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Patient Experience Compared to Airline Experience

Posted on May 6, 2015 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 was digging through my archive of draft posts and I came upon this tweet that I’d saved for future posting from last year. The tweet is still as applicable today as it was last year. Stephanie Zaremba raises an interesting point of comparison between the patient experience and the airlines experience. Can we learn something from this comparison?

Stephanie is totally right that the airline experience is going down quickly. I hate flying more and more every time I fly. That’s partially because I’m tired of being away from the family, but partially because they keep changing things and very rarely is the change for the better. However, do we really have a choice? If we need to travel, we purchase the plane ticket and grin and bear.

Does this sound a lot like healthcare? Sadly I think it does. Especially the last part. We all need healthcare and so we mostly just grin and bear. We’re seeing a slight change in that mindset with new high deductible plans. However, the medical industry is so complex that most patients just give up on trying to figure it out.

As I’ve thought about this comparison, I’ve wondered what would really change the patient experience. What could really cause things to change? Sadly, I think there’s a desire by many (doctors leading this charge) for a different system where it is a beautiful patient experience, but I don’t see a pathway to that new reality from our current reality.

Reminds me of one of my favorite thought exercises. What if you created an EHR that was focused on the patient and patient care and not on billing and government regulations? That EHR would look totally different than what we have today. Maybe it would look like a Care Management System.

Customizable EMRs Are Long Overdue

Posted on May 5, 2015 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.

EMRs can be customized to some extent today, but not that much. Providers can create interfaces between their EMR and other platforms, such as PACS or laboratory information systems, but you can’t really take the guts of the thing apart. The reality is that the EMR vendor’s configuration shapes how providers do business, not the other way around.

This has been the state of affairs for so long that you don’t hear too much complaining about it, but health IT execs should really be raising a ruckus. While some hospitals might prefer to have all of their EMR’s major functions locked down before it gets integrated with other systems, others would surely prefer to build out their own EMR from widgetized components on a generic platform.

Actually, a friend recently introduced me to a company which is taking just this approach. Ocean Informatics, which has built an eHealth base on the openEHR platform, offers end users the chance to build not only an EMR application, but also use clinical modules including infection control, care support, decision support and advanced care management, and a mobile platform. It also offers compatible knowledge-based management modules, including clinical modeling tools and a clinical modeling manager.

It’s telling that the New South Wales, Australia-based open source vendor sells directly to governments, including Brazil, Norway and Slovenia. True, U.S. government is obviously responsible for VistA, the VA’s universally beloved open source EMR, but the Department of Defense is currently in the process of picking between Epic and Cerner to implement its $11B EMR update. Even VistA’s backers have thrown it under the bus, in other words.

Given the long-established propensity of commercial vendors to sell a hard-welded product, it seems unlikely that they’re going to switch to a modular design anytime soon.  Epic and Cerner largely sell completely-built cars with a few expensive options. Open source offers a chassis, doors, wheels, a custom interior you can style with alligator skin if you’d like, and plenty of free options, at a price you more or less choose. But it would apparently be too sensible to expect EMR vendors to provide the flexible, affordable option.

That being said, as health systems are increasingly forced to be all things to all people — managers of population health, risk-bearing ACOs, trackers of mobile health data, providers of virtual medicine and more — they’ll be forced to throw their weight behind a more flexible architecture. Buying an EMR “out of the box” simply won’t make sense.

When commercial vendors finally concede to the inevitable and turn out modular eHealth data tools, providers will finally be in a position to handle their new roles efficiently. It’s about time Epic and Cerner vendors got it done!

Early Warnings Demonstrate an Early Advance in the Use of Analytics to Improve Health Care

Posted on May 4, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Early warning systems–such as the popular Modified Early Warning System (MEWS) used in many hospitals–form one of the first waves in the ocean of analytics we need to wash over our health care system. Eventually, health care will elegantly integrate medical device output, electronic patient records, research findings, software algorithms, and–yes, let us not forget–the clinician’s expertise in a timely intervention into patient care. Because early warning systems are more mature than many of the analytics that researchers are currently trying out, it’s useful to look at advances in early warning to see trends that can benefit the rest of health care as well.

