In my last post, we looked at two of the top five health IT trends I’m seeing for 2015. In this blog, we’ll conclude with a more in-depth look at the remaining three trends.

 

To recap, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.

 

While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other.

 

Here’s my take on the three remaining trends:

 

  1. Consumer-facing mobile strategies: To control spiraling healthcare costs related to managing patients with chronic conditions as well as to navigate new policy regulations, 70 percent of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018. This will create more demand for big data and analytics capability to support population health management initiatives. And to further my earlier points, the personalization of medicine relies on additional quality and population health management initiatives so these innovations and trends will fuel each other at faster rates as they become more integrated and mature.

  2. Consumer-directed interoperability: Along with the evolution of the consumerism of healthcare, you will see the convergence of health information exchange with consumer-directed data exchange. While this has been on the proverbial roadmap for many years, consumers are getting savvier as they engage their healthcare and look to manage their increasing healthcare costs better along with their families’ costs. Meaningful use regulations for stage 3 will drive this strategy this year but also just the shear demand by consumers will be a force as well. I am personally seeing a lot of exciting innovation in this area today.

  3. Virtual care: Last but certainly not least, tele-health, tele-medicine and virtual care will be top-of-mind in 2015. The progression of tele-health in recent years is perhaps best demonstrated by a recent report finding that the number of patients worldwide using tele-health services is expected to grow from 350,000 in 2013 to approximately 7 million by 2018. Moreover, three-fourths of the 100 million electronic visits expected to occur in 2015 will occur in North America. We are seeing progress not only on the innovation and provider adoption side but slowly public policy is starting to evolve. While the policy evolution should have occurred much sooner, last Congressional session we saw 57 bills introduced and as of June 2013, 40 out of 50 states had introduced legislation addressing tele-health policy. I see in every corner of the country that care providers want to use this type of technology and innovation to improve care coordination, increase access and efficiency, increase quality and decrease costs. Patients do as well so let’s keep pushing policy and regulation to catch up with reality.

 

While the headlines this year will be dominated by meaningful use (good and bad stories), ICD-10, interoperability (or data-blocking), and other sensational as well as eye-catching topics, I am extremely encouraged by the innovations emerging across this country. We are starting to bend the cost curve by implementing advanced payment and care delivery models. While change and evolution are never easy, we are surrounded by clinicians, patients, consumers, administrators, innovators and even legislators and regulators who are all thinking and acting in similar directions with respects to healthcare. This is fueling these changes “on the ground” in all of our communities. This year will be as tough as ever in the industry but also, a great opportunity to be a part of history.

 

What do you think? Agree or disagree with these trends?

 

As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 800 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. He recently launched a weekly radio show, “This Just In.”

While I know meaningful use (stages 2 and 3), electronic health record (EHR) interoperability, ICD-10 readiness, patient safety and mobile health will all continue to trend upwards with great importance, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.

 

While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other. It’s like a great marriage where the spouses make each other better and usually more successful because of their unity. I see the same occurring in 2015 and why I am so bullish on these integrated opportunities and innovations.

 

In this first part of my 2015 outlook blog, we’ll look at two of the top trends:

 

  1. Treating the patient as a consumer: This is due to numerous factors but a significant driver is the shift in various CMS regulations and incentives that have care providers and healthcare organizations focused on increased patient engagement as well as patient empowerment to improve communication, care coordination, patient satisfaction and even discharge management with hospitals. As a result of an increased focus on improving the patient/consumer experience, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018, thus requiring healthcare organizations to develop omni-channel strategies to provide a consistent experience across the web, mobile and telephonic channels. I have already begun to see this in hundreds of area hospitals and practices in Georgia and know it is occurring across the country.

  2. Personalized medicine: While this concept is not new, the actual care plan implementation as well as technology and services innovations supporting this implementation is being driven quickly by the increased pressure for all care providers to improve quality and manage costs. You will see this increase dramatically once Congress passes SGR Reform that received bipartisan and bicameral support last Congressional Session and Congressional leaders are poised to take up this legislation again in the next month. The latest statistics show that 15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans.

 

Tomorrow we’ll look closely at the other three 2015 trends in health IT.

 

What questions do you have? What are the trends you are seeing in the marketplace?

 

As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 800 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. He recently launched a weekly radio show, “This Just In.”

