Dr. Hubert Zajicek, Co-Founder of Health Wildcatters talks about their mentorship-driven healthcare seed accelerator. Read More
Jonathan Govette of Referral MD shares his founders story of how he created his health startup focused on streamlining the medical referral process.
Biometric Patient ID Technology with M2SYS President, Michael Trader podcast interview and it’s ability to prevent duplicate MRNs, identify theft, and improve a hospital’s ROI
Health information exchange is not just about establishing a repository of static data that sits and waits for people to access it. Instead, clinicians and health IT experts are considering ways that turn data into actionable, meaningful information that can be used to create individualized patient treatment plans while fostering heightened awareness of the health of patient populations.
One way to ensure health information exchanges become these types of vibrant networks is to utilize and leverage search engine power. By harnessing the intuitive nature of algorithms like those of Google, Bing and Watson, health IT leaders have the opportunity to transform how clinicians investigate patient conditions, and determine diagnosis and treatments.
The use of electronic health records and mandates through the HITECH Act all support the increased sharing of patient information through HIEs. But what will it take to develop an environment in which information sharing thrives? Jonathan Gold, MD, regional chief medical informatics officer for Catholic Health Initiatives, discusses his vision for organizing information and developing physician workflow in this interview with SearchHealthIT.
What does information exchange mean to an organization with as much breadth as Catholic Health Initiatives? How do you organize information across settings, and is there time/room after that to consider how to exchange information outside the organization?
We made a strategic plan a number of years ago to set up a health information exchange. This plan will include all our health care facilities across CHI’s nineteen different states. Each state has different rules/regulation about what can be shared, and it adds a layer of complexity for exchanging medical information across the organization.
We are going live in January 2013 at our first pilot sites, and then will roll out the exchange to our remaining facilities. We have a centralized server for sharing information; that is, data from a clinic or hospital will be uploaded to our data repository which will be located in Denver. This will help speed up the process for accessing information at the point of care.
What role do search functions play within HIEs? Do you believe that someday HIEs will have their own search engines that work like Google?
Yes, absolutely. Our thinking about HIEs must go beyond viewing them as repositories of aggregated paper records. We need to focus on giving the clinician information at the point of care. In short order we will want to tap into that power of information and actually apply what has happened in a large group of patients to specific patients.
The secondary use of medical data will empower the clinician to receive decision support tailored to a patient’s particular medical characteristics. For example, a physician might query “How many people in this database have a specific set of similar qualities.” From there, he or she might be able to drill down to questions targeted at choices about treatment for that specific patient by asking things like, “Well what happened to similar patients when they took Drug A or Drug B?”
More customized care for patients is a major goal of clinical research. How do HIEs fit into that goal? Who should be able to obtain and use information through exchanges? What are the privacy and access issues that must be addressed to ensure information is used accurately?
A patient’s right to privacy remains crucial. Clinical information that is meaningful and helpful for other patients must not harm the privacy of the patients who have allowed access to their records in an effort to advance research and help others. If we can share statistics about groups of patients in the database with the providers similar to those examined or treated at the point of care, we can enable the doctor to make more rational decisions for their patients.
You’ve spent a lot of time helping to develop workflows, physician systems and EHR functionalities. As more new and amazing exchange and search tools are developed, how will physicians find time to use them?
Doctors and other medical staff work in three different modes when it comes to diagnosing patients and understanding their conditions. First, they might recognize a pattern in its entirety for very common illnesses in the context of very common situations. Second, providers might feel comfortable that a pattern looks familiar, but there seem to be enough odd pieces in the puzzle that they should investigate what is happening (through diagnostic tests) in order to validate their thoughts. Last, they might not recognize any clear pattern of signs and symptoms and think, “I don’t know what is going on with my patient and I need to approach this logically.”
For simple things (sore throats, etc.) doctors might do a culture and send the patient home with a prescription. Physicians will probably not need to do a deep investigative diagnostic dive — they’ve seen this pattern often. Often, though, the pattern is not so clear or the patient has multiple chronic diseases and is receiving many medications. The clinician will need to look at the literature or talk with his or her peers.
That is the type of a situation where I see us searching the data in the HIE. Physicians who want more information to help guide them with their more complicated patients or who have a diagnosis but want to know the best treatment for complicated patients taking into account their specific myriad of diagnoses and medications.
Dr. Gold is a board-certified pediatrician with 15 years hospital and ambulatory care experience. He serves as Regional Chief Medical Informatics Officer for Catholic Health Initiatives, the nation’s third-largest Catholic health care system. He co-leads CHI’s Health Information Exchange program, Clinical Portal and Patient Portal.
