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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.

Barriers to Patient-Centered Research Aired at Harvard Symposium

Posted on July 2, 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.

While writing about health IT, I routinely find myself at legal conferences. Regulatory issues about patient privacy and safety arise everywhere health IT tries to have an impact, so people promoting change must keep in touch with policy-makers and lawyers in the health care area.

Thus I went this past Friday to Harvard for a one-day symposium, “Putting Patients at the Center of Research: Opportunities and Challenges for Ethical and Regulatory Oversight,” sponsored by Harvard’s Petrie-Flom Center.

Audience at Patient-Centered conference at Harvard

*Audience at Patient-Centered conference at Harvard

Involving patients in patient care is a surprisingly recent concern. There was a time when doctors made all the decisions, delivering them as if they had come directly from the entrails of an oracular temple. Visitors were severely limited at hospitals, because family members just got in the way of the professional staff. And although the attitude toward engaging patients and their families has softened somewhat in health care, rigid boundaries still exist in research.

As project leader Joel Weissman pointed out at the beginning of the Petrie-Flom conference, patient rights weren’t considered by health care professionals until the 1980s, as outgrowths of the civil rights and women’s rights movements. Patient engagement languished still longer. It received a legal toehold in the 2010 Affordable Care Act, which set up the Patient-Centered Outcomes Research Institute. Although more researchers over the past eight years have warmed to the idea of engaging with patients in other ways than subjects of clinical trials, the Petrie-Flom conference highlighted how little progress we have made.

In a “nothing about us without us” era, it would seem odd to an outsider like me that patients should be excluded from the roles now being tentatively offered:

  • Joining the research team in some capacity
  • Recruiting subjects for trials and engaging the patient community
  • Helping disseminate results
  • Acting as consultants in some other way

But risks are certainly entailed by inserting non-professionals of any stripe into the research environment, so some criteria and processes need to be set up. Before filling non-traditional roles, patients should be required to undergo training in ethics, the science behind the study, and some of the methodology. There are particular risks when the patients have access to personally identifiable data. (I don’t see why this should ever be necessary, but the possibility was raised several times during the day.)

The panelists also cited conflicts of interest as a risk. Many researchers recruit engaged patients from the companies that make related drugs or other products, simply because those are easy places to recruit. This problem highlights the importance of casting a wide net and recruiting diverse populations as engaged patients. However, one could argue that merely suffering from the condition that the researchers are investigating leaves one with a conflict of interest: you want the research to produce a cure, so you may not be even-handed in your acceptance of negative results.

What spurred this conference? The Petrie-Flom Center and PCORI have spent the past academic year doing a study of patient-centered research, and recently published an article by a team led by Weissman. The center presented the results at Friday’s conference to an audience of some 80 members of the health care field and interested observers.

The study was narrow and intensive. It focused on the attitudes of those running Institutional Review Boards, which are notoriously conservative. Thus, in my opinion, the results focused on what was holding back patient-centered research rather than what was already working well. The process was quite drawn out: questionnaires sent to hundreds of medical schools, public health schools, and hospitals; six focus groups with an iterative process for evaluating recommendations; and a modified Delphi consensus process among 17 experts, including (of course) representative patients.

Respondents to the survey expressed strong support for patient-centered research, believing (at a rate of about 90%) that it would benefit patients and clinicians, as well as (at a rate of about 80%) researchers. Those IRBs who tried out patient-centered research were especially enthusiastic, likely to say that it improved the quality of research results.

But IRB heads also openly expressed confusion and frustration about the pressure to include patients in the “non-traditional” roles listed earlier. Some of their reactions were productive: for instance, large majorities of respondents called on the federal government to provide standards, guidelines, and training for patient engagement. But some of the immediate measures IRBs put in place were irrelevant and even counterproductive. For instance, some required patients to sign informed consent forms, even though these patients were not the subjects of trials and therefore had no reason to need to consent. As patient advocate Jane Perlmutter pointed out, patients in non-traditional roles don’t require protection but require training to ensure that they protect the subjects of the research.

