The Health IT Policy Committee approves the Stage 3 Meaningful Use requirements that were recommended by its health policy workgroup, but only after cutting 30 percent of the functionality that was originally proposed.
CMS publishes its revised hardship exemption criteria for EHs and EPs. The new criteria essentially rubber stamps the exemption application for anyone that asks for one so long as they report "2014 Vendor Issues" in their request.
Carolinas HealthCare System is turning to predictive analytics to help identify ED patients that would likely be readmitted so that preventative measures can be taken. The hospital recorded a $5 million loss this year, its first loss in 30 years, and executives hope that analyzing the data from its EHR system will help it recover that loss.
A report from the National Institute of Standards and Technology finds that ambulatory EHR vendors are not doing a good enough job building key clinical workflows into EHR software.
The HIT Policy Committee submits its Meaningful Use Workgroup’s Stage 3 recommendations.
From Pointy Toes: “Re: CEHRT Hardship Exception Guidance. This is a joke. All you have to say to qualify for the Medicare hardship exemption to avoid the 2015 payment adjustment is say you had ‘2014 Vendor Issues.’ Tavenner previously said some ‘narrow’ hardship exemptions would be granted. Sounds like anyone wanting an exemption can request it and presumably one will be granted one. Why not just push the deadline back for everyone instead of requiring providers to jump through an extra hoop?” CMS issued guidance Tuesday for EPs and hospitals worried about being hit with penalties, even going so far as to provide instructions to choose “2014 Vendor Issues” no matter what their actual issue. It is ridiculous – setting the bar high officially, then accepting a wink-wink rubber stamp excuse for anyone who can’t make it. Maybe someone should track the vendors whose non-compliant yet certified products forced their users to claim hardship.
From Canuck: “Re: rumore that UHN in Toronto is replacing QuadraMed EHR with Cerner. I believe instead it came down to Cerner and Epic and Epic won.” Unverified.
Welcome to new HIStalk Gold Sponsor SyTrue. The Chico, CA-based company offers a business and clinical intelligence platform that tells hospitals how their clinical objectives are being deployed; what physicians are doing; and who in the market is providing services at a given cost and outcome. It integrates and structures disparate EHR information for predictive and clinical analytics used for data analysis, electronic abstraction, outcomes analytics, operations, population management, clinical research, and patient engagement. Thanks to SyTrue for supporting HIStalk.
Here’s one final mug shot featuring Tammi’s office de-stresser, which must have traveled furthest from Orlando while still not leaving the continental US (the UFO on a stick in the background should give a strong hint of her location).
Thanks to the 355 folks who have completed my reader survey so far. That number provides respondents with good odds of being randomly drawn for one of three $50 Amazon gift cards, but represents only around 1 percent of HIStalk’s 30,000+ readers. Spend less than five minutes completing the survey and you’ll help me plan the next year of HIStalk and earn my appreciation besides.
I’m always looking for interesting people to interview. Know someone who would be stimulating, fun, and a straight shooter? Let me know.
March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.
Acquisitions, Funding, Business, and Stock
First-half results from Scotland-based Craneware: revenue up five percent, pre-tax profit up seven percent.
CompuGroup Medical acquires three European HIT providers: lab software provider vision4health Laufenberg & Co and office-based physician software vendors Imagine Editions and Imagine Assistance.
Quest Diagnostics completes its acquisition of Solstas Lab Partners Group and raises its full-year 2014 financial guidance.
Employer benefits platform provider Castlight Health raises the price range of its IPO to $13-15 per share, up from the $9-11 range it set just a week ago. The company, which lost $62 million on $13 million of revenue in 2013, would receive proceeds of $140 million, valuing it at $1.5 billion. The company’s founders are Todd Park (US CTO and co-founder of athenahealth); Bryan Roberts, PhD (chairman and co-founder of venture capital firm Venrock); and Giovanni Colella, MD (founder of RelayHealth).
The Royal Free London NHS Foundation Trust selects OpenText to manage its scanned legacy case notes.
The Community of Hope (DC) is implementing Forward Health Group’s Populationmanager and The Guideline Advantage.
The VA awards Leidos three contracts worth $16 million to support blood bank software and the MyHealtheVet program.
TeleTracking Technologies names Diane Watson (Tilt, Inc.) COO and Joseph Tetzlaff (inVentiv Health) CTO.
Michael Hart is promoted to VP of IT applications at Arkansas Children’s Hospital.
Craig Joseph, MD (Agnesian HealthCare) is named ICD-10 and EHR physician advisor at Texas Children’s Hospital (TX).
Announcements and Implementations
Cox Health (MO) deploys Phytel’s population health and patient engagement platform.
McKesson announces QICS for Cardiology, a CVIS-based workflow and critical results communications platform. OSF Healthcare (IL) is piloting.
QuadraMed announces GA of its QCPR 6.0 enterprise EHR, which includes bar code medication administration, a comprehensive problem list, a Web-based patient portal, the ability to create a CCD, and Canada-specific architecture requirements.
In Canada, Bluewater Health will roll out patient flow software from Oculys.
University of Colorado Physicians goes live on the DocASAP self-scheduling system.
Government and Politics
Office of Civil Rights fines the public health department of Skagit County, WA $215,000 for HIPAA violations involving information on 1,581 people exposed in its public web server, the first time a HIPAA fine has been levied against a local government.
The White House launches #GeeksGetCovered, encouraging technology entrepreneurs who can now buy their own non-employer health insurance because of the Affordable Care Act to start their own businesses.
President Obama riffs hilariously with comedian Zach Galifianakis, appearing on “Between Two Ferns” to plug Healthcare.gov (“I wouldn’t be with you here today if I didn’t have something to plug … Healthcare.gov works great now.”)
The phrase “healthcare exchange” always seems to be preceded by “troubled,” so add Maryland’s $200 million version to the list. Like other states, it decided to create its own site, hired a contractor that it later said underperformed, missed its go-live date, and had to create a backup plan to accommodate people who wanted to enroll but couldn’t. HHS announces that it will investigate.
Hillary Clinton’s financial disclosure forms for 2012 reveal that her husband Bill took a $225,000 speaking fee from the struggling, non-profit Washington Hospital Center as it was laying off employees. The hospital also brought in George W. Bush to speak, but since his wife isn’t running for office, his fee remains confidential. Bill made a bunch of money in 2012 for addressing money-losing non-profits. Somewhere in those records is the payment he received from HIMSS if anyone knows how to locate them. I’d bet $400K.
A NIST report says that inadequate workflow integration forces users of ambulatory EHRs to develop system workarounds, suggesting that EHR vendors develop these capabilities:
The Charlotte, NC newspaper says that Carolinas HealthCare System will use innovative (unnamed) software and the information collected by its multiple EMR systems to identify ED patients who are likely to be readmitted, allowing team-based intervention and remote management. The system’s chief medical officer weighs in on hospitals that don’t use electronic medical records: “You don’t know how bad it is until you actually go back. It was like a time warp. The care is unsafe, it’s uncoordinated. It’s a nightmare…The system was absolutely stupid, and frightening.” I interviewed SVP/CIO Craig Richardville in September 2013. It might be time for a follow-up to talk about analytics.
