Hospitals Using Market-Leading EHR Have Higher HIE Use

A new study concludes that hospital engagement with HIEs is tied with the level of dominance their EHR vendor has in their marketplace. The study, which appeared in Health Affairs, looked at national data from 2012 and 2013 to look at how vendor dominance related to hospitals’ HIE involvement level. And their analysis suggests that the more market power a given vendor has, the more it may stifle hospitals’ HIE participation.

As researchers note, federal policymakers have expressed concern that some EHR vendors may be hampering the free flow of data between providers, in part by making cross-vendor HIE implementation difficult. To address this concern, the study looked at hospitals’ behavior in differently-structured EHR marketplaces.

Researchers concluded that hospitals using the EHR which dominated their marketplace engaged in an average of 45% more HIE activities than facilities using non-dominant vendors. On the other hand, in markets where the leading vendor was less dominant, controlling 20% of the market, hospitals using the dominant vendor engaged in 59% more HIE activities than hospitals using a different vendor.

Meanwhile, if the dominant EHR vendor controlled 80% of the market, hospitals using the leading vendor engaged in only 25% more HIE activities than those using a different vendor. In other words, high levels of local market dominance by a single vendor seemed to be associated with relatively low levels of HIE involvement.

According to the study’s authors, the data suggests that to promote cross-vendor HIE use, policymakers may need to take local market competition between EHR vendors into consideration. And though they don’t say this directly, they also seem to imply that both high vendor dominance and low vendor dominance can both slow HIE engagement, and that moderate dominance may foster such participation.

While this is interesting stuff, it may be moot. What the study doesn’t address is that the entire HIE model comes with handicaps that go beyond what it takes to integrate disparate EHR systems. Even if two hospital systems in a market are using, say, Cerner systems, how does it benefit them to work on sharing data that will help their rival deliver better care? I’ve heard this question asked by hospital financial types, and while it’s a brutal sentiment, it gets to something important.

Nonetheless, I’d argue that studying the dynamics of how EHR vendors compete is quite worthwhile. When a single vendor dominates a marketplace, it has to have an impact on everyone in that market’s healthcare system, including patients. Understanding just what that impact is makes a great deal of sense.

Posted in health information exchange, Healthcare Integration, HIE, Hospital EHR, Hospital EHR Company, Hospital EHR Vendor, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital EMR Company, Hospital EMR Vendor, Hospital Healthcare IT, Medical Economics | Tagged , , , | Comments Off on Hospitals Using Market-Leading EHR Have Higher HIE Use

Most Hospitals Offer Patients Online Access To Medical Records

New research from the American Hospital Association suggests that nearly all hospitals now offer individual patients online access to their medical records, and most offer them the ability to perform related tasks as well.

According to AHA research, 92% of hospitals gave patients access to their medical records in 2015, up from 43% in 2013. Also, 84% allowed them to download information from the record, 78% let them request changes to their record and 70% made it possible for them to send a referral summary. (The latter has seen the biggest change since 2013, as only 13% could send such a summary at that time.)

In addition, hospitals have begun giving patients the ability to schedule appointments, order prescription refills and pay bills. As the AHA notes, progress on this front isn’t universal, as organizations need to integrate data from revenue cycle, pharmacy and scheduling systems to make it happen. But as hospitals invest in integration engines they will have a greater ability to roll out these options.

As of 2015, 74% of hospitals let patients pay bills online, up from 56% in 2013. However, progress on other consumer-friendly functions has been slower. Only 45% of hospitals let patients schedule appointments online, a modest increase from 31% in 2013, and just 44% let patients refill prescriptions, up from 30% in 2013.

Meanwhile, hospitals are slowly but surely expanding tools letting patients communicate with physicians. The AHA found that 63% let patients securely message care providers, up from 55% in 2014, and 37% let patients submit self-generated data, a big jump from the 14% who did so in 2013.

All of this suggests that rollouts of patient portal tools are likely to continue well after Meaningful Use has landed in the dustbin. After all, research suggests that dollars spent on these technologies will pay off, especially under at-risk value-based care models.

For example, an eye-opening study appearing in Health Affairs found that use of patient-physician email at Kaiser Permanente is associated with a 2% to 6.5% improvement in HEDIS performance measures like HbA1c levels, cholesterol and blood press screening and control. The same study noted that users of its My Health Manager were 2.6 times more likely to remain KP members than non-users, a phenomenon which may well apply to providers.

