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Readers Write: Why Reverse Mentoring is Beneficial for HIT Employees

August 15, 2016 Readers Write 2 Comments

Why Reverse Mentoring is Beneficial for HIT Employees
By Frank Myeroff

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Reverse mentoring is when seasoned HIT professionals are paired with and mentored by the younger Millennial generation for the reasons of being extremely tech savvy, fast to adopt new technology, and not afraid of trying new things. In addition, it helps to bridge the gap between generations.

Reverse mentoring was introduced in the 1990s by Jack Welch, chairman and CEO of General Electric at that time. While it’s not exactly new, it’s gaining popularity fast. More and more organizations are recognizing the value of reverse mentoring and are developing formalized programs to ensure best practices in order to yield success. They believe that Millennials are well suited as mentors to help maximize HIT use and adoption in order to move organizations forward in this digital age.

Additionally, with the ever-changing landscape of technology and tools used in the HIT field, reverse mentorship can be extremely beneficial:

  • Young, fresh talent has a chance to share their skills, knowledge, and fresh perspectives with more senior employees. Hospitals and health systems often look for their HIT professionals to use technology to improve patient care, lower costs, and increase efficiency. This means that the latest technology is routinely sought. Organizations know that tech savvy younger generations will catch on to this quickly, presenting an opportunity for them to share their knowledge with a different generation. Not only HIT systems, but also technology and platforms such as social media could be unique topics for Millennials to share information and ideas on.
  • Creates a way for separate generations to build working relationships with one another. Reverse mentorship can help junior HIT employees feel more needed, confident and comfortable communicating with higher-up employees working together on projects or even in meetings. Additionally, this could create more cohesion in the workplace and begin to break down perceived barriers and stereotypes of each generation.
  • Gives junior employees a higher sense of purpose in the organization. Implementing a reverse mentorship program gives young HIT professionals a sense of empowerment and the idea that they are making an impactful contribution to the company. This in turn, could help increase retention and help to shape future leaders in the organization.
  • Continues to provide ways for senior employees to share their knowledge as well. Although called reverse mentorship, this type of program offers a two-way street for employees of all ages to learn from one another. Experienced professionals in the HIT field are able to share their insights and knowledge, in addition to learning new things.

While reverse mentorship can be extremely beneficial in the HIT industry and especially any industry with a tech focus, there are several conditions this type of relationship depends upon:

  • Trust. Each person needs to trust the other and put effort into bettering both careers.
  • Open mindedness. In a reverse mentorship, both employees will act as a mentor and a mentee and need to show a willingness to teach, but also a willingness to learn.
  • Expectations and rules. It will be important for both parties in the mentorship to communicate what they are looking to get from the relationship as well as staying committed to the process.

Reverse mentorship is an innovative way to bring together generations of employees to share knowledge. In addition, today’s Millennial mentors will be tomorrow’s chief healthcare officers. We will depend on them to lead the IT department and create strategies on how to handle the growing amount of digital data for healthcare workers and new ways to support technologically advanced patient care modalities.

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

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August 15, 2016 Readers Write 2 Comments

Readers Write: ACO, Heal Thyself

July 18, 2016 Readers Write 3 Comments

ACO, Heal Thyself
By Stuart Hochron, MD, JD

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I was recently asked to comment on the success (or lack thereof) of Accountable Care Organizations (ACO) and why I thought ACOs haven’t lived up to expectations and what additional incentives will be required for them to be successful – if, indeed, they ever will be.

The questions gave me pause. Certainly ACO performance to date has left much room for improvement. According to an analysis published by the Healthcare Financial Management Association, just over a quarter of ACOs were able to generate savings in an amount sufficient to make them eligible to receive a share of those savings.

But the implication that ACOs are biding their time until new incentives or perhaps a new business model emerges is alarming. This is not a situation where good things will necessarily come to those who wait.

I work with a number of ACOs, hospitals, and physician organizations. While I am not at liberty to share their financial performance data, I’ve distilled what I believe to be the best practices employed by those that will be successful.

It takes a platform

Fundamentally, ACOs require wide-scale patient-centric collaboration – that’s what underpins the hopes of achieving more-efficient, more-effective, less-wasteful, non-redundant care. But collaboration doesn’t just happen automatically, even when everyone on the team works in the same building. And for ACOs, comprised of multiple entities that don’t necessarily have any prior joint operating experience or relationship of any kind, the challenge is greater still.

Based on extensive discussions with healthcare executives and real-world performance analysis, it is clear that successful ACOs must make an investment in robust groupware tools, the kind that professional services organizations have had in place for decades to ensure that members of a distributed workforce can collaborate and coordinate as easily as if they were in next-door offices.

In the healthcare context, these tools will facilitate everything from patient scheduling to real-time sharing of PHI to charge capture and invoicing. Far beyond secure messaging, such platforms underpin the ACO’s activities, giving providers a common workspace for all manner of collaboration and ensuring that all providers across the care continuum are aware of and working towards a single set of organizational imperatives. The ACOs that don’t invest in the transformation – that try to piggyback on existing infrastructure – will ultimately find that their people don’t make the transformation either.

Patients at the center

All healthcare systems need to become more patient-centric and this is particularly true of ACOs, whose compensation, of course, is based on how successfully they treat (and, ideally, reduce the need to treat) patients. Thus, successful ACOs will make patient-centric collaboration and communication the centerpiece of an organization-wide operating system. 

Ideally, collaboration and communication won’t stop there. ACOs will implement population health initiatives by empowering patients, giving them the ability to take a more active role in keeping themselves healthy. This will be accomplished via tools such as mobile apps that enable people to access care services before they get sick and enable ACOs to reach out to the community, helping guide patients towards good lifestyle choices and, if they have received acute treatment, helping patients follow post-discharge instructions. So that same collaboration platform that will help care professionals work together better – it will need to extend seamlessly into the community as well.

Without aligned physicians, there’s no accountability

Technically, any organization that agrees to be “accountable for the quality, cost, and overall care of Medicare beneficiaries” can qualify under the definition of an ACO. But what all successful ACOs will have in common is tight alignment of physicians and care teams. I don’t simply mean financial alignment. Theoretically, all the physicians in an ACO are financially aligned. Nor do I just mean alignment around a patient.

True alignment means the physicians who form the core of the ACO understand the goals and priorities of the organization and feel invested in its success. Physicians make dozens of care decisions every day. They need to be making those decisions against the backdrop of the stated policies of the ACO. That requires being literally as well as figuratively connected to the organization, receiving regular communications such as educational materials, opinion, and thought leadership, being part of the daily give and take.

The financial incentives and disincentives under which ACOs operate change regularly, meaning the ACO’s organizational goals are updated all the time. The challenge is for providers to understand those incentives fully and to be able to adjust their practice methodologies and for that to happen on an organization-wide basis. Achieving and maintaining alignment requires an institution-wide collaboration platform. In a distributed entity such as an ACO, there’s no physician’s lounge. But with modern groupware, we can simulate one in a virtual environment and realize the same benefits.

Networks don’t build themselves

In my work with ACOs, one hurdle encountered by all is introducing and socializing the concept that the ACO establishes a new network of providers to which to refer cases. Intellectually it isn’t that hard to grasp. But as far as changing ingrained habits, that is much more of a challenge – not least because providers have no way of knowing which other providers are also members of the ACO, nor how effective any of those providers might be as physicians contributing to the stated financial goals (savings as well as revenues) of the ACO.

The only way to keep referrals within the organization – to combat the challenge of referral leakage, which will sink an otherwise effective ACO – is the ensure that every physician in the ACO is connected to a physician referral directory that lists all providers by specialty.For good measure, it will include a rating quantifying each provider’s service.

Improving clinical documentation

In the minutely quantified world of ACO financial performance, every dollar counts. The ACO’s income is based, in part, on costs saved, along with other metrics. As is well known, incomplete clinical documentation leads to tens of billions of dollars in disallowed reimbursements every year, a situation that only grows worse in a distributed organization such as an ACO. 

While we are imagining the infrastructure of the successful ACO of the future, let’s not neglect to include capabilities for crisply identifying and documenting treatments and procedures and thus enabling the medical billing professionals – who may have no physical or organizational connection to the care delivery professionals – to complete the paperwork correctly and maximize reimbursement revenue.

Conceptually, ACOs are the heart of the Affordable Care Act. Accountability – enforced by incentives and penalties – is central to our concept of how healthcare ought to work. If ACOs aren’t delivering on their promise, then that has ominous implications for the healthcare system overall. With the right communications infrastructure used as directed, ACOs can lead the way to the bright healthcare future we all want. Rather than stand on the sidelines as spectators, waiting for new incentives to come down from on high, ACOs can and must take action now.

