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Posts Tagged ‘healthcareIT’

Using Technology to Cure Healthcare Business Ailments

A recent article in the WSJ displayed how improving the health of patients is tied to being able to see the big picture. It just so happens that to improve the health of an organization, there is also a need to see the big picture, which requires having access to data. Research has shown that to remedy today’s healthcare problems, organizations must have a centralized home for data and up-to-date systems. According to the 2001 Institute of Medicines report, the healthcare system must evolve from a “highly decentralized, cottage industry, to one that is capable of providing primary and preventative care, caring for the chronically ill, and coping with acute and catastrophic services”. This requires a substantial investment in a myriad of advanced HIT systems that can provide risk stratifications, patient registries, education resources, alert services, prescription reminders, employee staffing, financial-outcome reports and overall decision support.

The problem here is that simply using EMRs will not do the trick. The real solution is to merge the data from EMRs with other data to paint the whole picture and avoid being “data rich but information poor”.  It results in a business that can use data to drive business and clinical decisions. Is it really worth the investment in an enterprise data warehouse, decision support and business intelligence? Simply stated, yes, because merging data allows organizations to develop solutions to overcome organization-wide issues, operational bottlenecks and provides a way to evaluate financial positions from an operations view.

Healthcare Efficiency
Efficiency is a key point in every organization. Alchian claimed that firms must have a positive profit to survive. While we don’t argue that point, it is important to note that firms strive to be profit maximizers, which requires educated business decisions that lead to specific outcomes. Those outcomes cannot be attained by taking a business-as-usual approach. Instead, it requires business intelligence systems to support defined and desired outcomes that promote profits and efficiency.

Healthcare providers who have a faint heart for efficiency and
investing in solutions to increase efficiency will be pressed to remain competitive in today’s landscape.  Efficiency and effectiveness are the key to the future.  They may come at a cost today, but without these solutions, organizations will struggle to provide quality services at affordable prices.  Is there really a choice anymore?

Data Profiling: The First Step in Data Quality

When I think of data quality, I think of three primary components: data profiling, data correction, and data monitoring. Data profiling is the act of analyzing your data contents. Data correction is the act of correcting your data content when it falls below your standards. And data monitoring is the ongoing act of establishing data quality standards in a set of metrics meaningful to the business, reviewing the results in a re-occurring fashion and taking corrective action whenever we exceed the acceptable thresholds of quality.

Today, I want to focus on data profiling. Data profiling is the analysis of data content in conjunction with every new and existing application effort. We can profile batch data, near/real time data, structured and non-structured data, or any data asset meaningful to the organization. Data profiling provides organizations the ability to analyze large amounts of data quickly in a systematic and repeatable process. Data profiling will provide your organization with a methodical, repeatable, consistent, and metrics-based means to evaluate your data. You should constantly evaluate your data given its dynamic nature. Read the rest of this post »

It’s Time to Get Real…

…Real-time analytics, that is.

One of the challenges in healthcare today is the lag in time for the acquisition, storage, analysis and delivery of data back to the physician or other healthcare provider for decision-making.  The majority of transactional information about a patient that is produced on reports or presented in terms of business intelligence is simply “old” or retrospective and, as such, limits its usefulness for decision-making.  The average reporting solution attached to the modern EMR software typically batches up information every 24 hours and makes it available for reporting and analysis.  In many healthcare decision-making settings like an Emergency Department, this data lag is frustrating and potentially dangerous from a patient safety point of view.  It’s not that EMR solutions can’t immediately reproduce the collected data quickly, but to analyze the data and present actionable information to a medical professional, the data lag for real business intelligence limits its return on investment and ongoing use.

The Challenge

The problem is simple – we need to perform complex real-time analytics on data, both structured and unstructured, that is in motion.    The ability to continuously analyze data, especially in healthcare, could make the famous “life and death” difference.  Let’s take a basic example.  Today, there are mobile devices that can stream electronic data like an EKG while you are in the ambulance headed to the ER.  The challenge is combining the real-time information fed from the telemetry with your existing electronic health record, filtering out extraneous data and presenting the key facts to the physician and the support team for decisions and preparation when you arrive.  This issue is especially true in modern trauma units where minutes count and integration of real-time data, especially lab results, is critical.  Instead of the doctor scanning all of the values for ones that are out of range, the real-time solution would highlight the out of range values and possibly recommend alternatives to address them.

