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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 |

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, 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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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news |

Sometime in the not-so-distant future, getting a checkup will be very different.

When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.

This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.

But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”

Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.

In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.

Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.

Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.

And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.

“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.

For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.

Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.

“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.

And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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Obamacare ruling ends threat to U.S. hospitals, insurers

Obamacare ruling ends threat to U.S. hospitals, insurers | Healthcare and Technology news |

The U.S. hospital and health insurance industries breathed a collective sigh of relief on Thursday after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law.

Shares in hospitals surged, with several hitting all-time highs, on the expectation that patients would be able to continue paying for services. Health insurer stocks also gained. Wall Street analysts called the ruling positive for an industry on the edge of consolidation.

Health economists have estimated $15 billion to $22 billion in healthcare spending was at risk with the decision. About 10 million Americans have insurance through the healthcare law's insurance exchanges and, of those, 6.4 million have subsidies.

The court ruled 6-3 that the 2010 Affordable Care Act (ACA), widely known as Obamacare, did not limit subsidies to states that establish their own online healthcare exchanges. It marked the second time in three years that the high court ruled against a major challenge to the law.

Trinity Health, one of the largest not-for-profit health systems, was holding a board meeting when the ruling hit.

"There was a ‘Yahoo!’ and a big round of applause," Dr. Richard Gilfillan, chief executive of the Livonia, Michigan-based hospital chain said.

Insurers said subsidies were key to bringing in new customers.

"For a lot of the individuals who were depending on these subsidies in order to have coverage, I think it is a major sigh of relief," said J. Mario Molina, chief executive of insurer Molina Healthcare.

Annie Wisecarver, 53, of Shepherdstown, West Virginia, receives a monthly subsidy of about $200 to buy Obamacare insurance.

"I really only purchased insurance for an emergency, like if I fell off a mountain and broke my leg," Wisecarver said. "I can’t see myself spending $300 or $400 a month on insurance just because I might have an accident."

The ruling could remove uncertainty for the insurers who are seeking deals, like Anthem Inc and Aetna Inc, Leerink Partners analyst Ana Gupte said.

Anthem is pursuing an acquisition of Cigna even after being rejected, while sources previously told Reuters that Humana put itself up for sale last month, with Cigna and Aetna making offers. Bloomberg reported on Thursday that an Aetna-Humana deal could be reached as soon as this weekend.

Humana jumped 7.5 percent. Aetna Inc gained 3.6 percent, Anthem Inc 1,1 percent, Cigna Corp 2.6 percent, and UnitedHealth Group Inc rose 2.7 percent.

Among hospitals, shares of Community Health Systems were up 13.3 percent, HCA Holdings rose 8.5 percent and Tenet Healthcare jumped 12.2 percent. HCA, Universal Health Services and LifePoint Health hit lifetime highs.


Since the subsidies were introduced last year, they have helped hospitals reduce the losses from covering the cost of uninsured patients.

"It's just a very positive thing because it takes away the overhang on the company and the industry," said Alan Miller, CEO of Universal Health Services, which has hospitals in 37 states.

Bill Carpenter, chief executive of Lifepoint Hospitals, which has 64 hospitals in 20 states, was at an offsite patient safety event and said everybody in the room was excited about the ruling.

"We are just are so pleased that those people who have secured coverage through state exchanges will have the peace of mind to know that their coverage is going to continue," Carpenter said, calling on states to expand Medicaid to more income levels, another goal of the ACA. "In many states, this has been about politics and not policy."

In Florida, one of the biggest remaining issues is expanding Medicaid, said Jim Nathan, president and chief executive of Lee Memorial Health System in Fort Myers, one of Florida's largest public, not-for-profit health systems.

Jason Montrie, president of Land of Lincoln Health, a non-profit CO-OP health insurance company launched in 2013 with the government funding of the Affordable Care Act, said subsidies are vital to most of its more than 50,000 members.

"We're relieved that our court made the right decision here," Montrie said.

Options activity had been sanguine in the days and weeks leading up to the ruling, with many traders betting on a rally in the hospital names after the Supreme Court decision.

The S&P 500 healthcare sector is up 11.3 percent in 2015 so far. The sector accounts for about 15 percent of the S&P 500 index.

Margarito Cruz's curator insight, 11 December 2015, 03:05

The role being discussed in this article is about Cheif Executive. I didnt realize that so many people were under Obama's Obamacare. I agree with these actions because of all the accidents that happen everyday. People who dont have insurance face the same dangers that the people that do have it. It would be nice to know that theres something that will pay for the ones not as wealthy. Obama is the organizer of Obamacare.!

Where are the most expensive hospitals?

Where are the most expensive hospitals? | Healthcare and Technology news |

Talk about sticker shock: Some U.S. hospitals charge patients more than 10 times the rates paid by Medicare.

Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, 20 operate in Florida, and half are owned by a single chain, according to a study published in the journal Health Affairs Monday.

That doesn't mean all or even most patients end up paying those charges. Private insurers are able to negotiate the sticker price down significantly. Patients paying out of pocket can often negotiate discounts or get charity care if they are low-income.

The average U.S. hospital charges a somewhat less staggering sum: 3.4 times the rates paid by Medicare, the federal health care plan for the elderly and disabled which pays fixed rates for procedures.

But for uninsured patients asked to pay full charges, insured patients who end up at an out-of-network hospital and patients whose treatment is covered by casualty or workers compensation insurance, these charges can matter a lot.

"Hopefully this is a wake-up call for people to recognize there's a problem," said Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, and one of the authors of the study, which analyzed 2012 Medicare cost reports.

    "There is no justification for these outrageous rates but no one tells hospitals they can't charge them," Anderson said. "For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates. They charge these prices simply because they can."

    Even after full expansion of coverage under the Affordable Care Act, 30 million Americans will remain uninsured and may face particularly high charges, the study said. The law requires nonprofit hospitals to offer reduced-cost or charity care to eligible patients, but the provision does not apply to for-profit hospitals.

    "Hospitals' high markups, therefore, subject many vulnerable patients to exceptionally high medical bills, which often leads to personal bankruptcy or the avoidance of needed medical services," the study said.

    Of the 50 highest chargers, half are owned by Community Health Systems, a for-profit chain with 199 hospitals. The company made $18 billion in profits in 2014 — 45 percent more than in 2013. The researchers looked at charges at nearly 4,500 Medicare-certified hospitals nationwide.

    Florida most likely had the most high-charging hospitals because it has an exceptionally high proportion of for-profit hospitals, consumer advocates said. North Okaloosa Medical Center, a CHA hospital in the Florida panhandle, had the highest charges of all: 12.6 times Medicare's rate.

    In a written statement, CHA spokesperson Tomi Galin said CHA provided more than $3.3 billion in charity care, discounts and other uncompensated care for patients in 2014, as well as "millions of dollars in taxes that help fund critically important services in every community where we operate."