Stuart Hochron, MD, JD is the chief medical officer of Uniphy Health of Minneapolis, MN.

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July 18, 2016 Readers Write 3 Comments

Readers Write: Why EHRs Will Have Different Documentation Requirements for Biosimilar Dispensing, Administration, and Outcomes

July 11, 2016 Readers Write No Comments

Why EHRs Will Have Different Documentation Requirements for Biosimilar Dispensing, Administration, and Outcomes
By Tony Schueth

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While a second biosimilar recently being approved in the United States does not a tsunami make, biosimilars are nonetheless expected to quickly become mainstream. In response, stakeholders are beginning to work on how to make them safe and useful within the parameters of today’s healthcare system because, biosimilars – like biologics – are made from living organisms, which makes them very different from today’s conventional drugs.

In fact, biosimilars are separated into two categories: biosimilars and interchangeables, both of which are treated differently from a regulatory standpoint. These differences will create challenges and opportunities in how they are integrated in electronic health records (EHRs) and user workflows as well as how patient safety may be improved.

EHRs must treat biosimilars differently than generics. As a result, EHR system vendors will need to make significant changes to accommodate the unique aspects of biosimilar dispensing, administration and outcomes.

Patient safety is a priority for development and use of all medicines. Manufacturers must provide safety assessments and risk management plans as part of the drug approval process by the Food and Drug Administration (FDA). Even so, biologics and biosimilars are associated with additional safety considerations because they are complex medicines made from living organisms. Even small changes during manufacturing can create unforeseen changes in biological composition of the resulting drug. These, in turn, have implications for treatment, safety, and outcomes. In order to address these issues, information about what was prescribed, administered, and outcomes must be documented in the patient’s medical record.

Substitution also is an issue because dispensed drugs may be very different than what was prescribed. As a result, it is important for physicians to know whether a substitution has been made and capture information about the drug that was administered in the patient’s medical record, especially when it comes to biologics and biosimilars. This is important for treatment and follow-up care, as well as in cases where an adverse event (AE) or patient outcome occurs later on.

Four drivers make the unique documentation requirements of biosimilars in EHR a priority.

  1. Utilization is expected to grow rapidly because of biosimilars’ lower-cost treatment for such chronic diseases as cancer and rheumatoid arthritis. It is easy to envision the availability of four biosimilars each for 20 reference products that could be available in 2020, given projected market expansions. That amounts to 100 biologics that will need to be addressed separately. As more biosimilars are approved and enter the market, it will become increasingly challenging and important to accurately identify and distinguish the source of the adverse events (AEs) from a biosimilar, its reference biologic, and other biosimilars.
  2. Physicians will need this information once biosimilars come on line and their use becomes widespread. Adverse complications — particularly immunologic reactions caused by formation of anti-drug antibodies – may occur at much later after the drug was administered. Physicians report more than a third of adverse events to the FDA, but need to know what was administered to the patient when the pharmacist performs a biosimilar substitution.
  3. Outcomes tracking and patient safety are growing priorities in healthcare. They are key pieces of the move toward value-based reimbursement and are a focus of public and private payers. Identifying, tracking, and reporting adverse events are expected to become key metrics for assessing care quality and pay-for-performance incentives.
  4. States are ahead of the curve when it comes to substitution. More than 30 are considering or have enacted substitution legislation for biosimilars, which creates urgency in how such information is captured and documented in EHRs. Some states require the pharmacy to communicate dispensing data to the prescriber’s EHR.

Because of the unique properties of biosimilar dispensing, administration and outcomes, many adjustments will be needed for documentation into EHRs used by physician offices in independent practices and integrated delivery systems (IDS). For example:

  • EHRs must be able to comprehensively record data on what was administered or dispensed for an individual patient, as well as what was prescribed. Modifications will be needed for tracking adverse event reports in various administration locations, including the physician’s office; an affiliated entity (e.g., practice infusion center); the patient’s home; or non-network providers.
  • Changes in drug data compendia will be needed to account for new naming conventions that soon will be put in place by the FDA and substitution equivalency.
  • Tracking the manufacturer and lot or batch numbers (similar to vaccine administration) can facilitate more accurate tracing of an AE back to the biologic. Fields will need be added to record the NDC code, manufacturer, and lot number of biosimilars that have been dispensed. 
  • NCPDP SCRIPT’s Medication History and RxFill transactions — already available for electronic prescribing in EHRs— can include the NDC and the recently added manufacturer and lot number as part of the notification to the prescriber. Although not widely used today, RxFill provides a compelling method to notify providers that a substitution occurred in the pharmacy.
  • EHRs will need to address barriers related to the use of biosimilars, such as creation of too many alerts; the usability of how the information is presented to the clinician; lack of consistency in the display of drugs and drug names; and conformance of screen features and workflow within and between systems.
  • IDS systems need to be interoperable and have a seamless transfer of information. This can be a challenge in trying to meld together multiple disparate health information technology systems and EHRs from different vendors.

The time is right for industry, hardware and software developers, and other stakeholders to address the opportunities and challenges posed by entrance of biologics and biosimilars into the US market. As patient safety issues arise, the EHR community must be in a position to capture and exchange needed information. Otherwise, states and other regulators could develop alternative tracking methods. Examples include state vaccine registries or prescription drug monitoring programs, which track controlled substances dispensing and vary from state to state. These programs have become complicated mechanisms for healthcare providers to address.

Tony Schueth is CEO and managing partner of Point-of-Care Partners of Coral Springs, FL.

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July 11, 2016 Readers Write No Comments

Readers Write: Election 2016

July 6, 2016 Readers Write 5 Comments

Election 2016
By Donald Trigg

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A provocative Atlantic magazine cover this month headlines, “How American Politics Went Insane.” Jonathan Rauch explores our current reality where “chaos has become the new normal — both in campaigns and government itself.”

As we struggle to draw rational signal from the noise, one can’t help but wonder if Trumpian chaos is resident in our favorite podcasts, journals, and websites. Are byzantine rule-makings not regularly bemoaned on HIStalk?  Do we not hear classes of readers singled out (particularly for using HIPPA and HIMMS)? Are we not struck by the rather small hands on the original HIStalk graphic?  

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HIStalk has been, all kidding aside, a thankful escape for many of us from a campaign that has been abysmal even by our diminished US standards. Fortunately, there are just 125 or so days left. And with few exceptions, these conversion dates hold.  

Here is the quadrennial cheat sheet.  

A proper understanding of the 2016 election starts with the massive advantage Democrats have in the Electoral College. The Democrats have a safe hold on 19 states (plus DC) representing 242 Electoral College votes. (Note: If you still are suffering under the delusion that the popular vote selects the president, let’s email about a couple of ideas for your trip to the Albert Gore Presidential Library). As a quick civics reminder, you only need 270 Electoral College votes to become president.  

So, with a probable shortfall of just 28 Electoral College votes to get to 270, the Democratic path is far easier. As an indicative example, a Republican could win every “swing” state from Ohio to Virginia, but lose Florida (29 EC) and thereby lose the presidency. It is not quite as challenging as running a health system with an antiquated MUMPS technical architecture, but it is still a daunting task for the GOP.         

The statistician-turned-blogger Nate Silver places the odds of a Hillary victory at 80 percent with one of his two models factoring in GDP (Q1 GDP was 1.1 percent) for a lower 75 percent chance. He probably has that about right and (spoiler alert) decisions like the Trump VP pick aren’t going to radically change that.

No matter the outcome at the top of the ticket, neither Democrats nor Republicans are likely to dominate the breadth of the electoral landscape. Republicans have a fairly solid grasp on the US House (247-188) and they also control 31 governorships. As Barron’s wrote over the long weekend, ongoing divided government will offer a muted welcome to any agenda this January.  

As for healthcare, the issue significantly trails the economy/jobs and terrorism when it comes to top voter concerns. Moreover, opinions are very settled and polarized. Forty-two percent favor the ACA, while 44 percent oppose it.  

Consequently, Clinton and Trump will use talking point level rhetoric, predominately to drive turnout. Hillary will take on big pharma, calling for caps on prescription drug costs. Trump will bemoan premium increases, call for ACA repeal, and assure us he is going to do something “fantastic.” You will feel like you are watching “Saturday Night Live.”

Notably, there is an important piece of emerging voter sentiment that we shouldn’t miss amid the posturing and platitudes. According to the June KFF poll, 90 percent are worried about the amount people pay for their healthcare premiums, while 85 percent are worried about increased cost of deductibles. Consternation over cost is growing and will be reinforced during open enrollment this fall. 

As we look out to first 100 days of the new administration, we will see a level of change on health policy that is more incremental than historic. Importantly, MACRA will continue to advance at the agency level, buttressed by solid bipartisan opposition to fee-for-service. At the state level, ongoing programmatic Medicaid changes move forward. Finally, even with the the Cadillac tax delay, employers experiment further with wellness incentives and alternative (and narrower) network design.  

