The Louis W. Sullivan Institute for Healthcare Innovation, which is dedicated to distribute health information technology innovation to transform quality and efficiency of healthcare delivery worldwide, announced the release of “A Year in Review: An Update on the 2013 WEDI Report & Roadmap for the Future of Healthcare Exchange.” The industry report evaluated public and private stakeholder progress in critical areas of focus.
The 2013 WEDI Report, the first roadmap for healthcare information exchange produced by WEDI since 1993, provided a framework for the next generation of healthcare information exchange designed to lower healthcare costs, improve healthcare delivery, and achieve better healthcare outcomes. In the past year, the Louis W. Sullivan Institute for Healthcare Innovation has monitored those stakeholder efforts to drive improvements through technology and data exchange, and has produced a progress report on those initiatives, which can be found here.
The initial report identified four key areas of focus and 10 related recommendations that would advance healthcare information exchange. Summarized below are assessments of how industry has performed in each of the core focus areas:
Patient Engagement
Progress rating = Green
Although the industry has lagged in driving improvements in health IT literacy, there has been continued momentum in patient information capture and patient identification. Private sector efforts, combined with a new federal vision and roadmap for health IT, are deemed to be on pace in meeting WEDI recommendations.
Payment Models
Progress rating = Yellow
Over the past several years, new payment models have leveraged technological advances to rapidly iterate, evolve, and scale across the country. However, models such as ACOs have yet to fully mature, and their success and sustainability remain uncertain – particularly in light of the mixed performance seen in 2014. A framework of core attributes and technological functionalities has yet to be developed and the industry needs further directed efforts to achieve the recommendations outlined in the initial report.
In today’s concierge economy there is an increasing number of things available on-demand at our beck and call. TV shows and movies, car services, local dining hot spots, even directions, are all accessible at the ready. With the proliferation of voice commands, typing has even been removed from the equation in certain instances. Patient portals aren’t quite there yet but the consumerization of IT has forever changed user expectations and unfortunately, left many industries struggling to catch up.
For the healthcare industry specifically, it’s been a hard pill to swallow as organizations have gone after the various government incentives offered through the HITECH Act. As those organizations have found out, the trail from paper-based records to fully digital portals can be a long and weary journey, but if the lofty consumer expectations can’t be met, the impatient patients will rear their ugly heads and make meaningful use requirements an even more elusive prey. The good news is that there are ways for healthcare organizations to make their patient portals seamless and efficient without having to develop an extravagant user experience that is on par with an Apple operating system.
When developing a patient portal, first and foremost, ease of use is of the essence to minimize the time needed for patients to accomplish tasks. Patients have very short and finite attention spans that are easily surpassed if they have to jump through too many hoops. Stage 2 meaningful use requirements included secure messaging, the ability to access and download electronic information, reminders sent for preventative and follow-up care, and general education materials.
These are all very basic tasks, but the parallel consumer experiences are incredibly user friendly, fast and intuitive. The key point to make is that the majority of patients really only need one of those criteria met for patient portals … speed. If patients can get what they need quickly, they are often satisfied. It’s not a social network, it’s a tool, so building patient portals with speed in mind is key to driving the patient engagement percentages required to meet the meaningful use standards. Given that so many of these processes are document heavy, streamlining the document viewing process is a key piece of the pie.
That document viewing part of the puzzle centers on the fact that patients benefit if only one method is needed to view the multitude of documents used in the healthcare realm. Records, prescriptions, X-rays and charts; the list goes on and on, not to mention the different digital formats in which the documents are often stored. Add to that the complexities involved when different organizations have different approaches to creating and storing these documents and the potential for complications and problems starts piling up quickly. Unfortunately, the place where all of these complexities converge is the patient. Portals need to be able to handle all of these document types with ease and again, quickly. HTML5 technology is a huge boost to this process as it enables browser-based document viewers to be easily integrated into patient portals. This means that any patient with an Internet connection and a standard browser can easily access any of their documents. There is no need for additional software downloads, such as Microsoft Word or Adobe Acrobat or even an image viewer, which is often the last straw for patients before giving up on the system completely.
Quality of care has long been a primary factor in choosing a healthcare provider, but convenience and communication are also becoming key considerations for patients. Still, many physicians do not appear to be offering the digital engagement services that can meet those demands.
According to a new nationwide survey conducted by TechnologyAdvice Research, a majority of patients (60.8 percent) said digital services like online appointment scheduling and online bill pay are either “important” or “somewhat important” when choosing a physician. However, when asked what services their current physician provides, less than one-third of patients indicated they have access to either online bill pay, online appointment scheduling, or the ability to view test results and diagnoses online, which are the top three services that patients report wanting the most.
In addition, 68.6 percent of respondents said it was either “somewhat important” or “very important” that a physician follow up with them, yet only 30 percent of respondents reported receiving a follow-up that wasn’t related to bill pay
“Primary care physicians are reporting some of the highest rates of EHR adoption to comply with government regulations and to receive incentives from Meaningful Use, but a significantly lower number of patients claim to have access to these patient portal services,” said TechnologyAdvice Managing Editor Cameron Graham, who authored the survey. “The issue here may not be implementation of digital services, but instead a lack of patient awareness. If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”
Guest post by Scott Zimmerman, president, TeleVox.