On the other hand, hospitals need to evaluate any potential portal solutions carefully. According to a study by research firm Peer60, many solutions have serious limitations that could lead providers to violate state laws or limit parent and minor engagement. Also, some organizations might not be ready to support patients who have issues adequately. Concerns like these might explain why 28% of the 200 healthcare execs surveyed by Peer60 said they weren’t looking at portal technology at the moment.

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Will We Be Sequencing Genomes at Home?

When I look at the digital health market, I see amazing things happening with wearable technology and digital health apps. I’m even enamored by how much impact the right text message at the right time can impact a person’s health. No doubt, I’m impressed by the simple solutions that seem obvious once someone’s actually implemented it.

While these are all impressive, I think nothing will have a bigger impact on our health than what’s happening with genomic medicine. What’s crazy to me is how quickly genomic sequencing has become accessible to everyone. The Medical Futurist, Berci Meskó, MD, PhD, shared this great National HUman Genome Research Institute chart which illustrates how quickly the cost to sequence a genome has dropped.

Cost of Genome Sequencing Over Time

In Berci’s post he suggests that one day soon it will cost more to mail in your sample than it costs to actually sequence your genome. Will we all have genomic sequencers in our homes like we all have thermometers today? Probably not, but given the cost curve we could if we wanted to have it.

This type of inexpensive genomic sequencing is going to change the way we’re treated by doctors. Given the pace of genomic sequencing, we’re certain to have all this genomic data before we really even know what to do with it. That’s normal since most innovations require us to have the data before we realize how that data can be used. In fact, the coolest innovations in the world often combined a whole series of small innovations. The same will be true as we extract value from our genomic data.

Have you sequenced your genome? Did it provide you any insights that were valuable to you?

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Healthcare Price Transparency Driving Choice – Just The Wrong Direction

Last month, the Healthcare Financial Management Association held their annual conference – #HFMA16ANI. The topics covered in the sessions and discussed in the aisles of the exhibit hall were wide-ranging. Financial patient experience, scoring based on propensity to pay, patient loans, financing options and price transparency were on the lips of many attendees.

The discussions on price transparency were particularly interesting. Attendees were not talking about transparency as the silver-bullet for reducing costs in healthcare like they were last year. Instead, attendees were talking about it as being just the first step in a long journey to a truly open market in healthcare.

Just a few years ago, price transparency was touted as the necessary catalyst for true consumer/patient choice in healthcare. It was believed that with detailed price information patients would be able to “shop around” for their care using price as a determining factor. Having this choice would mean healthcare organizations would have to become more price competitive – thus driving overall costs lower.

Check out this excellent post from Dan Munro @danmunro back in 2013 that captures the hope of price transparency at that time.

I believe that all the work around price transparency in the past few years has indeed pushed patients to make choices in their healthcare – just not the choices that we want.

This tweet from Annette McKinnon @anetto, a patient advocate from Toronto, during a recent #hcldr tweetchat perfectly illustrates the choices patients are making when they know the price of care:

Armed with price information, patients are not choosing to shop around for more affordable options, instead they are making the choice between forgoing care vs getting treatment. A Gallop poll found that in the US, 33% of families have put off medical treatment because of cost. That same poll shows that 22% of Americans have put off medical treatment for a “very” or “somewhat serious” condition.

So why aren’t patients taking the pricing information they receive and shopping around for cheaper alternatives? The biggest reason in my opinion is that patients do not have value transparency.

To me, value transparency is a state where patients purchasing healthcare services have a clear understanding of the expected outcomes, health benefits, disadvantages, risks and costs associated with it. In addition, patients would know how those services will be delivered (the workflow) and who is doing it. When a patient has access to this type of information and has the knowledge to interpret it, that’s when they have value transparency.

So what do we need to get to this state of value transparency in healthcare? Members of the #hcldr community had some interesting suggestions:

I believe that one day we will have value transparency in healthcare. Price transparency is an important first step. However, price in and of itself is not sufficient information to spur most patients to choose between different providers of care. In its current form, price transparency may be doing more harm than good for patients with chronic conditions that get worse without treatment – they may choose to forgo care due to cost only to end up in a more critical situation later because of the delay in treatment.

My hope is that someone will take today’s healthcare pricing tools and merge them with standardized quality metrics, crowdsourced patient experience data and provider histories to create a value transparency tool. In the meantime, the current crop of price transparency tools can at least help to reduce the fear of the unknown medical bill.

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Another Look At Easing EMR Adoption Problems

Though EMRs are no longer a brand-new thing, rolling them out is still a difficult challenge for hospitals. After all, even the best platforms can require significant changes in staffers’ day-to-day work, which isn’t easy for anyone. And some less technology-savvy workers may struggle to pick up new routines. Plus, we’re still seeing a lot of EMR implementations as hospitals switch EHR vendors, EHR vendors get sunset, and hospitals get acquired by larger hospitals with different EHR.

