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.

Switching electronic health record systems is no easy task

While buying an electronic health record (EHR) system for the first time is a veritable challenge, transitioning from one system to another is challenging as well.

There are a number of reasons an organization will switch to a new EHR system. For example, providers might need more functionality to manage workflow, or to bill directly from the system’s interface. They might also want to buy a certified system to participate in the Medicare and Medicaid EHR Incentive Program or even switch because of slow uptime and login speed.

One of the key barriers to switching EHR systems is data migration from the old to new system. A HITECH Answers article points out that collecting data from an old EHR system is a painstaking process, and providers should take steps to ensure valuable patient information isn’t lost. Additionally, transferring information can be an expensive process; often, a hospital or practice will outsource IT help for migration.

A second barrier is implementing tablets — such as iPads — into a health care setting. It’s possible that older EHR systems are intended to only work with onsite desktop computers and, therefore, more hardware is needed for tablet compliance. That’s when organizations must decide  to either purchase more technology or a new system altogether. However, the transition to tablets also brings new obstacles like encryption and device privacy, too.

Another issue for providers transitioning to a new system is closing the book on the current vendor. EHR vendors likely do not have a sufficient departure plan, which means an organization likely will continue to make payments to the old vendor,  if a new vendor is used. Given that providers need to access to older patient records, EHR vendors are likely to seek payments based on the “continuing use of licensed EHR software,” according to HITECH Answers.

Furthermore, the article offers tips on establishing an EHR contract that includes an “exit strategy” to switch to a new system and affords the time to do the following:

- Ensure sufficient time for selection and implementation;

- Ensure that all data is in a format that can be loaded easily into a new system;

- Continue use of data on the old EHR system.

How medical diagnostic codes may cloud clinical data analytics

The ongoing push for more descriptive medical diagnostic codes — the alphabet soup that is SNOMED CT, LOINC and, in the United States at least, ICD-10 — is motivated in part by a desire to improve data analytics for a host of clinical, billing and administrative purposes.

However, there can be an unfortunate consequence of such codes. The Journal of the American Medical Association has published the findings of a study suggesting that conclusions about reduced mortality rates among patients diagnosed with pneumonia may not have been entirely true.

The journal study found that, from 2003 to 2009, mortality rates did drop for patients with a primary diagnosis of pneumonia. Those with a primary diagnosis of sepsis or respiratory failure and a secondary diagnosis of pneumonia unfortunately did not share the same fate. When all three pneumonia diagnoses were combined, the mortality rate was “little changed” from the years prior to the study.

Here the impact of medical diagnostic codes can be readily seen. Focus specifically on codes referencing pneumonia and it appears that mortality is declining. Only when expanding the search to all relevant medical diagnostic codes referencing pneumonia does the bigger picture emerge.

This suggests that more descriptive medical diagnostic codes may make clinical data analytics more difficult. Compare the first research paper you ever wrote, which likely referred to only a handful of books from the elementary school library, to your graduate thesis, which sourced a veritable bookcase.

The issue isn’t the difficulty that descriptive medical diagnostic codes present so much as it is knowing what we can learn from them. One cannot expect an elementary school student to walk into the Boston Public Library and know where to find books about George Washington. Organizations are increasingly finding that it takes Ph.D informaticists, not to mention a clinical data warehouse, to get the most from that data.

Microsoft’s Kinect, HealthVault turns seniors into engaged patients

Getting senior citizens engaged in their health care isn’t always an easy task, especially with those who are suffering from chronic conditions. So far the Exergamers Wellness Club has excelled at it, combining fun and technology to get seniors more engaged in monitoring and improving their health.

Exergamers is based on a comprehensive health-and-wellness program developed by Partners in Care Foundation, but it brings Microsoft Kinect for Xbox 360 and Microsoft HealthVault into the picture, to give seniors a set of tools they can use to get fit and keep track of their progress. The program was unveiled earlier this month at the St. Barnabas Senior Center, Multipurpose Center in Los Angeles with a flash mob of dancing seniors.

The club is a public-private partnership between Microsoft, the Los Angeles Department of Aging, Partners in Care Foundation and St. Barnabas Senior Services, a non-profit organization that operates a popular senior center in Los Angeles.

Club members use Microsoft Kinect to make exercise fun, competing in virtual bowling tournaments with seniors in other cities, and dancing along to hip-hop, disco and salsa routines. The games keep them moving and give them an outlet for social activity, which helps to improve overall health. Then they can keep track of their health and fitness levels using Microsoft HealthVault.

If all this technology in the hands of the elderly gives you visions of oldmansearch, rest assured it was not put there without some training first. During a pilot for the program, seniors — some who had never worked with a computer before — were given basic computer literacy skills, said Brenda M. Vazquez, program director for disease prevention and health promotion at Partners in Care Foundation.

When asked if the seniors were worried about the privacy of their information entered into HealthVault, Vazquez said it was not a significant issue with the pilot group, but also noted that there was a level of trust already established between the seniors and the trainers who were helping them.

