Guest post by Scott Zimmerman, president, TeleVox.
If you caught Maria Bartiromo’sinterview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:
“Telehealth is going to be a booming industry.”
Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.
Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”
The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.
One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.
It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.
Progress Is Underway
Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.
Guest post by Michael Simpson is the CEO of Caradigm.
It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.
After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.
More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.
Stage 2 Challenges
It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.
Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements. These capabilities leverage and extend the functionality and benefits of the EHR.
Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.
Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.
Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?
I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.
What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?
I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.
We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.
Dr. Cliff Bleustein, chief medical officer and head of Dell’s global healthcare consulting services, leads an integrated team of clinical, business, and technical professionals who provide expertise to health systems, hospitals, physician practices, health plans and life sciences organizations. Here he discusses Dell’s healthcare vision; improving patient engagement and how he defines the term; data security; and trends that he thinks will be worth tracking in the near term — here’s a hint: smartphones, yes; wearables, no.
In your new role as chief medical officer and global head of healthcare consulting at Dell Services, what are your responsibilities?
As chief medical officer, I play a key role in Dell Services’ healthcare division supporting our aggressive strategic initiative to revolutionize the way healthcare is managed. I spend a lot time listening to customers and helping them to better manage patient-specific data that spans the entire continuum of care. Ultimately, better information and technology will drive improvements in quality, patient safety, efficiency and outcomes. I help shape our strategy and ensure that it meets the needs of our customers, both now and in the future.
Tell me about your background in healthcare and how you came to be passionate about the space.
Ever since I was a child, I knew that I wanted to be a physician. Originally I was fascinated with the ability of body builders to be able to grow muscle to such huge proportions and lift weights several times greater than their mass. As my career developed, I focused on how treatments and diagnostics could move from the lab to the bedside. During training and private practice, I became more involved in understanding how systems work and function and what drives them. I was fortunate enough in my career to work internationally, as well. This gives a much broader view about how healthcare can be improved on a larger scale. I am driven by a desire to continue to disrupt the market with new technologies and solutions that can have a meaningful impact on improving health at scale.
What is Dell’s background in healthcare IT and why does the company put an emphasis on this sector (other than for obvious financial reasons)?
People are often surprised to learn that Dell has more than 20 years of experience in serving healthcare customers. That, combined with our deep bench of clinical and technical experts, is why Gartner has ranked Dell number one among healthcare IT service providers for four years running. But it goes beyond that; it’s also personal. Michael Dell is keenly interested in exploring how technology can improve healthcare systems around the globe. And we have thousands of employees who get up every day and focus solely on the needs of our healthcare customers. With an aging population and the impact of chronic diseases, such as heart disease and diabetes, we must find ways to reduce cost, improve productivity and improve health outcomes. Technology has a huge role to play. We also know we can’t do it alone, and for that reason we work with and partner with some of the leading companies in the industry.
What solutions does Dell offer and how do they set the company apart from competing vendors?
What sets Dell apart is our holistic approach. It’s not enough to just add technology. It’s also about connecting people to the right technology and integrating that technology into their workflows. Processes need to be re-examined and, in many cases, re-engineered. So, in addition to the traditional IT products and services Dell is known for, we also offer a robust suite of solutions and services that are specially designed for healthcare. These include secure cloud solutions such as our Unified Clinical Archive, EHR implementation, mobile clinical computing, sophisticated analytics tools, social media integration, HIX and HIE services and support, and clinical transformation. We also have a strong focus on the life sciences, with a genomics analysis platform that supports clinical trials investigating personalized treatments for cancer.
In another display of beauty, the folks at CDW Healthcare recently released the following infographic describing the rise of the digital patient, a new specifies of mankind. As CDW notes, thanks to innovative mobile technology and the prevalence of broadband networks, patients are investing in their own healthcare more than ever before. Interest in their health and the ability to self diagnose ultimately may be the key to long-term patient engagement, but of course that’s a sticky wicket of its own.
“From searching for a physician online to tracking fitness activities via wearable technology to accessing their personal health records through a portal — patients are embracing mHealth and technologies that will help improve their well-being. In fact, the number of adults using smartphones to monitor their health grew to 75 million in 2012 — a number expected to more than triple by the end of 2014,” CDW writes on its blog.
