When looking forward, it sometimes helps to look back; sometimes.
Though the past is not always an indicator of things to come, sometimes we’re able to find a little guidance in the hindsight.
Much is being written by folks like myself in response to HIMSS asking the question of where Health IT is going to be a year from now, on the anniversary of second annual National Health IT Week.
Unlike several of my counterparts — perhaps I’ll be considered less of a forward thinker because of it — but instead of fast forwarding one year, I’d like to go back one year to formulate a response.
In May 2011, I had the pleasure of helping draft a column for my then boss for Imaging Economics magazine. The piece, one of my favorites, seemed to strike a chord, even if just with my office colleagues.
Nevertheless, this piece essentially answers the very question asked by HIMSS, a year before the asking.
And so, as we wrote back then, I’ll begin here again, with an encore of the piece as a response.
“Here’s how I see it: Healthcare is a world of major transition. Like life, there is some unpredictability, and most likely, there always will be.”
We continue: “Yet, during this time – call it one of change, progress, upheaval — we must continue focusing on creating a more mobile and connected place in which physicians and their patients share tools. We need to encourage a greater, more vested conversation, where health information exchanges and practice and patient portals are used, secure messaging and 24-hour access to records and patient data for the patient and their physician.”
This observation, according to my best estimate, couldn’t be any timelier.
We continue again:
“I see a healthcare environment that mirrors the rest of the world. Where, as a patient, I can see my labs at 3 a.m., can query my doctor and request refills; if I’m up for it, pay bills anywhere there’s a connection. I see this as accepted and practiced, in the practice of medicine. Always. Any time. Now.”
Perhaps we’re there now; perhaps not. Regardless, we’re talking about it and, given another year, I might be able to more profoundly announce, “Always. Any time. Now!”
If I remember correctly, in helping write this next section I spoke for myself: “But, here’s what I know: Patients are demanding greater ownership of their care and records (I was). They (I) want the always, any time, now. I also know that physicians – along with constant pressure of requirements and reform – need solutions they can trust; technology tools that are intuitive that help them provide the highest quality of care, all while meeting their patients’ needs.”
It seems nothing has changed in more than a year. I suspect little will change in another. Reform continues as we move past Stage 1 and into Stage 2, which are more rigorous than their predecessors. It will consume hours of healthcare professionals’ time. They will toil and try, and try and toil.
Despite the continuing and conflicting headlines, patients do want to get more involved in their care, but they need a reason to buy in; and physicians need tools that are going to improve their lives. They need more efficiency, more powerful and intuitive solutions. They need to start responding to survey that asks “What is the best system to use?” rather than “What is the least complex system to try to operate?”
Let me jump ahead now. “Physicians realize their sway within the healthcare market, both as practitioners and consumers, and they realize – like their patients — how technological connections enhance their experiences in other areas of their lives (read: paying bills online, online banking, booking appointments with the DMV through a website, purchasing movie tickets through a phone, etc.). This understanding of using technology as a tool is helping them improve and streamline their practices and, ultimately (for the better), engage their patients in care. “
Finally, here we get to the heart of the matter: “Technology by itself won’t improve patient care. Physicians know this – we all know this – and physicians play the key role in providing higher quality of patient care, but using technology as a tool to improve care improves outcomes, according to the physicians and patients I speak with. And, to me, that means improved outcomes equates to improved quality of care.”
“So, it makes sense that the practice of medicine is changing with technology, which calls for an adjustment of its perceptions in the space.”
And, to the tune of Paul Harvey, here’s the rest of the story:
“Because, as more attention flows into the market – with reform and regulation – it’s time to decide where the future of healthcare is going to be. Connection and interoperable features that drive ownership of patient care may be rooted in the patient-centered medical home and accountable-care organizations, but for that, more needs to be done. We have to be able to share data – again, that’s where connectivity comes in — and we’ll have to be able to move records quickly and efficiently, all while trying to remove the shackles from providers attempting to do what they sought the schooling and expertise for: To practice medicine.”
