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3 Questions Apple Must Answer to Reduce HealthKit Skepticism

There has been a lot of buzz around Apple’s announcement to enter the healthcare space with the unveiling of their Apple Watch and HealthKit app. HealthKit seems to be gaining momentum due in large part to Apple’s strategic partnerships with healthcare industry heavy-hitters. However, many questions remain 3 Questions Apple Must Answer to Reduce Skepticismunanswered and Apple must address them to gain buy-in from skeptics.

PRIVACY: How will patient information be kept private?
Having all patient information in one place seems like a necessary step to improve quality of care. A centralized location means the right person can have access to the right information at the right time. However, people are concerned about having all their private information in one location is too risky and makes them susceptible to hackers. Recently, Apple addressed privacy concerns by updating their privacy policy and their guidelines for app developers. Apps working with HealthKit, may not use the personal data gathered for advertising or data-mining uses other than for helping manage an individual’s health and fitness, or for medical research. Apple is also considering a “HealthKit Certification” for developers to help address the privacy concerns.

SECURITY: How will patient information be protected?
For years, there have been very little security concerns surrounding Apple, however, concerns over Apple’s security have risen recently after an alleged hack on iCloud led to several risque celebrity photos being published. According to cloud security vendor Skyhigh Networks, over 90% of cloud services used in healthcare pose medium to high security risk. Apple has promised to tighten up security on the iCloud to protect patient information. Healthcare consumers must regain confidence in Apple’s ability to keep their information secure and safe from hackers.

REAL-WORLD USE: How does the HealthKit work?
Lets face it, people are busy, Healthcare professionals are overloaded, and focused first and foremost on providing quality care to their patients. They do not have time to play with an iPhone app, needless to say,  HealthKit data must be streamlined. It must be convenient, provide accurate and timely information and integrate seamlessly into a patient’s electronic medical records. Simply put people aren’t just going to use HealthKit because it is an Apple app, they aren’t going to use it because it is a fad (at least not long-term), they will use it because it is convenient and can improve patient outcomes.

Apple continues to build on their partnerships with major players in the healthcare industry. They are preparing to launch trials with two prominent hospitals in the United States. The trials will focus on a group of people with diabetes and chronic diseases and will offer a glimpse on how the HealthKit will work. The HealthKit app will receive information from regulated medical devices such as glucose monitors and blood pressure meters.

Standford University Hospital is working with Apple to track blood sugar levels in children with diabetes and Duke University is helping to develop a pilot program to track blood pressure, weight and other measurements for patients with heart disease and cancer. The goal with both of these trials is to improve speed and accuracy of data reported. If these pilot programs run smoothly you can expect to see them rapidly expand to other hospitals.

It is still too early to tell what impact Apple will have on the healthcare industry, but they are certainly putting the right pieces together. More work needs to be done to address privacy and security concerns and gain trust from the healthcare community.  Their partnerships with hospitals, medical information services and medical device makers may be the perfect storm,  but the success of HealthKit will depend on those that actually “use” it.

The Meaningful Use Marketing Fail Keeping VPs up at Night

In a recent chat with the VP of a large health system, I learned what keeps him up at night.  His organization, like many across the nation, has invested mountains of time and money in Meaningful Use Stage 2.  Like most health systems (all but 11% says research groups like KLAS) they chose to invest in the patient portal modules available through the EHR vendor.  This Blog_What-Keeps-You-Up-at-Night2is largely because most Meaningful Use patient portal decisions are being made by IT, as opposed to business.  At the top of the list in IT decision making criteria is integration with EHR.  So, VPs like my new friend at this large health system are able to cross off the features required via Meaningful Use quite easy.  All except one…

They are having a heck of a time getting patients to actually adopt the patient portal technology.

