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Health Systems, Hospitals Getting Serious About Telemedicine

Posted on December 8, 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.

In the spring of last year, I wrote up a story about hospitals and health systems and their growing interest in telemedicine. The story included data from a survey on hospitals and telemedicine, which found that health systems averaged 5.51 telemedicine service lines at the time, up almost 20% from 2015.

Given these stats, I was not surprised to see a new press release from Teladoc reporting that the company now supports more than 200 hospitals, a number which represents a 100% growth in such relationships during this year.

If you’re wondering why this has happened, you’ll get more or less the same answer from last year’s study and Teladoc’s news release. In short, it’s all about the outcomes, baby.

When I wrote the story last year, one of the things that stood out for me was that 96% of respondents had said they were planning to roll up telemedicine services because they felt it would improve patient outcomes. While that made sense to me at the time, it seemed more like an aspiration rather than a practical plan.

What made the survey data even more provocative is that “improving financial returns” turned out to be a very low priority for hospitals working on telemedicine programs. At the time, this focus on outcomes rather than direct financial returns surprised me.

Now, about 18 months later, I’m doing the facepalm thing and saying “of course, hospitals want affordable, flexible care delivery options — they’re a great tool for managing population health!” It’s a no-brainer, actually, but I guess my brain wasn’t working at the time.

Now, as far as I know, the assumption that telemedicine can help with PHM and value-based delivery generally has not been rigorously tested. Also, even if the assumption is correct, hospitals are likely to struggle with deploying telemedicine for a while until they develop the most efficient workflows for using it.

Also, while it’s all well and good to say that focusing on outcomes will create ROI as a secondary effect, for some hospitals it will be pretty rough to carry telemedicine infrastructure and staffing costs upfront for a while. After all, if they want to make an impact with telemedicine, they have to make a serious commitment; I’m guessing that most of us would agree that a scattershot approach would get most hospitals nowhere.

Ultimately, though, I think hospitals have it right. Telemedicine is likely to offer health systems and hospitals some amazing options for extending service lines, managing populations more effectively, and yes, improving outcomes.

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.

Many Providers Still Struggle With Basic Data Sharing

Posted on February 15, 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.

One might assume that by this point, virtually every provider with a shred of IT in place is doing some form of patient data exchange. After all, many studies tout the number of healthcare data send and receive transactions a given vendor network or HIE has seen, and it sure sounds like a lot. But if a new survey is any indication, such assumptions are wrong.

According a study by Black Book Research, which surveyed 3,391 current hospital EMR users, 41% of responding medical record administrators find it hard to exchange patient health records with other providers, especially if the physicians involved aren’t on their EMR platform. Worse, 25% said they still can’t use any patient information that comes in from outside sources.

The problem isn’t a lack of interest in data sharing. In fact, Black Book found that 81% of network physicians hoped that their key health system partners’ EMR would provide interoperability among the providers in the system. Moreover, the respondents say they’re looking forward to working on initiatives that depend on shared patient data, such as value-based payment, population health and precision medicine.

The problem, as we all know, is that most hospitals are at an impasse and can’t find ways to make interoperability happen. According to the survey, 70% of hospitals that responded weren’t using information outside of their EMR.  Respondents told Black Book that they aren’t connecting clinicians because external provider data won’t integrate with their EMR’s workflow.

Even if the data flows are connected, that may not be enough. Researchers found that 22% of surveyed medical record administrators felt that transferred patient information wasn’t presented in a useful format. Meanwhile, 21% of hospital-based physicians contended that shared data couldn’t be trusted as accurate when it was transmitted between different systems.

Meanwhile, the survey found, technology issues may be a key breaking point for independent physicians, many of whom fear that they can’t make it on their own anymore.  Black Book found that 63% of independent docs are now mulling a merger with a big healthcare delivery system to both boost their tech capabilities and improve their revenue cycle results. Once they have the funds from an acquisition, they’re cleaning house; the survey found that EMR replacement activities climbed 52% in 2017 for acquired physician practices.

Time for a comment here. I wish I agreed with medical practice leaders that being acquired by a major health system would solve all of their technical problems. But I don’t, really. While being acquired may give them an early leg up, allowing them to dump their arguably flawed EMR, I’d wager that they won’t have the attention of senior IT people for long.

