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Will UnitedHealth’s New Personal Health Record Make An Impact?

Posted on October 26, 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.

Though the idea of a personal health record was a hot thing for a while, it didn’t become the fixture of the healthcare market that pundits had predicted. In fact, as many readers will recall, even deep pockets like Google and Microsoft couldn’t get their users to sign on to their PHRs en masse.

One of the main reasons the PHR model didn’t take is that people simply didn’t want to use them. In fact, at least at the time, the PHR was almost entirely a solution in search of a problem. After all, if a health data power user and patient advocate like myself didn’t want one, what hope did PHR backers have of interesting your average Joe Blow in aggregating their health data online?

Over time, however, the personal health data landscape has changed, with patient records becoming a bit more portable. While consumers still aren’t beating down the doors to get their own PHR, those who are interested in pulling together their medical records electronically have better access to their history.

Not only that, wearables makers like Apple and Fitbit are sweetening the pot, primarily by helping people pull self-generated data into their health record. Arguably, patient-generated data may not be as valuable as traditional records just yet, but consumers are likely to find it more interesting than the jargon-laden text found in provider records.

Given recent developments like these, I wasn’t entirely surprised to learn that UnitedHealth Group is picking up the PHR torch. According to an article in MedCity News, the giant payer plans to launch what sounds like an updated PHR platform next year to its 50 million benefited plan members.

Apparently, on an earnings call last week UnitedHealth CEO Dave Wichmann said that the company will launch a “fully integrated and fully portable individual health record” in 2019. Notably, this is not just a data repository, but rather an interactive tool that “delivers personalized next-best health actions to people and their caregivers.”

The new health record will be based on UnitedHealth’s Rally health and wellness platform, which the insurer picked up when it acquired Audax Health in 2014. The platform, which has 20 million registered users, works to influence members to perform healthy behaviors in exchange for the incentive dollars,

Over time, Wichmann said, UHG intends to build Rally into a platform which collects and distributes “deeply personalized” health information to individual members, MedCity reported. The idea behind this effort is to highlight gaps in care and help patients assess the care that they get.  Wichmann told earnings call listeners that the platform data will be packaged and presented to clinicians in a form similar to that used by existing EHRs.

UHG’s plans here are certainly worth keeping an eye on over the next year or two. I have no doubt that the nation’s largest commercial payer has some idea of how to format data and make it digestible by systems like Cerner and Epic.

But while patients have become a bit more familiar with the benefits of having their health data on hand, we’re not exactly seeing consumers stampede the providers demanding their own health record either, and I’m far from convinced that this effort will win new converts.

My skepticism comes partly from first-hand experience. As a recent UnitedHealth beneficiary, I’ve used the Rally application, and I didn’t find it all that motivating. Honestly, I doubt any online platform will make much of an impact on patient health on its own, as the reasons for many health issues are multifactorial and can’t be resolved by handing one of us a few Rally bucks.

Personal gripes aside, though, the bigger question remains whether consumers think they’ll get something valuable out of using the new UHG tool. As always, you can never count on them coming just because you built it.

Execs Say Silicon Valley Has The Jump On Healthcare Innovation

Posted on September 12, 2018 I Written By

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

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

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

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

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

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

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

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

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.

Seven Types of HIMSS18 Attendees: An Exhibitor’s Perspective

Posted on March 16, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

The HIMSSanity is over and everyone’s departed Las Vegas and headed for home (or SXSW). This year, my company was an exhibitor in Hall G at HIMSS. Our booth was on the main aisle, or “the thoroughfare” as those of us in the booth liked to call it. As such, I noticed some trends in the types of booth visits we encountered this year during HIMSS. These visits can be summed up into seven different types.

Integration on the Brain. “I need something to connect my disparate systems together.” Whether it’s EHR-to-EHR, EHR-to-other systems, PHR-to-EHR, or many Health IT combinations, there was no shortage of requests at HIMSS for a system or platform to make these connections happen more seamlessly. Inquiries about integration and connecting various technologies came up more frequently at our booth than any other topic at the show. These conversations were great for MedicaSoft because we can help them solve integration problems.

Partnership Hustle. “I make APIs, products, or provide services to complement your software offering. I think we’d make great partners.” HIMSS is certainly a place to find synergies and begin conversations for potential win-win situations for companies who want to partner together and go to market. Sometimes these meetings are the start of a perfect “meet cute.” Other times, they fall short. Either way, there are lots of folks out there with a wide variety of products and services making their rounds and searching for perfect business partners.