“All of this begins with the electronic record – other tools are essential, too, including patient portals; physician referring portals with the ability for images and notes to be accessed from anywhere there’s a connection; labs; refills and appointments through one interface, a seamless integration between practitioner and patient – is where I think we need to be, so we can move forward with the rest of the marketplace (meaning: banks, media and communication segments). With the value perceived in being able to share and communicate endlessly and with ease socially, we have to reach these heights in the practice of medicine.”
“Technology helps make lives better. Though, as noted above, technology doesn’t make doctors (or people of all kinds, for that matter) better, it just makes it easier for them to do their jobs (and live their lives). It won’t happen overnight, but I can see even better healthcare attained.”
And so, the encore performance may actually be a sign of things to come.
Guest post by Brandee Norris, assistant professor healthcare administration and management school of business and technology, Trevecca Nazarene University.
The health information technology (HIT) industry is on the verge of a dramatic dawning. As more healthcare organizations transition to paperless systems and to meaningful use of a certified electronic health record (EHR), the need to ensure the safety and integrity of healthcare data and to eliminate the risk of health IT breaches increases. In the past five years, the Department of Health and Human Services reported more than 800 breaches of healthcare patient data, breaches that affected more than 30 million patients. Breaches in electronic healthcare data cause serious negative outcomes for patients, stakeholders, and organizations—both public and private—and result in millions of dollars in fines and losses.
As the use of HIT systems increases within the healthcare industry, hospitals and providers of private practices are seeking effective methods to enhance data storage and streamline access to patient information without jeopardizing the privacy of the data. A possible solution to this problem is the transference of protected health information from a local system’s network to a cloud-based electronic medical records (EMR) service. Cloud computing may be categorized as private or public. Based on HIPAA regulations, professionals in the healthcare industry continue to dispute the legitimacy of public cloud computing and compliance with specific requirements of the HIPAA.
Contrary to provisions mandated by HIPAA, cloud-based platforms could accommodate the growing needs of healthcare organizations and provide flexibility to adapt to frequent changes, while providing significant cost savings. The primary objectives of using any variation of a cloud-based program are efficient leveraging of healthcare information, enhancement of patient experience, versatility for providers, and improved clinical outcomes. Cloud-based programs permit 24-hour patient access to electronic records.
Consumers in the 21st century prefer convenient methods to access healthcare services and manage personal information. Consequently, healthcare organizations have adopted patient-centered models to deliver health care and increase provider-patient communication. In addition, cloud-based platforms can facilitate the use of mobile devices, such as smartphones and iPads, allowing patients and providers to access health software applications. The number of healthcare consumers using smartphones to access health information soared from more than 60 million to more than70 million in the last two years. Anderson projects an estimated 20 percent annual increase of software application sales during the next five years.
Healthcare providers have suggested that significant benefits could occur for patients using mobile software applications to monitor their health status. Currently, numerous types of health software applications exist that are free or obtainable at a reasonable fee. Last year, healthcare providers used health software applications for obtaining diagnostic test results, sending alerts for patients to self- medicate, track and monitor levels of chronic pain, and store vital signs and emergency contact information. Consumers should be aware that a compatible operating system and adequate storage space are required to download health software applications to a mobile device.
Another trend of HIT is the use of telemedicine. Much healthcare research authenticates the use of telemedicine and its efficacy in delivering a level of quality services to consumers. The use of telehealth provides a method of delivering real-time consultations and treatment with added benefits—the promotion of wellness and prevention to patients via remote monitoring. A large percentage of patients from rural communities and other vulnerable patient populations, such as the incarcerated, has benefited from telehealth care. As the demands and needs of consumers continue to escalate, the advent of technology will revolutionize how healthcare will be delivered in the future.
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.
Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.
Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?
I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.
What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?
I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.
We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.