It appears as though the “if we build it they will come” concept hasn’t quite held true in the case of patient portal.  In fact, the statistics are rather staggering.  Recent research discussed in the HealthData Management article entitled “Patient Portals Not Yet Go-To Platform for Patients” reveals:

  • Almost half of patients don’t even know if their physician has a patient portal
  • 11 percent are confident their physician “does not” offer one

And here is the kicker for a recovering marketer like myself:

  • Less than half of those surveyed–49.2 percent–report actually being shown a patient portal by their primary care physician either during a visit or outside a visit

And why is this keeping folks like my VP friend awake at night?  Well, first and foremost it is because healthcare providers like him are fans of patient engagement and want to provide patients with the tools they need to stay healthy.  Taking it a step further, Meaningful Use Stage 2 is a financial incentive.  The criteria for getting those incentive dollars are not met when you build a patient portal.  They are met when a critical population of patients adopts the technology. Early results are in, and patients are not adopting.

So, what’s the the underlying problem here?  Well, it’s multifaceted, but much of the error falls in building patient portals that are not user centric.  he user, the patient, is and should be the center of our universe.  However, it is oftentimes not the department of IT, the department largely in charge of Meaningful Use, that invests in stores of knowledge like user experience.   I’ve also been met with many blank stares across conference room tables when I ask healthcare provider portal teams about campaigns their marketing team have created to drive attention to the portal and journey maps that have been created across their patient digital experience to drive patients into the portal.  In my opinion, Meaningful Use is one of the biggest marketing fails I’ve seen in my career thus far.  There is not alignment between IT and the rest of the organization on the measures needed to drive patient engagement.  In my opinion, which has now been validated by this research, a campaign that does not also consider physician adoption of portal technology is a campaign waiting to fail.  If the physicians are not using it, then their patients will not either.

This is why I began the dialogue a few of months back on what the market says you need in your patient portal.  The market, which in reality is simply cumulative actions of patient populations, is the most important input into the creation of a successful patient portal.  You can see some of the components of a user centric patient portal in that series:

 

 

 

 

Apple: The New Digital Hub for Healthcare Data

In 2001, Apple introduced the ipod, and even though they weren’t the first to create a digital music player, the innovation, convenience and simple integration into iTunes, helped the ipod take digital music to the masses. Apple hopes to have a similar experience with the Apple Watch.Apple: The New Digital Hub for Healthcare Data

In a much anticipated event the tech giant revealed the new Apple Watch (VIDEO), a comprehensive health and fitness device that will collect medical and fitness data. Apple’s introduction to the wearable technology space comes at an opportune time. Although wearable technologies have typically been owned by gadget enthusiasts, calorie-counters and fitness buffs, a recent analysis by Citi projected the smartwatch market to reach $10 billion worldwide by 2018. If Apple gets it right, they could be the first to make average people want to buy a wearable device.

Tracking health data is already common amongst many Americans. A January 2013 report by Pew Research found that 69% of U.S. adults track one or more health indicators. Of those that track data, 49% say they store the data in their head and 34% use paper. The Apple Watch will electronically collect the data and share it with healthcare providers through the Apple HealthKit app.

apple_watchThe Apple Watch and HealthKit app are a game changer for the healthcare industry but it is Apple’s partnerships with healthcare industry giants such as Epic and Mayo Clinic that will be the key to their success. These partnerships will be a win-win for everyone as healthcare stakeholders work together to achieve better patient outcomes and lower the cost of healthcare.

The combination of the Apple Watch, the HealthKit app and industry collaboration could help solve the healthcare data collection problem and facilitate continuous wellness rather than sick care. If Apple can solve the data collection challenge and provide seamless medical and fitness integration, the healthcare industry will be dramatically changed, and Apple may become the digital hub for healthcare data.

Do you think Apple will revolutionize the healthcare industry? Lets chat @Perficient_HC

ACA and QRS – Shoot for the Stars Part 2

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In this blog, we will take a closer look at the data derived measures and what factors a QHP issuer should consider to achieve high scores.

HC DataFor reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the data derived measures:

Leverage Accreditation Processes

It was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS data measures with HEDIS measures that are typically required during accreditation. So, make sure to leverage current investments to keep initial costs low while jump starting QRS efforts.
Read the rest of this post »

Re-think the Customer Portal Using Cloud

The Affordable Care Act (ACA) has had an enormous effect on health plan organizations. ACA has created choices for consumers,  impacted health plan business models and changed how they serve their members. Health plans are investing in technologies that align with their business strategies and seek scalable and flexible options that improve member interactions and customer service.