Perlmutter emphasized the importance of financial compensation. Without it, researchers will recruit mostly unemployed patients with independent incomes. To reach out to multiple ethnic groups, age ranges, and economic strata, payment must be offered for the work performed.

Unfortunately, I didn’t see much at Friday’s conference about topics directly related to health IT, such as privacy and ownership of data. Researcher Luke Gelinas mentioned that patient-centered research is more likely to use sensors, networking, social media, and other modern technology than more traditional research, and that these raise issues of informed consent, privacy, and ownership of data.

On the whole, the Petrie-Flom researchers thought there was no need for a whole new approach. But they are working on several recommendations to improve the current situation. In summary, the takeaways I derived from the symposium include:

  • The value of patient-centered research is widely appreciated, and its benefits have been demonstrated where it has been tried.
  • However, progress implementing patient-centered research is slow.
  • Training for patients in non-traditional roles is required, but not so much as to be daunting and make it difficult to participate.
  • Researchers have not devoted enough effort to diversity.
  • Governments can offer support in typical ways, such as setting standards and funding programs.

I also predict that the growth of patient-centered research will place additional strains on IT systems. Bringing in new team members in scattered environments will require multiple systems to interact without friction. Data will need to be segmented and released carefully to just the right people. Interfaces will have to be intuitive (if such a thing exists) and easy to use without much training and without risk of errors. So the field has its work cut out.

HITExpo ThankTanks Spur Online Discussion on the Nature of EHRs, Innovation & Patient Experience

Posted on June 7, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week at the inaugural 2018 Health IT Expo (#HITExpo), we kicked things off with three ThinkTank sessions:

  1. Going Beyond EHRs – https://www.youtube.com/watch?v=ULVQA4xEIRU
  2. Practical Innovation – https://www.youtube.com/watch?v=1Uc9_BCKQ84
  3. Communication & Patient Engagement – https://www.youtube.com/watch?v=60MAP04MoOw

These ThinkTanks were live-streamed via YouTube and were meant to engage members of the #HITMC, #HITsm, #hcldr and other online communities who could not be with us in person in New Orleans. Looking back over the tweets I believe it would be safe to say: mission accomplished.

The online discussion around the ThinkTanks was very rich and involved many different perspectives. During ThinkTank 1 Jim Tate had a keen bit of insight to share based on a comment made by panelist Shahid Shah of Netspective Media:

This was quickly followed by another interesting statement from Shah:

An interesting suggestion in ThinkThank 1 came from Dr. Fatima Paruk, Chief Medical Officer, Population Health at Allscripts – that it was never too late to get physicians involved in EHR optimization given that they are one of the main users of EHR systems. This was especially relevant given how much EHR frustration contributes to physician burnout.

Jeremy Coleman, one of the HITExpo’s social media ambassadors did an expert job at distilling a 5min during ThinkTank 1 into a single tweet:

The most interesting comment in ThinkTank 1 was made by Justin Campbell of Galen Healthcare. He suggested that one way to go beyond the EHR was to use the audit log information to identify workflow bottlenecks, training opportunities and UI improvements.

The second ThinkTank generated a spirited discussion amongst the panelists and with the online audience when the topic of blockchain technology was brought up. It started when John Lynn made the following statement:

Jared Jeffery from KLAS Research then immediately followed up his tweet with this humorous counter-point:

I agree with both John and Jared. The last thing we need is over-inflated hype around blockchain in healthcare. The technology itself holds promise but as an enabler of other technologies and processes. Simply slapping blockchain on existing processes is not going to yield the innovation healthcare needs. We need something more. The good news is that some pioneering organizations and HealthIT companies are experimenting with blockchain which will hopefully lead to incremental improvements.

Experimentation and the willingness to do something was on the mind of Jerry Cade – one of the panelist in ThinkTank 2. He had a poignant warning for all of us in healthcare:

In my opinion the most practical piece of advice of the day was shared by Shahid Shah during ThinkTank 2. It’s certainly something I’m going to pay more attention to in the future:

Your truly had the opportunity to moderate ThinkTank 3 and it was a blast. We had an amazing set of panelists that included nurses, HealthIT insiders, industry experts and the voice of the patient. It resulted in a robust discussion on the nature of patient experience.

