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Posts Tagged ‘healthcare IT’

Improving Patient Experience – Not Just for Inpatient Settings

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. 

patient engagementPositive Outcomes and Opportunities

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:

  1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
  2. Patient retention, loyalty, and growth - By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients.  As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy. Read the rest of this post »

Happily Ever After: The Benefits of Patient Engagement – #HIMSS14

Once upon a time last year, in a town not too far from you, there was a big hospital where a bright, young physician was providing care to a sick, old patient.  Okay, let me save you some time.  This fairytale, unlike those you are used to, doesn’t end simply by having Prince Charming (the physician) swoop in and save the beautiful, damsel in distress (patient).  This fairytale has a bit of twist that changes the standard storyline.  This twist is referred to as Patient Engagement.

Changing of the Patient-Provider Fairytale

patientengagementThe concept of patient engagement has changed the way providers tell their patient stories.  It is no longer, once upon a time, a patient was sick, the physician cured him/her, the end.

The fairytale now reads more like this…

  1. Patient came in.
  2. Physician introduces him or her to supporting characters (care team).
  3. The patient and physician discuss the plot (disease state) with alternative endings (treatment options).
  4. They co-write the script (care plan), including ideas for props (patient education, care communities, etc.) that will enhance the story.
  5. The physician quickly publishes (uploads to portal) the manuscript and associated material for review and follow-up (provides email, direct scheduling option, mobile alerts, etc.).
  6. And instead of “the end”, it is more like, “to be continued…”

Patient engagement is not a new concept, just one that has been brought to the forefront as part of the healthcare industry’s increased efforts around coordinated care. Read the rest of this post »

Cloud is Driving Scale, Compliance and Growth in Healthcare

Today, a report by market research consulting firm RNCOS released findings that predict the healthcare technology market will grow at a compound annual growth rate of about 10 percent between now and 2018.

shutterstock_151014941

About one-third of healthcare organizations now use cloud technology. 

According to Fierce Health IT:

Continued innovation and government suppport for such tools will factor into the market’s success, according to the report’s authors. The report examines five trends, including an increase in:

  • Wireless and cloud technology
  • Government initiatives
  • Strategic consolidations
  • Reduced operating expenses
  • “Technological upgradation”

The cloud offers the advantages of:

  • Quickly scalable on-demand infrastructure and storage, which clinics, hospitals and provider offices require.
  • Accessibility to healthcare data across multiple settings and geographies, creating a unique opportunity to better serve the patient by sharing information more easily than ever before, and improving operational efficiencies.
  • Vendor technological expertise to support the cloud model.

What about compliance, security, and privacy?

Healthcare organizations must comply with complex medical coding and billing rules, along with HIPAA (Health Insurance Portability and Accountability Act) privacy and security regulations. Healthcare data, including Protected Health Information (PHI), must be kept secure, confidential, available only to authorized users, traceable, reversible and preserved for long periods of time. The right cloud solution for a provider must account for all of these concerns while conforming to HIPAA and Meaningful Use requirements.

Read the rest of this post »

A Love Letter to Meaningful Use – #HIMSS14

It seems appropriate on Valentine’s Day to write love letters.  This is my letter of adoration to Meaningful Use.  In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills.  My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons.  I could wax poetic about the ease of checking on appointments and reviewing lab results.  The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy.  It was love at first click.

A Love Letter toInstead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic.  I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications!  I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila!  Several hours later, I received an email confirmation from the pharmacy that they were processing my order.  Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software.  I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view.  I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life.  This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. Read the rest of this post »

Reframing the ACO Analytics Problem with Malcolm Gladwell

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

Malcolm Gladwell quoteWhile I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely.  One of the key learning points for me from these sessions was this:  “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics?  There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics?  Do we “build vs. buy”?  Depending upon the organizational size, legacy systems and IT support, the decision can be difficult.  What is good for one system may not work in another.  So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step.  Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics.  Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

Read the rest of this post »

Database inferencing to get to trusted healthcare data

A health insurance client of mine recently embarked on an initiative to truly have “trusted data” in its Enterprise Data Warehouse so that business leaders could make decisions based on accurate data.  However, how can one truly know if your data is trustable??   In addition to having solid controls in place (e.g., unique indexes on the primary AND natural key), it is also necessary to measure how the data compares to defined quality rulesWithout this measurement, trusted data is a hope – not an assured reality. 

shutterstock_71078161To enable this measurement, I designed a repository for storing

  • configurable data quality rules,
  • metadata about data structures to be measured,
  • and the results of data quality measurements.

