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.

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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.

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.

Health Data Tell the Story at HIMSS13

 

The overarching theme I drew from HIMSS13 is that we’re in the early stages of understanding how to utilize health data for the benefit of patients.   Keynoter Eric Topol drove this point home by dubbing the “show me the money” scene in Jerry Maguire with “show me the data”: http://e-patients.net/archives/2013/03/show-me-the-data-eric-topol-rocks-the-himss13-keynote.html. Take a look; it’s worth the 1.25 minutes.

Another keynoter, former President Bill Clinton, spoke of how he developed the talent for storytelling growing up in Arkansas without television in his early years. Frankly, I think Clinton would have been a gifted storyteller with or without access to television. I summarized Clinton speech in the following tweet:

@janicemccallum: Lack of #transparency and policies & systems that disempower ordinary people need to change were key themes of Clinton’s keynote at #HIMSS13

Obviously, a single tweet can’t replicate a well-crafted story delivered by a master, but let’s highlight his use of the word “disempower” to describe how patients are treated in the current US healthcare system.  “Disempower” forcefully describes how our current system leaves patients on their own to navigate a complex and obscure system that can have devastating consequences to ordinary people if they are not able to advocate for themselves.

Conversely, a key theme in the exhibit hall at HIMSS was “patient engagement”. Let’s compare the power of the two terms when trying to appeal to “ordinary people”. Patient engagement strikes me as a term dreamed up by marketing to indicate that hospitals and other providers want to figure out how to convince patients that the providers know best, whereas disempowered conveys the sentiments of so many people once they step inside the door of a hospital. Which term is more likely to rally ordinary people to demand changes in healthcare that allow them to participate in their own care? I’ll let you be the judge.

Another Clinton quote that was tweeted by HIMSS relates more directly to health data:

‏@HIMSS: Clinton: “Whole promise of #healthIT is to manage data to know what the heck we are doing. You can do it. No pressure.” #HIMSS13

This statement provides a good segue to other themes central to HIMSS. There’s been so much focus on adoption of software and basic standards for the software that the HIMSS crowd has not focused on the critical task of understanding the content that flows through the EHRs and related health IT systems. Meaningful Use Stages 1 and 2 set the foundation for basic population health metrics, but as clinicians and researchers get a taste for how useful secondary data from EHRs can be, I predict an explosion in interest in analytic tools that help harness and mine health data and an overall maturing of the high-growth highly-fragmented health analytics segment.

At present, we’ve just touched the surface of harnessing health data for the benefit of patients. However, I noted good progress in providing patients access to their health records, as required by Meaningful Use at HIMSS. Recently, a colleague of mine was thrilled just to receive a visit summary from her doctor. After all, this is the first time most of us have received anything in writing from our doctors, with the exception of patient handouts written by Pharma companies or a scrawled Rx to take to the pharmacy. Having access to a more complete history of visits and lab test results is orders of magnitude more powerful than verbal communication in helping patients learn from their health data. To those who say that patients don’t have the ability to understand the information in their health record, my retort at HIMSS was “people love reading about themselves” and are more likely to invest time in understanding data about themselves than they would a generic label insert or patient handout.  

Janice surrounded by HITsm Tweetchat participants Jon Mertz, Michael Planchart, Keith Boone, and Chad Johnson at HIMSS13

On a related note, I participated in a live Tweetchat at HIMSS where my topic was:

How can patient-generated data influence medical care, research and patient engagement?

I chose this topic to open up a discussion of what the future may hold as all stakeholders gain experience and learn how to interpret new sources of data. I was pleased that one of the MDs in the audience supported my view that patient registries and patient reported data represent rich new information sources for medical research that can supplement today’s “gold standard” of randomized controlled clinical trials. See: http://www.hl7standards.com/blog/2013/03/06/in-case-you-missed-it-video-of-the-live-hitsm-chat-courtesy-of-hibc-tv/ starting at 5:40 minutes for my segment of the discussion. [Note, I’m not @motorcycleguy on Twitter. In fact, neither is Keith Boone, who precedes me in this video. It should be @motorcycle_guy. Slight typo on my Twitter handle, too. I’m @janicemccallum.]

To sum up my HIMSS 2013 story, I agree with several other analysts & pundits (e.g., Andy Oram, John Moore, Michael Planchart) who expressed sentiments that there was no awe-inspiring technology or great leap forward exhibited at HIMSS this year. In my view, 2013 is a transition year where the focus shifts from technology to data. Remember, after all, the “IM” in HIMSS stands for Information Management. It has taken a long time to build the basic infrastructure for health IT—and we still have many interoperability and usability issues to work out—but we have a foundation on which we can start building business intelligence/analytic models.

