To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.
Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.
As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.
Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?
As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.
In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.
I recently had the opportunity to attend PointClickCare’s annual user summit held in Orlando. Though the senior care market is not one I’ve spent a great deal of time covering, senior and long-term care are deeply interesting to me. There are several reasons for this interest: Seniors are becoming the largest population segment in the US and that has serious ramifications ranging from politics to economics, and because I’m interested in alternative care models. And, in some way, senior care effects all of us.
There are a number of differences between senior care and ambulatory or in patient, but the technology needs are still overwhelming and great. Senior care facilities across the US face tight budgets, extremely high levels of employee turnover and technology challenges, but the care they provide is still important, as is how the information they collect on behalf of their patients is similar to other sectors.
According to Mike Wessinger, CEO and co-founder, “PointClickCare’s goal is to enrich the lives of care providers through technology that will help them better care for their residents in ways that are effective and efficient.”
PointClickCare’s primary reason for being is to deliver electronic health record and practice management solutions, but the company has an eye on mobile delivery, where both Mike and brother David Wessingner, CTO and co-founder, feel the future of health IT lies.
Mobile is king for its ability to deliver health data quickly and where needed, as well as to alleviate stress and confusion of overwhelmed healthcare employees.
Hospitals, too, are overwhelmed. Data flowing in from various systems often goes unnoticed or unpackaged, a particular troubling problem for the senior population. When there’s a patient transferring in from a senior home to a hospital for emergency care, a health record of some kind may accompany them. A fully loaded paper chart may only be shuffled through and details lost.
The report includes a web-based interactive innovation scorecard to assess medtech companies based on leading innovation practices. Only 14 percent of medtech executives say that they formally manage innovation activities, which is essential to creating new services and business models.
Just 17 percent of med tech executives believe their companies are innovation pioneers. The PwC’s Health Research Institute report outlines how medtech companies need to expand their approaches to innovation outside traditional R&D to remain competitive.
“Historically, medtech innovation has relied on incremental improvement,” said Christopher Wasden, managing director and global healthcare innovation leader, PwC. “But ‘innovation’ needs redefining for an environment that rewards value – measured in affordable patient outcomes and customer satisfaction – over volume. True innovators learn from failure – fast, frequent, frugal failure. Medtech leaders need to change their business models, their corporate DNA, to embrace lean innovation beyond their core operations.”
HIMSS is one of the most exciting events on the health IT calendar. An annual parade of the pomp and circumstance, the mighty and the meek; the somewhat great equalizer for everyone in attendance (perhaps not measured by booth size but by mere participation).
HIMSS is the place to be seen as it holds a certain stature, like being invited to the hottest party in town or attending an industry’s red-carpet event. As such, there’s a level of elitism for those that make the journey as all that enter the grounds can claim that they’ve reached a certain stature in their careers.
There are the parties and toasts, educational and informational, evangelists and doomsdayers walking the same halls, shaking the same hands, seeking the same solutions and securing similar aspirations. As if a city of its own, HIMSS thrives upon its own economies and its communities, its own crooks and its own saints; it is the world in which we live, and great things tend to happen here, despite the few inevitable hiccups that happen along the way.
From the sessions to the show floor, the whole thing is a carnival. Like in the real world, everyone in attendance has their tribe and the land in which they’ve staked is the land in which they occupy.
I’ve done my time in the booth; standing at the edges of the territorial carpet, scanning the horizon, taking in the tourists and judging the competition for their various faults — from the poorly dressed sales folks to the vendors vying for supremacy from the land of the largest booth.
Sometimes, we cross the isle, make nice and say hello to a neighboring tribe. Others times we invade, stealing chachkis, and water and the occasional free massage.
We smile and make nice, and for a minute we’re friends, but then we remember that we come from the other side of the isle so we slither back to our tents and to our carnival barker duties. After all, it’s the show they love — the folks walking by – who window shop their way through the maze of capitalists.
We’re their entertainment, in our pressed shirts, standing in our corner smiling. We make passersby pass the time between sessions, but we understand our role. Even though we’re there to show some product and educate some minds, it’s a time for us all to come together and to celebrate the best that is healthcare, its technology and all its related parts.
For a few short days, we’re united and (somewhat) sincere with each other. Like a high school graduation party where everyone can come together even after years of disagreement or opposing views and think grand things about the future even though we know the roads we’ll travel will take us down very different paths.