In the Atlantic, Jonathan Rauch makes a lonely case for a renewed establishment that can impose some modicum of order. Few will like that treatment plan. His Chaos Syndrome diagnosis, however, is inarguable, as is his view that in the near term, “it will only get worse.”  

Donald Trigg is president of Cerner Health Ventures. In a previous life, he worked for President George W. Bush starting on the 2000 presidential campaign in Austin, Texas, and then after a brief Florida detour, in Washington, DC for the first half of Bush’s first term. 

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July 6, 2016 Readers Write 5 Comments

Readers Write: Who’s On First? Baseball’s Lessons for Hospital Shift Scheduling

June 29, 2016 Readers Write 1 Comment

Who’s On First? Baseball’s Lessons for Hospital Shift Scheduling
By Suvas Vajracharya, PhD

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A single MLB season includes over 1,200 players, 2,340 games, and 75 million fans in stadiums. In just 10 seasons, it’s possible to generate more baseball schedule options than there are atoms in the universe. Yet a full season of baseball scheduling is still far less complicated than just a single month of scheduling for 24/7 coverage shifts in a hospital emergency department. There’s good reason hospital operations teams are stressed about scheduling. Trying to do this manually with paper or a spreadsheet is an exercise in pure masochism.

First, a bit of history. Major League Baseball started out using a guy in the commissioner’s office to set up season schedules. Harry Simmons quickly found the task so overwhelming that he left the office and worked on the schedule as his full-time job (sound familiar?) In 1981, the league assigned the job to a husband-wife team named Henry and Holly Stephenson, who set the schedules for two decades using a mix of computers and manual scheduling.

Tech leaders at IBM, MIT, Stanford, and Carnegie Mellon all tried to unseat these scheduling gurus and failed until 2005, when the league switched to what is called “combinatorial optimization” technology to generate their schedules entirely by computer.

Today, the same applied mathematics technology is used in not just Major League Baseball, but in all sports leagues, airline schedules, and retail stores, too. Any time you’ve got a mix of teams, individuals, holidays, facilities, unpredictable weather patterns, changing demand, and lots and lots of rules that sound straight out of high school word problems … that’s a scheduling job for advanced computing.

Healthcare, as anyone with experience in the sector might guess, is behind the times when it comes to scheduling technology. The vast majority of hospital departments (an estimated 80 percentage) are still setting schedules manually, like our poor old friend Harry Simmons. It’s a problem that can’t be ignored any longer. Not only is manual scheduling a major time sink for hospital operations staff, it also contributes to the already significant issues of professional burnout and physician shortages.

The MLB uses scheduling software in two distinct ways. First, they generate an established schedule for the season using set rules. These include rules designed to prevent player burnout, such as requiring a day off after a team flies west to east across the country or not playing on certain holidays. There are also operational rules, such as not having two home games in the same city the same night or making sure the weekend and weekday games are equally divided among teams.

In healthcare, these established schedule rules include things like not scheduling back-to-back night shifts for a physician, making sure weekend on-call time is fairly distributed, and ensuring key sub-specialists are available 24/7 for procedures. This rules-based schedule serves as the baseline.

After this, a second type of scheduling tool comes into play. These are requests that let the schedule flexibly adapt to changes. When a blizzard knocks out a week of MLB games or they need to cancel a series in Puerto Rico due to Zika concerns, it’s this second set of optimization technologies that reconfigures the schedule to get things back on track for the season.

In healthcare, schedule requests happen any time and all the time. Vacation, maternity, schedule swaps, requests for overtime, adding locum tenens, adding mandatory training sessions — hospital schedules change far more frequently than MLB schedules, adding to the complexity.

A recent study of over 5,500 real medical department physician shift schedules showed that medical department scheduling varies by specialty. Emergency medicine has by far the most complex process with an average of 62 repeating scheduling rules and 276 monthly schedule change requests. Hospital medicine and OB-GYN follow behind and office-based schedules such as nephrology are much simpler but still beyond anything in the MLB. The math on the number of schedules you could generate with that complexity and variability in emergency medicine is mind-boggling. That specialty also just happens to have the highest rate of physician burnout.

It is time for hospital operations leaders to figure out what the MLB discovered way back in 1981: setting complex schedules is a job for computers. Using sophisticated machine learning to balance dozens of rules and to support flexibility for ongoing changes is good practice for baseball players, pilots, and physicians. With the help of technology, hospitals might already have the solutions they’re looking for when it comes to care coordination, physician retention, increasing patient volume, and preventing staff burnout. It’s time for hospital operations to play ball.

Suvas Vajracharya, PhD is founder and CEO of Lightning Bolt Solutions of South San Francisco, CA.

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June 29, 2016 Readers Write 1 Comment

Readers Write: Change Your Change Management

June 29, 2016 Readers Write 8 Comments

Change Your Change Management
By Tyler Smith

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Does your organization have a solid change management system in place? Hopefully for most, the answer is yes. In large-scale IT projects, it is essential that a well-constructed system of checks and balances for each system-affecting change be in place, as well as a forum for the discussion of each change that has a material effect on other pieces of the project.

However, due to overhyped fears of errant build moves, change management often becomes an organizational behemoth, larger and more threatening than the worst government bureaucracy and capable of effectively killing the desire of any analyst to make any change.

When the change control warps to such a state that analysts dread getting up and going to work because they know that every software improvement they make will cost them an exorbitant amount of time in the approval process, the project runs the risk of losing talented staff (if not in body, then in mind).

Having worked on a variety of EMR projects over the years, I have seen everything from no change control to a change ticket process that required a PhD to navigate the nuances and still left no one feeling fulfilled when the update in question eventually reached the live environment. Many times it isn’t just the process — it’s the outdated change management software that is used at these organizations, which causes the confusion and lengthy timelines. I’m not going to name names but anyone who has worked in these projects knows what I am talking about. These ancient enterprise change management software suites make the worst-performing EMR seem user-friendly.

The real loser in this dreaded combination of micromanagement and crappy software is the loss of productivity and creativity. If an analyst spends more time getting a change through than building it, that is not necessarily bad. Some simple changes require lots of analysis to see the broader system impact.

However, if every change requires a time effort 1.5 times or greater than the time spent to perform the actual configuration, that is a serious issue. You are effectively sacrificing productivity out of a fear of your analyst being incompetent or too short-sighted to see/think through the effect of their change. In effect, your organizational policy is stating, “We trust you to make changes in the system, but no we do not think you have any degree of comprehension of what these changes mean.”

Therefore, as organizations stabilize and try to determine how to get the best work from their full-time teams, I would highly suggest taking a look at your change management process and change management software vendor and see if the process and software really align with the other organizational initiatives you promote within your IT team.

Here are a few suggestions for moving forward:

  • Simplify. Cut down the change management process and software to the most necessary components. For example, do you really need to have seven different fields where a description is entered? Do the technical specifications ever need to be entered more than once? How long do these meetings need to be and do all changes need to be presented in such a forum? How many people need to attend? Trim the digital and process components. Every step whether in the software or in the change meeting/presentation process is like the dreaded extra click for the provider. Eliminate documentation processes that are redundant, in addition to required fields that do not serve a purpose.
  • As you simplify the governing structures, try giving analysts more control and in doing so see how little processes you actually need in place to maintain order. If analysts have the mental capacity to perform build tasks, they can probably handle taking on a degree of higher level organizational thinking regarding the impact of their change.
  • Do not allow the change control process to be constantly updated unless those changes are removing redundancies or irrelevant steps. Adding additional rules and processes often confuses analysts and these updates rarely serve their intended purpose.
  • Eliminate the standalone change control team altogether and make a committee formed from actual team members. It is OK to have a PM if the organization mandates such a structure. However, analysts who solely sit in a change control cube and who are not building in the system can never have a real world view of the software. These team members are essentially reactive (which means that in order to feel they have a purpose, they need to make the jobs of others more difficult, for better or worse). It may be a stretch to say that a change control team is a form of featherbedding, but the roles within it should be looked at with care as to the greater purpose they serve and their need to be full time.
  • Finally, if you can, scrap the medieval change control software and use the most minimally time invasive platform to document and present change and keep a record for the future. An Excel document may be enough. If the change control is linked to the help desk ticketing software this may not be possible without getting a new help desk software, but add this to the analysis.

Reducing change control staff and processes may not be pleasant. However, the long-term gains in efficiency and creativity that you will see in return from your analysts will benefit the end users of the software far more than the negatives of a temporary overhaul.

Tyler Smith is a consultant with TJPS Consulting of Atlanta, GA.

