Guest post by Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.
There’s a sea change underway in healthcare in the United States, an effort that’s focused on addressing the challenge to improve healthcare quality and outcomes for patients and the population at large, while at the same time controlling and reducing healthcare cost inflation. It’s no small task, and there is no shortage of opinions about how best to make the changes that will be required.
At the core of the discussions, however, is a general understanding that a fundamental change in the traditional orientation to healthcare, and healthcare financing is required. Episode focused, fee-for-service medicine has led to a systematic bias against coordination and collaboration.
The need for change is particularly acute in a world that is increasingly defined not by acute episodes of illness and injury, but by the constant demands placed by the burden of managing the impact of chronic disease. Transformation requires an expansion from the traditional focus on patients and episodes to include populations and the entire care journey experience from wellness, through illness and back again.
In short, an expansion:
From the needs of the patient to include the needs of the population
From the support of the individual provider at the point of care to include all providers across the spectrum of care
From the activities in a particular care setting to include the activities in the entire continuum of care
From the discrete episode of illness and care to include the activities that promote wellness and prevent illness and recurrence
From the treatment of chronic disease to include its management
From islands of automation to integrated information access across the entire continuum of care
The core competency in this new orientation is the ability to practice coordinated care and to manage the financial arrangements that support it. Medicare, and many commercial health plans, refer to this competency as “accountable care.”
Practicing in this new environment requires the ability to expand care beyond the traditional boundaries of a linear provider to patient interaction during a discrete episode of acute illness or injury. In a healthcare landscape characterized by long-term chronic disease, healthcare must include the patient’s lifestyle, environment and long-term personal health risk factors in care planning, delivery and management.
Delivering that care plan cost effectively using complex clinical technologies and innovations requires coordinating and integrating the activities and information from multiple care settings and many different providers. Financing a coordinated care delivery system requires expanding payment for activities beyond fees for the services rendered for a discrete episode to include compensation for the effort and the value delivered from collaboration, coordination and integration across the continuum of settings and providers.
Not surprisingly, the tools and capabilities required for practicing in the era of coordinated care are more complex and far reaching than those required in the traditional episode-based fee-for-service model.
Successful coordinated care requires:
Clinical information and point-of-care automation to ensure that information about the patient’s entire experience of health and healthcare is available at every patient encounter – and that decision support is available to the provider who is engaged in care plan activities and adjusting the care plan based on outcomes.
Data management and integration to ensure that the healthcare data assets that are required for practicing coordinated care are rationalized, useful and consumable at all the points in the care continuum.
Health information exchange that delivers useful and consumable information across the continuum of care and enables the participation of care providers in multiple disparate care settings, systems and locations.
Patient engagement strategies and technologies bringing the patient into the care planning, delivery and management process, enabling them to act on their own behalf and to use their energies and insights to promote improved outcomes, adherence and quality care.
Care management and coordination process automation informed by information assets generated across the care continuum, supports the work of care providers in disparate locations, settings and organizations on behalf of the patient.
Performance management systems and strategies for clinical, financial and administrative processes that ensure that goals of quality, outcomes, patient safety and financial sustainability are achieved and exceeded.
In an environment characterized by multiple, conflicting and interlocking mandates and transformation requirements it’s a difficult task to take on a new set of organizational and technology strategies, and tempting to focus instead on meeting the deadlines and details of the individual programs and requirements.
There is no single road map to success and the timeline, priorities and projects for each organization will vary based on their circumstances. The only certainty is that under the current set of clinical quality, patient safety and financial pressures and requirements, organizations that fail to develop and demonstrate coordinated care capability risk long-term clinical and financial failure.
Jordan Battani is the managing director for CSC’s Global Institute for Emerging Healthcare Practices, the applied research arm of CSC’s Healthcare Group. Battani has a strong professional track record in leveraging technology solutions to deliver business value.
Guest post by John Sung Kim, CEO of DoctorBase.com.
As been reported here and many other industry publications – patient use of mobile health apps is skyrocketing. So why can’t we email our doctors yet?
Since 2010, vendors of patient communications applications have seen a gradual uptick in healthcare providers who accept email from patients, but they are often for special circumstances and providers generally do not make their email address available to their entire patient tablet. When asked in an informal survey of 500 small to medium sized practices (SMB defined here as one to seven doctors in a single location) the top three reasons for not accepting patient email in 2011 were:
1) Lack of reimbursement
2) Potential to divest the practice of traditional in-office revenue
3) Security issues
In the same survey when asked how many doctors offered their email address to their patients the respondents indicated –
1) All my patients – less than 3%
2) In special circumstances – more than 22%
3) Rarely – more than 74%
4) If they were paid for their email response time – 46% said they would accept email from their general patient tablet if the reimbursement came direct from patients and bypassed payer paperwork.
