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Wednesday
May272015

Mom-memorials from #IHeartHIT Session at HIMSS15

Lindy Stotsky, known to many of you by her Twitter name @EMRAnswers, gave a compelling and compassionate account at HIMSS15 of how the lack of access to patient records — by clinicians, patients, and especially family members/caregivers— failed her mother during her stay in a long-term care facility. Her story, appended below, resonated with the audience and led several other people to describe how experiences trying to navigate the healthcare system without full access to information from health records spurred them to become involved in health IT.

I followed Linda with a story of how my mother became interested in examining the data in her health record only after I prodded her primary care practice to provide access, once I realized that they had implemented a patient portal.

It was notable that most of the personal stories from the audience that followed Linda & my brief talks at the #IHeartHIT session related to caring for our Moms. I want to thank Linda for sharing her story here on the Health Content Advisors site.

I Was My Mother’s “Scrap of Paper”

I’ve worked in healthcare over 25 years:  In administration through hospital credentialing and procurement, as a practice administrator shuffling through paper charts, missing codes, and reimbursement in an era of managed care.  It was during this time that my Mother became ill with CLL (Chronic Lymphocytic Leukemia), and COPD (Chronic Obstructive Pulmonary Disorder). My Mother was a staunch believer in Health CARE. She grew up believing that physicians were healers- and that nursing facilities took care of the elderly. Her decision to reside in such a facility began our descent into a world I could not have imagined.

I looked, as most caregivers do, at the inside of the building, the floors, the paint and the aesthetics. We are preoccupied, vulnerable and first impressions are everything. I judged the worthiness of the facility by its locale, the staff and our welcome.  I took for granted that “Nurses” were RN’s, having an MD as Chief of Staff meant he was there every day, and daily living meant more than struggling to survive. I didn’t know about physician track records, medical malpractice and negligence. All blue skies and daisies, until my Mom became a resident. That started our fragile dance between long-term care (LTC), emergency departments (ED), hospital, provider, back to LTC.

Thus began my advocacy. Not just for MY Mom. I was vigilant about everyone’s Mom— policing halls, looking into rooms, and answering cries for help.  I watched my Mother change from a vibrant, confident superhero to a terrified, confused and helpless patient. I took her to providers who placed her on medication, only to bring her back to a facility where medications were routinely discontinued because of cost.

I was “on call” 24/7. My Mom became my mission. My 3 year old knew where all the toys were kept in the ED, as we were frequent fliers.  “AMA” meant no ambulance was ever called. I loaded her, her wheelchair, her O2 tank, and my son into the car, and as I was running out, I grabbed a piece of notebook paper with her medications scribbled on it. This was her medical record. And I was the keeper of the key information.

My Mother passed away after three years of suffering, much of which was preventable. Not only was there a lack of communication, a culture of caring had been replaced by one of cost. Human lives took a back seat to ROI. Instead of treating aging elders with the respect and dignity they deserved after years of giving, nursing homes were nothing more than “death beds” waiting to empty. I was so engrossed in the day to day challenges, that I didn’t have time to stop and think about the larger picture of what was wrong. 

15 years later I am sorry to say that things have not changed much. My daughter recently had Thyroid Cancer. She was eager to use the patient portal to coordinate her labs, multiple tests, from all providers.  It was not that easy.  Information gaps were everywhere; care coordination was still back in the year 2000.  We need patient access. But it’s more than that. We need actionable information. It’s been nearly five years since the enactment of the ACA and little has been done to promote shared decision making. The recent proposed rule change in the Meaningful Use Stage 2 measure related to patient access and downloading of their information[1] will reduce the  threshold for Measure 2 from 5% to “at least 1 patient”  for eligible providers (EP). This change HALTS progress. WE CAN DO BETTER. My daughter is working hard to be a partner in her care, yet she has a toddler, and she’s tired, and sometimes it’s easier to give up rather than continue asking.

 Linda, Regina Holliday and me at HIMSS15

 Please help us win this. Stand up and ask —-demand electronic access to your patient record.  We should not have to carry around a tattered scrap of paper with medical information on it. Join members of The Walking Gallery[2] of Healthcare as we tell HHS, CMS, Politicians and Advocates that PATIENT LIVES MATTER.

