Five startups in the health information management (HIM) field pitched their ideas for a new product, service or business that harnesses health data and information to advance healthcare at the AHIMA19: Health Data and Information Conference. The winner, Drugviu, presented their population health platform that empowers communities of color to use their data to improve health outcomes.
The American Health Information Management Association’s (AHIMA) Pitch Competition, hosted in collaboration with MATTER, the health technology incubator based in Chicago, underscored the conference’s focus on innovation and change. The event served as an opportunity to inspire creative thinking at AHIMA19 and provide startups with a platform to present their health data and information solutions to a group of leading HIM experts.
Only six percent of clinical trials and research involves minorities. Drugviu, which received $5,000 for winning the competition, aims to end this under representation and improve health outcomes among minority communities by sourcing more minorities into clinical trials, providing education tailored to people of color and empowering people to share their medication experiences with their online community engagement platform.
Kwaku Owusu
“This award money will allow us to pursue our mission of expanding the data set of medication and health experiences to include minorities,” said Drugviu CEO Kwaku Owusu.
“Innovations that help connect people, health systems and ideas are key to improving health outcomes,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “With the inaugural AHIMA pitch competition, we’re putting the power to impact health in the hands of enterprising HIM professionals who are developing solutions to advance the healthcare industry. We congratulate Drugviu on their impressive platform to engage more minorities in clinical trials and research.”
Valhalla Healthcare received second place, winning $2,500 for its product Allevia, a fully patient-driven, AI-powered intake solution that automates clinical documentation for healthcare providers. Uppstroms received third place and $1,500 for their machine-learning application that addresses upstream social risk for promoting better health.
Additional semi-finalists included:
Smarter Health: A digital health startup aimed at transforming the way people collaborate to improve value-based healthcare
Tapcloud: A remote patient monitoring and engagement platform that helps patients and their clinicians achieve better health outcomes
“The best solutions to improve the healthcare experience are developed through collaboration between entrepreneurs and industry leaders,” said MATTER CEO Steven Collens. “Winning this competition is a great recognition for Drugviu and gives them the opportunity to work closely with leading health information professionals to further develop their solution.”
It’s tough to see the big picture when you’re “inside the frame.” That’s the underlying principle behind enterprise portfolio management (EPM), a top-down way for healthcare organizations to select and manage multiple projects and resources across the entire enterprise to maximize project portfolio value.
With EPM, large projects are centrally evaluated to determine overall progress and effectiveness, actual project spend versus budget, and continued alignment with the larger, strategic objectives of the organization. EPM is particularly valuable for healthcare organizations which often run multiple large projects simultaneously and frequently encounter ongoing project resource conflicts.
That was the constraint faced by a rapidly growing healthcare system which quickly discovered it could no longer manage new large-scale projects as if it were its older, smaller organization. The healthcare system could readily assess individual projects but lacked a big-picture view of the type, size, duration and risk of all of its project investments. The result? Unplanned operational and financial impacts from conflicting projects which led to recurring staff frustration as well as delays in project implementations and the realization of project benefits.
In response, the healthcare system devised and implemented an EPM process to more effectively prioritize its project resource allocations, timing and capacity, and ultimately guide its project investment decisions. While establishing an EPM system took time and resources up-front, it has helped the organization standardize the decision-making information presented to review and approval authorities and improved internal visibility into inflight work and capacity constraints in the system. The lessons learned by this healthcare system around EPM can serve as a guide to other healthcare organizations seeking similar gains in major project processes and outcomes.
Four Key Steps for EPM Success
You’ll first want to determine if an EPM approach is appropriate for your organization. The answer is likely “yes” if you’re regularly encountering any of the following:
Projects which are frequently delayed, leading to additional remediation costs, uncollected revenue and/or a delayed return on investment
Projects which spiral into “turf battles,” pitting business units, departments or teams against one another
Projects which do not or no longer align with and support organization-wide business goals
Projects which do not or will not deliver long-term value to the organization
Once you’ve determined the need to institute an EPM approach, you’ll have a much higher likelihood of success if you adhere to the following four fundamental recommendations.
