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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.

Low-Profile HIT Player Leidos A Major Presence

Posted on June 1, 2016 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 where I live in the Washington, DC metro, federal IT is a major presence. Government IT consulting firms cluster along the area’s highways, and their executives own countless sprawling manses in the nearby suburbs. Those players include Leidos, a northern Virginia-based contracting firm with clients in IT, biomedical research and public health.

Though the firm has annual revenues of about $5.1 billion, and 18,000 employees, Leidos generates little fanfare here, despite a pedigree that includes a $5 billion partnership with Lockheed Martin’s Information Systems & Global Solutions segment that provides IT and intelligence services. However, Leidos is actually the new identity of long-established power player SAIC, which restructured and changed its name in late 2013 and has deep roots in national security and government IT contracting.

Most readers probably care little about government IT unless they service that industry. But I’d argue that we should all know about Leidos Health which, among other distinctions, was part of the team (Cerner, Leidos and Accenture Federal) that won the $4.3 billion plus contract to implement an EMR for the US Department of Defense last summer.

The DoD contract was hotly contested, by teams that included an Epic, IBM and Impact Advisors combination, but the Cerner-fronted team pulled off a win that may have saved the EMR vendor’s brand in a brutally competitive market. While it’s not clear what role Leidos played in the win, a DoD official was quoted as saying that a Cerner deal was projected to be “much cheaper,” and it’s possible Leidos support pricing played some role in its calculations. Perhaps more tellingly, DoD officials said cybersecurity considerations played a major role in the award, which plays to Leidos’ strengths.

Leidos Health hasn’t had unmitigated success. Most recently, it was part of a team scheduled to assist with a little-mentioned Epic EMR rollout for the US Coast Guard, which was cancelled due to “various irregularities.” The Coast Guard, which pulled the plug on the rollout in April, had been planning its EMR implementation since 2010.

However, this probably wasn’t much of a setback. And Leidos still delivers health IT services to several other federal agencies, including HHS and the Department of Veterans Affairs, including cybersecurity, health analytics, IT infrastructure and support and software development. And it works with the gamut of enterprise EMR vendors, including Allscripts, Cerner, Epic, McKesson and Meditech.

Truth be told, Leidos may not deserve the “quiet company” label given to it by Healthcare Informatics magazine, which recently dubbed it one the most interesting vendors of 2016. I’m sure Beltway execs who compete for federal contracts are well aware of Leidos Health, which had annual revenues of $593 million last year. And government IT decision-makers are well acquainted with parent company SAIC, a pillar of federal contracting which has been in the business since 1969. (In fact, SAIC president of technology and engineering Deborah Lee James was sworn in as Secretary of the Air Force in late 2013.)

That being said, the DoD deal has dramatically raised Leidos Health’s visibility in the broader health IT world. It will be interesting to see what it does going forward, don’t you think?

HHS announces 2013 Healthcare IT Agenda

Posted on March 8, 2013 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.

Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner and the National Coordinator for Health Information Technology Farzad Mostashari, M.D., today announced HHS’s plan to accelerate health information exchange (HIE) and build a seamless and secure flow of information essential to transforming the health care system.

“Thanks to the Affordable Care Act, we are improving the way care is delivered while lowering costs,” said Acting Administrator Tavenner. “We are already seeing benefits, such as a reduction in hospital readmissions due to these reforms. Health IT and the secure exchange of information across providers are crucial to reforming the system, and must be a routine part of care delivery.”

This year, HHS will:

