Consumer-Engaged Healthcare: The Next Step

Greg Shilling

Approximately 70 percent of Americans utilize the Internet to research health-related information, according to a recent study conducted by Manhattan Research. This same study also noted that tens of millions of people – and growing very rapidly – turn to Facebook friends and other social media for peer support, self diagnosis and suggestions for dealing with common health problems. Yet these same consumers-as-patients don’t fully leverage similar technologies when interacting with their caregivers, nor do they actively participate in their personal health maintenance through these technologies. No, patients predominately use these health portals simply as information sources.

A group of healthcare industry leaders recently met at the HealthWeb Leadership Forum, hosted by Healthline, to ask the question, “How do we get patients to engage in and lead their personal health management through these healthcare portals?” Improvements in population health are certainly recognized through informing patients, but true and ongoing health improvements require patient action. What is it that will get patients to access a healthcare portal, engage in the health message provided and most importantly, take action?

Historically, EHR providers have approached this challenge through the development of PHRs (Personal Health Records), implemented through physician practices and health networks, asort of an “inside – out” approach to patient adoption. If as a patient, you want to maintain a copy of your personal medical record, or if you want to electronically communicate with your physician to schedule an appointment or request a prescription refill, you can certainly do so through a physician’s patient portal. But, where do you go if you would like to proactively (novel concept) engage in your health management; perhaps develop a lifestyle plan, such as a fitness plan, ideas for changing your diet, ways to avoid migraine headaches, etc., customized specifically for you based on insight from your personal and family medical history?

Perhaps a more friendly “outside – in” approach is more effective? Perhaps more of a consumer approach is more appropriate toward changing patient habits. As you perhaps query the Internet about weight loss, lowering cholesterol levels, headaches or managing arthritic pain, to name a few, what if you are led to an interactive site with easy-to-find and understandable advice, peer-based encouragement to take action, tools to help start a new lifestyle program, reminders sent to your smartphone encouraging or “guilting” you into following your lifestyle plan, interaction with online, peer-based support groups, access to medical resources (caregivers, trainers, products, etc.) and perhaps some financial insight estimating your payment responsibilities should you seek care. ( Let’s be real here, we need to remove any perceived obstacle preventing the consumer/patient to take action and cost is certainly a perceived obstacle.)
More than just information and advice, but rather tools, reminders, motivation and resources that we have become accustomed to expect as consumers and customers.

The good news is that there are a group of companies that agree, and are working to develop and promote healthcare consumer portals that engage patients in their healthcare, and not just serve as a healthcare information portal. Companies like Healthy Circles, Healthline, ShareCare, Patients Like Me and Walgreens all get it: lead the consumer/patient to take action. These companies are both technologists and marketers. Technology provides the platform, but marketing and a strong business model are the factors to their success. Technology has never been the issue; engaging patients to take action in managing their health is the real challenge, which must be supported by a business model more consumer-focused.

As EHR companies embrace this approach, exciting things happen. Consumers are engaged and then as patients become aligned with a personalized care network. Lifestyle changes and interests are integrated with patient information, lab test results, medical history, and vice versa. Personal health records that historically acted as an electronic repository of patient information can now lead patients to proactively and privately choose a personalized lifestyle and healthcare plan. As some friends of mine like to say, “There is a way to well” … and it starts with prompting healthcare consumers to take action.

Greg Shilling is vice president of corporate strategy at Greenway.

Finding Community Solutions

Autumn Cowart

I’ve just returned to Greenway from the National Association of Community Health Centers (NACHC) conference in Las Vegas, where executives from FQHC, RHC and community health centers nationwide gathered to discuss and learn ways to more effectively advance patient care and advance their own needs while meeting the ever-changing guidelines of the UDS (Uniform Data System.)

For this 2011 Financial, Operations Management/Information Technology (FOM/IT) event, the theme was “Real Solutions for Real Change in Health Care.” With limits to budgets, decreasing revenues and rapid changes in the healthcare industry, CHCs are facing many challenges. In order for these entities to continue to thrive, their leaders have to continuously seek new ways to operate more effectively and efficiently.

In my capacity as a conference and trade show coordinator, we utilized our booth space to demonstrate and explain just how Greenway is providing new efficiencies in the integration of EHR, practice management and interoperability to help CHCs meet federal reporting and payment requirements and serve their largely uninsured and underinsured patients, which is the mission of these comprehensive care centers, which often provide primary and specialty care, pharmacy and even dental services.

We are growing in this space to meet the demand for innovations to this patient population safety net due to our recent assets acquisition of CySolutions. We were received well at the conference and I met a lot of very interesting people, one of my favorite aspects of my job.

Opening a Cloud on Evidence and Learning

Jason Colquitt

Is the Learning Healthcare System an academic vision that will never see the light of day? I was fortunate enough to hear Dr. Charles Freidman, former chief scientific officer for the Office of the National Coordinator for Health Information Technology (ONC), recently speak on this topic. I got a brief moment afterward at lunch to personally hear his passion.  He stated the Learning Healthcare System was his life work. Although I did not know it by name, this concept was what I have been envisioning for some time.

