5 health IT trends set to shake up industry

For those healthcare providers still resistant to technology, you’ve got a problem on your hands: You’re going to be left behind. This is where healthcare it going – with or without you.

That’s according to a new Accenture report, Healthcare Technology Vision 2015, which lays out five key trends in the industry that show adaptation might be the best business model.

First, Accenture analytics are calling it the “platform revolution” – that is the ever-increasing ubiquity of mobile and cloud platforms that far surpass merely the ability to track in real-time a patient’s health. Rather, this is a platform that addresses interoperability, “that captures the data from disparate sources such as wearables, phones and glucometers, and pulls it all together to give a patient and caregiver a holistic and real-time view of the patient’s health,” they write.

[See also: Healthcare to enter ‘third wave of digital’.]

The second trend, as the report emphasizes, is around the “outcome economy.” In other words, “it’s about delivering results.” Hardware, nowadays, brings with it new intelligence. Better intelligence than ever before. And that’s going to make patient data accessible with a mere click. It’s going to give patients the convenience, and it’s ultimately going to lead to better outcomes, according to the report.

The third trend is around data, what’s billed in the report as the “intelligent enterprise” – essentially a “data explosion” that will lead to tremendous clinical outcomes opportunities.

In fact, big data has gotten so big that some 41 percent of healthcare executives say the data volume their organization manages has increased by a whopping 50 percent just from a year ago.

Tomorrow, Accenture officials say, this trend will turn into an EMR including a “lifetime’s worth of data”; it will be used regularly to predict ER visits. Consumers will be able to snap a photo of a skin rash and have a diagnosis shortly. Considering this trend, it may come as surprising that still only 28 percent of docs say they routinely use CPOE systems.

Coming it at No. 4 is the “Internet of me” trend – that is personalized medicine. And as more healthcare organizations invest in this technologies and system capabilities, they’re seeing positive results. In fact, an overwhelming 73 percent of health execs surveyed say they’ve seen ROI after investments in personalization technologies.

The last trend may make some feel a bit uneasy. And it’s about the emergence of machines. It’s the “workforce re-imagined.” Think digital self-scheduling, sharing your own electronic medical record, training machines and connecting with physicians via social platforms.

According to Accenture data, 66 percent of health systems in the U.S. will have self-scheduling by the start of 2020. And nearly half of health execs strongly agree that within three years, they’ll need to focus on training machines just as much as training employees. What does this mean exactly? Just think algorithms, machine learning and intelligent software.

“Patients can actually begin to care for themselves – relieve the burden of the delivery system and get a better result,” says Kaveh Safavi, MD, global managing director of Accenture’s healthcare business, in a video announcing the report. “That’s truly workforce reimagined, because now you’ve made the patient part of their own care-giving team, and the technology makes it possible.”

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Patient-Centered Medical Home Is a “Pragmatic” Shift in Care

Becoming a patient-centered medical home takes a great deal of hard work and a steady commitment to continual practice improvement.  To achieve the coveted Level III NCQA recognition, providers must operate at peak performance, leveraging health IT to bring coordinated, high-quality population health management to their communities.

But the patient-centered medical home (PCMH) recognition brings more than bragging rights to successful organizations.  As payers get serious about value-based reimbursement, providers that align themselves with emerging care delivery strategies may be in line for some financial success, as well.

At Valley Health Partners (VHP), the Physician Hospital Organization (PHO) centered at Holyoke Medical Center in Western Massachusetts, achieving PCMH recognition has been one part of the region’s overall acknowledgement that coordinated, value-based care is the wave of the future.

After significant investment in EHR infrastructure and a close working partnership with the Massachusetts eHealth Collaborative (MAeHC), Valley Health Partners took an incremental approach to PCMH recognition that emphasized manageable, meaningful steps towards embracing the high level of quality care its business partners are now demanding.

“Health New England, which is one of our local payers, was beginning to explore this budding concept of patient-centered care, and they really very much wanted us to dangle our feet in the water,” said Dr. Robert M. Fishman, DO, FACP, in an interview with HealthITAnalytics.com.

The program didn’t start with patient-centered medical home recognition as its ultimate goal, but as a more tailored accountable care project that would bring Valley Health Partners physicians a year-end bonus for meeting certain quality benchmarks for Health New England patients, Fishman explained.