There is talk in the medical industry of helping providers practice at the maximum of their licensure. One reason for this is that we don't have enough primary care physicians, and, in part, can address this gap with physician assistants, nurse practitioners, registered nurses, and a myriad of non-traditional team members like pharmacists and health coaches. It so happens that all of these individuals can be more cost-effective than physicians.

 

Medical assistants can do more than escort patients to an exam room and take vital signs. Nurse practitioners have the training and ability to move beyond acute illness diagnosis & treatment to engage in chronic disease management. Collaborative practice agreements allow pharmacists to manage complex patients on complicated medication regimens, assisting the healthcare team with their unique expertise in drug effects and interactions. As for doctors, the highest paid part of that pyramid, how do we make sure they are doing the things that only doctors can do while engaging their team to help with the rest?

 

Elevating the Patient Role

 

There's one team member who is often left out of this conversation -- the patient. How do we engage patients at the maximum of their ability? Patients are capable of doing a lot of more to manage their health if we would just give them the proper training and tools. By the way, patients are free. We don’t have to pay them to take care of themselves.

 

mHealth is the platform on which healthcare will move forward. What role can and should the users of mHealth technologies play? How do we maximize the impact that each user group can have on the health outcomes we are all working towards? How does everyone practice at the maximum of his or her licensure in a mhealth world?

 

It's important to remember the simple goal we are all working towards. We are trying to help people live healthier lives and trying to do it cost effectively. Patients are indispensable in working towards this goal. Patients have access to themselves all day, every day. They are on the front lines of healthcare, and they don’t cost anything.

 

Merging Patients and mHealth

 

In fact, according to an ONC-funded pilot project at Geisinger Health System, patients help to spot errors such as outdated information and omissions such as medications prescribed by another provider. Personal health records can drive these efforts.

 

  • Patients are eager to provide feedback on their medication list – 30 percent of patient feedback forms were completed and in 89 percent of cases, patients requested changes to their medication record.

 

  • Patient feedback is accurate and useful – on average, patients had 10.7 medications listed, with 2.4 requested changes. In 68 percent of cases, the pharmacist made changes to the medication list in the electronic health record based on the patient’s feedback.

 

ONC officials also write that the Open Notes Project, launched in 2010 by Geisinger, the University of Washington's Harborview Medical Center, Beth Israel Deaconess Medical Center and the Robert Wood Johnson Foundation, “found that patients who were given access to their doctors' notes reported they do better in taking their meds.”

 

If patients are going to become effective team members, we need to maximize their potential. mHealth solutions can help remove barriers by providing effective education, the necessary tools for tracking health and the right connectivity with other members of their healthcare team. This would allow the rest of the team to focus on the aspects of care they are uniquely qualified to address.

 

What questions do you have?

 

Lucienne Ide, co-author of this blog post, is CEO of Rimidi.com and Justin Barnes is a Managing Director at Justin Barnes Advisors.

Doctors and surgeons are some of the brightest individuals in the world. However, no one is immune to mistakes and simple oversights. Unintentional errors occur in any industry; what makes healthcare different is that a single misstep could cost a life. 

 

In, The Checklist Manifesto by Dr. Atul Gawande, he cites a fellow surgeon’s story of a seemingly routine stab wound.  The patient was at a costume party when he got into an altercation that led to the stabbing.  As the team prepared to treat the wound, the patient’s vitals began dropping rapidly. The surgeon and his team were unaware that the weapon was a bayonet that went more than a foot through the man, piecing his aorta.

 

After regaining control of the situation, the man recovered after a few days. This experience presented complications that no one could possibly predict unless the doctors had full knowledge of the situation.  Gawande states, “everyone involved got almost every step right […] except no one remembered to ask the patient or the medical technicians what the weapon was” (Gawande 3). There are many independent variables to account for; a standard checklist for incoming stab wound patients could ensure that episodes like this are avoided and that other red flags would be accounted for. 

 

Miscommunication between clinicians and patients annually accounts for roughly 800,000 deaths in the US, more than heart disease and more than cancer.  The healthcare industry spends roughly $8 billion on extended care as a result of clinical error every year. As accountable care continues to make progress, the healthcare industry is moving more towards evidence based medicine and best practices. This is certainly the case for care providers, but also for patients as well. 

