Farzad Mostashari, national health IT coordinator, says more progress has been made in health IT in the last 20 months than during the last 20 years. It’s a statement he made during the first day of National Health IT Week in September.
Increased adoption of electronic health records and the push toward meaningful use have been the catalysts for this movement, most of which has been driven by the financial incentives associated with meaningful use.
The ultimate goal of meaningful use, and the subsequent adoption of the healthcare technology, is data collection. A subset is patient engagement.
To a lot of different people, patient engagement means a lot of different things. For some, it’s about patients having access to their information, and for others it has nothing to do with “giving” patients information, but more about making them the center of care, Mostashari said recently.
Health and its information are owned by its community, he said, and the community must have access to its information. Policies and practices need to be set in place to unleash and unlock the activities of the community.
One effort to encourage this is “Blue Button.”
“Blue Button is national symbol for the concept of ‘give me my data,’” he said during his address at National Health IT Week in September 2012.
But the effort is transcending patients. It’s being brought to the vendor community, and their commitment is being requested. Mostashari has challenged vendors to make it easy for consumers, by as early 2013, to view, download and transmit to another party their health information through Blue Button. Engaging the vendor community is exactly the kind of effort the market needs since they have a seat at the table.
So far, several vendors have committed to meeting the deadline for the challenge, which is by the HIMSS Annual Conference in early March 2013. The current list of vendors to accept the challenge (those deserving some recognition) include:
Alere Wellogic
AllScripts
AthenaHealth
AZZLY
Cerner
eClinicalWorks
Greenway Medical Technologies
Intellicure
NextGen
SOAPware
Engaging the vendor community in this effort, for an early push toward view, download and transmit, is the right thing to do and it’s encouraging to to see Mostashari putting ONC’s muscle behind this effort.
Vendors are the folks playing a huge part in the overall effort for a transformed healthcare system and they plan to gain the most because of it. As such, it’s good to see them encouraged to take greater ownership of this process and play a larger role in encouraging the patient engagement process.
In the land of health IT, innovation is power and those that control it king.
There’s no status quo here. Resting on your laurels, despite all of the industry standardization related to efforts like meaningful use, will get you no where.
As several vendors are discovering that just because they’ve had products in the market for 20 or 30 years doesn’t mean they’ll be in play forever. We’re in the health 2.0 era. Heck, we’re in the era where even the federal government has entered the open source environment.
As such it’s great to see such a resource like Rock Health dedicating itself to the health IT entrepreneur. If you haven’t checked it out yet, you need to do yourself a favor and take a few minutes to familiarize yourself with its site. Then, you need to forward some of the information featured there to all of your entrepreneurial friends.
Not to sound like a commercial for the service, but it’s hard not to since some of the things going on here are pretty incredible. Actually, this is the kind of thing that happens in a country like ours when leaders, innovators, entrepreneurs, creative folks, business minds, a little money and some passion mix.
The cocktail that commences is Rock Health.
So, what is Rock Health?
It’s an accelerator exclusively for health start ups providing capital, office space, mentorship and operational support to entrepreneurs working on ideas in health. As a nonprofit, Rock Health looks for product-centric ideas that solve real problems in healthcare; “Products can be in the form of web or mobile apps, services, have a hardware or sensor component, and should be early and pre-VC funding.”
Ideas can be of anything as long as it solves a healthcare problem.
For those start ups bidding to participate in the Rock Health program, the selected start up receives a $100,000 investment offer from a VC group for an ownership of between 5 and 10 percent.
Other great Rock Health offerings (found on its site and free for everyone) include an interactive funding database that provides the public with sources for potential healthcare start up funding; videos that teach the unknowledgable upstarts almost everything they need to know about topics like marketing, creating boards, accounting, HIPAA, fund raising and dealing with the FDA; healthcare event listings; a great start up handbook that provides legal and financial advice (it’s comprehensive and overwhelmingly impressive); and finally, perhaps my favorite bit of information offered: interesting health facts that once learned will impress everyone, including your closest and most cynical friends.
You get the point.
Rock Health is more than an incubator and a disruptor for health IT — established vendor giants should be concerned about efforts like this — it is the future of innovation in the space, and if you haven’t taken notice, you should.
Judy Hanover, Research Director of IDC Health Insights
As health IT continues to mature and providers continue to adopt technologies like electronic health records, the data collected from their use in the care setting becomes the most obvious reason so much energy is being put behind getting practices to implement the systems.
