Study find US Healthcare lacks Data Standards, Registries

A study by the Boston Consulting Group (BCG) examined the use of clinical data to support value based healthcare and concluded the US should be doing more to improve data standards and diseases registries. The study looked at 12 countries and their efforts to improve patient health outcomes while lowering costs.

According to Information Week article on the study:

BCG researchers also identified four factors necessary for the successful implementation of a value-based healthcare system:

--Clinical engagement. Researchers' examination of 13 registries in five countries revealed that improvement in health outcomes are most effective when clinicians themselves are responsible for collecting and interpreting data and when clinicians lead the charge in clinical improvement.

--National infrastructure. A nationwide infrastructure must comprise common standards for tracking diagnoses, treatments, outcomes, and costs at the patient level as well as a limited number of shared IT platforms and a common legal framework within which to regulate the use of patient data.

--High-quality data. The most effective way to collect relevant data is through disease registries that track groups of patients' health outcomes who have the same diagnosis or who have undergone the same medical procedure. By analyzing the data, providers and payers can identify, codify, and promote more effective treatment protocols and enhance cost-effective care.

--Outcome-based incentives. The healthcare industry must use outcome data to drive incentives in the healthcare system. The data-driven incentive measures should spur changes in the way clinicians practice, payers reimburse, and suppliers of drugs and medical devices develop and deliver products and services.

The US has mixed results when it came to disease registries -- some being amongst the best, while others sorely lacking in data. The study praised efforts by Kaiser Permanente and Intermoutain Healthcare for their efforts patient outcomes amongst their members and providing incentives to physicians to use best practices based on outcomes-research.

In another related story Kaiser Permanente has launched a  health exchange pilot with the Social Security Administration to fast track disability claims and processing. The large-scale pilot is the first of its kind to use the Nationwide Health information exchange to transmit/exchange patient records. 

Health IT wins with SCOTUS decision on PPACA

Regardless of what you think of the PPACA and health care reform, HealthIT can be counted as amongst the winner of the SCOTUS decision. The establishment of Accountable Care Organizations (ACOs) will require a high-level of coordination between care providers. Technology can play a huge role in making this happen.

The various technologies I have reviewed in this blog can all help push forward the establishment of ACOs. We are likely to see increased investments in Telemedicine:

"Now that the Supreme Court has ruled, we can move forward with the modernization of our healthcare delivery system, integrating telemedicine to improve care, reduce costs and increase access for everyone in America," said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association. "ATA will continue to work with Federal and state legislators from both parties, as well as all public and private payers, to adopt these proven, valued technologies into our healthcare system." 

HIT and Health information Exchanges/Systems will take on more importance as PPACA strives to improve the quality of care, increase the efficiency of care, and encourages the use of health information for public health and research purposes. HIT will play a more prominent role in providing effective research and in clinical reporting and patient education to support evidence based care.

Text Message Reminders helps Seniors stay on top of Medications

A recent study published in the May issue of Clinical Therapeutics concluded that text message reminders to take prescription medication helped increase patient adherence to treatment plans. This was the first large scale study involving 580 employer-sponsored and Medicare members with different medical conditions. The study found that patients who received text message reminders adhered to medication regiments 85% of time compared to 77% adherence rates for those that didn't. Among patients on chronic anti-diabetes medication the adherence rates wer even higher at 91% for those receiving text message reminders as opposed to 82 percent adherence for those who did not receive reminders. 

From the press release regarding the study:

“This research provides strong evidence that technology can play a vital role in improving medication adherence, even among older patients” said Brian K. Solow, M.D., chief medical officer, OptumRx. “This is of great importance to all stakeholders in health care because poor medication adherence can lead to inferior treatment outcomes, higher hospitalization rates and increased health care costs.”

 ....

“Text messages and emerging technologies offer new opportunities to educate and engage patients so they can improve their health and ultimately rein in their health care costs,” said Kalee Foreman, Pharm.D, OptumRx, lead author of the study. “A study in the New England Journal of Medicine found that nearly 70 percent of medication-related hospital admissions in the United States are due to poor medication adherence, costing the health care system roughly $100 billion per year.”

Reducing ER visits with Google Maps and Education

According to a September 2010 study done by RAND Corp and published in Health Affairs, an estimated $4.4 billion could be saved through a nationwide campaign to educate healthcare consumers on alternatives to Emergency Room (ER) visits--by visiting urgent care centers and retail health clinics instead. Non-emergency conditions, such as ear infections, sinusitis, bronchitis etc., -- about 17% of ER visits --can be treated at these alternative institutions. Doing so reduces both undue burden on ERs, and patients can receive faster care for cheaper costs. Treatment for Strep throat for instance can cost up to $580 at the ER as opposed to $90 at a health clinic.

The study's finding were confirmed today, after a six-month long pilot by HealthCore, an outcomes-based research subsidiary of Wellpoint. The pilot targeted 32,000 consumers in the VA market, who were given education online and through automated phone calls to use Google Maps to locate alternatives to ERs. Google Maps made it easier for those participating in the pilot to locate nearby urgent care centers and walk-in clinics. The study found that an overall reduction of ER visits by 17%, and members educated through the campaign were twice as likely to search for alternatives to ERs compared to those who didn't participate in the pilot.