    The charges examined by the study, Galin said, "are not relevant measures of what consumers, insurers or the government pay for services."

    Chip Kahn, president and CEO of the Federation of American Hospitals, a trade group representing for-profit hospitals, also argued that the charges examined by the study were not a fair assessment of hospital prices. If the study had instead examined the actual payments by patients, they would have found that hospitals on the list charge just 1.3 times what Medicare pays, compared to a national average of 1.2, he said.

    A hospital's charges can matter even for patients with private insurance, said Ge Bai, a co-author on the study and a professor at Washington and Lee University. Hospitals use those charges as leverage during negotiations with insurers, and starting from a higher price point can drive up even discounted prices.

    "Except for patients with government insurance, few consumers are immune from negative financial impacts caused by hospitals' high markups," Bai said.

    "We as consumers are paying for this when hospitals charge 10 times what they should," added Anderson. "What other industry can you think of that marks up the price of their product by 1,000 percent and remains in business?"

    The highest charging hospitals were in 13 states, mostly in the South. Besides Florida, the states included Alabama, Arkansas, Arizona, California, Kentucky, New Jersey, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.

    The markups charged by the 50 hospitals on the list varied dramatically by procedure. Anesthesiology had the highest charges: an average of 112 times more than Medicare rates. The markup for nursery services, on the other hand, was three times the Medicare rate.

    The authors recommended that state and federal lawmakers enact policies to limit these charges. In Maryland and West Virginia, for example, state agencies set the rates that hospitals are allowed to charge for services. Requiring hospitals to disclose their charges for individual procedures could also help patients shop for the lowest-cost option, they said.

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    IT could save $100B for US healthcare

    IT could save $100B for US healthcare | Healthcare and Technology news |

    New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.

    In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.

    Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.

    It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).

    "A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

    Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.

    Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.

    Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.

    Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.

    The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.

    "The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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    Why Doctors Are Quitting -- And Why It's Not Obama's Fault

    Why Doctors Are Quitting -- And Why It's Not Obama's Fault | Healthcare and Technology news |

    In September 2009, Terry Jones wrote in Investor’s Business Dailythat the United States was barreling toward catastrophe: Nearly half the nation’s physicians were on the verge of hanging up their stethoscopes.

    “Four of nine doctors, or 45%, said they ‘would consider leaving their practice or taking an early retirement’ if Congress passes the plan the Democratic majority and White House have in mind,” Jones warned.

    “Projecting the poll’s finding … 360,000 doctors would consider quitting.”

    Well, Congress did pass that plan six months later. (You might have heard: It’s called the Affordable Care Act.)

    But our doctors didn’t go away.

    In fact, rather than lose 360,000 physicians, the nation’s gained nearly 100,000 practicing doctors in the past six years.

    Time and again, surveys have predicted that physicians’ anger over Obamacare, over regulations, over declining reimbursement is driving them out of the industry. That doctors’ gloom will lead to doom for American health care.

    “Six in 10 physicians say that it is likely that many physicians will retire earlier than planned in the next one to three years,” Deloitte warned in 2013.

    “Recent anecdotes suggest more physicians may be retiring earlier than in the past and [in] a large cohort,” the Lewin Group concluded — in 2004.

    But we see again and again: Intent doesn’t equal action. At least, not on a national scale.

    For instance, the Wall Street Journal in 2013 implied that doctors were leaving Medicare en masse. It wasn’t true.

    Last Friday, the latest high-profile pessimist popped up — Charles Krauthammer, a Harvard Medical School-trained doctor and a columnist for the Washington Post.

    In an essay carried in hundreds of newspapers, and originally called “Why Doctors Quit,” Krauthammer argued that the Obama administration has “demoralized doctors and degraded care” by pushing providers to quickly adopt electronic health records, known in shorthand as EHRs.

    In Krauthammer’s telling, EHRs have turned out to be “ health care’s Solyndra” — they haven’t justified the $27 billion in incentive payments that the White House used to get doctors to go digital.

    “Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized,” Krauthammer wrote.

    The stress of EHRs is so bad that many of his Harvard classmates from 1975 are thinking about quitting medicine, Krauthammer added. He writes:

    Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

    You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

    It’s true that doctors — especially older ones — are frustrated about the shift to electronic health records.

    And understandably so! EHRs have added a burden to a busy workday. The added value of digitized data isn’t always obvious. There’s evidence they hurt productivity.

    As a journalist, I’ve heard these complaints over and over again from doctors. And as a patient, I’ve witnessed doctors’ anger firsthand.

    A few years ago, I was in the office of a middle-aged neurologist, one of the greatest diagnosticians I’ve ever met. It was a routine check-up, but he spent more time looking at his computer screen than at me.

    “This gets in the way of patient care,” he groused, his eyes locked on the screen.

    “Why don’t you hire a medical scribe?” I asked the doctor. “Someone who can keep the notes while you see patients?”

    He swiveled around and scowled. “The hospital doesn’t want to pay,” he said, as his eyebrows scrunched. “I don’t know how much longer I can keep doing this.”

    But that doctor didn’t go anywhere. He’s got kids in Ivy League colleges and a D.C.-area household to fund. He’s got years invested in building a practice. And walking away from that will take more than frustration over a computer system.

    In fact, the real reason why doctors are quitting is less dramatic: They’re aging.

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    Fixing health care doesn't necessarily need political reform

    Fixing health care doesn't necessarily need political reform | Healthcare and Technology news |

    It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.

    Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

    At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

    Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.

    The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.

    My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

    I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.

    Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.

    For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.

    This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.

    Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.

    I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.

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    The Female Physician Perspective on Healthcare Today

    The Female Physician Perspective on Healthcare Today | Healthcare and Technology news |

    I'm not a doctor, but I've represented their interests for more than 18 years working for a professional association of physicians from all specialties and every type of practice setting. It wasn't too long ago that the stereotypical association member was akin to the fictional Marcus Welby, MD, an elderly male private-practice physician. Times certainly have changed.

    Shifting Physician Workforce Demographics

    Today, there are more women in medicine than at any point in history. In fact, according to The Physicians Foundation, females comprise 33 percent of the physician workforce in the United States, a number that continues to rise as women enter medical schools in record numbers.

    Responses from 20,000 physicians in a recent Physicians Foundation survey  revealed the angst many in the profession feel about the state of medicine. The survey sheds some light on changing workforce demographics and the diversity of attitudes and perspectives among America's doctors; specifically, it provides insight into the viewpoint of female physicians today.

    Issues Facing Physicians Today: The Female Perspective

    According to the survey, female physicians are slightly more optimistic than their male counterparts about healthcare today, yet despite this optimism, trepidation still exists among female physicians in regards to elements of reform, such as accountable care organizations (ACOs) and insurance exchanges. The survey reveals that:

    • 63.9 percent of female physicians give the Affordable Care Act a passing grade, while only 49 percent of male physicians stand by the reform;

    • 41 percent of female physicians are unsure about structure and purpose of ACOs, compared to 28 percent of their male counterparts; and

    • A smaller percentage of female doctors participate in exchanges and more females compared to males are unsure of whether the exchanges feature a restricted network of providers.

