Readers Write: Ambulatory Interoperability – Paving the Way for Improved Health

Ambulatory Interoperability: Paving the Way for Improved Health
By Rob Newman

The health IT industry is buzzing with talk of interoperability – a gap those of us in the market have long recognized and worked to overcome. Consumers and the media are now taking notice and discussing how healthcare delivery, costs, and outcomes could be improved if physicians and other care providers and their patients were better connected.

What does interoperability really mean to you and your practice? And in the digital age, where information flows quickly and freely, why is healthcare interoperability such a challenge?

Setting the Stage
If interoperability goes in one of your ears and out the other like any other buzzword, I’d like to take some time to set the stage. We define interoperability as the exchange and communication of health data across information technology systems with the goal of advancing effective delivery of healthcare. These systems may reside within an ambulatory practice, a hospital, a government agency or even with healthcare consumers through their mobile devices or wearables. When interoperability is working correctly, data flows seamlessly from one system to the other in a meaningful way, and with checks and balances in place to protect sensitive information. When interoperability fails, a patient’s data sits siloed with individual providers, or it is passed along in a way that is heavy on volume and low on actionable insight.

In the ambulatory space, interoperability ensures both the patient and provider gain access to the right information, at the right time, in the right place. Health outcomes can be improved for whole populations – making it possible to achieve success in a value-based model – when doctors treat more than an immediate health need by looking across the patient’s health record and medical history. This connectedness ensures physicians can see where, when, and how the person has been treated; what has worked versus what hasn’t … and can even keep tabs on patient compliance along the way.

The convenience of having this information available before a physician even encounters a patient in the office is also a game changer. Physicians want to manage their time wisely to ensure all patient needs are met in a timely manner. When data is well-connected, office visits become more streamlined and efficient with fewer introductory questions and less guessing. Actual visits to the office can even be prevented entirely … either through provider-patient communications and proactive care coordination, or early telemedicine or other online communications and interventions.

Through these linkages, providers also have access to the right information to make a proper diagnosis, care coordinators know how to follow up, and patients are empowered to be better healthcare consumers with access to their medical information and care plan. All of this helps facilitate ongoing, proactive care and better health.

There are Benefits, But …
Despite the benefits of interoperability, there are always hurdles with new technology solutions— particularly when those solutions contain data as sensitive as medical information. Currently, there’s no streamlined method in place to identify patients across offices and systems, and no national appetite for a unique patient identifier that would enable physicians to track a person in this way. Without such an identifier, data is mismatched when multiple people share names, dates of birth, or addresses because individual healthcare providers are using their own unique way to identify patients within their systems.

Headway at the KLAS Keystone Summit
Is there any good news about interoperability? The answer is a resounding yes. In recent years, interoperability has made significant strides forward in the ambulatory space with increased EHR adoption and collaborative efforts by EHR vendors to more effectively share data between their systems. While the aforementioned pain points around patient identity remain, solution providers are coming together to solve these issues as an industry. Greenway Health is a member of the Ehealth Exchange, Surescripts, and CommonWell Health Alliance, each of which is pushing to eliminate lost pockets of data. In fact, we recently convened with other key EHR solution executives and healthcare provider organizations at the KLAS Keystone Summit, where the group agreed to adopt a standard interoperability measurement tool. The vision is to link everyone together, regardless of EHR solution they’re on. We are all committed to building tools to bridge providers and patients, focusing on translating immense data into useful nuggets of actionable information to improve care coordination and health outcomes.

Let the Data Flow
If data sharing becomes seamless, the information will be a utility. As an example, we don’t think about the water getting to our faucet; we just expect that if we turn the faucet, water will come. But there was a time this wasn’t the case. Pipes had to be laid connecting a water source to a treatment plant to your house and back again. In the same respect, we’re currently building out the health data interoperability infrastructure. We have to figure out what size pipes to use and how to refine the data into actionable information that supports providers in most effectively determining how and when to take action. Along the way, the data must be protected and accurate, not corrupted or lost in transit.

I trust we will take down the barriers to clinical information and get to a place where providers don’t think about interoperability — not because it’s a buzzword, but because it’s so seamless they don’t have to worry what will happen when they turn on the faucet. When this data becomes more than information, it becomes powerful. It is the fuel necessary for efficiency, productivity, conversation and, ultimately, for improved health.

Rob Newman is vice president of interoperability at Greenway Health in Carrollton, GA.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 11/10/15

Top News

Scottsdale, AZ-based PM consulting firm PracticeMax acquires Brewster, NY-based Medical Management Corp. of America for an undisclosed sum. The acquisition provides PracticeMax access to MMCOA’s specialty physician client base in the Northeast. Its last acquisition was of Optimum Medical Management in September 2014.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Patient IO will use an undisclosed amount of funding from Athenahealth to ramp up product development of its care coordination tool, and integrate it with the AthenaNet cloud platform. The Austin, TX-based startup will also join Athenahealth’s More Disruption Please accelerator program, which conveniently opened a third location in Austin earlier this year.