And when it’s all over and life settles down, after the tent cities are razed and we’re back in our offices, we’ll remember the time we had where we came together and we’ll long for those time once again.
“There’s always next year,” some of us will say to ourselves, but we know it will never last forever.
Despite the good times we had round the hotel bar, in the ballroom or conference center board room, we realize that even the best of times must end and, ultimately, we pretend to know “it” (read: interoperability) could never work in the “real” world so we settle for and embrace the short-term relationships we’ve made knowing “we’re just not right for each other.”
Truth is, in the end, when the show is over, we’ll simply return to our silos and shut the door. Lights out, and once again we’ll be alone.
I’m not unique in that during this time of year I love to take a look at predictions made by some of the industry’s “best” and see if their predictions make sense, are surprising in a good way or if they are surprising in a stupid way.
With that in mind, I came across an interesting piece in Canadian Manufacturing of all places that features several intriguing predictions by analyst firm Gartner that I think are worth a look here as they have peripheral relation to healthcare.
So, here we go. Gartner’s top IT predictions include:
By 2015, big data demand will reach 4.4 million jobs globally, but only one-third of those jobs will be filled. According to the report: “The demand for big data is growing, and enterprises will need to reassess their competencies and skills to respond to this opportunity. Jobs that are filled will result in real financial and competitive benefits for organizations. Note that enterprises need people with new skills—data management, analytics and business expertise and nontraditional skills necessary for extracting the value of big data, as well as artists and designers for data visualization.”
In a market like healthcare, where highly skilled jobs are often difficult to fill, we should understand this prediction to be very true and one not to take too lightly. Some of these job vacancies will be at health system that needs the data to meet federal reporting requirements. The individuals with these skills will have a great deal of clout as they eventually move into the job market.
Employee-owned devices will be compromised by malware at more than double the rate of corporate-owned devices. “Corporate networks will become more like college and university networks, which were the original “bring your own device” (BYOD) environments. Because colleges and universities lack control over students’ devices, they focus on protecting their networks by enforcing policies that govern network access. Gartner believes that enterprises will adopt a similar approach and will block or restrict access for those devices that are not compliant with corporate policies. Enterprises that adopt BYOD initiatives should establish clear policies that outline which employee-owned devices will be allowed and which will be banned.”
BYOD continues to rear its head so don’t be caught unawares. AS Gartner predicts, you must have a plan for mobile device management and personal device use in the workplace. Ignorance is not bliss, in this case, and since employees are currently using their own devices in the healthcare setting where very important personal information can be exposed, develop a policy, stick with it and let your employees know you have one in place. Circulate it!
By 2016, wearable smart electronics in shoes, tattoos and accessories will emerge as a $10-billion industry. “The majority of revenue from wearable smart electronics over the next four years will come from athletic shoes and fitness tracking, communications devices for the ear, and automatic insulin delivery for diabetics. CIOs must evaluate how the data from wearable electronics can be used to improve worker productivity, asset tracking and workflow.”
Healthcare will play a role in how wearable electronics and traceable devices are used to track the health of individuals, especially in outpatient and in-home care. The data from these devices will flow directly into your EHR and become part of the patient record. Physicians will be forced to learn the benefits of these devices and patients are going to need to accept it.
By 2014, market consolidation will displace up to 20 percent of the top 100 IT services providers. “The convergence of cloud, big data, mobility and social media, along with continued global economic uncertainty, will accelerate the restructuring of the $1 trillion IT services market. By 2015, low-cost cloud services will cannibalize up to 15 percent of top outsourcing players’ revenue, and more than 20 percent of large IT outsourcers not investing enough in industrialization and value-added services will disappear through merger and acquisition. CIOs should re-evaluate the providers and types of providers used for IT services, with particular interest in cloud-enabled providers supporting information, mobile and social strategies.”
The prediction smacks of the ongoing discussion about the EHR vendor market and how much longer it can contain the number of players. Certainly, we’re seeing deterioration of this segment now, though it has been expected to erode more quickly than it has. Expect there to be fewer EHR vendors in the next 12 months, and realize that no vendor is too big to fail (see Allscripts). Prepare early and do your due diligence before signing the dotted line.
I’d love to know your thoughts. Do you agree with these predictions and my assessments? What are yours?
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.
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.”
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.
