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Wednesday
Apr192017

Patient Engagement Tools Mature into Workflow Solutions

In this part I of my HIMSS17 commentary, I describe how the array of patient engagement offerings at this year’s annual conference has matured to include many connected workflow solutions that benefit both providers and patients & their families: 

It has taken a long time for common standards and a sufficient installed base of EHR software to be adopted to create the necessary conditions for a connected health ecosystem. But there’s good news: based on advances reported at HIMSS17, all signs indicate that we are turning the corner toward the next phase where advanced analytic and productivity applications can be built upon the basic infrastructure layer. It’s still not plug and play, but enterprise-wide systems like customer relationship management (CRM) platforms for the healthcare sector are providing the backbone, along with APIs that supply the connective tissue to related apps, for a sustainable connected healthcare ecosystem.

At HIMSS17, one pleasant surprise was witnessing the progress that has been made on the patient engagement workflow front. Prior to HIMSS17, I was quoted as saying “Without fully including patients in their own health care decisions, patient engagement programs are nothing more than paternalistic compliance programs”. That statement garnered a lot of attention on social media and led to requests for meetings with several companies that offer a new generation of patient engagement tools that far outshine the first generation of prescription adherence apps and rudimentary patient portals.

HealthGrid, for example, has created a CRM platform, CareNarrative, which helps providers communicate with patients at appropriate times and offers solutions for ambulatory care, acute care and post-acute care. CareNotify is HealthGrid’s consumer-facing platform that enables patients and their family members/care team to access real-time information on inpatient care, discharge instructions, as well as education materials. CareNotify can be used to request appointments, complete check-in, fill in surveys and more.

Geisinger Health System also has found that a CRM platform is the best way to connect and manage patient-related data to engage patients on a personalized basis. Geisinger is working with Salesforce and Accenture to develop a custom CRM that can tailor care plans to individuals. This article in MobiHealthNews provides more detail on how the team at Geisinger has maintained a patient-centric mindset with a focus on improving outcomes.

In my discussions with Chanin Wendling, AVP Informatics and Jonathan Slotkin, MD, Medical Director, Division of Applied Research & Clinical Informatics at Geisinger, they further described use cases where an entire community will be served by its CRM by connecting to related organizations and retail health outlets across the community, as is being done in a pilot program in Scranton, PA. The Scranton pilot provides a glimpse into how social determinants of health (SDOH) could be incorporated into a CRM system to create a community-wide population health management system.

It is also worth mentioning that telemedicine services can be integrated into a CRM-based patient engagement system. Salesforce, the leading worldwide CRM vendor, offers a telemedicine capability through its own-branded HealthCloud patient relationship management solution.

B.well approaches patient engagement from a different angle. Kristen Valdes, founder and CEO of b.well, brings her experience working in the health plan segment to bear on improving the patient experience. B.well’s patient engagement platform for health plans, employers and brokers offers a single solution for providing patients and their care team access to care management and wellness tools, with an emphasis on understanding benefits and costs. At the same time, the platform serves as a population health management service that incorporates cost information for the payers that offer b.well.

The examples above represent just a fraction of the enhanced patient engagement solutions that were on display at HIMSS17. Although questions remain about control, access and security of patient relationship management platforms, integrated workflow systems serve a vital function in creating a health ecosystem that can help connect providers, patients, health plans and over time, the larger communities.

Growth in patient relationship management platforms has benefited from standards and IT advances that were developed for the provider market, as well as innovations in the consumer sector, (smartphones and mobile access, in particular). Part II of my HIMSS17 commentary will focus on workflow developments that enhance physician engagement.

For the original article, please see: http://www.himss.org/news/himss17-commentary-crm-platforms-elevate-patient-engagement-programs-workflow-solutions

Friday
Sep302016

Health IT Infrastructure Enables Clinical Decision Support within Workflow

“Infrastructure enables innovation” –Mignon Clyburn, FCC Commissioner 

I like this quote by Mignon Clyburn that Rob Havasy used in his presentation at the New England HIMSS National Health IT Week event last evening in Boston. People often balk at the effort and expense required for large infrastructure projects (remember, I’m from Boston and lived through the Big Dig!). Nonetheless, a strong reliable infrastructure is essential to establishing the basis for a vibrant and innovative ecosystem. 

