Tag Archives: Healthcare IT

Tapping real-time analytics to create a digitally enabled organization

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As a society, we can and are collecting data in many ways. The question is not how to get more data, but how to use it effectively?

By 2020, approximately 1.7 MB of new information will be created every second for every human being on the planet.1 That is an incredible amount of data!

Yet, of all the data the world is creating both personally and professionally, less than 0.5 percent of it is ever analyzed and used.2 Analyzing less than 0.5 percent leaves a lot of opportunity on the table.

Not just volume, connection and integration

Clearly, as a society, we can and are collecting data in many ways. The question is not how to get more data, but how to use it effectively? In healthcare, how do we capture greater knowledge from the right data at the right time for truly actionable insights?

Many healthcare organizations have started down the road to digital transformation by capturing more data from various service lines with different technologies and systems. However, that information is often captured and used within silos, which limits the impact. The true transformational change occurs when we put all of the data together – i.e., integrate the data, analyze and then share those insights across the organization.

Rapid analysis, insights and action

Better integrating and connecting data is, however, only one part of the equation. Insights from big data days, weeks, months or even years later limit our ability to make corrections and find opportunities for improvements. Speed to insights from the data is critical.

Technically, the data must be made available and analyzed in time to affect decisions. For example, near real time information is typically important for clinical care decisions. Once the data, analysis and insights have been generated, the individual making the decision needs to make that information part of the workflow and the decision-making process.

The digitally enabled organization

The organization needs to build trust in and adopt these new insights as tools to assist making the best decisions for each patient at the right place at the right time. This requires making the organization a digitally enabled organization.

The digitally enabled organization leverages experience, expertise and the best data-driven insights to make the right decisions, and operate most efficiently. The digitally enabled organization is agile and is enabled by the right insights at the right time. The digitally enabled organization drives the expansion of precision medicine, transforms the delivery of care and improves the patient experience.

Witness firsthand how digital agility and the digitally enabled organization can improve patient care and engagement. For example, organizations can create data-driven solutions to patient leakage challenges and rise to their operational opportunities. The result is optimal utilization and enhanced patient experience.3

Into the future

Achieving a digitally enabled organization lays a strong foundation to adopt new tools, ways of working and driving continuous improvement. This shift also allows the organization to incorporate predictive approaches and other advanced analytics that may include artificial intelligence. A layer of trust in insights creates a powerful data-driven culture that is transformative.

Can Apple Take Healthcare Beyond the Fax Machine?

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Can Apple Take Healthcare Beyond the Fax Machine?

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Despite spectacular advances in diagnostic imaging, non-invasive surgery, and gene editing, healthcare still faces a lackluster problem: many patients can only get health records from their doctor if the fax machine is working. Even when records are stored electronically, different chunks of every patient’s health information sit in the non-interoperable, inaccessible electronic record systems in different doctor’s offices.

Anyone who needs her medical files gets them either printed or faxed, or has to log on into separate portals for each doctor and hospital, and even then getting view-only access. View-only apps can’t access data to help patients share information with family and healthcare providers, make decisions, monitor disease, stay on course with medications, or just stay well.

On the positive side, this is changing, sort of. Using the iPhone Health app, patients will soon be able to download and view health records on their phones. On the one hand, don’t get too excited–it will initially only work for patients at a handful of institutions, Android users are still out in the cold, and the data available will be limited. And, some dismiss the impact of Apple’s move because of others’ failures to give patients control of their records.

However, Apple’s move is a decisive and consequential advance in patients’ struggle to get a copy of their own health data. Apple wisely chose to use open, non-proprietary approaches that will float all boats–even for Android users.

Every patient deserves a ‘bank account’ of her health data, under her control, with deposits made after every healthcare encounter. After my colleagues and I demonstrated an open, free version of a “bank account” to companies in 2006, Google and Microsoft launched similar personally controlled health records — GoogleHealth and Microsoft Healthvault. Walmart and other employers offered our version, Indivo, as an employee benefit. Unfortunately, even these industry giants couldn’t shake loose data from the proprietary computer systems in doctors’ offices, or make the case to patients that curating the data was worth the effort.

But 12 years later, Apple’s product enters healthcare under different circumstances.  A lot more patient data is electronic after a $48 billion federal investment in promoting the adoption of information technology to providers. But those products, mostly older software and purchased at enormous expense, still don’t promote record sharing with doctors or patients.

