Accountable Care Organizations and Health Information Exchange

No surprise here.  Accountable Care Organizations are going to require massive amounts of data sharing between the hospital, it's medical staff either as a whole or by  specialty.

Electronic health records and health information exchanges are an early beginning to having meaningful data, although the true nature and scope of HIE is limited by the fields that are interoperable and visible to users. Many health information exchanges only allow sharing of limited data....ie diagnosis, medications, and perhaps a discharge summary.  That in itself would be a helpful and very useful study.

Accountable Care Organizations will be searching for information systems to accomodate the needs of an ACO.

Hospital EMR & EHR reports

With accountable care becoming the standard for providers, more and more are seeking out best-of-breed vendors that can fill in the gaps in their health IT lineup and meet expected ACO requirements. It seems that just having it EMR in place doesn’t do the trick by itself. 

Management of an ACO is an entirely new industry, one that is very immature and the availabliity of experienced ACO  CEOs is very limited.  I am not sure what 'best of breed vendors means in such an immature market, nor how to compare or rate vendors.  This sounds much like a repeat of EHR software or Health Information Exchange offerings.

KLAS, a large consulting firm describes its mission, helping healthcare providers make informed technology decisions by reporting accurate, honest, and impartial vendor performance data.  The Best in KLAS Awards for Medical Equipment report is published June 15 and the Best in KLAS Awards for Software and Professional Services report is published December 15. 

 KLAS spoke with 73 organizations – mostly medium- to large-sized IDNs and hospitals –  to gauge where they are in their migration from volume to value and accountable care. The goal is to eliminate reimbursing for procedures to eliminate or minimize the 'do more' to gain  income mindset that has been embedded in the economics of medical reimbursement.

That's the conclusion from the newest KLAS report, "Accountable Care Timing 2013: Migration from Volume to Value Speeds Up," which shows that more than 65 percent of providers interviewed are looking to niche vendors to address the critical areas of population health, health information exchange and business intelligence.

We’ve known all along that the ACO game was going to be an expensive one. If KLAS is right, it’s going to be a whole new independent marketplace, in which providers shop for calls that fill in huge gaps in their existing ACO toolkit. If I were CIO, however, I’d be pretty annoyed that the huge investment made situation made in an EMR can’t get the job done all by itself.

Now the question is which health IT areas hospitals and medical practices will take on first; after all, there’s lots of ways to attack the question of how to prepare for the new, bold ACO world. My guess is that tools supporting population health measures will be particularly popular, as population health management is a key capability ACOs bring to the table that health systems alone may not.

The end game is complex, how to extract the data for analysis and merge it with population health measures, comparing expense with outcomes and maximizing better outcomes while holding expense flat, or decreasing it.

Some early ACO organizations are claiming some success in managing this goal, and it would be useful to survey what vendors and/or software combinations they use. Is it done in real time, or does it require separate data entry? 

The other big question is much like the analysis of ROI for EHR and HIX.  If the ACO will require new software, it will certainly be very expensive and no one can tell for certain what the ROI will be.

Several hospitals and INDs have lost considerable sums adopting well known EHR systems such as EPIC and/or Cerner. The failure of a central software infrastructure would be a fatal blow to a young ACO.  One that would rival the near catastrophic rollout of the national health benefit exchange in October 2013.

"This is a major shift from what we are seeing in most healthcare IT areas," said report author Mark Allphin. "What we are seeing in many areas is a migration toward integration. The fact that providers tell us that they will be looking to niche vendors over their EMRs tells us that the ACO market very likely is still up for grabs.”

So, this post raises more questions rather than answers. , 

Those early IDNs and early Pioneer ACOs may be ahead in discovering the answers to our questions.

Becker's Hospital Review lists 100 early ACOs, and CMS listed  32 initially, now down to 20 due to ACO dropouts.

Much of this information is open to question, a term which I call  "Truthiness'. CMS is claiming how successful their model is working.

According to CMS Nine of the 32 Pioneer ACOs are leaving the program, but the majority will continue. It is not surprising that some health care systems would re-evaluate their participation and choose to move on. The program does not guarantee that it will be the right fit for every health system. That’s the nature of innovation. And no model may be right for every population in every community.  It is important, however, to examine these departures for the lessons they offer.

Further commentary from CMS:

"We remain optimistic. ACOs represent one innovative model with the potential to improve care coordination, ideally leading to improved quality and lower costs. Testing of that model should continue, and we are pleased that the Medicare ACO program has given a boost to the development of ACOs, which are now proliferating among private health plans and provider groups"

Is this the message of idealogues, who will forge forward no matter the variability of success or failure.