Swag Gatherer. “I came here for the swag.” You know this person. This person has no desire to interact with you. They’re not sure what your company does and many times they don’t care to ask. This person wants to collect as much free stuff at the conference as possible. Sometimes they are annoyed when you don’t have a giveaway. You know you’ve encountered a swag gatherer by their refusal to make eye contact and how fast they exit your booth once they’ve snatched up whatever swag or tchotchke you have to offer.

IT Spy. “I must find out what the competition is doing right now, let me pretend I’m in the market for IT products and booth hop.” We’ve all seen it. We know when it’s happening. It can be hilarious when the spying company tries to act like they are NOT doing this. It’s pretty obvious. I’m on to you. My only request? Be nice about it. We’ll show you what we have. You don’t have to be obnoxious or play dumb. We are happy to share.

Things You Don’t Need. “You really need our product or service even if you think you don’t need our product or service.” Everyone has this happen at one point or another. Someone comes by and really wants to sell you something you don’t need. Sometimes they politely go on their way. Other times they linger on, refusing to acknowledge that you don’t need their product or service. Sometimes being upfront doesn’t help and they continue to launch into their sales pitch anyway. You have to give these folks credit, they really are trying to sell.

Neighborhood Friendly Booth Staff or First-time HIMSS-goer. “I just thought I’d say hello.” This could be neighboring booth staff coming over to say hello. It could also be an exhibitor or attendee who’s there for the first time. In either case, these are friendly people who want to ask questions. They are getting their bearings for the show and trying to learn as much as possible. Many times they ask for advice or directions.

Match Made in Heaven. “We’re looking to buy or replace our patient portal, PHR, EHR, or integration platform.” The crème de la crème of conference attendees. This person has done their research. They know what they want and what they want is what you offer! These types of meetings leave you jazzed for the rest of the conference and eager for post-conference follow-up. This type of conference attendee actually answers your emails and phone calls when you follow-up because they have a genuine interest in what you do and how you can help them solve their IT problems or challenges.

HIMSS18 exhibitors and attendees, what other types of booth attendees did you see this year at the show?

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.

The Real Problem with High Healthcare Costs

Posted on February 27, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

The rising cost of healthcare in the U.S. is something that nearly everyone experiences on a regular basis. Looking at the trend over the last few decades, there is an eye-opening surge in cost. There’s a great article/table by Kimberly Amadeo that outlines health care costs by year from 1960 to 2015. The cost per person for health care in 1960 was $146. In 2015, the cost per person was $9,990, over 68 times higher than it was in 1960.

The trend shows no sign of slowing; 2018 costs have only gotten higher. The National Conference of State Legislatures cited a figure from a Kaiser Employer Survey stating that annual premiums reached $18,764 in 2017. Costs for people purchasing insurance on an exchange or privately increased even more.

Increasing healthcare costs impact everyone. Why have costs gotten so high? Wasn’t the Affordable Care Act supposed to make coverage more affordable? Instead, many are faced with even higher insurance premiums for themselves and their families. Sometimes that equates to having to make difficult choices in care. And should people have to decide whether or not they can afford to seek care or treatment?

Many people want to blame insurance companies or hospitals or lobbyists or politicians. In truth, it’s a complex issue. And one of the core reasons it’s so hard to dissect is that there is a real lack of data – cost and price information, and clinical information on care quality and outcomes. Nobody has all of the data in one place. Without all of the data, the real problem or problems can’t be seen. If a problem can be guessed, it can’t be fixed. As in the Wizard of Oz, the real drivers are lurking behind the curtain; worse, the data that describes the drivers is splintered and located in different places, waiting to be collected in a way that reveals the whole truth.

How can health IT help? Are there ways that we can help solve the data problem and reduce high healthcare costs? Electronic Health Records can help gather the data. Adding claims data to complete, longitudinal patient health records can also help. Connecting PHRs, EHRs, and claims data together can help bridge the data gaps and tell more of a complete story. Until we have that story, the industry will continue to operate in siloes. Costs will continue to rise. And people will have a harder time seeking out the care they need.

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.