Wellocracy provides a well done comparison chart of wearable activity trackers.
A column by InfoWorld’s executor editor says a disconnect exists between complex government EHR requirements and the stubbornness of the healthcare industry to embrace them, summarizing, “We have a mess of proprietary EHR systems with highly customized processes, a set of HIEs that use different standards and protocols to connect them, and a mandate to provide human-readable data from these disparate systems. What could possibly go right?”
In England, University Hospital of North Staffordshire plans to conduct video consultations via Skype, saying the service will reduce outpatient appointments by 35 percent.
The Gainesville, FL newspaper profiles Shadow Health, whose founder licensed avatar technology from the University of Florida to create nursing school education tools that students buy for $89.
A study finds that incorrectly flagging patients as being allergic to penicillin increases overall inpatient days by 10 percent and increases resistance to broad-spectrum antibiotics. Up to 95 percent of patients who say they are allergic to penicillin really aren’t.
New York-Presbyterian Hospital will host a hospital hackathon this weekend in which teams will design apps for its portal that improve patient access to care. The hospital is offering $85,000 in prizes and has filled all of its slots with 120 participants. Dr. Oz provides the video introduction.
Seeking profits, developers are converting abandoned hospitals in New Jersey into medical malls. This turns out to be a good news, bad news story as described in a recent article (see: Repurposing Closed Hospitals as For-Profit Medical Malls). Below is an excerpt from it:
New Jersey has been losing hospitals for more than two decades....But in recent years, a few developers have purchased some of these abandoned structures, reopening them as private medical complexes that offer many of the services the hospitals once provided. For struggling cities like Paterson, N.J., the new use removes blight from the streets, restores health care services, creates jobs and provides a tax boost when a for-profit company replaces a nonprofit institution. Since 2008, developers have bought hospitals in Paterson, Jersey City, Hammonton and Trenton, converting the buildings into so-called medical malls that house an array of services like urgent care centers, doctors’ offices and dialysis centers. Critics worry that these new medical complexes are no substitute for the hospitals they’ve replaced and may siphon off paying patients from them. Unlike a hospital, individual providers in a private medical complex are not required to provide charity care, nor do these complexes have nonprofit missions to serve a community’s health needs, although some tenants are nonprofits. Nevertheless, these buildings are often ideal for medical uses — an emergency department can be repurposed as an urgent care center. Existing operating rooms can be used for outpatient surgical centers. And an inpatient floor is a natural fit for a subacute care facility. Added to that, the new use is certainly preferable to a deteriorating structure that contributes to urban decay....An urgent care center, for example, is not an emergency room that can admit patients. While a nonprofit hospital is required to serve a community’s health needs, a developer’s primary goal is to fill space with tenants who can pay the rent. So a primary care doctor or a pediatrician might not be as lucrative a tenant as a radiologist....But for communities with a high mix of uninsured patients, the services available at a medical mall are inaccessible to a sizable portion of the population. So the remaining hospitals absorb more uninsured patients, while they lose paying patients to a medical mall.
First of all, the charity care provided by non-profit hospitals as a requirement for their tax-free status turns out often to be a myth (see: Non-Profit Hospitals Drift from Their Mission Despite Subsidies; Can U.S. Hospitals Become More Oriented to Health Outcomes?; Cities Begin to Question Non-Profit Status, Tax Breaks of Their Hospitals). The care provided on this a basis is often minor compared to most of their business and even this percentage is unreliable because it's often accounted for on the basis of the inflated "retail cost" of care. Giant health systems like the the University of Pittsburgh Medical Center are anything but non-profit. Here are a few details about it (see: University of Pittsburgh Medical Center).
The University of Pittsburgh Medical Center (UPMC) is a $10 billion integrated global nonprofit health enterprise that has more than 62,000 employees, 22 hospitals with more than 4,700 licensed beds, 400 clinical locations including outpatient sites and doctors’ offices, a 2.2 million-member health insurance division, as well as commercial and international ventures.
Healthcare is one of the major drivers of the U.S. economy. According to the World Bank, in the U.S. it now comprises 17.9% of the GDP. In many urban centers with large numbers of unemployed and uninsured, the standard business model for hospitals is no longer viable. If developers can convert abandoned hospital buildings to medical malls, this shift should be welcomed. Here's an interesting quote about the cause of many hospital closures and rural "medical deserts" (see: Hospital closures will leave 'medical deserts').
The [hospital] closures are for a variety of reasons, including demographic shifts, politics and the economy,...and reimbursement cuts to hospitals due to healthcare reform....The issue is not just the lack of geographical access, but the fact that residents of "medical deserts" in rural areas are less likely to have good health insurance....
As I reported for MedCity News at HIMSS14 nearly two weeks ago, CMS Administrator Marilyn Tavenner announced plans to provide unspecified flexibility in claims for Meaningful Use Stage 2 hardship exemptions this year. Tavenner then left without speaking to the media.
The news left a lot of people scratching their heads and waiting for some details. Today, CMS issued some clarification, confirming that there would be exemptions for healthcare providers unable to have EHRs certified to 2014 standards in place for the 2014 reporting year. This is particularly important now because Medicare penalties for not achieving Meaningful Use take effect next year, but they are based on the 2014 reporting year (Oct. 1, 2013-Sept. 30, 2014 for hospitals, the 2014 calendar year for physicians and other individual “eligible providers.”)
The guidance confirms that CMS is aware of the problems caused by the slow pace of certification to the new, 2014 standards that Stage 2 requires. As of today, according to the ONC Certified Health IT Products List (CHPL), there are 3,736 ambulatory and 1,200 EHRs and EHR modules certified to 2011 standards, but just 899 total that meet 2014 certification.
The following is a guest blog post by Minnette Terlep from Amphion Medical Solutions.
Often lost in the overarching conversation surrounding the potential negatives of ICD-10 is the very real impact it could have on the selection of physicians and hospitals by health plans, MCOs and shared-risk organizations for participation in provider networks. To succeed, these organizations seek out providers with a strong track record of care that is both high quality and cost-efficient—which is where ICD-10 can hurt or help.
Physicians do not assign codes. They are, however, responsible for documenting at a level of specificity that allows the assignment of codes—the burden of which is exponentially higher under ICD-10. The coder can only assign codes matching the level of specificity supported by the documentation. If the assigned codes reflect a level of severity that is artificially low because of inadequate documentation, it can raise red flags for organizations who profile physicians.
That is because these organizations look not only at severity of illness and mortality rates, but also cost efficiency in providing care. If a physician appears to be over-utilizing resources based on the final assigned codes, it is very likely he or she will be considered a risk and excluded from the network.
For example, if a physician simply documents “pneumonia” as the principal diagnosis and the patient receives standard care for this simple pneumonia, the case will generally and appropriately assign to the lower weighted MS-DRG for community acquired pneumonia. But what if the patient is actually diagnosed with a type of gram negative pneumonia that is fully supported by a positive culture? If the physician fails to document this more resource-intensive type of pneumonia so the significantly higher weighted MS-DRG can be assigned, then the patient’s days in the ICU and on the medical floor for continued care would not appear to be justified.