    The Changing Healthcare Landscape

    All physicians today are feeling the pressure of rising costs and the plethora of new regulations as the industry moves from fee-for-service to pay-for-value. While the reform law did provide access to health insurance coverage for more Americans, it did little to ensure a stable physician workforce — a vital piece of the healthcare equation.

    On the positive side, with a focus on prevention and disease management, care delivery has become more patient-centered. The Physicians Foundation survey showed that 80 percent of physicians describe patient relations as the most satisfying factor of practicing medicine.

    When I started working at the Washington State Medical Association in the mid-1990s, 38 percent of our members were in solo practice; today the figure has plummeted to 8 percent. According to the survey, less than 20 percent of physicians nationwide are in solo practice, while the number of physicians in employed practice has jumped to over 50 percent. For the female demographic, 26.7 percent are in solo practice, 26 percent are employed by a medical group, and 32.5 percent are employed by a hospital.

    Despite the changes and apparent anxiety in regards to the future of healthcare, 72 percent of female physicians believe that medicine is still a rewarding profession. It's clear that women will play a prominent role in helping to shape the future of healthcare.

    No comment yet.!

    Research surgical robot hacked by computer science experts

    Research surgical robot hacked by computer science experts | Healthcare and Technology news |

    Researchers at the University of Washington in Seattle have demonstrated the ability to remotely hack a research surgical robot, the RAVEN II platform.

    Before continuing, I’ll stop to clarify one thing. The RAVEN II is not a clinically used surgical robot like, say, the Da Vinci surgical robot. It’s an “open-source” surgical robot developed at the University of Washington to test and demonstrate advanced concepts in robotic surgery. We contacted Applied Dexterity which is now in charge of the RAVEN platform and according to co-founder David Drajeske,

    The RAVEN II platform is not approved for use on humans. The system has been placed at 18 robotics research labs worldwide…that are using it to make advances in surgical robotics technologies…The low level software is open-source and it is designed to be “hackable” or readily reprogrammed.

    Clinically used surgical robots, like the Da Vinci platform, operate on secure local networks using proprietary (i.e. not publicly available) communications protocols between the console and the robot. By contrast, RAVEN II can work on unsecured public networks and uses a publicly available communications protocol (see below). So while some have proclaimed an imminent threat to robotic surgery, that’s simply not the case.

    That said, the work does have interesting implications; as pointed out by Mr. Drajeske and co-founder Blake Hannaford, RAVEN II is a great platform for testing these type of security issues. Tamara Bonaci, a graduate student at the University of Washigton, led this study to test the security vulnerabilities that could threaten surgeons using these tools and their patients. In this simulation, they aimed to recreate an environment that would be more akin to using these robots in remote areas.

    They tested a series of attacks on the RAVEN II system while an operator used it to complete a simulated task – moving rubber blocks around.

    They found that not only were they able to disrupt the “surgeon” by causing erratic movements of the robot, they were able to hijack the robot entirely. They also discovered they were able to easily access the video feed from the robot.

    One of the main use cases highlighted for surgical robots, or any number of medical robots for that matter, is that they can function in remote, difficult to reach, and underserved areas. In those areas, some of the conditions of this study are likely to be present – like having to use a relatively unsecured data network. And for cost reasons, using a more open-source platform may be important. So this study does however raise interesting questions about the use of medical robots – it just doesn’t mean that clinically used surgical robots are under some imminent threat.

    No comment yet.!

    Insurers take 1st steps to alter how doctors, hospitals paid

    Insurers take 1st steps to alter how doctors, hospitals paid | Healthcare and Technology news |

    A nationwide initiative to make the fragmented and costly health care system more efficient could affect the more than 340,000 people in Wisconsin enrolled in Medicare Advantage plans.

    Most probably are unaware that anything has changed. But there's a chance their care could be more coordinated, adhere more closely to clinical guidelines and cost less because of the initiative.

    Humana and UnitedHealthcare — two of the largest health insurers that offer Medicare Advantage plans — are striking agreements with what are known as accountable care organizations.

    The organizations, also known as ACOs, have become one of the key levers in the effort to improve the quality of care and slow the rise in costs.

    In an accountable care organization, health systems, physician networks or both are responsible for the cost and quality of care for a defined group of patients. If they provide care at a lower cost while meeting certain benchmarks for quality, they can receive bonuses. Under some of the agreements or contracts, they can pay penalties when they don't.

    At the start of this year, there were 744 accountable care organizations nationwide, up from 64 at the beginning of 2011, and an estimated 23.5 million people are covered by health plans with contracts with the organizations, according to Leavitt Partners, a consulting firm.

    That included 7.8 million people covered by traditional Medicare.

    Medicare Advantage plans — private health plans that are an alternative to traditional Medicare — are adding to those numbers.

    Humana, which has 72,000 people enrolled in its Medicare Advantage plans in Wisconsin, has signed contracts with accountable care organizations run by many of the large health systems in Wisconsin.

    It entered into an agreement with Aurora Health Care this year. It has agreements with ProHealth Care, United Hospital System in Kenosha, Prevea Health in Green Bay and Aspirus in Wausau.

    It also has agreements with accountable care organizations run by Bellin Health in Green Bay and ThedaCare in the Fox Valley as well as Integrated Health Network of Wisconsin, which includes Froedtert Health, Wheaton Franciscan Healthcare, Columbia St. Mary's and other health systems.

    UnitedHealthcare entered into a similar agreement this year with Integrated Health Network for more than 30,000 of the 123,000 people in the state enrolled in its Medicare Advantage plans.

    The agreements vary and for now start with paying bonuses for meeting certain quality measures, such as reducing emergency department visits.

    "We don't have a one size fits all," said Caraline Coats, a Humana vice president.

    Payment system overhaul

    The goal is to revamp the way doctors and hospitals are paid and in the process improve a health care system too often marked by inefficiencies, lack of coordination, poor quality and high costs.

    Accountable care organizations are seen as one of the ways to move away from the system in which hospitals and doctors are paid for the services they provide rather than improving health — what often is described as moving from paying for "volume" to paying for "value."

    The system provides few incentives to provide quality care or control costs. In many cases, health systems stand to make more money when they don't.

    The results can be seen throughout the health care system.

    The Institute of Medicine, the health arm of the National Academy of Sciences, estimates that excess costs accounted for 31% of total health spending in 2009. The sources include:

    ■Unnecessary services: $210 billion.

    ■Inefficiently delivered care: $130 billion.

    ■Missed prevention opportunities: $55 billion.

    Humana's and UnitedHealthcare's agreements for their Medicare Advantage plans are a long way from the ultimate goal of changing the way hospitals and doctors are paid. Both know that health systems will need time to change the way care is delivered.