I experienced the need to be able to perform a degree of “inferencing” in the relational database (DB2) being used for this repository.  Normally one thinks of inferencing as the domain of semantic modeling and semantic web technologies like RDF, OWL, SPARQL, Pellet, etc. – and these are indeed very powerful technologies that I have written about elsewhere.  However, using semantic web technologies wasn’t a possibility for this system.

Read the rest of this post »

Positive evidence that Health IT improves patient outcomes

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies) Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome. Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

This is a fascinating report on a study by RAND researchers about meaningful use. It shows strong evidence that Health IT improves patient outcomes, specifically quality, safety, and efficiency outcomes.

Michael Furukawa Director at the ONC , and Meghan Gabriel, Economist at the ONC, presented the results from this study in a blog post on HealthIT Buzz. They asked RAND to:

…examine recent evidence on the effects of meaningful use functionalities on quality, safety, and efficiency outcomes. The study was the largest and most comprehensive assessment of the health IT literature to date.

5 Reasons Big Data Improves Personalization of Medicine

I enjoyed an article today in IT Business Edge about the ways that Big Data is improving outcomes. We hear that all the time, right? But what does it really mean? Why does more (and better) patient data lead to improved healthcare for all? When business intelligence is leveraged properly to deliver insights to healthcare providers, we see the following:

  1. 5_waysLearning what we never knew before: 

    “Allowing for previously unknown factors involved in disease to be discovered and utilized as drug targets or disease biomarkers.”

  2. Comparing data points from various sources to individualize treatment plans, improving outcomes. 

    “We are able to align and compare multiple data points from various sources, tailoring individualized treatment plans for each patient.”

  3. A move from subjective interpretation to objective diagnosis.A coworker of mine said to me yesterday, “Can you imagine when our kids are older? They’ll be laughing at our stories of how doctors once said to us, ‘Based on your symptoms, I think you have [X disease].’”

    She’s right. Diagnoses vary from physician to physician based on his or her background and experience. Not any more! As this article states, we’re facing a “datafication” of patient samples.

    “A vast quantity of knowledge that can be statistically analyzed and quickly reviewed by multiple clinicians for solid diagnosis”

  4. Better – and faster – decisions about treatment as a result of more and better patient data
    “Clinicians can systematically extract more information from each patient without requiring multiple rounds of testing.”
  5.  More accurate diagnosis and more appropriate spending on treatments due to reproducible testing”Consistently reproducible test results are possible between clinicians and doctors for more accurate diagnosis and appropriate spending on therapy options.”

A Wish List for Data Modeling Technology

I was recently a panelist for a Dataversity webinar/discussion focused on the future of data modeling tools, functionality, and practice.  Given the holiday season, the panelists discussed their wish list for modeling tools – from currently practical (but maybe not economically viable) to futuristic (e.g., using a 3D printer to print models for model reviews, using Google Glass to move objects around on the model).

Modeling-BaseOf course, many modeling tools already support a vast array of functionality and sometimes can be difficult to use some of the non-core functionality without experiencing some unintended consequences, and so more intelligent guides and better semantics in the modeling tool will make these easier to use – so modelers can focus more on modeling and less on the technology.

More important than the technology – as important and interesting as that is – is having solid processes and modeling standards in place to ensure better model quality, reuse, and understandability.  

The Multicultural Effect on the Healthcare Industry

The healthcare industry in the United States is entering an intense, intricate, complex, and dynamic period of growth and modification. Many of the modifications have not been implemented for a significant period of time, such as the medical coding transition from ICD-9 to ICD-10. Additionally, the healthcare industry will integrate information technology and systems in its regular operational methodologies, while other industries have already undergone these changes. An apparent question to present is globalhealthcare1understanding the reasons why healthcare is behind in implementing changes than other industries. We can examine the reasons for this by including global and multicultural influences.

While healthcare resources and services can be limited domestically, other industries include global exchange and interactions as essential to industry efficiency and success. Therefore, modifications and updates had to happen regularly and periodically to accompany multicultural specifications. Examples include the transportation and financial industries that both rely on partnering countries and cannot be limited to operations within the United States. Therefore, it is reasonable to include the concept that the healthcare industry does and will rely on the same premise that eventually the success of domestic healthcare delivery systems will rely on partnering organizations on a global platform. As a result, this will lead to more frequent upgrade and standardization in healthcare as well.

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The Value in Voice-Natural Language Processing in Healthcare

Guilty!  I text while I drive…eek!  I know, I know, it is really bad and those anti-texting and driving commercials get me too.  That is why I am making a concentrated effort to ease up this one vice (stop laughing those that know me!) of mine.  Instead, I am beginning to use the voice text option and good ole Siri on my phone, which when I speak like a robot and articulate every word, does alright.  But old habits die hard, which is why I understand and sympathize with physicians constantly having to change their behavior in light of all the regulatory demands in recent years.

