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Infographic – Practical Interoperability in Healthcare

Posted on October 22, 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.

The team at HULFT sent me their new infographic that identifies the stakeholders that should be “at the table” to set your organization’s data sharing and interoperability policies.

There are a couple of things I really like about this infographic.

First, I like the mixture of disciplines and backgrounds that HULFT has identified as data stakeholders. There are people you would expect to see around the table like the CIO, CSO, Privacy Officer, COO, etc. But there are others who are a bit of a surprise: the Revenue Cycle Manager, Pharmacy Benefits Leader, Nurse Practitioner Informaticists, and Care Management Director.

The Care Management Director is an especially welcome inclusion. Without interoperability coordinating patient care is time consuming, frustrating for everyone involved and fraught with errors (medicine reconciliation anyone?). When I think about the need for interoperability, care coordination is what come springs to mind.

The second thing I like about this infographic is the consistency of the visual. The avatars seated at the miniature table at the top are the same as the enlarged versions underneath. This attention to visual detail appeals to the healthcare marketer in me.

Enjoy.

Rolling Over Mountains – An Interview with Niko Skievaski, President of Redox

Posted on October 16, 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.

Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their President and Co-Founder, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.

Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.

The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.

Skievaski and I had a wide-ranging conversation. I hope you enjoy it.

You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.

You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.

I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?

I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.

All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.

You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.

There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?

We do things fundamentally differently than existing vendors in the integration space.

In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.

Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.

Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.

I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.

One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?

We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.

Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.

The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.

Is there an ideal type of HealthIT company that Redox likes to work with?

With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.

Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.

Can you give me an example of an advantage Redox enjoys because you are cloud-based?

By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.

Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.

For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.

This level of integration is just not possible without being in the cloud.

One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?

I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.

I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.

The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.

When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.

I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.

Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?

Neither. It’s a business model problem.

There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.

Interoperability is the right thing to do, but it’s a hard thing to do.

What do you wish you could do with an EHR company that you cannot do today?

The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.

I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.

For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?

What’s next for Redox?

We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.

 

This may sound like a tall order, but maybe not for someone who rolls over mountains on a bike for fun.

[Update: Niko Skievaski’s title which was incorrectly reported as CEO. Skievaski is Redox’s President and Co-Founder]

The Importance of Nurses in Healthcare – #HITsm Chat Topic

Posted on October 9, 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 10/12 at Noon ET (9 AM PT). This week’s chat will be hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network (@HMNwriters) on the topic of “The Importance of Nurses in Healthcare”.

It’s time for #NursingNow. Nurses need to have a solid place at the table – from the C-Suite to Management, Entrepreneurs to Digital Health Innovators.  In collaboration with the World Health Organization and the International Council of Nurses, Nursing Now aims to raise the status and profile of nursing globally.  Nursing Now works to empower nurses to take their place at the heart of tackling 21st Century health challenges.

In this #HITMC chat, Carol Bush (@TheSocialNurse) and Janet Kennedy (@GetSocialHealth) will lead a discussion on Nurse Leadership and how every part of healthcare needs nurses to be present and actively involved.

Resources:

Topics for this week’s #HITsm Chat:
T1: Nurses have always been the backbone of healthcare. Do you think they have a large enough role in healthcare leadership? Why or why not? #HITsm

T2: Should the push to get more nurses in leadership come from nurses or other members of the healthcare team? Why do you think so? #HITsm

T3: Traditional concepts of a nurse’s role have changed over the past decade. What new career paths have you seen nurses take? #HITsm

T4: In a health system or practice setting, in what ways have nurses expanded their roles? #HITsm

T5: Nurses have been embracing entrepreneurship, both inside and outside of healthcare. What characteristics of nursing lend themselves to entrepreneurship? #HITsm

Bonus: Share your favorite nurse story. #HITsm

Upcoming #HITsm Chat Schedule
10/19 – Government Regulations for Healthcare – Where Are We At and Where Are We Headed?
Hosted by John Lynn (@techguy)

10/26 – TBD
Hosted by @bigdatadavid13

11/2 – TBD
Hosted by TBD

11/9 – TBD
Hosted by @technursejon

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Is FHIR Adoption At A Turning Point, Or Is This Just More Hype?

Posted on October 8, 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.

Over the last few years, healthcare industry players have continued to experiment with the use of HL7 FHIR to solve key interoperability problems.

