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

Posted on August 27, 2018 I Written By

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

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

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

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

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

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

At this point it’s time for some discussion.

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

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

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

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

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

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

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

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

A Missed Opportunity For Telemedicine Vendors

Posted on June 29, 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.

Today, most direct-to-consumer telemedicine companies operate on a very simple model.

You pay for a visit up front. You talk to the doctor via video, the doctor issues as a prescription if needed and you sign off. Thanks to the availability of e-prescribing options, it’s likely your medication will be waiting for you when you get to the pharmacy.

In my experience, the whole process often takes 45 minutes or less. This beats the heck out of having to wait in line at an urgent care center or worse, the emergency department.

But what about caring for chronic illnesses that can’t be managed by a drive-by virtual visit? Can telemedicine vendors play a role here? Maybe so.

We already know that combining telemedicine with remote monitoring devices can be very effective. In fact, some health systems have gone all-in on virtual chronic care management.

One fascinating example is the $54 million Mercy Virtual Care Center, which describes itself as a “hospital without beds.” The Center, which has a few hundred employees, monitors more than 3,800 remote patients; sponsors a telehealth stroke program offering neurology services to EDs nationwide; manages a team of virtual hospitalists caring for patient around-the-clock using virtual visit tools; and runs Mercy SafeWatch, which the Center says is the largest single-hub electronic intensive care unit in the U.S.

Another example of such hospital-based programs is Intermountain Healthcare’s ConnectCare Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its purpose is to supplement existing staffers and offer specialized services in rural communities where some of the services aren’t available.

Given the success of programs that maintain complex patients remotely, I think a private telemedicine company managing chronic care services might work as well. While hospitals have financial reasons to keep such care in-house, I believe an outside vendor could profit in other ways. That’s especially the case given the emergence of wearable trackers and smartwatches, which are far cheaper than the specialized tools needed in the past.

One likely buyer for this service would be health plans.

I’ve heard some complain publicly that in essence, telemedicine coverage just encourages patients to access care more often, which defeats the purpose of using it to lower healthcare costs. However, if an outside vendor offered to manage patients with chronic illnesses, it might be a more attractive proposition.

After all, health plans are understandably wringing their hands over the staggering cost of maintaining the health of millions of diabetics. In 2017, for example, the average medical expense for people diagnosed with diabetes was about $16,750 per year, with $9,600 due to diabetes. If health plans could lay the cost off to a specialized telemedicine vendor, some real savings might be possible.

Of course, being a telemedicine-based chronic care management company would be far different than offering direct-to-consumer telemedicine services on an occasional basis. The vendor would have to have comprehensive health data management tools, an army of case managers, tight relationships with clinicians and a boatload of remote monitoring devices on hand. None of this would come cheaply.

Still, while I haven’t fully run the numbers, my guess is that this could be a sustainable business model. It’s worth a try.

Google And Fitbit Partner On Wearables Data Options

Posted on May 7, 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.

Fitbit and Google have announced plans to work together, in a deal intended to “transform the future of digital health and wearables.” While the notion of transforming digital health is hyperbole even for companies the size of Google and Fitbit, the pairing does have plenty of potential.

In a nutshell, Fitbit and Google expect to take on both consumer and enterprise health projects that integrate data from EMRs, wearables and other sources of patient information together. Given the players involved, it’s hard to doubt that at least something neat will emerge from their union.

Among the first things the pair plans to use Google’s new Cloud Healthcare API to connect Fitbit data with EMRs. Of course, readers will know that it’s one thing to say this and another to actually do it, but gross oversimplifications aside, the idea is worth pursuing.

Also, using services such as those offered by Twine Health– a recent Fitbit acquisition — the two companies will work to better manage chronic conditions such as diabetes and hypertension. Twine offers a connected health platform which leverages Fitbit data to offer customized health coaching.

Of course, as part of the deal Fitbit is moving to the Google Cloud Platform, which will supply the expected cloud services and engineering support.

The two say that moving to the Cloud Platform will offer Fitbit advanced security capabilities which will help speed up the growth of Fitbit Health Solutions business. They also expect to make inroads in population health analysis. For its part, Google also notes that it will bring its AI, machine learning capabilities and predictive analytics algorithms to the table.