We have seen the early missteps of Health Benefit Exchanges and there should be no reason to trust  CMS plans and/or statements.

Digital Health Space will be watching this niche carefully.

Networked Intelligence in Health and Medicine fueled by Social Media

Attribution given to Bryan Vartabedian, MD

How does a hospital or provider move into the digital space ? And what part of the space should you participate ?

Are you a part of it, and do you want to be a part of it? Is this a necessity, or just a fad ?

Do you have an overall marketing plan, or separate department for marketing?

You will need to assess your reasons for HIT and social media.  Electronic Health Records, Health Information Exchanges, mHealth, social media, all serve different needs, some elective and some necessary.

An important component is time and money, neither of which are an infinite resource. Given the current massive health reform that is being legislated practice resources must be aligned with regulatory mandates.

Reality plays a big role.  Many social media users do it for pure enjoyment as a break from conventional routines of their day.  Some do it for making new contacts, social or medical, based on current interests.  Others look for new vistas, hobbies, and activities one would never entertain,unless in the process of social media it happens spontaneously.  Some social media hobbyists transition into a vocation in marketing, education, or entertainment.

Your regional  social media politically correct standards may play a role in your decision making. Social media is just that…….voluntary.  Let’s compare social events such as medical staff meetings, part business, part pleasure, and a source of much information and communication.  If you think about your daily activities, meetings, learning experiences, creative thinking can create reasons for using social media.

You may want to expand your visibility either locally, regionally, nationally, or internationally.

There are choices:

1. Do it yourself.  This requires significant time and effort as well as a learning curve to

do it efficiently. There are many who are willing and able to teach you, some for free, and

others who charge a fee.  One example is the Social Media Residency offered by Lee

Aase and the Mayo Clinic.

2.Hire someone or a professional digital marketer to do it for you. Since you are in

the business of medicine, highly skilled and have a relatively high ability to generate

income. Why bother yourself with these tasks.

There are innumerable online companies offering software products to encompass

a marketing plan.

3. Like Real Estate the main concern is ‘location, location, location. So too is social

media.  Your choices and perhaps limitations will depend on where you practice ?

Factors such as the form of your medical practice, solo,group, specialty, or academic

will more than influence your options. Listen to this story from “33 Charts”, a well known

blog.

DECEMBER 14, 2013Albert Flexner, M.D. (courtesy, National Library of Medicine)

Last year was part of a small group charged with building a social media toolkit for medical schools.  An early conference call participant made it clear that if the project didn’t meet certain criteria for academic advancement, he’d be unable to participate.  It was the last time we heard from him.  Unfortunate but predictable.

There is a movement to qualify and/or quantify social media publishing by clinicians and scientists. In an article published on iMedicalApps, one pharmacist had this to say about this prospect,

“The movement to start evaluating blogging and tweets on par with academic publications”

by Timothy Aungst, PharmD

What counts is what brings value

New forms of knowledge creation and how they fit into a dated system of promotion is a growing preoccupation for many physicians.  And the question of what should ‘count’ toward academic advancement is one that’s received attention lately.  Some have approached advancement committees to have their blogs recognized as evidence of scholarship.  I haven’t decided whether these attempts are noble or laughable.

What counts is what brings value.  And what brings value in medicine are cameos in peer-reviewed publications.  This makes sense.  Because in the era of analog medicine, this was the only means by which physicians communicated ideas and findings.  Appearance in this 17th century tool of idea transmission has defined leadership through most of medical history.

Embedded habits are slowly eroded, as better solutions appear.

The age of networked intelligence will spawn a new kind of leader

But things have changed and doctors have new ways to share ideas and change minds.  Now every doctor, independent of institutional affiliation, tenure, pedigree or lineage is empowered with the capacity to grow, share and develop ideas.

And so the age of networked intelligence will spawn a new type of leader.  Expect to see regular doctors emerge as influential not based on lists of publications but on the strength and novelty of their ideas.  Leadership will be determined in part by the capacity to leverage new tools to build, communicate and influence.

But don’t expect them to be promoted.  For now.

Think much, publish little

Despite how we connect and communicate, peer-reviewed research will remain an important element in the advancement of medicine.  But it represents only one way to lead.  For those early in their career, there are some things you can do.

Perhaps we should think more before we publish our blogs, tweet or build facebook and/or google pages.  (or at least make our posts less often, and shorter.

Thanks to Dr. Vartabedian for his insights.

