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Could On Demand Medical Services Be Good for Doctors?

Could On Demand Medical Services Be Good for Doctors? | Healthcare and Technology news | Scoop.it

I’ve been seeing a lot of discussion lately about the peer sharing economy and how it applies to healthcare. Some people like to call it the Uber of healthcare, but that phrase has been applied so many ways that it’s hard to know what people mean by it anymore. For example, is it Uber bringing your doctor to your home/work or is it an Uber like system of requesting healthcare? There are many more iterations.


I’ll to consider doing a whole series of posts on the Peer Sharing Economy and how it applies to healthcare. There’s a lot to chew on. However, most recently I’ve been chewing on the idea of on demand medical services. In most cases this is basically the Skype or Facetime telemedicine visit on a mobile device. These models are starting to develop and it won’t be long until all of us can easily hop on our mobile device and be in touch with a doctor directly through our phone. In some cases it will be a telemedicine visit. In other cases it might be the doctor coming to visit you. I’m sure we’ll have a wide variety of modalities that are available to patients.


Every patient loves this idea. Every insurance company is trying to figure out the right financial model to make this work. Most doctors are scared at what this means for their business. Certainly there are reasons for them to be concerned, but I believe that this new on demand medical service could be very good for doctors.


In our current system practices do amazing scheduling acrobatics to ensure that the doctor is seeing a full schedule of patients every day. They do this mostly because of all the patient no shows that occur. This makes life stressful for everyone involved. Imagine if instead of double booking appointments which leads to all sorts of issues, a doctor replaced no show appointments with an on demand visit with a patient waiting to be seen on a telemedicine platform. Basically the doctor could fill their “free time” with on demand appointments instead of double booking appointments which then causes them to get behind when both appointments do show up.


I can already hear doctors complaining about them being “mercenaries” and shouldn’t they be allowed free time to grab a coffee. I’d argue that in the current system they are mercenaries that are trying to fill their schedule as full as possible. The current double booking scheduling approach that so many take means that some days the doctor has a full schedule of appointments and some days they have more than a full schedule of appointments. If doctors chose to back fill no-shows with on demand appointments, then their schedule would be more free than it is today. Plus, if they didn’t want to back fill a no show, they could always make that choice too. That’s not an option in the double book approach they use today.


In fact, if there was an on demand platform where doctors could go and see patients anytime they wanted to see patients, it would open up a lot more flexibility for doctors much like Uber has done for drivers. Some doctors may want to work early in the morning while others want to work late at night. Some doctors might want to take off part of the day to see their kid’s school performance, but they can work later to make up for the time they took off (if they want of course).


Think about retired doctors. I’m reminded of my pharmacist friend who was still working at the age of 83. I asked him why he was still working at such an advanced age. He told me, “John, if I stop, I die.” I imagine that many retired doctors would love to still see some patients if they could do it in a less demanding environment that worked with their new retirement schedule. If there was an on demand platform where retired doctors could sign in and see patients at their whim, this would be possible. No doubt this is just one of many examples.


Currently there isn’t an on demand platform that doctors could sign into and see a patient who’s waiting to be seen. No doubt there are many legal, financial and logistical challenges associated with creating a platform of this nature. Not the least of which is that doctors are only licensed to practice in specific states. This is a problem which needs to be solved for a lot of reasons, but I think it will. In fact, I think that legal issues, reimbursement changes, and other logistical challenges will all be solved and one day we’ll have this type of on demand platform for healthcare. Patients will benefit from such a platform, but I believe it will open up a lot more options for doctors as well.

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Google Glass Shown Beneficial for Bedside Toxicology Consults

Google Glass Shown Beneficial for Bedside Toxicology Consults | Healthcare and Technology news | Scoop.it

Although Google Glass may have been pulled as a product for the masses, Alphabet plans on continuing to develop the device for professional applications. And it’s certainly proving itself useful in medicine, as a new study in Journal of Medical Toxicology has shown that it’s useful and effective for tele-toxicology consults. The project involved emergency medicine residents who wore Glass during evaluations of poisoned patients while toxicology fellows and attendings in a remote location participated in the consults via a video connection. They essentially set back and reviewed the findings of the emergency docs, offering advice as necessary.


The study looked at how everyone involved accepted the use of the communication medium, as well as how it affected the care provided. Interestingly, the toxicologists changed their opinions of how to treat the patients in 56% of cases after using Glass. In six cases the antidote that was prescribed was accurately selected only after using Glass. In 11 of cases the connection was too poor for usability, but that can probably be attributed to the network used.

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Hospitals work on allowing patients to actually sleep

Hospitals work on allowing patients to actually sleep | Healthcare and Technology news | Scoop.it

It's a common complaint — if you spend a night in the hospital, you probably won't get much sleep. There's the noise. There's the bright fluorescent hallway light. And there's the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws and the rest.

Peter Ubel, a physician and a professor at Duke University's business school, has studied the rational and irrational forces that affect health. But he was surprised when hospitalized at Duke -- in 2013 to get a small tumor removed -- at how difficult it was to sleep. "There was no coordination," he said. "One person would be in charge of measuring my blood pressure. Another would come in when the alarm went off, and they never thought, 'Gee if the alarm goes off, I should also do blood pressure.'"

"From a patient perspective," he added, "you're sitting there going, 'What the heck?'"

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted.

The American Hospital Association doesn't formally track how many hospitals are reviewing their patient-sleep policies, though it's aware a number are trying to do better, said Jennifer Schleman, an AHA spokeswoman.

And, though few studies specifically link quality of shut-eye and patient outcomes, doctors interviewed said the connection is obvious: patients need sleep. If they get more of it, they're likely to recover faster.

    Traditionally, hospitals have scheduled a number of nighttime activities around health professionals' needs — aligning them with shift changes, or updating patient's vital signs so the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

    "The reality for many, many patients is they're woken up multiple times for things that are not strictly medically necessary, or...multiple times for the convenience of staff," said Susan Frampton, president of Planetree, a nonprofit organization that encourages health systems to consider patient needs when designing care.

    Changing that "seems like kind of easy, low-hanging fruit," said Margaret Pisani, an associate professor at Yale School of Medicine. She is working with other staff at the Yale hospital to reduce unnecessary wake-ups, using strategies like letting nurses re-time when they give medicines to better match patient sleep schedules, changing when floors are washed or giving nurses checklists of things that can and should be taken care of before 11 p.m.

    Not only is the push for better patient sleep part of a larger drive to improve how hospitals take care of their patients, but it is fueled in part by measures in the 2010 health law tying some Medicare payments to patient approval scores. As more hospitals try to improve those numbers, experts said, more will likely home in on improving chances for a good night's sleep.

    "There's a movement toward patient-centered care, and this is definitely a part of it," said Melissa Bartick, an assistant professor at Harvard Medical School.

    That focus makes sense, since federal patient approval surveys specifically ask about nighttime noise levels. A number of hospitals initially struggled to get good scores on that, said Richard Evans, chief experience officer at Boston-based Massachusetts General Hospital.

    His hospital instituted quiet hours -- a couple of hours in the afternoon and between six and eight hours at night, depending on the hospital unit, in which lights are turned low and staff encouraged to reduce their noise levels. It also encourages staff members to consider whether patients really need particular care at night before waking them. "We're trying to [increase awareness] that patients need to rest, and we need to structure our care as much as possible to allow that to happen."

    It's hard to delineate the degree to which such efforts have affected patient approval scores, Evans said. Anecdotally, though, patients have expressed appreciation, he added.

    The Department of Veterans Affairs New Jersey Health Care System is taking this concern even further. In addition to quiet-time restrictions, in which they try to reduce the use of noisy equipment, staff chatter and things like phone volume, patients can opt to have lavender oil sprayed in their rooms or an evening cup of herbal tea to facilitate sleep.

    All of these kinds of changes can help, said Planetree's Frampton. But they don't get at the real problem for most patients.

    "Low scores on quiet-at-night [questions on patient suarveys] are not because it's overly noisy...but because patients are woken up repeatedly," she said. "Their sleep is disturbed so they're lying awake."

    To address that, hospitals may need to look at less obvious questions. At New York's Mount Sinai Hospital, doctors are rethinking when they prescribe medicines as well as what kind, said Rosanne Leipzig, a professor of geriatrics and palliative medicine and who practices at the hospital. For instance, some antibiotics can be given at six-hour intervals rather than four-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every six hours can instead be given four times a day during the hours patients are usually awake.

    The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Leipzig said. But not every patient's condition requires that they be roused every four hours, she added.

    About half of all patients woken up for vitals checks probably don't need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests waking those patients may contribute to bad patient results and dissatisfaction, and could increase the odds of patients having to come back to the hospital.

    Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep — particularly by rescheduling activities, nighttime checks and overnight medication doses so as not to wake patients. That paper, co-written by Bartick, the Harvard professor, found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous side effects such as falling or hospital delirium or confusion.

    "Sleep disruptions are actually not benign as far as patients are concerned," said Dana Edelson, an assistant professor of medicine at the University of Chicago and an author on the 2013 study. "We're putting them at unnecessary risk when we're waking them up in the middle of the night when they don't need to be." And possibly making the recovery a bit more difficult.

    "Patients will tell you, 'I was so exhausted, I couldn't wait to get home and go sleep,'" said Yale's Pisani.

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    National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare

    National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare | Healthcare and Technology news | Scoop.it

    On Aug. 6, the Washington, D.C.-based National Quality Forum released a white paper, “Data Needed for Systematically Improving Healthcare,” intended to highlight strategies to help make healthcare data and analytics “more meaningful, usable, and available in real time for providers and consumers.”


