Interoperability between different electronic health record (EHR) systems is one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.

However, let’s examine the real goals of interoperability within healthcare:

1) To make sure “information follows the patient regardless of geographic, organizational, or vendor boundaries”

2) To have at least one or more instances in which providers exchange an electronic summary of care with all the clinical data elements between different EHRs. Establishing this connectivity does not insure the real goal of collaborating across the continuum of care for the patient’s benefit.

The debate still rages on the role of the patient in this interoperability process as well. We have all, as patients, had our medical files spread across a family doctor, multiple hospitals, specialists, health plans and today, even multiple pharmacies. The prospect of creating a complete picture is staggering, let alone having all of those healthcare providers really collaborate on our behalf. Is it the patient’s responsibility in this ever-changing healthcare electronic revolution to compile this electronic mess into a coordinated whole or will the industry magically create it as a result of Meaningful Use Stage 2?

It is worth arguing that interoperability in Meaningful Use Stage 2 only creates a baseline of connectivity between two or more systems to exchange information and puts in place the ability of those systems to use the information that has been exchanged. It does not create collaboration on behalf of patients within the healthcare provider community, especially between competing players like local hospital systems or healthcare providers versus payers. Having the ability to connect only trades fax machines for electronic transactions, if tools aren’t employed for physicians for example to collaborate over a single patient.

In advocating for collaboration, let’s examine the reality of an exchange of a set of electronic transactions about a patient versus where the process would need to be for genuine care coordination. Today, a fax from the hospital to the family physician is the notification that the patient was hospitalized and needs follow-up in coming weeks. Based on the type of hospitalization, a call between the attending physician and family physician may be warranted, and a potential referral to a subsequent specialist may be in order. Simply communicating electronic documents doesn’t address the interaction between key people in the decision-making process and the assumption that the inclusion of unstructured physician notes will suffice may be optimistic.

This means that health information exchange is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability, especially to streamline real collaboration on behalf of patients. It is time to examine an expanded view of both interoperability and health information exchange to promote ease of collaboration between the parties involved, including secure physician to physician communications – electronic or instant message, for example, and secure physician to patient communications. As an individual patient having to deal with multiple patient portals today for communicating with my healthcare providers, there is a real concern to address this issue sooner rather than clean up confusion later.

Can we define collaboration in a way that traverses healthcare’s landscape of emerging connectivity?

When you played baseball as a youngster, and stepped into the batter’s box, the last thing you wanted to be was an “easy out”. Ironically, today many healthcare organizations are looking for the “easy out” to rapidly develop the business intelligence reporting needed to address regulatory reporting demands, population health management and chronic condition management, to name just a few.

The pressure to quickly stand-up an enterprise data warehouse, put data governance in place, start loading and cleaning data is intense just to get to the point of creating dashboards and offering mobile BI. Overloaded Healthcare IT teams are dealing with demands to compress traditional time-frames of 18-24 months to get the BI foundation in place down to as little as 4-5 months, start to finish.

This situation begs the old saying of “do you want it fast or do you want it right?” You can bet the answer today is both. Generally, healthcare organizations develop a BI strategy that examines the current state BI architecture, envision a future state BI architecture, document the gaps and create a time phased roadmap to build out the infrastructure, software and development required to meet the business needs. Just describing the process tells us that it will be complex and time consuming, right?

It is time to examine the traditional waterfall development approach to building enterprise data warehouses necessary for addressing the current demands for business intelligence in healthcare. While we could dialog on the use of Agile versus waterfall for development, I want to propose a more radical approach: a business intelligence assembly line process. We need to reorganize our thinking towards automating the steps to deliver raw materials quickly, i.e. identifying a data source, gauging its quality and delivering it for assembly, before adding it to the BI visualization process. The data normalization and data quality can be addressed with another manufacturing idea: continuous improvement over time. Instead of traditional thinking of having to move all data into a common data model, this approach allows for data sources (raw materials) to be substituted, if needed, in the assembly line process for business intelligence reporting over time.

The people, process and technologies need to be aligned to the assembly line process for delivering high-quality products (dashboards and reports) faster and faster from re-usable components in the process. Engineering a new product would start with a design goal and identify how it would be built as opposed to only delivering what the underlying data warehouse can deliver. This assembly line approach provides the flexibility to introduce new concepts like big data or streaming real-time data as manufacturing techniques to speed up assembly line delivery without the big bottleneck of forcing everything through a common data model or wait for assimilation into the enterprise data warehouse.