Recognizing this unacceptable limitation and having received a generous grant comprising a tiny fraction of that federal investment, our team created SMART on FHIR. SMART is an interface to make doctors’ electronic health records work like iPhones do. Apps can be added or deleted easily. The major electronic health record brands have built this interface into their products.

Apple uses SMART to connect the Health app to hospitals and doctors offices. The good news for patients, doctors, and innovators is that Apple chose a standardized, open connection over a proprietary, closed one. This approach lets any other app, whether running on the web,  iPhone, or Android, use that very same interface to connect.

So Apple will compete on value and customer satisfaction, rather than on an exclusive lock on the data. Does Apple’s approach help Americans trying to stay well or manage their conditions? Yes. But only with follow-through by Apple, health systems, technology companies, patient groups, policy makers, and government regulators. The emerging ecosystem’s nuances must be appreciated.

First of all, the floodgates for patient information are at least a crack open and will be very hard to close. As patients gain access to their data, they will recognize it is incomplete and feel frustrated it’s not available everywhere. But, patients in need will drive demand for data access in their role as health consumers.

Secondly, the government is effectively using law and regulations to compel an open interface. By selecting SMART on FHIR, Apple and its healthcare launch partners mark the importance of standardization. A uniform approach is critical for scale. Imagine if every electrical product required a differently shaped 120V outlet. Understanding this, Google, Quest Diagnostics, Eli Lily, Optum, and many other companies are using the same interface to plug into healthcare.

Thirdly, Apple’s first version of health records brings data onto the phone, but from there, like the portals many patients are already familiar with, the data are still “view-only.”  In 2009, I had the chance to meet with Apple’s rockstar Bud Tribble and talk about how the iPhone could serve healthcare. We concluded that crucial data–like the medication list–had to be as easy for iOS developers to use in their apps as contacts and location are now.  I would not be at all surprised if this is the next step in Apple’s journey–making the health records available to iPhone app developers. Here too is an opportunity to chose open interfaces, and to allow patients to export the data to another device.

Lastly, competition in healthcare IT is hot. Amazon, Google, Apple and Facebook all have healthcare divisions.  Apple’s extraordinary hardware, including sensors in the phone and watch, will monitor patients at home.  Google’s artificial intelligence will lead doctors and patients to diagnoses and decisions.  Amazon is rumored to be eying pharmacy management. Facebook has sifted through posts to detect and possibly intervene when users may be suicidal.

There are so many opportunities to compete. Locking up a patient’s data should never be one of them.

CapEx vs. OpEx

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Quick strategy question: If you could start from scratch and implement Microsoft Outlook by cutting a fat check to acquire the software and hardware to run it on-site, and then foot the bill to maintain both, would you really sign-off on that rather than simply subscribing to a cloud-based email service and letting someone else take care of the maintenance and upgrades?

That answer is a resounding ‘unlikely.’

Black Book, in fact, found that 92 percent of hospital C-suite executives believe that cloud shifts the IT cost burden from capital expenditure to operational expenditure with positive results. Doug Brown, Black Book Managing Partner, pulled that from research the firm conducted for its upcoming 2018 Health IT Trends report.

“Moving software purchases to a cloud model and the resulting flexibility in how a healthcare organization can account for these tools as an OpEx versus a CapEx is one of the many advantages that the cloud has brought to organizations,” Brown said.

Cloud: Here today and to stay

Cloud computing is not the next big thing, it’s already here and at this point moving to the cloud model is largely being driven by end users and tech shops. And that is creating something of a mess. Symantec researchers found that at the end of 2016, enterprises in various industries had 926 cloud apps in use, up from 841 the year before, but top executives estimated that number to be between 30 and 40 apps.

“The ultimate decision often comes down to the CIO,” said IDC Health Insights Research Director Mutaz Shegewi.

That poses its own set of problems, notably that some CIOs want to keep their data on-premise for fear of losing hold over it or are concerned about the larger value IT provides as a department when pieces of its role can be outsourced to the cloud, Shegewi said.

“Increasingly and with time, I have seen resistive CIOs give in and even advocate for the switch once they understand the value and benefits that could be brought about by the cloud, especially around security and vulnerability,” Shegewi said.

