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Predictive Analytics Will Save Hospitals, Not IT Investment

Posted on October 27, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most hospitals run on very slim operating margins. In fact, not-for-profit hospitals’ mean operating margins fell from 3.4% in fiscal year 2015 to 2.7% in fiscal year 2016, according to Moody’s Investors Service.

To turn this around, many seem to be pinning their hopes on better technology, spending between 25% and 35% of their capital budget on IT infrastructure investment. But that strategy might backfire, suggests an article appearing in the Harvard Business Review.

Author Sanjeev Agrawal, who serves as president of healthcare and chief marketing officer at healthcare predictive analytics company LeanTaaS, argues that throwing more money at IT won’t help hospitals become more profitable. “Healthcare providers can’t keep spending their way out of trouble by investing in more and more infrastructure,” he writes. “Instead, they must optimize the use of the assets currently in place.”

Instead, he suggests, hospitals need to go the way of retail, transportation and airlines, industries which also manage complex operations and work on narrow margins. Those industries have improved their performance by improving their data science capabilities.

“[Hospitals] need to create an operational ‘air traffic control’ for their hospitals — a centralized command-and-control capability that is predictive, learns continually, and uses optimization algorithms and artificial intelligence to deliver prescriptive recommendations throughout the system,” Agrawal says.

Agrawal predicts that hospitals will use predictive analytics to refine their key care-delivery processes, including resource utilization, staff schedules, and patient admits and discharges. If they get it right, they’ll meet many of their goals, including better patient throughput, lower costs and more efficient asset utilization.

For example, he notes, hospitals can optimize OR utilization, which brings in 65% of revenue at most hospitals. Rather than relying on current block-scheduling techniques, which have been proven to be inefficient, hospitals can use predictive analytics and mobile apps to give surgeons more control of OR scheduling.

Another area ripe for process improvements is the emergency department. As Agrawal notes, hospitals can avoid bottlenecks by using analytics to define the most efficient order for ED activities. Not only can this improve hospital finances, it can improve patient satisfaction, he says.

Of course, Agrawal works for a predictive analytics vendor, which makes him more than a little bit biased. But on the other hand, I doubt any of us would disagree that adopting predictive analytics strategies is the next frontier for hospitals.

After all, having spent many billions collectively to implement EMRs, hospitals have created enormous data stores, and few would argue that it’s high time to leverage them. For example, if they want to adopt population health management – and it’s a question of when, not if — they’ve got to use these tools to reduce outcome variations and improve quality of cost across populations. Also, while the deep-pocketed hospitals are doing it first, it seems likely that over time, virtually every hospital will use EMR data to streamline operations as well.

The question is, will vendors like LeanTaaS take a leading role in this transition, or will hospital IT leaders know what they want to do?  At this stage, it’s anyone’s guess.

Avoiding EMR-Related Lawsuits In The ED

Posted on October 25, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s hardly a secret that while EMRs may offer clinical benefits, they aren’t quite the patient safety or risk management tool one might hope they would be. Hospitals have much greater luck mining EMRs for clinical intelligence retroactively than they have using them to avoiding liability, in part because many aren’t designed to offer such protection.

But according to medical malpractice insurer CNA, there are steps hospitals can take to avoid EMR-related liability in the emergency department, in many cases if they simply avoid some key pitfalls which have caused problems for facilities in the past.

Avoiding copy and paste problems

As we all know, copying and pasting repetitive parts of a patient record from one note to another — such as the patient’s history — can save physicians lot of time. And if that’s all that gets copied, it’s seldom an issue.

However, when physicians rely too heavily on copy and paste functions, it can have a negative effect on patient care, in part by disseminating error-laden or outdated information, CNA has found. Overuse of copy-and-paste functions can also flood records with excess information and make it hard for subsequent providers to find what they need.

To avoid patient care errors associated with the use of copy and paste functions, CNA’s recommendations include the following:

  • Establish policies laying out how copy and paste functions should be used
  • Require clinicians to get ongoing education on proper use of these functions and patient safety risks associated with copy and paste misuse
  • Use a voice-activated dictation system for EMR data entry
  • Have the EMR highlight all copied information and/or prevent copying of high-sensitivity information such as the history of present illness
  • Audit EMRs to understand how providers use copy and paste, and responding when they seem to be abusing this function

Managing requests for EHR-based information

If your ED is facing a professional liability claim, you are likely to face requests for paper production of EMR archives. Part of your goal will be to limit how much EHR-based information is legally discoverable.

An important step in doing so is defining the legal medical record (LMR), which includes information on the provision of clinical care which would reasonably be expected upon request during discovery.