The Opportunity for Health Information Exchanges (HIEs) to Untangle Health Records

Posted on February 6, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

As the government’s Meaningful Use incentive program accelerated the adoption of Electronic Health Records, it also increased the use of patient portals and PHRs to meet MU patient engagement measures. You see this today when you’re offered a portal login at your doctor appointments. Other encouraging trends developed around the same time:

  1. Studies proved that engaged patients tend to exhibit more positive health outcomes at lower costs.
  2. Interest increased among patient populations to be involved in their health and wellness, including a desire to see (and even contribute to) their electronic medical records.
  3. Technology innovations flourished to support health (wearables, health devices, applications, etc.).

Despite these trends and the relative success of MU-driven deployments, the patient portal and personal health record landscape leaves much to be desired for their primary users and audience – patients. Many of these tools were created simply to satisfy MU requirements and while they do this, they don’t completely tie together patients’ complex health histories, include data from multiple providers, or travel with the patient from visit to visit. Instead, patients have many different portals – a different one from every different provider. Who wants 10 different portals? Nobody has time for that!

Patients need help assembling a single view of their health records. HIEs are unique in that they work with many different health systems, hospitals, and providers in their regions. HIEs represent an opportunity to be a true integrator of health information between providers and their patients. This can be a regional solution now, and with efforts like the Patient Centered Data Home (PCDH), there is greater opportunity for HIEs to share data across state and regional lines, further expanding their reach and extending real benefits to patients who want their data in one place.

HIEs can leverage their unique position into a meaningful benefit for patient by first creating a single patient record or universal health record (UHR). This UHR or platform works seamlessly with PHRs. By making PHRs available to providers in their exchange, they can then share health data among every provider they link up with and the connections grow from there when you add in PCDH connections in other regions and states. Once there is a platform in place that is truly interoperable, sharing data between providers, patients can start using PHRs that have useful, relevant health data from all of their providers. HIEs can then start building in other capabilities like analytics, population health, care quality metrics, and more.

A patient’s medical journey involves multiple providers and different physical locations as their lives and health evolve. Their health information – in a single, universal health record – should evolve with them. HIEs can play a significant role in making that happen.

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.

Patient Portals and Chronic Disease Management

Posted on January 16, 2018 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

Half of all U.S. adults, roughly 117 million people, have one or more chronic health conditions. 1 in 4 people have two or more chronic conditions. As a nation, we need some help addressing the chronic disease epidemic. Many patient portals today give patients access to pieces of their health information – lab results, for example – and some will flag upcoming appointments or refill a prescription, but where are the tools and the data in a portal to actually help patients manage chronic conditions, thereby improving their overall health and wellness? Sadly, many patient portals provide a very narrow view, with few opportunities to link data to actions to results in a way that closes the loop between patients and caregivers. Without a complete view of a patient’s health measures, wellness goals, and plans of action – and the tools to manage them – it is very difficult to connect health and wellness to address the whole patient.

Chronic disease management represents one of the best opportunities for a personal health record to link both wellness and healthcare together to affect positive health outcomes. What does it take to improve and maintain wellness? First, you need patient engagement. You need motivated patients who want to do a good job of actively tracking their conditions and working toward wellness goals. How do you convince a chronically ill patient to do this? Start by offering a tool that’s easy for them to track their data – complete with a workflow and user interface that makes it a breeze to enter and distill information at a glance and when they are on the go. Use technology similar to what patients use in their daily lives on their smart phones and laptops. Give patients tools to understand their health and take action based on how they are doing and what their health goals are! Provide a portal that allows the integration of popular wearable devices and lets the patient decide who should have access (Spouses? Caregivers?) to help them enter and manage their information.

Effectively managing chronic disease requires changing poor habits and forming good habits. Sometimes people need a gentle nudge or a push outside of the exam room. A platform that can send out reminders, gamify the experience, and even call a patient can go a long way in helping steer chronic disease patients in a more positive wellness direction. It’s not all about reminders, either. Texts and calls informing patients when they are doing a good job managing their daily wellness habits can also help.

Beyond helping patients, there’s an added benefit to coupling wellness capabilities with a PHR for providers – it has the ability to not only affect chronic disease factors, but to collect the data providers need to participate in the Quality Payment Program; the Merit-based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). To quickly review, the Quality Payment Program allows clinicians to be rewarded financially for providing high-quality and high value care through Advanced Alternate Payment Models (APMs) or MIPS that are based on various measures. These measures can be integrated into the PHR, allowing physicians to track their patient populations, run reports, submit information to the Quality Payment Program, and receive merit payments.

What are your thoughts? Would you use a PHR to manage a chronic condition you are experiencing? Would you encourage your loved ones to use one? As a provider, how do you feel about a PHR making it easier for you to track MIPS/MACRA measures?

