December 28, 2013

Healthcare Technology Transformation Over Disruption In the ACO PCMH Models by Jim Bloedau

With 47 million new users to be added, the US health system just had a big new bureaucracy placed on top of it and that costs money.  A couple of things are clear:
  • Above all else, cost pressures will rule – the amount of money available for healthcare will be spread much thinner.
  • For those people who will experience higher co-pays under the ACA than what they are used to, this will make the patient think twice about whether a certain procedure is really needed.
With margins continuing to be squeezed because of this continued thinning of reimbursement and utilization, and the need to cover more ground with fewer steps and less cost, what products will create the best market demand in 2014?  

Firstly, you can’t have innovation before the infrastructure is ready to support it.  Products that address workflows that are already happening but take steps out of the process are tops on my list.  As an example, consider why healthcare is the only industry that strongly supports pagers anymore – it’s a convoluted way of getting things done.  Eliminating pagers with a more open form of communication that let’s providers see the conversation that is taking place about a patient’s care by the staff will save steps.  If we can do this in a way that securely crosses the provider to consumer continuum, firewall and such then we’ve sped things along by eliminating some steps. 

Secondly, products that push responsibilities for care upstream also take steps out of the process.  We’ve seen a lot of consumer healthcare products with emphasis on tracking, early detection as well as preventive life-styles education over the last couple of years - most have not gained sufficient traction despite elegant and clearly beneficial outcomes.  Just as we saw the abolition of stenographers who would type letters for “Mad Men” era executives by putting word processors on every desktop, we’ll see more of this in healthcare.  Physicians will delegate more to their assistants, nurses and yet to be defined technicians so all can work where there’s more money - at the top of their license. This will cascade down to where today’s patient will be tomorrow’s PCP (Primary Care Person) and products that compress this process by providing the infrastructure to eliminate steps will be the winners.  Home, mobile, remote care and triage products that help the patient decide when to seek medical help and from who will again be the winners.

These are transformative innovations rather than disruptive and have always had a high degree of success.  If new technology does not have an economic benefit as well as patient, physician, staff or procedural benefit it will have a very strong barrier to entry let alone get past value analysis committees. Those who are trying to introduce a completely new method will face uphill battles.

November 1, 2013

$8.3 Billion Lost by Healthcare From Poor Communication

In the early days of modern manufacturing, value was only added to a product about 5 percent of the time.  The rest of the time it was sitting on the production line waiting for the next step to add value – a large portion of this waste came from information not being readily available.

If we look at the process a patient goes through when receiving care at a medical center we will find similarities. A 2013 Ponemon Institute survey of 577 U.S. health care professionals found clinicians wasting an average of 46 minutes per day waiting for patient information. The primary reasons included no Wi-Fi access, bans on use of personally owned devices and reliance on email and inefficient pagers.  That adds up to $5.1 billion annually across the health care industry or a productivity loss of $900,000 per year for the typical hospital. Additionally, the study found that hospitals waste $3.2 billion by continuing to rely on these older communications systems as part of the patient discharge process – about a third of the average discharge time of 102 minutes is due to waiting for hospital staff to respond with information necessary for the patient's release.   Overall this is costing U.S. hospitals an estimated $8.3 billion annually in lost productivity and increased patient discharge times.  

This struggle to get the right information at the right time is endemic in every industry.  For healthcare, CHIN’s in the 90s and RHIOs in the 2000s proved that pulling information together from various trading partners is beyond difficult.  HIEs are today’s permutation and they still suffer from scaling one technological and cooperative summit only to find that their efforts offered a better view of the genetically persistent problem – a sustainable business model.
More recently we see video, voice and data systems in the form of telehealth, mHealth, healthcare grade SMS and email, and remote care applications and devices showing good productivity returns from early demonstrations fermented by ACA.  In this environment, all are eager for successful business models that support data exchange efforts beyond enabling legislation and grants. When payers, patients and caregivers have collaborated and shared the cost savings from technology that produces greater throughput, less waste and most appropriate care, great changes have occurred in market perceptions and profitability - the Veterans Administration, Kaiser, Group Health Cooperatives and other provider entities have all done so without any government grants.

I think we are all comfortable with approaching summits of concern for privacy, security and patient consent – we’ve scaled them many times in the past. Yet, much of the discussion centers on trying to sell improved communications like they were selling the information super highway of old - difficult to do when the average provider community only sees, wants or can afford a cow path. 

The old models of the past are very "enterprise" and still have a place.  The social construct of communication that today's healthcare worker use in the form of Facebook walls, SMS, Twitter and others do a better job of offering a process that actually mimics what happens in workflows and their lives - a conversation. 

June 10, 2013

2013 HIPAA Modifications Allows Unencrypted Email Use, by Jim Bloedau

The 2013 modification to the HIPAA rules allow for covered entities to send individuals unencrypted emails if they have advised the individual of the risk, and the individual still prefers the unencrypted email.  A search of the language in the updated regulations did not produce any mention of texting, SMS, remote monitoring, telehealth or use of video . 

The upside is that the feds did allow some free choice by including the patient in the decision to use plain old unencrypted email if they so choose.  The downside is that the regulations stopped short of extending that right to choose to any of other popular and rapidly becoming commonplace ways of communicating and extending care to a remote patient.  
We know that it is a short jump to include forms of texting, SMS, remote monitoring or use of video in the administration of care and that it is being done by a few providers who are willing to take the security risk.  As once said, the best form of care is communication.  Does the approval of unencrypted email in the guidelines open the door to increasing the number of providers and patients willing to communicate with email?  How will it effect patient engagement? 

