Readers Write: Physicians Have an Influential Role in Driving Wearables Adoption

Physicians Have an Influential Role in Driving Wearables Adoption
By Dinesh Sheth, founder and CEO, Green Circle Health

Though wearable devices that track personal activity have dominated the consumer electronics market in recent years, one research report from Endeavor Partners indicates that nearly one-third of fitness trackers are abandoned within just six months. For providers, these wearables have advanced from counting steps to measuring heart rates and other physiological parameters, while also presenting one of the most cost-effective methods for ongoing monitoring of health data. Despite consumer popularity, adoption of home-based health monitoring and fitness devices and the use of such data among physicians remains low.

Although the payments for such services are typically not covered by payers, the economics of healthcare services are changing in the shift toward pay for performance. In addition, several new legislative initiatives and incentives – targeted at reducing the cost of treatment and improving outcomes – will pave a dynamic way for patient-provider interaction. The expanded availability of healthcare to millions of Americans through the Affordable Care Act increased costs, and the healthcare industry is prioritizing self-improvement to boost the overall efficiency and productivity in the evolving model. To this end, it is critical that physicians support the adoption of new devices and monitoring technologies to help patients develop healthy lifestyles and ensure long-term success.

Engagement is a Two-Way Street
The fact remains that even today’s high-tech healthcare facilities do not provide a unified view of patient data. Instead, medical records are typically spread across multiple systems and locations, and patients are not engaged in using health records to improve their own health. This can make a truly collaborative effort among physicians, care providers, patients, and family members impossible.

The industry has, in the past, done little to bring the patient into the equation. Initiatives such as Meaningful Use brought very limited results. For patients, remembering multiple usernames and passwords just to view limited data was hardly an attractive option and still fails to centralize the data that is being captured, stored, and shared. Physicians are baited with the promise of an HIE that could seamlessly tie together all medical records, but the reality of such an exchange is unknown.

The idea to bring patient-generated and -managed healthcare data into the system is a topic of intense debate among physicians, but things are changing rapidly. With remote monitoring of home health devices and wearables, patients are able to generate near real-time vitals that physicians can use to offer timely service, which empowers patients by giving them more control of their lives with appropriate help from physicians. Greater levels of shared understanding means that patients are more likely to acknowledge their conditions, understand their options, and follow through on treatment. In this system, the responsibility rests equally with the provider and the patient – enabling both to benefit from the use of health IT on a day-to-day basis, resulting in higher quality care and positively impacting patient health and physician bottom lines.

Transforming Approaches in Healthcare
The prevalence of activity trackers and a wider availability of technology that measures vitals have created new dynamics, both internally and externally, for healthcare providers. Traditionally, physicians have learned their soft communication skills at the patient bedside, something often considered to be the natural ability of a given practitioner. But medical students today receive instruction on techniques for listening, explaining, questioning, counseling, and motivating. With the use of electronic devices and modern technologies, an ongoing need for training has been created for communication using different methods. Similarly, better communication among nursing staff and physicians has positively impacted healthcare outcomes.

The data provided by today’s health-monitoring devices enables physicians to guide patients toward healthier lifestyles and reduce healthcare costs with greater effectiveness. As a result, physicians can better manage chronic conditions and avoid unnecessary episodic care. This ongoing engagement among physicians, other care providers and family members will help overcome the digital barriers that exist within the healthcare industry. Being connected on the health front, having access to the prescriptions and notes of your physician, getting reminders for your appointments, and being able to transfer information to any care giver is what makes the difference. When addressing existing hurdles in the healthcare system, technology helps to prioritize engagement among patients and providers, resulting in timely care, better outcomes, and reduced costs.

Overcoming More Challenges
Technology’s rate of change will always outpace regulation and as a result, healthcare administrators and staff may be struggling to keep everything secure, well-documented, and linked back into their EHRs. But, just as verbal communication is documented by a physician’s notes, some of the instant communication will have to move into the EHR via notes and other means.