People

Peter Tippett, MD (Verizon) joins the DataMotion Board of Directors.

Susan Anderson (Alberta Health) joins Orion Health as managing director of Canadian operations.

Telemedicine

XG Technology partners with GlobalMedia Group to offer a telemedicine delivery system for use in remote and underserved areas. The XMax Telemedicine Network Solution will combine XG’s mobile broadband technology with GMG’s telemedicine platform, and can also be adapted for use during emergency situations.

Walgreens expands and upgrades telemedicine services from MDLive to an additional 20 states via its mobile app. Telemedicine services were launched within the app in 2014, and are now available to consumers in 25 states.

On a related note, Walgreens launches the Connect app, offering its Balance Reward members who own Well at Walgreens connected blood glucose meters or blood pressure wrist monitors to earn points for taking daily readings. Measurements are captured and transmitted via Qualcomm Life’s 2net platform and mobile tools.

Government and Politics

The Patriot Promise Foundation launches ahead of Veterans Day to assist veterans in finding quality healthcare, which will including bringing commercially available healthcare technologies to the attention of physicians that care for veterans. Alliant Healthcare Products President and CEO Bob Taylor, who founded the organization, stresses that “we need to get beyond simply pointing fingers at the VA and work with them to do what it takes to find and fix any gaps in healthcare, whether it’s the availability of the latest technology or actively treating Post Traumatic Stress for vets.”

Members of the Senate HELP and Finance Committees write to CMS and OCR asking for an explanation of the steps being taken to aid medical identity theft victims and prevent future cyberattacks. The authors point out the increasing frequency of such attacks, and highlight the reluctance of CMS to correct Medicare billing records for identity theft victims. They conclude with a series of 12 questions in the hopes of receiving a response by November 24.

The above letter’s timing is especially apropos, given the White House’s release of Privacy and Trust Principles for its Precision Medicine Initiative. The four-page document assures participants they have the right to access results of the studies they participate in, and to be informed of any data breaches. It also prohibits re-identification of de-identified data.

The “who owns the data?” debate rages in Pennsylvania, as the House approves a bill that would require outpatient diagnostic imaging centers to notify patients or their designees of any significant abnormalities at the time of service or within 20 days after the results are mailed to the patient’s physician. Supporters of the bill, which now moves to the Senate, steadfastly believe that test results belong to the patient, while detractors are concerned such a practice will interfere with the sacred physician-patient relationship.

Research and Innovation

The third annual Practice Profitability Index shows that physicians still aren’t optimistic when it comes to turning a profit, though they are more upbeat about revenue than in years past. The forecasts align with the nearly 20 percent of practices that plan on budgeting for the replacement of their EHR and PM systems due to the prohibitive expense and sluggishness of current tools, plus their inability to easily integrate with other tech. The usual suspects – declining reimbursement, rising costs, and regulatory changes – ranked as the top threats to overall profit growth.

Other

Tweets from the HIMSS Connected Health Summit are flying fast and furiously, with HHS CTO Susannah Fox attempting to validate the usefulness of tweeting from conferences (a practice I know Mr. H has no time for, but I often enjoy.) Kudos to Fox, who spoke about insider views on government innovation, and cheekily referred to herself as “Lord of the Geeks” in the process.

The Wall Street Journal looks at the “Weird World of Brain Hacking” and the ethical concerns that arise when at-home scientists use DIY devices to treat a variety of conditions, including boosting creativity and cognitive performance. “You don’t often find a tool inside a lab that people replicate outside the lab and use their own way,” says MIT researcher Anna Wexler. “The controversy gets at the larger issue of who gets to control the tools of science.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 11/9/15

Top News

GE Healthcare acquires The Camden Group for an undisclosed sum. The Los Angeles-based Camden Group, which offers advisory services for physician groups and hospitals, will become the GE Healthcare Camden Group and serve as as the US business unit of global advisory firm GE Healthcare Partners. GEHCG becomes one of the largest consulting firms in the US, according to Daniel Marino, executive vice president of the new organization. GE Healthcare acquired UK-based Foresight Partnership and Finnamore last year.

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Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Durham, NC-based Validic signs on several new domestic and international clients including Australia-based Health&, France-based VisioMed, and Portland-based Conversa Health. The company, which specializes in connecting disparate digital health platforms, is on quite a roll, having signed on a new partner nearly every month in 2015.