So I was interested to read yet another take on how hospitals can survive this tumultuous period. This one comes from Next Services, an Ann Arbor, MI-based health IT software and consulting firm. Here’s some of the more interesting steps Next Services offers to help smooth out the adoption process:

  • Have managers create a 3×3 matrix sorting key players by skill and resistance. Along the top, divide the rows into high, medium and low skill sets, then along the left side, label three columns for high, medium and low resistance levels. Sorting workers into categories such as high skill/low resistance, high skill/high resistance, low skill/high resistance and so on can help managers predict what issues will arise for individual workers.
  • Roll out EMR in modules rather than phases, and don’t go to the next set of modules until you and your team are hundred percent confident that everyone can use them. Also, start with core modules that help document the basic chart, then expand outward to modules with greater functional depth.
  • Prepare staff for crises. Think through all of the ways that the rollout could go wrong during live patient care use, and make sure staffers are prepared to react appropriately when such an event happens.
  • Think of the rollout as a game. To encourage staffers, offer points for important factors such as knowledge, helpfulness and speed. Then put a chart presenting the results on a big monitor for everyone to review at the end of the day.
  • Celebrate your successes. Celebrating small wins with the staff during the rollout can help keep the atmosphere positive. Celebrations can be anything from an ice cream social to a simple group cheer.

While I find these suggestions to be interesting and useful, I’d love to see a companion list providing suggestions on how hospitals and health systems can help staffers cope with a second or third EMR rollout. My guess is that such a transition poses different management challenges than pulling the switch the very first time.

As I see it, such implementations could range from toxic (staff was exhausted by the first rollout and doesn’t want to play this time) to comparatively easy (staffers learned a lot the first time, and find additional changes to be less upsetting than they did the initial go-live). And obviously, much will depend upon how the next implementation is managed, how training is presented and how the previous rollout went.

Still, there must be ways to ease the blow regardless. What suggestions would you have for health IT leaders who are navigating their second or more EMR rollout?

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AristaMD Secures $11 Million Series A Financing

Digital Health Company to Enhance Functionality, Accelerate Commercialization
of Referral Intelligence Platform

SAN DIEGO, July 21, 2016 – Arista MD, a technology-enabled service company providing eConsults and a suite of related specialist referral support tools, announced today it completed $11 million in financing. The Series A round was led by Avalon Ventures with participation from Correlation Ventures. The proceeds will be used to accelerate commercialization and further enhance functionality of the company’s proprietary Referral Intelligence Platform.

As many as 60 percent of specialist visits are routine consults that do not require an in-person visit. , Unnecessary care results in $10 billion annually in costs, causes delays in care planning and exacerbates access challenges for the most vulnerable patients. AristaMD’s Referral Intelligence Platform is designed to significantly reduce these costs and improve access to specialist care by facilitating rapid collaboration between primary care providers and specialists. The Referral Intelligence Platform includes a two-part process that consists of comprehensive referral work-up checklists licensed exclusively from the University of California, San Francisco (UCSF), and a simple, effective electronic consult (eConsult) platform. The AristaMD solution is proven to reduce overall specialist visits by 30 percent or more while also reducing ER visits and hospital admissions.

“We’re thrilled that Avalon and Correlation share our vision to provide a solution that optimizes referrals in today’s era of value-based healthcare,” said Rebecca Cofinas, president and CEO of AristaMD. “Our investors’ proven track record of success with building transformational companies is instrumental for our continued growth and success.”

AristaMD’s clients range from small rural providers to large county health systems in urban environments. The Referral Intelligence Platform has been designed to be flexible to fit each individual client’s workflow, technology, and clinical needs.

“The AristaMD platform is the most comprehensive solution in the market,” Cofinas said. “Our platform saves the average provider years of precious time and resources by providing a strong foundation that can still be tailored for each unique environment.”

“Referrals to medical specialists have nearly doubled over the last decade, and that figure is set to double again in the next five years,” said Jay Lichter, Ph.D., managing director at Avalon Ventures and chairman of the board at AristaMD. “AristaMD’s Referral Intelligence Platform is a unique and innovative solution designed to improve appropriate patient access and significantly reduce costs. We are pleased to support AristaMD’s top-notch team as they continue their drive to the next level of growth and commercial success.”