    According to a press release issued on that date, “The report identifies several opportunities to improve data and make it more useful for systematic improvement. Specific stakeholder action could include the government making Medicare data more broadly available in a timely manner, states building an analytic platform for Medicaid, and private payers facilitating open data and public reporting. In addition, electronic health record (EHR) vendors and health information technology policymakers could promote “true” interoperability between different EHR systems and could improve the healthcare delivery system’s ability to retrieve and act on data by preventing recurring high fees for data access.”


    The press release noted further that “The report identifies actions that all stakeholders could take to make data more available and usable, including focusing on common metrics, ensuring that the healthcare workforce has the necessary tools to apply health data for improvement, and establishing standards for common data elements that can be collected, exchanged, and reported.”


    The report emerged out of an initiative supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, and spurred by a 2014 report by the President’s Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.


    The press release included a statement by Christine K. Cassel, M.D., president and CEO of NQF. “Data to measure progress is fundamental to improving care provided to patients and their outcomes, but the healthcare industry has yet to fully capture the value of big data to engineer large-scale change,” Dr. Cassel said in the statement. “This report outlines critical strategies to help make data more accessible and useful, for meaningful system wide improvement.” 

    Following the publication of the report, Rob Saunders, a senior director at the National Quality Forum, and one of the co-authors of the report, spoke with HCI Editor-in-Chief Mark Hagland about the report and its implications for healthcare IT leaders. Below are excerpts from that interview.


    What do you see as the most essential barriers to moving forward to capture and correctly use “big data” for clinical transformation and operational improvement in healthcare?

    There are sort of two buckets we looked at through this project. We looked at the availability of data, and we’re seeing more availability of electronic data. Interoperability remains a major challenge. But it wasn’t just about interoperability between electronic health records, but also being able to link in data from elsewhere.


    Does that mean data from pharmacies, from medical devices, from wearables?

    Some of these may be kinds of data from community health centers, or folks offering home-based and community-based services. So, getting a broader picture of people’s health, as they’re living their lives in their communities. And there are exciting things on the horizon, too, like wearable devices. But the first barrier we heard about was just getting more availability of data. Perhaps the harder problem right now is actually using more data, and turning that raw data into meaningful information that people can use. There’s so much raw data out there, but it so often is not actionable or immediately usable to clinicians.


    So what is the solution?

    That is an excellent question. Unfortunately, there’s no silver bullet. We’ve looked at a wide range of possible solutions, but it will take action from healthcare organizations trying to improve their internal capacity, for example, creating more training for clinicians to use data in their practices, or even state governments taking action. I think it will require a lot of action from all the stakeholders around healthcare to make progress.

     

    The white paper mentioned barriers involving information systems interoperability, data deidentification and aggregation, feedback cycles, data governance, and data usability issues. Let’s discuss those.

    I think one of the challenges with all of those is that there are some big strategic issues around all of those, and some large national conversations around all of those, esp. interoperability, but there are also just a lot of large technical details to iron out. And unfortunately, that’s not something we can just solve tomorrow. But there’s opportunity with these new delivery system models, and that will hopefully be helpful.


    How might all this play out with regard to ACOs, population health, bundled payments, and other new delivery and payment models?

    What we’ve heard is that those new models are becoming increasingly more common, and because of those, clinicians and hospitals have far more incentive to look far more holistically at the entire person, and think about improvement, and to really start digging into some of this data.


    Marrying EHR [electronic health record] and claims data for accountable care and population health is a very major topic for our magazine and its readers right now. Let’s talk about those issues.

    We didn’t necessarily go into great depth on that particular challenge. But clearly, that’s one of the big issues in trying to link all these different data sources together, and it also speaks to the challenge in getting this data together.


    Is there anything that healthcare IT vendors need to do better?

    And we actually called out healthcare IT vendors and EHR vendors, because they’re a really important sector here. Promoting interoperability speaks to both policy and technical challenges.


    Are you also concerned about data blocking?

    Yes, that’s how ONC and HHS have characterized it. But yes, we’re really talking about data access. Clearly, that’s a barrier. And then there are still some technical pieces here around how to create APIs that can really start to allow more innovative ways to analyze the data that’s already in a lot of these EHR and health IT systems, and that will allow some customization and capabilities.


    What’s your vision of change for the use of data in healthcare?

    There are a number of folks doing really exciting work using data for systemic improvement. So we showcased Virginia Mason as a model. And some of their work involves manual collection of data. And that can produce really remarkable results; and as you become more sophisticated, you’re able to incorporate that data collection into the EHR [electronic health record]  and other systems. That speaks to what we said earlier, that availability of data is a good thing, but it’s the use of data that seems to be more of an issue. Premier Inc. has done some really good things, collecting data through some of their groups, to share; and oftentimes, that was data people didn’t even have before.  You can also activate clinicians’ professional motivation—many physicians, nurses, really want to make care better for their patients. And data really can make a difference in that.

    And the last point is the fact of the important role that brings this down to patients and consumers, involving the broader public in this. What we’ve talked about so far has been very technical. But patients have a lot of data about themselves, and they’re also able to help out with a lot of this.

     

    So you’re talking about patient and consumer engagement in this?

     

    Yes, I am, but it’s not just that. I’m also talking about patients as an untapped data resource, and an untapped resource in general of folks who are highly motivated and who want to make care better, if they have the tools available and are able to do so.

     

    The “blessed cycle” of data collection, data analysis, data reporting, the sharing of data with end-users and clinician leaders for clinical and operational performance improvement, and the re-cycling into further data collection, reporting, etc., is very important. Any thoughts on that concept?

     

    We didn’t necessarily talk about that concept per se, but we did talk about the general idea of this all being a process. And improvement needs to start somewhere, and oftentimes, you need to start small. And your data will be rough and dirty when you start; and that’s not necessarily a bad thing. The real pioneers in this area started out with rough, dirty data, and learned by using that data, and were able to increase their sophistication over time. So that’s part of the issue—bringing data together, oftentimes, you don’t know what data you need, until you start to use it.

     

    So what should CIOs, CMIOs and their colleagues be doing right now, to help lead their colleagues forward in all these activities?

     

    We really want to encourage more organizations to start doing this type of system improvement work. There’s more that can be done, so we want to encourage that. And the second message that permeated the entire project was not only making sure that more data should be made available, but also building up use, and to encourage more folks to get into systematic improvement.

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    lucy gray's curator insight, August 17, 2015 11:35 AM

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    Why and Who Should Ensure Quality Health Data?

    Why and Who Should Ensure Quality Health Data? | Healthcare and Technology news | Scoop.it

    Contrary to common belief, technology does not own health data. Data exists as a result of the input of multiple sources of information throughout each patient’s healthcare continuum. The data does not exist only because of the technology but rather because of the careful selection of meaningful data items that need to be captured and at what frequency (ie. instantly, daily, weekly, etc.).


    We in healthcare collect granular data on anything ranging from demographics, past medical, surgical, and social history, medication dosage and usage, health issues and problem lists, disease and comorbidity prevalence, vital statistics, and everything in between. We collect data on financial performance with benchmarks and reimbursement trends using individual data elements from accounting transactions. Healthcare organizations have been collecting the same or similar data for decades but never before have we been able to operate with such efficiency as we do now thanks to advances in technology.


    We have become so data rich in the healthcare environment in a short amount of time and this data continues to multiply daily. But are we still information poor? When we continue to generate data but fail to aggregate the data into quality information, we are essentially wasting bandwidth and storage space with meaningless and disconnected data.


    Every time patients have interactions with healthcare providers and facilities, data is generated. Over time, the data that is generated could (and should) be used to paint a picture of trends in patient demographics, population health, best practices in care, comorbidities and disease management, payment models, and clinical outcomes. This information becomes useful in meeting regulatory requirements, overcoming reimbursement hurdles, clinical quality initiatives, and even promotional and marketing material for healthcare organizations. This data could have opposite effects if not properly governed and utilized.

    It goes back to the saying “garbage in, garbage out.” If the data cannot be standardized or trusted, it is useless. Input of data must be controlled with data models, hard-stops, templates, and collaborative development of clinical content. Capturing wrong or inconsistent data in healthcare can be dangerous to the patients and healthcare quality measurements as well as leading to unwanted legal actions for clinicians.


    So who is the right person for the job of ensuring quality data and information? I have seen bidding wars take place over the ownership of the data and tasks surrounding data analysis, database administration, and data governance. Information Technology/Systems wants to provide data ownership due to the skills in the development and implementation of the technology needed to generate and access data. Clinical Informatics professionals feel they are appropriate for the task due to the understanding of clinical workflow and EHR system optimization. Financial, Accounting, Revenue Integrity, and Decision Support departments feel comfortable handling data but may have motives focused too heavily on the financial impact. Other areas may provide input on clinical quality initiatives and govern clinician education and compliance but may be primarily focused on the input of data instead of the entire data lifecycle.


    When searching for an appropriate home for health data and information governance, organizations should look no further than Health Information Management (HIM) professionals. Information management is what HIM does and has always done. We have adapted and developed the data analytics skills needed to support the drive for quality data abstraction and data usage (just look at the education and credentialing criteria). HIM departments are a hub of information, both financial and clinical therefore governing data and information is an appropriate responsibility for this area. HIM also ensures an emphasis on HIPAA guidelines to keep data secure and in the right hands. Ensuring quality data is one of the most important tasks in healthcare today and trusting this task to HIM In collaboration with IT, Informatics, and other departments is the logical and appropriate choice.

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    cdebie's curator insight, August 17, 2015 4:32 AM

    As we get inundated with health data from multiple sources,, aggregation, classification and interpretation will require specialised skills and dedicated resources.

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    Where big data falls short

    Where big data falls short | Healthcare and Technology news | Scoop.it

    Big data and analytic tools have not yet been harnessed to bring meaningful improvement to the healthcare industry.

