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Quick EHR Twitter Roundup

Posted on May 26, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I use to do these types of posts a lot more. Not really sure why I stopped them since so much good information and so many good discussions are happening on Twitter. In these Twitter roundups, I select a few tweets to highlight and then add a few lines of my own commentary. I hope you enjoy. If you don’t like them, I’d love to hear that as well.


We’ve seen a lot of investors get really interested in the EMR and healthcare space. However, once they see the regulations they usually go running. No doubt it’s ripe for disruption and there’s a lot of disatisfaction and poor use of technology. However, most VCs underestimate what it takes to get into healthcare.


I’ll admit that I hadn’t seen an offer like this for a while. We use to see things like this all the time, but most EHR vendors have moved away from selling EHR software to leveraging their current EHR customers. I think that’s part of why we’ve seen the change in marketing. I feel bad for the salespeople still trying to sell EHR. Those that remain certainly have known about EHR and have chosen not to get one and so EHR sales today have to be a real challenge.


I actually don’t think Justin’s suggestion is that daring. However, I expect most doctors would think that it was a daring suggestion. There’s still a lot of resistance to this idea, but patients will continue pushing for it.

What I found more interesting about Justin’s tweet is the idea of a next-gen EMR. We’ll have to cover this in a future post, but I wonder if people think that a next-gen EMR will come along that will replace the current crop of EMR software. Or will the current EMR become a next-gen EMR. I’d love to hear your thoughts on how the next generation EMR will come to be.

Quadruple Aim of Healthcare Infographic

Posted on May 25, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s been a lot of talk about the triple aim of healthcare and the need to refocus many of the EHR and healthcare IT solutions on the triple aim. Many of the concepts are really good, but the triple aim is certainly not all encompassing.

This was highlighted really well by this infographic (see below) by Caradigm which suggests a 4th aim that should be added: Improving the work life of health care providers, including clinicans and staff.

The most ironic part of the infographic is the final section which talks about how technology solutions can be used to make providers’ lives better and decrease physician burnout. While I agree that technology solutions could and should help with this problem, the reality is that many of them have just made this problem worse. We could talk about whether the EHR is the whipping boy for regulations, but the EHR definitely is getting the blame for a lot of physician burnout. Will we turn the corner and start seeing technology as an enabler of this 4th aim? Or maybe I should say when will we see this?

Patient Engagement and Patient Experience

Posted on May 24, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I got tied up on some big projects today and so for today’s post I’m going to point you to some really great resources being shared around patient engagement and patient experience from the Patient Engagement Summit hosted by the Cleveland Clinic.

Here are two images that were shared from the summit which give you a flavor for the types of conversations and knowledge that was being shared at the Patient Engagement Summit.


Note: Adrienne Boissy, MD, MA, noted that the chart above comes from this article.

You can find more great content like this by checking out the hashtag #PESummit on Twitter.

Few Practices Rely Solely On EMR Analytics Tools To Wrangle Data

Posted on May 23, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new survey done by a trade group representing medical practices has concluded that only a minority of practices are getting full use of their EMR’s analytics tools.

The survey, which was reported on by Becker’s Hospital Review, was conducted by the Medical Group Management Association.  The MGMA’s survey called on about 900 of its members to ask how their practices used EMRs for analytics.

First, and most unexpectedly in today’s data-driven world, 11 percent of respondents said that they don’t analyze their EMR data at all.

Thirty-one percent of respondents told MGMA that they use all of their EMR’s analytical capabilities, and 22 percent of respondents said they used some of their EMR’s analytics capabilities.

Another 31 percent reported that they were using both their EMR’s analytics tools and tools from an external vendor. Meanwhile, 5 percent said they used only an external vendor for data analytics.

According to Derek Kosiorek, CPEHR, CPHIT, principal consultant with MGMA’s Health Care Consulting Group, the survey results aren’t as surprising as they may seem. In fact, few groups are likely to get  everything they need from EMR data, he notes.

