Patient-centric Data Capture—Where Is It?

hc-prof-blog-image-v2We all know how increasingly important the patient experience is becoming in clinical trials and healthcare. With more emphasis being placed on quality care and patients’ active participation in their own treatment, it follows that this will have an effect on what solutions and services are required to satisfy consumers in this market. Consumers nowadays have a flood of information available at their fingertips—an amount unimaginable even just 15 years ago. And while the ability to look up symptoms online in the middle of the night has undoubtedly increased the number of hypochondriacs, it has also led to a higher number of truly educated patients, and an accompanying need for specialists to respect and involve them in the diagnosis and treatment process.

But what does it mean to be patient-centric? Our good friend Wikipedia defines it as “support[ing] active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment.” Not much help, is it really?

The Institute of Medicine defines it as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” The difference in definitions seems to come down to how involved the patient gets in their healthcare. The first definition suggests that the specialist is at the center of decision making, but supports the patient involvement as well. The latter, at least in my opinion, implies that the specialist actively collaborates with the patient by empowering them with the necessary data to make their own treatment decisions.

By either definition, however, data capture is currently falling short of what it takes to be truly patient-centric, despite how far it has come over the last decade. Electronic Health Record (EHR) solutions have been widely adopted in a variety of healthcare specializations, and although the way they collect data can create friction and inefficiencies with specialists’ workflow, they still provide enormous benefits. They streamline access for the specialists to vast quantities of patient data more quickly than traditional paper-based systems, and they eliminate need for patients to fill out the same forms again and again at each specialist’s office.

With the power of technology growing at an exponential rate, new technology solutions are coming out every day, but the challenge is to figure out how to use these technologies to address the real problems that medical practices are facing. In other words, to provide the right technology solution, one that really works for practices. At the moment, more often than not, EHR software interferes with and takes time away from the doctor-patient interaction. However, by giving specialists data-capture tools that allow them to focus on their traditional role of caregivers and that reduce the time and energy that is diverted away from patients, everyone benefits: specialists win, and therefore so do their patients.

There are already good vendors out there who are designing solutions with specialists’ requirements in mind, and some of these certainly help to give specialists more time with patients. However, to achieve a truly patient-centric solution, data capture will need to both predict and adapt to the data being fed into it in real-time. This would give specialists relevant, up-to-date information right at their fingertips, which they could use both to inform their own decision-making process and to educate the patient on their particular condition. The result would be a collaborative, evidence-based plan of care that—because the patient had participated in creating it—would lead to an increased patient commitment to the plan and a better outcome overall.

That’s what providing a truly patient-centric solution looks like.

To find out more about the evolution of data capture and what to expect in the future, you can read our recent white paper on this topic.

How the Evolution Started in Data-Capture Technology

EvolutionDo you remember the days when cell phones were brand new? I am not referring to the Nokia 3310 (back when all we needed was a single game, Snake – simpler times . . .). I am talking about when they were first launched and introduced. Those were the days when cell phones were only purchased by business people and you could only make calls near a transmitter tower (oh how mobile!). They used to come with big cases, but these were not for the phone itself; their real purpose was to hold the phone’s huge battery! Despite that, the purpose of original cell phones was clear—to make phone calls on the move. Well, so long as you were going past at least one transmitter tower on the way . . .

Fast-forward to today—the cell phone we once knew has completely changed, and along with it, we see a transformation in how people see and use their phones. What used to be their original purpose (making phone calls) has now been virtually replaced by activities such as Internet browsing, checking social networks, shopping, listening to music, and playing games (you can still download Snake, but it’s no longer pre-installed!).

It would probably be more fitting to call them powerful mini-computers; the average smartphone today is millions of times more powerful than all of NASA’s combined computing power in 1969. Smartphones today are even powerful enough to run old Windows operating systems such as Windows 95. Good to know for all those old-operating-system enthusiasts who want a bit of nostalgia on the go.

The evolution of cell phones eventually led to a revolution in the market. The pace at which technology was developing eventually led to the creation of the first iPhone—the rest is history!

So how does the evolution and revolution in cell phones relate to data-capture technology? Just as the first cell phones had only one purpose—talking—data capture nowadays means simply sharing or collecting information. While 1990s-era electronic data capture focused almost exclusively on big data associated with clinical trials such as EDC and electronic patient reported outcomes (ePRO), it was eventually adapted for private medical practice. Over the years, the opportunities afforded by electronic data capture have grown, partly because of healthcare costs.

However, although these first digital data-capture systems offered some relief to physicians and other users, they were still time-consuming and cumbersome, creating more productivity issues than they solved. What was meant to save time actually had the opposite effect; while the new systems were being introduced, they actually resulted in physicians seeing fewer patients.