The difference in cost between the two scenarios is thousands of dollars, which is problematic on its own. However, it also presents ongoing challenges for the physician in the second scenario: Getting improperly tagged as a resource over-utilizer because, based on the codes and MS-DRG assignment, excessive care was provided. This could easily result in exclusion from a plan or participation in shared-risk initiatives.
We’ve been inundated with information on how clinical documentation must be significantly improved in advance of ICD-10 because of the impact under-coding can have on reimbursements and core measures performance. However, as illustrated in the pneumonia scenario, the potential impact on individual physicians runs deeper. When the highly detailed nature of ICD-10 is coupled with the growing emphasis on standardized care and quality over quantity, it spells potential financial and reputational ruin for physicians whose profile raises concerns about mortality rates and ability to provide cost effective care.
It may also impact the hospitals with which the physician is affiliated. Both can quickly find themselves locked out of networks and excluded from potentially lucrative shared-risk models. Exacerbating the potential impact is the growing (albeit slowly) emphasis patients place on identifying physicians and hospitals with high quality and outcomes rankings, both of which can be tainted by the specter of over-utilization.
While protecting a physician’s profile from the over-utilization category isn’t generally at the center of documentation improvement strategies in advance of ICD-10, there are ample reasons why it should be. So much of what we see and hear about the greater specificity required under ICD-10 is geared toward the impact DRG assignments will have on reimbursement, but in reality it can have far greater long-term financial and reputational repercussions.
Thus, identifying and correcting gaps and areas of weakness in clinical documentation will be beneficial not only for ensuring appropriate reimbursement levels and outcomes metrics reflecting true performance, but also to prevent unjust exclusion from provider networks.
Physicians and hospitals taking the time to analyze profiles to ensure they accurately reflect utilization rates, and to identify and correct documentation-related problem areas that may leave managed care and shared-risk organizations with the wrong impression, will find doors to participation will remain open—and benefit the bottom line.
Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.
Six Republican senators are calling on CMS to provide more details on its plan to grant healthcare providers more lenient hardship exemptions for Stage 2 Meaningful Use.
In England, a coroner at Royal United Hospital blames a new outpatient scheduling system in his report after a three-year-old boy passes away because he missed months of appointments booked to monitor a heart condition. The appointments were properly scheduled but were lost when the hospital migrated its scheduling data to the new system.
The HHS Office of Civil Rights settles a HIPAA violation with Skagit County, WA for $215,000. The case marks the first time that the OCR has targeted a county government.
Saturday I had the tremendous (that’s in the sarcasm font in case you missed it) opportunity to do a pediatric walk in visit for my daughter. Everything is fine and my daughter’s doing well. However, while I was waiting in the lobby, I saw the following sign posted on the wall:
For those who can’t see images, here’s what it says:
Mission: Deliver the highest quality of care to tall of our patients.
Promise: HealthCare Partners of Nevada and its team of professionals will not tolerate nor be indifferent to poor quality.
Creed: Live our mission; Keep our promise
Someone recently described my blog focus as covering the business of healthcare. I thought that was a pretty decent description. Certainly we have an IT bend to almost all of our content, but we’re happy to write about anything that relates to the business of healthcare. It just so happens that IT is involved in almost every business aspect of healthcare.
With this focus, I think I sometimes get a little jaded when it comes to healthcare organizations motivations when it comes to the care they provide their patients. I’ve often argued for the importance of the almighty dollar when it comes to influencing doctors in healthcare. This was reinforced just today in Dr. Jayne’s post on HIStalk where she said, “At least all of our physicians were migrated to a common contract in tandem with our EHR project more than half a decade ago because we realized only money would align them with our goals.”
While I still believe that the financial incentives are the best motivator, I think we need to be careful and not take it too far. Healthcare should be and can be more than just the financial incentives alone. In fact, any organization with a long term view will likely have a mission similar to the one espoused by Partners HealthCare.
I strive similarly with my blogs. Certainly I need my blogs to be a viable business and I want to continue building them to be able to reach more people. However, my goal is for my blogs to be about much more than just making a buck. I believe they have, can, and will have an important impact for good on healthcare. I’m sure I’ll overstep on occasion and my good readers will hold me accountable when I do. However, hopefully the Healthcare Scene network can stay focused on providing real value to those who read.
I should maybe consider having my wife do a guest blog post on Partners HealthCare’s above mission as well. She took two of my boys to the same pediatric office today for a scheduled appointment to get some immunizations they said were needed. After waiting an hour in a non-kid friendly exam room with two children, the doctor came in for the visit and noticed my son was acting wild. The doctor then asked if my son was ready for Kindergarten if he couldn’t sit still in the exam room. My wife quickly replied that if he hadn’t kept her waiting in a non-kid friendly exam room for an hour, then our son would have been fine. Not to mention, my son was not looking forward to the shots.
To add insult to injury, the doctor returned to inform my wife that my son didn’t actually need the immunizations. They had finally found the record and he had already had all the required shots. My guess is they couldn’t find the record because they’d had to switch EHR when their EHR vendor sunset their original EHR. This is the same EHR which the doctor had told me two days previously, “He hated even more than the previous one.” That’s almost enough for me to want a PHR for my children. However, it’s not like the school would accept an immunization record from the PHR.
One could argue that my wife’s experience above didn’t compromise the quality of care my children received. That’s true unless you consider the counseling my wife will need for being driven insane while she waited for an appointment she didn’t actually need.
Having worked in clinics, I’m sympathetic to the doctor and practice. We realize things run behind. We realize their are limitations on what child friendly things they can have in exam rooms (although, how about a TV?). We understand that records get lost or that mistakes are made when looking them up. Although, when all those things conspire against my wife, you can understand her frustration.
This discussion reminds me of a topic I’ve been talking a lot about recently. There’s a difference between quality of care and customer service. As patients we have very little understanding of the quality of care we’re being provided. We don’t really know if the quality of care we’re getting is good or not. However, we’re keenly aware of the customer service experience. If you look at any doctor ratings site, it’s all rating customer service. Yet, so many of us equate those ratings with the quality of care.
What’s the moral of the story? We can all do better. That’s the journey we have ahead of us in healthcare. Continue to improve and do the best we can to provide amazing care. This is not a one time battle that you win and move on. It’s an ongoing battle that never ends. That’s what makes it so difficult. It’s also what makes it so important.
