5 High-impact Outcomes Health Systems Can Achieve Using Clinical Analytics

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Subramaniam

Guest post by: Sai Subramaniam, Ph.D., Business Head, Life Sciences & Healthcare at Persistent Systems

According to a recent report only 16 percent of hospitals have clinical decision support capabilities, but IT leaders call it a top priority for the next 12 months. Healthcare reform is all about achieving better quality care at lower costs, and clinical analytics is integral in delivering on this promise. For example, reducing 30-day r-eadmissions and hospital-acquired infections alone is expected to save more than $25 billion dollars in the healthcare system. Analytics on integrated claims and clinical data will allow health systems to pinpoint effective clinical and operational interventions. Here are five high-impact outcomes that health systems can achieve using clinical analytics.

30-day Re-admission Avoidance: Hospital re-admission rates are high for patients whether they are in Medicare, Medicaid or Private insurance plans. People with multiple chronic conditions and mental health conditions are at an increased risk of re-hospitalization because of inadequate care at discharge. Demographic and social factors also dictate if the care transition will be effective or not. Evidence-based rules allow stratification of patients based on these factors. This allows caregivers to give more attention to high-risk patients during hospital discharge.

Enhanced Surveillance and Preventive Care:  Growing evidence suggests that education and health coaching will facilitate behavior change and achieve cost savings. The population in the program needs to be screened and stratified to identify at-risk patients. Predictive modeling and business rules can help to identify individuals who may not be diagnosed but have relatively high risk of developing diabetes in the future. Similarly, a cancer surveillance model based on linking environmental, genetic, and lifestyle factors can be used.  This will allow early interventions and proactive follow-up care.

Improved Medication Adherence: Non-adherence is said to be responsible for more than 10 percent of hospital admissions and 40 percent of nursing home admissions. Patients on average don’t fill more than 25 percent of new prescriptions. Costs because of lack of medication adherence exceeds $100 billion. Predictive analytics on patients’ past prescription claims data will allow the health system to create an adherence score, and facilitate a proactive approach to managing compliance.

Unplanned Admission Avoidance:  It’s important for health systems to identify patients with chronic conditions who may be at risk of emergency hospitalizations.  For example, studies suggest that people with respiratory and cardiac comorbidities, with higher hospital utilization in prior years, have a higher probability of hospital admission.  Determination of such factors along with socio-demographic characteristics, will allow application of predictive models to identify people at-risk.

Length of Stay Performance Management:  Several factors impact the patient’s length of stay in the hospital. This includes demographic as well as hospital operational characteristics. There are standards for length of stay based on diagnosis related group and clinical disease factors. By comparing this with patient profiles, providers can utilize resources efficiently to provide optimal patient care. This will result in significant cost savings as better case management should help to reduce the average length of stay.

Dr. Sai Subramaniam is the Vice-President of Persistent Systems’ Life Sciences & Healthcare business. In this role, Sai is responsible for the overall business growth of Healthcare & Life Sciences business segments.

 

 

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Though Much of the 2013 Transformation is Fueled by Government Initiatives, Healthcare is at a Tipping Point

Fifield

Office of the National Coordinator for Health IT

Guest post by: Lauren Fifield, senior health policy advisor, Practice Fusion

Many HIT vendors will be largely focused on major development efforts to meet 2014 edition certification requirements for meaningful use.  However, as Stage 2 measures aim at improving patient engagement, quality and interoperability, we may be surprised by the new technologies that existing and new companies develop to meet the requirements:

We’ll also see new industry movement toward improved patient safety through provider training, reporting and other efforts.  Thanks to the successful collaboration between vendors and the agencies that help providers achieve meaningful use, we expect the Food and Drug Administration to work with the Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC) to engage key stakeholders by addressing the 18-month study mandated in the FDA Safety and Innovation Act of June 2012.

Given the continued and ever-growing provider outcry to address the broken payment system, the Department of Health and Human Services (HHS) may finally develop plans to move to a reimbursement system that relies on quality and outcomes.  With the recent announcement of more than 106 new ACO contracts, growing provider participation in new payment models, and the new possibilities opened up by technology vendors, it may at last be time to put this broken system behind us.

Though much of the 2013 transformation is fueled by government initiatives, the healthcare industry is at a tipping point regardless of any push on Uncle Sam’s part. Patients will soon be expected to pay for more of their care, making consumer health tools, telehealth and personalized medicine more appealing and important. Providers tired of the payment system will partner with technologists and private payers to try alternative models and cash-based business.  And big data might just find a home amid all these new patient, provider and health system innovations.