Trusted data sources, like trusted raw material vendors, will be the secret to rapid BI manufacturing success. Do you like the idea of a business intelligence assembly line versus standing up a whole factory? Let’s poke holes in the idea to see if it is a better alternative!

In a recent issue of PC Today (www.pctoday.com), there was a quote by Cindi Howson of BI Scorecard that really stuck in my mind: “There are far too many cases of companies having good data, good tools, but a culture that’s a barrier to using that data for action.” Frequently, outside consultants are brought into an organization, especially in healthcare, to pull data out of silo’ed applications, cleanse it and land it in an enterprise data warehouse (EDW). Then the real fun begins as the organization tries to determine what their expectations are from this treasure trove of data. More importantly, this struggle to determine the value of the integration of clinical, operational and financial data can stall the return on investment for this important and difficult effort.

In conducting a business intelligence (BI) strategy, it is very important to investigate those silo’ed data sources to determine which elements can benefit which part of the organization and to notify internal groups of the new resources. In other words, the Enterprise Data Warehouse needs exploration and promotion to the key stakeholders or by the key stakeholders to gain new insights and derive the new value. Matching data to the right people is fundamental to success and deserves its own tracking mechanism in data governance. Moving beyond the original stakeholders and their requirements in a BI strategy and getting down to who really will use the data and how it is used helps drive stronger outcomes for the use of the integrated data. It truly isn’t just start with the end in mind, but exploring how the new integrated views of information can drive improved operational processes and solve daily problems in a real-time manner.

It is often frustrating to data warehouse builders because they understand the value stored inside but don’t know who needs the information to take action. It is worth educating and promoting this big investment! If a key data source is overlooked for real improvements in an important corporate process, then find it and add it. If data has moved past its useful life, then it should be moved to an archive to keep the enterprise data warehouse relevant and in step with the organization. Many organizations set up BI Competency Centers to help govern and develop the enterprise data warehouse, but my suggestion would be to make those centers a place for brainstorming, exploring and deriving value on an ongoing basis.

In healthcare, as we strive to lower costs and adopt a lean process improvement methodology, our process of using high-quality data should help identify new revenue opportunities, serve our communities more effectively and encourage us to explore possibilities. That exploration should start with the data that we work hard to acquire, extract, transform and load in our enterprise view. As data comes in faster, we need to respond quickly by connecting the data with the right users.

To summarize, in moving beyond the build stage of an enterprise data warehouse and gaining the return on investment, there are four key steps:

1. Identify the “new” stakeholders that will use the EDW in their daily jobs
2. Help the new stakeholders explore and learn what data is available to streamline clinical, operational or financial processes, possibly in a BI Competency Center to master tools
3. Promote the success stories to create action from all parts of the organization
4. Realize the return on investment from your EDW – celebrate!

In April 2014, I read a startling article that the United States was importing salt water, saline, from Norway due to a shortage in the United States¹. Bags of saline solution are one of the most common items used in modern healthcare and that is why it is amazing that American doctors have been facing a bizarre IV saline shortage that forces the import of heavily, unwieldy bags of salt water from overseas. As a result, hospitals, and especially cancer centers, have been keeping strict inventories of how many bags are on hand and struggling to avoid rationing their use. This turn of events led to a deeper look at the problems caused by drug shortages for healthcare organizations and developing a business intelligence blueprint to help manage shortages more effectively.

The IMS Institute for Healthcare Informatics, in their report Drug Shortages: A closer look at products, suppliers and volume volatility, identified 6 key insights:

1. The drug shortage problem is highly concentrated to generic injectables or five disease areas including oncology and cardiovascular diseases.
2. The supply of drugs on the shortages list has been stable or increased overall in the past five years.
3. There is significant volatility in the suppliers of the drugs, not the total volume supplied.
4. The recent volatility is a new trend compared to previous years.
5. The number of suppliers has fluctuated and may be one reason for the volatility.
6. Some states are feeling the drug shortage more acutely than others.