However, producing paper copies of EMR-based information differs from producing records originally created on paper, and hospital emergency departments might face additional liability issues if they haven’t prepared for this adequately. To do so, steps they can take include:

  • Developing policies and procedures for responding to requests for copies of the EMR and audit trails
  • Offering ongoing education for medical staff and employees on best practices for EMR documentation
  • Disclosing the EMR electronically in read-only mode rather than as a paper document

Eventually, of course, hospitals will want to do more than patch together defenses against problems that can occur when using a typical EMR design. Ultimately hospitals will want to make EMRs easy to use and supportive of clinical goals without being too intrusive. I know, most of us feel like we’ll grow old and gray waiting for this to happen, but we mustn’t let it fall off the radar.

In the meantime, the strategies CNA outlines could help your ED avoid medical malpractice litigation and protect patients from needless harm. It may be a transitional strategy but it’s better than nothing.

Apple Considers Healthcare Services Crossover

Posted on October 23, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Typically, we cover stories describing how technology companies are pitching their products to providers. This time, in a move I predict we’ll see more often in the future, it looks like Apple has been pondering how it can enter the brick-and-mortar primary care business. This should concern both hospitals and primary care organizations, particularly hospitals that own physician clinics.

Apparently, Apple has been thinking about expanding into the clinic business for at least a year, according to an article from CNBC. Sources told CNBC that the tech giant was in talks to buy a startup known as Crossover Health, which helps big employers create and operate on-site medical clinics. The article reports that while Apple and Crossover talked for months, the two didn’t strike an acquisition agreement.

That doesn’t mean that Apple is backing away from buying a provider organization. The story also notes that Apple has reportedly approached national primary care group One Medical, which charges patients an annual fee for concierge-style care. It’s clearly no coincidence that One Medical also pitches its program to employers.

There’s an argument to be made that Apple can pull this kind of deal off. If nothing else, Apple has been very successful with its chain of brick-and-mortar retail centers, which have been a major sales channel for the company. Between Apple’s magic-touch history with the stores, and large medical groups developing increasingly strong retail chops, there’s a lot of potential there. It’s possible that if Apple acquires or partners with the right clinics, it could be the first major tech company to be a roaring success in the sector.

It’s also worth noting that Apple customers are some of the most fanatically loyal buyers in the world, with many having stayed with the company during all of it ups and downs. If it can mobilize these fans, some of whom are also invested in Apple smartwatches and phones, it could invent new ways to enhance their care experiences. And that could set its clinics apart.

That being said, healthcare is far from perfecting the retail experience for its customers, though there are standouts like One Medical on the map. (Full disclosure: I was briefly a patient in its Washington DC office and came away impressed with the way the care was delivered and packaged.) Few hospitals or clinics are getting it right just yet.

Perhaps more importantly, while Apple has been at the margins of the healthcare business, I doubt it has a deep institutional understanding of healthcare mechanics. This might not be a big deal initially, but as the dust settles on an acquisition it could be a culture clash. After all, healthcare delivery is different from retail operations in some very important ways, including but not limited the herky-jerky way providers are forced to collect on their bills.

My feeling is that even if Apple pours endless capital into such a venture, what will matter more is how well it comes to understand healthcare operations. I believe that it might do better if it partners with a health system with plans to expand its clinic presence. After all, working with the health system would provide Apple with much deeper resources, a deep bench of executive talent and the ability to partner directly on rolling out medical groups. Let’s see if things head that way.

When Hospitals Leak Money

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago I was skimming healthcare business headlines and stumbled across this guaranteed showstopper: You’re probably leaving $22 million on the table. That headline is from a column by Jim Lazarus, who works in the Advisory Board’s Revenue Cycle Solutions division. In his column, he named four ways in which hospitals could recapture some of this lost revenue.

In the article, Lazarus notes that hospitals aren’t following best practices in four key areas, namely denial write-offs, bad debt, cost to collect and contract yield.  Unsurprisingly, Advisory Board benchmarks also demonstrate that median performing organizations are having trouble reducing net days in accounts receivable. The Advisory Board has also found that the overall average cost to collect has worsened by 70 points of net patient revenue from 2011 to 2015.

To turn the stats around, he suggests, hospitals should focus on four critical issues in revenue cycle management. They include:

  • Preventing denials rather than responding to them. “Hospitals are losing, on average, five percentage points of their margin to underpayments, denials and suboptimal contract negotiations,” Lazarus writes.
  • Collecting more from patients by improving their financial experience. According to Lazarus, between 2008 and 2015 the portion of patient obligations being written off as bad debt has climbed from 0.9% to 4.4%. To boost patient collections, hospitals must offer price estimates, convenient payment methods and a positive care encounter, he says.
  • Being sure not to take a hit on MACRA compliance. See that doctors, including those coming on board as employed physicians, get up to speed on documentation performance standards as quickly as possible.
  • Building the value of merged RCM departments. If multiple RCM organizations are being integrated as part of consolidation, look at ways to improve the value they deliver collectively. One approach is to create a shared services organization providing a common business intelligence platform across entities and service lines systemwide.