Previously Dr. Gold served as the physician development analyst for two major vendors, contributing subject matter expertise and assisting in medical application development, adding decision support and content to the electronic patient record and computerized physician order entry application, and meeting CCHIT requirements.
Interview/podcast with Carina Edwards, VP, Marketing at Nuance Healthcare where she discusses clinical documentation tech tools and it’s integration in clinical workflow including the following:
LISTEN BELOW OR CLICK HERE TO DOWNLOAD
HIT Consultant: Now given the announcement of the 1 year delay for ICD-10, have you seen any change in clients actually scaling down or have you seen people saying we are going to go full steam ahead and actually business pick up as a result of that delay?
Carina: That’s a great question. We’ve seen actually business as usual and business picking up. The nice thing for us, is the MD Assist solution that we’ve developed how it works very well with ICD-9. You still need to get that behavior change at the clinical documentation starting point with the physician. This now allows us to get the physician used to, in their common language, with their common ICD-9 backend and coding queries, get them used to being prompted and getting questioned at the point of documentation so then as we roll to ICD-10 and the complexity of what needs to be addressed increases given just the level of specificity changes required, it gives them a head start because they’re already used to the system. But we also know that some customers want to set up those environments so they can also start modeling out what the revenue implications for the hospital may be. So as they’re looking at their programs, they’re wondering where they can do ICD-10 pilots as a sub process so clearly not impacting their current revenue stream but just to get the analysis of what’s going to happen when they do shift to the standard and so now these tools can help them do both.
HIT Consultant: Now how important are all these tools? I’ve been reading a lot about clinical language understanding technology, clinical language indexing, HLI, IMO, all of these tools. How important do you think going forward utilizing all of these tools to get more specificity in documentation is going to be helpful in this industry?
Carina: You know, I think technology can always bring efficiency to a current process. I think the key though is how the technology is integrated into the current workflow. [pullquote] key though is how the technology is integrated into the current workflow.[/pullquote] So as these solutions are coming to market, we really support customers in looking at what is the existing clinical workflow today? What would have to change with the new technology implementation? How much change management would be required from a physician workflow perspective? And we found the least disruptive. If we can keep the physician focused on patient care, focused on documenting in their current workflow and not disrupt them too much, you’ll get stronger adoption of these solutions.[pullquote]If we can keep the physician focused on patient care, focused on documenting in their current workflow and not disrupt them too much, you’ll get stronger adoption of these solutions.[/pullquote] So I think there’s always a place for technology. Technology helps us in so many ways in our lives. Imagine the whole online banking example. Ten years ago, did we ever think we could scanning in, taking a picture of a check and that’s our deposit form? There’s so much things we can do to drive efficiency, but really at the end of the day it depends on the impact to clinical workflow to drive that adoption.
HIT Consultant: Right. So for potential clients that are going through and looking at different tools, what are some best practices when doing this type of selection of these tools. There are a lot of competing companies out there. In your opinion, what is some of the best practices for going through this process in selecting the right product for that particular organization?
Carina: I really think you have to understand where the technology’s deployed today, where it’s actually in clinical use. Really look for those reference sites and get the feedback from others like you. I think that’s critical. As we see new technologies introduced, there is an adoption period for new technologies. I think when you look at the foundation of that company’s ability to integrate into workflow, make it seamless. So really the proven nature of the product is going to be critical for customers. We always help facilitate, best practice for us, is to facilitate others like this and customer reference site calls and visits and really talking to other department heads and other quality and clinical and CIO counterparts in the industry just to say how this has worked in the past, how it will impact change and how it’s going to be adopted by physicians.
HIT Consultant: Any final thoughts or closing comments?
Carina: The closing comment I would leave everybody that’s listening to this podcast with is it goes back to for HIT consultants in general, we’re driving towards adoption of new technology and really understanding an architecting plan that both take into account the clinical workflow, the requirements of all the different regulatory needs, and then the tools and technology that can help support that transition and make it the easiest and simplest as possible. I really think they have to look at holistic solutions, deep partnerships, and RND integration efforts with these electronic health record vendors. It’s going to be critical because it’s with that interactivity and that connectedness that you’re going to get the most seamless experience for the physician practices.[pullquote] It’s going to be critical because it’s with that interactivity and that connectedness that you’re going to get the most seamless experience for the physician practices.[/pullquote] We’re excited about the market opportunity for Nuance. We see through our relationship with the EHR vendors and the deep RND relationships that we have, a lot of momentum into cloud, into mobile, that ability to truly capture that patient’s story anywhere and know with clinical language understanding, understand what is captured and use that information across the healthcare enterprise for reimbursement, for Meaningful Use reporting, for quality reporting. It’s a fun time and Nuance is excited to be in this space and great to be at this intersection of all that’s coming together.
HIT Consultant: Thank you.