I talked this week to Susan Niemeier, Chief Nursing Officer at CapsuleTech, a provider of medical device integration solutions. They sell (among other things) a bedside mobile clinical computer called the Neuron that collects, displays, and sends to the electronic medical record vital signs from medical devices: temperature, pulse, respiration, pulse oximetry, and so on. A recent enhancement called the Early Warning Scoring System (EWSS) adds an extra level of analytics that, according to Niemeier, can identify subtle signs of patient deterioration well before a critical event. It’s part of Capsule’s overarching aim to enable hospitals to do more with the massive amount of data generated by devices.

For more than 18 years, CapsuleTech provided bedside medical device connectivity products and services that captured patient vital signs and communicated that data to the hospital EMR. Rudimentary as this functionality may appear to people using automated systems in other industries, it was a welcome advance for nurses and doctors in hospitals. Formerly, according to Niemeier, nurses would scribble down on a scrap of paper or a napkin the vital signs they saw on the monitors. It might be a few hours before they could enter these into the record–and lots could go wrong in that time. Furthermore, the record was a simple repository, with no software observing trends or drawing conclusions.

Neuron 2 running Early Warning Scoring System

Neuron 2 running Early Warning Scoring System

So in addition to relieving the nurse of clerical work (along with likely errors that it entails), and enhancing workflow, the Neuron could make sure the record immediately reflected vital signs. Now the Neuron performs an even more important function: it can run a kind of clinical support to warn of patients whose conditions are deteriorating.

The Neuron EWSS application assigns a numerical score to each vital sign parameter. The total early warning score is then calculated on the basis of the algorithm implemented. The higher the score, the greater the likelihood of deterioration. The score is displayed on the Neuron along with actionable steps for immediate intervention. These might include more monitoring, or even calling the rapid response team right away.

The software algorithm is configured in a secure management tool accessible through a web browser and sent wirelessly to the Neuron at a scheduled time. The management tool is password protected and administered by a trained designee at the hospital, allowing for greater flexibility and complete ownership of the solution.

Naturally, the key to making this simple system effective is to choose the right algorithm for combining vital signs. The United Kingdom is out in front in this area. They developed a variety of algorithms in the late 1990s, whereas US hospitals started doing so only 5 years ago. The US cannot simply adopt the UK algorithms, though, because our care delivery and nursing model is different. Furthermore, each hospital has different patient demographics, priorities, and practices.

On the other hand, according to Niemeier, assigning different algorithms to different patients (young gun-shot victims versus elderly cardiac patients, for instance) would be impractical because mobile Neuron computers are used across the entire hospital facility. If you tune an algorithm for one patient demographic, a nurse might inadvertently use it on a different kind of patient as the computer moves from unit to unit. Better, then, to create a single algorithm that does its best to reflect the average patient. The algorithm should use vital signs and observations that are consistently collected, not vitals that are intermittently measured and documented.

Furthermore, algorithms can be tuned over time. Not only do patient populations evolve, but hospitals can learn from the data they collect. CapsuleTech advises a retrospective chart review of rapid response events prior to selecting an algorithm. What vital signs did the patient have during the eight hours before the urgent event? Retrospectively apply the EWSS to the vital signs to determine the right algorithm and trends in that data to recognize deterioration earlier.

Without help such as the Early Warning Scoring System, rapid response teams have to be called when a clear crisis emerges or when a nurse’s intuition suggests they are needed. Now the nurse can check his intuition against the number generated by the system.

I think clinicians are open to the value of analytics in early warning systems because they dramatically heighten chances for avoiding disaster (and the resulting expense). The successes in early warning systems give us a glimpse of what data can do for more mundane aspects of health care as well. Naturally, effective use of data takes a lot more research: we need to know the best ways to collect the data, what standards allow us to aggregate it, and ultimately what the data can tell us. Advances in this research, along with rich new data sources, can put information at the center of medicine.

5 Lessons Providers Can Learn from Payers Infographic

Posted on May 1, 2015 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.