Ensure top-level buy-in across the enterprise – Understand that instituting EPM processes may represent a significant change to some within your organization. As with any significant change, some individuals may be resistant to EPM, no matter its merits, unless they’re brought on board early in the process to understand EPM and help establish it within the organization.
To gain top-level buy-in, consider facilitating brainstorming workshops with your organization’s senior executives to define the EPM scope, scale and desired outcomes. Ultimately, your goal is to design and develop a multi-phased, enterprise-wide rollout strategy for EPM, to facilitate gradual understanding and adoption of EPM by staff. A phased rollout strategy might include adding a new project intake and vetting process, standardizing project proposal documentation and creating a project inventory listing key criteria for evaluation.
The American Health Information Management Association (AHIMA) recognized recipients of the 2019 AHIMA Triumph Awards at the Appreciation Celebration at Chicago’s Navy Pier during the AHIMA19: Health Data and Information Conference. This honor is presented to members who have demonstrated excellence in their dedication and service to the health information management profession.
“The AHIMA Triumph Awards recognize the contributions of health information management (HIM) leaders who have enriched the field by preparing future HIM professionals, encouraging fresh HIM talent and leadership and contributing to our knowledge base,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “We are pleased to honor the following individuals with these awards.”
Distinguished Member Award
Cassi L. Birnbaum, MS, RHIA, CPHQ, FAHIMA, was named Distinguished Member, AHIMA’s highest honor. Birnbaum has been a dedicated volunteer for more than 30 years and has served as a past Board president/chair of AHIMA and as an AHIMA director. She led and guided the industry and profession through a successful transition to ICD-10, information governance, analytics, informatics and CDI strategies. She is currently employed by the University of California San Diego (UCSD) Health System as system-wide director of HIM/revenue integrity, as well as adjunct faculty member for San Diego Mesa College and UCSD Extension academic programs.
Advocacy Award
AHIMA is proud to have selected the Ohio Health Information Management Association (OHIMA) as the recipient of the 2019 AHIMA Advocacy Triumph Award. OHIMA advocated for the HIM profession by creating a short, animated video showcasing the diverse job settings, skills and functions that make up the HIM profession to aid potential students, human resource departments and the general HIM profession in understanding the field. Kristin M. Nelson, MS, RHIA; Lauren W. Manson, RHIA; and the OHIMA Board are credited with leading this strategic advocacy project.
Educator Award
Marquetta M. Massey, MBA, RHIA, was honored with the Educator Award. Massey has been an instructor at Central Piedmont Community College (CPCC) in Charlotte, N.C. since 2012 and a program chair since 2015. In 2018, she received a CPCC award for “Best Instructional Video” based on her use of creative teaching tools and methods used in her online courses. Massey is recognized for her “student-first” stance and persistent and widespread use of technology to enhance her students’ learning experience. As a mentor and active member, Massey encourages students to become involved with AHIMA and their local state association.
Emerging Leader Award
Kenneth H. Lugo-Morales, MS, RHIA, received the Emerging Leader Award. Lugo-Morales directs the Health Information Management Department at the San Jorge Children and Women’s Hospital in San Juan, Puerto Rico, where he has successfully implemented a committee resulting in greater chargemaster accuracy and improved documentation and coding outcomes. He is a former president of the Puerto Rico Health Information Management Association (PRHIMA) and is a CSA Delegate to the AHIMA House of Delegates.
Innovation Award
Patricia S. Coffey, RHIA, CPHIMS, CPHI, was honored with the Innovation Award. She is currently employed by the National Institutes of Health (NIH) as chief of the HIM department in the Clinical Center. Coffey helped influence NIH gender identity efforts, cutting-edge patient engagement and efforts to facilitate the collection and management of critical research data while ensuring the integrity of clinical data and patient information. Before transitioning to electronic medical records was a national initiative, she positioned the HIM department at NIH to transition to a completely paperless medical record.
Leadership Award
Chrisann K. Lemery, MSE, RHIA, CHPS, FAHIMA, received the Leadership Award. She has served in various leadership capacities including president, past president and board member of the Wisconsin Health Information Management Association (WHIMA) and secretary of the AHIMA Board of Directors and Speaker of the House of Delegates. Lemery served on the award-winning HIPAA Collaborative of Wisconsin (HIPAA COW) Board of Directors as well as government-appointed committees addressing electronic health records and medical record copy fees. She has given more than 70 presentations sharing her knowledge.