Grace Jaime of Oneview Healthcare shared a keen insight which triggered a round of discussion on the need to clearly measure patient experience and communication effectiveness – If you can’t measure something, you can’t improve:

Grace Cordovano, professional patient advocate, then had this to add:

During ThinkTank 3 Sarah Bennight of Stericycle Communication Solutions made an interesting observation about patient advocacy and how it could be modeled after a legal precedent:

If you didn’t have the chance to catch the ThinkTanks live, I’d encourage you to watch the recordings (links above). The sessions were filled with valuable insights and practical advice that you can use right away. It was a lot of fun to participate in these ThinkTanks and I am definitely looking forward to doing more in the future.

In closing I think this tweet summed up the overall sentiment (from friend Ashley Dauwer at MEDITECH):

Patient Access to Health Data: The AHA Doesn’t Really Want to Know

Posted on March 8, 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.

As Spring holds off a bit longer this March in New England, it’s certainly pleasant to read a sunny assessment of patient access to records, based on a survey by the American Hospital Association. Clearly, a lot of progress has been made toward the requirement that doctors have been on the hook for during the past decade: giving patients access to their own health data. We can also go online to accomplish many of the same tasks with our doctors as we’re used to doing with restaurants, banks, or auto repair shops. But the researchers did not dig very deep. This report may stand as a model for how to cover up problems by asking superficial questions.

I don’t want to denigrate a leap from 27% to 93%, over a four to five year period, in the hospitals who provide patients with their health data through portals. Even more impressive is the leap in the number of hospitals who provide data to patient caregivers (from zero to 83%). In this case, a “caregiver” appears to be a family member or other non-professional advocate, not a member of a health team–a crucial distinction I’ll return to later.

I’m disappointed that only 50% of health systems allow patients to reorder prescriptions online, but that’s still a big improvement over 22% in 2012. A smaller increase (from 55% to 68%) is seen in the number of providers who allow patients to send secure online messages, a recalcitrance that we might guess is related to the lack of reimbursement for time spent reading messages.

That gives you a flavor of the types of questions answered by the survey–you can easily read all four pages for yourself. The report ends with four questions about promoting more patient engagement through IT. The questions stay at the same superficial level as the rest of the report, however. My questions would probe a little more uncomfortably. These questions are:

  • How much of the record is available to the patient?
  • How speedily is it provided?
  • Is it in standard formats and units?
  • Does it facilitate a team approach?

The rest of this article looks at why I’d like to ask providers these questions.

How much of the record is available to the patient?

I base this question on personal interactions with my primary care physician. A few years ago he installed a patient portal based on the eClinicalWorks electronic health record system used at the hospital with which he is affiliated. When I pointed out that it contained hardly any information, he admitted that the practice had contracted with a consultant who charges a significant fee for every field of the record exposed to patients. The portal didn’t even show my diagnoses.

Recently the affiliated hospital (and therefore my PCP) joined the industry rush to Epic, and I ended up with Epic’s hugely ballyhooed MyChart portal. It is much richer than the old one. For a while, it had a bug in the prescription ordering process that would take too long to describe here–an interesting case study in computer-driven disambiguation. My online chart shows a lot of key facts, such as diagnoses, allergies, and medications. But it lacks much more than it has. For instance:

  • There are none of the crucial lab notes my doctors have diligently typed into my record over multiple visits.
  • It doesn’t indicate my surgical history, because the surgeries I’ve had took place before I joined the current practice.
  • Its immunization record doesn’t show childhood immunizations, or long-lasting shots I got in order to travel to Brazil many years ago.

Clearly, this record would be useless for serious medical interventions. A doctor treating me in an emergency room wouldn’t know a childhood injury I got, or might think I was suffering from a tropical disease against which I got an inoculation. She wouldn’t know about questions I asked over the years, or whether and why the doctor told me not to worry about those things. My doctor and his Epic-embracing hospital are still hoarding the data needed for my treatment.