It might be worth a small caution here. Google makes a point of saying it is “committed” to meeting HIPAA standards, and that most Google Cloud products do already. That “most” qualifier would make me a little bit nervous as a provider, but I know, why worry about these niceties when big deals are afoot. However, fair warning that when someone says general comments like this about meeting HIPAA standards, it probably means they already employ high security standards which are likely better than HIPAA. However, it also means that they probably don’t comply with HIPAA since HIPAA is about more than security and requires a contractual relationship between provider and business associate and the associated liability of being a business associate.

Anyway, to round out all of this good stuff, Fitbit and Google said they expect to “innovate and transform” the future of wearables, pairing Fitbit’s brand, community, data and high-profile devices with Google’s extreme data management and cloud capabilities.

You know folks, it’s not that I don’t think this is interesting. I wouldn’t be writing about if I didn’t. But I do think it’s worth pointing out how little this news announcement says, really.

Yes, I realize that when partnerships begin, they are by definition all big ideas and plans. But when giants like Google, much less Fitbit, have to fall back on words like innovate and transform (yawn!), the whole thing is still pretty speculative. Just sayin’.

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?

Small Grounds for Celebration and Many Lurking Risks in HIMSS Survey

Posted on March 12, 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.

When trying to bypass the breathless enthusiasm of press releases and determine where health IT is really headed, we can benefit from a recent HIMMS survey, released around the time of their main annual conference. They managed to get responses from 224 managers of health care facilities–which range from hospitals and clinics to nursing homes–and 145 high-tech developers that fall into the large categories of “vendors” and “consultants.” What we learn is that vendors are preparing for major advances in health IT, but that clinicians are less ready for them.

On the positive side, both the clinicians and the vendors assign fairly high priority to data analytics and to human factors and design (page 7). In fact, data analytics have come to be much more appreciated by clinicians in the past year (page 9). This may reflect the astonishing successes of deep learning artificial intelligence reported recently in the general press, and herald a willingness to invest in these technologies to improve health care. As for human factors and design, the importance of these disciplines has been repeatedly shown in HxRefactored conferences.

Genomics ranks fairly low for both sides, which I think is reasonable given that there are still relatively few insights we can gain from genetics to change our treatments. Numerous studies have turned up disappointing results: genetic testing doesn’t work very well yet, and tends to lead only to temporary improvements. In fact, both clinicians and vendors show a big drop in interest in precision medicine and genetics (pages 9 and 10). The drop in precision medicine, in particular, may be related to the strong association the term has with Vice President Joe Biden in the previous administration, although NIH seems to still be committed to it. Everybody knows that these research efforts will sprout big payoffs someday–but probably not soon enough for the business models of most companies.

But much more of the HIMSS report is given over to disturbing perception gaps between the clinicians and vendors. For instance, clinicians hold patient safety in higher regard than vendors (page 7). I view this concern cynically. Privacy and safety have often been invoked to hold back data exchange. I cannot believe that vendors in the health care space treat patient safety or privacy carelessly. I think it more likely that clinicians are using it as a shield to hide their refusal to try valuable new technologies.

In turn, vendors are much more interested in data exchange and integration than clinicians (page 7). This may just reflect a different level of appreciation for the effects of technology on outcomes. That is, data exchange and integration may be complex and abstract concepts, so perhaps the vendors are in a better position to understand that it ultimately determines whether a patient gets the treatment her condition demands. But really, how difficult can it be to be to understand data exchange? It seems like the clinicians are undermining the path to better care through coordination.

I have trouble explaining the big drops in interest in care coordination and public health (pages 9 and 10), which is worrisome because these things will probably do more than anything to produce healthier populations. The problem, I think, is probably that there’s no reimbursement for taking on these big, hairy problems. HIMMS explains the drop as a shift of attention to data analytics, which should ultimately help achieve the broader goals (page 11).