Can you tell us about Axial Exchange, its mission and why patient engagement is important – beyond the bumper sticker response?
We are a nation of chronic disease. Our health system today is geared around trauma and acute problems. If you break a bunch of bones, the system works well. If you have diabetes, heart disease, and COPD, which many Americans have, then no amount of office visits are going to change your prognosis without you becoming a smarter patient and more invested in your own care. In the 15 to 20 minutes you see a doctor, every minute counts. If you know your illness, your patterns and work toward shared goals (keeping on your insulin, for example), then those 20 minutes can be used to discuss next steps, not rehash the past based on unspecific information like “I’ve been feeling really bad lately.”
If we are to bend the cost/value curve in this country, it will be because patients and their families and caregivers have more information and data to act on so they can better control their own health, and the time spent with physicians is focused on meaningful data. Fortunately, with the rapid changes in technology of mobile devices, this is now becoming a reality.
Can you define patient engagement? There’s seems to be a fairly flexible interpretation of the term throughout healthcare.
To Axial, an engaged patient is one that takes a more active role in self-care. The three areas we address today are: education, medication management and symptom/biometric tracking. We’ve chosen these because there are multiple clinical studies to show that patients who understand their disease, adhere to their medications, and are aware of their symptoms and vitals and the impact their behavior has on them, have better outcomes than those who don’t. It’s not realistic to assume that a physician can impact these three subjects fully during their visits with the patients.
Where do you see patient engagement going and how are we actually going to get there? What are some of its biggest impediments? How did it exist prior to meaningful use?
Long term we are fully supportive of the Office of the National Coordinator of Health IT (ONC) and the National eHealth Collaborative Patient Engagement Framework designed to help health systems design and roll out patient engagement programs. The framework, which was vetted by more than 150 healthcare stakeholders, is also aligned with meaningful use through Stage 4. (For more details on the framework, check our Patient Engagement School on our website and download “A Patient Engagement Primer for Health Systems”).
This is going to be a huge transition for healthcare organizations, and it is primarily driven by the change from fee-based to value-based compensation. In business terms, for 50 years, the incentives were to fill beds and run machines around the clock. Now, the goal is to improve outcomes by reducing costs. This changes practically everything about our health system. The role of primary care specialists is front and center. Care managers and disease educators become increasingly important. So while our software helps organizations make this shift a workable reality there are many fundamental jobs and roles that need to change first.
While meaningful use is important, it’s not nearly as important as the overall shift in how hospitals and physicians get paid. Across the country, most organizations understand where we are headed, but they are at various stages at making this massive transition of care.
From your experience, what have been patient engagement’s most surprising issues, or what surprises you most about patient engagement?
I continue to be surprised by the disconnect between what patients are willing to do and what the physicians believe they will do. Many doctors will speak about how poorly patients comply on issues like diet and medication. However, we find that most patients want to make changes but they don’t know how. They don’t fully understand their illnesses or what their medications do. They can’t always draw the connection between what they eat or what medications they take and how they feel. But if you give patients and their families the tools to do so, a large number of them will become better managers of their diseases — it may not be everyone, but a meaningful slice of the population.
Who are Axial’s customers and how do they use the company’s patient engagement mobile application?
We sell primarily to integrated delivery networks, both hospital systems and groups of community doctors. All of our clients make the application available to all their patients and families through the Apple App and Droid stores. Some of our clients, particularly those who have a large part of their client base under some form of capitation, link this patient-generated data back to the physicians as part of the work flow around the office visit (done through integration back to the EMR). We have a couple of very forward-thinking clients that are moving toward proactive case management as I described earlier.
How do patient engagement apps, like Axial’s, improve care outcomes and reduce readmission rates? Specifically.
