Leveraging the Liberated Data

Todd Park, CTO of HHS, gave an inspiring keynote at the Rock Health Book 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.

Look to Payers for Innovation in Health Information

So much attention has been focused on the adoption of EHRs by provider organizations—largely because of ARRA HITECH funding—that one could be led to believe that most health IT advances are occurring on the clinical side of healthcare.  In reality, the business side has been quicker to adopt IT systems that add efficiency to the workflow of the participants. Practice management software and revenue cycle management solutions are two examples.

However, the exchange of data between stakeholder groups remains the stumbling block in improving the efficiency of our healthcare system.  On the provider side, it has been evident from the start that one of the most “meaningful” uses of a patient’s electronic record is the ability to make the information available where, when and to whom it is needed.  But, the pathway to meaningful health information exchange (HIE) is a bumpy one—not just because of technical issues, rather because of the regional nature of healthcare laws and regulations that has led to a very fragmented healthcare market.  I overheard someone from a hospital system in Florida at HIMSS say that a Florida-wide exchange may be a good thing, but it doesn’t solve his real problem of the snowbirds who come to Florida in winter but whose primary healthcare providers are in the Northeast. 

But once again, payers are leading the way in “meaningful” exchange of patient data between providers and payers.  The infrastructure created for revenue cycle management applications—eligibility checks, claims submissions, etc.—already exists, so why not build upon it?

In March, I attended the grand opening of NaviNet’s new headquarters in Boston.  I knew that NaviNet provided a communications platform for payers to exchange information with providers and that they were actively expanding their portfolio of services, so I wanted to know more about them.  I left that evening thinking that NaviNet’s existing platform that already connects 470,000 physicians in 128,000 offices to a growing number of large health care plans could be leveraged for exchanging clinical data. 

This week I had a follow-on conversation with Kimberly Labow, Chief Marketing Officer at NaviNet.  Kim confirmed that NaviNet recognizes the opportunity to leverage their existing network to become a single point of contact for business and clinical communications. 

At this point, NaviNet has already expanded to offer practice management and EMR applications to provider clients and has recently launched a mobile eprescribing application in Florida in conjunction with Aetna.  It’s interesting to note that Availity is also part of this strategic partnership because they were working with Aetna and Prematics prior to NaviNet’s involvement.  NaviNet subsequently acquired Prematics, which led to this multi-factorial “coopetition”.  [Note: Aetna has recently acquired Medicity, a health information exchange vendor, which makes the level of coopetition even more multi-dimensional.] However, this level of cooperation is not an anomaly; I see it is a sign of things to come as our healthcare system undergoes periods of consolidation within and across stakeholder groups. 

Given the existing structure of our healthcare system, the payer segment— unlike the providers—has clear incentives to use information to increase efficiency in business and clinical areas.  Payers recognize the benefits of working with patients to encourage more healthful behavior and are taking an active role in creating care plans and follow-on communication with patients.   At the recent Patient-Centered Computing and eHealth: Transforming Healthcare Quality course, Blackford Middleton suggested that in an alternate future, if providers don’t respond to the challenges of adopting health IT and learning how to use and analyze data, they will be disrupted and the insurers will become our healthcare coaches. 

I doubt that many patients, physicians or hospital groups want health insurance plans to become the primary source of health advice and care management.  However, we are moving toward a more integrated payer-provider model with ACOs and we have witnessed the success of integrated delivery networks like Kaiser Permanente. Convergence is occurring from all directions: providers are merging with physician groups, providers are consolidating, payers are consolidating, and payers are also diversifying into healthcare delivery.  A recent Wall St. Journal article described the payer diversification efforts as including: “acquisitions and partnerships that will allow the [health insurers] to employ doctors directly, delivery health information technologies, and participate in new hospital-doctor groups known and accountable-care organizations”. 

With alliances and acquisitions occurring within and across stakeholder lines, it is becoming a challenge to coordinate standards efforts and for analysts like me to try to diagram an industry that’s in flux.

NaviNet is trying to make a contribution toward coordinating efforts with the Unified Patient Information Management (UPIM) platform they are supporting. For my part, I rely on variations of the convergence diagram below that I created some time ago, which attempts to illustrate the clinical information market in an EHR-centric world. The initial version had payers outside of the inner circle. After writing this post, I think it’s time for another updated illustration that more closely aligns providers and payers!

 

Clinical Information Flows in an EHR-Centric World