Dr. Anne Brooks, a Nun, is the House-calling Country Physician Everyone of Us Wishes We Could Have

Dr. Brooks in Tutwiler
Dr. Brooks, in Tutwiler, returning from a house call early in her career.

I’ve known Dr. Anne Brooks for nearly three years and I consider her a friend. She’s always receptive, available and willing to lend an ear, and offers insight I can only hope to have one day.

Plus, her stories are chronicle-like and filled with wit, humor and poignancy. And she’s got a tomb’s worth of them she could tell, and probably should. But, perhaps she doesn’t have the time. She’s too busy caring for the folks of her adopted hometown of Tutwiler, Mississippi.

Dr. Brooks is a nun. She’s taken a vow of poverty. In Tutwiler, she’s needed it. The people here are part of the one of the poorest in the United States. Patients pay for their care, if they can, with vegetables or other goods. Some times they drop a few bucks on the counter, but it’s a guarantee that by the end of the year, the clinic – Tutwiler Clinic – is going to be significantly short of operating funds.

More than 75 percent of its operating funds come from donations by individuals and grants. Those who wish can contribute through a PayPal donate button on the clinic’s site.

The Tutwiler Clinic is a nonprofit founded in 1983 by Dr. Brooks, D.O. and three other Sisters of the Holy Names. Its purpose is to provide wholistic healthcare in Tallahatchie County, located in the middle of the Mississippi Delta. According to its site, the median household income in the county is $18,800, while the US poverty level for a family of four is set at $20,650.

Two-thirds of the clinic’s new patients have no Medicare or Medicaid or other health coverage assistance. To say Brooks has operated the clinic as a personal mission for the last 20 years is no understatement.

The clinic is her calling; Tutwiler is her home.

She became a physician at age 40, following a career in education. However, for 17 years prior, from the time she became a nun, she was confined to a wheelchair because of what had been diagnosed as severe rheumatoid arthritis. She eventually met a physician in Clearwater, Florida, who asked to treat her and through osteopathic methods and acupuncture, eventually she was out of the chair and walking again.

The same doctor to help treat her was the same physician who encouraged her to join him in the medical ranks. She acquiesced and eventually began to study.

When she graduated, she wandered around the south through Mississippi, Louisiana and Florida seeking a clinic to serve. Next, she wrote several letters to towns that were in medically deprived areas offering her services. Tutwiler was only community to respond.

The town gave her a few funds to refurbish the clinic that had been shuttered since the early 1960s and she opened it in August 1983. By January she was seeing more than 700 patients a month. The clinic had a segregated waiting area when she arrived, but she immediately changed tat.

She serves as medical director and chief administrator at the Tutwiler Clinic, serving about 8,500 patients a year. She also is Chief of the Department of Medicine at the Northwest Mississippi Regional Medical Center in Clarksdale, where she has also is on the board of trustees and has served as Chief of Staff.

She is one of three doctors in the county, and currently mentors two medical students. She admits that she is desperate for another doctor at the clinic, which has a staff of 30.

She prays every day for anew doctor to join their staff, but to date (she’s been searching nonstop for months) she’s received little interest.

Sister Anne Brooks
Sister Anne Brooks recently with a young patient at the Tutwiler Clinic.

Brooks is a country doctor in so many ways, like you’d imagine from the 19th century: she makes house calls, and has seen the greatest level of poverty and unhealthful living. Her heart seems to explode with passion for those she cares for and the folks she cares for often suffer from sever chronic conditions, such obesity and diabetes, because of lack of quality nutrition because of their poverty.

She prays a lot for them. When she’s not praying, the 74-year-old who works 12 hour days, most days a week. She believes in wholistic care — taking care of the whole person and enabling a person to care for themselves.

When not providing care, she and her staff run a Habitat for Humanity program that has built 37 homes, and she also started a second-hand clothing store and a community center, with a gym and library and helps residents learn everything from life skills like cooking, to earning a GED, to staying fit with Zumba. To fund the community center, they sell locally made quilts.

Even though she lives in a world seemingly lost, if not a little forgotten, she’s dedicated the Tutwiler Clinic to employing the most current tools to ensure her patients receive the best care possible.

