Readers Write: The Elephant in the Waiting Room: Healthcare Organizations Can No Longer Afford to Look the Other Way on Patient Pay

The Elephant in the Waiting Room: Healthcare Organizations Can No Longer Afford to Look the Other Way on Patient Pay
By Sean Biehle

In the past five years, patient payment responsibility has risen dramatically and continues to increase with the implementation of the Affordable Care Act. More people insured means more people who don’t understand their health insurance and many of the plans on the healthcare exchanges are high-deductible plans. At the beginning of the year, Aetna CEO Mark Bertolini projected patient pay responsibility to climb to 50 percent of the healthcare dollar by the end of the decade.

The New Normal: High-Deductible Plans

Once considered a last-resort alternative for those with limited income, high deductible (HDP) or “catastrophic” plans have gone Fortune 500. As a result, self-pay now includes a lot of the people who have insurance with HDPs.

• A 2012 Rand research brief estimated that half of all workers on employer-sponsored health plans could be on high-deductible insurance within a decade.
• The average deductible in employee sponsored health plans was $1,100 in 2013, but deductibles in the healthcare exchanges average between $3,000-$5,000.
• A report released by S&P Capital IQ estimates that 90 percent of S&P 500 companies will shift their workers from employer-sponsored insurance plans to health exchange plans by 2020.

As more Americans are paying a greater proportion of their healthcare costs out of pocket, getting reimbursed for the patient pay segment could now be the most important number to a healthcare organization’s bottom line. Collecting from patients is estimated to cost up to three times more than collecting from payers. 

Focus on Education

Healthcare organizations should make it their mission to help patients understand their bills, educate them on payment options, and help them navigate any insurance issues. Seventy-five percent of patients say that understanding their out-of-pocket costs improves their ability to pay for healthcare.

Plus, the Hospital Value-Based Purchasing (VBP) portion of the Affordable Care Act returns higher Medicare reimbursements based on patient experience scores. The payment process is integral to the patient experience. Patients who don’t understand their bills, what they owe, and why they owe it tend to give lower scores on patient satisfaction surveys. Last year, 2013, more hospitals were penalized than bonused, leaving millions on the table.

Create a Consumer-Focused Culture

Because patients are paying more, they are using social media and other online tools to shop around for physicians and hospitals that not only provide the best care, but also the best service. Service is more than having a good bedside manner. Service means providing frequent and transparent patient communications, especially as it relates to billing.

• Emphasize patient satisfaction over collections.
• Create a consumer-focused culture – align staff incentives with patient satisfaction.
• Perform patient satisfaction surveys to help identify potential problems before they escalate and determine reimbursement rates.

Be There When and Where It’s Convenient for the Patient

Many patients work and they have to take off work to visit their office or facility. Don’t make them take more time off when it comes to having to figure out their bills.

• Offer extended call center hours, including open evenings and weekends, to optimize patient access.
• Offer online payment platforms to provide 24/7 access for making payments, arranging payment plans, and viewing and updating demographic and insurance information.
• Offer services in multiple languages so no patient gets left behind.

Make It Convenient and Easy for Patients to Pay

Connecting with patients in a meaningful way helps them understand the how and the why eliminates any confusion when it comes to their bills. Show patients how easy paying their bills can be.

When possible, consolidate payments and balances across the entire patient care continuum. This makes it easy for the patient to pay everything in one place and drastically simplifies the patient pay process.

Provide multi-channel patient communications and payment options:

• Point-of-service (POS) payment portals make it easy to collect balances at the time of service.
• Automated phone/IVRS options enable payment over the phone.
• Online payment processing for debit and credit cards and electronic checks provides 24/7 access for patient payments.

Additionally, a number of provider organizations have developed pricing transparency tools for consumers to access clear and easy-to-understand billing information.

Offer Payment Plans Upfront

Medical bills can be daunting and patients are far less inclined to pay on larger balances, especially over $400. However, informing patients of their payment options at the time of billing greatly increases the odds of getting paid.

Offer Incentives for Self Pay

Unlike insurance companies, patients don’t get to negotiate adjustments to what they are charged for a procedure. Sweetening the pot by offering payment incentives can greatly increase reimbursement and patient satisfaction.

Treat Patients with Dignity and Respect During the Billing Process

Patients aren’t just numbers. In fact, we’re all patients, so it’s easy to see how frustrating it can be in the absence of clear, reliable, and efficient patient billing communications. Healthcare is one of the very last vestiges of American culture in which the consumer doesn’t have access to complete transparency to what they will owe before they incur the costs

Until the continuum of patient communications can be fixed from the inside out, it’s imperative to treat each individual with the respect and dignity they deserve throughout the entire billing process. Help them avoid collections at all costs using the strategies above and show them that the care provided continues beyond the bedside.

Expected Results

When focused on patient education and satisfaction, physician groups and hospitals can expect stronger reimbursement on patient balances. Educated patients pay their bills. Satisfied patients translate to higher Medicare reimbursements. Many organizations have seen their reimbursement rates increase by more than 30 percent after adopting patient education and satisfaction programs.

Emphasizing customer service can also help verify insurance and uncover secondary or additional insurance. This can dramatically streamline the revenue cycle process. Many organizations find after talking to their patients they discover additional insurance on accounts originally categorized as patient pay.

Lastly and perhaps most importantly, providing clarity of communications builds patient loyalty and increases trust over time. Patients who are highly satisfied with an organization’s billing process are twice as likely to return. Plus, over 80 percent of patients who are satisfied with their billing experience are likely to recommend an organization to their friends.

Sean Biehle is marketing manager for MedData of Brecksville, OH.

Readers Write: Protecting the Network with Endpoint Security

Protecting the Network with Endpoint Security
By Jeff Multz

CIOs are forever struggling to ensure that technology helps their businesses run efficiently and effectively and that their networks are protected. That’s a heavy undertaking for any business, but especially for healthcare organizations, as medical professionals rely on a bevy of computer devices (including their own.) These devices have become high targets for threat actors who are increasingly attacking endpoints (laptops, workstations, and mobile devices) to break into networks of healthcare and financial institutions.

The FBI recently issued an alert following a highly publicized attack on a US hospital group that warned healthcare companies they are being targeted by hackers.

"We are seeing an increase in attacks within healthcare," said Ann Patterson, senior vice president and program director of the Medical Identity Fraud Alliance. "The healthcare sector’s security and privacy controls differ from more secure industries, such as financial services, and [healthcare organizations] may be easier targets."

Why is healthcare so attractive to threat actors? A few reasons.

• Nation states are after the intellectual property of medical equipment and pharmaceutical companies so they can copy their products and sell them more cheaply.
• Threat actors are also after personal identifiable information (PII) of healthcare providers, which attackers use to open up new credit card accounts under the names of patients. That PII includes a patient’s name, address, phone number, Social Security number, date of birth, and billing information.

Because it is often difficult to evade network detection devices such as firewalls and intrusion detection/prevention systems (IDS/IPS), attackers are going directly to the end user via phishing or watering hole attacks to break into networks. The trusting souls who click on the links or attachments inside these emails have no idea that when they do, that malware is automatically downloaded.

While there have been new innovations in protecting the network from outsiders, there’s been a dearth of innovation in endpoint security technology. Since antivirus (AV) software is not very effective, it has become quite easy for attackers to infect endpoints. Defenses for endpoints are still mostly malware-signature based, so threat actors run pre-attack tests to see which signatures are being detected and which ones aren’t.

This ploy has worked so well that attackers sell their testing services to other attackers, running a service similar to that of VirusTotal, which scans malware for detection rates. However, unlike VirusTotal, the threat actors don’t share the results with AV vendors.

With about 200,000 new pieces of malware being created each day, according to Kaspersky Labs, and much of the malware being polymorphic, signature-based threat detection methods can’t keep up with the pace of new malware creation.

It’s hard to keep endpoints, especially personally owned endpoints, up to date with the latest patches. There are more applications than ever that people download onto their devices and all these applications have flaws, making them easy targets for attackers. Additionally, Web-based technologies are being designed so users can do anything over the Web using HTTP or HTTPS, which subverts perimeter-based controls and makes the Web an easy way to deliver malware.

With the Internet of Things (IoT) growing daily, the front line of attack has moved from servers to the endpoint. This year alone, IDC expects shipments of smart-connected devices (PCs, tablets, and smartphones) to surpass 1.7 billion units worldwide. Organizations are being attacked via their endpoints, yet have no idea they’ve been compromised.

The average time it takes for organizations to discover they have been compromised is 229 days and 69 percent of the discoveries are made from outside sources, such as federal authorities, the FBI, or private security companies.