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What We Think When We’re Led to Think a Certain Way: Wolters Kluwer’s Survey About Healthcare and the American Uninformed

Wolters Kluwer recently released a gem of a survey fit for the bandwagon of health IT topics currently underway.

On its head, the survey results are intriguing and the data does provide some insight into what the American public is thinking when led to think a certain way about a specific topic that, quite frankly, most don’t know much about.

Now, I’m not saying Wolters Kluwer data is flawed. On the contrary, the firm, which makes its living producing qualified data, knows what it’s doing. What I’m implying is that Wolters Kluwer is producing a survey with data collected by an audience that doesn’t truly understand the topic in which it’s responding to.

Let’s dive in and I’ll explain.

According to the survey by the Philadelphia-based company, 80 percent of consumers believe the greater “consumerization” of healthcare – or the trend of individuals taking a greater and more active role in their own healthcare – is positive for Americans.

“Survey data suggests many Americans feel that a greater role in their care is not only good, but necessary, with 86 percent of consumers reporting that they feel they have to take a more proactive role in managing their own healthcare to ensure better quality of care.”

Let’s start here. As a member of the healthcare community, I’ve helped produce similar reports based on surveys I have even helped write, produce, analyze and release to the public. Does that mean my data was a good as Wolters Kluwer? No, not at all.

My point is that there is nothing new here. Nearly every survey of the American public about healthcare tends to suggest that they need to be more involved in their care. All Americans want to take greater control of their car until, seemingly, it’s time to do so.

Even the results suggest that Americans have the information and tools available to them to take on more responsibility.

“Most consumers also say they feel prepared to take on a greater role in managing their own healthcare, with 76 percent reporting that they have the information and tools to take a more proactive role in healthcare decisions ranging from choosing healthcare providers to researching treatment options. Despite feeling prepared, only 19 percent report that they have their own electronic Personal Health Record (PHR).”

Well, there’s the catch. There always something holding people back; no, it’s not the fact that when it comes time for the rubber to meet the road no one is ready to actually start their journey. If only everyone had access to a PHR, everyone would clamor to be more involved in their care.

Certainly, most of us know that this is simply an excuse so no one has to take responsibility for their actions. And, when PHRs are readily available, some other hurdle will keep Americans from moving forward with their engagement.

Finally, of the 1,000 respondents, Wolters Kluwer suggests that a mind boggling 30 percent of Americans want the same experiences with their physicians as they have with other consumer interactions, such as while shopping, traveling or lodging, complete with choices and control.

Here’s where my suspension of disbelief ceases. There’s just no simple to explain this nor is there very much credibility in the statement. The flaw in this piece of detail, in my opinion, is that we’ll never be able to have the same experiences with our physicians as we can with our travel agent or the baker in the local supermarket.

Physicians, after all, develop a much more intimate with their “consumers.” I mean, physicians see us naked and stick us with needles and get a lot closer than the clerk at your local department store. There is simply no way the relationship nor the experience is going to be the same. Which brings me back to my original point: the survey just seems to try to be so much more than it is seemingly as a result of trying to be part of a larger conversation.

But, to mitigate against the risk of you thinking I’m holding out on you, here are the remaining results. Let me know if you agree with my assessment:

According to Wolters Kluwer: “When it comes to choices about physicians, assuming that experience levels and care reputations are similar, consumers rank costs of visits and procedures (20 percent); technologically advanced offices, including the ability to communicate via email with doctors and nurses, schedule appointments online (19 percent); location of practice/office (19 percent) and friendliness of staff (14 percent) as the top four factors influencing their decision.”

Among other findings from the survey:

 

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HealthIT.gov: Offering Support and Education about Mobile Devices in Healthcare

I’ve long been an advocate of HealthIT.gov, which I’ve profiled here multiple times for the guidance the site provides about electronic health records and ways to use the technology.

A new addition to the site is guidance for physicians about mobile health technology, which is beginning to pervade the healthcare landscape.

As healthcare workers and professionals continue to use mobile devices in the care setting, they’ll need accurate and helpful information to protect them and their patients from issues such as security breeches.

To that end, it’s nice to see the Department of Health and Human Services to assemble a series of tips and information to the public’s greater good.

The site features several articles and videos designed to offer support and education about using mobile device in healthcare.

For example, articles include topics such as:

For those who prefer video, topics covered include:

In addition, there’s also frequently asked questions and downloadable materials. All in all, the site is filled with a great deal of rich content.

On top of that, there’s a plethora of other information including tips for integrating privacy and security into a medical practice, building a health information privacy and security plan, information about health IT security resources, cyber security and mobile device security.

