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.

FCC approves MBAN

The Federal Communications Commission has announced dedicating the wireless spectrum band  2360-2400 MHz as Medical Body Area Network (MBAN). Hospitals have been using wireless sensors attached to patients to monitor their activities and status. However, having wireless data from patients compete with other wireless information used in the hospital overwhelms hospital wireless systems. Not only that the technology is limited and constricted to the hospital setting. With MBANs hospitals can use wireless monitoring and mobile technology to offer better care to patients, increasing their mobility, comfort and care. Monitoring can continue for patients from critical care to any changes in care settings including after being discharged home.

According to the FCC: “The MBAN concept would allow medical professionals to place multiple inexpensive wireless sensors at different locations on or around a patient’s body and to aggregate data from the sensors for backhaul to a monitoring station using a variety of communications media. We conclude that an MBAN represents an improvement over traditional medical monitoring devices (both wired and wireless) in several ways, and will reduce the cost, risk and complexity associated with health care.”


The US is the first nation is the world to dedicate the wireless bandwidth for medical devices, and is rightly being hailed as a step in the right direction.

Here is an excellent forum on MBAN and its benefits:

iPad in the Emergency Department

http://www.healthcare-informatics.com/blogs/david-raths/could-ipads-and-killer-app-transform-ed

Sparrow EDIS is a native iPad app that allows ED staff to relate to their patients without having to move away to a computer station to do additional tasks. With the iPad solution, doctors and nursers can continue interacting with their patients while taking notes on the iPad. The app also connects with the hospitals EMR to bring up existing patient records and history. It allows doctors to dictate notes and use voice recognition technology to transcribe them. In addition, the app allows the staff to order lab tests, MRIs, Xrays extra through the app which interfaces with other hospitals systems to make it happen.

Apps like Sparrow EDIS can really help improve the quality of care and help prevent disruptions in the workflow in the critical ER/ED setting.

RFID and Pharma

One logical use of Radio Frequency Identification (RFID) technology is in the management of the drug supply chain. This article outlines the FDA’s position in support of the use of RFID and it’s stepped up efforts to track the sale and supply of drugs. In November 2004, the FDA published a policy compliance guide aimed at “increas[ing] the safety of medications consumers receive by creating the capacity to track a drug from manufacturer all the way to the pharmacy.” RFID allows for easy tracking of authentic drugs, by creating an “electronic pedigree—a record of the chain of custody from the point of manufacture to the point of dispensing."

Several drug manufactures have already “[placed] RFID tags on bottles” of pain medications and other controlled substances. With RFID technology in place the FDA has increased capabilities to track, monitor and prevent the sale of counterfeit drugs and to reduce the “diversion of prescription drugs” for illicit transcations.The FDA considers RFID’s capabilities as an “electronic safety net,” and  hopes “more firms will use RFID technology and gain experience with transferring, storing, and securing data that RFID provides.

The FDA's goal of bringing all drug manufacturers in compliance with RFID requirements however remains a challenge. Cost associated not only with production but further management of the supply chain using RFID, including handling recalls, remains a barrier. "RFID in the pharmaceutical industry set to explode from $90 million in 2006 to a staggering $2.1 billion by 2016, making RFID one of the fastest growing industries in packaging."

Howard notes an important difference between the food and pharmacheutical industries in implementing RFID: "The main difference between the food industry and the pharmaceutical industry is one of priority. The food industry is interested in placing RFID on pallets and cases at the request of the retailers, while the pharmaceutical industry is mainly interested in placing RFID on individual items, bottles and packages. Unlike the food industry its first concern is patient safety and wellbeing."

UPMC adopts RFID technology

http://www.healthcareitnews.com/news/upmc-deploys-wi-fi-based-rfid

This article reports on the University of Pittsburgh Medical Center's adoption of RFID technology. In addition to using RFID tags to monitor it's medical devices and assests, UPMC also monitors temperatures in their refrigerators and freezers, "helping prevent spoilage of medicines, vaccines, and even food." The technology will connect to their existing wireless system which has reduced their operational costs.