In the wake of all this data being available, the challenge of physicians being able to receive this data and integrate it into their EHRs also looms. Providers need to have a proactive and elaborate approach in managing the increasing volume of inbound data, taking into account the likelihood that more patients will eventually adopt better devices and methods of health-data sharing.

By overcoming these challenges, physicians will eliminate unnecessary visits and quickly adjust treatments and attention as-needed. The quantitative benefit for the healthcare industry is a reduction in costs and the ability to see a greater number of patients when they need help in a most effective way, while the qualitative impact is an improved patient experience with better outcomes and being more in tune with evolving patient ‘adopted’ behaviors.

Dinesh Sheth is founder and CEO of Green Circle Health.

Contacts

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

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5 Questions with Murray Fox, MD CEO, Premier Patient Network

Murray Fox, MD is the newly appointed president and CEO of Premier Patient Network, a Texas-based physician alliance created from the merger earlier this month between Premier Patient Health Care and Patient Physician Network.

What was the impetus for creating the Premier Patient Network? Do you foresee expanding beyond the Dallas-Fort Worth area?
Simply put, we are two organizations (Patient Physician Network and Premier Patient Healthcare ACO) representing independent physicians with complementary strengths and needs. The Patient Physician Network has strength in commercial healthcare contracts. The Premier Patient Network ACO has strength in the Medicare Shared Savings Program and technology designed for a value-based environment. By joining together, independent physicians now have a support infrastructure enabling them to thrive in a value-based environment.

With regard to our location, at this time we are focused on getting our physicians ready to participate in the changing environment. We believe that we represent a large number of physicians who wish to remain independent who belong to physician organizations similar to ours. If we are successful and may be of assistance to others, we welcome that opportunity.

As CEO, what will be your biggest job in getting Premier Patient Network off the ground?
Communication! Communication with the physician members, the payers, and employers. Physicians are very busy people. Achieving movement with physicians has been likened to herding cats. Dealing in the commercial space is different than dealing in the Medicare space. Rules and regulations are different for independent, non-financially integrated physicians in the commercial space. In addition, significant communication will be required for physicians not accustomed to the value-based payment system. The team concept with patient care coordinators and more efficient use of physician office personnel will also require physician adjustment.

Payers are also very busy trying to keep their members happy and saving money while maintaining quality healthcare. Patient Physician Network has long been known for very high quality scores and cost efficiency. Premier has demonstrated both in the Medicare Shared Savings Program. Helping payers embrace the new Premier Patient Network entity will take time. The employers have the hardest time because of the demographics of their employees. It is very difficult for one physician group to satisfy all of the needs of a given employer owing to the large area of the employee footprint.

How will technology impact the work of the Premier Patient Network in assisting independent physicians to keep up with today’s changing business/reimbursement models?
Approximately 5 percent of a patient population is responsible for 60 percent of the cost. Our technology is new but already proven. It is a critical tool in supporting physicians to more effectively manage patient populations to deliver the highest quality care at the lowest possible cost while appropriately prioritizing resources to sicker and over-utilizing patients. Participating physicians will now have timely information at their fingertips, providing insights on who needs care and how to demonstrate the delivery of that quality to payers so they are appropriately compensated for providing it.

What are the biggest IT challenges faced by physicians within the Premier Patient Network? How will its operating model assist them in keeping up with Meaningful Use, transitioning to ICD-10, etc.?
Disparity. With over 800 physicians in more than 400 offices with numerous different EHR and PM software programs, connecting all of the physicians is a very large and costly task. Clinical Pathology Laboratories has had to solve this problem in order to communicate with their physician clients. They are a partner in providing this connectivity.

Regarding Meaningful use and ICD – 10 preparations, although the independent physician offices are ultimately responsible for their preparation and participation, Premier Patient Network has provided in-service and webinar information to help prepare for the changes.

Have you/will you enter into any partnerships with local health systems or payers, especially regarding utilization of healthcare IT to increase access to care and improve outcomes?
We will look to the health plans for single source data dumps. We have proprietary software to analyze and present the data to the physicians to ensure access, quality and cost efficiencies.