How speedily is it provided?

Timeliness matters. My lab results are shown quickly in MyChart, and it seems like other updates take place expeditiously. But I want to hear whether other practices can provide information fast enough for patients and caregivers to take useful steps, and show relevant facts to specialists they visit.

Is it in standard formats and units?

Although high-level exchange is getting better with the adoption of the FHIR specification, many EHRs still refuse to conform to existing standards. A 2016 survey from Minnesota says, “Most clinics do not incorporate electronic information from other providers into their EHRs as standardized data. Only 31 percent of clinics integrated data in standardized format for immunization, 25 percent for medication history, 19 percent for lab results, and just 12 percent for summary-of-care records.”

The paragraph goes on to say, “The vast majority said they fax/scan/PDF the data to and from outside sources.” So FHIR may lead to a quick improvement in those shockingly low percentages.

Labs also fail to cooperate in using standards.

Does it facilitate a team approach?

This is really the bottom line, isn’t it–what we’re all aiming at? We want the PCP, the specialist, the visiting nurse, the physical therapist and occupational therapist, the rehab facility staff, and every random caregiver who comes along to work hand-in-latex-glove as a team. The previous sections of this article indicate that the patient portal doesn’t foster such collaboration. Will the American Hospital Association be able to tell me it does? And if not, when will they get to the position where they can care collaboratively for our needy populations?

Why Should Patients Control Their Health Data? Here Are A Few Ideas.

Posted on September 29, 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.

Lately, healthcare organizations have begun working to give patients more access to their personal health data. They’ve concluded that the more control patients have, the more engaged they become in your care, which in turn leads to better outcomes.

But patient engagement isn’t the only reason for giving patients the keys to their PHI. In fact, organizational control of patient health data can cause problems for everyone in the healthcare data exchange chain.

An item found on the Allscripts blog does a nice job of articulating issues that can arise.  According to the blog item, those issues include the following:

  • The patient is in the best position to address inconsistencies in their medical record. For example, if one doctor diagnoses the patient with asthma, then another physician conclusively demonstrates the patient is not asthmatic, the patient can reconcile the two physicians’ conclusions.
  • Patients have a better overview of their care than most doctors. When a chronically ill patient sees multiple clinicians, their impressions may conflict with one another, but the patient can provide context on their overall conditions.
  • If a patient consents to multiple uses of their health data, and the consents seem to be in conflict, only the patient can articulate what their intentions were.
  • If the master patient indexing process generates a false match with someone else’s records, the patient will recognize this immediately, while physicians may not.
  • Giving patients control of the record allows them to decide how long those records should be maintained. Otherwise, HIEs — or other entities not bound by record retention laws — might destroy the data prematurely.
  • When patients have control of their data, they can make sure it gets to whomever they choose. On the other hand, patient data may not make it to other care settings if providers drop the ball.

To be sure, delegating control of their PHI to patients can go too far.

For example, if they’re transmitting most or all of their health data between providers, it could pose a significant administrative burden.  Patients may not have the time or energy to route the data files between their providers, assure that data has been received on the other end and make certain that the data was formatted in a way their clinicians can use.

Also, if the patient is chronically ill and sees multiple providers, they may end up having to manage a large body of data files, and not everyone can do so effectively. Ultimately, they may get too overwhelmed to send their records to anyone, or send the wrong records, which can create complications of its own.

Still, on the whole, healthcare organizations are giving patients more control of their health data for good reasons. When patients take responsibility for their health data, they’re far more likely to understand their condition and take steps to address problems. Establishing a balance between patient and provider control may be tricky, but it can and should be done.

Patients Message Providers More When Providers Reach Out

Posted on April 26, 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 patients use secure electronic messaging more when their primary care providers initiate and respond to secure messages.

To conduct the study, the research team worked a large database stocked with information on health care transactions and secure messaging records on 81,645 US Army soldiers. The data also included information from almost 3,000 clinicians with access to a patient portal system. The dataset encompassed the 4-year period between January 2011 and November 2014.