“Many practices do not have the resources to mine the data and organize it in ways to create new insights from the clinical, administrative and financial information being captured daily,” said Kosiorek in a related blog post. “Even if your practice has the staff with the knowledge and time to create reports, the system often requires an add-on product sold by the vendor or an outside product or service to analyze the data.”

However, he predicts that this will change in the near future. Not only will EMR analytics help groups to tame their internal data, it will also aggregate data from varied community settings such as the emergency department, outpatient care and nursing homes, he suggests. He also expects to see analytics tools offer a perspective on care issues brought by regional data for similar patients.

At this point I’m going to jump in and pick up the mic. While I haven’t seen anyone from MGMA comment on this, I think this data – and Kosiorek’s comments in particular – underscore the tension between population health models and day-to-day medical practice. Specifically, they remind us that doctors and regional health systems naturally have different perspectives on why and how they use data.

On the one hand there’s medical practices which, from what I’ve seen, are of necessity practical. These providers want first and foremost to make individual patients feel good and if sick get better. If that can be done safely and effectively I doubt most care about how they do it. Sure, doctors are aware of pop health issues, but those aren’t and can’t be their priority in most cases.

Then, you have hospitals, health systems and ACOs, which are already at the forefront of population health management. For them, having a consistent and comprehensive set of tools for analyzing clinical data across their network is becoming job one. That’s far removed from focusing on day-to-day patient care.

It’s all well and good to measure whether physicians use EMR analytics tools or not. The real issue is whether large health organizations and practices can develop compatible analytics goals.

MIPS Eligibility Letters and Physician Reputation – MACRA Monday

Posted on May 22, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Anshu Jindal has a great post up on the My MIPS Score website that talks about the MIPS Eligibility letters that so many people have been waiting for to know if they are required to participate in MIPS or if they are exempt from participating in MIPS.

Here’s a sample eligibility letter that they shared:
MIPS Eligibility Letter from CMS

There are a number of interesting options available based on if your group TIN is eligible to be included in MIPS or not and if your providers are eligible or not at the NPI level. In the post mentioned above, Anshu does a nice analysis of the financial impact of choosing to participate in MIPS at the TIN level vs the individual provider level or vice versa. The financial impact can be quite large for your organization and so you’ll want to go through that post and see what this means for your practice.

As they also mention in their post, the short-term financial impact of not participating in MIPS could be more than most people realize. However, not having a MIPS composite score could have an even larger impact on your long-term reputation. The more I’ve considered this idea, the more I’ve realized that a lot of practices that choose to opt out of MIPS are going to get blindsided by this.

This is true for those that choose the most basic pick your pace option as well. When a potential future patient sees that you have a very low MIPS score on one of the consumer facing physician rating websites, they’re not going to know how to appropriately assess what a low MIPS composite score means. They’ll naturally (and quite often incorrectly) assume that a low MIPS composite score means that you’re a poor doctor. Most of these rating websites aren’t going to educate their end users on how to properly interpret the MIPS score and your reputation will suffer if you have no score or if you purposefully choose to get a low score.

I know quite a few doctors who are choosing to not participate in MIPS out of principle. In some areas where there is more demand for doctors in their specialty than supply, then it might not be a huge issue. However, in a lot of areas, not participating in MIPS could potentially have a significant impact on your reputation. Sad, but true.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT

Posted on May 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Usually, particularly when I have complaints, I don’t name the providers or vendors who serve my healthcare needs, largely because I don’t want to let my personal gripes overshadow my analysis of a particular health IT issue.

That being said, I thought I’d veer from that rule today, as I wanted to share some details on how Kaiser Permanente, my new provider and health plan, supports consumers with health IT functions. Despite having started with Kaiser – in this case the DC metro division – less than a week ago, being an e-patient I’ve had my hands all over its Web – and mobile-based options for patients.

