SHSMD17 Opening Keynote, Ceci Connolly, Delivers Refreshing Dose of Perspective

On a hot and muggy day in Orlando, Ceci Connolly, President and CEO at the Alliance of Community Health Plans, delivered an opening keynote that felt like a splash of refreshing cool water at the 2017 Society for Healthcare Strategy & Marketing Development Conference (SHSMD17).

It would have been easy for Connolly, a former Washington Post national health correspondent, to focus her keynote on the impact Capitol Hill has had on US Healthcare. Instead, Connolly used her 60 minute talk to provide the SHSMD17 audience with repeated doses of perspective. You could almost hear the gears turning in people’s heads as she dispelled common healthcare misconceptions and reframed daunting challenges.

Connolly started by highlighting the problem of the rising cost of healthcare. In 1960 US healthcare spending as a percentage of US Gross Domestic Product (GDP) was just above 5%. By 2010 it was almost 18%.

According to the Centers for Medicare & Medicaid Services (CMS), national health spending is projected to grow 1.2% FASTER than GDP per year until 2025. This means that by 2025, US healthcare spending as a percentage of GDP would reach a whopping 19.9%.

This in and of itself is not news, but what Connolly did was expertly re-frame these statistics:

The more that healthcare consumes our GDP, we will have less and less money for things like building national infrastructure, fueling economic growth and oh, helping people recover from devastating hurricanes. Those priorities will suffer because healthcare will dominate our GDP spending.

Connolly’s statement was especially poignant given SHSMD President Ruth Portacci’s early comments about the heroic efforts of healthcare workers in Florida, Texas, Louisiana, Puerto Rico and the Caribbean to help those areas recover from devastating hurricanes.

From there Connolly proceeded to cast a new light on the wave of healthcare provider consolidation, payer mega-mergers, patient consumerism, aging populations, millennial expectations and retail health. Particularly noteworthy was Connolly’s take on rising drug prices and high deductible health plans (HDHPs).

According to Connolly, drug prices go up when new drugs are introduced for specific conditions. These new drugs, often with fancy names, are brought to market at prices higher than existing alternatives. The companies that own those existing drugs then raise their prices to match the new entrant and justify the increase with a mountain of evidence that their drug is every bit as good as the new one.

Connolly also took aim at HDHPs. During the industrial boom, US employers offered to pay for employee healthcare as way to entice workers to join their ranks. In short order, employer-sponsored health became the standard. Fast forward to 2017 and employers can’t shed healthcare costs fast enough. Instead of offering more health coverage, employers are offering HDHPs and transferring the burden to employees. According to Connolly the era of employer-sponsored healthcare is ending and that will have enormous consequences for US Healthcare where almost 50% of Americans still receive their health coverage through their employer.

It certainly was not your typical rah-rah opening keynote, but in these challenging times, it was courageous and refreshing to have someone stand up in front of 1,500 healthcare insiders and get us to think differently.

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BUFFALO, NY – HEALTHeLINK, Western New York’s clinical information exchange, has reached one million uniquely consented patients. Approximately 95% of those who consent authorize their health information to be shared among treating providers.

“Getting to one million patients is a significant milestone as patients hold the key to enabling their treating providers to have a more complete picture of their medical record,” said Daniel Porreca, HEALTHeLINK’s executive director. “By consenting to allow your health care providers to access your medical information through HEALTHeLINK, you are giving them instant access to information that has proven to improve the quality of care, enhance safety, and reduce health care costs through the elimination of duplicate testing.”

Consent to HEALTHeLINK can be done at any participating hospital or provider office, or by downloading a form at A parent or legal guardian can also sign a HEALTHeLINK consent form on behalf of their child, age 17 and younger. Once a patient has consented to HEALTHeLINK, treating providers are able to view lab reports, medication history, diagnostic images, and a wide range of other health information securely at the point of care.