After studying a research survey from the November/December 2013 issue of the Journal of Managed Care Pharmacy entitled “Effects on Patient Care Caused by Drug Shortages: A Survey”, several key aspects of the blueprint for managing drug shortages began to emerge:

1. Purchasing history of medications including vendors, costs and availability, typically from an Enterprise Resource Planning (ERP) system, needed to be integrated with physician orders for medications and patient history of medications administered, generally available from an Electronic Medical Record (EMR) system.
2. External data from a public drug shortage list compiled and maintained by the Food and Drug

Administration (FDA) and American Society of Health-System Pharmacists (ASHP) could help identify key medications to monitor.

3. The internal data sources, the ERP and EMR information, and external data source of drug shortages should be normalized into the healthcare organization’s enterprise data warehouse to allow tracking of patient safety, adverse events, delayed patient care and other impacts of the drug shortages.
4. A dimensional data mart for medications would be created over the enterprise data warehouse to allow advanced analytics especially for viewing trends and predicting future shortages or patient impacts. A few of the key dimensions would be medication vendors, categories of medications, therapy areas impacted by shortages, price or cost, inventory availability and, of course, time.
5. Reporting from the dimensional data mart would provide a healthcare organization with an early warning system for drug shortages. Some of the key reports would be risk identification reporting which examines the vendors, how many drugs are provided by key vendors and the financial expenditures with those vendors. Demand forecasting reporting would look at the combination of purchased medication history, past patient clinical history of medications administered and current physician medication orders to predict potential shortages for risk mitigation. Volatility reporting could track average medication price over time to provide visibility of inflation or sudden increases in per capita uses of key drugs. Most importantly, current and future patient impact report would predict potential delays in treatment, identify alternatives for timely treatment and help minimize patient impacts.

This blueprint for managing drug shortages can help hospital administrators, pharmacy managers and physicians take a closer look at the products, the suppliers or vendors, and the volume or price volatility in a rapidly changing marketplace. The number of drug companies supplying these key products, like saline IV bags, has fluctuated over the last five years with an increasing number of companies no longer supplying the products on the FDA/ASHP shortages list. With medication suppliers citing production-related issues and increased demand as the top reasons for shortages, now is the time to act to create these early warning systems and protect patient safety.

1. “We’re Importing Salt Water from Norway“
2. “Effects on Patient Care Caused by Drug Shortages: A Survey“, Journal of Managed Care Pharmacy JMCP November/December 2013 Vol. 19, No. 9
3. Drug Shortages: A closer look at products, suppliers and volume volatility. Report by the IMS Institute for Healthcare Informatics, November 2011.

One of the hot healthcare topics at health plans this year has been medication therapy management. Hopefully, you have had the drill with your primary care physician of listing the medications that you are taking and discussing the impact of one medication on another for you as a patient. Having said that, I have heard some real horror stories lately of senior citizens taking a long list of daily drugs, then being hospitalized and on discharge given a new set of prescriptions. Confused, the senior citizen ends up taking double doses of some dangerous medications like blood thinners, for example. We are all seeking the least expensive co-payment or cash payment for medications for a chronic condition, sourcing medications from different pharmacies, and no one is looking at the drug interactions. Health plans that see these pharmacy claims are moving rapidly to address the need for a comprehensive review of medications for an insured individual, especially those people taking eight or more medications.

It isn’t well known that some drugs taken for one chronic condition can make another chronic condition worse in the same patient. Researchers at the Yale School of Medicine and Oregon State University have found that 23% of Medicare patients with multiple chronic conditions were taking at least one prescription medication that could adversely affect a co-existing condition. One clear example is the nearly 4 million older Americans that are being treated for high blood pressure and chronic obstructive pulmonary disease (COPD). Taking a beta-blocker for hypertension could make your COPD worse. Alternatively, taking the COPD drugs can worsen hypertension. Nearly 3 out of 4 older Americans have two or more chronic health conditions and they are often diagnosed and treated by different doctors.