India-based Omega Healthcare prepares to benefit from the transition to ICD-10 and resultant shortage of qualified coders in the United States. The company, which already employs, 2,500 coders, plans to hire an additional 1,000 in the coming quarter and hopes to realize a 30-percent increase in revenue as a result. India employs over 10,000 coders, of which Omega employs the biggest chunk.

Announcements and Implementations

Flatiron Health adds Billing Insights to the analytics capabilities of its OncologyCloud platform, enabling oncology practices and cancer centers to link EHR and billing data to recover missed or incorrectly billed charges.

The Wright Center (PA) receives the 2015 HIMSS Ambulatory Davies Award. The center, which has used the Medent EHR since 2005, provides safety net care to 10,000 patients annually, and provides residency and fellowship opportunities for medical students.

Figmd and Alpha II complete EHNAC’s Data Registry Accreditation Program. They are the first two organizations to complete the third-party review for registries that provide services to HIEs, RECs, and other government entities.

People

WEDI awards its 2015 Sullivan Award to Walter Suarez, executive director of health IT strategy and policy, Kaiser Permanente. Suarez was appointed by HHS Secretary Sylvia Burwell to head up the agency’s National Committee on Vital and Health Statistics earlier this year.

Erica Galvez (ONC) joins Aledade as director of HIE.

The AMA Foundation honors fourth-year University of Buffalo medical student (and Taylor Swift doppelgänger) Michele Smith with its 2015 Physicians of Tomorrow Award.

Telemedicine

Japan plans to allow limited drone package delivery by 2018, including deliveries of prescription drugs and blood for transfusions, as part of a nationwide push to invest in new technologies. The nation also plans to ease up on current telemedicine regulations so that AI tools that diagnose conditions based on skin images can be brought to market in the next three years. While the concepts seem promising, the rushed timeline would certainly give me pause, especially if I were an investor. Like so many other Olympic host nations before it, Japan may be rushing innovation too quickly to meet its 2020 deadline in Tokyo. I suppose time will tell if Japan’s plans to use driverless buses and taxis during the games will pan out.

The State of New Jersey’s Senate HHS and Senior Citizens Committee meets to discuss telemedicine applications and services, including legislation introduced earlier this year that focuses on the state’s regulation and reimbursement of telemedicine delivery. It seems New Jersey’s Medicaid program reimburses for telemedicine services, but has not yet afforded the same privilege to private payers, managed care plans, or state employee plans.

Kura MD adds TriageNow nurse call-center services to its telemedicine platform for employers.

Government and Politics

AAFP representatives take their anti-Meaningful Use letter-writing campaign one step further and meet with House Minority Whip Steny Hoyer to further stress the need to delay Stage 3. “We gave him concrete examples of how EHRs are not beneficial for patient care,” says AAFP President Wanda Filer, MD. “We explained how it can be difficult to get pertinent information from the records. Just checking boxes for meaningful use requirements is not advancing patient care. He seemed receptive to our concerns.” Filer also expressed the need to keep AHRQ alive, and increase the federal budget for programs that expand primary care.

Rep. Tom Price (R-GA), a member of the House Ways and Means Committee, introduces the Meaningful Use Hardship Relief Act, offering EPs a special hardship exemption from MU penalties due to the delayed release of the modified Stage 2 rule. For those still keeping track, CMS released the final rule with less than 90 days left in the year, leaving MU participants little time to adjust and collect measurements required in 2015. Price, as readers may recall, co-hosted AMA’s first town hall meeting this summer, where he heard a “Meaningful Use” earful from Atlanta-area physicians.

Other

Infectious disease professor Tara Smith feels compelled to rank pop culture portrayals of zombie outbreaks on a realism scale of 0 to 10. (I can’t believe she left out Shaun of the Dead – THE standard for feel-good zombie flicks.) Her findings, backed up by thorough research:

• The Walking Dead: 4 out of 10
• 28 Days Later (my favorite): 5 out of 10
• World War Z: 0 out of 10 (book, 6 out of 10)
• Resident Evil series: –20 out of 10
• The Last of Us: 7 out of 10

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Population Health Management Weekly Wrap Up 11/8/15

NavigatorMD rebrands to NavMD and launches new population health products including Healthie, a predictive analytics tool designed to drive participation in employer-sponsored wellness programs; and Advocate, a point-of-care coordination tool targeted to chronic disease populations.

In its latest earnings call, Cerner says that Epic-using Geisinger chose Cerner for population health management because “our capabilities could not be equaled by a competitor.” Mr. H offers highlights from the call here.

The California Hospital Association completes its Population Health Management Certification series. Led by consulting firm Kaufman, Hall & Associates, the program focused on implementation approaches and lessons learned by CHA’s member hospitals.

