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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.

Stanford Survey Generates Predictable Result: Doctors Want EHR Changes

Posted on June 11, 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.

I know you’re going to have trouble believing this, but many PCPs think EHRs need substantial changes.

Such is the unsurprising conclusion drawn by a survey conducted by The Harris Poll on behalf of Stanford Medicine. The poll, which took place between March 2 and March 27 of this year, surveyed 521 PCPs licensed to practice in the U.S. who have been using their current EHR system for at least one month.

The physicians were recruited via snail mail from the American Medical Association Masterfile. Figures for years in practice by gender, region and primary medical specialty were weighted where necessary to bring them into line with their actual proportions in the population of PCPs in the U.S.

According to the survey, about two-thirds of PCPs think EHRs have generally improved care (63%). Two-thirds said they were at least somewhat satisfied with their current systems, though only 18% were very satisfied.

Meanwhile, a total of 34% were somewhat or very dissatisfied with their system, and 40% of PCPs said that EHRs create more challenges than benefits. Also, 49% of office-based PCPs reported that using an EHR detracts from their clinical effectiveness.  Forty-four percent of PCPs said that primary value of EHRs is data storage, while just 8% said that the biggest benefits were clinically-related.

To improve EHRs’ clinical value, it will take a lot of effort, with 51% saying they think EHRs need a complete overhaul.  Seventy-two percent of PCPs said that improving user interfaces could best address their needs in the immediate future.

Meanwhile, 67% of respondents said that solving interoperability problems should be the top priority for EHR development over the next decade, and 43% reported wanting improved predictive analytics capabilities.

Nearly all (99%) of PCPs said that EHR capabilities should include maintaining a high-quality record of patient data over time, followed closely by providing an intuitive user experience. Also, 88% said that providing clinical decision support at the moment of care was important, followed by identifying high-risk patients in their patient panel (86%).

When asked what EHR features they found most satisfying, they cited maintaining a high-quality patient record (73%), offering patients access to medical records (71%), sharing information with providers across the care continuum (65%) and supporting practice/revenue cycle management needs (60%).

However, EHRs still have a long way to go in offering other preferred capabilities, including changing and adapting in response to user feedback, improving patient-provider interaction, coordinating care for patients with complex conditions and engaging patients in prescribed care plans through mobile technologies. Vendors, you have been warned.

How Do You Make Health Data Useful to Individuals?

Posted on May 2, 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.

The healthcare world is flush with data and every health system seems to have a portal to access some of that data. However, far too often that data sits unused and never becomes useful for patients. At the #HIMSS18 conference, Healthcare Scene talked with Mike O’Neill, Chief Executive Officer at MedicaSoft, and Randy Farmer, Chief Operating Officer at Delaware Health Information Network (DHIN) to talk about their unique approach to the personal health record and how access to this data is beneficial to patients.

Mike and Randy address the questions of whether DHIN members find access to their data useful and in which ways they find it useful. We talk about HIE sustainability and how a proper patient portal that provides value to patients is one important element to becoming sustainable. If you want to learn more about how technology can help make data useful to individual patients, watch the video interview below:

What do you think of Medicasoft and DHIN’s approach? Do you wish more healthcare organizations and HIEs should be working similar to this? Is there something holding them back? Why haven’t most organizations embraced new technology and patient access to data? Please share your thoughts in the comments or on Twitter with @HealthcareScene and @MedicaSoftLLC

Want to find more great healthcare IT interviews, be sure to subscribe to Healthcare Scene on YouTube or peruse all of Healthcare Scene’s video interviews.

*Medicasoft is a sponsor of Healthcare Scene.

More Ways AI Can Transform Healthcare

Posted on April 25, 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.

You’ve probably already heard a lot about how AI will change healthcare. Me too. Still, given its potential, I’m always interested in hearing more, and the following article struck me as offering some worthwhile ideas.

The article, which was written by Humberto Alexander Lee of Tesser Health, looks at ways in which AI tools can reduce data complexity and detect patterns which would be difficult or even impossible for humans to detect.

His list of AI’s transformative powers includes the following:

  • Identifying diseases and providing diagnoses

AI algorithms can predict when people are likely to develop heart disease far more accurately than humans. For example, at Google healthcare technology subsidiary Verily, scientists created an algorithm that can predict heart disease by looking at the back of a person’s eyes and pinpoint early signs of specific heart conditions.

