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Archive for July, 2011

How the Healthcare CIO Saves Lives: #4 Makes Healthcare Available Across Vast Distance

Technologies such as mobile health, telehealth, and social portal solutions are making great waves in healthcare organizations around the world.  Gone are the days where a patient needed to go to the doctor’s office to get important care.  As uses for these technologies increase, and this data is integrated across the care continuum, the Healthcare CIO becomes the focal point for saving lives by connecting patients to providers across distances.  Here are some of the key ways this happens:

Socially-Enabled Patient Portals: A platform where physicians and patients can work together toward their combined goals of better health.  These technologies are particularly effective in rural and low income areas.  These social technologies are being used to enhance the quality of care for diabetic populations in low income areas, for example.  Portals are used to not only transmit data about weight and self-administered blood sugar tests, blood pressure, etc. but also as a virtual classroom to learn about nutrition, exercise, and health education.  Patients are enabled with the ability to send instant messages and email to their healthcare providers and to discuss their disease with other patients via HIPAA compliance discussion boards.  These technologies show great promise for providers and health plans  interested in managing chronic disease, especially for the uninsured. 

Virtual Visits: Healthcare providers such as Kaiser Permanente are increasingly offering virtual visits to accomodate appointments that can take place from a distance.  One question often remains when considering these virtual visits.  How do they accommodate care that must take place in person, such as listening to a patient’s heartbeat?  There are advances in telemedicine that physicians can now call on, such as the scope-to-scope application by 3M.  This innovation gives physicians the ability to hear actual heart and body sounds in real time from any distance – even space.  Using this technology, and similar technologies that are surely on their way, doctors can provide care from across town, deep into rural areas, or even to astronauts at a space station. 

Cellphone as a Doctor Tool:  Increasingly, cell phones are being used to collect and share healthcare data.  As detailed in the Project Health Design article “Using Cell Phones to Improve the Health of Babies and Children Around the World” cell phones are expanding healthcare to those with limited access.  These technologies are being used for medication adhereance, disease management, health and wellness education, and safety monitoring.   These technologies reduce readmissions and slow the progression of disease by providing reminders for medication and allerting providers when necessary.  Check out this article from Mobi Health News on 7 medical phone peripherals you should know.  Dreaming of a day when sodium, glucose, and blood oxygen levels can be monitored via nanosensor “tattoo” through the iPhone (read: no pin prick).  That innovation is here and it is called Nanosensor Tatoo. 

Healthcare technology is an exciting place.  There is great innovation taking place in telehealth, mobile health, and social technologies that are transforming the way care is delivered.  By making these technologies available, the Healthcare CIO  is enabling life-saving care across great distances.

Why Healthcare Organizations are Embracing Social Media

It is no secret that the role of social media in health care continues to evolve and be better defined. As health care professions begin to venture into this new space many red flags and warnings are being issued.  Dr. Brian Vartabedian of the Texas Children’s Hospital/Baylor College of Medicine and collegues from the Mayo Clinic Center for Social Media posted an interesting blog titled Social Media, Residents and Responsibility. What makes this blog interesting is the fact that doctors and respectable entities are condoning the use of online social media outlets for health care professionals, because if done properly the benefits of online communication far outweigh the costs.

Why social media and why the uptick in interest amongst healthcare professionals and entities? The video notes that social media is a way to get the right information to patients and that this is a critical point because patients are getting more involved in their care.

As health care professionals look forward approaches to incorporate health care social media into a practice need to be established. However, health care social media outlets should not limit themselves by thinking that social media means Twitter and Facebook.  Incorporating social media into your health care business plan is about best practices and procedures. Social media endevours are simply stated – another way to address the demands from health care consumers.  

The role of patients within the healthcare industry is evolving and requires new Utilization Management methods. Patients, especially Generation X patients, are demanding a more robust health care environment that is patient centered. Their demands for electronic medical record access, doctor competency scores, hospital infection rates, procedure prices, etc. are being met.  As these demands gain momentum, firms will be forced to examine how social media fits into their business objectives and acknowledge how it has changed the traditionally inelastic healthcare demand curve into an elastic healthcare curve with a competitive landscape.

Moving forward it is important to dig into what consumers are demanding to ensure that (1) they can get what they want, and (2) the organization is properly outfitted to meet consumers new demands.

New Models of Care Delivery Fuel Health IT Discussions

New models of care delivery are inevitable. Whether it’s accountable care, or another favored form, the current incentive structure is evolving.  This is occurring in hopes that waste can be eliminated and quality can improve.

Although there is still much uncertainty, the inevitable truth is that the need to streamline and share information is central to this effort.  Health IT systems will facilitate physicians and clinicians in meeting the highest standards of patient care through electronic participation in a patient’s continuity of care among multiple providers.  In the very near future, providers must be able to identify, access, and seamlessly share patient information to drive efficiencies.