Since attending my first national HIMSS meeting in 2010, this has been my consistent refrain: we need to establish foundational health IT infrastructure so that we can move on to disseminating information more efficiently and enabling advanced analytics. Large scale outcomes analysis and population health management simply aren’t feasible without a basic layer of data organization and management provided by open standards and interoperable systems. 

Much has been achieved in establishing the core record-keeping infrastructure. Currently, we’re making good progress in establishing interoperability standards for basic data exchange. Still, we need to go further than simple data exchange; the data that are exchanged have to be executable if we want to build real-time clinical decision support applications. In other words, we need a higher level of data interoperability that includes sufficient metadata to enable real-time integration into analytics systems for population health management analysis, diagnostic support systems, and the like.

CDS hooks

One of the initiatives in the health IT standards domain that I find promising is the CDS (clinical decision support) Hooks effort spearheaded by Josh Mandel, MD, a health informatics researcher at Harvard Medical School & Boston Children’s Hospital[1]. CDS Hooks works within the SMART on FHIR ecosystem to send notifications of information sources that may be of value to the user in real time. Users don’t have to know in advance that resources are available; instead relevant resources are presented within the user’s workflow for them to consult at their option.

For the most part, CDS resources have been important reference sources for academic and medical researchers, but their usage by practicing clinicians has remained limited. To move from being “nice to have” reference sources to truly achieving the goal of “making the right decisions as easy as possible to come by, and as easy as possible to execute”[2], clinical decision support tools need to be embedded in the workflow of the clinician, patient, or other decision maker.  There are still a lot of interoperability issues to work out, but I plan to watch the development in CDS Hooks and encourage publishers of evidence-based databases and other resources to explore intently how they can connect their resources to the SMART on FHIR ecosystem.

Delivering the right information to the person at the right time in the right format via the right channel (the 5 rights of clinical decision support) enables better decisions and supports improved information flows to all stakeholders, including patients. Advancements in core health IT infrastructure and improved interoperability standards will help make these 5 rights an everyday practice. That’s why #IHeartHIT.

 


[1] This interview with Josh in Healthcare Informatics provides a useful introduction to CDS Hooks: http://www.healthcare-informatics.com/blogs/david-raths/interoperability/what-cds-hooks-interview-josh-mandel-about-fhir-and-clinical

[2] Jonathan Teich, MD quoted in http://www.healthcareitnews.com/news/amia-maps-road-decision-support, June 14, 2006.

Monday
Aug312015

Health Data Management Top 16 Health IT Experts List

Health Data Management Magazine is an obvious go-to source for me, given my focus on developments related to the sources and uses of health data.  

It’s gratifying to see that the feeling is mutual. HDM Magazine recently published a list of 16 Experts on Twitter Who are Leading the Discussion in Health IT and included me among some highly respected peers.

Any curated list is going to leave out some equally good candidates. Every time a list comes out, people who aren’t included tend to call out bias in the selection process. There’s always bias. But, as a publication that is well-versed in editorial curation, HDM Magazine does an excellent job of selecting a core group that is consistent in their focus on health IT and data-driven developments in healthcare and are known for providing a good deal of context around the issues. Better yet, the group includes a range of perspectives from within provider organizations, health IT vendors, patient advocates, government agencies, analysts, start-ups and research foundations. Despite the different perspectives, this group includes people who demonstrate a genuine interest in improving our current healthcare industry (I would say “healthcare system”, but that raises too many thoughts about lack of systems thinking in healthcare).

I don’t know if HDM Magazine made a conscious effort to include an equal number of women and men, but if they did, they exceeded that goal by naming nine women and seven men. In today’s world, that still merits a special mention and a “thank you” from the #HITChicks community!

Here’s the complete list of Twitter handles:

@EricTopol

@SeattleMamaDoc

@ePatientDave

@Farzad_MD

@SusannahFox

@DrVal

@Cascadia

@Nxtstop1

@MandiBPro

@janicemccallum

@john_chilmark

@KBDeSalvo

@DrLeslieSaxon

@StephenJDowns

@kmmore

@deansittig

The list includes some people who have been part of my Twitter community from the beginning (e.g., @ePatientDave @Cascadia and @SusannahFox) and some newer colleagues and friends and a couple of people I should obviously add to my list. 

