At a certain point in the lifecycle in any business, the predominant business model gets exhausted.

Medicine is a case in point. The dominant U.S. business model—visit based, fee-for-service—is slowly buckling under the crushing cost burden it is imposing our society.

Although it will take awhile to transform this $2 trillion bloated behemoth into a system that offers better care at a lower cost, there are flurry of movements under way that are both interesting and promising. One of the most interesting and most promising is the patient centered medical home (PCMH).

What is it? It is a primary care practice that puts together a mix of people, process, and technology so that patients get better care and better customer service.  It also intended to help increasingly burnt-out providers step off the 30 visit a day rat-race and reconnect them to a more satisfying and less frantic patient care model.

At the people level, the PCMH emphasizes teams of care providers vs. strict reliance on the physician for all clinical and patient decision making. The teams consist of doctors, PAs, nurses, medical assistants—and even administrative staff. This does not mean that the receptionist is making diagnoses, but rather provides the basis for a more coordinated effort to meet patient needs both before and after the visit. A simple example: a patient is referred to a cardiologist. Did they go? Has the practice received the documentation of the visit? Physicians are not going to track this, but a team member certainly can.

At the process level, the PCMH require practices to think about their practices not as a visit factory organized around the availability of overworked providers, but as a patient-centric service center, where it is easy for patients to make last minute appointments and communicate with the care team as question arise.

A PCMH also brings an element of practice accountability to patient care: Am I managing my diabetics effectively?  Are my cardiac patients adhering to the recommended meds? This is a distinct switch from the predominant model of reactive medicine to a proactive approach. This can have a big payoff for the management of chronically ill patients that consume much of our health care dollars.

It is impossible to implement these people and process changes without technology. The technology centerpiece of the medical home is the electronic health record (EHR), which provides not only a repository for patient information, but can also trigger preventative reminders based on the patient’s condition, plus practical tools such as e-prescribing. The EHRs make the patient record universally available to anyone with access to a workstation—a critical requirement for team based care.

While EHRs are very well suited to individual record keeping, they may not be as well suited at looking at populations of patients (i.e. How many of my diabetic patients are well controlled for HgA1c?). To help answer these questions some PCMHs may use a disease registry (more technology) to track patients.  Finally, since patient engagement and easy access to providers is a core element of the patient centered medical home, many are adopting patient portals and secure messaging to provide an alternative to traditional phone and fax communication.

Does the PCMH work? At least one study suggests that they do. Research done by Seattle-based Group Health’s medical home pilot (published in Health Affairs in May of 2012) indicated that medical home patients (when compared to patients in traditional Group Health practices) had 29 percent fewer ER visits and 6 percent fewer hospitalizations, with a net savings of about $10 per patient per month. The data also suggest improved patient satisfaction and happier providers.

The downside: setting up a PCMH is hard work and expensive (team based care means more practice FTEs per patient). However, the PCMH model that is not going away and is fully aligned with the necessary shift from quantity to quality in American medicine. It is the right approach.

What questions do you have?

Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel

To provoke some thinking about what the future holds for healthcare IT professionals—as well as all of us as individuals—there’s  a new TED talk I highly recommend.

Intel fellow Eric Dishman, GM for healthcare at Intel, distills his difficult and confusing journey through the healthcare system – and how technology can improve such journeys for future patients. You can see the video here.

This talk is inspiring on at least two different levels. It’s inspiring to see how computing innovation can help solve big problems, and make our lives safer and more convenient. And it’s an inspiring story of how human compassion from a stranger saved Eric’s life, giving him the kidney that he needed.

In the presentation, Eric demonstrates an example of how patients will be more involved in their own care, something that he has worked on for more than a decade at Intel. He conducts a live online conversation with his nephrologist while, using a handheld device, projecting a live ultrasound image of his newly transplanted kidney for the audience.

The talk weaves together three themes of “personal health” aided by new technology and emerging models of care:

Care anywhere – the infusion of mobile devices and communications technologies that let clinicians and patients stay on track – beyond wires and organizational walls.

Care networking – the shift from solo-based practice to true team-based care. He says, “We have got to go beyond this paradigm of isolated specialists doing parts care to multi-disciplinary teams doing person care.” Eric contrasts the efficient and comprehensive care he received from the kidney transplant team with the scattered and unconnected care he received for many years when no one knew precisely how to treat him.

“The sacred and somewhat over-romanticized doctor-patient 1-on-1 is a relic of the past. The future of healthcare is smart teams – and you better be on that team for yourself,” he says.

Care customization – the development of a care plan for the individual, taking into account everything from one’s needs and personal wishes to one’s unique genomic variations. He tells the audience how he is living proof that we are living at the cusp of a revolution in personalized medicine. He challenges the medical research community to “experiment on my avatar in software, not my body in suffering,” he says.