That same survey in 2012 yielded as the top three reasons for not accepting patient email —
1) Lack of reimbursement
2) Potential to divest the practice of traditional in-office revenue
3) Security issues
When asked how many offered their email address to their patients the respondents indicated –
1) All my patients – less than 6%
2) In special circumstances – more than 37%
3) Rarely – more than 56%
4) If they were paid for their email time – 66% said they would accept email from their general patient tablet if the reimbursement came direct from patients and bypassed payer paperwork.
The lack of reimbursed time continues to be the primary concern for providers as they wrestle with the increasingly mobile and digital world of communications, with divesture of traditional in-office revenues as a close second. One thing not mentioned in the stats above was that “HIPAA compliance and security concerns” was a distant third behind economic factors in both annual surveys.
While we saw the explosion of smartphone sales from 2011 to 2012, the number of doctors offering their email address to their general patient tablet grew very little (about 3%) while the biggest gain was in doctors who offered their email in “special circumstances.”
From this sampling we can potentially infer that economic forces – not security – is the primary driver in doctors offering their patients email services. And who can blame them – would we work for free?
Most of those surveyed were small to medium sized (SMB) group practices that ranged from specialties such as OB/GYN to Internal Medicine. As such, the statistical significance is more relevant to this segment of the provider market. As well, the patient communications industry is in its infancy and coming regulatory changes with HIPAA Omnibus 2013 and Meaningful Use Stage 2 may affect provider behavior in the next 24 months. Surveys conducted using Surveymonkey.
The inventor of the first Cloud-based contact center and founder of Five9.com, John Sung Kim is the current CEO of DoctorBase.com – the leading provider of mSaaS (Mobile Software as a Service) that allows healthcare providers to easily monetize mobile communications with patients.
A tremendously interesting and probably important experiment has been taking place at the University of California, Irvine since 2010.
Since then, the university has been using iPads to improve student learning and the program is successful. Specifically, the med students that are part of the program that is using the mobile devices are getting better results, developing apps for the technology and even working to improve healthcare.
Named the “iMedEd Initiative,” all of the students enrolled in the college’s med school received iPads with their textbooks already loaded on them. According to the report, as featured on TabTimes, “The iPads offered access to lecture podcasts, patient records and recorded data from digital stethoscopes, bedside diagnostic ultrasound units and a variety of other medical devices.’”
“UC Irvine reports that students taking participating in the program scored on average 23 percent higher on their exams than previous UC Irvine medical school classes, but such has been the success of the roll-out that some students are even hoping to utilize the iPad to improve healthcare across the globe,” the site reported.
One group of medical students at the school formed the “iMedEd Innovators Group” to discuss which new technologies that could be used at the medical school, and even partnered with the Donald Bren School of Information & Computer Sciences to hold a “Med AppJam” session in the aim of building iPad apps specifically for healthcare, resulting in 19 specialized iPad healthcare apps being developed by more than 100 participants at the school in just 10 days.
Other students are now looking at how pairing the iPad with a portable ultrasound unit could improve healthcare and medical education in other countries where the technology is not so readily available.
The results of this program, however, are not unique. In fact, the site Mashable recently reported that students who use touch technology, like an iPad, in the school setting advanced more quickly than those who did not use them and pair this with the fact that there are more than 2 million tablets being used in schools – a number that will increase dramatically as the technology becomes more accessible and affordable.
Clearly, it’s time for more of us to embrace the technology like they have at UC Irvine. It’s certainly a valuable tool inside the classroom, and as many of you know, it’s a valuable solution in the practice setting as well.
As technology moves, so do we and the world as we know it. With the benefits we’re seeing here, it’s clear to see that we’ve only just begun.
When my wife forwarded me the following heartwarming link to a tender, but powerful presentation about leadership and teamwork, and later in the day I came across a piece titled “5 Facts that Top Teams Learn From Geese,” I figured it was some sort of sign so thought I’d share with the readers of Electronic Health Reporter.
The link to the presentation is here, and it’s worth a look. Even though it’s a slide show, I understand if you don’t have the time or the desire to follow a link. As such, I’ve included the piece, from HR Pulse (thanks to writer Charles Lubbe for compiling this post, his in full below).
Is it about health IT? No. But, it’s about leadership and taking common sense steps to help improve your teams and your organizations. These are simple tips that apply to every business and should be embraced by every leader — and, who doesn’t like an animal story?
Fact #1: As each bird flaps its wings, it creates a “current” that lifts the bird following it. By flying in a V formation, the whole flock adds 71 percent more flying range than if one bird flew alone.
Lesson learned: People who share a common direction and sense of community can get where they are going quicker and easier if they travel on the strength of one another. The clearer the vision or certainty of a team, the more courage they demonstrate in achieving their results and the less they concern themselves with individual effort.
Fact #2: Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to take advantage of the lifting power of the bird immediately in front of it.
Lesson learned: If we have as much sense as geese, we will stay in formation with those who are ahead of where we want to go and be willing to accept their help and give ours to others. Top teams encourage discipline and look forward to opportunities for positive criticism, ensuring that the entire team reaps the reward.
Fact #3: When the lead goose gets tired, it rotates back into the formation and another goose flies at the point position.