According to the graphic, patients are “better informed” before they enter their physician’s office, are looking to social media for their health research and are embracing mobile devices as a way to connect with their caregivers. Additionally, the vast majority of patients want access to their medical records online. The graphic also suggests that patients are becoming more aware and attracted to portals, though I’m still skeptical that this is a widespread phenomenon.
Consumers also are getting more interested in wearable health tech, however, and are tracking their outcomes, especially using their smartphones; 112 million devices are expected to be in use by 2018.
Finally, security of the information and its exchange is of the highest importance to consumers , as if is for all of us, but it’s worth pointing out because even with all of the development and patient involvement in their care, they are still concerned about the safety of their information.
Take a look at the following graphic to see if there’s anything surprising here.
The term “patient engagement” has emerged as this year’s buzz phrase much the same way “patient portals” were a couple years ago and even similar to “electronic health records” and “meaningful use” before that. Volumes of articles, case studies, white papers and educational sessions have been dedicated to the topic of patient engagement and even at this years’ annual HIMSS conference patient engagement as a topic discussed was the rule and not the exception. With every step through the maze of booths in Orlando it seemed as if the words – “patient engagement” — were whispered and shouted from every direction.
Patient engagement is now synonymous with health IT, yet the topic is proving to be one of healthcare’s stickiest wickets because no matter whom or how many people you ask there seems to be a different response or definition to the term and how it is achieved.
With all of this uncertainty and confusion about patient engagement, I set out to see if I could define the term by asking a number of health IT insiders what they thought “patient engagement” meant, or what it meant to them. Their insightful and educational responses are what follow.
MobileSmith is an online app development platform, enabling hospitals and health organizations to create custom, native apps, across iPhone, Android and iPad devices, without any coding required.
We have a platform that allows a marketing department with no development experience to create custom, native mobile apps. With us, any hospital can enhance their patient engagement strategy, without coding, and without the cost of hiring developers.
The earliest foundations of the company that would become MobileSmith, were laid in 1993. Back then, the company, known as SmartOnline, sold software to assist small businesses. SmartOnline became one of the early pioneers of the SaaS (Software as a Service) model that we use today. The company worked to adapt to the constantly changing technology. In 2010, the company hired Bob Dieterle as senior VP and general manager. He advocated and orchestrated a complete overhaul of the company services, and focused the company, instead, on the budding industry of mobile applications. The company wanted to deliver organizations a means to quickly create and manage apps to connect to their consumers, without having to rely heavily on an IT department. Working to that end, the MobileSmith online platform was developed, and in July 2013, the overhaul was complete, as the company rebranded itself as MobileSmith Inc. and has since focused entirely on delivering quality and cost-effective mobile apps to organizations.
Market Opportunity and Strategy
There are several app development platforms out there, such as Appcelerator or Kony. These platforms still require a programmer or developer to write code for the apps. Our platform requires no coding whatsoever. A designer or marketer can easily come to us and use our platform to design, prototype, build and deploy an app. While we have clients from a variety of fields, healthcare providers have found our platform particularly useful. With healthcare IT departments swamped with EHR implementation and marketing desperately trying to enhance patient engagement options, our platform has been able to fill their needs without placing any further burden on their IT, and avoiding the higher labor cost of developers. As only 35 percent of healthcare providers offer mobile apps, according to the HIMSS Analytics Survey, there is a clear need in the healthcare industry for our platform, and several organizations have found us to be an excellent means of enhancing their patient engagement via mobile apps.
Hospital readmissions continue to be a major contributor to soaring healthcare costs and a drain on the U.S. economy. According to the Robert Wood Johnson Foundation, 4.4 million hospital readmissions account for $30 billion every year, while 20 percent of Medicare patients are expected to return to the hospital within 30 days of discharge. The Affordable Care Act of 2010 requires the U.S. Department of Health & Human Services to establish a readmission reduction program.
This program provides incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Centers for Medicare and Medicaid Services (CMS) has created quality programs that reward healthcare providers and hospitals with incentive payments for using electronic health records (EHR) to promote improved care quality and better care coordination. The reasons for hospital readmissions include adverse drug effects (ADE), lack of a proper follow-up care, inability of patients to understand the importance of their medications and diagnoses, unidentified root causes, and misdiagnosis. Technology could play a vital role here by properly documenting, tracking, diagnosing, monitoring, and enabling better communication between patient and provider.