Here’s the verbiage from the regulations or you can go to the link above and search the document using the tools in your browser.

“Comment: Several commenters specifically commented on the option to provide electronic protected health information via unencrypted email. Covered entities requested clarification that they are permitted to send individuals unencrypted emails if they have advised the individual of the risk, and the individual still prefers the unencrypted email. Some felt that the “duty to warn” individuals of risks associated with unencrypted email would be unduly burdensome on covered entities. Covered entities also requested clarification that they would not be responsible for breach notification in the event that unauthorized access of protected health information occurred as a result of sending an unencrypted email based on an individual's request. Finally, one commenter emphasized the importance that individuals are allowed to decide if they want to receive unencrypted emails.

Response: We clarify that covered entities are permitted to send individuals unencrypted emails if they have advised the individual of the risk, and the individual still prefers the unencrypted email. We disagree that the “duty to warn” individuals of risks associated with unencrypted email would be unduly burdensome on covered entities and believe this is a necessary step in protecting the protected health information. We do not expect covered entities to educate individuals about encryption technology and the information security. Rather, we merely expect the covered entity to notify the individual that there may be some level of risk that the information in the email could be read by a third party. If individuals are notified of the risks and still prefer unencrypted email, the individual has the right to receive protected health information in that way, and covered entities are not responsible for unauthorized access of protected health information while in transmission to the individual based on the individual's request. Further, covered entities are not responsible for safeguarding information once delivered to the individual.”

May 16, 2013

The Mobile Experiment, Experience Trumps Youthful Enthusiasm? by Jim Bloedau

In two studies cited by our friends over at MobiHealthNews, Jonah Comstock shines up the ongoing dilemma of mobile technology finding the right fit with physicians.  Two of the studies he presents points out the importance of managing expectations for what tech can do for you and how it will fit your professional life. The 50% crash of youthful enthusiasm for iPads by medical residents at the University of Chicago laid up against the practical side of practicing medicine in the real world in the Deloitte study suggests a couple of things.  First that the adoption of mobile tech is tempered by the experience of running a medical practice, there’s a much more deliberate consensus reached about the value each innovation brings.  Also, the practice of medicine becomes very stylized when left to find it’s own way.  How tech is adopted depends on motivations and more importantly the practicalities of the value created by it. Finally, both studies below reminded me of the collegiality of medicine, to give it the ‘old college try” and to always ask, “Is this the best way to do things?”  Both of these studies could be perceived as disheartening, but under the surface they hold great promise. 

Physician adoption of health information technology: Implications for medical practice leaders and business partners is a Deloitte survey of 613 physicians that found 43 percent of doctors use smartphones or tablets for clinical purposes, which the firm suggested included EHR access, e-prescribing, and physician-to-physician communication. Of the 57 percent of physicians that do not use their mobile devices for clinical purposes, 44 percent said that their work doesn’t provide mobile devices and they’re unwilling to use their own, 29 percent were concerned about patient privacy, and 26 percent said the apps and programs available weren’t suited to their needs. However, 22 percent of the non-users indicated a plan to use mobile health technology in the future.”

 “In another study, a JMIR study of 115 medical residents at the University of Chicago published this month compared the “hype” of iPads (the expected use prior to the roll out) with their actual use. Before the roll out, 34 percent of residents strongly agreed that the iPad would benefit patient care and 41 percent strongly agreed that it would increase ward efficiency. Four months later, 15 percent strongly agreed it had benefitted patient care and 24 percent felt it had increased efficiency. Still, overall satisfaction with the iPads was high, with 84 percent of residents believing the iPad was a good investment for the residency program.”

April 25, 2013

ACO, PCMH and All Healthcare Needs Simplification by Jim Bloedau

What can we expect when introducing digital technology to patients?  Rhonda Daniel, Sr. Manager of Market Research at CEA, summarizes their just released research on how consumers are using their smartphones and other digital devices.  Two things stand out:
  • That people rapidly get rid of their single use devices if they can aggregate the same functionality on to their smartphones.
  • That their initial usage tracks what their pre-purchase expectation were.
If you have already been part of the connected life style for a while and have developed comfort with the digital functionality you use daily being made mobile and on one device, then nothing new here. Now add an integrated glucometer, if you're diabetic, or blue tooth enabled scale, if you're obese or managing congestive heart failure, or a GPS tracking app to see how far you walk as you try to get healthier after a hip replacement or long hospitalization.  What we are doing is adding not only great functionality but elevated complexity to an already complex path to engaging in our health - is this any way to treat a customer? Accessing an analogue healthcare system, like a doctor's appointment, and then laying new and not so easy to use technology on top of it isn't simplifying healthcare for those who use it the most.  My call here is that we need to simplify the analogue side as we add complexity to the digital side. 

The early results from the Direct Primary Care (DPC) model where patient's pay a low monthly fee directly to a doctor and bypass the added complexity of payer involvement is suggesting this may be the right path to be explored.  Lower utilization and higher satisfaction with equal or better outcomes for both the doctor and patient is what's in the literature.  The Kaiser model also streamlines healthcare because it reduces the dual agenda independent payer/provider model to one agenda...and it works too.