If you’re an IT leader reading this, it’s probably pretty clear that you have a substantial role in meeting these goals.

For example, if your hospital wants to lower its rate of claims denials, having the right applications in place to assist is critical. Do your coding and billing managers have the visibility they need into these processes? Does senior management?

Also, if the hospital wants to improve patient payment experiences, it takes far more than offering a credit card processing interface to make things work. You’ll want to create a payment system which includes multiple consumer touch points and financing options, which is integrated with other data to offer sophisticated analyses of patient payment patterns.

Of course, the ideas shared by Lazarus are just the beginning. While all organizations leave some money on the table, they have their own quirks as to why this happens. The important thing is to identify them. Regardless, whether you are in RCM, operations or IT, it never hurts to assume you’re losing money and work backward from there.

Heard at #AHIMACon17: Lessons Learned for HIM – HIM Scene

Posted on October 18, 2017 I Written By

The following is a HIM Scene guest blog post by Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, Vice President, Privacy, Compliance and HIM Policy, at MRO.  

The American Health Information Management Association (AHIMA) held its annual convention and exhibit in Los Angeles last week. Beginning with preconvention meetings and symposia, this year’s event delivered a renewed focus on the profession’s stalwart responsibility to protect and govern patient information. Updates for privacy, security, interoperability and information governance were provided. Here is a quick overview of my lessons learned at AHIMACon17.

Privacy and Security Institute

The 11th anniversary of AHIMA’s Privacy and Security Institute didn’t disappoint. Speakers from the HHS Office for Civil Rights (OCR), Federal Bureau of Investigations (FBI) and HITRUST joined privacy and HIM consultants for an information-packed two-day symposium. The most important information for HIM professionals and privacy officers came from the nation’s capital.

Cutbacks underway—Recent defunding of the Chief Privacy Officer (CPO) position by ONC makes practical sense for the healthcare industry and the national budget. The position has been vacant for the past year, and during this time Deven McGraw successfully served as acting CPO and deputy director for health information privacy. Her imminent departure along with other cutbacks will have a trickle-down impact for privacy compliance in 2018.

Onsite audits cease—Yun-kyung (Peggy) Lee, Deputy Regional Manager, OCR, informed attendees that onsite HIPAA audits would no longer be conducted for covered entities or business associates due to staffing cutbacks in Washington, D.C. The concern here is that whatever doesn’t get regulatory attention, may not get done.

To ensure a continued focus on privacy monitoring, HIM and privacy professionals must remain diligent at the organizational, regional, state and national levels to:

  • Maintain internal privacy audit activities
  • Review any patterns in privacy issues and address through corrective action
  • Use environmental scanning to assess resolution agreement results
  • Review published privacy complaints to determine how to handle similar situations
  • Compare your state of readiness to known complaints

Interoperability advances HIPAA—The national push for greater interoperability is an absolute necessity to improve healthcare delivery. However, 30 years of new technology and communication capabilities must be incorporated into HIPAA rules. Old guidelines block us from addressing new goals. We expect more fine-tuning of HIPAA in 2018 to achieve the greater good of patient access and health information exchange.

Luminary Healthcare Panel

Tuesday’s keynote session was the second most relevant discussion for my role as vice president of privacy, compliance and HIM policy at MRO. Panelists provided a glimpse into the future of healthcare while reiterating HIM’s destiny—data integrity and information governance.

HIM’s role extends beyond ensuring correctly coded data for revenue cycle performance. It also includes the provision of correct and complete data for the entire healthcare enterprise and patient care continuum under value-based reimbursement. The need for stronger data integrity and overall information governance was threaded through every conversation during this session.

Final Takeaway

Make no doubt about it! HIM’s role is expanding. We have the underlying knowledge of the importance of data and the information it yields. More technology leads to more data and an increased need for sophisticated health information management and governance. Our history of protecting patient information opens the door to our future in the healthcare industry.

