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Healthcare Costs and the New Cost Conscious Patient

Posted on June 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.

My favorite health economist, Jane Sarasohn-Kahn, has put out a really interesting post on her Health Populi blog talking about what the SCOTUS ACA ruling means for health consumers (Side Note: Here’s the lesson I took from the ruling.). Jane offers an important perspective that we should think about as we look to the future of healthcare. Here’s an excerpt from her article:

There are still tweaks and adjustments to be made to the law, and market supports that must deal with the ever-rising price of health care. While optimists report health care cost increases moderated to 6.5% in 2015, this growth rate is nonetheless many times greater than peoples’ wage increases (relatively stagnant for a decade) and the Consumer Price Index which in the previous year was actually negative (due to lower costs of petrol and other decreasing costs in the household budget). The one cost households can count on going up, up, up is….healthcare.

And so with the growth of high-deductible health plans and health savings accounts, health consumers must become health care shoppers — that is, if people want to gain some control over their financial wellness.

What does this new cost conscious patient mean for healthcare? What systems are we going to need to be able to handle the patient? Will we be able to continue providing care to patients without any real idea on how much that care will cost? Or will we need systems that help us know what the cost of care will be so the patient can choose to buy that care or not? Will cost conscious patients want to be kept well instead of just having their current complaint treated?

There are these and a lot of other questions that are raised by this shift in patient consumption of healthcare services. Understanding these changes is going to be extremely important for healthcare organizations to survive.

Specialty Specific EHR

Posted on June 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’ve long been a fan of the specialty specific EHR vendor. I’ve seen over and over again how much of a difference a specialty specific EHR can make in a practice. It’s a slippery slope when a specialty specific EHR starts entering other specialties. We’d like to think that every doctor is the same, but the variation in the needs of different specialties is rarely given the attention it deserves.

What scares me is that if we’re not careful, the specialty specific EHR vendor might be a dying breed. This isn’t because the specialty specific EHR vendors aren’t loved by their users more than the alternatives. Instead it’s the shift towards hospital owned medical practices that puts the specialty specific EHR in danger.

While hospital systems would love to support a best of breed approach to EHR software and allow each specialty to choose their own, I’ve never seen it actually happen. When push comes to shove, the hospital system starts rolling out an EHR vendor that “supports” every one of their specialties. It’s hard to blame an executive for making this choice. The logistics of supporting 20+ EHR vendors is onerous to put it lightly. The efficiency of one EHR vendor for a large multi specialty organization is just impossible to ignore. Long term however, I wonder if the downsides will cause major issues.

I should also declare that I don’t think a specialty specific EHR is always the best option. Some specialty specific EHR software aren’t very good either. In fact, I was recently thinking through the list of medical specialties and there were a lot of specialties where I didn’t know of a specialty specific EHR for them.

The one that struck me the most was that I didn’t know of an OB/GYN specific EHR. Is that really the case? I’ve seen hundreds of EHR and I couldn’t think of ever seeing an OB/GYN specific EHR. Maybe I’ve missed it, and if I have then I’d love to learn about one. I imagine the reason there isn’t one is because many of the larger All in One EHR vendors have put a decent focus on OB/GYN functionality. So, maybe no one wanted to compete with what was out there already? That’s speculation. What’s odd to me though is that OB/GYN seems like the perfect case where a specialty specific EHR could really benefit that specialty. They have some really unique needs and workflows. I’d think there would be massive competition around their specific challenges.

What I’ve also found is even the EHR vendors that are happy to sell to any specialty and probably have a few templates for that specialty (Yes, that’s how many EHR vendors “support” every specialty), even the All In One EHR vendors work better for certain specialties. This is often based on which specialties the EHR vendor had success with first. If 80 of your first 100 EHR sales are to cardiologists, then you can bet that your EHR is going to work better for cardiologists than it will for podiatrists.

With this in mind, let’s work as a community to aggregate a list of specialty specific EHR vendors. I’ll be generous and say that if an EHR vendor works with more than 10 EHR specialties, then it’s not a specialty specific EHR (5 is probably a better number). If you’re an EHR vendor and want to admit which specialties you work better for, then I’d love to hear that too.

Can we find a specialty specific EHR for every medical specialty? I look forward to seeing if we can in the comments.

Some Methods For Improving EMR Alerts

Posted on June 25, 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.

A new study appearing in the Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.

Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.

Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.

The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.