Here are 3 important tips help improve your medication safety as a patient:

1. Keep a complete list of your medications with you for visiting with all medical personnel, including your dentist. It is important to list the name of the medication, the dose and how frequently you take it. Your list should include vitamins, supplements and over the counter medications that are used on a regular basis.
2. Talk to the pharmacist when you get refills about potential drug interactions or side effects using your complete list of medications, especially when taking a new medication for the first time. Maybe keep your medication list in Notepad on your smartphone for convenience.
3. Talk to your general practitioner or family doctor immediately if you believe you have a drug interaction or side effect from a medication. Use your family doctor to coordinate with your other medical specialists to avoid medication issues. Get one quarterback for the team and stick with them!

One final note, it is important to continue to ask your family doctor if you need to continue on a medication periodically and not assume that you will take a medication indefinitely. It is a healthy conversation to review your medication list and see what can be removed or replaced with a newer, more effective drug, for example. Health plans are working hard to avoid their insured members ending up in the emergency room with medication problems and each of us can do our part to be smarter healthcare consumers.

The Heartbleed bug is causing some real heart palpitations in the healthcare community (sorry for the pun), regardless of whether your organization is a health plan, a health provider or both.

That’s according to Phil Lerner, chief information security officer at Beth Israel Deaconess Medical Center, who, on a scale from 1 to 10, ranks the bug a solid “high priority” at 7.5.

“It’s a serious threat for any enterprise, quite frankly, that’s using OpenSSL,” said Lerner. When Lerner and his BIDMC security team first saw Heartbleed, they shifted into gear working closely together to ensure compliance and resolutions. The bug continues to be “top of the food chain” and a chief priority for Lerner. From the looks of it, this appears to be the general consensus across all industries.

(Source: “Insurers, providers try to dodge Heartbleed” by Erin McCann, Healthcare Payer News)

The biggest challenge is that Heartbleed is a silent threat to the security of protected healthcare information (PHI) and, as such, a potential exposure for a HIPAA violation.

Kevin Johnson, chief executive officer of security consulting firm Secure Ideas, called the miscreant Heartbleed a “very serious deal,” as the attack against the bug can go undetected. “If your system is being exploited, the logs and such do not show any maliciousness,” he explained. There are, of course, newly-built detection rules that can now aid vulnerable servers, he pointed out.

As a result, Heartbleed reinforces the need for the encryption of healthcare data both in-flight where there is exposure with OpenSSL and at rest in data storage. Building multiple layers of protection for PHI must bubble up to the top of the healthcare IT priority list, and Heartbleed is just a warning.

In a previous blog, my suggestion was to use tokenization of PHI as a security strategy to meet HIPAA security requirements. Tokenization is the process of replacing sensitive data with unique identification symbols that retain all the essential information without compromising its security. Tokenization has become popular as a means of bolstering the security of credit card and e-commerce transactions while minimizing the cost and complexity of compliance with industry standards and government regulations. With increasing regulation of protected healthcare information, tokenization is the right technology to address the transfer of sensitive information over public or private networks. The feedback to the blog points out the challenges of tokenization and the benefits of encryption of the PHI at rest as a more effective best practice.

The Heartbleed forces our hand, and the timing is now to implement the strong encryption of protected healthcare information. Despite encryption superseding the idea of tokenization, the process of segregating the PHI server physically (redundant, of course) is still another layer of protection. The PHI server would contain the 18 or more key protected data elements and their corresponding keys. A web service would retrieve the protected information temporarily for healthcare applications and updates, but would prevent local storage of the information to maintain control. This segregation server process would be implemented in conjunction with an Enterprise Master Patient Index (EMPI) system for a healthcare organization. The centralized server for protected health information would allow stronger security controls within an organization as well, and support a clear means of auditing access to PHI as well.

The rash of recent security breaches in the retail space demonstrates the perseverance of hackers to penetrate even hardened systems. Building layers of security for protected health information including strong encryption, both in flight and at rest, and separate servers where applicable are only a starting point.

Let’s prioritize this cyber fight and get creative in thwarting the criminals in order to protect our patients and their medical identities.

At the Fourteenth Population Health Colloquium in Philadelphia, Perficient’s own Lesli Adams, MPA, took the stage with Sanjay Udoshi, MD and Brady Davis to present “Shared Accountability: How Informatics and Data for Clinical Decision Workflow engages Consumers on the Quality/Cost Equation.” This Mini Summit presentation was sponsored by Oracle Health Sciences and Perficient. The kick-off of the presentation was fun because it introduced the speakers as a business analyst geek (Lesli), an innovation and strategy guy (Brady) and a doc in the box (Dr. Udoshi). The presentation was targeted at the opportunities for quality improvement and cost control including wellness and chronic disease care gaps. At the risk of seeming biased, this presentation was one of the more practical, down to earth approaches at this week’s Colloquium event.