My name is Linda Stotsky, and I share my story as a patient, a caregiver, a Mom, a daughter and a Health IT Product Manager. I am currently the Director of Business Development at LogicNets.

 I can be reached at Linda.Stotsky@gmail.com or on Twitter via @EMRAnswers

[1] http://e-patients.net/archives/2015/05/add-your-voice-meaningful-use-regulations-musnt-leave-patient-engagement-in-the-dust.html

[2] For information on TheWalking Gallery, see http://reginaholliday.blogspot.com/2011/04/walking-gallery.html.

 

Thursday
Apr232015

Data Was Big at HIMSS15

Data Was Big at HIMSS15

Since I attended my first HIMSS in 2010, my consistent theme has centered on the fact that implementing EHRs with some standard functionality was a necessary precursor to achieving the core goals associated with improving quality and increasing the value of the healthcare we provide to individuals and groups. Having the ability to track and analyze outcomes in a systematic fashion benefits medical researchers, payers, patients, and policy makers (Pharma and device companies, too), not just providers.

HIMSS15 confirmed that the spotlight is now on data—and what can be done with digital data. In other words, we’ve moved on from the era of adopting EHRs to the era of leveraging the data collection and reporting capabilities of EHRs. To someone who has been a champion of “meaningful use” of EHR data through the rough times of less-than-perfect EHR platforms, I feel as though the HIMSS universe is finally reaching the stage where the benefits of putting outcomes data to work via software solutions are apparent.  

Marc Andreessen said that “software is eating the world”, but from my perspective software isn’t of any use without the data to fuel the software engine.[1]

Granted, we haven’t entirely said goodbye to issues related to basic EHR architecture, usability, and interoperability, but the spotlight has shifted to what can be done when the data generated by EHRs and other sources. Note, it goes without saying that careful data management is required throughout the entire process of generating, analyzing, integrating, sharing and reporting data.

In a follow-on post, I’ll dive more deeply into some of the clinical decision support solutions I saw at HIMSS15. For this post, I’ll stay at 35,000 feet and review the HIMSS15 experience relative to my expectations.

A couple of months prior to HIMSS15, I was asked by the HIMSS Social Media organizers what top trends I expected to see at HIMSS15. I narrowed it down to three topics:

  1. More advanced uses of population health data.
  2. Consolidation in the health IT segment led by enterprise software vendors.
  3. Evidence of 2015’s becoming the “The Year of Patient Decision Tools”.

I’d say I scored a 2.5 out of 3, but let me explain in case you don’t see things through my lens.

On the first trend, I don’t think anyone would argue against the point that population health applications and analytics were at the top of the list of buzzwords at HIMSS15.

Regarding the continued relevance of the Meaningful Use program, I’ve argued in the past that we’ll know that we’ve made progress when we no longer need external regulations to drive optimal design and use of health IT systems. At the current time, healthcare providers are still largely driven by external regulations, except we’re moving from ONC-driven EHR adoption incentives to CMS reimbursement/payment-driven policies. Long-term changes in payment/reimbursement and delivery models will have a stronger impact on IT priorities of providers than a short-term incentive program like the Meaningful Use program.

On number 2, the consolidation theme, this is what I wrote prior to HIMSS15:

Just about everyone expects consolidation among the fragmented EHR vendor segment; but I predict that we’ll start to see some EHR vendors acquired by large multi-industry enterprise resource planning (ERP) vendors, such as SAP or Oracle. The large vendors have experience integrating multiple systems and already have some experience in healthcare with financial and talent management software systems. It doesn’t take a big stretch of the imagination to envision further integration with clinical systems, especially in light of new payment models where financial performance is a function of clinical performance.

It’s a shame I didn’t include IBM in my list of large multi-industry enterprise vendors, since one of the biggest announcements was the acquisition of Explorys and Phytel by IBM for its Watson Health unit. [2]

Although Watson Health isn’t an ERP solution, it is part of a large corporation that provides multiple solutions to provider organizations. Furthermore, IBM is more entrenched in the business side of the spectrum and building up Watson Health represents an investment on the clinical side of the spectrum. My overarching point is that new reimbursement models are driving the need to close the divide between admin systems and clinical systems. New reimbursement models tie financial outcomes to clinical outcomes, so admin and business intelligence systems need to integrate clinical outcomes data.