    Think of the challenge just in lessening the variation in how hundreds or thousands of physicians, each making dozens if not hundreds of decisions a day, practice medicine.

    "This stuff doesn't happen overnight," said Ryan Catignani, who oversees contracting for Humana in Michigan and Wisconsin.

    Humana nonetheless wants to have 75% of the people in its Medicare Advantage plans covered by contracts at least partly tied to performance by 2017.

    No comment yet.!

    SSNs to Disappear from Medicare Cards

    SSNs to Disappear from Medicare Cards | Healthcare and Technology news |

    President Obama has signed a bill that provides $320 million in funding to remove Social Security numbers from Medicare beneficiary ID cards within the next four years in an effort to fight identity theft and fraud.

    The law calling for removal of Social Security numbers from Medicare beneficiary cards comes after several years of recommendations for such a move by government watchdog agencies, including the Government Accountability Office. GAO has repeatedly issued reports in recent years recommending eliminating Social Security numbers from Medicare cards to help protect individuals from falling victim to ID theft and fraud, ranging from healthcare-related fraud to thieves opening credit card accounts using those IDs.

    In a 2013 report, the GAO noted that it had made multiple recommendations to HHS' Centers for Medicare and Medicaid Services to remove the numbers from beneficiaries' Medicare cards to help prevent identity theft. "HHS agreed with these recommendations, but reported that CMS could not proceed with the changes for a variety of reasons, including funding limitations, and therefore has not taken action," the report noted.

    Provision Details

    The 95-page Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2), a broad measure that repeals the controversial Medicare sustainable growth rate for paying physicians that was signed by Obama on April 16, includes a provision prohibiting the inclusion of Social Security numbers on Medicare cards.

    The bill instructs the secretary of Health and Human Services, in consultation with the commissioner of Social Security, to "establish cost-effective procedures to ensure that Social Security numbers, or derivatives, are not displayed, coded or embedded in Medicare cards issued to individuals entitled to [Medicare] benefits."

    Privacy and security experts say the bill is a big step in the right direction to fight fraud.

    "The removal of Social Security numbers from Medicare cards is long overdue and much needed," says privacy attorney Adam Greene, partner at law firm Davis Wright Tremaine. "It is an important step in getting Social Security numbers out of the healthcare industry. The use of Social Security numbers by Medicare currently causes too high a risk of identity theft because too many people in health care need access to Social Security numbers to do their jobs, leading to too many opportunities to misuse the information."

    Making the Change

    The provision, which falls under a section, "Protecting the Integrity of Medicare," calls for the change in the cards to be made no later than four years after the bill was enacted. It also recommends that HHS consider implementing the change through a process, similar to one used for Railroad Retirement Board beneficiaries, "under which a Medicare beneficiary identifier which is not a Social Security account number - or derivative thereof - is used external to HHS and is convertible over to a Social Security account number - or derivative - for use internal to HHS and the Social Security Administration."

    The funding for the project, spread out from fiscal 2015 through 2018, comes from other federal sources, including the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.

    Security expert Mac McMillan, CEO of consulting firm CynergisTek, says time will tell whether the $320 million allocated for the project will be sufficient to cover the cost.

    "Hopefully, those that put the request together considered their costs, but it would not be the first time a government program was either underfunded because it wasn't truly understood what it would cost or the money allocated initially was a compromise to get the program off the ground," he says.

    "The important thing is it is a 'funded' program. With approximately 50 million people covered by Medicare, that number may or may not be enough, but it's a start. Obviously things that will affect this are costs of operating the program, the technology used with the new cards and the cards themselves, issuing the new cards and mailing costs associated with getting them in the hands of the people who need them, etc."

    Bipartisan Effort

    The bill's provision to remove Social Security numbers from Medicare cards originated in a separate bipartisan Medicare ID theft prevention bill introduced by Rep. Lloyd Doggett, D-Texas and Rep. Sam Johnson, R-Texas, that was approved by the House on March 26.

    In a statement to Information Security Media Group, Doggett said, "Legislation to protect seniors from identity theft, for which I originally obtained House approval in 2008, has finally been signed into law. Millions of Americans carry in their wallet or purse something that makes them more vulnerable to identity theft - their Medicare card. No longer will carrying a Medicare card needlessly put seniors' life savings and credit at risk. With identity thieves becoming increasingly sophisticated, a little prevention can save a lot of heartache."

    Whistle-Blower Incentives

    In addition to the removal of Social Security numbers from Medicare cards, the bill signed by Obama also contains a provision instructing HHS to improve incentives of an existing Medicare fraud whistleblower program under HIPAA.

    The new law says the secretary of HHS "shall develop a plan to revise the incentive program under HIPAA to encourage greater participation by individuals to report fraud and abuse in the Medicare program." The plan must include recommendations for ways to enhance rewards for individuals reporting fraud under the incentive program, including rewards based on information that leads to an administrative action. It also calls for extending the incentive program to the Medicaid program.

    The provision also calls for HHS to develop a public awareness and education campaign to encourage participation in the revised incentive program for reporting fraud.

    "Fraud is a huge issue in healthcare, and, in particular, in Medicare, that hurts the program, hurts the industry, hurts individuals and hurts the American taxpayer. So if this provision incents more reporting that results in less fraud, then it's a good thing," McMillan notes. "Healthcare in America amounts to almost $2.7 trillion dollars, and it has been estimated that fraud costs could be as high as one tenth of that, or $270 billion. It's a big problem that needs all the help it can get."

    McMillan says healthcare organizations should encourage patients to review their bills with their caregiver and not just blindly pay them. "We need people to report things that are suspicious," he says.

    No comment yet.!

    Will Health Systems Own Healthcare?

    Will Health Systems Own Healthcare? | Healthcare and Technology news |

    In all of my many conversations this past week, there was an underlying understanding that health systems are getting bigger and bigger. The trends of hospitals acquiring other hospitals is having a major impact on healthcare. Hospitals acquiring ambulatory clinics is probably having an even bigger impact.

    As I ponder on this trend, I really can’t imagine a way that we return to the previous status quo. Certainly some doctors will tire of being employed by health systems, but I’m sad to say that once they’re ready to leave they may not find many doors available for them to take.

    Aside from a limited number of direct primary care doctors in affluent areas, I believe it’s going to become extremely difficult for a doctor to leave a health system. In some areas, this is already the case. However, value based reimbursement is going to make this an impossibility for many.

    I don’t think we know all the unintended consequences of this change in healthcare. As a capitalist, I love economies of scale and you can see how healthcare could benefit from some of these economies. However, what isn’t clear to me is that health systems do a great job capitalizing on economies of scale. In fact, I bet if you studied it you’d probably find that small physician practices run much cheaper than a large health system. If someone knows of a study that looks at this, I’d love to see it.

