Navigating Healthcare – Patient Safety and Personal Healthcare Management

Patient Centered Systems

What will it take to move our healthcare system to a truly patient-centered system? We know based on multiple data points that engaged patients have a big impact on the successful outcome of treatment. Leonard Kish cited the phrase back in 2012

Patient Engagement is the Blockbuster Drug of the Century

Referencing a 2009 Kaiser study of coordinated cardiac care and comparing to those not enrolled in the study

“patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program.”

“clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent.”

And this study in Telemedicine and e-Health. Dec 2008; Vol.14 (10): 1118-1126 that showed impressive results for chronic disease management:

  • 19.74% reduction in hospital admissions
  • 25.31% reduction in bed days of care
  • 86% patient satisfaction
  • $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
  • 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression

 

Patient Data Ownership

I believe as do many others that the patient is at the center of everything we do and deliver in healthcare. By placing the patient and their information at the center of care and allowing them access and control we empower them and enable a model that moves away from the historical paternalistic delivery of healthcare to patient-centered and enabled care. It does come with challenges since many people contribute to that care and the current administrative and financial configuration focus the management and ownership of data with providers, healthcare systems and payors. While many patients want access to their data and some even want to own and manage it, many do not and are ill equipped to be responsible for this data. Perhaps what we need are some independent services and providers who aggregate, manage, secure and maintain patient data on behalf of patients – much as banks do with our money. There was some hope when Google and Microsoft jumped into healthcare offering Google Health and Microsoft Health Vault respectively. Microsoft’s version continues to this day – google withdrew theirs and Sergey Brin was widely quoted when he said

“Generally, health is just so heavily regulated. It’s just a painful business to be in, I think the regulatory burden in the US is so high that think it would dissuade a lot of entrepreneurs.”

But while complex, not insurmountable and as he rightly points out

“I am really excited about the possibility of data also, to improve health”

I am too and while there remain many challenges associated with securing and sharing that data the “entrance” of these alternative participants into the healthcare space – some perhaps looking at this from a simple employee perspective, is an opportunity for new ideas, insights, and people applying the collective brain power to one of our most pressing problems. I continue to hear from colleagues and friends of companies that are exploring and looking at healthcare. UPS highlighted their healthcare focus and the potential for 3-D printing in a recent tweet:

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And I heard from a friend that Dyson even has a healthcare “focus”.

Protecting Patients

There are some major concerns as these data-focused companies offer access but do so with agreements that contain so much legalese as to be unintelligible and opaque to the consumer who may well be giving up much more than his own personal data but potentially giving up his future health. The GINA act offers some protection to individuals who in sharing personal genomic data that tag them with a “pre-existing’ condition could have found themselves unable to access care. But the act did not go far enough failing to address the issue of other insurance and employers who can use this data to deny access or coverage and perhaps even employment?

We need the combined power of this patient data to create the insights into diseases but not at that personal expense. There are many technologies on the horizon that offer a potential path to help achieve this and blockchain represents an interesting innovation of decentralized secured data that offers individualized control and dynamic revocation options for access. If you are interested in learning more about Blockchain this article in HealthcareIt News is a good primer for its potential in Healthcare: How does blockchain actually work for healthcare?. It is not a panacea and the fundamental rights and ownership still need to be addressed without giving away the farm to corporations and businesses.

Interoperability

The existing healthcare system incentivizes behavior that is in opposition to a scalable nationwide vendor neutral interoperable patient-centered data. Our model has multiple groups who have a vested interest in the control and ownership of data (for example Payers, Providers, Patients and even employers). Each has their own economic and commercial drivers and in many instances, these do not coincide with open sharing of data. In a system that is driven by activity and delivering care (Fee for Service) sharing data could mean a reduction in work and income. Until our reimbursement system moves to a more holistic care model that focuses on wellness and outcomes and incentivizes behavior that delivers better health and outcomes for patients through cooperative and coordinated care and ultimately equitably rewards all the contributors to these outcomes we will remain stuck in the quagmire of limited interoperability.