About HEALTHeLINK:  HEALTHeLINK is a collaboration among hospitals, physicians, health plans and other health care providers in the eight counties of western New York State to securely exchange clinical information to improve the quality of care, enhance patient safety and mitigate health care costs. HEALTHeLINK is a Qualified Entity of the Statewide Health Information Network for New York (SHIN-NY), which enables providers to access their patients’ data from across the state. HEALTHeLINK is also a founding member of the Strategic Health Information Exchange Collaborative (SHIEC), the national trade association of health information exchanges. Providers and patients can or @HEALTHeLINK on both Facebook and Twitter for more information.

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AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Posted in Healthcare Integration, HIPAA, 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, Hospital HIPAA, Meaningful Use, Telemedicine | Tagged , , , , , , , , , | Comments Off on AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Predictive Analytics with Andy Bartley from Intel

#Paid content sponsored by Intel.

In the latest Healthcare Scene video interview, I talk with Andy Bartley, Senior Solutions Architect in the Health and Life Sciences Group at Intel. Andy and I talk about the benefits of and challenges to using predictive analytics in healthcare.

Andy offers some great insights on the subject, having had a long and varied career in the industry. Before joining Intel, he served in multiple healthcare organizations, including nurse communication and scheduling application startup NurseGrid, primary care practice One Medical Group and medical device manufacturer Stryker.

In my interview, he provides a perspective on what hospitals and health systems should be doing to leverage predictive analytics to improve care and outcomes, even if they don’t have a massive budget. Plus, he talks about predictive analytics that are already happening today.

Here are the list of questions I asked him if you’d like to skip to a specific topic in the video. Otherwise, you can watch the full video interview in the embedded video at the bottom of this post:

What are your thoughts on predictive analytics? How is it changing healthcare as we know it? What examples have you seen of effective predictive analytics? We look forward to seeing your thoughts in the comments and on social media.

Posted in Healthcare Analytics, Healthcare Big Data, Hospital CIO, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT, Revenue cycle management | Tagged , , , , , , , | Comments Off on Predictive Analytics with Andy Bartley from Intel

Interoperability: Is Your Aging Healthcare Integration Engine the Problem?

The following is a guest blog post by Gary Palgon, VP Healthcare and Life Sciences Solutions at Liaison Technologies.
There is no shortage of data collected by healthcare organizations that can be used to improve clinical as well as business decisions. Announcements of new technology that collects patient information, clinical outcome data and operational metrics that will make a physician or hospital provide better, more cost-effective care bombard us on a regular basis.

The problem today is not the amount of data available to help us make better decisions; the problem is the inaccessibility of the data. When different users – physicians, allied health professionals, administrators and financial managers – turn to data for decision support, they find themselves limited to their own silos of information. The inability to access and share data across different disciplines within the healthcare organization prevents the user from making a decision based on a holistic view of the patient or operational process.

In a recent article, Alan Portela points out that precision medicine, which requires “the ability to collect real-time data from medical devices at the moment of care,” cannot happen easily without interoperability – the ability to access data across disparate systems and applications. He also points out that interoperability does not exist yet in healthcare.

Why are healthcare IT departments struggling to achieve interoperability?

Although new and improved applications are adopted on a regular basis, healthcare organizations are just now realizing that their integration middleware is no longer able to handle new types of data such as social media, the volume of data and the increasing number of methods to connect on a real-time basis. Their integration platforms also cannot handle the exchange of information from disparate data systems and applications beyond the four walls of hospitals. In fact, hospitals of 500 beds or more average 25 unique data sources with six electronic medical records systems in use. Those numbers will only move up over time, not down.

Integration engines in place throughout healthcare today were designed well before the explosion of the data-collection tools and digital information that exist today. Although updates and additions to integration platforms have enabled some interoperability, the need for complete interoperability is creating a movement to replace integration middleware with cloud-based managed services.

A study by the Aberdeen Group reveals that 76 percent of organizations will be replacing their integration middleware, and 70 percent of those organizations will adopt cloud-based integration solutions in the next three years.