We have relationships with ancillary providers to accept the responsibility for the total continuum of care including pharmacy, home healthcare, radiology, and laboratory. We continue developing relationships with hospitals under our contracts as downstream providers and partners.

Contacts

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

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5 Questions with Shashi Kusuma, MD CEO, Symplast

Shashi Kusuma, MD is co-founder, chairman and CEO of Symplast, a Fort Lauderdale, FL-based mobile medical software startup for plastic surgeons and med spa physicians. Kusuma is also the owner and medical director of Suria Plastic Surgery (FL), which he founded in 2010 after relocating from Cleveland where he worked as an attending surgeon at Cleveland Clinic. SPS has not attested to Meaningful Use due to the burdensome nature of its requirements, and the “sheer aggravation and mental stress” it caused staff. The practice uses different IT systems for different purposes. “We currently use an outdated client/server legacy system for clinical documentation,” Kusuma explains. “I elected not to renew their support package nearly 18 months ago, as I felt I was being overcharged and underserved. We use a different system for multimedia and a different system for IT support.”

“I grew up with EHRs from my first day as a resident at Vanderbilt University, where we used a system called MARS,” Kusuma adds. “I’ve also used Vista, Epic, Cerner, Meditech, and many others. While the intent of these solutions was good, the true benefits were never realized. As most of my colleagues would attest, these EHRs took away from our abilities to be doctors, discouraged us from using common sense, and prevented us from connecting and developing a true relationship with patients. It really took the fun and fulfillment away from the original intent of being a doctor.”

What was the impetus for creating Symplast?
I was looking for a better experience as a doctor. I worked so hard to become the best doctor I could be, but I wasn’t having fun and engaging with my patients as much as I wanted to. The idea for Symplast came to me after another long night at the office finishing up notes and tedious administrative tasks. These duties wasted a lot of my time, did not help me treat my patients, and took me away from my family.

I was beyond frustrated with the deficiencies of medical software solutions: the impersonal nature; the impracticality; the poor designs; the long, frustrating hours; the fragmentation; the lack of innovation … I could go on and on. Despite searching long and hard and wide, I could not find what I thought was a great system. People became resigned to what was available and did not have the energy or time to do something about it. The conversation always seemed to emanate from businessmen, entrepreneurs, and software personnel, and not from the providers and doctors who were on the front line.

I also observed a growing trend within our practice and the practices of my colleagues: the role of smartphones in the doctor-patient relationship. Patients were introducing smartphones into the equation, sharing post-surgical photos, conducting virtual consults over their mobile devices, and taking selfies from their consultations. I knew that this was the future of healthcare IT. People today want on-demand input and consumption of their data. Multimedia is crucial, and smartphones enable communication to go from a text-oriented manner to a visual medium. Handing you a three-page printout of instructions is not as effective as sending you a 30-second instructional video that you can consume on your smartphone.

The timing for Symplast seemed perfect. Smartphones have evolved to the point where the camera quality, screen sizes, and voice-dictation accuracy are ready to be introduced into the exam room. The real mobile technology matured to the point where sophisticated applications can run seamlessly and natively on your device, eliminating the need for plugins and online portals.

The true potential for Symplast is to merge these disjointed modules into one complete solution, becoming a mobile ecosystem that integrates technology such as secure communication, telemedicine, patient engagement and big data into one complete solution. Symplast can leverage mobile tools to drive costs down, increase ROI, and improve the overall experience for both the patients and the care providers. 

The idea for Symplast has evolved over the past three years. The actual development has been underway for about 26 months. We now have five full-time employees and 12 developers, as well as an advisory board consisting of surgeons and physicians, seasoned businessmen and CEOs, ancillary medical care staff, and IT professionals.

What unique challenges do plastic surgeons and med spa providers face when it comes to selecting, implementing, and using healthcare IT?
Plastic surgery is a true market-based economy in medicine. As plastic surgeons, we must rely on our reputation and our outcomes to attract new patients and customers. We deal with a highly educated audience that has done extensive research and price comparisons. Marketing is critical if you want to survive in this specialty. Our field is unique in this sense, and so the healthcare IT solution needs to placate this reality.