The data, which appears in a paper published in the Journal of Medical Internet Research, suggests that current provider-patient exchanges via secure messaging aren’t that common. For example, during the study period just 7 percent of patients initiated a secure message during a given month. Meanwhile, Providers initiated an average of 0.007 messages per patient each month, while responding to 0.09 messages per patient during a month.

That being said, when physicians got more engaged with the messaging process, patients responded dramatically.

Patients who knew their providers were responsive initiated a whopping 334 percent more secure messages than their baseline. Even among patients whose providers responded infrequently to their messages, the level at which they initiated messages to their clinicians was 254 percent higher than with PCPs who weren’t responding. (Oddly, when PCP response rates were at the “medium” level, patients increased messaging by 167 percent.)

In fact, when clinicians communicated more, there seemed to be spillover effects. Specifically, the researchers found that patients messaged PCPs more if that provider was very responsive to other patients, suggesting that there’s a network effect in play here.

Meanwhile, when PCPs were the ones prone to initiating messages, patients were 60 percent more likely to send a secure message. In other words, patients were more energized by PCP responses than clinician-initiated messages.

Of course, for secure messaging to have any real impact on care quality and outcomes, a critical mass of patients need to use messaging tools. Historically, though, providers have struggled to get patients to use their portal, with usage levels hovering between 10 percent and 32 percent.

Usage rates for portals have stayed stubbornly low even when doctors work hard to get their patients interested. Even patients who have signed up to use the portal often don’t follow through, research suggests. And of course, patients who don’t touch the portal aren’t exchanging care-enhancing messages with their provider.

If we’re going to get patients to participate in messaging with their doctor, we’re going to have to admit that the features offered by basic portals simply aren’t that valuable. While most offer patients access to some details of their medical records and test results, and sometimes allow them to schedule appointments, many don’t provide much more.

Meanwhile, a surprising number of providers haven’t even enabled a secure messaging function on their portal, which confines it to being a sterile data receptacle. I’d argue that without offering this feature, portals do almost nothing to engage their typical patient.

Of course, physicians fear being overwhelmed by patient messages, and reasonably fear that they won’t have time to respond adequately. Even though many organizations including the research of Dr. CT Lin has shown this just isn’t the case. That being said, if they want to increase patient engagement – and improve their overall health – secure messaging is one of the simplest tools for making that happen. So even if it means redesigning their workflow or tasking advanced practice nurse with responding to routine queries, it’s worth doing.

CVS Launches Analytics-Based Diabetes Mgmt Program For PBMs

Posted on December 29, 2016 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.

CVS Health has launched a new diabetes management program for its pharmacy benefit management customers designed to improve diabetes outcomes through advanced analytics.  The new program will be available in early 2017.

The CVS program, Transform Diabetes Care, is designed to cut pharmacy and medical costs by improving diabetics’ medication adherence, A1C levels and health behaviors.

CVS is so confident that it can improve diabetics’ self-management that it’s guaranteeing that percentage increases in spending for antidiabetic meds will remain in the single digits – and apparently that’s pretty good. Or looked another way, CVS contends that its PBM clients could save anywhere from $3,000 to $5,000 per year for each member that improves their diabetes control.

To achieve these results, CVS is using analytics tools to find specific ways enrolled members can better care for themselves. The pharmacy giant is also using its Health Engagement Engine to find opportunities for personalized counseling with diabetics. The counseling sessions, driven by this technology, will be delivered at no charge to enrolled members, either in person at a CVS pharmacy location or via telephone.

Interestingly, members will also have access to diabetes visit at CVS’s Minute Clinics – at no out-of-pocket cost. I’ve seen few occasions where CVS seems to have really milked the existence of Minute Clinics for a broader purpose, and often wondered where the long-term value was in the commodity care they deliver. But this kind of approach makes sense.

Anyway, not surprisingly the program also includes a connected health component. Diabetics who participate in the program will be offered a connected glucometer, and when they use it, the device will share their blood glucose levels with a pharmacist-led team via a “health cloud.” (It might be good if CVS shared details on this — after all, calling it a health cloud is more than a little vague – but it appears that the idea is to make decentralized patient data sharing easy.) And of course, members have access to tools like medication refill reminders, plus the ability to refill a prescription via two-way texting, via the CVS Pharmacy.