About Rita Bowen
In her role as Vice President of Privacy, Compliance and HIM Policy for MRO, Bowen serves as the company’s Privacy and Compliance Officer (PCO), oversees the company’s compliance with HIPAA, and ensures new and existing client HIM policies and procedures are to code. She has more than 40 years of experience in Health Information Management (HIM), holding a variety of HIM director and consulting roles. Prior to joining MRO, she was Senior Vice President and Privacy Officer for HealthPort, Inc., now known as CIOX Health. Bowen is an active member of the American Health Information Management Association (AHIMA), having served as its President and Board Chair, as a member of the Board of Directors, and of the Council on Certification. Additionally, Bowen is the chair for the AHIMA Foundation. She has been honored with AHIMA’s Triumph Award in the mentor category; she is also the recipient of the Distinguished Member Award from the Tennessee Health Information Management Association (THIMA). Bowen is an established author and speaker on HIM topics and has taught HIM studies at Chattanooga State and the University of Tennessee Memphis. Bowen holds a Bachelor of Medical Science degree with a focus in medical record administration and a Master’s degree in Health Information/ Informatics Management Technology.

MRO is a proud sponsor of HIM Scene.  If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Waiting For The Perfect “Standard” Is Not The Answer To Healthcare’s Interoperability Problem

Posted on October 16, 2017 I Written By

The following is a guest blog post by Gary Palgon, VP Healthcare and Life Sciences Solutions at Liaison Technologies.

Have you bought into the “standards will solve healthcare’s interoperability woes” train of thought? Everyone understands that standards are necessary to enable disparate systems to communicate with each other, but as new applications and new uses for data continually appear, healthcare organizations that are waiting for universal standards, are not maximizing the value of their data. More importantly, they will be waiting a long time to realize the full potential of their data.

Healthcare interoperability is not just a matter of transferring data as an entire file from one user to another. Instead, effective exchange of information allows each user to select which elements of a patient’s chart are needed, and then access them in a format that enables analysis of different data sets to provide a holistic picture of the patient’s medical history or clinical trends in a population of patients. Healthcare’s interoperability challenge is further exacerbated by different contextual interpretations of the words within those fields. For instance, how many different ways are there to say heart attack?

The development of the Health Level Seven (HL7®) FHIR®, which stands for Fast Healthcare Interoperability Resources, represents a significant step forward to interoperability. While the data exchange draft that is being developed and published by HL7 eliminates many of the complexities of earlier HL7 versions and facilitates real-time data exchange via web technology, publication of release 4 – the first normative version of the standard – is not anticipated until October 2018.

As these standards are further developed, the key to universal adoption will be simplicity, according to John Lynn, founder of the HealthcareScene.com. However, he suggests that CIOs stop waiting for “perfect standards” and focus on how they can best achieve interoperability now.

Even with standards that can be implemented in all organizations, the complexity and diversity of the healthcare environment means that it will take time to move everyone to the same standards. This is complicated by the number of legacy systems and patchwork of applications that have been added to healthcare IT systems in an effort to meet quickly changing needs throughout the organization. Shrinking financial resources for capital investment and increasing competition for IT professionals limits a health system’s ability to make the overall changes necessary for interoperability – no matter which standards are adopted.

Some organizations are turning to cloud-based, managed service platforms to perform the integration, aggregation and harmonization that makes data available to all users – regardless of the system or application in which the information was originally collected. This approach solves the financial and human resource challenges by making it possible to budget integration and data management requirements as an operational rather than a capital investment. This strategy also relieves the burden on in-house IT staff by relying on the expertise of professionals who focus on emerging technologies, standards and regulations that enable safe, compliant data exchange.

How are you planning to scale your interoperability and integration efforts?  If you're waiting for standards, why are you waiting?

As a leading provider of healthcare interoperability solutions, Liaison is a proud sponsor of Healthcare Scene. While the conversation about interoperability has been ongoing for many years, ideas, new technology and new strategies discussed and shared by IT professionals will lead to successful healthcare data exchange that will transform healthcare and result in better patient care.

About Gary Palgon
Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences verticals. Gary’s unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce. As a respected thought leader in the healthcare IT industry, Gary has had numerous articles published, is a frequent speaker at conferences, and often serves as a knowledgeable resource for analysts and journalists. Gary holds a Bachelor of Science degree in Computer and Information Sciences from the University of Florida.

Visible and Useful Patient Data in an Era of Interoperability Failure

Posted on October 13, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor.
Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare.
twitter: @coherencemed

Health record interoperability and patient data is a debated topic in Health IT. Government requirements and business interests create a complex exchange about who should own data and how it should be used and who should profit from patient data. Many find themselves asking what the next steps in innovation are. Patient data, when it is available, is usually not in a format that is visible and useful for patients or providers. The debate about data can distract from progress in making patient data visible and useful.

Improvements in HealthIT will improve outcomes through better data interpretation and visibility. Increasing the utility of health data is a needed step. Visibility of patient data has been a topic of debate since the creation of electronic health records. This was highlighted in a recent exchange between former vice president Joe Biden and Judy Faulkner, CEO of Epic Systems.