One behavior that physicians are being asked to change is their practice patterns of dictating or handwriting clinical notes and discharge summaries.   The change comes from the desire to move away from unstructured data to more structured data for consistent, easily minable and extractable information for more robust and quality NLPreporting and analytics.  80% of clinical documentation that exists in healthcare today is unstructured and is buried in electronic medical records (EMR) and clinical notes1.  Many healthcare providers are looking to natural language processing (NLP) technologies to assist in taking their valuable unstructured data, and turning it into meaningful and actionable structured data to improve patient care.

Natural Language Processing and Clinical Language Understanding

In its simplest definition, NLP is the interaction between artificial intelligence and linguistics.  It encompasses anything a computer needs to understand typed or spoken language and also generate the language2.  More specifically, NLP applied to the medical domain is called Clinical Language Understanding (CLU), with the main difference being that CLU works off of a complete, highly granular medical ontology, which has been tuned to relate and identify all kinds of medical facts so that the underlying NLP engine can “understand” what the caregiver is saying1.  NLP has been around for years, but it wasn’t till recently that healthcare industry took notice of the value of this effectively powerful technology.

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Identity and the Internet of Things – Lessons for Healthcare

Attending Dreamforce in San Francisco last month, I was reminded of an article I read in All Things Digital about the role of Identity and the Internet of Things.  Apparently Marc Benioff, salesforce.com’s CEO, mentioned during a presentation at the Bank of America Merrill Lynch 2013 Technology Conference,  that Phillips, the electronics company long known for staple consumer products like TVs, cameras and audio equipment, was working on a new toothbrush. The toothbrush under development was not just any ordinary toothbrush but included GPS, Wi-Fi and “realtime” feedback on how a person brushes their teeth.  Voila, no more lying to your dentist – self-quantification will rat you out with your own data.

While the concept of “The Internet of Things” like the high-tech toothbrush isn’t new, salesforce.com’s forward thinking CEO was previewing a new trend — connected devices are becoming inextricably tied to identity.  Just like my registration email at Dreamforce using a barcode to speed check-in and attendance at sessions.  My identity Internet-Of-Thingswas tied to a “thing” in the Internet of Things.  Lots of my personal devices are internet-enabled as well, connecting my identity to how far I walk for exercise, where I travel, what hotels I stay at, etc.  In the world of social, devices like the smartphone, activity tracking wristbands, etc. are creating comprehensive profiles of our “real” behaviors like brushing our teeth.

It doesn’t take a big leap to understand the impact of connecting my identity and devices on managing my health or lifestyle.  You can easily imagine a healthcare plan, like Geico does on cars, offering a discounted health plan in exchange for your comprehensive lifestyle profile, or at least lower deductibles for positive behaviors, including taking your medications on time.  The challenge will be making certain that your identity is truly linked to your proper information in healthcare systems and there are clear safeguards in place.  As the article in All Things Digital states

“And to be clear, trust-based relationships with users means that privacy must be accounted for and the right controls must be in place before businesses start collecting and using this data. With the proper opt-in/out privacy controls in place, identity-defining traits like hometown, religious beliefs, relationships status, likes, activities and social graph can be available to marketers and used to drive hyper-relevant marketing campaigns.”

As the list of connected “things” in our lives grows and uses our identity to tie our behavior profile to our healthcare management, the pressure will be increased for outstanding master data management by healthcare providers and healthcare plans.  It is amazingly difficult for healthcare companies to conquer enterprise-level master patient indexes to resolve your one identity and create a combined view of your medical history.  While your smartphone revolves around your Facebook username and password, Twitter log-ins, etc. to know you, the fragmented healthcare system must piece together that you go by your middle name, use a nickname or don’t really know your actual Social Security Number.

Master Data Management and Identity Management for healthcare is literally a matter of life and death, especially for people with medication allergies, chronic conditions like diabetes and people with medical implants like pacemakers.  Dick Chaney took the extreme step of firewalling his wireless connection on his pacemaker, for example, to block terrorists from attacking him based on his device and identity.  While we enjoy the idea of our exercise wrist band taking to our smart thermostat to cool down the house after a run, we need to understand the broader implication of this degree of connectivity into our own safety as patients.

You may laugh the next time that the hospital asks you your name for the umpteenth time or marks the site of your surgery with a marker, but identity matters in healthcare and as that industry becomes more connected like your devices, make sure that your information is correct, up to date and is “real.”  It could literally save your life.