The hospital system hopes to use RFID technology to manage patient care:

"Following the success of its current implementation, UPMC plans to extend the technology. It will use AeroScout when it introduces a SmartRoom system at its new UPMC East hospital in Monroeville, which is scheduled to open this summer. Officials say the SmartRoom will use RTLS to identify caregivers as they walk into a patient’s room and provide clinicians with real-time, relevant information at the patient’s bedside."

Big Data and Healthcare

The application of a Big Data strategy is critical to the Healthcare industry more than other industries. Big Data is both a problem and a solution in healthcare. It's problem because the sheer volume of data is currently unstructured, fragmented and unusable. Putting aside the question of capacity to host this data, the effort involved in structuring the data into usable formats presents a challenge.

Nevertheless the benefits of Big Data to Healthcare are two fold. On the one hand, Business Intelligence software can help identify weaknesses is a payer's commercial strategy and help advance products with the a dynamic understanding of market data. Secondly, a Big Data strategy can help with providing evidence based healthcare that reduces costs and delivers better results to our members.

As Jordan Robertson argues in "The Healthcare Industry Turns to Big Data":

As hospitals digitize patient records and amass huge amounts of data, many are turning to companies such as Microsoft, SAS, Dell (DELL), IBM (IBM), and Oracle (ORCL) for their data-mining expertise, which can help medical providers perform detective work and improve care. The so-called Big Data business has already permeated other industries and generated more than $30 billion in revenues last year, according to research firm IDC. It’s expected to grow to close to $34 billion this year in part because of increased use in the health-care industry. Crunching numbers is potentially good business for hospitals as well. By making “meaningful use” of computer systems, they’re eligible for millions of dollars in government funding from the Obama administration’s $14.6 billion program launched in 2009 to encourage adoption of electronic medical records.

This WSJ article summarizes the challenges and opportunities well:


Kaveh Safavi, who leads Accenture's ACN -0.56% health practice for North America, says big data gives two benefits to clinicians. First is "the ability to see information across time in ways that aren't possible.

"The second is to begin the process of pattern recognition, particularly when you are looking for low frequency events, or things that where the signal is very small and might not be discernible when looking at very small groups," he says. A well known example of this is the ability for Google to track the progress of flu through looking at search terms.

"Trends in Healthcare" from HP

In today's post I'm summarizing the discussion from a HP webinar on "Trends in Healthcare" by Charlie West and Ellen Weize of HP. I found this webinar useful in capturing at a high-level the market, business and technology disruptions that will shape the payer landscape healthcare in the years to come.

The presenters identify the following pressures in the healthcare ecosystem that will define strategy in the coming years:

Emerging market looks significantly different than what payers are used to. Due to the individual mandate, Individuals will be entering the market who were never insured, or were under-insured. These customers are driving business disruption as payers need to develop strategies to win their business where the functional requirements for their products are different. There is also new payers in the market, as the health exchanges have helped auto, home insurance companies and banks and financial companies to enter the market. We're also likely to see many mergers and acquisitions in this environment. Combined to the greater competition in the market place are the additional burdens of Health care reform, such as decrease in medical loss ratio, that put pressure on payers to bring down administrative costs. But a number of technological advancement in Analytics, BI, cloud/virtualization, and mobile technology providers payers the ability to leverage technology disruption to provide better products and services.

The presenters conclude any payer IT strategy must involve a coordinated plan that is focused on survival into the next period and then plans to modernize and thrive in the new environment. For this healthcare companies will have to focus on Remediation projects such as 5010, ICD-10 migrations, etc. as well as modernize their infrastructure, outsourcing non-differentiators, create transparency to increase productivity and customer satisfaction, prospectively use data mining to address fraud and abuse, etc.

This road map from HP helps to identify some of the key trends and pressures that will face Healthcare CIOs in the near future.

Treating chronic disease with better-informed and coordinated care

For this blog post I’m reviewing a white paper, “Addressing the cost of chronic disease withbetter-informed and coordinated care” by Lorraine Fernandes, global health ambassador at IBM and Susan J. Hyatt, an advisor to governments and global technology companies for the past 30 years. The paper seeks to outline the type of information systems architecture that governments can invest in and implement to reduce costs and improve care for chronic disease patients.

The authors observe that chronic diseases are responsible for more deaths globally than all other diseases combined. As populations age so will chronic illness, and costs associated with caring for chronically ill patients.

