Latest Articles & News
- Social Gamification – the next big thing in HealthcareMay 20, 2013 | Posted By: Sandeep Kutcharlapati
Gamification typically involves applying game design ideas to non-game applications to make them more fun and engaging. . When this principle is combined with social gaming, the results can have a promising impact on improving patient health. It might also result in a game-changing new market to battle for. (The US social gaming market is expected to be worth five billion dollars by 2015.)
Studies suggest that gamification is a powerful tool to influence behavior when games are provided with social networking features like sharing results and viewing others’ achievements. A recent paper by Juho Hamari of University of Tampere, Finland on a 1.5-year experiment is one example. Results show that the mere implementation of gamification mechanics does not automatically lead to significant increases in user activity in the studied utilitarian service, however those users who actively monitored their own achievements and those of others in the study showed an increased user activity.
Though social gamification in the healthcare industry is relatively new, there are companies that have already launched applications/games to influence user behavior. Health insurance providers were among the first to explore social gamification followed by many startup firms:
1. OptumizeMe is an app launched by UnitedHealth Group that allows users to participate in fitness contests with social networking features.
2. MeYou Health is developed by Healthways, another insurance provider. It has a rewards program for people who complete one health-related task a day.
3. GymPact uses GPS to track its users’ visits to the gym. Users who meet their workout goals win cash, much of it from GymPact members who pay penalties for failing to exercise as promised.
4. Fitbit, markets wireless tracking devices that sync to smartphones and computers using which users can track their steps, stairs climbed and sleep.
5. Fitocracy is a social network where people can track their workouts, challenge friends to fitness contests and earn virtual rewards for meeting their goals.
However, the path isn’t straightforward for these firms; one thing all firms must look out for is patient privacy. All firms that provide patient care (hospitals, insurers etc.) are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to protect personal health information for all their patients. However, the rules for other companies that don’t provide direct patient care are much fuzzier.
In conclusion, social gamification industry is a new idea with a significant growth potential. It could help lower healthcare costs in the future as the industry matures and consolidates.
- Top 5: Publicly-Available Health Information DatabasesMay 10, 2013 | Posted By: Miao Zhang
As a recent research shows, patients benefit from proactively accessing to their own health information in EHRs or other web portals. By having better communication and understanding for their own health conditions, empowered patients with easier access to personal health information and better understanding about healthcare can participate in their own care; this is also thanks to the PCC (Patient-Centered Care) initiatives championed by AHRQ and thus adopted by their healthcare providers. With the increasing quantity and improved quality of data available, researchers can develop deeper insights using these invaluable online resources.
We have identified five online health information databases we find especially useful and encourage our readers to explore these easily available services.
Sponsored by AHRQ (the Agency for Healthcare Research and Quality), HCUP stands for Healthcare Cost and Utilization Project, a family of healthcare databases and related software tools/products. This project is made possible by a Federal-State-Industry partnership. A multi-state, multi-year health data system set up to enhance healthcare research and decision making, it consists of databases with detailed inpatient and outpatient data from the national and state-level, and includes various payers (e.g, Medicare, Medicaid, private insurance or even uninsured), some of databases even include data for the years back to 1988. For these databases, AHRQ also developed free, cross-functional software tools that can be used both for the below listed databases and other administrative databases. Click here (under “Software Tools”) to download.
Here is a table summarizing the purchase method of these databases.
- Nationwide Inpatient Sample (NIS): Started in 1988, this is the largest all-payer inpatient care database in the United States. The NIS contains data from approximately eight million hospital stays from roughly 1,000 hospitals; this amounts to nearly a 20-percent stratified sample of US community hospitals. The data can be purchased through the central HCUP distributor, but the participating states vary by year.