Mentor Award
Tressa A. Lyon, RHIT, received the Mentor Award. Lyon is currently the HIM manager at Norman Regional Hospital in Norman, Okla., and a member of the executive board for the Oklahoma Health Information Management Association (OkHIMA). She has been involved with professional committees and projects including the Medical Decision-Making Committee, the Patient Portal Committee and the Outcomes and Efficiencies Team. Lyon serves as a mentor for many colleges and universities in Oklahoma and through OkHIMA.
Rising Star Award
Laura A. Shue, MPA, CHDA, CPHIMS, was awarded the Rising Star Award. Shue received a master’s in public administration with a concentration in healthcare administration from Eastern Michigan University. She earned her CHDA in 2012 and CPHIMS in 2016. Shue currently serves as the HIM operations director for Michigan Medicine where she has engaged in wide-scale efforts to reduce medical record delinquencies and improve EHR functionality, and has advocated for quality, data management, data analytics and management development. She is currently president-elect of the Michigan Health Information Management Association (MHIMA).
Access to data and the interoperability of health information has the power to change the face of healthcare, according to Alexandra Mugge, deputy chief health informatics officer at the Centers for Medicare & Medicaid Services (CMS).
Addressing leaders in health information management (HIM) at the AHIMA19: Health Data and Information Conference, the American Health Information Management Association’s (AHIMA) annual conference, Mugge outlined CMS’ Interoperability and Patient Access Initiative efforts and what the agency will focus on next.
“We believe electronic data exchange is the future of healthcare, and interoperability is the foundation of value-based care,” Mugge said. “CMS is dedicated to advancing interoperability throughout healthcare.”
Emphasizing that the privacy and security of health records underpins all CMS activity on interoperability, Mugge pointed to several initiatives in 2019 aimed at improving data exchange among providers, payers and patients, including:
The CMS interoperability and patient access proposed rule addressing new policies to expand the exchange of information across all aspects of healthcare
The Office of the National Coordinator for Health Information Technology (ONC) 21st Century Cures Act proposed rule
The Blue Button 2.0 initiative, an application programming interface (API) containing four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries that allows patient access to their health information.
Looking ahead to 2020, Mugge said CMS will focus on addressing challenges to patient matching, updating provider directories, expanding data elements to be standardized and incorporating behavioral and public health social determinants in healthcare.
HIM professionals are essential to ensuring access to health information where and when it is needed, Mugge said, adding that HIM professionals are responsible for shaping the data that ultimately comes together as a part of a patient’s complete healthcare picture.
“CMS is a valued contributor to our ongoing support of interoperability and its benefits to patients, providers and payers,” said Wylecia Wiggs Harris, AHIMA CEO, PhD, CAE. “AHIMA stands in alignment with the goals of interoperability in helping people to live healthier lives and creating access to health information that empowers people to impact health.”
The digitization and expansion of access to data and health information will continue to change healthcare, making this an exciting time in the industry, Mugge added.
“Patients are no longer passive participants in their care, they now have the ability to be empowered consumers of the healthcare industry through access to data that puts them in the driver’s seat to make the best and most informed decisions about their health,” Mugge said. “And providers who have historically been forced to work with incomplete information can now unlock large amounts of data about their patients that will improve care.”
By John Schneider, chief technology officer, Apixio.
John Schneider
Signed into law nearly a quarter century ago, the Health Insurance Portability and Accountability Act (HIPAA) has not aged well in the information technology world. HIPAA itself is largely misunderstood. I don’t know how many times I’ve heard someone tell me about the “Health Information Privacy Act.” However, it’s easy to understand where the confusion comes from. Who hasn’t heard a story about a ransomware attack, data breach, or privacy violation in the news? And it’s not just happening in the healthcare domain—it’s happening everywhere.