An organization must be able to see all activity taking place on the endpoints so they can remove attackers as soon as they enter the network. The only way an organization can know whether it has been compromised is to continuously monitor the network and the endpoints. It needs to see what’s going on at the endpoint and tie that to what is going on across the network. Anomalous activity must be spotted as soon as it occurs.

An organization should be able to determine what happened when the affected system ran, who the system communicated to, what changed on that system, what the lateral movement was, and what tools were used. Endpoint activities should continuously be collected and logged. The information should be fed into a system that takes an end-to-endpoint view of all that has occurred, providing full visibility into a network. Organizations can then take that information and adapt their infrastructure, user training, and applications accordingly to defend the network.

As soon as anomalous activity is spotted, an investigation should be initiated. If the investigation reveals that an endpoint was compromised, the system can provide a blueprint of all activity that has occurred, and all activity as it is occurring, so the threat can be contained as quickly as possible.

The 2014 SANS Health Care Cyberthreat Report found that endpoint devices not only provide challenges for securing them and the network they are connected to, but also for recovering from an incident. Continuously scanning endpoint devices that are connected to a network can tell an organization exactly where the infection is hiding in the endpoint and how to remediate it. Breaches can often be remediated without being wiped or re-imaged, alleviating the possibility of inadvertent data loss during a wipe.

Work stations are critical attack vectors, and organizations that have a multitude of high target endpoint devices must always be on high alert for attacks. For now, there is only one way to do that. Gartner calls the solution Endpoint Threat Detection & Response, also known as Advanced Endpoint Threat Detection. It should be mandatory for any organization that needs to protect its business.

Jeff Multz is director of North America Midmarket for Dell SecureWorks of Atlanta, GA.

Health IT from the Investor’s Chair 9/17/14

Some Musings from the Chair

With summer winding down and Labor Day in the rear view mirror, it felt like a good time to write a quick Investor’s Chair post and share one or two of the more interesting things I’ve noted in the market of late.

The biggest news of the summer was clearly Cerner’s announced acquisition of Siemens’ healthcare information technology unit (or, as we old timers would say, Shared Medical Systems.) When I got a call from a reporter related to the transaction, my first reaction was a sense (as perhaps the Siemens folks would say) of schadenfreude, as this is yet another example of yet another European technology company foundering on the shores of the US healthcare IT market (think Misys).

Recall that Siemens bought SMS 15 years ago for $2.1 billion, only to sell it now for $1.3 billion. Why the decrease in value? Perhaps because in the greatest boom times our sector has ever seen (thanks in no small part to ARRA), revenues over these 15 years were astoundingly FLAT!

With this purchase, Cerner is now the clear sector leader and will enjoy mammoth cross-selling opportunities given the product fit. Cerner is a clinical leader, where Siemens (née SMS) always lagged there and was more focused on financial systems. (In fact, I recall the former CEO of SMS explaining to me that Cerner’s clinical focus was off base!)

From an investor perspective, this was a good use of both the cash hoard Cerner had built up on its balance sheet and its high-multiple stock, allowing the deal to be almost instantly accretive – especially with the $175 million in pre-tax synergies the company guided to in its press release. While the stock traded fairly flat around the release (likely because rumors had circulated for several weeks prior to the deal, causing the deal to already be priced into the stock), Cerner’s shares are up almost 10 percent as I’m writing this post, more than twice the S&P — Ms. Market seems to be more excited.

The vast majority of analyst commentary has been positive and we here at the Chair are fans of the purchase as well. The only thing that gives me pause as a long time Cerner watcher (and fan) is that the company has zero history of large-scale M&A and the sector has not been kind to such large-scale bets in the past.  What’s especially noteworthy here though is that the cultures of the two companies are literally more than an ocean apart, and in the words of famed management guru, Peter Drucker, “Culture eats strategy over breakfast”.

That said, the price Cerner paid clearly de-risks the acquisition, and Cerner is known for its strong culture (and full parking lots).

Another aspect of autumn I’m eagerly anticipating is attending the Health 2.0 Fall Conference in a few weeks. My impressions of the 2010 event can be found here. I missed it last year, so I’m really looking forward to the opportunity to see some of the new thinking and more cutting edge tech that this event usually attracts. With “digital health” so beloved of the venture world these days, I’m expecting both a fair number of cheap but cheerful innovators with apps and dreams, but also know there will be more than a few companies straight out of HBO’s show “Silicon Valley” strutting their stuff and spending their VCs’ money on booths and travel like there’s no tomorrow (and if they’re not careful, there won’t be).

Part of what I like most about this event is the great dichotomy in participants, sponsors, and attendees. I’m also particularly excited to be mentoring the HealthTraction component, Health 2.0’s Startup Championship – CEO mentoring for companies of all sizes is one of my favorite aspects of ST Advisors’ work.

As for the actual sessions, in the past they’ve varied from truly fascinating to really annoying, but that’s the beauty of industry conferences. My big complaint is that the conference moved from San Francisco to “the Valley,” but I’m keeping an open mind and will be writing a debrief post afterwards. Drop me a note if you’d like to drink some sponsor’s wine or coffee during the event.

Ben Rooks spent a decade as an equity analyst and six years as an investment banker. Five years ago he formed ST Advisors to work with companies on issues of strategy, growth, and exit planning (among other fun topics). He lives in San Francisco with his wife and the cutest dog ever!

Morning Headlines 9/17/14

HIMSS, CHIME, AHA, AMA, and others urge HHS to reduce 2015 attestation period to 90 days.

Several industry advocacy groups write a co-signed letter to HHS secretary Sylvia Burwell calling for the 2015 Meaningful Use attestation period to be reduced from 365 days to just 90 days.

Outsourcing Firm Cognizant to Buy TriZetto for $2.7 Billion

IT outsourcing firm Cognizant Technology Solutions will buy health IT vendor TriZetto for $2.7 billion in an effort to bolster its health IT portfolio.

Federal Health Care Website Faces Security Risks, Watchdog Finds

The GAO publishes a report on the security of Healthcare.gov, concluding that despite increased security efforts "weaknesses remained in the security and privacy protections applied to HealthCare.gov and its supporting systems."

AMA Calls for Design Overhaul of Electronic Health Records to Improve Usability

The American Medical Association publishes a framework with eight recommended changes for improving EHR usability.

News 9/17/14

Top News

Several member organizations — including HIMSS, CHIME, AHA, and AMA — urge HHS Secretary Sylvia Burwell to shorten the 365-day 2015 Meaningful Use reporting period to 90 days. The groups say they are “incredibly concerned” that the full-year reporting period will kill the Meaningful Use momentum, pointing out that only single-digit percentages of providers are ready for Stage 2 with only 15 days remaining. Meanwhile, Burwell focuses on more important issues – writing her first HHS blog post, in which quite a bit of Presidential butt is kissed.

Reader Comments

From Hospital IT’er: “Re: GE Centricity HIS. We have been getting calls from GE asking us when we’ll get off their platform. It is clear to me that they are going to abandon the product line sooner rather than later.” Unverified.

From Teddy Lemur: “Re: Tuesday’s CMS/ONC Meaningful Use webinar. One of the most confusing I’ve attended. If you were to try and create a decision tree based on whether the site is an EH/EP/CAH, their Stage, their Year, site’s first year of attestation, date of attestations, site’s mix of certified EHRs, EHR’s level of certification,  etc., etc., it would rival the family tree of European royalty for the last 700 years. How would you like to be a MU auditor and try to judge a site’s 2014 attestation a year or two from now? It’s time to figure out how to best achieve the MU program’s future goals. Better patient care, anyone?”  

Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Outsourcer Cognizant will acquire TriZetto for $2.7 billion in cash from its majority owner, London-based private equity firm Apax Partners. I reported on August 19 that Apax was hoping to flip its 2008 investment of $1.4 billion in TriZetto, which earns $190 million in annual profits, for $3 billion.

Craneware announces FY2014 results: revenue up 3 percent, EPS $0.34 vs. $0.33.

Readmission software vendor RightCare Solutions raises $4 million in funding.

QPID Health will move to a larger Boston headquarters building and open a West Coast office in Carlsbad, CA.

Sales

Flagler Hospital (FL) chooses Allscripts dbMotion to connect community EHRs.

Oncology device and software vendor Varian Medical Systems will deploy the Infor Cloverleaf Integration and Information Exchange Suite.