The key to a patient-centered interconnected care model is the free flow of data between all the areas responsible for delivering care. We moved away from the single index card medical record held by your personal physician who was the focal point of care and care coordination to a distributed team-based model of care that encompasses multiple areas and people. In some instances, thatcher coordination may be carried out, at least in part by the patient or their family members, and they need to be included and ultimately in control of the data and its flow. The only way this team can deliver excellent care is through the frictionless flow of enhanced data and knowledge. This information flow must include the patient and all their family members that are authorized, interested and engaged in their care. Data should be shared with the patient’s consent with everyone concerned and available for as long as it is needed to deliver care but this access should be flexible enough to allow it to be revoked or removed when it is no longer needed or necessary

Welcome to the Fray

I am a big fan of learning from other industries and perspectives and spoke about this at HIMSS Conference in Orlando

The Best Exotic Marigold Hotel and I am excited to see the rush of companies and people into the healthcare space but for those stepping in and thinking about data and the ownership and control of this data, I would suggest this requires a new way of thinking. Much like security – patient access and control needs to be baked in from the start. Taking ownership and rights away from patients will stall progress and anger your constituents and community. As ePatient Dave would say or better yet sing:

Give me My Damn Data

Here’s hoping that these new players see the value of the engaged patient and include some of these principles in their march towards our common goal of better more cost effective healthcare. For the large organizations thinking about the data, remember you and your family members are patients too. The following thoughts are offered as some basic guiding principles on data stewardship:

  • Patients want control of their own data,
  • Patients want to be able to share safely and securely share their data with all their care providers and participants (this will include family members and friends)
  • Patients want granular control of some elements of the data limiting individual access to certain elements and areas
  • Patients requires a full audit capability tracking who has access and has accessed their data
  • Patients want to be able to easily and dynamically revoke access
  • Patients will share their data for research and benefit of others but their contributions need to be recognized and accounted for
  • Data cannot be used against Patients to deny coverage or increase their costs

 

What have I missed – what controls or limits would you place on your data that would make you more willing to share your data. What would stop you from sharing your data and why?

 

 

Patient Centered Systems was originally published on Dr Nick – The Incrementalist

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Achieving Effective Population Health

Posted in Analytics, bigdata, Disruptive, Healthcare Technology, Interoperability by drnic on March 10, 2016

value-based-payments - nvt

The move to value-based payments will be the most significant trend of 2016, because it will force both caregivers and health plans to radically change the way they think and act. Population health, which emphasizes identifying risk and gaps in care, and filling those gaps, will be an existential capability for hospitals, physicians and health plans. If they get it right, they will prosper. If not, they will struggle at best or worse, wither and fail.

Effective population healthcare requires both a change in thinking and adoption of new technology for success. Organizations that have focused on episodic care and procedures to pay the bills will be the most challenged, because a completely new mindset will be needed.

If you are a surgeon who has been highly valued by a hospital because you bring in lucrative procedures, your life will change radically over the next couple of years.

  • Hospitals will be looking to physicians who can reduce costs and avoid the need for expensive interventions to help them succeed.
  • The surgeons (and other procedure-based specialties) will still be needed, of course, but they won’t have the rarified status in the future that they enjoy today.

Those who can find innovative ways to help patients improve their health status without a hospital stay or other expensive interventions will be the most successful in this new world.

Hospitals and physicians will also need to add technological capabilities to succeed. They will need to integrate data, analyze that data and use telehealth and remote monitoring to provide more effective use of resources and delivery of care. For many organizations, data integration probably seems overwhelming with too many applications speaking disparate languages.

The good news is that technology exists now which can create a nearly seamless interface among all these silos and allow data from a wide variety of sources to be used for population health, better treatments and more efficient operations.

Physicians will find a light at the end of the tunnel for those who hate their EHRs, as new vendors provide applications that make using an EHR simpler and more efficient. These vendors are creating applications that use the EHR and other clinical applications like a database, presenting patient data in a simpler, more clinically relevant user interface. This will mean that organizations can make their caregivers much more satisfied and efficient without having to ditch the huge investments they’ve made in clinical technology.