Why do I believe that? Well, I felt that many of the attendees at the Colloquium were seeking real how-to knowledge. Not that the big healthcare organization’s experience in implementing population health management aren’t valuable insights, but there was a lot of buzz about whether population health management can be done in a cost effective manner, and this presentation addressed the type of informatics required to change traditional approaches. The first step was to outline the process in a slide called Population Health Management 101. The key concept was moving paper processes for care management to a digital platform to analyze and manage costs, see figure 1.

Figure 1. Population Health Management 101

Figure 2. Re-engineering Clinical Care

The second idea was to re-engineer clinical care to identify and manage care gaps. The first step is to identify the key populations to be managed, then determine the key Goals for that population, and finally to manage addressing the gaps in care or Action Arms (Figure 2). Note that different populations have unique goals but subsequently could have common Action Arms. To address creating the care gaps and related Action Arms, the healthcare organization has to have a strategic vision for these target populations and combine that with the right tactical tools, namely informatics. The challenge of creating these informatics isn’t simply addressed with technology tools, but requires several key steps including:

• Structured Data Capture vs Natural Language Processing (NLP)
• Diagnosis Naming Conventions
• Establishing the Digital “Gold” Standard”
• Influencing the Problem List
• HCCs and Chronic Disease Management
• Best Practice Alerting and Health Maintenance Modifiers
• Guideline Based Bundles and Closing Care Gaps

Addressing Care Gaps is very practical advice for healthcare organizations seeking to really manage populations. Creating informatics solutions that support closing preventive, chronic and restorative care gaps will drive health care value for patients and health plans alike. Creating these informatics requires data mining, process re-engineering and the ability to extract data from modern electronic health record systems. Building patient-centric plans of care based on this process will need to be supported through proactive outreach as well. The key is applying technology tools in novel ways to enhance shared decision-making between the clinician and patient.

Lesli Adams outlined what I see as the key factor to population health management: cost management. The integration of clinical information and financial data is key to cost management and often this data resides in silo’ed or separate software applications. The ability to manage costs by having standardized pathways, then examine costs at a Patient Level will lead to better decision-making and more cost effective care. Putting the disciplines in place to examine physician variability against the standardized pathways is the enforcement technique to bring costs under control. When organizations commit to collecting and cleaning this level of costing information, then profitability reports by service line, DRG and Physician become reliable tools for key decisions about operations. One of the highlights of the presentation was micro-costing examples to highlight the key decision points for clinicians.

Lesli Adams will be presenting at the Oracle Industry Connect event on Tuesday and Wednesday, March 25-26 in Boston. For more information on Perficient’s informatics offerings, especially related to Population Health Management, please contact us.

It was a privilege to attend the Fourteenth Population Health Colloquium in Philadelphia starting on a snowy St. Patrick’s Day. One of my favorite sessions on Monday afternoon was led by Terry O’Rourke, MD who postponed his celebration of the holiday to present “Managing Populations: The Role of a Large Health System.” CHE Trinity as a healthcare organization treats 18 million patients a year and Dr. O’Rourke had a great perspective on the challenges of population health management.

Dr. O’Rourke stated that CHE Trinity was one of the largest home care providers in the United States and that their healthcare organization encompassed 86 hospitals and 21,600 physicians. More importantly, CHE Trinity was participating in 6 bundled payment programs and 29 patient centered medical home programs. His observation that “All Healthcare is Local, All Healthcare Standards are National” comes from an understanding of the need for clinically integrated networks and the role of data driven decision making in reducing variations in outcomes. Terry noted that despite hard work on adopting standards that there is still a wide variation in healthcare delivery. He also noted that the lesser but still significant variation in outcomes across a large healthcare organization was more proof of the resiliency of human body than the careful adoption of standardized procedures.