    That's according to a new report from the National Quality Forum outlining the challenges to making health data andanalytics more usable and available in real time for providers and consumers.


    Whereas big data has supported improvement in certain settings, such as reducing ventilator-acquired pneumonia, data analytics has been largely overlooked in the area of healthcare costs, even though this data can inform and assess efforts to improve the affordability and quality of care.


    What's more, effective data management is necessary for the success of other incentives to enhance care, such as payment programs, as providers need timely information to understand where to improve and track their progress.


    NQF found multiple challenges to making better use of health information, such as interoperability and linking disparate data sources, leveraging data for benchmarking, providing the ability to gather data directly from patients and de-identify it to generate knowledge, and the need to ensure that the data itself is trustworthy.


    Then there's the matter of electronic health records software. "While greater EHR adoption is positive, these records do not contain all of the data needed for improvement," the report said. NQF pointed to operational or clinical data not captured in an EHR, such as the time a nurse spends caring for a particular patient or the time to transfer a patient from surgery to a post-operative recovery unit to a hospital room, as common examples.


    The report noted there have been many ongoing attempts to develop interoperability between EHRs and clinical data sources recording patients' experiences and outcomes. Beyond linking healthcare data, however, "there is a need to learn from data spanning other determinants of health, as the most significant and sustained individual and population healthimprovements occur when healthcare organizations collaborate with community or public health organizations."


    NQF also highlighted a widespread need to appreciate the value of nonfinancial incentives, such as peer and public reporting, in improvement initiatives.


    "Overall, there was a desire to move from a retrospective approach of quality metrics and analytics to one that uses real-time data to identify potential challenges and gauge progress," the report said.


    The report was supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, the initiative was spurred by a 2014 report by the President's Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.

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    What Obama's precision medicine plan needs to succeed

    What Obama's precision medicine plan needs to succeed | Healthcare and Technology news | Scoop.it

    President Obama's Precision Medicine Initiative to accelerate understanding of individual variability and its effect on disease and treatment is going to necessitate a regulatory system robust enough to facilitate big data analytics for genomics research – no small feat.


    That's according to a white paper by the Center for Data Innovation and Health IT Now Coalition, in which the authors contend that to be maximally effective this initiative will require the public and private sectors to work in tandem to realize the next generation of medicine and overcome the institutional challenges that increasingly hinder progress.


    Policymakers, in other words, must modernize the regulatory system. To that end, the authors recommend the following:


    1. Improve interoperability and data sharing. Stronger federal requirements are needed to ensure that genomic and other health data can be retrieved and compared across health record systems


    2. Engage patients. The public and private sectors share an interest in raising the tone of discourse on the role that genomics and other big-data applications might play in revolutionizing our expensive and underperforming health system


    3. Re-think privacy law. The strict privacy requirements of the Health Information Portability and Accountability Act and complementary federal and state laws, including the Common Rule, present formidable obstacles to realizing the potential of genomic medicine


    President Obama included $215 million in his latest budget to fund initiatives at the National Institutes of Health, the National Cancer Institute, the Food and Drug Administration, and the Office of the National Coordinator for Health Information Technology.

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    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market?

    What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market? | Healthcare and Technology news | Scoop.it

    As if everyone’s heads in healthcare IT weren’t already spinning like that of Linda Blair in 1973’s “The Exorcist,” here comes yet another acquisition in healthcare IT, this time the Armonk, N.Y.-based IBM announcing on Thursday its acquisition of the Chicago-based Merge Healthcare.


    All mergers and acquisitions are interesting, but this one offers particular facets worth pondering. First of all, of course, its timing, less than four months after that giant company had just swallowed up the Dallas-based Phytel and the Cleveland-based Explorys back in April, a move announced during the HIMSS Conference.


    That double acquisition is one of the reasons that we editors at Healthcare Informatics made IBM one of our “Most Interesting Vendors” this year, as its trajectory has encapsulated some of the mergers and acquisitions that have taken place in order to give some vendors a particular edge as competition intensifies in the healthcare IT world. As Senior Editor Rajiv Leventhal wrote regarding IBM’s analytics push, “Enter the Watson Health Cloud, which IBM will sell to doctors, hospitals, insurers and patients. That offering will be the centerpiece of a new dedicated, Boston-area business unit, IBM Watson Health, which now includes both Explorys and Phytel.” Leventhal quoted Anil Jain, M.D., chief medical officer (CMO) for Explorys, as saying that “[IBM] is complimenting much of what we do around traditional analytics using machine learning algorithms with some of the cognitive computing and the Watson analytics that Watson Health group will be leveraging. We became the content that will fuel some of the next generation analytics that Watson has become famous for.”


    In a blog published today on AuntMinnie.com, staff writer Erik Ridley wrote this: “For IBM's new Watson Health unit, the deal gives the company access to Merge's image management and analysis software and its installed base of more than 7,500 U.S. institutions, clinical research institutes, and pharmaceutical companies. IBM is adding Merge to other recent acquisitions, such as population health firm Phytel and cloud-based healthcare intelligence company Explorys.”

    Ridley went on to note that “IBM plans to offer Watson Health Cloud to analyze and cross-reference images against lab results, electronic health records (EHRs), genomic tests, clinical studies, and other health-related sources. In aggregate, these represent 315 billion data points and 90 million unique records, according to the company. This could provide Merge's installed base with a useful consolidated, patient-centric view of current and historical images, EHRs, data from wearable devices, and other related medical data.”


    So far, so good. I think that IBM is gaining clear advantage in acquiring Merge Healthcare at this time., as it brings imaging informatics into the fold and potentially will integrate elements of imaging informatics with its already-advancing work in analytics. Indeed, Joe Marion, a Wisconsin-based consultant who blogs regularly for Healthcare Informatics and who is one of the most knowledgeable observers of the imaging informatics sector around, sees clearly the advantages to this pairing. As Joe wrote Thursday in a blog on this site, “Today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.”


    Joe further noted that, “In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS [radiology information system/picture archiving and communications system (issues)] previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And,” he added, “the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.”


    I agree completely with Joe’s perspective on this. Now, what about Merge Healthcare itself? I’ve been following Merge very closely as a company for several years now. Merge has some very talented senior executives, and solutions that are respected and appreciated by providers. The challenge for the company’s senior management has been facing is the shifting landscape of the imaging informatics market right now. PACS solutions have become almost totally commoditized; I’m sure there are PACS systems that are at last marginally better than others, but, given the accelerating demands facing patient care organizations, the need to move quickly into accountable care- and population health-based arrangements, and clinicians’ demands for always-available computing, even significant solution quality differentiation is simply no longer enough (and let’s not even talk about how commoditized RIS solutions have become).


    So, clearly, for senior executives at Merge, a respected company that has been going through some major management changes and has been treading water in a rapidly shifting imaging informatics vendor landscape, this deal makes a lot of sense, too.


    The challenge now will be to make this pairing work for current Merge Healthcare customers and for IBM customers—and customers of the former Phytel and Explorys, too. We all know about the trajectories of healthcare IT vendors that have grown too rapidly through acquisition and that have ended up becoming a jumble of unintegrated parts.

    IBM’s moves so far seem thoughtful and precisely judged. Only time will tell how everything turns out ultimately—and clearly, that will depend on execution. Skillful execution is to healthcare IT what location is to real estate—a fundamental element of success. And this trajectory for IBM is a fascinating one. So stay tuned—because this is going to be an interesting path ahead.

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    A Potential Change to Stark Regs. Affecting Docs

    A Potential Change to Stark Regs. Affecting Docs | Healthcare and Technology news | Scoop.it

    On July 8, 2015, CMS issued the proposed 2016 Physician Fee Schedule (“Proposed Rule”), which was published in the Federal Register one week later.  Among many provisions within the proposed rule were ones that could possibly impact the physician self-referral regulations (“Stark”). This included the following:


    • Recruiting advanced practitioners may become easier under CMS’ proposal to establish a new Stark exception for payments made by a hospital, Federally Qualified Health Center (“FQHC”), or Rural Health Center (“RHC”) to a physician to assist in the recruitment and employment of non-physicians.  This would allow the recruitment of PAs, NPs, and other mid-levels, as long as they become bona fide employees of the physician or physician practice receiving the support and if they are employed to render primary care services. CMS’ proposal would limit the financial support to two years, but the exception would otherwise be similar to the current recruitment exception.


    • Easing technical issues and confusion is another goal of the Proposed Rule’s changes to Stark, particularly as it relates to CMS’ Voluntary Self-Referral Disclosure Protocol. Some clarifications that are proposed, which will be beneficial to providers include:


      a. Clarifying that a “writing” or “written agreement” does not actually require a single formal contract. This means that a series of contemporaneous documents that could demonstrate the course of the parties’ conduct could meet this “writing” requirement, depending on the facts.


      b. Providing 90 days (instead of the current 30 days) to obtain missing signatures to an agreement, regardless of the reason the parties failed to obtain the signatures in a timely manner.


    c. Allowing a holdover arrangement as long as it continues on the same terms and conditions as the original compliant arrangement and payment remains fair-market value throughout the holdover period.


    • CMS proposes to allow timeshare leases under a new exception for lease arrangements involving the non-exclusive “timeshare” lease of space, equipment and personnel.  Arrangements would qualify if certain requirements are satisfied, and as long as the arrangement does not involve advanced imaging equipment, radiation therapy equipment, or clinical /pathology laboratory equipment. This exception would not be available to non-hospital/ physician organizations (such as IDTFs and clinical labs) and the space must be used predominantly.