  • Crowdsourcing treatment options and monitoring drug response

As wearable devices and mobile applications mature, and data interoperability improves thanks to standards such as FHIR, data scientists and clinicians are beginning to generate new insights using machine learning. This is leading to customizable treatments that can provide better results than existing approaches.

  • Monitoring health epidemics

While performing such a task would be virtually impossible for humans, AI and AI-related technologies can sift through staggering pools of data, including government intelligence and millions of social media posts, and combine them with ecological, biogeographical and public health information, to track epidemics. In some cases, this process will predict health threats before they blossom.

  • Virtual assistance helping patients and physicians communicate clearly

AI technology can improve communication between patients and physicians, including by creating software that simplifies patient communication, in part by transforming complex medical terminology into digestible information. This helps patients and physicians engage in a meaningful two-way conversation using mobile devices and portals.

  • Developing better care management by improving clinical documentation

Machine learning technology can improve documentation, including user-written patient notes, by analyzing millions of rows of data and letting doctors know if any data is missing or clarification is needed on any procedures. Also, Deep Neural Network algorithms can sift through information in written clinical documentation. These processes can improve outcomes by identifying patterns almost invisible to human eyes.

Lee is so bullish on AI that he believes we can do even more than he has described in his piece. And generally speaking, it’s hard to disagree with him that there’s a great deal of untapped potential here.

That being said, Lee cautions that there are pitfalls we should be aware of when we implement AI. What risks do you see in widespread AI implementation in healthcare?

Designing for the Whole Patient Journey: Lumeon Enters the US Health Provider Market

Posted on April 23, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Lots of companies strive to unshackle health IT’s potential to make the health care industry more engaging, more adaptable, and more efficient. Lumeon intrigues me in this space because they have a holistic approach that seems to be producing good results in the UK and Europe–and recently they have entered the US market.

Superficially, the elements of the Lumeon platform echo advances made by many other health IT applications. Alerts and reminders? Check. Workflow automation? Check. Integration with a variety of EHRs? Of course! But there is something more to Lumeon’s approach to design that makes it a significant player. I had the opportunity to talk to Andrew Wyatt, Chief Operating Officer, to hear what he felt were Lumeon’s unique strengths.

Before discussing the platform itself, we have to understand Lumeon’s devotion to understanding the patient’s end-to-end experience, also sometimes known as the patient journey. Lumeon is not so idealistic as to ask providers to consider a patient’s needs from womb to tomb–although that would certainly help. But they ask such questions as: can the patient physically get to appointments? Can she navigate her apartment building’s stairs and her apartment after discharge from surgery? Can she get her medication?

Lumeon workflow view

*Lumeon workflow view

Such questions are the beginning of good user experience design (UX), and are critical to successful treatment. This is why I covered the HxRefactored conference in Boston in 2016 and 2017. Such questions were central to the conference.

It’s also intriguing that criminal justice reformers focus attention on the whole sequence of punishment and rehabilitation, including reentry into mainstream society.

Thinking about every step of the patient experience, before and after treatments as well as when she enters the office, is called a longitudinal view. Even in countries with national health care systems, less than half the institutions take such a view, and adoption of the view is growing only slowly.

Another trait of longitudinal thinking Wyatt looks for is coordinated care with strong involvement from the family. The main problem he ascribed to current health IT systems is that they serve the clinician. (I think many doctors would dispute this, saying that the systems serve only administrators and payers–not the clinician or the patient.)

Here are a couple success stories from Wyatt. After summarizing them, I’ll look at the platform that made them possible.

Alliance Medical, a major provider of MRI scans and other imaging services, used Lumeon to streamline the entire patient journey, from initial referral to delivery of final image and report. For instance, an online form asks patients during the intake process whether the patient has metal in his body, which would indicate the use of an alternative test instead of an MRI. The next question then becomes what test would meet the current diagnostic needs and be reimbursed by the payer. Lumeon automates these logistical tasks. After the test, automation provided by the Lumeon platform can make sure that a clinician reviews the image within the required time and that the image gets to the people who need it.