Therein lies the opportunity for forward-thinking finance executives to help lead their IT counterparts toward the cloud and its OpEx cost advantages. Who better to spearhead that migration?

Former hospital CFO Kim Lee, who is now COO at Faith Community Hospital in Wichita Falls, Texas, ranked the cloud model’s positive points as lower upfront costs and shorter implementation time as well as upgrades managed for customers, and less of a support burden on the IT team. She added to that list with easier remote access and connecting to apps, as well as improved security management.

Lee said that Faith Community Hospital as an organization, in fact, recommends certain cloud-based apps to its user base.

“We find cloud apps are less likely to experience security issues compared to utilizing a third-party vendor who may have to go through an interface process to talk to the software,” Kim said. “It takes out the middleman approach and the mobility support is provided by your software vendor.”

And with Black Book predicting that 57 percent of hospitals with 200 or more beds will pair back, if not freeze altogether, CapEx investments in IT during 2018 and the same goes for 85 percent of hospitals with fewer than 200 beds, now is the time for finance teams to get more involved in cloud decisions by working closely with the CIO and other technology leaders.

That’s not to suggest everything should be moved into the cloud strictly for the sake of OpEx, of course.

CapEx vs. OpEx considerations

Northwell Health CFO Michele Cusack works with the IT department to help make choices about what to put in the cloud and what should really stay on-site.

Cusack said it’s important to evaluate which systems can better fuel the overall mission on-premise or do so in the cloud. Certain applications, like email, commodity and productivity apps, are a good OpEx fit.

Software that houses sensitive patient data, on the other hand, requires more careful consideration before transitioning that out to the cloud, if at all.

Northwell is now in amidst a shift to the cloud for its human capital management system, for instance, and it subscribes to other key applications running in private clouds.

“We look at the overall savings by comparing the monthly fees to the upfront capital costs, the potential reduction or elimination of certain on premise IT infrastructure, the cost benefit of seamless future upgrades to systems, and the cost benefit of being able to scale resources quickly in response to demand,” Cusack explained.

Lee added to that list of aspects to account for when tapping into the cloud for apps or bigger software services.

“A few of the top considerations when choosing a cloud-based software is reviewing your contract to ensure there are procedures in place for internet downtimes, procedures for access to facility records long-term, certification of compliance with HIPAA, Security Risk Assessments and PHI, processes in place to accommodate your back up requirements and adequate planning prior to implementation and timely notification for new software releases,” Lee said.

CFO as the new cloud champions

Cusack and Lee are not the only CFOs reaping the cloud’s OpEx advantages.

Seventy-two percent of the finance chiefs Black Book polled reported that IT spend as a percentage of operating expenses in their organizations increased at least 50 percent since 2015’s study.

“In current economic times with most organizations in the pursuit of maintaining a lean balance sheet to preserve cash flow, the cloud migration decision is appropriately led by the Chief Financial Officer,” said Doug Brown, managing partner of research firm Black Book. “It shouldn’t be a CIO’s job to determine CapEx or OpEx or the benefits of accounting for technology investments as an operational expense versus a capital expense.”

 

Health-Care Transactions Update: Deals Significantly Up in Third Quarter

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Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

July, August, and September have been the most active deal months in 2017 so far, with over 299 recorded deals. That can be contrasted with the same quarter in 2016, during which only 167 deals were recorded, making it the slowest quarter that year.

The three most active sectors in summer 2017 were long-term care, health-care information technology, and physician practices, as strategic and financial buyers continued to actively shop for assets. The much-discussed market uncertainty—stemming from the political environment, regulatory uncertainty, and other factors—doesn’t seem to be hindering transaction activity.

Long-Term Care Has Been Most Active

Long-term care, including home health, continues to outpace the industry, with 215 transactions year to date. The sector remains attractive for many investors looking to position their portfolios for future growth, predominantly due to demand fundamentals such as an aging U.S. population and shifting preferences of seniors.

It is estimated that 10,000 U.S. residents turn 65 each day, adding to an already sizable population demographic that historically utilizes the vast majority of health-care spending. In particular, as the U.S. health-care system increasingly places emphasis on efficient outcomes and lowering cost of care, long-term care will offer a critical value proposition as an effective means of reducing the number of acute-care hospital visits and maintaining the overall health of seniors.