Earlier this year at the Cancer Moonshoot, Faulkner expressed her skepticism about the usefulness of allowing patients access to their medical records. Biden replied, asking Faulkner for his personal health data.

Faulkner was quick to retort, questioning why Mr. Biden wanted his records, and reportedly responded “Why do you want your medical records?” There are a thousand pages of which you understand 10.”

My interpretation of her response-“You don’t even know what you are asking. Do not get distracted by the shiny vendor trying to make money from interpreting my company’s data”

As reported in Politico Biden–and really, I think that man can do no wrong, responded, “None of your business.”

In the wake of the Biden Faulkner exchange, the entire internet constituency of Health IT and patient records had an ischemic attack. Since this exchange we’ve gone on to look at interoperability in times of crisis. We’ve had records from Houston and Puerto Rico and natural disasters. The importance of sharing data and the scope of useful data is the same. 

During what I call the beginning of several months of research about the state of interoperability I started reading about the Biden and Faulkner exchange. This was not the first time I had been reading extensively about patient data and if EHR and EMR data is useful. It just reminded me of the frustrations I’ve heard for years about EHR records being useless. Like many of us, I disappeared down the rabbit hole of tweets about electronic health records for a full day. Patient advocates STILL frustrated by the lack of cooperation between EHR and EMR vendors found renewed vigor; they cited valid data. Studies were boldly thrown back and the exchange included some seriously questionable math and a medium level of personal attack.

Everyone was like, Are we STILL on this problem where very little happens and it’s incredibly complex? How? How do we still not have a system that makes patient data more useful? Others were like, Obviously it doesn’t make sense because A) usefulness in care, and B) money.

Some argued that patients just want to get better. Others pointed out that acting like patients were stupid children not only causes a culture of contempt for providers and vendors alike, but also kills patients. Interestingly, Christina Farr CNBC reported that the original exchange may have been more civil than originally interpreted. 

My personal opinion: Biden obviously knew we needed to talk about patient rights, open data, and interoperability more. It has had more coverage since then. I don’t know Faulkner, but it sounds like a lot of people on Twitter don’t feel like she is very cooperative. She sounds like a slightly savage businesswoman, which for me is usually a positive thing. I met Peter from Epic who works with interoperability and population health and genomics and he was delightful.

Undeniably, there is some validity to Judy’s assertion that the data would not be useful to Biden; EHR and EMR data, at least in the format available from the rare cooperative vendors, is not very useful. They are a digital electronic paper record. I am willing to bet Biden–much as I adore the guy–didn’t even offer a jump drive on which to store his data. The potential of EHR data visualization to improve patient outcomes needs more coverage. Let’s not focus on the business motivations of parties that don’t want to share their data, let’s look at potential improvements in data usefulness. 

It was magic because I had just had a conversation about data innovation with Dr. Michael Rothman. An early veteran in the artificial intelligence field, Dr. Rothman worked in data modeling before the AI winter of the 80s and the current resurgence in investment and popularity. He predates the current buzz cycle of blockchain and artificial intelligence everything. With many data scientists frustrated by an abandonment of elegant, simple solutions in favor of venture capital and sexy advertising vaporware, it is timely to look at tools that improve outcomes.

In speaking with Dr. Rothman, I was surprised by the cadence of his voice, he asked me what I knew about the history of artificial intelligence, and I asked him to tell his data story. He started by outlining the theory of statistical modeling and data dump in neural net modeling. His company, PeraHealth, represents part of the solution for making EMR and EHR data useful to clinicians and patients.

The idea that data is going to give you the solution is, in a sense, slightly possible but extremely unlikely. If you look at situations where people have been successful, there is a lot of human ingenuity that goes into selecting and transforming the variables into meaningful forms before building the neural network or deep learning algorithm. Without a framework of understanding, a lot of EHR data is simply a data dump that lacks clinical knowledge or visualization to provide appropriate scaffolding.  You do need ingenuity, and you do need the right data. There are so many problems and complexities with data that innovation and ingenuity is lagging behind with healthIT.

The question is – is the answer you are looking for in the input data? If you have the answer in the data, you will be able to provide insights based on it. Innovation in healthcare predictions and patient records will come from looking at data sets that are actually predictive of health.

Dr. Rothman’s work in healthcare started with a medical error. His mother had valve replacement surgery and came through in good shape. Although initially she was recovering quickly, she started to deteriorate after a few days. And the problem was that the system made it difficult to see.  Each day she was evaluated.  Each day her condition was viewed as reasonable given her surgery and age.  What they couldn’t see was that each day she was getting worse.  They couldn’t see the trend.  She was discharged and returned to the ED 4-days later and died.