Population health management and PM firm Privia Health expands its medical group in Texas, adding Mark Cone, MD as market president of PMG – Gulf Coast Texas. Over 60 physicians from nine practices have already joined the new organization.

Legacy Health (OR) selects population health management tools from Evolent Health as part of a multi-year partnership in which the organizations will focus on value-based care strategy and improving clinical programs.

Consulting firm The Chartis Group acquires iVantage Health Analytics. The company announced the acquisition nearly a year to the day it acquired Aspen Advisors to shore up its advisory services.

Medecision and Forward Health Group partner to provide population health management solutions to New York DSRIP participants.

Signet Accel integrates Predixion Software’s Insight analytics tool into its Avec data integration platform. The companies are collaborating on clinical and translational medicine client projects, and plan to release an exclusive joint offering.

The Harvard T.H. Chan School of Public Health selects Wellness Workdays to conduct a $1.3 million worksite wellness study with BJ’s Wholesale Club. The study will encompass onsite biometric screenings, personal health assessments, team-based fitness activities, and behavior change programs. “My team will utilize our expertise in population health management to determine the best strategies to promote positive outcomes for BJ’s Team Members,” says Wellness Workdays CEO Debra Wein. “With support from Harvard and the leadership at BJ’s, we are confident we can promote changes in overall employee health and productivity and, over time, moderate rises in health care costs.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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News 11/5/15

Top News

Walgreens decides to move its Healthcare Clinics over to Epic beginning in early 2016. The chain of over 400 clinics, which is currently using a proprietary EHR, cites Epic’s Care Everywhere interoperability network as a deciding factor in the transition. Walgreen is no stranger to vetting vendors, having selected Greenway’s EHR for its pharmacies in 2012 as part of the company’s HealthCloud initiative. A Walgreens rep declined to comment on how much the retailer will pay for the technology, other vendors considered, and the proposed implementation timeline.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

Vision Source partners with The Health Council of East Central Florida, a nonprofit planning agency that offers research, education, and program support to regional healthcare stakeholders. Vision Source’s 27 member optometry practices will become a part of the council’s HealthSpan Coordinated Chronic Care Network, set to launch later this month. The network will offer physicians centralized patient referral,  chronic care management services, tools to help reduce hospital readmissions, and home patient monitoring through their practices.

BreezyNotes EHR launches cloud-based mental health PM software for solo and small-group therapists. Founded by father and son team Jim and Paul Jonas, the Eden Prairie, MN-based startup worked with 7 Medical, Visible Technology Solutions, and Vibe Behavioral Health Consultants to develop the new platform.

Acquisitions, Funding, Business, and Stock

The Atlanta-based Forge Founders Forum invites digital health startups to apply to its 2016 accelerator program, which kicks off in January and ends with a demo day in mid-March. Accepted applicants will receive seed money, work space, access to mentors, and networking and demo opportunities. Applications are due November 13.

Kareo announces that nearly 100 percent of ICD-10 coded claims from its independent practice customers have been successfully processed. Nearly 90 percent have been paid successfully for at least one of those claims. Eleven days seems to be the average time to payment.

Telemedicine

TouchCare adds new features to its telemedicine platform including a Practice Dashboard that enables physicians to delegate certain tasks to staff, integrated credit card payment capabilities, and appointment-verification improvements. The upgrades come a week after the company welcomed former US Senator Joseph Robert “Bob” Kerrey and Brad Wilson (BCBS of North Carolina) to its Board of Directors.

Iowa’s Medicaid program begins reimbursing providers for telemedicine services thanks to new rules that take effect this week. The services must be “to the same extent as such services covered under Medicaid when they are rendered in person.” The rule seems to be the state’s first official take on the matter. As of July 2015, 48 state Medicaid programs (including Iowa) and Washington, DC offer reimbursement for live-video telemedicine.

Research and Innovation

Vanderbilt University School of Engineering transitions its medical capsule robot hardware and software to open source in an effort to help further research and development in the field. “We’ve done custom capsule design – one for the colon, one for the stomach, another one with a surgical clip to stop bleeding – but we saw we were basically reusing the same components,” explains Pietro Valdastri, director of Vanderbilt’s Science and Technology of Robotics in Medicine (STORM) Lab. “Like it is with Lego bricks, you can reassemble them for different functions. We wanted to provide the people working in this field with their own Lego bricks for their own capsules.”

University of Pennsylvania researchers discover that nine out of 10 websites leak user data to other sites like WordPress, Google (the worst perpetrator), and Facebook without the user’s knowledge. While I don’t find it surprising that so many sites leak user data, I am concerned by the facts that at least six out of 10 sites generate third-party cookies, eight out of 10 load external Javascript code onto a user’s computer, and most ignore a user’s Do Not Track Me settings.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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