In this video, Fernando Acosta, Director of Infrastructure Management, Blue Shield of California discusses the changing healthcare landscape and how Blue Shield of California chose Perficient as their system integration partner because of their healthcare expertise . Perficient’s Doug McCulloh (@dougmcculloh), Director of Business Development is also featured and discusses how Perficient uses portal patterns to speed deployment.

The new robust customer portal allows Blue Shield of California the ability to grow on demand and deploy new environments in hours rather than months and improves customer experience.

7 Features the Market Wants in Your Patient Portal: Blog Series

In case you missed it, we recently concluded our blog series on What the Market Says You Need in Your Patient Portal. Two of our healthcare experts, Melody Smith Jones, Manager of Connected Health (@melsmithjones) and Nick Lecker, Director of Architecture and Interoperability teamed up to take a deeper look into the 7 features that the market wants in your patient portal:7 Features the Market Wants in Your Patient Portal Blog Series

Healthcare consumers are at the center of the industry’s evolution and patient portals are going to continue to be a vital tool for connecting, engaging and empowering them.

 

Beyond the BI Strategy: 4 Steps to ROI

In a recent issue of PC Today (www.pctoday.com), there was a quote by Cindi Howson of BI Scorecard that really stuck in my mind: “There are far too many cases of companies having good data, good tools, but a culture that’s a barrier to using that data for action.” Frequently, outside Beyond the BI Strategy: 4 Steps to ROIconsultants are brought into an organization, especially in healthcare, to pull data out of silo’ed applications, cleanse it and land it in an enterprise data warehouse (EDW). Then the real fun begins as the organization tries to determine what their expectations are from this treasure trove of data. More importantly, this struggle to determine the value of the integration of clinical, operational and financial data can stall the return on investment for this important and difficult effort.

In conducting a business intelligence (BI) strategy, it is very important to investigate those silo’ed data sources to determine which elements can benefit which part of the organization and to notify internal groups of the new resources. In other words, the Enterprise Data Warehouse needs exploration and promotion to the key stakeholders or by the key stakeholders to gain new insights and derive the new value. Matching data to the right people is fundamental to success and deserves its own tracking mechanism in data governance. Moving beyond the original stakeholders and their requirements in a BI strategy and getting down to who really will use the data and how it is used helps drive stronger outcomes for the use of the integrated data. It truly isn’t just start with the end in mind, but exploring how the new integrated views of information can drive improved operational processes and solve daily problems in a real-time manner.

It is often frustrating to data warehouse builders because they understand the value stored inside but don’t know who needs the information to take action. It is worth educating and promoting this big investment! If a key data source is overlooked for real improvements in an important corporate process, then find it and add it. If data has moved past its useful life, then it should be moved to an archive to keep the enterprise data warehouse relevant and in step with the organization. Many organizations set up BI Competency Centers to help govern and develop the enterprise data warehouse, but my suggestion would be to make those centers a place for brainstorming, exploring and deriving value on an ongoing basis.

In healthcare, as we strive to lower costs and adopt a lean process improvement methodology, our process of using high-quality data should help identify new revenue opportunities, serve our communities more effectively and encourage us to explore possibilities. That exploration should start with the data that we work hard to acquire, extract, transform and load in our enterprise view. As data comes in faster, we need to respond quickly by connecting the data with the right users.

To summarize, in moving beyond the build stage of an enterprise data warehouse and gaining the return on investment, there are four key steps:

  1. Identify the “new” stakeholders that will use the EDW in their daily jobs
  2. Help the new stakeholders explore and learn what data is available to streamline clinical, operational or financial processes, possibly in a BI Competency Center to master tools
  3. Promote the success stories to create action from all parts of the organization
  4. Realize the return on investment from your EDW – celebrate!