Perhaps the most recent efforts to do so is the Da Vinci Project, which brings together a group of payers, health IT vendors, and providers dedicated to fostering value-based care with FHIR. The group has begun work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery.

This wasn’t big news, as it doesn’t seem to be doing anything that new. In fact, few if any of these projects — of which there have been many — have come close to establishing FHIR firmly established as a standard, much less fostering major change in the healthcare industry.

Now, a new analysis by the ONC suggests that we may finally be on the verge of a FHIR breakthrough.

According to ONC’s research, which looked at how health IT developers used FHIR to meet 2015 Edition certification requirements, roughly 32% of the health IT developers certified are using FHIR Release 2, and nearly 51% of health IT developers seem to be using a version of FHIR combined with OAuth 2.0.

While this may not sound very impressive (and at first glance, it didn’t to me), the certified products issued by the top 10 certified health IT developers serve about 82% of hospitals and 64% of clinicians.

Not only that, big tech companies staking out an expanded position in healthcare are leveraging FHIR 2, the ONC notes. For example, Apple is using a FHIR-based client app as part of its healthcare deployment.  Amazon, Alphabet, and Microsoft are working to establish themselves in the healthcare industry as well, and it seems likely that FHIR-based interoperability will come to play a part in their efforts.

In addition, CMS has shown faith in FHIR as well, investing in FHIR through its Blue Button 2.0,  a standards-based API allowing Medicare beneficiaries to connect their claims data to applications, services, and research programs.

That being said, after citing this progress, the agency concedes that FHIR still has a way to go, from standards development implementation, before it becomes the lingua franca of the industry. In other words, ONC’s definition of “turning point” may be a little different than yours or mine. Have I missed something here?

Look, I don’t like being “that guy,” but how encouraging is this really? By my standards at least, FHIR uptake is relatively modest for such a hot idea. For example, compare FHIR adoption of AI technology or blockchain. In some ways, interoperability may be a harder “get” than blockchain or AI in some ways, but one would think it would be further along if it were completely practical. Maybe I’m just a cynic.

Medication Compliance & Drug Monitoring – #HITsm Chat Topic

Posted on October 3, 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 10/5 at Noon ET (9 AM PT). This week’s chat will be hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth) on the topic of “Medication Compliance & Drug Monitoring”.

One of the most effective medical interventions to significantly improve the health of patients doesn’t require the latest technology or expensive medication but simply involves helping them take their existing medication as prescribed.

It’s not a light topic, but we believe that people can benefit from more awareness about their actual risks, as opposed to sensationalized risks that make good stories for the popular media.

  • Between 41% and 59% of mentally ill patients take their medication infrequently or not at all.
  • Examples of common non-adherence behaviors include:
    • 1 in 2 people missed a dose
    • 1 in 3 forgot if they took the med
    • 1 in 4 did not get a refill on time

Medication non-adherence is an enormous problem that is still largely unaddressed by the healthcare system, but it’s not totally out of our control. Join us for this week’s #HITsm chat as we talk about medication compliance and drug monitoring.

Topics for this week’s #HITsm Chat:
T1: In what ways has medication non-compliance affected you or anyone you know? Professional or Personal. Can be acute or episodic… #HITsm

T2: Why didn’t the patient adhere? Was there a social determinant? An issue with side effects, access or money? Possible Rx abuse? #HITsm

T3: We know communication with healthcare professionals is key in patient’s adherence and that Medication Reconciliation is gaining traction with MIPS, etc., but are providers going into this level of detail (see example) to ensure patients truly understand why they need to take the meds they are prescribed? Why or why not? #HITsm

T4: Beyond condition management, what impact do you think medication non-compliance has on society as a whole? #HITsm

T5: What ideas & thoughts do you have around strategies for improving medication compliance? Have you come across any impactful strategies or workflows? #HITsm

Bonus: What technology do you think could help with these challenges? #HITsm

Upcoming #HITsm Chat Schedule
10/12 – The Importance of Nurses in Healthcare
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

How Does Interoperability Affect Technology Adoption in Healthcare? – #HITsm Chat Topic

Posted on September 25, 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/28 at Noon ET (9 AM PT). This week’s chat will be hosted by Niko Skievaski @niko_ski from @redox.