The truth of the matter is that security and privacy breaches in healthcare and other industries are a common occurrence. This has resulted in an unhealthy preoccupation by the healthcare community with the security and privacy provisions in the HIPAA legislation that fall under Title II Administrative Simplification. This too is easy to understand—unlike other industries that seemingly get off Scot free after a breach, the healthcare industry is held to an actual standard, and there are penalties for not meeting this standard that can be reputationally and financially ruinous.
To fully understand the healthcare community’s preoccupation with the HIPAA Title II provisions, we need a little background on what HIPAA is. HIPAA has five provisions called Titles. The two key provisions are Title I, HIPAA Health Insurance Reform, and Title II, HIPAA Administrative Simplification. All of the security and privacy regulations stem from Title II, but “Administrative Simplification” doesn’t exactly shout out “security and privacy” (although the Privacy Rule and Security Rule are 2 of the 5 sections in Title II). Title II doesn’t even provide regulations—it simply hands that responsibility off to the Department of Health and Human Services (HHS) to create such regulations as it sees fit, so ultimately, these are the regulations that we’re contending with and are driving behavior that’s limiting the value of data we’re collecting in healthcare.
Let’s first look at the two types of regulations that cause the most adverse behavior.
Sharing Constraints: There are a number of requirements in privacy regulations that constrain sharing, and many are common-sense business-use rules that protect patients effectively. There are also some regulations that state that covered entities (regulation-speak for providers) should only share data they have with other business associates that are directly participating in the care and management of the patient. These effectively prevent the use of healthcare data to create new and innovative products because product development isn’t related to patient care or management.
Punishments for Breaches: Breaches can be financially painful or even ruinous for a business. The penalties associated with breaches make executives think twice about the use of the data they have, even with business associates helping them manage care, because the risk to them is very real. What this means in the real world is that it can take a long time for a new business with a good idea to improve healthcare delivery to gain traction because the holders of data are reluctant to give these businesses the data they need.
These issues are real and are having negative effects in the healthcare industry. However, these same issues are not impeding innovation in other industries that have just as much (or more) private information. What gives here? Healthcare isn’t getting a fair shake.
There are a number of inequities in healthcare that we should take issue with:
There’s an uneven playing field. Think about where the data is in healthcare. It’s largely in the hands of the providers. They effectively own this data, even though technically it belongs to patients. Small startups have no access to this data. They have to hunt for providers willing to share. Often, the cost of sharing are onerous business terms. The larger the cache of data, the more advantaged you become, and in an industry like healthcare that is ostensibly rallied around social good, this should not be okay.
If you do get data, you might become a target. There are many examples where companies (for example, Google this past year) are harassed for doing innovative research for no other reason than they’re visible and have deep pockets. The problem is that we have obsolete regulations that are being used to make a point that isn’t valid in our modern context.
Most of the data we’ve accumulated isn’t used for innovation. The data outlook in healthcare has come a long way in the last ten years since the HITECH act was passed. Electronic medical records have gone from being sparsely used to nearly universal, but most of this data goes unused beyond the walled gardens of the medical record systems they live in. Artificial intelligence and machine learning applications depend on large, real-world datasets and could be put to use to build technology and resources to identify distinct risk profiles, analyze the effectiveness of treatment protocols across specific patient populations, or surface insights that can dramatically improve the speed and quality of care. But only the few commercial entities that have access to data can play in this space.
As primary care providers (PCPs), we’re increasingly trying to manage total patient care for more patients and facing worsening challenges in ensuring our patients can access the care they need.
In 2009, a short ten years ago, there were an estimated 209,000 PCPs providing services for a patient population that has now already exceeded 325 million individuals. The number of specialist referrals has doubled since 1999, increasing wait times and potentially diminishing overall healthcare quality for patients. Even more worrisome and adding to the challenge of access to specialty care is the projected shortage of up to 104,900 physicians in the United States by 2030—61,800 of whom will be specialists.
This worsening shortage in specialty care physicians adds to other factors challenging access, including Medicaid and Medicare acceptance rates, geographic barriers, and financial burden. eConsults can provide a solution for this growing problem. eConsults help mitigate access challenges by providing rapid specialist insights to PCPs who allow us to provide more comprehensive care, improving patient outcomes and satisfaction, all while reducing healthcare costs for patients and paying entities.