Another large provider in ophthalmology looked for a way to improve efficiency and outcomes in the common disease of glaucoma, by putting images of the eye in a cloud and providing a preliminary, automated diagnosis that the doctor would check. None of the cloud and telemedicine solutions covered ophthalmology, so the practice used the Lumeon platform to create one. The design process functioned as a discipline allowing them to put a robust process for processing patients in place, leading to better outcomes. From the patient’s point of view, the change was even more dramatic: they could come in to the office just once instead of four times to get their diagnosis.

An imaging provider found that they wasted 5 to 10 minutes each time they moved a machine between an upper body position and a lower body position. They saved many hours–and therefore millions of dollars–simply by scheduling all the upper body scans for one part of the day and all lower body scans for another. Lumeon made this planning possible.

In most of the US, value-based care is still in its infancy. The longitudinal view is not found widely in health care. But Wyatt says his service can help businesses stuck in the fee-for-service model too. For example, one surgical practice suffered lots of delays and cancellations because the necessary paperwork wasn’t complete the day before surgery. Lumeon helped them build a system that knew what tests were needed before each surgery and that prompted staff to get them done on time. The system required coordination of many physicians and labs.

Another example of a solution that is valuable in fee-for-service contexts is creating a reminder for calling colonoscopy patients when they need to repeat the procedure. Each patient has to be called at a different time interval, which can be years in the future.

Lumeon has been in business 12 years and serves about 60 providers in the UK and Europe, some very large. They provide the service on a SaaS basis, running on a HIPAA-compliant AWS cloud except in the UK, where they run their own data center in order to interact with legacy National Health Service systems.

The company has encountered along the way an enormous range of health care disciplines, with organizations ranging from small to huge in size, and some needing only a simple alerting service while others re-imagined the whole patient journey. Wyatt says that their design process helps the care provider articulate the care pathway they want to support and then automate it. Certainly, a powerful and flexible platform is needed to support so many services. As Wyatt said, “Health care is not linear.” He describes three key parts to the Lumeon system:

  1. Integration engine. This is what allows them to interact with the EHR, as well as with other IT systems such as Salesforce. Often, the unique workflow system developed by Lumeon for the site can pop up inside the EHR interface, which is important because doctors hate to exit a workflow and start up another.

    Any new system they encounter–for instance, some institutions have unique IT systems they created in-house–can be plugged in by developing a driver for it. Wyatt made this seem like a small job, which underscores that a lack of data exchange among hospitals is due to business and organizational factors, not technical EHR problems. Web services and a growing support for FHIR make integration easier

  2. Communications. Like the integration engine, this has a common substrate and a multiplicity of interfaces so doctors, patients, and all those involved in the health care journey can use text, email, web forms, and mobile apps as they choose.

  3. Workflow or content engine. Once they learn the system, clinicians can develop pathways without going back to Lumeon for support. The body scan solution mentioned earlier is an example of a solution designed and implemented entirely by the clinical service on its own.

  4. Transparency is another benefit of a good workflow design. In most environments, staff must remember complex sequences of events that vary from patient to patient (ordering labs, making referrals, etc.). The sequence is usually opaque to the patient herself. A typical Lumeon design will show the milestones in a visual form so everybody knows what steps took place and what remain to be done.

Wyatt describes Lumeon as a big step beyond most current workflow and messaging solutions. It will be interesting to watch the company’s growth, and to see which of its traits are adopted by other health IT firms.

Healthcare Dashboards, Data, and FHIR

Posted on March 30, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

We live in a dashboard society. We love our dashboards! We have mechanisms to track, analyze, and display all sorts of data at our fingertips any time of the day or night and everywhere we turn. We like it that way! Data is knowledge. Data is power. Data drives decisions. Data is king.

But what about healthcare data? Specifically, what about YOUR healthcare data? Is it all available in one place where you can easily access it, analyze it, and make decisions about your health? Chances are, it’s not. Most likely, it’s locked up inside various EHRs and many tethered (read: connected to the provider, not shareable to other providers) patient portals you received access to when you visited your doctors for various appointments. In some cases, the information that is there might not be correct. In other cases, there might not be much data there at all.

How are you supposed to act as an informed patient or caregiver when you don’t have your data or accurate data for those you are caring for? When health information is spread across multiple portals and the onus is on you to remember every login and password and what data is where for each of these portals, are you really using them effectively? Do you want to use them? It’s not very easy to connect the dots when the dots can’t be located because they’re in different places in varying degrees of completeness.