I’m not going to say the system is perfect by any means. There are some blind alleys on the web site, and some problems in integrating clinical information into consumer records, but so far their set-up largely seems thoughtful and well-managed.

Having allegedly spent $4 billion plus on its Epic rollout, it’s hard to imagine how Kaiser could have realized that big a return even several years later, but it seems that the healthcare giant is at least doing many of the right things.

Getting enrolled

My first contact with Kaiser, after signing up with Healthcare.gov, was a piece of snail-mail which provided us with our insurance cards and a summary of our particular coverage. The insurance cards included my health plan ID/medical record number.

To enroll on the core Kaiser site, kp.org, I had to supply the record number, my birth date and a few other basic pieces of information. I also downloaded the KP app, which offers a far-more-elegant interface to the same functions.

Medical appointments

Once logged in, it was easy to choose a primary care doctor and OB/GYN by searching the site and clicking a selection button. If you wished you could review physician profiles and educational history as well as testimonial quotes from patients about that doctor before you chose them.

Having chosen a doctor, booking an appointment with them online was easy.  As with Zocdoc.com, you entered a range of dates for a possible consult, then chose the slot that worked for you. And if you need to cancel one of those appointments, it’s easy to do so online.

Digital communication

I was glad to see that the Kaiser portal allows you to email your doctor directly, something which is less common than you might think. (My last primary care group wouldn’t even put their doctors on the phone.)

Not only that, everyone I’ve talked to at KP so far– three medical appointments, as I was playing catch-up — has stressed that the email function isn’t just for show. My new providers insisted that they do answer email messages, and that I shouldn’t hesitate to write if I have questions or concerns.

Another way KP leverages digital communications is the simple, but effective, device of texting me when my prescriptions are due for a refill. This may not sound like much, but convenience matters! (I can also check med reminders by logging in to a custom KP meds app.)

Data sharing

Given that everyone at Kaiser uses the same Epic EMR, clinicians are of course more aware of what their colleagues are doing than my past gaggle of disconnected specialists. They seem quite serious about reading this history before seeing me, something which past physicians haven’t always done, even if I was previously seen by someone else in their practice.

KP also uses Epic’s Care Everywhere function, which allows them to pull in a limited summary of care from other Epic-based providers. While Care Everywhere has limits, the providers are making use of what they can.

One small wrinkle was that prior to two of my visits, I filled out a questionnaire online and when asked to submit it to my electronic patient record, did so. Nonetheless, I was asked to fill out the same questionnaire again, on paper, when I saw a specialist.

Test results

KP seems to be set up appropriately to share standard test results. However, I’ve already had one test, a mammogram, and in doing so found out that their data sharing infrastructure isn’t quite complete.

After being scanned, I was told that I’d receive my results via snail-mail, in about two weeks. I’m glad that this was a routine screening, rather than a test to investigate something scary, as I would have been pretty upset with this news if I was worried.

My conclusions

I don’t want to romanticize Kaiser’s consumer HIT services. After all, looked at one way, KP is only doing what integrated health systems are supposed to do, and not without at least a few hitches.

Still, at least on first view, on the whole I’m pretty happy with how Kaiser’s interactive functions are deployed, as well the general attitude staff members seem to have about consumer use of HIT tools. Generally speaking, they seem to encourage it, and for someone like me that’s quite welcome.

As I see it, if providers outside of the Kaiser bubble were as married to a shared infrastructure as KP providers are, my care would be much improved. Let’s see if I still if I still feel that way after the new health plan smell has worn off!

Women Executives in Telehealth American Telemedicine Association ATA2017

Posted on May 18, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Susan Dentzer, Charlotte Yeh, Janet McIntyre, and Janae Sharp at the American Telemed Women Executives in Telehealth Panel

One of the highlights of the American Telemedicine conference in Orlando Florida was excellent coverage of women in telemedicine and leadership.  They had a panel of women in leadership which focused on promoting women in telemedicine and had the best moderation of a panel I’ve seen at a conference.  Highlights of great advice for women in HealthIT were from that panel, and from speaking with women that were tasked with going to the conference as buyers in the telemedicine space.