In England, Wrightington, Wigan and Leigh NHS Foundation Trust names Allscripts as its preferred EHR vendor. Allscripts acquired Oasis Medical Solutions in July 2014 to improve its position as a single-source vendor to NHS Trusts in pairing that company’s patient administration system with Allscripts Sunrise.

Willis-Knighton Health System (LA) selects Merge’s enterprise cardiology and interoperability solutions.

People

Phil Fasano (Kaiser Permanente) joins insurance company AIG in the newly created position of EVP/CIO. His pre-Kaiser background was in the financial sector.

Joining Phil Fasano in leaving Kaiser Permanente for AIG is Madhu Nutakki, KP’s VP of digital health, who has taken the role of CTO of data, innovation, and advanced technology at AIG.

Brad Allen (Lumeris) joins ESD as regional VP, as does Aaron Johnson (The Morel Company).  

Patientco names Jared Lisenby (Greenway Health) as VP of sales.

John Volanto, VP/CIO of Nyack Hospital (NY), is named interim CEO after the resignation of David Freed.

Announcements and Implementations

Surescripts adds four pharmacy benefit management companies and six EHRs to its electronic prior authorization service.

Registration for HIMSS15 is open along with hotel booking. Early bird registration (through the end of January) is $745. A new (and somewhat odd) option is the free Conference Plus Pass, which allows Sunday pre-conference attendees to move from one session to another during breaks, which would be a benefit primarily if the one you paid $325 for is a dud and you’re willing to roll the dice.

Billian’s HealthDATA makes its searchable Vitals hospital news and RFP feed available at no charge.  

Siemens will offer its customers patient financing programs from CarePayment.

InstaMed and Coalfire release a white paper covering the security of payment cards in healthcare.

Infor announces CloudSite Healthcare, providing its solutions via Amazon Web Services as a subscription service.

Government and Politics

A trade group for healthcare app developers asks Congressman Tom Marino (R-PA) to influence HHS to change HIPAA regulations, saying they are “mired in a Washington, DC mindset that revolves around reading the Federal Register” or “hiring consultants to explain what should be clear in the regulation itself.” It adds that small-scale app developers have few resources to help them understand their HIPAA responsibilities. The letter asks HHS to (a) publish a HIPAA FAQ for app developers; (b) update HHS’s HIPAA technical documentation, which in some cases pre-dates the iPhone; and (c) participate in developer-focused events.

A GAO report will call out security vulnerabilities in Healthcare.gov, warning that they will persist until fixed. GAO says CMS didn’t finish security plans, didn’t perform adequate security testing, failed to enforce password strength requirements, didn’t secure some of its infrastructure from Internet access, and failed to create a failover site.

Technology

Stanford University Hospital and Duke University Health System will pilot the use of Apple’s HealthKit for tracking patient information. Stanford will send two pediatric diabetic patients home with an iPod Touch to record blood glucose levels, while Duke will track basic vital signs for some unannounced number of cancer and cardiac patients. Both health systems use Epic, with Stanford saying it hopes to be able to trigger alerts from the patient-provided blood glucose levels that will be sent back to the patient via Epic’s MyChart. It’s not much of a commitment by either organization and little detail was provided, so I assume it’s just a couple of university people playing around with Apple’s technology just because they can, possibly (or not) to eventual patient advantage.

IBM is desperately seeking new nails for its Watson hammer that has failed to hit its sales numbers, now packaging it as Watson Analytics.

In Canada, volunteers at Bruyere’s Saint Vincent Hospital develop a headband-powered computer navigation system for quadriplegics using open source tools and consumer-grade parts. A quadriplegic resident of seven years says, “It makes life interesting. When you are in bed, it’s boring. If you can go online, you can go anywhere. With Google Maps, I can go on virtual tours.” She also uses the technology to connect with family via Skype.

Other

The American Medical Association lists eight recommendations to make EHRs better:

1. Design systems to enable physician-patient engagement, with fewer pop-up reminders and complicated menus.
2. Allow physicians to delegate tasks.
3. Track referrals, consults, orders, and lab results automatically.
4. Modularize system design for easier configuration.
5. Create tools that provide more context-sensitive, real-time information beyond overly structured data capture.
6. Open up systems for interoperability.
7. Link EHRs to patient apps and telehealth to support digital patient engagement.
8. Build in capabilities for users to send product feedback and problem reports to vendors.

HL7 tweeted out this photo of the brilliant and always-entertaining “Father of HL7,” Ed Hammond of Duke University.

Eastern Maine Healthcare Systems (ME) will eliminate 43 IT jobs, about 12 percent of the department’s headcount, hoping to avoid a $100 million shortfall by 2019.  

Kaiser Permanente Hawaii launches an internal medicine residency, touting in the announcement its HealthConnect system.

A Wisconsin newspaper is amused in its coverage of Epic UGM, reporting that Judy Faulkner joked that health IT acquisitions will accelerate and Epic will buy GE and rename it General Epic. She said, “The greatest users of electronic health records are the patients.” The photo above was tweeted out by David K. Butler, MD.

Weird News Andy says this is one of his “pet” peeves among vets of the animal kind. A Colorado veterinarian pleads guilty to charges of unauthorized practice for using creams on humans.

Sponsor Updates

• PerfectServe will exhibit at MGMA and the ACPE Fall Institute.
• Impact Advisors is included in Modern Healthcare’s “Largest Revenue Cycle Management Firms.”
• MedAptus announces that approximately 4,000 charge capture and management suite end-users have rolled out its ICD-10 software upgrade.
• Allscripts offers a short list of dos and don’ts of clinical IT deployment based on a new Alberta Health Services case study.
• Consulting Magazine names Aspen Advisors, Deloitte Consulting, and Impact Advisors to its “2014 Best Firms to Work For” list.
• The Massachusetts eHealth Collaborative receives ONC HIT 2014 Edition Modular EHR certification from ICSA Labs.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 9/16/14

 Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

A new RAND report conducted with the American Medical Association finds that EHR use is a direct contributor to physician burnout. Physician survey respondents  cite poor clinical notes, interruption of face-to-face time with patients, time consuming data entry, and less fulfilling work as EHR-related drivers of their dissatisfaction.

Apple HealthKit Trials Spearheaded By Duke And Stanford University Hospitals: Report

Stanford University and Duke Medicine announce plans to use Apple’s HealthKit to streamline data capture in support of their population health initiatives. Stanford Children’s Hospital will track blood sugar levels in its type 1 diabetes population, while Duke will capture weight, blood pressure, and other values to monitor heart disease and cancer patients.

Glitch in health care law allows employers to offer substandard insurance

A known bug in the validation tool that Healthcare.gov uses to ensure each plan listed on the market meets the minimum requirements outlined in the Affordable Care Act has resulted in employers flooding the site with cheap substandard insurance plans that do not offer basic protections, like hospitalization coverage.

AIG Raises Profile for Technology With Creation of CIO Job

Former Kaiser Permanente CIO Philip Fasano has been hired to a newly created CIO position with insurance giant American International Group.

Curbside Consult with Dr. Jayne 9/15/14

I was having a pretty pleasant week until one of my group’s more challenging physicians walked into my office with a copy (printed, of course) of an article entitled, “Physicians report losing 48 minutes a day to EHR processing.” Once again, Medical Economics uses an eye-catching headline to remind us why EHRs are evil.

When looking at patient care, my colleagues will sit in Journal Club and rip scholarly articles to shreds, dissecting them and discussing why they do or do not apply to our patient population and care paradigm. They’ll argue about the composition of the study population as well as the methodology. Only when they’re fully convinced as to the integrity of the data and the statistical analyses performed will they agree to add the paper’s recommendations to their clinical protocols.

When there’s disparagement of EHRs to be had, however, they take the article as gospel without a single moment of review and pass it all around the physician lounge. This is the same physician who barged into a meeting last year with a survey of EHR satisfaction, demanding we replace our system. He didn’t both to notice that fewer than 20 respondents use the same EHR as us and are likely not in the same situation.

He took the same approach with this article and wouldn’t listen to anything I had to say, ultimately storming out when I wouldn’t feed into his negative energy. For anyone who does want to listen, however, here is my critical review of the article.

First, the article cites a survey by the American College of Physicians as the source of the data. Key points cited in the Medical Economics article included:

• 89.9 percent reported at least one data management function was slower with EHR
• 63.9 percent reported that note writing took longer
• 33.9 percent said data review took longer
• 32.2 percent said it took longer to read electronic notes

In digging deeper, the survey results were published in a letter in the Journal of the American Medical Association’s Internal Medicine. They weren’t published as part of a peer-reviewed study, which is an important distinction.