They believe IT technology solutions can help with care of chronically ill patients while reducing costs.
To achieve this goal they urge governments to create programs that are well-managed and coordinate care close to patient’s home or community. Such community based care can be coordinated effectively with greater access to patient and provider information and reduce the use of expensive acute care facilities.

Community based care faces obstacles due to the complexity of coordinating care. It requires “integrated and timely communication between health and community services,” where up-to-date patient information is available and readily accessible by care providers. Care coordination is often fragmented due to little interoperability between healthcare systems. This appears to be case even where EHRs have been implements – they have often replaced paper silos for electronic ones.

The authors argue that to overcome these challenges government investment is required to provide the infrastructure needed to provide complete, real-time patient and provider information to coordinate care for chronically ill patients in community care settings. The current, more costly government investments in acute care can be reduced by investing in technology solutions that end up saving money in the long run.

With interoperable systems of coordinating care we can make available complete patient and provider information. This will result in better care management, increase accuracy of treatment and reduce duplicate treatment or tests, allow for better medication management and reducing risks of drug interactions or overdose, using mobile technology to deliver reminders of medications or care, telemedicine to reduce need for travel and wait times for care, and coordinate ePrescriptions and transportation for patients.

The requirements for such IT solutions includes providing systems that are interoperable, scalable to the growing data needs, provide accurate patient data with daily or weekly snapshots of near real-time information and must be easy to implement.

WellDoc -- Care coaching app for Diabetes

This article reports on a study published in the journal Diabetes Care by BCBS of Maryland, medical manufacturer LifeScan, and Sprint, on their WellDoc app which is used to support patients with Diabetes.

 “The researchers tracked 163 patients with type 2 diabetes at 26 primary care practices across Maryland over a one-year period. All were covered by commercial insurance. Patients were divided into four groups: a control group with traditional, office-based care; a group given WellDoc coaching and a secure Web portal so they could communicate with their physicians; a group with the WellDoc system whose doctors could see patient self-entered data; and a group whose physicians had clinical decision support that linked data to standards of care and evidence-based care guidelines. “
….
“Patients could communicate by phone or secure portal with diabetes educators acting as "virtual case managers," though they were encouraged to choose electronic messaging. Patients received an "action plan" through the portal every 2.5 months that helped with self-management and served as clinical summaries prior to doctor visits.
The researchers found that the group whose doctors had access to clinical decision support saw their A1c levels decline by 1.9 percentage points, while patients in the control group had a median reduction of just 0.7 points. The control group saw improvements simply from having proper education, according to the study. The Maryland team cited earlier studies showing that merely 55% of people with type 2 diabetes received diabetes education and that only 16% followed recommended self-management regimens.”

Although the study concludes that further research is needed to test for the usefulness of this app, the greater decline in A1c levels points to the effectiveness of combing traditional patient care with app-driven care.

EHR: Lifting the Roadblocks

In this post I want to discuss some solutions that can help alleviate the concerns with EMR/EHR implementation. As noted in last blog post, providers raise several concerns with EHR adoption having to do with costs, training, interoperability and security. These concerns however can be mitigated by advancements in technology that allow for faster adoption of EHRs.

One solution to the cost problem is to make avail of the incentives from HITECH. In addition, providers can utilize several cloud vendors that offer a Service-as-a-Platform model for EMR/EHRs. Going to the cloud model will mitigate the need to invested in a costly IT infrastructure and hardware. In the long-run EMR/EHR adoption helps generate greater ROI by increasing productivity, decreases costs associated with paper-systems (printing, storage, etc.) and increases quality of care and patient satisfaction.

 In terms of challenges with interoperability and application development, taking an iterative approach based on an analysis of feasibility and importance can help prioritize and plan the migration. Simply put, tackle the routine functions that can be moved to EHR right away such as enrollment and billing, and other administrative data, and handle the harder clinical data later on. Same strategy applies for handling historical medical information. While the long-term goal for EHR is to centralize data in a NIHS and produce Longitudinal Patient Records, the more immediate need is to get EMR systems functioning and operational.

