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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.

We Share Health Data with Marketing Companies, Why Not with Healthcare Providers? Answer: $$

Posted on November 20, 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.

For those who don’t realize it, your health data is being shared all over the place. Yes, we like to think that our health care data is being stored and protected and that laws like HIPAA keep them safe, but there are plenty of ways to legally share health care data today. In fact, many EHR vendors sell your health care data for a pretty penny.

Of course, many would argue that it’s shared in a way that complies with all the laws and that it’s done in a way that your health record isn’t individually identified. They’re only sharing your health data in a de-identified manner. Others would argue that you can’t deidentify the health data and that there are ways to reidentify the data. I’ll leave those arguments for another post. We’ll also leave the argument over whether all this sharing of health data (usually to marketing, pharma and insurance companies) is safe or not for a future post as well.

What’s undeniable is that health data for pretty much all of us is being bought and sold all over health care. If you don’t believe it’s so, take a minute to look at the work of Deborah Peel from Patient Privacy Rights and learn about her project theDataMap. She’ll be happy to inform you of all the ways data is currently being bought and sold. It’s a really big business.

Here’s where the irony comes in. We have no trouble sharing health data (Yes, even EHR vendors have no problem sharing data and lets be clear that not all EHR vendors share data with these outside companies but mare are sharing data) with marketing companies, payers and pharma companies that are willing to pay for access to that data. Yet, when we ask EHR vendors to share health data with other EHR vendors or with an HIE, they balk at the idea as if it’s impossible. They follow that up with a bunch of lame excuses about HIPAA privacy or the complexity of health care data.

Let’s call a spade a spade. We could pretty easily be interoperable in health care if we wanted to be interoperable. We know that’s true because when the money is there from these third party companies, EHR vendors can share data with them. The problem has been that the money has never been there before for EHR vendors to be motivated enough to make interoperability between EHR vendors possible. In fact, you could easily argue that the money was instructing EHR vendors not to be interoperable.

However, times are changing. Certainly the government pressure to be interoperable is out there, but that doesn’t really motivate the industry if there’s not some financial teeth behind it. Luckily the financial teeth are starting to appear in the form of value based reimbursement and the move away from fee for service. That and other trends are pushing healthcare providers to want interoperable health records as an important part of their business. That’s a far cry from where interoperability was seen as bad for their business.

I heard about this shift first hand recently when I was talking with Micky Tripathi, President & CEO of the Massachusetts eHealth Collaborative. Micky told me that his organization had recently run a few RFPs for healthcare organizations searching for an EHR. As part of the EHR selection process Micky recounted that interoperability of health records was not only included in the RFP, but was one of the deciding factors in the healthcare organizations’ EHR selections. The same thing would have never been said even 3-5 years ago.

No doubt interoperability of health records has a long way to go, but there are signs that times are changing. The economics are starting to make sense for organizations to embrace interoperablity. That’s a great thing since we know they can do it once the right economic motivations are present.