Simply put, this is a great resource for all of us in healthcare, patients included. Well done, well done, HealthIT.gov.

 

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Usurping the King of Health IT: Allscripts No Longer Needs Former CEO Glen Tullman’s Pomp and Circumstance

Glen Tullman, former CEO of Allscripts

Every leader of a competing electronics health records vendor probably jumped for joy once they heard the news that Glen Tullman was ousted by Allscripts, the company that he made what it is. Or, maybe I’m wrong. Perhaps leaders of competitive companies would have liked to have kept him around because of what he did to the organization following the acquisition of Eclipsys.

The man, for the most part, has been considered a genius. Peers in the industry gave his performance praise, patted him on the back and showered him in adulation through the maneuvered takeover of the hospital health IT giant. At the time, in 2010, the move made by Allscripts was hailed as a magnificent effort.

It was the kind of move that was supposed to have turned the industry on its head. Many thought it would, and many eyed the effort with envy for such a move was powerful and assertive.

It did rock the industry. Competitors shook in slight fear with the announcement of the news, and many feared for their longevity. In this fact I am serious. I know. I was at a competitor. The whispers went something like this: “Will this new monster kill us all?”

Though all of we worked to secure our shores, many of us were fearful of the coming tide.

But, from the beginning, there was always a sense that Allscripts, and Tullman specifically, was positioned as too big to fail. Perhaps we should have seen a previous merger, the failed move to integrate Mysis, as a harbinger of things to come.

There was even a point in which I had dubbed him the king of health IT. I referred to him as such during internal meetings in my effort to create the queen of health IT, who was a president of another firm in which I worked.

There was a level of pomp and circumstance about everything he seemed to do through his promoted PR moves and image building to his constant appearances and associations with Washington’s power elite, including the president.

I can’t imagine Tullman saw this coming during his rise to the top. Just 18 months ago he was on top of the health IT world, seemingly unafraid of the world in which he lived, or so it seemed from my outside position.

Hindsight is 20/20, though, and it’s easy to question failed policy after decisions have been made.

When the recent takeover bids failed to take the Allscripts private, the company had but one choice and he and other leaders of the company had to go. It’s a common scenario in the world of politics, another world which Tullman is known to frequent. As things grew worse for the once mighty giant, everyone associated with the debacle had to go.

And, even in lands where great kings have ruled, even their glory days come to an end.

But, does it surprise me that he and others at the disheveled vendor are gone? Gone from the vendor that positioned itself as too big to fail? Gone from the vendor that asserted itself upon the market; that worked to take over a market in which its ambitions were bigger than its capabilities?

No, I’m not surprised.

In many ways Tullman died at the hand of his own sword.

And, as we’ve seen countless times and will see again, no company nor its mascot is too big to fail. No kingdom too vast to conquer, no land immune from the trials of the nations it builds.

And so, the king of health IT is no longer king, but neither is he a pauper. And, like most who have achieved his heights, it’s safe to say we probably haven’t seen the last of him.

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Six Ways to Improve Care Using Patient Portals

I continue to be a fan of quality reporting from publications such as Physicians Practice, and I’ve cited their reports in several of my blog posts in the past. Today is no different. As regular reader here may know, I’ve spent a good bit of time on the subject of patient engagement, specifically how physicians and practice leaders can engage patients to improve their care outcomes and their health.

That brings me to a recent piece by Rosemarie Nelson titled, “Patient Portal: 6 Ways to Improve Patient Care.

In the piece, Nelson discusses “meaningful use incentives, increased profitability or improved quality of care.” In exacting terms, she makes a call for patient portals and how it can get “patients engaged in their own care and satisfy just about any goal.”

Though I’m somewhat of a skeptic at the party for patient portals (I don’t think that in their current status they’ll actually lead the patient engagement charge), she offers six pretty interesting and solid tips for helping practices lighten their administrative loads.

Thanks, Rosemarie. It’s hard to argue these points:

Self-registration: “Invite and encourage patients to self-register on the portal. It will save your front-desk staff time, reduce costs, and patient data will be more complete and accurate. When patients call to schedule appointments use that time to introduce them to your patient portal, and explain that advance online registration will save them time on the day of their visit, because their paperwork will already be filled out. Advance registration on the portal provides your practice with three core requirements to meet meaningful use too.”

Collect patient data. “A tightly integrated or interfaced patient portal and EHR will deliver data back to the patient from their encounter. Push the patient’s medication list, medication allergies, problem list, and diagnostic test results from the EHR into the portal and patients almost naturally become more engaged in their healthcare.”