In looking at the letter itself, I’m not following the math. They said they sent the survey to 900 ACP members and 102 non-members. That’s 1,002 people by my math. In the next paragraph, they talk about “845 invitees.” Since 485 opened the email, that gives them a contact rate of 62.5 percent. But if you divide by the original 1,002 people to whom the survey was sent, I get 48 percent. Either way, only 411 of the responses were valid.

The survey also found differences in the time “lost” by residents vs. attending physicians differed – 48 minutes vs. 18 minutes, respectively. They suggest “better computing skills and shorter (half-day) clinic assignments” as possible contributing factors. I found the last sentence of the results section particularly interesting: “For the 59.4 percent of all respondents who did lose time, the mean loss was 78 minutes per clinic day.” Pulling out my handy math skills again, that would seem to indicate that 40 percent of respondents did not lose time.

The fact that this data was self-reported makes it less reliable than observer data. Their methodology relies on physicians remembering what their days were like a year ago (or two, or three, depending on when they went live on EHR) and comparing it to the present. I don’t know about you, but my clinical time is significantly harder for a lot of other reasons other than the fact that I’m on an EHR.

I’ve used EHRs for more than a decade and have to say that the Meaningful Use program (with its many required data elements) alone increased the time I spend charting. It wasn’t due to the EHR per se, but due to the required data. It’s kind of like when E&M coding was introduced – notes took longer because the volume of required data increased.

They authors seem to acknowledge this with their statement: “The loss of free time that our respondents reported was large and pervasive and could decrease access or increase costs of care. Policy makers should consider these costs in future EMR mandates.”

I also find it interesting that they didn’t mention results of any questions asking about how many data functions were faster with EHR. From my own experiences (across eight or nine different platforms) there are always areas that work faster and better in EHR and others that were faster on paper. But faster doesn’t equal safer, more reportable, or higher quality – it simply means faster. You can’t look at speed alone as a marker of EHR value, but I’ll take my EHR’s telephone message system over chart pulls and little pink pieces of paper any day.

When our medical group initially went live on ambulatory EHR, we actually did the time and motion studies pre-EHR and at multiple points post-EHR. We had data that showed that the EHR was neutral for time as well as for revenue. It didn’t matter that we had good data, however, because physicians naturally assumed that we “cooked the books” on it to show the EHR in a favorable light. That kind of bias is hard to overcome.

Looking at some of the raw data from our observations, we found the presence of a computer during documentation to be a confounder. Physicians were more likely to access other resources, such as UpToDate,  formulary information, or our system’s clinical repository, while reviewing data and documenting. Those resources were simply not available to them in the paper world. It’s hard to separate that kind of computer use from the actual use of the EHR product when you’re considering how long it takes to complete your notes.

I would much rather take a little longer because I spent a few minutes validating something in UpToDate than to simply finish faster. I also spend time in the EHR making sure patients get appropriate personalized education handouts, which I couldn’t do in the paper world. A survey cannot control for these other types of computer usage within the context of the EHR. Because of single sign-on and CCOW, half of my physicians would be unable to tell you where the EHR proper ends and the rest of our data universe begins.

What’s the bottom line? Although this survey has scholarly trappings, if other research was conducted this way, it would have holes like a block of Lorraine Swiss. The fact that review and documentation takes longer may not necessarily be a bad thing.

I’m interested to see what readers thing about the publication of this letter. Have thoughts about it? Or a favorite Swiss of your own? Email me.

Email Dr. Jayne.

HIStalk Interviews Marc Grossman, Principal, WeiserMazars

Marc Grossman is principal with WeiserMazars of New York, NY.

Tell me about yourself and the company.

I’ve been in the healthcare IT industry for 30 years. I’ve worked on the provider side as a hospital administrator and have been doing healthcare IT consulting for about 25 years.

I work for WeiserMazars. It’s an international consulting and accounting firm. I head up the healthcare national practice within the United States. Our clients are all provider-side clients in healthcare IT.

How are hospitals selecting and implementing systems differently now than they were five or 10 years ago?

There’s really not been that much change in how they’re selecting core systems. Hospitals typically keep systems for 10 to 20 years, which is a lot longer than most people would expect. I think it’s due to financial reasons.

We’ve gone through a lot of clinical selections recently. Our emphasis was on clinical systems due to Meaningful Use. There’s a cycle that I see the industry going through in the type of system, whether it’s financial, patient accounting, clinical lab, radiology, and so forth. But the process is basically still the same. That hasn’t changed.

The pendulum always swings back. People are paying more attention to revenue cycle and even talking about customer relationship management systems. What systems do you think are poised to make a comeback?

Patient accounting is going to see a big shift. That also has a lot to do with the fact that Siemens is being purchased by Cerner. Lab systems are starting to go through a cycle again.

People have in the past three or four years started looking at systems that haven’t taken off significantly yet. Systems related to population health management, data analytics, data warehousing, business intelligence. Those types of systems will cause a shift in purchases.

What are you seeing with lab systems? 

We’re seeing a push for an integrated approach, getting away from best of breed. You see it with Epic. You see it with Cerner. Those are probably the two biggest right now that I see people moving to. If they already have Epic, they’re moving to Epic’s lab. If they have Cerner, they’re moving to Cerner’s lab. 

We have seen that in lab systems, there seems to be a cycle about every seven years. I’d say about half of organizations are replacing. They keep it for about 14 years, typically, and about every seven years, we seem to be doing a lot more lab system selections than we have in the past. I’m talking about replacement of whatever they have — best of breed or some kind of niche vendor system.

How do you see Cerner’s acquisition of Siemens unfolding?

A lot of it’s going to depend on where the Siemens client is. Are they live on Soarian or in the process of implementing Soarian? Cerner has been much more successful with their patient accounting system recently. They’ve changed the name because it had such a bad reputation – they no longer call it ProFit. 

I believe Cerner is buying Siemens for intellectual property. On the patient accounting side, I think they’re also looking at the RCO base that Siemens has, which is a great revenue stream for them. 

Given Cerner’s history and the industry’s history over the last 20-30 years, Siemens Soarian and Invision product support is going to go downhill. I think they probably won’t sunset it officially for at least 10 years, just because I know Siemens does have numerous contracts which are going out 10 years. I also hear Siemens’ sales guys are really pushing to provide great deals right now, to get people to sign up or extend their contracts for 10 years. 

Like we’ve seen with many other vendors that purchased other systems, Cerner is clearly not going to put R&D money into two patient accounting systems and two clinical systems if they have an integrated system now. I just don’t see any indication that Cerner is going to continue the development of any of the Soarian or Invision products.

What are you seeing with population health management and analytics?

We’re seeing a lot of disappointment because the systems are so early in their life cycles. People are hearing a lot of promises from various vendors, both the major players like Cerner, Epic, and Allscripts and down the line. They have products in their infancy.

Then you have the niche players, which definitely have more mature systems, but there’s still a lot of disappointment even with those. Difficulty with interfacing issues and difficulty with the depth and breadth part of the applications.

Is there a mature enough process in place in hospitals that even if the systems could give them what they want, that they could follow through on the promise of either population health management or analytics?

I’ll say eventually we’ll get there. I don’t think we’re there yet.

Some of the larger academic medical centers that have large IT shops, are more sophisticated, and have a lot more money to spend have gotten their feet wet, some of them 10 years ago. But a lesson we have to learn is that vendors and consultants set false expectations. It’s a multifaceted challenge that we’re dealing with in our industry.

The biggest problem we have is that our industry is the only industry that I know of where the revenue side of the financial equation is heavily regulated, but the cost side is totally unregulated. We have a ton of regulations, a ton of incentive programs, but the money isn’t there to pay for all the wants and the needs.

We also as an industry need to accept responsibility for the fact in that we don’t have real standards when it comes to interoperability. Each hospital thinks that it’s unique. I’m not suggesting that they’re not different in some ways and some have certain specialties that others don’t. But the reality is that they’re in competition with each other, so they’re not willing to share things where they should be sharing.

The other issue is that each individual hospital’s incentives are not in sync with the government’s incentives and drive. The government can save money by having hospitals operate in a certain way. Each hospital doesn’t necessarily benefit from it. The desire of where we’re going to put our money at each hospital is not consistent.

Is the era of hospitals running applications from their own data centers fading as they move to the cloud?

We’re at least five to 10 years away from that. I’m hearing from a lot of our clients – they want to get out of the data center business. I don’t know if it’s going to necessarily be the cloud. There’s definitely a push to move more to RCO-RHO kind of approach like Siemens and Cerner have been doing for many years.

When hospitals negotiate agreements with companies to host their applications in whatever form, what’s important for them to look at contractually to protect their interest?