Note, HDM Magazine created a similar list several years ago of top health IT social media people to follow and John Poikonen (@poikonen)  created a public Twitter list to make it easy for anyone to follow all the people on the list. That list remains one of my favorite lists to scan each morning. Note, John has added a few names to his list, as is his prerogative. In that same vein, I’ve just created a public list with all 16 of the health IT experts that HDM Magazine included on their list and have made two additions: @HDMMagazine and @poikonen! Here’s the link to the public list:   

https://twitter.com/janicemccallum/lists/hdmhealthitlist

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.

 

Saturday
Jan042014

Healthcare IT Predictions for 2014: Patient Engagement, Interoperability and the Value of Price Transparency

As 2013 comes to a close, we are excited to welcome the insights of top healthcare IT leaders in our Healthcare IT Predictions for 2014 blog series. So far we’ve heard from David Harlow, renowned healthcare lawyer, and John Lynn, prolific blogger on healthcare IT, EMR and HIPAA. Today, we welcome Janice McCallum, managing director of Health Content Advisors. Janice is a top authority on commercial applications across stakeholder groups and relevant sectors, including providers, clinicians, payers, life sciences, government and patients. At Health Content Advisors, Janice helps publishers and suppliers of healthcare information services develop effective marketing and business development strategies for reaching today’s clinicians and consumers.


1)    What healthcare IT buzzwords will move to the center of conversation in 2014?

Patient engagement will continue to be a hot topic in 2014 because of the increased role that patients are playing in nearly every aspect of their healthcare. However, there’s not much clarity on the definition of “patient engagement”. Since the Meaningful Use program is a key driver of patient engagement initiatives; and since IT infrastructure is critical to Meaningful Use implementation, patient engagement is still very much a health IT issue. I’ve said many times that providing patients with access to their data is the most important element for providers that want to engage patients. But, patient engagement is just a first step in a process to rebalance the current information asymmetry between physicians and patients.

Leonard Kish coined the phrase: “Patient Engagement is the Blockbuster Drug of the Century” last year.  I agree, but due to the range of interpretations of what it encompasses, I expect “patient engagement” to be the most overused and least understood buzzword in 2014.

2)    Jacob Reider has taken over for Farzad Mostashari as Interim National Coordinator post at the ONC; what does the industry need most from the next leader?

Given the political environment, our next National Coordinator for Health IT will need have a rare mix of health IT knowledge, political savvy and management skills. To respond to concerns from provider organizations, I would recommend that the next ONC leader have some experience within a provider organization; ideally, someone who has dealt with implementing reporting systems for early stage Meaningful Use. Better yet, I’d like to see a new ONC leader who wants to put him or herself out of a job by helping to consolidate the various quality-reporting programs within HHS and encouraging industry associations to take over the leadership function for health IT standards.

3)    What is your top prediction for Healthcare IT in 2014?

My top prediction is that the topic of price transparency will be paramount. Even though price is a business rather than an IT issue, provider IT systems need to be capable of providing reliable price estimates to patients, since an increasing number of providers require patients to pre-pay their copay portion of medical bills at check-in. We can’t expect patients to approve an unknown charge to their credit card or their bank account without some reasonable estimates of costs, although I have heard of plans by some providers to do just that! Price transparency also helps inform consumer choices about where to seek care and what care plans to choose.

4)    What initiatives do healthcare stakeholders need to prioritize in order to reach true interoperability in 2014?

I’m not even sure how to define true interoperability. Common data standards are a huge part of facilitating data interoperability. But, different stakeholder groups will continue to have different data standards, especially when the different parties include research data, clinical data, patient-reported data and sensor data. Furthermore, a big part of the health information exchange problem stems from the incomplete nature of patient records in any single institution or network, errors in patient records, and the lack of unique IDs. The solution has to involve patient review and control of his/her own records.

This post was originally published at the Orion Health Blog on December 3, 2013.