The Institute of Medicine has done a nice job outlining the definition around evidence-based medicine, research and other goals, but my definition of the Learning Health System reads like this. A system which drives value for everyone and leaves no one out. Patient-centric communication is a key component to this system. It strives to continuously improve itself. It is data driven, sees that data as good for all, and available for all types of outcomes analysis. The system itself is self-aware and drives point of care knowledge.  Health information technology at large and EHRs are core dependencies. Last is the engagement of the scientific community and allowing access to these rich data sets to feed back into the system.

My introduction to healthcare was on the delivery side through the lens of an EHR technologist. I have since also seen through the lens of HIT interoperability as well generating meaningful quality measurements out of the EHR.  I have been enlightened over the years by sitting on federal and regional panels, workgroups, and boards. Over the last few years my focus has shifted into the broad landscape of leveraging healthcare data within the life sciences. This journey in my career embodies a life cycle of researching new therapies and interventions through clinical research, treating patients, reviewing outcomes, predicting patterns, and seeing changes in care driven from the aforementioned steps.

Terms like personalized medicine and predictive analytics come to mind as mega terms we are now hearing around this cycle. Are these steps core to a Learning Healthcare System?  How do we change or build connectivity across the different siloed aspects of this chain?

I understand construction principles as I was the general contractor on my current home which was no small feat.  In this process you learn your foundation is core. This leads me to my latest passion and work that I believe is pouring the foundation for a revolutionary platform called PrimeDATACLOUD. This is a platform by which we enable clinical research. This is a platform by which we empower our providers who together treat millions of patients. This is a platform by which we can make patient data available longitudinally. This is a platform by which we enable outcomes and quality related analysis.  This is a platform by which we provide business intelligence tools. This is a platform by which we leverage data for predictive and decision support. And lastly, this is a platform which can be federated into other systems or platforms.

I started out this blog with a question about the attainability of a Learning Healthcare System. I answer my own question with a question: if a system provides value for everyone in its value chain why would that momentum not propel it into existence? While ultimately we would like to see this as a national model, I think this must be a community-led crusade to the top. I personally talk to and see many providers trying to figure out what is the first step toward a smarter healthcare system.  I think PrimeDATACLOUD is that first step. PrimeDATACLOUD is and will continue to enable patients, providers, payers, public health, and life sciences to listen, react, and change. Starting in communities like New York City, Carrollton, GA and Austin, TX, these PrimeDATACLOUD sites and communities will mature and multiply.

Dispatch from the National Beacon Community meeting

Tone S.

by Tone Southerland

I spent the last two days at the national Beacon Community meeting in Salt Lake City entitled “Meaningful Use of EHRs and Other Technologies to Achieve Measurable Improvements in Health and Care Quality.”

Part of the purpose of this meeting was to bring together EHR solution providers and Beacon Community leaders to discuss the advancement of health IT and care coordination. The breakout sessions were effectively orchestrated by encouraging open discussion on topics such as data extraction and normalization, creating effective feedback loops and collecting/integrating patient reported information.

Begun by the Office of the National Coordinator for Health Information Technology (ONC), Beacon communities are health systems showing advanced use and integration of EHRs and data sharing interoperability programs. There are 17 regional Beacon communities in the country today, supported by ONC funding. Greenway has been involved in their advancement and connecting providers to these communities for some time, and it’s an important project seeking further integration with similar programs to continue to advance patient care.

One of these merging initiatives is including Beacons within the recently created REC Community of Practice (CoP). This is a huge step in the right direction as the charters given to both Regional Extension Centers and Beacons often intersect. Through this CoP we will be able to further explore some key innovation areas.

Data extraction and normalization is the process of moving data from EHR systems to Beacon Community systems. In some cases Beacons have partnered with Health Information Exchanges (HIEs), in other cases they have built their own solutions to collect and process EHR data directly. Data extraction is further broken down into two parts: data modeling and terminology mapping. Data modeling is ensuring that disparate systems agree on the structure of data. Terminology mapping addresses issues of crosswalks between different vocabularies, which is significantly more challenging because vocabularies do not always have one to one maps and they also may represent different aspects of a particular data element. For example, NDC codes to the manufacturer whereas RxNorm codes to the dose form so there might exist multiple NDC codes to a single RxNorm code.

Achieving standardization of Clinical Decision Support (CDS) among EHR providers and Beacons is a significantly more challenging goal, but it is doable if we can align appropriately and look to utilize existing standards to address this. The key to success here is the separation of content and transport, meaning that how questions are asked and how answers are processed is separate from the questions and answers themselves. Such an approach will facilitate rapid implementation across both population demographics as well as medical disciplines. This has been addressed in both IHE and HL7 and standards are available, the challenge will be in implementing these standards before the Beacon grants expire in 18 or so months.

Lastly we need to continue to pursue a fail fast approach uncovering issues sooner rather than later. In the software development world we call this an iterative or agile approach. The sooner issues are found the sooner they can be incorporated back into the development process and addressed appropriately.

