In today’s lineup, we will explore two specific sites.  One of these sites is meant for physicians and the other is meant for patients.

Doximity

Although Doximity was not mentioned in the University of British of Columbia study that spawned this blog series, I am going to start here for good reason.  Although they are a relative newcomer to the space,  Doximity has experienced very strong growth.  Last year Doximity doubled their network to a total of 250,000 members, which is 25% of all physicians in the US.  What I find fascinating about Doximity is that it was started by the AMA.  It’s oftentimes the case that, in the David vs. Goliath world of social media, hip start ups are the ones that people want to follow.  The AMA now finds themselves in a situation where they have more users of their social network than they do actual members.

Doximity does a few things right.  It’s most popular features, beyond making upgrades that make the user interface more like Facebook or LinkedIn, include:

• An API that enables “Facebook Connect” for easy authentication
• A built in recruiting tool called Talent Finder
• A continuing medical education (CME) platform
• A “digital fax line” that allows physicians to receive their faxes (I know…don’t get me started) through their network via a personal fax number

PatientsLikeMe

PatientsLikeMe is a site where e-patients can collaborate with one another in a peer-to-peer supportive setting.  The site was launched in 2004 by the family members of an architect that contracted amyotrophic lateral sclerosis (ALS) at the age of 29.  They had originally raised millions, literally, in a failed attempt to find a cure for ALS.  They also created this patient social network to go along with that effort.

PatientsLikeMe now has over 200,000 members with groups for approximately 1,800 disease states. The most popular networks are neurological diseases such as ALS, multiple sclerosis and Parkinson’s, but there has been growth in members with HIV/AIDs and mood disorders like anxiety and depression.  Cancer, with its numerous subtypes, has been a more challenging group to tackle.  I have found that these subtypes often form their own online patient communities.  You can find a list of these on e-Patient Dave’s website, which I definitely recommend you visit if you want to learn more about how patients are using social in life altering ways.

One of the most incredible things about PatientsLikeMe is not as obvious.  Let’s consider a typical patient journey: we get sick, we go to the doctor, the doctor captures data during that visit including family history, bloodwork, scans, biopsies, etc.  Then there is the follow up appointment.  Perhaps a follow up call by a nurse.  But as I often say, that’s only 1% of the story.  It is the other 99% of the time when that patient is out there in the real world that matters a lot.  So, where do we get all of that data that takes place during the “meantime”.   PatientsLikeMe is often heralded as the producer of the most compelling clinical data the health care industry has ever seen for this reason.

As compelling as this data may be, it’s only a speck of sand on the beach.  There is far better data capture to be had by socially integrating patient and physician in a meaningful way.  This takes me back.  Way back.  To a post I actually wrote in 2011.  What I said then will be where I end here today:

“Patients are online.  Physicians are online.  However, these two groups are running in different social circles…this presents a true medical problem.”

Healthcare providers have been using direct secure messaging for care coordinating for a while but there may be ways to use it more fully to reduce readmissions, reduce unnecessary testing and procedures and even increase provider productivity.  Some benefits may include:

1. Providers can insert secure messages into any point of their workflow.
2. Primary care providers can interact with specialists to potentially result in fewer referrals; ultimately reducing costs to the healthcare system.
3. Hospitals can improve transitions to nursing facilities and nursing homes can improve the communication with providers to reduce the need for readmissions back to the hospital.
4. Medical records departments can interact with the patient send their records more easily saving them time and money.
5. Researchers can seamlessly interact with patients on release of health sciences information.

Once HIEs are fully implemented, query based networks will provide robust data exchanges, but DSMs will continue to be valuable especially for smaller practices and hospitals that do not have the means to implement sophisticated EHRs. 

Perficient places the consumer at the forefront of healthcare technology solutions. Our dedicated national practice, combined with Perficient’s more than 1,000 business and technology professionals, delivers innovative and intelligent solutions for hospitals and health systems, integrated delivery networks, health plans, life sciences and state and federal government agencies. Perficient is uniquely positioned to deliver HIE assessments and strategic roadmaps.  Stop by our booth at #HIMSS14 booth #2035 to view our case studies.

