Is increased technology the key to ACO care delivery?

With the accountable care organization (ACO) destined to impact health IT strategy, insurer Aetna and Banner Health Network (BHN) — a non-profit health care system — are adding technology aimed at expanding its collaborative efforts.

The organizations will use for population health management and patient services products, targeting more than 200,000 patients, according to a company press release. Further, the partnership will support 50,000 Medicare patients covered by the Pioneer ACO shared savings program in the Aetna and BHN ACO collaboration. The Pioneer ACO program was established for health entities that have experience in managing care for patients across care settings.

There are three technologies to be added, starting with health information exchange services through Medicity. Medicity will deploy a “secure, two-way exchange of health information across a patient’s entire care team, including hospitals, physicians, labs, pharmacies and other ambulatory services,” according to Aetna.

Another technology to be deployed is clinical decision support (CDS) via ActiveHealth Management. The CDS system includes a workflow tool to monitor and coordinate patient health outcomes. The final technology delves into mobile health, as smartphones will enable patients to select appointment times via iTriage, a health and fitness app available for download in the iTunes store and Android Market.

One reason for adding new technology is because traditional EMR systems lack a certain level of clinical knowledge to succeed in ACOs, said Charles Kennedy, M.D., CEO for Aetna Accountable Care Solutions in the press release, adding that harmonizing “clinical and claim information to create a broader patient record available to the entire care team.”

Purchasing more technology seems to be a common trend among providers and organizations that form ACOs, which need to ensure an effective, interoperable flow of information for better care coordination.

Among ACOs, health information exchange technology to — for example — connect with specialists is a key initiative.

While the ACO will decide which information is needed for better coordination, the information needs to be interoperable. What’s more, HIE functionality will also need to be tied to an ACO’s EHR system so providers can view the data within the care setting.

ONC seeks comments on nationwide health information network governance

The ONC is in the process of shaping the governance structure needed to establish the nationwide health information network, or NHIN, and is seeking comments from the public. This governance structure is necessary to establish a common set of rules for privacy, security, business and technical requirements for nationwide health information exchange.

In anticipation of developing a notice of proposed rulemaking (NPRM) to establish this governance mechanism, the ONC has released a request for information, seeking broad input on a range of topics.

The ONC’s proposed governance structure for the nationwide health information network includes establishing a set of “conditions for trusted exchange (CTEs)” and a voluntary validation process for entities to prove they have met these conditions.

The RFI has not been officially published in the Federal Register yet — the target date is May 15, and comments will close 30 days after that — but the “pre-publication” can be downloaded now.

Will election influence meaningful use stage 2 release date?

Here at SearchHealthIT, we’re creating an office pool for when the final meaningful use stage 2 rule will drop.

National HIT policy leader and Beth Israel Deaconess Medical Center CIO John Halamka, MD says it’s on track for August delivery. Vendor co-op Premier Healthcare Alliance affirmed its support for such a timetable in comments to CMS.

But that could be just wishful thinking during this presidential election season. Whether the election’s close or not - and why wouldn’t it be, considering the last three have been - will President Obama’s administration want to risk further attack on his health care policies on the campaign trail? Every move either candidate makes is deeply scrutinized by his foes, leading to silly gestures such as a judge forcing U.S. Attorney General Eric Holder to affirm that the administration recognizes the Supreme Court’s authority. While that particular incident didn’t involve meaningful use regulations, it was part of the legal challenge to Obama’s health reform law.

One would think that shenanigans like these would make any candidate - liberal, conservative or moderate - think twice about introducing new regulations into the debate stream.

My guess as to when meaningful use stage 2 will arrive? I’m torn. If Obama’s re-elected, I’d imagine the final rule will arrive sometime between Election Day and Thanksgiving. If he isn’t? Maybe never.

The president put pending regulations on hold for 60 days when he first took office, subjecting them to administrative review, and last year established new policies for vetting regulations. If Mitt Romney, the presumptive Republican nominee, wins, you’d have to figure he’d put a similar freeze on pending regs.

Can you imagine a rookie president inserting himself into a politicized health IT debate featuring associations squared off against patient advocates like Regina Holliday picketing the American Hospital Association annual meeting? It’s difficult enough for us to follow, and we have seen most every episode of this reality show since the HITECH Act was enacted.

Forced to choose a date for the release of the final meaningful use stage 2 rule - and the office pool’s rules dictate that players must choose a single date - I’ll take Nov. 16. After all, documents seem to drop on Fridays a lot, and I’m 60-40 sure (subject to change, day by day, between now and November) Obama will be re-elected. But I’m not a handicapper for a living, so if you’re really interested in betting, call your local bookie to find out what the wiseguys are saying.