Charlotte Yeh acted as moderator of the panel. She framed what the panel would cover and what they were not concerned with. She mentioned that we would not cover work life balance since that also applies to men and has been covered on many platforms.  Framing a conversation within the conference and healthcare setting made a huge impact.  Promoting women in telemedicine and HealthIT needs to have a specific framework.

Susan Dentzer, President and CEO of the Network for Excellence in Healthcare innovation suggested making an award for advancing women in leadership in Telehealth.  I’m a huge fan of medals for participation. Every day I get up and when I work out I suspect that I deserve a medal.  The medals for best contribution for advancing women next year should be an amazing ceremony at ATA.

Susan quoted Madeline Albright that “there’s a special place in hell for women who don’t support other women.” Think deliberately about creating something you want to be a part of. This year I’ve personally seen Max Stroud of Doyenne Connections simply create something she wanted to be a part of.

Julie Hall-Barrow invited leaders to find a young woman and become their mentor. Some of the women in leadership in healthcare are happy to promote other women but the promotion seems more strategic than like actual concern. Leaders should purposefully craft their ideal mentor relationship. ATA discussed creating a group dedicated to what women and companies in the telemedicine space would like to do with collaboration.

Paula Guy, when asked what she would tell a younger self, said “first of all I would tell myself not to get married so many times.” Her advice was hilarious and focused on not letting people tell you no. There is a power in knowing what you are capable of and surrounding yourself with other women who are also in that space. Paula’s advice was also to be part of a group that promotes mentors and other women working together.

Kristi Henderson spoke about not being afraid to push boundaries. Never settle until you get where you want to go. The advice and positive belief that women are capable of breaking through boundaries and leveraging their social connecting makes women poised for success despite being underrepresented.

Janet McIntyre, The Vice President of Professional services of the Colorado Hospital association, decided to approach Patrick Kennedy about coming to Colorado to help with the opioid epidemic there. He shared his family story and personal conviction about making a difference and Janet decided to invite him to help with her state.  Women need to be fearless in their ask and expect that people will want to help them succeed.

Rachel Dixon, director of Telehealth for AccessCare services, pointed out that women should have a safe space to discuss gender issues in their work. We can create a place to discuss which companies are working well with women in the telemedicine space and which ask about an older man partner or lack professionalism. I shared a story with her about a potential employer asking if he should consider my job only a work proposition.  Gender issues for a younger woman in leadership can be complex in navigating personal relationship. A soft intelligence network about how a company treats women is valuable for investors and employees.

I was impressed with the positive planning of women in healthcare leadership in telehealth. The thought leadership at this conference was one of the best organized in terms of giving organizations and individuals actionable plans for increasing female technology talent in leadership positions.

Dogged By Privacy Concerns, Consumers Wonder If Using HIT Is Worthwhile

Posted on May 17, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I just came across a survey suggesting that while we in the health IT world see a world of possibilities in emerging technologies, consumers aren’t so sure. The researchers found that consumers question the value of many tech platforms popular with health execs, apparently because they don’t trust providers to keep their personal health data secure.

The study, which was conducted between September and December 2016, was done by technology research firm Black Book. To conduct the survey, Black Book reached out to 12,090 adult consumers across the United States.

The topline conclusion from the study was that 57 percent of consumers who had been exposed to HIT through physicians, hospitals or ancillary providers doubted its benefits. Their concerns extended not only to EHRs, but also to many commonly-deployed solutions such as patient portals and mobile apps. The survey also concluded that 70 percent of Americans distrusted HIT, up sharply from just 10 percent in 2014.

Black Book researchers tied consumers’ skepticism to their very substantial  privacy concerns. Survey data indicated that 87 percent of respondents weren’t willing to divulge all of their personal health data, even if it improved their care.

