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Better Choices Needed to Manage US Healthcare Cost Growth 

Better Choices Needed to Manage US Healthcare Cost Growth  | Healthcare and Technology news |

LAS VEGAS – In a fireside chat at the HX360 conference, Nobel Prize-winning economist Paul Krugman said there are reasons for optimism even as the U.S. healthcare system faces serious financial challenges. 


In a fireside chat with HIMSS CEO Hal Wolf, Krugman said the demographic challenge is serious, “but not as serious as one would think.”


He said that healthcare has been absorbing about 18 percent of GDP since 2010 but that there has been a flattening of the cost curve. He believes that healthcare’s share of GDP should remain constant for at least a few years.


Wolf said that he has concerns that as baby boomers live longer and the financial burden of treating disease kicks up, the population takes on more costs.


Though the U.S. still has the highest healthcare costs in the world, there are a few options that could be used to dig out of that -- any of which would be better than the current state, said Krugman, which he described with a quote from Homer Simpson: “The U.S. government is an insurance company with an army.” 


To Krugman, “Medicaid looks more like the systems in other countries and is a well-established system. But if the goal was the cheapest care, we’d do something like the NHS -- but I don’t see that happening in my lifetime.”


While a single-payer system is expensive, costs can be mitigated by a system that would more carefully scrutinize unnecessary elective treatments.


The Veterans Health Administration, which has been working to improve its system since the 1980s, presents a good model for how to overhaul healthcare, said Krugman. They were pioneers, the first to implement EHRs and shifted a lot of their care from hospitals to health centers. It was a precursor to the private sector.

“We have the capacity, but it would require that you have capable leadership,” said Krugman.


Krugman also explained that healthcare costs aren’t necessarily in a crisis, “but it still needs improvement.” And that means everyone is going to have to find a solution to limit costs.

“It’s not that the whole structure of healthcare is unsustainable. But it has the historical pattern of ever-rising costs that cannot continue,” he said.


Reflecting on the Dot-com bust and the real estate crisis, Krugman said we were able to dig out of those situations, “but right now, we’re still reeling from what feels like a permanent hangover from the last crisis. And it’s not at all clear that we resolved the issues that brought us there in the first place.”


Though the country has low interest rates, the private sector debt is still high, said Krugman. But he’s less worried about that,than the fact that “when these crises hit, no one sees it coming.” We’re all set up to do it again one of these days.”


Adding to the worry is America’s deficit. “When the next crisis comes along, it’s going to increase debt,” he said.

Krugman called the latest tax cuts passed by Congress a really bad policy that could make things much worse if a trade war breaks out. What’s worse is that the tax cuts were “not designed for anything really. There were a bunch of people that wanted a tax cut, and they were obliged to that.”


That might make our current situation worse when combined with the trade wars. Calling it a “really bad policy,” he did specify that it doesn’t necessarily mean “tremendous risk.” It does mean, however, Krugman said he checks Twitter “every 40 minutes to see if the trade war has broken out.”

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HIMSS mHealth Study, Technology in Healthcare |

HIMSS mHealth Study, Technology in Healthcare | | Healthcare and Technology news |
Use of mHealth within the healthcare industry on the rise.

The use of mHealth within the healthcare industry is on the rise according to a study published by the Healthcare Information and Management Systems Society (HIMSS). The findings within the study showed that smartphone and tablet use within hospitals is increasing

According to the data, tablet computers and smartphones appear to be starting to replace the use of desktop or laptop computers to access information. Approximately 28 percent of polled hospitals indicated that their organization used smartphones and 24 percent indicated that their organization utilized tablet computers. Data indicates that an average of 169 devices are deployed per hospital.

Practitioners polled also reported that the use of these updated technologies improved their ability to communicate with other healthcare providers and that the use of these devices gave them a more positive overall work experience.

Another benefit of physicians using mobile devices could improve patient care. One-third of providers reported that using smartphones and table computers could have a positive impact on quality of care and care coordination, as well as improve care efficiencies.

Though the practitioners that currently utilize these updated technologies seemed optimistic about the use of these devices, the data revealed room for improvement. Only 33 percent of providers polled indicated that they are confident in their ability to access the clinical technologies they required through smartphones or tablet computers.