Training is a real concern that needs to be seem as a cultural and emotional problem. And many SAAS vendors come with training packages that providers can use to train their staff in the new system. In addition introduction of new technologies such as mobile computing and speech recognition can make interactions with the EHR intuitive, lower costs, and increase productivity. Any introduction of disruptive technology will take some time to adjust, however EHR systems are designed to make input of data easier and to reduce human error and manual entry. Automated drug or disease registries for instance can make capturing patient information and treatment plans so much simpler. 

...to be continued.

EHR Cont'd: Challenges to Adoption

Given the benefits reviewed in my last post on EHR, why haven't hospitals and clinics jumped at the chance to adopt EHR? In fact, the US lags behind other countries in the adoption of EHR and as of 2008, according to one HIMSS study, only 44% of hospitals had fully functional EMR systems, and only 4% of US physicians had access to a EHR system. Although with the incentives on offer with the HITECH Act and the possible penalties for failing to adopt to EHR, this scenario is shifting and we're starting to see a critical mass develop towards adoption. According to a recent study conducted by IDC concludes "meaningful-use" adoption can reach as high as 80% by 2016.

Hospitals and clinics report a number of barriers to adoption. These include costs, interoperability issues, conversion of historical documents, training and usage, and privacy/security concerns. These issues are often interrelated and identifying to solutions for that will be key to the successful implementation of EHR systems.

Costs: Many providers are unable to accept the financial burdens of adopting EHR. To successfully implement a EHR system the hospital will have to bear hardware costs (servers, scanners, etc.), software costs (billing applications, clinical applications, drug databases, etc.) and other interface application costs (lab interfaces, medical device data, etc.). By some estimation it costs between $40,000 to $70,000 for a single doctor and his patients' records to be successfully migrated to EHR.

Interoperability issues: When implementing EHR system hospitals need to worry about multiple applications being able to interact with each other and share data. For instance, data from lab applications may not integrate well with data from billing systems. Again, projects to support interoperability will hike up implementation costs.

Training staff to use the new EHR system is a major concern, as EHR systems will be a completely new way of doing care plans or charting.

And lastly hospitals worry about the protection of their patients data. A breach could occur with the paper filing system as well, but can be restricted to limited say to one filing cabinet. (How many medical records can a thief run away with?). However with a breach in EHR databases can comprise the information of an entire department or hospital.

These concerns while valid are not insurmountable.... In my next post, I will look at some of the solutions available to hospitals that address these concerns.

Electronic Health Records (EHR): Introduction

The concept of Electronic Health Records is as old as any computerized form of record keeping. As early as 1991 Health and Human Services (HHS) began to urge providers to adopt Electronic Medical Records (EMR) in their facilities to computerize their patient records. However, adoption of EMRs and the move towards a National Health Information Network (NHIN) that would provide a centralized national database of Health records is yet to materialize. I hope to explore the concept of EHR, it's benefits, challenges to adoption, and future prospects in many posts to come. In this post, I will provide a brief introduction to EHR.

EMR & EHR

A EMR is a digitized documentation of clinical records, patient data, and billing information processed in a single health care facility. EMR also refers to the system/databases that a provider uses to document such information. EHR refers to,

"a systematic collection of electronic health information about individual patients or populations. It is a record in digital format that is theoretically capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information."

EMRs and EHRs are obviously not unique to the US and have been adopted and being developed in many parts of the world. In fact, the US has one of the lowest adoption rates in the world and is lagging behind in employing this technology to keep track of patient information.

There are number of benefits to EHR adoption. 

• EHR's make it easy for clinicians and staff to access patient information and make informed decisions without having to sort through paper files.
• Errors produced by human transcription or illegible handwritten for instance as less of concern with EHR. Although human data entry error is still possible, there are a number of ways to reduce this by automatic entry information.
• Access to patient records over various care settings can reduce redundancies with testing and analysis. 
• Reduces the risk of conflicting treatment plans and medication toxicity across multiple providers.
• Reduces administrative costs associated with space for file storage, retrieval of archived information, and processing requests for records across facilities.
• Increased security with disaster recovery and encryption of PHI.