 

Implementing checklists in all aspects of healthcare can eliminate simple mistakes and common oversights by medical professionals and empower patients to become more educated and informed. Studies by the Journal of the American Medical Association (JAMA) as well as the New England Journal of Medicine (NEJM) have concluded that implementing checklists in various facets of care can reduce errors by up to half. Certain implementations of checklists in Intensive Care Units for infection mitigation resulted in reducing infections by 100 percent.

 

Compelling evidence of the need for checklisting can be found in the preparation process for a colonoscopy.  Colonoscopy preparation is a rigorous process that requires patients to be watching their diet and the clock for two days before procedure.  It is not uncommon for a colonoscopy to fail due to inadequate patient preparation. Before the procedure, the patient must pay attention to an arsenal of instructions regarding food, liquid, and medication. A detailed checklist that guides each patient through the process would practically eliminate any errors and failures due to inadequate patient preparation. 

 

From the patient’s perspective, checklisting everything from pre-surgery preparation to a routine checkup should be a priority.   At the end of the day, the patient has the most at stake and should be entitled to a clear, user-friendly system to understand every last detail of any procedure or treatment.

 

A couple of companies are making waves in the area of patient safety checklists, most notably of which are BluMenlo and Parallax.

 

BluMenlo is a mobile patient safety firm founded in 2012. Its desktop, tablet, and mobile solution drives utilization of checklists for patient handoffs, infection mitigation, and Radiation Oncology Machine QA. Although initial focus is in the areas mentioned, BluMenlo is expanding into standardizing best practices hospital and ACO-wide.

 

Parallax specializes in operating room patient safety. Its CHaRM offering incorporates a Heads Up Display to leverage checklists in the Operating Room. The software learns a surgeon’s habits and techniques to accurately predict how long an operation may take as well as predict possible errors.

 

Electronic checklists will certainly take hold as health systems, ACOs and accountable care networks continue to focus on increased patient safety, improved provider communications and best practices for reducing costs across their organizations. We will even see these best practices expedited if we begin to inquire with our care providers as informed and engaged patients.

 

What questions about checklists do you have?

 

As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor who also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.

Living in Atlanta and working within the healthcare delivery innovation community, the mounting Ebola outbreak taught us all how quickly the “global” can become local.

 

For a healthcare system threatened by infectious disease, complex chronic illness, environmental and population management issues, the outbreak also reinforces how new technologies are advancing patient and caregiver safety, prevention, patient monitoring, diagnosis and even treatment.

 

The answer, through non-contact medicine, is literally in the airwaves.

 

Researchers at Stanford are pursuing the combined use of laser and carbon nanotubes to provide a more detailed view of blood flow in the brain – down to single capillaries – to increase the understanding of cerebral-vascular disease beyond the imaging provided by CT scan or MRI.

 

Other researchers are utilizing laser and sound waves to approach skin disorders through light absorption to better gauge tumor depth.

 

Similar to research at Stanford, the expanded use of infra-red and near-infrared light is being pursued to measure oxygen levels in human tissue for tumor detection, and non-contact infra-red thermometers are becoming available to caregivers.

 

An ultra-wideband radar sensor developed in Atlanta can see through solid objects and human tissue to continuously monitor cardio-respiratory rate, patient movement, bed presence and other clinically important motion.

 

And in many of these instances, the future is now, based on published data demonstrating outcomes.

 

A comparative study appearing in the March 14 edition of the Journal of American Medicine found a range of benefits from non-contact sensors tracking biomotion. Produced in a hospital setting, the study found that over nine months, the utilization of sensors decreased code blue instances dramatically by 86 percent. Days in ICU after surgical transfer, for example, decreased 45 percent and overall length of stay by nine percent.

 

These types of non-contact biosensors provide continuous and real-time actionable and sharable data scalable to ubiquitous applications. Their use for chronic conditions or within emergency situations such as burn units and the potential to aid differing patient populations continues to expand. In cases of presently non-curable or highly infectious disease states, advances in non-contact medicine could provide equal benefits.

 

Many Americans are using or are aware of the wearable sensors embedded into clothing or the light-contact wrist bands that provide basic vitals or lifestyle data. Even bathroom scales are generating data that can be captured or shared, all within the realm of passive or compliant patient-generated data.