The next year will be a wild ride for many organizations, as they adapt to all these changes, but the work and effort should pay off in all kinds of important ways, liberating data for effective use in traditional clinical and patient care and unleashing innovation for its use and in new and unimagined ways.

This article originally appeared on the HIMSS16 Conference Blog here

 

Achieving Effective Population Health was originally published on Dr Nick van Terheyden, MD

Our Remote Future in Healthcare

Its an exciting time to be in healthcare and medicine – technology is bringing so much innovation and opportunity to improve the delivery, quality and reduce the cost of healthcare. Much remains to be done

At our our recent DellWorld conference we captured insights into this exciting future

As Dr. Jai Menon vice president and chief research officer for Dell Research Data said data may well be the oil of the 21st Century and in healthcare this is especially true as we see an explosion of insights and data into our health, clinical status, genome, biome and beyond

We finished sequencing the first human genome in 2003

and things have only accelerated from there with sequencing now taking less than 24 hours and costing less than $1,000

Just this one area is going to add huge amounts of data that needs to be turned into knowledge as I shared in this presentation to the Austin Healthcare Thinktank Roundtable

http://www.slideshare.net/nvt/slideshelf
But even before we get to that point there are so many opportunities emerging into our daily lives to improve the service and the healthcare delivery system. Telehealth or Telemedicine is a clear winner and the regulatory and reimbursement systems seem to be catching up (details in this presentation form Connected Health).

Integrating the data and providing intelligence and insights from the mass of data that is sweeping over healthcare will be important but as we gather more our understanding improves expect this area to accelerate with deeper more meaningful insights tied closely to the ability to integrate the data from multiple (and importantly non-traditional sources).

To get a sense of the opportunities and changes coming watch the video compilation form the conference below:

 

Its a great time to be in healthcare as we open new doors to knowledge with the data

Our Remote Future in Healthcare was originally published on DrNic1

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Personal Healthcare Management

This piece by Aaron Carroll detailing his personal experiences with the healthcare system for what should be an easy and simple activity represents the frustration and challenges everyone faces on a daily basis including myself

I have the exactly the same challenges with renewal of what is a long standing formulation

I know this is not good for anyone and as pointed out it is not good for personal health – in my case as my wife and family will attest it definitely raises my blood pressure as I spend countless hours on the phone fighting with systems.

Everyone’s story will be different and in my case I don’t love the drug company who have taken long standing medication mixed them in a standard way and patented this to make it extraordinarily expensive for a formulation that contains one over the counter medication (OTC) and one generic prescription medication. And because of the artificial limits placed on supplies (90 days supplies with a maximum 1 year) behavior is modified attempting to reduce unnecessary costs. Ultimately everyone is behaving in the way the system incents.

Imagine that experience in the store – CostCo refusing to allow you to buy your supplies in bulk limiting your purchase to 3 months supply of toilet paper

and having to keep going back to an external party to require approval for purchasing when CostCo offers a special deal to purchase 12 units that might cover you for a year. Costco want you to purchase more and if you have the space and storage and will use it you want to buy in volume because it saves you money and the manufacturer wants purchasing their product. Costco is focused on making the process and cost as efficient as possible.

Before the deluge of complaints that buying drugs is not the same as buying toilet paper – true but take many maintenance drugs with excellent efficacy and safety. Even if it does require regular blood tests forcing the workflow to link the two in an sequence that tortures everyone in the process makes no sense. Engaged patients want an efficient process, will follow sensible and safe treatment guidelines and don’t need to be squeezed into a sequential process that includes steps that are linked for clinical reasons but remain disconnected in real life and difficult and expensive to follow for everyone concerned

As the costs shift to the individual the frustrations rise with the process and the necessary costs and waste – expect a rising voice of complaints and frustrations that might hopefully start to effect change

Personal Healthcare Management was originally published on DrNic1

Burning Health IT Issues – Discussion with John Lynn

Posted in #hcsm, ACO, EHR, HealthIT, Interoperability, Meaningful Use by drnic on October 29, 2012

Video interview wiht John Lynne (@Techguy and @EHRandHIT) on topics ranging from EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs (originally posted here):