Judy Hanover, research director of IDC Health Insights, recently told me, though, that one of the biggest challenges faced by ambulatory and hospital leaders is that the data entering the electronic systems, in most cases, is unstructured, which makes it almost useless from an analytics standpoint.
Without structured data, Hanover said, quantitative analysis across the population can be complicated, and little can be compared to gain an accurate picture of what’s actually taking place in the market. Without structured data, analytics is greatly compromised, and the information gained can only be analyzed from a single, siloed location.
“There must be synergy between the data collected,” Hanover said. “We’re entering the period of structured data where we’re now seeing the benefits of structured data but still need to manage unstructured data.”
In many cases, critical elements of data collected — like medications, vitals, allergies and health condition — are difficult to reconcile between multiple data sources, reducing the quality of the data, she said. Unstructured data proves less useful for tracking care outcomes of a population’s health with traditional analytics.
For example, tax information and census data are collected the same way across their respective spectrums. All the fields in their respective fields are the same and can be measured against each other. This is not the case with the data entering an EHR. Each practice, and even each user of the system, potentially may collect data differently in a manner that’s most comfortable to the person entering the data. And as long as practices continue to forgo establishing official policies for data entry and requiring data to be entered according to a structured model, the quality of the information going in it will be a reflection of the data coming out.
Lack of quality going in means lack of quality coming out.
“In many cases, structured data is not as useful for analytics as we’d hoped,” Hanover said. “There are inconsistencies in the fields of data being entered in to the systems; and that affect data quality as well as results from analytics.
“As we move into the post EHR era, how we choose to leverage the data collected is what will matter,” she said. “We’ll examine cost outcomes, optimize the setting of care and view the technology’s impact.”
As foundational technology, EHRs are allowing for the creation of meaningful use, but once the reform is fully in place, the shift will focus on analytics, outcomes and benefits of care provided.
Currently electronic health records define healthcare, but health information exchanges (HIE) will cause a dramatic shift in the market leading to further automation of the providing care and will change how location-based services and clinical decision making are viewed.
Though some practices are clearly leveraging their current data, others are not. For them, EHRs are nothing more than a computer system that replaced their paper records and qualified them for incentives.
In the very near term, the technology will have to have more capability than simply serving as a repository for information collected, but will become a database of reference material that will have to be drawn upon rather than simply housed.
“Health reform is the end game,” Hanover said. “And there can be no successful reform without EHRs. They are the foundational technology for accountable care.”
The data collected in this manner will lead to a stronger accountable care model, which will once again bring the practice of care in connection with the payment of care.
Evidence-based approaches will continue to dominate care when the data suggests certain protocols require it, which means insurers will feel as though they are working to control costs.
Unfortunately, all of the regulation comes at an obvious cost at the expense of the technology and its vendors, said Hanover. EHR innovation continues to suffer with the aggressive push for reform through meaningful use as vendors scramble to keep up with requirements.
“There’s little or no innovation because all of the vendors are being hemmed down by meaningful use and certification requirements,” she said.
Product standardization means there are far fewer products that actually stand out in the market.
More innovation will likely only come following market consolidation in which only the strong will survive. Hanover suggests that in this scenario, survivors will focus on innovative product research and development and will take a leadership role in moving the market forward
Though vendors will suffer, users of the systems will likely face major set backs and upheavals at the market shifts and settles. Especially as consolidation occurs, suppliers disappear or change ownership, practices and physicians using these systems face the toughest road as they’ll be forced to find new solutions to meet their needs, learn the systems and try to get back to where they were in a meaningful way in a relatively short period of time.
Likely, deciding which system to implement may bear just as much weight as deciding how to use it.
Perhaps creating an opportunity is nothing more than observing the details and taking action once one has been identified.
Lack of opportunity, on the other hand, might be the opposite – keeping your head down and barreling through life without taking an adequate measure of the terrain in which you are navigating.
The feds missed an opportunity. During their planning and roll out of meaningful use, in their effort to collect the health data of this country’s population, specialists, in many cases, were not considered as recipients of their meaningful use incentives.
For many specialties, this might not apply. But pediatrics are different entirely. Not so much for the physicians’ sake, but for the patients they serve.
Given the direct marketing plan that the federal government has undertaken with its latest healthcare pet project, Blue Button, I’m surprised by its lack of foresight related to patient involvement to this group when it comes to meaningful use.
As the feds work desperately to change the perception of electronic data collection, and to move the most information into electronic records as possible, one might think the best way to ensure absolute adoption is by requiring the one group of physicians who might be able to affect the longest term change to participate in the incentive program.