 

This consumer market approach, though, is giving way to increased attention and research in the more critical arena of clinical, in-patient and point-of-care solutions, where efficiencies and costs are also important to an advanced and egalitarian healthcare system striving for greater care coordination.

 

Invited to September’s annual TEDMED conference on health and medicine as part of its innovation and collaboration sessions known as “The Hive,” we expect to learn more about and share information on these and many other breakthroughs in patient care that will likely impact all of our lives or our communities in an increasingly connected world where the future should always be now.

 

Robert Arkin and Dr. Jiten Chhabra collaborated on this blog post. Robert Arkin is CEO, and Dr. Jiten Chhabra is Medical Director, at Sensiotec. Justin Barnes is an Entrepreneur-in-Residence with the GA Tech Advanced Technology Development Center.

As I continue to travel around the country and speak to healthcare practitioners, it's becoming clear that the realities of patient consumerist behavior coupled with engagement incentives are leading caregivers to more actively pursue innovative solutions and long-term strategies.

 

And one main point I continue to make is that it is increasingly important to understand that the empowered patient is a benefit to your practice and not a hindrance, especially when market forces are leading patients in that direction.

 

At a recent presentation before practice administrators, payers and health IT executives during a regional MGMA conference, I found a ready audience looking for best practices.

 

By now it is – or should be - largely understood that high-deductible health plans and alternative care sites such as retail clinics are leading patients to be more cost conscious than ever before. This has led to “doctor shopping” and the growth of websites rating the overall patient experience along with costs and the history of a practitioner’s procedural, certification and work history.

 

All of this is of course fueled by informational consumer technologies and mobile applications along with those empowering patients to self-measure, self-monitor and self-manage aspects of their healthcare.

 

It is estimated that globally some 500 million people are expected to access a mobile health application by 2016.

 

And even within the industry, new transparencies such as the CMS Physician Compare website, is adding to the consumerism of healthcare.

 

Embracing Transparency and Patient Collaboration

 

Adopting the mindset that an empowered patient is a loyal patient – and a more compliant patient – is a sound strategy backed by recent studies.

 

A pilot project by Geisinger Health System opening up medication records to patients for their review found that patients were eager to provide input toward reconciling and updating medication lists and offering changes that could be entered into EHRs.

 

A similar program by a consortium of health systems known as the Open Notes Project found that patients given access to provider notes were more compliant in their medication regimens.

 

Therefore transparency itself is a patient engagement strategy.

 

What to do with Patient-Generated Data

 

The next frontier for caregivers in any setting is how to absorb, share and in general prepare for the emergence of Patient-Generated Health Data.

 

The growth of mobile and consumer-directed monitors and devices is a big part of the healthcare applications marketplace.

 

And by now you should be aware that agencies such as ONC are calling for practitioners to be able to accept these types of data into the EHR, and that doing so is among the criteria proposals within Stage 3 of meaningful use.

 

If you are equipped with a patient portal and in addition the ability to integrate it with a personal health record (PHR) then you have reached some technological engagement foundations.

 

New technologies are making it so easy for the patient-consumer to create health data – via everything from a bathroom scale to wearables – that old-fashioned notions of patient compliance or regular checkups is being replaced by strategies to understand how to accept and coordinate this data into an alert-driven or actionable technology.

 

It is important to stay abreast of consumer-driven care coordination technologies emerging in the market. I came across a technology called OneCare, a data hub free to consumers that merges health data from the provider, PHR or other personal sources and collaborates with health plans to track health metrics matched to patient financial incentives.

 

There are even solutions such as Gozio Health’s smartphone wayfinding platform that uses sensor fusion technology to provide better “customer service” during a visit.

 

This isn’t high-tech benevolence – engaged visitors translate into fewer missed and late appointments, higher HCACHPS scores and more easily met MU-2 objectives.

 

Strategic Foundations

 

To meet the demands of the new consumerist and patient-generated data horizons of quality-driven healthcare and payment models, adopt a collaborative and proactive approach to patient populations.

 

It’s important to survey this population to understand their expectations and their own levels of technological abilities and the importance they place upon it.

 

Turning this information into analytics and then a sound strategy – for both incentive program requirements and realistic patient engagement as well as empowerment programs – are keys to putting theory into practice.

 

What questions do you have?

 

As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor who also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.