    One other non-Stark item in the Proposed Rule that may be particularly interesting to physicians is a change to the “incident to rules.” These  provisions allow services provided by auxiliary personnel to be billed as though furnished by a physician or other provider if direct supervision is provided (except chronic and transitional care management, which now requires only general supervision).  Although many physicians already grapple with proper use of these rules, CMS now proposes to require “that the physician or other practitioner who bills for ‘incident to’ services must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the ‘incident to service.’”  


    Under the current regulations, the billing physician or other practitioner need not be the supervising physician or other practitioner.  This rule may complicate scheduling among providers and make the provision of transitional care management and chronic care management less cost-effective, since these services currently only require general supervision. Furthermore, the proposed changes are not in keeping with efforts to reduce health care costs and increase efficiencies.

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    NIH is asking for feedback on using smartphones and wearables to collect medical information

    NIH is asking for feedback on using smartphones and wearables to collect medical information | Healthcare and Technology news | Scoop.it

    The NIH is currently asking for pubic feedback on using smartphones and wearables to collect health and lifestyle data for its Precision Medicine Initiative — an initiative that hopes to collect data on more than 1 million individuals. The NIH’s Precision Medicine Initiative is described as:


    a bold new enterprise to revolutionize medicine and generate the scientific evidence needed to move the concept of precision medicine into every day clinical practice


    What exactly that means is a bit nebulous, but a New England Journal of Medicineperspective sheds some light:


    Ultimately, we will need to evaluate the most promising approaches in much larger numbers of people over longer periods. Toward this end, we envisage assembling over time a longitudinal “cohort” of 1 million or more Americans who have volunteered to participate in research.


    Qualified researchers from many organizations will, with appropriate protection of patient confidentiality, have access to the cohort’s data, so that the world’s brightest scientific and clinical minds can contribute insights and analysis.


    The NIH is specifically asking the following:


    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.


    It’s exciting to see the NIH see the potential of digital health. They specifically mention how smartphones and wearables can be utilized to collect a wide variety of data: location information, mobile questionnaires, heart rate, physical activity levels, and more.


    There is already a robust discussion taking place in the comments section at the NIH website, and we encourage our readers to contribute.

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    Richard Platt's curator insight, July 30, 2015 7:37 PM

    The NIH is specifically asking the following:

    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
    Lionel Reichardt / le Pharmageek's curator insight, July 31, 2015 1:31 AM

    The NIH is specifically asking the following:

    • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
    • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
    • How often people would be willing to let researchers collect data through devices without being an inconvenience.
    • The kind of information participants might like to receive back from researchers, and how often.
    • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
    Heather Taylor's curator insight, August 31, 2015 10:33 PM

    #wearables #healthcare #wearabledevices

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    The Age of Fitness Trackers

    The Age of Fitness Trackers | Healthcare and Technology news | Scoop.it

    Fitbit… AppleWatch… Jawbone — Oh my! The age of personal fitness trackers is upon us and judging by its rapid growth, it is here to stay. Worldwide, healthcare is experiencing a massive shift in the way patients and physicians are interacting with medical records and information. Technology and Federal Regulations are among the many driving forces serving to reshape the medical industry; growing technological innovations such as Cloud technology and fitness trackers are inspiring a new era characterized by interactive, patient-centered care. With home health technologies projected to skyrocket — jumping from 14.3 million worldwide in 2014 to 78.5 million by 2020 — the ability for patients to access images, information, and updates is no longer a luxury but a necessity. As fitness trackers, Cloud technology, and other innovations continue to improve upon the immediacy and ease with which patients can access personal medical records, physicians and consumers alike are being prescribed an entirely new patient care experience.


    Fitness trackers such as Fitbit’s “Charge HR”, Apple’s “Sport Watch”, and Jawbone’s “UP2” have made an enormous dent within an ever-expanding wearable technologies market. The Fitness tracker craze has transcended various demographics including age as both Millenials and older generations are exhibiting support for the use of wearable technologies within the fitness world and in other markets.


    Regarding fitness trackers specifically, consumers cite improved safety, healthier living, and ease of use when discussing the benefits of wearing such products. With features such as heart-rate monitoring, sleep tracking, and exercise progress reports, fitness trackers are redefining the ways in which consumers interact with and view personal health records. Currently, about 1 in 5 adults owns a wearable device. This number is expected to grow as healthcare and technology continue to fuse in an effort to bring patients’ needs to the forefront of EMR accessibility regulation.


    Many are projecting healthy growth for the future of fitness tracking wearable device technology markets. As stated in the PWC article entitled, “Wearable Technology Future is Ripe”, “As wearable devices gain traction over the next five to ten years, they can help consumers better manage their health and their healthcare costs.” The article continues to point out that, “ wearables’ potential in the $2.8 trillion US healthcare system will only be realized if companies engage consumers, turn data into insights and focus on improving consumer health.” As Meaningful Use and other Federal Government regulations continue to guide healthcare systems toward more efficient, patient-centered processes it seems likely that the growing fitness tracker market will undoubtedly impact the future state of healthcare in the US and beyond.


    Is your practice in shape for a health tech driven future?

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    Nicole Avarello's curator insight, July 16, 2015 1:35 PM

    Do you track your fitness? I have been considering about investing in a FitBit for quite some time now. The benefits seem nice and I am hoping it will motivate me to be more active and conscious of my decisions.

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    Epic at work on new tech to avert falls

    Epic at work on new tech to avert falls | Healthcare and Technology news | Scoop.it

    Healthcare IT giant Epic is working on a clinical decision tool aimed at helping healthcare providers reduce the risk of falls in unsteady patients. The technology is expected to be ready and available to Epic's EHRclients by year's end.


    Longtime Epic customer Kaiser Permanente will roll out the tool at its facilities across the country and will also make its evidence-based falls prevention program widely available to other health systems and health plans.

    The technology is called STEADI, an acronym for Stopping Elderly Accidents, Deaths & Injuries. The tool is being designed based on CDC's guidelines for falls assessment. The goal is to make it easier for healthcare providers to screen for falls, intervene to reduce risk and provide follow-up care.


    The announcement came at the end of a White House Fact Sheet released this morning regarding The White House Conference on Aging, which President Barack Obama is hosting today.


    The sweeping conference agenda focuses on issues facing Americans as they plan for retirement. Many of the measures proposed build on the Affordable Care Act and on efforts to improve Medicare and Medicaid.


    "In a year that marks the 50th anniversary of Medicare, Medicaid and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging is an opportunity to recognize the importance of these programs, highlight new actions to support Americans as we age and focus on the powerful role that technology can play in the lives of older Americans in the decade ahead," the White House announced.

    Federal data to be released

    The Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans would be made easily available on Data.gov, the repository for the U.S. government's open data. This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety and education. 

    Health IT efforts

    Like Epic's several of the planned initiatives surrounding the aging initiative have healthcare IT underpinnings. These are put forward by the private sector:


    • As part of its annual HackFest, LeadingAge, an association of 6,000 not-for-profit organizations and businesses representing a broad field of aging services, will partner with Hewlett-Packard using HP's 3D immersive computing platform and Federal open data to challenge innovators to create technology-driven tools to improve the lives of older adults and their families.
    • The employer coalition ReACT (Respect a Caregiver's Time), Care.com and the Massachusetts Institute of Technology are joining forces to generate the tools employers need to effectively support employees who are caregivers. MIT and Care.com will jointly conduct a case study based on MIT's approach to employer-supported elder care. 
    • Uber is announcing pilot programs in Florida, Texas, Ohio, Arizona and California that will partner with senior community centers and other advocates to provide free technology tutorials and free or discounted rides to older Americans to increase access to transportation options and support mobility and independence.
    • Airbnb has conducted research to support and understand the experience of older Americans in their travels and in their use of technology and is partnering with communities to enhance accessibility and the user experience for older populations. 
    • Walgreens has made advancements in its digital technologies to connect individuals with its telehealth services provider, which offers 24/7 access to U.S. board-certified doctors.  Seniors also can track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.
    • Peapod has adopted "best in class" Web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications. 
    • Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans. 
    • The University of Washington's School of Nursing and the HEALTH-E (Home-based Environmental Assisted Living Technologies for Healthy Elders) initiative are introducing an Aging and Technology Laboratory, which includes hardware and software tools to support participatory design of technology for older adults.  The laboratory will allow scientists, engineers, and others to engage older adults and their families to accelerate the generation of new solutions to support aging.
    • The Stanford Center on Longevity will develop a State of Longevity Index to be released in early 2016 that will measure how well the U.S. is doing to improve the prospects for long-term well-being in financial security, physical health, social connectedness, educational attainment, and age-friendly communities. 
    • IDEO is announcing the launch of "The Powerful Now," a project to build a cross-sector collaboration around positive aging for all.


    Among the planned government initiatives are.


    • Facilitating state efforts to provide workplace-based retirement saving opportunities: About a third of the workforce lacks access to a workplace retirement plan, the White House notes. That's why, in every budget since taking office, the President has put forth proposals to provide access for 30 million Americans to workplace-based retirement savings by requiring employers not currently offering a retirement plan to automatically enroll their workers in an IRA.  But in the absence of Congressional action, the states are leading the charge.
    • Launching Aging.gov – today: The intent is to provide older Americans, their families, friends and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.
    • Modernizing federal rules that affect long-term care, healthy aging and elder justice: Steps announced today include: a new Centers for Medicare and Medicaid Services proposed rule to update, for the first time in nearly 25 years, the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities to improve quality of life, enhance person-centered care and services for residents in nursing homes, improve resident safety, and bring these regulatory requirements into closer alignment with current professional standards.
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    Four Unique Healthcare Apps

    Four Unique Healthcare Apps | Healthcare and Technology news | Scoop.it

    The last seven years has seen the rise of the smartphone and tablet as personal technology devices utilized by almost all professions in some capacity or another. The healthcare industry is no different and the veritable volume of applications or "apps" that have been developed and utilized by physicians and patients in the last few years has skyrocketed. Inevitably, the large volume of apps makes it difficult for individuals looking to make an impact to stand out in the crowd, as certain conventions become standard. Having a unique "hook" definitely helps to boost such apps into the spotlight, but it also serves to help physicians and patients look at new ways to utilize software (and the devices they run on).