- Nationwide Emergency Department Sample (NEDS): The NEDS started in 2006 and is the largest all-payer ED database in the United States. It was constructed using records from both the SEDD and the SID databases mentioned below to capture information both on ED visits that do not result in admission/hospitalization and on ED visits that result in an admission to the same hospital. The NEDS contains more than 25 million unweighted records for ED visits at about 1,000 US community hospitals and approximates a 20-percent stratified sample of US hospital-based EDs. The data can also be purchased through central HCUP distributor.
- Kids’ Inpatient Database (KID): the only all-payer inpatient care database for children in the United States, KID data covers the years 1997, 2000, 2003, and 2006. The 2006 KID contains a sample of over three million discharges for children age 20 and younger from more than 3,500 US community hospitals. The data can be purchased through central HCUP distributor, but as with NIS the participating states and discharges can vary by year.
- State Inpatient Databases (SID): Started in 1990, currently 44 states participate in this database. It claims to encompasses 95% of all US community hospital discharges. Some states’ data have been broken down to specific categories such as pediatric institution or state county. Most state data can be purchased through central HCUP distributor.
- State Ambulatory Surgery Databases (SASD): Started in 1997, currently 29 states participate in this database. The SASD contains data from ambulatory care encounters in hospital-affiliated (and sometimes freestanding) ambulatory surgery sites. Most state data can be purchased through central HCUP distributor.
- State Emergency Department Databases (SEDD): Started at in 1999, currently 29 states participate in this database. The SEDD contains data from hospital-affiliated ED abstracts for visits that do not result in hospitalization. Some state data can be purchased through central HCUP distributor.
Name Start Year Purchase Method Nationwide Inpatient Sample (NIS) 1988 Through central HCUP distributor (participating states vary by years) Nationwide Emergency Department Sample (NEDS) 2006 Through central HCUP distributor Kids’ Inpatient Database (KID) 1997 Through central HCUP distributor (participating states vary by years) State Inpatient Databases (SID) 1990 Through central HCUP distributor State Ambulatory Surgery Databases (SASD) 1997 Through central HCUP distributor State Emergency Department Databases (SEDD) 1999 Through central HCUP distributor (Some state stats are not available for purchase)
Started in 1996, MEPS stands for the Medical Expenditure Panel Survey, which is a set of comprehensive national surveys of families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.) and employers across the United States. MEPS collects data on the cost of specific health services that Americans use, how the services are funded and reimbursed, and also how frequently the services are used. The database also included cost, scope and breadth of individual medical insurance plans available to US workers.
MEPS includes two major components: the Household Component (HC) and the Insurance/Employer Component (IC). The HC uses questionnaires to collect data from individual household members and extrapolates nationally representative data based on demographic characteristics, health conditions, health status, medical care usage and satisfaction, health insurance coverage, income and employment status. Currently projected until year 2016, HC data are available to the public in data tables, downloadable data files (person, job, event, or condition level), interactive data tools for query, as well as in publications.
For the IC, also known as the Health Insurance Cost Study, MEPS collects data from a sample of private and public sector employers on the health insurance plans they offer to their employees. The collected data includes the number and types of private insurance plans offered (if any), contributions by employers and employees to premiums, eligibility requirements, benefits associated with the plans, as well as employer characteristics. Like HC data, IC estimates are available on the MEPS Web site and in publications using IC data and interactive data tools. IC data are also arranged in tabular form for national, regional, state, and metropolitan areas; However, IC data files are not available for public release.
MEPS HC data also includes a Medical Provider Component (MPC. In 1996 MEPS included a Nursing Home Component (NHC).
Made available by Medicare.gov, Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. From this website, a visitor can get a snapshot of the quality of hospitals in their local area as well as nationwide data for the following six aspects:
- Timeliness and effectiveness of care: how often and how quickly each hospital adopts new treatment recommendations for medical conditions like heart attack, heart failure, pneumonia, children’s asthma, and also for surgical patients.
- Readmissions, complications and mortalities:
- Readmission rates and 30-day mortality rates for conditions such heart attacks, heart failures and pneumonia.
- The likelihood that admitted patients will suffer complications.
- The frequency that patients get conditions that are preventable by adopting best practices.