I’ve been fortunate enough to share a lot of podiums with great minds and innovators, from last year’s White House economic summit to annual health IT gatherings like the HIMSS annual conference, but I don’t think I’ve ever been as energized about our country’s technology community as from what I’m experiencing on the ground floor.

 

Named by Forbes as one of the Top 12 Business Incubators Changing the World, the Advanced Technology Development Center (ATDC) at Georgia Tech in Atlanta is a hub for technology startups with national reach and attention from investment groups to established companies like Intel and many more.

 

As a new ATDC entrepreneur-in-residence, I primarily focus on mentoring healthcare and health IT executives from startup firms to young high-growth companies but I’m also afforded the opportunity to collaborate on current and future ATDC community-enhancing programs. Over the last few decades the Center has nurtured more than 150 successful startups into the marketplace and at any given time has another 40 in the pipeline.  It is certainly an exciting and rewarding time at a multitude of levels.

 

ATDC's affiliation with the Georgia Institute of Technology, alignment with the university’s Enterprise Innovation Institute, VentureLab’s center for technology commercialization and the Flashpoint startup accelerator program probably speaks for itself as to what kind of resources can be combined in technology hubs around the country.

 

The ATDC’s renown led to a visit by the United States’ first Chief Technology Officer Aneesh Chopra on July 9 on the potential for transformative public-private technology initiatives was as inspiring as it was educational. I was fortunate enough to work with Aneesh while he was in the White House and it was great to hear about his current healthcare and open-skills data initiative projects as well as his new insightful book, Innovative State.

 

Whether it’s health IT or big data or financial technology firms being developed at ATDC, what’s been most inspiring is not so much an open-source technology as the open-source mindset of sharing and collaboration that is fostered.

 

In healthcare, the ATDC is nurturing firms like Rimidi Diabetes, Inc., which was officially launched in Washington, D.C. at the mHealth Summit and went on to test its cloud-based platform with a California-based accountable care organization. This algorithm-based technology merging blood glucose levels with fitness and behavioral metrics is a positive gain for the much-needed advancement in quality and outcomes-based healthcare.

 

Another community success story, BluMenlo, provides physicians and clinicians with a mobile application providing live procedural checklists of proper clinical care that is leading to increased patient safety and decreased preventable medical errors that contribute to about 800,000 annual deaths and cost hospitals roughly $7 billion a year. These are staggering numbers and it’s encouraging that startup brain trusts are tackling real issues, which does not go unnoticed by the growth capital community.

 

As you can tell, I am highly energetic and optimistic about our Atlanta-based technology innovations, but more so about our nation’s renewed entrepreneurial spirit and blessed opportunities in many important markets and sectors that our country and global economies are thirsting for.

 

I would encourage everyone in the corporate sector and certainly the health and care provider community to welcome or become involved with the startup or incubation community in your part of the country. There are exciting innovations that your organizations could pilot or implement that will positively affect your bottom-line in every way. In my healthcare realm, I see powerful cost-effective and efficient innovations that dramatically increase patient safety, improve care quality, advance patient engagement, save millions of dollars and best of all, save lives.

 

What questions about health IT innovation do you have?

 

As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor and also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.

 

Follow him on Twitter (@HITAdvisor)

See his other posts here

Whether the ICD-10 delay and Medicare payment fluctuations bring relief or frustration, there are still many ways to position your organization for a successful future.

 

In fact, despite the recent disposition toward delay, now is actually the time to energize or re-energize your focus on existing programs that create a strong foundation for evolving and future value-based and alternative payment incentive models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

 

As you may know, the congressional stalemate on how to pay for long-term Medicare payment stability — coupled with the phasing out of fee-for-service (FFS) — brought ICD-10 into pre-midterm election politics. The result? A one-year delay of the advent of ICD-10 in the U.S. until Oct. 1, 2015. In addition, a one-year Medicare payment patch averted a 24-percent cut, instead increasing Medicare payments by 0.5 percent for the next 12 months.

 

Both actions temporarily slowed the momentum of the SGR Repeal and Medicare Provider Payment Modernization Act (SGR Repeal), which proposed to stabilize Medicare payments through 2018 and that same year institute a value-based purchasing program similar to accountable care structures while phasing out FFS.

