Guest post by Fauzia Khan, MD, FCAP, is chief medical officer and co-founder of Alere Analytics.
This has been a very interesting year for the healthcare industry, which appears to be on the brink of a real sea change. Government mandates are driving transformative discussions in the C-suite circles on topics such as meeting meaningful use Stage 2 and Stage 3 requirements, satisfying Accountable Care Organization (ACO) standards, care delivery models in the patient-centered medical home and much, much more.
Guest post by Alex Horan is the senior product manager at CORE Security.
In 2012 we saw an increasing number of health breaches across the country – and across continents. We saw an employee’s lost laptop turn into a healthcare records breach of more than 2,000 sensitive medical records of Boston Children’s Hospital patients. We heard how one weak password allowed a hacker to access the Utah Department of Technology Services’ server and steal approximately 780,000 patients’ health and personal information. We even read about Russian hackers encrypting thousands of patient health records and holding the information for ransom for thousands of dollars.
Healthcare fraud or medical identity theft put both individuals and healthcare organizations at huge and severe risk. Since 2010, Ponemon Institute has annually benchmarked the progressing and evolving issues of patient privacy and security. The third annual study, released in December 2012, found that healthcare organizations still face an uphill battle in their efforts to stop and reduce the loss or theft of protected health information (PHI) and patient records. What’s more, data breaches can have severe economic consequences – and the repercussion costs are only climbing. The study estimates the average price tag for dealing with breaches has increased from $2.1 million in 2010 to $2.4 million in 2012. The report projects that the economic impact of continuous breaches and medical identity theft could be as high as $7 billion annually, for the healthcare industry alone.
In the past decade, academics and industry experts have published conflicting reports on whether electronic health records (EHRs) actually save money. Recent studies based on large, historical data from diverse providers suggest that EHRs haven[i]’t decreased costs[ii][iii] – contrast this with cost benefit analyses published back in 2003 that predicted EHRs would save around $15,000 to $20,000 per primary care physician per year[iv][v]. In addition, multiple vendors, academics and industry experts have published positive case studies on how EHR provides a positive return on investment or saves money in areas such as billing and staffing costs.
So why the divergence? Are providers simply not achieving what we expected in 2003? Are the positive case studies overly selective? Is it a case of what’s true for some is not true for all?
EHRs actually enable more productivity and satisfy more demand, and this is what drives cost. For providers, this also means driving up revenues.
Supply and Demand
One reason healthcare costs have not uniformly decreased is that more (efficient) supply from EHRs leads to more demand.
Firstly, consider the Jevons Paradox: energy efficiency leads to greater consumption (e.g. as air conditioning becomes more efficient and affordable, more air conditioners are purchased.) Taking a healthcare analogy, data center capacity has grown exponentially and EHR functionality has improved in recent years. In response, providers are storing larger amounts of detailed patient data and accessing greater capabilities. For example, providers are integrating IT and medical devices for real time patient data monitoring, storage and beyond. Additionally, a 2012 study supports this theory in that physicians ordered 40 percent to 70 percent more radiology exams with EHRs than with paper records. The efficiency and capability of EHRs (supply) have driven up the demand.
Secondly, I’ll paraphrase Parkinson’s Law: work expands to fill the time available. Demand for services in (public) healthcare will always outstrip the supply. This is because there is a backlog of patients waiting for currently available services and once this backlog is cleared, expectations of what should be provided will increase. It is therefore important to recognize that current health care reforms may not automatically decrease costs with EMRs in place, as demand will then increase too.
Increased demand means increased cost.
So if cost doesn’t uniformly decrease with EHRs, does anything improve? Productivity does. A 2009 Wisconsin Medical Journal Study[vi] found that physician productivity increased about 20 percent and remained at that sustained level of productivity following EHR implementation. This means that more patients were seen on a given day. Not bad, considering the average wait time to see a physician in the U.S. is 20 days.
Increased productivity, however, leads to increased costs.
Payers vs. Providers
Another way to explain the divergence may lie in who we’re actually talking about. Do we mean payers like Medicaid/Medicare or providers like primary care physicians or hospitals? Studies often reference cost but fail to discuss revenue increases that an EHR system delivers to providers. Seeing more patients means more revenue to providers. In addition, providers with integrated EHR and billing benefit by eliminating billing errors and enabling better revenue protection. Payers, however, don’t share these financial benefits as more procedures means their costs are rising. Indeed, payers may not realize the full cost savings of EHR until providers move away from pay-per-procedure to quality based payments. Quality based payments of course, are next to impossible without the enabling reporting capabilities of EHR systems.
So when we talk about the cost of EHR systems, it’s important to distinguish who we’re talking about. In addition, when comparing pre- and post-EHR situations, instead of simply asking: “What’s the cost?” we should also be asking “What do we get for this cost?”
David Farrell is an IT strategy specialist at PA Consulting Group, focusing on project management and strategy for healthcare providers. He has worked with accountable care organizations and county-run hospitals on both U.S. coasts, assisting clients in building business cases, managing project benefits and forecasting the long term infrastructure impact of EHR.
By the time the market is ready to move, the technology they’ve been told to move to won’t exist as it has been depicted.
This is much the same thing as technology that has been developed that upon its arrival has been pronounced dead. An example of this was the iPad. Before it hit the market analysts and naysayers said the technology – which I don’t have to tell you is essentially a hand-held, touch screen computer – was worthless. No one had a need for PC that one could carry about wherever they went; we had laptops after all. But they failed to see the upside.