As such, she utilizes an electronic health record.

In her 20 years as a physician, “Care has changed in many, many ways,” she said recently.

There are new forms of care, new understandings of how various body systems that medicine can affect, and, most notable to her, are genome studies and the potential for tailoring medicine to a specific patient.

“You know, every direction you turn, especially in your area of expertise, there are new and exciting ideas about integrating medical records seamlessly into patient care,” she said, “or should it be the other way around?”

Perhaps it makes no matter. Machine at her side or not, she still knows how to provide the best care she knows how to provide, and the people she cares for are blessed to have her at home in her community. In many cases, they owe her their lives; at the very least she should be given some thanks.

Perhaps that’s why the American Osteopathic Foundation recently named her the 2012 physician of the year.

Steps to Reducing Practice Waste, and Increasing Productivity and Profitability

Any mention of money and people’s ears seem to perk. Work, for the money, on the other hand, seems to stifle a person’s desire to embark on the profitable journey.

“Money here.”

“What’s that, you say? Money? Where?”

“Well, I’m glad you asked. By taking the following simple steps, by performing the following tasks, you might be able to save your practice time and money.”

“Tasks? ‘Might?’”

“Right.”

“How much?”

Shoulder shrug…

“See ya.”

The above over dramatization is courtesy of yours truly. Stellar dialogue, wouldn’t you say? Among my many talents. I’m actually a playwright. No, really. Published and everything.

Anyway, getting to the point, it seems that not matter where we turn, in this new healthcare environment where there seem to be opportunities for ‘49ers where ever you turn, someone is trying to tell you how to produce more profitability or efficiency for your practice.

Despite the zingers, there really are a few good pieces of advice out there that do seem to make sense, but, yes, you’ll need to put in a little time and work.

Here’s one example, courtesy of Carol Stryker and Physicians Practice magazine. According to Stryker, 30 percent of any activity is wasted. Thus, as she so eloquently writes, “The more useless labor you can eliminate, the bigger the increase in productivity and the fewer mistakes. A careful review of some or all of the processes in a medical office can generally be expected to yield productivity gains of at least 30 percent in the areas addressed.”

So, to eliminate wasted work and improve efficiency, which improves profitability, establish a process and iron out the wrinkles. The following six steps will help, she says.

1. Choose a process to streamline. One that is causing problems will most likely be easy to identify and will probably already will be taking your attention.

2. Answer this question, Stryker says: “What should the process accomplish and why is that important?” She encourages practice leaders to clearly identity the purpose and value of the process and write it down. “This is the yardstick for future evaluations. This is the only aspect of the project that the physician(s) cannot delegate or outsource,” she said.

3. Write down the steps to follow, in order. Once all the steps are documented, walk them through them to be certain you have not left anything out. Add what you left out and walk through again. Repeat until all steps have been captured.

4. For each step, ask the group:What does this have to do with the goal?” If nothing, eliminate it. If not much, eliminate it or combine it with another step.

Is another step performing the same function?” If so, which one produces the best outcome? Eliminate the less effective step.

Is there a better way?” Do you have a tool, not available when the process was first developed, that gets the job done more effectively and/or efficiently?

“Could a step be added that would have a positive impact on a subsequent step?”

5. For the amended process, ask:Are any additional steps necessary? If something will be printed now that was not printed before, what will be done with the paper?

Are the steps in the most logical order?” Examine alternative sequencing as a possible improvement to the process.

Is the process intuitive?” Will it be easy for the person doing the work to remember or to engage?

Are any steps error-prone?” What can be done to eliminate error? If it can’t be done away with, what can be done to validate the step was done properly?

Repeat from Step 5 until satisfied with the proposed process.

6. Once the improved process is implemented, choose another process and repeat the analysis. Continue until satisfied with the way the office works.

According to Stryker, “The only difficulty is finding the time and discipline to perform an analysis of a process and implement improvements. Each successful project frees up resources and makes it easier to address another process. Morale improves because office operations are improving. Stress decreases because there is actually time to do what needs to be done. Staff turnover goes down and profits go up.”