Some categories of health information were especially sensitive for consumers. Ninety-nine percent were worried about providers sharing their mental health data with anyone but payers, 90 percent didn’t want their prescription data shared and 81 percent didn’t want information on their chronic conditions shared.

And their data security worries go beyond clinical data. A full 93 percent responding said they were concerned about the security of their personal financial information, particularly as banking and credit card data are increasingly shared among providers.

As a result, at least some consumers said they weren’t disclosing all of their health information. Also, 69 percent of patients admitted that they were holding back information from their current primary care physicians because they doubted the PCPs knew enough about technology to protect patient data effectively.

One of the reason patients are so protective of their data is because many don’t understand health IT, the survey suggested. For example, Black Book found that 92 percent of nurse leaders in hospital under 200 beds said they had no time during the discharge process to improve patient tech literacy. (In contrast, only 55 percent of nurse leaders working in large hospitals had this complaint, one of the few bright spots in Black Book’s data.)

When it comes to tech training, medical practices aren’t much help either. A whopping 96 percent of patients said that physicians and staff didn’t do a good job of explaining how to use the patient portal. About 40 percent of patients tried to use their medical practice’s portal, but 83 percent said they had trouble using it when they were at home.

All that being said, consumers seemed to feel much differently about data they generate on their own. In fact, 91 percent of consumers with wearables reported that they’d like to see their physician practice’s medical record system store any health data they request. In fact, 91 percent of patients who feel that their apps and devices were important to improving their health were disappointed when providers wouldn’t store their personal data.

Researcher Puts Epic In Third Place For EMR Market Share

Posted on May 16, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new research report tracking market share held by EMR vendors puts Epic in third place, behind Cerner and McKesson, a conclusion which is likely to spark debate among industry watchers.

The analyst firm behind the report, Rockville, MD-based Kalorama Information, starts by pointing out that despite the hegemony maintained by larger EMR vendors, the competition for business is still quite lively. With customers still dissatisfied with their systems, the hundreds of vendors still in the market have a shot at thriving, it notes.

Kalorama publisher Bruce Carlson argues that until the larger firms get their act together, there will still be plenty of opportunity for these scrappy smaller players: “It’s still true to say no company, not even the largest healthcare IT firms, have even a fifth of this market,” Carlson said in a published statement. “We think that is because there’s still usability, vendor-switching, lack of mindshare in the market and customers are aching for better.”

In calculating how much each vendor has of the EMR market, the analyst firm estimated each vendors’ hardware, software and services revenue flowing directly from EMRs, breaking out the percentage each category represented for each vendor. All projects were based on 2016 data.

Among the giants, Kalorama ranks Cerner as having the biggest market share, McKesson as second in place and Epic as third. The report’s observations include:

  • That Cerner is picking up new business, in part, due to the addition of its CernerITWorks suite, which works with hospital IT departments, and Cerner RevWorks, which supports revenue cycle management functions. Kalorama also attributes Cerner’s success to the acquisition of Siemens IT and its having won the Department of Defense EMR contract.
  • That McKesson is building on its overall success as a health IT vendor, which puts it in a good position to build on its existing technology. For example, it has solutions addressing medication safety, information access, revenue cycle management, resource use and physician adoption of EMRs, including Paragon, Horizon, EHRM, Star and Series for hospitals, along with Practice Partners, Practice Point Plus and Fusion for ambulatory care.
  • That Epic serves giant customers like Kaiser Permanente, as well as holding a major share of new business in the EMR market. Kalorama is predicting that Epic will pick up more ambulatory customers, which it has focused on more closely of late.

The report also lists Allscripts Healthcare Solution, which came in fourth. Meanwhile, it tosses in GE Healthcare, Athenahealth’s Intersystems, QSI/NextGen, MEDITECH, Greenway and eClinicalWorks in with a bundle of at least 600 companies active in the EMR market.

The report summary we editors got didn’t include some details on how the market components broke down. I would like to know more about the niches in which these vendors play.