Service levels, to make sure that response time and downtime is going to be sufficient. Address areas related to growth and the impact on fees. Also, the whole issue of who really owns the data and how do you access that data if and when the arrangement ends. It sounds like a simple thing, but the reality is that it’s often very difficult for hospitals when they’re trying to pull out of an RCO arrangement to easily get their data.

Those are probably the biggest issues in my mind — cost, access, and availability.

What are the top issues that are challenging health system IT departments?

What I’m hearing from most of our clients are four or five big issues. CIOs expressing concern that they have too much on their plates, not just individually, but as an organization. They have too many high priorities and don’t have the necessary resources in most instances. ICD-10, Meaningful Use, the related offshoots from all of that, population health, changes in reimbursement, growth in terms of hospitals buying up physician practices or buying other hospitals or merging.

A second category is lack of strong IT governance. A lot of what relates to that unfortunately at many hospitals, especially at smaller hospitals, CIOs still do not have a full seat at the table. They’re often viewed as not being strategic. A lot of the hospital executives still view IT as a necessary evil rather than a strategic enabler. It becomes an uphill battle for CIOs.

There’s a lot of frustration and lack of trust among a lot of the executive leadership at many healthcare providers due to the history of false promises and expectations that were not met in the industry over the many years. Look at how many failures we’ve had with just EMRs alone and how organizations have had to replace systems.

Even in this day and age, I find a lot of executives don’t understand what systems are going to really give them and that systems are not going to solve all their problems. It’s just an enabler as opposed to the solution itself.

Do you have any concluding thoughts?

We’ve actually grown a lot as an industry. I think we still have a lot of growing to do.

Morning Headlines 9/15/2014

Advocate, NorthShore merger means 16 hospitals, 3 million patients

In Illinois, Advocate Health Care and NorthShore University Health System announce merger plans that will result in a 16 hospital, 45,000 employee organization with a $6.5 billion combined revenue.

State abandons search for new health exchange company

Nevada abandons its search for a new health insurance exchange contractor, after firing Xerox in May, and announces that it will join Healthcare.gov instead.

Docs frustrated with transition to electronic medical records

A local paper covers the frustrations that clinicians at Community Health of Central Washington are experiencing as they transition to a new EHR that has fallen short of their expectations. CMO Michael Schaffrinna is quoted saying “It reads like a translated Russian novel. It doesn’t flow, and that means it takes a lot longer for people to find the information they’re looking for to care for the patient.”

Monday Morning Update 9/15/14

Top News

Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.

Reader Comments

From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.

From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”

HIStalk Announcements and Requests

HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.

Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”

Sales

The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.

Announcements and Implementations

Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.

Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.

National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.

Government and Politics

Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.

Other

The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 

Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.

”The Onion” covers telehealth.

The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
4. EHRs provide clinical value, but slow physicians down.
5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.

Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.

An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Readers Write: The Engaged Patient – Are They Really?

The Engaged Patient – Are They Really?
By Helen Figge

Sorry to be the bearer of mediocre news, but despite the growing conversations around the value of engaging patients in their own healthcare, the term “patient engagement” is a really cute flavor of the month healthcare buzz phrase.

Many seem to be confused by what “patient engagement” means. It lacks a standardized approach to its interventional aspects or for a better sense rules of engagement.

The major thrust for patient engagement legitimacy comes in most part to the expansion of health insurers rewarding providers based on services that support the improvement of a patient’s health and wellbeing. Likewise, the anticipation that engaging the patient will reduce the utilization of healthcare resources plays into this concept. Finally, healthcare providers were vocal concerning the 10 percent patient engagement threshold originally mandated in Stage 2 of Meaningful Use and these “squeaky wheels” enabled a pushback to 5 percent.

The legitimacy behind engaging the patient appears evident because investing in the healthcare consumer who utilizes our healthcare resources (you and me) and turn creating healthier assets is the overarching goal of better health. This in turn fundamentally assumes we lower costs of healthcare. So, from this point of view, “investing” in consumers of healthcare and helping them to be more effective partners in our own care makes good sense practical sense, right? 

One would think and hope so. Based on several research sources, it is indeed possible to meet the requirements to support these patient initiatives through various technologies on the market today, like the patient portal, yet only a small percentage of providers are currently supporting these efforts.

The basic question is how do we engage patients to want to stay in control of their own health’s trajectory? What motivates and stimulates and excites someone to want to get and keep control of his or her own health destiny?

This is the one question gone awry, because the majority of consumers consistently participating in their health is quite low, with the majority of less than 5 percent consistently engaged if at all in their healthcare. Many practitioners are finding out that each and every one of us is motivated by something different when it comes to our own healthcare.

My dad was a great example of a non-compliant chronic disease sufferer who, when he felt better stopped taking his meds. Only when his blood glucose reading recordings were hooked up to his senior citizen daily calendar for dating (he was 87) did he remember to record his blood sugar readings for his care coordinator. One could say my dad’s health was directly stimulated by his desire to see which eligible senior citizen lady friend was going to the senior center that night for bingo.

In order for any patient engagement opportunity to be successful, each and every engagement might have to be customizable with each step in the care process to create a meaningful role for patients and their families and specifically tailored in such a way that helps patients acquire the knowledge and skills they need to effectively manage their health and do so in a consistent manner.

We also need to realize that some patients are not prepared to take on any type of role in their healthcare and might not be able to cope with their various illnesses regardless of the enticement. This is oftentimes a concern with those suffering from chronic diseases, where they will need to engage for the duration of their lives to keep and maintain their health.

I equate this type of patient engagement to eating your favorite food every day until after a while, boredom sets in. Your favorite food loses its luster. You just stop eating it and substitute another. When patients are unable to manage these types of often complex tasks, the result is less control over a person’s health and well being and ultimately higher health care and human costs.

If patient engagement has a chance to really hit the numbers we hope it will, it is important to tailor the care and instructions a patient has to support that care. In healthcare, we tend to provide the same amount of support regardless of the patient population or skill set at hand. We always try to standardize approaches, which 99 percent of the time is great, but patient engagement is that 1 percent where it just can’t be done. This is the reason for the low numbers in patient engagement we are seeing firsthand today. Each patient needs to be motivated in his or her own way to accomplish the empowerment needed for successful personal intervention.

Finally, another point to consider in all of this when trying to motivate a patient to “engage” in their own care is that it cannot be monetarily based. Patients are not motivated by financial incentives direct or otherwise for long-term behavior change. It is documented that highly engaged patients with the skills and knowledge respond better to the monetary gains of engaging in their healthcare, while some less than enthusiastic patients accept defeat much easier and accept their disease states and the sequelae of them regardless of intervention and assume it is what it is and thus accept any increased cost incurred by the disease state to be inevitable.

So when considering patient engagement, consider the patient first and foremost because patient engagement is based on the patient’s active and sustained participation in managing their health. It is a marathon race, not a sprint. Only through this mechanism will this lead to better health outcomes.

Proactive action to change and maintain our health into productive health behaviors is the mainstay of the effort. At its center is the concept of taking an active role in our own health and healthcare. We know objectively it can be measured using various tools like the Patient Activation Measure (PAM). This testing helps to identify a patient’s engagement level and used as a tool for improving activation for health and wellness, although I’m not sure how helpful it is right now given the lower-than-expected statistics of patient engagement overall.

The evidence suggests that increasing a patient’s engagement in their own health trajectory can have an impact on controlling costs and helping patients to become healthier – to live longer with fewer complications. The problem is that no one has come up with a standardized approach as to how to engage a patient for long-term success to any disease resolution. 

Maybe we need to interview each patient and see what drives him or her to wake up each morning. For my 87-year-old dad, it was trying to find a date for bingo night at the senior citizen center. Only after he answered his blood glucose reading did the senior citizen screen pop up. Maybe we need to do something like this for each and every patient. 

Helen Figge, PharmD, MBA is VP of clinical integrations of Alere Accountable Care Solutions. 

Readers Write: State-Based Health Insurance Exchanges

State-Based Health Insurance Exchanges
By Jason Deck

I was invited recently to join a forum at Northwestern University to discuss the state-based health insurance exchanges (HIX). It included leaders of the state exchanges, legislators, consultants, insurance industry executives, and physicians. Topics included policy discussion, pricing and transparency issues, and growth plans. 

I came away with one resounding thought: there are an awful lot of very smart people working tirelessly on the challenge of ensuring that all Americans have affordable access to healthcare. It is inspiring to witness.