ClinicSpectrum has been putting out a whole series of healthcare IT infographics. I recently saw one of them that really caught my eye as it came across my Twitter stream. The infographic offers 5 things providers can learn from payers. I’m sure that concept is a bit unsettling for some providers, but the list is quite intriguing:

  1. Leverage Data to Identify High-Risk Patients
  2. Help Patients Manage Their Meds
  3. Designate a Patient Engagement Advocate
  4. Build Partnerships
  5. Seek Interoperability Opportunities

What do you think about these ideas? Check out the full infographic below for more details:
5 Lessons Learned from Payers
Full Disclosure: ClinicSpectrum sponsors posts on Healthcare Scene.

Survey: ICD-10 Business Areas of Concern

Posted on April 30, 2015 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.

Each year, NueMD does a survey of providers around ICD-10. 2015 was no exception. You can see the full results of their ICD-10 survey here. They had over 1000 respondents to the survey with the majority of them coming from small practices and 43% of them coming from patient care (DO, MD, DC, NP, RN, etc).

You should take a minute to check out the full results, but this chart from the survey results really caught my eye:

ICD-10 Business Areas of Concern for Doctors

Regardless of whether you’re interested in the results or not, the list of possible areas of concern is worth considering for your organization: Training/Education, Payer Testing, Software Upgrade Cost, Claims Processing, and Compliance Timelines/Deadlines. Are any of these areas a cause for concern with your practice when it comes to ICD-10? My guess is that it has many of you concerned about the switch to ICD-10.

I was glad to see that claims processing was the biggest concern. It should be a concern for doctors and you better prepare for it to be an issue. If you don’t, it’s very likely that you could run into a cash flow issue for your practice.

All signs seem to be pointing towards no more ICD-10 delays. Although, I did hear someone tell me that Congress had 15 (at least somewhere in that range) more opportunities to slip in language to delay ICD-10 again. That’s not likely comforting for healthcare organizations out there. However, I think at this point, organizations need to assume that it’s coming and prepare accordingly. Not doing so could have some dire circumstances come October.

When Will Genomic Medicine Become As Common As Antibiotics?

Posted on April 29, 2015 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’m completely and utterly fascinated by the work that so many companies are doing with genomic medicine. I think that’s a good thing since I believe genomic medicine is just now starting to make its way into mainstream medicine. Plus, over the next couple years, genomic medicine is going to be a huge part of what every doctor does in healthcare. Maybe it won’t be as common as the antibiotic (what is?), but it will be extremely important to healthcare.

With that in mind, I’ve been devouring this whitepaper on the evolving promise of genomic medicine. It offers such a great overview of what’s happening with genomic medicine.

For example, they offer a great list of reasons why genomic medicine has become so important today: descreased cost of sequencing, speed of sequencing, availability of genomic tests, ways the genome can be used, reimbursement by payors, etc. That’s such a powerful cocktail of improvements. Does anyone doubt that widespread genomic medicine is near?

I also love how the whitepaper highlights the three pillars of genomic medicine: sequencing, translational medicine and personalized healthcare. That provides a great framework for starting to understand what’s happening with genomic medicine. Plus, the whitepaper offers these place where we’re seeing real benefits in healthcare: prediction of drug response, diagnosis of disease, and identification of targeted therapies. While much of this is still being tested, I’m excited by its progress.

I still have a lot to learn about genomic medicine, but the evolving promise of genomic medicine whitepaper has me even more interested in what’s happening. I’d be interested to hear what companies you think are most interesting in the genomic medicine space.

Finding New Patients Twitter Chat and Webinar

Posted on April 28, 2015 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’ve gotten together with Healthcare Scene sponsor Kareo to present a webinar titled “5 Marketing Tips to Get New Patients Now” on Wednesday, May 6 at 1 PM ET (10 AM PT). I’ll be focusing on the digital methods for finding new patients and will cover topics like an effective practice website, Search Engine Optimization (SEO), a practice blog, managing your online reputation and patient engagement tools. It should be a great webinar that many doctors and practice managers will appreciate.

