Now that I have stepped off of my soapbox, below you will see the three steps they used to solve their problem using cloud based technology.

Step 1: Analysis and Planning

Used support of network and desktop teams.  Reached out to a few employees and received positive feedback.  Need to establish an appropriate scope.  Decided it was naïve to say that they couldn’t put the data they use in that system.  They went forward assuming it would include PHI.  Worked with desktop and network teams to identify actual target technology.  Engaged Information Security early.

Step 2: Prototype Pilot Implementation

MD Anderson used the following process to implement their pilot

• Implement gradually and with care.
• Evaluate surveys and usage data.
• Pilot with a mixed user base, prototype with power users and set end user expectations

Pilot program tips were to address security concerns early, take the time to test support and administrative tools, and don’t forget about the support staff.

Step 3: Support and Marketing

Partner with key groups for support.  Advertise that these services are available.  For internal collaboration I often suggest you communicate these new tools “7 different times in 7 different ways”.  In MD Anderson’s case this included advertising the tool on their very own television station and using the help desk to document users that they knew were already using cloud based storage (perhaps inappropriately) and targeting those users.  One of the ways definitely need to be a training program that highlights any self-service functions built into the new program.

What drove the adoption of this mobile technology?  There were three main reasons.

1. Supports compliant workflows: They learned that doctors were using their cellphones to take pictures of images and then texting them to other physicians that were not onsite to get their opinions.  This obviously gave compliance officers a heart burn.  So, they wanted to make the right thing the easy thing by providing a high quality mobile platform that was HIPAA compliant.
2. Improves care coordination: Data silos are a problem.  We all know this.  This mobile platform provided physicians with access to data in a single application.  They had this access no matter where they were when they needed this data.  This expedited the speed of care in emergency situations.  I’m sure it also answered the common call from physicians: “I go from room to room to room all day. If it is not on my mobile device, then I don’t care about it.”
3. Encourages engagement: There is 91% US adult adoption of mobile technology.  As a result, these mobile platforms leverage the use of equipment that physicians are already familiar with.  This fact encouraged engagement and interest in the program.   For those of us that make implementation of technology in healthcare a habit, easy physician adoption of technology is pretty awesome.

Analytics have shown that the technology is highly utilized by Rockdale physicians.  It has also provided a competitive advantage in their provider heavy location of Atlanta.  Among other goals, Rockdale’s next steps are to partner with their local EMS and establish objectives to improve the quality of patient care in the Emergency Department.

While I normally lean towards the positive in providing insights from these breakout sessions, being a presenter is no easy feat, I must start with a couple of not so positive qualifiers.  “Patient portal” was not really discussed during this session.  Rather, “digital means of communication”, such as public websites and social media, is a more appropriate definition of the technologies discussed.  Fair enough on the surface.  However, not knowing the difference between public and secured technologies created a real problem when the presenter spoke of how HIPAA creates barriers to providing teens with health information via digital means.  The patient portal, used thoughtfully, can assuage these privacy concerns.  I feel that the presenter should have understood this.  Her lack of knowledge on portal was amplified when I asked a question related to the timing of the data she collected in Approach 2, mentioned below, in relation to  Meaningful Use Stage 2.  She did not know what  Meaningful Use Stage 2 was.

With that being said, I will carry on with insights from the session that I did find insightful.  To present these in the correct context, I will mention that digital health in adolescents presents a number of quandaries for the healthcare provider.  While most healthcare decisions and procedures can and do involve parental consent, not all can.  I involved my colleague Dr. Marcie Stoshak-Chavez in defining what decisions and procedures do not involve parental consent.  As she mentioned, although healthcare statutes vary by state, procedures for sexually transmitted diseases, pregnancy, contraception, psychiatric disorders, and drug or alcohol abuse typically do not involve parental consent and include additional privacy rules that exclude parents.  

Since teens can and do use digital technology, and technology is often used by consumers to collect information because of the anonymity involved, it is quite apropos to discuss using digital health means, such as patient portal, when providing care for teens.  This becomes a much more important conversation in those areas of care where parents should not, by law, have a seat at the table.  Of course, it must be considered that oftentimes the devices teens use are not actually owned by them.  This also must be considered.