Market Driven Patient Portal: Integration of Data

In our last conversation about  “What the market says you need in your patient portal” we discussed the needs of integration and interoperability. This is an area that, while interesting to the IT team, often does not get a lot of attention. This is not because this topic lacks interest, rather, it’s just not the most appealing topic to talk about. For example, when you are Market Driven Patient Portal: Integrate Dataremodeling your bathroom, you discuss the fixtures, the new shower, the new faucets, even the fancy commode; but do you get excited talking about the plumbing? Likely not, however it is the ability to move and connect the items of interest together that makes the project all come together. If you do not connect something the right way you get water all over…or worse.

So, what does this have to do with clinical and financial data? For one, the data is generally in various systems and data stores throughout the organization and generally it comes from multiple organizations. For example, if you look at these concepts from a health plans point of view, the clinical data is coming from HIE’s, provider facilities, clinical labs, purchased data sources, and others. The financial data is coming from claim systems across multiple lines of business, GL systems, AR/AP systems, and others. All of this data still has to be aggregated, cleansed and organized to make it useful. This is not an easy task and having the strategy, the information models, the plan and the governance are all key to ensuring success of these efforts.

Another reason integration is important is it helps define the consumer of the information. Typically, financial data has been reserved to back office functions or it is used to help define/negotiate the cost of services whether they be premiums, reimbursements, subsidies, etc. With the advent of consumerism, the patient is demanding more information in this arena. Patients want to know what their total cost of services are. They want to know the details of the fees. They want the ability to compare costs, values, outcomes so they can make a well-defined choice. Patients generally look at the cost as the driver, yet there are behavioral changes that need to be overcome; e.g. the higher priced option must be the best, right?

There is a lot still to overcome in this area as providers have typically held on to this information and patients may not be able to understand the complexities of where the money actually flows. Integrating the clinical and financial data is a stepping stone in the path to a full consumer-driven healthcare model. Government mandates are forcing the need for change, however, breaking down the walls to integrate information will not be easy. Meaningful Use Stage 2 (MU2) will be one of the drivers to help make healthcare interoperability a reality.

Core to solving these problems is having a clear understanding of the business capabilities and processes that drive the solutions. Understanding (documenting) the business capabilities, defining the information needs (again documenting) and then defining the business processes (yes writing it down) that act between the capabilities and information will be the blueprints and guides to setting and achieving the vision. With the vision established, we then can begin the process of connecting the dots of where the information lives to where it needs to go and the format which it needs to be in. There are a number of technical challenges given that interoperability is not just a simple plug-n-play solution. The movement of the information needs to follow standards (which by-enlarge exist) yet all of the connections and the subtleties of the content need to be clearly outlined in the road map of integrating clinical and financial data.

This concludes our “What the market says you need in your patient portal” blog series.

Perficient Ranked One of the Largest Healthcare Consulting Firms

For the sixth year in a row Perficient has been recognized as one of the largest healthcare management consulting firms by Modern Healthcare. This year we were recognized at #13 on the list, which is comprised of the 70 largest healthcare management consulting firms in the US, ranked by 2013 Perficient Ranked One of the Largest Healthcare Consulting Firmsrevenue from provider consulting fees.

Being ranked one of the largest consulting firms in the healthcare industry is an honor and we are proud to be recognized alongside other influential healthcare firms.

The full list is available for purchase from the Modern Healthcare website.

 

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Market Driven Patient Portal: HIE Across Diverse Care Settings

So far in this discussion about “What the market says you need in your patient portal” we have been driving toward changes that are core to new engagement models. However, we have not addressed a core enabler: “It’s all about the data!”

Consumers demand access to information that meets their needs and they are not complacent Market Driven Patient Portal: Health Information Exchange Across Diverse Care Settingswith becoming hunters and gatherers for the information is truly about them. Consumers in today’s market demand accurate and up-to-date information about their health profile, just like they do with respect to their financial profile. However, the systems and processes to make that information available are not all there.

