ACO | Hospital EMR and EHR

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

I had the tremendous opportunity to spend the day hearing and interacting with a group of healthcare leaders across the entire spectrum of healthcare. I was invited to the Healthcare Forum as a guest of The Breakaway Group. They’d told me that the group would have a large number of influential people in healthcare and they were right. Along with recognizable names like Dr. Farzad Mostashari, Glen Tullman and Lee Shapiro were a number of hospital CEOs, CIOs, and CMIOs. There were doctors, insurance executives, and many other executives which made for a very well rounded and interesting discussion.

I won’t go through an entire recap of the event and all the things that were shared during the various presentations. If that interests you, go and read through my @ehrandhit tweets and check out the #simplehealth hashtag and you’ll get a good overview of everything that was presented from those of us live tweeting the event.

I do want to highlight a couple key takeaways and then suggest a list of major themes we’ll be confronting in healthcare.

Farzad Mostashari, MD was the event keynote with a great view on the future of healthcare. Farzad’s intro was perfect when Charles Fred, Founder & CEO of The Breakaway Group, said, “The wedding of healthcare and technology is over and Farzad has joined us for the marriage.”

Farzad’s message covered a lot of ground including a message of optimism for healthcare, the need to affect all parts of healthcare both small and large, and using the “most underutilized resource in healthcare…the patient.” He also talked about the need for some accountability in healthcare. Farzad suggested that there’s no “scale” in healthcare that we can step on and know how well we are doing. We need the data to be able to tell us how we are doing so we can improve. Without the data we almost always overestimate how good we are and underestimate the things we’re doing poorly.

One of the most powerful concepts Farzad discussed was around being careful not to change healthcare from a social contract into a financial contract. He said, “Incentives and money aren’t always the same.” This point was illustrated brilliantly by one of the attendees who said, “An ACO should be the way we live and breathe healthcare every day and not just a reimbursement program.” I think we often need a reminder to not let the business of healthcare overwhelm the care provided.

Finally, for those of us who love EMR and EHR, Farzad offered this incredible perspective on where we are at when it comes to EHR progress, “We are at about 50% EHR adoption and about 5% workflow adjustment.” It’s the first time I’ve seen him acknowledge the idea that EHR adoption isn’t enough. In fact, the initial implementation of an EHR is just the very first step in a process of really optimizing the EHR for your workflow and for improved patient care. It does make me wonder what things ONC might do in the future to try and address the 95% of EHR workflow adjustments that remain.

I’m sure I’ll be pulling nuggets of information out of Dr. Jennifer Brull, Bill Rieger, Dr. CT Lin, Ashwin Ram, and Heather Haugen’s talks in future posts. They all offered some unique insights into quality of care, EHR leadership, patient engagement, patient portals, and EHR implementation.

Here’s the list of themes from the day as identified by those who attended:

Using Data
Transparency
Need for Leadership to Change
Adoption vs. Implementation (EHR)
Patient and Family Involvement in Care (through social media often)
Change Happens at a Different Pace for Different People

And then we identified the following important future healthcare topics:

Interoperability
Social and Mobile
Patient Engagement
How Do We Ask the Best Questions
Make the Right Thing to Do, Easy
Big Data, Small Actions (for doctors and patients)
Changing Reimbursement

The Healthcare Forum at TEDMED was a well organized event that provided a lot of food for thought. My only complaint from the experience was that pretty much everyone in the room could have been a speaker at the event. Thinking about that makes me wish there had been more time to hear from those in the audience. Although, it isn’t a bad thing to leave us thirsting for more.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox blog and follow@XeroxHealthcare.

ACOs Need Population Health Help From EMRs

It’s hard to argue that without an EMR, Accountable Care Organizations would be somewhat adrift. After all, any structure that demands a high level of coordination between multiple organizations benefits from a shared EMR backbone.

But do EMRs do a good job of managing population health, the other key responsibility of ACO clinicians? Let’s take a look at the criteria suggested by David Nash, MD, MBA, who’s Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University. Dr. Nash notes that primary care physicians in an ACO need the following:

A registry to monitor and evaluate my patients – not just individually but as a population
Relevant data on my patients who share a specific diagnosis such as hypertension or asthma
Information on how my medical management and patient outcomes compare with other local practices
Information on where my practice stands in comparison with national benchmarks

Let’s see. Do leading EMRS offer a registry to monitor patients as a group? Automatically serve up data on patients who share a specific diagnosis? Offer means of benchmarking outcomes with other local practices or national standards? No, no and no.