Of note in the third quarter was BlueMountain’s $700 million purchase of skilled nursing and assisted living assets from Kindred Healthcare. Continued interest and heightened activity are expected in this sector.

Physicians Have More Buyer Options for Transactions

Historically, large independent physician networks looking to partner with either a strategic or financial sponsor were limited in their options—mainly larger physician groups and local health systems. The landscape has quickly evolved as more organizations are seeing the value in controlling large patient populations.

Private equity buyers and insurance giants are increasingly interested in physician groups and are willing to purchase partial or complete interests at a premium. In the third quarter, Ares Capital invested $1.45 billion in DuPage Medical Group, a multi-specialty practice in Illinois previously owned by the private equity group Summit Partners.

Financial sponsors see an opportunity to leverage size and scale through acquisition and de novo growth, to increase patient populations and capture added revenues in a changing reimbursement environment. In April, Optum, a subsidiary of UnitedHealth Group, purchased American Health Network, a 300-physician practice in Indiana for $184 million. The insurer’s strategy is to control the delivery and cost of health care in all settings outside of the hospital.

Strategic buyers such as hospitals continue to actively recruit independent physicians, but are increasingly disadvantaged when forced to compete with the deep pockets of private equity investors and large insurers. Further compounding the problem for hospitals are the fair market value requirements that, by regulation, limit physician compensation options.

The single specialty provider space has experienced some of the highest activity in all of health-care services. With over 100 single specialty practices completing or announcing a transaction so far in 2017, independent physician groups are viewing an active mergers and acquisitions marketplace as an opportunity to secure future growth and viability.

A growing shift away from a hospital setting has increased the negotiating power of private practitioners and many are turning to private equity partners as a way to further increase their geographic footprint through aggressive growth strategies.

More and more groups are expected to pursue partnership and sale options as physicians continue to witness these large transaction values.

Size Is Attractive for Hospital Buyers

Bigger isn’t always better, but when it comes to hospital transactions, there is a market for sizable assets. In this quarter, Ascension Health, the country’s largest health system, emerged as the buyer of the struggling Presence Health in the Chicago area.

Despite Presence’s poor operations, it was able to align with a financially strong provider because it offered immediate scale in the Chicago market. With this transaction, Ascension, through its Amita Health joint venture with Adventist, vaulted up the market-share list from number four (8.1 percent) to number one (18.8 percent), according to Presence Health’s 2016 official statement. Acquiring and maintaining strong market share will continue to be a significant driver of financial success, thus the opportunity to immediately acquire scale through an acquisition will always be attractive.

Health-Care IT Remains Active

For many years, experts have thought that technology would be the key to driving value (high quality at a low cost). The activity in this space demonstrates the truth of that belief as there have been 133 transactions year to date. Notably, large private equity players have been active.

Clayton, Dubilier & Rice Inc., a private equity firm, acquired Carestream Dental in the third quarter, purchasing the dental imaging and practice management company with an eye toward growth, and expecting to leverage the technological expertise to grow the business.

Final Thoughts

While the summer months remained active, we believe the market will stay strong through the end of the year. Activity spawns more activity, and sellers are undoubtedly attracted to the high valuation multiples offered by buyers with tremendous access to capital and few investment options more attractive than health care.

84% of Execs: Artificial Intelligence Will Transform Healthcare

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Artificial intelligence in healthcare

Artificial intelligence has the potential to completely revolutionize the way healthcare systems interact with their patients.

More than 80 percent of healthcare executives polled by Accenture believe that artificial intelligence is on track to completely revolutionize healthcare, and a similar number believe that the advent of machine learning and digital healthcare is driving a significant restructuring of industry economics.

“AI is the new UI,” proclaims the report. “It’s a new world where artificial intelligence is moving beyond a back-end tool for the healthcare enterprise to the forefront of the consumer and clinician experience.”

“AI is taking on more sophisticated roles, with the potential to make every technology interface both simple and smart – setting a high bar for how future interactions work.”

The report envisions a healthcare environment where AI can take over the majority of processes currently overseen by humans.  Consumer relations and patient engagement are likely to be among the first tasks to undergo the shift.