From my experience, there are three main benefits that eConsults contribute to delivering timely access to high-quality care:
At community health center practices, a routine referral can take 1 to 2 months before patients are able to be seen face-to-face by a specialist. For our patients, barriers to specialty care access are multi-faceted including limited regional specialist availability, patient transportation to and from visits, as well as a multitude of cost factors such as missed work, childcare, and out-of-pocket expenses. The use of eConsults provides a method of collaborating with specialists via an online portal to quickly provide access to specialty care for many patients—some of whom may otherwise go without.
Leveraging eConsults allows us to identify whether a face-to-face specialist referral is necessary for a patient, or if they can be treated within primary care with specialist guidance. eConsults are capable of replacing a large percentage of face-to-face referrals, but even in cases where the eConsult specialist does recommend a face-to-face visit, PCPs gain insight prior to the appointment on any workup that can be done in advance of the patient’s specialist visit. This saves time for both patients and overworked specialists. AristaMD’s eConsult platform is a guide to help PCPs provide patients with comprehensive, efficient, and effective care. It gives us the ability to provide “double the care for the patient” as they are being cared for by their primary physician and the consulting specialist.
In my experience, eConsults have been particularly successful with endocrinology cases. Typically, these cases don’t require a face-to-face visit, but instead require diagnostics that can be ordered by a PCP and reviewed by a specialist who provides a quick recommendation on the patient’s treatment plan. I’ve had cases in the past where a specialist’s treatment plan included diagnostic lab testing every 4 to 6 months for the patient. In this case, the patient was able to avoid numerous specialist visits and was able to do the routine lab regimen within primary care.
As PCPs, it’s our responsibility to do what we can to positively impact the health of our communities. As part of this duty, it’s imperative we shepherd innovative solutions, such as different types of telehealth. I’ve used eConsults as an effective tool to reduce specialist referrals, which results in low-acuity patients being treated quickly within primary care. This ensures many patients are able to access care within days, opposed to months. For many patients, this is the difference between a worsening condition and sending them to the ER, versus managing their conditions within the comfort of their PCP’s office.
Imagine your favorite football team is in a real neck-to-neck with another team, and the game could tip in anyone’s favor. It is the last minute, and in an insane turn of events, the quarterback throws the ball in the air, hoping the player in the end zone could make a touchdown. Instead, the reckless throw results in confusion, the guy in the end zone gets tackled, and the game ends in disappointment.
Now, let’s step out of football and look at these statistics that show a little picture of referrals in healthcare:
Only about 50% of referrals result in a completed appointment
Less than 25% of referrals are completed as intended by the referring provider
In case one, the player didn’t score a touchdown, and in the second case, the patient didn’t end up with the right provider and the treatment. The reason being the process— a reckless throw and an inefficient referral procedure.
Most healthcare organizations lose about 30% to 60% of patients on account of inefficient referrals. Value-based care is expected to become the leading payment model by the year 2020, and healthcare organizations cannot afford losing more than half of their revenues due to reduced referral leakages.
How do you know that your referral management needs healing?
Imagine a situation where a patient, in his early 60s, suddenly suffers from severe abdominal pain. He goes to his doctor, and the doctor directs him to a specialist she knew out of her professional knowledge.
Now the situation can unfold in many ways, where the patient might end up getting treated or the exact opposite of it. In all the scenarios, the part where things might go wrong is the process of referring the patient. The problems that these stakeholders might face include:
The inability to identify in-network providers
Lack of proper patient information
Limited access to information flow among providers
Reliance on age-old techniques of fax-based referrals
… and many more.
Now the question is: ‘What is the solution?’
It all boils down to just one thing— having the right data. Imagine you visit your doctor. The moment you tell him your problem, he looks into his screen to look for the right specialist. In just one click, he gets all the correct specialists in a listicle format. And all he has to do for the rest of the story is just click on the ‘Refer’ button.
Seems undoable? Actually, all we need is a data-driven strategy.
Don’t just plan your data but also your approach
It is never about just knowing the patients but understanding them, their health, their socio-economic condition, and their care journeys. All of this is not possible if we do not have access to the right data. Whether it be a lab test or spiking blood pressure— nothing should be left undetected.