As a scientist, he recognized that the hospital staff didn’t have everything they needed to avoid an error like this. He approached the hospital CEO and asked for permission to help them solve the problem. Dr. Rothman explained, I didn’t feel that the doctors had given poor medical care, this was a failure of the system.

The hospital CEO did something remarkable. They shared their data. In a safe system they allowed an expert in data science to come in to see what he could find in their patient records, rather than telling him he probably wouldn’t understand the printout. The hospital was an early adopter of EHR records, so they were able to look at a long history of data to find what was being missed. Using vital signs, lab tests, and importantly, an overlooked source of data, nursing notes, Dr. Rothman (and his brother) found a way to synthesize a unified score, a single number which captures the overall condition of the patient, a single number which was fed from the EMR and WOULD show a trend.  There is an answer if you include the right data.  

Doctors and nurses look at a myriad of data and synthesize it, to reach an understanding.  Judy is right that a layman looking at random pieces of data will not likely gain much understanding, BUT they may.  And with more help they might.  Certainly, they deserve a chance to look.  And certainly, the EMR and EHR companies have an obligation to present the data in some readable form.

Patients should be demanding data, they should be demanding hospitals give them usable care and normalize data based on their personal history to help save their lives.

Based on this experience, Michael and Steven built the Rothman Index, a measure of patient health based on analytics that visualizes data found in EHRs. They went on to found PeraHealth, which enables nursing kiosks to show the line and screens to see if any patients decline. In some health systems, an attending physician can get an alert about patients in danger. The visualization from the record isn’t just a screen by the patient, it is also on the physicians and nurses’ screens and includes warnings. Providers have time to evaluate what is wrong before it is too late. The data in the health record is made visual and can be a tool for providers.


Visualization of Patient Status with the Rothman Index and Perahealth

Is Perahealth everywhere? Not yet. For every innovation and potential improvement there is a period of time where slow adopters wait and invest in sure bets. Just like interoperable data isn’t an actuality in a system that desperately needs it, this is a basic step toward improving patient outcomes. Scaling implementation of an effective data tool is not always clear to hospital CMIO and CEO teams.  The triage of what healthIT solution a healthcare system chooses to implement is complex. Change also requires strong collaborative efforts and clear expectations. Often, even if hospital systems know something provides benefits to patients, they don’t have the correct format to implement the solution. They need a strategy for adoption and a strong motivation. It seems that the strongest motivations are financial and outcomes based. The largest profit savings with the minimum effort usually takes adoption precedent. This should also be aligned with end users- if a nurse uses the system it needs to improve their workflow, not just give them another task.

One of the hospitals that is successfully collaborating to make patient data more useful and visual is Houston Methodist. I spoke to Katherine Walsh, Chief Nursing Officer from Houston Methodist about their journey to use EHR data with Perahealth. She explained it to me- Data is the tool, without great doctors and nurses knowing the danger zone, it doesn’t help. This reminded me of Faulkner’s reaction that not all patient data is useful. Clinical support should be designed around visible data to give better care. Without a plan, data is not actionable. Katherine explained that when nurses could see that the data was useful, they also had to make sure their workflow included timely records. When EHR data is actually being used in the care of patients, suddenly data entry workflow changes. When nurses and doctors can see that their actions are saving lives, they are motivated.
The process to change their workflow and visualize patient data did not happen overnight. In the story of Houston Methodist’s adoption of Perahealth, Walsh said they wanted to make sure they helped doctors and nurses understand what the data meant.  “We put large screens on all the units- you can immediately see the patients that are at risk- it’s aggregated by the highest risk factor.” If you are waiting for someone to pull this data up on their desktop, you are waiting for them to search something. But putting it on the unit where you can see it makes it much easier to round, and makes it much easier to get a sense of what is going on. You can always identify what and who is at risk because it’s on a TV screen. The Houston Methodist team showed great leadership in nursing informatics, improving outcomes and using an internal strategy for implementation.

They normalize the variants for each person- a heart rate of 40 for a runner might be normal- then on the next shift 60 seems normal- then at 80 it also seems normal- you can tell them when you want an alert. To help with motivation, Walsh needed to make the impact of PeraHealth visual. They hung 23 hospital gowns around a room, representing the patients they had saved using the system.
The future of electronic health records will be about creating usable data, not just a data dump of fields. It is transforming EHRs from a cost hemorrhage to a life-saving tool through partnerships. Physicians don’t want another administrative task or another impersonal device. Nurses don’t want to go through meaningless measures and lose track of patients during shift changes. Show them the success they’ve had and let the data help them give great care.