With MAeHC’s help, Valley Health Partners had already made a concerted effort to participate in the EHR Incentive Programs close to the beginning of the meaningful use era.  Most providers had chosen to implement a single vendor’s EHR products, which made further efforts to coordinate care across the community that much simpler.

“We set up a very modest program with Health New England, where we would pick a couple of diagnoses in internal medicine and a couple of diagnoses in pediatrics and we would begin to set up policies and think in a more patient-centric way to reach certain goals,” he said.

“We concentrated on CHF and COPD, because those two conditions produce a lot of readmissions and emergency department visits.  There’s a lot of expense.  If we could really get a handle on those conditions, we could improve care, improve outcomes and decrease costs.  Three things that we’re all very interested in.”

After several years of focusing on diagnosis-specific population health management, MAeHC had an interesting proposition for building on the organization’s success.

“The Mass eHealth Collaborative approached us and they said, ‘You know, if we do an assessment of each of your practices in terms of the 2011 criteria for NCQA PCMH accreditation, we can find out how far away you are from actually doing a patient centered medical home for all of your patients, not just your Health New England patients, and becoming NCQA certified,’” Fishman explained.

The National Committee for Quality Assurance framework for PCMH recognition demands a number of data-driven quality improvements from potential applicants, including individualized care management, a heightened emphasis on chronic disease care, referral tracking and care coordination, and a plan for sustained improvement over time.  For some providers, the process seems daunting.  For Valley Health Partners, it was just a continuation of what was already being accomplished.

“During the assessment, our MAeHC consultants found that we weren’t too far away,” Fishman said.  “We had a lot of work to do, but a lot of it had already been done.  And if we could ramp up our efforts, we could probably get it done.”

“Most of us signed up for it.  A couple of providers opted not to.  Two providers who were still using paper-based workflows opted in, and we went ahead,” he continued.  “The eHealth Collaborative helped train our staff, and they stayed on us to make the necessary improvements.”

“We started using our patient portals to send messages to patients when they hadn’t been seen for a year, or they were overdue for a mammogram or a colonoscopy.  It was very easy to communicate with patients and say, ‘Hey, you’re a diabetic and you haven’t been seen in five months.  You should have been in two months ago.  Set up an appointment.  We’ve got things to discuss.’”

Implementing the workflow changes that support the patient-centered medical home requires a shift in perspective that can be challenging to some providers who feel overwhelmed by the basic necessities of providing care.  Expanding access to care is one of the fundamental “must-pass” requirements for recognition, but can be stressful for organizations that have trouble juggling their patient schedules.

“We changed the philosophy in all of our practices when it came to patient access to same-day appointments,” said Fishman.  “It used to be that we would have emergency slots that we could fill if someone needs to be seen, but now we think of them as same-day appointments.”

“If a patient calls and they want to be seen, put them in.  Patients are more likely to call if they don’t think that it has to be some sort of emergency for us to let them in.  That’s not what we want them to think.  We want to reduce as many barriers to quicker care as possible.”

The effort has paid off handsomely.  “We found out last month that everyone who committed to the patient-centered medical home initiative succeeded,” Fishman was pleased to report. “And everyone succeeded at Level III, with the exception of the two paper-based practices.  Going into it, they knew that the highest they would be eligible for was Level II, because they didn’t have an EHR, and they made Level II.  So we think this was a slam dunk, massive success.”

Fishman credits the achievement largely to the slow-and-steady pace of practice transformation his organization has adopted.  “We got our staff onboard with all these changes by doing the pilot project with Health New England,” he explained.  “So by the time we said that we’re going to do this full tilt, it wasn’t really a major shift.  It was just an expansion of what we were doing already.”

“We started out with a few slow baby steps.  Those baby steps became larger steps for about two to three years.  And then the state assessment that was done showed that hey, we’re not that far from the finish line.  So it wasn’t an overnight deluge of issues.”

The cultural and organizational changes that made patient-centered medical home recognition a possibility were rooted in Valley Health Partners’ approach to EHR adoption when the EHR Incentive Programs first enticed physicians to invest in health IT by offering financial rewards.

“We felt we should adopt electronic health records is because we couldn’t get past thinking that if the federal government wants to spend $44,000 on every single physician in this country, they must be pretty serious about it, and we shouldn’t be blind to that,” Fishman recalled.