I applaud the Robert Wood Johnson Foundation for sponsoring this event as well as Beacon Community leaders and fellow Electronic Health Record Association (EHR Association) members for traveling across time zones, (on a time-change weekend no less) in interest of increasing collaboration between groups to ultimately achieve better patient care.

The Alphabet Soup of Health IT Standards

Tone S.

by Tone Southerland

As both a developer and implementer of healthcare IT standards the past several years, I have had the opportunity to build up quite a vocabulary of acronyms.

From talking to people within my company about what C32 actually stands for (It’s Component 32 per the Health Information Technology Standards Panel reference, with the organization better known as HITSP, or “HITSPY.”) to discussing clinical workflows and which interoperability standards are appropriate for which workflows, I am presented with the opportunity to mingle with both standards geeks and non-geeks alike. This variety of conversation requires that I maintain quite a vocabulary of acronyms and translations. A conversation with a fellow standards geek at Greenway might go something like this:

“Hey Todd, did you get the issues worked out with building the PCC XPHR document so that we can send it to the HIE via an XDS ITI-41 transaction? We’ll also need to run it through the NIST validator to ensure that it conforms to HITSP C32, C80 and C83 in addition to the underlying standards of CCD and CDA. And I still need to work with Miguel to ensure that the XDS pipeline will make a call out to the ATNA ARR using the TCP option. We will also need to review the WCF code that handles the TLS connection. Also, do you have any idea as to whether there is a use case to send this over RFD? After that we’ll need to look at the mappers for APS, XDS-MS and IC, and check to make sure the new CVX codes are in place for immunizations.”

Why do we even use acronyms? For starters they are catchy, fun to remember, and for the unaware they make us sound like we know a different language. On a more serious note, they actually help us to be more efficient workers. By shortening lengthy, hard to pronounce words to a few letters our minds are free to focus on higher priority tasks. While it is certainly more convenient to say ATM instead of automated teller machine or TV instead of television, it becomes almost required to use acronyms in the world of a software engineer. Similar to speed-reading where one comprehends groups of words instead of individual words, the use of acronyms allows engineers to achieve their goals faster. In the case of the speed reader the goal is reaching the end of the book. In the case of the software engineer it is delivery of a viable solution to the customer.

Below is an image of the word counts for the above quoted conversation both with and without acronyms used. In the acronym free version there are 53 additional words, 523 additional characters and seven additional lines. In percentages, that translates to 37 percent more words, 73 percent more characters and 70 percent more lines – that is a LOT of extra baggage! Think if this blog post was 37 percent longer. That means that if it took you two minutes to read this post with acronyms it would take an additional 44 seconds without the use of acronyms. This may not seem like a lot as a single instance and it is a rather short blog post, but when compounded over time seconds turn into minutes and minutes into hours. With the pace at which we move in today’s quickly changing healthcare IT landscape, these minutes and hours become extremely valuable.

Acronyms offer at a minimum added convenience in daily life and also increase our efficiency in professional life by freeing up our minds to focus on the important tasks at hand. As creators of software and services solutions, acronyms ultimately help us to innovate, create and deliver viable solutions for our customers.

Tone Southerland is a senior interoperability developer at Greenway. 

Live from National Health IT Week: One Voice, One Vision

Martina Clark

Justin Barnes

National Health IT Week commenced on September 11, 2011, and nearly 2,000 healthcare professionals and leaders descended upon Capitol Hill to discuss the future of the industry. Monday’s events began on Capitol Hill with the Institute for e-Health Policy Congressional Panel entitled “Implications of HIT for Patient Safety & Quality”. Greenway Medical Technologies was among the participants, and a very informative panel discussion was led by Justin Barnes, Vice President of Marketing, Industry and Government Affairs.  Among the topics of discussion were patient safety and quality as well as what needs to be accomplished from a legislative standpoint to address these issues.

U.S. Senator Kent Conrad (R-ND) also addressed the group to explain the necessary impact telehealth has on the patient safety and quality of his constituents’ care.  North Dakota and several parts of the nation are composed of rural areas, and many citizens must drive 100 miles or more to receive services. Healthcare professionals must take action to improve upon these inefficiencies and truly adopt interoperable technology at the core of their practice which will allow constituents access to better care coordination, leading to increased positive outcomes.

Tuesday began with the Capitol Hill National Health IT Week Press Conference at the House triangle. Among the speakers at this event was Congressman Phil Gingrey, M.D. of Georgia’s 11th District, a strong proponent for the adoption of health information technology who expressed the need for the EHR incentive program as a motivator for healthcare professionals to take necessary steps which will transform healthcare by improving population health and safety. Later that afternoon, Dr. Gingrey released public comments further noting his support, urging other Congressional members to follow suit and protect the EHR adoption funds through the Super Committee negotiation currently underway.

Several other Members of Congress spoke in support of health IT adoption and then that led straight into Justin Barnes’ statement at the podium as he announced the initiatives behind the Accountable Care Community of Practice (ACCoP). The Community of Practice is a consortium of healthcare IT leaders committed to collaborating on issues of mutual concern for the benefit of providers that are developing or planning to develop an ACO or accountable care strategy.