Walk-in clinics located in CVS and Walgreens stores offer a wide range of basic services such as vaccinations and the treatment of minor ailments. Some are even some offering lab tests (see: Lab Testing Now Being Offered in Walgreens California Stores). Although there are other players in this business, I think that these two companies dominate the field. They offer the convenience of multiple locations and effective marketing. Since their inception, one of the weaknesses of walk-in clinics in general has been their rudimentary electronic records. This gap now seems to be closing, at least for the CVS MinuteClinics (see: CVS-Epic deal will add EHRs to Minute Clinic in run-up to major expansion). Below is an excerpt from an article on this topic:
Just as CVS Caremark is poised to expand its MinuteClinic system, it’s inked a deal with Epic Systems to provide ambulatory electronic health record support for the clinics. The EHR/EMR giant will replace the homegrown EHR system CVS developed....It reflects a growing maturity of the MinuteClinic concept as it moves beyond flu vaccinations and blood pressure readings to provide more non-emergency care, and it is one of the healthcare industry trends to reduce healthcare costs by providing alternatives to hospitals or the doctor’s office. The clinics are equipped to provide vaccines, do some lab tests and provide several non-emergency care services....Dr. Nancy Gagliano, MinuteClinic’s chief medical officer, said Epic’s support of national interoperability standards, analytics and customization helped cement the deal. CVS currently has more than 800 MinuteClinic locations and expects that to almost double to 1,500 locations....“We need a robust IT system, an EHR that will effectively interconnect with our affiliated partners,” as well as health information exchanges, [Gagliano] said. “We’re going to have over 1,500 clinics in just over a couple of years. We see 4 million patients a year and we’ll see 10 million patients a year in the near future. So we need a big company to support the volume that we’ll have.”
It will be a while before people should expect to see Epic’s EHRs in action. It will take about 12 months to train staff and set up “specialized interfaces” and another year to roll out the EHR network across MinuteClinic locations. A couple of components of the EHR network CVS is installing are Care Everywhere, which works as a health information exchange between Epic customers; and Care Elsewhere, which makes interoperability possible between Epic systems and other non-Epic providers or health information exchanges....CVS just joined the CommonWell Health Alliance — a group of health IT companies to improve the way healthcare data is shared. At the time of its launch last year, the alliance was perceived...as an attempt to better compete with Epic....In the announcement last week at HIMSS, a statement said that CVS is joining CommonWell as a contributing member, and would work with RelayHealth to embed these services natively into its pharmacy system.” It will also help providers securely access prescription information to improve patient safety. “Through the Alliance, pharmacies and health care providers will be able to better connect with the broader health ecosystem.”
These deals and alliances with Epic, RelayHealth, and CommonWell on the part of the CVS MinuteClinics are all about the integration of information and access to prescription data for patients. I suspect that the long-term plan for CVS is to position their clinics as the most basic rung in the U.S. healthcare delivery system. As such, they need to provide clinical and drug information up the line and also get access to the medical records of other providers. This yields both integration and legitimacy.
So what's in this deal for Epic. A huge number of patient records, obviously. Here's a quote from above: [CVS is] going to have over 1,500 clinics in just over a couple of years. We see 4 million patients a year and we’ll see 10 million patients a year in the near future. Although Epic will continue to connect its hospital clients with health information exchanges (HIEs) when available, I also believe that Epic's goal is to become a de facto HIE for their large client base (see: Connectivity and Hospital-Based EMRs; The EMR as an Operating System?; A Reader Comments on Epic Interoperability and Care Everywhere; Surescripts May Capture the Health Information Network (HIN) Business; Sharing Medical Records across Hospitals with Epic's Care Everywhere; Judith Faulkner, EMR Interoperability, and Washington IT Politics). In this context, providing support for the MinuteClinics makes perfect sense.
This week was the beginning of what I suspect will be a long and painful project at work. If I wanted to deal with mergers and acquisitions, I would have gone to business school. Instead, I went into medical school, but nevertheless here I am.
Like so many other health systems across the US, mine has been in growth mode. We were accelerating the growth of our employed medical group going back as far as 2008. The push towards more tightly integrated delivery systems has only added fuel to the fire.
We had previously been purchasing groups in the three- to 10-physician practice space, with a couple of outliers that had 15 or so physicians. Now we’ve gone and purchased a 75-physician group. I’m sure it looked great to the hospitals as a way to further consolidate their referral bases. It was also a grab for the revenue that the new group’s imaging division was bringing in on the side.
I had the opportunity to speak with a few of their physician leaders in a couple of weeks ago. My ears perked up when they mentioned one upside of being part of our health system as “better support with IT projects including Meaningful Use and PQRS.”
Red lights started flashing in my head and alarms were going off. Thinking that PQRS or Meaningful Use are “IT projects” is like thinking that a heart/lung transplant is a “plumbing project.”
I immediately scheduled a series of meetings with their leadership and IT teams and our counterparts to figure out what had been promised by the C-suite and how we were going to deliver it. It’s bad enough to have to deal with a culture shift, but when technology and millions of dollars in incentives are involved, the problem is magnified. Our C-suite has a track record of promising technology projects that they can’t deliver (such as a complete EHR conversion in 30 days) so we quickly formed a betting pool to entertain just how bad this might get.
One of the reasons they get us into these kinds of binds is they’re afraid to involve too many people in the acquisitions. They fear that other physicians will get word of them and become demanding or that there will be a loss of bargaining power if it’s public too early. I understand that, but I also understand the need to do due diligence around merging or converting IT systems before the promises are made and the papers are signed.
Every once in a while, one of the VPs will ask someone from IT to “look under the hood” at an acquisition target, but it’s usually more along the lines of valuing their hardware, calculating their maintenance, and figuring out how to connect them to the hospital backbone than it is to assessing the quality of their data and how well their workflows and care gel with our existing best practices.
Unfortunately, the ink was already dry before I knew about it. Our group president made some assumptions that since our target was on the same EHR as we are that it should be fairly easy to just “throw them on our system and have them attest with our docs.” Oh, so much easier said then done, my friend. When I started throwing out reasons why it doesn’t really work that way, he actually referred to me as Debbie Downer and reminded me that we have to make it work because we already said we would.
I can’t believe that’s what passes for leadership these days, but our health system seems to love this guy. He’s personable and kind of a teddy bear, but he’s generally all fluff and no stuff, which leaves the rest of us to scramble around behind him to try to make things work.
This week began the series of meetings to try to figure out how to deliver the impossible. We now have two installations of the EHR to deal with. Their group has a lot of primary care docs that refer to our specialists. Given the number of common patients between the platforms, I’m not confident of being able to do a clean conversion without a lot of data integrity issues and a substantial commitment for clinical cleanup even if we had a nice long time interval. That’s problem number one.
Problem number two is that both installations have to take a major upgrade before we start the attestation period for Meaningful Use on July 1. Leadership assumed we could combine the systems quickly and do a single upgrade, but in addition to the patient issue, we also have a fair amount of customization and client-specific configuration on each system that will have to be evaluated. We can’t just throw it all away and assume physicians will be immediately facile on a plain vanilla system.
We also have the issue that at least 40 of their providers are going to be attesting for MU the first time. That means that not only do we have to get their upgrade live early enough prior to July 1 that the users have enough time to burn in the new workflows and make sure they’re entering quality data, but we need to plan to have our MU and auditing teams work around the clock at the end of the quarter so we can attest for them by the deadline. Problem number three.
Let’s see, the end of that quarter also puts us at October 1, which is ICD-10 go-time. That makes problem number four.