Report patient data. “There has always been a mystery surrounding that paper medical chart for patients. By delivering key components of their health information to them automatically, you can satisfy their curiosity and engage them in their own healthcare. As your nurse discharges the patient at the end of the office visit, use that discharge instruction time as an opportunity to introduce patients to the kind of information they will be able to find on the portal.”

Provide clinical summaries. “The integration/interface from the portal to the EHR allows for automation of data exchange after the patient visit. Clinical documentation is completed and made available to the patient without any action from your staff. In addition to further engaging patients in their own care, you’ll have achieved two more core requirements of meaningful use.”

Secure messaging. “Once you’ve got your patients using the portal to access information, you can begin to communicate with them via the secure online messaging function. Communicating online instead of on the telephone will streamline your practice operations significantly, even if all of your patients aren’t using the portal. Your staff can use the portal to deliver automatic reminders to patients regarding preventive care and/or follow-up care. No more manual logs or tickler files and no more mail merges to process. Developing HIPAA-compliant processes and standard messages frees up your staff to provide direct patient care.”

Provide patient education materials. “Secure messaging can also be used to direct each patient to educational information that is specific to their own individual needs and conditions. Your practice will achieve greater percentages of patients meeting quality measures and your patients will feel as well cared for as their pets. Three more requirements for meaningful use can be checked off, too.”

Well said, well said.

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Is Gartner Right in Recommending that Healthcare Embrace or Avoid these IT Trends?

Though there no longer necessarily a “season” for trend and projection pieces, but given our place in the calendar year, it’s appropriate that analyst firm Gartner recently released its latest piece, “Healthcare IT Trends to Embrace/Health IT Trends to Avoid,” published recently on CIO.

The following tips are part of a larger article about big data that, other than being a bit of a clumsy read, is worth a look. One of Gartner’s top healthcare analysts, Vi Shaffer, opines about the current state of healthcare and how those in it can begin to embrace the changes ahead.

So, without further ado, here’s some of the things you should definitely do (according to Gartner, that is), if you’re seeking ROI. I’ve made some edits to the list in points not relevant to this blog.

According to Gartner, the following are four healthcare IT trends to avoid. For various reasons, I don’t agree with any of these reasons, do you?

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If an EHR Company’s Business Model Can Be Beautiful, Hello Health May Be Hard to Turn Away From

Can a business model be beautiful? Yes, it can, according to Hello Health’s Steve Ferguson, vice president of marketing.

The business model, and the way things get done, at Hello Health are what set it apart from other electronic health records in the market place, Ferguson said.

Hello Health was built from the ground up and launched by the private company Myca in 2008. It made its meaningful use certified EHR available in 2011. The Hello Health system includes everything needed to run a small practice, the area of the ambulatory market in which the company focuses.

Originally designed for single doc practices, the system now scales up, with practices of as many as 10 physicians using it.

At its most basic, Hello Health is a web-based EHR and patient health record, and it’s free to for qualified physicians to use. A qualified practice is typically one with 1,500 active patients on its panel. Unlike Practice Fusion, another well-known free cloud-based electronic health record, it’s not powered by ads, but instead is a revenue source for practices as monthly access subscriptions can be sold to practices’ patients, allowing the patient to access the system’s patient portal, where their personal information is kept.

The patient subscription model allows patients to schedule appointments, view lab results, communicate with their physicians through the HIPAA-compliant portal and, in some cases, view their complete record including visit notes.

Steven Ferguson
Steve Ferguson, vice president of marketing at Hello Health

Those patients that don’t subscribe are still allowed limited access to the portal, but they can’t access all of the information available to them. Cost of monthly subscriptions range between $3 and $10, Ferguson said, but the average is closer to $5.

The annual revenue earned through patient subscriptions is $10,000 per practice, he said, with 30 percent of patients, on average, signing up in each of the practices Hello Health serves. In some cases, more than 50 percent of a practice’s patients have signed up for access to their health information.

Currently, the typical age of a Hello Health subscribing patient is 57 years old and has at least on chronic condition. The “indestructible” 30-something is less likely to subscribe to access to the portal, said Ferguson.

In some cases, patients are able to skip a practice visit or an in-office consult because of their prescription to Hello Health, Ferguson said, and practices are okay with it because they can still bill for the visit.

It’s a simple model, and with the number of portals currently available and the likelihood that access to them will increase alongside meaningful use stage 2, it’s a wonder why other vendors are not creating similar strategies.