“It’s one thing to state that mobile technology is cool” said David Collins, Senior Director, Health Information Systems for HIMSS North America. “it’s another to determine what value it brings to the healthcare equation.”

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HIMSS15 Provides Both Clarity Confusion

HIMSS15 Provides Both Clarity Confusion | Healthcare and Technology news |

For the first time since 2009, the HIMSS Annual Conference & Exhibition was back in its hometown of Chicago this year. And, with more than 43,000 attendees and 1,200 exhibiting vendors flocking to McCormick Place Convention Center, this proved to be the largest HIMSS conference on record. Many of the same pressing topics from HIMSS14 were prevalent again at this year’s event — namely interoperability and population health management.

A Step Forward For Interoperability

Interoperability continues to be one of the biggest challenges facing the health IT industry. And, thankfully, HIMSS15 actually seemed to provide some much needed direction in this area as opposed to just rhetoric.

For example, HIMSS15 provided one of the biggest venues for health IT industry leaders to sit down with members of the ONC to discuss the nationwide Interoperability Roadmap that was drafted earlier this year. This roadmap charts a path for the health IT industry to achieve interoperability progress in 3, 6, and 10 years using core critical building blocks identified by the ONC.

The ONC even organized several listening sessions dedicated to fostering industry collaboration on the Roadmap. One, titled Advancing Interoperability and Standards, was open to all HIMSS attendees and aimed to answer questions, provide clarity, and set realistic expectations surrounding the Roadmap. Another, titled ONC Interoperability Listening Session With Health IT Developers, was specifically designed for the software developer community to discuss the unique challenges and opportunities associated with developing an interoperable infrastructure for health IT. Yet another ONC interoperability listening session targeted clinicians in an effort to gain a better understanding of their interoperability demands.

The ONC’s take on interoperability was summed up well by the organization’s National Coordinator Karen DeSalvo, MD during her keynote on Thursday morning.  During her speech, DeSalvo referenced that she participated in dozens of similar interoperability listening sessions throughout the year and she believes the path to health IT interoperability hinges on three primary objectives:

  1. Creating standardized standards, including APIs;
  2. Improving clarity regarding the trust environment, particularly data security and privacy; and
  3. Establishing sustainable and durable incentives that promote interoperability and appropriate use of health information between systems.

Finally, HIMSS15 once again featured an Interoperability Showcase, where more than 50 sponsoring vendors offered first-hand demonstrations as to how their technologies could be leveraged to deliver health IT interoperability in a variety of care settings. This year’s Interoperability Showcase was the largest landmark on the exhibit floor and provided visitors with real-world insight into how interoperability can be achieved.

A Muddled Population Health Management Message

While HIMSS15 did an admirable job of attempting to clarify the interoperability dilemma facing health IT and the go-forward strategy, I believe it had the opposite effect in regards to Population Health Management (PHM). PHM was one of the biggest buzzwords at HIMSS15. Just about every other vendor on the exhibit floor promoted how its product or service was instrumental in the PHM equation. I can’t help but think that all of this noise was confusing to the providers in attendance searching for an effective PHM solution.

From my perspective, HIMSS15 clearly illustrated the clear need for a universally accepted definition for PHM in the health IT industry. I must have spoken to executives from more than a dozen self-proclaimed PHM vendors at HIMSS, and I never heard the term defined the same way twice.

Rather than simply complain about the lack of an agreed upon PHM definition, I thought I might take a crack at getting the ball rolling toward this end. Based on my conversations at HIMSS and my editorial coverage on PHM to date, a true PHM initiative must include the following key elements:

  1. It must incorporate data aggregation from multiple sources;
  2. It must include the analytics technology necessary to turn that aggregated data into actionable intelligence;
  3. It must provide workflow tools to facilitate/automate case management and care coordination; and
  4. It must deliver mechanisms for patient engagement and feedback.

In my opinion, if a vendor product or service doesn’t address all four of these areas, then it only solves part of the equation, and isn’t a true PHM solution. While I doubt the list of criteria outlined above is the universal PHM definition the industry needs, I believe these elements provide the building blocks upon which that definition can be based. What factors am I missing? How can we round out this rough skeleton to create an accurate PHM definition that clarifies the concept as opposed to leaving it up to multiple interpretations? I’d be interested in your thoughts and feedback.  

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