And hopefully, once all of the steps in the process have been completed, you’ll find yourself with more time, a more efficient practice and you’ll identify ways to free up a little extra cash.

Half of Physicians Under Age 40 Would Walk Away If They Could; 60 Percent of All Physicians Want to Quit Now

For some, it’s frightening time to be in healthcare.

Given the continual changes related to reform and reimbursements, compounded by the fact that independent practices are being gobbled up by hospital systems and independent practitioners are becoming employees, but a new study commissioned by The Physicians Foundation say that roughly 60 percent of physicians would quit the profession or retire today if given the opportunity.

This is no new trend. And as noted in HealthLeaders Media report, that’s what makes this latest piece of data so much more shocking.

What’s also somewhat shocking about the Physicians Foundation study, which featured more than 13,000 physicians, is that the results clearly reflect this sentiment – that physicians are frustrated with the overwhelming pressure facing them – and that they would rather get out than picture themselves as professional caregivers for the long haul.

Certainly, this is not insignificant. These are not your typical professionals working a job, taking an hour lunch and then heading home to the family. It’s not like they’re working in one field one week and they decide to try a new job at a different company the next week. These are highly educated professionals who have dedicated their lives to a cause and a belief that they could make a difference by helping people “get better.” Simply put, they’ve made a lifelong decision to practice medicine that the majority could sooner walk away from.

Apparently, physicians just don’t feel they are being heard. They feel their opinions don’t matter so the only way they may have to make themselves heard is to pack up and hit the road.

Because of the pressure they face from regulation, reduced reimbursements and providing greater quality at a lesser cost, many feel alienated, and some are beginning to do something about it.

For starters, they’re reducing or eliminating the number of Medicare and Medicaid patients they’re seeing. Some are leaving private practice (some by choice, others not) and becoming employees where they’ll have fewer managerial worries than if they were to stay put in their practices. After all, employees are hired to do a job; managers are required to solve most of a business’ problems. Employed physicians are employed because, for the most part, they got tired of trying to solve the world’s problems.

But, according to the study, becoming an employee is not viewed as a positive move. Especially for what has traditionally been a fiercely independent population.

What’s most troubling about this study is that most physicians just want out. They want to turn in their white coats and head for the sunset. They want to come to Florida, where the sun always shines, hit the beach and play with sand between their toes. (I made that last part up.)

Here’s the heart of it, and I quote the HealthLeaders story: “We found that 60 percent said they would retire today if given the opportunity. What was worrisome is that this is up from 45 percent in 2008,” Walker Ray, MD, vice president of the nonprofit foundation. “We also know from the survey that we disaggregated it into certain categories, 47 percent of physicians under 40 said they would retire today if given the opportunity.”

Almost half of physicians under age 40 would board the windows and find another way to pay their student loans.

Half!

In some cases, there are certainly doctors among this population that just got into practice. These are the physicians who are supposed to be changing the way, setting the new normal for the industry; unabashedly accepting that this is the new world order of things and the hells bells, we’re in it to win it.

If this is indeed the truth, that so many young physicians are wondering why they spent so much time in school and spending so much money on their educations just so they could become employees of the “state,” the future doesn’t see that much different than the present and we have bigger problems that we’re anticipating.

 

Dr. Eugene Heslin, NYeC Board Member, On EHR Adoption, Interoperability and Predictive Analysis

Dr. Eugene Heslin

Dr. Eugene Heslin has always loved technology. In his 20 years in practice, he’s embraced it.  From the start, in 1992, he brought in a practice management system when he opened his practice’s doors.

Since then, the practice has grown to a five-physician group of family practitioners serving more than 14,000 patients is Saugerties, New York — about 100 miles north of New York City — and has added an electronic health record system to the mix.

The “home-grown” practice serves patients ranging from younger than one month to older than 107; from near life to near death, and everything in between. Physicians at the practice, Bridge Street Family Practice, see the whole gambit and provide care to a lot of people using technology to do so, Dr. Heslin said recently.

Heslin is a self-proclaimed technology advocate. As far as he’s concerned, it provides clear benefits at the practice level, and, ultimately, improves patient care.