- Medical imaging usage: use of tests like CT scans and MRIs.
- Patients experience surveys: recently discharged patients responses to a national survey about their hospital experience, e.g, how quickly hospital staff responded to their needs.
- Number of Medicare patients: how many patients with Medicare insurance have been treated for certain conditions or diagnoses in each hospital. This does not include critical access hospitals because of their different payment methods.
- Medicare payment: how the hospitals are paid by Medicare.
4) Health Indicators Warehouse (HIW)
The purpose of this website is to provide a single, user-friendly source for national, state and community health indicators. It also serves to meet the needs of multiple initiatives headed by different agencies such as HHS (the Department of Health and Human Services), HRSA (Health Resources and Health Administraion) , facilitate the standardization of the indicators (i.e, there will not be overlapping indicators with the mere naming differences) among the initiatives and also to link indicators with initiatives. As a data hub for HHS (the Department of Health and Human Services), it also encourage innovative data applications and catalyze changes to bring about community health improvement.
Currently, this data warehouse includes 1,204 indicators from five major sources:
- Robert Wood Johnson Foundation/University of Wisconsin Population Health Institute’s County Health Rankings.
- Community Health Status Indicators, a joint venture from HRSA (Health Resources and Health Administraion), CDC (Centers for Disease Control and Prevention), NLM (National Library of Medicine), PHF (Public Health Foundation).
- Healthy People 2020 from HHS.
- CMS (Centers for Medicare & Medicaid Services) indicators (a set of community-level, Medicare utilization, sociodemographic, patient safety and quality indicators).
- Additional indicators as determined by the HHS Interagency Governance Group.
Aimed to provide summary data at a variety of geographic levels and for different populations, HIW indicators are constructed from individual-level data obtained from other governmental and private initiatives, and are presented at an aggregate level.
Started in 2008, HEDIS has been used to measure performance on care and services by more than 90% of America’s health plans. Developed by NCQA (National Committee for Quality Assurance) , HEDIS consists of 75 measures across eight domains of care:
- Asthma medication use
- Persistence of beta-blocker treatment after a heart attack
- Controlling high blood pressure
- Comprehensive diabetes care
- Breast cancer screening
- Antidepressant medication management
- Childhood and adolescent immunization status
- Childhood and adult weight/BMI assessment
HEDIS encompasses many health plans with clear, confusion-proof definitions and prides itself for enabling “apples-to-apples” comparisons for consumers, employers and health providers. To ensure the accuracy of the data, NCQA has established a process to update the dataset each year. Notably NCQA has already started to incorporate the ongoing ICD-9 to ICD-10 conversion into HEDIS.
- Unique Device Identification (UDI)May 3, 2013 | Posted By: Alex Hur
The Unique Device Identification (UDI) System for medical devices was created and signed into law in 2007. The system came about after a study determined that tens of thousands of deaths each year were due to preventable medical errors. More accurate and prompt identification of problems would enable more rapid action to reduce the incidence of the adverse events. Public health safety alerts, for example, could be more accurate and timely, and recall actions could more effectively target the problem device. The increased accuracy of adverse medical device reporting and improved recalls should reduce the total number of adverse medical device events.
Under the UDI system, most medical devices will bear a unique label/identifier containing a host of data that will reside in an FDA database. The objective is to help device makers: help them to have better inventory control, save on regulatory costs and develop better products. The FDA also hopes that this system will improve patient safety and help in recall efforts. The program will require firms to submit product and usage information to an FDA database, so having consistent data about a product is crucial.
- The label of a device will bear a unique identifier
- The identifier will be able to identify the device through distribution and use
- The identifier will include the lot or serial number specified by FDA
- Manufacturers can keep track of when and how devices are used. Also, if devices with a UDI are captured in the medical record, providers will have a better understanding of how the products are used, leading to a more efficient purchasing process.
- Device makers will have improved inventory control and therefore a lowered rate of expired products.