Given these benefits, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009 to encourage EHR adoption and made it a national priority. The carrots and stick approach of HITECH provides incentives for early adoption and mandates adoption by 2015 or be faced with penalties. Given the influx of money available to providers to adopt EHR more and more hospitals and clinics are beginning to adopt EHR. Still, EHR remains a challenge for many providers. I'll explore these challenges in future posts...

Multi-Channel Contact Center: Introduction

Recently I received a parking ticket from the City of New Haven for supposedly unauthorized parking in a lot for which I hold a parking pass. The pass was on display on my dashboard, yet I was ticketed anyway. Not wanting to fork over $35 for this unjust treatment I decided to file an appeal. I was dreading having to drive over to the Parking Authority and deal with an appeal's agent. To my surprise I found a website on the back of the ticket and a web portal that I could use to file the appeal. It also listed a phone number I could call to verify and check status on the appeal. I immediately used my iPhone to capture the link on the ticket clicked on it and went over to the site. I plugged in the information from the ticket, took a picture of my parking pass from my phone and attached it for support, and my appeal was filed. A few days later I called the number on the ticket and spoke to an agent who said my appeal was being reviewed. Several days later, I received mail notifying me my ticket has been successfully nullified.

I was thrilled by the outcome, but was also thoroughly satisfied with the ease with which I was able to accomplish this task. No need to go over to the Parking authority to speak to someone, spend time and gas driving back and forth to an appeal's hearing, etc. All of this got me thinking of the way customer interactions have dramatically changed over the past few years. If a government agency can adopt to the modern age and make a (often intentionally) difficult interaction seem painless, businesses that want to engage their customers, keep them satisfied and retain their loyalty, need strategies that can make their interactions just as painless, if not pleasurable.

A growing number of organizations are investing a considerable amount of effort in developing Multi-Channel Contact Centers to provide multiple touch-points with their customers. In the era of emails, SMS, and web chats, it's no longer a luxury to provide new channels of contact with the customer. By necessity, organizations need to develop a MCC strategy that allows them to quickly respond to customer inquiries and put across a unified message across various platforms. Many consumers turn to the internet and social media for review and feedback on products. Therefore it is crucial for any company to have a social media presence to not only advertise their goods and services but to engage with the commentary and help shape the discussions. One viral video of a bad customer experience is all that it takes to damage the reputation of a company.

When thinking about a MCC strategy it is important to connect it with the overall business strategy and tailor it specific to our customer needs. In future posts I'd like to delve deeper into this topic and look at some of the best practices and challenges associated with implementing MCC.

Paging Dr. Watson to the Oncology Ward

It wasn't all fun and games for Watson, the IBM super computer that played and won on "Jeopardy." Watson is going to work. One of the first commercial applications of Watson will be its partnership with the health insurance company, Wellpoint, Inc.

Wellpoint currently has two use-cases/pilots in the works with Watson:

Utilization Management (UM) RN Assistant

This pilot will help Wellpoint nurses process treatment requests at a faster rate and with  more efficiency. With the use of Watson Wellpoint nurses can streamline the UM process and support members by providing the best care in accordance with evidence-based guidelines. Wellpoint hopes to reduce administrative costs associated with UM and better manage the health of it's members. The pilot is also designed to teach Watson to provide beneficial clinical information.

Oncology Pilot

The other more exciting pilot involves Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, which is partnering with Wellpoint and IBM-Watson to help shape the first health care solution utilizing Watson's technology. The goal for Watson is to assist physicians in evaluating evidence-based treatment options in a matter of seconds. Watson's ability to respond to inquiries posed in natural language and it's powerful processing speeds, allow for evidence-based, scientific analysis of health care data can be done within minutes and empower the physicians and patients to make the best and most effective treatment plan and improve the quality of patient care.


Here's a snippet from the press on the oncology pilot:

WellPoint Inc., which has 34.2 million members, will integrate Watson's lightning speed and deep health care database into its existing patient information, helping it choose among treatment options and medicines.

"This very much fits into the sweet spot of what we envisioned for the applications of Watson," said Manoj Saxena, general manager of an IBM division looking at how the computer can be marketed.

Lori Beer, an executive vice president at Indianapolis-based WellPoint, agreed.

"It's really a game-changer in health care," she said.