In her opening remarks at the 2nd ONC Interoperability Forum, Centers for Medicaid and Medicare (CMS) Administrator Seema Verma set the goal of eliminating the use of fax machines in healthcare by 2020. It’s true – fax is still the most common form of communication among providers for transmission of medical records, test results, instructions, and treatment regimens all thanks to its insusceptibility to hacking. While the rest of the world is embracing digitalization and the benefits it has brought us, healthcare seemed a bit reluctant about moving on. Fax or other paper-based records are largely inconvenient and created barriers to information exchange.

In the era of artificial intelligence and machine learning, we’re generating data in an unbelievable speed – more information to process, exchange and analyze, posing bigger challenges for snail-paced interoperability progress. Tech giants see this lack of interoperability as a perfect opportunity to enter healthcare and disrupt the “broken” industry. Apple Health is promoting open API for iOS users to own their health data; Amazon’s working with multiple healthcare organizations to build its own system; and the recent interoperability pledge by the six big companies is set to transform healthcare data infrastructure.

Coming from an outsider perspective, these companies are familiar with the user authorization approach. When you sign in to an app with your Google account, you’ll be asked to grant the app access to your information through an authentication protocol called OAuth 2.0. Ideally, this is the vision for healthcare data use in the future.

But the existing healthcare data infrastructure, in the meantime, is drastically different from the one these tech giants are familiar with. Perhaps a more realistic, pragmatic approach is to work with the established stakeholders in healthcare, particularly the big EHR vendors, instead of bringing in a whole new system to solve interoperability.

Join us for this week’s #HITsm chat to discuss interoperability’s impact on technology adoption in healthcare and share your opinions on what stakeholders need to do to improve interoperability and accelerate technology adoption.

Topics for this week’s #HITsm Chat:
T1: What are the biggest barriers to technology adoption in healthcare? #HITsm

T2: Is interoperability more challenging now with more data generated by technologies such as AI? #HITsm

T3: Will patient-authorized API access bring fundamental changes to interoperability? #HITsm

T4: How will tech giants’ move into healthcare impact interoperability? #HITsm

T5: What needs to be done by the established stakeholders in healthcare, e.g. EHR vendors, to solve interoperability? #HITsm

Bonus: What do you want as a patient when it comes to interoperability? #HITsm

Upcoming #HITsm Chat Schedule
10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

10/12 – TBD
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

A Caregiver’s Perspective on Patient Engagement

Posted on August 20, 2018 I Written By

The following is a guest blog post by Michael Archuleta, Founder and CEO of ArcSYS, where he shares his experience as a caregiver for his father trying to navigate the healthcare system.

My dad is 99 years old. Having moved him to Utah 6 months ago into a retirement home, our first step was to get an appointment with a new primary care physician. I brought along a list of his medications and watched the nurse tediously look up and enter each into the EHR. Dad and the doctor got along great on that first visit. She assured us that she could help manage his medications. There was nothing realistically that could be done to really improve quality of life. When you’re 99, you’re stuck.

Around the middle of March Dad noticed blood and clots in his urine. Off to the primary care provider we went. They took a sample of urine, tested it, and there was no sign of an infection. Maybe we should look up a specialist in urology. A referral was given and a few days later the urology practice contacted us to make an appointment. Dad declined.

He didn’t want to see another doctor. Period. But day by day, the blood was always present in the urine. He started to worry and finally relented to going to the urologist. Off to the new doctor. Oh, yes, I brought along the list of medications and watched another nurse go to the process of keying them in.

The next day, I got an email via Updox saying there was a message from Dad’s doctor. Updox?? Really?? That was pretty cool. After being on the front end where our EMR system (Red Planet) uploads everything, this was interesting to see how another EMR system was employing Updox. Sure enough, there was the urologist’s note that had been completed 3 hours after the appointment. But, as I read it, I couldn’t help feel a little disappointed. A boilerplate. Since I had been in the room, I knew what was asked. Some questions were never asked and obviously inferred. Maybe a minor point, but I knew it. Anyway, the recommendation was to get an ultrasound. Off to another provider!

Within one day another message alert came from Updox. On logging into the Updox account, there was the report from radiology. Good news, nothing out of the ordinary.

A week passed and it was back to the urologist for a cystoscopy. I was in the room with Dad while the doctor performed the procedure. “Want to see this tumor?” the doctor asked me. “Sure.” I replied. Through the scope I could see a dark mass on the wall of the bladder. The recommendation was to perform surgery to remove the mass and biopsy it.