 

Moving your healthcare organization forward

Keep in mind that throughout this process, congressional leaders said they will still work hard to resurrect the bipartisan SGR Repeal Act widely supported by Capitol Hill, provider groups and the health IT industry. This is the right thing to do to advance preventive, coordinated care and move toward a sustainable healthcare system.

 

In the case of ICD-10, many organizations were readying for the conversion this fall, respecting its merits toward advancing quality reporting, expanding performance measures and improving overall population health.

 

You can make the most of these changes by staying focused on creating strategies for implementing the value-based and alternative payment incentive models the SGR Repeal Act proposes:

 

Accountable care organizations — With more than 600 voluntary structures currently operational, many of your peers have moved into coordinated care programs based on quality incentives. Don’t be left behind. These programs are another example of how private payers and healthcare organizations have followed the lead of the original Medicare Shared Savings Programs.

 

Patient-centered medical homes — This equally successful program has been expanded to include specialty medicine, with the March 2013 launch of the Patient-Centered Specialty Practice (PCSP) program by the National Committee for Quality Assurance (NCQA).

 

Meaningful use Stage 2 — Stage 2 is an example of how quality measure incentive programs will come to pass. Keep in mind that for the 2014 reporting year, any 90-day or fixed-quarter attestation can be pursued, so there’s plenty of time to capitalize and ready your organization for success. There are incentive funds still on the table.

 

With aspects of healthcare coverage, payment and sustainability such a paramount issue for our country — intertwined with health IT adoption and improved population health goals — it’s essential to continually assess what programs are best for your organization and your patients.

 

It’s safe to say you will need to engage these programs despite periods of fluctuation to successfully compete in a future of healthcare dominated by accountable care, value-based purchasing and alternative payment models.

 

Justin Barnes is a vice president at Greenway Health, chairman emeritus of the Electronic Health Record Association (EHR Association) and co-chair of the Accountable Care Community of Practice (ACCoP).

 

Follow Justin on Twitter (@HITAdvisor)

See his other posts here

I recently joined a panel of learned colleagues working in public health, telemedicine and acute care at an Institute of Medicine (IOM) forum focusing on the state of our nation’s healthcare system relating to population health and emergency preparedness and response due to natural disaster or other factors.

 

Along with seeking programmatic opportunities within the Affordable Care Act (ACA), I was asked to represent the view of the healthcare information technology sector on ways to advance resilience through technology that keeps the focus on the patient.

 

Doing so means establishing an infrastructure around current national standards (such as Direct & C-CDA) for data exchange and readable content, as well as increasingly open architectures around application programming interfaces (APIs) that expand integration with emergency response departments, responders, hospital EDs and HIEs, along with the current integration of electronic health records.

 

The expansion of patient portals, personal health records and cloud technology must also keep pace with available standards such as Blue Button, along with the ability for providers to utilize mobile EHR innovations to access these standard and readable patient records. After all, hospitals and practices are not immune to disaster, as the nation experienced certainly with Hurricane Katrina and most recently during Hurricane Sandy.

 

Also, a national patient identifier strategy is equally crucial to develop, one that can link the needed clinical information to the right displaced patient.

 

Both the American Recovery and Reinvestment Act (ARRA, 2009) and ACA provide the means to put this infrastructure in place, and in fact such networks are already taking shape. The ACA’s Health Center Controlled Networks fund was primarily focused on EHR and meaningful use adoption in the front lines, and provides the opportunity for resiliency expansion.

 

ARRA’s HIE Cooperative Agreement Program seeded state and regional HIEs, from which a debut collaboration this year of 10 HIEs has formed under the name SERCH, specifically to manage emergency response using vetted exchange standards, all while some individual state HIEs are expanding linkage to include EMS and fire departments.

 

And yes, taking a measured, national and analytical approach to resilient, technology-driven strategies is a best practice for achieving best practices in the field. Here too, ACA can be leveraged through a pair of well-funded and important programs, the Patient Centered Outcomes Research Institute (PCORI) and the Prevention and Public Health Fund, where respectively analysis and additional research options for emergency healthcare and IT exist, and where implementation can follow.

 

And finally, it’s again not just emergency response, but also preparedness, where for example outbreak surveillance, immunizations and registries have long been a national goal. Here there are new and existing collaborations between ONC, CDC and EHR developers that can be further integrated.