Hospital administrators don’t want another data tool that doesn’t improve patient outcomes but has raised capital on vaporware. Creators don’t want more EHR companies that don’t know how to work with agile partners to create innovation.

The real ingenuity is in understanding – what data do you need? What data do patients need? Who can electronic healthcare record companies partner with to bridge the data divide?

We can bridge the gap of electronic health records that aren’t legible or useful to patients and create tools to save lives. Tools like those from PeraHealth are the result of a collaborative effort to take the data we have and synthesize it and visualize it and let care providers SEE their patients.  This saves lives.

Without this, the data is there, it’s just not usable.

Don’t just give the patients their data, show them their health.

Geisinger Partners With Pharmas To Improve Diabetes Outcomes

Posted on October 10, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Geisinger has struck a deal with Boehringer Ingelheim to develop a risk-prediction model for three of the most common adverse outcomes from type 2 diabetes. The agreement is on behalf of Boehringer’s diabetes alliance with Eli Lilly and Company.

What makes this partnership interesting is that the players involved in this kind of pharma relationship are usually health plans. For example:

  • In May, UnitedHealth Group’s Optum struck a deal to model reimbursement models in which payment for prescription drugs is better structured to improve outcomes.
  • Earlier this year, Aetna cut a deal with Merck in which the two will use predictive analytics to identify target populations and offer them specialized health and wellness services. The program started by focusing on patients with diabetes and hypertension in the mid-Atlantic US.
  • Another example is the 2015 agreement between Harvard Pilgrim health plan and Amgen, in which the pharma would pay rebates if its cholesterol-control medication Repatha didn’t meet agreed-upon thresholds.

As the two organizations note in their joint press statement, cardiovascular disease is the leading cause of death associated with diabetes, and diabetes is the top cause of kidney failure in the U.S. population. Cardiovascular complications alone cost the U.S. more than $23 billion per year, and roughly 68 percent of deaths in people with type 2 diabetes in the U.S. are caused by cardiovascular disease.

The two partners hope to improve the odds for diabetics by identifying their condition quickly and treating it effectively.

Under the Geisinger/Boehringer agreement, the partners will attempt to predict which adults with type 2 diabetes are most likely to develop kidney failure, undergo hospitalization for heart failure or die from cardiovascular causes.

To improve the health of diabetics, the partners will develop predictive risk models using de-identified EHR data from Geisinger. The goal is to develop more precise treatment pathways for people with type 2 diabetes, and see that the pathways align with quality guidelines.

Though this agreement itself doesn’t have a value-based component, it’s likely that health systems like Geisinger will take up health plans’ strategies for lowering spend on medications, as the systems will soon be on the hook for excess spending.

After all, according to a KPMG survey, value-based contracts are becoming a meaningful percentage of health system revenue. The survey found that while value-based agreements aren’t dominant, 36 percent of respondents generated some of their revenue from value-based payments and 14 percent said the majority of revenue is generated by value-based payments.

In the meantime, partnerships like this one may help to improve outcomes for expensive, prevalent conditions like diabetes, high blood pressure, arthritis and heart disease. Expect to see more health systems strike such agreements in the near future.

KLAS Summit: Interoperability Doing the Work to Move HealthIT Forward

Posted on October 9, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor.
Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare.
twitter: @coherencemed

I had the privilege of attending the KLAS research event with leaders in patient data interoperability. From the ONC to EHR vendors- executives from EHR vendors and hospital systems made their way to a summit about standards for measurement and improvement. These meetings are convened with the mutual goal of contributing to advancement in Health IT and improvement of patient outcomes. I’m a big fan of collaborative efforts that produce measurable results. KLAS research is successfully convening meetings everyone in the HealthIT industry has said are necessary for progress.

The theme of Interoperability lately is: Things are not moving fast enough.

The long history of data in health records and variety in standards across records have created a system that is reluctant to change. Some EMR vendors seem to think the next step is a single patient record- their record.

Watching interactions between EHR vendors and the ONC was interesting. Vendors are frustrated that progress and years of financial investment might be overturned by an unstable political atmosphere and lack of funding. Additionally, device innovation and creation is changing the medical device landscape at a rapid rate. We aren’t on the same page with new data and we are creating more and more data from disparate sources.

Informatics experts in healthcare require a huge knowledge base to organize data sharing and create a needs based strategy for data sharing. They have such a unique perspective across the organization. Few of the other executives have the optics into the business sense of the organization. They have to understand clinical workflows and strategy., as well as financial reimbursement. Informatics management is a major burden and responsibility- they are in charge of improving care and making workflows easier for clinicians and patients. EMR use has frequently been cited as a contributor to physician burnout and early retirement. Data moving from one system can have a huge impact on care delivery costs and patient outcomes. Duplicated tests and records can mean delayed diagnosis for surgeons and specialists. Participants of the summit discussed that patients can be part of improving data sharing.

