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Thursday
May302013

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.

...

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.

Friday
Oct282011

Using Data Content to Build a Patient-Centric Healthcare System

Every healthcare industry pundit seems to be talking about healthcare data: big data, data analytics, patient-generated data, population health data, predictive data, and more. Variations on the theme of: “data, data everywhere, but not a [fill in the blank]” are cropping up all over the place at healthcare conferences. We all agree that electronic medical records, large-scale medical research studies, and devices for recording health and wellness metrics are generating more data, but the expertise for managing the data is in short supply.

At InfoCommerce Group, we understand that data by themselves don’t solve problems, but well-managed data can be programmed to serve any number of purposes. We call it “data that can do stuff”.

Applying best practices for data management requires planning and effort. Quantity without quality will get us nowhere. Join us for the Healthcare Roundtable discussion at Data Content11 next week and participate in a lively conversation about how we can corral the expanding sources of health data, “leverage the liberated data” as I wrote in September, and create a collaborative learning system that establishes a robust base for the next generation of evidence-based medicine and shared decisionmaking between patients, providers and payers. 

Tuesday
May312011

Patient-Centered Computing and eHealth 

In early May, I had the opportunity to attend the Harvard Medical School CME course, Patient Centered Computing and eHealth: Transforming Healthcare Quality. The 2 1/2 day course is directed by  Blackford Middleton,MD, MPH, MSc Corporate Director Clinical Informatics Research and Development Partners HealthCare and co-directed by Patricia C.Dykes, DNSc, MA, RN Senior Nurse Scientist Nursing Research Program Director Center for Nursing Excellence Brigham and Women’s Hospital.  The outstanding faculty of experts included Brent James, Paul Tang, Patti Brennan, John Halamka, Fabienne Bourgeois, Josh Seidman, Victor Strecher, Judy Murphy, and many others.  The full list of the faculty and their affiliations is included on the site linked to above.   I served as the “official tweeter” for the course and want to share with my readers some of the highlights of this practical course designed for the physicians who are responsible for adopting EHRs and applying health IT in “meaningful” ways to improve healthcare quality.

The full transcript can be found at: http://hashtags.foxepractice.com/healthcare-hashtag-transcript.php?hashtag=PCeHealth11.  For smaller doses, you can read the daily summaries here:

Day 1 Summary

Day 2 Summary

Day 3 Summary

The course included workshops, panel discussions and plenary presentations. To give a taste of the topics covered and insights shared, I’m posting a few outtakes from the Twitter stream for #PCeHealth11 below:

 

dahern1 

 Brent James opening keynote sobering view of healthcare crisis but making case of HIT as one key factor for positive change

Clinicians are poor at “rate estimation” and need technology tools to support decision making - James 

bfm 

Brent James — more important to standardize care than anything else to control costs and improve quality. Great opening talk!

 

Sobko: 25% of Medicare recipients had a complication during care transition within 30 days post-discharge

janicemccallum 

Sobko on care transition: setting goals helps engage patients with care plans; also teach them when there is a red-flag.

bfm

 

Vic #Strecher #UMich to achieve behavior change don’t always need Health Coach, often eHeatlh tools sufficient, or combo 

janicemccallum 

Common theme for engaging #patients : establish a mission or goal to drive behavior change. Tools alone aren’t sufficient.

 

#MU incentives have to be aligned so that efficiency gains aren’t viewed as income reduction by some: @jhalamka.

 

#NHIN isn’t a “thing”; it’s a set of data usage agreements and standards: @jhalamka #HIE

 

Micky Tripathi: think of #HIE as a verb, the act of exchanging information. 

 

Common theme here: secure provider-patient communication saves time b/c it replaces phone calls that typically take more time.

 

Recap from @bfm for day 1: healthcare system is in crisis (Brent James) & has severely negative effect on US financial health.

 

Need to train physicians to be effective knowledge managers; simply too much to know everything. @bfm #KM #CDS #pcehealth11

bgaustin 

Paul Tang keynote: cannot change issues like obesity one person at a time. Change must be community-driven.

janicemccallum 

Jon Wald—biggest driver of usage of patient journals in study: marketing of the patient portal by the practice. #PHR

bgaustin 

“Any doctor who can be replaced by a computer deserves to be replaced.” -Dr Warner Slack

janicemccallum 

Who sponsors #PHRs? 50% health insurers; 25% providers. J. Wald, RTI.org

 

Not much focus on #patient-reported data yet in #EHRs; Wald calls it “patient-entered data” or P-E-D. #PHR

 

BI-like dashboards w/ trend data in #EHRs help provide early warning signs to physicians. #analytics

 

Too many facts to remember & the right information is often not available at point of need. #CDS #EBM #POC @bfm

 

Referral is weak link in continuum of care: Zuccotti’s team developed clinical referral management system. Patient role was key.

 

Jonathan Teich def of #CDS: makes the right thing to do the easy thing to do. #EBM

 

Teich refers to #AHRQ’s eRecommendations project: http://bit.ly/jMMS3G #CDS

 

Cool: @jjseidman describing new program #pophealth: http://projectpophealth.org/ Open-sourced qual measures prog. #CDS #MU

 

AF4Q works with #ONC #REC (regional ext. centers) to help them w/ #quality measures; also trying to harmonize the many meaures.

 

janicemccallum

Alt. future: If providers don’t respond to challenges they will be disrupted & insurers & payers will become coaches @bfm

 

#ARRA #HITECH: the $27B tail wagging the $2.5T dog (Paul Tang). #HCR

 

#EHR and #CDS adoption isn’t so much a function of fear of techology; rather physicians need to be convinced of added value. @bfm

 

#ACOs will shine light on importance of handoffs btwn providers & reduce missed communication. Luke Sato

bgaustin

Powerful keynote by Brent James: “Today’s problems are nearly always yesterday’s solutions.” #EBM