The WellPoint application will combine data from three sources: a patient's chart and electronic records that a doctor or hospital has, the insurance company's history of medicines and treatments, and Watson's huge library of textbooks and medical journals.

IBM says the computer can then sift through it all and answer a question in moments, providing several possible diagnoses or treatments, ranked in order of the computer's confidence, along with the basis for its answer.

"Imagine having the ability within three seconds to look through all of that information, to have it be up to date, scientifically presented to you, and based on that patients' medical needs at the moment you're caring for that patient," said WellPoint's chief medical officer, Dr. Sam Nussbaum.

“Quite Elementary My Dear Waston”

I remember the much talked about 1996 & 1997 Chess championship matches between then reigning champ Garry Kasparov and IBM’s “Deep Blue” super-computer. Kasparov beat Deep Blue in ’96 series only to have his tail handed to him in ’97. What made the difference a year later was pure “brute force”:

It was a massively parallel, RS/6000 SP Thin P2SC-based system with 30 nodes, with each node containing a 120 MHz P2SC microprocessor for a total of 30, enhanced with 480 special purpose VLSI chess chips. Its chess playing program was written in C and ran under the AIX operating system. It was capable of evaluating 200 million positions per second, twice as fast as the 1996 version. In June 1997, Deep Blue was the 259th most powerful supercomputer according to the TOP500 list, achieving 11.38 GFLOPS on the High-Performance LINPACK benchmark.  

My teenage self was impressed.

But looking back, Deep Blue’s achievement seems not so awe-inspiring. After-all there was no real artificial intelligence (AI) at work, and Deep Blue could not do much else than play chess. Chess -- though a complex game--is confined to a 64sq board and fixed rules of play. If we can build a computer fast enough to process all possible lines of play after each move, to figure out the optimal strategy, then such a computer can become nearly unbeatable at chess.

Even IBM admitted as much, and at the end of the day Deep Blue was a publicity stunt more than a real advancement for AI.

Enter Watson. IBM’s latest super-computer, and it's no gimmick. 

IBM’s latest invention is the fastest, smartest super computer on the planet and what really sets Watson apart is its ability to understand natural language. 

IBM put Watson to the test last year by making it compete in a Jeopardy challenge against two of the smartest brains to compete on the game show. Watson took on Ken Jennings, who holds the record for longest winning streak on the show, and Brad Rutter, the biggest all-time money winner.

And Watson won!

IBM chose the Jeopardy challenge to test Watson, since to compete effectively on the show, Watson needed to be fast, be able to understand human conversational language and the nuances associated with it, form a statistical analysis of the correct possible answers after querying it databases, and then make a risk/reward assessment as to whether to buzz in. In the initial test runs Watson’s performance was dismal. It failed to understand subtle differences in language and elementary distinctions easy for the human brain to process. 

But what enabled Watson to improve was its ability to learn from examples as it goes, using a complex statistical algorithm, powerful processors and memory, and vast database of human knowledge. The key proved to be it's ability to learn from it's mistakes and building on patter recognition to process natural language. In other words, Watson learns as it goes. Once Watson is fed the right answer it incorporates that pattern into its databases to make a better analysis and return a better result next time. 

According to IBM,  

“Watson is a workload optimized system designed for complex analytics, made possible by integrating massively parallel POWER7 processors and the IBM DeepQA software to answer Jeopardy! questions in under three seconds. Watson is made up of a cluster of ninety IBM Power 750 servers (plus additional I/O, network and cluster controller nodes in 10 racks) with a total of 2880 POWER7 processor cores and 16 Terabytes of RAM. Each Power 750 server uses a 3.5 GHz POWER7 eight core processor, with four threads per core. The POWER7 processor's massively parallel processing capability is an ideal match for Watson's IBM DeepQA software which is embarrassingly parallel (that is a workload that is easily split up into multiple parallel tasks)."

"Nova on PBS" recently aired an episode on Watson and its trials with Jeopardy. You can watch it here:

Watch Smartest Machine on Earth on PBS. See more from NOVA.

In my future posts I will look at some of the business application of Watson including its use in healthcare.

Thoughts on Mobile vs Native App Debate

In my last (&first) post, I commented on the exciting developments in Mobile Technology that allow health care companies to develop a mobile strategy that can help drive down administrative costs,  and add value to our customers. 