- Cost savings should occur as internal processes are standardized.
- Data captured will assist experts in evaluating health outcomes related to various devices. This information can be leveraged to conduct research and development.
A UDI system will create a common database for reporting and tracking devices. It will enable the FDA to assist in identifying problems with defective products while also improving overall patient care (e.g., improving the recall process). The final rule regarding the development of UDI regulation is due by 6/2013 while the timeline of UDI implementation activities are as follows:
- 6/2013 – GUDID Available for Submission
- 1 Year (6/2014) – Deadline for Class III devices in Global UDI Database (GUDID) (Includes High Risk Implants and life sustaining)
- 2 Years (6/2015) – Deadline for Class II Implants and Life Supporting/Life Sustaining in GUDID
- 3 Years (6/2016) – Deadline for Rest of Class II devices in GUDID
- 5 Years (6/2018) – Deadline for Class I devices in GUDID
- Health Decision Systems: Unleashing Data and Creating JobsApril 26, 2013 | Posted By: Emily McPherson
Earlier this week Matthew Yglesias covered research presented at last week’s 2nd Forum of the European Society for Radiotherapy and Oncology; the findings suggest that some mathematical models could be better than doctors at predicting patient outcomes and responses to various treatments. In turn Mr. Yglesias hypothesized that advances in the area of algorithmic diagnosis could lead to job growth in related areas of nursing and that this would be a very positive development given the relative decline in America of middle-skill occupations. However he cautioned that states must first relax “scopes of practice” so that nurses would be allowed to order and carry out the treatments proposed by the mathematical models.
“Unleashing Data to Transform Healthcare” was a theme of last year’s Workshop on Health IT and Economics (WHITE). Panelist Joshua Rosenthal reminded us that health start-ups, some of which might aim to bring about the above-mentioned algorithmic advances, tend to fail at a very high rate. (They have also failed to attract significant venture capital investment.) Dr. Rosenthal predicted that savvy start-ups would take advantage of new incentives and support coming from the Centers for Medicare & Medicaid Services (CMS). An example of this could be the Office of Information Products and Data Analytics, CMS’s recent creation which is charged with coordinating and facilitating the use of CMS data by internal and external parties.
WHITE 2013 is scheduled for November 15-16.
- Survey finds Industry not yet ready for ICD-10 transitionApril 19, 2013 | Posted By: Sandeep Kutcharlapati
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a revision of the ICD-9-CM system. Physicians and other providers use this system to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care in the US. The ICD, which is published by World Health Organization (WHO), uses alphanumeric codes to identify known diseases and other health issues. According to the WHO, the ICD helps with the storage and retrieval of diagnostic information and also in the compilation of national mortality and morbidity statistics. The ICD-10-CM revision has more than 68,000 diagnostic codes, compared to the 13,000 found in ICD-9-CM. The revision also includes twice as many categories and it introduces alphanumeric category classifications.
The US was initially set to begin the use of ICD-10 in October 2013. In early 2012, the Department of Health and Human Services announced its intention to delay the compliance deadline to an unspecified date; the date was later set to October 1, 2014. As the deadlines approach, it appears that the industry is not yet ready for the transition.Read the rest of this post
The Workgroup for Electronic Data Interchange (WEDI) announced last Thursday that it had submitted its ICD-10 industry readiness survey report to the Centers for Medicare & Medicaid Services. Its findings continue to show insufficient readiness for the October 2014 transition deadline. Participation in this latest survey included 974 respondents consisting of 778 providers, 87 vendors, and 109 health plans. The ICD-10 survey questions are aimed mostly at status, rather than approaches to compliance. They parallel those in the February 2012 survey to facilitate a direct comparison. Results suggest there’s been a shift in project timelines. The survey shows that factors contributing to this slow progress include the change in compliance dates, competing internal priorities and other regulatory mandates.
Other findings from the report:
• Nearly half of health plans expect to begin external ICD-10 testing by the end of this year.