“I think that providers who haven’t adopted EHRs by now are all behind the eight ball, because things are moving quickly, he added. “A lot of the payers looking at contracts with us want to know that we’re doing patient-centered activities, and that we’re beginning to do registry work and population health management.”

“The biggest challenge is always physician buy-in and physician engagement,” he acknowledged.  “I think we’ve done a very, very good job of engaging the physicians and getting them to understand what we’re trying to accomplish.”

“And even if they don’t philosophically agree with it, which is fine, they know that this is how reimbursement is going to look as we move forward.  We have seen that has been no increase in fee-for-service payments by most of the insurance companies for the past few years.  They want us to report on quality measures.  They want us to raise the level of care.  So if you want to get paid, be a pragmatist and get it done.”

EHR adoption, coupled with such significant operational change, isn’t without its pitfalls, Fishman admitted.  Productivity has been a casualty of the process, even as Fishman dedicates more time to consulting with his patients to provide them with the personalized care they crave.

“I spend a lot more time with my patients now, and the kick in the head is that I don’t really want to spend less time with them, because we all find it very satisfying to work together like that,” he said.  “The patients have responded well to this.  They enjoy when we reach out to them by letter or by portal.  They respond favorably.”

“But since adopting the EHR, I have been very slow to get back to my baseline productivity, which has hurt me financially.  My documentation is far greater than it’s ever been, and that takes time. And I’m home at nights documenting, which I don’t like.  But I’m hopeful that as our value-based reimbursements take off, I might be able to get back to what I once was financially, without cramming in 25 patients a day,” he added.

While there may be negatives that must be mitigated, EHR adoption and the patient-centered medical home has helped to coordinate care across the Holyoke community.  Dr. Fishman has some simple advice for other healthcare providers who are investigating the PCMH as a way to invest in the care strategies and frameworks that will support future value-based reimbursement structures.

“Number one, get an EHR,” he stated.  “Number two, work with someone who is invested in your wellbeing, like your local hospital.  Number three, start out slow and have realistic goals.  And when you achieve those goals, set out new goals.  And number four, which is absolutely important, have a consultant that knows what they’re doing.”

“We couldn’t do any of this without our consultants,” he reiterated.  “We have a lot of folks here who are pretty sharp and savvy with health IT, but this wasn’t their niche.  We needed to consult with someone who really understood the patient-centered medical home and everything that had to go into it.”

“The folks that work for the Massachusetts eHealth Collaborative have been certified in doing this stuff, and they’re very good at what they do.  And I applaud them for that.  I know they applaud us for the hard work that we’ve done.  Just like every other part of the patient-centered medical home, you need to take a team-based approach to healthcare.”

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Google unveils smart wristband for health tracking, but it’s not for consumers

Google’s latest device is aimed at letting doctors know how you’re doing, even between checkups.

The company unveiled on Tuesday a new sensor-packed wristband, meant to collect information on vital signs for medical professionals. The device will measure pulse, heart rhythm and skin temperature, as well as things like light exposure and noise levels. Bloomberg earlierreported the news.

The device was developed by Google X, the search giant’s experimental-research division. But unlike other smartwatches that are powered by Google’s Android Wear software and also have health tracking features, the new device isn’t targeted at consumers. Instead, the aim is for patients to wear the band during clinical trials and drug tests, so the data can be used by medical researchers and physicians. The idea is for doctors to get a complete picture of patients’ activity as it relates to their health, even if they rarely come in for an examination.

“Our hope is that this technology could unlock a new class of continuous, medical-grade information that makes it easier to understand these patterns and manage serious health conditions,” Andy Conrad, head of Google’s life sciences team, said in a statement.

The move comes as Google has become increasingly ambitious about expanding its scope of products beyond its juggernaut search engine. Its search and advertising business is still the most dominant in the world, making more than $50 billion a year. But as the Internet evolves, CEO Larry Page has been looking to new categories and directions for the company. Google has made big bets on everything from smartphones to wearable devices to driverless cars.

Google said the device is still in a very experimental phase. The company is working with academic researchers and drugmakers to make sure the device and its sensors are actually accurate and helpful to medical professionals. Google said that process could take years, but once the device is ready, the company will work with partners to build and distribute the wristband to a larger audience.