Big data. Along with big data, you need to make sure you’re making a move to structured data collection. In its most simple terms, you need to make sure that all of the data being collected in the practice is being collected in the same fashion, and that all of the same data is being collected. Once your data gets “bigger,” you’ll be better able to work with and analyze it. According to Gartner, “This may take time to implement, but it will have a “transformational” benefit and organizations that implement all facets of big data by 2015 can expect to start to outperform their competitors by as much as 20 percent.”
E-visits. “This facet of telemedicine is catching on now that EHR systems and patient portals include secure messaging. Success comes with setting expectations and enforcing policies,” Gartner says.
Wireless health asset management. Putting RFID chips on anything that moves—equipment as well as patient wristbands—is an “increasingly routine component of cost and patient care quality management.” Since there’s a lot to monitor, CIOs must collaboration with clinical engineering or biomedical device departments.
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?
Patient decision aids and personal health management tools. These appear largely in the form of interactive apps that educate patients or help them make care decisions, such as seeking treatment or undergoing surgery for a particular ailment. Though, Gartner says their effectiveness is questionable and adoption remains low, I’m not sure I’m convinced that they should be avoided. There is some value to these programs, especially if they help with patient engagement and education.
Personal health records. “The concept is attractive, as it gives patients ownership of their data, but poor usability and vendor disinterest have hindered adoption. Only with a government mandate, as is the case in Australia, does PHR adoption seem to catch on, Gartner says. Patient portals, which connect patients directly to their caregivers, are more popular.” Not only are they more popular, they are required through meaningful use and, if leveraged properly, can be quite effective in helping drive engagement and education.
The patient-centered medical home. “There’s been much discussion of making this a reality, especially in light of the accountable care organization model, but information exchange challenges and a reimbursement model unfavorable to insurers hinder adoption.” Again, not sure if I agree with Gartner. I don’t have any hard reasons why except that for some, they actually have proven successful. Check out this piece for more about a practice that clearly has leveraged the PCMH successfully.
Patient self-serve kiosks. “While these can streamline patient registration and payment collection, the ROI isn’t there, Gartner says. Most organizations are better off focusing on meaningful use or the conversion to the ICD-10 code set, which must be done by Oct. 1, 2014.” Again, for some organizations, these are simply good tools help streamline the patient intake process. They may not improve ROI, but they can get people into the practice more easily and to their physician without the cumbersome paper and pen approach.
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:
68 percent of participants reported that their organization already had a mobile technology plan in place
An additional 27 percent are currently developing theirs
Only 4 percent indicated that they had no plans to develop a mobile technology policy at the time.
Two thirds of participants report that they are in the process of developing a policy, expected to be completed in the next six months
25 percent anticipate completion of the policy within six months to a year
Two percent believe it will take more than two years to implement a 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
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
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:
Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible
Improve the certification process for EHR technology to ensure accurate EHR reports.
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?
Mobile device management is vitally important. Mobile devices are not going away and they continue to affect the professional setting, and managing the safety of mobile devices is important to organizations.
As a business leader with an enterprise to protect, one of the most important, and possibly easiest, steps to take is managing the safety of mobile devices. There is no way to avoid, or ignore, employee’s personal use of mobile devices in your “public” setting.
75 percent of mobile users believe it’s critical to their jobs to use a mobile device. Employees feel that using mobile devices makes their jobs easier, and they feel more productive. Employers also feel that allowing their employees to use the devices means their employees are always connected and always on.
85 percent of IT managers believe that the introduction of a mobile ecosystem has made the companies they manage more productive. With the exception of having to implement policies to monitor, protect and mange employee’s personal devices, mobile devices also help save companies money and create efficiencies.
Smartphones and laptops are the obvious front runner as the device most used in the workplace, but personal tablets are increasingly becoming more common in the professional setting.
According to CDW, 25 percent of mobile device users use tablets at work; 69 percent of tablet users use their own tablet at work.
The trend is expected to rise by 117 percent in the next two years. No surprise here. If you are surprised by this point then you might be wondering why this is so important.
Why? I’ll let Leiva-Gomez sum it up, as it does so aptly: “The CDW report concludes that 67 percent of IT managers aren’t even familiar with the concept of Mobile Device Management. Are you?”
MDM is much too important to ignore. Not taking an active role in its implementation or its management could put you and your practice’s health information in jeopardy. If swiped, stolen or ripped off, there’s also a pretty good chance you’ll face violations and fines for your HIPAA breeches.
If for no other reason, let this be a motivation for you. An ounce of prevention is worth a pound of cure, or so I’m told.