“Technology is exponentially changing the practice of care, and I consider it a tool much the same as my stethoscope or my reflex hammer,” he said. “I’ve pretty much given up my desk for my laptop.”

He spoke to me as he sat on a train headed to the City where was able to access his EHR remotely and send a few messages to the practice and patients. He also reviewed a few records and handled some administrative work all from his laptop.

“The access to information is much improved. I’m practicing smarter because I am able to access information in my time instead of sitting with a pile of paper charts,” he said.

His is a story similar to others. When he implemented the EHR he got rid of the paper, found time for other more important things than paperwork and now provides care from anywhere. Because he’s connected, he can interact directly with his patients through his EHR’s patient portal, which patients seem to like.

But the real power of his EHR is in its ability to help track and manage the patient population’s health and outcomes. Though there is much that can be done in an electronic system that can also be done using a paper record, this is just not one of those things, he said.

He’s now in control of all the patient data in his practice and it’s truly helping improve patient’s lives, especially those with chronic conditions.

“The true power of EHRs for the majority of physicians is that we’re going to need this data, and the only way to gather the data is to do so electronically,” he said.

A lover of technology, Heslin is not brand loyal and he’s not married to any system. He’s on his second EHR and he’s seen or tested several of the market’s top names. Each does some things very well, but not everything.

But as the market continues to change and with adoption recently reaching 70 percent of all physicians, Heslin said that the systems are going to be standard equipment for any practice in the near future.

Certainly that comes as no surprise, he admits. What’s next, he said, is interoperability of the each of the different vendor’s systems so that information can easily flow from one to another. Ultimately, the data contained in each must be controlled by the physician rather than by the vendor.

Care givers need to be able to move data within the health sphere, with each system offering point-to-point communication abilities that are far more advanced than today’s version of glorified email.

As the landscape continues to embrace electronic records, the data extracted will become more robust and provide for better modeling of care. Perhaps one day, the technology will begin to allow for a bit of predictive analysis, he said, at which point care can become about prevention of disease rather than about fighting existing conditions.

Essentially, if people can be kept out of the hospital or from exhaustive care programs, resources can be reallocated and eventually saved.

Heslin’s are not predictions of a country doctor hoping for the best through the use of technology. In the health IT community he has some clout. A board member (he’s actually treasurer) of the New York eHealth Collaborative (NYeC), he’s part of one of the most proactive groups in the United States working to improve care.

NYeC works to educate the healthcare industry and those in need of treatment, with a goal of elevating the level of general understanding as to how health IT can improve care. He’s part of the public/private partnership that’s working to move healthcare forward with health IT. Everyone, like himself, has an opportunity to participate, he said, which strengthens the movement.

New York is a complex place, though. There’s a great deal of diversity in the care and cultural spectrum. However, if a successful program to move health policy forward can be built here, it can be built anywhere, he said.

And if the policies lead to better care outcomes, more engagement from the community and its professionals, then real change can be accomplished, and all of the efforts made over the course of the last several years will be worth it, he said.

An Exciting Time for Health IT, Indeed: EHR Adoption Rates Surpass 70 Percent

What might be considered somewhat of a sizeable victory for the world of Health IT can be found in the recent announcement made by writer Ken Terry on the pages of InformationWeek in his article, “EHR Adoption Passes The Tipping Point.”

According to Terry’s article in which he features a report from CapSite, electronic health records are now being used by about 70 percent of physicians.

Really, this is no small achievement and should be celebrated by all of us in health IT. The promise of the technology is being realized, and federal incentives aside, I believe physicians are clearly standing behind the fact that EHRs do in fact create more efficient, streamlined care that will help produce better care outcomes and improve lives.

Clearly, as a community, we have decided that as an industry, it’s time to move forward like many of the other giants of our age, like banking and web commerce. Technology is paramount, mobility is a requirement and access is no longer optional.

Patients realize the importance of access to data and they (we), are skeptical by nature. We want to be coddled and to be assured that everything is going to be okay. Like children, we are growing more comfortable with the fact that with an electronic, connected system we are able to make better decisions, can more easily engage and, frankly, can better educate ourselves when needed.

