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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.

A Look At Geisinger’s Big Data Efforts

Posted on December 28, 2016 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.

This week I got a look at a story appearing in a recent issue of Harvard Business Review which offers a description of Geisinger Health System’s recent big data initiatives. The ambitious project is designed not only to track and analyze patient outcomes, but also to visualize healthcare data across cohorts of patients and networks of providers and even correlate genomic sequences with clinical care. Particularly given that Geisinger has stayed on the cutting edge of HIT for many years, I think it’s worth a look.

As the article’s authors note, Geisinger rolled out a full-featured EMR in 1996, well ahead of most of its peers. Like many other health systems, Geisinger has struggled to aggregate and make use of data. That’s particularly the case because as with other systems, Geisinger’s legacy analytics systems still in place can’t accommodate the growing flood of new data types emerging today.

Last year, Geisinger decided to create a new infrastructure which could bring this data together. It implemented Unified Data Architecture allowing it to integrate big data into its existing data analytics and management.  According to the article, Geisinger’s UDA rollout is the largest practical application of point-of-care big data in the industry. Of particular note, Geisinger is crunching not only enterprise healthcare data (including HIE inputs, clinical departmental systems and patient satisfaction surveys) and consumer health tools (like smartphone apps) but even grocery store and loyalty program info.

Though all of its data hasn’t yet been moved to the UDA, Geisinger has already seen some big data successes, including:

* “Close the Loop” program:  Using natural language processing, the UDA analyzes clinical and diagnostic imaging reports, including free text. Sometimes it detects problems that may not be relevant to the initial issue (such as injuries from a car crash) which can themselves cause serious harm. The program has already saved patient lives.

* Early sepsis detection/treatment: Geisinger uses the UDA to bring all sepsis-patient information in one place as they travel through the hospital. The system alerts providers to real-time physiologic data in patients with life-threatening septic shock, as well as tracking when antibiotics are prescribed and administered. Ninety percent of providers who use this tool consistently adhere to sepsis treatment protocols, as opposed to 40% of those who don’t.

* Surgery costs/outcomes: The Geisinger UDA tracks and integrates surgical supply-chain data, plus clinical data by surgery type and provider, which offers a comprehensive view of performance by provider and surgery type.  In addition to offering performance insight, this approach has also helped generate insights about supply use patterns which allow the health system to negotiate better vendor deals.

To me, one of the most interesting things about this story is that while Geisinger is at a relatively early stage of its big data efforts, it has already managed to generate meaningful benefits from its efforts. My guess is that its early successes are more due to smart planning – which includes worthwhile goals from day one of the rollout — than the technology per se. Regardless, let’s hope other hospital big data projects fare so well. (Meanwhile, for a look at another interesting hospital big data project, check out this story.)

Rush University Medical Center Rolls Out OpenNotes

Posted on November 18, 2016 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.

Back in 2010, a group of primary care doctors from three different healthcare organizations across the US came together to launch a project in which they’d begin sharing their clinical notes directly with their patients. The doctors involved were part of a 12-month study designed to explore how such sharing would affect healthcare. The project was a success, and today, 10 million patients have access to their clinicians’ notes via OpenNotes.

Now, Rush University Medical Center has joined the party. The 664-bed academic hospital, which is based in Chicago, now allows patients to see all of their doctor’s notes through a secure web link which is part of Epic’s MyChart portal. According to Internet Health Management, Rush has been piloting OpenNotes since February and rolled it out across the system last month.  Patients could already use MyChart to review physician instructions, prescriptions and test orders online.

If past research is any indication, the new service is likely to be hit with patients. According to a study from a few years ago, which looked at 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center, 99% of study participants wanted continued access to clinician notes after having it for one year. This was true despite the fact that almost 37% of patients reported being concerned about privacy after using the portal during that time.

Dr. Allison Weathers, Rush associate chief medical information officer, told the site that having access to the notes can help individuals with complex health needs and under the care of multiple providers. “Research shows that when patients can access their physicians’ notes, they better understand the medical issues and treatment plan as active partners in their care,” she said. “When a patient is sick, tired or stressed during a doctor’s visit, they may forget what the doctors said or prescribed.”

I think it’s also apparent that giving patients access to clinician notes helps them engage further with the process of care. Ordinarily, for many patients, medical notes from their doctor are just something that they hand along to another doctor. However, when they have easy access to their notes, alongside of the test results, appointment scheduling, physician email access and other portal functions, it helps them become accustomed to wading through these reports.

Of course, some doctors still aren’t OpenNotes-friendly. It’s easy to see why. For many, the idea of such sharing private notes — and perhaps some unflattering conclusions — has been out of the question. Many have suggested that if patients read the notes, they can’t feel free to share their real opinion on matters of patient care and prognosis. But the growth of the OpenNotes program suggests to me that the effect of sharing notes has largely been beneficial, giving patients the opportunity not only to correct any factual mistakes but to better understand their provider’s perspective. As I see it, only good can come from this over the long run.

