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Market-Driven Patient Portal: Telehealth Beyond the Virtual Visit

Last month I published a post entitled “What the market says you need in your patient portal” that garnered a lot of interest. In that post I addressed the balancing act that healthcare executives face when market based initiatives are sidelined in order to drive focus to regulatory requirements such as Meaningful Use. Sometimes the market and regulatory requirements are in sync. However, when those regulatory initiatives get delayed things get complicated. My advice is that, beyond Meaningful Use, ultimately the market will determine what true patient engagement means, and I highlighted seven features that a market driven portal should have. I will spend time during this series going into detail on those features. They include:google-smart-contact-lens-glucose-sensor-640x353

  • Telehealth that moves beyond the virtual visit
  • Dynamic scheduling
  • Social collaboration
  • Gamification and serious games
  • Avatars for personalized health coaching
  • Health information exchange across diverse care settings
  • Integration of clinical and financial data

Today we will begin with telehealth. The topic has been in the news quite a bit recently – mostly in terms of telehealth reimbursement. The world of telehealth is not only in a state of transition currently, telehealth is also one of the major net deltas that we will see between healthcare of today and the healthcare of ten years from now. So, what does telehealth look like beyond the virtual visit? We are pushing towards a world where technological innovations will make the brick and mortar less and less relevant even in the world of healthcare. One of the more interesting developments in this area is a push by X Prize, by way of multiple multimillion-dollar prizes, to innovate technologies in such a way to diagnose common medical conditions with no intervention from a health care professional. With this drive in the marketplace in mind, telehealth in a market-driven patient portal you would find:

  • Socially Enabled Patient Portals: In a socially enabled patient portal, physicians and patients can work together toward their combined goals of better health using tactics like dynamic messaging, activity feeds, blogging, and open question forums.  These technologies are particularly effective in rural and low-income areas and are being used to enhance the quality of care for diabetic populations in low-income areas, for example.  These technologies show great promise for providers and health plans interested in managing chronic disease in a cost-effective fashion, especially for the uninsured.
  • Robotics:  Children’s hospitals have been the early adopters of telehealth technologies. Some innovations of interest are in the realm of robotics. Boston Children’s Hospital has an impressive telehealth program with a video-monitoring robot. These 4-foot-6, 17-pound, two wheel robots help with post-operative consultations and care primarily as a means of videoconferencing, giving the families of hospital patients a way to keep in touch with doctors and nurses in between post-surgical appointments. Equipped with cameras, audio gear and a video screen for a “face,” the robots are operated remotely by Children’s Hospital staff. In addition to facilitating communication, they can take video and close-up photos of surgical scars or other key areas of interest to help medical staff monitor recovery.
  • The Smart House: When it comes to uncovering issues early, the tracking of vitals, combined with analytics that readily alert clinicians when those vitals show potential for problem, have been crucial to telehealth outside the virtual visit. We are seeing innovations that embedded fiberoptics into carpeting that can track the activity of patients in and out of their bed while at at home. There is also an innovation called the Health-e-Chair that incorporates a vast array of biosensors to measure vital signs including weight, blood pressure, temperature, ECG, auscultation of heart and lung sounds, blood oxygen saturation, motion analysis and reflex response time. The chair incorporates a communication unit with a remotely controlled camera.
  • Nanosensors: Taking the tracking of remote patient monitoring microscopic is no longer just something we will get to eventually. There are innovations on the market now that can make a big difference in population health. Diabetes is a serious issue in the world of healthcare (understatement of the year award nomination). One of the leading causes of blindness in the world, diabetes patients have a risk of developing retinopathy, which could ultimately lead to blindness. Nanotatoos have already proven out in diagnostic efforts to track blood glucose levels, for example. Google and friends are also innovating around embedded camera functionality into contact lenses to find early signs of diabetic retinopathy.