So what does this mean for the health IT vendors? One easy prediction: there will be a slew of alliances and acquisitions between healthIT vendors and analytics firms in the coming year or two.  

Big Data: Helping Scholarly Publishers Cut Through the Hype

Last week, I had the privilege of participating in an executive panel at the PSP Annual Conference in Washington, DC. Topics included semantic technology, mobile technology and models, big data, and user analytics.

My presentation on Big Data was added to Slideshare on Saturday and started trending on LinkedIn and Twitter almost immediately. Clearly, Big Data is a hot topic!  Furthermore, gaining a solid understanding of what Big Data means and what it means to your business is important to publishers of all sorts. This presentation was customized for scholarly publishers, including the top medical publishers, and provides some recommendations for  participating in the high-growth and quickly changing Big Data field.

J mc callumbig datapsp2013 from janicemc

Many thanks to Audrey Melkin from Atypon for inviting me to speak and for moderating the panel. I look forward to your feedback on the presentation and on continuing the conversation about developments in the field of Big Data and healthcare analytics.

Trends in Mobile Health Devices

Happy New Year to all the readers of this blog! You’ve probably noticed that the frequency of posts has declined over the past year. We’re putting more focus on contributing to some other publications (in 2012 that included Health Data Management, Dorland Health’s Social Media in Healthcare, and several others). We’ll add a media page in 2013 to list publications, podcasts, videos, interviews and presentations.  If you’ve so much as dabbled in social media, you know we’re prolific on Twitter (@janicemccallum) and use LinkedIn and Google+ to share industry news. Contact me if you want to know the best way to receive updates that suit your needs.

My parting thought for 2012 relates to mobile health (a.k.a. mhealth). There’s general agreement among analysts that mobile devices and mobile communication vastly improve the ability to reach more patients at a reduced cost. There’s also strong evidence that people who use mobile devices to track their activities and vital signs become better at managing their health. Unfortunately, some regulatory hurdles and standards issues stand in the way of optimal sharing of data between stakeholders.  In addition, there’s not much agreement on what business model will prevail in the field of mhealth. My advice for divining the future of mhealth: think of the medical devices, mobile devices, and the data that are produced and monitored by the devices as an integrated unit because it’s the value of the data that will determine the best potential revenue models in the long run. 

We’re entering a phase where medical devices have become digital sensors that collect, transmit and analyze data. At the same time, the technology has advanced to the point where devices can be miniaturized to allow “wearable tech”, that is, devices that can be clipped to one’s clothing, strapped on one’s body, even imbedded into one’s body. Also, mobile phones are adding physical attachments and apps that extend the functionality of smart phones to include tasks that previously   required single-purpose specialized medical devices—including stethoscopes and ECG machines, like the AliveCor ECG pictured at left. Many of the more advanced apps are targeted to physicians. However, it is consumer interest in wearable tech devices for tracking fitness and vital signs that will drive down costs and increase overall demand for advanced health and fitness applications.

Medical device manufacturers that currently sell implantable devices to providers have some thorny issues to work out related to access and control of the data that are generated by the devices. Hugo Campos, who has an implantable cardioverter defibrillator (ICD), has brought these issues to light through his advocacy efforts based on his desire to learn from the data tracked by his ICD.

The future of mhealth devices and data monitoring will be brighter if the consumers who wear the devices have full access to the data generated by the devices and have control over who else is allowed to access their data. I advise the medical device industry to watch carefully what is happening in the consumer fitness and wellness device segment. Companies like Nike with its Fuelband and Motorola with its MOTOACTV device (both pictured at left), which can be worn on one’s wrist and BodyMedia’s Fit Link armband device are measuring much more than early devices that weren’t much more than upgraded pedometers. The mobile technology will likely follow a standard path of further miniaturization and increasing processing power with costs declining over time. It’s rather ironic that portions of our population that have eschewed traditional wristwatches in favor of mobile phones may soon be sporting devices that include orders of magnitude more functionality than early cellular phones on their wrists as fashion items that have the side benefit of helping them stay healthy—and can tell the time. The wristwatch may soon enjoy a renaissance!

References and further reading for this article:

http://www.npr.org/blogs/health/2012/05/28/153706099/patients-crusade-for-access-to-their-medical-device-data

http://www.domusweb.it/en/design/fitness-by-design/

http://thewirecutter.com/reviews/fitbit-ultra-is-the-best-activity-tracker/

http://www.venturevalkyrie.com/2012/12/10/in-car-health-monitoring-lemon-or-lifesaver/4849

http://www.ihealthbeat.org/special-reports/2012/several-forces-driving-explosion-in-mobile-health-care-industry-experts-say.aspx