    CARROT Fit


    Sometimes, "unconventional" is as simple as looking at something in a different or even humorous way. For example, CARROT Fit is an app developed by Brian Mueller that provides you with a sarcastic and merciless "fitness overlord" (modeled after his mother, sister, and wife) who motivates you through such innovative techniques as referring to you as "meatbag" and threatening you with "squirrel attacks" (yes, you read that right) when you fail to exercise. Mueller started out by writing alarm clock and to-do apps and received such a positive response about the personality of the Carrot A.I. (artificial intelligence) that a workout app seemed like the next logical step.


    '"The CARROT series of apps are all about taking things that people hate doing … and making them fun and rewarding," said Mueller. "I think most people feel upset when they step on a scale … but CARROT's humor turns that around and makes it a positive experience they can laugh about — and because they connect with the character so much, they're actually motivated to do better the next day."


    Bowel Mover Pro and Autism Tracker Pro


    Another way to stand out in a field of "me too" health apps is to focus on areas of health that may be less common or more challenging to discuss. Case in point is developer Uwe Heiss. His company, Track & Share, developed Bowel Mover Pro and Autism Tracker Pro to empower patients with self-tracking tools that would make the patient-care team encounter more effective.


    Any physician who has ever had to discuss bowel habits with an IBS patient knows how frustrating it can be to get vague feedback on patient symptoms. "All of my apps are designed to help people to spot trends, patterns, and how things might be related to each other," said Heiss. "For example, 'Does stress appear to aggravate my IBS symptoms?' 'Since I started Yoga, did my daily average stress level go down?' 'Was I able to avoid peak stress …?'"


    Heiss stresses that three things which guided the design of his apps were the ability to highly customize what patients tracked, to provide powerful graphing options to identify patterns over time, and the ability to share data via external tools such as Excel, increasing the physician's ability to use the data in a meaningful way.


    Symple


    Developer Natasha Gajewski echoes some of these thoughts and developed her symptom-tracking app around one basic concept that also gave the app its name, "Symple." "I developed this app when I became a patient … one of my most important duties was to deliver an accurate symptom history between doctor visits," she said. "I had limited use of my hands and fingers … so I designed the touch interactions to be as simple as possible. We also worked hard to keep the cognitive load to a minimum."


    One thing is certain. Regardless of the reason for defying convention, all developers believe the future of medicine will involve more integration of such apps and more active user interaction in an effort to enhance the patient-doctor encounter. At the end of the day, if visionaries succeed in this lofty endeavor, it will be because of the conventions they chose to modify or ignore in an effort to stand out and stand up for a better healthcare experience.

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    Readmissions Penalties Get Very, Very Real

    Readmissions Penalties Get Very, Very Real | Healthcare and Technology news | Scoop.it

    It was quite bracing to read the August 3 Kaiser Health News report entitled “Half of Nation’s Hospitals Fail Again to Escape Medicare’s Readmission Penalties.” As Jordan Rau wrote in the article, “Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge—this time losing a combined $420 million, government records show. In the fourth year of federal readmission penalties,” Rau reported, “2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital—readmitted or not –starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged. Since the fines began,” he added, “national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.”


    What’s more, Rau noted, “Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found.”


    As hospital executives already know, the fines for failure to meet the criteria of the Centers for Medicare & Medicaid Services (CMS) focus on five conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacements, and are based on readmissions between July 2011 and June 2014.


    And these reimbursement cuts are everywhere—indeed, the penalties will be assessed on hospitals in every state except for Maryland, as that state has a special payment arrangement with Medicare. And the cuts will affect three-quarters or more of hospitals in the following states: Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, and the District of Columbia.


    What’s more, the readmissions-driven reimbursement cuts are hitting hospitals on top of cuts coming out of the mandatory value-based purchasing program and the mandatory healthcare-acquired conditions (mostly hospital-acquired infections) program.


     Meanwhile, the average penalties by state are being found to vary tremendously. Nationwide, 54 percent of hospitals (2,592 organizations) are being penalized, with an average Medicare pay cut of 0.61 percent. But those nationwide averages encompass huge variations. On one end of the spectrum, in North Dakota, where only three hospitals, or seven percent of the state’s hospital organizations, are being penalized this year, the average penalty is just 0.14 percent of Medicare payments. But in Kentucky, where 62 organizations, representing 65 percent of the state’s hospitals, are being penalized, the average penalty amounts to a full 1.19 percent of Medicare revenues—that’s an 850-percent spread.


    And as everyone knows, many not-for-profit community hospitals in the U.S. are surviving on operating margins of between 1 and 3 percent; and for those with a majority of their revenues coming from Medicare reimbursement, a penalty of more than 1 percent could potentially be devastating.


    Five years ago when the U.S. Congress passed he Affordable Care Act, and President Obama signed it, I predicted that the mandatory readmissions program would be one of the healthcare system reform provisions in the ACA that would be one of its most impactful; and it already has been. As we all know, ten years ago, if you were talk walk into the office of the average CFO in the average inpatient hospital in the U.S. and were to ask that CFO what her/his hospital’s average 30-day readmissions rates were for patients with documented congestive heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), s/he could likely not have told you. Now, that CFO needs to know that number—and needs to be working with all levels and disciplines of leadership in her/his hospital to reduce that number.


    What’s more, private health insurers are absolutely moving forward to implement similar programs in their hospital contracts, since, as is nearly always the case with such things, once the Medicare program, the U.S. healthcare system’s proverbial 800-pound gorilla, moves forward in an area, all the major private health insurers quickly follow Medicare’s lead and design their own versions of the same initiative.


    Industry experts have long noted that many, if not most, readmissions that occur within 30 days are relatively easily predicted. Research, and the experiences of pioneering hospital organizations, have found that the key gaps in this area have to do with care management on multiple levels—ensuring effective discharge planning, including really robust patient and family member education; and then, very importantly, case manager/care manager nurse follow-up with the discharged patient in a day or two at most following discharge, via phone communication, which must involve the scheduling of a follow-up primary care physician appointment; and then of course, that follow-up PCP visit, along with further coaching, education, and care management.


    And all of those processes must be strategically directed, excellently executed, and very strongly facilitated by robust information systems run by hospital and health system leaders with commitment to strategic goals and to success over long periods of time and across large groups of patients. Now, clearly, the leaders of many patient care organizations are moving forward with alacrity to develop accountable care organizations (ACOs), either under the aegis of one of Medicare’s ACO programs, or in collaboration with private health plans; as well as implementing population health management programs, and developing patient-centered medical homes.


    But here’s the thing about the Medicare readmissions reduction program: because it’s mandatory, it is forcing action on the part of every hospital that receives regular Medicare payment, regardless of whether or not that hospital is also pursuing ACO, population health, or PCMH strategies, or not.


    So the same “blessed cycle” of performance improvement is called for on the part of all regular U.S. hospitals receiving Medicare reimbursement, at this point. And that means creating really good data collection and reporting mechanisms, reporting the data, developing continuous clinical performance improvement processes to reduce predictable 30-day readmissions, making those improvements, and continuously sharing with clinicians, clinician leaders, and administrative executives and managers the ongoing results of those efforts, for further improvement work.


    In other words, we’re talking about a continuous learning system in U.S. healthcare. And guess what? It’s no longer optional.

    The reality is that healthcare IT leaders are playing and will continue to play, an extremely important role in all of this work; indeed, their contributions will be vital to success, at the data and information level, the process improvement level, and the strategic level, organization-wide. The one thing that neither healthcare IT leaders nor any other leaders can do is to sit any longer in denial about what is happening. Because, along with the mandatory value-based purchasing program under Medicare, and to a lesser extent as well, the mandatory healthcare-acquired conditions reduction program under Medicare, continuous clinical performance improvement is in effect now a core component of federal policy.


    In other words, folks, this is happening.


    The good news is that leaders at the most pioneering hospitals and health systems are lighting the way for others to follow. The bad news is that anyone waiting for further “clarity” on all this is going to be waiting so long as to potentially endanger the future of their hospital organization. So as the readmissions reduction program under Medicare—and inevitably under many, if not most, private health insurers as well—expands and ramps up, it will be incumbent on healthcare IT leaders and on all healthcare leaders to get ahead of the curve, because the penalties are only going to get more and more real—and won’t ever be reversing.

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    7 ways physicians can improve health care quality

    7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

    Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


    Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

    Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

    Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


    Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


    The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


    This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

    But let me come back to the report itself in a minute.


    The quality conundrum


    A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


    That may explain why keeping track is such a challenge for all parties involved.


    Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


    The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


    7 actions physicians can take


    That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


    1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


    2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


    3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


    Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


    Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


    Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


    4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


    And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


    5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


    An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


    Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


    6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

    Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


    7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


    In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


    Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


    Fortunately, medical practice today is far more science than art.


    What patients should do


    The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


    And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


    The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

    The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


    Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


    We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

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    Health insurers working the system to pad their profits

    Health insurers working the system to pad their profits | Healthcare and Technology news | Scoop.it

    One of the reasons the health insurance industry worked behind the scenes in 2009 and 2010 to derail Obamacare was the fear that changes mandated by the law would cut their Medicare Advantage profits. Medicare Advantage plans are federally funded but privately run alternatives to traditional fee-for-service Medicare. 

    Although the industry’s biggest trade group, America’s Health Insurance Plans, said repeatedly that insurers supported Obamacare, the group was secretly financing the U.S. Chamber of Commerce’s TV campaign against reform. Among the companies most concerned about the law were those benefiting from overpayments the federal government had been making to their Medicare Advantage plans since George W. Bush was in the White House.  