Christine Ferguson, director of the Rhode Island exchange, made a powerful statement: “Nothing like this has ever been attempted before. Ever.” She was referring to the task of overhauling the extremely complicated incumbent system of healthcare delivery by bringing together public and private sector interests, policy making, technology, and care providers. It is a daunting task.

How they did it depends on the state, all of which had to have some version of a working exchange in place and functional by October 1, 2013. Some states chose to build their own, while others partnered with the federal government’s Healthcare.gov. That was not a perfect process, but given the complexities and the timeframe under which these states were operating, I will posit that the result was a success.

Much of the discussion in our forum revolved around the way forward. Three key themes emerged:

1. Integrated eligibility platforms
2. Consumer outreach and education
3. Financial viability

A key tenet of the Affordable Care Act is the insurance subsidy offered to individuals and families below 400 percent of the poverty limit. When individuals go to their state’s HIX to shop for and purchase an insurance policy, one of the early and important steps is to determine whether they qualify for a subsidy. Their eligibility is determined in part by first confirming the individual is not eligible for Medicaid. 

The insurance exchanges and Medicaid applications are not integrated except in a few states, so applicants must register themselves with the HIX, then go to Medicaid and apply specifically to be denied. They then receive a denial number to bring back to the HIX to continue their eligibility application.

Confused? Everyone is. Integrating these systems will deliver a quantum leap in the end user experience and ease of registration.

Which brings us to the second key initiative: consumer outreach and education.

The HIX executives who spoke at the forum agreed they had an early wave of low-hanging fruit their exchanges would enroll, but that they were quickly (and happily) working their way through that population. The next frontier is more difficult — small business owners and individuals with some resistance to buying health insurance.

To that end, the exchanges invest heavily in community outreach with sophisticated marketing programs, local offices, advertising, branding campaigns, etc. The results are promising. There was a productive conversation about which techniques are delivering the best results in new enrollment. Without exception, every HIX executive to whom I spoke named education and outreach as a top-of-mind concern.

On a related note, I was pleasantly surprised at the general tone the HIX leadership uses with regard to their constituents. They talk about improving the quality of the products and service, ensuring that call center wait times are kept short, and agents are trained to educate the customer. Many of these exchanges are organized under a government agency, but their leadership sure talks like private sector business leaders.

The federal government invested funds to build these exchanges, but not for their ongoing operations (there were more than a few jokes about the feds serving as the VC investor to the exchanges.) Jokes aside, the need to become financially solvent is a real issue and the audience proved creative in their approaches.

Many great ideas were exchanged, ranging from implementation of user fees, advertising strategies, use of insurer assessments, and excise taxes. While each state will ultimately land on its own model for its P&L management, the normal issues of operating costs, well-forecasted growth, and disciplined budgeting will be increasingly important to the HIX executives as they move from their launch phase into steady state.

The forum provided a great opportunity for many stakeholders in the development of state-based health insurance exchanges to discuss their progress, lessons learned, and ideas for the future. There will be bumps in the road to be sure, but we all have much to be excited about as the evolution to a more efficient and transparent health insurance ecosystem continues.

Jason Deck is vice president of strategic development of Logicworks.

Morning Headlines 9/12/14

Allscripts Ex-CEO Glen Tullman Launches Livongo Health At Disrupt, Backed By General Catalyst

Glen Tullman launches a digital health startup called Livongo Health, backed by a $10 million investment from General Catalyst. The company is building chronic disease management platforms that use technology to connect patients, care providers, and family members.

States Graded on Telemedicine Policy

The American Telemedicine Association publishes two reports analyzing the telemedicine policies of all 50 states, focusing on coverage, reimbursement, practice standards, and licensure requirements.

Medicine’s Manhattan Project: Can The World’s Richest Doctor Fix Health Care?

Forbes profiles healthcare billionaire Patrick Soon-Shiong and his startup NantHealth, which he promises will revolutionize healthcare. Forbes calls him a blowhard and quotes John Halamka, MD saying “The marketing is three years ahead of the engineering.”

Epic Systems again ranked as No. 1 Dane County employer

Just ahead of its annual user conference, Epic is named the largest employer in Dane County.

News 9/12/14

Top News

Former Allscripts CEO Glen Tullman launches Livongo Health, which will offer diabetes monitoring that includes an FDA-approved interactive glucometer and analytics. The company received a $10 million investment from General Catalyst. Its leadership team is sprinkled with former Allscripts people.

Reader Comments

From Vendor_Neutral: “Re: Apple. After months of being annoyed by misleading blog posts about Apple and Epic’s alleged partnership, I went back and watched that portion of WWDC this morning. Here is the direct quote: ‘We’re also working with leaders in health care applications like Epic Systems, now they provide the tech that enables hospitals serving over 100 million Americans, and so now with their integration with HealthKit, patients at these leading institutions will be able to get closer in sharing their information with their doctors.’ That’s all they said! NOTHING about a ‘partnership.’ They merely got early access to HealthKit. Let it be known that that is it.”

From Kaiser Roll: “Re: Phil Fasano. Resigned as CIO of Kaiser Permanente as announced in an email from CEO Bernard Tyson.” Unverified.

HIStalk Announcements and Requests

This week on HIStalk Practice: ABQ Healthcare Partners goes live on Allscripts. American College of Physicians outlines why MDs hate EHRs. Amazing Charts, athenaClinicals, and Meditouch vie for best EHR title. Research shows that primary care practices that create their own patient portal adoption strategy earn strong participation. The American Telemedicine Association grades states on telemedicine reimbursement and physician practice standards. Thanks for reading.

This week on HIStalk Connect: Apple unveils its long-awaited smartwatch, which will track activity and heart rate, but still falls short of what many were expecting for health features. The Mayo Clinic announces that it will work with IBM on a project that will use the Watson supercomputer to help analyze patient charts and match them with relevant clinical trails. Wellframe, a Boston-based startup, raises an $8.5 million Series A for its smartphone-based patient education and reminder tools.

Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Acquisitions, Funding, Business, and Stock

Google acquires Lift Labs, which makes a sensor-powered stabilizing spoon that helps people with tremors eat normally.

Streamline Health Solutions announces Q2 results: revenue down 17 percent, EPS –$0.14 vs. -$0.07. Above is the one-year share price chart of STRM (blue) vs. the Nasdaq (red).

Privacy monitoring vendor FairWarning announces first-half results that include 104 percent growth in existing-customer revenue, 6,500 healthcare facilities as clients, and 64 hospitals running its SaaS-based product.

Sales

Capella Healthcare (TN) chooses Medhost’s YourCareLink to submit information to state public health reporting agencies.

Phoebe Putney Health System (GA) selects Harris Corporation’s FusionFX Provider Portal.

Evans Army Community Hospital (CO) will deploy AtHoc’s emergency communication solution.

Community Health Network (IN) will link its community Epic, Cerner, and Meditech EHRs through Health Catalyst’s Late-Binding Data Warehouse and Analytics Platform.

People

Jack Janoso is named CEO of Fairfield Medical Center (OH). He was promoted from VP/CIO to CEO at Sharon Regional Health System (PA) before taking the new job.

Beaumont Health (MI) — formed via the merger of Beaumont Health System, Botsford Health Care, and Oakwood Healthcare – names Subra Sripada as chief transformation officer of the 10-member executive team. He was previously chief administrative and information officer at Beaumont Health System.

David Sides (iMDsoft) joins Streamline Health Solutions as EVP/COO.

Boston Software Systems promotes Matthew Hawkins to EVP of healthcare strategy and sales.

Jay Anders, MD (McKesson) is named chief medical officer of Medicomp Systems.

Announcements and Implementations

Gillette Children’s Specialty Healthcare (MN) goes live on the Versus Advantages Clinic patient flow system.

AirWatch introduces AirWatch AppShield to provide security and management capabilities.

MModal launches an outpatient medical coding service.

Elsevier chooses Clinical Architecture’s Symedical terminology management system for its InOrder order set tool.

MetroChicago HIE goes live with 31 hospitals using technology from Sandlot Solutions.

A Health Catalyst-sponsored survey of CHIME members (70 respondents) finds that analytics is the highest-priority IT investment, followed by population health and ICD-10.

Government and Politics

ONC announces that it will make minor tweaks to its 2014 certification criteria instead of rolling out voluntary 2015 criteria as previously planned. It will also name certification criteria by their year of approval going forward and will discontinue the “Complete EHR” certification.