Read the rest of this post »

2011 Top #HITsm Contributor Awards

Just in time for the season of celebrations, the #HITsm Twitter community, focused on creating discussions on Health IT, has announced its 2011 Top #HITsm Contributors list. The list is broken into Individual Contributors, Organizations and Publications. Perficient Healthcare, under the Twitter handle @Perficient_HC, is proud to be recognized in the Organizations group for its contributions. Also, Perficient’s own Melody Smith Jones was recognized as an Individual Contributor under her handle @MelSmithJones!

 

So, in the spirit of celebration, we would like to recognize some of the individuals we have had great #HITsm interactions with in 2011, some from the HL7 Standards list, and some of our own.

@OchoTex – One of the faces behind the list. While obviously not included, he has been the man behind many of the weekly #HITsm chats, responsible for engaging this great community.

@NateOsit – Never afraid to voice an opinion during weekly #HITsm chats, and always on the ball with news! Great at starting discussions, collaborating, and getting exciting conversations started.

@motorcycle_guy – The #HITsm resident standards expert who posts great content under his own blog that gets everyone thinking.

@techguy – Blogger extraordinaire and all-around nice guy! Be sure to check him out at any of our healthcare conferences, and you won’t be disappointed.

@EMRAnswers – Great friend of Perficient and passionate health IT advocate. Each family has a glue that binds them; she’s ours.

@TheGr8Chalupa – Playful instigator of the #HITsm community. Who doesn’t love a lady who likes black coffee and dark beer?

@MelissaColeHTR – We think the future leaders of healthcare will be the RN’s and doctors that truly know healthcare technology. She’s one of them! Melissa’s positive attitude and encouragement have touched many members of the community.

@SmyrnaGirl – A passionate Health IT advocate. Make sure to check out her many articles on Health IT News.

@DrNanN – Feels like an old time friend at this point. Check out the numerous podcast interviews we did with @DrNanN on how Health IT connects her to her patients.

@ahier – When we think of Health IT leaders, we want to be Brian when we grow up! Check out our interview with him at HIMSS 2011.

@2healthguru – Curious about the latest news on ACO? Just ask Gregg!

@pjmachado – One of the few Health IT geeks that has as much to say in the provider space as he does in the payor space.

@janicemccallum – She fits the definition of Health IT influencer. Check her out in the interview we did last year at HIMSS on BI and Meaningful Use.

If you’re interested in becoming part of the #HITsm community these are just a few of the people we recommend engaging with. Also, join our weekly Tweetchats, starting up again in January 2012 – more information at http://www.hl7standards.com. Thank you all for such a great #HITsm year – we are looking forward to new faces and continued conversations in 2012!

Who have been your most valuable #HITsm contributors this year? 

Is the Top-Down Approach to Meaningful Use Really Causing Problems?

Taking a top-down approach to government initiatives has been scorned by New Public Management advocates, who claim that a top-down hierarchical structure hampers efficiency, fails to meet the needs of society and lends itself to poor outcomes.  Yet, today’s Meaningful Use initiative is noted for taking a top-down approach.  If scholars are right, then Meaningful Use should flop – yet, it continues to thrive.

In Ken Terry’s recent post, British EHR fiasco shows U.S. may be on the right track , top healthcare officials noted that the success of implementing EHRs and Meaningful Use is heavily dependent upon establishing a horizontal hierarchy to include input from physicians, providers and patients.  They also point out that a top-down approach to Meaningful Use will not work, because HIT is implemented on a local level not national level.

Since the Health IT Policy Committee is focusing on meeting Meaningful Use agenda items instead of working hand-in-hand with the private sector/providers to incorporate their needs and desires, the initiative is predicted to meet some resistance beginning in Stage 2.  If applying top-down approaches to government initiatives typically result in failures, then when is it appropriate to apply this approach and why is Meaningful Use experiencing such wide-spread acceptance? 

The prediction is that providers will begin digging in their heels during stage 2, because their voice isn’t being heard. However, that mentality grossly contorts providers and provider’s views on care.  Providers (and payers) advocate for top-notch quality care that produces results.  The healthcare industry isn’t against Meaningful Use, it isn’t against improving care and using new technologies to add value and decrease costs.  As a matter of fact, healthcare executives have made achieving Meaningful use their number one priority.

The truth is, Meaningful Use is going to be a success, because the healthcare industry is embracing the initiative.  Professionals aren’t arguing about incentive or a command-and-control structures, they aren’t digging their heels in because of procedure.  Instead, healthcare industry employees have risen above the bantering and focused on the value of implementing EHRs, applying analytics to overcome healthcare hurdles and transferring data to help better serve society. 

Perhaps it is time to praise healthcare employees and leaders for looking past the difficulties associated with top-down approaches and instead applying a “can-do” attitude in the midst of change.