Health IT enables accountable care by:

Providing a Strong Analytical Foundation: The accountable care approach must be based on a strong information management foundation including enterprise data warehousing, advanced analytics and data governance.  If organizations want to track outcomes for judging quality and episodic care management, then near real-time, holistic and integrated information will be critical to success.  A roadmap must be developed for technology to support the new world of accountable care.  Business Intelligence also makes it possible to analyze a patient population to study a disease state, such as diabetes, through clinical studies of a narrow geography. Healthcare organizations then have the ability to handle care issues across the geography and the public health questions that result.

Increasing Data Exchange in Health Communities: Fragmented data across healthcare communities leads to increased cost and decreased patient experience. The ability to exchange clinical information will be critical to ACO success.  Beyond the important aspects of delivering quality care, there are real business drivers that favor an environment where clinical and cost information are combined into a comprehensive system delivery model. The Enterprise HIE eco-system is one approach that innovative healthcare systems are using to enable them to connect patients and physicians together in a more collaborative environment.

Increasing Collaboration Among Patients, Physicians, and Healthcare Communities: Enabling patients and physicians into the design of care increases the financial effectiveness of an ACO, and there are many smart options available to invite collaboration. Healthcare portals can be used to empower patients by providing meaningful access to their care and connect a patient to the entire health system that impacts their care. Similarly, community portals can be created to connect patients to those with similar disease states for information sharing, support, and advice. This empowers patients to work with ACOs in creating cost saving, and patient centric, clinical care. Organizations can also use physician portals to connect physicians to the critical components of clinical care which can then be incorporated into executive decision making. This would enable stakeholders of a healthcare system to come together to create better services and relationships within the community that they serve and increase an ACO’s success as a result.

Given that the healthcare of today and the models represented under accountable care are vastly different, there is a lot of discussion going on in healthcare circles across the country.  I am certain that the ideas shared will continue to flow If you have some thoughts you would like to add to the discourse, then please make a comment below.

How the Healthcare CIO Saves Lives: #3 Decreases our Reliance on Paper

The U.S. healthcare system is run by highly talented people that are using outmoded forms of communication. Many clinicians still use paper files and faxes to communicate and lack the basic infrastructure to communicate efficiently regarding critical care decisions.  As health insurance companies and health providers struggle with efforts to control costs, reduce administration and improve efficiencies, we need to break out of the paper-oriented approach. With EMR and HIE initiatives, the Federal Government has clearly decided that now is the time to go electronic and electronically integrate healthcare systems.

Unfortunately, there are many challenges to adopting electronic medical records (EMR):

  • More than 50% or physician practices are three physicians or less. These small practices will find it difficult to invest and adopt EHR systems. Many physicians lack the knowledge and skills to use these electronic tools and solutions.
  • Physicians have a perception that these tools will impact their productivity and interaction with their patients.
  • Healthcare providers that have adopted these electronic solutions have seen limited analytic data or information to improve or change their healthcare delivery practices.

Despite these challenges, the benefits of electronic health data outweigh the risks. Ultimately, an introduction of EMR will lead to dramatically increased efficiency and more exacting communication around critical patient care decisions. 

Some time ago, one of my colleagues recommended the book “Paper Kills 2.0 – How Health IT Can Save Your Life and Your Money”.  After having given it a read myself, I highly recommend it.  There are some tragic stories inside that will literally cause your hair to stand on end.  The bottom line is that physicians need the very best information in order to make the best decisions.  Oftentimes these decisions need to be made with little time to spare.  Imagine trying to make these critical decisions based on lab results that are a photocopy of a fax of a photocopy.  Though any change is difficult, the paper-based medical world is not a pretty reality.  Even further, one need only look as far as the recent tornado disasters to realize how important electronic medical records were in providing critical emergency care.

Using Enterprise HIE to Move Clinical Information in an ACO

An Enterprise HIE is defined as the mobilization of healthcare information electronically across organizations.  The Enterprise HIE can be used to move information within a region, community or hospital system.  As such, the Enterprise HIE system is a great answer to problems found when forming an ACO.  HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. A HIE can also assist public health authorities in the analysis of the health of the population, which aids the cost cutting goals of accountable care. Ultimately, the goal of an HIE is to facilitate access to and retrieval of clinical data.

As a result, the Enterprise HIE data becomes:

Safer: The Enterprise HIE environment is a highly secured ecosystem that ensures authorized users are the only participants and that the patient grants approval only to those whom they wish to have access to their clinical information. In addition, the information is encrypted and when appropriate is made available for analytic purposes in a de-identified basis. The Enterprise HIE adheres to all HIPAA regulatory requirements that have been and are being mandated by the federal government.