Technology

Samsung pokes fun at this week’s somewhat anemic (and health-free) announcements from Apple, which seems to be morphing into Microsoft as it (a) pre-announces a product that won’t be available for a long time; (b) enters an existing market (smart watches) instead of creating a new one; and (c) fails to meet expectations in not talking about its rumored Health offering, possibly because of (a) limited stage time given the urgency of discussing fashionable watches and enlarged iPhone screens; (b) the moving target nature of whatever it’s going to eventually do, or (c) poor timing given that iCloud was just hacked.

Researchers from MIT and Georgia Tech find that Google Glass can measure pulse and respiration using its built-in gyroscope, accelerometer, and camera. You could say it’s for people who wouldn’t be caught dead wearing Glass.

Other

The American Telemedicine Association reviews the telemedicine-related physician practice and licensure standards of all 50 states. The components included physician-patient encounter (are in-person initial visits required are are more restrictive standards in place); telepresenter (does the law require someone to be physically present with the patient during the session); informed consent (is the patient required to sign off differently than for in-person visits); and licensure (does the state offer out-of-state licensure reciprocity, exemptions for physician-to-physician consultations, and conditional licensure). Twenty-three states and DC earned an A grade, 27 got a B, and one (Alabama) had the lowest composite score and a C grade.

Billionaire doctor Patrick Soon-Shiong makes the cover of the September 29 issue of Forbes, whose reporter seems as confused as the rest of us over whether he’s a genius, a blowhard huckster, or both. It points out that despite his spending $1.3 billion of his own money to acquire a bunch of unrelated technology companies (most notable in healthcare IT: iSirona), his grand ideas for “solving” healthcare are vaporware so far even as a rollout to Providence Health & Services is planned. The article mentioned Soon-Shiong’s tendency toward wild hype and his historic, greedy shafting of business partners, investors, and family members (“more of a wheeler-dealer than a scientist.”) Forbes concludes that his Nant-related holdings (including NantHealth) are worth $7.7 billion and he will start running IPOs next year, with NantHealth being the first.

Several publications are running breathy news items that Epic has hired a lobbying firm, none of them crediting HIStalk as their source since I reported it here on August 14 as tipped of by a reader who follows federal lobbying registrations.

Epic’s user group meeting starts Monday, with 10,000 attendees riding buses from hotels as far away as Wisconsin Dells to get to Verona. Meanwhile, the company is again named the largest employer in Dane County, WI with 7,400 FTEs.

In the UK, breast cancer screening vans are upgraded with satellite links to allow employees to enter and access patient information and to send images directly to hospitals.

The family of Joan Rivers will reportedly file a $100 million lawsuit against the for-profit endoscopy clinic where she died during a throat operation, claiming the clinic allowed one of the doctors to perform an unplanned biopsy that should have been done in a hospital instead.

Weird News Andy titles this story “Moob.” In England, a man complains of gender discrimination when NHS turns down his request for cosmetic breast surgery to correct a lopsided condition caused by gynecomastia. “Women get boob jobs on the NHS but I can’t get help,” he says, while NHS maintains that they don’t pay for surgery that has no demonstrable health benefit.

Sponsor Updates

• MedAssets issues a call for speakers for the 2015 Healthcare Business Summit April 7-9, 2015 in Las Vegas.
• Connance presents a video case study of the challenges and successes of Carolinas HealthCare System (NC) after implementing its revenue cycle solution.
• Billian’s HealthDATA offers its Vitals hospital news and RFP feed free to the public.
• Aventura will participate in the SE conference of the HIMSS Summit in Nashville September 16-17.
• The CDC and Premier release research indicating that unnecessary hospital antibiotic use costs $163 million.
• Chilmark Research names Wellcentive a “Standout” Vendor in Product and Market ratings in Population Health Management Analysis.
• Health Catalyst shares the results of its recent survey of CHIME members which indicates analytics is their top priority.
• Aspen Advisors highlights its framework and recent engagements with organizations that are realizing the full value of their EHR.
• Frost & Sullivan recognizes GE Healthcare IT with an innovation award for Centricity Financial Risk Manager.

EPtalk by Dr. Jayne

It’s amazing how varied my work as a CMIO can be at times. Hot on the heels of some ridiculous implementation escapades, I’ve had a week of actually enjoyable work. I started the week attending a web-based focus group for one of our vendors. They did a great job putting it on and I give them an A-plus for facilitation skills.

The task at hand was to review some mock-ups for updated Patient-Centered Medical Home workflows. Instead of just throwing us into the content, they took the time to talk with the group about our existing workflows, including the good aspects as well as the challenges. The moderator made sure everyone was participating with a good mix of calling on people and letting them volunteer.

Web meetings are always hard, especially with a group of attendees that don’t really know one another. Someone is always trying to talk over the group or failing to mute themselves while they’re banging around their office, but we didn’t have any of that.

Only after they heard our needs did we see the mock-ups. It was an effective strategy because you didn’t have people throwing out all kinds of additional needs because they hadn’t thought it through. We were validating our needs against their ideas rather than being reactive.

Additionally, their mock-ups were well done with real-world scenarios. I’ve seen samples from other vendors where it looks like they just chose random drugs from a reference book, but these were spot on. I appreciated the fact that they prepared for us rather than asking us to imagine how it would be for the scenarios we see every day.

Usually after a four-hour web meeting I’m ready to bang my head against the wall (assuming no martinis are available), but I was actually a bit sad to see this one end. We’re regrouping in a few weeks, however, so that gives me something to look forward to.

Following the focus group, I was able to use the fact that my boss is out of town and our standing one-on-one is cancelled to do some belated spring cleaning in my office. It’s amazing how much junk accumulates. I’m ashamed to say I found a bunch of marketing collateral from HIMSS that I shoved in a drawer six months ago and promptly forgot. Sorry, marketing folks, I won’t be following up. But the cool Mylar folding wine bottle drip-proofer attached to one packet was a nice find.

Today I was able to spend some time mentoring a relatively new physician champion at one of our hospitals across town. Although he has a great deal of knowledge on the inpatient side, he’s just starting to get involved in ambulatory projects. He’s also studying for the clinical informatics board exam next month, so we talked about tips and tricks.

His facility is relatively new and has always been paperless, so it will be interesting to see how he does working with physicians who are transitioning from paper to EHR at the same time they’re transitioning to being employed. I’ve shared some of my horror stories, but from the expression on his face, I’m pretty sure he thought I was making them up. I can’t wait until he has a war story of his own.

The most fun thing about working with him is showing him some of the cooler features of our EHR. I spend so much time listening to physician complaints about how bad it is and how computers are ruining the practice of medicine that it was good to get an outsider view of its capabilities. He’s had formal training from the vendor, but taking that knowledge and applying it to a real-world practice workflow when you’re being interrupted by phone calls, nurses popping their heads through the doorway, and the mounds of paper that inhabit our “paperless” offices is another thing.

The best part of the meeting was when he asked what websites I would recommend to help him learn more about the IT landscape. I get an “F” on my mentor report card because I unfortunately couldn’t tell him about HIStalk. Hopefully he’ll stumble upon it or maybe one of the other informatics staff will recommend it, but it’s always a surreal experience when my worlds almost collide.

Got an alter ego? Email me.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 9/11/14

2014 Edition Release 2 Electronic Health Record (EHR) Certification Criteria and the ONC HIT Certification Program

ONC scraps its voluntary 2015 Edition EHR certification criteria, providing some flexibility for EHR vendors, but doing little for providers that are not yet ready for the start of the MU 2 attestation period.

Epic retains lobbyist to improve image on Capitol Hill

Epic hires lobbying firm Card & Associates to help address its reputation on Capitol Hill as an opportunistic EHR vendor selling closed systems that are unable to exchange data with other vendors.

Watchdog Says V.A. Officials Lied

Richard J. Griffin, the VA’s acting  inspector general, said in testimony to the Senate Veterans’ Affairs committee on Tuesday that during its investigation on scheduling improprieties, 42 VA health care facilities were found to be altering appointment wait times. Additionally, 13 VA administrators are accused of lying to IG staff during the investigation.

Homeland Security picks Mass company for electronic health record system

eClinicalWorks wins a $5 million contract to provide EHRs for the U.S. Immigration and Customs Enforcement’s detention facilities.

An HIT Moment with … Travis Bond

An HIT Moment with ... is a quick interview with someone we find interesting. Travis Bond is founder and CEO of CareSync of Wesley Chapel, FL.

Consumers have voted with their feet in failing to adopt personal health records platforms that require them to maintain their information manually. How is CareSync different?

Traditional PHRs have failed for a lot of reasons, but it ultimately boils down to the fact that gathering and organizing health information is a lot of work. A complete hassle, actually. Let’s face it, unless it’s out of necessity, it never becomes a priority for most people.