Back then, these solutions were designed for primary-care physicians. Specialists, who needed to maintain smaller sets of data, found that these first digital systems did not take their specific needs into account. What specialists required was a solution that would allow them to see many patients without sacrificing data quality and regulatory compliance. Fortunately, there were a few vendors who had the insight to rise up to the challenge and help to solve these specialty-specific problems.

To find out more about the evolution of data capture and how EHR solutions are becoming revolutionary—like smartphones—read our recent whitepaper on this topic.

What is HCIT Friction?

wheelThe Truth Is Stranger Than Friction

I just returned from two eye-opening experiences: HIMSS, the largest health IT event in the industry, and AAOS, the country’s largest orthopaedic conference. Of course, I heard about the amazing benefits of many new technological and medical breakthroughs . . . But what really got my attention was hearing some physicians say that when it comes to productivity, they wish they could return to the days of paper charts.

What? Since when do medical professionals want to turn back time on medical technology advancements like productivity solutions? All of those innovations were designed with an important goal in mind: to help doctors have more time to help more patients. However, due to many reasons, the data collection process is getting in between doctors and patients. That friction is rubbing both parties the wrong way—and the need to get beyond that friction was the clear message I took away from both HIMSS and AAOS.

Friction isn’t inherently bad: it is the force that allows our tires to grip the pavement, lets us steer the way we want to go, and enables our brakes to stop us from crashing. However, excess friction hinders movement and wastes energy: that’s what’s happening right now in the world of EHR solutions. What we need are systems that work with—not against—physicians while they perform their very important work. By creating smarter solutions, we can transform friction into traction: positive momentum that takes us where we want to go, faster—in a way that enhances, instead of interferes with, the doctor-patient experience.

In order to really help advance healthcare, the next generation of EHR solutions must do more than just capture data. They must be intelligent technologies that go beyond frictionless, creating the traction to:

  • Operate in the way that best supports each doctor’s work style, so that physicians can concentrate on patients, not iPads
  • Enable seamless data collection during patient interactions, so that doctors are not spending hours recording data later
  • Leverage mobile platforms and predictive technologies that not only keep up with busy specialists but actually help move them forward

Turning meaningless friction into meaningful traction is the driving force behind what we are calling Smart Workflows. Living and practicing in the Information Age, the only way to go is forward—not to reduce the technology involved, but to reduce its intrusiveness by developing software that easily captures required data while actually prioritizing the physician’s role in medicine. That’s something no EHR has ever done—nor any paper chart, for that matter.

To frictionless and beyond!

~ Khal Rai

Top 5 Observations at HIMSS16

HIMSS16

With a conference that draws over 50,000 attendees, 1300+ vendors, 300 educational sessions, and interesting keynote speakers, there is always plenty of food for thought. So much so that it can take a while to really assimilate all the information and process it into key observations.

Our team has just returned from the show, so I just wanted to quickly share our top 5 observations at HIMSS16:

  1. Value-based payments: There was much discussion on the shift to value-based payment. The MACRA/MIPS regulations are expected in the spring, which could mean as early as March or as late as June, with the Final Regulations mandated to be published by November 1. While the goal of MIPS is to simplify life for providers (by rolling up all the various current programs into one streamlined program), it’s a good bet that things will get more complex before they get easier. All of this begs the question: How will physicians be ready to comply beginning on January 1, 2017?
  1. Interoperability: No surprise that everyone was talking about this! This was reinforced when big-name healthcare technology providers promised to use standardized APIs to make access to patient information easier. Interestingly enough, this also ties in with the HHS wanting to expand its oversight of electronic health record vendors. The proposal they released on March 1 would allow the agency to review how certified health IT products interact with other products, with the aim to prevent data blocking, and to review certified HIT vendors if required (and even to take away their certification if necessary!) The comment period for the ONC rule ends on May 2.
  1. Population Health: This is increasingly becoming one of the top buzzwords at this show. More and more people are talking about it, but there does not seem to be a clear definition about what value this brings. After discussions with different attendees and vendors, it was clear how unclear it was: everyone was providing different answers. The term population health is much more widely used than it was back in 2003 when it was defined by Greg Soddart and David Kindig as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” The management element is using the aggregation of patient data to devise actions that improve both clinical and financial outcomes. But what data should be used, especially when it comes to specialty practices? Clearly this is something that needs to be defined to ensure we are getting real value from these solutions.
  1. HHS and CMS: There was an interesting session with Karen DeSalvo (National Coordinator for HIT, Asst. Secretary HHS) and Andy Slavitt (Acting Administrator, CMS) where the barriers to data sharing was discussed, and 3 commitments were announced:
    1. Consumers will be able to easily and securely access their electronic health information and send it wherever and to whomever they want.
    2. Providers will share information for patient care with other providers and will refrain from information blocking.
    3. The government will implement national interoperability standards, policies, and practices and will adopt best practices related to privacy and security.