For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.

While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:

  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.

The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.

When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.

The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.

But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

We’re Hosting the #KareoChat and Discussing Value Based Care and ACOs – Join Us!

Posted on June 23, 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.

ACO and Value Based Reimbursement Twitter Chat
We’re excited to be hosting this week’s #KareoChat on Thursday, 6/25 at 9 AM PT (Noon ET) where we’ll be diving into the details around Value Based Care and ACOs. We’ll be hosting the chat from @ehrandhit and chiming in on occasion from @techguy and @healthcarescene as well.

The topic of value based care and ACOs is extremely important to small practice physicians since understanding and participating in it will be key to their survival. At least that’s my take. I look forward to hearing other people’s thoughts on these changes on Thursday’s Twitter chat. Here are the questions we’ll be discussing over the hour:

  1. What’s the latest trends in value based reimbursement that we should know or watch? #KareoChat
  2. Why or why aren’t you participating in an ACO? #KareoChat
  3. Describe the pros and cons you see with the change to value based reimbursement. #KareoChat
  4. What are you doing to prepare your practice for value based reimbursement and ACOs? #KareoChat
  5. Which technologies and applications will we need in a value based reimbursement and ACO world? #KareoChat
  6. What’s the role of small practices in a value based reimbursement world? Can they survive? #KareoChat

For those of you not familiar with a Twitter chat, you can follow the discussion on Twitter by watching the hashtag #KareoChat. You can also take part in the Twitter chat by including the #KareoChat hashtag in any tweets you send.

I look forward to “seeing” and learning from many of you on Twitter on Thursday. Feel free to start the conversation in the comments below as well.

Full Disclosure: Kareo is a sponsor of EMR and EHR.

Do We Want a Relationship With Our Doctor?

Posted on June 22, 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.

As is often the case, this weekend I was browsing Twitter. Many of the people and hashtags I follow are healthcare and health IT related. Many of the tweets related to the need to change the healthcare system. You know the usual themes: We pay too much for healthcare. We deserve better quality healthcare. We need to change the current healthcare system to be focused on the patient. Etc etc etc.

This wave of tweets ended with one that said “It’s all about the relationships.” I actually think the tweet had more to do with how a company was run, but in the beautiful world of Twitter you get to mesh ideas from multiple disciplines in the same Twitter stream (assuming you follow a good mix of people). I took the tweet and asked the question, “Do We Want a Relationship With Our Doctor?

If you’d asked me a year ago, I would have said, no! Why would I want a relationship with my doctor? I don’t want any relationship with my doctor, because that means that I’m sick and need him to fix something that’s wrong with me. I hope to never see my doctor. Doctor = Bad. Don’t even get me started with hospitals. If Doctor = Bad then Hospital > Doctor.

I’m personally still battling through a change in mindset. It’s not an easy change. It’s really hard to change culture. We have a hard core culture in America of healthcare being sick care. We all want to be healthy, but none of us want to be sick. Going to the doctor admits that we are sick and we don’t want anything to do with that. If we have an actual relationship with our doctor, then we must be really sick.

From the other perspective, do doctors want relationships with their patients? I’ve met some really jaded doctors who probably don’t, but most of the doctors I’ve met would love an actual, deep relationship with their patients. However, they all are asking the question, “How?” They still have to pay the bills, pay off their debts, etc. I don’t know many doctors who have reconciled these practical needs with the desire to have a relationship with their patients.

The closest I’ve seen is the direct primary care and concierge models. It’s still not clear to me that these options will scale across healthcare. Plus, what’s the solution for specialists? Will ACOs and Value Based Reimbursement get us there. I hear a lot of talk in this regard which scares me. Lots of talk without a clear path to results really scares me in healthcare.

What do you think? Do you want a relationship with your doctor? Do doctors want a relationship with their patients? What’s the path to making this a practical reality? Are you already practicing medicine where you have a deep, meaningful relationship with your patient? We’d love to hear your experience.

A 6 Step Guide to Succeeding as an ACO

Posted on June 18, 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.

Farzad Mostashari’s company, Aledade, raising $30 million is a good sign that healthcare organizations are going to be spending a lot of time and money figuring out these new ACO and value based reimbursement models. If you’re a healthcare organization that hasn’t started learning about ACOs, here’s a good whitepaper to start.