Expect to see a lot more of this approach, which makes too much sense to ignore. In fact, CVS itself plans to launch a suite of “Transform Care” programs focused on managing expensive chronic conditions. I can only assume that its competitors will follow suit.

Meanwhile, I should note that while I expect to see providers launch similar efforts, so far I haven’t seen many attempts. That may be because patient engagement technology is relatively new, and probably pretty expensive too. Still, as value-based care becomes the dominant payment model, providers will need to get better at managing chronic diseases systematically. Perhaps, as the CVS effort unfolds, it can provide useful ideas to consider.

A Patient Engagement Company Could Be Anything

Posted on October 21, 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’ve been spending the past couple days at the Connected Health Symposium in Boston. After talking to hundreds of people I was realizing my problem with companies saying that they are a patient engagement company. If you tell me you’re a patient engagement company, then I have no idea what you do.

The same isn’t true for an EHR company. If you say that you’re an EHR company, then I know that you’re helping doctors chart electronically. Sure, some people have used that term incorrectly or have executed poorly, but we all basically know what a company is doing if they’re an EHR company. Same is true for revenue cycle management companies and practice management software vendors.

The same can’t be said for patient engagement companies. If you say that you do patient engagement, that could literally be anything. In fact, is every company a patient engagement company?

I think we should banish the term patient engagement when describing a company. Instead, companies should tell us how they’re engaging the patient. Then, we can have an idea of what you’re doing and be able to understand how you fit into the healthcare ecosystem.

Just to be clear, I’m not suggesting we shouldn’t engage patients. Absolutely not. We 100% should be doing patient engagement. However, there are 1000s of ways that we can engage patients and many of them don’t involve technology at all. Those can all be great things, but it’s not a category of software companies.

E-Patient Update: The Patient Data Engagement Leader

Posted on October 20, 2016 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.

As healthcare delivery models shift responsibility for patient health to the patients themselves, it’s becoming more important to give them tools to help them get and stay healthy. Increasingly, digital health tools are filling the bill.

For example, portals are moving from largely billing and scheduling apps to exchanging of patient data, holding two-way conversations between patient and doctor and even tracking key indicators like blood glucose levels. Wearables are slowly becoming capable of helping doctors improve diagnoses, and patterns revealed by big data should soon be used to create personalized treatment plants.

The ultimate goal of all this, of course, is to push as much data power as possible into the hands of consumers. After all, for patients to be engaged with their health, it helps to make them feel in control, and the more sophisticated information they get, the better choices they can make. Or at least that’s how the traditional script reads.

Now, as an e-patient, the above is certainly true for me. Every incremental improvement in the data I get me brings me closer to taking on otherwise overwhelming health challenges. That’s true, in part, because I’m comfortable reading charts, extrapolating conclusions from data points and visualizing ways to make use of the information. But if you want less tech-friendly patients to get on board, they’re going to need help.

The patient engagement leader

And where will that help come from? I’d argue that hospitals and clinics need to create a new position dedicated to helping engage patients, including though not limited to helping them make their health data their own. This position would cut across several disciplines, ranging from patient health education clinical medicine to data analytics.

The person owning this position would need to be current in patient engagement goals across the population and by disease/condition type, understand the preferred usage patterns established by the hospital, ACO, delivery network or clinic and understand trends in health behavior well enough to help steer patients in the right direction.

It also wouldn’t hurt if such a person had a healthy dose of marketing skills under their belt, as part of the patient engagement process is simply selling consumers on the idea that they can and should take more responsibility for their health outcomes. Speaking from personal experience, a good marketer can wheedle, nudge and empower people by turns, and this will be very necessary to boost your engagement.

While this could be a middle management position, it would at least need to have the full support of the C-suite. After all, you can’t promote population-wide improvements in health by nibbling around the edges of the problem. Such measures need to be comprehensive and strategic to the mission of the healthcare organization as a whole, and the person behind the needs to have the authority to see them through.