    Bush and other Republicans saw the Medicare Advantage program as a way to incrementally privatize Medicare. To entice insurers to participate in the program, the federal government devised a payment scheme that resulted in taxpayers paying far more for people enrolled in the Medicare Advantage plans than those who remained in the traditional program. The extra cash enables insurers to offer benefits traditional Medicare doesn’t, like coverage for glasses and hearing aids, and to cap enrollees’ out-of-pocket expenses.


    When the Affordable Care Act became law in 2010, the payments to Medicare Advantage plans exceeded traditional Medicare payments by 14 percent. To end what they considered an unfair advantage for private insurers, and to reduce overall spending on Medicare, Democrats who wrote the reform law included language to gradually eliminate the over-payments.  So far, the 14 percent disparity has been reduced to 2 percent.  The final reductions are scheduled to be made next year.


    Despite that decrease, the fears by Republicans and insurance company executives that the reductions would lead to a steady decline in Medicare Advantage enrollees have proved to be completely unfounded. In fact, the plans have continued to grow at a fast clip.

    In March 2010, the month Obamacare became law, 11.1 million people were enrolled in Medicare Advantage plans—one of every four people eligible for Medicare. That was an increase from the 10.5 million Medicare Advantage enrollees in March 2009. Since then, Medicare Advantage membership has grown by more than 8 percent annually. Now 17.3 million—one in three people eligible for Medicare—are enrolled in private plans.


    As Center for Public Integrity senior reporter Fred Schulte has written over the past year, many insurers have discovered that even though the overpayments are being reduced, they can boost profits another way: by manipulating a provision of a 2003 law that allows them to get additional cash for enrollees deemed to be sicker than average.


    A risk-coding program was put in place by the government primarily because insurers were targeting their marketing efforts to attract younger and healthier—and thus cheaper— beneficiaries. Under the risk-coding program, insurers are paid more to cover patients who are older and sicker; the idea was to encourage the firms to cover those folks by offering a financial incentive. They get more money, for example, to cover someone with a history of heart disease than they do for someone with no such risk.  Last week Schulte uncovered whistleblower accusations that a medical consulting firm and more than two dozen Medicare Advantage plans have been ripping taxpayers off by conducting in-home patient exams that allegedly overstated how much the plans should be paid.

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    Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare?

    Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare? | Healthcare and Technology news | Scoop.it

    It was fascinating to read a new issue brief from the New York-based Commonwealth Fund published August 5, on primary care providers’ (both primary care physicians’ and mid-level practitioners’) perceptions of new payment models in healthcare.


    The Commonwealth Fund, a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” had issued the brief, entitled “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment,” based on a survey of 1,624 primary care physicians and 525 mid-level clinicians (nurse practitioners and physician assistants).


    The abstract to the issue brief notes that “A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”


    The core findings of the survey were that primary care physicians, far more than mid-level practitioners, expressed considerable skepticism about the new healthcare delivery and payment models, in particular the two that were asked about specifically—accountable care organizations and patient-centered medical homes; though those PCPs who had worked under ACO or PMCH arrangements were far more likely to agree that they offered the potential for improving the quality of care delivery to patients being cared for under those types of arrangements.


    As to why a strong plurality of primary care physicians have negative perceptions of the potential for the value-based outcomes measures embedded in ACO and PCMH arrangements to improve quality and efficiency, Melinda Abrams, The Commonwealth Fund’s vice president for delivery system reform, told me, “To be honest, we don’t know why they don’t like the quality measures; we only know there’s a fair bit of dissatisfaction with the quality measures. When we asked physicians whether they thought the increased use of quality measures was impacting their ability to provide high-quality care, 50 percent were negative on that, and only 22 percent were positive. We also asked, are you receive quality incentive-based payments? That reflected the entire group, but even among those receiving incentive payments based on quality, 50 percent felt it was negative, and only 28 percent felt it was positive.”


    Still, as the issue brief’s abstract noted, “The survey results indicate that primary care providers’ views of many of these new models are more negative than positive. There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records.8 Our survey results also may reflect clinicians’ earlier exposure to certain models and tools. National adoption of electronic health records received a boost from the Health Information Technology for Economic and Clinical Health (HITECH) Act of the federal stimulus package of 2009, while the four primary care specialty societies announced a joint statement regarding medical homes in February 2007, several years before passage of the Affordable Care Act.”


    “Our results show that 50 percent of primary care providers say that healthcare IT is improving the quality of care they provide,” Abrams told me. “And what we’ve learned from other studies is this: other studies have found that providers generally accept the promise of HIT as a concept, even as they dislike the process of transitioning to electronic from paper. Our specific question was on the impact of their ability to provide high-quality care to their patients. It’s a more general question than about the transition. We weren’t asking about the transition. So half of physicians and two-thirds of mid-level providers see the advance of health IT as having a positive impact,” she noted.

    What is inevitable is that clinicians, but most especially primary care physicians, will be demanding a great deal from the clinical and other information systems that are being implemented now to facilitate accountable care, population health management, and patient-centered medical home-based care.


    As Abrams put it to me, “There’s nothing in the survey findings that would indicate that increased success with IT would improve their views of ACOs and medical homes; our findings don’t show that. But I would suspect that, to fulfill the promise of ACOs and PCMHs requires ease of use of IT and the data from that technology, the more they learn to use technology effectively to optimize patient care, yes, I believe they will become more positive about ACOs and patient-centered medical homes, yes. And more pieces will help them embrace ACOs and PCMHs.”


    So such interpretations of survey data only help to reinforce what seemed apparent already: that healthcare IT leaders are facing a gigantic opportunity/risk proposition ahead of them, when it comes to clinical and other information systems supporting accountable care and population health management. Physicians, and primary care physicians in particular, are looking to those systems to carry them to the “promised land” of greater clinical effectiveness and practice efficiency, and to help them master the intricate challenges of succeeding in carrying out risk-based contracting in a high-pressure, high-stakes environment.


    And this is in an environment in which we all know that the IT solutions offered by vendors, both major and smaller, still leave some things to be desired, and that tremendous amounts of customization are being required to make population health, analytics, clinical decision support, and other systems needed to make pop health and accountable care work, are being poured into those systems.


    So the next few years inevitably are going to be filled with tension for healthcare IT leaders, as healthcare IT professionals work to get all the foundations, and the details, right, with those systems. But the light at the end of the tunnel is this: that, as primary care physicians become adept at using the increasingly-adept solutions that will be applied to population health- and accountable care-based clinical practice, primary care physicians’ perceptions not only of those tools, but of value-based care delivery and payment itself, will get better over time. And that will definitely significant for all of us, as we pursue the new healthcare in earnest.

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    Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC

    Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC | Healthcare and Technology news | Scoop.it

     Premier, Inc. (NASDAQ: PINC), a leading healthcare improvement company, today announced that it has acquired Healthcare Insights, LLC for $65 million in cash. Healthcare Insights is a privately-held,integrated financial management software developer that provides hospitals and healthcare systems with budgeting, forecasting, labor productivity and cost analytic capabilities.


    “As the healthcare industry becomes more complex, value-driven, and data-dependent, the need for health systems to clearly understand their performance in every arena is a top concern,” said Keith J. Figlioli, Premier’s senior vice president of health informatics. “It is not enough to have financial, operational and clinical data. Health systems must understand how to translate that information into effective cost containment strategies, as well as superior clinical outcomes.”


    The industry’s increased focus on cost is largely driven by the Affordable Care Act, which reduces overall reimbursement, and increasingly holds providers accountable for the total costs and quality of the care delivered. Coupled with the growing movement to value-based payments such as bundling or shared savings, healthcare providers need solutions that can help them understand cost drivers and opportunities for improvement in detail. Healthcare Insights is expected to enable Premier to offer a more complete solution that delivers additional value by adding budgeting, clinical financial management and productivity analytics to existing cost and quality applications, including the company’s enterprise resource planning (ERP) solution.


    Thomas Johnston, Healthcare Insights’ chief executive officer, said, “This strategic combination will allow us to offer a more complete ERP solution with an end-to-end view of cost management. We expect this to increase our hospitals’ and health systems’ understanding of their clinical, operational and financial performance, and help them deliver more efficient, higher quality care.”


    Founded in 2000, Healthcare Insights’ current customer base includes over 7,500 users across 200 facilities associated with 94 health systems, 49 of which do not currently have a relationship with Premier. KLAS, a leading research firm that provides ratings for more than 900 healthcare products and services, has ranked Healthcare Insights first place in budgeting for the past four years.


    The Healthcare Insights acquisition, which was effective July 31, is currently projected to be modestly accretive to Premier’s fiscal 2016 revenue growth and adjusted EBITDA. Expected revenue and adjusted EBITDA contributions from the acquisition will be incorporated into Premier’s fiscal year 2016 guidance, which is scheduled to be announced on August 24, when the company reports fiscal fourth-quarter and full-year 2015 financial results.

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    Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug

    Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug | Healthcare and Technology news | Scoop.it

    The Obama administration has decided that Medicare will pay for one of the newest, most expensive cancer medications, which costs about $178,000 for a standard course of treatment.

    Patients, doctors, hospital executives and insurers have expressed concern about the high cost of prescription drugs, especially new cancer medicines and treatments tailored to the genetic characteristics of individual patients. Medicare officials recognized the cost and value of one such product, the anticancer drug Blincyto, by agreeing to make additional payments for it starting Oct. 1. The drug is made by Amgen for patients with a particularly aggressive form of leukemia.