In this post, I’d like to dig a little deeper and discuss a central question that all IT organizations must answer when developing a mobile strategy: What type of app to build – native or mobile?

A google search on the topic will return a wealth of material from supporters and naysayers for both. Here is a collection of polemics from experts. Below I will summarize this debate and offer some thoughts on how to think through a strategy for healthcare companies (and other industries as well).

This Worklight webinar offers an excellent overview of the pros and cons for both native and mobile apps, and “hybrid” models. 

Native Apps

 

Simply put, native apps are those that you typically buy/download from an app store or market-place such as iTunes, Google Play, Windows Phone store, etc. They are built uniquely for a mobile device (iPhone, Droids, Blackberry, etc.) and the app’s functionalities are contingent on the device’s API environment.  A native app built on iOS is not portable/usable in an android phone and vice versa.

Native apps have several advantages:

-apps can utilize other device functionalities such as cameras, geo-location, address book, etc. to offer a more enhanced, immersive user experience.

-apps can be run offline, not requiring a wifi connection. Content data can be cached and re-used.

-apps get a lot more market exposure being part of the app store; will show up in search results and can gain traction from user ratings. This also allows the developers to get instant feedback and improve their apps based on user needs.

-apps can include revenue generating advertising. 

There are also several disadvantages:

-they’re costly to develop and deploy, requiring a diverse mobile architecture.

-they require resources trained in the various platforms.   

-they require approval from third party store owners before deployment, and involve a vendor fee.

Mobile Apps

 

Mobile apps are those that require a browser app-shell to run on. They’re designed using web languages (java script, html5) and can be run on any device using any browser (Safari, Dolphin, Opera, etc.). Mobile apps are accessed through a URL or hyperlink.

The disadvantages we saw with native apps are all advantages for mobile apps:

-they’re not dependent on the device, and therefore only require a single development team.

-they can be updated and modified faster, cheaper, without relying on third-party, store approval.

On the flip-side, mobile apps cannot provide the same level of functionality and user experience as native apps. They are typically only accessed by those already familiar with your site by typing the URL or clicking on the hyper-link to get there. They are also dependent on a wifi connection to execute.

Given these benefits and downsides to both native and mobile apps, what direction should health care organizations choose?

Mobile Strategy

I don’t have a specific answer (and will be shot if I revealed the thinking within my company :)) but I believe the answer must start with (1) an understanding of who is in our customer base and what they want. (2) We must also look ahead and understand how our business and technology will evolve in the future. (3) What the return-on-investment (ROI) from each will be.

Market research of mobile users, and customer segmentation specific to the industry will provide the data we need to understand how our customers prefer to relate to our business. Currently, several studies show a dead heat between mobile app vs native app users. I have reviewed several case studies (not available online) that show customers are split in terms of their preference. There’s a clear advantage when it comes to the number of native app offerings (400,000+ according to one study) as opposed to mobile apps (48,000+ or 10% of native apps). But this number is misleading as several native apps are quickly designed games and catalogs pushed to the market, as opposed to more robust applications.

Secondly, as we look ahead to the future, both the demographic shifts and the individual mandate coming into effect, we can expect an influx of younger customers entering the health care market. Younger people tend to prefer native apps but consumers generally prefer to shop using a web browser (mobile sites and apps). As browsers and web languages develop further (like html 5) some of the functionalities of native apps can now be incorporated into mobile apps (such as geo-location, connecting to google contacts, etc.). 

The third determination, ROI, is the toughest to measure, given the relative newness of this technology. A survey of use-cases I have seen makes a strong case for both, with a slight edge to mobile apps, given their low cost of development. However, the higher visibility of Native Apps help generate more revenue over-time, even if immediate ROI is smaller.

In the final analysis I believe what’s important in choosing the right strategy is flexibility. An initial go with mobile apps might be cost effective and provide an easy transition for customers already familiar with our web portals. But as we move into the world of health-exchanges and individual buyers, native apps can attract new business and provide cost-effective services in a much better way than mobile apps. But as mobile app/browser technology evolves and hybrid apps become more common, an adjustment in strategy might again be necessary.