    I do think that some specialists are bonding together in some areas to create super groups in order to combat this trend. In many ways they essentially create a monopoly of sorts around a certain specialty physician service in a local area. I’ll be interested to see how this plays out. Might be a short term win, but I’m not sure they can survive long term.

    No comment yet.!

    US patients want a deeper digital relationship with their doctors

    US patients want a deeper digital relationship with their doctors | Healthcare and Technology news |

    As digital health becomes more of a reality, a recent survey of over 2,000 US adults finds that most of us -- 84 percent to be exact -- see doctors who provide patient online portals.

    One of the survey's most surprising findings is that 61 percent of older adults -- aged 55 and up -- access their health information through the portal, while just 45 percent of their younger counterparts in the 18 to 54 age group do so.

    The survey found that 37 percent of those who own a wearable fitness tracker wear it everyday.

    Of wearable users, 78 percent who use their devices more than once a month say it's practical for their doctors to access that information.

    Sixty-four percent of adults would choose telehealth visits over in-person visits at least some of the time, especially for follow-up visits and for minor concerns such as eye infections and skin checks.

    More than one quarter, or 27 percent said they would always choose a telehealth visit instead of an in-person visit.

    Of parents with children under the age of 18 living under their roof, 76 percent said they would sometimes choose telehealth visits, whereas only 61 percent of those without children under the age of 18 said they would.

    Sixty percent of respondents said they would use the online portal for appointment scheduling if it wasn't already available for this purpose.

    The survey was conducted by eClinicalWorks, which also surveyed a group of 2,922 US healthcare professionals separately.

    Seventy-five percent of healthcare professionals surveyed said online portals made it easy to share patient information with other doctors and allowed patients to access their medical health record with more ease than before.

    Automated alerts and reminders about appointments were among the other benefits they cited at a rate of 75 percent.

    Fifty-six percent of healthcare professionals said a top benefit of online portals is the ease of appointment scheduling.

    Sixty-one percent of healthcare professionals said they would recommend telehealth visits to patients at least some of the time.

    More than half of healthcare professionals said they found it useful to be able to access the information collected by patients' wearable devices.

    No comment yet.!

    In Colorado, a Collaboration Around Healthcare Technology

    In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news |

    Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.

     In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.

    To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.

    In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.

    UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”

    Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.

    Bringing the Data to the Doctor

    For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.

    Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.

    Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”

    Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.

     This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”

    Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

    Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.

    As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

    Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.

    Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.

    Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

    No comment yet.!

    How New Jersey Public Policy Fails Primary-Care Physicians

    How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news |

    We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.

    With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

    Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.

    Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  

    As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.

    The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.

    Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

    No comment yet.!

    400 million people still lack access to key health care services

    400 million people still lack access to key health care services | Healthcare and Technology news |

    Some 400 million people worldwide lack access to essential health services, and the cost of healthcare is forcing many into poverty, the World Bank and World Health Organization reported Friday.

    A new report by the bank and WHO on tracking universal health care (UHC) coverage said more people than ever around the world, 80 percent, have access to key health services.

    Universal health care, the two institutions say, encompasses services that should reach everyone regardless of socioeconomic level: family planning, antenatal care, skilled support when giving birth, child immunization, TB treatment, HIV antiretroviral therapy, improved water sources and improved sanitary facilities.

    But hundreds of millions are reached by only a few of those services. In addition, in low and middle-income countries, six percent of the people were at risk of being forced into or pushed further into poverty by health care costs.

    "This report is a wakeup call: It shows that we're a long way from achieving universal health coverage," said Tim Evans, senior director of health, nutrition and population at the World Bank.

    "We must expand access to health and protect the poorest from health expenses that are causing them severe financial hardship."

    For some kinds of services, well over 80 percent of people have access, the report says.

    And it said that the impoverishing impact of catastrophic health expenses has diminished over the past decade.

    "However, there is still a long way to go on the road to UHC, both in terms of health service and financial protection coverage," the report said.

    The new report seeks to define UHC, in terms of measurable essential services, to be able to assess how governments and communities are performing.

    No comment yet.!

    Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace

    Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace | Healthcare and Technology news |

    The Rochester, Minn.-based Mayo Clinic and the health analytics and data community and marketplace Apervita are launching a health measures platform that will allow health professionals to publish or subscribe health measures which will turn definitions into analytics.

    According to the companies, while there are already thousands of health measures for quality, safety, outcomes, and finance that are increasingly the basis for measurement of performance and reimbursement for value-based care, they are notoriously complex and organizations struggle with the costly process of implementing and maintaining them. This often results in delays of more than 12 months to report new measures or update existing measures.

    With this new approach, Apervita will offer a family of open interfaces, including open web service APIs, allowing standard measure definitions to be imported, edited, published, executed and exported. Once an author has developed a measure, it can be connected to different data sets as well as shared through a global marketplace. Measure results can be displayed on the Apervita platform or accessed through APIs for display within electronic medical records (EMRs), third-party systems and mobile applications. The import and export of measures supports the Centers for Medicare and Medicaid Services (CMS) quality data model (QDM) through which all modern measures are today made available, the companies say.

    “Healthcare providers and facilities should focus on what they do best, providing high quality patient care. After all, that’s what health are measures are designed to enable,” Dr. Jyotishman Pathak Ph.D., professor of Biomedical Informatics at Mayo Clinic, said in a statement. “With thousands of healthcare measures which continuously evolve, keeping track of, implementing and monitoring the measures has shifted some of that focus away from the patients, and it needs to shift back.”

    No comment yet.!

    Are Bigger MD Groups Better Prepared for Population Health?

    Are Bigger MD Groups Better Prepared for Population Health? | Healthcare and Technology news |

    It was fascinating to interview Donald W. Fisher, Ph.D., the president of the Alexandria, Va.-based American Medical Group Association (AMGA), earlier this spring, as I researched and reported our May/June cover story on population health and data analytics. For one thing, Dr. Fisher has been in the trenches in supporting the management of larger medical groups in the U.S. for decades now, so his perspectives are weighted with many years’ experience and understanding of the healthcare system at the physician group management level.

    What’s more, anyone familiar with AMGA knows that the leaders of its member medical groups have been at the forefront of healthcare delivery and payment innovation for years now. It was in fact the participation of a number of a number of AMGA member medical groups whose involvement and learnings in several different Medicare-facilitated primary care and care management initiatives helped convince senior CMS (Centers for Medicare and Medicaid Services) officials to move forward to the go-live of the Pioneer ACO Program a few years ago.

    And it has been not only in the Medicare accountable care organization sphere that the leaders of large medical groups have been trailblazers; large medical groups have been pioneers, with a “small p,” in private-sector ACOs, collaborating in very innovative ways with private health insurers nationwide.

    So what has been learned? Among other things, as Dr. Fisher told me this spring, and as was revealed in our extended interview published this week, one key challenge remains that, as he put it, “Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then,” he added, “there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid fee-for-service, and still mostly paying your doctors fee-for service, you need to change that, and that is something they’re trying to get over pretty quickly.”