Another alert came through within a day via Updox. Still the same boilerplate style with default answers. Oh well, if nothing else it was timely.

On May 21 the procedure was done at an outpatient surgical facility. This time I was lucky: No one had to enter the list of medications. From here, unfortunately, things started to go downhill. Dad was left with a catheter and a bag which became his (our) buddy for 10 days. The unfortunate thing was being confined to his room. He could (would) not walk to the dining room at the retirement facility for his meals. So the meals were brought to him each day in a white clam shell styrofoam container. One piece of good news was delivered via Updox, the biopsy was benign.

Once the catheter was removed, he could be mobile, but was too weak to walk. He languished in his room. I coaxed him to try walking. No result. Others in my family encouraged him with the same non-result. I finally took him back to the primary care doctor. One look at him, and she noticed that the spark of life had been extinguished. She took me aside and asked if she needed to play hard ball with him. “You bet” was my response. In a firm way she told Dad that if he didn’t start walking he was going to be dead in 3 months.

That was the trick. Dad was furious that a doctor would be so “unprofessional” as to say anything like that. As soon as we arrived at the retirement home he pushed his walker half way down the hallway just to prove he could walk just fine, thank you. (Mission accomplished.)

But when you’re 99, the body just doesn’t really get better. There was still blood and clots, but were told that would be expected. A couple of weeks later he calls me to say he was in excruciating pain and can’t pee. By the time I arrive the pain was so bad I need to get a hold of the paramedics. They show up in 5 minutes and whisk him to the ER.

Fortunately, the ER has his list of medications so I’m spared having to go through that process. The doctor on call briefly examined him and turned control over to the nurse. A few hours later we have our “friends” the catheter and bag and head home. At least he was committed to walking to the dining room.

A couple of weeks pass and I received a phone call from the paramedics who inform me that Dad had a fall on his way to breakfast. They are transporting him to the ER. He was diagnosed at the ER with a bladder infection and they are concerned about his cardiac functions. Lab results also indicate e. coli and sepsis. Since they don’t have an on-site cardiologist, he was transferred to another hospital and admitted. And, yes, we have to go through the whole list of medications there because they don’t have access to that information? Go figure.

He hated the hospital. There was no rest. Every hour someone was taking vitals, getting him up, doing this, doing that. He was desperate for sleep and rest. At discharge, the cardiologist gave me explicit verbal instructions to take him off his Furosemide. She also gave orders for home nursing and physical therapy.

Whew. He was back home but again too weak to walk to the dining room. The Updox report came through and the written instructions by the cardiologist tell him to continue all meds including Furosemide. Really? Did she forget what she told me. Did she not take her own notes? The nurse showed up at his apartment, took lots of notes, asked lots of questions and examined him. Hmm. Concerned about the swelling in his feet and ankles. It was bad. We confer and decided the Furosemide needed to be restarted. The nurse reached out to the PCP who concurred.

Over the next 3 weeks the swelling slowly receded. The nurse and physical therapist helped him but the improvement was ever so slow.

What I have experienced was a medical world of silos. Each health care provider focused on just what they do. The urologist was pleased with surgery and how well it turned out. But he didn’t have to deal with 3 months of bags, styrofoam meals, ER visits, depression and hospitalizations. None of the doctors conferred with each other about the best treatment. The number of times I filled out past medical histories was finger-numbing. The written documentation didn’t accurately match what took place or what was verbally instructed. The cardiologist was adamant about the meds which would be best for his heart. Within each silo the people were very kind, compassionate, caring and professional. But, the EHR systems just seemed to get in the way of real care. Yes, INDIVIDUALLY, everything was working, but PEOPLE and their SYSTEMS were not interacting to solve the problem.

On the up-side, not one out-of-pocket penny was spent by way of the Medicare Advantage plan. Insurance and billing performed flawlessly. A little over $65,000 was billed and $12,000 was paid.

Clearly, providing health care is not easy. Maybe things should have been done differently. This was a relatively simple issue, but there was no clear direction. Will any healthcare administrator ever be aware of this situation? Probably not. Will any insurance company ever study this case? Doubtful. In hindsight, it would have been just as easy for me to pass out copies of medications and histories and have people tape them to the wall. A few phone calls between providers would certainly have come up with a better solution. But here we are down the road and Dad is not a happy camper.

Is anybody listening?