On point 3, with my optimist hat on, I predicted that HIMSS15 would highlight patient decision tools, not only decision tools designed for clinicians. I did see some impressive communications and decision tools for patients, including GetWell:) Network and Tonic, which has partnered with Elsevier to market its patient engagement solution. There were other patient engagement & decision tool vendors at HIMSS15, and this topic merits more attention. For now, I’ll stick with my prediction that in 2015 we’ll see a lot of activity in the patient decision tool space and I will provide more indepth coverage later.

Finally, I’d like to thank HIMSS for including me in the Social Media Ambassador program this year. It was terrific to be grouped with the elite digerati in health IT and healthcare. This is a forward-thinking group that generously shares their insights via social media.

I’ll wrap up with a few photo highlights from my HIMSS15 experience. 

 

 

The awesome Social Media Ambassador group for HIMSS15. Nearly all long-time health IT social media friends, along with a couple of new connections for me.

 

 

 

Meetup of #TheWalkingGallery members at the #IHeartHIT session on Monday, April 13, 2015. 

 

Last, but not least, the HIMSS experience always extends into the evening. Here’s one of my favorite pictures, a group selfie taken by @DrNic1 at John Lynn’s #HITMC meetup at Gino’s East on Tuesday, April 14, 2015, with @DrNic1, me, @OchoTex and @askJoyRios, photo-bombed by @DocWeighsIn and @SarahBennight:

 

 

Stay tuned for additional posts on HIMSS15 that will cover developments in Clinical Decision Support. 


[1] Marc Andreessen, Wall St. Journal, August 20, 2011:http://www.wsj.com/articles/SB10001424053111903480904576512250915629460, accessed April 23, 2015.

[2] http://www.healthcareitnews.com/news/ibms-big-buy, accessed April 23, 2015.

Thursday
Apr232015

Surplus of Blame, Shortage of Trust: Healthcare, Heal Thyself!

Introduction

In 2012, following the HIMSS12 conference, I wrote about the importance of trust in healthcare exchange markets. Here’s an excerpt from my blog article 3 years ago:

The importance of building and maintaining trust among entities that are collaborating or exchanging goods & services is paramount. Without trust, markets where imperfect or asymmetrical information exists won’t operate efficiently. Whether we like it or not, “imperfect” and “asymmetrical” define the current mechanisms used to exchange personal health information.

So, how far have we come in three years? This guest post by Frank Ingari, President & CEO of Navinet, Inc., indicates that we still have a long way to go to develop adequate trust between payers & providers in order to achieve the level of risk-sharing and collaboration needed for new models of healthcare delivery.

===================================================================

Surplus of Blame, Shortage of Trust: Healthcare, Heal Thyself!

After putting in their 10,000 steps a day at HIMSS15, anyone can tell you how much blame there is to go around in the complex dysfunction of U.S. healthcare. Rapturous vendor claims aside, how do we get to the interoperable learning system described in The Office of the National Coordinator of Healthcare Information Technology’s Interoperability Roadmap?

In my blog post on the Roadmap (Will Today’s Payer Have the Role they Want Tomorrow?), I argued that we must include payers in the clinical connectivity movement to have a chance.  My friend John Moore at Chilmark Research responded with an astute critique, “The relationship(s) between payers and providers is typically not one built on a whole lot of trust. I have not seen vast and growing evidence that this is occurring—yet.”

Of course John is correct—payer-provider antagonism is deeply rooted. But imagining that we can deliver reform without addressing pervasive industry distrust is an illusion.

The truth is, trust is in short supply across the healthcare ecosystem. Doctors don’t trust lawyers or even the regulators whose regulations the lawyers enforce. Specialists often don’t trust their hospital employers to be transparent on financial productivity. EMR vendors don’t trust their competitors.  Clinicians don’t trust big data systems to provide pristine “evidence-based guidance,” while big data vendors don’t trust clinicians to tell the whole truth in the clinical record. Consumers don’t trust the healthcare “research” flooding the Internet—but they’re not too sure about the healthcare establishment either.