The whitepaper is titled “Succeeding as an ACO: A 6-Step Guide for Health Care Organizations” and does a lot more than just talk about the 6 steps to building an ACO. It covers ACO in a pretty thorough way. However, the 6 steps are pretty valuable as well:

1. Understand Your Costs
2. Reduce Out-Migration from Your Network
3. Maximize Pay-for-Performance Reimbursement
4. Identify Early Opportunities for Utilization Reductions
5. Support Chronic Care and Disease Management
6. Predict Who Will Develop Issues

Is your healthcare organization ready for the changing reimbursement model and ACOs? If you’re not sure, read through this FREE whitepaper and you’ll have a better idea of what’s happening and how you want to position yourself and your organization in this changing reimbursement environment.

Marketing Predicted the Failure of Meaningful Use Stage II Patient Engagement

Posted on June 17, 2015 I Written By

The following is a guest post by John Sung Kim, General Manager of DoctorBase, a Kareo Company.
John Sung Kim
Marketers knew far ahead of CMS and the ONC that certain components of Meaningful Use Stage 2 (MU2) were simply not attainable. Thankfully, one of the original components of MU2, whereby 5% of a provider’s patients have to exchange secure messages, is now being relaxed to the simple ability to have secure messaging as an available option for patients.

When MU2 was first drafted, the original threshold was 10%, which was met with a wave of criticism from vendors, analysts, and providers who pointed out that forcing patients to adopt a new technology was outside of a provider’s control.

Yet, even the subsequently reduced 5% goal was difficult to achieve for most organizations, especially smaller independent practices that were dealing with a confluence of changing competitive markets, new billing codes, and mandated technological updates. Any digital marketer with two years of experience running ad campaigns could have told us this would become the case.

There were several marketing related reasons why 5% (or 1 in 20 patients) was simply not achievable for many practices, even with many modern EHR systems:

  • Activation Energy: Most patient portals are too difficult to register for. It’s a well known marketing rule that the number of fields a user has to fill in to register for a service is inversely proportional to the completion rate. Marketers call the amount of effort that users are required to obtain a desired action on a computer or mobile device the “activation energy.” Quite simply, the activation energy required to register for most patient portals is too high.
  • The Funnel: The most common way that patients look for the address or phone number of a provider is to enter permutations of the doctor’s name in search engines. This is what marketers call the “top of the funnel.” If a patient portal is not optimized for search engines (very few are) patients won’t enter the funnel, in other words—what can’t be seen at the top of a Google search result simply doesn’t exist to the patient.
  • Call to Action: Any modern digital marketing campaign has a “Call to Action,” commonly referred to as a CTA. In healthcare, it’s rare that any brochure, office sign, or practice website has a CTA asking patients to engage or interact, and that’s a shame since colorful, visible (and often large) buttons directing the user to click have interaction rates that are often on an order of magnitude greater than collateral without a clear CTA.
  • Email Marketing: Having worked in both digital health and digital marketing, I know how important collecting email addresses of users is, and how poorly most practices actually do this in a routine fashion. A “typical” small or group practice will have no more than 20% to 25% of their patients’ email addresses. So when a marketer does the math of registering 5% of their users through emails, the true number becomes much larger. For example, a practice with 20% of their panel with an email address would need a 25% engagement rate—not 5%! That’s an incredibly aggressive target, even for the biggest brands and best marketers.

Is it time for the Office of the National Coordinator and CMS to start hiring more marketers?

About John Sung Kim
John Sung Kim is the founder and founding CEO of Five9 (NASDAQ: FIVN) widely recognized as the leading company in the contact center industry. He’s acted as a consultant to numerous startups including LGC Wireless (acquired by ADC), Qualys (NASDAQ: QLYS), RingCentral (NYSE: RNG), Odesk (merger w/ Elance), 6connect (funded by Hummer Winblad) and M5 Networks (acquired by ShoreTel). Follow him @JohnSungKim.

Kareo, the leading provider of cloud-based software and services for independent medical practices, is a sponsor of EMR and EHR. Find out more about Kareo’s award-winning solutions at http://www.kareo.com/.

Katy Perry “Roar” Sleep Apnea Parody

Posted on June 16, 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.

If you like creative online video education, you’ll enjoy this Katy Perry “Roar” parody by ZDoggMD. Ok, it might not be all that educational, but it’s pretty hilarious. I think we all have someone in our life with this problem it seems. So, I’m sure that many of you will relate. Enjoy the video embedded below.