 

Right now the opportunities far outweigh the barriers toward establishing a coordinated national approach to population health when we may need it most, and it’s important to continue this discussion as the health IT industry itself continues to mature.

 

See the IOM panel presentation slides here.

 

Justin Barnes is a vice president with Greenway Medical Technologies, chairman emeritus of the national Electronic Health Record Association (EHR Association), co-chair of the Accountable Care Community of Practice (ACCoP) and a board member of the CommonWell Health Alliance.

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. Tee Green new headshot.jpg

 

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.

As the headlines surrounding Stage 2 focus on specific interoperability tied to summary of care, information exchange in many forms is really the broader theme as meaningful use helps drive care coordination.

 

As Stage 2 nears, it’s time to nurture caregivers beyond the historical focus of interoperability as a jargon-heavy, system-to-system infrastructure. Interoperability not as a technical challenge, but a multi-faceted approach to coordinating care and advancing value-based medicine.

 

Today, we need to think about  interoperability as provider to provider, provider to patient, provider to device, provider to HIEs, registries and public health agencies for example, all tied to integrated EHRs and health IT platforms.

 

In terms of provider to patient, Stage 2 alone includes four patient engagement measures that call for the ability to exchange information. That’s interoperability with a human face. Taken a step further, if a provider is also part of a CMS Shared Savings program, patient satisfaction scoring – and therefore engagement – also becomes a measure of information exchange and a successful business goal with today’s patient-consumers.

 

Each of these facets of interoperability – menu items exchanging data with cancer registries, for example – is a technology tied to standards, creating a universal language and a longitudinal patient record, one that encompasses mobile technologies, scalable, flexible and customizable platforms that can expand throughout a care community.

 

As EHR-driven solutions establish the ability to exchange on all levels, caregivers can take the foundations achieved through meaningful use and apply them to the best fit for their practice, be it a patient-centered medical home, CMS ACO, private payer or hybrid payment and delivery model.

 

Interoperability is not the age-old debate between nature versus nurture. For true care coordination, it is both.

 

What questions do you have?

 

Justin Barnes is a vice president at Greenway Medical Technologies, chairman emeritus of the Electronic Health Record Association (EHR Association) and co-chair of the national Accountable Care Community of Practice (ACCoP).

See Part I of Justin Barnes' ACO blog

 

Statetate Medicaid officials are moving quickly to  understand and establish accountable care models around community ACOs, provider-led programs or hybrid models merging health plans and care providers.


This public-private initiative is being aided by organizations such as the non-profit Center for Health Care Strategies (CHCS) and the CMS Innovation Center, as all stakeholders realize the need for coordinated care for a patient population most in need of preventive and cost-efficient medicine that can build upon the Medicaid coverage expansion within ACA. Right now state Medicaid ACO pilot programs are being formed in at least seven states.


Meanwhile, many of the nation’s uninsured and elderly are increasingly taking advantage of the growth and accessibility of retail health clinics.
The number of Americans visiting these clinics for vaccinations, treatments for respiratory infections and preventive measures, for example, quadrupled – from nearly 1.5 to six million people - between 2007 and 2009, according to an August 15th Rand Corp. study published in Health Affairs. It is notable the study found that nearly 33 percent of these patients lack health insurance.


These rates will be impacted by the coverage mandate and the future of health insurance exchanges also within the Affordable Care Act, likely combining to fuel an increase in patient volumes at traditional practices as well, adding stress to our already strained delivery system in terms of the documented decline of the number of primary care physicians.


That dynamic will also continue to fuel expanding scope of practice debates on the roles of nurse practitioners (NPs) and physician assistants (PAs) moving within primary care. These issues are tied together provided that quality care can be achieved in retail settings, which I believe has been initially demonstrated and can continue to accelerate into more advanced primary care as an ambulatory option for more patients.


Steps to Accountable Care Success
Accountable care and care coordination in all of its forms is an essential building block for improved healthcare, along with EHR adoption, meaningful use and interoperability. In broad terms, this transformative journey seeks to improve patient safety and quality of care. The vehicle for that journey: further integration of care and a focus on disease management through new bundled payment models, value-based purchasing initiatives and benchmarking analysis. That’s where health information enters the picture. The robust use of data aggregation, analytics, and shared information directly support patient care coordination and population health management, which are the most critical clinical components of managing risk-based reimbursements.
For care providers and practices seeking to form or join an accountable care community, there are prerequisites to address:


1. Begin by assessing your EHR, interoperability and overall technology infrastructure, as well as your beneficiary patient volume. Then engage your peers, associations, payers, employers, and health systems in your community to identify government, private payer, or combined opportunities.