Alongside the webinar, I’m also hosting the #KareoChat this week on the same topic. The #KareoChat Twitter chat is held every week on Thursday at 9 AM PT. I’m sure we’ll have a lively conversation which will be a great lead in to the webinar.
Kareo Chat - John Lynn - Healthcare Scene
If you’d like to participate in the #KareoChat, here are the 6 questions we’ll be covering in the chat:

Q1: Can your website get you new #patients? What features would you say attract new patients most? @ehrandhit #KareoChat #smallpractice

Q2: Is search engine optimization worth the money? How do you approach #SEO? #KareoChat @ehrandhit #physicians #marketing #smallpractice

Q3: What topics should you cover on your practice’s #blog? How often should you post? #KareoChat @ehrandhit #physicians #patients #marketing

Q4: How do you make the most of #physician rating and review sites? How do you manage your #reputation? #KareoChat @ehrandhit

Q5: What #socialmedia have you found useful for finding new #patients? How? #KareoChat @ehrandhit #smallpractices #physicians #marketing

Q6: What #patientengagement tools drive new and returning #patients to your practice? #KareoChat @ehrandhit #marketing

I look forward to seeing many of you at the webinar and on the Twitter chat.

The athenahealth EHR and Meaningful Use Guarantees

Posted on April 27, 2015 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’ve written many times about the various meaningful use guarantees that many companies have made over the years. athenahealth being one of the first to do so. In fact, they’ve made it part of their company culture to make guarantees. They’ve done it with Meaningful Use, ICD-10, EOBs, PQRS and MSSP guarantees. Jonathan Bush, President and CEO of athenahealth, recently did a blog post that explained why they do these guarantees:

When Leon Leonwood Bean, founder of L.L.Bean, first created the infamous Bean Boot (officially known as the Maine Hunting Shoe), he sent mailers out to local fishermen and hunters to promote the new boot and guarantee complete satisfaction. Within a few weeks, 90 of the first 100 boots purchased were returned. The leather uppers had separated from the rubber bottoms. Though it almost put L.L.Bean out of business, L. L. stayed true to the guarantee and refunded the customers. After borrowing more money to perfect the boot, he put them back on the market. This winter, over 100 years later, L.L.Bean couldn’t even keep up with the demand for Bean Boots. They’ve even become the latest badge of hipsterdom.

Today, L.L.Bean continues to guarantee satisfaction on all its products. Customers are always trying to return 10 year old boots for brand new ones. But the company doesn’t get persnickety about it. The amount of business the guarantee drives (as evident by this year’s demand) more than makes up for the cost of some free boots, which may never have become a practical winter fashion statement without putting money on the line.

Jonathan Bush goes on to talk about how many people think that the guarantee is about marketing, but it’s not. It’s about a corporate mandate that inspires innovation around something that’s important to customers. You can see how this works. If your bottom line is affected by a guarantee, then you’re sure as heck going to work like crazy to figure out how to solve that problem. At least you better, or your going to go out of business.

Pretty smart thinking as long as you’re smart about which things are worth guaranteeing. The wrong guarantee and you could have your company spending time innovating on something that doesn’t matter. Of course, at least you also get the benefit of the guarantee marketing bump whether Jonthan wants to admit it or not.

Partnerships Between Behavioral Health & Telemedicine Drive Real Value and Impact Outcomes

Posted on April 24, 2015 I Written By

The following is a guest blog post by Dr. Bill Bithoney, Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation.
Bill Bithoney
The behavioral health and medical care delivery systems have long been separate, but the tides are changing. We’re starting to see more of a push to integrate the two, and it’s a trend expected to continue. Increased efforts to grow behavioral health service capacity through better integration with clinical care have health systems turning toward telemedicine. The benefits of this partnership are almost considered a “no brainer” when you take a look at the numbers and the opportunity for growth:

  • $6 billion: Where the telemedicine market will grow by 2020, according to the American Medical Association.
  • 7 million: The number of individuals with co-occurring substance abuse disorders and mental health issues, according to SAMHSA’s most recent National Survey on Drug Use and Health.
  • 38 percent: The number of adults with diagnosable mental health problems who actually receive needed treatment, according to the Department of Health and Human Services.

