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The Dawn of The Community EMR

Posted on May 29, 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.

While many healthcare stakeholders would like to see clinical data shared freely, the models we have in place simply can’t get this done.

Take private HIEs, for example. Some of them have been quite successful at fostering data sharing between different parts of a health system, but the higher clinical functions aren’t integrated — just the data.

Another dead end comes when a health system uses a single EMR across its entire line of properties. That may integrate clinical workflow to some degree, but far too often, the different instances of the EMR can’t share data directly.

If healthcare is to transform itself, a new platform will be necessary which can be both the data-sharing and clinical tool needed for every healthcare player in a community. Consider the vision laid out by Forbes contributor Dave Chase:

Just as the previous wars impacted which countries would lead the world in prosperity, the “war” we are in will dictate the communities that get the lion’s share of the jobs (and thus prosperity). Smart economic development directors and mayors will stake their claim to be the place where healthcare gets reinvented.

In Chase’s column, he notes that companies like IBM have begun to base their decisions about where to locate new technology centers partly on how efficiently, effectively and affordably care can be delivered in that community. For example, the tech giant recently decided to locate 4,000 new jobs in Dubuque, Iowa after concluding that the region offered the best value for their healthcare dollar.

To compete with the Dubuques of the world, Chase says, communities will need to pool their existing healthcare spending — ideally $1B or more — and use it to transform how their entire region delivers care.

While Chase doesn’t mention this, one element which will be critical in building smart healthcare communities is an EMR that works as both a workflow and care coordination tool AND a platform for sharing data. I can’t imagine how entire communities can rebuild their care without sharing a single tool like this.

A few years ago I wrote about how the next generation of  EMRs would probably be architected as a platform with a stack of apps built over it that suit individual organizations. The idea doesn’t seem to have gained a lot of traction in the U.S. since 2012, but the approach is very much alive outside the country, with vendors like Australia’s Ocean Informatics selling this type of technology to government entities around the world. And maybe it can bring cities and regions together too.

For the short term, getting a community of providers to go all in on such an architecture doesn’t seem too likely. Instead, they’ll cling to ACO models which offer at least an illusion of independence. But when communities that offer good healthcare value start to steal their patients and corporate customers, they may think again.

Fitbit Data Being Used In Personal Injury Case

Posted on December 8, 2014 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.

Lately, there’s been a lot of debate over whether data from wearable health bands is useful to clinicians or only benefits the consumer user. On the one hand, there are those that say that a patient’s medical care could be improved if doctors had data on their activity levels, heart rate, respirations and other standard metrics. Others, meanwhile, suggest that unless it can be integrated into an EMR and made usable, such data is just a distraction from other more important health indicators.

What hasn’t come up in these debates, but might far more frequently in the future,  is the idea that health band data can be used in personal injury cases to show the effects of an accident on a plaintiff. According to Forbes, a law firm in Calgary is working on what may be the first personal injury case to leverage smart band data, in this case activity data from a Fitbit.

The plaintiff, a young woman, was injured in an accident four years ago. While Fitbit hadn’t entered the market yet, her lawyers at McLeod Law believe they can establish the fact that she led an active lifestyle prior to her accident. They’ve now started processing data from her Fitbit to show that her activity levels have fallen under the baseline for someone of her age and profession.

It’s worth noting that rather than using Fitbit data directly, they’re processing it using analytics platform Vivametrica, which uses public research to compare people’s activity data with that of the general population. (Its core business is to analyze data from wearable sensor devices for the assessment of health and wellness.) The plaintiff will share her Fitbit data with Vivametrica for several months to present a rich picture of her activities.

Using even analyzed, processed data generated by a smart band is “unique,” according to her attorneys. “Till now we’ve always had to rely on clinical interpretation,” says Simon Muller of McLeod Law. “Now we’re looking at longer periods of time to the course of the day, and we have hard data.”

But even if the woman wins her case, there could be a downside to this trend. As Forbes notes, insurers will want wearable device data as much as plaintiffs will, and while they can’t force claimants to wear health bands, they can request a court order demanding the data from whoever holds the data. Dr. Rick Hu, co-founder and CEO of Vivametrica, tells Forbes that his company wouldn’t release such data, but doesn’t explain how he will be able to refuse to honor a court-ordered disclosure.

In fact, wearable devices could become a “black box” for the human body, according to Matthew Pearn, an associate lawyer with Canadian claims processing firm Foster & Company. In a piece for an insurance magazine, Pearn points out that it’s not clear, at least in his country, what privacy rights the wearers of health bands maintain over the data they generate once they file a personal injury suit.

Meanwhile, it’s still not clear how HIPAA protections apply to such data in the US. When FierceHealthIT recently spoke with Deven McGraw, a partner in the healthcare practice of Manatt, Phelps & Phillips, she pointed out that HIPAA only regulates data “in the hands of, with the control of, or within the purview of a medical provider, a health plan or other covered entity under the law.”  In other words, once the wearable data makes it into the doctor’s record, HIPAA protections are in force, but until then they are not.

All told, it’s pretty sobering to consider that millions of consumers are generating wearables data without knowing how vulnerable it is.

Bank of America + Verizon = Patient Demand for EMRs

Posted on January 5, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

You may have noticed several big businesses in the news recently capitulating to customer outrage over new and unnecessary (or completely gratuitous) fees. Bank of America made news in late 2011 when it tried to institute a $5 fee for any customer that wanted to use a debit card. Verizon made a similar move when it tried to put in place a $2 fee for payment made by phone or Web. (Really? You’re going to charge me to pay you?)

I’d even go so far as to lump Netflix’s blunderings in 2011 in with this group. First the price increase, and then the ultimately jettisoned decision to split the business into two product lines – one for DVDs and one for streaming. Though customer outrage wasn’t enough to derail the price increase, I can only assume the backlash had something to do with the decision to ultimately stay with one brand for both services.

As Erika Morphy wrote in a recent Forbes.com article, “It doesn’t take much to enrage consumers these days and while Verizon doesn’t fall in the ignominious category of [a] Wall Street bank, it doesn’t exactly engender fierce customer loyalty or devotion either, the way, for example, Apple does.”

She hit the nail on the head, in my opinion. No matter what your opinion of the Occupy Wall Street movement, I believe it has made the average US consumer more confident in their dealings with Big Business, more apt to cry foul when companies like Bank of America and Verizon try to pull more money out of people’s pockets just because they can. (I know I’m oversimplifying things here, and that these companies have seemingly valid reasons for these fees.) As any healthcare vendor will tell you, being in business is ultimately about the bottom line. So it stands to reason that Big Business will always want to get bigger.

To bring it back around to healthcare, I firmly believe that the customer’s newfound voice of “We’re not going to take it anymore” should be applied to healthcare. Consumers are patients and vice versa. At the end of the day, we all want the best care possible for the least amount of money and inconvenience. Let’s take these lessons learned in the traditionally consumer world and apply them to the patient experience.

Are you looking for a new family practitioner? Choose one that has high quality outcomes, has effectively been using an electronic medical record, is willing to explain the benefits of a homegrown personal health record, and is happy to coordinate care with your specialist two counties away. For that matter, you could make similar demands of your health insurance provider.

I know interoperability isn’t always at the top of our to do lists when it comes time to go to the doctor – often a sudden and unplanned event. If you find yourself being cared for by a doc that’s getting by with paper, become an advocate for change within that practice when the time is right.

It doesn’t hurt to start a dialogue. And as Big Business has shown us, using your voice can actually bring about better outcomes for all.