I hope Halamka’s prediction of August delivery turns out to be right, and this blog post’s a bunch of conjecture. But thinking about how the proposed rule finally saw the light of day, it’s safe to say that nothing ever goes as planned. A hell of a notion, as Styx once put it.

Do you want in? Put in your two cents’ worth - and your best guess for a date - in the comments section below.

Patients, providers alike benefit from dermatology rural telemedicine

With scores of health IT leaders leaving the ATA’s annual meeting at the beginning of May, it is no surprise telemedicine news continues to make headlines — in particular, to deploy rural telemedicine services for underserved and impoverished areas around the U.S.

One name to watch is David Wong, M.D., a Stanford dermatologist, and co-founder and CEO of Direct Dermatology, an initiative that seeks to bring dermatology care to rural areas in California. Direct Dermatology physicians treat a range of conditions from acne to melanoma and psoriasis.

While speaking as a panelist at the Healthcare Innovation Summit at Stanford in April, Wong explained how Direct Dermatology functions. A patient takes a picture of their skin ailment and sends it via secure email to a provider with additional medical history enclosed. The provider will then examine the ailment and issue a report to the patient including prescriptions. Wong said that despite the provider-patient interaction occurring from a distance, in-person review might not always be needed for dermatology because consultations are image-driven from the start. The patient generally has to wait two days to receive reports post telemedicine visit.

Extending skin care to rural areas started gaining steam even before Wong’s initiative. A 2010 study found that online dermatology visits are as effective as office-based visits. The study was recorded after 151 women with mild acne had an office visit with a dermatologist — including researchers who took baseline pictures of the participants’ faces — and had to follow up with the dermatologist online. Patients also learned how to take photos of their own face to compare them to the original baseline photos, which were uploaded to their computer. Finally, during an online visit, patients filled out a questionnaire about their acne and sent it to the dermatologists in the study.

Researchers found that not only did online consultations save time, but traditional office visits don’t have to be the norm when both patients and providers are satisfied with online care.

Although California is the only state Direct Dermatology provides rural telemedicine care to at this time, it’s not out of the question that more providers and patients will take a similar route to their care if it’s available in the comfort of home — especially if home is underserved in the health care spectrum.

Comments closing for meaningful use stage 2 proposed rule

As the meaningful use stage 2 comment period comes to a close, the Office of the National Coordinator for Health IT (ONC) will have its hands full gathering and analyzing all the feedback received. Reactions to meaningful use stage 2 from industry stakeholders have been a mixed bag, with immediate concerns focusing on the measures that are perceived to be out of providers’ control, such as the requirement that 10% of patients “view, download or transmit” their electronic personal health information.

Many health care industry organizations have weighed in on the meaningful use stage 2 proposed rule, but one in particular — the American Hospital Association (AHA) — ruffled feathers among patient advocates, including Regina Holliday. The AHA’s 68-page comment letter was criticized by Holliday and others for pushing back on the requirement that patients be given the ability to view online, download and transmit information about a hospital admission within 36 hours.

Meanwhile, the American Medical Association got together with 38 other organizations to publish its comments on stage 2 proposed rules, with an emphasis on “a potential concern with pushing too many requirements into meaningful use.”

The College of Healthcare Information Management Executives (CHIME) expressed similar concerns about providers’ ability to meet existing deadlines for meaningful use stage 2 criteria. CHIME urged CMS to “follow the precedent set in stage 1,” and allow providers to “demonstrate meaningful use during a continuous 90-day reporting period for their first payment year in stage 2.”

Many other organizations have also published comments on the proposed meaningful use stage 2 criteria: The American Medical Group Association, the American Medical Informatics Association, the National Rural Health Association, and the American Heart Association, just to name a few. Hopefully the folks at ONC have taken some speed reading classes.

Visit the ONC website for full details on the meaningful use stage 2 proposed rule.

UCLA researchers bring gaming, crowdsourcing to telemedicine platform

There are many different telemedicine platforms making their way into the U.S. health care system: Telestroke services, remote patient monitoring and the use of text messaging are just a few. Here’s one more that could be joining the forefront: Telepathology.

Researchers at the UCLA Henry Samueli School of Engineering and Applied Science and the David Geffen School of Medicine at UCLA have brought together online gaming and crowdsourcing to create a telemedicine platform that lets online gamers diagnose malaria.