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See my blog “What is the role of health exchanges to maximize our time in the doctor’s office?” to learn more.

There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?

It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”

The American Health Care Association (AHCA), the largest association representing skilled nursing care centers in the country, reports that every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Of readmissions, one fourth are skilled nursing care patients, receiving post-acute care (recuperative or rehabilitative services).

According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447).

CMS concurred on the recommendations from the report to:

1. Develop a quality measure that describes nursing home resident hospitalization rates and
2. Instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.

As noted in David Gifford’s blog on January 17, 2014, AHCA also agrees however does not think the OIG went far enough.

What will it take to get the right data to actually make the changes needed to decrease readmissions, cost of care and, most importantly, quality of health for nursing home residents? What would it take to get timely access to risk-adjusted Medicare claims data in addition to claims data for supplemental coverage by other insurance and health plans? What other clinical data would be critical to this analysis?

Seems that there is no way around having to optimize claims and financial data with other clinical data and quality measures. Population management and predictive analytics could help identify what changes are needed to decrease these and other readmission. Stop by the Perficient booth #2035 at HIMSS 2014 and talk with us about your experience in decreasing readmission rates.

Well I clicked my heels three times and eventually moved us back to our Mayberry.  It’s been three years and my son and I will still giggle together when we order french fries and see someone going out of his or her way to offer ketchup.  And when we say “Yes, Please”, we get several packets.

Consulting in Healthcare is no different. We’ve grown accustomed to the “build to spec” approach.  You get exactly what you asked for.

I’m thankful to be a part of Perficient and the Oracle Healthcare Business Intelligence team.  We share a common philosophy – understand what the customer wants to achieve, coach and advise available options, design and deliver a solution that fulfills their NOW problem and simultaneously prepared them for the next 5 years.  It’s not just a report – it’s Healthcare Analytics.

…and yes, we do say “Please and Thank You!”

A Master Person Index (MPI) is a solution intended to solve the common problem where multiple systems or applications within the organization gradually become inconsistent with the most current data.  When this information changes and only one system is updated, the MPI solution ensures that the change is propagated to all other systems to create the single best view.  The MPI may be found at the single system level, facility level, enterprise or health information exchange (HIE) level.  A “person” in the healthcare context may be a physician, patient, member, payers, etc.

Data management is one of my favorite subjects and I’m very excited about the evolution of MPIs for identity resolution, as well as, other Master Data Management solutions. But let’s focus on the benefits of the Master Person Index.  Some examples are:

• Correctly matching a point of reference to patient, clinician, payer or other entities within and across the organization can improve care coordination and ensure trusted information in an emergency.
• Accuracy in building the “best single view” of the patient will empower both disease management and research activities.
• Using an MPI solution will enhance governance and risk management capabilities since MPI solutions are compliant with IHE audit messaging and recording standards.
• Using an MPI automated solutions provide a means to interpret and analyze patterns in incoming data to help trace lineage of the values to determine original source of bad data.

Perficient’s dedicated national practice, combined with hundreds of business and technology professionals, delivers innovative and intelligent solutions for hospitals and health systems, integrated delivery networks, health plans, life sciences and state and federal government agencies.  We are uniquely positioned to deliver identify management assessments and strategic roadmaps.  Stop by our booth at #HIMSS14 booth #2035 to view our case studies.

Follow me @teriemc

See my blog “Direct Secure Messaging and Improved Care Coordination” to learn more about the Oracle HIE platform.

You see the commercials on TV, the alluring websites, digital advertising in airports, on billboards, on the radio, in magazines, everywhere. Let’s face it, the war for patients in healthcare is in full swing. Whether you are a hospital, a physician, a pharmaceutical company or any combination thereof, you are now operating in a highly competitive environment. Frankly, it was inevitable.