But he saves the best for last. You need to see how his 15-minute TED talk ties it all together at the end. It’s a tribute to people who make a difference, and an inspiring call to action.

What questions do you have?

The benefits of analytics in healthcare are compelling, and big data is fueling this with increasing quantity and quality of patient data with potential to enable major improvements in evidence based medicine, ultimately enabling greatly improved quality of care.

Combining this with cloud computing enables healthcare to rapidly realize benefits with less initial capital investment, more of a pay-as-you-go financial approach, and much greater agility, amongst other benefits. However, privacy and security are major concerns and an impediment to many healthcare organizations realizing these benefits. Further, legal and regulatory compliance challenges abound, from national to state level regulations, and across verticals and different types of data.

I had the privilege of moderating and participating on a workshop panel filmed at HIMSS 2013 in New Orleans with a group of leading experts:

• Nicole Martinez, Director of Nursing Informatics, Robert Wood Johnson University

• Brian Balow, Partner, Dickinson Wright PLLC

• Dr Khaled el Emam, CEO, Privacy Analytics

• Kim Singletary, Director of Technical Solutions Marketing, McAfee

See highlights of our workshop panel at the video above.

We discuss frontline healthcare workers real experience with analytics, the compelling benefits, common challenges, and practical solutions encountered in implementation. We also discuss the regulatory and legal landscape, and practical strategies for compliance.

A multi-layered approach to security emerges in our discussion as a best practice to mitigate risk, and we discuss several key security safeguards including risk based de-identification, tokenization, encryption and various administrative security controls including policy, effective training, audit and compliance, and contracts and plans with Business Associates.

We also discuss results from a recent HIMSS global research survey of frontline healthcare workers, highlighting challenges with IT department responsiveness and flexibility, the usability of solutions and security, and how usability is much more than a “nice to have”, having real impacts on compliance and risk where healthcare workers are compelled to use workarounds.

Based on this research we pose and discuss the pertinent question: “If we are going to secure our data in the cloud, which cloud is the data in?” We discuss how this research shows that the use of workarounds by healthcare workers can drive sensitive healthcare data into “side clouds” outside of the control of the healthcare organization, where it is at increased risk of confidentiality / breach, integrity, and potential trans-border data flow issues.

Last but not least, we discuss how usable hardware based security solutions can enable strong and usable security that avoid compelling healthcare workers to use workarounds, thereby improve compliance and reduce risk, and ultimately help ensure sensitive healthcare data stays in clouds where it is supposed to be, within the control and effective security of the healthcare organization.

What kinds of benefits, risks and practical solutions are you seeing with healthcare analytics in the cloud?

The success of healthcare IT depends on providing better care to patients. At HIMSS 2013, we gathered three doctors who are on the front lines of innovating this technology and use it daily as they interact with their patients. Joseph Kim, MD, MPH, president of MCM Education, Dr. Luis Saldana, attending emergency physician, and Dr. Dirk Stanley, chief medical information officer, all agree that the best way to provide better medical care is to create a patient-centered care system. Clinicians implementing this model must plan for mobile technology, privacy and security, and cloud computing.

Watch the above video for a quick look at their thoughts on the future of health IT, and see the full panel discussion here. 

Mobile technology is already penetrating healthcare. For Dr. Kim, this mobility means better patient care. "A physician used to draw what they were communicating using a pen and paper. Mobile devices allow for multimedia, which brings the doctor's ideas alive for the patient," said Dr. Kim.

These mobile devices will not only allow physicians to share quality information easily, physicians and patients can also capture larger amounts of data. But with the additional data, comes additional risks to privacy and security.

“Patients must trust that their information will be seen by only the right people at the right time,” said Dr. Stanley.  Stringent privacy and security measures must occur with the hardware, software and where the data is stored.

Dr. Kim predicts that encryption and will continue to advance and features on mobile devices like remote wipe features will continue to be at the forefront of security. 

Implementing this technology presents challenges, but creating a partnership between the physicians and IT can lead to a smoother transaction. Dr. Luis Saldana advises that technology must serve a personal reason as well as a professional reason. “These tools must be accessible for them to be successful. We follow the information flow to determine our technology strategy,” he said.

When both patient and doctor feel comfortable with the technologies, both have the opportunity to generate a considerable amount of data. Managing big data is on the minds of all hospital CIOs. “We ask ourselves how do we process this data? What tools do we use? How often do we collect it?” said Dr. Stanley.