It’s the same approach Google has taken with development of its smart contact lens, another Google X product, which has sensors that measure glucose levels in tears for diabetes patients. Last July, Google announced it was partnering with the pharmaceutical giant Novartis to produce the contact lenses.

Google is also working on software to help clinicians securely store, analyze and interpret the data gathered from the device, a Google spokeswoman told CNET. The company is working with medical partners to refine the user interfaces of the software and the analytics that support the system, the spokesperson said.

The move may raise concern from privacy advocates who worry that Google already has access to too much of people’s personal data. Google, which makes the bulk of its revenue on advertising, lives on knowing information about its users, including where they travel on a map or what they search for online.

But the company stressed it has teams in place to ensure privacy and security. Institutional review boards — independent ethics committees that review medical research involving humans — also have oversight of the project, a Google spokeswoman said.

Google also has other life science projects under way. In 2013, Google launched Calico, a company with the overarching goal of extending the human lifespan. The company is run by former Genentech CEO Arthur Levinson. Last September, Calico announced a partnership with the biopharmaceutical firm AbbVie to pour up to $1.5 billion into a research facility focused on fighting age-related diseases.

Google also announced a project last summer called the Baseline study, also led by Conrad, aimed at learning enough about the human body to be able to detect fatal diseases like cancer or heart disease earlier, so treatment is more preventative and not reactive. Google said the new wristband would be used to help further the study.

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‘Wireless health’ has become redundant

We have mobile health, connected health, e-health, digital health, but no longer “wireless” health. Wireless technology has become so ubiquitous in healthcare that the word itself has lost its cachet.

I have a saved search on Google News for “wireless health.” It used to be fertile ground for finding stories related to health IT. That’s no longer the case.

This morning’s scan of the news turned up a lot more “noise” than anything relevant to my beat covering health IT. I’ll be deleting that from my saved searches shortly.

Meanwhile, this week, the West Health Institute tweaking its focus once again by debuting a new website and, more importantly, adding a section called Successful Aging. That means ” enabling seniors to live their lives on their own terms with access to high-quality health and support services that preserve and protect one’s dignity, quality of life and independence,” according to a blog post from West Health Institute CEO Nicholas Valeriani.

“[W]e are leveraging all of our previous work, such as our drive to advance medical device interoperability, in support of enabling successful aging for all seniors,” Valeriani continued. In other words, wireless technology will be a central part of this, but it’s not explicitly stated. That probably was intentional.

West Health Institute, née West Wireless Health Institute, dropped the second word from its name in 2012. At the time of its founding, the La Jolla, Calif.-based institute was closely tied to wireless chip-maker Qualcomm, but West Health wanted to dispel the notion that it was an arm of Qualcomm.

In a larger sense, wireless probably seemed too narrow a focus because, after all, technology is just a tool to provide better care. It doesn’t matter if it’s called wireless, mobile, digital, connected or e-health. When it comes down to it, it’s all just health. We’ve seen the term “wireless health” wane, and are starting to see the same for “m-health.”

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Google’s new health watch will keep tabs on patients’ vitals

Google unveiled a new wearable today, though it won’t be competing with the Apple Watch any time soon. Developed by Google X (the company’s advanced research division), the experimental device is geared specifically for clinical research. It monitors not just the wearer’s stats (including pulse, heart rhythm and temperature) but also environmental variables like light and noise levels as well.

This device could be a boon to medical research as it allows doctors to continually gather important data on their patients in real life conditions. “Historically, doctors do everything — patients just need to turn up at the trial site,” Kara Dennis, managing director of mobile health at Medidata, told Bloomberg. “Now, we’re asking patients to take on meaningful responsibility in gathering information.” Google plans to partner with academic institutions to ensure the device’s accuracy before seeking regulatory approval in both the US and Europe later this summer.

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UC Irvine Health Data Breach Affects 4,800 Patients

UC Irvine Medical Center announced last week that an employee viewed thousands of patient records over a four-year period “without a job-related purpose,” potentially compromising the information of 4,859 patients and leading to a health data breach.

UC Irvine officials discovered on March 13, 2015, that an employee had viewed records between June 2011 and March 2015. Some PHI may have been viewed, according to a medical center statement.

