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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?
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.

Time To Build EHRs That Address Human Complexity

Posted on September 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 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.

As things stand in our world, caring for patients generally falls into two broad categories: treating the body and its innumerable mysteries, and caring for practicalities of the patient’s mental and social health. The two are interrelated, of course, but often they’re treated independently, as if each existed in a separate world.

But we know that this is a false dichotomy. People don’t go from being patients at one point and human beings later, and treating them that way can fail or even cause them harm. At every point, they’re people living in a complex world which may overwhelm their capacity for getting good healthcare. Their values, social networks, resources (or lack thereof), education and mental health status are just a few of the many dimensions that influence a patient’s overall functioning in the world.

This isn’t a new idea. As Frances Peabody noted in a 1927 lecture to Harvard Medical School students, “the secret of the care of the patient is in caring for the patient,” by understanding how a patient’s personal and emotional circumstances influence their health status. It’s a concept that needs revisiting, particularly given that the automation of care seems likely to further alienate doctors from patients.

Given how seldom physicians have a chance to address patients’ life circumstances, and how important it is that medicine returns to this approach, it was good to see the The Journal of the American Medical Association weigh in on the issue.

In the Viewpoint piece, entitled “Evolutionary Pressures on the Electronic Health Record: Caring for Complexity,” the authors contend that next-generation EHRs will need to do much more to help physicians address an increasingly complex patient mix.  They suggest that rising patient complexity – due to issues such as co-occurring chronic and rare diseases, organ transplantation and artificial devices – are changing the practice of medicine. Meanwhile, they point out, patients’ personal experience of illness and the social context in which they live are still important considerations.

But EHRs aren’t developing the capacity to meet these needs, they note:

The evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life. While clinicians can calculate a patient’s likelihood of future myocardial infarction, risk of osteoporotic fracture, and odds of developing certain cancers, most systems do not integrate these tools in a way that supports tailored treatment decisions based on an individual’s unique characteristics.

Existing EHRs aren’t designed to help physicians use predictive analytics to deliver preventative care or services to targeted individuals either, they note. Nor are they helping clinicians to learn from past cases in a systematic manner, the piece says:

When a 55-year-old woman of Asian heritage presents to her physician with asthma and new-onset moderate hypertension, it would be helpful for an EHR system to find a personalized cohort of patients (based on key similarities or by using population data weighted by specific patient characteristics) to suggest a course of action based on how those patients responded to certain antihypertensive medication classes, thus providing practice-based evidence when randomized trial evidence is lacking.

The JAMA authors also take EHR vendors to task for doing nothing to capture social and behavioral data (otherwise known as “social determinants of health”)  which could have a big impact on health outcomes and treatment responses:

In this world of patient portals and electronic tablets, it should be possible to collect from individuals key information about their environment and unique stressors – at home or in the workplace – in the medical record. What is the story of the individual?  The most sophisticated computerized algorithms, if limited to medical data, may underestimate a patient’s risk (eg, through ignorance about neighborhood dangers contributing to sedentary behavior and poor nutrition) or recommend suboptimal treatment (eg, escalating asthma medications for symptoms triggered by second-hand smoke).

If EHRs evolve successfully to embrace such factors – and move away from their origins in billing support – physicians may spend much less time with them in the future. In fact, the authors speak lovingly of a future in which “deimplementing the EHR” becomes a trend, and care no longer revolves around a computer. This may not happen anytime soon.

Still, perhaps we can speak of “rehumanizing the EHR” with information that address the whole, complex person. A rehumanized EHR that Francis Perkins would use, were he alive today, is something physicians should demand.

Social Determinants of Health (SDOH) Chart

Posted on June 28, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems like my latest kick is talking about Social Determinants of Health (SDOH) and their impact on our health and the health system (Note: I blame Mandi Bishop for this). Many of you might remember that I recently asked if doctors ever cared about SDOH. The topic also came up in the recent Health Disruptors chat where I asked pointed questions about SDOH from a practicing doctor. Dr. Vanagon’s responses were quite insightful.