Lie Luo of Global Intelligence Alliance, based on an extensive study of trends concludes:

So far we have been mainly discussing the choice between native and Web apps for mobile devices. It is important to recognize that we are increasingly moving toward a ‘multi-screen’ world, where brands will want to engage their users across a variety of media touch points. In that light the same debate will carry on to tablet devices and now Web-connected TVs, thanks to the expansion of Android and iOS platforms.
Personally I believe Web apps will take on a larger mind share among both publishers and consumers, as hardware complexity grows and the desire for immediacy increasingly dominates modern media consumption behavior.

Mobile Health Wallet

A week ago I arrived at an MRI appointment just on time, fighting rush hour traffic, only to realize I didn't bring my new insurance card. At least I remembered to bring my wallet. I'm notorious for misplacing it, and once even considered (after watching too many infomercials) to buy a wireless wallet locator.

Well, such devices seem silly now, when one considers the recent trend to forgo the physical wallet altogether for an e-Wallet. Health management organizations have recently jumped on this trend to produce Mobile Health Wallets that carry more than just your digitized insurance cards.

Earlier this year UnitedHealthCare announced the launch of a native app, "Health4me" available through iTunes & Android app stores. The app allows its members to "store their health plan identification card, find the closest hospital or clinic, get information on claims and benefits and keep track of deductible spending."

That's not all:

"Among the technologies that will enhance UnitedHealthcare members' ability to monitor their health is the CareSpeak Communications' medication and disease management application that enables patients to manage their care using two-way text messaging on their mobile phones. The CareSpeak system allows patients to report their medication intakes and biometric data such as blood glucose levels, blood pressure, and weight to their care providers. Patients also receive educational and motivational messages, as well as incentives and rewards for meeting their health goals. 

For those who want to lose weight, Lose It!, created by FitNow, is a mobile app that runs on iPhones or Android devices. The app can improve consumer's ability to track their progress, offering peer support, and providing important caloric and nutritional information on what they eat." 

I agree with Bud Flagstad, Vice President of strategic initiatives at United Health Group, that "[i]n the face of high cost health plans and consumers having to pay more [for the cost of healthcare], these kinds of technology tools have started to become very important." 

A transition from physical ID cards to mobile ID cards alone would save millions of dollars in costs associated  with card activation, print, mail&distribution. Already, Explanation-of-Benefit (EOB) statements are accessible as a pdf document through consumer portals from most major insurers. Even so, pushing the statement to your mobile app would drastically cut down costs associated with portal maintenance and service--and is obviously more cost beneficial (and Eco-friendly) than paper statements. We can also easily add a click-to-chat function to allow for clarification or questions on your EOB with a claims representative. 

Mobile apps that assist consumers to make better health-style choices, such as, helping them develop a customized diet and exercise plan, will contribute to preventative care, saving costs in the long run. If electronic transfer of biometric data becomes refined, many routine checkups, tests, and follow up care can be done from the comfort of ones home and minimize the need for a hospital visit, and save on the associated claim and billing costs.

This trend is not unique to the States. Here are interesting articles on the use of mobile technology in the African context and it's life saving potential. Mobile technology offers the potential to be a great equalizer in the delivery of quality care.

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Welcome to the Technology Innovation & HealthCare Blog

Welcome to Naveen Jaganathan's blog on Technology Innovation & Health Care!

My vision for this blog is to catalog and comment on the latest trends in technology innovation as it relates to health care management and delivery. As we enter a world of gadget-wizadry from mobile phones to tablet computing, voice/facial recognition to biometrics, cloud computing to quantum processors, health care organizations can now leverage disruptive technology to deliver solutions that can revolutionize the management & delivery of health care. Topics I'd like to explore includes: mobile apps, cloud strategy, big data strategy, claim processing, privacy & security, to name a few. I believe disruptive technology can play a role in addressing the dual crises affecting our health care system: growing number of people who lack coverage and access to quality health care, and the rising cost of health administration. Imagine a mobile app that would allow you to video conference with your physician(s) on demand (already exists), or attend a session with your physical therapist using Kinect? Imagine the cost savings and increased access to healthcare such innovations would bring!

I hope you find my posts interesting, and I welcome your feedback.