Essentially, digital health provides the most obvious form of communication between provider and teen.  However, there are many constraints.  What follows are three areas of study that Peggy Smith provided:

Approach One: Web based platform for sexual health for at-risk youth

This method involved avatars named Tiff and Ty that were available for anonymous questions on sexual health via a clinical website (read: not portal).  This research was a qualitative assessment that evaluated the anonymous questions that were submitted via the website.  There were a total of 916 queries received.  Six major question types  were identified in order of frequency:

• Cost (Might seem surprising at first, but makes sense in decision making that does not include parents)
• STD testing
• Birth control
• Personal health concerns
• Parental consent and confidentiality
• Sexual health misconceptions

Some of the questions included, “Does it cost to have a regular check up and pap smear?” and  “I was wondering if yall had HIVSTD testing available and how much it would cost?”  and “Can I come in for birth control and will my insurance voer the cost for it?”

Approach Two: Evaluation of the adoption of electronic platforms by public health professionals 

This method involved studying decision makers for technology platforms within the healthcare provider industry.  This study wanted to understand to what extent public health professionals, the ones making the decisions, were familiar with electronic messaging and what their attitudes towards acceptance of these platforms were.  This is the one where I must mention that the data was collected in 2011, which predates Meaningful Use Stage 2.  I would guess that these figures would be much higher now, but it is interesting to see how failing we were in adoption of these technologies without the financial incentives.  I must also point out that it is likely that the researchers did not describe these digital care methods in the context of portal, since they did not understand the difference between web and portal.  If I were a decision maker, then that would have painted my answer in this case.

At the time of the study, only 37% of decisions makers stated that they currently had these systems in place.  Only 15% of these decision makers stated that they had future plans for implementing these technologies.  Recurrent themes in the research included a lack of confidence in the processes surrounding digital health, the depersonalization of healthcare, and the concerns for privacy.  It is also interesting to note that there was a stated difference in age cohorts.  Older decision makers were less likely to move forward in developing digital health infrastructure than their younger counterparts.

Approach Three: Global portal for information across continents

The method here was to use the upgraded website teenhealthclinic.org to provide a number of health education tools.  These included a presence in social networking, a short message service, and health education webisodes.  These webisodes targeted 16 and 17 year olds that were mostly Latino.  They used the concept of “Edutainment” (education + entertainment) to provide information on topics such as HIV testing.  Story ideas were based on real stories, contained entertainment value, provided context of audience lives, and focused on characters and their relationships.

There wasn’t much information provided on the impact of this approach other than to point to the “issues that HIPAA presented” when it came to public websites.  Again, knowing the difference between public website and portal would be helpful here.  Also, one information session participant commented that providing webisodes like this would have astronomical production costs.

Reaching Teens with Digital Health

Teen health education can oftentimes be a divisive topic, but the debates on this topic will not make these issues go away.  In fact, it has been proven via cost data that limiting healthcare to teens generates a major drain on the healthcare system.   With all of these facts in mind, do you believe technologies like patient portal can be used effectively in the area of teen health?

1. Healthcare will become more data driven: This is clearly at the heart of what Paul Grundy, and the patient centered medical home movement, is passionate about.  The driving question here is “Where is the data and how does it impact care at the elemental level?” with the goal of having all data available and able to act upon.
2. Every person will have a plan: This is an interesting one for me.  My mind immediately harkened back to the Connected Health Symposium a couple of years back when Joseph Kvedar, MD spoke of using genetic data for personalized preventive medicine.  You can read my post about it here.  There is also a post by Dr. Marie Stoshak-Chavez on whether we will ever see personalized preventative medicine in the future.
3. The delivery system will be team based:  Check out this piece on the core principles and values of team based care.  They correctly point out that care has not always been a team sport.  In the “good old days” meaning “still happening today sometimes” all care was curated by the doctor as the “all knowing sage”.  The complexity of modern healthcare provides us with a situation where the entire team needs to work together harmoniously to provide care quality.  This brings us to….
4. Managing a population down to the person:  Here is what I hope is the “patient centered” part of PCMH. It my (not so) humble opinion, the healthcare of the future will not reach its fullest potential until it is truly patient centered.  This means that the patient needs a seat in team based care.