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June 29, 2016 Readers Write 8 Comments

Readers Write: Patient Privacy — A New Way Forward

June 20, 2016 Readers Write No Comments

Patient Privacy — A New Way Forward
By Robert Lord

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Health data security and patient privacy are in a state of crisis. Electronic health records (EHRs) are in the process of being ubiquitously rolled out, providing access to as much patient data as possible, to as many users as possible, in as little time as possible. As a consequence, hundreds of millions of patient records have been made easily accessible to millions of health system employees and affiliates, with essentially no oversight of who is viewing what patient data in the EHR and if that access is appropriate.

However, this isn’t because of health system negligence – it’s about a collective lack of accountability among several key stakeholders. Due to the sheer volume and complexity of patient records accessed each day, it is impossible for privacy and security officers to efficiently detect breaches without new and practical solutions and standards.

Something needs to change. Despite promises of role-based access controls, training programs, and security templates, the problem just isn’t being solved, and HIPAA violations continue to affect hospitals on a daily basis. That critical human layer of access is the root of these problems, and that doesn’t have an easy solution.

A new report from the Brookings Institution details that the majority of recent healthcare data breaches are caused by theft or unauthorized access. Research also shows it takes more than 200 days to detect an insider threat, if it is detected at all. And the in-depth report from ProPublica last December helped bring into focus that small-scale violations of medical privacy — like the Walgreens pharmacist who snooped in the prescription records of her boyfriend’s ex — often cause the most harm.

We are now at an inflection point that will decide the future of patient privacy. The actions and decisions of four key stakeholders and their collective will to collaborate through an independent fifth apparatus will significantly advance or stall patient privacy protection and next-generation health data security.

Patient privacy technology vendors need to invest in their teams and products to take advantage of the significant advances made in big data analytics, clinical informatics, and cybersecurity. These advances have changed many other fields, but cybersecurity and compliance solutions built for non-healthcare industries are rarely effective in the complex and idiosyncratic healthcare environment.

Furthermore, the big data environments that define many modern hospitals also require big data solutions that are at the cutting-edge of technological possibility. Critically, vendors need to better listen to their customers to create clinically-aware, healthcare-first solutions that address patient privacy. Health systems cannot purchase what does not exist and rarely have the in-house bandwidth to create production-ready systems.

Hospitals and health systems are working hard to protect patient privacy, but their security and privacy teams are stuck in a reactive mode, having to put out fires with limited resources. It’s clear that CISOs and chief privacy officers need a seat at the boardroom table and their roles need to give them the breathing room to see into the future rather than just to react to challenges as they occur.

Furthermore, compliance and bare-minimum standards are no longer enough. To truly protect patient data, a close relationship between hospital security and privacy groups must be formed. This partnership must be augmented by the technology necessary to detect and remediate threats and their collective mission must be aligned with the board. Fundamentally, resources and C-suite support must be allocated to tackle the next generation of privacy and security challenges, as current efforts aren’t on the right trajectory.

The federal government, with privacy protection authorities like the Office of Civil Rights and standard-setting bodies like ONC, want very earnestly to protect vulnerable populations and help hospitals protect patient data, and I have always been impressed by my interactions with them. However, there is no denying that they are under-resourced and limited in the amount of time they can spend looking into better solutions that could serve as next-generation patient privacy platforms. As a result, they are not able to offer much substantive guidance on what hospitals should and shouldn’t do to keep patient data secure. While distance must be maintained between vendors and regulators, greater public-private partnerships, like those in national security, are critical.

All of us as patients are an important but (amazingly) often overlooked constituency when it comes to advancing the protection of health data. Just as we wouldn’t keep our money in a bank that didn’t use passwords for online accounts or locks on their vaults, patients should expect and ask for more details about a hospital’s security posture. When hospitals ask you to sign forms that let them use your data, we should request that our providers detail how they’re protecting our information. A basic set of criteria about data encryption, proactive patient privacy monitoring, dual-factor authentication, network security, and whether or not a CISO/CPO are part of the team can tell you a huge amount about a hospital’s stewardship of patient data. We are all patients and I’m just as guilty of signing a HIPAA release form without thinking as anyone else. But if we’re to drive change, we have to think hard about what’s truly important to us and take a stand.

Ultimately, each of the above stakeholders has its own incentives, and I would contend, its own set of responsibilities and roles with respect to bringing about a new standard of patient privacy. In addition, while industry partnerships and bodies like the NH-ISAC are steps in the right direction in unifying these stakeholders, we need collective accountability and transparency regarding insider threats and HIPAA breaches beyond HHS’s “wall of shame.” Only through creating central, practical, collaborative bodies that bring all of these stakeholders to the table will we be able to move patient privacy forward and set a new standard for protecting our patients’ data.

Robert Lord is co-founder and CEO of Protenus in Baltimore, MD.

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June 20, 2016 Readers Write No Comments

Readers Write: Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions

June 20, 2016 Readers Write 2 Comments

Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions
By Nancy Ham

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Analytics are like a GPS navigation system for healthcare. With a full view of your route, they give you step-by-step directions for exactly where you need to go. By aggregating data from electronic medical records (EMRs), claims, health risk assessments, admission / discharge / transfer (ADT) systems, and other sources, analytics can create 360-degree views of individual patients and entire populations. This holistic approach drives smarter decisions and better outcomes.

When providers can see which patients are not following treatment guidelines, visiting out-of-network specialists, or are at risk for readmission, they can deliver more impactful interventions, close gaps in care, and improve quality. In a recent survey, 82 percent of healthcare decision makers say analytics have helped to improve patient care at their hospital or health system and 63 percent say analytics helped to reduce readmission rates.

With the right technology and strategies in place, health systems can drive change and shift value-based care initiatives into high gear.

Strategy #1: Keep patients in-network

When patient care falls outside of a health system’s network, it can lead to gaps in care, administrative referral headaches, and lost revenue opportunities. However, keeping patients in-network is a challenge, especially in today’s competitive healthcare market. Having the right data to even know who is going out of network and why compounds the problem.

Yet studies estimate that only 35-45 percent of adult inpatient care stays in network. For one accountable care organization with 27,000 lives, out-of-network services resulted in lost data, missed care coordination opportunities, and increased costs. Patients seeking treatment for hip/knee replacements saw a:

  • 10 percent increase in radiology services
  • 32 percent increase in emergency and medical visits
  • 25 percent increase in physical therapy sessions

Advanced analytics with drill-down capabilities can help. It allows users to tap into claims and clinical data so they can identify out-of-network drivers by service line and provider. These systems even allow users to see how much they are losing by diagnosis code.

From there, health systems can find ways to close gaps in services and create a strategy to keep patients in-network. For example, health systems may find opportunities to improve retention by expanding their cancer service line or adding a new service such as electrophysiology. As a result, out-of-network referrals are reduced, in-network retention improves, and the health system finds new revenue opportunities.

With this detailed level of insight, it’s also possible for health systems to pinpoint network leakage down to the provider level and use this information to educate providers about their referral patterns. When doctors and other caregivers see the impact of their referral processes on overall network performance, it’s easier to have collaborative conversations and work towards improving retention.

Strategy #2: Coordinate care to reduce readmissions

Patient data resides in a number of different sources across the continuum of care, including ambulatory EMRs, community health records, and hospital information systems. By aggregating and analyzing this data and applying predictive algorithms, it’s possible to create readmission risk scores for admitted patients so they can be proactively flagged for intervention or special consideration upon discharge.

Capabilities like these are critical for improving outcomes, particularly when it comes to managing the five percent of patients who drive more than 40 percent of our healthcare costs. When this type of information is presented as part of the clinical workflow, providers can review discharge data, anticipate potential roadblocks, take action quickly and efficiently, and reduce readmission rates.

Strategy #3: Leverage actionable intelligence and analytics

Data and analytics can help providers to gain a clearer picture of all of the populations they serve. With data from multiple sources in one central location, it’s possible to layer and visualize this information in new ways. Much like how a GPS presents directions differently based on whether you are walking, driving, or taking public transit, these tools offer users flexibility on how to view and analyze data.

By looking at clinical and claims data in a new light, providers can better understand a patient’s complete profile, including lab tests, self-reported data, health conditions, co-morbidities, lifestyle risk factors, and gaps in care. As a result, it’s possible to better stratify risk, match patients to the right interventions, and address high-risk conditions before they lead to costly treatment. Providers can then prioritize the appropriate interventions and determine a complete care plan that includes support, such as personalized patient education and coaching.