HIMSS found that clinicians expect to decrease their investments in health IT over the upcoming year, or at least to keep the amount steady (page 14). I suspect this is because they realize they’ve been soaked by suppliers and vendors. Since Meaningful Use was instituted in 2009, clinicians have poured billions of dollars and countless staff time into new EHRs, reaping mostly revenue-threatening costs and physician burn-out. However, as HIMSS points out, vendors expect clinicians to increase their investments in health IT–and may be sorely disappointed, especially as they enter a robust hiring phase (page 15).

Reading the report, I come away feeling that the future of health care may be bright–but that the glow you see comes from far over the horizon.

New Study Suggests That HIEs Deliver Value by Aggregating Patient Data

Posted on March 5, 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.

Historically, I’ve been pretty skeptical about the benefits that HIEs offer, not because the concept was flawed, but that the execution was uncertain. Toss in the fact that few have figured out how to be self-supporting financially, and you have a very shaky business model on your hands. But maybe, at long last, we’re discovering better uses for the vast amount of data HIEs have been trading.

New research by one exchange suggests that some of the key value they offer is aggregating patient data from multiple providers into a longitudinal view of patients. The research, completed by the Kansas Health Information Network and Diameter Health suggests that the Qualified Clinical Data Registries promoted by MACRA/QPP could be a winning approach.

To conduct the research, the partners extracted data from the KHIN exchange on primary care practices in which more than 50,000 patients visited toward 214 care sites in 2016 and 2017. This is certainly interesting, as most of the multi-site studies I’ve seen on this scale are done within a single provider’s network. It’s also notable that the data is relatively fresh, rather than relying on, say, Medicare data which is often several years older.

According to KHIN, using interoperable interfaces to providers and collecting near real-time clinical data makes prompt quality measure calculation possible. According to KHIN executive director Laura McCrary, Ed.D., this marks a significant change from current methods. “This [approach is in stark contrast to the current model which computes quality measures from only the data in the provider’s EHR,” she notes.

FWIW, the two research partners will be delivering a presentation on the research study at the HIMSS18 conference on Friday, March 9, from 12 to 1 PM. I’m betting it will offer some interesting insights.

But even if you can’t make it to this presentation, it’s still worth noting that it emphasizes the increasing importance of the longitudinal patient record. Eventually, under value-based care, it will become critical to have access not only to a single provider’s EHR data, but rather a fuller data set which also includes connected health/wearables data, data from payer claims, overarching population health data and more. And obviously, HIEs play a major role in making this happen.

Like other pundits, I’d go so far to say that without developing this kind of robust longitudinal patient record, which includes virtually every source of relevant patient data, health systems and providers won’t be able to manage patients well enough to meet their individual patient or population health goals.

If HIEs can help us get there, more power to them.

Talking Genomic Medicine at #CES2016

Posted on January 19, 2016 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.

I was lucky to moderate a panel at the Digital Health Summit at CES 2016. The session was called “Look Who’s Talking: Newborn Genomic Data Enables Precision Medicine” and I was joined by 2 amazing panelists:

  • Andy De, Global Managing Director and General Manager for Healthcare and Life Sciences at Tableau
  • Aaron Black, Director, Informatics, Inova Translational Medicine Institute

It’s amazing to see the work Andy and Aaron are doing with genomic medicine. It’s truly uncharted territory and we’re still discovering what’s going to be possible. However, I think we do a good job looking at some of the things that are reality today in genomic medicine.

Check out all of the healthcare IT conferences we attend throughout the year.

Great Interview with Jonathan Bush

Posted on May 29, 2015 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.

Jonathan Bush is the very best interview in healthcare IT. A few years back, Neil Versel grabbed Jonathan Bush at his athenahealth cloud party at HIMSS for an interview. It’s now become quite a tradition. They talk a lot about CommonWell, the impact of Medicare penalties, and much more. Here’s this year’s interview of Jonathan Bush at HIMSS by Neil Versel:

P.S. Yes, HIMSS was forever ago and I’m just catching up on stuff now.

What Is Population Health?

Posted on March 24, 2015 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.

This is a really important question that I think healthcare leaders across the country and even the world are trying to figure out. This video does a pretty good job of explaining the current state of population health.

We’d love to hear your thoughts and comments on population health as it stands today and where it’s headed in the comments.