One in five Medicare patients are readmitted to a hospital within 30 days of discharge, and one in three are readmitted within 90 days. It’s estimated that 75% of all hospital readmissions are preventable. Telehealth provides many benefits as a virtual visit. However, it is taking telehealth beyond the virtual visit that the market will push towards as we work to bring down the cost of care and reduce readmissions. Stay tuned for a future post on how the integration of all of this data takes this effort a giant leap forward.

Anything you think I’m missing? I’d love to hear your thoughts in the comments below.

Transparency: It’s about the patient

I’ve talked a lot lately about cost vs. quality but this time, I want to talk about why all this is important by telling a little story.

A few years ago, I was visiting a CFO for a large academic medical center and he was interrupted for a discussion about a chronically ill international patient with a rare form of cancer. The patient and the diagnosis were not verbalized but the discussion was about whether the services needed could (and whether they should) be provided at no cost. This discussion was not only about the pricing or what the expense to the patient’s family would be (no insurance discussion here) but also about whether the institution really understood the cost and impact of providing the service from a margin perspective. The real truth is that they only knew what they charged for the treatment.

Properly allocating costs to understand them at the patient level is the subject of the this video by Oracle’s William Bercik, Director of Healthcare for Oracle and a former CFO.

Properly Allocating Healthcare Costs: The Key to Understanding Profitability

Join us as our team of industry experts discuss how to “Align Patient Outcomes with Financial Data: A Formula for Correlating Cost and Quality” on August 13, 2014. Using a case study discussing multiple scenarios for activity based costing for Pediatric Care Transitions, this webinar will explore how the Perficient High Performance Costing Expressway extracts clinical cost data, consolidates and allocates across the system to discover true patient costs.

Register Now

 

 

 

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The “Yellow Brick Road” to Value-Based Care

“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?The “Yellow Brick Road” to Value Based Care

Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.

As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician.   This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?! Read the rest of this post »

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Apple HealthKit: A Game Changer

I have been an athlete all my life, but since I’ve reached my 30′s, had 5 reconstructive surgeries, and moved back to the Midwest to a completely sedentary job, staying fit and healthy has become more challenging than ever before.

As an Apple lover for years, I have a myriad of Apps I enlisted to help. Between TargetWEIGHT, MYFitnesspal, MapMyFitness, myWOD, and Nike Fit Band, I have been unsuccessful in maintaining the health and fitness level of my satisfaction.Apple HealthKit: A Game Changer

When I heard about the Apple HealthKit platform and the ability for it to sync with third party application data, the question I posed to myself was, will this help me? I have no chronic illness. I’m not sick. I just want to be healthy. After doing some primitive research, if Apple can pull this off as they say they can, it will revolutionize not just my health technology experience, but the way any doctor in my future will diagnose and treat me.

The Apple HealthKit in addition to the Myhealth App promises to connect Apple Applications & other devices to one another, and to your physician if you choose to. Alleged, my myriad of applications will update one another automatically so I can work (at my nutrition & fitness) smarter and more accurately. Or, if I choose to use the Myhealth, this data will aggregate within the application in a single profile to use and share. Myhealth has 47 different tracking options to help me reach my goals, along with tracking my health milestones and medications/allergies. Furthermore, in case of an emergency, this historical account of my vitals, fitness level, and health milestones such as a chronic illness diagnosis are logged and can be shared with the ER Doctor. This may be critical in saving my life.

I am very conscious however that many folks are extremely uncomfortable with having this type of data in the cloud. I believe this will be a large barrier for Apple along with other 3rd party development partners to overcome. However the technology to keep this information secure exists, and I believe it can be done right. The challenge for Apple is to relay to the public the capabilities of internet security. Now educating Baby Boomers, Generation X, and Y’ers on Cloud Security and gaining the trust to make this Application helpful to all generations may be a challenge and will come with time.