Let’s back up a little, though. If they’re such a solid, established group, I wonder why more than half of them are just now going after MU Stage 1? That was the topic of Wednesday’s half-day working session, when I really dug into the fact that they think MU, PQRS, and other quality initiatives are IT projects. That’s when I came up with problem number five, which unfortunately is the biggest one of all. The reason they haven’t attested yet is they’ve been attempting to have IT lead all these projects without adequate operational and clinical support.
They seriously think that there is some kind of magical IT wand that will be waved around and the physicians will do what they are asked along with all the support staff. They have zero physician alignment strategy. Physicians have no financial skin in the game for MU or any of the other incentive programs. They don’t even have a standard physician contract. All the physicians have been able to negotiate their own deals even those in the same physical location. That makes it a little tricky when partners are able to earn the same income seeing dramatically different numbers of patients per month.
The IT team listed off more than a dozen resentful bitter physician disagreements without even taking a breath. At least all of our physicians were migrated to a common contract in tandem with our EHR project more than half a decade ago because we realized only money would align them with our goals. These folks (including the one operations person that bothered to show up at the meeting) acted like they have never heard such a thing.
Their staffing ratios are also a mess. Everyone has the same number of support staff regardless of specialty, productivity, or how they run their offices. There is no common scheduling methodology across their locations, which adds another worry of how we’ll do an appointment conversion if we decide to do one when we move them to our database. No wonder they were ripe for the picking — they were undoubtedly losing money with how they were running. By the end of the meeting, I was scarfing down Advil like they were the green M&Ms in Inga’s Quipstar dressing room at HIMSS.
I spent most of Friday with my trusted lieutenants trying to figure out how we’re going to do this and still preserve our sanity and keep our team intact. After looking at all the pros and cons, I think I’m going to be lucky to make it through the next two quarters without losing my own mind or quitting my job. My liver can’t take as many martinis as I think I’ll need to get through the inevitable goat rodeo this will become, so I figured it was time to find a less-harmful way to self-medicate.
My drug of choice: pastry. This week’s offering is pictured at top. I’m a big fan of doing things old-school so I can let out my stress cutting the butter into the flour by hand as I pursue the perfect crust. I can release my creative energies by trying different fillings. If I really need to escape, I can do decorative top crusts or make little designs with dough cutouts.
I may not be able to make this project work, but I’m armed and dangerous where an egg wash is concerned. I’m going to go all Martha Stewart in my free time, just without the insider trading or the prison term.
Got a recommendation for pastry therapy? Email me.
Email Dr. Jayne.
Regina Holliday is a Washington, DC-based patient advocate and artist known for painting a series of murals depicting the need for clarity and transparency in medical records. After her husband’s death from kidney cancer in 2009, she painted "73 Cents," a mural showing her husband dying in darkness surrounded by inaccessible technological tools in a closed data loop. The title refers to the cost per page charged to patients to obtain their medical records in the state of Maryland.
Give me some background about what you do and what The Walking Gallery is.
Almost five years ago, my husband had cancer. He was in the hospital for 11 weeks. We had very little access to his electronic medical record. He died in the 12th week. I decided I would do everything in my power — speaking, painting, writing — to try to change healthcare and make it become where the patient’s story is front and center, and within hospitals, you can get to your medical record in real time.
That’s why I paint giant murals and that’s why I started a movement called The Walking Gallery, where people have paintings on the back of their business suit jackets and the goal of the patient’s story is front and center.
You just spoke at the HIMSS conference. Did you leave it feeling that patient engagement and advocacy are really taking hold or is it just a few folks hoping that it is while the rest are indifferent?
I’ve spoken now at several different informatics societies. I’ve been excited to see how much HIMSS is embracing patient advocacy in a real way. It doesn’t seem to be token and it’s growing every year, which is real exciting to see. I’m sure it’s incredibly frightening for them to watch it take off.
HIMSS tries to serve two factions, high-paying vendors who want to sell products and providers who are their prospects and users. But usually absent from those discussion are the patients all of that technology affects.
Before I worked in healthcare, I came from the toy industry. I’m very familiar with Toy Fair, which is gigantic trade show. There’s a lot of similarities, because just like in that world, you’re focused on sales, high-dollar items, and what’s going to move that year. But you’re also really focused on the fact that your customers are children. There’s this wonderful, youthful spontaneity to that product line, the concept of selling toys.
In healthcare, we have somewhat distanced ourselves from the end user, which is patients. I’ve been wanting to see the realization come back that when you’re a vendor, when you’re a provider, whoever you are at HIMSS, inside of you, you are a patient. It’s been really exciting to see people flip and relate to themselves as their patient self before they relate to themselves as their vendor-provider self.
Will patients ever have that kind of power where they’re like a customer in any other industry?
Yes. It’s coming. The beautiful thing that happened to medicine was social media. The ability for patients, regular folks who have no organization behind them, to have an equal voice to a company.
While I was at HIMSS, they had trouble getting my hotel room. I was tweeting about it, and within less than two hours, I was talking to Hilton, the national channel. Later that day, I was talking to Hyatt, the national channel. That kind of power didn’t exist before — the ability as an individual to communicate with large organizations. It’s changing everything.
Do you think that’s really the case? At Hilton or Hyatt, you’re paying the bill, and if you’re unhappy, you stop using them. But in healthcare, you don’t necessarily get to choose where you receive your care or control what you pay for …
I disagree with that. The model of care is rapidly changing. With the Affordable Care Act and a lot of consumers becoming high-deductible plan payers, they’re determining where they’re getting their care. The ability to make choices about where you’re going to get your care affects the bottom line in institutions. With things like HCAHPS scores, patient satisfaction scores, now being publically available, with transparency in pricing becoming more and more demanded, you have an end-user consumer that’s actually becoming very empowered.
What do you see as the impact of the Affordable Care Act?
Major major groundswell change. People becoming very interested in the fact they have choices in policies. 2008 really hurt a lot of this country. People were wedded to a location, a job, and insurance that came with that job. Which meant that, unfortunately, a lot of people who should have been able to move so they could economically better themselves found themselves not in a position to do so.
Affordable Care Act comes on the stage. Now all of a sudden we are getting the ability to untangle our health life from our job life. That allows for a whole bunch of people to work at different organizations, start new businesses, go the freelance, self-employed contractor route when they thought they couldn’t do that before because they couldn’t get insured. That allows us to have a looser economy.
Honestly, when it comes to Americans, we are spectacular at innovation and creativity. Those things are squashed if you’re forced to stay in a job that you don’t want to be in any more. For a long time, the way we set up our insurance in this country, you were forced in that position.
Inpatient demand is dropping, so hospitals are using their money and clout to buy physician practices to shore up their protected markets. Will they be able to end run the trend that would place them less at the center of the healthcare universe?
Not if we do a really good job with transparency exposure in social media. You’re opening people up to what’s really going on and then make different decisions. Also, we need to get in the world view wonderful facilities that are the future of healthcare.
I just toured Eskenazi Health in Indianapolis. It’s a safety net public hospital. It’s astounding. They get it. They get where the future’s heading, which is a health and wellness hub where the community is still going to the hospital, but they’re not going to the hospital for the same reasons they used to go.