After mobility, security measures and cloud computing have been implemented, clinicians can focus on collaboration to create a patient-centered model. “So many patients are tech-savvy. They’ll use these tools to collaborate on their own care,” said Dr. Kim.

“Our focus is on keeping patients out of the hospital,” said Dr. Saldana.

The three physicians agree that collaboration is key to good patient care. For Dr. Stanley these tools and collaboration will lead to the keystone in good patient care. “We need to move toward a one patient, one chart model to make patient-centered care a reality.”

What do you think?

See the full panel discussion with Dr. Kim, Dr. Saldana and Dr. Stanley

Tablets were once considered companion devices in health IT. However, today’s new models, like convertibles that act as both laptop and tablet, feature extra power inside that allow clinicians to collaborate with colleagues as well as enter data into EHRs. The result? Tablets are becoming primary devices in mobile point-of-care scenarios.

Watch the video conversation above with Lenovo ambassador Ashley Rodrigue as she describes the impact that tablets are having on healthcare.

What questions do you have?

Below is a guest blog post from Tee Green, president and chief executive officer of Greenway Medical Technologies, Inc.

Should every health system, hospital or group practice CIO know that to do interoperability right they need to consider XDS or PIX at the core of functionality? That these cross enterprise document sharing and patient identifier cross reference protocols can reach into another EHR?

Health IT solution providers should, and it’s clear from a survey of CIOs commissioned by Greenway that CIOs want leaders who will partner in their pursuit of the data liquidity that fits their needs. Right now education outranks selling, as interoperability is arguably the most important factor in addressing the range of care coordination programs every healthcare entity is facing.

It’s also clear that the growing EHR replacement market is being fueled by a reassessment of original platforms lacking in comprehensive data exchange at a point when the improvement of population health should not take any backward steps.

The survey specifically found that the primary concern CIOs have about utilizing technology in their healthcare system is of course interoperability. Twenty-six percent voiced it in basic terms, and another 18 percent specifically in terms of medical staff alignment, which is itself a function of interoperability through the alignment of hospitals and clinics on EHR platforms capable of seamlessly exchanging data. That’s 44 percent overall, which outweighed cost at 22 percent.

Who should carry the burden of interoperability? Forty-nine percent chose a shared process between health IT solution providers and the healthcare system. Thirty-three percent chose a shared approach additionally led by health IT. Taken together that’s 82 percent voicing the need for a shared partnership. That’s an overwhelming result the industry needs to listen to.

And don’t think that today’s patient-consumers are not aware that technology matters. We surveyed them too, and 56 percent notice when technology is used at the point of care, and believe it helps their doctors do a better job. They also realize, by a 3-to-1 margin, that technology beats paper when it comes to sharing data.

Where do we go from here?

National organizations like the EHR/HIE Interoperability Workgroup - a coalition of state agencies, EHR companies, HIEs and certification experts - are solidifying standards, from PIX to C-CDA, and must also foster and project a sense of selfless collaboration with CIOs and doctors and nurses.

This is a key example of how together health IT leaders can create a smarter and sustainable healthcare system, and takes away any skepticism that the industry is not in it for population health. And the movement to national interoperability must be led by the industry, not by external policy, to further assure CIOs that motivations are in the right place.

Our survey did not reflect an overly negative attitude, and that’s because health IT leaders are already showing the willingness to partner with each other.

Development agreements and data exchange pilots by perceived market competitors are starting to emerge that align hospitals and clinics and integrate with HIEs, and select EHR-to-EHR exchange has become a staple of an interoperability showcase near you.

I predict that by the time meaningful use Stage 2 gets underway in 2014, the thresholds for data exchange being tied to incentives - electronically transmitting 10 percent of care transitions, at least one to a different EHR platform - will be eclipsed. The healthcare industry expects it. It’s the primary concern, the primary need for partnership, and the primary way for health IT to deliver.

What do you think?

View the entire survey, “Healthcare Information Technology: Trends and Transformations,” at www.meetgreenway.com.

The experience of flipping through clean, colorful presentations of vital patient data drew enthusiastic visitors to the Intel booth at HIMSS this week.

In a demonstration created by Intel, Microsoft and Cleveland Clinic (pictured), visitors were able to explore the value of next-generation touch interfaces on Intel-powered tablets and devices. The Windows* 8 proof-of-concept application showed the potential of developing useful new presentation layers that automatically surface key pieces of clinical data for a set of patients being treated:  risk status, vitals, recent labs, medications, notes and visit information, images, etc.

“This effort is deeply grounded in the needs of clinical teams to access the latest and most relevant patient information as they move throughout their shifts,” said Mark Blatt, MD, worldwide medical director for Intel’s health IT team.