And I believe we are educating ourselves, especially when it comes to the value of these electronic systems.

This education is helping us, as patients, encourage our care providers to adopt electronic health records. Personally, I don’t believe, meaningful use is sole reason behind the increased adoption. A large portion, yes, but, obviously, not the only thing driving adoption. As consumer patients, we’re helping drive change in healthcare, and through this partnership, there are many great things coming.

The first of which is the news that as far as adoption of electronic health records, we’ve finally reached a passing grade.

As we continue moving forward with adoption, I’m looking forward to seeing more of what’s to come. I’m excited to see what the data collected tells us and how it can be used to drive care; and

I’m anxious to see what’s next as we begin to enter the post-EHR era.

It’s a good time to be here; an exciting time indeed.

 

Healthcare Trivia That’s Also Informative and Eye Opening

For all of you info nuts, I discovered a fascinating repository of healthcare trivia facts collaborated by Rock Health.

There’s some pretty terrific and wonderful information here, and some pieces of trivia that I would never have imagined.

For example, this may be a softball, but, think America has got it all? Apparently not. It’s the only wealthy, industrialized nation that doesn’t have a universal health system. Speaking of wealthy, we Americans spend about $8,000 per capita on healthcare. That’s twice the amount of our next closest competition. That’s heavy.

We’re also a heavy nation. Nearly 70 percent of all adults are obese. And as “advanced” as we are in our healthcare, our life expectancy is at about 79 years. That’s 50th globally. Maybe the mortality rate has something to do with the obesity rate.

Perhaps it has something to do with the number of medical error deaths each year: between 50,000 and 100,000.

For those of us in otherwise non-final stages of life, there’s a good chance we’re living with a chronic condition. One in two Americans suffer some form of chronic illness. That’s a lot of pain.

Moving on, what do we spend our healthcare money on? Give yourself a pat on the back if you know some of these figures. Shocking.

Total healthcare dollars spent in 2010 was $2.6 trillion. Nearly all of that is spent on personal care, at $2.2 trillion. No wonder we spend so much time talking about the subject. That’s a lot of dough changing hands. By the way, in case you’re keeping track, the rest of the money was spent on health insurance admin and public health, according to CMS. Thanks to Rock Health for also pointing out that of the $2.2 trillion spent in personal health care expenditures, Medicare and Medicaid finance $525 billion and $400 billion respectively, or more than 40 percent of health care. That’s a lot of public assistance.

If you’re involved with healthcare IT in any matter, you probably already know that 17 percent of our nation’s gross domestic product was spent on healthcare. That’s more than any other developed nation.

Hospital care, physician and other clinical services make up about 51 percent of all health spending at $1.3 trillion, according to CMS, with prescription drugs making up about 10 percent of all health spending ($259B)

More than 30 percent of all healthcare spending is wasted.

How about this one? And don’t shake your head like it’s a shame when you might be part of this problem: 75 percent of all healthcare dollars are spent on patients with one or more chronic conditions, many of which can be prevented including diabetes, obesity, heart disease, lung disease and high blood pressure. You do your part, I’m doing mine.

In the care setting, 35 percent of U.S. hospitals have adopted electronic health records, and 57 percent of office-based physicians have adopted the systems. According to Rock Health, the number of hospitals using health information technology has more than doubled in the last two years, and the number of health IT jobs in the U.S. is expected to increase by 20 percent from 2008 to 2018. Maybe not for PR folks like me, but I wish you the best if you’re in sales, R&D and training and support.

For you mobile folks, and there are a lot of you, perhaps you’ll take comfort knowing that there’s strength in numbers. Apparently, there are more than 104 million folks in the U.S. that own smartphones. Fifty percent are app users and download them regularly. More that 142 million will use them by 2016.

For you doctors, apparently about 84 percent of you use tablets in your daily work. Very mobilely progressive of you.

Now for a little health on the web. More than 80 percent of Internet users, or 59 percent of U.S. adults, look online for health information. About 25 percent of Internet users have consulted online reviews of particular drugs or medical treatments.

And, nothing shocking here, 18 percent of Internet users of adults, have gone online to find others who might have health concerns similar to theirs. People living with chronic and rare conditions are significantly more likely to do this. Who hasn’t done this?