During that chat, I started listing off some of the possible social determinants of health. I knew my list was lacking and I figured someone else had created a much better list. As fate would have it, this list popped up on my social news feed:

Social Determinants of Health (SDOH) Chart

Does anyone else get a bit overwhelmed when you see a full list like this? However, it also displays huge opportunities since our current health system is working on such a small portion of this chart. We’re going to have to expand what we’re doing if we truly want to lower the cost of healthcare as we know it. Although, it’s also important to note that doctors can only influence so much of what impacts our health.

Which SDOH factors do you think it would be best for our health system to work on first?

When Did A Doctor Last Worry About Social Determinants of Health (SDOH)?

Posted on June 16, 2016 I Written By

John Lynn is the Founder of the 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 and 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 heard over and over the importance of social determinants of health (SDOH) and their impact on healthcare costs. The concept is fascinating and challenging. There are thousands of examples. A simple one to illustrate the challenge is the patient who arrives at the emergency room with a fever. The doctor treats the fever and then sends them back to their home where they have no heat and are likely to get sick again.

I ask all the doctors that read this blog, when was the last time you worried about these various social determinants of health (SDOH) in the care you provided a patient?

I’ll be interested to hear people’s responses to this question. I’m sure it would create some incredible stories from doctors who really care about their patients and go above and beyond their job duties. In fact, it would be amazing to hear and share some of these stories. We could learn a lot from them. However, I’m also quite sure that almost all of those stories would end with the doctor saying “I wasn’t paid to help the patient this way but it was the right thing to do.”

Let me be clear. I’m not blaming doctors for not doing more for their patients. If I were a doctor, I’m sure I’d have made similar decisions to most of the doctors out there. They do what they’re paid to do.

As I’ve been sitting through the AHIP Institute conference, I’m pondering on if this will change. Will value based reimbursement force doctors to understand SDOH or will they just leave that to their health system or their various software systems to figure it out for them?

I’m torn on the answer to that question. A part of me thinks that most doctors won’t want to dive into that area of health. Their training wasn’t designed for that type of thinking and it would be a tough transition of mindset for many. On the other hand, I think there’s a really important human component that’s going to be required in SDOH. Doctors have an inherent level of trust that is extremely valuable with patients.

What do you think of SDOH? Will doctors need to learn about it? Will the systems just take care of it for them?

Healthcare IT Twitter Roundup

Posted on March 17, 2016 I Written By

John Lynn is the Founder of the 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 and 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 a huge fan of sucking the nectar out of Twitter and providing me own commentary on what people are sharing.

This would be a good step forward. Machine to machine communication can be a lot more accurate.

When you see some of the amazing things they’re starting to discover in genetics, you can see why many are focusing on genetics. However, Pat’s point is a good one that we should focus on other social determinants of health (SDOH) also since they can have a lot of impact.

This is where the cloud is so powerful. Cloud computing is going to be the solution to this problem.

I see more and more efforts to include the patient voice. Love this!

Social Determinants of Health (#SDOH)

Posted on July 28, 2014 I Written By

John Lynn is the Founder of the 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 and 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 a recent chat that I think was hosted by HIMSS, they used the hashtag #SDOH. I’ll admit that the hashtag wasn’t familiar to me, so I was glad that they included a link to resources on the HIMSS Future Care website that defined #SDOH as Social Determinants of Health. Had you heard of this hashtag or term before?

I’d never heard of Social Determinants of Health before, but I’d certainly heard of some of the concepts. I think there is a lot to be said about how our social interactions can be used to determine our health. I think the real challenge with it is taking it from a conceptual idea and turn it into a science. Not to mention turning it into a science where technology could be applied.

What I just described is the perfect opportunity for an entrepreneur. Some of the best new companies take something really challenging and make it simple for the end user. I think that’s exactly what will happen with social determinants of health. With the plethora of social signals that are easily available and accessible now, a large mix of entrepreneurs will be able to work on this challenge. That’s really exciting for me.

The real question I have with social determinants of health is whether they’ll just be a consumer based application or whether the healthcare system will embrace these notions as well. My guess is that it will start as a consumer focused application and then as the science of SDOH matures, the rest of the healthcare system will start to accept and use it as well.

Have you seen applications of SDOH? Do you think social signals aren’t very valuable in determining someone’s health? Can they be leveraged reliably? Will we eventually see SDOH in EMR and EHR software?