Pediatricians, like it or not, have not been given special treatment as far as meaningful use is concerned. They, like another large group of physicians, OBGYNs, are left to fend for themselves. You can read more about OBs and their fierce independence in my recent interview with digiChart’s CEO Phil Suiter. The reason is well known and obvious: these groups of caregivers don’t necessarily rely on the government (Medicare/Medicaid) to keep their doors open.
The nature of pediatric practice is such that Medicare is not a significant part of their practice so meaningful use incentives don’t apply here. Therefore, the only avenue left for pediatrics is the Medicaid option – and it only works for practices that have more than 20 percent of their volume as Medicaid. In most cases, these groups of physicians don’t meet the minimum requirements of serving Medicare and Medicaid recipients to qualify, and, also in most cases, they don’t go out of their way to do so.
Therefore, given the logic that A+B=C, they are not lining up to get their share of the incentive checks.
But, one would think the feds would try to find some way to make an exception for pediatricians to participate in meaningful use without having to meet the minimum requirement that 20 percent of their population participate in Medicare. I’m not trying to re-open an issue that I know has been discussed countless times; I’m trying to make a different point.
That is, given the new push for patient engagement and the social media-like approach being taken through the Blue Button movement, I believe the importance of pediatricians has been overlooked.
Why? Well, it’s obvious to me that to engage a population, it’s best to change the population’s behavior. To do so, you have to catch them young; so young that they never knew a difference otherwise.
For example, children today will never know what life was prior to the web. They won’t be able to imagine life before mobile devices turned us into an always on society. There’s a lot they’ll never know.
Thus, if they are exposed to electronic health records in their doctor’s office as they grow up, by the time they reach adulthood, they’ll expect their doctors to use nothing but electronic health records. In fact, they won’t even know what to do with a paper record – how to read and understand it – and, therefore, won’t give their money to doctors without the systems.
It’s really the most direct route to changing a population’s behavior.
Indoctrination.
Sure, engaging the adult population through a service like Blue Button is important, and will certainly help fill the gap currently experience in healthcare’s ownership issue, but as we’ve seen in every other area of life, true change won’t come until those who know no other way become the majority and know no other way.
As the self-proclaimed ONC Blue Button movement gains steam and more members of the public sign up to make sure their data gets downloaded, it seems the Office of the National Coordinator, among others in the fold, have borrowed a marketing campaign from office supply chain, Staples.
The “Easy Button” is vernacular for something that get done at the press of a button, even if said task isn’t necessarily as easy as just pushing as button. Obviously, that’s the point.
Same goes for the Blue Button. From a marketing perspective, the concept is genius. With the simple push of a button, you too (read: “consumer/patient”) can have instant access to every last bit of your media records and personal health information like never before.
With the campaign just getting started, there are already more than one million people who have signed up for the Blue Button service (sounds sort of like “black tie event” when I read it like this). Eventually, the movement will take hold, no doubt, and the consuming public will be on board like never before. I anticipate Blue Button will grow enormously, similar in nature to the culture that social sites the likes of Facebook and Twitter have become. Not that we’ll sit around sharing our records with those who “like” us or posting comments about each others ailments and conditions, I think people will perceive blue button to have the same value.
It’s about access to information – information that until now many people have not realized they owned or had access to – instantly, as long as Blue Button is available to them.
That’s the catch after all, isn’t it? Blue Button has to be available to consumers for them to be able to push that little easy button. Seems like there are only a couple things that might keep someone from it. The most obvious is that a patient’s physician must have a meaningful use EHR in place. Another is that the practice must choose to offer the service.
It goes without saying, then, that consumers without insurance most likely won’t have access to Blue Button as they’ll likely not have access to a regular physician with a certified EHR. The current healthcare reform may change this slightly as more people will be “encouraged” to insure themselves. And, as practices move to EHR, access to Blue Button will increase.
All of these details are beside the point. Right now, it’s about the marketing. Making sure patients know that the health information that is rightfully theirs can be in the palm of their hands as easily as pushing a little button.
As we know, or so we’ve hypothesized, that the more you can engage patients in their care, the better care they’ll take of themselves.
And you’ve got to hand it to the ONC. Creating a message that directly engages the public rather than hoping that physicians and their vendors will carry the task is something I have long advocated for.
So getting us, as patient consumers, to engage in and to own our care really took little more effort than developing an app and marketing it directly to the people.