• Roughly half of the providers polled said they didn’t know when testing would occur.
• More than two-fifths of them said they did not know when they would complete their impact assessment and business changes.
• As for vendors, some two-thirds said they planned to begin customer review and beta testing by the end of this year – roughly similar to the number who expected to begin by the end of 2012 in the prior survey.
WEDI will continue to conduct surveys throughout 2013 and 2014.
- The Patient Engagement Index from Axial Exchange, a New Measure of Patient-Centered CareApril 12, 2013 | Posted By: Miao Zhang
On April 4th, Axial Exchange, a health IT company based in Raleigh, North Carolina, launched its PEI (Patient Engagement Index), a ranking of major hospitals in Florida. Rankings for hospitals in other states will release in upcoming months. Among the 74 hospitals ranked, the top three are also the only ones with scores in the 80s on a 0-100 scale. They are: Parrish Medical Center (89), Palmetto General Hospital (88) and Hialeah Hospital (87). 18 hospitals were assigned the “best” badge, while the worst-ranking hospitals trailed at around the 30s.
By Axial’s definition, patient engagement is “the process by which patients become invested in their own health.” With an effective patient engagement component embedded, health systems will provide patients with the information and tools needed to make informed decisions about their care.
The PEI consists of three major metrics:
- Personal Health Management (maximum 50 points) is based on how health systems allow patients electronic access to their data as well as resources needed for daily disease management. According to Axial’s standard, the best health systems offer the tools “via the device of the patient’s choice,” be it desktops, tablets or smartphones. The source data is gathered from public websites and mobile applications. The rationale behind this metric is straightforward; as the official blog notes, “How can patients engage in their health care without the information to understand what is going on with their health and the tools to manage progress against health goals?”
- Patient Satisfaction (maximum 25 points) is measured by an annual CMS (Centers for Medicare & Medicaid) patient survey, HCAHPS (Hospital Consumer Assessment of Health Plans Survey). HCAHPS is a standardized measuring instrument for patients’ perspectives on hospital care and is endorsed by the NQF (National Quality Forum). The rationale for this metric, also noted in the Axial blog, is based on a study which demonstrated that higher patient satisfaction via the HCAHPS survey is associated with improved guideline adherence and lower inpatient mortality rates.
- Social media engagement (maximum 25 points) measures the extent to which existing health systems get communities involved via social media sites. Systems ranked best are ones that actively reach out to a large audience with positive views toward the systems. Research has shown a high correlation with lower readmission and mortality rates for hospitals with more than five user ratings on Yelp.com, a popular consumer-rating website.
As one of the first-ever rankings to include patient engagement, this index is a significant innovation of measurement and evaluation of healthcare quality. For 23 years, US News & World Report has produced its popular, hospital rankings without taking patient satisfaction into account. Moreover, widespread internet access has enabled consumers to consult others’ opinions and facilitates transparent information exchange. In January 2013, the NeHC (National eHealth Collaborative) unveiled its Patient Engagement Framework, which provides a path to improving quality and outcomes through patient empowerment.Read the rest of this post
All this echoes with PCC (patient-centered care), which empowers and enables patients to impose their will and values throughout the healthcare decision-making process, thus effectively facilitating information exchange amongst patients, healthcare providers and other stakeholders.
Patient satisfaction and engagement in payment reform have a combined 30% weight in the score of Medicare’s new VBP (Value-Based Purchasing) program. As an innovative indicator measuring these two elements, PEI uses measurement and evaluation tools to quantify the efforts toward PCC (patient-centered care):
- For hospitals: top PEI ranking can highlight successful patient-facing initiatives, while lower ranking can incentivize institutions to learn from best-practices from their peer hospital and boost efforts at involving patients more fully in their own care.
- For patients: the PEI ranking can indicate those hospitals that are most likely to support them in their aftercare and choose hospitals accordingly.