The key to his presentation was the observation that clinicians need to lead the effort to standardize care, not hospital administrations or others. CHE Trinity created a unified clinical organization with the help of outside consultants that streamlined many silos within the large organization into a whole unit. As a result of unifying the clinical organization, Dr. O’Rourke noted that operating cash flow margins improved to 9.4 – 9.6% across the system. The second step beyond unification was to improve their reporting to encourage data driven decision-making. It was interesting to see how the metrics were converted into grades, like school grades, for easy consumption and judging performance. The different hospital boards had GPAs ranging from a low of 2.1 to a high of 3.6 on a 4 point scale. The goal of the data-driven decision support process was to improve the ease of consuming and acting on the information.

To summarize, Dr. O’Rourke said that “good care is cost effective care.” Clearly, CHE Trinity is focused on bringing a level of consistency in clinical procedures in population health management and improving cash flow margins in the process. As with most organizational business solutions, the focus on people and process yields the best results with technology playing a supporting role was my observation. The focus on people, patients, as the central figure in their clinical processes is real population health management.

While my interest is always in the convergence of technology like the Internet of Things and healthcare IT, the role of sensors in managing health and wellness is just exploding.

“The most popular device functionality in the wearable tech market is heart rate monitoring, with nearly 12 million such devices shipped in 2013. Pedometers and activity trackers accounted for a combined 16 million shipments over the same period.” (According to a report released Thursday by ABI Research)

– Source: New report shows smartwatches and AR glasses have their work cut out.

“The role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.”

You can’t turn anywhere without reading about the latest running gadgets, fitness bands, Bluetooth blood pressure cuffs, etc. In the inevitable rush to wearable computing, one key idea can get lost: what are we doing with all of that data?

The data produced by these devices and sensors has to be interpreted and turned into information that is actionable. The fitness band that looks at your goal of 10,000 steps, sees that you are at 8,000 steps right after dinner and encourages you for one final walk around the neighborhood, will ultimately win out over all others. In order to pull off that trick, we need analytics and, sometimes, predictive analytics.

Just as the sensors are working in the background without us even taking notice, the role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive. The goal of healthcare analytics or informatics should be to create an environment for the healthcare consumer that makes life better, easier and more enjoyable.

An example is when the running app sees your pace slowing down towards the end of a run, then it kicks in a song with a faster pace to help you finish strong. Today those apps require you to recognize that situation and take action of pressing a button. It’s all there but it’s not automated. What we need is that invisible intelligence that recognizes the situation and then takes action to assist us.

At HIMSS 2014, we will be seeing this jump in interest in predictive analytics as it applies to healthcare, especially two distinct types of predictive analytics.

1. One type is the traditional forecasting model of advanced analytics that trends past information to predict future states.
2. The second type of predictive analytics is statistical models that encompass multiple feeds or variables to predict a future outcome. This modeling is rapidly moving past the arena of data scientists who create the models and is moving more within the grasp of smart business analysts. These models can predict your longevity based on multiple factors like your BMI, blood sugar readings for diabetics and other factors from your medical history.

Of course, we want to be able to predict health outcomes, especially when faced with several choices for changing our behaviors or lifestyle. It will be exciting to see how healthcare application vendors are addressing this important next step in analytics.

The use of predictive analytics could really change the nature of a patient engagement with your doctor. How will we react when we see the outcome of our current lifestyle? Will we shut off Netflix bingeing and head to the gym? See you at HIMSS 2014 to find out! Stop by Perficient’s booth #2035 and tell us what you found out!

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.

Instead 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.

Like a lot of relationships, alas, things are not perfect. The EMR and patient portal have a mobile application that is still very basic. It gets high marks for security, but lacks the medication refill capability of the patient portal. I would venture a guess that it will be there eventually, but it brings to mind the challenges of screen real estate on a typical web browser on a laptop versus a mobile phone. Nevertheless, love can overlook some imperfections.

In a period when our government is making these big investments in electronic medical records and expecting Meaningful Use to be demonstrated in return, it’s time to send out some positive news: keep the faith and push forward because the healthcare consumer will benefit. I know that simplifying the ordering of refills seems like a small thing in the course of things, but if it saves time, productivity and especially errors, then it is a big deal. Thanks to my physician, who re-invested and made the commitment to real Meaningful Use. Here’s your love letter!