What are your thoughts?  Do you think he nailed it, or are there some holes in his vision of where medicine will evolve into the future?

From the interview, I take away at least 10 major benefits to establishing and leveraging an enterprise information management strategy in healthcare settings:

An EIM strategy can:

1. Help manage access to enterprise information in a secure, HIPAA-compliant manner.
2. Allow healthcare professionals to turn mountains of data into real-time decisions.
3. Help focus people, process, policies, frameworks and foundational technologies toward how to best leverage enterprise data.
4. Set forth the framework that will be used to provide the information delivery capability,whether the information is in the form of data (structured or unstructured) or unstructured content, or a combination of both.
5. Help an organization respond to evolving regulatory requirements and reimbursement models.
6. Define the information management model that will be used to harmonize the delivery of both content and data specific to a healthcare organization’s goals and objectives.
7. Ensure the delivery of information in the form of a trustworthy source that can be interpreted, used and managed consistently across the enterprise.
8. Give a clinician or healthcare knowledge worker the access they need to the many sources or types of information from which to make decisions.
9. Ensure information is timely, accurate, valid, verified and generally fit for purpose.
10. Produce a more holistic view of the patient, derived from structured data stored in an electronic health record and other clinical systems, as well as unstructured information or content made available in some of the forms previously stated.

Read the full interview here.

Participatory medicine is a care model in where the role of the patient is active, enabled, and emphasized.  Participatory medicine requires the “mindful” inclusion of the patient in the care delivery process.  When you see online patient communities forming, then you see participatory medicine at work.  You will also witness shared decision making, patient participation on the treatment team, and evidence based patient choice.  The director of the U.S. National Institutes of Health has been quoted as saying:

As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive. It must be based on education and communication.

These are the types of sentiments that make someone like me very happy.  The fact that I get to play a role, even though quite small, in this movement is the kind of intrinsic motivator that gets me up each day happy to do my work in Connected Health.

In Connected Health we design technologies meant for patient engagement.  They are the communication lines that extend outside of the eight minute patient visit and into the lives of patients wherever they are when healthful decision making counts.  As a result, another participatory term set is beginning to exit my mouth more frequently.  That is, namely, participatory design.  Participatory design, also known as cooperative design, emphasizes active inclusion of all stakeholders, even those that do not know how to use Photoshop, in the design process.  Key to this end is the end user.  In our case that means the patient.  By using participatory design, we are able to create environments that are more responsive and appropriate to a patient’s cultural, emotional, spiritual and practical needs. User empowerment is built into the core of this process.

So, what if patients were crowd-sourced more regularly to solve all of those challenging patient engagement issues?  For example, many of the biggest challenges I see on provider websites occur because it is challenging for an employee of a health system, the ones actually making the final decisions, to release their mind from the confines of their day job.  This usually means that the content of the public website is architected in the way that employees see the organization: by department or facility.  Problem is, this gets in the way of patients trying to find the information they need to be more healthful.  Patients shouldn’t have to navigate 5 layers deep to find content specific to their condition or health concern.  Patients won’t work that hard.  Instead, the hub of digital patient engagement should have, at its core, the patient user experience.

Not being new to the public website creation rodeo, I’ve found the process and final product to be greatly improved through the addition of patient voices throughout the entire website design process.  I’ve never met two patient populations that are the same, so while there is general advice on tailoring a message to patient needs, insight should always be collected from the target market in question.  This insight informs the nuts and bolts of information architecture and the engagement of graphic design.

As a result, a one and done approach to patient feedback is good.  An iterative approach to patient feedback on site design is better.  Co-designing a site with patients?  I would love to see that on every provider website.  By using participatory design to reach out to patients in the beginning of the relationship, with the website that engenders a culture of participation, then it makes it that much easier for that participation to be embedded throughout the entire collaborative care model.

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. 