For example, having seen a prediction earlier this year that the physician practice market would hit $17.6 billion worldwide within seven years, it would be interesting to see that dot connected with the rest of the market share information. Specifically, I’d like to know how much of the ambulatory EMR market included integrated practice management software. That would tell me something about where overall solutions for physicians were headed.

However, I still got something out of the information Kalorama shared.  As our esteemed publisher John Lynn often notes, all market share measurements are a bit, um, idiosyncratic at best, and some are not even that reliable. But as I see it the estimates are worth considering nonetheless, as they challenge us to look at the key moving parts in the EMR market. Hey, and it gives us something to talk about at tradeshow parties!

The Sexiest Data in Health IT: Datapalooza 2017

Posted on May 15, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

The data at this conference was the Best Data. The Biggest Data. No one has better data than this conference.

The sexiest data in all of healthIT was highlighted in Washington DC at Datapalooza April 27-28, 2017.  One of the main themes was how to deal with social determinants of health and the value of that data.  Sachin H. Jain, MD of Caremore Health reminded us that “If a patient doesn’t have food at home waiting for them they won’t get better” social data needs to be in the equation. Some of the chatter on the subject of healthcare reform has been criticism that providing mandatory coverage hasn’t always been paired with knowledge of the area. If a patient qualifies for Medicaid and has a lower paying job how can they afford to miss work and get care for their health issues?
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Rural areas also have access issues. Patient “Charles” works full time during the week and qualifies for Medicaid. He can’t afford to miss a lot of work but needs a half a day to get treatments which affect his ability to work. There is no public transportation in his town to the hospital in a city an hour and a half away. Charles can’t afford the gas or unpaid time off work for his treatment.

Urban patient “Haley” returns to her local ER department more than once a week with Asthma attacks.  Her treatments are failing because she lives in an apartment with mold in the walls. As Craig Kartchner from the Intermountain Healthcare team responded to the #datapalooza  hashtag online- These can be the most difficult things to change.

The 2016 report to Congress addresses the difficulty of the intersection between social factors and providing quality healthcare in terms of Social Determinants of Health:

“If beneficiaries with social risk factors have worse health outcomes because the providers they see provide low quality care, value based purchasing could be a powerful tool to drive improvements in care and reduce health disparities. However, if beneficiaries with social risk factors have worse health outcomes because of elements beyond the quality of care provided, such as the social risk factors themselves, value based payment models could do just the opposite. If providers have limited ability to influence health outcomes for beneficiaries with social risk factors, they may become reluctant to care for beneficiaries with social risk factors, out of fear of incurring penalties due to factors they have limited ability to influence.”

Innovaccer just launched a free tool to help care teams track and monitor Medicare advantage plans. I went to their website and looked at my county and found data about the strengths in Salt Lake where I’m located. They included:

  • Low prevalence of smoking
  • Low Unemployed Percentage
  • Low prevalence of physically inactive adults

Challenges for my area?

  • Low graduation rate
  • High average of daily Air pollution
  • High income inequality
  • High Violent crime rate per 100,000 population

Salt Lake actually has some really bad inversion problems during the winter months and some days the particulate matter in the air creates problems for respiratory problems. During the 2016-2017 winter there were 18 days of red air quality and 28 days of yellow air quality. A smart solution for addressing social determinants of health that negatively impact patients in this area could be addressing decreasing air pollution through increased public transportation. Healthcare systems will see an increase in cost of care during those times and long term population health challenges can emerge. You can look at your county after you enter your email address on their site. This kind of social data visualization can give high level insights into the social factors your population faces.

One of the themes of HealthDataPalooza was how to use system change to navigate the intersection between taking care of patients and not finding way to exclude groups. During his panel discussion of predictive analytics, Craig Monson the medical director for analytics and reporting discussed how “data analytics is the shiny new toy of healthcare.”    In addition to winning the unofficial datapalooza award for the most quotes and one liners – Craig presented the Clinical Risk Prediction Initiative (CRISPI).  This is a multi variable logistic regression model with data from the Atrius health data warehouse. His questions for systems to remember in their data analysis selection are “Who is the population you are serving? What is the outcome you need? What is the intervention you should implement?”