Telehealth Continues to Gain Favor

Telehealth, not to be confused with telemedicine, is the delivery of health-related services and information via telecommunications technologies. It is yet another way to address healthcare quality issues and offer consumer-centric healthcare.  InMedica’s most recent report, “The World Market for Telehealth – A Quantitative Market Assessment – 2011 Edition,” projects the telehealth market will “exceed $1 billion by 2016 and could jump to $6 billion in 2020”.  The telehealth frenzy is being driven by two seperate, but complementary streams – Its noted cost-savings and increases in quality and the heightened attention on managing chronic diseases  and the government telehealth grants.  Together these seperate streams of information are spurring the adoption of telehealth as a cost-effective solution to engage patients, decrease costs and increase outcomes. 

According to the Office for the Advancement of Telehealth, telehealth is a prime solution to meet the needs of underserved people by providing alternative care to patients with mobile difficulties due to disease or geographic location.  Telehealth can be used to educate and care for patients who need to manage illnesses but do not require an office visit.  This type of alternative is a win for all parties.  Currently, payers boast of telehealth cost-savings by discouraging frivolous practices.  Providers see telehealth as an alternative way to increase quality, better manage illnesses and treat more patients.  

Meanwhile, the benefits of telehealth have been noticed by consumers. Patients are excited to have the ability to manage their illness/es from a distance and avoid spending time traveling to and from time-consuming doctor visits.  Consumers also view telehealth as a way to receive affordable care and become more engaged in their care.  Engaging patients in care allows providers and payers to get better results by motivating, coaching and integrating healthcare with social networking that is shown to alter healthcare choices. 

If patients have it their way, telehealth will become the norm to managing illnesses and disease – of the surveyed U.S. healthcare consumers, half of  the respondents  say they would use telehealth.  It is time that capitalism does its thing and providers consumers with more and better telehealth options.

HIEs post another Win within the Healthcare Industry

One of the most costly and concerning healthcare expenditures is emergency room visits.  Providers and payers are especially concerned with the uptick in ER visits, because ER visits are known to be extra costly and peppered with discressionary visits.  Providers and payers have decided lowering ER useage could be done by identifying ER abusers and preventing people from getting sick.  However, to do this having access to information is necessary.   In a recent report in Healthcare Payer News UnitedHealthcare discussed how they have reduced hospital and ER usage, increased quality and decreased operating costs by sharing patient data through a healthcare information exchange (HIE).

HIEs are known to improve coordinated care and care management as well as minimize unnecessary costs by sharing patient information amongst payers and providers.  UnitedHealthcare cited an additional HIE advantage from its real-time system – better follow up care which resulted in lower readmission rates and fewer ER visits.  Dr. Sam Ho, the executive Vice President and Chief Medical Officer at UnitedHealthcare, noted that HIEs will be critical for ER and Inpatient services because, “that is where the most discretionary utilization occurs, and that’s where the most impact can be achieved in terms of developing more affordable services and healthcare.”

In a previous post a colleague of mine identified 9 key drivers to enterprise HIE .  Of these drivers there are 3 that benefit everyone involved:

Ensuring appropriate care is given at the correct time:  Enterprise HIEs are driven by the clinical goal of ensuring that the appropriate level of care is provided to patients in a timely manner.

Promoting preventive medicine: Preventive medical services traditionally occur within a conglomerate of divergent clinical care settings.  An appropriate Enterprise HIE solution must drive disease-management programs to promote preventive medicine services and reduce the costs associated with these critical health care services overall.

A self-sustaining business model:  An Enterprise 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.  With the advent of healthcare reform, this strong business model will provide an efficient foundation upon which many more citizens can be incorporated into the existing ecosystem as will be required.

Together these three objectives explain how the industry will do more with less.  HIEs are electronic powerhouses that move and connect information from disparate systems to different parties to promote quality through connected and informed care.  In return organizations are better able to decrease excessive and unnecessary costs such as unnecessary ER visits and other healthcare misuses through analyses on data sets which identify operational weaknesses and high-risk patients within the system.  Success stories, like that of UnitedHealthcare, reiterate the importance of HIEs within the industry.

Real or Satire?

Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry

KETTERING, OH—A comprehensive digital cataloging system that keeps track of its customers’ car maintenance history, oil-change needs, and past fuel-filter replacements puts Karl’s Lube & Go’s computerized record- keeping an estimated six years ahead of the medical industry’s, sources confirmed Friday…

Alas, it’s from The Onion.