About Arista MD
AristaMD is a digital health company focused on assisting primary care providers in offering expanded specialty care through high-impact tools and solutions to reduce unnecessary referrals. Designed by practicing physicians, the AristaMD Referral Intelligence Platform combines clinical guidelines developed at UCSF, specialist eConsults and robust data collection and reporting into one easy-to-use software platform that is interoperable with core EMRs. AristaMD partners with clients to use the company’s platform for their own specialists or can directly provide eConsults through its comprehensive panel of board-certified specialists. AristaMD is at the forefront of designing exceptional tools to enable physicians to collaborate, promoting efficiency and optimal clinical care.

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E-Patient Update: Hospitals Need Virtual Clinicians

Hospitals have a lot to lose if patients are readmitted not long after discharge. But in most cases, their follow-up care coordination efforts post-discharge are perfunctory at best.

My husband’s experience seems to be typical: a few weeks after his discharge, a nurse called and asked perhaps five or six very broad questions about his status. I doubt such as superficial intervention has ever done much prevent a patient from deteriorating. But this dynamic can be changed. As an active, involved e-patient, I think it’s time to bring artificial intelligence technology into the mix.

In recent times, AI platforms have emerged that may offer a big improvement on the, well, largely nothing hospitals do to prevent patients from deteriorating after they leave the facility. In fact, artificial intelligence technology has evolved to the point where it’s possible to provide a “virtual clinician” which serves as a resource for patients.

One example of this emerging technology comes from AI startup Sense.ly, which has developed a virtual nurse named Molly. According to the company, Molly is designed to offer customized patient monitoring and follow-up care, particularly for patients with chronic diseases. Its customers include the UK’s National Health Service, Kaiser Permanente, San Mateo Medical Center, University of California San Francisco, Microsoft and Allscripts.

Molly, an avatar-based system which was designed to mimic the bedside manner patients crave, can access data to assist with real-time care decisions. It also monitors vital signs – though I imagine this works better with a remote connected device — and tracks patient compliance with meds. Molly even creates custom questionnaires on the fly to assess patients, analyzes those responses for risk, and connects patients directly to real- life clinicians if need be.

While this is admittedly a groundbreaking approach, some independent research already exists to suggest that it works. Back in 2011, Northeastern University researchers found that patients who interacted with virtual nurse Elizabeth were more likely to know their diagnoses and make follow-up appointments with their doctor, ZDNet reports.

And if you’re afraid that using such a tool exposes your facility to big legal risks, well, that’s not necessarily the case, according to veteran healthcare attorney David Harlow.

“The issue is always in the terms of use, and if you frame that properly – and build the logic properly – you should be OK,” Harlow told me. He concedes that if hospitals can be sued for patient care problems generated by EMR failures — which happens now and then — a cause of action could arise from use of virtual clinician. But my sense from talking with him was that there’s nothing inherently more dangerous about deploying an AI nurse than using any other technology as part of care.

Speaking for myself, I can’t wait until hospitals and medical practices deploy a tool like Molly, particularly if the alternative is no support at all. Like those who tested Elizabeth at Northeastern University, I’d find it much easier to exchange information with an infinitely patient, focused and nonjudgmental software entity than a rushed nurse with dozens or hundreds of other patients on their mind.

I realize that I’m probably ahead of the market in my comfort with AI technology. (My mother would have a stroke if you asked her to interact with a virtual human.) But I’d argue that patients like me are in the vanguard, and you want to keep us happy. Besides, you might be pleasantly surprised by the clinical impact such interventions can have. Seems like a win-win.

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Philips Acquires Wellcentive

AMSTERDAM–(BUSINESS WIRE)–Royal Philips (NYSE: PHG, AEX: PHIA) today announced that it has signed an agreement to acquire Wellcentive, a leading US-based provider of population health management software solutions. Financial details of the transaction will not be disclosed.

In population health management, Philips already offers enterprise telehealth, home monitoring, personal emergency response systems (PERS) and personal health services that address multiple groups within a population from intensive ambulatory care for high-risk patients to prevention and personal health programs for the general population. Wellcentive complements Philips’ portfolio with cloud-based IT solutions to import, aggregate and analyze clinical, claims and financial data across hospital and health systems to help care providers deliver coordinated care that meets new healthcare quality requirements and reimbursement models.

Upon completion of the transaction, which is expected later today, Wellcentive and its employees will become part of the Population Health Management business group within Philips. Tom Zajac, CEO of Wellcentive and an experienced healthcare industry leader, will be appointed to lead this business group.