The report also points out that as healthcare organizations move from an on-premises solution to a cloud-based platform, business leaders see migration to the cloud and managed services as a way to better manage operational expenses on a monthly basis versus large, up-front capital investments. An additional benefit is better use of in-house IT staff members who are tasked with mission critical, day-to-day responsibilities and may not be able to focus on continuous improvements to the platform to ensure its ability to handle future needs.

Healthcare has come a long way in the adoption of technology that can collect essential information and put it in the hands of clinical and operational decision makers. Taking that next step to effective, meaningful interoperability is critical.

As a leading provider of healthcare interoperability solutions, Liaison is a proud sponsor of Healthcare Scene. It is only through discussions and information-sharing among Health IT professionals that healthcare will achieve the organizational support for the steps required for interoperability.

Join John Lynn and Liaison for an insightful webinar on October 5, titled: The Future of Interoperability & Integration in Healthcare: How can your organization prepare?

About Gary Palgon
Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences verticals. Gary’s unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce. As a respected thought leader in the healthcare IT industry, Gary has had numerous articles published, is a frequent speaker at conferences, and often serves as a knowledgeable resource for analysts and journalists. Gary holds a Bachelor of Science degree in Computer and Information Sciences from the University of Florida.

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Patient Centered Design and Business Centered Design with Amy Cueva

During the busy conference season I often shoot a lot of videos and there’s never enough time to process all of the videos I shoot. So, a number of great videos slip through the cracks. Well, as I prepare for another busy fall conference season I realized I never processed the video interview I did with Amy Cueva, Founder and Chief Experience Officer at Mad*Pow, last year at the Connected Health Symposium.

Amy is one of my favorite people in healthcare to talk with because she’s so focused and interested in how we can redesign healthcare with the patient at the center. She was one of the first people I met that talked about user centered design in healthcare or more aptly put patient centered design.

You can learn more about Amy and her company Mad*Pow in the video interview embedded at the bottom of this post. Plus, in the video I asked her about a new thing she’s working on called business centered design. This is something that is needed in healthcare as much as patient centered design. In fact, in many ways, that’s why we created Health IT Expo.

For those who don’t watch the full video interview below, here’s a great quote from our interview with Amy:

What do people really need and want. The way the health system is structured we expect patients to be obedient and adherent and serve us. Well, how do we create a system that serves them and their needs and what’s important to them and design it accordingly because then we’re going to get better results.

Check out our full video interview with Amy Cueva:

If you like this video interview with Amy Cueva, be sure to subscribe to Healthcare Scene on YouTube and check out our other videos.

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Open Source Tool Offers “Synthetic” Patients For Hospital Big Data Projects

As readers will know, using big data in healthcare comes with a host of security and privacy problems, many of which are thorny.

For one thing, the more patient data you accumulate, the bigger the disaster when and if the database is hacked. Another important concern is that if you decide to share the data, there’s always the chance that your partner will use it inappropriately, violating the terms of whatever consent to disclose you had in mind. Then, there’s the issue of working with incomplete or corrupted data which, if extensive enough, can interfere with your analysis or even lead to inaccurate results.

But now, there may be a realistic alternative, one which allows you to experiment with big data models without taking all of these risks. A unique software project is underway which gives healthcare organizations a chance to scope out big data projects without using real patient data.

The software, Synthea, is an open source synthetic patient generator that models the medical history of synthetic patients. It seems to have been built by The MITRE Corporation, a not-for-profit research and development organization sponsored by the U.S. federal government. (This page offers a list of other open source projects in which MITRE is or has been involved.)

Synthea is built on a Generic Module Framework which allows it to model varied diseases and conditions that play a role in the medical history of these patients. The Synthea modules create synthetic patients using not only clinical data, but also real-world statistics collected by agencies like the CDC and NIH. MITRE kicked off the project using models based on the top ten reasons patients see primary care physicians and the top ten conditions that shorten years of life.

Its makers were so thorough that each patient’s medical experiences are simulated independently from their “birth” to the present day. The profiles include a full medical history, which includes medication lists, allergies, physician encounters and social determinants of health. The data can be shared using C-CDA, HL7 FHIR, CSV and other formats.