So how do we grow trust in healthcare? It may be that the payer-provider relationship, strange as it seems, is the best place to build a new foundation.

One scholar who has devoted much of his career to the study of societal trust is Professor Roy Lewicki, a pioneer in conflict management. He points out that trust and distrust are not true opposites: “contrary to traditional, normative views that trust is good and distrust is bad… both trust and distrust have a valid role in managing complex relationships… trust is valuable insofar as it is appropriate to the context, and a healthy amount of distrust can protect against the risk of exploitation” (Lewicki & Wiethoff, Trust, Trust Development and Trust Repair, 2000).

Lewicki’s insights support the idea that the payer-provider relationship, while historically difficult, may offer the indispensable ingredients to grow trust. Given the centrality of the payer-provider relationship to the core concept of reform (increase quality while reducing cost), this could be key to our national success.

 

Lewicki suggests the best way for organizations to increase trust is to use a contractual framework to demonstrate competence, consistency, predictability, empathy, and sharing of control—repeatedly, and over time. The VBR contracts proliferating between payers and providers, underlying new risk-sharing agreements, present an excellent platform for the development of mutual trust along these dimensions. Successful VBR contracts require competent performance by payer and provider, detail the sharing of control in key areas such as Medical Management, and specify the metrics and methods by which performance will be judged. The sheer number of such contracts across multiple payers and insurance products provides health systems with unparalleled opportunity to evaluate the trustworthiness of each payer as partner across multiple contract cycles. 

Lewicki goes on to suggest that it is equally important to decrease distrust –which certainly rings true in healthcare. Once again, he focuses on the central role of formal contract agreements to enable clear specification of each party’s obligations. The contract can then specify how each party’s actions can be monitored and verified, under the protection of legal recourse and supported by the existence of third party arbitrators.   

Compared with the payer-provider relationship, no other “axis of distrust” in healthcare offers such rich, powerful, or frequent contract mechanisms that can establish the repeated demonstration of trustworthiness. What’s more, the government’s growing role as the ultimate payer means that critically important standards of behavior and objective third-party regulation are increasingly transparent and available.

We at NaviNet are seeing the trust-building process play out at an accelerated rate around the country. It may be more exciting to suggest that providers are suddenly going to become payers and put the dreaded insurer out of business, but it may be more accurate to focus on the mainstream of health systems who are experimenting carefully in sequential product-specific partnerships with selected payers to explore roles, responsibilities, risks and rewards in new collaborative contracts.  This will be at least as true for the health system “payviders” who are trying to become insurers themselves, typically in close cooperation with a payer-based “value-based TPA” partner, as they develop internal payer functions such as Utilization Management for the first time.

The ONC and academic reformers could miss a golden opportunity by ignoring this trend. By the time clinical interoperability could possibly be accomplished by “provider-only” means, healthcare industry structure will have been changed utterly by virtue of the innovations spawned by cooperation between payers and providers in shared risk for Medicare Advantage, Managed Medicaid, Exchanges, and commercial ACOs.  In Darwinian fashion, the healthcare entities who thrive in reform will have learned to build trust between payer and provider functions by proving to each other that they are competent, predictable, and trustworthy by means of repeated cycles of shared-risk success in VBR contracts.

 

 

Frank Ingari is President and Chief Executive Officer of NaviNet, Inc., America’s leading healthcare collaboration network. NaviNet helps payers and providers boost care quality, lower costs, and improve population health management with NaviNet Open, its payer-provider collaboration platform. @FrankIngari

Monday
Mar162015

Meet Your Social Media Ambassador to HIMSS15 Conference

The annual HIMSS Conference begins next month in Chicago (April 12-16). This year, I am very pleased to announce that I was named one of the HIMSS Social Media Ambassadors for the event. The #SoME ambassadors group includes many influential, super-knowledgeable, and prolific information-curators and contributors to a wide range of publications. I know most of these people from online conversations and in many cases met them at the first HIMSS conference I attended in 2010. Needless to say, I am thrilled to be included in this group!

