Most times when the word “participatory” enters my lexicon it is closely followed by the word “medicine”. I’m a fan of participatory medicine. If you don’t believe me, then you can look here, or here, or here for written proof.
Participatory medicine is a care model in where the role of the patient is active, enabled, and emphasized. Participatory medicine requires the “mindful” inclusion of the patient in the care delivery process. When you see online patient communities forming, then you see participatory medicine at work. You will also witness shared decision making, patient participation on the treatment team, and evidence based patient choice. The director of the U.S. National Institutes of Health has been quoted as saying:
As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive. It must be based on education and communication.
These are the types of sentiments that make someone like me very happy. The fact that I get to play a role, even though quite small, in this movement is the kind of intrinsic motivator that gets me up each day happy to do my work in Connected Health.
In Connected Health we design technologies meant for patient engagement. They are the communication lines that extend outside of the eight minute patient visit and into the lives of patients wherever they are when healthful decision making counts. As a result, another participatory term set is beginning to exit my mouth more frequently. That is, namely, participatory design. Participatory design, also known as cooperative design, emphasizes active inclusion of all stakeholders, even those that do not know how to use Photoshop, in the design process. Key to this end is the end user. In our case that means the patient. By using participatory design, we are able to create environments that are more responsive and appropriate to a patient’s cultural, emotional, spiritual and practical needs. User empowerment is built into the core of this process.
So, what if patients were crowd-sourced more regularly to solve all of those challenging patient engagement issues? For example, many of the biggest challenges I see on provider websites occur because it is challenging for an employee of a health system, the ones actually making the final decisions, to release their mind from the confines of their day job. This usually means that the content of the public website is architected in the way that employees see the organization: by department or facility. Problem is, this gets in the way of patients trying to find the information they need to be more healthful. Patients shouldn’t have to navigate 5 layers deep to find content specific to their condition or health concern. Patients won’t work that hard. Instead, the hub of digital patient engagement should have, at its core, the patient user experience.
Not being new to the public website creation rodeo, I’ve found the process and final product to be greatly improved through the addition of patient voices throughout the entire website design process. I’ve never met two patient populations that are the same, so while there is general advice on tailoring a message to patient needs, insight should always be collected from the target market in question. This insight informs the nuts and bolts of information architecture and the engagement of graphic design.
As a result, a one and done approach to patient feedback is good. An iterative approach to patient feedback on site design is better. Co-designing a site with patients? I would love to see that on every provider website. By using participatory design to reach out to patients in the beginning of the relationship, with the website that engenders a culture of participation, then it makes it that much easier for that participation to be embedded throughout the entire collaborative care model.
Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like.
With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience. However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting. Therefore, it is equally, if not more important for those in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model.
The benefits to improving patient experience are plentiful, regardless of the care setting. However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities. Here are the exact details they provide:
Ok, it’s true. I’m a closet geek. I think no one knows how much I love maps. (Lesli Adams, my colleague at Perficient, often describes herself as a geek so this is homage to her). There are so many different kinds of maps, so which ones do I favor, you ask? I think the best maps are the three “G’s”,
Let me show you how all of these have relevance to healthcare:
Let’s start with geospatial.
I am fascinated by the heat maps of disease prevalence, patient engagement and demographics that have started to electrify Healthcare. Duane Schafer, Director of Microsoft Business Intelligence for Perficient, recently revealed a great demo at HIMSS, based on Population Health statistics from ProHealth in Wisconsin. Using basic tools from the Microsoft stack, Duane was able to visually map important population health statistics from ProHealth and present that data in a way that entices the viewer to explore deeper. It allows the organization to see, at a glance, major population demographics in their region. This can then be combined with additional analytics to determine trending of disease in the area, frequencies of patient visits to the Emergency Departments over time and correlations of missed appointments to care gaps in specific chronic disease management. Geospatial mapping even hit the news recently when a contamination at Lake Champlain caused concern about the risk of spreading disease and therefore assisted with facilitating a rapid Public Health response in this situation. Of course, there are many more examples but you get the idea. Read the rest of this post »
There is no doubt that the relationship between payers and providers is beginning to change, evolving from challenging and adversarial interactions into more collaborative exchanges. Kurt Allman, in his article in Healthcare Payer News this week, outlines 3 components for this relationship to be successful:
Now, we see that payers and providers must collaborate in order to truly drive value, more so than they ever needed to in the past.
When payers and providers work together to achieve all three of the above imperatives, they’ll identify opportunities that will become mutually beneficial. Each can begin by asking themselves whether their high-priority projects are working to help them to obtain higher transparency, data collection and sharing, and a mutual, more collaborative relationship with the other.