    The decision suggests a new willingness by Medicare to help pay for promising therapies that are still being evaluated. It is also significant because Medicare officials reversed themselves on every major scientific issue involved. After receiving pleas from Amgen and a dossier of scientific evidence, the officials agreed that the drug was a substantial improvement over existing treatments for some patients.

    At issue are special “add-on payments” that Medicare makes to hospitals for new technology whose costs are not yet reflected in the standard lump-sum amounts that hospitals receive for treating patients with a particular disease or disorder.

    In a preliminary decision in April, the Obama administration said it did not intend to pay extra for Blincyto because clinical studies were “not sufficient to demonstrate” that it substantially improved the treatment of Medicare patients with acute lymphoblastic leukemia, a cancer of the blood and bone marrow. Medicare officials said Amgen’s application was based on data from “a small sample group of patients whose age demographic is much younger than the age demographic of eligible Medicare beneficiaries.”

    But in a final rule to be published in the Federal Register on Aug. 17, the administration says it received “additional information and input” from Amgen and other experts and now agrees with their arguments.

    Blincyto “is not substantially similar” to other drugs available to leukemia patients, the administration said, and it “represents a substantial clinical improvement over existing treatment options.”

    Jane E. Wirth, 59, of Reno, Nev., a former preschool teacher, said her cancer was in remission after 28 days of treatment with Blincyto, also known as blinatumomab.

    “It was amazing to me that it could work so well so quickly,” Ms. Wirth said in an interview. “I had just spent a month going through standardchemotherapy, which did not make the cancer go away. It seemed so hopeless.”

    The drug, engineered from two antibodies, harnesses the body’s immune system to help fight cancer. It brings certain white blood cells close to malignant cells so the blood cells can destroy the cancer cells.

    Dr. Anthony S. Stein, a researcher at City of Hope National Medical Center in Duarte, Calif., who has treated more than 50 patients in clinical trials of Blincyto, said, “Its mechanism of action is totally different from that of any other approved drug.”

    After the Food and Drug Administration approved Blincyto in December, Amgen said the price would be about $178,000 for the recommended two 28-day cycles of treatment, each followed by a two-week break. Medicare says it will now allow a “new technology add-on payment” to hospitals for a fraction of that amount, up to $27,000. Actual payments will vary based on the length of a patient’s hospital stays.

    A cycle of treatment begins with intravenous infusions in a hospital. Patients typically continue treatments outside the hospital — at doctor’s offices, at infusion centers or at home, with the help of specially trained nurses — and Medicare will help pay for the drug at those sites, too.

    The prices of new cancer drugs often exceed $100,000 a year.

    Health policy experts said that President Obama had personally expressed concern in recent weeks about high drug prices and their impact on consumers and federal programs. In February, he asked Congress to authorize the secretary of health and human services to negotiate with manufacturers to determine prices for high-cost medicines taken by Medicare beneficiaries.

    poll by the Kaiser Family Foundation released last month found that 94 percent of Democrats and 84 percent of Republicans support allowing the federal government to negotiate with drug makers to get lower prices on medications for those beneficiaries.

    Dr. Steven M. Safyer, president of Montefiore Medical Center in the Bronx, said the Obama administration should use its influence with drug companies to restrain costs. “There are a number of very important breakthroughs with pharmaceuticals that can make a difference between life and death, and the price is too high,” he said.

    More than 100 oncologists from cancer hospitals around the country recently issued a manifesto decrying the prices of new drugs.

    “Effective new cancer therapies are being developed by pharmaceutical and biotechnology companies at a faster rate than ever before,” they said in a commentary in the journal Mayo Clinic Proceedings. But, they added, “the current pricing system is unsustainable and not affordable for many patients.”

    Robert E. Zirkelbach, a spokesman for Pharmaceutical Research and Manufacturers of America, the lobby for drug makers, said that new spending projections issued by the government in July undercut such claims.

    “Even with new treatments and cures for hepatitis C, high cholesterol and cancer,” Mr. Zirkelbach said, “spending on retail prescription medicines is projected to remain approximately 10 percent of U.S. health care spending through 2024, the same percentage as in 1960.” In the last two decades, he added, the cancer death rate has fallen 22 percent, thanks in part to new medicines.

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    IBM and Merge: Here We Go Again!

    IBM and Merge: Here We Go Again! | Healthcare and Technology news | Scoop.it

    Today’s announcement of IBM’s acquisition of Merge Healthcare might be called a deal changer.  In today’s rapidly changing healthcare environment, it would seem that merging IBM’s deep pockets and technological talent with Merge’s clinical technology and applications capabilities would be a good thing.  And, it may prove to be given the current environment. 


    On the other hand, this is déjà vu, as I have personally seen IBM try to play in the healthcare space several times before.  Years ago, IBM developed a product and attempted to be a player in the Radiology Information System (RIS) business.  Eventually it was sold off.  IBM teamed with GE in the early 80’s to integrate RIS and PACS (Picture Archive and Communication System), only to exit amidst the company’s financial woes in the early days of Lou Gerstner’s chairmanship. 


    There were also several failed attempts in the dictation/transcription business.  There was the IBM Executary line.  Then came the IBM VoiceType system.  And finally, there was IBM MedSpeak/Radiology, the first product to exploit IBM’s speech recognition technology.  Each time, IBM realized that the total medical market for such products could be measured in the thousands, not the hundreds of thousands of potential users.  In the end, IBM sold off these products on the basis of market dynamics versus disproportionate development and support costs.  It was unfortunate, as IBM had some of the best technology in the business!  Another part of the argument always was that IBM sold product to other healthcare vendors, and competing with them would jeopardize that business.


    So, will the past repeat itself?  Or, have IBM and the market changed enough to make this a winning proposition for IBM?  I would have to say, only time will tell.  But, today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.


    In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And, the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.


    Both IBM and Merge have sufficient technical expertise to make it work.  But, the glass is only half full.  Imaging informatics is a growing market, but it pales in comparison to the general healthcare IT market such as for EMR’s (Electronic Medical Record).  How well the market is willing to play with an IBM-Merge entity will be interesting to see.  Or, does IBM have more companies in its sights?  It’s ironic that an IBM spinoff (Lexmark) has positioned itself to be a formidable competitor in this space as well.  What will be the reaction of others such as HP and Dell that have had evolving healthcare strategies over the years?  IBM’s forays into the consumer market (remember the PC Junior or OS/2?) have not proven all that successful either. 


    Here’s hoping that IBM has evolved and learned from its past, and will find ways to make this one work!  As always your comments and perspective are welcome.

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    Three Tips for Hiring Better Front-Desk Staff

    Three Tips for Hiring Better Front-Desk Staff | Healthcare and Technology news | Scoop.it

    Many practices really struggle with hiring and training a front-desk person (the person who will create that all-important first impression for your practice). The struggles are real; most offices budget near-minimum wage for this position and seem to have difficulty finding the right person to handle the huge responsibility of this position.


    My go-to answer for this problem is to pay a little more in salary to recruit for this position. It's true; you often get better quality applicants if you can raise the hourly rate of pay for this vital position. It can be difficult to find a professional with the type of experience you are looking for if you only pay a low hourly rate.


    But if you can't find the extra money to increase salary, what other options are available that won't necessarily cost more? Here are some options:


    1. Rearrange responsibilities.

    Perhaps you should take away appointment scheduling from the front desk, as there are often face-to-face patients requiring more attention. Calls could be redirected through an automated PBX system to another staff member.


    2. Search for candidates with a high attention to detail.

    This is as simple as giving applicants specific instructions to follow. If they don't follow those instructions in the application process, exactly, then don't even give them a second look. After all, if they are responsible for the first impression in your office, they should be diligent in making the optimal first impression to you.


    3. Hire for personality and train the skills.

    You can't train someone into a bright, sunny, and welcoming demeanor. So hire for personality, attitude, and work ethic — the skills and other aspects of the job can be taught.


    It doesn't have to cost you more money to find the perfect front-desk staff member. There are great candidates out there to meet every budget, who will help you create stellar front-desk first impressions.

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    IBM Watson antes up $1B to buy Merge

    IBM Watson antes up $1B to buy Merge | Healthcare and Technology news | Scoop.it

    Continuing its shopping spree, IBM on Thursday announced that it will spend a cool $1 billion to acquire Merge Healthcare in a deal that will combine Merge's medical imaging technologies with IBM's Watson. 

    Watson will gain the ability to "see" by bringing together Watson's advanced image analytics and cognitive capabilities with data and images obtained from Merge Healthcare's medical imaging management platform, IBM executives said in announcing the deal.


    The intent, say IBM executives is to to unlock the value of medical images to help physicians make better patient care decisions.


    Merge is a public company, traded on NASDAQ as MRGE.

    Its technology platforms are used at more than 7,500 U.S. healthcare sites, as well as most of the world's leading clinicalresearch institutes and pharmaceutical firms to manage a growing body of medical images.


    As IBM execs see it, these organizations could use the Watson Health Cloud to surface new insights from a consolidated, patient-centric view of current and historical images, electronic health records, data from wearable devices and other related medical data, in a HIPAA-enabled environment.


    Under terms of the transaction, Merge shareholders would receive $7.13 per share in cash, for a total transaction value of $1 billion. The closing of the transaction is subject to regulatory review, Merge shareholder approval, and other customary closing conditions. It is expected to occur later this year.


    It is IBM's third major health-related acquisition – and the largest – since launching its Watson Health unit in April, following Phytel, a population health company and Explorys, a cloud-based intelligence firm.

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    The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles

    The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles | Healthcare and Technology news | Scoop.it

    Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.


    Although rural living offers many advantages, according to the National Rural Health Association (NRHA), rural healthcare in America faces challenges not seen in urban areas. Population loss, poverty and access to healthcare have been problematic in recent years. Here are just a few of the initiatives that have been launched to improve the health needs and overall well-being of rural Pennsylvanians.