Easier it is for providers to understand, efficient will be the referral
You cannot expect the rest of the process to be perfect if the beginning is imperfect. If the provider is stuck finding the information, not only will this delay the referral but also increase the chances of errors. What they need is a single screen view of specialists in a list that includes every detail such as geography, specialist ranking, availability, and fees, among others.
Connecting communities and care teams to deliver the best care
It is crucial that care teams and communities remain aware of the events happening in the patients’ care journeys. They need a streamlined tracking of patient referrals at the clinical or patient level. It will reduce the turnaround time for escalations.
The patient lost in the process is the revenue lost
The right referral strategy includes two significant aspects:
Increasing the visibility into the process to the patient
Using advanced analytics tools to develop a lens into the referral process
What they need is a simple reminder that enlists all the details regarding the visit and gives timely updates to them regarding the specialist and the appointment date. Organizations can increase patients’ access to telehealth services by allowing plans to propose the use of telehealth services instead of promoting in-person visits.
By Adarsh Jain, editor, Transparency Market Research.
A rosy picture is always a tricky perception. Artificial Intelligence or AI as it is known, is also very similar. Research publications are inundated with the findings that integrate AI with industry for better outcomes. And in most cases, these findings prove to be worthy in one way or other. But, the picture for healthcare is not as rosy as it seems to be. While tech companies across the world have invested in developing products that will assist the practitioner in making better decisions, doctors have their own doubts in implementing them. Despite these doubts, there is enough hope for players in an upcoming market like AI in healthcare, finds a Transparency Market Research study.
Will AI take away jobs?
In most industries, this has been the million dollar question. And, as serious as it may sound, experts have, time and again, clarified that AI is not going to take away jobs. It, of course, will augment decision-making and, thus, help produce better outcomes. Healthcare should be no different.
Before medical practitioners make a hasty call, it is important for them to realize that AI is a machine, and it clearly works based on algorithms. A machine does not have a human brain to be able to take conscious decisions. It, however, is only a critical aid in taking better decisions. There is no doubt that a large pool of data on admissions, medical history, procedures, conditions, etc. remains untouched across the world, states the TMR study. Processing and inferring from this large a pool of data is humanly impossible. This is where AI can aid physicians. What has happened is that the use of AI has affected radiologists and pathologists the most. For long, these two healthcare professionals have been the backbone of discerning abnormalities in human body functions or detecting conditions.
While healthcare organizations and experts, including government representatives, have proposed the use of AI in diagnosis, the risk of misjudgment bothers medical professionals. A wrong diagnosis or treatment could result in loss of life, and invite severe action against the healthcare professional. This argument from the healthcare professionals hold weight and, perhaps is a strong emotional reason for doctors from being reluctant towards introducing AI in their practice.
Lack of regulations is the caveat
A process bound by regulations is always more effective. In most countries, there is no law that defines the use of AI in medical practice. There is hardly any information that speaks about the limit to which the use of AI should be restricted. Also, the lack of information on the right usage, and ensuring all inferences or decisions based on AI are error-free is a huge caveat.
At a time when tech giants, especially in the United States, are vigorously working towards rolling out AI in healthcare, it is prudent to have regulations that define usage. It is just the matter of one country making the move, and when that happens, the rest are likely to follow suit, states the TMR report.
The 
Imagine your favorite football team is in a real neck-to-neck with another team, and the game could tip in anyone’s favor. It is the last minute, and in an insane turn of events, the quarterback throws the ball in the air, hoping the player in the end zone could make a touchdown. Instead, the reckless throw results in confusion, the guy in the end zone gets tackled, and the game ends in disappointment.
A rosy picture is always a tricky perception. Artificial Intelligence or AI as it is known, is also very similar. Research publications are inundated with the findings that integrate AI with industry for better outcomes. And in most cases, these findings prove to be worthy in one way or other. But, the picture for healthcare is not as rosy as it seems to be. While tech companies across the world have invested in developing products that will assist the practitioner in making better decisions, doctors have their own doubts in implementing them. Despite these doubts, there is enough hope for players in an upcoming market like AI in healthcare, finds a