More timely: The patient clinical information is available immediately at the time of care or retrospectively for population disease management.

Efficient: The clinical information is made available through a RLS which negates the need to store and duplicate the clinical information and makes the request more efficient and timely.

Effective: Because the clinical information is from all healthcare service provider locations, physicians and healthcare systems can effectively treat and manage the patient from a real holistic point of view.

Equitable: Since the Enterprise HIE does not discriminate patients by any criteria, physicians and healthcare systems can get access to all citizen/patient information as long as they are receiving care at a healthcare provider that is participating in the Enterprise HIE ecosystem. In addition, many HIE business models have considered moving towards a consumption-based pricing model and therefore participants are charged only for what they use. This ensures that the burden on the cost of the HIE is not unfairly or unjustly charged to the physician community.

Patient-Centered Care: The Enterprise HIE ecosystem provides the backbone to enable the long-term goal of an Accountable Care Organization (ACO) structure with the ability to connect the patient’s home to complete the full cycle of healthcare information sources from the citizen/patient point of view.

Creating this common store of knowledge will ultimately feed the best practices that make healthcare organizations both patient care centric and successful at delivering optimum care.

Does Health Information Technology & Primum non Nocere Live in the Same House?

In a recent American Medical News post, Doctors and Pharmacists unite to improve outcomes, the finding’s of an impressive pilot program were published. The program was focused on examining the impact of patient’s health when physicians and pharmacists collaborate. Results confirmed that individuals with chronic illnesses take their medications only 60-70% of time, but when physicians and pharmacists take a coordinated approach and transfer information amongst each other prescription rates increase to 90%.

Sharing information and collaborating creates bonds and ties that serve as the breeding ground for success. The issue in healthcare is that transferring information has been minimal and data siloed. However, solutions now exist to increase system interoperability, business intelligence and provide analytic support. Investing in these solutions will create a competitive advantage that will ensure long term success.

For example, having synchronized systems and business intelligence can provide organizations with the ability to use their data to improve quality of care. This is increasingly important as changes like improved informed consent includes even more data about costs, alternative treatments, and doctor and hospital performance – or as quality measures are made public.
If the positive results of compliance and HIT upgrades are responsible for notable feats in quality of care, then one question remains: Is it fair to say that organizations investing in life saving HIT will be viewed as the organizations that fully comprehend the “Do No Harm” oath?

How the Healthcare CIO Saves Lives: #2 Promotes Preventive Medicine

Preventive medical services traditionally occur within a conglomerate of divergent clinical care settings.  When these systems are integrated to become fully interoperable, Health IT can be a catalyst for disease-management programs by 1) promoting preventive medicine services and 2) reducing the costs associated with these critical healthcare services overall.

Strategic opportunities in preventive medicine include:

Improving quality of life: By creating a preventive, community-based medicine program, interoperable care creates integrated systems through which the quality of life for each patient can be optimized.

Enabling targeted healthcare services: A single repository of clinical information allows public health and healthcare systems to more effectively create healthcare programs that target those patients who can benefit in more cost-effective and preventive healthcare services. By considering clinical results and looking at other factors such as ethnicity, gender and social-economic criteria, healthcare systems can develop targeted programs that will deliver healthcare services to the at-risk population in more cost-effective measures.

Increasing potential value by encouraging group purchasing: Having a group of patients in a group collaborative can enable them to work collectively in both improving care services and in the purchasing of healthcare services, products and materials. By aligning these groups together, volume-based purchasing can occur and help to more effectively drive down both the individual and community-based cost of healthcare services. Health systems can easily identify these groups and then empower them to take collective action to reduce the cost of healthcare services.

Encouraging focus groups to support one another: Preventive medicine is the best way to ensure the overall quality of life for individual citizens and entire geographic areas. Enhancing integration between the critical components of preventive medicine has the potential to increase the power of preventive medicine exponentially.  Collaboration will drive down the cost of medical care while simultaneously increasing the health of a given area’s population.

Creating a Self-Sustaining Business Model for HIE

It is important for state and local agencies building an HIE solution to have a self-sustaining business model.  This will be especially important once the federal government grant money ends.  It is just as important for healthcare systems to consider the value proposition they need or want to get out of their HIE solution. Therefore, the HIE must be born from a strong business model that is self-sustaining and not overtly dependent on grant funding alone in order to be successful.

A strong business model must:

Be efficient in order to decrease the total cost of ownership: The HIE needs to be easy and cost effective to adopt but, more importantly must provide consumers of the HIE services a value-added proposition. The HIE must help physicians be more efficient and effective in their delivery of healthcare services to their existing and potential patient population. The HIE must not encumber the delivery of care by slowing down or preventing a physician in delivering patient healthcare services. If the solution does not effectively improve patient services, access and outcomes, the utilization and adoption will be negatively impacted.

