Health Data Meaningful Updates

I’ve been so busy with guest posts and speaking engagements in the past couple of months that I’ve neglected updating my own site. I’ll try to rectify that now with condensed versions of some recent activity below.

       I.            Navinet Expert Interview Series, March 2013

Laura McCaughey and I discuss big data, population health, health IT, shared decisionmaking, the Accountable Care Act and medical cost trends, all in under 2 pages! A few outtakes:

Laura: What do you see as the biggest developments in HIT in the next year?

Janice: “I think the biggest developments will occur as provider organizations build upon the population health analysis that got its start with the foundation laid by the Meaningful Use framework. In particular, we’ll see more analyses of treatment plans, costs, and outcomes by segments of patients. The segmentation possibilities are almost endless. When combined with genomic data and other nontraditional types of data, they will bring us a long way toward the goal of personalized medicine.”

Laura: There’s been so much talk around big data for a variety of industries, but what does it mean for the healthcare industry?

Janice: “…to benefit from many of the existing Big Data technologies and modeling that are being used in retail, financial services, and other industries, the health care industry needs to improve the amount of collaboration at the level of sharing data sets and sharing results from previous analyses. Obviously, there are some limitations on how patient registries can be shared, but there is good progress in creating large research datasets that include de-identified patient data. In fact, the Agency for Healthcare and Quality recently released a registry of patient registries (RoPR).”

Laura: Last year you identified the accountable care organization (ACO) model as one of the major factors to shape care collaboration. How much of that has happened, and how much further do we need to go? 

Janice: “I think most ACOs have just scratched the surface in establishing a new model of providing care and involving patients in decisions about their care. It will take some time for the culture of physician-patient communication to change. Furthermore, the tools that have been available to educate and support clinicians and patients haven’t kept up with the organizational changes. In particular, patient education/patient information tools and materials are sorely lacking for patients who want to take a more active role in their health and medical care. I cringe every time I hear that patient education materials have to be prepared to meet the reading level of the “lowest common denominator” in the spectrum of patients. While I understand that some public health messages must be understandable to a very broad spectrum of the population, the same rationale doesn’t apply to all information made available to patients.”

Laura: What are some of the key components that a HIT platform needs in order to be successful in today’s changing healthcare landscape? 

Janice: “ACOs and the so-called patient-centered medical home (PCMH) concept should put a high priority on configuring their systems so that patients can both contribute information and download information from their records. This way patients can act as their own up-to-date “mobile record.” Not all patients are ready to take on this role, but that’s not a good reason to prevent those patients who are ready from improving access to information that can improve the quality of care they receive and possibly reduce the cost. The early innovators among the patient populations who actively track, update, and analyze their personal health records can serve as models for the “laggards” who will wait until the benefits become more obvious and the tools become easier to use.”

Laura: The Accountable Care Act (ACA)will soon be implemented, and millions of newly insured Americans will be receiving care that did not previously. How are payers planning to handle this? 

Janice: “Apart from having designed new plans that are ready to be promoted and sold on health insurance exchanges (now called health insurance marketplaces), I can only make an educated guess on how payers are planning to handle the new populations of patients who will be insured as a result of the ACA. Note, I have a different view on how much the newly insured will increase the demand for medical services, compared with the conventional wisdom, which estimates that the previously uninsured will flood primary care physicians with pent-up need for medical care. I agree that physician practices will enroll many new patients in areas where there had been a large number of uninsured. However, I think that a large number of the newly insured patients will have so much experience managing their own care that they won’t overburden the provider organizations as much as some analysts predict. Plus, many of the insurance plans available to these populations will include significant co-pays (significant is in the eye of the beholder in this case!). With high co-pays, I predict that populations that were unable to afford insurance coverage in the past will not be able to afford most co-pays and will find ways to reduce their costs of care whenever possible by using retail clinics and other lower-cost options, such as telehealth.”

Laura: The medical cost trend has slowed considerably in the past few years. What can providers and payers do to help keep costs from rising?

Janice: “The best advice I have to keep costs from rising is to provide more information about costs to patients before they choose a course of treatment. Providing more information about the likely benefits and risks of treatment plan options under consideration to patients will also increase the patient’s level of commitment to the chosen treatment plan. Moving to this “shared decision-making” model will likely reduce costs in the short term, although that’s not a sure bet, since cost is not the only criterion that patients will consider.

As I consider the topics we’ve just discussed, it occurs to me that the most significant move that payers could make to slow the rise in costs would be to simplify health insurance plans so that costs are far more transparent. Some payers are ahead of others in offering data on costs. For instance, Aetna offers an average estimated cost by region in its Aetna Navigator tool. Although not complete, Aetna’s move in the direction of providing cost information is a step in the right direction.”