Luckily, as a thirty-something that needs to keep track of my own family’s health along with my aging parent’s health, having health information at my fingertips may not just be convenient but literally may be a life saver. The Mayo Clinic thinks so, they have partnered with Apple along with Epic to make this endeavor successful. You can read more at:

http://www.imedicalapps.com/2014/06/apple-partnership-epic-game-changer/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+iMedicalApps+%28iMedicalApps%29

Connect with Consumers as People, Not Numbers

It is a tumultuous time for the healthcare industry, and health plans are not immune to the disruption. The Affordable Care Act has raised a new level of consumer awareness about the purchase of healthcare and the competitive health plan environment. Battles for market share drive the need to understand member demographics and behaviors in order to more effectively communicate with them. Health plans are trying to differentiate their services and offerings to gain a competitive advantage. Additionally, a newer, younger Connect with Consumers as People Not Numberscustomer segment has higher expectations of speed, information and mobile accessibility.

Despite this new focus on consumer engagement, health plan infrastructure and systems are typically inadequate to meet user demands. New levels of integration are required between front-end portals and back-end systems, so health plans’ growing social and collaborative relationships with customers can be maintained. To keep costs low but yield improved customer service and satisfaction, scalable cloud-based applications are becoming increasingly viable solutions.

Having a customer relationship management (CRM) solution at the center of the overall business strategy allows health plans to adapt to new regulatory requirements while meeting the needs of the connected consumer. Tools that enable personalized user experiences in a secure, yet flexible, environment, make connected health a reality.

A comprehensive CRM solution includes marketing, customer acquisition, retention and overall care management. CRM systems help healthcare organizations have a more personalized approach when reaching consumers (they are people, not numbers) and enable patients, providers and health plans to share information easily – creating an integrated experience and improved patient outcomes.

The consumer-centric approach is all about empowering consumers to be more involved in their health journey. In order to connect with consumers, healthcare organizations must engage with them in new ways using a more personalized method. Customer relationship management (CRM) technologies allow healthcare organizations to do just that; they are a natural fit for the healthcare industry that has adopted the “retail” model.

The food, retail and healthcare industries are going to continue to merge as we head toward a more holistic health model, and CRM will be an integral part in the success of this evolution.

Is your organization using a CRM solution? How have you seen CRM solutions evolve in the healthcare industry? Share your thoughts with us on Twitter @Perficient_HC

It’s IaaS not IaaS – Creating a nimble Healthcare organization

I always find industry acronyms amusing. Sometimes they describe new technologies, other times they are a new name for an existing technology (maybe with a slight twist).  And then there are those times when two different technologies, models, theories, etc. end upwith the same acronym. Such is the case with Information as a Service and Infrastructure as a Service. Both are interesting concepts that deserve equal time, but today I would like to talk about Information as a Service (IaaS).

IaaS PicIaaS is certainly not a new concept. It has been around for a while. But it does merit a re-visit every now and then, since many healthcare organizations still struggle with integrating multiple systems and data sources.

At the core of IaaS is the concept of developing a common data model (also known as a canonical model) using schematic mapping and master data management. The common data model that is exposed represents multiple autonomous information sources that organizations use in order to transact business on a daily basis. Read the rest of this post »

Healthcare Benchmarking – Part 1 of 2

I am an avid sports junkie. I literally wake up and fall asleep watching SportsCenter. Last month, while watching the NBA Finals (Go Spurs!), I concluded that sports and healthcare have a lot in common. Sport, is a “physical activity that is governed by a set of rules or customs and often engaged in competitively1.” If we simply swap out the words physical activity for medical practice(s) in the aforementioned definition, we would be describing today’s healthcare organization, no?

For me, the parallel of the two industries really lies in their competitive nature-seeking to be the best. The whole premise of sports is to encourage competition, to be the world’s best Healthcare Benchmarking - Part 1 of 2player, team, or country. Similarly, the healthcare industry encourages competition by seeking the best physician, practice, health system, equipment, outcomes, cost and efficiencies. However, you cannot be the best unless you know what “best” means. What is the threshold you are comparing yourself to in order to be called the best? What are the weaknesses that are holding you back from being the best?  What is the benchmark for best?