Follow this elite group on Twitter and you’ll be well-informed about health IT standards & policy, behavioral health, advances in EHR technology, healthcare analytics/big data, new clinical decision support services, healthcare economics and more. The group includes:        

  • Brian Ahier @ahier
  • Mandi Bishop @MandiBPro
  • Wen Dombrowski, MD @HealthcareWen
  • Susan Hull @SusanCHull
  • Gregg Masters @2healthguru
  • Janice McCallum @janicemccallum
  • Jane Sarasohn-Kahn @healthythinker
  • Shahid Shah @shahidNShah
  • Linda Stotsky @EMRAnswers
  • Michelle Troseth @CPMRCmichelle
  • Charles Webster @wareFLO

[To follow this group, subscribe to Twitter list:https://twitter.com/HIMSS/lists/himss15-smas/members]

Healthcare IT News is publishing a profile of each of the SoMe ambassadors to provide more insight into the areas of specialization of each member of the group. The profiles go beyond our geeky health IT and policy backgrounds to include some lesser-known aspects of our lives. My profile was published today and I have to congratulate the writer, Scott Thaler, on incorporating so many aspects of my career in designing & marketing digital information products and overall interest in the intersection of health IT and health content. Read more to learn of some other interests of mine: http://www.healthcareitnews.com/news/janice-mccallum-avid-tennis-player-cat-lover-health-visionary

If you will be attending HIMSS15, come by the #IHeartHIT Meetup to meet me and the other SoMe ambassadors on Monday, April 13, at 3:30pm. Register here.

Whether you are attending or not, be sure to follow the #HIMSS15 hashtag on social media. Since that list may get overwhelming during the conference, I want to reinforce my recommendation to follow the #SoMe list, which is guaranteed to serve up carefully curated selections from the sessions, exhibit hall, press briefings, and social events.

I look forward to seeing many colleagues at HIMSS15. Please contact me if you would like to set up a briefing.

 

Thursday
Jan152015

Springer Science+Business Merges with Holtzbrinck’s Macmillan Science Group

One could get dizzy trying to trace the M&A history of Springer Science+Business. I recall analyzing their likely future back when they were owned by two private equity companies, Cinven and Candover in the mid-2000s. Cinven & Candover had formed Springer Science + Business by merging Kluwer Academic Publishing with Springer in 2004. In late 2009, Cinven & Candover  sold Springer Science + Business to EQT, a Swedish private equity firm, for 2.3 B EUR (note, Springer held 2.2 B EUR of debt at the time).

In 2013, EQT sold Springer to BC Partners for 3.3 B EUR.

Today, it was announced that BC Partners will merge Springer with Holtzbrinck Publishing Group’s Macmillan Science Group (well, almost all of MSG). Holtzbrinck becomes majority investor with a 53% stake; BCP retains minority ownership. Derk Haank, the CEO of Springer, will become CEO of the combined company. Annette Thomas, current CEO of Macmillan, will serve as Chief Scientific Officer.

The combined entity will have 13,000 employees and annual sales of 1.5 B EUR ($1.7 B US).

The rationale for the merger centered on the need for market share in the scholarly publishing segment. Derk Haank is quoted as saying, “Together, we will be able to offer authors and contributors more publishing opportunities and institutional libraries and individual buyers will have more choice. The expected economies of scale will allow for additional investments in new product development.” 

Scale and market share are becoming increasingly important as large publishers, including Elsevier, Wolters Kluwer, and Wiley, along with Springer, are competing to acquire titles from scholarly societies and other small publishers. Having control over the high quality scientific and medical journal content allows the big publishers to reinforce the value of bundled access to their collective publications (as well as subsets of their publications). But, perhaps more important, by accumulating rights to a significant share of the journals that serve as the arbiters of quality research— and by association, quality scientific and medical evidence—these leading scientific, technical and medical (STM) publishers will remain essential to any analytics engine that aims to mine the universe of important research results.

In brief, scale affords digital information businesses far more options in their choice of business models than would be available to a small publisher. Springer Science + Business now has Nature and its portfolio of journals in its camp. Together, they should be able to better compete in a segment that will continue to consolidate.