    Beyond those issues, there is this issue that Dr. Fisher brought up in our interview, and which I think goes to the heart of the question of how the leaders of larger medical groups are turbocharging their learning process around accountable care and population health: “The thing is,” he told me, “that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work these data sets and predictive analytics, but,” he added, “it can make a very big difference in patients’ lives; patients are just doing so much better as a result.”

    And therein lies one of the keys to unlocking the secret of population health and accountable care success—the interplay between the harnessing of data analytics and the continuous process change work that needs to undergird everything.

    In other words, at the same time that the leaders of a medical group—or, for that matter, any patient care organization—are collecting data, analyzing that data, making determinations of how to act on their analyses, and moving forward to make changes based on those analyses, they need to be engaged in continuous clinical and operational performance improvement, whether using methodologies like Lean management, Six Sigma, and Toyota Production System for healthcare, or any combination of those or other methodologies, or developing their own.

    It’s all about a virtuous cycle or “blessed cycle,” as some are calling it, in which process change and analytics work are all intelligently and strategically combined. Now, here’s a legitimate question: what size medical group might do this best?

    Of course, every physician group has a different organizational structure, specialty and clinician composition, history, culture, and set of IT and other tools, at its disposal. And it goes without saying that every medical organization has a different set of personalities. But, given sufficient leadership capability, and the taking on of personal-professional risk on the part of leaders in an organization committed to transformational change, anything is possible. But it does seem that larger medical groups—those with enough management skill individuation that they have not only a chief medical officer but also probably a CMIO, as well as someone who serves as a chief quality officer, and with each of those leaders having some team with at least part-time responsibility to participate in robust change management—it does seem that larger medical groups are more fully advantaged in the context of this kind of work.

    And even though Medicare’s Pioneer ACO Program in particular has been facing challenges as of late, what is clear is that larger medical groups are moving forward with alacrity to pioneer, again with a “small p,” a lot of the innovations that are beginning to emerge as groundbreaking for the population health/accountable care path ahead for all of us. So it will be important for everyone to keep their eyes on all these developments in the next few years, as the ramp-up towards broader innovation is going to be both rapid and challenging. But as the leaders of some of the most innovative larger medical groups know, their organizations are continuing to be amazing test-beds of real innovation along all dimensions, in healthcare, and that combination of continuous process change around care delivery and the intensive, strategic leveraging of healthcare IT and especially data analytics, is bound to reap major rewards in the coming months and next few years.

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    Connecticut Legislature Considers Giving Statewide HIE Another Try

    Connecticut Legislature Considers Giving Statewide HIE Another Try | Healthcare and Technology news |

    Although it is surrounded by states that have had relative success with statewide health information exchange efforts, Connecticut has struggled to develop an HIE. Last year it pulled the plug on its earlier efforts after spending $4.3 million in federal grant money. But legislators are taking another stab at it. Last week the state Senate passed a comprehensive healthcare bill that would establish a statewide HIE, according to the Connecticut Mirror, an online publication. 

    The Mirror story quotes Senate Minority Leader Len Fasano, R-North Haven, as warning that the lack of a neutral, statewide system can give large health systems a business advantage, steering patients to other providers within the same system.

    In written testimony earlier this year, Yale New Haven Health System noted that an earlier form of the bill did not take into account what many hospitals are already doing to share data and provide access to healthcare agencies and community physicians.

    Between 2010 and 2014, the Health Information Technology Exchange of CT, or HITE-CT, spent $4.3 million unsuccessfully trying to create an exchange before being shut down by the state.

    A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream.

    “HITE-CT was unable to meet its strategic and operational schedule primarily due to its inability to adapt quickly to changing market conditions. The exchange’s board of directors recognized that the terms in the original contract with its vendor required significant modification to reflect the evolving market place for an integrated statewide electronic health information infrastructure,” the audit said. “A lengthy renegotiation period with its primary vendor reduced the exchange’s options for achieving sustainability. The resulting amended contract with the vendor had a reduced scope for deliverables. It no longer included the establishment of an operational statewide health information exchange that could provide desired revenue producing services to stakeholders through fees and other assessments.”

    The responsibility for health information exchange efforts rests with the state Department of Social Services, and the bill allows DSS to propose an alternative solution to a centralized statewide HIE, the Mirror article said. The bill now goes to the Connecticut House for consideration.

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    Physicians Need to Take Time for Themselves

    Physicians Need to Take Time for Themselves | Healthcare and Technology news |

    Doctors and their office staffs, like nearly everyone else, are living to ripe old ages. As such, they need to pace themselves for the long haul. A personal story helps illustrate the point: I worked with my friend Peter, for Smyth Manufacturing Company, the famed book binding equipment manufacturer, the summer before we entered college. It was my only time in a job shop, and I learned many lasting lessons, such as the importance of cleanliness in an industrial setting.

    Before you left for the evening, you oiled your machine, wiped the floor and counters, and cleared away scraps and extraneous items so you could begin the next day without impediments. The craftsmen sometimes elaborately cleaned and reorganized items in the middle of the day as well, as they switched from one job to another. When you're working with potentially dangerous industrial equipment, you can't afford to have a stray bolt or paper clip lying around that could catch in a gear and fly across the factory floor into someone's face.

    Control of their immediate environment

    As deftly as these job shop professionals worked, they continually maintained control of their immediate environment because they understood its importance on many levels. In case you think they were being overly cautious or were paid some admirable hourly wage, guess again. These workers were paid by the piece, and they were known as "piece workers."

    Any one of them could have easily increased their output on a given day by slacking off on cleaning and maintenance procedures. After all, if you can turn out seven pieces in a day spending 30 percent of your time cleaning and maintaining, you might be able to produce more than 10 pieces if you completely concentrate on your output. In the short-term, you could make more money. Longer term, you could injure yourself or others, create more waste, shorten the equipment's life, or get fired.

    The lesson for us all: "pay as you go," clear the decks each night, arrive ready for the next day, and pace yourself for the long haul.

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    As sensors shrink, watch as 'wearables' disappear

    As sensors shrink, watch as 'wearables' disappear | Healthcare and Technology news |

    Forget 'wearables', and even 'hearables'. The next big thing in mobile devices: 'disappearables'.

    Even as the new Apple Watch piques consumer interest in wrist-worn devices, the pace of innovation and the tumbling cost, and size, of components will make wearables smaller - so small, some in the industry say, that no one will see them.

    Within five years, wearables like the Watch could be overtaken by hearables - devices with tiny chips and sensors that can fit inside your ear. They, in turn, could be superseded by disappearables - technology tucked inside your clothing, or even inside your body.

    "In five years, when we look back, everything we see (now) will absolutely be classified as toys, as the first very basic steps of getting this right," says Nikolaj Hviid, the man behind smart earbuds called the Dash.