About Carina Edwards:
Carina is responsible for Nuance Healthcare’s marketing strategy and has direct line of authority for managing the solutions marketing efforts of the individual lines of business including HIM, Diagnostics and Dragon Medical. Prior to joining the company in January of 2011, Carina was the Vice President of Marketing and Product Management at Zynx Health. In this role, Carina transformed the marketing and product management capabilities for the Corporation, as well as redesigned the infrastructure, organization, and governance to achieve the organizations aggressive growth goals. Prior to Zynx Health, Carina held global marketing, product management, and business development leadership roles at Phillips Healthcare, Sapient, and Impact Innovations Group. Carina holds a Master of Business Administration (MBA) degree from Boston College, as well as a Bachelor of Science (BS) degree in Management Information Systems and Decision Sciences from George Mason University.
CMS Dr. Thompson talks challenges of Meaningful Use implementation IHT2 Editor Joseph F. Jalkiewicz
As chief medical officer for the Centers for Medicare and Medicaid Services (CMS) Regional Office in San Francisco, Dr. Thompson serves as the chief CMS clinician for Region IX. She is also the principal liaison with professional organizations in the region with respect to quality improvement and healthcare reform.
In advance of the HIT Summit, IHT2 Editor Joseph F. Jalkiewicz spoke with Dr. Thompson about Meaningful Use and how providers can meet the challenges of implementing MU as quickly and efficiently as possible.
Can you tell us about how your role as Chief Medical Officer at the CMS, positions you as a leader in the health IT transformation?
One of the major roles I play is to serve as a liaison to health care professionals for a variety of our quality initiatives, and that means both outreach and education. But not only am I taking our initiatives out to our providers, but I’m also in a good place to get feedback back into the central office on various initiatives, and doing some environmental scanning for the agency. That’s one part of it, but the other part of is that I really see HIT as a necessary foundation for where we need to go in terms of health reform. HIT is really a basic foundation for almost all of the work I do at the agency related to quality.
How big of a role does HIT play in your overall responsibilities?
We have a major health care problem in this country. We are on an unsustainable trajectory, and health information technology is the foundation on which we can transform the system. It’s a central, critical role getting us to where we need to be in a fairly short order of time
With your background at the CDC and in the payer industry, what are your thoughts on how HIT can impact issues like population health management? Can you share an example or two?
I think it depends a little on how you define population health management [but] it harks back to that little phrase, “what gets measured, gets done.” You can’t manage population health without data. There are a number of ways to collect data, but HIT is the most efficient way to get data. And without that you just can’t do the work. In terms of a concrete example from the clinician’s perspective, [they’re wondering] “How do I manage my diabetic patients’ health? How do I make sure all the women who should have Pap smears have gotten them? Without information technology you’re kind of stuck. You can do some kind of work around with registries or something else, but really you need EHRs; you need a good technology platform. I can tell you about numerous doctor’s offices I’ve worked with in the past where they were great docs giving really good care, but it wasn’t until they implemented electronic medical records that they realized there were a whole lot of patients who weren’t coming into the office, and while [the doctors] thought they ordered mammograms for 90 percent of the women for whom they were indicated, it was really only 50 percent. And where they thought they ordered A1C’s for every diabetic who needed them, they found it was only 30 percent.
You really do have to measure things to know where you are. I’m giving a very clinical perspective, but you can also look at it on a more global scale. What is going on in San Diego, or San Francisco? Without a data system it’s just extremely difficult to know what’s going on, much less what to do about it.
From a national perspective, what do you view as the biggest challenges in implementing the changes in health policy as related to Meaningful Use.
I happen to have a fond spot in my heart for small practices and the numerous clinicians who are still not associated with larger, perhaps more sophisticated, systems with more infrastructure. I continue to be very concerned about small practices from both the HIT Meaningful Use perspective as well as from a policy perspective.
With Meaningful Use Stage 2 just recently announced, can you share some of the initial feedback (both pushback & positive) from the various stakeholders groups with which CMS works?
I can’t say a lot about this at this point because we’re still in the process of gathering comments, but a couple things I do want to mention. Remember, these are proposed rules and the reason we put proposed rules out is because we want to garner comment; we want to hear from everyone. We really value the input. It will help us make a much better final rule. [Having said that,] you can group these into two groups: the “too much” group versus the “too little” group. There’s always a group that says,”It’s too much, too fast, and we can’t do this. You’re going to push some people out.” And then we have another group that’s just as vocal—and it’s hard to say which [group] is larger—who say, “It’s not enough. You need to do more, faster.” At the end of the day, that’s the major tension that we’ll see.