How do we fix this? What steps need to be taken? Aggregating our health information isn’t just collecting the raw data and calling it a complete record. It’s more than being able to send files back and forth. It’s critical to get your data right, at the core, as part of your platform. That’s what lets you build useful services, like a patient dashboard, or a provider EHR, or a payer analytics capability. A modern data model that represents your health information as a longitudinal patient record is key.

Many IT companies have realized HL7 FHIR (Fast Healthcare Interoperability Resources) is the preferred way to get there and are exploring its uses for interoperability. These companies have started using FHIR to map health information from their current data models to FHIR in order to allow information exchange.

This is just the beginning, though. If you want robust records that support models of the future, you need a powerful, coherent data model, like FHIR, as your internal data model, too.  Then take it a step further and use technologies similar to those used by other enterprise scale systems like Netflix and LinkedIn, to give patients and caregivers highly available, scalable, and responsive tools just like their other consumer-facing applications. Solutions that are built on legacy systems can’t scale in this way and offer these benefits.

Our current healthcare IT environment hasn’t made it easy for patients to aggregate their health information or aggregated it for them. If we want to meet the needs of today and tomorrow’s patients and caregivers, we need patient-centric systems designed to make it easy to gather health information from all sources – doctors, hospitals, laboratories, HIEs, and personal health devices and smartphones.

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or @MedicaSoftLLC.

About MedicaSoft
MedicaSoft  designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. MedicaSoft is a proud sponsor of Healthcare Scene. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Hopes for Big Impact from Validic: Making Use of Consumer Device Data

Posted on March 20, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Validic, a company that provides solutions in data connectivity to health care organizations, came to HIMMS this year with a new platform called Impact that takes a big step toward turning raw data into actionable alerts. I talked to Brian Carter, senior vice president of product at Validic, about the key contributions of Impact.

Routinely, I find companies that allow health-related monitoring in the home. Each one has a solution it’s marketing to doctors: a solution reminding patients to take their meds, monitoring vital signs for diabetes, monitoring vital signs for congestive heart failure, or something else fairly specific. These are usually integrated solutions that provide their own devices. The achievement of Validic, built through years of painstakingly learning the details of almost 400 different devices and how to extract their data, is to give the provider control over which device to use. Now a provider can contract with some application developer to create a monitoring solution for diabetes or whatever the provider is tracking, and then choose a device based on cost, quality, and suitability.

Validic’s Impact platform actually does many of the things that a third-party monitoring solution can do. But rather than trying to become a full solutions provider for such things as hospital readmissions, Validic augments existing care management systems by integrating its platform directly into the clinical workflow. With Impact, clinicians can draw conclusions directly from the data they collect to generate intelligent alerts.

For instance, a doctor can request that Impact sample data from a sensor at certain intervals and define a threshold (such as blood sugar levels) at which Impact contacts the doctor. Carter defines this service more as descriptive analytics than predictive analytics. However, Validic plans to increase the sophistication of its analysis to move more toward predictive analytics. Thus, they hope in the future not just to report when blood sugar hits a dangerous threshold, but to analyze a patient’s data over time and compare it to other patients to predict if and when his blood sugar will rise. They also hope to track the all too common tendency to abandon the use of consumer devices, and predict when a patient is likely to do so, allowing the doctor to intervene and offer encouragement to keep using the device.

Validic has evolved far beyond its original mission of connecting devices to health care providers and wellness organizations. This mission is still important, because device manufacturers are slow to adopt standards that would make such connections trivial to implement. Most devices still offer proprietary APIs, and even if they all settled on something such as FHIR, Carter says that the task of connecting each device would still require manual programming effort. “Instead of setting up connections to ten different devices, a hospital can connect to Validic once and get access to all ten.”

However, interconnection is slowly progressing, so Validic needs to move up the value chain. Furthermore, clinicians are slow to use the valuable information that devices in the home can offer, because they produce a flood of data that is hard to interpret. With Impact, they can derive some immediate benefit from device data, as the critical information is elevated above the noise while still being integrated into their health records. They can contract further with other application developers to run analytical services and integrate with their health records.