Still, providers and payors often find themselves asking, “How can I ensure this partnership will drive real value for the organization and impact outcomes?”

Telemedicine provides caregivers the ability to be in multiple locations at once – and provides patients access to care at times and places more convenient to them. As noted above, only 38 percent of adults with diagnosable mental health problems actually receive treatment. This means that more than 60 percent of individuals who know they need help aren’t able to receive it due to commonly cited challenges of not knowing where to go, inconvenience and lack of transportation. Further, psychiatrists, particularly those certified in addiction treatment, are in high demand nationwide. Indiana, which is experimenting with behavioral health telemedicine, has 462 in a state that should have 600.

And telemedicine has been proven effective in behavioral health treatment in numerous studies. Smartphones and apps are actually preferred by patients over prescriptions for medication. Through practices such as screening, brief intervention and referral to treatment (SBIRT)—included in Medicare telehealth services since 2013­­—problematic use issues, abuse and dependence on alcohol and illicit drugs can be proactively identified, reduced and prevented before ballooning into something greater. Moreover, the reduction in facility costs and increased access to patients makes telehealth, and telepsychiatry specifically, a cost-effective alternative to in-person treatments, while delivering much needed care.

Virtual visits and virtual early intervention through SBIRT impact not only the consumer’s health by extending the potential reach of substance abuse and mental health providers, but also the finances of the individual’s employer and insurer since the risks of costly and unanticipated urgent care and emergency department visits are greatly reduced. Additionally, insurers view this aggregation of data as a way to proactively monitor patients’ health, which can help prevent the risk of costly hospital admissions and readmissions.

The era of a partnership between behavioral health and telemedicine is upon us. Developing new avenues to deliver care that support behavior change, while engaging individuals in their own health, can not only be a more cost-effective strategy than simply providing more (or different) health care services, but can also be a smarter strategy to ensure better quality of care.

Dr. Bill Bithoney is a Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation. He can be reached at bbithoney@bdo.com

 

Innovative Collaboration on Medication Management and Community Resources

Posted on April 23, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Although experts agree that the future of health is coordinated care, it is sorely lacking in the US health care system now. This article focuses on the single, relatively simple issue of medication management. Patients are prescribed barrels of pills, but there is little coordination other than looking for contra-indications and drug interactions–and these often suffer from the caretaker’s not knowing the patient’s full complement of drugs.

Sandra Raup, president of Datuit, points out that all kinds of subtleties get lost when patients are simply told how often to take a medication. For instance, if medications are spaced out throughout the day instead of being being taken all at once when we remember to take them (as so many people do), they may be absorbed more effectively and tolerated by the body. Patients–especially those with lower incomes and less education, who are more likely to be on multiple medications in the first place–need all sorts of support.

Here we come to an interesting twist: coordinated care does not have to be initiated by doctors. Given the doctor shortage and the forces keeping clinicians from adopting new models of treatment, other professionals can take on the long-term goals of improving patient health.

In a pilot ramping up in a residence for low-income seniors and the disabled in Maryland, Connected Health Resources is working with Alfa Specialty pharmacy using its Community Health Gateway to help patients straighten out their medications and keep to their schedules. This works because the pharmacy is in a somewhat unusual position: they have supported this community for some time and have built relationships with patients informally. The Gateway pilot has created a service, using Datuit’s SafeIX public API, that can potentially fulfill these needs with less work on the pharmacist’s part. The service is designed for easy navigation by the patients and their family caregivers, making it attractive to the patients and the pharmacists.

Connected Health Resources logo

The SafeIX Platform is designed using modern programming technologies to integrate data from multiple sources (including EHRs and HIEs) into a patient record for both patients and healthcare providers to use, based on their rights to access and share it. In the Gateway implementation, the pharmacist uses the SafeIX Platform to receive CDA documents from the HIE and to auto-assist medical data reconciliation between the various documents.