We need robust patient engagement tools with automated, personalized communication offerings that will help us increase practice revenue. The biggest frustrations we experience with the current software offerings for this specialty are the complexity and fragmentation of the platforms that lack true patient engagement, marketing, and multimedia features.

Symplast was founded by three practicing plastic surgeons who understand first-hand the unique challenges this field faces on a daily basis. That’s why our product is specifically targeting plastic surgeons and med spa providers to start with. Patients in these fields demand a certain level of engagement and communication that Symplast delivers.

How does Symplast’s PM and EHR tools help meet these needs?
We don’t classify Symplast as just an EMR/EHR or PM. Symplast is a complete mobile ecosystem that provides every module a plastic surgery practice or med spa needs to operate on a daily basis. While the EHR is certainly one component of Symplast, we also include PM, patient engagement, multimedia, inventory management, cosmetic quotes, financial reporting, automated marketing, and more. Symplast allows you to run your entire practice from your smartphone, tablet or PC.

We understand how important security is for SaaS cloud-based solutions, and that is why we have three layers of security that ensures your data is 100-percent safe. No data is stored on your device; it is all encrypted and stored in the cloud.

How did beta testing go? What type of feedback did you receive, and how does the final technology reflect that feedback?
Beta testing was tremendous. As expected, we learned and made enhancements to the UI/UX of our technology. We understand that there is no such thing as a “perfect” product. We will continuously push ourselves to improve and innovate, and user feedback is a critical element to that objective. This is just the beginning.

On a personal note, I find it inspiring that you have provided free care on several occasions in India. How have you seen healthcare technology impacting such patient populations?
This is actually a great example of how mobility is transforming healthcare. In the past, I wasn’t able to properly engage with patients when I traveled. Now, thanks to the penetration of smartphones and mobile devices, I can truly interact and connect with these patients. Millions of people around the world have grown up in the mobile age, completely bypassing the desktop generation. They will now be engaged with the Symplast ecosystem. 

Symplast is actually in the early stages of creating a partnership with some charities that would facilitate the use of our patent-pending mobile technology in medical missions around the world in the near future. This is the mobile world we will live in very, very soon.

Contacts

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

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Population Health Management Weekly Wrap Up 7/24/15

Top News

Anthem finalizes its acquisition of Cigna in a deal valued at $54.2 billion, $6.2 billion more than the initial bid. The newly combined company will cover close to 53 million members, making it the country’s largest payer by enrollment. Cigna CEO David Cordani will become president and COO of the new organization, while Anthem CEO Joseph Swedish will serve as chairman and CEO.

Webinars

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Announcements and Implementations

KLAS recognizes Cerner as “a supplier most considered for future population health management (PHM) capabilities” in its latest report.

Morrissey Associates launches a practitioner performance reporting tool to offer physicians an enterprise view of improvement opportunities and benchmarking, as well as recommended performance metrics and implementation guidelines.

Population health management and wellness company U.S. Preventive Medicine earns validation from the Intel-GE Care Innovations Validation Institute for its ability to achieve a significantly sustained reduction in healthcare costs associated with wellness-sensitive medical events.

People

University of Missouri Health Care promotes Michael LeFevre, MD to medical director of population health.

Intermedix Corp. names Jack Hemmert (Verisk Health) CIO and promotes Melissa Leigh to chief compliance officer.

Government and Politics

HHS launches the Response and Recovery Resources Compendium to support government officials in managing health and emergency operations during disaster response and recovery operations. The compendium includes resources across 24 categories including patient movement, hospital care, and personnel such as medical staff from the U.S. Public Health Service and National Disaster Medical System.

Research and Innovation

Dell Services and Massachusetts-based Baystate Health’s TechSpring technology innovation center announce three innovation programs, including a telehealth pilot, evaluation of freestanding healthcare kiosks, and use of Dell’s  Population Health Analytics to target patients for more effective care management.