In sports it is a little easier to identify. For example, after six titles, five Most Valuable Player awards and 10 scoring titles, Michael Jordan is considered to be the best player of all time. He is the benchmark of greatness in the sport of basketball-he is what all other players aspire to be and what they evaluate themselves against. Unfortunately, in healthcare it is not as easy, as these types of statistics are not as readily available. However, in recent years, in an effort to help define and understand “best”, more and more healthcare organizations are finding value in benchmarking as a tool to assess their current thresholds and a way to improve their process and overall performance in an attempt to be the best.

In this blog post, you will be provided a general overview of benchmarking. In the next blog post we will take a closer look at the actual process of benchmarking. Read the rest of this post »

ACA’s Quality Rating System – An opportunity to gain market share

Starting in 2015 all issuers of Qualified Health Plans (QHPs) on the Healthcare Marketplace will need to provide Quality Rating System (QRS) measurements that will be aggregated and scored to provide consumers with a star rating for each product offered.

How many stars will you have?

How many stars will you have?

Although there are still details to be worked out by CMS, the required measures for the 2015 beta test are in place. All issuers that wish to continue providing QHPs on the Marketplace will need to provide the required measures. There are two different sets of measures included in the beta specifications.

The first is a set of clinical quality measurements that are mostly taken from the current NCQA HEDIS accreditation process. Many issuers already collect the data for these measures; especially, if they are meeting the requirement to be accredited for the Marketplace today and are using NCQA for that process.

The second is set of measures derived from an enrollee satisfaction survey (ESS) that needs to be performed by an accredited third party survey vendor. Most of the questions in the ESS are drawn from CAHPS. The survey processes requires that a sample of data is drawn, audited by a third party and provided to the survey vendor. The vendor then performs the survey and reports the results to CMS. Questions focus on rating an enrollee’s satisfaction with a plan over a six month period.

While the QRS initiative driven by the ACA attempts to provide transparency, it also creates a competitive market that will force issuers to look at ways to increase the quality of care and enrollee satisfaction to deliver better scores. The prize? For consumers, better products. For issuers, a larger share of the market.

Want to participate and win? Then you need a solution that not only provides the required measures, but also provides insight and the ability to drive quality improvements. This can be accomplished with a well thought out solution architecture that provides processes for delivering the measures and the means for analyzing data to drive improvements.

Creepy or Cool? A View of Connected Health in 2025

One of the fun aspects of my job is research.  I get to research the Connected Health trends to understand where the market is headed and how to then prepare healthcare organizations for those changes to capitalize off of the advantage of public health meets good timing meets technology.  I typically chart the trends out through the next ten years.  Some recent information that caught my attention include this infographic by Bupa and a study by Thomson Reuters IP & Science.  Want to know what the world of Connected Health will look like in ten years?  There will be four major themes:

the-futureMicro Mobile: The biggest net delta to be seen in the world of Connected Health between now and 2025 will be in the form of mobile technology.  Mobile capabilities will continue to be provided in smaller form providing the Healthcare industry with opportunities to, for example, use contact lenses that can take pictures of the retina to identify early symptoms of diabetic retinopathy. Sensing capabilities from fiberoptics are currently being used within telehealth in the form of smart carpets that relay signals from footstep patterns.  These capabilities are forecasted to innovate into a form that could signal the possible onset of diseases such as skin cancer when applied to human skin.  Mobile capabilities imbedded in shoes, socks, and baby diapers will impact our ability to monitor weight, fitness goals, hydration, temperature, sleeping patterns, and other symptoms of illness.  Nano tattoos are already used to measure blood glucose levels.  These tattoos, that are half the width of a human hair, are expected to be able to detect precise temperature changes to indicate cardiovascular activity in the future.