Hospitals that get it, that see the future as the way it is coming, are going to succeed. The hospitals who don’t get it, there’s a really good chance they’re going to go down.
It’s rare anything takes root in healthcare unless someone makes money from it. The right thing to do doesn’t always win. Does patient involvement have a strong business case?
Yes. We in the past have not looked at the potential the facility has. We were all about, “Fill the beds, fill the beds.” That’s not necessarily the future way people are going.
Videoconferencing, mobile technologies, people wanting to have a health community. Patient communities are really, really skyrocketing. You have to think in a different way. It’s more of like a library hub direction with wellness activities and physical activities. Why can’t there be sick child care? I was in Lawrence, Kansas back when they were doing that back in the 1990s.
There’s different ways that you can make money that are wonderful, legitimate ways to make money that actually helps citizens, as opposed to the system that we’ve had that were incentives for failure. There were incentives for person getting an infection and staying longer. We have to flip that matrix to where healthiness is the incentive.
Putting patients at the center of healthcare is, unfortunately, a big change. For those overwhelmed by the long-term vision, what would be some short-term goals you would settle for?
I often look at the intersection of health and art. That’s one of my focuses. We need way, way more realistic visuals of care. Less stock photography, more painting. More involving regular people into the life of your hospital.
I would like to see patients — not just a patient advisory council at hospitals, which a lot of them have — on every board and council throughout the entire facility. I’m talking like EMR workflows as well as M&M reports. We need to be part of the conversation. Because what is absolutely beautiful if you do this is that patients can say things that staff can’t. Staff may be thinking it, but politically they’re put in a position where they can’t say it. Their job can be affected. We don’t want to rock the boat.
Patients, not in a bad way, can say the words, since we’re not hired by the institution, that everybody might be thinking but don’t feel the power to say. Once we’ve said it, all of a sudden things break open. Doors break open and pathways change.
One of the major things I would love to see is truly embracing us as part of the team. Not a token. Don’t have us design your lobby again. But really, seriously involve us in decision-making processes and get our feedback. That’s a great short-term goal, very doable by next week.
What do you think would happen if you bought a random patient a HIMSS conference badge and said, “Tell me what you think about what you saw there?”
I think that would rock. We should totally do that next year. Let’s have a scholarship fund. We’ll call it the HIStalk Scholarship Fund. We will just take random people and send them to HIMSS. Let’s do it.
I think they would not only feel uncomfortable there, they might actually be angry to see all the machinations that go on behind the scenes that affects them but doesn’t involve them.
I think you’re right. There’s some people who would be very freaked out. I would recommend a cross section throughout the United States. Since I speak nationally, I do find there’s major regional differences in the way people talk to folks, strangers in crowds and things like that. If we had a good cross section — West Coast, Midwest, South, East — attend HIMSS, that would be spectacular. Since it’s in Chicago this coming year, it can be an entire concept since that’s the middle of the country. I would totally be behind you on that.
Did you see any technology in the exhibit hall that excites you in being able to allow patients to get more involved in their care and see their own information?
This year I felt HIMSS wasn’t showing a lot of new product. I thought HIMSS was truly embracing the stuff they were introducing as new products a few years ago. Now mobile health wasn’t like this weird new thing of will it work, but pretty much an accepted reality, which that was really great to see.
I don’t know if you saw my painting, HIMSS and HERS, that I painted at the event. I was still frustrated by the way larger demographic that is male than female at HIMSS. I even went by a booth where the women were complaining about their heels. I said, “Why don’t you just wear sensible shoes?” They were like, “Well, you know, we have to wear nice clothes because somebody could come to the booth and see us not dressed appropriately.” Whoa, is this the 1950s? Do you really think you have to be a booth babe when you’re just as competent at technology as all these guys that are in the space?
I heard that HIMSS had some resistance to bringing you this year because of cost even though they’ve helped you out in years past.
Well, they invited me to attend. They said they had no funding for travel or lodging.
You’re self-funded, right?
Yes. I don’t have an organization behind me. I started a Gittip fund, a crowdsourcing, sustaining model which is pretty cool. I was very excited. I had never seen that before. To help pay for me being at HIMSS.
Between my babysitting fees and going there, I spent close to a thousand dollars just getting there. As patients, we aren’t being paid back by our business to be there because there isn’t one. It is one of those things that can be a hardship. That’s why I was really excited to see Chicago’s coming up, because at least it’s in the middle of the country and it’s easier to fly there so it’s not so much of a hardship to be part of the experience.
Not that your role wasn’t substantial this year because they at least did put you on the patient engagement stage, but what do you see as your involvement next time?
Hmm. I’d love to be on a main stage. That would totally be great. That hasn’t happened yet. My goal is one day to keynote at HIMSS. I’m sure it will happen. It’s just a matter of time.
How did you feel that the opening keynote, the most important speaking slot at HIMSS, went to an insurance company CEO?
It was sort of an odd choice. I think it might have been partially because of the Affordable Care Act kind of year. They thought that talking to someone from the industry, especially the insurance industry, would make a lot of sense in this timeframe.
I tend not to judge necessarily so much where a person comes from, what business they come from, but whether they are they an amazing speaker. Do they get the space and do they inspire people? I was really excited when Eric Topol’s keynote last year because he gets it. He understands the space. He understands how to inspire.
When people come to a convention or a conference, they’re not just coming there for the most current information and to get the good vendor deals. Those are really important things. But they’re also going there to recharge, to have the energy to go into next year and be better than they were the year before.
At times, it seems that HIMSS has lost sight of this. Why don’t we just stay home? We can get good deals from home. We go to an event to network with people and to recharge our soul. I look forward to embracing that more deeply in the future.
What would you say to healthcare software vendors?
I want you to think of your parent in that bed or your child or your wife or your husband when you’re designing software. I want you to think of them. Because every single thing you do should be to make sure they get the best possible care. God, I hope you get to that point before it happens in your very own life. If I can do anything or say anything to get you to emotionally that point where you’re thinking about them while you’re designing, then I’ve done my job.
An article called you the Rosa Parks of healthcare.
Because I’m a regular person. I was a teacher, a special needs mom, and a wife. I worked in a toy store for 16 years. I was normal. I decided that as a normal, regular person, I’m going to stand up to injustice. That’s what Rosa Parks did. I didn’t come from healthcare, but I will do everything I can to make it better for folks who live within it.
What are your thoughts for the future?
One of my major goals is that when we get to Stage 3 of Meaningful Use, we have real-time access to the medical record – nurses’ notes, progress notes, doctors’ progress notes, all labs, all information. That should be available to the hospitalized patient just as much as the discharged patient because the hospitalized patient is spending the most money and they need that information in the most timely fashion. That’s my overarching goal and everything I do is toward that overarching goal.
Any concluding thoughts?
This has been absolutely delightful. I look forward to us putting together the HIStalk Scholarship Fund for next year.
That would be fun. Unfortunately, it’s become somewhat predictable in how conferences handle patients on the podium. The person tells a moving, compelling story about a something bad that happened to them, everybody in the audience feels embarrassed and gives them a standing ovation, then they just wipe the tear from their eye and go back to what they were doing before that allowed the problem to occur. The emotional tug is there, but nobody can figure out how turn it into something useful.