To this point in the meaningful use experiment, Phil Suiter, CEO of digiChart, has had the privilege of sitting at the front of one of healthcare’s greatest movements. From his place, he’s watched the market act and react, and has seen colleagues seek solutions to corner their respective markets all in the name of providing the best service for the most people.
Suiter, however, may have a view of the current health IT landscape like no other. Leading a specialty only provider of electronic health records and practice management systems, digiChart serves only OBGYNs.
Long before healthcare reform and the thought of meaningful use, digiChart created and built solutions solely for this space, and, unaplogoetically, will continue to serve the space. Plans for expansion may one day include moving into the pediatrician market, which seems to be a safe bet given the connection between the two specialties, but according to Suiter, that’s not a plan actively being pursued.
What’s interesting about digiChart’s position, as Suiter tells it, is that even though meaningful use is vitally important to digiChart and the company has helped many physician achieve stage 1, OBGYNs have not voraciously jumped aboard the program.
What this means, he says, is that it’s a clear sign that the OBGYN market continues to live up to its reputation as a fiercely independent group of healthcare providers. Suiter said that only 20 percent of all digiChart’s clients have chosen to pursue meaningful use. Apparently, the other 80 percent have chosen to overlook the federal incentives and go at it alone.
From conversations he’s had with clients, they’re just are not seeing the benefit of meaningful use, especially for all of the work required with the only benefit is $44,000 over five years.
“At this particular point, they don’t realistically see a flip side in changing. In some practices, some have decided that they are better off without changing,” Suiter said. “Practices have determined that they can survive and be profitable if they are efficient and continue doing what they are doing, especially in the OBGYN space.”
Being profitable means they’ll ultimately forego Medicare patients to avoid the federal penalties levied against them for not meeting meaningful use. In many cases, they don’t see enough Medicare and Medicaid patients to make all the effort worth their while, Suiter said, so the work required simply is not worth the effort.
And, frankly, the question remains: Is the federal money going to still be available as stage 2 progresses? And, what happens in February 2013, should a new administration take office?
Despite the answers to these questions and whatever happens with the election in November, Suiter sees plenty of change ahead for the market. For example, EHR vendor contraction is coming after a period of great anticipation.
He predicts the market will dramatically shrink from more than 400 companies to less than 100, many fewer of them actually viable and sustainable long term.
At the same time, he believes hospital’s appetite for buying and owning private practices will disintegrate as soon as 12 months from now.
“I think we’ll see a disgorgement of practices by hospital systems within the next 12 to 18 months,” Suiter said, marking the end of a repeat performance last seen in the mid-1990s (1995, ’96 and ’97, he said specifically).
Hospitals have been voraciously trying to align themselves with private practice to capitalize on funds generated from meaningful use; however, they don’t seem capable of effectively managing private practices and their employees as they seem to be able to do with their internal systems and hospital employees, he said.
Private practices are too independent, for the most part, he said; especially, OBGYNs.
The fiercely independent group of physicians might have all the leverage they need to withstand outside pressure for adopting new technologies or changing the way they run there businesses at this point in their careers.
Why?
The average physician in the OBGYN space is 62 years old. At this point in their careers, they are not particularly interested in becoming hospital employees and if they are not interested pursuing meaningful use, which seems to be the case, they’ll either retire or go their own way.
Clearly, the technology used in healthcare will gain greater acceptance as new doctors enter the space. As colleges begin to implement the systems to train their residents (which they are not readily doing now), perhaps the appetite within the space will change. Clearly, there’s room for more adoption in the market Suiter serves.
But, digiChart is positioned well, serving a market it, and Suiter, understand, and know they’re place – as leaders – in it. There are very few vendors that can represent the specialty space well, especially in the land grad market of one-size-fits-all solutions penetrating the market. DigiChart and Suiter seem to understand that sometimes it’s better not to be the jack of all trades, but a master of one.
When I go to the doctor for a check up of another ailment, I understand that the record kept regarding my care is ultimately mine. Not because I’m told, not because I’ve asked (though I have on some occasions), but because the information collected comes from me. Without my providing it, my physician would not have it to keep it.
Maybe it’s my make up, but I pride myself on knowing what others often consider trite and trivial. For most, knowing who owns their health record is exactly that, trivial.
Interestingly, though, is that for every person with a health record, there are the same number of people with a care provider to tell them that the record is theirs. So why then doesn’t everyone know that their health record is theirs?
I don’t think the answer to this question lies in the patient apathy or the population’s potential indifference toward their health outcomes. Innately, I believe people do care.