Seema Verma Calls for the End of Fax in Healthcare – Here’s The Real Problem

Posted on August 10, 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.

In case you missed it, CMS Administrator, Seema Verma challenged the audience at the Interop Forum hosted by ONC to “make every doctor’s office fax free by 2020.” Many in healthcare celebrated this challenge with statements like the following:

“It is inconceivable that providers still rely on technology that should have faded away at least 10 years ago.”

Statements like this make it seem like doctors and other healthcare leaders are luddites that are holding on to their fax machine out of some principal. They make it sound like healthcare professionals love their fax machines. Let me assure you that neither thing is the case. The reason faxes are so prominent in healthcare is a complex issue. However, the core problem is that there’s no better solution.

Everyone calls for the end of faxes in healthcare. The problem with this is that when you slam faxes, you’re slamming the most interoperable piece of healthcare. That’s sad, but true.

Faxes aren’t the problem. The lack of better solutions is the problem. So, instead of slamming fax machines, we should better understand the qualities that make faxes the interoperability choice of healthcare.

Here’s a look at why fax is so common in healthcare:
Faxes are HIPAA Compliant – The reality is that case law and other HHS comments have declared Faxes to be HIPAA compliant. That’s not to say that faxes are secure. We could talk over whether it’s secure or not and even edge cases where it’s still not HIPAA compliant. However, what’s clear to everyone in healthcare is that you can fax PHI and there’s no HIPAA violation. At least that’s the perception and how people treat it in action. This is a powerful idea that can’t be understated. Perceptions deeply influence people’s behaviors. Especially in risk-averse doctors’ offices.

Published Fax Numbers – Every practice has a fax machine and they all publish their fax number on their website. Thanks to Google, there’s basically an online directory where I can search any doctor and find their fax number.

Faxes Are Standard – Unlike so many other healthcare interoperability standards, every fax machine knows how to call and talk with another fax machine. There’s no need to ask what version or flavor of the fax standard you are using. There’s no need to ask where you’re storing certain information. Every fax uses the same standard and delivers the same result regardless of organization.

Every Practice Has a Fax Workflow In most cases, practices have their fax machines integrated directly into their EHR. Regardless, they all have some workflow that gets from the fax machine to the provider. Don’t underestimate the power of this workflow.

Faxes are Free – Ok, this has evolved a little over the years as healthcare organizations have moved to secure fax and fax servers which might charge a monthly fee. However, faxes are relatively cheap and have a known cost structure behind them. In many cases, it’s a cost that’s already been incurred. There’s no incremental cost to send more faxes.

That’s a pretty compelling feature set and I’m sure I’ve missed something. If healthcare provided a solution that offered all of these things, healthcare organizations would happily take this replacement. Plus, a replacement could and should do things that faxes don’t do like granular data.

However, direct messaging taught us a really important lesson about granular data which also highlights why fax machines are still so popular and direct messaging is not. Machines love granular data. That’s why machines are ok with a massive CCDA document that’s chock full of data. However, those CCDA documents are almost impossible for a human to read and cause doctors to say that CCDA is an abomination that doesn’t improve care. They’re right if you’re talking about a human reading a CCDA.

Humans need healthcare documentation designed for humans! Leave the XML health data files to machines.

When you understand this idea, it’s easy to see why doctors still love to receive faxed notes and hate CCDAs. Faxed notes are generally human-readable documents (EHR note bloat aside). CCDAs are not. The ideal solution is that we could have both. We just haven’t gotten there yet, but we could get there if we could overcome many of the other compelling fax features listed above.

What About Patients?
There’s a common problem we have when discussing technology in healthcare. Healthcare is so complex that we often confuse various uses of the same technology. The fax machine is a great example. All of the above analysis was how healthcare providers use a fax machine to communicate with other healthcare providers and other healthcare organizations. All of these entities have a fax machine and know how to use it. This is why the fax is a compelling option in healthcare. However, when you add the patient to the mix, it changes the equation.

Many of the people who want to ax the fax are talking about it from the perspective of a patient. That’s a totally different equation than the one described above. Many patients don’t have fax machines anymore and they’re unlikely to ever get one. It’s not unreasonable to say that healthcare should abolish trying to fax healthcare information to patients. A fax is rarely the best workflow for a patient. Healthcare providers should consider patient-friendly options.

When talking about faxing, we need to separate the discussion of patient interoperability and provider interoperability. They are very different beasts and not separating them confuses the discussion.