Positive 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.
3. Success with accreditation and regulatory agencies - Agencies that accredit health plans now scrutinize patient satisfaction data during the accreditation process. Health plans annually measure patient satisfaction as an external review and accreditation requirement of the National Committee for Quality Assurance (NCQA), which instituted a member satisfaction survey as part of its Healthcare Effectiveness Data and Information Set (HEDIS) quality standards as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey that measures the experiences of patients with their physicians and medical groups.
4. Favored relationships with health plans - To become the plan of choice for consumers, health plans want to show high CAHPS scores to prospective customers. They know members defect when they are dissatisfied and they want to retain them in their plans, so most have instituted several incentives or sanctions—all designed to encourage practices and other ambulatory care settings to enhance the patient experience.  The better a medical practice or ambulatory care center satisfies its patients, the greater negotiating power with payers.
5. Lower costs of doing business – By providing the exceptional patient experience, medical practices and ambulatory care centers also reduce the costs of doing business. Patients more satisfied with their experience are also less likely to file malpractice lawsuits that drain provider time, energy and coffers. Also the work climate is more satisfying to staff which in turn reduces costly staff turnover.
6. Reputation, pride and satisfaction – In an atmosphere of consumer savvy and scrutiny, the quality patient experience wins physicians and ambulatory care centers an admirable reputation and a grapevine that results in widespread respect in the community. Members of the care team build relationships with patients that last. People trust the care team, and because they are more satisfied, they complain less. All of this translates into the psychic rewards of greater job satisfaction for the care team and greater pride in their impact on their patients’ health status.
7. Profitability - By providing an exceptional patient experience, medical practices and ambulatory care centers win favor from consumers, purchasers, accrediting agencies and health plans that affect their practice’s financial health and profitability. 

As the U.S strives to change patient experience from a fad to a priority in how we deliver care, outpatient medical practices need to understand the positive impact improvement can make, not only to their business operations, but more importantly to the outcome of patient care.

What other benefits do you see by improving your patient’s experience?

1. geospatial,
2. genomic and
3. geocaching.

Let me show you how all of these have relevance to healthcare:

Let’s start with geospatial. 

I am fascinated by the heat maps of disease prevalence, patient engagement and demographics that have started to electrify Healthcare.  Duane Schafer, Director of Microsoft Business Intelligence for Perficient, recently revealed a great demo at HIMSS, based on Population Health statistics from ProHealth in Wisconsin.  Using basic tools from the Microsoft stack, Duane was able to visually map important population health statistics from ProHealth and present that data in a way that entices the viewer to explore deeper.  It allows the organization to see, at a glance, major population demographics in their region.  This can then be combined with additional analytics to determine trending of disease in the area, frequencies of patient visits to the Emergency Departments over time and correlations of missed appointments to care gaps in specific chronic disease management.   Geospatial mapping even hit the news recently when a contamination at Lake Champlain caused concern about the risk of spreading disease and therefore assisted with facilitating a rapid Public Health response in this  situation. Of course, there are many more examples but you get the idea.

Secondly, genomic mapping

Genomic mapping and personalized medicine have emerged at the forefront of cutting edge research and treatment.  Pharmacogenomics have been utilized for targeted cancer treatments, anticoagulation treatment choice and diabetes management already.  In a February 28, 2014 article in BMC Medicine, “Personalized medicine: risk prediction, targeted therapies and mobile health technology”, several forum contributors wrote about new and exciting potential uses for genomics and personalized medicine in stroke prevention and treatment, oncology and mobile health.  One particular passage summed up the future use in medicine quite well:

“My second vision for the future is the next-generation sequencing approach. This is the future of oncology, and we are really looking forward to that. The third area for the future of personalized oncology, I think, is not so much a scientific revolution as it is a sociologic revolution, and that is the issue of being able to look at so-called ‘big data’. With the advent of the use of electronic medical records in many medical practices around the US, we are going to have the ability to potentially review millions of patients’ outcomes in the future and apply the lessons we have learned from previous retrospective analyses of how patients do when they are treated in various ways.”

This encourages me to think that eventually information, genomics and individualization WILL combine to vastly improve our ability to provide healthcare for each unique individual.  So IBM’s Watson or the Oracle Health Sciences Translational Research Center could help provide the backbone.