The ObamaCare Paper Pile-Up

The Obamacare Paper Pileup




When HealthCare.gov and some state-run insurance marketplaces ran into trouble with their Web sites in October and November, they urged consumers to submit paper applications.


Now, ProPublica's Charles Ornstein reports , it's time to process all that paper. And with the deadline to enroll in health plans less than two weeks away, there's growing concern that some of these applications won't be processed in time.

Some key points compiled from reporting around the nation:
After a conference call earlier this week with federal health officials, Illinois health officials sent a memo Thursday to their roughly 1,600 navigators saying there is no way to complete enrollment through a paper application.



Covered California in recent days disclosed that it had a backlog of 25,000 paper applications that had to be processed before the Dec. 23 deadline to sign up for coverage that begins Jan. 1.
In Oregon, a state official disclosed this week that more than 30,000 people who submitted health insurance applications still don't have enrollmentpackets

In Maryland, another state whose exchange has been plagued by difficulties, 8,500 paper applications were pending as of last week.

In Vermont, there is a backlog of 1,210 applications, some dating back to as early as Oct. 30.
It does not look good for a smooth transition to a January 1 startup date.  Even for those who have enrolled there have been no reports as to who has received premium billings. That is the bottom line......no $$ no insurance. Perhaps our government should automatically pay the premiums for the first 90 days to make up for their negligence, and not really giving a damn if this works.

The full story is available here: http://www.propublica.org/article/the-obamacare-paper-pileup

- See more at: http://digitalhealthspace.blogspot.com/#.dpuf

HealthCare.gov

The Obamacare Paper Pileup

When HealthCare.gov and some state-run insurance marketplaces ran into trouble with their Web sites in October and November, they urged consumers to submit paper applications.



Now, ProPublica's Charles Ornstein reports , it's time to process all that paper. And with the deadline to enroll in health plans less than two weeks away, there's growing concern that some of these applications won't be processed in time.

Some key points compiled from reporting around the nation:

• After a conference call earlier this week with federal health officials, Illinois health officials sent a memo Thursday to their roughly 1,600 navigators saying there is no way to complete enrollment through a paper application.
• Covered California in recent days disclosed that it had a backlog of 25,000 paper applications that had to be processed before the Dec. 23 deadline to sign up for coverage that begins Jan. 1.
• In Oregon, a state official disclosed this week that more than 30,000 people who submitted health insurance applications still don't have enrollmentpackets
• 
  
• In Maryland, another state whose exchange has been plagued by difficulties, 8,500 paper applications were pending as of last week.
• In Vermont, there is a backlog of 1,210 applications, some dating back to as early as Oct. 30.

It does not look good for a smooth transition to a January 1 startup date.  Even for those who have enrolled there have been no reports as to who has received premium billings. That is the bottom line......no $$ no insurance. Perhaps our government should automatically pay the premiums for the first 90 days to make up for their negligence, and not really giving a damn if this works.

The full story is available here: http://www.propublica.org/article/the-obamacare-paper-pileup

Project Moonshot-----Dell launches mini-servers

Project Moonshot, Dell's innovative approach to the cloud and servers is coming to healthcare. Many providers utilize cloud services for electronic medical records to avoid hardware expense, and maintenance of software.  Other than real security issues it allows HIT and EMRs to be affordable.

However the large data centers use considerable energy for running the servers and cooling.  They are often located in areas where energy costs are low, such as near hydroelectric generating facilities.

Moore's law of computer processing power doubling every year is no longer a limitng or consideration in designing new systems.



What is HPs new server? Basically, it’s a server, a very small server that consumes very little energy.  Smaller than a typical hardcover book, it consumes 89 percent less energy to operate, and takes up 94 percent less space than a typical server. And, when packed into a large rack with many more servers like it, the amount of computing power that can be harnessed in one relatively small place is pretty impressive.  The idea is pretty straightforward: Cram 2,800 servers into a single rack that would today house a few dozen, or at most 128, blade servers. 

Moonshot m300 server cartridge based on Intel Avoton Atom chips 

ARM processors are found in tablet pcs, cell phones. They draw less power and generate less heat than conventional x86 processors.  attribution for some content is given to:

About Daniel RobinsonDaniel Robinson is technology editor at V3, and has been working as a technology journalist for over two decades. Dan has served on a number of publications including PC Direct and enterprise news publication IT Week. Areas of coverage include desktops, laptops, smartphones, enterprise mobility, storage, networks, servers, microprocessors, virtualisation and cloud computing.