Patients in control

If things go right, establishing this position would lead to the creation of a better-educated, more-confident patient population with a greater sense of self efficacy regarding their health. While specific goals would vary from one healthcare organization to the other, such an initiative would ideally lead to improvements in key metrics such as A1c levels population-wide, drops in hospital admission and readmission rates and simultaneously, lower spending on more intense modes of care.

Not only that, you could very well see patient satisfaction increase as well. After all, patients may not feel capable of making important health changes on their own, and if you help them do that it stands to reason that they’ll appreciate it.

Ultimately, engaging patients with their health calls for participation by everyone who touches the patient, from techs to the physician, nurses to the billing department. But if you put a patient engagement officer in place, it’s more likely that these efforts will have a focus.

Validic Survey Raises Hopes of Merging Big Data Into Clinical Trials

Posted on September 30, 2016 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 has been integrating medical device data with electronic health records, patient portals, remote patient monitoring platforms, wellness challenges, and other health databases for years. On Monday, they highlighted a particularly crucial and interesting segment of their clientele by releasing a short report based on a survey of clinical researchers. And this report, although it doesn’t go into depth about how pharmaceutical companies and other researchers are using devices, reveals great promise in their use. It also opens up discussions of whether researchers could achieve even more by sharing this data.

The survey broadly shows two trends toward the productive use of device data:

  • Devices can report changes in a subject’s condition more quickly and accurately than conventional subject reports (which involve marking observations down by hand or coming into the researcher’s office). Of course, this practice raises questions about the device’s own accuracy. Researchers will probably splurge for professional or “clinical-grade” devices that are more reliable than consumer health wearables.

  • Devices can keep the subject connected to the research for months or even years after the end of the clinical trial. This connection can turn up long-range side effects or other impacts from the treatment.

Together these advances address two of the most vexing problems of clinical trials: their cost (and length) and their tendency to miss subtle effects. The cost and length of trials form the backbone of the current publicity campaign by pharma companies to justify price hikes that have recently brought them public embarrassment and opprobrium. Regardless of the relationship between the cost of trials and the cost of the resulting drugs, everyone would benefit if trials could demonstrate results more quickly. Meanwhile, longitudinal research with massive amounts of data can reveal the kinds of problems that led to the Vioxx scandal–but also new off-label uses for established medications.

So I’m excited to hear that two-thirds of the respondents are using “digital health technologies” (which covers mobile apps, clinical-grade devices, and wearables) in their trials, and that nearly all respondents plan to do so over the next five years. Big data benefits are not the only ones they envision. Some of the benefits have more to do with communication and convenience–and these are certainly commendable as well. For instance, if a subject can transmit data from her home instead of having to come to the office for a test, the subject will be much more likely to participate and provide accurate data.

Another trend hinted at by the survey was a closer connection between researchers and patient communities. Validic announced the report in a press release that is quite informative in its own right.

So over the next few years we may enter the age that health IT reformers have envisioned for some time: a merger of big data and clinical trials in a way to reap the benefits of both. Now we must ask the researchers to multiply the value of the data by a whole new dimension by sharing it. This can be done in two ways: de-identifying results and uploading them to public or industry-maintained databases, or providing identifying information along with the data to organizations approved by the subject who is identified. Although researchers are legally permitted to share de-identified information without subjects’ consent (depending on the agreements they signed when they began the trials), I would urge patient consent for all releases.

Pharma companies are already under intense pressure for hiding the results of trials–but even the new regulations cover only results, not the data that led to those results. Organizations such as Sage Bionetworks, which I have covered many times, are working closely with pharmaceutical companies and researchers to promote both the software tools and the organizational agreements that foster data sharing. Such efforts allow people in different research facilities and even on different continents to work on different aspects of a target and quickly share results. Even better, someone launching a new project can compare her data to a project run five years before by another company. Researchers will have millions of data points to work with instead of hundreds.

One disappointment in the Validic survey was a minority of respondents saw a return on investment in their use of devices. With responsible data sharing, the next Validic survey may raise this response rate considerably.