“We are excited to show how Windows 8 apps have the potential to push critical information from the enterprise EHR to the clinician,” Dr. Blatt said. “Windows 8 and new Intel-powered mobile devices also allow clinicians the flexibility to use touch to enter data in tablet mode and keyboard and mouse to enter data in laptop mode. This offers a two-in-one benefit, a tablet when you want it and a laptop when you need it.”

The demonstration application allows clinicians to view a risk-stratified list of patients based on their health status via a live Windows 8 interface tile. Users can then select a patient and view the updated medical record in the Windows 8 touchscreen experience. 

“Innovation has always been the cornerstone of Cleveland Clinic's pursuit of providing the best patient care,” said Will Morris, MD, associate chief medical information officer at Cleveland Clinic. “With our long history of integrating health information technology into clinical practice, we are always looking for new opportunities, like this one, that allow us to explore and develop the latest tools and technologies.”

“Healthcare organizations need a no-compromise mobile productivity solution to help manage the multiple workflows and improve the collaboration of teams,” said Michael Robinson, vice president, U.S. Health and Life Sciences, Microsoft. “We believe that Windows 8 can help empower mobile teams to be more productive and secure, while complementing existing EHR systems.”

What questions do you have?

Much of the chatter coming out of HIMSS13 hinges on the concept of integration. Specifically, this idea that integrating physicians with other community care givers will naturally foster a better, less expensive quality of care. It’s an idea whose time has come. So, what are healthcare CIOs doing to facilitate better communications among clinicians working inside and outside the hospital? The short answer: not much.

Sure, the innovative ones are trying. But as a group, most are still thinking in terms of individual activities performed by individual actors in individual silos. We’re seeing push-back around data sharing. We even have people pronouncing the HIEs dead, declaring that data exchange is too hard, too complex. Yet this vital communication at the point of care is too useful and too necessary to disregard.

With HIE technology becoming dated and outpaced by newer technologies – and the added challenge that many EMRs certified as interoperable don’t really interoperate – one approach being advocated by health IT experts is the use of mobile tools for real-time voice and video communication.

Collaboration using video conferencing and real-time streaming medical data makes tremendous sense at the point of care. But it’s a hard leap for many healthcare CIOs, a destination they’re striving for but haven’t yet reached.

Atlantic Health System’s Linda Reed, RN, MBA, FCHIME, vice president and CIO, and president of her regional HIE, is among those CIOs tasked with balancing physician demands for rapid communications inside and outside the hospital against her organization’s need to maintain security and compliance.

Right now, the Morristown, N.J.-based health system, which has 2,852 physicians and 1,310 licensed beds spanning three locations, limits the use of real-time video to its telemedicine stroke program — but Reed anticipates the technology’s inevitable arrival as a widespread mobile communications tool.

“Whether it’s through Facetime, or Skype, or what have you, the real-time video wave is coming, especially with more people having iOS and Android applications,” Reed says. “For the moment though, in hospitals, we try to discourage all that because we don’t want people sending photos of patients. Everything comes back to compliance.”

Like most healthcare CIOs, Reed has embraced the BYO phenomenon, implementing Citrix and VMWare solutions that enable physicians to use their own devices while maintaining access to legacy applications that are still client/server-based.

To better facilitate rapid communication among physicians, Atlantic has begun piloting a secure text messaging app that appears promising. Currently, about 60 physicians are using the PIN-protected app, enabling them to receive PHI on-the-fly without violating any privacy rules. It took a while to find the right vendor because some of the apps were just too cumbersome to use, but it’s proven a reliable, safe tool for time sensitive communications.

“These are the things we’re doing now, but who knows,” adds Reed. “As healthcare changes and hospitals become smaller as the ambulatory side grows, what other tools will we need to support patients in their homes?”

Intel’s Worldwide Medical Director, Mark Blatt, M.D., is among those convinced that that’s where real-time voice and video technologies increasingly will come into play, enabling true POC collaboration among clinicians.

Although it will likely be another two quarters before he has the proof points he needs to offer examples of healthcare organizations that are effectively and creatively using IA mobile tools in this manner, he’s convinced we’re getting close.

Proactive CIOs who want to position their organizations accordingly, he says, should embrace three key concepts: choose the right device for the task; rearrange workflows to move toward collaboration; and, think about the compute model and how information is delivered to a mobile device.

“The mobile form factors are slate computers when you want them, laptops when you need them,” Dr. Blatt says. “And if I’m thinking about it from an operating perspective, consider that Windows* 8 is backward compatible with all your legacy equipment. All your peripherals and drivers just work, and you have the trusted security and manageability tools you’ve become comfortable with.”

What steps is your healthcare organization taking to better integrate clinicians and community-based care givers?

As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.