Adverse drug events constitute the majority of hospital readmissions. A cohort study, including a survey of patients and a chart review, at four adult primary care practices in Boston (two hospital-based and two community-based), involving a total of 1202 outpatients indicated that 27.6 percent of these ADEs were preventable, of which 38 percent were serious or fatal. Human error was the leading contributor to these ADEs, followed by patient adherence. Additionally, patients who screened positive for depression were three times as likely to be readmitted compared to others.
Our analysis indicates that 28 percent of adult hospital stays involved a mental health condition. A study of Medicaid beneficiaries in New York State determined that, among patients at high risk of rehospitalization, 69 percent had a history of mental illness and 54 percent had a history of both mental illness and alcohol and substance use. We know that a properly implemented mental health screening protocol can lead to effective diagnosis, and that proper management of these issues can positively impact the reduction of hospital readmissions.
Further studies show that most cases of readmissions for certain chronic conditions have an underlying mental health issue, which appears in patients who have not been previously diagnosed for a mental health condition (i.e., anxiety, bipolar disorder or depression). For example, anxiety and/or depression increases the risk of stroke and decreases post-stroke survival, and plays a key role in diabetes treatment as 33 percent of this patient population is found to be depressed and patients with bipolar disorder have reduced life spans. Other cases where depression affects the patient’s survival and treatment cost include hypertension, stable coronary disorder, ischemia, unstable angina, post myocardial infarction and congestive heart failure.
An important point to note: congestive heart failure is the major driver of hospital readmissions in the U.S., accounting for 24.7 percent of all readmissions. Another study concluded that patients with severe anxiety had a threefold risk of cardiac-related readmission, compared to those without anxiety.
On the first day of HIMSS 2014 in Orlando, I stepped into a bewildering echo chamber. “We’re doing population health,” repeated everyone, be they physicians at a hospital whose EHR system my company implemented, the IT directors of other hospitals looking to update their EHR system or competing EHR experts. Everyone was interested in buying it, and everyone was interested in selling it. On one particular walk of the floor a colleague quipped, “Will there be a prize for the one millionth person to say ‘population health?’”
Despite this obsessive buzz nobody seemed able to define what population health is. It’s the proverbial elephant described by touch rather than sight. Is it a concept of health or a study of the various factors that affect health? Is it a course of action for the treatment of the population in its entirety or individual patients only?
The Affordable Care Act, which cites population health as an essential component of its mandate, aims to expand access to the healthcare delivery system, improve the quality of care, enhance prevention, make healthcare providers responsible for outcomes, and promote disease prevention at the community level.
All of this is commendable, but, in the end, what is population health? What does it look like? Will we recognize it if we achieve it? A friend of mine on the payer side observes that vendors claim it’s everything and providers don’t know exactly what they want it to be. Put those together and the term becomes meaningless.
There are additional questions about population health that remain unanswered. Is it an outcome, as the ACA approach suggests, or is it a foundation built on big data, analytics, ACO tools, bundled payments, systems consolidations or something else? At every HIMSS booth, the answer to these questions was a resounding “Yes.”
Guest post by Darin VanderWell, Director of Product, DocuTAP.
Rumors about the next phase of the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program has prompted concern among healthcare providers. To truly understand meaningful use Stage 3 and its impact, it is important to differentiate between the rumors and the truth.
The final rule for meaningful use Stage 3 has yet to be published, so discussion on its effects are based on available drafts. Even those drafts are in question since the December 2013 announcement that Stage 3 would be delayed until 2017. One reason cited was to allow more time to research the impacts of Stage 2 before finalizing Stage 3. The delay will be particularly important for that research, since compared to Stage 1, 2011 Edition, there are so few Stage 2 vendors certified currently.
As for what is expected, the attention turns from data capture and access (Stage 1) and information exchange (Stage 2) to improved outcomes in Stage 3. One expected goal is to simplify and reduce the reporting requirements on those attesting. Some of that change can be achieved by consolidating the program’s current objectives, which I expect hospitals and providers will welcome, provided it truly reduces the reporting burden and does not coincide with other, new objectives and reporting requirements.
Stage 3’s goal of improving outcomes will be incredibly interesting – through November 2013, CMS had disbursed nearly $18 billion in incentive payments. Until now, the program’s success has been judged by the number of participants adopting certified EHRs. At some point during Stage 3 (or thereafter), we will know whether those payments have truly improved outcomes.