We recently did some interviews with a handful of our users and almost everybody said the same thing: “I knew that I needed to get my hands on this information, but just the thought of getting it overwhelmed me.”

We obviously love technology and I believe that the ball is moving in the right direction in HIT, but we’ve got a long way to go before technology solves the data, communication, and care coordination problems that plague healthcare. Collecting medical records from various providers is a hassle, the data is fragmented across various health systems and providers, and even if you manage to get them all together, the information isn’t particularly meaningful.

We often have internal debates whether or not we are a PHR. We are in many ways, but our approach is completely different. It’s not just the high tech, but rather the combination of great technology and high-touch concierge services to connect people and data and truly redefine the role of the patient in healthcare.

We have a team of people who gather all of a user’s available medical records from all of their providers. They enter data such as health conditions, medications, and allergies into structured, codified fields. They build a digital record of each past medical visit, including the provider’s assessment and plan. This comprehensive Health Timeline is easily filtered and electronically transmitted to providers directly from the app.

Users add family, friends, and other members to their care team. We believe in the “it takes a village” concept when it comes to managing healthcare, so family and other caregivers can help with tasks, appointment prep, and medication compliance. They receive notifications and alerts to help their loved one stay on track.

Our latest release includes tracking and measurements. We’re layering clinical data with patient and family-generated data in the form of journals and pain scales, vitals, and behavioral data with integrations with tracking and wearable devices.

We make the data accessible, useful, easy-to-understand, and even easier to share with the people who need access to it.

How do you sell subscriptions to consumers without spending a fortune on marketing?

We focus our marketing energy and dollars on targeting the population where our solution meets a true need today. That’s primarily people who have a chronic illness and the people who help take care of them. We’ve been successful with social media engagement, speaking at events, and doing some targeted advertising. We have partnered with some chronic and rare disease organizations as well.

We also sell CareSync to businesses, including hospitals, payers, employers, pharma, and even universities. Each use it a little differently, but everybody benefits when people are healthier and engaged in their care. Employers are offering it as an employee perk and to reduce their healthcare costs. A specialty hospital is relying on our newly released Pro version that functions as a communication layer between their organization and the patient and caregivers.

Very satisfied customers, word-of-mouth, and people adding family members and other caregivers who quickly become paying customers helps, too.

What’s different about creating technology for patients and families instead of for doctors?

This is somewhat hard to say without sounding harsh, but we believe the biggest difference has been how appreciative patients and caregivers are. We get calls and letters every day from our users who are thankful for how we helped them better understand their condition, prepared them for an important visit with a super specialist, and helped carry the burdens that come with being a patient or caregiver. It’s very satisfying knowing that what you’re offering really does make life better for the people who use it.

All that said, doctors are really benefitting from CareSync, too. One doctor I recently talked to told me that it was a breath of fresh air to, for the first time in his career, have access to information from his patients’ other doctors. Like patients, doctors are also really frustrated by the system and truly do want to help their patients.

We have seen CareSync reignite the fire for a lot of doctors by giving them data and engaged patients. One user shared that her doctor hopped up to sit next to her on the exam table to go through her CareSync data. She left the visit with a long-awaited diagnosis and a high five from the doctor.

It’s a refreshing reminder that healthcare can be better.

Healthcare is the only industry in which its ultimate customer has had little voice and is almost lost in the business model. Can that be changed and can technology help?

The only way that healthcare will really improve is to get patients and their families involved, equipped with information and tools to manage and share it, and enough convenience to make them want to participate in what has traditionally been a frustrating and often overwhelming experience.

We have to redefine the role of the patient and give them a voice and unprecedented confidence in choosing what’s right for them.

It’s not just about cost. It’s about decisions around quality of life and personal preferences. It’s about helping the healthy stay that way and not making people feel so vulnerable when they are sick.

You’ve been in healthcare IT for a long time. What are the most positive aspects of it that you are seeing compared to a few years ago?

In 2003, I actually said, “How hard can it be to build an EMR?” It didn’t take long to realize that doing anything in healthcare is more of a challenge than it should be. I believe we’ve made a ton of progress in creating standards. We are starting to move toward accessible, cloud-based solutions.

There are a lot of really intelligent innovators and entrepreneurs tackling the inefficiencies of healthcare, building really great solutions. Change is happening. Technology and the power of the Internet are finally starting to help healthcare like they have in just about every other industry.

Patients are starting to wake up and say, “Enough is enough.” They are equipped with always-on smartphones. People are starting to apply the age of consumerism mentality to their healthcare. Once we get there, that’s where we’ll see the tide shift.

Health IT from the CIO’s Chair 9/10/14

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

EMRs – Application or Platform?

It is hard to go very far these days with out someone looking to dismiss EMRs as “just the transactional system.” It seems every new IT innovation or idea is the next big thing that will do us the favor of connecting with our installed systems, but do so much more. Population health, analytics, mobility, and patient engagement are all the new platforms to focus on.

Wait. EMRs are depended on every minute of every day to enable care delivery through zillions of transactions and are the result of years of hard work and untold dollars. They aren’t a platform? Really?

I want to believe that our enterprise EMRs are really agile platforms on which care delivery can be transformed. They are just works in progress. Oracle, SAP, Facebook, and Salesforce.com all started as applications and grew into platforms. Some better than others, but it was a journey.

In my mind, our industry’s EMRs are on this same path. I think that the EMRs brought to us by Epic, Cerner, and Meditech (which I will refer to as the Gang of Three) all have a shot to truly be called a platform.

If the Gang of Three want to be seen as a platform and not just an application, they will need to evolve as did their big brothers in the ERP world.

Demonstrate market share dominance through rapid growth, consolidation, and the other vendors pivoting their business models in other directions as not to compete head to head. A goal here is to establish enough customer mass that effective and brilliant “group think” could take place. The market moves buyers to want enterprise all-in-one solutions instead of best-of-breed department ones.

I’m going to give the Gang of Three a grade of A on this one.

Demonstrate innovation of function, design, and features. Basically, they should be darned good — maybe even outright awesome — at transactions. Expect to see massive investments in R&D and lots of co-innovation with customers.

I’m going to give the Gang of Three” an A on this one, too.

Be regarded as having deep industry capabilities, clear and comprehensive road maps, and embedded best practices. Other software vendors from other industries would view the vertical as too complex to enter based on the learning curve.

The Gang of Three earns a split grade on this one. Deep healthcare knowledge, A. Comprehensive roadmaps, B. Embedded best practices, C.

Provide analytics. This would be translated as performance suites with end user-centric dashboards, complex and robust data integration suites, comprehensive data quality tools, and the real belief that they are enabling massive amounts of information to be transformed to competitive knowledge.

The Gang of Three gets a B+ for focus and initial efforts, but a C for execution.

Support mobility. This would be demonstrated by enabling wireless workflows across the organization. Optimized work can be done from anywhere, at any time, and on any device. Costs and tools matter in this space, so device management and security are key parts of all offered solutions.

The Gang of Three earns a C. Good progress on vision and good early applications, but with lots of work ahead.

Demonstrate reliability, flawless uptime and performance, and sub-second response times. Terabytes of data managed and delivered at the speed of thought. The paradigm of all information available in real time would be realized and would drive the enablement of new workflows never imaged before the system was installed. With the reliable availability of information, new business models to share and move data around the ecosystem would emerge.

I’m going to give the Gang of Three a B+.

Platforms are not just about function, but equally about cost. They would need to enable the shift within the IT organization of today that typically has 80 percent of costs on tactical IT delivery and 20 percent on strategic initiatives to at least a 50/50 split. IT operational costs consuming the majority of resources are lowered through hosting, cloud, and other leveraged services to allow for greater spending on innovation. Support costs are predictable and fall over time. Costs act as a consolidation driver as much or more than workflow.

This earns a B for the Gang of Three.

The toughest and probably the most important area for our gang to distinguish themselves as a platform is to create choice by building a leveraged open ecosystem. Choice would be fully realized by creating open APIs to access data models and workflows. Customers and third-party vendors would look to solve problems by building solutions within the system and innovation would be an open challenge to solve for everyone.

The Gang of Three gets a D-. This alone isn’t the definition of a platform, but it is crucial to the mix. This is the biggest area in which our gang needs to improve.

So, Gang of Three, it is time to get everyone involved to help us solve problems. Talk to your customers and third-party developers, court them, and encourage them to build their applications in such a way that they have a technology dependency on you. Risk some value you may create on your own, but balance it by figuring out how to extract value from your new workforce – your third-party developers.

It is time to enable choice!

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.