According to Manish Oza, a Medical Director at Wellpoint and a ER physician, "the highest rates of avoidable ER use are among people 34 and younger--those who are less likely to have a primary care physician but more likely to be technology [savvy] consumers.... We chose to develop Google Maps in the states where our affiliated health plans are located and created online advertising because that's where people go for infomration when they're deciding whether to go to the ER or not."

Facial Recognition Technology

Facial Recognition Technology (FRT) has several beneficial uses for the healthcare industry. Healthcare professionals can use FRT to identify and validate patients, and prevent mistreatment and fraud. A northern New Jersey area hospital, Atlantic Health, for instance, recently adopted FRT to identify high-risk individuals. The hospital is located in a high-crime neighborhood. It has several entry points to the hospital in order make it accessible; however this increases the risk of entry of high-risk individuals. With the use of FRT, the hospital security cameras can capture images of individuals and recognize threats and alert the hospital staff. The hospital also pays a fee to access several security databases which interface with its FRT to identify individual with a criminal history. FRT also helps the hospital reduce fraud by detecting individuals seeking treatment under false identities.

Sensible Vision, a biometric company specializing in FRT released a product called FastAccess that has been implemented in several hospitals around the country. FastAccess, according tothe company, “replaces a user password with their face, giving healthcare professional, a simple, hands-free way of securely accessing sensitive healthcare records” . Instead of typing in a password repeatedly or through several security checkpoints, the FRT can activate access as long as the person is facing the system, and can lock out the system when they step away.  With the advent of Telemedicine and e-Health programs, FRT can be useful in identifying individuals, both healthcare professionals and individuals seeking treatment. The potential for fraud and abuse is a higher risk for e-Health programs, and FRT can reduce this risk by validating individuals.

RDT Readers Combat Global Diseases

http://www.sciencedaily.com/releases/2012/04/120427100224.htm

Rapid Diagnostic Tests or RDTs are used in developing countries to test patients for various diseases. A small sample of blood or other fluids is placed on a RDT strip, which changes colors if an infection is present. The test has been administered to detect, HIV, malaria, tuberculous, and other diseases.

Manual reading and analysis of RDTs by healthcare professionals however can be error prone. Simply due to the volume of strips being analyzed or other human errors. For this reason, researchers at UCLA have invented a digital RDT reader. The strips can plug into the reader which is then plugged to a mobile phone. An app on the phone (both iPhone & Android) can "read" the data on the strip with its camera, and make the correct diagnosis.

"The diagnosis is then transmitted wirelessly to a global database which employs GoogleMaps to plot the instances of disease.

Together, the universal RDT reader and the mapping feature, which have been implemented on both iPhones and Android-based smart-phones, could significantly increase our ability to track emerging epidemics worldwide and aid in epidemic preparedness, the researchers say.

"This platform would be quite useful for global health professionals, as well as for policymakers, to understand cause-effect relationships at a much larger scale for combating infectious diseases," Ozcan said."

CONNECT Solution enables Health Information Exchange

The Office of the National Coordinator for Health IT (ONC) has been busy with a number of projects to support expansion of EHR adoption and the building of a National Health Information Exchange/System (NHIS). One significant contribution towards this effort has been their CONNECT solution. Among the many challenges of building a robust, usable NHIS is with standardizing EHR systems nationally, not only at the interface level, but also in the data gathered. "Meaningful use" guidelines, discussed in previous blog posts, have provided the standards needed for EHR adoption, but still interoperability and data consistency will remain a significant issue to be addressed. The CONNECT solution is aimed at providing such "standards and services to ensure that health information exchanges are compatible with other exchanges throughout the country."

According to a ONC fact-sheet on CONNECT, "CONNECT was developed by federal agencies to support their health-related missions. It is now available as an open source solution to any organization seeking to establish health information exchanges using nationally-recognized interoperability standards."

By utilizing the CONNECT solution healthcare organization can transmit and receive health records and patient medical information overcoming interoperability issues. "It enhances security, promotes public health, and empowers patients to be more active and involved in their own care decisions."

There are three main pillars to the CONNECT solution:
1. "Core Services Gateway": This component allows healthcare organizations to "request and receive documents associated with the patient, and record these transactions for subsequent auditing..." In addition, it can authenticate network users, and check proper authorization for "release of medical information."

2. "Enterprise Service Components": These provide various critical enterprise components that support health information exchange, "including a Master Patient Index,... Authorization Policy Engine,... HIPPA-compliant Audit Log", etc.

3. "Universal client Framework" which includes a "set of applications that can be updated to quickly create an edge system, and be used as a reference system, and/or can be used as a test and demonstration system for the gateway solution."


With CONNECT being open source further development and enhancement of this tool can help make Health Information Exchanges function seamlessly across various platform, leading to better knowledge of diseases and treatments and improvements to quality of patient care.