Having a comprehensive, 360-degree view of a patient or population—much like the one a GPS navigational system would provide—can ensure your journey is a successful one. With this perspective, you can reach your destination of high-quality, cost-effective care by following these key takeaways:

  • Concentrate on keeping patients in-network to improve quality care, capture vital performance metrics, and retain service revenue
  • Strengthen care coordination to reduce readmissions
  • Visualize data in new and different ways through enhanced analytic capabilities to promote better clinical and financial performance

Providers need a full picture of their patients and populations to deliver high-quality, impactful care. By harnessing a wide range of data and actionable insights, healthcare organizations can make smarter decisions that better engage patients and clinicians, reduce duplicative services, mitigate risk, and improve quality.

Nancy Ham is CEO of Medicity and VP of Healthagen Population Health Solutions, an Aetna company.

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June 20, 2016 Readers Write 2 Comments

Readers Write: A Healthcare Merger, Acquisition, or Consolidation Doesn’t Have to Spell Disaster

June 1, 2016 Readers Write No Comments

A Healthcare Merger, Acquisition, or Consolidation Doesn’t Have to Spell Disaster
By Sandra Lillie

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Healthcare organizations are undergoing significant change to survive (and thrive) under new reimbursement models. Mergers, acquisitions, and consolidations of healthcare organizations are rampant. It is not surprising that health IT is under tremendous pressure to advance information strategies in support of their organizations in its ever-changing portfolio of IT systems.

Much has been discussed about the changes in adoption of EHR technology during M&A activities and the amount of due diligence involved. But what about the 80 percent of healthcare data that is unstructured and resides mostly outside the EHR? Nowhere is this scenario more complicated than the unique space known as medical imaging, which makes up the lion’s share of unstructured data and is the most complex to manage.

Today, health IT often oversees multiple PACS solutions in support of radiology and cardiology for their institutions. The variety of systems grows exponentially with organizations that are involved in M&A transactions, leaving very complex support environments for IT departments when there are multiple differing proprietary PACS systems that require unique IT infrastructures.

Evolving this diverse portfolio into an enterprise strategy that can flexibly adapt to change is paramount for both acquiring and divesting organizations. Including a vendor neutral archive (VNA) as part of this strategy can:

Liberate. Healthcare organizations have the opportunity to take back ownership of valuable clinical imaging content from PACS and make that information available in a patient-centered, aggregate manner to providers of care, where and when they need it, to deliver positive outcomes for patients.

Consolidate. In addition to the ability to consolidate and economize for storage, new hospitals and partners can more easily integrate into existing networks and gain access to systems. Fewer systems alleviate IT departmental stress. Additionally, when new hospitals are acquired, core VNA services are simply extended to the newly-acquired locations. New imaging studies from these locations are efficiently redirected to the VNA to aggregate all of the enterprise’s images centrally.

Aggregate. A VNA is intrinsic to the lifecycle management of the breadth of images associated with a patient. This can include radiology, cardiology, dermatology, ophthalmology, wound care, endoscopy, and many more in a patient-centered association. VNAs support the ability to integrate studies directly into the patient’s record in the EHR. This benefits everyone – the radiologist, the referring physician, clinicians, and the patient – because it brings vital and comprehensive patient information to the care team.

Divest. Ownership of these images also provides improved capability to segment images to accompany the divestiture of a facility from the hospital organization.

VNA selection criteria should include not only technology, but also:  

  • Experience. Select a VNA technology with a proven track record of vendor neutrality across a wide range of imaging vendors.
  • Diversity. Be sure the VNA product provides support for all images that exist outside of radiology and cardiology.
  • Visualization. Review enterprise image viewers that enable the seamless visualization of images across care stakeholders and settings.

Adopting VNA as part of an M&A strategy can accelerate the ability to adapt to or lead change.

Sandra Lillie is industry manager of enterprise imaging for Lexmark Healthcare of Lexington, KY.

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June 1, 2016 Readers Write No Comments

Readers Write: New State Mandates for Opiates Create the Next Wave of Requirements for EHRs

June 1, 2016 Readers Write No Comments

New State Mandates for Opiates Create the Next Wave of Requirements for EHRs
By Connie Sinclair, RPh

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New York’s I-STOP mandates have dominated health information technology news for the last three years. I-STOP requires electronic prescribing  for all prescriptions, which has driven most EHR and e-prescribing vendors to come fully up to speed on e-prescribing for controlled substances (EPCS). Now many of these same vendors are moving on to the huge task of rolling out their EPCS-compliant versions to prescribers in other states.

More states are expected to follow suit with their own legislative mandates, especially now that New York’s deadline has passed without earth-shattering problems. Indeed, Massachusetts and Maine have recently passed sweeping changes to address the opiate crisis, but in true federalist style, each state is addressing the problem in unique ways and are calling upon the EHRs and e-prescribing systems to fall into line in new and different ways.

Very recently, Massachusetts and Maine passed new laws that will limit the quantities of opiate prescriptions prescribed; require the prescribers to view the prescription drug monitoring program (PDMP) under specific circumstances; and require the pharmacy to notify the prescriber via the EHR if lesser amounts of opiates are dispensed than what was prescribed. Most pharmacies do not have the ability to send messages of this type to the prescriber’s EHR, and EHRs are not equipped to receive them.

This notification requirement is similar to the biosimilar substitution notice required by several states and will require a different type of interoperability between pharmacy and EHR than what exists in practice today. Maine’s new law will also require EPCS for opiates and also impacts prescriptions for benzodiazepines. Massachusetts patients will have the ability to complete a non-opiate directive form which indicates that the patient does not want to be prescribed opiates. The prescriber must retain this form and rules have not yet been promulgated to describe how this information can be recorded in the “interoperable electronic health record.”

With all of these legislative mandates, it is clear that states and the federal government are reacting to the national epidemic of drug overdoses. According to the Centers for Disease Control and Prevention, nearly half a million people died from drug overdoses from 2010 to 2014, the vast majority of which were from prescription pain medications and heroin. Put another way, 78 Americans die every day from an opioid overdose. Officials fear the death toll will continue to escalate, which is creating urgency for new laws and programs to address the situation.

One method that seems to be successful in addressing the opiate problem is the popular mandate to require PDMP viewing by prescribers. PDMPs are databases maintained by each state (except Missouri) of prescriptions for controlled substances. This information can help prescribers be more savvy about their patients who may be inappropriately seeking pain medications. This one feature alone goes a long way toward inhibiting the doctor shopping (patients who go from one practitioner to the next requesting new prescriptions).

Some states have the technology and laws to support PDMP data sharing with neighboring states to better address this problem. A few states have enacted laws to require or encourage the integration of state PDMPs into EHR systems and workflows. The federal government also is working to make PDMPs more interoperable with EHRs and each other.

Addressing opioid abuse is one of our nation’s top priorities. States will continue to introduce bills for new mandates to address the opiate crisis. The challenge for EHRs and practitioners is that each state seems to put its own twist on their laws, so that they impact a different subset of drugs or require different quantity limits or PDMP viewing time frames. Vendors will be challenged to keep up with this developing patchwork of regulation and determine how to facilitate workflows that will help their prescriber clients with compliance.

Connie Sinclair, RPh is director of the Regulatory Resource Center of  Point-of-Care Partners of Coral Springs, FL.

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June 1, 2016 Readers Write No Comments

Readers Write: Why HIT Leaders Should Consider Mentoring

May 25, 2016 Readers Write No Comments

Why HIT Leaders Should Consider Mentoring
By Frank Myeroff

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The most successful leaders in healthcare IT tend to have something in common: they all have had a mentor or multiple mentors. A mentorship program can offer support towards an individual’s career as well as help to build knowledge among mentees which ultimately strengthens the organization.

Through four different types of mentorship programs, HIT leaders can use their experiences and knowledge to share with mentees, but also can benefit their own careers.

  • New hire mentorships. Mentors offer insight and guidance through new employees’ first couple of weeks of work. This helps mentees to become acclimated to the new work culture and environment while learning new things from an experienced HIT employee quicker.
  • Career mentoring. Mentors assist in the development of a mentee in the healthcare IT field. This could be formally organized through a mentorship program or informally take place in an organization where managers accept mentoring requests from employees. Professionals who are one or two positions above mentees can give valuable coaching and help to work through challenging work situations.
  • Networking mentoring. This allows individuals to share ideas and contacts throughout the marketplace. Networking mentoring is often informal and can take place at industry trade shows, healthcare IT conferences, or even social media platforms such as LinkedIn. Jeffrey Pelot, CIO at Denver Health, has used networking mentoring in his career. “I have sought out CIOs in various industries that have been willing to provide mentorship or act as sounding boards when I have been faced with difficult situations.”
  • Untapped potential mentoring. This type of mentoring is targeted towards an average or underperforming employee who has great potential, but has other components preventing them from reaching it. This can help an employee develop and discover how to excel in the field, and provide he or she with knowledge to succeed.