Conclusion
All in all, Seema Verma can call for the end of fax until she’s blue in the face. Until there’s an alternative that’s better than the fax, we’re not going to see faxes out of healthcare. It’s no inconceivable or even ridiculous that healthcare organizations continue to use the best workflow they can find for their organization. In many cases today that workflow is the fax. Once that equation changes, every healthcare provider I know will change. I’ve never met a single provider that’s nostalgic for faxes. They hate them as much as the next person but don’t see a better option.

Of course, as Ed Gaines pointed out on Twitter, Seema may want to start by taking a good look in the mirror. How about CMS stops using fax as the only option for some of the things they do? Once CMS abolishes faxes from their organization, that will give her a more powerful platform to call on the rest of healthcare to do the same. Unfortunately, I think Seema will quickly realize that there’s a reason that faxes are still so popular, there’s nothing better.

If Seema does away with faxes in healthcare, she’ll be doing away with the only form of nationwide healthcare interoperability that we have today. What’s going to replace it?

5 Practical Use Cases Anchoring Blockchain in Healthcare

Posted on August 1, 2018 I Written By


The following is a guest blog post by David Houlding MSc CISSP CIPP, Principal Healthcare Industry Lead at Microsoft Health working specifically on the Azure Team.

The hardest thing about blockchain is not the technology. To be clear, there are many technical challenges that must be addressed to be successful with blockchain, and these are not trivial. However, even harder is building the network of healthcare organizations and trust to a point where they are willing to participate, connect, and transact.

Existing B2B Healthcare Networks

It is faster to apply blockchain to an existing B2B network of healthcare organizations than to build a new network around a new use case from scratch. This is why blockchain is first taking hold in healthcare in existing B2B networks where healthcare organizations already transact around a use case, albeit with a conventional “hub-and-spoke”, centralized architecture with a trusted intermediary. In some cases, these existing B2B networks are looser, with healthcare organizations collaborating ad-hoc as needed, even via antiquated technologies such as faxes, rather than fully automated and integrated systems.

Cost Reduction Value Prop

These business value propositions are driving blockchain forward in healthcare:

  1. Improving patient outcomes
  2. Reducing healthcare costs
  3. Improving patient experience, and engagement
  4. Improving healthcare worker experience

Amongst these, those that have a strong cost reduction value proposition have the most interest from healthcare organizations—most want to see a strong near-term ROI justification for participation.

Leading Use Cases for Blockchain in Healthcare

In this article I highlight 5 practical use cases—plus one emerging use case—where blockchain is taking hold. Here are the ways that blockchain is adding value in these networks:

  • Decentralization, avoiding the need for a central hub (and associated costs, delays, and single point of failure).
  • Improving trust through a shared immutable ledger.
  • Mitigating fraud through transparency of transactions.
  • Improving performance and efficiency.
  • Paving the way for new levels of automation and collaboration around smart contracts and DAOs (Decentralized Autonomous Organization).

1. Health Information Exchange

Currently, the healthcare industry experiences major inefficiencies due to diverse, uncoordinated and unconnected data sources and systems. Effective care collaboration is vital to improve healthcare outcomes. With digitized health data, the exchange of healthcare information across healthcare organizations is required.

Grapevine World is one of the leaders in the application of blockchain technology. They make use of the IHE methodology for interoperability, and multiple blockchains for tracking data provenance and providing a crypto token as means of exchange within their ecosystem.

2. Provider Directory

Healthcare organizations, including payers, must maintain directories of healthcare providers, or doctors. Today this is done redundantly across multiple organizations. Further, if these directories get out of sync, it can lead to issues such as claims bouncing. Through blockchains, provider directories can be maintained by various healthcare organizations in a shared, decentralized ledger. This reduces redundancies and inconsistencies, and thereby improves operational efficiencies (including around claims adjudication).

Optum is one of the leaders in applying blockchain technology to the directory use case.

3. Provider Credentialing

Doctors, nurses, and other healthcare workers must have credentials to provide healthcare. These credentials must be validated by every healthcare organization they practice at, and periodically thereafter, usually every two years. This creates a huge amount of redundant effort and cost, and often delays a doctor’s ability to practice at a new facility. Blockchain provides a way for healthcare organizations in a consortium to update doctors’ credentials. That includes the validations of those credentials, helping to eliminate redundant effort. Doctors will be able to practice at new facilities with minimal delay.