This information, along with the pharmacist recommendations, are organized into a daily medication calendar using an application from Polyglot Systems Incorporated, a company that offers medication regimen summaries in 18 languages. Low health literacy and the estimated 50 million people who do not speak English at home result in many patients not understanding their medication instructions. The plain language and multilingual, easy-to-use daily calendar can make the difference between understanding and total confusion.

Datuit’s SafeIX Platform uses interoperability standards (including, in test mode, the next-generation FHIR standard) to create a patient record that can show patients everything seen by multiple clinicians and allow a patient’s self-selected care team to view and add to a shared care plan. Datuit is encouraging app developers to build mobile apps for SafeIX that would prompt patients to take medications and record whether they did so, but that’s outside the scope of the pilot. There are plenty of challenges just fulfilling the tasks they have already taken on.

First, Connected Health Resources has to break down the clinical data silos that make it difficult for patients to collect their information. According to co-founder Shannah Koss, Maryland has a relatively advanced Health Information Exchange (HIE) called CRISP. However, it is defined as a provider-to-provider exchange, so it was only after a long-term relationship and negotiation that Connected Health Resources could collect medical data on behalf of the patients. This is the first time CRISP has allowed data to be retrieved for a patient-facing organization that is not a provider.

When enrolling, the patient gives the Gateway permission to get data through CRISP. Family and friends can be invited by patients to be part of their health community and enroll in the Gateway. The invitation includes a unique code that allows the Gateway to securely share records and help with health and social services navigation. If the patient wants help or is incapable of managing the medication list, a caregiver can do so.

CRISP transmits data primarily from hospitals. To round out a more comprehensive listing of medications from clinics and other healthcare providers, CRISP has enabled the ability to query Surescripts, which provides prescription fill data from chain pharmacies and pharmaceutical benefit management companies.

Pilot participants authorize the Gateway and the Alfa pharmacists to access their medication information and maintain, share, and augment the information in the secure SafeIX Platform. The CRISP data gives more complete medication records for the pilot participants. CRISP also provides an event notification system that let’s the pharmacist know whether a patient has been admitted to a hospital or visited the emergency department. These types of transition are precisely when medications get changed, but the clinicians at those crucial junctures often don’t know all of a patient’s current medications.

Finally, over-the-counter (OTC) medications can play an important role in a patient’s care. This has to be added to the daily calendar. The Alfa Pharmacist is helping round out the complete medication picture by working with the patient and family to identify OTC medications, supplements, and the medications that are actually being taken through the medication therapy management (MTM) program. The Gateway provides the means for everyone to better understand and manage the medicines for the best outcomes.

Further, the Gateway Community Resource Finder has enabled information about important resources such as transportation, meal delivery, social services, and home nursing. The MTM pharmacist knows that patients without food or transportation to their physicians cannot adequately manage their health or medications. The underlying SafeIX Platform also allows the Gateway to offer secure messaging that looks like email and lets the pharmacist, patient, friends, and family exchange messages about the patient’s care.

Traditional EHRs don’t accommodate treatment plans of the specificity designed by the pharmacy for patients in the pilot. This is where Datuit is pushing the EHR to new horizons: its SafeIX Platform helps multiple clinicians (including long term care providers), patients, and family caregivers contribute data. For example, patients can enter their own healthcare problems, such as fear of falling. The patients, families, and clinicians can then add interventions to address them.

Like other new organizations I’ve spoken too in health care, Connected Health Resources has grand plans beyond the current pilot. They are taking it slow, because Koss believes personal health records (PHRs) have tried to do too much at once and have overwhelmed their users with too many possibilities. But she would like Connected Health Resources to grow in response to what patients and families say they need. The Gateway tools already include the ability to generate multi-lingual discharge instruction from Polyglot. The initial pilot purposefully focuses on the more narrow scope of medications along with the health and social services support. The next step will be to engage hospitals to provide the plain language multi-lingual discharge instructions.

Chronic care ultimately goes beyond medications to things supported by a patient-centered medical home (PCMH), community health workers, and the many community-based service providers. The Gateway in partnership with the Datuit SafeIX Platform are poised to allow all participants identified by the patient and families to contribute to and be part of their health community.