  • Set aggressive goals for 2013: HHS is setting the goal of 50 percent of physician offices using electronic health records (EHR) and 80 percent of eligible hospitals receiving meaningful use incentive payments by the end of 2013.
  • Increase the emphasis on interoperability: HHS will increase its emphasis on ensuring electronic exchange across providers. It will start that effort by issuing a request for information (RFI) seeking public input about a variety of policies that will strengthen the business case for electronic exchange across providers to ensure patients’ health information will follow them seamlessly and securely wherever they access care.
  • Enhance the effective use of electronic health records through initiatives like the Blue Button initiative. Medicare beneficiaries can access their full Medicare records online today. HHS is working with the Veterans Administration and more than 450 different organizations to make health care information available to patients and health plan members. HHS is also encouraging Medicare Advantage plans to expand the use of Blue Button to provide beneficiaries with one-click secure access to their health information.
  • Implement Meaningful Use Stage 2: HHS is implementing rules that define what data must be able to be exchanged between Health IT systems, including how data will be structured and coded so that providers will have one uniform way to format and securely send data.
  • Underscore program integrity: HHS is taking new steps to ensure the integrity of the program is sound and technology is not being used to game the system. For example, it is conducting extensive medical reviews and issuing Comparative Billing reports that identify providers.

The goals build on the significant progress HHS and its partners have already made on expanding health information technology use. EHR adoption has tripled since 2010, increasing to 44 percent in 2012 and computerized physician order entry has more than doubled (increased 168 percent) since 2008.

“The 2014 standards for electronic health records create the technical capacity for providers to be able to share information with each and with the patient,” said Dr. Mostashari. “Through the RFI, we are interested in hearing about policies that could provide an even greater business case for such information sharing.”

In addition to seeking public input, the RFI also discusses several potential new policies and ideas to accelerate interoperability and exchange of a patient’s health information across care settings so that they can deliver better and more affordable care to their patients.

The RFI can be found at http://www.ofr.gov/OFRUpload/OFRData/2013-05266_PI.pdf. Deadline for comments is April 21, 2013.

Mostashari Supports Meaningful Use Stage 2 Delay to 2014

Posted on July 7, 2011 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.

Katherine wrote previously on EMR and EHR about the Meaningful Use Stage 2 delay that was agreed to by the Health IT policy committee. However, that committee is basically just a recommendation engine. They can’t make or create policies. So, it’s pretty big news (although not that unexpected) reported by Government Health IT that Mostashari is supporting the meaningful use stage 2 delay until 2014.

Here’s a short quote from that article:

By giving providers and vendors additional time, requirements for stage 2 can be more rigorous than would otherwise be possible if stage 2 were to begin in 2013 as originally planned, Mostashari said.

“In consideration of these points and the concerns expressed by multiple stakeholders, we agree with the logic of delaying the start of stage 2 of meaningful use for a period of one year for those first attesting to meaningful use in 2011. We also agree that it makes sense to maintain the current expectations for those first attesting to meaningful use in 2012 so that all providers attesting to meaningful use in 2011 or 2012 would attest to stage 2 in 2014,” he said.

Although, the article above also offers some even more interesting comments from Mostashari about those that attest to meaningful use in 2011 versus those who attest to meaningful use in 2012.

Providers who attest to meaningful use at the earliest possible time in 2011 should be rewarded, Mostashari said at the July 6 policy committee meeting. Delaying the onset of stage 2 may encourage more providers to attest in 2011.

“The last thing we want to do is provide a disincentive towards attesting for meaningful use in 2011. We recognize that not accepting your recommendation to delay the start of stage 2 could negatively impact provider participation rates in the EHR incentive program in 2011,” he added.

It’s nice to see Mostashari talking about these sorts of topics in public. They are things that we’ve discussed extensively on EMR and HIPAA and EMR and EHR. It’s a topic that is very important to clinics deciding on how to approach meaningful use.

Reasons for EHR Market Failure According to ONC Director Mostashari

Posted on June 16, 2011 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.

In the write up of the Farzad Mostashari closing keynote of the Government Health IT conference in Washington, Tom Sullivan provided the following summary and quote (emphasis mine):

Competition is a wonderful thing, said Mostashari, but “classic causes of market failure,” in this instance prohibitively high switching costs, vendor or data lock-in, among others, weaken the competitive landscape.

“We need to create a better marketplace,” he said. “We want as little government involvement as possible, but no less.”

These two items are worth considering when it comes to an EHR selection and implementation: prohibitively high switching costs and vendor or data lock-in.

I think I might have to write some future posts on these topics and possible other reasons that the EHR market has issues. For example, a clear way to differentiate EMR products seems like another EMR market failure.