“Companies are so in grained in the license model, and on paper it may seem easy to change, but it’s tough to change a business model,” Ferguson said.

Among another key difference between Hello Health and competitor systems is that it doesn’t charge for training and allows as much training as is needed so practice employees are comfortable using the system and are able to educate patients about the value of subscribing to the patient portal.

“Practices really have a partner in Hello Health,” he said. “We take extra time to implement and train employees so they can educate patients to use the systems and better understand the benefits of it.”

Ferguson said Hello Health is experiencing explosive growth, though, would not confirm the number of practices using the system nor the number of patient subscribers because the company is private. However, it is currently available in 27 states, with concentrations of users in New York, New Jersey, Texas, California, Georgia and Florida.

The value proposition to physicians is Hello Health’s business model and the fact that it is a revenue driver.

“Our differentiator is our business model,” Ferguson said. “Everyone tries to sell to the physicians, but most physicians are forced to push back because they can’t afford another bill.”

The fact that the system is free to implement and offers unlimited training is also a plus, he said.

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HIMSS Study: Mobile Technology Allows Physicians to Embrace New Ways of Collecting Information and Connecting with Patients

According to the results of the 2nd Annual HIMSS Mobile Technology Survey, mobile technology is increasingly important to healthcare. Patients are obviously on board, but so are physicians and their employers.

Extensive adoption of almost every type of technology continues to take hold in the space, including smartphones, tablets, laptops and “movable workstations.”

An argument I remember hearing during my time in the vendor space is that if patients/consumers evolved into a mobile community, physicians would follow. Obviously, we’re seeing this prediction come true, but I can’t think of any reason why it wouldn’t be the case as it’s the type of technology that’s cheap, assessable, mobile and effective.

More so, according to the HIMSS study, “physicians are embracing new ways of collecting information and connecting with patients.” I do wonder, though, if physicians thought they’d be using their technology to connect with their patients as much as they have reported through the survey.

Surprisingly, (for me, at least) is the HIMSS reports that 93 percent of all physicians use mobile health technology in their day-to-day activities, and 80 percent use it to provide patient care.

A little less surprising is that nearly 25 percent have EHR systems that capture clinical information from mobile devices, and 36 percent allow patients to access information and health records using a mobile device.

The survey featured 180 individuals who “were directly responsible for some aspect of a healthcare organization’s mobile health policy shows that the number of mobile health programs in hospitals and individual practices increased.”

In my experience with this type of research, and as my former colleagues in research might point out, the sample size is statistically pretty small, though, and I’d like to see how the numbers would come out with an inflated sample size. I’d be surprised if 93 percent of physicians used so much mobile tech.

Finally, according to the survey, and I’m just reporting the facts here:

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Nothing New Here: Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program

In a new report that’s been gaining quite a bit of attention in recent weeks, CMS faces several obstacles in overseeing the meaningful use incentive program.

Here’s what OIG found in its assessment:

“CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the report states. “Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments post payment is also limited. The Office of the National Coordinator for Health Information Technology (ONC) requirements for EHR reports may contribute to CMS’s oversight obstacles.”

Essentially, OIG has concerns that the ONC is simply giving away money without verifying whether those who have attested actually completed the process properly. I think it’s a valid concern, though, given the number of hurdles physicians face and the degree in which their meaningful use systems must undergo to become certified, I think it’s probably a little far fetched that an overwhelming number of practices are going to bilk the system (though it could happen).

What follows are the recommendations for the administration of the meaningful use program, per OIG:

First, it is recommended that CMS:

Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information and

OIG wants CMS to conduct occasional spot audits prior to payment for them to receive their money. It won’t happen. After all of the work and time invested at the practice level, there is going to be too much push back to administer an audit cycle of this magnitude, and CMS doesn’t have the time nor resources to undertake it as an action item.

Frankly, this seems like a point made for the sake of making a point. This is big government we’re talking about. Everyone feels the need to participate in a conversation just to they look important while doing it. These may be some valid points, but OIG comes off a little out of touch in doing so.

Also, according to the report, CMS did not concur with OIG’s first recommendation, stating that “prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments.”

Finally, OIG recommended that ONC:

ONC concurred with both recommendations, which I think are beside the point.

Perhaps the most “intriguing” element of the report, though, is its actual title. Let’s take a look: Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.

Is it me or can the title be any more vague? Seriously? CMS face obstacles? That’s a pretty bland statement given the scope of meaningful use, and (perhaps I’m reaching) that seems to diminish the validity of the entire report, which brings me back to my previous point: Is OIG inserting itself into a conversation in which, at this point, it really has very little to say?

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