- For other stakeholders: the PEI ranking can better inform them of the hospitals with better quality of care and aftercare. With better knowledge of patients’ health, the related stakeholders and communities can strive to reduce the uncertainties and risks after patients have returned the communities.
The creation of the PEI responds to the need arising from a growing awareness of patients’ own efforts and initiative to self-manage, but the usefulness of this instrument remains to be seen. As a first attempt to gauge the patient engagement, the PEI has the potential to be a useful tool to measure an important element of PCC (Patient-centered Care).
- The HITECH ActApril 5, 2013 | Posted By: Alex Hur
Affordable Care Act – HITECH Act
The $19.2 billion Health Information Technology for Economic and Clinical Health Act (HITECH Act) that was signed into law in 2009 seeks to improve the quality of our healthcare system and patient care while lowering its costs through an investment in Health IT: computerizing all of America’s medical records. The goal is to cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. To help accomplish this goal, the Act has created a system of incentives to encourage practices to implement electronic health records (EHRs). Providers who demonstrate “meaningful use” of a “certified” EHR will be eligible to receive incentive payments of up to $44,000 from Medicare and $65,000 from Medicaid per individual physician to help cover the cost of EHR adoption.
- The bulk of spending in the Act, which is more than $17 billion, goes towards incentives for hospitals and healthcare professionals to encourage the widespread adoption of EHRs.
- It also includes $2 billion to support health IT infrastructure, loans, research, training, and education.
- $2 billion to the Office of the National Coordinator for infrastructure necessary to allow the electronic exchange and use of health information for each individual in the United States.
- $1 billion for renovation and repair of health centers and for the acquisition of health IT systems.
- $300 million to support regional efforts towards health information exchange.
- $40 million to be used by the Social Security Administration to use EHRs to submit disability claims.
The HITECH Act also includes several new security provisions such as: requirements to notify patients and HHS of security breaches of “Protected Patient Information,” new Health Insurance Portability and Accountability Act (HIPAA) regulations regarding business partners and enforcement of penalties, ensuring that patients have access to their electronic health information. The HITECH Act also requires the National High-Performance Computing Program to coordinate federal R&D programs related to the development and deployment of health IT, including activities related to computer infrastructure and data security.
Some advantages of the incentives in Act regarding EHRs and cloud computing are:
- Costs, labor and capital expenditures may be reduced.
- Users can access applications using a web browser regardless of their location.
- Data is managed off-site, which makes it suitable for business continuity and disaster recovery.
- Security is often better because vendors can spend more money, resources, and time, specifically protecting patient information with standards that live up to HIPAA Security standards.
Some disadvantages include the investment that is required to implement cloud computing technology. To implement and sustain EHR infrastructure will require an extensive IT network with servers and abundant storage. A major risk that is currently being debated stems from how HIPAA and patient data will be regulated and enforced in the “cloud.” This security risk is a major issue in the transition to a cloud-based health care system. Revised HIPAA rules under the HITECH Act have extended the requirements for providers to secure “Protected Patient Data.”
Overall, this mandate will benefit our society and the health care industry by providing accurate, up-to-date, and complete information about patients at the point of care, enabling quick access to patient records for more coordinated efficient care, helping providers to diagnose patients, reduce medical errors, and provide safer care to patients.
- Adoption of e-PrescribingMarch 29, 2013 | Posted By: Anant Bhatia
Despite having to forfeit 1.5% of total Medicare reimbursements due to a penalty for non-compliance with the ePrescribing mandate for Medicare Health Care Providers (HCPs), 40% of HCPs have yet to comply with the mandate. Even an incentive program (Medicare’s Electronic Prescribing Program) that pays 0.5% to HCPs that have implemented an e-Prescription (eRx) system has failed to boost compliance.
Besides benefits such as lowering of risks due to illegible handwriting, limiting Adverse Drug Effects (ADEs) and easier transmission of drugs to the pharmacy, eRx systems are indispensable if Electronic Health Records (EHRs) systems are to have a meaningful implementation. In fact, data has shown that integrated eRx-EHR systems have a higher utilization at 53% compared to standalone eRx systems. Surprisingly, EHR systems have become a major barrier to the adoption of eRx systems.