Healthcare Needs Disruptive Innovations in Meaning

I recently read the excellent Design Driven Innovation, Roberto Verganti’s fascinating take on how certain paradigm-shifting products and services are created.  In it, he introduces the concept of “innovation in meaning,” which he contrasts throughout the book with “innovation in technology.”  Here’s my high-level summary of the differences:

  • Innovation in technology: new electronics, parts, components, etc. that are smaller, cheaper, and more effective at accomplishing existing tasks and which may allow for new things to be accomplished
  • Innovation in meaning: new and different experiences that users have that redefine how, what, and why they do things

Innovations in meaning often result from inspirations drawn from situations where the context, if not the content, is similar to the area of concern.  A great example that Verganti provides is of an Italian lamp manufacturer that worked with a renowned opera director to understand how light can influence human emotion and to in turn incorporate that understanding into the design of a new lamp.

Healthcare is filled with examples of innovation in technology but is relatively light on examples of innovation in meaning.  Take diabetes management, for example.  Technological innovations such as strips for testing blood sugar (first with urine and later with blood), single-use syringes, and portable glucose meters all made it easier for physicians to treat patients with diabetes.  But these technological innovations alone were not enough to dramatically change the status quo in which diabetic patients were essentially at the mercy of the treatments given to them by their physicians.

That status quo was disrupted with the advent of diabetes self-management, something that was brought on by a radical innovation in meaning.  In 1969, Richard K. Bernstein learned about a novel technology—the portable glucose meter.  Bernstein, a diabetic and engineer at the time, became intrigued at the prospect of measuring and monitoring his own glucose.  Leveraging his wife’s position as psychiatrist (sales of the monitors were restricted to medical personnel), Bernstein found a way around the status quo and obtained his own portable glucose monitor.  Like any good engineer, Bernstein began frequently measuring his glucose levels and eventually became the first patient to self-adjust his diet and insulin dosage based on his blood glucose levels.

By applying the mentality of an engineer to the problem of diabetes, Richard Bernstein changed what it meant to be a patient living with diabetes.  And while his innovation used a novel technology, the real breakthrough was in his taking ownership of his condition.  Read more about Bernstein (who went on to become on influential physician) in this excellent article in the Journal of Participatory Medicine.

The healthcare industry–loaded with technology and filled with complexity and entrenched protocols–is ripe for the type of disruptive innovation in meaning exhibited by Richard Bernstein.  Such innovation doesn’t require great technological breakthroughs—it simply requires a willingness to collaborate and to question the status quo.  What does it really mean to be a patient, a healthcare practitioner, or a hospital administrator?  What should “health insurance” actually cover?  How should healthcare reimbursement work?

Of course, answering these questions and implementing the changes that the answers call for is often easier said than done.

Healthcare Informatics Made Easy?

This Fast Company article about the hot credit card-processing startup Square (their product is on the left side of the above image) got me thinking about health data, especially this snippet:

Rabois says Square was designed to be the “Google Analytics” of small- to medium-size businesses, and unlike traditional POS systems, the app’s simple dashboard design takes virtually no training to understand. All sales are tracked to the Nth degree, enabling merchants to easily compare, for example, their price of a cappuccino to a local competitor’s, to the neighborhood cafes’, or to the city’s coffee shops as a whole.

What if we could apply the same powerful simplicity to healthcare data?  Providers could compare not only prices but also any other healthcare metrics that can be tracked.  Patients could also compare prices and maybe even service ratings.

About an hour after reading that Fast Company article, I saw a tweet linking to a Medgadget blog post about a new personal health card from LifeNexus (this is the product shown in the right side of the above image).  The LifeNexus Personal Health Payment Card is an all-in-one solution that stores a patient’s health record on a chip that’s embedded in what is essentially a credit card that can be used to pay for healthcare services.  Here’s a snippet from that post:

An individual’s personal health record is stored on the card’s embedded microcomputer, the iChip, which is encrypted and password-protected, providing a highly secure environment that the individual owns and controls…The multi-functionality of the LifeNexus Personal Health Payment Card™ provides an additional and exceptional benefit. If individuals choose to have the Personal Health Card on a payment card, they can make purchases, providing a convenient way to manage their health-related information and make general day-to-day purchases on the same card.

For the time being, Square-like analytics don’t seem to be in the strategic cards for LifeNexus, as they are marketing their solution as an alternative to storing data in “the cloud.”  But an obvious source of potential revenue for the data collected by LifeNexus would be providing de-identified data to drug and device manufacturers , healthcare informatics companies, or payer-sponsored comparative effectiveness studies.  Especially if they can create a user experience as simple and easy as Square.