The Secret Life of a QUANT

Whatsa  "Quant" ?

It sounds like a new previously undiscovered subatomic particle somewhere between a quark, a string, a lepton,a boson,a prion,mesons and baryons.

Well, a quant is none of that. While those fundamental particles are essential to matter and energy and some are theoretical, the "Quant" is a far more threatening player in health care and the financial world. On one hand quants offer great hope for some, and for others they are a barrier to obtaining health care.


Quants are the math wizards and computer programmers in the engine room of our global financial system who designed the financial products that almost crashed Wall st.

The Quants arrived quietly some time ago in  health care. The similarities between the crash of the global financial system and current health care systems is frightening.

Quants are sometimes known as "Algos".

Barbara Duck, who writes at The Medical Quack:

     Attack of the Killer Algorithms – “Algo Duping 101″

     In health care this is well underway with the Affordable Care Act,
     Accountable Care Organizations, Outcome Studies, Preferred Practice Pattern;  all have been developed by "Quants".

Here’s a selection of videos that offer a lot of information, which I call “Algo Duping”. Barbara Duck has written several posts on the Medical Quack about this topic and here’s a group of MUST SEE videos if you want to understand what is happening in the world. The general public does not like math, is afraid of it, etc. but banks and corporations are not and they use it against us.

First off let’s hear from Charlie Siefe, Who Wrote the Book, “Proofiness, The Dark Arts of Mathematical Deception.


 Physicians, too are afraid of the math, although trained in scientific methodology. One cannot defend against something one does not know about. For most, statistical probability and algorithms fall into that category.

Health insurers have been big on algos, that is how they separated the sick,(read expensive) and infirm from the healthy (read inexpensive) beneficiaries.

How will they work around the Affordable Care Act ?  When there is challenge their is opportunity (to make a profit). The  Affordable Care Act's initial thrust is to eliminate pre-existing conditions as a reason for non insurability.  This flies in the face of previous algo's.

The first law of algo's is: "If the first algo fails, another algo will appear"

The second algo will disavow the original algo as "obsolete and not suited to the changes in health finance".

Jobs in quants are fluorishing in health care with enterprises attempting to game the system.

There is a continuing tension between quants and quals (those who emphasize quality, regardless of cost ).

As in the financial world risk is a key metric for a health algorithm. Population health is a field in which quants are essential.



Is this occurring in health reform? This is a documentary called “Quants, the Alchemists of Wall Street” and they make the math and formulas that move money. Banks and companies use these all the time and the one interview tells you that yes they are smart and talks about their attitudes as they literally have the CEOs by the balls, as they don’t understand their own business models that they pay royally for the Quants to write. In this video you see the software designer who created the software for the big mortgage scam. It’s not his fault but rather how it was used and abused. He makes one very good quote at the end, “You Can Do Anything With Software”

There is a saying amongst quants (read statisticians) “You Can Do Anything With Software” and also points out the software models and the real world do clash

Challenges of Interoperability in Healthcare

Although regional  health information exchanges were promoted and funded early in 2004-2006 by then appointed David Brailer MD and the Office of the National Coordinator for Information (by George Bush), progress has been slow due to a number of factors.


At the recent 2013 AHIMA meeting, interoperability was a topic discussed by Steve Bonney, VP of Business Development and Strategy at BayScribe.

 In this video interview. Steve discusses the challenges of getting structured data in healthcare and how you can use good technology to get the healthcare data without disrupting the physician workflow. Steve also discusses some of the benefits of having interoperable data in healthcare. Then,we ask him if Meaningful Use is going to make structured, interoperable data a reality.

Despite the increased acceptance of EHR many providers, and hospitals are reticent to 'buy in' to connectivity based upon costs and an unknown ROI. On the other hand there are many large outstanding and credible health institutions that have built networks between their hospitals and providers.

Perhaps the addition of the Affordable Care Act, it's mandates and looming deadlines have diverted manpower and financial  resources from health information exchanges, making it a lower priority with unknown results financially from the Affordable Care Act. Providers and hospitals are clearly challenged with developing Accountable Care Organizations, EHRs, Health Information Exchanges, and the possible change in reimbursement paradigm.

On the one hand health information exchanges could reduce costs, however achieving both ends....interoperable EHRs and the Affordable Care Act may take longer to achieve than originally antcipated.

Nevertheless the sum of the parts should be greater than the whole, and the transformation cannot be complete without each paradigm suceeding. Each part has it's proponents.

In my next blog posting, we'll discuss 'BIG DATA' and analytics...the promises and disappointments to come.