Assembling data is both a technical and political challenge. I’ve been involved with multiple hospitals where the finance and clinical teams never really collaborate and therefore the lenses put on either domain is not terribly realistic. Truly merging and using the data requires clinical and financial leaders to establish trust and shared goals that promote an environment of accountability. The key to trusted data is transparency.
Assembling this data requires a robust technical architecture that easily stores the data relationships with contextual integrity along with the ability to resolve patient or person identity. Once the data is assembled, leaders of the organization can build disease registries to manage the cost of care for populations and to model service line profitability, analyze payer contracts and more. The most important benefit of this transformation is that the organization begins to speak a common language of accountability and front line managers begin to understand the relationships between volume drivers and departmental workload leading to increased ownership of controlling these variables. The costing step is important ensure the data as well as the transaction level calculated cost is fully accessible to decision makers. All too often we hear that “my patients are sicker than theirs” or my surgical device has better outcomes. The proof is in the data!
The Oracle Enterprise Health Analytics (EHA) platform in concert with the Oracle Hyperion Profitability & Cost Management (HPCM) solution facilitates the merging of clinical and financial data to perform costing calculations. This fully burdened cost data associated with other clinical metrics such as quality and outcomes measures answer both administrative and operational questions. Using the Oracle platform, patient volumes, outcomes and operational measures are not viewed in an independent environment but instead become dependencies to understanding case mix index, reasons for readmissions, and staffing mix (on a case level), among other things.
Perficient offers design, implementation and support capabilities for Hyperion Profitability and Cost Management (HPCM) and Oracle Enterprise Health Analytics (EHA) solutions as well as the full Oracle Hyperion EPM suite of solutions. We are a silver sponsor for the #OracleIC14 and we are looking forward to talking with you about Health Analytics and Population Health.
Stop by to meet our dynamic team at the Partner Networking Zone, Marriott Copley Square, 4th Floor to discuss new ways to optimize your systems, along with new solutions that will take your organization to the next level.
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Healthcare executives will get together to discuss how to use data to manage populations, increase efficiencies and advance personalized medicine, among other topics at the Oracle Industry Connect, an event that will take place on March 25 and 26 at Marriott Copley Place in Boston. The agenda includes keynote sessions on big data informatics and healthcare analytics, with speakers from Mayo Clinic, Pfizer, UPMC, Walgreens, and other industry leaders.
The Health and Life Sciences breakouts will showcase how these organizations are implementing enterprise-wide data warehouses and analytics capabilities that provide a comprehensive view of healthcare operations—patient visits, diagnoses, test results, prescriptions, referrals, and more—making it possible to arrive at insights that can lead to improved patient care and outcomes.
Perficient is uniquely positioned to deliver the Oracle Enterprise Health Analytics (EHA) platform as well as strategic healthcare analytic roadmaps. Our Oracle EHA based analytic solutions and dashboards provide clients with a short time to value solution that meets immediate needs around disease management, operational efficiency, costing and profitability and quality.
Stop by to meet our dynamic team at the Partner Networking Zone at #OracleIC14, at the Marriott Copley Square 4th Floor to discuss new ways to optimize your systems, along with new solutions that will take your organization to the next level.
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At the Fourteenth Population Health Colloquium in Philadelphia, Perficient’s own Lesli Adams, MPA, took the stage with Sanjay Udoshi, MD and Brady Davis to present “Shared Accountability: How Informatics and Data for Clinical Decision Workflow engages Consumers on the Quality/Cost Equation.” This Mini Summit presentation was sponsored by Oracle Health Sciences and Perficient. The kick-off of the presentation was fun because it introduced the speakers as a business analyst geek (Lesli), an innovation and strategy guy (Brady) and a doc in the box (Dr. Udoshi). The presentation was targeted at the opportunities for quality improvement and cost control including wellness and chronic disease care gaps. At the risk of seeming biased, this presentation was one of the more practical, down to earth approaches at this week’s Colloquium event.
Why do I believe that? Well, I felt that many of the attendees at the Colloquium were seeking real how-to knowledge. Not that the big healthcare organization’s experience in implementing population health management aren’t valuable insights, but there was a lot of buzz about whether population health management can be done in a cost effective manner, and this presentation addressed the type of informatics required to change traditional approaches. The first step was to outline the process in a slide called Population Health Management 101. The key concept was moving paper processes for care management to a digital platform to analyze and manage costs, see figure 1.