    Developed by Munich-based Bragi GmbH, the Dash is a wireless in-ear headphone that looks like a discreet hearing aid. Packed inside is a music player, 4 gigabytes of storage, a microphone to take phone calls - just nod your head to accept - and sensors that monitor your position, heart rate and body temperature.

    Nick Hunn, a consultant who lays claim to the term 'hearables', reckons the Dash is just the start. He predicts smartwatches will dominate wearable sales for the next three years, hearables will then overtake and, by 2020, will account for more than half of a $30 billion wearable device market.

    This rapid shift is being driven, he says, by a new generation of chipsets using Bluetooth wireless communication and using far less power than their predecessors. Designers now realize "the ear has potential beyond listening to music - it's an ideal site for measuring a variety of vital signs," Hunn wrote in a recent report.


    A parallel revolution in sensors is making this possible.

    Kow Ping, whose Hong Kong company Well Being Digital Ltd provides algorithms and reference designs on wearable sensing to companies like Philips, Motorola, Haier and Parrot, says chipmakers have invested heavily in reducing the power consumption and size of sensors.

    An accelerometer, which measures things like position, motion and orientation, for example, is now 1 square millimeter. "A few years ago," he says, "it was two or three times as big and two or three times less refined."

    When they can harvest energy from the body's heat or motion they'll be even smaller, autonomous and ubiquitous.

    Andrew Sheehy of Generator Research calculates that, for example, the heat in a human eyeball could power a 5 milliwatt transmitter - more than enough, he says, to power a connection from a smart contact lens to a smartphone or other controlling device.

    And Ping's company is working with a top Asian university to add sensors to a sports bra which could harvest energy from relative motion. In five years, he says, "there will be people building sensors into every existing wearable device or apparel."


    Bragi's Hviid calls these 'disappearables'. And while medical and fitness top the list of what these devices might measure, he and others are looking beyond that. A dozen sensors in your pants, he suggests, could advise on how to improve your posture or gait when trying to impress a suitor.

    "It's more like a butler ... they do some basic stuff that you really want, but there are deeper experiences in there," Hviid says.

    Sheehy points beyond the personal, as parallel advances in machine learning and artificial intelligence "come together and lead to some remarkable use cases:" a politician's contact lens, for example, might provide real-time feedback from a sample of voters, allowing for a speech to be tweaked on the fly.

    A lot of this technology is already here.

    Google is working with Novartis on a contact lens to measure glucose levels in tears. The healthcare group has also invested in Proteus Digital Health, a biotech start-up which promises edible embedded microchips, the size of a grain of sand, which are powered by stomach juices and transmit data via Bluetooth.

    "We're looking at a major technological revolution of a similar magnitude to the mobile revolution," says Sheehy.


    Not everyone agrees that disappearables are necessarily just around the corner. Wearables still need to gain widespread acceptance - remember Google Glass - and the technology still needs to finessed.

    While Bragi has raised more than $3 million from crowdfunding website Kickstarter and another $10 million from angel investors, Hviid says communication problems between the left and right earbuds have delayed launch of the Dash until September. It was originally due out late last year.

    Ping's company has been working since 2006 on wearables, and owns more than a dozen patents, but he says bringing all the technical parts together, understanding the consumer and mastering manufacturing pose a real challenge.

    BAM Labs's curator insight, 21 May 2015, 20:58

    And under the mattress, turn any bed into a smart bed.!

    Cedars-Sinai goes all-in on Apple HealthKit

    Cedars-Sinai goes all-in on Apple HealthKit | Healthcare and Technology news |

    Cedars-Sinai Medical Center in Los Angeles has become the latest provider organization to link its electronic medical records system to Apple's HealthKit software.

    CIO Darren Dworkin, speaking to Bloomberg Business, said that information from HealthKit now will appear in health records for more than 80,000 patients. Several other hospitals, including the Mayo Clinic in Rochester, Minnesota, and New Orleans-based Ochsner Health System, as well as Stanford University Hospital and Duke University, also integrate with HealthKit.

    "This is just another set of data that we're confident our physicians will take into account as they make clinical and medical judgments," Dworkin said, who added that use of HealthKit will be a learning experience.

    "We don't really, fully know and understand how patients will want to use this," he said.

    Dworkin added that HealthKit will be available for all patients throughout the system to use as they choose. 

    "The opt-out is just don't use it," he said.

    At the Healthcare Information and Management Systems Society's mHealth Summit in the District of Columbia last December, Ochsner Chief Clinical Transformation Officer Richard Milani and Duke Medicine Director of Mobile Technology Ricky Bloomfield shared insight into their respective organizations' HealthKit integrations. Both facilities use Epic's patient portal, MyChart.

    Milani said the amount of data patients could generate that could then go into their records was pretty small; he said about 50 to 60 discreet elements such as weight, sodium intake and blood pressure could be entered. Bloomfield, however, said that based on conversations with Apple healthcare executives, he expects that number to grow.

    Bloomfield added that HealthKit integration will help to transform the use of EHRs for providers.

    "This was finally something we could give them that would live up to the promise of what EHRs can provide, and what having access to this kind of data can provide," Bloomfield said at the Summit.

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    Building Effective Patient Education Programs

    Building Effective Patient Education Programs | Healthcare and Technology news |

    Patient education programs have been around for a long time, but typically these programs have been geared toward only the chronically ill and those that needed extensive management. In this era of the Patient-Centered Medical Home patients and insurers are looking more to physician practices to provide effective patient education in all aspects of their care. In fact, many insurance companies are actively measuring physicians' performance on quality metrics. Current accountable care models factor in patient utilization of emergency rooms, hospital visits, and prescriptions, and attribute that cost to the patient's primary-care doctor, which may also include specialties such as cardiology.

    So what does this mean to your practice? With more accountability comes the need to manage patient populations more effectively to be able to hold the line on costs. If you are not doing a good job in actively engaging patients to "self manage" their own care, and utilizing lower-cost opportunities for managing your patients' care, then you may soon find yourself failing to achieve a targeted level of care and cost utilization, and that will cost you money.

    Creating and implementing effective programs

    The most effective education programs are those that are customized to each patient. But don't let that daunt you. You can define general care plans and then customize those on a patient-by-patient basis.

    • First, determine what conditions to tackle. Get to know your patient population. What are the most complex and costly conditions that you manage? What conditions apply to the most patients across your practice? Hone in on those areas to begin with, set up and fine-tune a program or two, and then you can replicate successful programs across your entire patient base from there.

    • Second, assess your patients' needs. Determine what actual resources and help is needed by your particular patients. Do not hesitate to poll your patients by asking them directly what their specific needs and challenges for self-management may be. If you make assumptions about your patients' needs, you may only meet the goals of a small part of your population, which can be counterproductive and result in poor compliance with the program. In addition to assessing needs, assess the challenges (such as lack of family support) and skills (Internet use, reading ability etc.) of your patients and build a program that can adequately meet them where they are coming from.

