folk just weren’t connecting with him.

I’m in the right field fam.

We definitely underestimate the nuances required to communicate effectively across cultures. It’s such an important nuance that’s often missed. As we start to automate more of our healthcare communication with chat bots and other AI empowered communication, I wonder if we’ll take some of these cultural nuances into account. That’s a really challenging problem, but something we should consider a lot more in our healthcare communication.