The second idea was to re-engineer clinical care to identify and manage care gaps. The first step is to identify the key populations to be managed, then determine the key Goals for that population, and finally to manage addressing the gaps in care or Action Arms (Figure 2). Note that different populations have unique goals but subsequently could have common Action Arms. To address creating the care gaps and related Action Arms, the healthcare organization has to have a strategic vision for these target populations and combine that with the right tactical tools, namely informatics. The challenge of creating these informatics isn’t simply addressed with technology tools, but requires several key steps including:
Addressing Care Gaps is very practical advice for healthcare organizations seeking to really manage populations. Creating informatics solutions that support closing preventive, chronic and restorative care gaps will drive health care value for patients and health plans alike. Creating these informatics requires data mining, process re-engineering and the ability to extract data from modern electronic health record systems. Building patient-centric plans of care based on this process will need to be supported through proactive outreach as well. The key is applying technology tools in novel ways to enhance shared decision-making between the clinician and patient.
Lesli Adams outlined what I see as the key factor to population health management: cost management. The integration of clinical information and financial data is key to cost management and often this data resides in silo’ed or separate software applications. The ability to manage costs by having standardized pathways, then examine costs at a Patient Level will lead to better decision-making and more cost effective care. Putting the disciplines in place to examine physician variability against the standardized pathways is the enforcement technique to bring costs under control. When organizations commit to collecting and cleaning this level of costing information, then profitability reports by service line, DRG and Physician become reliable tools for key decisions about operations. One of the highlights of the presentation was micro-costing examples to highlight the key decision points for clinicians.
Lesli Adams will be presenting at the Oracle Industry Connect event on Tuesday and Wednesday, March 25-26 in Boston. For more information on Perficient’s informatics offerings, especially related to Population Health Management, please contact us.
It was a privilege to attend the Fourteenth Population Health Colloquium in Philadelphia starting on a snowy St. Patrick’s Day. One of my favorite sessions on Monday afternoon was led by Terry O’Rourke, MD who postponed his celebration of the holiday to present “Managing Populations: The Role of a Large Health System.” CHE Trinity as a healthcare organization treats 18 million patients a year and Dr. O’Rourke had a great perspective on the challenges of population health management.
Dr. O’Rourke stated that CHE Trinity was one of the largest home care providers in the United States and that their healthcare organization encompassed 86 hospitals and 21,600 physicians. More importantly, CHE Trinity was participating in 6 bundled payment programs and 29 patient centered medical home programs. His observation that “All Healthcare is Local, All Healthcare Standards are National” comes from an understanding of the need for clinically integrated networks and the role of data driven decision making in reducing variations in outcomes. Terry noted that despite hard work on adopting standards that there is still a wide variation in healthcare delivery. He also noted that the lesser but still significant variation in outcomes across a large healthcare organization was more proof of the resiliency of human body than the careful adoption of standardized procedures.
The key to his presentation was the observation that clinicians need to lead the effort to standardize care, not hospital administrations or others. CHE Trinity created a unified clinical organization with the help of outside consultants that streamlined many silos within the large organization into a whole unit. As a result of unifying the clinical organization, Dr. O’Rourke noted that operating cash flow margins improved to 9.4 – 9.6% across the system. The second step beyond unification was to improve their reporting to encourage data driven decision-making. It was interesting to see how the metrics were converted into grades, like school grades, for easy consumption and judging performance. The different hospital boards had GPAs ranging from a low of 2.1 to a high of 3.6 on a 4 point scale. The goal of the data-driven decision support process was to improve the ease of consuming and acting on the information.
To summarize, Dr. O’Rourke said that “good care is cost effective care.” Clearly, CHE Trinity is focused on bringing a level of consistency in clinical procedures in population health management and improving cash flow margins in the process. As with most organizational business solutions, the focus on people and process yields the best results with technology playing a supporting role was my observation. The focus on people, patients, as the central figure in their clinical processes is real population health management.
The process of effectively managing population health while consistently measuring and reporting its outcomes can be a challenge for healthcare providers.
We will be having a conversation with Christine Bessler, CIO and VP of Information Technology at ProHealth Care and Juliet Silver, Director of Healthcare Advisory Services at Perficient on Wednesday, March 26. We will be discussing some of these issues as well as how ProHealth Care was the first healthcare system to produce reports and data out of Epic’s Cogito data warehouse in a production environment.
During the session, Christine will be answering the following questions:
Juliet will share insight into the methodology applied to establish data governance as a discipline at ProHealth Care, and how the Business Intelligence Competency Center came to be.
Christine Bessler will answer these questions and more during our free webinar on March 26th at 1:00pm CT.
To register for the webinar click here.
I read a blog post recently with references to Oracle’s Marc Perlman @marcdperlman speaking about how Healthcare entities are nearing the timeframe where they can reap the benefits of implementing electronic health records. To quote Marc, “As healthcare providers look to establish enterprise data warehouses, they should begin with a specific project that hinges on this kind of data-driven approach. Once done, enterprise data warehouses become “the gift that keeps on giving,” because they can be used to spread actionable insights to other parts of the organization, as well.”