Did you know most of this information? If so, good job. Nonetheless, good stuff, this information. I told you Rock Health offered some really great information.

Take Notice: Rock Health Is Building Useful Things and Helping Solve Many Problems in Healthcare

In the land of health IT, innovation is power and those that control it king.

There’s no status quo here. Resting on your laurels, despite all of the industry standardization related to efforts like meaningful use, will get you no where.

As several vendors are discovering that just because they’ve had products in the market for 20 or 30 years doesn’t mean they’ll be in play forever. We’re in the health 2.0 era. Heck, we’re in the era where even the federal government has entered the open source environment.

As such it’s great to see such a resource like Rock Health dedicating itself to the health IT entrepreneur. If you haven’t checked it out yet, you need to do yourself a favor and take a few minutes to familiarize yourself with its site. Then, you need to forward some of the information featured there to all of your entrepreneurial friends.

Not to sound like a commercial for the service, but it’s hard not to since some of the things going on here are pretty incredible. Actually, this is the kind of thing that happens in a country like ours when leaders, innovators, entrepreneurs, creative folks, business minds, a little money and some passion mix.

The cocktail that commences is Rock Health.

So, what is Rock Health?

It’s an accelerator exclusively for health start ups providing capital, office space, mentorship and operational support to entrepreneurs working on ideas in health. As a nonprofit, Rock Health looks for product-centric ideas that solve real problems in healthcare; “Products can be in the form of web or mobile apps, services, have a hardware or sensor component, and should be early and pre-VC funding.”

Ideas can be of anything as long as it solves a healthcare problem.

For those start ups bidding to participate in the Rock Health program, the selected start up receives a $100,000 investment offer from a VC group for an ownership of between 5 and 10 percent.

Other great Rock Health offerings (found on its site and free for everyone) include an interactive funding database that provides the public with sources for potential healthcare start up funding; videos that teach the unknowledgable upstarts almost everything they need to know about topics like marketing, creating boards, accounting, HIPAA, fund raising and dealing with the FDA; healthcare event listings; a great start up handbook that provides legal and financial advice (it’s comprehensive and overwhelmingly impressive); and finally, perhaps my favorite bit of information offered: interesting health facts that once learned will impress everyone, including your closest and most cynical friends.

You get the point.

Rock Health is more than an incubator and a disruptor for health IT — established vendor giants should be concerned about efforts like this — it is the future of innovation in the space, and if you haven’t taken notice, you should.

Crowd Funding Sites like Medstartr Are Good for All of Us; and May Be Good for Our Health

LogoCrowd funding continues to play big in technology and the star of today continues to be Kickstarter. The site is a funding platform for creative projects including films, games, music, art, design and technology.

According to its site, through it, more than 2.5 million people have pledged more than $350 million to projects posted since 2009 by everyone including company CEOs to hobbyists. Each project is independently created by the person behind it, who have complete control and responsibility over their projects.

If people like the project, they can pledge money to make it happen. If the project succeeds in reaching its funding goal, all backers’ credit cards are charged when time expires. If the project falls short, no one is charged. Funding on Kickstarter is all-or-nothing.

In most cases, the majority of funding comes from the fans and friends of each project. If they like it, they’ll spread the word to their friends, and so on.

Given the scope, there’s an obvious need for something similar in the healthcare space. Hence, it’s good to see MedStartr emerge, a new crowd funding site dedicated solely to the healthcare space.

According to MedStartr, it “is a new way to fund healthcare projects, startups and innovations that improve healthcare and help people live longer, better lives.” Like KickStarter, “MedStartr is powered by an all-or-nothing funding method where projects must be fully-funded or no money changes hands. This makes it so you have no obligations either way if critical mass is not achieved to get to your minimum viable product.”

Medstartr encourages users, such as patients, entrepreneurs, physicians, researchers, nonprofits, artists, filmmakers, musicians, designers, writers, performers and others to drive healthcare forward.