Years ago, I was a motivational speaker before lunch at a CMIO boot camp. They said, would you like to stay for lunch? I said yes, I’d love to stay for lunch, so I ate lunch with them. Then they said, now we’re going to go into our work sessions and there was that quiet pause moment. I said, can I go to the work session, too? They said, uh, well, yes, it’s going to be very technical, but you’re welcome to come.
I sat in this giant hall with 40 CMIOs. They were talking about a specific vendor system that I had actually seen. I had gone to the company and seen it person. They were talking about problems with files where they didn’t know who the person was, like recognition of the correct patient. I said, I’m confused, you’re using so-and-so’s system and I know they have the ability to have a visual avatar. Every field can have a picture of the patient right there on the field. Why are you having this problem?
They said, no, it doesn’t, it doesn’t have that feature. I said, yes it does. The only way it doesn’t have it at your hospitals is that somebody turned it off. Everyone’s head turned to the front of the room where the man was standing in the front who’d been speaking and was in charge of these all of these facilities. He said, yeah, I just turned it off because I thought nobody would want that.
What was so cool about that moment was that I may have been the motivational speaker of the morning, but I had information to give those individuals that they didn’t have prior to that. That’s the beauty of involving patients. They can often be that little hinge pin that can change things.
Did you ever consider developing a checklist of how to make an EMR more patient friendly?
We’ve talked within the Society for Participatory Medicine about concepts like that. I don’t think there’s a uniform thing yet, but it’s definitely something to put on the list of things we need to do.
There’s things about standardization at work and then there’s some things that don’t work regionally, so you want to have an overarching checklist that you can work with. But the really thing that’s important to remember is every institution works a tiny little bit differently. It’s important to catch their unique differences. That’s one of the things that overarching standards often miss.
What do you think about the Open Notes project?
Love it! I was on Twitter back in 2010 complaining about not having open doctor’s notes when the Robert Wood Johnson foundation tweeted to me. I was like, what are you doing? They said, we’re just holding. We’re doing this amazing study. Watch what we’re doing for the next two years. And I did.
I was so excited at the 2012 press conference when they talked about it. I was there. It was really exciting to paint about it and talk about it. I went to Tom Delbanco and was like, you know, your whole concept made me think of the open note within music, the whole note, the patient is everything, it’s part of the communication with the provider. And Tom Delbanco said you know, it really is that. I’m a musician. The whole concept behind Open Notes was a musical note.
Isn’t that beautiful? It’s one of those things that’s the idea of all of us as provider and patient working together in the totality of ourselves.
— Vanessa Ulrich (@vanessulr) March 6, 2014
This is true if the actors are well intentioned. I’ve found that most in healthcare have the right intentions. Although, many don’t have the right data that could help them make better decisions.
— HealthcareNOWradio (@HCNowRadio) March 6, 2014
I’m going to have to chew on the idea of EMR sales being non-linear. An interesting observation by Chandresh. I’m excited to hear Chandresh share more of his experience with EMR sales at the Health IT Marketing and PR conference.
[Infographic] Secure access to patient data is more relevant than data privacy or cost reduction http://t.co/ix38jbuw9W
— EMC Documentum (@EMCdocumentum) March 6, 2014
I’m not sure if this was the exact intent of this tweet, but it reminded me of a discussion I had with some really chronic patients. To a person (and the parents since these were kids), they couldn’t give a rip about privacy. They were more than happy to give up any and all privacy if it would help them find a cure or treatment for their child. This reminds me that context is really important when it comes to privacy.
Since Lipitor has come off patent, Pfizer has been facing very serious competition from the manufacturers of generic copies of its former cash-cow (see: Pfizer Lipitor Sales Are Threatened by Ranbaxy Generic Copy). But the company continues to try to breathe new life into the product by now proposing an OTC version (see: Lipitor Down, But Not Out: Pfizer Plans an OTC Version). Here are some of the details:
I've been following Lipitor's "demise" ever since Pfizer vowed the drug would maintain a 40% share of the total U.S. atorvastatin market. In May 2012, we all thought Pfizer Threw In the Lipitor Marketing Towel when the Lipitor co-pay card/PBM discount plan failed to meet its goal of maintaining the aforementioned 40% share of the combined market for Lipitor and its generic equivalents for at least 6 months after generic brands were launched. At that time Lipitor's U.S. market share was 33%. Guess what Lipitor's U.S. market share versus generic atorvastatin is today. As reported in the WSJ (here), global sales of Lipitor plummeted in 2012 and 2013 to about 20% of what it was in the blockbuster heyday....
...Pfizer is preparing to sell an over-the-counter (OTC) version of Lipitor. According to the WSJ, "Pfizer recently started a 1,200-patient clinical trial to test if consumers taking a nonprescription Lipitor get their own blood tests to see if the medicine is improving their cholesterol and then make the right decisions based on the results." The FDA has to approve the switch to OTC status. Keep in mind that FDA already has "rejected proposals by Merck & Co. to sell an OTC version of the statin Mevacor, amid doubts that consumers could correctly choose to take a statin on their own or sufficiently monitor themselves for changes in cholesterol levels and side effects."
Will consumers "undertreat" their cholesterol because the proposed OTC version of Lipitor will come in a 10 milligram dosage form versus the 40 to 80 milligram Rx dosage forms?...[I]t all depends upon the price consumers will have to pay out of pocket -- medical insurance doesn't cover OTC medicines. Most people would think a little bit of cheap OTC Lipitor...is better than no treatment at all -- and surely better than generics that lack brand "personality." And because it is OTC, consumers will think it is as safe as aspirin and won't cause any problems that require monitoring. Pfizer can then market it like aspirin without mentioning any of the potential problems/side effects.
This is very interesting--a proposal by Pfizer to sell Lipitor OTC with the assumption that consumers will monitor their own cholesterol levels and thus treat themselves effectively and appropriately even with only a low-dose OTC product available. This will be a particular challenge for those with high levels who may not be diligent in seeking medical advices. I agree with the author of this blog note in that consumers frequently consider OTC drugs as "safe as aspirin" which, by the way, is not all that safe.
I am fascinated by the idea that an OTC drug could potentially be accompanied by a recommendation that the consumer should periodically monitor cholesterol levels. I suppose that such an OTC statin could be sold with a test kit for measuring cholesterol levels at home (see: Cholesterol Home Test Kits). However, this involves a finger-stick with a lancet and I suspect that this would be a challenge for many people. Sounds much too complicated so I doubt that it would be approved by the FDA.
::Update on 3/08/2014 at 9:15 a.m.
This year I’m chairing a healthcare IT event series called HealthIMPACT — it’s what I’m hoping will be some of the best places for healthcare technology enthusiasts and buyers to get actionable advice on what’s real, what’s BS, what to buy, what not to buy, and perhaps most importantly, which guidance is worth following. In order to make sure we cover the right topics, we have created a very short survey so that we have some evidence-driven approaches to proving we’re focusing on the right areas.