HIT leaders can participate in any of these mentorship programs to offer advice, share past experiences, and help up-and-coming leaders in the field. In fact, HIT leaders should view mentoring as an essential leadership skill. Mony Weschler, chief technology and innovation strategist at Montefiore Medical Center (NY) has had many great mentors who helped propel his career. Now he gives back, and according to Weschler, “What I really enjoy is mentoring others and infecting them with a passion for healthcare IT.”

There’s no doubt that mentoring others can be quite rewarding. By participating and becoming a mentor, you are likely to:

  • Obtain personal satisfaction from making a difference to the career development of another person.
  • Help in shaping future leaders and thereby impact the organization’s succession planning.
  • Increase your professional networks.
  • Enhance your people skills in areas such as leadership, interpersonal skills, and communication.
  • Learn more about areas in the organization where you may not be as knowledgeable.
  • Re-energize your career.

Overall, mentors can provide so much value for mentees and often mentorship programs are what shape future leaders of companies. When asked about mentors, Sue Schade, founding advisor at Next Wave Health Advisors and serving as Interim CIO at University Hospitals in Cleveland, summed it up nicely: “I’ve had mentors along the way, people I have either worked side by side with or as my boss. These have been some really solid people who have been able to give me good advice and who have been supportive and helped me stretch. Knowing how I have been supported in my career is why I have been so willing to do the same for others, to give back now that I have something to offer.”

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

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May 25, 2016 Readers Write No Comments

Readers Write: Ten Ways to Avoid Making the List

May 25, 2016 Readers Write 1 Comment

Ten Ways to Avoid Making the List
By Ryan Secan, MD, MPH

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In honor of the Year of the Hospitalist, I would like to share some hard-earned wisdom with those just entering our profession.

There are many unique things about hospitalist medicine – the seven on/seven off schedule (don’t get me started on this one – that’s another post), the exclusive inpatient focus, and the unfortunate administrative tasks that always seem to fall on our shoulders. Since we don’t have appointments, our patient assignments are determined early each morning at about 7:00 a.m. And often, ‘making the list’ is a job that falls to one of the hospitalists (despite hospital administrators consistently talking about everyone practicing at the top of their license). This remains a manual process that is time-consuming, painful, and delays everyone’s start to the day.

In my 15+ years of experience as a practicing hospitalist, I’ve never run into anyone who enjoys this process, and in fact have seen lots of creative ways that folks have been able to avoid the job. At one of my prior programs, the first doc who arrived in the morning made the list, so everyone started coming in later and later to avoid it. When you feel like you aren’t up for the task, feel free to borrow from:

The Top Ten Ways to Avoid Making the List

  1. Refuse to shovel your driveway. Even if the hospital sends someone out to get you, the list should be done by then (this will only work in Boston through April).
  2. Delete Waze and just accept that traffic will make you late.
  3. Make the list really badly once. They’ll never ask you again.
  4. Keep handy a picture of your car with a flat tire. Send to your program director in the morning as needed (but remember, you have four tires).
  5. Hide in your car until everyone else has gone in.
  6. Park really far away to get those 10,000 steps.
  7. Schedule 7:00 a.m. family meetings.
  8. Fake an emergency page.
  9. Become a nocturnist.
  10. Talk to IT. Isn’t there an app for that?

Ryan Secan, MD, MPH is chief medical officer of MedAptus of Boston, MA.

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May 25, 2016 Readers Write 1 Comment

Readers Write: Telehealth Can Create a Healthcare Nirvana: More Access, Lower Cost, and Enhanced Experience

May 25, 2016 Readers Write No Comments

Telehealth Can Create a Healthcare Nirvana: More Access, Lower Cost, and Enhanced Experience
By Rohan Kulkarni

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Healthcare in the United States generally inspires a sense of foreboding despite the progress that has been made since the 2010 enactment of the Affordable Care Act (ACA). While there continues to be challenges on both the cost of care and patient experience fronts, I believe that the most progress has and can continue to occur with access to care, which can in turn impact cost and experience.

It’s important to recognize the evolving patient population and how that will impact healthcare over the next 5-10 years.

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The Millennial generation was recently recognized as the largest generation, overtaking the baby boomers. They make up approximately a third of our total population.

The implications of that are highly consequential. Consider this: Millennials are currently low consumers of healthcare, accounting for less than 10 percent of the total spend. But historically, care consumption begins to steadily rise at a dramatic pace after women turn 25 and after men turn 30. This trend indicates that over the next five years, Millennial consumption of healthcare will significantly increase. Given the size and consumption preferences of that population, we are going to see marked changes in how healthcare is delivered.

One area in which Millennials will drive a seismic shift is the engagement of providers through virtual and mobile channels. It is seismic not only because of the size of the generational population, but their impact on the adjacent generation of Gen X who have had to continuously adapt to the new technologies. Let us consider a few ways in which they will manifest the idea.

Access

  • Alternate channels. In early 2016, Oliver Wyman published a white paper titled “The new front door to healthcare is here” in which they describe non-primary care physician interaction such as pharmacy- based clinics, mobile apps, and telemedicine in an alternate setting as the new front door of healthcare. As consumers find these alternate channels better, easier to access, and possibly less expensive, close to $200 billion in current healthcare spend is poised to flow from traditional venues to one or more of these alternatives. In fact, once you use a retail clinic or telemedicine, you are less likely to use traditional care.
  • Increased conditions supported. Telemedicine used to be for the simple stuff. Not any more. It is able to support more complex situations including strokes, intensive care unit situations, and behavioral health. As the number of conditions expands from the simple to the complex and as the monitoring of chronic conditions such as sugar levels for diabetes, heart rate, blood pressure, etc. becomes more stable, telemedicine will potentially become the channel of choice for healthcare interactions.

Cost

  • Impact on cost of care. There is a sense that telemedicine will bend the cost curve. However, it will be a while before the needle begins to move in any meaningful manner. In the short term, providers will need to strategically invest in telemedicine to extend their front offices all the way to patient homes or wherever it is that patients choose to connect from. But this investment will be a fraction of what it would take to build new physical structures. Consequently, there will be near term capital cost benefits with longer term operational savings that will be sustainable and meaningful.
  • Payers are paying. Recognizing the value of telemedicine both in its ability to provide care and optimize costs in the midterm, more payers are willing to reimburse these costs. Today, 29 states require insurers to pay for telemedicine services. Medicare is also beginning to pay for telemedicine-based care, which is a strong signal of the faith in the efficacy of this newer channel.

Experience

  • Convenience. Telemedicine offers new levels of convenience: the ability to get healthcare from the comfort of one’s home is very compelling. Paired with the prospect of having the physician send prescriptions to the local pharmacy that can deliver it to the home enhances medication adherence. This heightened level of convenience will influence the use of care in a timely manner. Patients will be able to avoid driving through traffic and decreased productivity at work but still receive the care they need.
  • Streamlined service. There is a very high likelihood that healthcare is about to be digitized end to end like never before, and that has healthy consequences. The telemedicine platform will be connected to the EMR platform, claims, and revenue cycle management, driving new levels of efficiency and enhanced patient experience. Healthcare will be at the tip of your digits.

Telemedicine is coming of age thanks to the large Millennial population that is likely to consume healthcare through this newer channel and payers’ willingness to pay for it. It is improving access at a fraction of the cost of a new ambulatory setup and giving rural constituents a chance for good healthcare. While still very small as a channel for healthcare delivery, it is about to be turned on its head like never before.

Rohan Kulkarni is vice president of strategy and portfolio for Xerox Healthcare Business Group.

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May 25, 2016 Readers Write No Comments

Readers Write: Giving Patients Access to Prior Mammograms: For Me, It’s Personal

May 11, 2016 Readers Write 2 Comments

Giving Patients Access to Prior Mammograms: For Me, It’s Personal
By Kathryn Pearson Peyton, MD, Chair of the Women’s Health Advisory Board, LifeImage

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I never imagined that I would be a radiologist advocating for patients in the healthcare tech world. The life pursuit of throwing open access to prior mammograms for women wasn’t on my career to-do list when I consulted my high school guidance counselor to narrow my college choices.

In due time, however, the career found me. Here’s my story.

I grew up in Northern California, in an area where breast cancer risk is doubled simply by virtue of being born there. Breast cancer had a strong history in my family. My great-grandmother died of it. In those days they didn’t screen. By the time they found her breast cancer, it was metastatic to the brain.

My grandmother had a mastectomy in her 40s. Her twin daughters had breast cancer, one in her 40s and the other developing three pathologically distinct breast cancers. Another aunt was diagnosed when she was 38 and passed away leaving two-year-old twins. My mom had breast cancer.