If you caught Maria Bartiromo’sinterview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:
“Telehealth is going to be a booming industry.”
Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.
Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”
The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.
One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.
It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.
Progress Is Underway
Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.
Guest post by Michael Simpson is the CEO of Caradigm.
It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.
After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.
More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.
Stage 2 Challenges
It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.
Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements. These capabilities leverage and extend the functionality and benefits of the EHR.
Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.
Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.
Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?
I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.
What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?
I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.
We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.
Dr. Cliff Bleustein, chief medical officer and head of Dell’s global healthcare consulting services, leads an integrated team of clinical, business, and technical professionals who provide expertise to health systems, hospitals, physician practices, health plans and life sciences organizations. Here he discusses Dell’s healthcare vision; improving patient engagement and how he defines the term; data security; and trends that he thinks will be worth tracking in the near term — here’s a hint: smartphones, yes; wearables, no.
In your new role as chief medical officer and global head of healthcare consulting at Dell Services, what are your responsibilities?
As chief medical officer, I play a key role in Dell Services’ healthcare division supporting our aggressive strategic initiative to revolutionize the way healthcare is managed. I spend a lot time listening to customers and helping them to better manage patient-specific data that spans the entire continuum of care. Ultimately, better information and technology will drive improvements in quality, patient safety, efficiency and outcomes. I help shape our strategy and ensure that it meets the needs of our customers, both now and in the future.
Tell me about your background in healthcare and how you came to be passionate about the space.
Ever since I was a child, I knew that I wanted to be a physician. Originally I was fascinated with the ability of body builders to be able to grow muscle to such huge proportions and lift weights several times greater than their mass. As my career developed, I focused on how treatments and diagnostics could move from the lab to the bedside. During training and private practice, I became more involved in understanding how systems work and function and what drives them. I was fortunate enough in my career to work internationally, as well. This gives a much broader view about how healthcare can be improved on a larger scale. I am driven by a desire to continue to disrupt the market with new technologies and solutions that can have a meaningful impact on improving health at scale.
What is Dell’s background in healthcare IT and why does the company put an emphasis on this sector (other than for obvious financial reasons)?
People are often surprised to learn that Dell has more than 20 years of experience in serving healthcare customers. That, combined with our deep bench of clinical and technical experts, is why Gartner has ranked Dell number one among healthcare IT service providers for four years running. But it goes beyond that; it’s also personal. Michael Dell is keenly interested in exploring how technology can improve healthcare systems around the globe. And we have thousands of employees who get up every day and focus solely on the needs of our healthcare customers. With an aging population and the impact of chronic diseases, such as heart disease and diabetes, we must find ways to reduce cost, improve productivity and improve health outcomes. Technology has a huge role to play. We also know we can’t do it alone, and for that reason we work with and partner with some of the leading companies in the industry.
What solutions does Dell offer and how do they set the company apart from competing vendors?
What sets Dell apart is our holistic approach. It’s not enough to just add technology. It’s also about connecting people to the right technology and integrating that technology into their workflows. Processes need to be re-examined and, in many cases, re-engineered. So, in addition to the traditional IT products and services Dell is known for, we also offer a robust suite of solutions and services that are specially designed for healthcare. These include secure cloud solutions such as our Unified Clinical Archive, EHR implementation, mobile clinical computing, sophisticated analytics tools, social media integration, HIX and HIE services and support, and clinical transformation. We also have a strong focus on the life sciences, with a genomics analysis platform that supports clinical trials investigating personalized treatments for cancer.
In another display of beauty, the folks at CDW Healthcare recently released the following infographic describing the rise of the digital patient, a new specifies of mankind. As CDW notes, thanks to innovative mobile technology and the prevalence of broadband networks, patients are investing in their own healthcare more than ever before. Interest in their health and the ability to self diagnose ultimately may be the key to long-term patient engagement, but of course that’s a sticky wicket of its own.
“From searching for a physician online to tracking fitness activities via wearable technology to accessing their personal health records through a portal — patients are embracing mHealth and technologies that will help improve their well-being. In fact, the number of adults using smartphones to monitor their health grew to 75 million in 2012 — a number expected to more than triple by the end of 2014,” CDW writes on its blog.
According to the graphic, patients are “better informed” before they enter their physician’s office, are looking to social media for their health research and are embracing mobile devices as a way to connect with their caregivers. Additionally, the vast majority of patients want access to their medical records online. The graphic also suggests that patients are becoming more aware and attracted to portals, though I’m still skeptical that this is a widespread phenomenon.
Consumers also are getting more interested in wearable health tech, however, and are tracking their outcomes, especially using their smartphones; 112 million devices are expected to be in use by 2018.
Finally, security of the information and its exchange is of the highest importance to consumers , as if is for all of us, but it’s worth pointing out because even with all of the development and patient involvement in their care, they are still concerned about the safety of their information.
Take a look at the following graphic to see if there’s anything surprising here.
The Louis W. Sullivan Institute for Healthcare Innovation, which is dedicated to distribute health information technology innovation to transform quality and efficiency of healthcare delivery worldwide, announced the release of “A Year in Review: An Update on the 2013 WEDI Report & Roadmap for the Future of Healthcare Exchange.” The industry report evaluated public and private stakeholder progress in critical areas of focus.