 See full interview at: http://www.navinet.net/blog/2013-navinet-expert-interview-series-janice-mccallum-health-content-advisors

     II. Making Health Data Healthier: How to Determine What’s Valuable and How to Use It

A dialogue between Geeta Nayyar, MD, MBA, Chief Medical Information Officer at AT&T, and me about managing and leveraging health data for the benefit of providers and patients.

On the topic of Meaningful Use:

Geeta: In your opinion, how does Meaningful Use help advance the value of data in medical research and clinical applications?

Janice:  “The Meaningful Use incentive program has jump-started the adoption of electronic health records and set the framework for coordinating a fragmented group of providers, health IT vendors, and analytics companies. The common sets of data to be collected, tracked, and analyzed set the stage for greater collaboration between providers/clinicians, payer organizations, medical researchers and patients.

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Frankly, I wish the value of data standards and collaboration were so obvious that providers and payers would develop industry standards without external pressure. Since that wasn’t the case prior to the Meaningful Use program, I would say that we’ve seen great strides in enhancing the value of data available for medical and clinical applications in a short period of time.”

See full interview at:

http://networkingexchangeblog.att.com/enterprise-business/making-health-data-healthier/.

   III.            Webinar on Meaningful Use for Medical Librarians

I recently gave an hour-long webinar, Meaningful Use: A Means to an End, to the National Network of Libraries of Medicine (NN/LM), New England Region.  Along with providing some context to the Meaningful Use program, the webinar focused on roles for medical librarians in implementing meaningful use programs, especially elements that relate to patient engagement, quality measures, and clinical decision support.

Please contact me (janice@healthcontentadvisors.com) if you are interested in a customized version of the webinar/presentation for another audience.

Leveraging the Liberated Data

Todd Park, CTO of HHS, gave an inspiring keynote at the Rock Health Boot Camp yesterday that could turn the starkest pessimistic into an optimist about the future of healthcare in the US. From what I know, Park always gives inspiring keynotes, but I want to use his message to connect the key themes I extracted from the Rock Health event (#hcbc) and Health Camp SF Bay (#hcsfbay) on Friday.

My first observation: nearly every speaker referred to the plethora of new apps and technology companies in healthcare. We’re beginning to get inundated by new apps that often compete with dozens of similar apps to do nearly the same thing.

Second, it is a safe statement to say that health remains a siloed ecosystem. Collaboration is improving as a result of internal and external forces, with the HITECH Act and ACA (Affordable Care Act) among the most powerful forces promoting change. But we’re at early stages of figuring out how to share data and collaborate for the good of patient outcomes and overall population health.

Yet in this technology-rich environment, the level of awareness of existing data sources is poor. We can liberate all the data in the world and make it available on the Web, but if entrepreneurs are focused on sexy new gadgets that add to the data explosion but do nothing to help organize and normalize the massive datasets that already exist, we’ll fail to make use of the data in meaningful ways (yes, I used the term “meaningful” on purpose).

Park spent some time describing Healthcare.gov and HealthData.gov and how they can act as a resource for entrepreneurs. I loved his analogy between HealthData.gov and NOAA data. He told an anecdote of how someone once told him that NOAA is unnecessary because one can find the same data in a more user-friendly application on Weather.com.  What the commenter didn’t realize is that NOAA data form the backbone of Weather.com. The federal government provides the data gathering, normalizing, and updating functions and then makes the data available to others who can overlay, combine, segment, analyze, integrate and distribute the data in any variety of mashed-up and improved formats.

The tradition of building data businesses on the foundation of federal, state, and local government data is strong. Savvy data publishing entrepreneurs have been digging deeply into government sources of data and providing new applications based on the data for centuries and new data products and services continue to emerge. The opportunities for leveraging data aren’t restricted to using government data by any means. Just look at companies like IMS Health that compiles data on prescribing behavior from pharmacies.

Some healthcare IT companies understand the power of leveraging data. In fact, athenahealth, Todd Parks’ former company, is one of them. Thomson Reuters Healthcare (now Truven Healthcare Analytics) is another company that has built a big part of its portfolio around leveraging CMS data.

Bob Kocher, a partner at Venrock, also spoke at the Rock Health event. He stated that healthcare is the only industry where investments in IT haven’t led to labor-saving productivity improvements. I’m not surprised by this fact. We’ve had lots of new technologies in healthcare that help us do things we weren’t able to do before.  However, we haven’t been very good at building on our innovations to create a better healthcare system.  In today’s world, combining data with software to build tools that improve efficiency and productivity leads to much richer sets of products and services. Readers of this blog have heard this sentiment from me before and I’m known for defining “meaningful use” as the intelligent combination of IT and content.  It’s a theme worth repeating and I was pleased to hear it articulated so well by Todd Park, Bob Kocher and others yesterday.