On its site, MITRE says its intent in creating Synthea is to provide “high-quality, synthetic, realistic but not real patient data and associated health records covering every aspect of healthcare.” As MITRE notes, having a batch of synthetic patient data on hand can be pretty, well, handy in evaluating new treatment models, care management systems, clinical support tools and more. It’s also a convenient way to predict the impact of public health decisions quickly.

This is such a good idea that I’m surprised nobody else has done something comparable. (Well, at least as far as I know no one has.) Not only that, it’s great to see the software being made available freely via the open source distribution model.

Of course, in the final analysis, healthcare organizations want to work with their own data, not synthetic substitutes. But at least in some cases, Synthea may offer hospitals and health systems a nice head start.

Posted in health information exchange, Healthcare Analytics, Healthcare Big Data, HL7, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT | Tagged , , , , , , , | Comments Off on Open Source Tool Offers “Synthetic” Patients For Hospital Big Data Projects

Healthcare Interoperability and Standards Rules

Dave Winer is a true expert on standards. I remember coming across him in the early days of social media when every platform was considering some sort of API. To illustrate his early involvement in standards, Dave was one of the early developers of the RSS standard that is now available on every blog and many other places.

With this background in mind, I was extremely fascinated by a manifesto that Dave Winer published earlier this year that he calls “Rules for Standards-Makers.” Sounds like something we really need in healthcare no?

You should really go and read the full manifesto if you’re someone involved in healthcare standards. However, here’s the list of rules Dave offers standards makers:

  1. There are tradeoffs in standards
  2. Software matters more than formats (much)
  3. Users matter even more than software
  4. One way is better than two
  5. Fewer formats is better
  6. Fewer format features is better
  7. Perfection is a waste of time
  8. Write specs in plain English
  9. Explain the curiosities
  10. If practice deviates from the spec, change the spec
  11. No breakage
  12. Freeze the spec
  13. Keep it simple
  14. Developers are busy
  15. Mail lists don’t rule
  16. Praise developers who make it easy to interop

If you’ve never had to program to a standard, then you might not understand these. However, those who are deep into standards will understand the pitfalls. Plus, you’ll have horror stories about when you didn’t follow these rules and what challenges that caused for you going forward.

The thing I love most about Dave’s rules is that it focuses on simplicity and function. Unfortunately, many standards in healthcare are focused on complexity and perfection. Healthcare has nailed the complexity part and as Dave’s rules highlight, perfection is impossible with standards.

In fact, I skipped over Dave’s first rule for standards makers which highlights the above really well:

Rule #1: Interop is all that matters

As I briefly mentioned in the last CXO Scene podcast, many healthcare CIOs are waiting until the standards are perfect before they worry about interoperability. It’s as if they think that waiting for the perfect standard is going to solve healthcare interoperability. It won’t.

I hope that those building out standards in healthcare will take a deep look at the rules Dave Winer outlines above. We need better standards in healthcare and we need healthcare data to be interoperable.

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Hospital EMR Adoption Divide Widening, With Critical Access Hospitals Lagging

I don’t know about you, but I was a bit skeptical when HIMSS Analytics rolled out its EMRAM {Electronic Medical Record Adoption Model) research program. As some of you doubtless know, EMRAM breaks EMR adoption into eight stages, from Stage 0 (no health IT ancillaries installed) to Stage 7 (complete EMR installed, with data analytics on board).

From its launch onward, I’ve been skeptical about EMRAM’s value, in part because I’ve never been sure that hospital EMR adoption could be packaged neatly into the EMRAM stages. Perhaps the research model is constructed well, but the presumption that a multivariate process of health IT adoption can be tracked this way is a bit iffy in my opinion.

On the other hand, I like the way the following study breaks things out. New research published in the Journal of the American Medical Informatics Association looks at broader measures of hospital EHR adoption, as well as their level of performance in two key categories.