EHR systems are expensive investments both in terms of money and time to be implemented. There is a substantial implementation cost to the provider, but there is perhaps a more fundamental reason that could explain the slow adoption: resistance to change and comfort with the conventional system of writing prescriptions. The workflow impact is two-fold because of the employee learning curve and the task of inputting demographic, allergy and medication information for each existing patient. Another issue with eRx systems is their limited interoperability with other clinical IT systems; it will be extremely important to have interoperability especially with the EHR systems to fully utilize the benefits of the EHR incentive program. Also, for security reasons, e-prescription of certain controlled drugs is limited, although this barrier is being overcome through improvements in system security.
91% of the nation’s pharmacies accept eRx while 58% of office-based physicians use eRx; the existence of barriers to adoption for physicians is evident through such numbers. Some states namely Rhode Island (where 97% pharmacies that accept eRx), Minnesota with its strict compliance laws and Delaware (that ranks #1 in Surescripts safe Rx rankings) have been distinctly active at incentivizing and promoting eRx. Some of the larger states have been slow at adoption and that includes the nation’s capital. Minnesota is an eRx leader; a Surescripts ranking of states’ adoption rates can be found here.
The rate of adoption by bigger practices is slow and needs to catch up with pharmacies. According the National Progress Report, the adoption rate is a mere 27% for practices with 100 or more providers compared to 55% for a 6-10 practice size. The data suggests that it is easier for smaller practices to adopt eRx compared to bigger practices such as hospitals. This is surprising given that economies of scale could be expected at bigger practices. Perhaps the need of the hour is to look beyond incentives and penalties structure to understand their slow adoption rate. Perhaps they are looking for integrated solutions or are on a wait and watch mode to understand how the market shapes and find integrated solutions rather than buying piecemeal solutions before committing to a huge investment. At present, the top 3 eRx vendors ranked according to the satisfaction index are Practice Fusion, DrFirst and Advanced MD (ADP).
- 3D printing – There lies the future of healthcareMarch 23, 2013 | Posted By: Sandeep Kutcharlapati
It was year 2005 when the film The Island was released and was categorized under “science fiction”. An insurance company comes up with the idea of creating clones for its customers. The clones will be raised in a special facility unaware of the rest of the world. Their only purpose is to serve as organ reservoirs. When a customer needs an organ replacement, the clone will be killed and the organ is replaced. This was fiction.
Not even a decade has passed and we have come up with a much more advanced and efficient way for the same problem, only that this time it isn’t fiction. Imagine printing human organs instead of growing them or storing them. Imagine printing out replacement tissue patches during the course of a game for injured professional athletes, printing out a brand-new heart as a retirement gift for your older loved ones, skipping the long queue for organ transplants by printing up a new kidney in your garage, or shopping for designer prosthetic limbs in the same way that you currently shop for clothes online. With three-dimensional (3D) printing, those days are not far off.
Traditional 3D printing, also known as additive manufacturing, is the process of making three-dimensional solid objects from a digital model. 3D printing is achieved using additive processes, in which an object is created by laying down successive layers of material such as plastic, ceramics, glass or metal. Companies including Boeing, General Electric and Honeywell use this type of 3D printing to manufacture parts.Read the rest of this post
Organovo, a San Diego-based company that focuses on regenerative medicine, is using 3D printers, called bioprinters, to print functional human tissue for medical research and regenerative therapies. Bioprinters use a “bio-ink” made of living cell mixtures to form human tissue; this ink is used to build a 3D structure of cells, layer by layer, to form tissue. Eventually, medical researchers hope to be able to use the printed tissue to make organs for organ replacement. The current technology is less than ten years away from being able to completely print human organs.