This further reinforces the 2nd observation in this post about HHS wanting to expand its oversight of electronic health record vendors. This session also brought up an interesting point about data blocking; DeSalvo pointed out that a year ago there were a “host of organizations who denied that blocking even was happening,” and now these same groups are “willing to publicly say that they want to engage in something now they’ve acknowledged info blocking can exist.” Hopefully, these same groups will follow with their pledges. As Slavitt advised, “I strongly encourage you to recognize those that don’t [live up to their pledges]” (FierceHealthIT).

  1. EHR collides with NFL: Denver Broncos quarterback Peyton Manning, the reigning Super Bowl Champ, gave a speech at the show thanking the health IT community. For a man who has gone through 3 potentially career-breaking, neck surgeries, I think it is fair to say he can “fully appreciate the value of information systems to keep hospitals functioning.” A physician joined Manning on stage, discussing the NFL’s EHR system and their portals, allowing players access to their medical details. Manning put it like this: “Football is a game. Revolutionizing healthcare is a mighty endeavor.” He also mentioned that leaders in any field need to evolve to match circumstances (HealthcareIT News).

Of course, HIMMS is a huge show where other topics were discussed too, such as patient engagement and RCM. The points mentioned above were only our key takeaways from it. We want to understand the latest regulations and trends, and how these will impact healthcare specialists. What were your key takeaways?

The End of MU… Oh, Never Mind!

chameleon-315pxAccording to a recent speech by Andy Slavitt, Acting Administrator of CMS, “The Meaningful Use program as it has existed will now be effectively over.” Not surprisingly, the media picked up this news—particularly the word “now”—and ran with it, gleefully proclaiming the “End of MU in 2016,” “CIOs Celebrate End of MU,” “MU on Deathwatch,” etc. It was easy to believe that Slavitt was predicting the demise of MU to be imminent since the stated topic of his talk was “policy areas that will affect the healthcare sector in 2016.” However, in Tuesday’s CMS Blog, Slavitt—writing with Karen DeSalvo—walked his statement back a bit. That said, this is still quite significant news: CMS has formally acknowledged what Slavitt himself referred to as the frustration and burden that physicians have been dealing with since the start of MU.

The key phrase in his statement about MU is “as it has existed.” MU is to be, in Slavitt’s words, “replaced with something better”—i.e., a new and improved version of itself. It is not going away. We already knew that MU had been identified as an integral part of a new program called MIPS under MACRA, the regulations for which are still being written by CMS. MACRA, the legislation that replaces the Medicare Fee Schedule’s SGR calculation, becomes effective in 2017, with a new schedule of payment adjustments (a.k.a. incentives and penalties) beginning in 2019.

Slavitt’s “announcement” was clouded by uncertainty, but was greeted, nevertheless, with great jubilation and high expectations, some of which were dashed by the clarifications published in the subsequent CMS Blog. In his speech, Slavitt had provided little insight into exactly how MU will be restructured. It begged the questions: Will the changes to the requirements be radical enough to be perceived by physicians as “something better?” What will become of the Stage 3 Rule, which is currently undergoing finalization and is due to go into effect in no later than 2018? And, will the MU penalties scheduled for 2017 and 2018 remain in effect or be eliminated? The CMS Blog answered some of these questions, to the disillusionment of many providers:

  • The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards.
  • We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations—including meaningful use Stage 3—are still in effect.

Despite the myriad details yet to be determined, what we do know about the future is that physicians will increasingly be rewarded for quality over quantity of care. Therefore, a critical component of the new government programs will be the demonstration and reporting of improved patient outcomes (most likely in PQRS fashion). We can also be confident that MACRA (and any new version of MU it contains) will demand heightened interoperability and patient engagement, and physicians will have to meet requirements that support these goals.

The question of timing notwithstanding, should you be excited about this announcement? I would suggest cautiously so. We are optimistic that the anticipated changes will bring some relief from the unnecessary administrative burdens with which physicians have been struggling and let them get back to focusing on the practice of medicine. But unless concomitant changes are forthcoming on ONC’s side to streamline the excessive EHR certification requirements on the books for 2017/2018, EHR developers and vendors will still not have the necessary time or freedom to focus on innovations that would deliver the efficiencies and clinical benefits that would be of maximum value to physicians and their patients.

As always, SRS will keep you up to date on all developments in this area as they are revealed over the next few months. Please feel free to contact Lynn Scheps, Vice President, Government Affairs, if you have any questions.