Other

Lincoln/Lancaster County, NE launches PulsePoint AED, a smartphone app that helps users locate the nearest automated external defibrillators. The app also allows “citizen-rescuers” to add and edit AED locations. County officials will integrate the desktop app into the emergency dispatch system later this year so that dispatchers can direct callers to the nearest potentially life-saving device.

Contacts

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

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Readers Write: Interoperability – the Solution for EHR Frustrations

Interoperability: the Solution for EHR Frustrations
By Ruby Raley

Physicians are frustrated with EHRs – in part, because EHRs often do not allow for the transfer of patient records to colleagues outside of their own network. This frustration is a thorn in the side of healthcare – one that quickly needs to be removed.

More efficient interoperability is on the way to help streamline the industry, but the important question we need to ask today is this: What can doctors do in the meantime, while they wait for better interoperability?

First, let’s consider why physicians are frustrated with EHRs.

EHR/EMR vendors initially focused on the clinical workflow, as it was critical to capture information and fit it into the practice routines. It was less important for information to be shared externally when workflow and usability were critical to productivity for physician offices. Physician practices can experience a drop in the number of patients seen in a day when they have to enter data into an EHR. A few years ago, vendors were focused on solving this roadblock – physicians could not afford an EHR if their revenues dropped on adoption.

While the good news is the industry is maturing. The bad news is that we have a new issue: We need to improve care coordination, and more fully engage the patient in their own healthcare decisions and course of treatment. The pressure is on from government and consumer advocates to exchange data freely – the ONC interoperability roadmap calls this out explicitly.

What are the issues now? Vendors often charge extra for connectivity, especially point-to-point interfaces between partners in the healthcare community. Direct (a secure email exchange program) was conceived to address this issue, and this approach has seen steady adoption over time. However, a few issues with the automation remain. Direct can require practice team members to review and manually load the secure email received from all partners. This is time consuming, and it is time that small practices and busy physicians can’t afford. Direct can interoperate with more sophisticated use cases. There are protocols that enable cross-community collaboration (XCA), but these have not been consistently adopted by industry and some offices do not have the technical skills to support this type of exchange without external help from a vendor or service provider – leading to more cost.

HIEs were envisioned and subsidized by ONC with grants to serve as a clearinghouse and facilitator of clinical data exchange at a state level. HIEs received a lot of press and focus, which led to limited success in communities and states across the U.S., but never achieved the goal of ubiquitous data exchange.

There are a few changes on the horizon that may offer a solution to the challenges of interoperability. ONC has stated it intends to ‘encourage interoperability’ through public information sharing (or shaming) and regulatory pressure from CMS. Congress has even held hearings on interoperability – challenging vendors to make it simple and cheap (or free) to share data with others. Vendors are forming alliances to promote interoperability and including data exchange functionality in base releases. Many see the challenges of data exchange easing and gradually disappearing through the work of the vendor community. Additionally, a new protocol, FHIR, has emerged to address some of the challenges of sharing Continuity of Care Documents (CCDs). (You can think of a CCD as an electronic version of your paper chart that the doctor reviewed and marked on your visit). FHIR makes it easy to share only the portion of the CCD needed – medications, for example. FHIR is receiving a lot of attention, but it is not yet widely adopted. In a few years, we may see this as a widely used protocol for data exchange.

What can physicians do about it? They should expect data exchange to be included in their EHR platform. Ask questions and seek this functionality in new releases or when purchasing a new platform. Physicians should look to join communities that facilitate data exchange – such as HISP (a service provider for the Direct solution). Advocacy is important for all of us – there are real advantages to data exchange, and we all can benefit. Vendors who get that value of data exchange will do more than move data from one door step to another (data interoperability). They will ensure process interoperability is achieved – cleansing and consuming the data so it is usable without manual effort. Process interoperability is essential for the physician office. Physicians want to focus on helping patients; most do not want to juggle technical issues and program workarounds in their systems. The vendor community with support and guidance from regulators must provide the tools and capabilities to resolve the challenge.

Ruby Raley is executive vice president of product strategy at Edifecs.

Contacts

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

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