The shift from company to consumer is happening everywhere, and healthcare is no exception. To read Joan’s full blog post, click here.

Still, producing a monthly income statement is one thing, and there is certainly no shortage of guidance whether considering GAAP or public sector fund management reporting requirements, but how do we merge the clinical effectiveness discussion with the finance and accounting discussion? 

In my view, these two areas converge at the decision support team who have been supporting contract management and costing activities for decades.  Perficient views the costing activity as an enabler for business to deliver strategic advice, moving away from low value transactional activities, through increased focus on:

• cost reduction and ability to support the introduction of new products/services or new markets
• understanding spend according to the value a function or activity creates
• promoting transparency with a wider view to cost data to allow management to better understand spend through driver-based information on “cause of cost”.

Our team will assist to refocus and strengthen existing management processes to promote a sustainable cost-focused culture with a forward looking view of expense performance, affordability and priority setting within a sustainable cost management business model.

We are an Oracle certified education partner for the Hyperion Profitability & Cost Management (HPCM) application and we also have experience with non-Oracle costing solutions in large healthcare provider organizations.  Our experienced team is prepared to lead the design of costing methodologies for both traditional and activity based cost models, as well as, the software configuration and implementation within the Oracle Enterprise Heath Analytic and Oracle Enterprise Performance Management platform.

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.  Stop by our booth at #HIMSS14 booth #2035 to view our case studies.

Follow me on twitter @teriemc.

Learn more:

• View “A Profitability and Cost Management Strategy for Healthcare Providers” on-demand webinar
• Download “A Solution to the “Signal to Noise” Problem for Healthcare Organizations” white paper

The study correctly titles Twitter as a “microblog.”  With microblogs, we take many of the same concepts found in my previous post about blogging, namely community and collaboration, and we widdle them down to 140 characters or less.  Twitter is that place where communities of people that are interested in a similar topic, be that interoperability or Oscar night, digest a lot of information quickly together.  I rely on Twitter heavily to keep me up to date on everything related to #hitsm (health it), #hcsm (healthcare social media), #mhealth (mobile health) and #connectedhealth (I’m sure you’ve got that one without need of assistance).

The study gets extra points for classifying three broad categories of tweeting styles:

The word therblig was the creation of Frank Bunker Gilbreth and Lillian Moller Gilbreth, American industrial psychologists who invented the field of time and motion study. It is a reversal of the name Gilbreth, with ‘th’ transposed. Therbligs are 18 kinds of elemental motions used in the study of motion economy in the workplace. A workplace task is analyzed by recording each of the therblig units for a process, with the results used for optimization of manual labor by eliminating unneeded movements. (Wikipedia)

I remember, and it was a lifetime ago.  But then again, the Gilbreth’s were turn-of-the-century industrial psychologists who invented the field of time and motion study.  I consider them the founding parents of Industrial Engineering.

So why are we talking about therbligs in Healthcare?

Ah, young Jedi, the time has come to learn our lessons much the same way that the industrial giants like Ford, Carnegie Steel and General Electric learned 100 years ago during Teddy Roosevelt’s administration.  These early lessons became the standards of the mid-century boom in manufacturing and production output.

So the healthcare technology space has finally gotten to its tipping point.  In order to survive, the healthcare industry will need to invest in Industrial Engineering principles and it will need to do product line, service line, episodic, acute and outpatient time and motion studies.

Those of us in healthcare will need to work toward getting accurate reporting on the most discrete work activity, person performing the function and the time duration.  From there, the folks with the green eye shades get to take over and “cost” the task, activity, and visit.  Quality Improvement gets to join in and look at idiosyncrasies in practice.

Very soon healthcare providers will know how much your wellness visit or the orthopedic hip replacement truly costs from a micro costing approach.  Gone are the RCC or RVU estimates that just collapse and average.

And yes, as Frank and Lillian Gilbreth know – it is cheaper by the dozen!