Unfortunately, though, it doesn’t appear that much money has changed hands using MedStartr, even though there is a clear need. For example, of the four successful projects featured on the site, one of them is for the launch of MedStartr. The other three only grossed $23,733. That’s a far cry from some of the projects funded on KickStarter, which reach as highas a few millions dollars.

Okay, so it’s not important that the funding goals are so far apart. In principal, the two sites are competitors, I guess, but they serve much different audiences for the most part. However, given the continuous chatter for improved tech tools the healthcare market needs, and that we’re in the age of do-it-yourself, I surprises me that more people, entrepreneurs and so on, are not using the service.

There are a few apps featured there, and some community events (like conferences), but very few systems or technology that can be used to actually enhance or better healthcare for providers or patients. At least to this point, anyway.

It makes me wonder if MedStartr simply needs to conduct a better PR campaign (call me, I’d be glad to help) or if there’s just not an appetite for micro, crowd-funded project in the healthcare technology space.

There’s a draw, though, and with time there’s a god chance that many good things will come because of the site. Hopefully so. I’d like to see it embraced, and I’d like to see it succeed. If for no other reason than it’s good for all of us, and may be good for our health.

IDC Health Insights’ Judy Hanover on the Need for Structured Data, and the Long-term Affects of Health IT Reform

Judy Hanover, Research Director of IDC Health Insights

As health IT continues to mature and providers continue to adopt technologies like electronic health records, the data collected from their use in the care setting becomes the most obvious reason so much energy is being put behind getting practices to implement the systems.

Judy Hanover, research director of IDC Health Insights, recently told me, though, that one of the biggest challenges faced by ambulatory and hospital leaders is that the data entering the electronic systems, in most cases, is unstructured, which makes it almost useless from an analytics standpoint.

Without structured data, Hanover said, quantitative analysis across the population can be complicated, and little can be compared to gain an accurate picture of what’s actually taking place in the market. Without structured data, analytics is greatly compromised, and the information gained can only be analyzed from a single, siloed location.

“There must be synergy between the data collected,” Hanover said. “We’re entering the period of structured data where we’re now seeing the benefits of structured data but still need to manage unstructured data.”

In many cases, critical elements of data collected — like medications, vitals, allergies and health condition — are difficult to reconcile between multiple data sources, reducing the quality of the data, she said. Unstructured data proves less useful for tracking care outcomes of a population’s health with traditional analytics.

For example, tax information and census data are collected the same way across their respective spectrums. All the fields in their respective fields are the same and can be measured against each other. This is not the case with the data entering an EHR. Each practice, and even each user of the system, potentially may collect data differently in a manner that’s most comfortable to the person entering the data. And as long as practices continue to forgo establishing official policies for data entry and requiring data to be entered according to a structured model, the quality of the information going in it will be a reflection of the data coming out.

Lack of quality going in means lack of quality coming out.

“In many cases, structured data is not as useful for analytics as we’d hoped,” Hanover said. “There are inconsistencies in the fields of data being entered in to the systems; and that affect data quality as well as results from analytics.

“As we move into the post EHR era, how we choose to leverage the data collected is what will matter,” she said. “We’ll examine cost outcomes, optimize the setting of care and view the technology’s impact.”

As foundational technology, EHRs are allowing for the creation of meaningful use, but once the reform is fully in place, the shift will focus on analytics, outcomes and benefits of care provided.

Currently electronic health records define healthcare, but health information exchanges (HIE) will cause a dramatic shift in the market leading to further automation of the providing care and will change how location-based services and clinical decision making are viewed.

Though some practices are clearly leveraging their current data, others are not. For them, EHRs are nothing more than a computer system that replaced their paper records and qualified them for incentives.

In the very near term, the technology will have to have more capability than simply serving as a repository for information collected, but will become a database of reference material that will have to be drawn upon rather than simply housed.

“Health reform is the end game,” Hanover said. “And there can be no successful reform without EHRs. They are the foundational technology for accountable care.”

The data collected in this manner will lead to a stronger accountable care model, which will once again bring the practice of care in connection with the payment of care.

Evidence-based approaches will continue to dominate care when the data suggests certain protocols require it, which means insurers will feel as though they are working to control costs.