ProCredEx and Hashed Health are leaders in the application of blockchain technology to the provider credentialing use case.

4. Drug Supply Chain

Medications must be tracked from manufacturers (such as the big pharmaceuticals), through distributors, to dispensaries (such as pharmacies). This enables the pharmacist, patient, or family caregiver to verify the authenticity, provenance, and safety of the product. It helps reduce drug counterfeiting and enables improved operational efficiencies, with associated cost reductions. Blockchain is particularly well suited to applications that require tracking of items across organizations. Regulations such as DSCSA also require tracking of drugs through the supply chain. And compliance with these regulations provides an additional incentive, or forcing function for the adoption of blockchain.

Adents and the C4SCS (Center for Supply Chain Studies) are leaders in the application of blockchain technology to the drug supply chain use case.

5. Medical Device Track and Trace

This is another example of a supply chain use case; except medical devices are being tracked, rather than drugs. Devices can range from implantables to MRI machines. The idea is to track these across the supply chain and throughout their life cycles, or even multiple life cycles as they are resold and reused. Such tracking enables fast response to recalls, thereby improving patient safety and operational efficiency. It enables one to monitor the maintenance of these devices over their lifetime—which can also help improve quality, and patient  outcomes.

Spiritus Partners is a leader in the application of blockchain technology to the medical device track and trace use case in healthcare.

Emerging: Anti-Fraud

Anti-fraud is another use case that is starting to take hold in healthcare. It is interesting both as a stand-alone use case (of particular interest to healthcare payers), and as a more general business value enabled by blockchain. Fraud prevention is attractive across most other use cases for blockchain in healthcare. For example, blockchain can help mitigate counterfeiting fraud in the drug supply chain use case. Blockchain has major potential to block fraud through:

  • Immutability (transactions cannot be altered)
  • Improving detection through transparency
  • Advancing artificial intelligence used for anti-fraud

For more on this use case and fundamental value of blockchain see Blockchain as a Tool for Anti-Fraud.

What other use cases do you see blockchain being applied to in healthcare? Welcome any comments, questions, or feedback you may have below. Blockchain in healthcare is fast evolving. I post updates extensively for blockchain in healthcare. Reach out to me on LinkedIn or Twitter.

About David Houlding
David Houlding is the Worldwide Healthcare Industry Leader on the Microsoft Azure Industry Experiences Team. David has more than 24 years of experience in healthcare spanning provider, payer, pharmaceutical, and life sciences segments worldwide, and has deep experience and expertise in blockchain, privacy, security, compliance, and AI / ML, and cloud computing. David also currently serves as Chair of the HIMSS Blockchain in Healthcare Task Force, a group of 50+ leaders from across healthcare worldwide, collaborating to advance blockchain in healthcare.

How Hospitals Can Drive Revenue in Value-Based Care Using 7 Key Cycles of Their Data

Posted on July 5, 2018 I Written By

The following is a guest blog post by Richard A. Royer, Chief Executive Officer of Primaris.

Back in the day – the late 1960s, when social norms and the face of America was rapidly changing – a familiar public service announcement began preceding the nightly news cast. “It’s 10 p.m. Do you know where your children are?”

Today, as the healthcare landscape changes rapidly with a seismic shift from the fee-for-service payment model to value-based care models, there’s a similar but new clarion call for quality healthcare: “It’s 2018. Do you know where your data is?”

Compliance with the increasingly complex alphabet soup of quality reporting and reimbursement rules – indeed, the fuel for the engine driving value-based car – is strongly dependent on data. The promising benefits of the age of digital health, from electronic health records (EHRs) to wearable technology and other bells and whistles, will occur only as the result of accurate, reliable, actionable data. Providers and healthcare systems that master the data and then use it to improve quality of care for better population health and at less cost will benefit from financial incentives. Those who do not connect their data to quality improvement will suffer the consequences.

As for the alphabet soup? For starters, we’re as familiar now with these acronyms as we are with our own birth dates: MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), which created the QPP (Quality Payment Program), which birthed MIPS (Merit-based Incentive Payment System).