Finally there is geocaching. 

What could geocaching have to do with healthcare, you ask?  I believe it adds the final piece to the puzzle.  Geocaching could be used for gamification in healthcare, as described by Perficient’s Martin Sizemore and Melody Smith Jones, allowing patients to do a virtual Healthcare “cache” and collect badges when they complete their prescribed exercise or educational lessons suggested by their provider.  Better still, geocaching could be used as the exercise component of a wellness program managed by a Healthcare provider, system or health plan.  Not only would it exercise the body, but it would also challenge the mind.

So is Healthcare a leader or a follower when it comes to mapping?  I’m curious to know your thoughts so tweet me @DrMarcieSC.

1. Data collection
   “Payers collect a lot of data, which can provide a broad picture of what is happening in a population and across the entire continuum of care. Health systems bring a rich vein of information related to specific components of that continuum.”
2. Transparency
   “We rely on this data to make sure we know what works, and when it doesn’t work, we use the information to identify opportunities for improvement,” says Kevin Sears, vice president of payer strategy and product development at CHE Trinity Health in Lavonia, Mich.
3. Mutual understanding
   In the past, providers worked to drive up revenue from the payer, while the payers needed to drive down costs to please their customers, both employers and employees/members. Now the two have to work together to reduce waist and improve care.
   

Now, we see that payers and providers must collaborate in order to truly drive value, more so than they ever needed to in the past.

When payers and providers work together to achieve all three of the above imperatives, they’ll identify opportunities that will become mutually beneficial. Each can begin by asking themselves whether their high-priority projects are working to help them to obtain higher transparency, data collection and sharing, and a mutual, more collaborative relationship with the other.

Combining clinical and financial data for cost management is a popular topic given the political and economic environment. This activity generally includes these data requirements:

• Claims data for diagnosis codes, patient demographics and encounter information and services provided; this data usually resides in the patient billing system
• Clinical data such as labs for quality and outcomes ; this data usually resides in the EMR, EHA or other ancillary clinical systems
• Accounting and finance data from the general ledger, budget and sub-ledger systems.

Assembling this data requires a robust technical architecture that easily stores the data relationships with contextual integrity along with the ability to resolve patient or person identity. Once the data is assembled, leaders of the organization can build disease registries to manage the cost of care for populations and to model service line profitability, analyze payer contracts and more. The most important benefit of this transformation is that the organization begins to speak a common language of accountability and front line managers begin to understand the relationships between volume drivers and departmental workload leading to increased ownership of controlling these variables.  The costing step is important ensure the data as well as the transaction level calculated cost is fully accessible to decision makers.  All too often we hear that “my patients are sicker than theirs” or my surgical device has better outcomes.  The proof is in the data!

The Oracle Enterprise Health Analytics (EHA) platform in concert with the Oracle Hyperion Profitability & Cost Management (HPCM) solution facilitates the merging of clinical and financial data to perform costing calculations. This fully burdened cost data associated with other clinical metrics such as quality and outcomes measures answer both administrative and operational questions.   Using the Oracle platform, patient volumes, outcomes and operational measures are not viewed in an independent environment but instead become dependencies to understanding case mix index, reasons for readmissions, and staffing mix (on a case level), among other things.

Perficient offers design, implementation and support capabilities for Hyperion Profitability and Cost Management (HPCM) and Oracle Enterprise Health Analytics (EHA) solutions as well as the full Oracle Hyperion EPM suite of solutions.  We are a silver sponsor for the #OracleIC14  and we are looking forward to talking with you about Health Analytics and Population Health.

Stop by to meet our dynamic team at the Partner Networking Zone, Marriott Copley Square, 4th Floor to discuss new ways to optimize your systems, along with new solutions that will take your organization to the next level.

Join us in Boston! Follow our healthcare experts on Twitter @Perficient_HC and check our Healthcare blog.

Follow me on twitter @teriemc

View my recent blogs:

Elevating the Role of Finance within the Hospital

Enterprise Warehouses: The Gift that Keeps on Giving

Balancing clinical effectiveness with profitability