Warning- Craig reminds us that in a world of increasing sexy artificial intelligence coding a lot of the value analysis can be done with regression. Based on that statement alone I think he can be trusted. I still need to see his data.

CRISPI analyzed the relative utility of certain types of data, and didn’t have a large jump in utility when adding Social Determinant Data. This data was one of the most popular data sets during Datapalooza discussions but the reality of making actionable insights into system improvement? Craig’s analysis said it was lacking. Does this mean social determinant data isn’t significant or that it needs to be handled with a combination of traditional modeling and other methods?  Craig’s assertion seemed to fly in the face of the hot new trend of Social Determinants of Health data from the surface.

Do we have too much data or the wrong use of the data? Most of the companies investing into this space used data sources outside the traditional definition to help create solutions with social determinate of health and Patient outcomes. They differed in how they analyzed social determinant data. Traditional data sources for the social determinants of health are well defined within the public health research.  The conditions in which you work and live impact your health.

Datapalooza had some of the greatest minds in data analytics and speakers addressed gaps in data usefulness. Knowing that a certain large county wide population has a problem with air quality might not be enough to improve patient outcomes. There is need for analysis of traditional data sources in this realm and how they can get meaningful impact for patients and communities. Healthcare innovators need to look at different data sources.  Nick Dawson, Executive director of Johns-Hopkins Sibley Innovation Hub responded to the conversation about food at home with the data about Washington DC.  “DC like many cities has open public data on food scarcity. But it’s not part of a clinical record. The two datasets never touch.” Data about food scarcity can help hospital systems collaborate with SNAP and Government as well as local food programs. Dawson leads an innovation lab at Johns Hopkins Sibley where managers, directors, VPs and C Suite leaders are responsible for working with 4 innovation projects each year.

Audun Utengen, the Co Founder of Symplur said “There’s so much gold in the social media data if you choose to see it.” Social data available online helps providers meet patients where they are and collect valuable data.  Social media data is another source to collect data about patient preferences and interactions for reaching healthcare populations providers are trying to serve. With so much data available sorting through relevant and helpful data provides a new challenge for healthcare systems and providers.

New Data sources can be paired with a consultative model for improving the intersection of accountable care and lack of access due to social factors. We have more sophisticated analytic tools than ever for providing high value care in the intersection between provider responsibility and social collaboration. This proactive collaboration needs to occur on local and national levels.  “It’s the social determinants of health and the behavioral aspects that we need to fund and will change healthcare” we were reminded. Finding local community programs that have success and helping develop a strategy for approaching Social Determinants of Health is on the mind of healthIT professionals.

A number of companies examine data from sources such as social media and internet usage or behavioral data to design improvements for social determinants of health outcomes.   They seek to bridge the gaps mentioned by Dawson. Data sets exist that could help build programs for social determinants of health.  Mandi Bishop started Lifely Insights centered around building custom community plans with behavioral insights into social determinant data. Health in all Policies is a government initiative supporting increased structure and guidelines in these areas. They support local and State initiatives with a focus on prevention.

I’m looking forward to seeing how the data landscape evolves this year. Government Challenges such as the Healthy Behavior Data Challenge launched at Datapalooza will help fund great improvements. All the data people will get together and determine meaningful data sets for building programs addressing the social determinants of health. They will have visualization tools with Tableau. They will find ways to get food to patients at home so those patients will get better. Programs will find a way to get care to rural patients with financial difficulty and build safe housing.

From a healthcare delivery perspective the idea of collaborating about data models can help improve community health and decrease provider and payer cost. The social determinants of health can cost healthcare organizations more money than data modeling and proactive community collaboration.

Great regressions, saving money and improving outcomes?

That is Datapalooza.