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New York Presbyterian brings ER to patients via Mobile Stroke Treatment Unit

Posted on November 3, 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.

After a year in operation, New York Presbyterian’s (NYP) Mobile Stroke Treatment Unit (MSTU) continues to be a shining example of how healthcare technology can be used to facilitate true patient-centered care.

“The MSTU program was started with the singular goal of reducing the disability resulting from stroke,” explains Dr Michael Lerario, Medical Director of NYP’s MSTU Program and Assistant Professor of Clinical Neurology at Weill Cornell Medicine. “There is a term we use when we talk about stroke: Time is Brain. Every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die from the lack of oxygen. This loss can lead to severe cognitive and physical disability for patients.”

Two feet longer than a regular New York City ambulance, the MSTU houses a Samsung portable computer tomography (CT) scanner, a point-of-care laboratory, a complete mobile EHR station (with super-fast WiFi) and a Cisco tele-presence system. The MSTU is staffed by four team members who are specially trained:

  • 1 CT Technician
  • 1 Registered Nurse (RN)
  • 2 Paramedics

With this sophisticated equipment, the MSTU team is able to bring stroke treatment directly to patients where they are instead of waiting for the patient to be transported to the hospital’s ER. Those precious minutes can be the difference between a full recovery and months of rehabilitation (or permanent disability).

When a 911 call comes in, the operator quickly determines if it is a potential stoke situation using a predetermined set of criteria (Plerior referrs to them as “triggers”). This specific protocol was jointly developed by NYP and the New York Fire Department which handles all 911 calls. If the criteria are met, the MSTU is dispatched to the patient’s location.

Upon arrival, the MSTU team stabilizes the patient and quickly conducts a number of diagnostic tests using the equipment onboard: PT/INR test, hemoglobin test and a CT scan. The CT images are sent wirelessly in real-time to NYP’s PACS system where the on-call neurologist reviews the results with the MSTU’s RN via a tele-conference. Based on the scans and the onsite lab work, the neurologist and the onsite team can decide the best course of treatment.

If the scans show that the patient is suffering an ischemic stroke (an obstruction within a blood vessel supplying blood to the brain) and is not already taking anticoagulant medication, then tPA (tissue plasminogen activator – a clot dissolving medication) can immediately be administered. Often referred to as the “gold standard” of Ischemic Stroke Treatment, if tPA is administered quickly it significantly improves the chances for a full recovery.

“Right from the beginning we had complete buy-in and support from within our organization,” says Lerario. “The Neurology and Emergency Medical Services departments in particular were very excited about the MSTU program. They had seen the positive impact MSTU’s were having in Europe and the team wanted to bring that treatment to the people of New York City.”

In just one year of operation, the MSTU has been dispatched on 400+ calls and the response from patients has been universally positive. In fact, a number of cases have been highlighted as good news stories in the press including one about a famous Brazilian singer.

“It won’t be long before mobile stroke treatment will become the standard of care,” Lerario continues. “The benefits are now well documented and more and more people are becoming aware of the impact an MSTU can have on your quality of life following a stroke. People are starting to demand this type of care from their care providers.”

MSTUs are also fantastic for healthcare as a whole. It costs far less to operate an MSTU than it does to treat and rehabilitate patients who suffer disabilities because tPA was not administered quickly enough.

From a patient, provider and public perspective, New York Presbyterian’s MSTU is a winning combination of healthcare technology and patient-centered thinking.

AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Posted on September 22, 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.

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Promoting Internal Innovation to Drive Healthcare Efficiency

Posted on June 1, 2017 I Written By

The following is a guest blog post by Peyman S. Zand, Partner, Pivot Point Consulting, a Vaco Company.

Technical innovation in healthcare has historically been viewed through the lens of disruption. As tech adoption in the industry matures, perceptions on the origin of innovation are evolving as well. Healthcare leadership teams are increasingly leaning on feedback from the front lines of care delivery to identify ways to eliminate waste and drive greater efficiency. Rather than leaving innovation up to third parties, many health organizations are formalizing programs to advance innovation within their own facilities.

There are two schools of thought on healthcare innovation. Some argue that the market’s unique challenges can only be understood by those in the field, leaving outside influencers destined to fail. Others view innovation success in outside markets as an opportunity for healthcare stakeholders to learn from the wins and losses of more technically progressive industries. By mimicking other industries’ approach to promoting innovation (as opposed to their byproducts) in our hospitals and health systems, healthcare can draw from the best of both worlds. What we know is that the process in which innovation is adopted is very similar in all industries. However, the types of innovations and specific models can and should be tailored to the healthcare industry.

Innovation in Healthcare: Three Examples at a  Glance

There are several examples of health organizations successfully forging a path to institutionalized innovation. University of Pittsburg Medical Center (UPMC), Intermountain Healthcare and Mayo Clinic have pioneered innovation programs that merge internal clinical expertise with technical innovators from vertical markets in and outside healthcare. This article highlights some of the ways these progressive organizations have achieved success.

Innovation at UPMC

UPMC Enterprises boasts a 200-person staff managed by top provider and payer executives at UPMC. The innovation team is presently engaged in more than a dozen commercial partnerships, including support for Vivify Health’s chronic care telehealth solutions, medCPU’s real-time decision support solutions and Health Catalyst’s data warehousing and analytics solutions. Each project is focused on the goal of improving patient outcomes. The innovation group was recently rumored to be partnering with Microsoft on machine learning initiatives and the results may have a profound impact on how we use technology in care delivery.

UPMC Enterprises supports entrepreneurs—both internal individuals and established companies—with capital, technical resources, partner networks, recruiting and marketing assistance to support innovation. Dedicated focus in the following areas lends structure to the innovation program:

  • Translational science
  • Improving outcomes
  • Infrastructure and efficiency
  • Consumer engagement

All profits generated from investments are reinvested to support further research and innovation.

Innovation at Intermountain Healthcare

Like UPMC, Intermountain’s Healthcare Transformation Lab supports innovation in the areas of telehealth and natural language processing (NLP), among others. Like most providers, one of Intermountain’s primary goals is controlling costs. The group’s self-developed NLP program is designed to help identify high-risk patients ahead of catastrophic events using data stored in free-text documents. Telehealth innovations let patients self-triage to the right level of care to incentivize use of the least expensive form of care available. Intermountain’s ProComp solution offers its providers on-the-spot transparency about the cost of instruments, drugs and devices they use. That innovation alone net the health system roughly $80 million in reduced costs between 2013 and 2015.

Most of Intermountain’s innovation initiatives are physician led or co-led. The program strives for small innovations in day-to-day work, supported by a suite of innovation support services and resource centers. Selected innovations from outside startups are supported by the company’s Healthbox Accelerator program involvement, while internal innovations are managed by the Intermountain Foundry. Intermountain offers online innovation idea submissions to promote easy participation. The health organization’s $35 million Innovation Fund supports innovations through formalized investment criteria and trustee governance resources. It is important to note that Intermountain Healthcare is interested in all aspects of innovation including supply chain and other non-clinical related projects.

Innovation at Mayo Clinic

Mayo Clinic’s Center for Innovation (CFI) brings in innovation best practices from both healthcare and non-healthcare backgrounds to drive new ideas. The innovation team’s external advisory council is comprised of both designers and physicians to drive innovation and efficiency in care delivery. The CFI features a Multidisciplinary Design Clinic that invites patients into the innovation process as well.

CFI staff found it was essential to show physicians data that demonstrated known problems and how proposed innovations could make a difference to their patients. They emphasize temporary changes, or “rapid prototyping,” to garner physician buy-in. Mayo’s CFI promotes employee involvement in innovative design through its Culture & Competency of Innovation platform, which features weekly meetings, institution-wide classes, lunch discussion groups and an annual symposium. Mayo’s innovation efforts include these additional physician-led platforms:

  • Mayo Clinic Connection—supporting shared physician experience
  • Prediction and Prevention
  • Wellness—promoting patient education
  • Destination Mayo Clinic—focused on improving patient experience

While these innovation examples represent large healthcare organizations, fostering innovation does not require a big budget. Mayo Clinic’s “think big, start small, move fast” approach to innovation illustrates a common thread among successful innovation programs. Here are practical strategies to advance innovation in healthcare, regardless of organizational size or budget.

Four Steps to Implementing an Innovation Program in Your Organization

Innovation doesn’t have to be grandiose or expensive. Organizations can start small. Begin by opening a companywide dialogue on innovation and launching a simple, online idea submission process to engage personnel in your organization. The most important part of this process is educating your teams to understand how to evaluate new innovations against a relatively pre-defined set of criteria.  For example, are you trying to improve patient safety, quality of care, reduce cost, increase patient or physician satisfaction, etc.

Another key element of successful innovation is encouraging collaboration and participation across a wide variety of stakeholders. Cross-functional teams bring multifaceted perspectives to the problem-solving process. Strive for incremental gains in facilitating opportunities for cross-department collaboration in your organization. This is particularly important for the implementation step.

Measure success using performance metrics where clinical efficiencies are concerned. Physician satisfaction, while difficult to quantify, can also pose big wins. You can expect some failures, but stack the odds by learning from other departments, organizations and industries to avoid making the same mistakes.

To work, innovation must happen often and organically. Dedicate funding, establish cross-department teams and build a formal process for vetting internal ideas. Consider offering staff incentives to drive engagement. Not all ideas will succeed. Identify metrics that will help determine ROI (not all ROIs are measured in dollars) on pilot programs so you can weed out initiatives that aren’t delivering early on to protect resources. Also, keep in mind that you can improve these innovations at each iteration.  Make the process iterative and roll out the initiatives quickly. If it fails, shut the process down quickly and move on. If it is successful, improve it for the next iteration and scale it quickly to maximize the benefits.

Whether you’re cross-pollinating internal teams to promote innovation, building partnerships with other organizations or leveraging technology to better connect providers and patients, healthcare’s ability to successfully collaborate is vital to advancing innovation in healthcare.

About Peyman S. Zand
Peyman S. Zand is a Partner at Pivot Point Consulting, a Vaco company, where he is responsible for strategic services solving healthcare clients’ complex challenges. Currently serving as interim regional CIO for Tenet Healthcare, Zand was previously a member of the University of North Carolina Healthcare System, leading Strategy, Governance, and Program/Project Management. He oversaw major initiatives including system-wide EHR implementation, regulatory programs, and physician practice rollouts. Prior to UNC, Zand formed the Applied Vision Group, a firm dedicated to assisting healthcare organizations with strategic planning, governance, and program and project management for key initiatives.

Zand holds a Bachelor’s of Science in Computational Mathematics and Engineering from Michigan State University, and a Master of Business Administration from the University of Michigan.

The Distributed Hospital On The Horizon

Posted on February 24, 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.

If you’re reading this blog, you already know that distributed, connected devices and networks are the future of healthcare.  Connected monitoring devices are growing more mature by the day, network architectures are becoming amazingly fluid, and with the growth of the IoT, we’re adding huge numbers of smart devices to an already-diverse array of endpoints.  While we may not know what all of this will look when it’s fully mature, we’ve already made amazing progress in connecting care.

But how will these trends play out? One nice look at where all this is headed comes from Jeroen Tas, chief innovation and strategy officer at Philips. In a recent article, Tas describes a world in which even major brick-and-mortar players like hospitals go almost completely virtual.  Certainly, there are other takes out there on this subject, but I really like how Tas explains things.

He starts with the assertion that the hospital of the future “is not a physical location with waiting rooms, beds and labs.” Instead, a hospital will become an abstract network overlay connecting nodes. It’s worth noting that this isn’t just a concept. For an example, Tas points to the Mercy Virtual Care Center, a $54 million “hospital without beds” dedicated to telehealth and connected care.  The Center, which has over 300 employees, cares for patients at home and in beds across 38 hospitals in seven states.

