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.

No Comments | Categories: Health 2.0 | Health IT | HIPAA | mHealth |

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.

1)      HCUP

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.

• 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.

Read the rest of this post

No Comments | Categories: AHRQ | Patient-Centered Care |

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.

System requirements:

• 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

Advantages:

• 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

No Comments | Categories: FDA | Global Health | Health 2.0 | Health Information Exchanges |

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.

No Comments | Categories: CMS | Decision Support | WHITE |

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

No Comments | Categories: Accountable Care Act | Health IT |

On April 4^th, 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

No Comments | Categories: Axial Exchange | CMS | Patient-Centered Care |

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 following is a breakdown of the HITECH Act’s fund allocation:

• 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.”

No Comments | Categories: Accountable Care Act | Cloud | eHealth | Health IT |

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).

No Comments | Categories: e-prescribing | eHealth | EHRs | Electronic Prescribing Incentive Program | eRx | Meaningful Use | Medicaid |

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

No Comments | Categories: Health IT | HIT |

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

No Comments | Categories: ACOs | AHRQ | Institute of Medicine | Patient-Centered Care |