We have made great progress in terms of interoperability but there is still much to be done. Some of the discussion was interesting, such as the monumental task the VA has in patient data with troop deployment and care. There was also frank discussion about business interests and data blocking ranging from government reluctance to create a single patient identifier to a lack of resources to clean duplicated records.

Stakeholders want to know what the next steps are- how do we innovate and how do we improve from this point forward? Do we create it internally or partner with outside vendors for scale? They are tired of the confusion and lack of progress. Participants want more. I asked a few participants what they think will help things move forward more quickly. Not everyone really knows how to make things move forward faster.

Keith Fraidenburg of CHIME praised systems for coming together and sharing patient data- to improve patient outcomes. I spoke with him about the Summit itself and his work with informatics in healthcare. He discussed how the people involved in this effort are some of the hardest working people in healthcare. Their expertise in terms of clinical knowledge and data science is highly specialized and has huge implications in patient outcomes.

“To get agreement on standards would be an important big step forward. It wouldn’t solve everything but to get industry wide standards to move things forward the industry needs a single set of standards or a playbook.”

We might have different interests, but the people involved in interoperability care about interoperability advancement. Klas research formed a collaborative of over 31 organizations that are dedicated to giving great feedback and data about end users. The formation of THE EMR Improvement Collaborative can help measure the success of data interoperability. Current satisfaction measures are helpful, but might not give health IT experts and CMIOs and CIOs the data they need to formulate an interoperability strategy.

The gaps in transitions of care is a significant oversight in the existing interoperability marketplace. Post acute organizations have a huge need for better data sharing and interorganizational trust is a factor. Government mandates about data blocking and regulating sharing has a huge impact on data coordination. Don Rucker, MD, John Fleming, MD, Genevieve Morris and Steve Posnack participated in a listening session about interoperability.  Some EMR vendors mentioned this listening session and ability to have a face to face meeting were the most valuable part of the Summit.

Conversations and meetings about interoperability help bridge the gaps in progress. Convening the key conversations between stakeholders helps healthcare interoperability move faster. There is still work to be done and many opportunities for innovation and improvement. Slow progress is still progress. Sharing data from these efforts by the KLAS research team shows a dedication to driving interoperability advancement. We will need better business communication between stakeholders and better data sharing to meet the needs of an increasingly complex and data rich world.

What do you think the next steps are in interoperability?

Social Media Still Controversial in Healthcare?

Posted on October 6, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Thirteen years after the first Facebook post and eleven years after the first tweet, social media use by healthcare professionals continues to be a controversial topic.

In October last year, nurse Carolyn Strom was found guilty of “professional misconduct” by the Saskatchewan Registered Nurses’ Association (SRNA) for a post she made on Facebook. On February 25th 2015 Strom posted the following comment following her grandfather’s death at St Joseph’s Health Facility (Strom did not work at that facility):

“My grandfather spent a week in palliative care before he died and after hearing about his and my family’s experience there, it is evident that not everyone is ‘up to speed’ on how to approach end of life care or how to help maintain an aging senior’s dignity.”

“I challenge the people involved in decision making with that facility to please get all your staff a refresher on this topic and more. Don’t get me wrong, ‘some’ people have provided excellent care so I thank you so very much for your efforts, but to those who made Grandpa’s last years less than desirable, please do better next time.”

André Picard wrote an excellent post earlier this year about the Strom “professional misconduct” decision by the nurse association.

This case and a recent Canadian Medical Association session on the lack of civility between physicians on social media served as the kernel of a recent #hcldr chat led by guest hosts Pat Rich @pat_health and Trish Paton @TrishPaton.

A clear sentiment from the #hcldr community was that healthcare regulatory bodies and professional associations were woefully behind-the-times when it came to social media policy.

Matthew Katz MD had a keen observation and suggestion for regulators:

Fear of fines and sanctions from regulatory bodies/associations coupled with the very real danger of being ostracized by peers, have effectively made social media into a “no-go” zone for healthcare professionals.

Robert Mahoney @mahoneyr had a very interesting take on social media posts from healthcare professionals.

Thankfully there are some progressive healthcare organizations out there who actually encourage their healthcare professionals to get engaged online. To help their staff navigate social media, they have created clear policies and guidelines so that they do not run afoul of regulatory bodies. The Mayo Clinic shared theirs with the community:

What are your thoughts about healthcare professionals, governing associations and social media?