If you or someone in your family have been diagnosed with congestive heart failure, you’re not alone. Heart failure affects nearly 6 million Americans. Roughly 670,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than 65. Worse still, 25 percent of those patients will end up back in the hospital within 90 days. That’s why this is a major priority for U.S. hospitals. The Center for Medicare and Medicaid, in an effort to lower re-admissions, is penalizing hospitals that have the highest quartile of re-admission rates. But how can re-admissions be avoided? It turns out that the single most accurate predictive factor for heart failure is rapid weight gain because of fluid retention. Leading health systems are planning on using wireless scales to proactively identify at-risk patients, and make sure they have the appropriate medical treatment before another heart failure occurs. How? Axial allows you to link patient data from wireless scales and other devices to the hospital information systems and case management tools so that medical professionals can see what’s happening in real time. A nurse or physician’s assistant can reach out to the patient whose weight has rapidly increased and intervene, having the patient come in for a physician visit before the condition escalates. The evidence? We’re working with major health systems now to put these kind of capabilities in place.
How is Axial Exchange different from other patient engagement tools available today and where is the company headed, and how is it likely to evolve past patient engagement?
Axial links two worlds — the consumer wellness/mobile world and the institutional health system world. Most organizations that call themselves patient engagement companies are either consumer companies that make point solutions that aren’t part of the care cycle. Conversely, most hospitals have invested hundreds of millions in big moat-like systems organized around the hospital and care process. They are not consumer-friendly (or doctor-friendly for that matter). We believe that by linking these two worlds, you can build smarter patients and doctors that can be more effective in the limited time they have. Our patient-facing software is elegant, intuitive and easy to use. That data is transmitted and sent to the hospital’s EHR and population health systems so they have timelier, richer information within their existing workflow. We have seen very few companies that can be part of both worlds.
I’m not sure we want to evolve past patient engagement because healthcare is at the beginning of a change to become more consumer-centric. Instead, we see sharing more and more information — price transparency, information about approved support groups, disease registries, etc. This is just the beginning of a tidal change of how healthcare will be delivered.
In your opinion, what are the most pressing issues facing the healthcare industry today? How does your company help address these?
Healthcare institutions need help understanding how their institutions must change in this new world. All of a sudden, they must do things they haven’t done before — like become payers or work closely with payers. They need to recruit populations like local employers, and different skills like clinically schooled case managers. This is a huge amount of change in a short period of time.
Axial helps by working with their existing workflow and systems to bring information to providers as they are ready to use it. We have clients in all stages of this transition, from those who are still buying practices and other hospitals but are primarily fee-based, to full ACOs. In any care model, getting closer to the patient is a key part of the organization’s success. We grow with provider organizations as they move toward full risk, while letting them maximize the investments they have already made in core operational systems. Getting a full resolution picture of patients helps all health systems and their patients.
Guest post by Paul Brient, CEO, PatientKeeper, Inc. Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber. Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at […]
Rohan Kulkarni, vice president of healthcare strategy and portfolio at Conduent, speaks here about Conduent’s healthcare strategy and the company’s move to brand following its separation from Xerox. While doing so, he steps back to look briefly at aspects of healthcare technology’s past then pivots to its future and what he’s most excited about in the […]
When looking forward, it sometimes helps to look back; sometimes. Though the past is not always an indicator of things to come, sometimes we’re able to find a little guidance in the hindsight. Much is being written by folks like myself in response to HIMSS asking the question of where Health IT is going to […]
Guest post by Brandee Norris, assistant professor healthcare administration and management school of business and technology, Trevecca Nazarene University. The health information technology (HIT) industry is on the verge of a dramatic dawning. As more healthcare organizations transition to paperless systems and to meaningful use of a certified electronic health record (EHR), the need to […]
Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS […]
Guest post by Paul Brient, CEO, PatientKeeper, Inc. Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber. Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at […]
Rohan Kulkarni, vice president of healthcare strategy and portfolio at Conduent, speaks here about Conduent’s healthcare strategy and the company’s move to brand following its separation from Xerox. While doing so, he steps back to look briefly at aspects of healthcare technology’s past then pivots to its future and what he’s most excited about in the […]