And HealthVault is set up to make sure the user has full control over every bit of data in there, said Melissa O’Neil, product manager for HealthVault. “So I can share what I’m doing through the program, but I can block view into [certain data]. It’s pretty clear to patients how to do that,” she added.

Though it was a challenge getting the seniors up to speed with the technology, once they were comfortable with the basics, they started to explore things on their own. And when the information became relevant to them, said Vazquez, they really got engaged.

It also helped that the facility used for the program had a “cyber cafe,” with a number of computer stations and laptops available, and  also wireless Internet access.

For the program, a special geriatric health-management application developed by Get Real Consulting was integrated with HealthVault to make it easy for seniors to monitor chronic conditions, track their progress over time and share the information with their health care providers or other caregivers.

“All members reported feeling happier, enjoying life more, and feeling empowered and in charge as a result of participation in the Exergamers Wellness Club,” said St. Barnabas CEO Rigo Saborio in a press release.

One member of the program, 77-year old Orlando Estrada, said the Exergamers Club helped him to go from “a wheelchair to a walker to double canes to, now, a walking stick just for balance.”

The Exergamers Wellness Club is being expanded to all of the senior centers within the Department of Aging service area. Partners in Care is excited about the success of the project, and is seeking funds to conduct more formal research into the benefits of the program, according to Vazquez.

Health care social media growing among patients more than providers

To hospital promotions departments, health care social media presents a tremendous marketing opportunity. To CIOs and compliance officers, social media sites are HIPAA violations waiting to happen. Or to the CFO, episodes of informal care that can’t be captured for billing.

To patients, however, social media is a way to interact with friends and family, sharing symptoms, trading stories about care they’re receiving, reviewing health plans, hospitals and specialists, and commiserating with patients who have similar health issues. Oh yeah, and to go over their doctor’s head and consult their pals on whether or not they should get a second opinion. That’s all according to the PriceWaterhouseCoopers (PwC) report “Social media ‘likes’ healthcare: From marketing to social business.”

The bad news is that hospitals are not fully connecting health care social media to business strategy, making it a resource driving customer relationship management or quality of care. While 80% of hospitals have some social media presence, it’s minimal, with total post counts typically in the hundreds, not thousands. Yet the report suggests that social media sites - such as Facebook and its 845 million users, more than the population of Europe - represent an untapped resource for health care to drive revenue growth.

The good news? Health care is so lightly represented on social media sites that the more than 1,000 patients PwC surveyed for the report indicate that they still trust the information providers post, when they do take the time to do it. Some 61% of consumer respondents are likely to trust information posted by providers and 41% are likely to share with providers via social media. That almost doubles the 37% who said they trust information posted by a drug company, and 28% likely to share information with a drug company.

While all this portends to a new era in health care - and another coming phase of the health IT revolution where more paper-based processes go online - patients already are warning their providers: Do it right, or don’t do it at all.

“More than 75% of consumers surveyed would expect healthcare companies to respond within a day or less to appointment requests via social media, while nearly half would expect a response within a few hours,” PwC reports. Meaning, halfhearted attempts to start serving patients in social media venues will only lead to frustration on the part of patient and provider alike.

Colorado health information exchange interested in behavioral health integration

Harmonizing behavioral health providers and primary care doctors through health information exchanges (HIEs) is a relatively new concept in the health IT space. Arguably, the most prominent example comes from Maine, where HealthInfoNet — Maine’s official HIE — is the centerpiece of connecting these two areas of care through a grant.

Maine’s not the only state considering this process, though. The Colorado Regional Health Information Organization (CORHIO), in addition to establishing a multi-stakeholder behavioral health committee, issued a report featuring strategies for including behavioral health in the state’s HIE.

The report came together after CORHIO held six meetings with different communities in Colorado. Collectively more than120 consumers, providers and disparate behavioral health stakeholders attended these meetings to develop HIE plans.

The report noted that there’s significant interest among consumers to access their personal health information (PHI) within a HIE. In fact, according to the CORHIO report, almost 90% of survey respondents agree that behavioral health should be commonplace among a patient’s health care continuum.

Concerns were brought up in the report as well, particularly over the privacy of PHI and who’s able to view patient data. While creating better health results is the top priority among providers and patients alike, health information cannot be compromised in data breaches.

“We have to be sure to strike a careful balance between protecting individual privacy with the need to have comprehensive information available for high-quality health care treatment and services,” said Amanda Kearney-Smith, director of the Colorado Mental Wellness Network and member of the stakeholder committee.

Another noteworthy concern, though not noted in the report, is that behavioral health information is not well assimilated into primary care electronic health record (EHR) functionality. Additionally, grants for developing that functionality are often hard to come by since behavioral health’s not included in the HITECH Act of 2009, much to the chagrin of some.

Although bringing disparate forms of care together is a smart move in theory, it begs the question: Are health information exchanges sustainable enough for this type of move? According to two reports, HIEs will not flourish without sufficient planning, a clear, completed market assessment and understanding by health IT leaders of the technical and financial requirements.