Information inappropriately accessed includes names, dates of birth, gender, medical record numbers, height, weight, medical center account numbers, allergy information, home address, medical documentation, diagnoses, test orders and results, medications, employment status, and the names of patient’s health plans and employers. However, Social Security numbers, driver’s licenses or state ID card numbers, and credit or debit card information were not accessed.

Hospital spokesperson John Murray told The Orange County Register that there is no evidence that the records were downloaded or distributed via e-mail. Murray added that while he could not comment on whether or not the employee in question still worked for UC Irvine, the employee was disciplined and no longer has access to the medical center’s computer systems.

A copy of notification letters being sent patients was posted on the California Office of Attorney General website. In that letter, UC Irvine explained why patients were being alerted of this incident months after the initial discovery was made:

“Due to its on-going investigation, local law enforcement asked us not to notify patients right away, because sending out notifications could have interfered with its investigation. Local law enforcement has now informed us that we are free to notify patients.”

The notification letter added that the hospital “hired independent experts in computer forensics to conduct a thorough investigation,” after the breach discovery. Those experts reported that there was no evidence that patient information was removed from the medical center. Local law enforcement were also notified, and they are conducting an on-going investigation. The letter also verified that the employee’s access to medical center computer systems was removed and that “disciplinary action” was imposed.

Affected patients will also be offered one year of free credit monitoring and identity theft protection, according to UC Irvine.

This is not the first health data security incident that UC Irvine has faced in recent years. Just over one year ago, the medical center reported that 1,813 students and some non-students were impacted by a data breach involving keylogging software malware.

The security office learned that the breach had affected three student health center computers on March 26, 2014 and that they had been infected for about six weeks.

Patient names, health or dental insurance numbers, CPT code(s), ICD9 code(s) and/or diagnoses and student ID numbers may have been transmitted to unauthorized servers.

“UC Irvine is committed to maintaining the privacy of students’ and non-student patients’ personally identified information and takes many precautions for the security of personal and medical information,” the medical center said at the time. “The University is continually modifying its systems and practices to enhance the security of sensitive information.”

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Health Information Exchange Should Extend Past Meaningful Use

The efficient sharing of medical data is key to improving patient care across the country, which is why the federal government has pushed forward the development of the state health information exchange (HIE). Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the healthcare industry has been adopting certified EHR technology and attempting to improve connectivity among healthcare IT systems as well as develop effective medical data exchange.

To learn more about the progress of health information exchange developments, the Office of the National Coordinator for Health IT (ONC) has worked with NORC at the University of Chicago to evaluate the program over a handful of years.

In a finalized report called “Provider Experiences with HIE: Key Findings from a Six-State Review,” a summary of healthcare provider interviews detail the priorities and needs of the medical industry, case studies of health information exchange systems, and the challenges overcome during HIE program development.

Between March and May of 2014, the organization conducted site visits as well as general provider interviews and discussions throughout six states, which included Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming. The discussions revolved around viewpoints on state health information exchange programs as well as general attitudes toward medical data exchange.

A wide variety of medical facilities were visited such as long-term care centers, hospital associations, critical access hospitals, and physician organizations. Several key findings were uncovered. For example, HIE needs go beyond meeting meaningful use regulations or system connectivity. Providers now needs HIE systems to proffer important clinical data at the point of care to enhance the delivery of medical services along with care coordination.

“Meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care,” the report stated. “Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift.”

The provider interviews also found that healthcare professionals encountered a variety of obstacles when it comes to advancing health information exchange at their facility. These challenges include competing priorities, difficulty managing the revenue cycle, lack of training or experienced staff, and insufficient support from their EHR or HIE vendors.

Some positive findings from the discussions revolve around the bringing of awareness for state health information exchange programs and the benefits of data sharing. Essentially, providers see the need for health information exchange. While the EHR Incentive Programs may not have targeted long-term care and behavioral health facilities, state HIE programs did further involve the participation of these providers.

“Awareness of and demand for HIE has been steadily increasing throughout the life of the program,” the report concluded. “Providers we spoke with in previous and current activities reported an appreciation for the State HIE Program’s role in communicating with providers of all types, bringing together stakeholders, and communicating the value of HIE. Now that HIE is better established—both in terms of visibility and available services—providers have identified new priorities and challenges. These have evolved from early issues surrounding basic implementation and awareness of the benefits of HIE into a search for solutions to meet greater demand for information, while balancing cost and multiple information exchange priorities.”

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