2. If your practice or organization is approached to participate in an ACO, evaluate it carefully. Consider your financial and strategic incentives for joining, data requirements, and access to bi-directional data and whether your commitment is binding or non-binding.


3. ACOs positioned for success should have three- to five-year plans that incorporate growth strategies and best practices. These include utilizing health information technology, engaging and educating patients, developing care management resources, and monitoring care delivery and follow-up.


4. It is also important to assess your own understanding of the different risk models being offered. Determine how much risk you can assume initially and over time.


The Supreme Court ruling on the ACA was a big step in this journey, and the next focal point is of course whether Shared Savings structures and the financial risk tracks succeed, causing more providers, health systems, private payers, and employers to embrace coordinated care and payment models.


We are seeing solid evidence of this already, which represents an encouraging sign of what the next several years will bring.

 

What questions do you have?

 

Justin Barnes is co-chair of the national Accountable Care Community of Practice (ACCoP), chairman emeritus of the EHR Association and a vice president at Greenway Medical Technologies. He has appeared before White House and Congressional panels on matters of health information technology on more than a dozen occasions since 2005, and has advised current and former presidential administrations on industry policy.

Now that the healthcare industry can work with clarity on care coordination strategies and programs, a new expansion of ACO models, trends in patient behavior and the companion issue of provider scope of practice have quickly emerged as critically-relevant spotlights.


And with a presidential political season upon us, mutual clarity on what the election returns could bring is also at hand based on conjecture that a GOP White House and/or Congress would attempt to counteract the Affordable Care Act. And here some historical perspective helps.


Simply put, even with the political leadership makeup potentially in flux this fall, there is strong bipartisan support for aligning payment and care delivery models with improving quality to create a smarter and sustainable healthcare system, backed by historical precedent.


For me and my colleagues in the trenches of pursuing fiscally sound care delivery nearly a decade ago, it is well remembered that the origins of accountable care reside within a 2004 HHS document entitled “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care.” This “Framework for Strategic Action” (as it is also known) was delivered to then-HHS Secretary and GOP-appointee Tommy Thompson. And it was delivered by the nation’s first National Coordinator for Health Information Technology, Dr. David Brailer.


The document’s goals of introducing health IT solutions to clinical practices, electronically connecting clinicians, using “information tools” to personalize care and advance population health reporting followed an executive order calling for widespread adoption of interoperable EHRs within 10 years.


That core bipartisan support for these goals, also evidenced by the success of meaningful use, has weathered the political winds, and no doubt like many in health IT, I keep a copy of this foundational document at hand.


To continue to get us to where we are today, the report was followed the next year by the Physician Group Practice (PGP) demonstration, a five-year program of 10 sites pursuing early shared savings goals. This program was widely resurrected as a reference point when the current Medicare Shared Savings proposals were first issued.


A year later, Dartmouth Medical School’s Dr. Elliott Fisher began voicing the concept and vocabulary of accountable care during a Nov. 9, 2006, Medicare Payment Advisory Commission (MedPAC) meeting then put to paper by year’s end. MedPAC’s research over the past year only further supports this evolution.


Today, more than 27 state legislatures have proposed programs related to accountable and coordinated care, and there are more than 250 accountable care communities active in the vast majority of states. More than 70 of these are led by physicians, nearly double the number only eight months prior. And while closely associated with the CMS Medicare Shared Savings program (rightfully so now that an additional 10,000 Americans are becoming Medicare-eligible every day), health plan, private payer and even employer models are keeping pace.


Tomorrow in Part II: How Medicaid Models, Patient Trends and Scope of Practice Move Accountable Care Beyond Medicare Shared Savings

 

Justin Barnes is co-chair of the national Accountable Care Community of Practice (ACCoP), chairman emeritus of the EHR Association and a vice president at Greenway Medical Technologies. He has appeared before White House and Congressional panels on matters of health information technology on more than a dozen occasions since 2005, and has advised current and former presidential administrations on industry policy.

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