Patients Can Squawk, But We Have Little To Crow About Open Data

Posted on June 15, 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.

One of the biggest disappointments at this year’s Health Datapalooza (which I found disappointing overall) was the continued impasse presented to patients who, bolstered by the best thinking in health care as well as Federal laws and regulations, ask for health data stored about them by doctors and other institutions.

Activists such as Regina Holliday and e-Patient Dave proved years ago that giving patients information and involving them in decisions will save lives. The Society for Participatory Medicine enshrines the principle. But the best witnesses for patient empowerment are the thousands of anonymous patients, spouses, parents, and children quietly trundling folders with their own records through the halls of hospitals, building up more knowledge of their chronic conditions than any professional clinician possesses, and calmly but inflexibly insisting on being equal partners with those who treat them.

There were plenty of high-minded words at the Datapalooza about patient rights to data. It was recognized as a key element of patient empowerment (or “activation,” as the more timid speakers liked to say) as well as an aid to better care. An online petition backed by an impressive array of health reformers is collecting signatures (whom someone will presumably look at) and encourages activists to speak up about this topic on July 4. HHS announced that anyone denied access to data to which the law gives her a right can submit an informal report to noinformationblocking@cms.hhs.gov.

Although occasional mention was made of personal health records (PHRs), most of the constant discussion about interoperability stayed on the safe topic of provider-to-provider data exchange. Keeping data with health care providers leads to all sorts of contorted practices. For instance, patient matching and obtaining consent are some of the most difficult challenges facing health IT in the U.S., all caused by keeping data with providers instead of the patients themselves.

The industry’s slowness to appreciate patient-generated data is also frustrating. Certainly, the health IT field needs to do a lot more to prepare data for use: consumer device manufacturers must assure clinicians of the devices’ accuracy, and researchers need to provide useful analytics that clinicians can plug in to their electronic systems. Still, doctors are demonstrating a disappointing lack of creativity in the face of this revolutionary source of information. It’s all to easy to carp about accuracy (after all, lab tests have limited accuracy as well) or just to state that you don’t know what to do with the data.

I heard about recent progress at the UK’s National Health Service from Brian Ahier, who is the only person I know who can explain the nuances of extensions to FHIR resources while actively using both his laptop and his cell phone at the same time. Ahier heard at a UK-US Bootcamp before the Datapalooza that the NHS has given 97% of its patients access to their records.

But there’s a bit of a caution around that statistic: only one-fifth of the patients have taken advantage of this right. This doesn’t bother me. First of all, one-fifth of the population with access to their personal records would be a dizzying accomplishment for most countries, including the U.S. Second, few people need access to records until some major problem arises, such as the need to see a specialist. They probably feel relieved to know the records will be there when needed.

Another aspect of patient control over data is research. The standard researcher-centered model is seen as increasingly paternalistic, driving patients away. They’re not impressed with being told that some study will benefit people like them–they want to tell researchers what really matters to them as sufferers, and hear more about the study as it goes along. Researchers are frantic to reverse a situation where most studies fail simply because they can’t sign up enough subjects.

The Patient-Centered Outcomes Research Institute (PCORI) is one of the progressive institutions in health care who understand that giving patients more of a say will be increasingly important for signing up patients in the first place, as well doing research of value to them. Its PCORnet combines traditional research databases with databases maintained by patient advocacy groups. Each member network can create its own policies for getting consent, which allows researchers to bend with the needs of their research subjects.

OpenClinica, the open source clinical research platform, just announced the release of an app that may contribute to the goals of taking input from patients and binding them closer to the research endeavor.

Public health officials also recognize the sensibilities of the people they monitor. At a panel on data about low-income people, speakers stressed the importance of collecting data in a respectful way that doesn’t make people feel they’re being spied on or could be punished for their behavior.

Let’s talk a minute about health care costs, if only because doctors and insurers don’t want to. (Some doctors are prohibited by their employers from telling patients how much a recommended procedure will cost, supposedly because they don’t want costs to intrude on what should ideally be a clinical decision. This is changing with the increase in deductibles, but often the doctors don’t even know what the final cost will be after insurance.)

One app so admired by the Datapalooza team that they allowed the company to demonstrate its product on the main stage during keynote time was Sensentia. This product everybody is so impressed with takes in information from health plans to allow patients as well as the staff at health care providers to quickly find the health plan benefits for a procedure. (I recently covered another company doing similar work with insurance and costs.)