Group Develops EMR-Less HIE Technology

Posted on August 22, 2012 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 pair of major tech players and a group led by Geisinger have come together to create tools making health information exchanges accessible to providers who don’t have an EMR in place. The tools are aimed at skilled nursing facilities, but from what I can see, the approach would work for other providers too.

Federal standards already require SNFs to submit MDSs — which are electronic patient assessments — to both the Medicare and Medicaid programs. The thing is, MDS data doesn’t conform to the Continuity of Care standard, so it can’t be shared amongst various providers across an HIE.

What’s happening is that Geisinger’s Keystone Beacon Community and GE-Microsoft joint venture Caradigm have created a MDS (minimum data set)-to-CCD transformer which turns patient care data into a Continuity of Care Document.  Providers can then take their CCD document and transfer it to  an HIE.

The Keystone Beacon Community, which is part of an HHS-backed program established in 2009, was launched to speed up the ability of health IT to transform local healthcare systems.  Keystone includes a network of 17 central Pennsylvania providers, including medical practices, hospitals, long-term care communities and others.

I’m not surprised to see Geisinger driving this train, as it’s been ahead of the EMR curve for many years. Geisinger is also large enough to conduct a real test of new technologies, as its network single-handedly serves more than 2.6 million residents of 42 area counties.

Still, I’ve got to wonder whether efforts like the Direct Project aren’t a better place to invest energy at the moment. It seems to me that Direct Project technologies are far simpler to deal with and still get a great deal done. But then again, maybe I’m just being a party pooper.  Nonetheless, I can’t help feeling that in this situation, less (complicated technology) is more.

Why Do People Dislike Epic So Much? Let Me Count The Ways

Posted on August 21, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Man oh man, Epic is burning up the track. As my colleague John Lynn noted in a recent post, there are tons of reasons why it’s developed a near monopoly in some sectors, especially with large hospitals.

Founded in 1979 with an initial investment of $70,000, the company now is conservatively estimated by Wall Street analysts to be worth $1.2 billion (as of 2008), Lynn notes.

And there’s tons of reasons Epic is doing so well (facts courtesy of @DanMunro) including:

* Kent Gale, president of KLAS Enterprises, a research firm known in healthcare specifically for its customer surveys said “…there’s a huge gap between Epic and the other vendors. That is probably the biggest differentiator. They are able to keep their commitments better.”
* Epic ranked No. 1 in seven out of 20 categories in one of KLAS’ most recent survey (and they don’t sell products for several of the categories).
* Epic’s software enabled Kaiser, the country’s largest health system (outside of VA?), to confirm that Vioxx increased the risk of blood clots, leading to the prescription painkiller being pulled from the market.
* The company rarely negotiates on price. There is one exception: It has been known to give breaks, such as waiving its annual maintenance fee, to struggling hospitals.

But is that all there is to the story? I don’t think such complaints are enough to generate the resentment, heck, hatred you pick up out there sometimes regarding the EMR giant.

It can’t help that many users dislike the Epic interface and generally find the product to be a PITA to use.  That doesn’t exactly generate good will.

The capper, really, may be the way Epic is handling its clout. CEO Judith Faulkner seems to be taking on an imperial attitude, doubtless because her company controls so many installations that it practically controls aspects of the entire US health reform process.

If you think that’s scary, consider the following. About six years ago, Geisinger Health System spent $35 million on an Epic Systems install. Not only after, during a pilot test of the software, the hospital’s psychiatric unit started to get wildly inconsistent and inappropriate medication orders. Apparently, the problem was an incompatibility between a commonly-used pharmacy database in place at Geisinger and the Epic system.

OK, just about any system can fail, and unfortunately, drug dosage problems are one of the many possible points of failure. That’s not what frightens me.

What had me reeling was a quote from a Business Week article written not long after the Geisinger debacle. When questioned, Faulkner didn’t apologize: she said, in essence, that it was Geisinger that was at fault for having the temerity to try and integrate Epic technology with existing systems. “It doesn’t work when you mix and match vendors,” Faulker told the magazine. “It has to be one system, or it can be dangerous for patients.”

Bear in mind that this was several years ago. I can only imagine that Faulker’s attitude has hardened since then, as her company’s market share and power has grown.  Will her position — that using best-of-breed, integrated health IT products is a bad idea — push the entire industry in that direction?  Perish the thought.

And that, my friends, is reason enough alone to reject Epic and all of its works, if you have the option.  At minimum, a healthy dislike seems very much in order. But maybe I’m being too harsh. What do you think?