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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.

I Have Seen The Portal, And It Is Handy

Posted on July 14, 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.

After writing about EMRs/EHRs and portals for many years, I’ve finally begun using an enterprise-class portal to guide my own care. Here’s some of my impressions as an “inside” (EMR researcher) and “outside” (not employed as a provider) user of this tool. My conclusion is that it’s pretty handy, though it’s still rather difficult to leverage what I’ve learned despite being relatively sophisticated.

First, some background. I get most of my care from northern Virginia-based Inova Health System, including inpatient, primary care, imaging and specialist care. Inova has invested in a honking Epic installation which links the majority of these sites together (though I’ve been informed that its imaging facilities still aren’t hooked up to core medical record. D’oh!) After my last visit with an Inova doctor, I decided to register and use its Epic portal.

Epic’s MyChart has a robust, seemingly quite secure process for registering and accessing information, requiring the use of a long alphanumeric code along with unique personal data to establish an account. When I had trouble reading the code and couldn’t register, telephone-based tech support solved the problem quickly.  (Getting nearsighted as I move from middle- to old-aged!)

Using MyChart, I found it easy to access lab results, my drug list and an overview of health issues. In a plus for both me and the health system, it also includes access to a more organized record of charges and balances due than I’ve been able to put together in many years.

When I looked into extracting and sharing the records, I found myself connected to Lucy, an Epic PHR module. In case you’ve never heard of it (I hadn’t) here’s Epic’s description:

Lucy is a PHR that is not connected to any facility’s electronic medical record system. It stays with patients wherever they receive care and allows them to organize their medical information in one place that is readily accessible. Patients can enter health data directly into Lucy, pull in MyChart data or upload standards-compliant Continuity of Care Documents from other facilities.

As great as the possibility of integrating outside records sounds, that’s where I ran into my first snag. When I attempted to hook up with the portal for DC-based Sibley Memorial Hospital — a Johns Hopkins facility — and integrate the records from its Epic system into the Inova’s Lucy PHR, I was unable to do so since I hadn’t connected within 48 hours of a recent discharge. When I tried to remedy the situation, an employee from the hospital’s Health Information Management department gave me an unhelpful kiss-off, telling me that there was no way to issue a second security code. I was told she had to speak to her office manager; I told her access to my medical record was not up for a vote, and irritated, terminated the call.

Another snag came when I tried to respond to information I’d found in my chart summary. When I noted that one of my tests fell outside the standard range provided by the lab, I called the medical group to ask why I’d been told all tests were normal. After a long wait, I was put on the line with a physician who knew nothing about my case and promptly brushed off my concerns. I appreciate that the group found somebody to talk to me, but if I wasn’t a persistent lady, I’d be reluctant to speak up in the future given this level of disinterest.

All told, using the portal is a big step up from my previous experiences interacting with my providers, and I know it will be empowering for someone like myself. That being said, it seems clear that even in this day and age, even a sophisticated integrated health system isn’t geared to respond to the questions patients may have about their data.

For one thing, even if the Lucy portal delivers as promised, it’s clear that integrating data from varied institutions isn’t a task for the faint of heart. HIM departments still seem to house many staffers who are trained to be clerks, not supporters of digital health. That will have to change.

Also, hospitals and medical practices must train employees to enthusiastically, cheerfully support patients who want to leverage their health record data. They may also want to create a central call center, staffed by clinicians, to engage with patients who are raising questions related to their health data. Otherwise, it seems unlikely that they’ll bother to use it.

EMR Ready: The Smartphone Physical

Posted on April 9, 2013 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.

Here’s the kind of thinking that makes me wish I was going to TEDMED 13 (John Lynn will be there if any other readers are attending.).  At this years’ show, a team of current and future medical professionals plan to do a complete “smartphone physical” for attendees, using a bunch of devices that appear to be compatible with an iPhone. Not only is the data immediately readable as the testing goes on, it’s EMR-ready, too, both pretty neat features.

Check out just how thorough the physical is going to be (courtesy of the TEDMED blog):

• Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

•Heart electrophysiology using the AliveCor Heart Monitor.

•Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patient’s lungs and heart.

• Carotid artery visualization using a Mobisante probe.

Participant Shiv Gagliani, a Johns Hopkins medical student, tells TEDMED that the smartphone physical can improve doctor-patient relationships, as the real-time, audible and visual results help connect patients to the tests and increase their understanding of their bodies.  Not only that, the patients can help gather the data themselves, increasing their engagement with their care.

And of course, the devices that make the smartphone checkup possible are also very portable, making it possible for doctors to take them wherever they go, be it down the street or across the globe.  What’s more, less-trained global health workers will be able to use these devices to gather baseline readings and via telemedical links, get instructions on how to treat patients. This device connectivity is part of what John suggested was needed for successful Telehealth.

To learn more about this project, visit http://www.smartphonephysical.org/. I’d definitely take a look; it seems to me that this type of mobile health technology is here to stay.