The study’s main goal was to assess the divide between hospitals using their EHRs in an advanced fashion and those that were not. One of the key steps in their process was to crunch numbers in a manner allowing them to identify hospital characteristics associated with high adoption in each of the advanced use criteria.

To conduct the research, the authors dug into 2008 to 2015 American Hospital Association Information Technology Supplement survey data. Using the data, the researchers measured “basic” and “comprehensive” EHR adoption among hospitals. (The ONC has created definitions for both basic and advanced adoption.)

Next, the research team used new supplement questions to evaluate advanced use of EHRs. As part of this process, they also used EHR data to evaluate performance management and patient engagement functions.

When all was said and done, they drew the following conclusions:

  • 80.5% of hospitals had adopted a basic EHR system, up 5.3% from 2014
  • 37.5% of hospitals had adopted at least 8 (of 10) EHR data sets useful for performance measurement
  • 41.7% of hospitals adopted at least 8 (of 10) EHR functions related to patient engagement

One thing that stood out among all the data was that critical access hospitals were less likely to have adopted at least 8 performance measurement functions and at least eight patient engagement functions. (Notably, HIMSS Analytics research from 2015 had already found that rural hospitals had begun to close this gap.)

“A digital divide appears to be emerging [among hospitals], with critical-access hospitals in particular lagging behind,” the article says. “This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance.”

While the results don’t surprise me – and probably won’t surprise you either – it’s a shame to be reminded that critical access hospitals are trailing other facilities. As we all know, they’re always behind the eight ball financially, often understaffed and overloaded.

Given their challenges, it’s predictable that critical access hospitals would continue lag behind in the health IT adoption curve. Unfortunately, this deprives them of feedback which could improve care and perhaps offer a welcome boost to their efficiency as well. It’s a shame the way the poor always get poorer.

Posted in Critical Access Hospitals, Healthcare Analytics, HITECH, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT | Tagged , , , , , , , , | Comments Off on Hospital EMR Adoption Divide Widening, With Critical Access Hospitals Lagging

Preview of #AHIMACon17 – HIM Scene

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

I thought it might be interesting to check out the #AHIMACon17 conference hashtag for the AHIMA Annual Convention to get an idea of what the hot topics were going to be going into the annual convention. Unfortunately, there wasn’t much conversation happening on the hashtag yet. Here’s a sample of a few things I found and some of my commentary about each.

I’m excited to hear Viola Davis as well. I’m sure she has some amazing stories. It’s not clear to me her connection to healthcare, but I’m all about hearing the stories of successful people. I hope they let her tell her story and not try to have her be a healthcare speaker. Ironically, the MGMA Annual Conference is happening at the same time as the AHIMA Annual Convention about 45 minutes away. Viola Davis is keynoting both. I’m not sure if they planned this together or if it’s just coincidence. Either way, I guess I get 2 chances to hear Viola, but trying to manage both events is hard.

This tweet from Ciox made me laugh. There’s a lot of things in healthcare that are still stuck in the 80s. As Mr. H from HIStalk likes to say, Healthcare is where old technology goes to die. There’s certainly some modernization that could happen at about every healthcare organization.

This tweet is ironic after the above tweet talking about the need to modernize. I wonder how many in the AHIMA community are familiar with NLP based technology. For those not familiar, NLP stands for natural language processing. It can be used in a variety of ways, but in the AHIMA world it’s most commonly used to analyze medical records and assess if the documentation matches the coding. It’s pretty amazing technology. I also love seeing NLP used on narrative sections of a note to identify granular data elements that could be used to better inform clinical decision support tools. Do many HIM professionals care about this technology? Are they using it? I think I’ll ask when I’m at the event.

I think security will be an extremely hot topic this year. Given HIM’s role in doing release of information (ROI), it’s always had an important role. In fact, they have a pre-conference Privacy & Security Institute that I’ve heard a lot of great things about. I’m hoping to go this year if they let press attend.

Will you be at #AHIMACon17? What do you expect to be the hot topics? Are there sessions you absolutely must attend? Who’s going to throw the best party? I hope to see many of you at the conference!

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

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