The colorful acronyms are deeply rooted in data. As a result, understanding the data life cycle of quality reporting for MACRA and MIPS, along with myriad registries, core measures, and others, is crucial for both compliance and optimal reimbursement. There is a lot at stake. For example, the Hospital Readmissions Reduction Program (HRRP) is an example of a program that has changed how hospitals manage their patients. For the 2017 fiscal year, around half of the hospitals in the United States were dinged with readmission penalties. Those penalties resulted in hospitals losing an estimated $528 million for fiscal year 2017.

The key to achieving new financial incentives (with red-ink consequences increasingly in play) is data that is reliable, accurate and actionable. Now, more than ever, it is crucial to understand the data life cycle and how it affects healthcare organizations. The list below varies slightly in order and emphasis compared with other data life cycle charts.

  • Find the data.
  • Capture the data.
  • Normalize the data.
  • Aggregate the data.
  • Report the data.
  • Understand the data.
  • Act upon the data.


One additional stage, which is a combination of several, is secure, manage, and maintain the data.

  • Find the data. Where is it located? Paper charts? Electronic health records (EHRs)? Claims Systems? Revenue Cycle Systems? And how many different EHRs are used by providers – from radiology to labs to primary care or specialists’ offices to others providing care? This step is even more crucial now as providers locate the sources of data required for quality and other reporting.
  • Capture the data. Some data will be available electronically, some can be acquired electronically, but some will require manual abstraction. If a provider, health system or Accountable Care Organization (ACO) outsources that important work, it is imperative that the abstraction partner understand how to get into each EHR or paper-recording system.
     
    And there is structured and unstructured data. A structured item in the EHR like a check box or treatment/diagnosis code can be captured electronically, but a qualitative clinician note must be abstracted manually. A patient presenting with frequent headaches will have details noted on a chart that might be digitally extracted, but the clinician’s note, “Patient was tense due to job situation,” requires manual retrieval.
  • Normalize the data. Normalization ensures the data can be more than a number or a note but meaningful data that can form the basis for action. One simple example of normalizing data is reconciling formats of the data. For example, a reconciling a form that lists patients’ last names first with a chart that lists the patients’ first name first. Are we abstracting data for “Doe, John O.” or “John O. Doe?” Different EHR and other systems will have different ways of recording that information.
     
    Normalization ensures that information is used in the same way. The accuracy and reliability that results from normalization is of paramount importance. Normalization makes the information unambiguous.
  • Aggregate the data. This step is crucial for value-based care because it consolidates the data from individual patients to groups or pools of patients. For example, if there is a pool of 100,000 lives, we can list ages, diagnosis, tests, clinical protocols and outcomes for each patient. Aggregating the data is necessary before healthcare providers can analyze the overall impact and performance of the whole pool.
     
    If a healthcare organization has quality and cost responsibilities for a pool of patients, they must be able to closely identify the patients that will affect the patient pool’s risks. Aggregation and analyzing provides that opportunity.
  • Report the data. Reporting of healthcare data to registries and the Centers for Medicare and Medicaid Services (CMS) is not new, but it is a growing need. Required reporting will become even more integral to health care quality improvement as private payers follow the CMS lead towards value-base care.
  • Understand the data. What was effective? What is the clinical point of view versus a dollars/cost point of view? How are these two points of view reconciled to get the “right” results?
     
    When Drug B is half the price but equally as effective as Drug A, that is an example of evidence-based medicine, which was the result of the data life cycle. When healthcare organizations and providers have data they can understand, a root cause analysis is an ideal way to achieve sometimes conflicting goals of quality and cost– and move forward – on solving deficiencies or other problems flagged by the data.
  • Use the data. There are other crucial facets of the data life cycle that must be dealt with, including data maintenance and management and purging or destroying data in a way that is compliant with HIPAA. But the most important function of data is using it to improve clinical processes and outcomes, the patient experience, and the financial bottom line.
     
    Data that is accurate and reliable is not all that useful until it is actionable. How is the data being used to manage quality of care and cost of care? The final stage in the data life cycle is certainly the most important. The technology and human capital needed to accomplish the other aspects of the life cycle are extensive, and expensive. But data gathering is a lost cause and, really, an exercise in futility unless the flurry of data and reporting activity leads to action. In the age of value-based healthcare, data is the key that will allow providers to be financially successful in the future as payments become more heavily based on value, and patients seek providers that meet their growing expectations.

About Primaris
Richard A. Royer, Chief Executive Officer of Primaris, a healthcare consulting and services firm that works with hospitals, physicians and nursing homes to drive better health outcomes, improve patient experiences and reduce costs.