My sense is that hospital and health system leaders are focused externally rather than internally. Most of the big threats and opportunities – like ACO integration – are coming at leaders from the outside.

True, if a practice is a valuable ally, but independent of the health system, CIOs and VPs may spend lots of time and money to link arms with them technically. But once they get in house, it’s more of a “get in line” situation from what I’ve seen.  Readers, what is your experience?

Population Health Tech Will Lag Until Standards Emerge

Posted on June 22, 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.

There’s little doubt that healthcare organizations will continue to partner up with peers and acquire physician practices. The forces that drive healthcare network development are only intensifying as time goes by, particularly as the drive toward value-based payment moves ahead. But there’s a lot more to making such deals work than a handshake and a check. To make these deals work, it’s critical that networks become experts at population health management — and unfortunately, that’s going to be tough.

While merging health systems into ACOs or acquiring referring physicians has merit, this strategy won’t grow the steadily dropping pace of hospital admissions, notes William Faber, M.D., senior vice president of the GE Healthcare Camden Group. “Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base,” making it unlikely that the networks will grow admissions, he points out.

To make a clinically integrated network successful, it certainly helps to take the initiative – to get to market more quickly than competitors – and to do a better job of controlling costs of care and demonstrating higher quality and service. Where things get stickier, however, is in managing that care across a large group. “The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management,” he writes.

And this, I’d argue, is where things get very tricky. Well, judge for yourself, but I’d argue that the HIT industry is ill-equipped to support these goals. Despite many years of paper-chart experimentation with population health, and several with population health technology, my sense is that the tech is far behind what it needs to be. Health IT vendors won’t get far until providers do a better job of defining what they need.

A different mindset

The truth is, this generation of EMRs is designed to track individual patients across an experience of care. While CIOs can add a layer of analytics technology to the mix, that is a far cry from creating tools that natively track population health trends. Looking at populations is simply a different mindset.

Admittedly, vendors will tell you that they’ve got the problem licked, but if they were completely candid many would have to admit that their products aren’t mature yet. Until someone creates an EMR or other basic tool which is designed, at its core, to track group health trends, I foresee more half-baked hacks than results.

What’s more, I doubt the health IT business will be able to help until it has at least an informal standard to which such products must adhere. Should such tools measure costs of care by diagnosis code? Compare such costs to national standards? Highlight patients in outpatient settings whose tests or exams suggest a crisis is about to happen? If so, which settings, and what cutoffs should be tracked for test scores? Does such a system need natural language processing to scour physician notes for trigger words, and if so which ones?

Without a doubt, medical and business executives leading integrated networks will come together and develop more answers to these questions. But until they do, health IT vendors won’t be able to help much with the population health challenge.

Hospitals Say Meaningful Use Compliance Remains A Big Challenge

Posted on April 26, 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.

Sure, EMR use is picking up rapidly across the U.S.  But is the process going well? Maybe not, according to a new poll released by audit, tax and advisory services firm KPMG LLP.

According to KPMG, 48 percent of hospitals and health system respondents said they were confident they could reach Stage 1 Meaningful Use requirements. Meanwhile, 39 percent were somewhat confident and 3 percent weren’t confident at all.

Perhaps most strikingly, 10 percent didn’t know what their level of readiness was. (If I were a health system CEO, those folks would bother me the most; not even knowing is a dangerous state of affairs.)

So what’s holding them back?

*  25 percent said they just aren’t sure how to demonstrate MU
*  20 percent said training and change management were concerns
*  18 percent said they weren’t confident they could capture relevant data from clinical workflows
*  12 percent weren’t ready since they don’t have a Meaningful Use team in place
*  Six percent said they didn’t have the right certified technology yet

It’s not that the hospitals IT folks are sitting on their hands. Researchers at KPMG found that 71 percent of the hospitals and health systems were more than 50 percent of the way to finalizing EMR adoption.  But that apparently hasn’t been enough to reassure them that they’re on the mark where Meaningful Use is concerned.

The whole thing sounds like a trainwreck waiting to happen, in my view. I say, let’s pause a bit and really take these numbers seriously — providers are struggling out there! — before hospitals waste more money and time messing around and feeling clobbered.