Deliver demonstrable value to the key stakeholders in the process: The most obvious benefactors of the HIE are the physicians and patients that are part of the community that is supported by the HIE. Whether it is empowering physicians or patients with clinical information or aligning more effectively patients with physician services, the HIE must enable this relationship to thrive and flourish. In addition, healthcare systems will benefit by aligning these two parties and therefore creating a more cost effective, preventive care delivery system that will reduce costs by minimizing the number of ER and acute care admissions through these preventive care services.

Serve as a platform for enabling additional value-add services that create additional sources for funding and financial support: The HIE can be the platform to which additional services can be added outside of the standard clinical results and care model. Additional services such as ePrescribing, eReferral Management, Medical Home and Disease State Management services are just a few of the features that can be added and drive additional value to the consumers of the HIE solution platform.

Promote cost effective health care services and or materials: Cost-effective measures include discount prescription drug programs, preventive disease-management programs and overall health education programs to promote the wellness of the citizens of that geographic area.

Reside within the context of a flexible eco-system: This flexibility will enable other services such as eligibility checking for citizen’s healthcare insurance coverage. With the advent of healthcare reform, this strong business model will provide an efficient foundation upon which many more citizens can be incorporated into and will drive a more effective use of the HIE ecosystem.

How the Healthcare CIO Saves Lives: #1 Ensures Care is Given at the Correct Time

When we think of a Health IT project like Health Information Exchange, many focus on the technology-oriented aspects of designing, selecting, implementing, and managing a technology project. However, Health IT should ultimately be driven by the clinical goal of ensuring that the appropriate level of care is provided to patients in a timely manner.  By connecting all of the disparate parts of a healthcare system, the Healthcare CIO is instrumental in ensuring the timeliness of  this care.

The true clinical goals include:

Enable clinicians in their care processes: By providing clinicians with longitudinal patient healthcare data, physicians will be able to see all healthcare-related services that have been provided, even if that physician was not the individual that delivered that care. In addition, physicians can review healthcare results including laboratory results and prescribed medications.  Physicians can also collaborate on the same patient data to improve outcomes. 

Improving the quality of care for patients across a given condition: This would include quality outcomes around selected disease states as well as specific geographic, ethnic, and gender factors to better target and deliver specific healthcare education and associated services.

Reduce costs associated with providing quality care: Though one of the most important aspects of Health IT is improved quality of care for patients, controlling and being aware of the cost of the care is just as important. By including costs in the exchange of clinical information both healthcare systems and government agencies can begin to understand the correlation between the quality of care and the costs associated with that care. By understanding what was the cost of care, better clinical guidelines and programs can be established to balance cost with better clinical outcomes.

Ensure that personal information remains protected: As more and more clinical information is put into an electronic format, many citizens and patients worry about how this information is protected from unauthorized access. Even with the HIPAA security rules and regulations, healthcare systems, and state government agencies must ensure that as EHR and HIE go live, these solutions provides the necessary protection and access controls to build trust and confidence in those that patients that participate.

A successful Health IT project must be secure, accurate, dependable, appropriate, and responsive to the needs of the users of clinical information to ensure that the appropriate care is delivered. The technology selected should be supportive of these crucial clinical goals rather than become the overriding focus of IT implementation.  When this is achieved, then Health IT can also achieve the ultimate goal of delivering important care at the appropriate time can become a reality.

Avoiding Inaccurate Patient Identification for Healthcare Services

As we mentioned in an earlier post about Tracking a Single Patient in a Connected Healthcare Environment, the key to making an integrated healthcare system work is identifying and managing a unique patient identifier that can be used to connect one patient across a diverse network of care providers.

In this post we are going to explore the options available for unique patient identifiers in a connected healthcare world.  There are two broad options for managing unique identifiers:

Record locator service (RLS): RLS provides the ability for a request for patient clinical information across disparate electronic health record systems to use a set of criteria and rules to query these source systems to identify whether clinical information exists for the individual at that location.

Records bank model (RBS): The records bank concept enables citizens/patients to store and update their clinical information, through consent, from those healthcare systems and ancillary care centers that generate healthcare results. Patients can add and access clinical information associated with them and can grant access to other care providers that are part of that citizen/patient care delivery team.

An incomplete – or worse, inaccurate – master person or provider index is a source of serious concern.  As such, ensuring that integrated Health IT project includes a feature-rich master person/provider index is critical.

However, the most important – but often overlooked – aspect of this important index is creating the strategic business processes necessary to maintain an accurate person/provider index.  This often requires an organization to venture into the dicey waters of change management.  You can find some team-based change management tips in our earlier post Preparing a Healthcare Organization for Change: