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From virtual doctor visits to online diagnoses, 5 high-tech fixes for patients – Wall St. Journal

Posted by timmreardon on 12/27/2013
Posted in: Health Care Costs, Helathcare Delivery. Tagged: , , , , , , , . Leave a comment
Dec. 23, 2013 7:24 p.m. ET

Informed Patient columnist Laura Landro joins Lunch Break with five innovations in medical care that are percolating and are ones to watch in 2014. Photo: The Christ Hospital Health Network, Cincinnati.

From virtual doctor visits to online diagnoses, information technology is rapidly changing the way patients interact with the health system. Here are some innovations that are catching on more broadly and could improve care in 2014:

Monitor Long-Distance

An electronic intensive-care unit, or eICU, lets critical-care doctors and nurses check on patients in several hospitals from a remote command center with a bank of monitors displaying patients’ vital signs. They can alert bedside staff if they see a subtle change in a patient that could signal a worsening condition. Remote monitoring by specialists is also catching on for emergency rooms and surgical units to help evaluate patients with stroke, seizures and other conditions.

Patients in a hospital with an eICU program were 26% more likely to survive their stay and were discharged 20% faster than those receiving usual ICU care, according to a study published earlier in December in the journal CHEST. The study analyzed some 120,000 patients in 56 ICUs over five years.

Video cameras can be activated if the remote team needs to visually check the patient, and can be used to check regularly on patients who might be at risk for falls, according to Brian Rosenfeld, an inventor of the eICU technology and chief medical officer for telehealth at Philips Healthcare, a unit of Dutch technology giant Royal Philips that purchased his company in 2008. As more evidence of its benefits has emerged, resistance among some critical-care doctors to having a remote doctor looking over their shoulder has dissipated, he says, but some “still think they are delivering perfect care and no one can help them.”

The eICU helps especially in rural areas where there can be a shortage of specialists. Phoenix-based hospital-and-health system Banner Health currently monitors and supports more than 450 ICU beds across several Western states from command centers in Mesa, Ariz., and Greeley, Colo., and even uses some doctors in a Tel Aviv, Israel, center to cover shifts.

Crowdsource an Ailment

Patients can crowdsource their symptoms to find a diagnosis. As strange as it sounds, health experts say this may hold promise. On a new website, CrowdMed.com, patients who haven’t been able to get a firm diagnosis can post their symptoms online to crowdsource an answer.

Founded by technology entrepreneur Jared Heyman after his sister Carly went three years with an undiagnosed illness, CrowdMed lets users offer a cash reward that goes directly to the “medical detectives”—be they laypeople or physicians—who help solve their case. Medical detectives may suggest a diagnosis and bet points on others’ suggestions. Each diagnosis is treated as a stock with a share price that moves based on “demand” for the diagnosis. CrowdMed uses an algorithm to calculate the probability of each diagnosis being correct according to betting behavior, ranks the diagnoses from most to least likely, and presents the patient with the top 3 to 6. The average reward on the site is currently $200, the company says. Detectives split the rewards based on how many points they bet on the correct diagnosis.

Mr. Heyman says the idea isn’t to replace doctors, but to come up with a list of possibilities a doctor might not have considered. Before the site launched, doctors diagnosed his sister with a disorder that includes early menopause symptoms. CrowdMed used her case to test the system later and within three weeks it was diagnosed correctly.

Luke Hoelscher, 31, recently posted his case on CrowdMed.com, after what he describes as several frustrating years of going from doctor to doctor with undiagnosed symptoms that included blurry vision, severe light sensitivity, bodily pain, and fatigue. He is offering a $500 reward. A former software engineer who can no longer work due to his health issues, Mr. Hoelscher says he has yet to find an answer through the site, but is optimistic. “There have to be people out there who have dealt with what I am dealing with,” he says.

CrowdMed, along with increasingly sophisticated online “symptom checker” programs for consumers, allow patients to use some of the same strategies that doctors are already turning to for help with difficult cases. Some doctors participate in private, online social networks to seek input from other physicians and use Web-based programs that analyze reams of data to suggest possible diagnoses.

Consult Via Video

Hospitals, insurers and health systems are increasingly allowing patients to make an appointment online or consult a physician via video chat. Insurer Cigna, for example, recently teamed up with Sunrise, Fla.-based MDLive to allow some health-plan members to schedule a virtual consultation with a doctor for nonemergency situations such as allergies and sinus infections.

In a pilot program, Mercy Health in Cincinnati has offered patients at two of its medical practices electronic visits. Patients complete an online survey specific to certain conditions, such as sore throat or headache and a doctor responds within 24 hours determining next steps such as calling in a prescription, or recommending rest. Physicians can attend to the electronic visits in between seeing other patients in the office. A spokeswoman says Mercy requests a $35 copay for these visits and about 10% of health plans cover the visits. Patient surveys indicated that even if the payer didn’t cover the visit, she adds, patients would be willing to pay out of pocket for the service because of its convenience – such as no need to miss work, or arrange for childcare.

Sharecare, an online health-and-wellness site whose founders include celebrity doctor Mehmet Oz, recently launched AskMD, an app that collects information about symptoms, locates doctors, filters results by insurance, specialty and distance and directs users to the nearest emergency room if it looks like they need one. Hospital Corp. of America, a major hospital chain, is a sponsor of the launch, and some of its affiliated doctors and hospitals will be featured.

Text a Nurse

When Valerie Weichart, 56, was hospitalized recently for back surgery at St. Rita’s Medical Center in Lima, Ohio, she was provided with a tablet device. It allowed her to view her medical chart and lab-test results, read up on her medications, see bios and photos of the staff caring for her, and text a nurse for help. St. Rita’s parent, Catholic Health Partners, aims to roll out the system to its 23 hospitals after having completed a successful pilot. The system, called MyChartBedside, is linked to patients’ electronic medical records. Patients can also use the device to surf the Web and play games.

“I felt more comfortable knowing what my medications were, so I didn’t have to ask so many questions,” Ms. Weichart says.

NewYork-Presbyterian Hospital also has been testing arming patients with tablets. “We worried at first about how nurses would adjust to it, but they really like it,” says hospital chief executive Steven Corwin. The units are quieter without the ring of call buttons. The messaging system makes it easier for nurses to prioritize patient needs and requests. And patients are more fully engaged in their own care, Dr. Corwin says.

Calculate the Cost of Care

With the coming changes in insurance coverage, calculating copayments and other out-of-pocket costs could be daunting. Insurers and health plans are offering cost estimates online and through mobile apps that calculate how much patients will have to pay out of pocket, how much a plan will pay, and available in-network reduced rates. UnitedHealthcare’s myHealthcare Cost Estimator, launched last year, recently added inpatient hospital information including knee replacement, childbirth, and spinal surgery. The costs can vary widely. For example, the company says, childbirth, including prenatal and postnatal care can range from $9,699 to $29,076 in the New York City area. In a survey of its users, 67% said the calculator gave them the confidence to make better cost choices.

Write to Laura Landro at laura.landro@wsj.com

The global standard: International Consortium for Health Outcomes Measurement – ICHOM

Posted by timmreardon on 12/27/2013
Posted in: Global Standards, Health Outcomes, Integrated Electronic Health Records, Quality Measures. Tagged: , , , , , , , . Leave a comment

From ICHOM: http://www.ichom.org/

“The International Consortium for Health Outcomes Measurement (ICHOM) is a non-profit organization founded by three esteemed institutions with the purpose to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way.”

“We believe outcomes are the ultimate measure of success in health care. When seeking treatment, patients want to know what their life will be like after treatment: will I return to work, will I be able to take care of myself, and will my symptoms improve? Helping patients answer these questions is why we formed ICHOM.”

“ICHOM organizes global teams of physician leaders, outcomes researchers and patient advocates to define Standard Sets of outcomes per medical condition, and then drives adoption to enable health care providers globally to compare, learn, and improve.”

Care coordination software key to realizing the value of HIE – Healthcare IT News

Posted by timmreardon on 12/09/2013
Posted in: Health Care Costs, Health Care Economics, Integrated Electronic Health Records, Quality Measures. Tagged: , , , , , , , . Leave a comment

Lori Evans Bernstein, President of GSI Health

December 6, 2013

Hospital systems and accountable care organizations are demanding tools to better manage population health.  A major challenge healthcare organizations face is choosing health information technology solutions that place clinical value, care coordination and patient outcomes first.

A traditional health information exchange (HIE) assembles clinical data from a variety of disparate sources and presents it to users. These traditional systems are necessary but not sufficient to support care coordination and population health.  Care Coordination software is essential to realizing the value of health information exchange.  Here’s why:

  • Data overload: An HIE summary may contain too much data and, paradoxically, not enough information. There are plenty of relevant details, but the information must be actionable and intelligently organized in order to support clinical programs and workflow among care team partners.
  • Lack of meaningful context: A traditional HIE system may not provide the clinical workflow context to the information to appropriately guide the next steps in care coordination. Care teams need this context applied to the information via workflow friendly applications provided by care coordination software.

Care coordination software can make HIE more valuable, giving it more currency to help providers track and manage patients as they move through the delivery system, including: dynamic management of care transitions, care planning, referral management, clinical decision support and medication reconciliation. Here’s how:

  1. It applies clinical relevance and workflow context to the information: Care coordination software condenses and reconciles the data from different sources and formats into customized summaries that each provider sets up, presenting the details most relevant to their role as a care manager, primary care physician, specialist and other team members. Behind the scenes, the platform automatically applies logic to the information and feeds it to the relevant applications and users in support of care coordination. For example, a primary care physician is alerted to hospital discharge and can immediately view/update a care plan, manage referrals, reconcile medication list and initiate additional services or communications with other providers.
  2. Puts the power in the hands of the user: A care coordination software platform helps manage population health through efficient clinical decision support.  For example, according to established clinical protocols, upon hospital discharge a patient is required to visit the primary care physician within seven days. The care providers would be prompted if the patient has not followed the care instructions. The clinical protocols or care steps operate behind the scenes while the platform watches for any deviation from the protocols.
  3. Uses collaborative tools to reconcile information and streamline communication: Care coordination software can increase the efficiency of processes such as medication reconciliation as patients receive care among multiple settings. For example, the care manager can survey the patient’s full medication record in order to create a care coordination summary of medications excluding old information that’s no longer relevant and including new information in real-time providing timely updates. This helps the care team to be able to quickly know the top line issues facing their sickest and most costly patients.  The physician can quickly review the care manager’s actions and click to confirm the medication reconciliation.

Care coordination software is essential to realizing the value of health information exchange. Organizations and delivery systems need data presented in more actionable and more valuable formats through workflow friendly applications to improve care coordination and manage population health to improve patient outcomes.

WHAT KIND OF IT DO WE NEED FOR VALUE-BASED HEALTHCARE? – HIE Watch

Posted by timmreardon on 12/06/2013
Posted in: Integrated Electronic Health Records, Quality Measures. Tagged: , , , , , , , . Leave a comment

Source: Robert Rowley, MD, GroupMD     Date: Dec 4, 2013    e-mail to a friend

Article link: http://www.hiewatch.com/perspective/what-kind-it-do-we-need-value-based-healthcare

The trend toward value-based payment is gaining momentum. Except for efforts around managed care, where a fixed capitated fee is paid to risk-taking organizations for a defined population of patients, fee-for-service has been at the core of how we do business in healthcare. What kind of health IT tools do we need for the new direction?

Traditional Medicare, based on a fee-for-service model, has experienced cost escalation year-over-year. One way of mitigating this faster-than-inflation escalation of Medicare costs was the Sustainable Growth Rate (SGR) formula, which ratchets down the dollars-per-unit of service to partly offset the growth in units of service that are billed by healthcare providers. That would have meant that each year, Medicare payment rates would have been lowered – with the adverse outcome that more doctors would refuse to participate in Medicare, and access to enrollees would be more limited.

Each year, Congress has come up with last-minute postponements in SGR, with the results that the SGR formula is seen by many as a fundamentally broken process.

Against this backdrop, the recent news that both houses of Congress are intending to work together to scrap the broken SGR formula, and replace it with a more permanent solution is very significant. Notable among the key points on the SGR discussion is to “improve the physician payment system to reward value over volume, ensuring beneficiaries and taxpayers receive value for the money spent.”

Value based pay for performance


Simultaneous to this shift in federal circles toward a more value-centered method of paying for healthcare, similar shifts are being seen in the managed care market. In California, HMO care has mainly been deployed through large, sophisticated risk-taking medical groups and IPAs (the “delegated model”), where these groups receive fixed payments from HMO insurers and assume responsibility for rendering quality healthcare. Since 2001, the Integrated Healthcare Association (IHA) – a consortium of HMO insurers, hospital systems and medical groups – has set criteria for evaluating and measuring performance, and has facilitated a pay-for-performance (P4P) method where good-performing groups get paid a bonus by health plans over-and-above their base capitation rates. This is a business model for quality.

Since the inception of P4P, the focus has been mainly of measuring and improving quality. However, for a number of reasons, this has not bent the cost-escalation curve. Now, the IHA is moving toward a new methodology, referred to as Value Based P4P, where the rewards are not just based on quality and other measures, but also on the total cost of care (hospital, outpatient, ancillary and pharmacy costs). Medical groups that participate in the IHA are looking at how to re-tool themselves to take on this new challenge.

What kinds of health IT do we need?


Clearly, these two examples of major system changes (there are other examples, to be sure) illustrate the growing momentum toward a healthcare delivery system that needs to measure and be accountable for quality, while keeping track of the total cost of healthcare delivered. It is a fundamental paradigm shift that runs underneath the headlines.

We have come a long way in moving healthcare documentation from paper to electronic platforms in the past several years. In 2007 somewhere around 7 percent of ambulatory doctors’ offices used electronic health records (EHRs), and most of them were closely associated with institutions and medical centers that provided them. In 2013, over 50 percent of doctors in the U.S. were using certified EHR systems.

Moving from paper to EHRs has been a significant step forward. However, health data remains largely siloed, residing within the institutions that created them. There has certainly been consolidation – linking hospitals with community physicians (mostly through local community health information exchange mechanisms), and creating “enterprise charts” for patients within unified delivery systems. But we still have a long way to go.

The two main areas where modern health IT will be needed for the changes toward value-based reimbursement might be thought of as these:

  1. Tools to measure the health status of populations. This is a combination of Clinical Quality Measures (CQMs), which are population-based measures showing how different providers are faring with respect to managing their patients’ conditions, and Clinical Decision Support (CDS), which are patient-specific prompts letting the provider know what recommended things are due at the time of service. These tools need to measure cost as well as quality.

  2. Tools that facilitate care collaboration. As healthcare delivery becomes more accountable, it must become more collaborative. There need to be tools that support real-time communication between healthcare providers, allowing conversations to take place that have access to shared, universal patient data. Further, patients need to be able to participate in these conversations, and give proper consent for access to their data.

To elaborate a bit more on the second point: a collaboration platform is more than just a shared patient record (though, certainly, a shared patient record is part of it). A universal PHR (Personal Health Record), though a step in the right direction, is still currently a library that one needs to go to in order to pull data that is in there (and whose usefulness is a function of the number of subscribing inputs).

Collaboration is more real-time, more dynamic. It needs to be a mobile-first technology, more than a web-first one. It needs to be able to capture bits of conversation back and forth between care team members (including the patient), sharing cumulative patient data. That data is populated by the conversation content as it accumulates, in addition to EHR data pulled from each participating provider.

Conclusions

How we pay for healthcare is changing. The fee-for-service approach, a hallmark of U.S. healthcare traditionally, is being phased into a system that pays for value over volume. We see this in some major trends – the discussion at the federal level of replacing the broken SGR formula with something more value-oriented, and the shift in managed care toward Value Based P4P.

The technology needs for this new paradigm will be different. Of course, we need health data to be on electronic platforms. These platforms will evolve to serve the institutions that deploy them, and will contain CQM and CDS capabilities, as well as cost-visualization capabilities that include all areas where cost is generated (hospital, outpatient, pharmacy and ancillary) – such systems will show you “what you have done,” somewhat retrospectively.

Just as important (arguably, even more important) are technologies that facilitate care collaboration. This is patient-oriented, provider-driven, cross-institutional, mobile-first, nimble and data-centered. Such systems will show you “what you are doing,” not in retrospect, but in real-time and going-forward. Needless to say, this is where my current interest is focused.

Robert Rowley is a co-founder and chief medical officer of GroupMD; this blog originally appeared at robertrowleymd.com.

“So much data-gathering, so little doctoring” – Why the Medical Profession needs to define the standard EHR

Posted by timmreardon on 11/25/2013
Posted in: Integrated Electronic Health Records, Uncategorized. Tagged: , , , , , , , . Leave a comment
Labor Pains

So much data-gathering, so little doctoring

The electronic medical record is the latest wrench the healthcare industry has thrown in the way of doctors just listening to their patients.

http://www.latimes.com/opinion/commentary/la-oe-jones-doctor-emr-labor-pains-20131124,0,5317576.story#ixzz2lgDFDESvElectronic medical record

The healthcare industry wants exam room visits documented as electronic medical records. (Los Angeles Times)

By Michael P. Jones

November 24, 2013

I’m a stomach doc. I’ve seen thousands of patients, inside and out, for 25 years. I’ve done research, I’ve taught, I’ve been an administrator. And as the years rolled by, I’ve watched the healthcare industry begin to undo healthcare itself. It’s complex, cumbersome and bureaucratic, and the bigger the practice or the clinic or the hospital and research facilities — like the universities I used to work at — the worse the problem.

For a physician and his patient, the exam room visit is everything. Healing begins right then and there. The process of telling your story, being heard, being touched and feeling connected to your doctor is an incredibly powerful element of healing. While we’re bombarded with the latest and greatest discoveries and inventions of medical science, the fact of the matter is that most people who walk into a doctor’s office don’t have some horrible disease. They simply don’t feel well. My job is to listen and observe, to figure out who really does have something bad going on and who may simply be feeling the effects of life’s wear and tear.

There’s a huge difference between that and the healthcare industry, which is more about industry than health or care. Third-party payors don’t really care what happens in an exam room. The visit that you, as a patient, have been anxiously waiting for could just as easily be shoes or oranges or pork bellies to these folks. It’s just a commodity. It’s just data. And now the industry wants it documented in a format that works for billers and statisticians but not so much for doctors: the electronic medical record.

ESSAY SERIES: How we work now

That’s the note your doctor is probably busy pecking away at while you’re trying to explain what ails you. In theory, an EMR should make care better and more efficient. It’s falling pretty far short of that goal.

For starters, a lot of the software is clunky and the way it asks for information is unnatural. It can take more time to complete the “necessary” documentation for a colonoscopy or other endoscopic procedure than it took to do the procedure itself. Doctors and nurses and lab techs suddenly have to be data-entry clerks, filling in multiple “fields” and negotiating drop-down menus.

I’ve seen nurses get so busy typing what they do, they can’t do it. I’ve watched when an alarm sounded, indicating that a patient was breathing inadequately — the sensor had simply fallen off the patient’s finger. The nurse, back to the patient and typing furiously, shouts “Breathe!” without ever looking around. These aren’t bad nurses; they’re good nurses in bad situations.

I had my first encounter with an electronic medical record as a patient at my internist’s office. I consider him to be a model physician: smart, conversational, part friend and part counselor. I was pretty stunned, then, when I mostly saw he back of his head as he asked me questions and typed, badly.

“Hey, Jeff, does any of this look like a good doctor-patient interaction?” I asked.

“Hell, no,” was the prompt reply. “But I’ve got to do this now or I’ll never get finished on time.”

Whatever the EMR may become, right now it’s mostly a receipt for a transaction, a bill of sale. We all want to be sure we’re getting what we pay for. The government and insurance companies are no different — they require lots of documentation. What gets entered into the “elements of the encounter” field on the EMR determines how much the insurance company will pay, which only makes the unholy mess of electronic medical records worse.

With doctors everywhere working more for less, the pressure is on to perform lots of “elements” and to treat these notes like an old Chinese restaurant menu: “One from column A, two from column B …”

It used to be that a physician’s note contained dubious penmanship but concise, insightful information that guided the evaluation and treatment of the patient. Now notes are pages long, often containing verbiage simply cut and pasted from previous notes so as to speed the awful process or maybe to fulfill the requirements for “billing at a higher level.” I may have to dig through scads of detailed “data” that justify payment but don’t necessarily result in better care.

This system clearly needs some work. Or a boycott.

When I chose to leave the world of academic medicine for private practice, I went back in time. I joined a small practice that prides itself on service. There is no answering machine. Your call is answered by an honest-to-goodness human being. Because it’s a small group, we’re not yet required to switch to electronic medical records. I write, by hand, notes that contain the information I need to help you feel better. When I finish our visit, I dictate a letter and often call or text your referring physician to let them know what’s going on. I bill based on the notes, but no one’s costing out the “elements of the encounter.”

So old school. So unacceptable. So effective.

I feel as if I’ve stumbled into a medical oasis. My time is spent being a doc rather than a scribe or grocery clerk ringing up a sale. My time is spent interacting with a person who wants my help; it isn’t diluted with a perverse treasure hunt for clinically irrelevant but EMR-encouraged information. I’m happier in my work than I have been in a decade. My patients now are happier than my patients then. Everybody recognizes and responds to good service, whether it’s in a doctor’s office or an auto repair shop.

I have no doubt that my little oasis will come under the thumb of the new era of healthcare. And when that happens, we’ll do our best to make it work for our patients. But for now, while it lasts, I’m going to enjoy being the kind of doc that I always wanted to be.

Michael P. Jones is a gastroenterologist in Virginia.

Find additional essays in the Labor Pains series. Has your work changed in recent years? Tell us about it by email at laborpains@latimes.com or on Twitter at #latlaborpains.

Copyright © 2013, Los Angeles Times

http://www.latimes.com/opinion/commentary/la-oe-jones-doctor-emr-labor-pains-20131124,0,5317576.story#ixzz2lgD7SabF

“..lack of interoperability amongst healthcare IT systems, even the multiple ones deployed in a single institution, could hamstring however much progress is made toward engaging patients in their own care

Posted by timmreardon on 11/15/2013
Posted in: Integrated Electronic Health Records, Uncategorized. Tagged: , , , , , , , . Leave a comment

EHRs can’t do everything

November 14, 2013
Like many other industries, healthcare is becoming more consumer-focused. As Eric Wicklund and Mike Miliard have recently documented for Healthcare IT News, patients and doctors alike have spoken out against EHR solutions for interfering with rather than facilitating doctor-patient interactions. While thorough data collection and analysis, where EHRs offer great value, feeds research at the population level, it seems that the apparent failure of current EHRs to accommodate patients as unique cases has sparked this shift in attitude in the health IT industry.

[See also: Docs ‘stressed and unhappy’ about EHRs.] and [EHRs at risk of becoming irrelevant.]
The issue may not be so much the failure of EHRs, as their falling short of unduly high expectations — expectations not only from the people who use them, but also the vendors themselves.
“I think it’s a myth that EHR vendors are going to be able to provide everything.  Every other industry has proven this wrong, says Joanne Rohde, CEO of Axial Exchange, in an interview with Healthcare IT News.

Rohde, an exponent of open source philosophy — she was the COO and director of Health IT strategy at Red Hat prior to Axial — contrasted open source design with EHR vendors’ current design approach, suggesting that large, branded EHR vendors have made the mistake of dictating users’ workflow rather than providing them with software that actually complements how they normally work.
“There’s no question that modular design, open source practices, iterative design would do a much better job in ending up with things that people want to use…[Epic’s] approach is exactly the opposite, and their approach is that we’re going to tell you how this works, you have to change your workflows to match our system, and then and only then are you going to get benefits from this system”
This domineering EHR design approach, while perhaps expedient for expanding a company’s market share, could backfire with the progressive consumerization of healthcare IT.  The question, then, is how to begin to amend this approach in light of this trend.
“I think the [EHR vendors] that will be successful,” said Rohde, “are going to be the ones that don’t try to hold on to what they have, look at it with a clean slate, and say ‘alright, we need to engage the patient; how do we do that?’ and then secondarily ask ‘how does this integrate with the software we already have?’”
More and more, healthcare professionals are talking about patient engagement, though it can be difficult, as with all buzz words, to parse what that means in practical terms. mHealth has grown extremely popular as a patient-centric, healthcare model, and Axial Exchange, billing itself as patient engagement software, has successfully deployed mobile applications for Parrish Medical Center in Florida, the Colorado Medical Group, and several others, following a patient-centric design strategy that offers a health information library, along with numerous health trackers for blood glucose, migraines, pregnancy, and even mood.  In other words, letting patients learn about themselves, to engage in their own care.
Patient engagement, as the phrase’s ambiguous grammar suggests, goes both ways. HIT solutions, like Axial’s, allow the patients to learn about and monitor their care so that they can bring more actionable information, and not just numbers or vague descriptions of their issues to physician visits. But, as Rohde said, Axial is “committed to not only the patients knowing themselves, but the hospitals knowing their patients.” Axial has also complemented its mHealth work with a provider-side tool for engaging patients, a blind analytics service that allows hospitals to see what health issues their patients are researching.

[See also: 5 ways Cleveland Clinic improved its patient engagement strategies.]
Still, the lack of interoperability amongst healthcare IT systems, even the multiple ones deployed in a single institution, could hamstring however much progress is made toward engaging patients in their own care.  More-informed patients and providers can’t overcome the technological isolation of medical records.

Of Common Well’s Top 3 Challenges – Number one Challenge: “1.Patient matching. Simply put, there is no single way to match patients…” – The case for National Patient IDs

Posted by timmreardon on 11/13/2013
Posted in: Integrated Electronic Health Records, Uncategorized. Tagged: , , , , , , , . Leave a comment

Source: Tom Sullivan     Date: Nov 7, 2013

Article link: http://www.hiewatch.com/news/commonwells-top-3-hie-challenges

As it nears the launch of its interoperability pilot project, officials from the CommonWell Health Alliance used AHIMA’s annual conference to outline some of the toughest health information exchange challenges facing vendors and providers today.

“If you want to share information with 5 organizations, you need 10 contracts,” Dan Schipfer, senior vice president at Cerner said Monday morning, explaining that regional HIE is happening, but thus far it is limited to local exchange.

“We EHR vendors have not made it easy for you to interoperate,” within the nomenclature and the organization, he said. “It’s a big deal, it’s something you believe in, we believe in, but there are challenges.”

Joining Schipfer on stage, Patrice Wolfe, senior vice president of McKesson’s RelayHealth unit, outlined what she see as the top 3 challenges.

  1. Patient matching. Simply put, there is no single way to match patients, which is among CommonWell’s chief goals.
  2. Data access. Health information today lives in silos, and even among integrated delivery networks, doctors don’t always get the entire picture of a patient’s record.
  3. Cost. This one cannot be underestimated, Wolfe said; after CommonWell launched at HIMSS13 “hospitals were begging to be part of the pilot,” Wolfe said.

Considering the pilot as infrastructure that would enable HIE, Wolfe said that we as a nation have to be able to pull data nationally, not just regionally.

That’s why CommonWell is creating a database of consenting patients, which Wolfe was careful to explain is not a central repository of clinical information, to address business deterrents that Schipfer rattled off, including cost, competition, complexity, and consent.

Wolfe added that CommonWell is working to deliver a handful of tasks such as registering organizations, enrolling people, matching patients, and querying documents.

“We think we have a better mousetrap,” Wolfe said. “Let’s let the basic plumbing get done once and share it across the vendors.”

HIE interoperability ‘a great hurdle with little relief in sight’ – Government Health IT

Posted by timmreardon on 11/08/2013
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Interoperability is still the largest challenge for most health information exchanges.

“Despite the incorporation of new meaningful use policies, it is clear that interoperability issues are still stifling organizations’ ability to connect,” the Washington-based eHealth Initiative wrote in its 10th annual HIE survey. “The survey results reveal that interoperability remains a great hurdle with little relief in sight.”

The survey of 199 health information exchanges around the country also revealed that HIEs do have large opportunities to support health reform, and many already are, but to do that they have to support patient portals and self-service — an area HIEs and hospitals too are lagging in.

The eHealth Initiative called the report the “challenge to connect.” Of the 199 HIEs, 68 have had to connect to more than 10 different systems. Seventy five of the 199 HIEs listed hard-to-build interfaces as a key challenge, and 73 listed difficulty encouraging area organizations to share information.

More than half of the HIEs said they would like to see standardized integrated products and pricing from vendors. Many also indicted that they’d like to see more “plug-and-play” platform options, and others said they would like to see a greater use of consensus-based data standards.

Despite the obstacles, many HIEs are already connected to EHRs. More than 100 told the eHealth survey that they offer connectivity to EHRs, with continuity of care summaries, a master patient index and results delivery, 65 HIEs are supporting ACOs, and 90 are offering Direct Messaging.

HIEs are still lagging in patient portals, a communications option that the federal government is hoping will spur more engaged patients and shared decision making. Only 37 HIEs let patients view their records online and only 31 HIEs offer patients access to their information; 24 HIEs support patient self-scheduling and 17 let patients report data directly to the HIE.

“As health data exchange initiatives evolve in 2013 and beyond, it will be critical for community stakeholders, healthcare organizations, and policymakers to address emerging challenges — particularly in light of the growing complexity of the landscape and the expected changes that will occur as a result of federal funding and support winding down,” the organization wrote. “This year’s results illustrate that many challenges still need to be addressed.”

Article link: http://www.govhealthit.com/news/hies-not-meeting-interoperability-reform-expectations

CommonWell’s top 3 HIE challenges – HIE Watch

Posted by timmreardon on 11/07/2013
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As it nears the launch of its interoperability pilot project, officials from the CommonWell Health Alliance used AHIMA’s annual conference to outline some of the toughest health information exchange challenges facing vendors and providers today.

“If you want to share information with 5 organizations, you need 10 contracts,” Dan Schipfer, senior vice president at Cerner said Monday morning, explaining that regional HIE is happening, but thus far it is limited to local exchange.

“We EHR vendors have not made it easy for you to interoperate,” within the nomenclature and the organization, he said. “It’s a big deal, it’s something you believe in, we believe in, but there are challenges.”

Joining Schipfer on stage, Patrice Wolfe, senior vice president of McKesson’s RelayHealth unit, outlined what she see as the top 3 challenges.

  1. Patient matching. Simply put, there is no single way to match patients, which is among CommonWell’s chief goals.
  2. Data access. Health information today lives in silos, and even among integrated delivery networks, doctors don’t always get the entire picture of a patient’s record.
  3. Cost. This one cannot be underestimated, Wolfe said; after CommonWell launched at HIMSS13 “hospitals were begging to be part of the pilot,” Wolfe said.

Considering the pilot as infrastructure that would enable HIE, Wolfe said that we as a nation have to be able to pull data nationally, not just regionally.

That’s why CommonWell is creating a database of consenting patients, which Wolfe was careful to explain is not a central repository of clinical information, to address business deterrents that Schipfer rattled off, including cost, competition, complexity, and consent.

Wolfe added that CommonWell is working to deliver a handful of tasks such as registering organizations, enrolling people, matching patients, and querying documents.

“We think we have a better mousetrap,” Wolfe said. “Let’s let the basic plumbing get done once and share it across the vendors.”

Article link:http://www.hiewatch.com/news/commonwells-top-3-hie-challenges

Addressing Fragmentation in Healthcare – Mayo Clinic

Posted by timmreardon on 11/01/2013
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Massachusetts Medical Society’s Forum
Posted on October 30th, 2013 by John Noseworthy, M.D.
http://futureofhealthcareblog.mayoclinic.org/discussion/massachusetts-medical-societys-forum?6638549=1

Dr. Noseworthy at Mass Medical
This morning, I presented at the Massachusetts Medical Society’s “State of the State’s Health Care Leadership Forum” in Waltham, Mass. I shared how Mayo Clinic as an academic, integrated group practice of medicine is responding to profound change in health care.

Fragmentation is real and a profound problem for health care in America. It results in uneven quality and drives up health care spending. Too often, as providers, we use resources in ways that lead to repeated tests, procedures and treatment delays.

Mayo Clinic believes providers have an obligation to lead. To address fragmentation, Mayo Clinic is focused on efforts to create value, improve quality and reduce costs.

This approach is reflected in Mayo Clinic’s work today — through initiatives that improve safety, access and integration of care for patients. Examples include Mayo Clinic Care Network, our work in telestroke and efforts to help patients recover from surgery more quickly.

Mass Medical tweetsWe are sharing knowledge to deliver patients the best health care, health guidance and health information.

We recognize and appreciate that the cost of care is a tough nut to crack. We believe that driving change is best done with data and teams of people working together to address the problem. For Mayo, our most scalable asset is our knowledge. We have found sharing knowledge is a powerful integrator that reduces fragmentation, improves quality and drives down costs.

Editor’s note: John Noseworthy, M.D., is the president and CEO of Mayo Clinic.