There are various sources of the information that are relevant to the patients/consumers (and also to the providers providing care to their patients). Much of this data has been distributed through the provider community. Some of the data is in the provider’s own systems. Some of the data is in the hospitals EHR systems. Some of the data is in outpatient facility systems. Other data is isolated and hard to locate.

With the push to HIEs some of the data is now becoming more available to the providers and to the patients they serve. However integrating the data into a holistic view is still a challenge. The information still needs to be gathered / extracted from the source systems, transformed into a structure that the HIE can understand and then there are the issues of translating the codes and values to normalized/consistent terms following a defined set of vocabularies. Additionally, ensuring a unified view of the individual can be a challenge. Enterprises IT groups are leveraging Enterprise Master Person Index (EMPI) solutions to construct the golden record of the individual but this also has its challenges.

Once all of the data is assembled (assuming that it is) the next challenge is to get the information to the right person at the right time. The HIE now needs to be integrated to the rest of the enterprise. Exposing the information in terms of the services or APIs can now begin. Finally the Portal (and this is just one of the consumers) can begin to consume these services and make the information available to the consumers. What’s also of importance is that the consumers can access this data from multiple perspectives. The provider can see full episodes of care across multiple care locations. The patient can see their health profile all in one location.

Having a single view of one’s health profile (or even the illusion of) is a powerful tool. Not only does it provide insights for better care, it breaks down the walls of information silos that have challenged providers and patient’s alike. Again, it is all about the data, and integration and interoperability are the key.

ACA and QRS – Shoot for the stars! Part 1

Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space.  In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few Shoot for the stars!posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:

  • Clinical Effectiveness
  • Patient Safety
  • Care Coordination
  • Prevention
  • Access
  • Doctor and Care
  • Efficiency and Affordability
  • Plan Services

The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.

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Market Driven Patient Portal: Avatars for Personalized Coaching

In our next installation from the “What the market says you need in your patient portal” series we bring you avatars. These avatars are closely related to our last post on gamification and serious games, but their real value proposition is in what I like to call “high touch digital healthcare.” Many may think that “high touch” and Market Driven Patient Portal - Avatars“digital” cannot exist in the same concept, but oh they can.  We are actually beginning to see that in some cases patients prefer high touch digital to face-to-face care.

Here are some examples:

  • Patient Education: In the realm of patient education, we had a study that used digital avatars with human characteristics to help women through preconception health.  In this case human interaction was not replaced.  Rather, the avatar augmented and furthered the patient experience through the use of digital technology.  The avatar asked initial questions and then triaged the more difficult interactions to clinicians.  This allows clinicians to have more time to deal with complex issues. Add this to a patient portal and you begin to see how patient health concerns can be triaged remotely with the requisite education embedded throughout.
  • Appointment Registration: I love that more and more healthcare organizations are making online pre-registration an option.  Going even a step further many hospitals and ambulatory care centers are digitizing the in person appointment registration, which I mentioned in an earlier post of this series. Let’s add avatars to this process, which adds a “human” touch to an otherwise clinical process (pardon the pun).
  • Patient Discharge: The discharge process is ripe for errors and omissions.  All too many times patients arrive home without having absorbed the right data they need to maintain their health.  The result is often costly readmission.  Even a couple years back I was able to witness a demonstration of the use of avatars during the discharge process.  Through an automated touch display, patients were able to navigate through their discharge instructions in an interactive way.  The avatar even threw in fun questions like whether or not the patient preferred the Red Sox or Yankees (read: the hospital was in Boston).  Patients provided rave reviews for their avatar led discharge experience.  In fact, the experience was rated higher than in person discharge by a wide margin. Now, let’s add this functionality into the patient portal as well to continue that interaction remotely to ensure that those discharge instructions are followed. I’d suspect that you would see a marked improvement in readmissions rates simply because discharge instructions are adhered to.

Overall, avatars and other forms of digital high touch are a win-win-win.  They are low cost (win), add a sense of fun to otherwise lackluster processes (win), and increase quality all at the same time (win). Stay tuned for our final posts in the series where we start to discuss the importance of health information exchange and interoperability as they relate to the patient portal.