The survey should only take a couple of minutes to take and includes the following questions:
If you have a few minutes, please take the survey and help us make sure that these events are as filled with actionable advice as possible.
A week after the craziness that is HIMSS (there’s a reason the #HIMSSanity hashtag has done so well), I’m kicking around an idea that came to my mind on my flight home from HIMSS. Overwhelmed by the 5 days of in depth discussions, I closed out my HIMSS talking about healthcare IT with the lovely lady sitting next to me. It just so happened that she was a HIE coordinator at a hospital in California and was heading home from HIMSS as well.
We had a far reaching discussion on the 5 or so hour flight home from Orlando. At one point we started the discussion of personalized medicine. I think I freaked her out a little bit when I mentioned the concept of every organ having an IP address.
Our discussion prompted to me to consider this really interesting an important question:
Can we abolish a disease because we’re so good at predicting that disease that we prevent it from ever happening?
When I considered this idea, it reminded me of Bill Gates (and many others) efforts to literally eradicate Polio from off the face of the earth. They’re doing so using vaccines and I can’t remember the exact timeline, but they’re only a few years out from this goal. It’s so empowering to think about eradicating a disease. Could health IT have a similar impact?
I haven’t thought through all the diseases and all the technology that could benefit from this concept, but I’m quite certain this is the real future of healthcare IT. How wonderful would it be to work on a project that determined the cause of diabetes early enough that we no longer had diabetics? What if we no longer had coughs and colds because we could identify the warning signs early enough that we could stop them from ever happening? We just need to get past the beauracracy and regulation and on to solving these major problems. No doubt this will take an enormous effort and resources and people beyond the traditional health IT.
This is a lofty concept indeed. However, I don’t think these ideas are that far away. What do you think? Could healthcare IT be used to abolish a disease?
One of the most interesting things I wrote about thanks to the HIMSS conference was what I called the real cause of hospital readmissions. I’m still interested in working with more hospitals to verify the data that’s presented in that blog post, but I’ll be surprised if it doesn’t play out as an important finding when it comes to reducing hospital readmissions.
In the post, I probably was a little aggressive in my statements about how the hospital can reduce readmissions through their own actions versus depending on home health, primary care doctors, or post-acute care providers. The good news is that my great readers always hold me accountable when I step too far over the line. In this case, Richard D. Tomlinson, RN, BSME, CMUP and Founder & CEO of Nuclei Health Consultancy, offered up a deeper perspective on the complexities associated with solving the hospital readmission problem.
I would like to take a moment to provide some perspective relative to your blog post today.
Hospital readmissions are, of course, clinically complex at times. In actuality, the risk for readmission can be influenced/increased due to lack of or missed opportunity for interventions prior to patient discharge. Effective quality measures, and robust analytics, with effective data feedback and clinical governance, can be deployed as components to an overall readmission reduction strategy; more on that later.
When we discuss readmissions we must consider the fact every case is unique; the circumstances, follow up care, coordination with 3rd party caregivers/providers (e.g. home health), level of transitional intervention, cultural influences, income levels, environment, stress levels. These factors are difficult to quantify, yet I do believe there is a way to translate these factors into reasonable algorithms.
I mentioned readmission as a strategy. Hospital readmission with most health systems I have worked with do not view it in strategic terms, and they must in my opinion in order to be effective (it could be argued Very often, initiatives are tactile in their core and therefore do not have a genesis of the strategic perspective when planning/implementing. As such, critical components such as clinical governance and workflow changes within the readmioften fall by the wayside or are missed completely. Add to that BI tools in the market today are not addressing predictive analysis for readmission risk as a dynamic in the overall care plan. A future-state, effective, model in my opinion would incorporate all the aforementioned factors, and in real-time track these factors and provide the care team with dynamic risk for readmission. That, combined with robust strategic tools and models in place, would have in my view significant outcomes.
Readmission engineering must be redesigned and retooled before any ROI level discussion can take place. Thank you for your fine Site and information exchange. All the Best, RDT.
I agree completely that the hospital readmission problem is not a simple problem. However, I still think a lot of people are looking in the wrong place. I look forward to digging into this problem a lot more. Reducing hospital readmissions is great for everyone involved.
A colleague of mine, Dr. Alan Weder, has recently begun to offer his services as a medical navigator to patients and their families for an hourly fee. He is a retired University of Michigan Medical School faculty member. In a previous note, I discussed how so-called "navigators" have begun to crop up as staff members in physician offices (see: Yet Another Type of Healthcare Professional Who Focuses on Patient Support). Dr. Weder is also offering to serve as a navigator but one who is independent of any caregivers and working solely on behalf of the patient. I personally think that such advice can be very useful but, obviously, the quality is highly dependent on the skill set of the physician-navigator. There are also for-profit physician navigator companies advertising on the web but I can't vouch for their quality (see, for example: Your Medical Navigator). In a previous note, I commented about how difficult it was to say "no' to physician recommendations; this is relevant to the emergence of medical navigators (see: Teaching Consumers to Say "No" to Physicians' Recommendations). Here is an quote from it:
It will be extremely difficult for most consumers to say "no" to their physicians. The knowledge and experience in diagnosing and treating disease lies with the physicians we consult for problems. Such a scenario rarely lead to "no". However, try substituting the word "maybe" for "no" in response to a physician's recommendations. This "maybe" approach allows the patient to seek more information to determine whether the recommendation is appropriate. Don't attempt this in the pressure-cooker environment of a doctor's office.
Seeking the services of an independent physician navigator provides another source of information for a patient and family. Here are a number of interesting points I learned during my discussions with Dr. Weder:
Last Spring, after attending an Institute of Medicine meeting on Childhood Obesity, I wrote about fronts and Heroes in the Health Attention War. Arguing that if we were going to do anything about long-term patient engagement around health and influencing healthy decisions, we had to start with habits and getting attention at an early age. Attention is the first step towards long-term behavior change.
At that time, I was happy to see the The Ad Council, who has been so successful in campaigns around littering and drunk driving, was working to get attention around childhood obesity to some specific communities. Advertising, after all, is all about directing attention, the necessary first step towards new behavior change. Meanwhile, some school districts were using the ideas behind behavioral economics to influence healthy food choices in schools, which continue to show success.
Today, I’m happy to report that something – or many things – have been working. Via the Robert Wood Johnson Foundation (RWJF) a JAMA Report “shows that that obesity prevalence among 2 to 5 year olds has dropped by approximately 40 percent in eight years.” This is truly outstanding progress. This is the most important age group to address as habits formed here can remain very hard to break later in life.
RWJF goes on to say “After decades of seemingly endless bad news about obesity, our collective efforts over the last several years show that we as a nation are finally moving in the right direction. Of course we can’t stop now.”
Also encouraging, they mention a report yesterday by “Let’s Move” declaring , “Nine out of ten schools across the country are certified to meet healthier lunch standards, and all schools with 40 percent of students qualifying for free or reduced-price lunch will soon be able to provide healthier, free meals to all of their students.”
Let’s continue to build on this progress, getting attention and enabling smarter choices around the problem that eventually became our nation’s health care crisis.