While the virtual hospital may not rely on a single, central campus, physical care locations will still matter – they’ll just be distributed differently. According to Tas, the connected health network will work best if care is provided as needed through retail-type outlets near where people live, specialist hubs, inpatient facilities and outpatient clinics. Yes, of course, we already have all of these things in place, but in the new connected world, they’ll all be on a single network.

Ultimately, even if brick-and-mortar hospitals never disappear, virtual care should make it possible to cut down dramatically on hospital admissions, he suggests.  For example, Tas notes that Philips partner Banner Health has slashed hospital admissions almost 50% by using telehealth and advanced analytics for patients with multiple chronic conditions. (We’ve also reported on a related pilot by Partners HealthCare Brigham and Women’s Hospital, the “Home Hospital,” which sends patients home with remote monitoring devices as an alternative to admissions.)

Of course, the broad connected care outline Tas offers can only take us so far. It’s all well and good to have a vision, but there are still some major problems we’ll have to solve before connected care becomes practical as a backbone for healthcare delivery.

After all, to cite one major challenge, community-wide connected health won’t be very practical until interoperable data sharing becomes easier – and we really don’t know when that will happen. Also, until big data analytics tools are widely accessible (rather than the province of the biggest, best-funded institutions) it will be hard for providers to manage the data generated by millions of virtual care endpoints.

Still, if Tas’s piece is any indication, consensus is building on what next-gen care networks can and should be, and there’s certainly plenty of ways to lay the groundwork for the future. Even small-scale, preliminary connected health efforts seem to be fostering meaningful changes in how care is delivered. And there’s little doubt that over time, connected health will turn many brick-and-mortar care models on their heads, becoming a large – or even dominant – part of care delivery.

Getting there may be tricky, but if providers keep working at connected care, it should offer an immense payoff.

Telemedicine A Growing Priority For Hospitals

Posted on April 29, 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.

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?

Keeping Telehealth in Compliance

Posted on December 9, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

Telehealth, or telemedicine, promises to create better opportunities for increased access to healthcare. It makes perfect sense to meet patients where they are instead of requiring them to travel sometimes long distances for adequate care. We know that some diagnoses and treatments will definitely require an office or hospital visit but staying healthy, keeping compliant with medications, and maintaining chronic diseases could easily be addressed with telehealth.

Technology and EHR advances are already making many healthcare tasks easier and more convenient such as remote coding and web-based training. Smart phones and secure texting are being used by interdisciplinary teams to conveniently reach members of the team for coordination of care. Telehealth fits right into the mix using technology to bridge the geographic distance and gaps in patients’ access to care.

As with all healthcare operations, we must remember the sensitive nature of the subject matter at hand. Many try to cite HIPAA compliance as a potential barrier to adopting new technology. In contrast, HIPAA laws are being updated inline with the technology changes and we are able to securely exchange information by following the rules and taking appropriate measures to safeguard protected health information.

In order to successfully use telehealth, providers must work with health information technology professionals to ensure the technical and physical safeguards are in place for transmitting information to and from patients. Information must be kept secure and private which will continue to challenge health IT and HIM professionals. Patients must feel comfortable trusting that their personal information will be protected in the telehealth format just as it is in other media formats.

Other key concerns with telehealth are payment and insurance coverage. While telehealth will reduce the costs of healthcare, there is still a need for reimbursement to cover the provider’s time and expertise provided through a telehealth “visit” and the technology needed. There are many new conversations going to Congress in the near future to address the need for funding for telehealth particularly in rural areas. One of these is a bill referred to as the Telehealth Innovation and Improvement Act introduced recently. Until the benefits, cost savings, and effectiveness of telehealth can be understood by the Federal Government, we will continue to see the slow adoption rate. Once these issues are addressed and Government funding becomes available, there will be explicit guidelines and criteria for providers to meet in order to be in compliance with the payment structures.

We continue to strive for the best possible methods of meeting the needs of healthcare consumers in today’s technology driven society. We must marry the best of both worlds to provide convenient and cost-effective access to healthcare with secure and confidential methods of transferring protected health information. All of this will come with a price tag and will require the successful collaboration of health IT, HIM, and compliance professionals.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.