I can hear EMR vendors out there saying, “Hey, wait a minute. That stuff is not our problem!” And historically, they’d probably be right. After all, it’s a formidable enough job creating usable, flexible, reliable medical record analogues in digital form.

The truth is, however, that population health measures are central to the medical home, ACOs and the future of medicine generally.

My guess is that for the next few years, hospitals and large medical practices — even those who have launched an ACO — will be preoccupied enough with meeting Meaningful Use measures that they won’t be demanding more extensive population measures soon.

Still, enterprise EMR vendors will need to offer tools that meet broad population health goals eventually, as the large organizations that buy their products will soon be demanding these types of functions. The only question is when.

Hospital-Backed HIE On The Rocks

In an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange. For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

Expanding HIEs Taking Role As Backbone For Reform Efforts

It looks like we may be seeing a tipping point for HIEs, which for many years have seen only isolated successes. According to a new report from the eHealth Initiative, the number of HIEs has grown meaningfully between last year and this year, and this year should see many new HIE organizations form. Perhaps more importantly, it looks like HIEs are taking their place as the backbone for up and coming reform efforts.

When eHI reached out to survey HIEs, it found 322 organizations to survey, up from 255 last year. Of that group, 88 HIE initiatives are at the highest stages of development on eHIs HIE development scale, an increase of 13 from last year. As researchers see it, we’ll see even more growth and maturing technologies in 2013.

Over the last several years, the HIEs which have stayed on their feet and matured have almost all been propped up by federal dollars. Twenty-seven of the advanced HIEs surveyed said that the single most substantial source of funding they had was from the federal government; also, 22 of these HIEs were classified as state designated entities.

Unlike the past, however, it seems that HIEs believe they can survive without grant money from the government. Of 39 state-designated entities responding to the study, 37 said they believe it is ‘very likely’ or ‘likely’ that they will remain operational after the HITECH dollars stop flowing. An additional 31 of the SDEs said t hat it is ‘very likely’ or ‘likely’ that they will be financially sustainable three years from now even without additional federal dollars.

Now, here’s where it gets really interesting (to me at least). As part of the study, the eHealth Initiative asked some questions about how HIEs were playing into preparations for the full rolllout of health reform.

What they found out is that HIEs are increasingly playing a major role in health reform-related efforts such as ACOs and/or Patient-Centered Medical Homes. More than half (109) of the HIE respondents said that they are supporting ACOs or PCMHs.

The HIEs aren’t just dumb pipes either; not only are they offering technical infrastructure, they’re providing data analytics services around cost efficiencies and quality improvement.

Looks like 2013 should be a pivotal year for HIEs. I for one am excited to see what HIE organizations will be able to accomplish over the next 12 months prior to full rollout of health reform. Go team HIE!

5 Mistakes Healthcare Vendors Make in Tracking Customer Satisfaction

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com

A lot of our work revolves around helping our healthcare vendor clients engage with their customers, specifically to track satisfaction and loyalty. We have seen what passes for customer research in the industry, and while the efforts are commendable, the execution typically leaves a lot to be desired. There are five common mistakes we regularly see healthcare vendors make in their customer loyalty programs:

Survey Fatigue: Most companies use lengthy, complex surveys which just take too much time. Also, providers get hit with a lot of survey requests. These two concerns induce low response rates and poor data quality.
Low Response Rates: Many structured survey programs yield single-digit response rates. If this is the case for your program, you need to rethink the entire process, from how you notify your customers to the tools you are using to gather information. Getting more of your customers engaged is as much about process as it is about product.
Low Frequency: Given the effort required to conduct a wide-ranging customer satisfaction poll, most vendors who do so usually engage once a year, or twice a year tops. Too many things are happening in your customer base in the intervening six or twelve months to stay out of touch.
Lack of Consumability: Typically, it takes weeks and months for a customer research program to turn around the results of the campaign. To be truly effective, the information needs to be as close to real time as possible. That means making the data immediately available and consumable for decision makers as it comes in, not after the fact.
Lack of Closing the Loop: Few customer research programs provide an effective means for applying the results in a way that positively and quickly impacts the customer experience.

Savvy vendors are finding ways to avoid these common mistakes. These companies understand that engaging customers in a consistent, meaningful manner must be a corporate focus, not an afterthought. And customer satisfaction is only becoming more important for hospitals as well, as requirements around patient engagement and similar initiatives will likely be part of the ACO model.

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The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

ACOs Need Population Health Help From EMRs

Hospital-Backed HIE On The Rocks

Expanding HIEs Taking Role As Backbone For Reform Efforts

5 Mistakes Healthcare Vendors Make in Tracking Customer Satisfaction

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