Personalized Prevention: Now lets take microscopic mobile and pair it with the more prevalent DNA mapping that will occur in 2025.  Babies born in that year will be tested at the DNA level with full genomic mapping.  We are not talking once or twice.  We are talking continuously tested using nano-probes inserted in the body to identify potential onset of disease.  When it comes to the most costly chronic conditions (both in terms of dollars and hardship), a simple and inexpensive genomics test can be used to help a patient, and their team of clinicians, understand the risk of certain disease states. These individuals can then be given the right treatments and education from the start and throughout life.  Imagine the impact of this level of personalized prevention can have not only for the individual involved but for population health in terms of obesity, diabetes, cancer, and the like.

The Internet of Everywhere: The “internet of things” is defined as an environment where everyday physical objects are connected to the internet and are able to identify themselves to other devices.  We do that at some level today.  By 2025, the internet of things will be everywhere, and everything will be connected.  A report from Thomson Reuters IP & Science states “Thanks to the prevalence of improved semiconductors, graphene-carbon nanotube capacitators, cell-free networks of service antenna, and 5G technology, wireless communications will dominate everything, everywhere.”  What does that mean for Connected Health?  That means your nutrition can talk to you medication because your fridge can talk to your prescription bottles.  Really.

Continuous Data Collection & Instant Reporting: These Connected Health innovations not only provide the ability for healthcare organizations to continually monitor health conditions but also with the ability to collect and report on this data.  This can drive positive behavior change through incentivizing verifiable behaviors.  At the organizational level, this can be used to augment current loyalty programs that rely upon CRM data.  Just imagine the power this also provides to public health research programs worldwide.

Creepy or cool?  What do you think about what is to come in the world of Connected Health?

Social Media Experiments & Public Health. To be or not to be?

So, I’m guessing you heard about the “Experimental evidence of massive-scale emotional contagion through social networks“, no?  That’s the official title for the Facebook study published in The Proceedings of National Academy of the United States of America that you’ve likely already heard about.  In this study you have a Facebook data scientist Adam Kramer and two academics, Jamie Guillory of UC San Francisco and Jeffrey  Hancock of Cornell University, that “subtly tweaked the news feeds” of approximately 700,000 Facebook users. The researchers used an algorithm for one week’s time to eliminate “negative” messages from some users’ news feeds. For others the algorithm eliminated “positive” messages.  For a control group they simply deleted a random selection of messages. Here is the stated significance from the research results:

We show, via a massive (N = 689,003) experiment on Facebook, that emotional states can be transferred to others via emotional contagion, leading people to experience the same emotions without their awareness. We provide experimental evidence that emotional contagion occurs without direct interaction between people (exposure to a friend expressing an emotion is sufficient), and in the complete absence of nonverbal cues.

FacebookPrivacyExperimentThere has been quite a media frenzy around the study.  Most of it has been negative.  The most compelling of those arguments is around “informed consent”.  The belief there is that even if we can agree that the results are of scientific importance (some don’t) and the methodology of the study is concrete (some don’t), it still violated the rights of research subjects.  After the ethical calamities that are the Tuskegee Syphilis Experiment and Project Chatter, informed consent essentially means that a research subject in a study needs to have basic information about the study, understand the nature of the experiment along with its risks and benefits, and have the ability to withhold consent without fear of harm or retribution.

However, there are also supporters of the study.   Ethicist and lawyer Michelle N. Meyer states that as a private company Facebook is not subject to an academic institutional review board.  She goes further to say that had it been, then this study would have likely passed muster. Supporters further state that, with social media being a relatively new phenomena, Facebook has a moral obligation to inform its users of the social or psychological impact of their website.  It’s likely that studies like this will continue.  With the media firestorm that erupted it is likely, though, that they will not be published.  That comes with its own set of problems.