We have worked hard to provide more flexibility for specialists in the stage 2 proposal. There are a number of exclusions for providers whose scope of practice wouldn’t permit them to meet certain measures. There are new objectives for imaging and cancer reporting registries and other specialist registries. Some of the comments we heard in the past led us to incorporate some of the things you’ll see in the proposed rule. We hope there will be some positive comments about those changes, but we know there will also be many others that want to see additional changes.
Where do you think most providers will find their biggest challenge in MU2?
As I said, we’re shooting for providing more flexibility and reduced burden in Stage 2. Having said that, the new rule emphasizes health information exchange and interoperability, and frankly, those are challenging issues not just for providers but for everyone in the health information exchange world as well. There are also more robust objectives proposed around exchanging summary-of-care information with different providers that have different certified EHR technology. These will be challenges, but they are ones we have to meet. Having everyone have an independent EHR that works well in their office but doesn’t communicate with surrounding offices may be minimally helpful to the physicians or clinicians in those offices, but it’s not helpful from a systems perspective.
Do you have any guidance for those getting an early start?
Don’t just think about this as a federal regulation and what’s required. Really focus on quality improvement. That’s what this is all about: more efficient, higher-quality, and less costly care. Focus on areas where you’ll get the most bang for your buck for your practice and your patients, like bigger gains in patient health status indicators. I do want to emphasize that we’re proposing that Stage 2 kick in in 2014, not 2013, so for those who did a test for Meaningful Use in 2011, they have a little more time before the Stage 2 requirements have to be met, although we’re certainly happy for people to meet them early. The other thing that’s important for providers to know is we’re working hard to reduce the burden of reporting. The proposed rule further aligns the EHR program with some of our other quality reporting systems, such as the physician quality reporting system as well as the new ACO or shared savings program and some others. Providers can look for more of that.
At iHT2’s Health IT Summit in San Francisco, you are speaking on a Meaningful Use panel discussion focused on leveraging technology to improve outcomes & efficiency – from which criteria will we see the biggest impacts from the upgrades to Meaningful Use Stage 2?
I’m not a big one for the crystal ball gazing. I want to emphasize again that [Stage 2] is proposed rules, and they represent a big step forward from Stage 1. I think the biggest impact overall comes from the ability to truly exchange health information well as to advance clinical care processes. For example, one of the fairly simple ones that is proposed is to use the EHR to provide reminders for preventive and follow-up care. It seems like such a no-brainer, but …many people who have had EHR’s for a very long time have not been using [them for reminders], and this is something that we know can substantially increase the rate of many screening tests and [routine] vaccinations. Depending on the test, you can see anywhere from 20 percent to 40 percent increase in the percentage of people who will get that screening or vaccination. That’s a huge change when you think about an entire population. If you break down each of these and think about what that can mean on a population basis, the impact is quite significant.
What do you think will provide the biggest impact per dollar spent?
I won’t even hazard a guess. I think it’s the whole package together that’s important.
Do you have a sense of how patients are reacting to the transformation in their care environment and what the biggest issues are from their perspective?
People are starting to vote with your feet. My mother just moved to a new state and she needs a lot of help coordinating her care. When I started looking for providers for her it was very important for me to get her into a system where I knew we wouldn’t be chasing her health records down all the time. That’s not something you want to be doing when you have a loved one who’s sick or possibly dying. With that in mind, patients really do have to be at the center of all this, and I think the Stage 2 rules continue our push toward that patient-centered delivery system that we so need in this country. You’ll see new objectives centered around the patient’s ability to view, to download, and to access their own health information in a timely way, as well as to make sure their providers can communicate that [information] with one another and that [patients] can communicate with their provider using secure electronic messaging. We really mean it when we say we need to get the patient at the center of care and health information technology can help us achieve that.
Looking forward, what is your best advice for providers making the trek to achieve Meaningful Use Stage 2?I’ll go back to what I was saying earlier: Don’t focus on this as a government program. Focus on what you can do to improve, what you can accomplish, in your own practice to enhance the care you deliver and to improve the workflow in your office. The groups that take it in that vein invariably do better than the ones inclined to just check off the boxes. I think it’s also important to look at the proposed rule, if you’re so inclined, and where you think we have it wrong, tell us before the comment period expires. Stage 2 is when we want to be advancing clinical processes so think of it that way.
I started out talking about the enormous challenges we’re facing in our healthcare system as a whole, and that is very real. We really are on an unsustainable trajectory. I want to underscore the importance that we cannot afford to fail over the next few years in transforming the healthcare system. We have to work together to make it the best system that we can. And I’d like to make one more plea for providers to tell us what they like and what they don’t like in Stage 2 [MU} and help us craft a final regulation that will strike the right balance between promoting greater use of EHRs while recognizing the challenges that are faced by providers as the implement these EHRs.