“With this strategic acquisition, we will strengthen our Population Health Management business and its leadership, as health systems gradually shift from volume to value-based care, and provide more preventative and chronic care services outside of the hospital,” said Jeroen Tas, Philips’ CEO Connected Care & Health Informatics. “Our sweet spot is at the point of care as we give consumers, patients, care teams and clinicians the tools, such as remote monitoring solutions and therapy devices, to optimize care. Wellcentive’s solutions will provide our customers with the ability to collect data from large populations, detect patterns, assess risks and then deploy care programs tailored to the needs of specific groups.”

“Over the past 11 years, the Wellcentive team has focused on delivering data-driven clinical, financial, and human outcomes for our customers as they provide care management for more than 30 million patients,” said Tom Zajac, CEO of Wellcentive. “Combining forces with Philips and its broad portfolio of health technologies and global reach will create a great foundation to accelerate growth in connected care – from healthy living and prevention, to diagnosis, treatment and home care – enabling consumers, providers and health organizations to benefit from our combined, stronger offering in population health management.”

Wellcentive’s applications will be integrated in the Philips HealthSuite cloud, the company’s digital enabler for the next generation of connected health solutions. One example of Philips’ existing care programs for population health management is the Intensive Ambulatory Care (eIAC) program: this combines telehealth technologies and population health management software to help care teams monitor and coach patients at home. It aims to improve patient outcomes, care team efficiency, and prevent patients from entering the hospital, where costs are significantly higher.

Founded in 2005 and headquartered in Atlanta, Georgia, Wellcentive employs approximately 115 employees. The company has a strong customer base in the US.

About Royal Philips
Royal Philips (NYSE: PHG, AEX: PHIA) is a leading health technology company focused on improving people’s health and enabling better outcomes across the health continuum from healthy living and prevention, to diagnosis, treatment and home care. Philips leverages advanced technology and deep clinical and consumer insights to deliver integrated solutions. The company is a leader in diagnostic imaging, image-guided therapy, patient monitoring and health informatics, as well as in consumer health and home care. Headquartered in the Netherlands, Philips’ health technology portfolio generated 2015 sales of EUR 16.8 billion and employs approximately 69,000 employees with sales and services in more than 100 countries. News about Philips can be found at www.philips.com/newscenter.

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Virtual Reality and Treating Dizziness

Mark Cuban has a pretty amazing post that talks about his experience as an active, engaged patient in his care and how he found virtual reality helped him achieve the desired relief from dizziness that he desired. If you’ve stayed up with the virtual reality space, you’ll find this quite intriguing since virtual reality is often condemned because of the dizziness it causes. Obviously, what you’re watching on VR matters a lot.

Go ahead and read Mark’s full post to see his experience as an active patient trying to deal with his Dizziness. We’ll be here when you get back. You can also watch this video he made:

It’s pretty amazing how active Mark Cuban was in his care. Sure, he has the money to be as active as possible. He literally was looking at buying a massive medical device or even investing in a business to bring the treatment he wanted to Dallas. That’s extraordinary and something that most of us can’t do as patients.

For those who haven’t read the whole story, Mark Cuban was getting treatment in California that was helping him with his dizziness from Dizziland.com. However, he couldn’t stay in California to finish the treatment. That’s when he discovered that the Samsung VR set he had might be the solution to creating a portable solution for him. Turns out, it did the trick for him. As a true businessman, he’s now working with the company to commercialize the product.

To be clear, this device setup is not FDA approved. It’s something that Mark found and tried that worked for him. We won’t be seeing doctors prescribing this for a while to come. Although, it will be interesting to see if and how solutions like this do go to market. Will they need to be FDA approved? Will they be regulated? How much will they cost? Lots of interesting questions since the videos and technology to watch them are quite cheap.

I love the story of technology making an impact on someone’s health for good. I also love seeing an active patient taking a serious interest in their care. Although, it’s amazing how a billionaire’s interest in their health is similar to any person with a major health issue.

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Healthcare Scene’s @techguy Slots In At #7 on the #HIT100 List

For those not familiar with the #HIT100, it’s a crowd sourced, peer nominated list of people that are doing great and influential things on healthcare social media. Being crowd sourced means that the list is far from perfect. No doubt there are people that are much more influential in healthcare IT at the bottom of the list than some of those people who are at the top. However, having so many peers recognize the work you do in healthcare social media is a great experience.

At Healthcare Scene we’re excited that our very own John Lynn, (@techguy) was listed at #7 on the official #HIT100 list. It’s exciting to be recognized alongside so many influential people in healthcare social media.

This is the 6th year in a row that Healthcare Scene has been recognized on this list. We’ll continue to do what we can to contribute to healthcare IT and share our insights, views, and expertise. Be sure to follow @techguy on Twitter to find all the latest insights and updates.

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