    Healthcare Issues in Rural Pennsylvania


    In general, rural residents in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets, and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.


    Population Loss


    Between 2000 and 2010, Gary Rotstein of the Pittsburgh Post-Gazettereports, rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only due to eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.


    In some places, the situation is bleak. Rotstein highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18,” Rotstein adds. “That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”


    For rural areas where population is declining or (slowly) rising, healthcare faces challenges. Economic opportunity is threatened when workers and students pursue a better future. And when healthcare professionals depart, accessibility is undermined. In addition, communities with a disproportionately older population can require more healthcare resources, at the same time as access is dwindling.


    Economic Challenges


    According to the Rural Assistance Center (RAC), rural Pennsylvania lagged behind urban areas in poverty, unemployment and income for 2013:


    14.3 percent poverty rate; 13.6 percent in urban areas

    7.9 percent unemployment rate; 7.3 percent in urban areas

    $36,099 per-capita income; $46,202 for the state

    The Center for Rural Pennsylvania adds that from 2007 to 2011, 39 percent of rural households had incomes below $35,000.


    Access to Healthcare


    Rural Pennsylvania also has less access to healthcare than is available in urban areas. The Center for Rural Pennsylvania reports that in 2008, rural counties had just one primary care physician for every 1,507 residents, while urban counties had one physician for every 981 residents. In 2009, rural counties had one practicing dentist for every 2,665 residents, while urban areas had one for every 1,845 residents.


    Solutions and Initiatives


    In response to some of the healthcare challenges facing residents in rural Pennsylvania, the following solutions and initiatives have been developed.


    Telehealth


    Based on a 2014 research report from The Center for Rural Pennsylvania, telehealth can promote strong health to reduce chronic conditions and diseases, educate the public and healthcare workers, enable senior citizens to remain in their homes and much more. Using videoconferencing, online remote monitoring and diagnostic scans, electronic health records and other tools, telehealth can help providers give high-quality, affordable and accessible healthcare even in remote locations.


    The study estimated that telehealth’s universal implementation would result in a 22 percent savings for the first year, increasing to 66 percent for the 20th year. Instead of a healthcare cost of $25,500 per person each year, the cost would be just $8,500; Pennsylvania would save $194 billion in the 20th year of implementation. Not only would the healthcare be less expensive, it would also be higher quality.


    Currently, telehealth in rural Pennsylvania is not widely used and quality is poor. However, investing in the infrastructure and getting more healthcare providers on board can help improve the quality and access to this care, giving rural residents the chance to experience affordable, quality healthcare.


    Rural Healthcare Funding


    Federal programs are available to help rural areas across the country improve healthcare delivery. One example is the Rural Health Care Coordination Network Partnership Program, which supports organizations that are trying to improve the outcomes chronic diseases, specifically chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and Type 2 diabetes. It awards up to $200,000 per year for three years to qualified rural health networks.

    These types of programs can help overcome the economic disparity that most rural communities faced, compared to urban areas.


    The Office of Rural Health Policy (ORHP), part of the Health Resources and Services Administration (HRSA), offers other grant programs and initiatives to help support healthcare in rural areas across the country.


    Expanding the Scope of Healthcare Workers


    The need for more accessible healthcare is not just an issue in rural areas. According to the HRSA, there is a projected shortage of 20,400 primary care physicians across the U.S. for 2020, if the current system remains unchanged. To counter this trend, the HRSA projects the number of nurse practitioners and physician assistants to increase.


    Nurses are expected to play an integral role in meeting the need for increased healthcare practitioners. In 2010, the Institute of Medicineannounced that nurses would need to respond to the changes taking place in the healthcare system, which gives nurses more opportunities to provide quality care. It called for higher education standards, including 80 percent of all nurses to hold bachelor’s degrees. To meet these needs, nursing is growing quickly; the Bureau of Labor Statistics already expects the profession to grow by more 19 percent through 2022, making it one of the fastest growing professions in the country.


    In rural Pennsylvania, a higher concentration of educated nurses could help make up for this shortage of physicians and the changes taking place in the healthcare system.

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    Pledges of $3.4 billion for Ebola recovery made at United Nations

    Pledges of $3.4 billion for Ebola recovery made at United Nations | Healthcare and Technology news | Scoop.it

     Some $3.4 billion in pledges were made at the United Nations on Friday to help Liberia, Sierra Leone and Guinea stamp out Ebola and begin rebuilding health systems and economies devastated by the worst outbreak on record of the deadly hemorrhagic fever.


    The United Nations had said that $3.2 billion was needed to support the three states' national recovery plans for the next two years. Liberia's President Ellen Johnson-Sirleaf had said $4 billion was needed to cover a separate sub-regional plan.


    Helen Clark, head of the U.N. Development Programme, said the preliminary tally of pledges on Friday took the total amount allocated so far for Ebola recovery to more than $5 billion, which she described as "a great start."


    Johnson-Sirleaf also again appealed for international donors to cancel debt owed by the West African nations.


    "The world as a whole has a great stake in how we together respond to this global threat," Johnson-Sirleaf told the pledging conference. "Diseases, just like terrorism, know no national boundaries."


    The Ebola outbreak, which began in Guinea in December 2013, has killed more than 11,200 people across West Africa. Ebola re-emerged in Liberia last week, nearly two months after it was declared free of the virus, while neighboring Guinea and Sierra Leone are still struggling to eliminate it.


    "The threat is never over until we rebuild the health sectors Ebola demolished, until we rebuild the livelihoods in agriculture that it compromised, until we shore up government revenues it dried up; and until we breathe life again into the private sector it has suffocated,"

    Sierra Leone's President Ernest Bai Koroma told the U.N. conference.


    Among the largest pledges were some $381 million from Britain, $266 million from the United States, $650 million from the World Bank, $220 million from Germany, $500 million from the European Union, $745 million from the African Development Bank and $360 million from the Islamic Development Bank.


    "We cannot yet breathe a sigh of relief. Instead, let us collectively take a deep breath and resolve to finish the job," U.N. Secretary-General Ban Ki-moon said earlier on Friday.

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    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate

    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate | Healthcare and Technology news | Scoop.it

    On Friday afternoon, July 10, the U.S. House of Representatives passed the 21st Century Cures Act, H.R. 6, by a vote of 344-77, sending it to the U.S. Senate. The main focus of the legislation is an attempt to remove regulatory roadblocks in the review process for new pharmaceuticals and medical devices on the part of the Food and Drug Administration (FDA). In addition, according to Congress.gov, the federal government’s official legislation tracking service, “Requirements are established [in the bill] for interoperability and certification of health information technology. Practices that discourage the exchange of electronic health information are prohibited.”


    After the House’s passage of the bill, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement attributed to Leslie Krigstein, interim vice president of public policy, praising the bill’s focus on interoperability.  “The 21st Century Cures Act is a landmark piece of legislation that will move our nation closer to a 21st Century healthcare system,” Krigstein said in the statement. “As recognized in this bill, health information technology will serve as the foundation to foster many of the ideologies in delivering lifesaving cures to patients more rapidly.”


    Krigstein’s statement went on to say that “The Committee's choice to tackle the complex issue of interoperability is to be commended. Without nationwide interoperability, we will be unable to derive the value promised by the nation's $30 billion investment in electronic health records (EHRs). Expediting cures to patients will not be possible without a health information highway that allows providers and patients the data they need, when and where they need it.”


    Krigstein added that “CHIME appreciates the Committee's recognition that harmonizing standards adoption will exponentially move interoperability forward. We agree that clear, enforceable standards are necessary to foster nationwide interoperability. The inclusion of increased testing requirements for certified products, including 'real world' testing, is a priority for CHIME members as a means to bring value to the certification program. We appreciate the Committee's inclusion of the need to ensure the information in one's EHR belongs to the patient. We hope that this language will begin a sincere dialogue on the need to address the ongoing patient safety and care coordination challenges arbitrarily imposed by the lack of a national approach to patient identification. Without a patient identity matching strategy, patient data matching errors and mismatches will become exponentially more problematic and dangerous.”


    The CHIME statement concluded by stating that “We view this legislation as a starting point in the conversation on health IT reform. We hope to build on the language in 21st Century Cures Act to ensure the Meaningful Use Program, among other ongoing federal policy initiatives, enable the implementation and use of EHR systems to meaningfully improve patient care.”


    Additional praise for the House of Representatives’ passage of the bill came from the Charlotte-based Premier healthcare alliance. Attributed to Blair Childs, Premier’s senior vice president of public affairs, it said, “Members of the Premier healthcare alliance commend House leadership for the passage of new health information technology (HIT) interoperability requirements within the 21st Century Cures legislation that passed overwhelmingly today. Requiring free and secure exchange of health information among disparate IT assets will improve patient care, reduce costs, and unlock “big data” in healthcare.  This is also an essential ingredient in enabling providers to improve the health of a defined population health across the care continuum.” That statement concluded by stating that “We are encouraged by the Senate’s equal focus on achieving interoperability among EHR systems.”


    How did the legislation pass the House, and what are its chances in the Senate? Alex Lash, writing Friday in xconomy.com, wrote this: Passage in the House was due in no small part to the bill’s original sponsors, Reps. Diana DeGette (D-CO) (pictured) and Fred Upton (R-MI), whose work—appearances, town halls, info-gathering sessions—for more than a year leading up to the vote at times resembled a permanent campaign. But the Cures Act still must get through the Senate, where single opponents can often hold popular legislation hostage,” Lash noted. “And, despite the strong support in the House, critics are asking if the rush to approve new drugs might tilt away from traditional safeguardstoo much. Fiscal hawks will no doubt pick through the costs associated with the bill, as reported last month by the Congressional Budget Office.”

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