Eighty-four percent of executives believe that AI will fundamentally alter how they gain information from patients and interact with consumers.  A similar number have prioritized the implementation of centralized platforms that take advantage of messaging bots and other services.

More than three-quarters believe that these decisions will make or break their ability to develop a competitive advantage over their peers in the near future.  Eighty-two percent agree that industry leadership will be defined by how well healthcare organizations architect comprehensive, seamless digital ecosystems that truly understand what motivates the choices of their patients.

“The new frontier of digital experience is technology specifically designed for individual human behavior,” the report asserts. “Healthcare leaders recognize that as technology shrinks the gap between effective human and machine cooperation, accounting for unique human behavior expands not only the quality of the experience, but also the effectiveness of technology solutions.”

 

A Surprising Place to Find Anti-Kickback Rules

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Some aspects of EHRs, telemedicine might technically be illegal.

Federal anti-kickback laws may be old, but they’re still relevant, even with something very modern like health information technology (IT), Scott Grubman, JD, said here Thursday at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

“So much technology in the healthcare space is to facilitate referrals,” such as when one provider transmits information to another, said Grubman, an attorney at Chilivis, Cochran, Larkins & Bever, in Atlanta. “If those referrals wind up being reimbursed by a federal healthcare program, a company can violate the anti-kickback statute.”

An 82-Year-Old Law

The anti-kickback statute, a version of which was first passed in 1935 and has been amended several times since with the introduction of Medicare and Medicaid, prohibits anyone from “knowingly and willfully paying, offering, soliciting, or receiving remuneration” in return for referring patients to services that are paid for by Medicare, Medicaid, and other federal healthcare programs.

The statute not only prohibits payments to providers, but also prohibits remuneration to beneficiaries, which means services like telemedicine and electronic health records (EHRs) might also be involved, Grubman noted.

Although the government says it wants to encourage technology growth in healthcare, “unfortunately sometimes what they don’t realize is that regulations that have been on the books for years — and are still applicable — don’t mesh well with the explosion of healthcare technology.”

There are two ways technology could be implicated in violations of the anti-kickback rule, he continued. The first way is if technology is being given to a provider to be used to actually issue the referrals that are implicated in the act — in bygone days this would mean if physicians are given fax machines to fax referral orders for which they get bonuses.

“There is lots of guidance [in the rule] that’s related to fax machines, so we have to figure out how to apply [the fax machine guidance] to the provision of tablets or electronic health records [to doctors],” he said.

The second way is if a technology that is used in any way to facilitate referrals — such as to provide the medical information to justify a referral order. “So if there’s technology that can facilitate a referral between a physician and a hospital, or between a hospital and pathology lab, that technology potentially implicates the anti-kickback statute.”

The Digital Snake Oil of the Early 21st Century

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Sticks and stones and snake oil: What will inform next chapter of healthcare IT development?

Digital Hospital

Name calling often gets attention, but it rarely solves problems. So when the CEO of the American Medical Association, Dr. James Madara, recently called healthcare IT “the digital snake oil of the early 21st century,” his words were widely reported, though not uniformly praised.

His inflammatory analogy aside, Dr. Madara had a valid point: many physicians are indeed incredibly frustrated with the majority of healthcare IT solutions. What’s more, the usability improvements that Dr. Madara called for are completely reasonable and appropriate.

No other industry on Earth has accepted lower productivity and efficiency as a result of computerization. Do accountants spend more time doing a company’s books using computers than they did by hand? Of course not. Or imagine Netflix subscribers spending twice the amount of time trying to navigate the on-screen interface than it would take to simply pop in a DVD or drive to the local theater. Consumers simply wouldn’t deal with it.

50 things to know about Epic and Judy Faulkner

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With roots dating back to 1979, Epic Systems has become a major player in the health IT world.

The vendor has achieved this status without going public, and without significant marketing efforts.

Epic is one of the biggest EHR providers for hospitals and health systems nationwide. As of March 2015, it was the third most commonly used EHR among hospitals and health systems participating in meaningful use, according to data from CMS. Additionally, a September KLAS report found Epic was one of just two vendors that did not lose any clients in 2014 (athenahealth was the other).

Here are 50 things to know about Epic Systems and the woman behind it all.

DirectTrust predicts the end of Meaningful Use

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Interoperability, “freed” health data, patient engagement and data security among trends to watch in 2016