Currently, malaria is diagnosed by a trained pathologist using a microscope, in a process that is very time-consuming. This presents a challenge for countries with a large number of cases of malaria and few resources to properly diagnose them. A false positive diagnosis — which is common with cases reported in sub-Sahara Africa — can lead to treatment that is costly and unnecessary.

UCLA’s researchers are hoping that the special game they created, which can be played on cell phones and computers from anywhere in the world, will help solve this problem. Players are first given a brief online tutorial that explains what malaria-infected red blood cells look like, then they play the game, in which they are given tools to “kill” infected cells and gather healthy ones together. The game includes control images that allow it to dynamically estimate the performance of each player and assign a score.

While a single person playing the game did not produce results comparable to those from a trained medical professional, the researchers found that a small group of players (mostly undergraduate student volunteers) could collectively be pretty accurate — within 1.25 percent of a professional.  The researchers believe this collective accuracy could lead to a unique telemedicine platform that could diagnose a much larger volume of malaria cases — at no cost.

“The idea is to use crowds to get collectively better in pathologic analysis of microscopic images, which could be applicable to various telemedicine problems,” said Sam Mavandadi, a postdoctoral scholar in the research group and the study’s first author, in a news release from UCLA.

The team hopes to bring this telemedicine platform into the field through clinical trials, and would like to see it scale up to be used for “other biomedical and environmental applications in which microscopic images need to be examined by experts.”

The meshing of gaming and health care is not new, but the idea of a bunch of gamers collectively diagnosing malaria sure seems unique. The researchers at UCLA predict skepticism from traditional microscopists, pathologists, clinical laboratory personnel and malaria experts — but hope that further clinical studies will prove that the platform works.

Alaska telehealth access to specialists beats Boston in-person

SAN JOSE, CA – Incoming American Telemedicine Association president and CIO of the Alaska Native Tribal Health Consortium Stewart Ferguson is a health IT stalwart. Previously, he oversaw the Alaska Federal Health Care Access Network (AFHCAN), Alaska’s largest telehealth project, which comprises 248 remote site deployments. AFCHAN conducts more than 33,000 telemedicine encounters yearly.

Dressed to the nines in a kilt, opening for keynote speaker and Apple co-founder Steve Wozniak at ATA’s annual meeting, Ferguson compared the telehealth access AFHCAN offers to in-person access in U.S. major urban centers: Boston offers the longest wait time to get an appointment in-person with a specialist, averaging more than 40 days. In contrast, four hours is on the long side to see a specialist via a telemedicine encounter in Alaska, he said, with 30% done in 60 minutes and 60% within four hours.

This despite grueling winters that shut off whole communities from the outside world for weeks at a time – and polar bears running wild in the streets that sometimes drive a town’s inhabitants indoors until they pass through.

“One of the things that’s very interesting to me is that we are able to provide a level of service using telehealth that we cannot achieve without telehealth,” Ferguson told the crowd assembled at San Jose Civic Auditorium, the historic venue in which the Rolling Stones debuted “Satisfaction” on stage, and Wozniak later admitted he watched roller derby matches as a kid. “I would challenge you to go to a major metropolitan area and get a specialty consult from your primary care physician in 60 minutes or less. The point is that telehealth, from my perspective, is not just as good as in-person. It can, in fact, be better.”

Ferguson’s point: Telemedicine shouldn’t just be for underserved populations in remote areas, although he’s got the stats to prove it works – it should be integrated into the mainstream as a way to offset difficulties throughout the U.S. health care system.

He acknowledged that most hospitals — challenged right now with adopting meaningful use, ICD-10, accountable care and other IT-intensive projects – don’t have the resources to take on telehealth projects. But they need to.

“I don’t believe the health system can just keep on doing what it’s doing, and make it,” Ferguson said. “I believe, with the changes that are going on right now, that telehealth is perfectly positioned to be a part of a more efficient health care system.”

VA mental health department scrutinized over performance metrics, care delivery

In an effort to bolster data and boost performance measures, managers pushed staffers to create ways that delivered minimum amounts of care to veterans while increasing the number of patients seen for mental health-related services, according to testimony from Nicolas Tolentino, former administrator at the VA Medical Center in Manchester, N.H.

Tolentino participated in a hearing in front of the Senate Veterans’ Affairs Committee in April after a VA inspector general report found that the VA exaggerated how quickly mental care was provided to veterans.

Tolentino disputes the VA’s claim that 95% of veterans who seek mental health treatment receive care within 14 days. To that end, only 64% of veterans are treated within 14 days while an estimate of 94,000 patient appointments wait almost six weeks on average before treatment begins, according to the report.