Lesson learned: It pays to take turns doing the hard tasks and sharing leadership. Teams that are focused on their vision understand situational leadership and don’t need to be micro managed.
Fact #4: The geese in formation honk from behind to encourage those up front to keep up their speed.
Lesson learned: We need to make sure our “honking” from behind is encouraging, and not something else. Teams that place a value on regular check in and feedback hold their shape.
Fact #5: When a goose gets sick, is wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again, or dies. They then launch out on their own, with another formation, or they catch up with their flock.
Lesson learned: If we have as much sense as geese do, we too, will stand by each other in difficult times as well as when we are strong.
I’d love to know your thoughts and if you think the previous points are worth the read, and more importantly, if they are worth implementing.
Guest post by Kim Lennan, Director of Healthcare Markets at Sensage
Healthcare organizations of every size face a growing number of threats and regulations associated with patient data management. Pharmacies must be on the lookout for falsified prescriptions issued to employee family members. Hospitals must track access to patient records, from both inside and out, to identify individuals trying to gain health details about a celebrity, a neighbor or family member. Network connections must be analyzed to pinpoint situations when passwords have been compromised or mobile devices have fallen in the wrong hands. Finally, meaningful use Stage 1 requires the identification of devices, systems and applications that are dormant or redundant.
To address these scenarios, IT teams must establish monitoring capabilities around a disparate set of systems and activities. This leads to incredibly manual, risk-prone event data collection, correlation and analysis processes across clinical and non-clinical sources, which discourages most IT teams from even taking the first step.
A successful event data management initiative provides three important benefits, which are often overlooked:
The ability to understand patterns and establish baselines by which risk can be measured against. When you know what “secure” activities look like, you can create alerts when an unusual activity exceeds acceptable boundaries or thresholds. For example, if you know a set of workstations are not used during the hours of 11 p.m. to 4 a.m., you can easily set up a notification when a flurry of activity takes place on one of them during that period.
The much-needed context to drive better policy creation and compliance. If you are able to demonstrate events that create risk, you are more likely to drive understanding with users and influence appropriate behaviors. For example, correlate data from your time management system with log-out details on a shared workstation to identify high-risk individuals who fail to log out when they go off duty, leaving that system open to compromise.
The valuable insight needed to investigate a breach or establish compliance with internal or external regulations and policies. All too often, the data that can tell the story was either not collected or is impossible to analyze after the fact. In cases where an incident or breach spanned more than 90 days, most organizations have no historical perspective to review, which could prove a non-event.
For greatest success, security practitioners, auditors and compliance teams will need to align around processes that aid their shared efforts and actions. Here are some must-haves that need to be in place — or at minimum discussed:
Collect and centrally store all event data, even if you don’t think you need it. This is especially important since you don’t always know what you have—or what you will need—in the way of historical data analysis.
Establish basic measurements, understand them, then expand. Start somewhere … anywhere … to establish a metric and then work to make that metric useful or replace it with a better one that you’ve discovered in the process. Don’t just poke around or take a whack-a-mole approach to your discovery process — prioritize your effort so that you can accumulate and maintain a portfolio of metrics that maximize the value of your initiative.
Be consistent or face the consequences. Don’t spend a month on analysis then move on if nothing pops up. Maintaining consistent vigilance is the key to spotting trends or variance. Erratic monitoring and analysis leads to a false sense of security and reduces your ability to continuously reflect and refine based on known patterns.
Be ready to change. There is a tendency to take a finding, create a counter-measure around it, and then never look back. Be intellectually honest when you make new discoveries, particularly if they show a need to change an established rule, alert or policy. While flexibility and change seemingly conflict with “be consistent,” get comfortable with the idea that you will often learn something new which will require a policy or process change.
Engage experts and ignite managers. The dynamic nature of attacks may also lead you to integrate data from systems you didn’t initially consider using to drive critical correlations. As you think about what data to analyze, solicit input from teams who know the systems, devices, people or information associated with all areas of infrastructure. They may shed light on interdependencies or relationships that are critical to better metric definition. Leverage “the truth” established with the experts to ignite the support needed from managers.
A healthy, sustainable data management initiative starts with a single version of the truth. When everyone is looking at the same data, there is an increased likelihood that anomalies will be spotted and risks can be detected more rapidly. Here are some of the capabilities to look for:
A data management solution that makes event data collection from any source a simple task.
A scalable system that gives you the ability to collect and store vast amounts of data without ever-increasing hardware or maintenance costs.
Correlation capabilities that leverage a standards-based event taxonomy so analysis is possible across all data, regardless of source, without additional work from you.
Flexible analysis options that address the needs of every user – from standard reports to customizable dashboards and ad-hoc querying.
There is much we are learning every day when it comes to protecting patient data, and – to evolve – we must adopt new disciplines and continuous improvement around risk monitoring. We applaud Cerner, our innovative partner, and customers like Adventist Health Systems, who are breaking new ground with the “science of risk management” and developing a centralized approach to the systematic inspection across their clinical and non-clinical landscape.