My concerns move into the realm of public health.  As I mentioned in a 2011 post called “New Tools for Managing a Public Health Crisis“, data is the most important component in managing public health.  With a successful suicide committed in this world every 30 seconds, mental health is a major public health concern.  It takes precious time and resources to manage the health of a planet inhabited by 7 billion people.  This is an interconnected planet, and a public health crisis knows no barriers and time does matter.  One of the breakthrough lessons I received in my life was from Dr. Greg Smith, my graduate data mining professor at Xavier University.  He explained that “like things tend to cluster”.  This makes social media a great way to find the useful data needed to uncover a public health crisis. Social media technology enables two-way communication.  As such, experts are turning to social media outlets like Facebook and Twitter to not only communicate with the public about disease outbreaks and health issues but to also gather necessary data to discover outbreaks at their source.  Social media can also be used to recruit medical volunteers to a location and align response efforts once on the ground.  However, to make this all work, public health officials need to be given access to social media data, and this is often an issue.

So, ultimately, my feelings on the study are quite mixed.  I am a staunch supporter of ethics.  However, I am of the belief that this study passed the ethical bar.  Even more, I have strong feelings on the topic of mental health.  I do believe that social media, with all of its countless benefits, has a new and not yet verified impact on mental health.   I believe that it is data that will help us understand ourselves in ways that we did not before, and that data can save lives.

Patients Shopping for Quality and Value

Data from a recent study by the Employee Benefit Research Institute shows that individuals enrolled in high-deductible health plans are more likely to behave like consumers and seek data on price and quality before receiving care.1 This, combined with the effects of the Affordable Care Act, where trends are reflecting that more than 80% of individuals enrolled in exchange plans chose high cost sharing plans, are turning patients into consumers.2

Patients shopping for quality and valueThe high-deductible health plans are reinforcing the need to provide accurate pricing and quality data to patient shoppers as well as the need for provider organizations to understand service line margin to be able to adjust their service offerings accordingly.

My colleague Melody Smith Jones, @MelSmithJones, recently wrote about this in her blog post, What the Market Says You Need in Your Patient Portal.

“The forward-thinking strategists in healthcare organizations nationwide should have their sites on the marketplace horizon.”

I invite you to read Melody’s entire blog for more about what features the market is demanding, but I would like to focus on the last item in her list: “Integration of clinical and financial data”… Read the rest of this post »

The ‘Holy Grail’ – One Reporting Platform – #Interact14

The Perficient team is at  HIUG Interact 2014,  booth #206 and is available daily to discuss solutions and topics around:

  • Business Intelligence – Industry direction (self-service, structured vs. unstructured data, cloud vs on-premise), dashboards, reporting tools, and technology
  • Enterprise Performance Management – “Planning in the Cloud” Oracle’s Planning and Budgeting Cloud Service The "Holy Grail" - One Reporting Platform(PBCS), profitability and cost management, financial close and reporting
  • Data Warehousing – What is the path from PeopleSoft EPM to Oracle Business Analytics Warehouse? Integration with EPIC, Cerner, Facets, and more; Enterprise health analytic data model
  • Customer Experience – Member/patient portals, call centers, campaign management, content management, social media and handheld devices
  • Oracle Patient-Centered Medical Home – Oracle technology can fulfill the requirements for Patient-Centered Medical Home (PCMH). Perficient will demo the PCMH within OBIEE, using the enterprise health analytic data model, and show how both patients and care managers will access the PCMH using both WebCenter and RNOW

In addition, Perficient will showcase and present the following session at the conference:

The ‘Holy Grail’: One Reporting Platform – Ken Schesser, Director, Oracle Healthcare Practice, Perficient
Monday, June 23, 2:15 – 3:15 PM in St Johns 24 (session #13129)

Join us to learn how to leverage Oracle BI tools for your Hyperion EPM and PeopleSoft or eBusiness Suite environments. Our experts will walk through the reporting options including OBIEE, Endeca, Smartview and Financial Reporting, when to use each tool, and potential migration paths from PeopleSoft EPM to Oracle Business Analytics Warehouse.

Stop by our booth, #206 to view our demos!

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