3D printing is projected to save a lot of time and money for the healthcare industry. Although it is difficult to estimate the efficiencies this early, we do have estimates from other industries in which 3D printing is being used. German auto giant BMW saves 58% in costs and 92% in time by manufacturing its jigs and fixtures with 3D printing technique instead of traditional machining techniques. Similarly, we could soon expect great efficiencies in healthcare as well.
- Patient-centered Care--Powered by Health IT and Informed UsageMarch 15, 2013 | Posted By: Miao Zhang
We have previously covered (for previous blog posts, see here, here and here) the impact of the ACA (Affordable Care Act), which involves three major themes: 1) enhancing quality reporting and measurement; 2) establishing uniform operation rules and standards; 3) promoting health IT workforce development. This post will cover a core component of the ACA, which is also a key metric for the IOM’s (Institute of Medicine) six quality aims: PCC (patient-centered care).
Under the IOM definition, patient-centered care means “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions”.
A report issued in January by AHRQ (Agency for Healthcare Research and Quality), reviewed 16 health IT projects for lessons that could be learned. These projects were funded through AHRQ’s 2007 Health IT Grant Initiative focused on PCC.
Four areas of interest were covered in these projects: patient self-management, access to medical information, patient-clinician communication and shared decision making. Although the 16 projects were designed to study existing strategies for using health IT to create/enhance PCC models in the ambulatory setting, they also helped shed light on how important it is to combine health IT adoption and patient active engagement to deliver quality healthcare services in general. This finding provided further evidence for positive impacts of PCC-focused health IT on healthcare delivery and improvement.
(1) As for patient self-management, defined by IOM as “the systematic provision of education and supportive interventions by healthcare staff to increase patients’ skills and confidence in managing their health problems”, it can help connect patients with chronic conditions to actively engage in disease management, as well as medication management or prevention. This area of interest was studied universally in the 16 projects.Read the rest of this post
(2) For access to medical information involves implementing health IT infrastructure that supports one- or two-way exchange of clinical information amongst patients, healthcare providers, and other stakeholders to ensure informed decision-making and quality services. This area of interest was covered in ten projects.
(3) Patient-clinician the use of health IT to support effective clinical interactions during office visits as well as the delivery of clinical services through secure electronic channels. A total of seven projects pointed to the positive effects of enhanced communication and higher patient satisfaction.
(4) Shared decision-making is another crucial area of interest; this is a process in which both the patient and physician contribute to the medical decision-making process to arrive at informed, mutually-agreed choices. The role that health IT can potentially play in this area is examined in two studies. It is used to support collaboration between patients and clinicians and to facilitate informed and consensual decision-making. For instance, in one project, the implemented system enabled patients to collaborate with clinicians asynchronously to design and monitor clinical care plans for certain conditions. Patients and clinicians can customize care plans based on predefined templates to include specific clinical issues; hence the clinicians and patients will reach agreement on the care plans.
Featured in FierceHealthIT, a new paper by our Center’s Director Professor Ritu Agarwal discusses factors affecting patient adoption of PHR (Personal Health Records) and SM (Secure Messaging), shedding further light on four areas that influence human behavior regarding health IT adoption and the consequences on patient-centered care:
- Individual factors, measured by patient activation, satisfaction with providers;
- Environmental factors, measured by perception of available technologies and mass media communications;
- Technology factors, measured by perceived tool empowerment potential and value of tool functionality); and
- Organizational factors, measured by communication tactics adopted by the organization.
As we can see in the aforementioned AHRQ report on 16 PCC initiative projects, researchers have emphasized the importance to have effective communication tactics and technology in the process of PHR implementation. Dr. Agarwal’s study suggests that provider behavior that may also influence PHR adoption thus influencing the patient-centered care.
To sum up, we would say that PCC initiatives will and should be powered by wide health IT adoption and informed usage, be it from patient side or from provider side. Then the recurring PCC theme in the CMS-proposed ACOs (Accountable Care Organization) menu of options will materialize and validate the claim that the ACA can “help providers help patients.”