The point I’m making here is that I think the ONC’s latest effort to market direct-to-consumer (DTC) information is well intentioned but perhaps the burden for doing so is misplaced.
Do we think physicians and their practice colleagues should be spending their time doting on the ownership of their patient’s health record? Is anything other than patient health and outcomes a priority they should be focused on? The ONC thinks so, and given meaningful use and the increased pressure providers face to record and provide results of meaningful health outcomes, physicians are being arm twisted to ensure this level of grassroots marketing provides the ends to the ONC’s means.
Certainly, we as consumers must continue to receive information and education to keep us informed about the world of health IT. It’s true that very few actually understand just how far back healthcare technology is from the mainstream in regard to use of technology. But, as I’ve said before in this very forum, should all of the responsibility for this lie on the providers’ shoulders?
Not so, in my opinion. Sure, physicians and care givers can be advocates to consumer enlightenment, but more of the responsibility really should go to the health IT vendors. After all, they are the ones selling the products to the physicians. It behooves them, and enriches them, the educate consumers to the value of the systems’ worth and how help improve health outcomes.
Sending this message to consumers, and helping to educate them of the benefits of these systems, will go a long way toward convincing them that their physicians need the systems. If consumers find value of these systems, they’ll let their wallets do the talking and give their business to physicians and practice that employ health IT.
And, if the physicians are truly going to be “the sales force for health IT,” perhaps it’s time the vendors started incentivizing these walking billboards the ONC wants them to be.
In speaking with a CEO of a major EHR/PM vendor recently, the conversation about the future of health IT kept coming back to money. Not necessarily the money saved by practices because of the implemented technology, but the money being flushed into the space by the government.
Though the money is flowing and the incentives are pouring into the economy and getting freely spent, there are obviously some still inside the vendor (and probably the practice) space that remain concerned about the viability of the government’s financial involvement in health IT in the long term.
The federal government’s money has created the structure of what we now know as health IT. Because of the push – the money, or the carrot and the stick, if you will – there’s now a deeper foundation set; there are studs and rafters in place, and even a few pieces of siding in some cases.
With roughly half (being generous) of the ambulatory market currently using some sort of an EHR, ground has obviously been gained in the market. It would have come eventually, the advancements, but the federal incentives no doubt hastened the proliferation of the technology. But, for the sake of argument, let’s say the federal money drives up or is re-appropriated. What happens then? Where does that leave the market, as my CEO colleague hypothesized?
I hadn’t exactly thought of it that way, especially now at this late stage in the program. But the man does pontificate an interesting point.
Given all of the money flowing into the health IT market, it’s one of the few booming economic segments, and given the number of parties staking claim to it hoping to make monumental returns on their investment, the scenario actually brings another very similar boom to mind.
From early 2004 though 2005, the profits were record breaking. Ad sales were way up, circulation was expanding into new markets and staffs were being bumped up to counter efforts made by the competition.
However, by late 2006, as a cautionary note, hiring slowed and expansion stopped. At the beginning of 2007, the layoffs began. Reporters, editors and production staff were cut. The newspaper chain I wrote for shuttered offices and cut more costs. Another round of employees was let go. Ad revenue hit the floor; newspapers stopped circulating, the market shrank and even more people were laid off. The business entered a tailspin that even now, five years later it hasn’t recovered from.
It never will.
The boom times went bust, and for newspapers, caught up in the seemingly never ending flow of cash from advertisers, who happened to be home builders and contractors, little planning for the future was done and any thoughts of a rainy day fund seemingly were little more than thoughts.
In Florida, at the time, you couldn’t spit or throw a stone without hitting a new housing development or condo conversion. There were housing starts everywhere. Houses, in all phases of development, were being erected. The building was constant. There was no end in sight. Contractors were hiring employees everyday, banks were lending, people were fighting, literally, over houses that were for sale.
When the boom was booming, everything even peripherally related to the market was booming. But when the housing market busted, well, I don’t need to tell you about how that affected each one of us.
So, my friend the CEO asks an interesting question. One that was probably asked thousands of times during the great housing bubble of the middle of the 21st century’s first decade: What happens if, God forbid, the money suddenly runs out of Health IT?
Come down to South Florida and see. I’m sure you could get yourself a pretty good deal on one of the thousands of properties sitting half built and empty.
Sure, they’ve got a good foundation, walls, rafters and, in some cases, a bit of siding, but they sure aren’t much to look at much less much better to live in.