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.

Patient Portal Use Rising Rapidly

Posted on October 25, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

 

Scenarios for Health Care Reform (Part 2 of 2)

Posted on May 18, 2017 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.

The first part of this article suggested two scenarios that could promote health care reform. We’ll finish off the scenarios in this part of the article.

Capitalism Disrupts Health Care

In the third scenario, reform is stimulated by an intrepid data science firm that takes on health care with greater success than most of its predecessors. After assembling an impressive analytics toolkit from open source software components–thus simplifying licensing–it approaches health care providers and offers them a deal they can’t refuse: analytics demonstrated to save them money and support their growth, all delivered for free. The data science firm asks in return only that they let it use deidentified data from their patients and practices to build an enhanced service that it will offer paying customers.

Some health care providers balk at the requirement to share data, but their legal and marketing teams explain that they have been doing it for years already with companies whose motives are less commendable. Increasingly, the providers are won over. The analytics service appeals particularly to small, rural, and safety-net providers. Hammered by payment cuts and growing needs among their populations, they are on the edge of going out of business and grasp the service as their last chance to stay in the black.

Participating in the program requires the extraction of data from electronic health records, and some EHR vendors try to stand in the way in order to protect their own monopoly on the data. Some even point to clauses in their licenses that prohibit the sharing. But they get a rude message in return: so valuable are the analytics that the providers are ready to jettison the vendors in a minute. The vendors ultimately go along and even compete on the basis of their ability to connect to the analytics.

Once stability and survival are established, the providers can use the analytics for more and more sophisticated benefits. Unlike the inadequate quality measures currently in use, the analytics provide a robust framework for assessing risk, stratifying populations, and determining how much a provider should be rewarded for treating each patient. Fee-for-outcome becomes standard.

Providers make deals to sign up patients for long-term relationships. Unlike the weak Medicare ACO model, which punishes a provider for things their patients do outside their relationship, the emerging system requires a commitment from the patient to stick with a provider. However, if the patient can demonstrate that she was neglected or failed to receive standard of care, she can switch to another provider and even require the misbehaving provider to cover costs. To hold up their end of this deal, providers find it necessary to reveal their practices and prices. Physician organizations develop quality-measurement platforms such as the recent PRIME registry in family medicine. A race to the top ensues.

What If Nothing Changes?

I’ll finish this upbeat article with a fourth scenario in which we muddle along as we have for years.

The ONC and Centers for Medicare & Medicaid Services continue to swat at waste in the health care system by pushing accountable care. But their ratings penalize safety-net providers, and payments fail to correlate with costs as hoped.

Fee-for-outcome flounders, so health care costs continue to rise to intolerable levels. Already, in Massachusetts, the US state that leads in universal health coverage, 40% of the state budget goes to Medicaid, where likely federal cuts will make it impossible to keep up coverage. Many other states and countries are witnessing the same pattern of rising costs.

The same pressures ride like a tidal wave through the rest of the health care system. Private insurers continue to withdraw from markets or lose money by staying. So either explicitly or through complex and inscrutable regulatory changes, the government allows insurers to cut sick people from their rolls and raise the cost burdens on patients and their employers. As patient rolls shrink, more hospitals close. Political rancor grows as the public watches employer money go into their health insurance instead of wages, and more of their own stagnant incomes go to health care costs, and government budgets tied up in health care instead of education and other social benefits.

Chronic diseases creep through the population, mocking crippled efforts at public health. Rampant obesity among children leads to more and earlier diabetes. Dementia also rises as the population ages, and climate change scatters its effects across all demographics.

Furthermore, when patients realize the costs they must take on to ask for health care, they delay doctor visits until their symptoms are unbearable. More people become disabled or perish, with negative impacts that spread through the economy. Output decline and more families become trapped in poverty. Self-medication for pain and mental illness becomes more popular, with predictable impacts on the opiate addiction crisis. Even our security is affected: the military finds it hard to recruit find healthy soldiers, and our foreign policy depends increasingly on drone strikes that kill civilians and inflame negative attitudes toward the US.

I think that, after considering this scenario, most of us would prefer one of the previous three I laid out in this article. If health care continues to be a major political issue for the next election, experts should try to direct discussion away from the current unproductive rhetoric toward advocacy for solutions. Some who read this article will hopefully feel impelled to apply themselves to one of the positive scenarios and bring it to fruition.

Scenarios for Health Care Reform (Part 1 of 2)

Posted on May 16, 2017 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.