Two recent reports offer insight into HIE failure

By Greg McInerney, Editorial Assistant

Health information exchanges (HIEs) have been touted as an excellent way to improve the health care industry for both providers and patients.  Yet however well-intentioned the concept of HIEs may be, they are not immune to failure. There have been many examples of HIEs failing to sustain themselves in the long run, primarily due to a lack of organization and financial sustainability.

The National eHealth Collaborative (NeHC) recently published a much anticipated report, “Health Information Exchange Roadmap: The Landscape and a Path Forward.” The report aims to “offer stakeholders a clear picture of efforts being undertaken by both the public and private sectors to create and implement the key building blocks that will allow for truly interoperable HIE.”

NeHC interviewed over 75 experts and prominent figures within the industry when compiling its report, which includes case studies from across the United States, encompassing a broad variety of HIE models including private, private/public and government operated.

Despite covering a broad range of HIEs with differing operational methods, the report concludes that there are four critical components to the implementation and sustainability of a HIE:

• HIE objectives and vision;
• Market assessment;
• Strategy development;
• Strategy implementation.

Another report recently published by IDC Health Insights, “Best Practices: Establishing Sustainable Health Information Exchange,” also emphasizes the importance of planning. The report describes how a lack of effective planning will inevitably consign a HIE to failure, regardless of how well-intentioned it is.

These failed ventures often sought out potential solutions, systems, partners and vendors before they had concretely identified the financial and technical requirements of the HIEs they wished to create.

IDC’s report is also critical of the failure of HIEs to design and implement their systems in conjunction with an evolving “patient-centric” health care industry. In order for interoperability to be more than just a buzz word, HIEs need to work in conjunction with stakeholders and gain their trust, according to executives that were interviewed.

The underlying message of both reports seems to be a simple one — plan effectively. “Too many [HIEs] have relied on the ‘build and they will come’ strategy,” asserts Lynne A. Dunbrack, program director at IDC Health Insights. HIEs must plan for sustainability from the very beginning, said Dunbrack, adding that “If the [HIE] will not be sustainable after the initial funding, then careful consideration should be given to whether to launch…in the first place.”

ICD-10 implementation: Can we please just get on with it?

“#wimps.” That was the email I sent to my colleagues upon reading that CMS officially put off ICD-10 implementation for a year.

Let me explain: Us SearchHealthIT editors frequently lard emails among ourselves with social media shorthand (in this case, a Twitter hashtag) and ridiculous Memegenerator.com images referencing inside jokes. While some of them even we don’t quite get ourselves, “#wimps” should be pretty clear to anyone.

In regard to ICD-10: Technically, it’s not my job to sympathize with anyone, and I don’t, mostly. It’s my job to tell the long story of our U.S. health IT implementation reality show as it unfolds, one episode at a time.

Certainly I don’t sympathize with the American Medical Association or the Medical Group Management Association, more #wimps, judging from their responses to CMS’s yearlong ICD-10 stay, which resonate like my eight-year-old arguing for extra video-game time when he should have been in bed an hour ago.

It’s not that I’m a CMS fan, either, although I do agree with the agency’s contention that it’s time to move off of ICD-9, a technology peer of the IBM punch card, for gosh sakes. Neither am I a Big Health Care fan, even though well-heeled health systems and payers probably are best equipped to weather the ICD-10 transition. Can’t even say that I’m a T Bedirhan Üstün, M.D. fan, either.

But one can’t help but appreciate the position - and conviction - of ICD-10 backers, who contend that American health care needs to quit dragging its feet and implement the diagnostic code set that most of the rest of the world did years ago (and, amazingly, without physicians wringing their hands).

The only people, really, deserving any sympathy in this latest chapter of ICD-10 theater are the leaders of College of Healthcare Information Management Executives (CHIME) and the American Health Information Management Association (AHIMA). Why? Not only are their members the coding staffers and IT leaders who must ensure that ICD-10 gets implemented, but they are a smart, organized gang driven by concrete deadlines to do what they do best: Measured rollouts, tested and validated before go-live.

That, and they can’t call CMS and the AMA a bunch of #wimps.

CMS names 27 participants in Medicare ACO model

The Centers for Medicare and Medicaid Services (CMS) have announced the first 27 participants under the Medicare Shared Savings Program (MSSP) accountable care organization (ACO) model.

According to CMS, these groups, whose participation in the ACO model went into effect April 1, serve 375,000 patients in 18 states. Five of the 27 groups have opted for the Advance Payment ACO Model, which offers money up front to rural and physician-based ACOs so they can better develop the infrastructure needed to improve care coordination.

The MSSP ACO model differs from the previously announced Pioneer ACO Model. The 32 participants in the latter program, representing 18 states and about 860,000 Medicare patients, take on higher levels of risk (and reward) than those in the former program. In addition, the Pioneer ACO program is now closed, whereas CMS is evaluating about 150 applications for a July 1 start to the MSSP ACO model program and accepting applications for a Jan. 1, 2013 start.

The concept of the accountable care organization as an alternative to the fee-for-service method of providing care was introduced in the health reform law of 2010, with the Pioneer ACO Model announced in the spring of 2011 and the MSSP ACO model following in the fall.