P.S. — No personal healthcare information (PHI) was harmed in the making of this blog. If you are curious about which EMR software is so terrific, stop by our booth #2035 at HIMSS, and I will whisper it in your ear. HIMSS 2014 is going to be a great event!

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 was 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.

If the pressure to obtain and implement Customer Relationship Management software by healthcare organizations is any indication, decision makers are recognizing the increasing importance of consumer knowledge in the race to improve patient satisfaction scores. Indeed, today, patient insights can lead healthcare organizations to their best opportunities for growth and restoration of profitability far more accurately than that marketing presentation in the boardroom. The increasingly reluctant spending by healthcare consumers needs to be better understood because a healthy healthcare delivery system depends on it. The challenge is that healthcare consumer interactions are not typically structured information that is easily analyzed to be acted upon, but are increasingly emails, phone conversations, web-based chat support and other unstructured information.

Increasingly, outbound direct mail or telemarketing is simply not getting results for healthcare marketing departments. The focus needs to shift to creating a great consumer experience on the inbound approach as an alternative. Doesn’t everyone enjoy doing business with a company that is easy to find and obtain what you are looking for? You don’t have to look far for proof of this idea. No longer able to differentiate on brand reputation, leading companies instead are focusing on the consumer experience–the all-important feelings that consumers develop about a company and its products or services across all touch points–as the key opportunity to break from their competition and regain lost revenue from programs like hospital value based purchasing. Outside of healthcare, the evidence of this new emphasis is found in the emergence of the “chief consumer officer” (CCO) role across the Fortune 1000 community. Companies such as United Airlines, Samsung and Chrysler have all implemented chief consumer officers as part of their executive suites. Should healthcare plans and providers consider this key competitive move too?

The first challenge faced by these newly minted executives in healthcare will be consumer experience management (CEM)–the practice of actively listening to patients and healthcare consumers, analyzing what they are saying to make better business decisions and measuring the impact of those decisions to drive organizational performance and loyalty. Fortunately, there are new technologies to address all of the unstructured information that comes from consumer interactions – data mining and text analytics. Text analytics is specialized software that annotates and restructures text into a form suitable for data mining. Text mining comes from data mining, a statistically rooted approach to classification, clustering, and derivation of association rules. Fortunately, there is much to be learned about how to handle unstructured data from two decades of struggling with similar problems in the structured data world. We now know as needs change and evolve, organizations will require the flexibility to integrate the most appropriate text processing technologies to extract desired information. They must enable users to apply time-tested analytical approaches that can be modified or expanded upon as understanding of issues and opportunities emerges from the data itself. For example, a call center should be able to apply a multi-dimensional analysis (i.e., “slice and dice”) to call center logs and email text for assessing trends, root causes, and relationships between issues, people, time to resolution, etc. Organizations should have the infrastructure, storage, and user interfaces to process and efficiently explore large volumes of data. And they need to easily leverage their existing BI and data warehousing (DW) tools presently used only for structured data analyses, to analyze unstructured data alongside structured data. In healthcare settings, these same tools can help analyze physician and nursing notes, thus serving a dual purpose.

When text analytics are implemented against unstructured consumer information, Consumer Experience Management will drive significant, quantifiable benefits for the healthcare enterprise. In the most effective approaches to CEM, companies use text analytics to collect and analyze intelligence from all of the varied sources of feedback available inside and beyond the enterprise. They grow more intimate with their current or future consumers and more agilely adopt informed improvements. The focus is a real-time feedback loop that will result in a continual, systematic capability for measuring and improving consumer experience. With the new emphasis on managing patient satisfaction scores to keep current revenue streams in place or increase them, the time to act on this capability is now.

When creating successful solutions, I believe that the real magic always lives in the intersection of key technologies. Using text analytics for identifying the opportunities and trends from your healthcare consumers then requires action – positive messages, feedback on offered services, and referrals that are generally implemented using automated workflows during the consumer interaction, whether is it through the public facing website or mobile application. The faster and smoother the consumer transaction occurs, like appointment setting or obtaining discharge instructions, will help ensure “positive” feelings for the healthcare consumer experience. A carefully architected solution implementation will drive this all important synergy for outstanding competitive results – and happy consumers seeking out your healthcare services. The new manta for marketing: Listen to your patients and healthcare consumers and make them happy.