The VA’s main issues are performance measurement and care delivery. That statement was reiterated by William Schoenhard, the VA’s deputy under secretary for health, saying that: “We fully embrace that our performance measurement system needs to be revised.”

Regardless, the pressure to meet performance metrics might lead to providers attempting to circumvent the system, or, as Tolentino put it, “gaming the system.” Although the scenario of providers attempting to get ahead is likely to remain, every organization that decides to incent providers must measure and incent based on the right initiatives, said Kerry McDermott, senior policy director at West Health Policy Center in Washington, D.C., adding that organizations “get the system they incent for.”

The VA is working to resolve mental health problems and is cooperating with investigators. Additionally, the organization has begun hiring more staff. Specifically, 1,600 mental health workers and 300 support staff are expected to be added.

Virtual training in health care: Docs want it, report shows

By Greg McInerney, Editorial Assistant

“Give us more technology” cry physicians across America. At least according to a recent report jointly published by communications company ON24 and MedData, a health care research firm.

The April 2012 Joint Survey of Physician Digital Behavior certainly produced some telling results. Of the 971 participants surveyed, 84.1% would prefer to attend continuing medical education (CME) training online, followed by:

• Pharmaceutical Education - 31.6%
• Dinner Meetings - 29.4%
• Medical Device Training - 27.1%

Yet despite this demand, the supply of digital training content has not been forthcoming. Only 6.4% of those surveyed actually participated in virtual training or any type of virtual event very often.

Bill Reinstein, president of MedData believes the reason for this is quite simple. “We found that physicians simply will not take time out of their busy days to consume this digital content if it is at the expense of their patient care or their revenue,” he said in an interview, adding “This is reflected in the fact that 63% would prefer early evening times for this type of virtual training.”

Virtual training providers have to sit up and take notice of this sooner or later. Three quarters of doctors reported seeing an increase in the number of virtual events and webcasts offered, and nearly all doctors (96.1%)  say it’s beneficial to attend more conferences, meetings and CME events virtually.

There also appears to be a strong desire to experience this digital training “on the go,” a trend that was stressed by speakers at last year’s HealthMart conference in reference to providing EHR training for physicians. Mobile devices will naturally be integral to this and, unsurprisingly, the iPad comes out on top with nearly three quarters of physicians surveyed planning to buy one in the next six months.

The disparity between the physicians’ demand for virtual training and the current level of adoption is perhaps the most intriguing finding in this report. It represents big opportunities across the board, according to Reinstein.

“That opportunity gap is good news for pretty much everyone across the health ecosystem,” he said. “Of course it represents a short term problem, but also a long term opportunity for everyone from the providers of online training to pharmaceutical companies.”

ATA: Burning issues chase telemedicine providers

Last year, SearchHealthIT covered its first American Telemedicine Association (ATA) meeting, after running into telemedicine pioneer and ATA president emeritus Jay Sanders, M.D. at a 2010 conference in D.C. - and his amazingly upbeat evangelism for the telehealth-care niche drew us to this gathering of telemedicine providers.

The meeting, held in Tampa last year and in San Jose next week, didn’t disappoint. Turns out Sanders wasn’t an outlier; the ATA is loaded with tireless crusaders for technology-driven health care. It was much smaller than HIMSS, and seemingly less vendor-driven and more collegial.

There’s a reason for that: From the moment Sanders and colleague Ken Bird, M.D. launched telemedicine with a microwave line in 1967 to transmit television images across Boston in order to more efficiently treat patients, telemedicine has gotten the short end of the stick in reimbursements and in some practitioners’ eyes, legitimacy.

But in the coming health care ecosystem of accountable care organizations - or whatever payment model will replace the fee-for-service morass the current U.S. health care system has grown into - that will likely change. Payers, governments, employers and patients are all searching for ways to more efficiently hook up patients - especially in rural areas - with the specialists and subspecialists they need. Technology’s evolving to the point where live HD video isn’t relegated to Star Trek and The Jetsons. Service providers are laying broadband pipes to create infrastructure to support all this potential health care.

While no one knows exactly which new payment model currently in development will eventually win out and dominate U.S. health care, one thing’s for certain: Telemedicine has to play a more significant role in administering patient care than ever before. The rapid adoption of mHealth applications - cousins of telemedicine or its child, depending on where you stand in health care - will also bolster the acceptance of telemedicine among payers and traditional hospitals who might have previously resisted implementing telemedicine services.

All that being said, it’s a great time to bust out of New England and headed to ATA. Stay tuned for our blanket coverage of the show.