Breast cancer ravaged my family emotionally, starting with my grandmother, who was psychologically crippled from her surgery, which in those days was deforming. My aunts were terrified and anxious. By the time I came along, it was painfully obvious there was a genetic predisposition toward breast cancer in my family, and I wouldn’t be far behind.

Breast cancer found me, too

While I was in early medical training at the University of California, San Francisco in my mid-20s, I went through genetic counseling for breast cancer. A counselor looked at my family history and determined I had an 85 percent lifetime risk of developing breast cancer. They advised me not to get tested for the gene since, by law in California, that would assign me a pre-existing condition that would preclude me from qualifying for health insurance.

I followed their advice and did not get tested. What I did, however, was learn everything I possibly could about breast cancer. I became a radiologist, followed by a fellowship in breast imaging with Ed Sickles, MD, one of the fathers of mammography. I monitored myself, starting screening mammography at age 30.

During those years, I practiced high-volume breast imaging in San Francisco and Jacksonville, Florida, for 15 years. Every time I diagnosed a patient’s breast cancer, I thought, “This could be me … this will be me.”

Finally in my mid-40s, it was me. The signs of early bilateral breast cancer appeared on my own MRI screening: 6 cm of abnormal ductal enhancement in one breast and an entire lower inner quadrant in the other. A negative biopsy would not have reassured me, and the uncertain future of my extremely dense breast tissue was a ticking time bomb. The decision was easy. I don’t mind surgery. I do mind chemotherapy.

Without hesitation, I underwent a nipple-sparing bilateral mastectomy, which was unusual at the time – before Angelina Jolie’s raising awareness of the decision process that some women choose for preventive medicine.

That whole experience gave me a wake-up call. I was burning myself out practicing radiology 10 hours a day during the week and three to four weekend days a month. I stopped practicing.

Fixing mammography, one scan at a time

While I had stopped seeing patients, I still had a strong interest in helping women and I certainly knew a lot about medicine and breast cancer in general. It was clear to me this was an area in which we could improve medicine. Research shows that, with increased availability of prior exams, the quality of patient care and outcomes are improved. Breast cancer can be detected earlier, therefore resulting in less-traumatic and less-costly treatments.

In a study at UCSF, the risk of unnecessary additional examinations is increased 260 percent when prior mammograms are not available for comparison. These high recall rates account for the majority of imaging costs related to breast cancer screening.

Because breast tissue is unique to each individual, archived images provide a benchmark for evaluating changes in tissue composition and assist in the early detection of cancer. When there is a perceived abnormality, the patient is called back for additional imaging of a screening finding. In a grand majority of the time, it is not cancer, and therefore a false-positive result is discovered. This average callback rate for mammography screening in the United States is approximately 10 percent, according to peer-reviewed studies that have examined the data.

Yet it is technically difficult to keep patients connected to their prior mammograms. Patients move between locales, health systems, or both. Some hospitals willingly share mammograms with patients. Others are hesitant, for fear of losing them.

I found the lack of accessibility to priors a barrier for patients and launched Mammosphere to help solve this problem. The concept is a mammogram-sharing cloud that provides hospitals, imaging centers, and patients with electronic access to prior mammograms. It is most active in the Jacksonville, Florida where Mammosphere was formed. Now we’ve joined forces with LifeImage, and in the coming months, the reach of the network will open mammogram access to millions more women.

For patients, the health IT interoperability argument is real

Among the bits, bytes, and bottom lines of technological and financial considerations involved with health IT initiatives, we must never lose sight of the patients and their stories. They need to be at the center of all technology initiatives to improve care.

Physicians who are informaticists can lead the way in accomplishing care improvements. They comprehend not only the technology, but its usefulness in care paths, as well as the specific clinical justifications for using technology to overcome challenges that today create financial waste as well as angst, inconvenience, and sometimes pain for patients.

While it would have been impossible for me to foresee this career path, I now find myself in the health IT realm as a patient advocate. Like many others, I’m hoping to positively influence care quality while helping reduce costs for patients, providers, and payers. By using technology as the tool to achieve it, I believe it’s possible, and that breakthroughs on a national scale are right around the corner.

The top federal health IT leaders came to HIMSS16 pushing health data interoperability. It might sound geeky, but it’s not. It is foundational to helping 60 million women who undergo regular mammograms in the United States, 39 million of whom screen annually. They need access to prior mammograms in a central cloud repository, and they need to maintain freedom of choice to see healthcare practitioners best suited to their needs and personal circumstances.

How do I know all of this is true? Because I am that person. A radiologist who sees the potential power of health IT to fix broken care paths and take on breast cancer – which found me through my family tree. I will not rest until we stop this disease.

Kathryn Pearson Peyton, MD is chair of the Women’s Health Advisory Board of LifeImage.

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May 11, 2016 Readers Write 2 Comments

Readers Write: Healthcare Consumerism

April 27, 2016 Readers Write 1 Comment

Healthcare Consumerism
By Helen Figge

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Everyone has at least one healthcare catastrophe to share. Mine is simple. My mother died of a mischievous breast cancer that disintegrated her bones, but only after it was missed “buried” in a pile of papers several years before.

One sentence tells all in a scribbled office note: “current testing could not rule out malignancy — suggest follow up.” The problem was that no one ever informed my mother. We only found incidentally upon her demise. The electronic health record with data exchange capabilities could have given a temporary reprieve.

Technology, however, did enter her life before her untimely death. Mobile technology in her final days delivered every hospital amenity into her home, supporting her last wish “to die in the same room I was born in,”which was 64 years earlier. Innovative healthcare technologies do indeed play a role and can satisfy the healthcare consumer, but certainly in this instance, arrived too late to be her savior.

Technologies are gearing more towards self-monitoring, self-direction and consumer empowerment. At least 52 percent of smartphone users directly gather their health-related information along with indications of how poorly or well one is living life. Healthcare technologies are creating an opportunity for the consumer’s total control of his/her own health destiny. But is this proactive or counter-productive? Is it a sustainable model for healthcare awareness?

Companies are offering technologies that provide the consumer access to laboratory results via apps that are private, secure, and fast, able to be viewed 24/7. However, in some instances, inaccurate results create self-doubt to the end user and clinicians. As the next chapters of technology dissemination evolve, vendors need to better understand what the end user is really looking for in order to support and sustain this new wave of healthcare consumerism.

Chronic diseases are often manageable and sometimes even preventable, yet the healthcare delivery system seems to do better at optimizing managing rather than preventing diseases. In order to turn the pendulum around in healthcare delivery and disease prevention and finally make us all healthy, a technology solution set is needed that is all-encompassing and that comes second nature to the end user. The true challenge in healthcare is to implement a practical solution that comes second nature to us in life’s daily workflow.

Several studies in healthcare show that most consumers want to use digital services for healthcare regardless of age, thanks to the success of Facebook and other social media platforms. The demand for mobile healthcare is definitely there and is resonating throughout all age groups. Consumers also state that they do not want bells and whistles, but the simple brick and mortar in the healthcare technologies to service their basic needs (supporting efficiency and accuracy). Reinforcing the phrase, “Going big is not always better.”

Given the leveling off of healthcare technology spending, the industry needs to better listen to the healthcare consumer’s wish and bring us back to the basics. Our society is not short of technology solutions, but the healthcare consumer is realizing that for health sustainability, sometimes the reliability and usability of a product might now be worth the effort to keep it.

Providing solutions that will allow self-diagnosis and self reflection are the first steps in acknowledging illness, thereafter empowering steps of going to a clinician for an unbiased assessment.

Helen Figge, PharmD, MBA is senior vice president of LumiraDx of Waltham, MA.

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April 27, 2016 Readers Write 1 Comment

Readers Write: Why Secure Messaging is Failing Hospitals

April 27, 2016 Readers Write 2 Comments

Why Secure Messaging is Failing Hospitals
By Ben Moore

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Healthcare communications are growing up. Where we were once reliant on interruptive, one-way message pushes; device juggling; and kludgy workflows driven by pager use, modern clinicians have a wealth of tools at their disposal to facilitate effective care coordination.

Yet despite a relatively crowded marketplace (some estimates put the number of secure healthcare messaging providers at over 70) and a market that is ripe for disruption (just ask anyone who still uses a pager if they enjoy it), healthcare messaging solutions still face relatively low adoption, with an estimated 85 percent of hospitals still eschewing smartphones in favor of pagers.

Secure messaging and pagers share a common thread. Neither was specifically designed to address the nuances of healthcare communications. They were mass-market solutions that were adopted by healthcare owing to being in the right place place at the right time.

For pagers, adoption was spurred by the need to deliver around-the-clock care while also allowing providers to (occasionally) leave the hospital. For secure messaging solutions, it was a matter of encrypting PHI that clinicians were transmitting from unsecured personal smartphones, mitigating the risk that came with smartphone use in a clinical setting.