Unfortunately, all of the regulation comes at an obvious cost at the expense of the technology and its vendors, said Hanover. EHR innovation continues to suffer with the aggressive push for reform through meaningful use as vendors scramble to keep up with requirements.

“There’s little or no innovation because all of the vendors are being hemmed down by meaningful use and certification requirements,” she said.

Product standardization means there are far fewer products that actually stand out in the market.

More innovation will likely only come following market consolidation in which only the strong will survive. Hanover suggests that in this scenario, survivors will focus on innovative product research and development and will take a leadership role in moving the market forward

Though vendors will suffer, users of the systems will likely face major set backs and upheavals at the market shifts and settles. Especially as consolidation occurs, suppliers disappear or change ownership, practices and physicians using these systems face the toughest road as they’ll be forced to find new solutions to meet their needs, learn the systems and try to get back to where they were in a meaningful way in a relatively short period of time.

Likely, deciding which system to implement may bear just as much weight as deciding how to use it.

Pediatricians May Be the Only Group of Physicians Who Can Create Life-long Electronic Health Record Users and Advocates

Perhaps creating an opportunity is nothing more than observing the details and taking action once one has been identified.

Lack of opportunity, on the other hand, might be the opposite – keeping your head down and barreling through life without taking an adequate measure of the terrain in which you are navigating.

The feds missed an opportunity. During their planning and roll out of meaningful use, in their effort to collect the health data of this country’s population, specialists, in many cases, were not considered as recipients of their meaningful use incentives.

For many specialties, this might not apply. But pediatrics are different entirely. Not so much for the physicians’ sake, but for the patients they serve.

Given the direct marketing plan that the federal government has undertaken with its latest healthcare pet project, Blue Button, I’m surprised by its lack of foresight related to patient involvement to this group when it comes to meaningful use.

As the feds work desperately to change the perception of electronic data collection, and to move the most information into electronic records as possible, one might think the best way to ensure absolute adoption is by requiring the one group of physicians who might be able to affect the longest term change to participate in the incentive program.

Pediatricians, like it or not, have not been given special treatment as far as meaningful use is concerned. They, like another large group of physicians, OBGYNs, are left to fend for themselves. You can read more about OBs and their fierce independence in my recent interview with digiChart’s CEO Phil Suiter. The reason is well known and obvious: these groups of caregivers don’t necessarily rely on the government (Medicare/Medicaid) to keep their doors open.

The nature of pediatric practice is such that Medicare is not a significant part of their practice so meaningful use incentives don’t apply here. Therefore, the only avenue left for pediatrics is the Medicaid option – and it only works for practices that have more than 20 percent of their volume as Medicaid. In most cases, these groups of physicians don’t meet the minimum requirements of serving Medicare and Medicaid recipients to qualify, and, also in most cases, they don’t go out of their way to do so.

Therefore, given the logic that A+B=C, they are not lining up to get their share of the incentive checks.

But, one would think the feds would try to find some way to make an exception for pediatricians to participate in meaningful use without having to meet the minimum requirement that 20 percent of their population participate in Medicare. I’m not trying to re-open an issue that I know has been discussed countless times; I’m trying to make a different point.

That is, given the new push for patient engagement and the social media-like approach being taken through the Blue Button movement, I believe the importance of pediatricians has been overlooked.

Why? Well, it’s obvious to me that to engage a population, it’s best to change the population’s behavior. To do so, you have to catch them young; so young that they never knew a difference otherwise.

For example, children today will never know what life was prior to the web. They won’t be able to imagine life before mobile devices turned us into an always on society. There’s a lot they’ll never know.

Thus, if they are exposed to electronic health records in their doctor’s office as they grow up, by the time they reach adulthood, they’ll expect their doctors to use nothing but electronic health records. In fact, they won’t even know what to do with a paper record – how to read and understand it – and, therefore, won’t give their money to doctors without the systems.

It’s really the most direct route to changing a population’s behavior.

Indoctrination.

Sure, engaging the adult population through a service like Blue Button is important, and will certainly help fill the gap currently experience in healthcare’s ownership issue, but as we’ve seen in every other area of life, true change won’t come until those who know no other way become the majority and know no other way.