    • Third, use what's available. Don't reinvent the wheel. There are lots of good materials, courses, and programs available. It's OK to adopt a program you like; just make sure to thoroughly review all of the material and adjust the sections, ideas, concepts, and so forth to fit with your specific patients' needs and your style of practicing medicine.

    • Fourth, communicate effectively and set small targets. Let your patients know about these programs and educate them about what they are expected to do. Priorities should be clearly stated, mutually understood, and mutually agreed upon, and patients should be provided with information about what to do if they go "off the plan." That will help to keep them empowered and engaged in their own care, and keep them communicating effectively with you and the office when there is a problem. Keep the goals small and manageable to begin with and don't overload the patient with information. Tip sheets and goal targets should be the core of the program; then add in more information as the patient progresses. Keeping material simple, clear, and to the point will help with comprehension.

    Setting one target per visit is a manageable way for patients to begin working a program. For example, set a new diabetes patient the goal of reducing his intake of sweets to three desserts per week, and provide a cheat sheet of desserts that are diabetes-friendly to choose from on the plan. At the next visit, you identify a new goal to add to the first one, and repeat. While it may take a while to turn a patient's health around, research confirms that small, incremental changes are much more likely to be lasting changes, so think in terms of a marathon rather than a sprint to the finish line.

    Lastly, make the plans, goals, materials, and office staff highly available to the patient. Post the educational material on your site, mail follow-up materials to patients, place outbound follow-up calls and/or e-mails to patients to check on how they are doing between visits. These touch points matter and can be the difference between a successful program and good patient engagement or wasted effort and time.

    And don't forget, as of January 2015, you can now bill a monthly, per patient code for chronic care coordination, CPT 99490. Just make sure to check the guidelines for this code to adhere to the description of services before you bill it.

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    Is health reform contributing to physician burnout?

    Is health reform contributing to physician burnout? | Healthcare and Technology news |

    Many physicians feel burnt-out from their careers

    A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has increased since the last survey in 2013, with 46 percent overall reporting these feelings. When looking at specific specialties, the most burnt-out physicians are critical care and emergency doctors. Half of primary care physicians, family doctors, internists and general surgeons also felt burnt-out. These survey results are alarming as they reflect poor physician well-being.

    Physician well-being is a burgeoning area of focus

    A generation or two ago, few people talked about the physical and mental health of our doctors. However, in the last decade, researchers have begun to characterize professional burnout and associated problems. For example, physicians have one of the highest rates of suicide compared to other professions. Family physicians and internal medicine doctors are the most likely to say they would not choose their specialty again if they could redo their careers. Psychiatrists and anesthesiologists have a higher rate of substance abuse than other specialists. These studies have cast a spotlight on trying to improve physicians’ satisfaction, well-being, and mental health by addressing the unique challenges physicians face.

    My residency program incorporates a wellness curriculum

    Trainees face a unique set of circumstances, working long hours in stressful situations. The regulatory body for residency programs has put limits on the hours that interns and residents can work. However, simply changing our work hours is not enough to ensure our mental and physical well-being. In order to help us meet the unique challenges of being medical residents, my residency program developed a curriculum with lectures by psychologists, mediation sessions, reflective exercises and development of coping skills. Although our training is easier than that endured by physicians in the past, residents still develop depression, commit suicide and undergo divorce, and a wellness curriculum helps reduce these devastating consequences.

    Burnout is everywhere

    Even in my practice, I have colleagues, trainees and supervisors who report some degree of dissatisfaction, frustration and disappointment with their work. I know some physicians who left medicine to work in industry or consulting. Most of those who are burnt out feel that paperwork, bureaucratic tasks, and insufficient reimbursement for the hours worked are the main contributing factors. Unfortunately, changes like the Affordable Care Act or implementation of computerized health care may exacerbate these causes rather than ameliorate them. In pursuing some admirable goals, we cause other unintentional negative consequences.

    We need to reduce burnout and improve well-being

    Physician burnout affects patient care; burnt-out physicians cannot exhibit the compassion necessary to care for patients, and they are unlikely to go above and beyond their clinical duties. There is an urgent need for research in improving physician well-being, such as training in coping mechanisms, development of mindfulness techniques and restructuring the bureaucracy of medicine. I am early in my career and still go to work with excitement, curiosity, and engagement, but I am deeply aware of the risks of this profession and hope to maintain my well-being. What are your thoughts on physician burnout?

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    IBM Announces Deal to Acquire Both Phytel and Explorys; Goal Is Data Transformation

    IBM Announces Deal to Acquire Both Phytel and Explorys; Goal Is Data Transformation | Healthcare and Technology news |

    Senior executives at the Armonk, N.Y.-based IBM announced in a press conference held on Monday afternoon, April 13, at the McCormick Place Convention Center in Chicago, during the course of the HIMSS Conference, that it was acquiring both the Dallas-based Phytel and the Cleveland-based Explorys, in a combination that senior IBM executives said held great potential for the leveraging of data capabilities to transform healthcare.

    Both Phytel, a leading population health management vendor, and Explorys, a healthcare intelligence cloud firm, will become part of the new Watson Health unit, about which IBM said, “IBM Watson Health is creating a more complete and personalized picture of health, powered by cognitive computing. Now individuals are empowered to understand more about their health, while doctors, researchers, and insurers can make better, faster, and more cost-effective decisions.

    In its announcement of the Phytel acquisition, the company noted that, “The acquisition once completed will bolster the company’s efforts to apply advanced analytics and cognitive computing to help primary care providers, large hospital systems and physician networks improve healthcare quality and effect healthier patient outcomes.”

    And in its announcement of the Explorys acquisition, IBM noted that, “Since its spin-off from the Cleveland Clinic in 2009, Explorys has secured a robust healthcare database derived from numerous and diverse financial, operational and medical record systems comprising 315 billion longitudinal data points across the continuum of care. This powerful body of insight will help fuel IBM Watson Health Cloud, a new open platform that allows information to be securely de-identified, shared and combined with a dynamic and constantly growing aggregated view of clinical, health and social research data.”

    Mike Rhodin, senior vice president, IBM Watson, said at Monday’s press conference, “Connecting the data and information is why we need to pull the information together into this [Watson Health]. So we’re extending what we’ve been doing with Watson into this. We’re bringing in great partners to help us fulfill the promise of an open platform to build solutions to leverage data in new ways. We actually believe that in the data are the answers to many of the diseases we struggle with today, the answers to the costs in healthcare,” he added. “It’s all in there, it’s all in silos. All this data needs to be able to be brought into a HIPAA-secured, cloud-enabled framework, for providers, payers, everyone. To get the answers, we look to the market, we look to world-class companies, the entrepreneurs who had the vision to begin to build this transformation.”

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