Sensentia is a neat product, I am willing to aver. It accepts natural language queries, crunches the data about health plans and insurers, and returns the actual health plan benefits for a treatment. Of course, I know the cost of flying from Boston to San Francisco after six clicks in my browser, even though the calculations that go into offering me a price are at least as complicated as those run by health plans. One may be shocked to hear that that current phone calls to an insurer cost $3-$10. This is the state of health care–it costs more than five bucks on average for a doctor just to find out how much it will cost to offer his own service.

A panel on patient-generated data reported more barriers than successes in getting doctors to work with data from patient devices and reports from everyday life. Another panel about improving quality measures culminated in the moderator admitting that more patients use Yelp than anything else to choose providers–and that it works pretty well for them.

For me that was the conference’s low point, and a moment of despairing cynicism that doesn’t reflect the mood of the conference or the health care field as a whole. Truly, if Yelp could solve our quality problems, we wouldn’t need a Datapalooza or the richness of data analysis it highlights. But I think reformers need more strategies to leap the hurdles we’re facing and implement the vision we all share.

Is Claims Data Really So Bad For Health Care Analytics?

Posted on June 12, 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.

Two commonplaces heard in the health IT field are that the data in EHRs is aimed at billing, and that billing data is unreliable input to clinical decision support or other clinically related analytics. These statements form two premises to a syllogism for which you can fill in the conclusion. But at two conferences last week–the Health Datapalooza and the Health Privacy Summit–speakers indicated that smart analysis can derive a lot of value from claims data.

The Healthcare Cost and Utilization Project (HCUP), run by the government’s Agency for Healthcare Research and Quality (AHRQ), is based on hospital release data. Major elements include the payer, diagnoses, procedures, charges, length of stay, etc. along with potentially richer information such as patients’ ages, genders, and income levels. A separate Clinical Content Enhancement Toolkit does allow states to add clinical data, while American Hospital Association Linkage Files let hospitals upload data about their facilities.

But basically. HCUP data revolves around the claims from all-payer databases. It is collected currently from 47 states, and varies on a state-by-state basis depending on what data they allow to be released. HCUP goes back to 2006 and powers a lot of research, notably to improve outreach to underserved racial and ethnic groups.

During an interview at the Health Privacy Summit, Lucia Savage, Chief Privacy Officer at ONC, mentioned that one can use claims data to determine what treatments doctors offer for various conditions (such as mammograms, which tend to be underused, and antibiotics, which tend to be overused). Thus, analysts can target providers who fail to adhere to standards of care and theoretically improve outcomes.

M1, a large data analytics company serving a number of industries, bases a number of products in the health care space on claims data. For instance, medical device companies contract with M1 to find out which devices doctors are ordering. Insurance companies use it to sniff out fraud.

M1’s business model, incidentally, is a bit different from that pursued by most analytics organizations in the health care arena. Most firms contract with some institution–an insurer, for instance–to analyze its data and provide it with unique findings. But M1 goes around buying up data from multiple institutions and combining it for deeper insights. It then sells results back to these institutions, often paying out taking in payment from the same company.

In short, smart organizations are shelling out money for data about billing and claims. It looks like, if you have a lot of this data, you can reliably lower costs, improve marketing, and–most important of all–improve care. But we mustn’t lose sight of the serious limitations and weaknesses of this data.

  • A scandalously amount of it is clinical just wrong. Doctors “upcode” to extract the largest possible reimbursement for what they treat. A number of them go further and assign codes that have no justification whatsoever. And that doesn’t even count outright fraud, which reaches into the billions of dollars each year and therefore must leave a lot of bad data in the system.

  • Data is atomized, each claim standing on its own. A researcher will find it difficult to impossible (if patient identifiers are totally stripped out) to trace a sequence of visits that tell you about the progress of treatment.

  • Data is relatively impoverished. Clinical records flesh out the diagnosis with related conditions, demographic information, and other things that make the difference between correct and incorrect treatments.

But on the other hand, to go beyond billing data and reach the data utopia that reformers dream about, we’d have to slurp up a lot of complex and sensitive patient data. This has pitfalls of its own. Little clinical data is structured, and the doctors who do take the effort to enter it into structured fields do so inconsistently. Privacy concerns also raise their threatening heads when you get deep into patient conditions and demographics. So perhaps we should see how far we can get with claims data.