For example, iPads are the ideal technology for busy physicians (as you well know) making rounds jumping from patient to patient throughout a practice, as well as have had a profound effect on the treatment and education of individuals with autism and other developmental disabilities.
For example, tablet devices have opened the door for children with special needs, many of whom use them easily and effectively. Not only have they become a learning tool for many of these children, they have also become communication devices. According to Mashable, students using an iPad advance more quickly than those who did not use them. Even in education, there are currently more than 2 million tablets, like iPads, being used and the number will increase dramatically as the technology becomes more accessible and affordable.
As of December 2012, there are more than 20,000 apps for mobile devices that teach communication, speech, language, motor skills, social skills, academic skills, behavioral skills and more than 900 apps for students with disabilities, including autism.
I believe something similar will happen to the patient portal market. Heavily pushed on physicians by EHR vendors for the last three years, this has led to their increased popularity. Meaningful use hasn’t hurt either.
However, by the time the market adjusts to their availability and the reasons for their existence – bill administration, appointment scheduling, viewing records (in some cases) and communicating securely with physicians – the technology as we now know it will no longer exist.
Monique Levy, vice president of research for Manhattan Research recently made an interesting point about the future use of patient portals and I think it’s hard to disagree with her: Today, patient portals are most commonly used for scheduling appointments, viewing medical results and sending messages to doctors or nurses, Levy says. But many more advanced features are not only possible, but are available and waiting to be implemented. This includes access to video chat with a healthcare professional, pre- or post-operative care instruction videos and consolidation of all of a patient’s medical data from multiple sources in one place.
For instance, mobile health technologies will feed patient data directly to the patient portal to improve care and treatment options.
In a lot of ways, this sounds a lot like a Hootsuite interface that used to collate and track all of our social media channels. For example, I can track my Twitter feeds and Facebook pages as well as can interact, post and broadcast content through it. Patient portals are likely moving in this direction and will end up being so much more than the base model systems currently being implemented.
Most likely, the standard bi-directional portals that current vendors produce are likely going to be passé in short order and new systems and interfaces are likely to crop up and take over the market, changing the landscape once again.
Simply stated, perhaps it’s best not to believe all that we’re being told. It may benefits us to think about where our decisions regarding technology investments take us.
To follow the belief that the stale portals of today will match what in the future will most likely be vibrant interfaces may be similar to denying the viability and importance of devices like tablet PCs in healthcare and beyond, though, many thought them worthless at the point of issue.
Guest post by Stein Soelberg, director of marketing, KORE Telematics
As a provider of machine-to-machine (M2M) wireless networking services specifically designed for connecting mHealth solutions, KORE is approached every day with new use-case scenarios where telemedicine can provide life-saving or quality-of-life improving solutions for patients.
Currently, there are many health conditions that are being positively affected by the growth of mHealth applications; however, the top five health conditions for telemedicine treatment are active heart monitoring, blood pressure, diabetes, prescription compliance and sleep apnea.
1. Active heart monitoring. For at-risk patients, wireless heart monitoring devices have already proven to reduce hospitalization through early detection of heart failure. In addition, these devices are able to limit the time that physicians spend looking at data that is not pertinent, since they only send notifications with information that is outside an acceptable range.
2. Blood pressure. Wireless sensor nodes have become cost-effective, compact and energy efficient, which allows for continuous cycle reporting and electronic dispatch in urgent situations. It is important, however, to distinguish in this category between “critical monitoring” and “convenience monitoring.” The former are able to account for stress, eating habits and other external triggers more completely and pinpoint life-or-death issues. The latter are iPhone Apps for the health conscious consumer.
3. Diabetes. Wireless glucose monitoring devices can send alerts to patients and doctors alike when values move outside an acceptable range. These devices can also monitor for dietary intake to help impact a patient’s lifestyle choices.
4. Prescription compliance. On the surface this is an easy one. Patient health risks — and the risk of hospital admission — get greatly reduced by patients taking their medications as directed. But there is also a need to ensure that people take entire drug courses and eliminate the potential for re-prescribing. Literally billions of dollars each year reach their expiration date in patient’s medicine cabinets. Additional intangible benefits include fewer provider phone calls, and even shorter wait times in provider offices, by eliminating visits from improper prescription utilization.
5. Sleep Apnea. The thing that is really interesting about telemedicine devices for sleep apnea is that they can handle both investigatory and direct treatment. The two-way nature of the device can report on sleep patterns, body position and breathing to refine research and treatment course for any given patient. There is a direct cost saving here as well, since the devices directly eliminate the need for expensive Polysomnography exams and limit the need for overnight hospital stays, on an ongoing basis.
These mHealth applications are helping to promote more efficient use of medical equipment and resources, ensuring that devices and medication are being used as prescribed, improving patient outcomes by providing real-time data, improving patient quality of life, decreasing treatment costs and minimizing travel to and from offices and hospitals to allow for ease in care. Overall, the rise of mHealth/telemedicine will drastically and positively affect the lives of patients with a wide variety of health conditions.
Stein leads a team whose responsibility is to own the branding, advertising, customer engagement, loyalty, partnership and public relations initiatives designed to propel KORE into the 21st century. With more than 15 years of technology marketing experience in the business to business software, Internet services and telecommunications industries, Stein brings a proven track record of launching successful MVNOs and building those brands into leaders.