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NC Health System Uses Big Data To Improve Care

While everybody talks about the potential for so-called “big data” in healthcare, there seems to be more smoke than fire at this point. To date, health payers have been a lot more engaged with using big data than providers, according to IDC Health Insights.

That being said, there are some providers out there who have been able to get their arms around big data projects which improve careFierceHealthIT reports.

One example is the University of North Carolina Health Care (UNCHC), a health system based in Chapel Hill, N.C., where they’ve begun programs to leverage big data in improving the quality of care and reporting, according to FierceHealthIT.

As the UNCHC system has grown, it’s seen a dramatic increase in the amount of data each facility was holding — and making things even more challenging, 80 percent of the data was unstructured, according to Carlton Moore, MD, associate professor of medicine at UNCHC.

As Dr. Moore notes, it’s difficult to use unstructured data to meet accountable care objectives. For example, when patients get cancer screenings at another institution, physicians write that in the unstructured notes, but don’t check off that they’ve  had the study because it wasn’t done there.

But UNCHC has taken on the mass of data under its roof. It’s developed a unique algorithm inserted into a natural language processing plan which allows researchers to find and address abnormal results on pap smears and mammography screenings.

While this is just a beginning, UNCHC has bigger plans. It intends to take next steps in analyzing and using its mass of data such as analyzing medication compliance and determining the number of clinic visits associated with bad health outcomes.

Kudos to UNHCH on their progress. But I don’t expect to see a ton of these projects showing up in the public arena; there’s just too much involved, particularly with ICD-10 and Meaningful Use draining resources like crazy.

In the mean time, though, providers may want to embrace “skinny” healthcare data, argues my colleague John Lynn.  The concept:  instead of creating a huge enterprise data warehouse for all purposes, why not focus on smaller problems?  That might be a faster path to results, and a decent preparation for the big data future, no?

November 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

EMR Med Reconciliation Works, But Doesn’t Come Easy

Medication reconciliation is a complex process which could always stand to be improved — so how about leveraging your EMR?

Editor Maria Durben Hirsch of FierceEMR recently talked with a handful of health IT execs about how it’s working out to use EMRs as part of their med reconciliation process, and learned that while health leaders are enthusiastic about med reconciliation in the EMR, they’re still working out kinks in the process.

Health IT leaders do seem enthusiastic about the possibilities for using EMR med functions.

For example, Texas Health Resources, a 25-hospital health system in the Dallas/Fort Worth area, has found that using EMRs improves the accuracy of the process by providing tools to capture the patient’s previous med history, better managing new med orders and generating instructions for patients, CMIO Ferdinand Velasco, MD, told FEMR.

And at Naperville, Ill.-based Edward Hospital,  staff are happily using a “pretty robust” functionality for med reconciliation, CIO Bobbie Byrne told Durben Hirsch. Their EMR offers several useful features , including a home medication list, tools to convert meds to inpatient orders or provide substitutions, and features to continue meds after discharge and generate prescriptions.

But there are still issues with using this technology, Byrne told FEMR.  For one thing, she notes, a transaction that takes no time at all in a physician’s mind takes longer, and is more complicated. What’s more, med reconciliation itself is more difficult these days, given that many patients have chronic diseases and are on 10 to 15 meds before coming to the hospital.

And Mary Beth Mitchell, chief nursing information officer at Texas Health Resources, points out that the EMR-based med reconciliation process requires patience and thoroughness: “This process is dependent on the nurse or physician going to the medication reconciliation activity and identifying the current status of each med, every time the patient moves throughout the system,” she told Durben Hirsch.

The bottom line seems to be that while EMRs have made a lot of progress in the med reconciliation arena, few if any EMRs offer the simple process we all know it should be. Getting medication reconciliation right is critical, though. Let’s hope vendors get the kinks out soon.

August 19, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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.

February 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Massachusetts HIE Kicks Off With Golden Spikes

If you’re a history buff, you may know of the Golden Spike connecting the eastgoing and westgoing tracks of the First Transcontinental Railroad in 1869. It’s hard to overestimate how important that day was in the history of U.S. industry and transportation, despite the fact that it didn’t actually mark the day a seamless coast-to-coast rail network was completed.

This week, another big link-up was celebrated with ceremonial golden spikes, with some comparably high hopes attached. This one, however, was between disparate EMRs in Massachusetts, writes John Halamka, MD in Life As A Healthcare CIO:

Today we made history in the Commonwealth of Massachusetts.   At 11:35am Governor Deval and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center.   It arrived and was integrated into Baystate’s Cerner medical record.

Lots of other demonstrations followed, pingponging data from hospitals to payers to physicians to the Massachusetts eHealth Collaborative (which measures quality and performs data analytics).

Among the most interesting facts Dr. Halamka noted was the list of varied EMRs that shared data, including Partners Healthcare’s LMR, eClinicalWorks, a custom payer system and self-built analytics applications.

What took place was no less than a revolutionary event, suggested Dr. Halamka:

Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts.  

By the way, for those who haven’t crossed paths with the indefatigable Dr. Halamka, he’s Chief Information Officer of Beth Israel Deaconess Medical Center. So his institution is central to this new effort (of which he’s quite justifiably proud).

My question is just how this trick was pulled off. Did the participants use the CCD format, Direct Project protocols, discrete data or something else?  Regardless of how the data’s being exchanged, it seems to me that the rest of the country should consider following suit.

October 25, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

The Meaningful Use Song (To The Tune Of “Modern Major General”)

Folks, this should make you smile. It’s an elegantly worded Meaningful Use commentary, based on the “Modern Major General” song from Gilbert and Sullivan’s “Pirates of Penzance.” The words were written by Peggy Polaneczky, MD. Enjoy, and see if you too are “the model user of an EMR that’s meaningful.”

July 18, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Is There Such A Thing As Too Much Patient Info Sharing?

Today, when I was skimming my tweetstream, I caught a message that stopped me dead in my tracks:

We spend a lot of time on these pages mulling over the best ways to get information from one provider to another, be it via the Direct Project approach, EMR integration across sites or HIEs. And all of this discussion is predicated on the notion that more sharing is largely a Very Good Thing.

And we have good reason to do so. For all of the bitterly skeptical things we can say about EMRs, in the rare cases where they’re humming like a fine ‘Vette they can improve care and avoid patient harm in a long list of ways.  They can also serve as a repository for data which can be manipulated, studied, and learned from for both commercial and public health purposes.

But I had never taken a moment to stop and think how ease of sharing patient records might come with downsides of its own. I’m not sure which ones Dr. Trainer had in mind, but my guesses would be:

-  HIPAA mistakes become much easier to make and much harder to fix, as data tends to stay where its sent.

-  Clicking one button and sending 600 pages of information may be easier for the sending provider, but it may be far more data than needed, which can actually distract from finding the right information.

While security is of course a top priority for the business, making it simple for doctors to send just what’s needed isn’t at the top of the charts for EMR vendors to my knowledge.  Maybe it should be.

July 12, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.