As smartphone use grew organically in healthcare workplaces, HIPAA pitfalls abounded:

  • Data remained resident on personal (and often unprotected) devices.
  • There was little control or policy enforcement.
  • There was no guarantee of SMS message receipt.
  • There was no visibility at an organizational level that any communication had occurred at all.
  • Clinicians became accustomed to utilizing shorthand codes or acronyms to communicate, increasing the propensity for error.

The end result of this was an enormous financial risk of HIPAA violation and compromised care delivery and confusion in the healthcare setting. Secure messaging vendors sought to correct these problems by handling data through a single vendor, implementing message self-destruction from personal devices, guaranteeing message delivery, supporting rich media such as images and video, and performing integrated directory lookup.

If security is the only concern (and don’t get me wrong—it should be a very big concern), these solutions fit the bill. But if the 85 percent of hospitals still utilizing pagers are any indication, healthcare providers are looking for much more when it comes to enabling mobile communications.

In application beyond HIPAA compliance, secure messaging is falling short in a big way. According to a survey conducted this year, 56 percent of providers felt a lack of useful integrations with other software was the leading reason current providers fell short; 44 percent felt they lacked structure and policy; and 33 percent felt that low user adoption was the biggest hindrance.

Inclusion and integrations must be addressed by secure texting apps. Messages are data in its rawest form. If this information is siloed from other departments (for example, if nurses and physicians use different mediums) or different systems (such as scheduling, EMR, nurse call, and paging systems), it’s useless.

The Joint Commission ruling on secure texting states that mobile order entry is not permitted because basic secure messaging lacks the ability to verify the identity of the sender and record a copy of the original message against the EMR. Integrations with Active Directory and EMR software (in that order) ensure that mobile orders remain compliant. Ask any physician if they’re looking for another way be awakened at 4 a.m. when they’re not on call and you may begin to understand why they’re not falling over themselves to try something new (see “adoption issues.”) This can be easily mitigated by integrating with the on-call schedule to ensure that messages and notifications are automatically routed to the correct on-call party.

In the age of big data and informed decisions – and, we’re told, interoperability — there is no excuse for messaging applications to not pull and push relevant or necessary information from other systems to provide additional context, value, and insight.

Healthcare communications are, by and large, structure- and policy-based. Providers in a clinical setting are familiar with not only which information needs to be captured, but who that information needs to be relayed to and when. Basic messaging such as SMS or chat does absolutely nothing to address this (just look at a millennial’s messaging history to confirm.)

For a healthcare communications application to succeed, it must be able to ensure that the relevant information is being captured, and then navigate a complex web of individual providers, care teams, departments, and schedules to deliver that information to the appropriate individuals. Further, secure communication solutions must provide an automated escalation policy and user confirmation of receipt of critical labs to ensure those results are delivered in a timely manner, according to JCAHO’s National Patient Safety Goals.

To address this, next-generation healthcare messaging solutions are building fail-safes into the software itself, including continuous multi-channel delivery attempts (by text and phone), automated escalation rules and message routing in the event that a recipient is unavailable, and delivery visibility so that senders can conclusively confirm a message has been received.

Lastly, in the world of healthcare technology, particularly communication applications, a product is only as good as the number of people who use it. It’s no surprise that a number of secure messaging implementations have been scrapped or cancelled in the face of low adoption. Concerns about device number privacy, a lack of time to learn a new product, or even, yes, pager attachment (a digital version of Stockholm Syndrome) can prevent secure messaging solutions from being successfully rolled out enterprise-wide.

To overcome these obstacles, solution providers must support dedicated number provisioning (providing a unique phone number that exclusively works for communications within the app), pager network integration and pager functionality via a smartphone app (for the pager holdouts), and driving messaging through integration points (some hospitals use as many as 10 disparate systems, including call centers, scheduling solutions, and so on) and providing a user experience that is, at minimum, better than native SMS functionality on smartphones. Really, it’s not that difficult to do.

As a whole, secure healthcare messaging has a lot of room for improvement. However, with the willingness to listen to customers and the ambition to look beyond simply providing security as a service, the opportunity to transform how healthcare workers communicate, collaborate, and deliver care is there.

Ben Moore is founder and CEO of TelmedIQ of Seattle, WA.

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April 27, 2016 Readers Write 2 Comments

Readers Write: The Journey from Population Health Management to Precision Medicine

April 20, 2016 Readers Write 1 Comment

The Journey from Population Health Management to Precision Medicine
By David Bennett

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Imagine a world where individuals receive custom-tailored healthcare. Patients are at the center of their own care, making key decisions themselves. They are supported by research and education, and their information is shared easily between caregivers and clinicians. Preventive care is more effective than ever, and medical interventions occur in record time.

With precision medicine, this world is not just within reach — it’s already happening.

Precision medicine (also known as personalized medicine) is the next step in population health management, transforming healthcare from being about many, to focusing on one.

Population health serves as the “who” to identify cohorts of patients that are at risk and require attention. Precision medicine is the “what,” providing caregivers with the specific information they need to create effective prevention and treatment plans that are customized for each individual.

Having the largest variety of data sets possible optimizes therapeutic tracking of each patient’s care plan to make and refine diagnoses. This sets the stage to pursue the most personalized therapy possible by detecting patterns in clinical assessments, behavior, and outcomes.

Data is essential, but it’s only useful if you have the ability to make big data small in order to personalize care. Today’s technology platforms can do just that, by capturing vast amounts of health data and applying real-time analytics that provide information and tools that help healthcare professionals and health insurers make more effective, individualized treatment decisions.

Using this information to engage patients and guide care management makes the journey from population health management to precision medicine that much easier, paving the way for an era of truly personalized medicine that prevents the deterioration of health.

The timing couldn’t be better for precision medicine’s heyday, and here’s why: one-size care does not fit all.

Many factors are converging to make the adoption of precision medicine a reality:

  • A growing number of EMRs, EHRs, and HIEs are being connected and cover a significant number of individuals.
  • Patients are more interested in participating in their care, especially when they get access to their own data. There are myriad devices on the market today that are relevant — from wearable devices that measure activity and sleep quality, to wireless scales that integrate with smartphone apps, to medical devices that send alerts (such as pacemakers and insulin level trackers). The data from these devices contribute to a robust longitudinal patient record. The interactive nature of the technology is also an excellent way to engage patients.
  • MHealth advances allow us to easily capture consumer data using cellphone technology and monitoring patients remotely with telehealth and virtual consultations.
  • Ability to see which inherited genetic variation within families contributes both directly and indirectly to disease development. We can now adjust care plans when genetic mutations occur as a reaction to the treatment in place.

If we look at healthcare outcomes in the United States, it’s clear that we need to anticipate patients’ needs with evidence and knowledge-based solutions. Only then will we will be able to identify a patient’s susceptibility to disease, predict how the patient will respond to a particular therapy, and identify the best treatment options for optimal outcomes. Precision medicine will get us there.

Precision medicine is about aggregating all forms of relevant data to enable different types of real-time data explorations. More concretely, specific areas of medicine are expected to make use of new sources of evidence, and the data types they leverage vary based on medical specialty. A good example would be the difference between the data sets used by oncologists versus immunologists.

There are two critical types of data explorations that both need a very large number of data sets to bring results:

  • Medical research with scientific modeling. Precision medicine can be leveraged to advance the ways in which large data sets are collected and analyzed, which will lead to better ways and new approaches to managing disease.
  • Clinical applications. Treatment plans and decisions can be greatly improved by identifying individuals at higher risk of disease, dependent on the prevalence and heritability of the disease. We call this cognitive support at the point of impact. To support this, more control is needed in real time over macro variables: genomics, proteomics, metabolism, medication, exercise, diet, stress, environmental exposure, social, etc. Precision medicine provides a platform that has an extensive number of data sets with the ability to easily create custom data sets to capture these types of variables.

Precision medicine not only means care tailored to the individual, it also brings to the healthcare industry the visibility on variability and the speed necessary to act expediently on findings to prevent the deterioration of health. Not only does this enhance patients’ lives, it saves healthcare dollars and prevents waste.

Tailoring deliverables to the needs of individuals is nothing new, at least in other fields such as banking and retail. Pioneers in these industries have leveraged open-source technology on a solid data foundation to meet their markets’ challenges.

Surely we can do the same in healthcare, where it’s literally a matter of life and death. That’s why so many of us are working on a daily basis to accelerate the science behind precision medicine and to encourage its adoption. Precision medicine is nothing short of revolutionary, and together, we can all make it a reality.

David Bennett is executive vice president of product and strategy at Orion Health of Auckland, New Zealand.

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April 20, 2016 Readers Write 1 Comment

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