As my colleague, Lesli Adams @lesliadams writes in her blog: “A healthcare treasure map leading to a single data warehouse”, the Oracle Enterprise Health Analytics platform is a treasure trove of data. The platform combines Oracle Database, Oracle Healthcare Data Warehouse Foundation, and data modeling, integration, and analytics capabilities in an integrated stack that runs on Oracle’s highly engineered Exadata Database Machine. The result is a scalable, high-performance data warehouse that serves as a central repository for health data analysis, which can be done using the built-in tools that come with the system, Oracle Endeca Information Discovery, Oracle Business Intelligence Enterprise Edition, or other analytics applications that are available to run on it.
Perficient is uniquely positioned to deliver the Oracle Enterprise Health Analytics platform as well as strategic healthcare analytic roadmaps. Perficient will be at the Population Health Colloquium #pophealth, and we are looking forward to talking with you about Health Analytics and Population Health.
See our presentation on Tuesday at the Mini Summit on Shared Accountability: How Informatics and Data for Clinical Decision Workflow Engages Consumers on the Quality/Cost Equation. Sponsored by Oracle Health Sciences and Perficient, featuring:
Meet our dynamic team at booth #32 to discuss new ways to optimize your systems, along with new solutions that will take your business to the next level.
Follow me on twitter @teriemc
What are the benefits of online patient communities?
I find myself answering this question quite a bit lately. It struck me this week that I have never answered this question on the blog. But, first things first, what is an online patient community? Online patient communities are, essentially, condition specific socially enabled support groups. These networks provide patients with an opportunity to connect with those that are experiencing similar challenges. Together this collective of voices provides helpful discussion and the sharing of resources. By their very nature, their benefits are many. However, when they are organized by a trusted authority in care, namely healthcare providers, the benefits grow quite dramatically.
So, here is my list of the benefits of online patient communities. Have any more to share? I’d love to hear more from your experiences in the comments section below.
There are some additional benefits for the healthcare provider as well:
The journey into the (officially scientific) exploration of healthcare social media would not be complete without a look into the realm of healthcare specific networking sites that I’ll playfully call “medicinal sites.” These are closed sites that are aimed exclusively for those with either a certain designation or disease state.
In today’s lineup, we will explore two specific sites. One of these sites is meant for physicians and the other is meant for patients.
Although Doximity was not mentioned in the University of British of Columbia study that spawned this blog series, I am going to start here for good reason. Although they are a relative newcomer to the space, Doximity has experienced very strong growth. Last year Doximity doubled their network to a total of 250,000 members, which is 25% of all physicians in the US. What I find fascinating about Doximity is that it was started by the AMA. It’s oftentimes the case that, in the David vs. Goliath world of social media, hip start ups are the ones that people want to follow. The AMA now finds themselves in a situation where they have more users of their social network than they do actual members.
Doximity does a few things right. It’s most popular features, beyond making upgrades that make the user interface more like Facebook or LinkedIn, include:
PatientsLikeMe is a site where e-patients can collaborate with one another in a peer-to-peer supportive setting. The site was launched in 2004 by the family members of an architect that contracted amyotrophic lateral sclerosis (ALS) at the age of 29. They had originally raised millions, literally, in a failed attempt to find a cure for ALS. They also created this patient social network to go along with that effort.
PatientsLikeMe now has over 200,000 members with groups for approximately 1,800 disease states. The most popular networks are neurological diseases such as ALS, multiple sclerosis and Parkinson’s, but there has been growth in members with HIV/AIDs and mood disorders like anxiety and depression. Cancer, with its numerous subtypes, has been a more challenging group to tackle. I have found that these subtypes often form their own online patient communities. You can find a list of these on e-Patient Dave’s website, which I definitely recommend you visit if you want to learn more about how patients are using social in life altering ways.
One of the most incredible things about PatientsLikeMe is not as obvious. Let’s consider a typical patient journey: we get sick, we go to the doctor, the doctor captures data during that visit including family history, bloodwork, scans, biopsies, etc. Then there is the follow up appointment. Perhaps a follow up call by a nurse. But as I often say, that’s only 1% of the story. It is the other 99% of the time when that patient is out there in the real world that matters a lot. So, where do we get all of that data that takes place during the “meantime”. PatientsLikeMe is often heralded as the producer of the most compelling clinical data the health care industry has ever seen for this reason.
As compelling as this data may be, it’s only a speck of sand on the beach. There is far better data capture to be had by socially integrating patient and physician in a meaningful way. This takes me back. Way back. To a post I actually wrote in 2011. What I said then will be where I end here today:
“Patients are online. Physicians are online. However, these two groups are running in different social circles…this presents a true medical problem.”