All reformers in health care know what the field needs to do; I laid out four years ago the consensus about patient-supplied data, widespread analytics, mHealth, and transparency. Our frustration comes in when trying to crack the current hide-bound system open and create change. Recent interventions by US Republicans to repeal the Affordable Care Act, whatever their effects on costs and insurance coverage, offer no promise to affect workflows or treatment. So this article suggests three potential scenarios where reform could succeed, along with a vision of what will happen if none of them take hold.

Patients Forge Their Own Way Forward

In the first scenario, a tiny group of selfer-trackers, athletes, and empowered patients start a movement that ultimately wins over hundreds of millions of individuals.

These scattered enthusiasts, driven to overcome debilitating health problems or achieve extraordinary athletic feats, start to pursue self-tracking with fanaticism. Consumer or medical-grade devices provide them with ongoing data about their progress, and an open source platform such as HIE of One gives them a personal health record (PHR).

They also take charge of their interactions with the health care system. They find that most primary care providers aren’t interested in the data and concerns they bring, or don’t have time to process those data and concerns in the depth they need, or don’t know how to. Therefore, while preserving standard relationships with primary care providers and specialists where appropriate, the self-trackers seek out doctors and other providers to provide consultation about their personal health programs. A small number of providers recognize an opportunity here and set up practices around these consultations. The interactions look quite different from standard doctor visits. The customers, instead of just submitting themselves to examination and gathering advice, steer the conversation and set the goals.

Power relationships between doctors and customers also start to change. Although traditional patients can (and often do) walk away and effectively boycott a practice with which they’re not comfortable, the new customers use this power to set the agenda and to sort out the health care providers they find beneficial.

The turning point probably comes when someone–probabaly a research facility, because it puts customer needs above business models–invents a cheap, comfortable, and easy-to-use device that meets the basic needs for monitoring and transmitting vital signs. It may rest on the waist or some other place where it can be hidden, so that there is no stigma to wearing it constantly and no reason to reject its use on fashion grounds. A beneficent foundation invests several million dollars to make the device available to schoolchildren or some other needy population, and suddenly the community of empowered patients leaps from a miniscule pool to a mainstream phenomenon.

Researchers join the community in search of subjects for their experiments, and patients offer data to the researchers in the hope of speeding up cures. At all times, the data is under control of the subjects, who help to direct research based on their needs. Analytics start to turn up findings that inform clinical decision support.

I haven’t mentioned the collection of genetic information so far, because it requires more expensive processes, presents numerous privacy risks, and isn’t usually useful–normally it tells you that you have something like a 2% risk of getting a disease instead of the general population’s 1% risk. But where genetic testing is useful, it can definitely fit into this system.

Ultimately, the market for consultants that started out tiny becomes the dominant model for delivering health care. Specialists and hospitals are brought in only when their specific contributions are needed. The savings that result bring down insurance costs for everyone. And chronic disease goes way down as people get quick feedback on their lifestyle choices.

Government Puts Its Foot Down

After a decade of cajoling health care providers to share data and adopt a fee-for-outcome model, only to witness progress at a snail’s pace, the federal government decides to try a totally different tack in this second scenario. As part of the Precision Medicine initiative (which originally planned to sign up one million volunteers), and leveraging the ever-growing database of Medicare data, the Office of the National Coordinator sets up a consortium and runs analytics on top of its data to be shared with all legitimate researchers. The government also promises to share the benefits of the analytics with anyone in the world who adds their data to the database.

The goals of the analytics are multi-faceted, combining fraud checks, a search for cures, and everyday recommendations about improving interventions to save money and treat patients earlier in the disease cycle. The notorious 17-year gap between research findings and widespread implementation shrinks radically. Now, best practices are available to any patient who chooses to participate.

As with the personal health records in the previous scenario, the government database in this scenario creates a research platform of unprecedented size, both in the number of records and the variety of participating researchers.

To further expand the power of the analytics, the government demands exponentially greater transparency not just in medical settings but in all things that make us sick: the food we eat (reversing the rulings that protect manufacturers and restaurants from revealing what they’re putting in our bodies), the air and water that surrounds us, the effects of climate change (a major public health issue, spreading scourges such as mosquito-borne diseases and heat exhaustion), disparities in food and exercise options among neighborhoods, and more. Public awareness leads to improvements in health that lagged for decades.

In the next section of this article, I’ll present a third scenario that achieves reform from a different angle.