Tuesday, November 09, 2010

#WHIT iPhone and Smartphones used in HealthCare

More from WHIT:

4:00 pm -
4:45 pm
Integrating Mobile Devices to Improve Member Health and Wellness
Understand challenges involved in support of mobile devices from the myriad of new devices, disparate operating platforms and devices types and the overriding requirement to ensure privacy of information without squashing the “cool factor” for end users.
  • Capturing innovation, during ideation
  • Evaluation for adoption of emerging technologies
Aurel Kleinerman, MD, PhD
Chairman and CEO, Blue Iris Division
MITEM Corporation 

 View Biography

20% of physicians use Epocrates on iPhone = 175k physicians

Physicians and clinical workers ambulate.  They are mobile. 
Many Computers - No desk. 
Multi-tasking environment
Except when face-to-face with patients.

Physicians are information "Gluttons"
Medical references and Patient Data.

Healthcare delivery is a team effort. The Physician needs to be in touch.

The Appeal is a device that provides voice and data in one device.

All smartphones do this - But iPhone is doing it "right".

Large screen, lots of memory, push notification

Push Notifications are authenticated and encrypted. Works over cellular or WiFi.

iPad - Large screen and large battery - no need to recharge during the day unlike many laptops.

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#WHIT

#WHIT - 
11:15 am -
12:00 pm
The Role of Incentives in Driving Member Behavior – What Works and What Doesn’t
Although behavioral interventions have the potential to improve health, sustainable behavior change is difficult. Many people have difficulty changing health behaviors because it requires trade-offs between immediate consumption and delayed, often intangible, health benefits. Rewards and incentives can provide people with immediate and tangible feedback that helps make it easier for them to do in the sort-term what is in their long-term best interest (and the best interest of employers, insurers, and public policy - the quadruple bottom line).
  • Incorporating incentives platforms into your strategy
  • Explore how to measure results
  • Evaluate cost benefits
Les McPhearson
Director, Consumer Innovation
Humana, Inc. 

 View Biography

70-75% of cost in Healthcare is from preventable lifestyle driven issues.

ie. 15% of GDP  spending is preventable. $1.5T

"Every extra pound of belly fat is proof of the power of advertising"

Ken Thorpe, Emory University: Obesity related health care spending will quadruple to $344B in nine years

This is a business problem because businesses benefit from employees being healthy.
 Everyone else benefits from people being sick - Dee Eddington.

Focus on chronic conditions to bring down costs through disease management and clinical programs

Focus on 80% of low utilizers to KEEP costs down.

Wellness needs to be Proactive. Most are currently Reactive.
Incentives have a role to play. 

Engage people in their health, even when they aren't sick in ways that are fun and meaningful and reward participation and achievement.

Promote effective and on going relationships.

- Recognize needs
- Find passion points
- Build on existing relationships

Hyperbolic discounting. E.g. we discount value of exercise today for it's future intangible benefit.
don't see benefit = Don't Do.

Incentives make people do something they wouldn't have done.

- Initial sign-up 
- Participation
- Long term engagement

The incentive has to match the value of the benefit and effort to participate.

"Facilitate Health"   - Be supportive not prescriptive
Meet People where they are.

Make Fun things healthy.

Foster entanglement.... Make it coo, Fun and drive Excitement to maintain engagement
e.g. involve the family.

Incentives: Tangible and Intangible

It's not just gift cards. Intangibles are important such as Recognition, Virtual rewards, acceptance, group competition and Social Responsibility.

We are competing against Madison Avenue. 

Don't forget the financial and actuarial rigor.

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#whit Checking out Health Plan Innovation from Intermountain

More from WHIT: 

10:30 am -
11:15 am
Delivering an Integrated Patient Portal - An Intermountain Case Study
  • Defining a patient and member centric approach to developing functionality
  • Driving the organization towards integrated functionality across disparate business units and divisions, including hospitals, clinics and the health plan
  • Creating a system level governance model for decision making
Ryan Smith
Assistant Vice President, I.S. Operations and eBusiness
Intermountain Healthcare 

 View Biography

Looking at Patient Portal - 4 yr old design in transition.

Labs are most popular feature on the patient MyHealth site

PatientCam is an interesting initiative. 

Parents of children in the Newborn Intensive Care Unit. Introduced in 2009 at one site. Now expanding to other sites (they have 7 NICUs)

Parents can register and be able to log on to myHealth and be able to view (no audio) the crib that their baby is in.  30 minute segments of video are allowed. Nurses can override to take video offline.

This has reduced family stress when one or both parents can't be physically present at the NICU site. For example if the mother is being treated in another hospital or part of the hospital.

Family Tree - Family Health. Working with Microsoft HealthVault to capture family history information. 

InterMountain is largely a SharePoint Portal site with a FACETS back-end 
User Centric Design includes a Patient Advisory Council.

Emergency Medical Card allows a CCD export so members can take information from medical records with them.

New design:

More color.
Loses Left side navigation and move to Horizontal Tab metaphor.

Building a browser-based App for mobile. Basic functions. e.g. Request a Prescription Refill.

Governance: eBusiness Chairs Committee and involves senior executives from all groups.

"When you look at information from Patient/Consumer Perspective you have a compelling argument for creating an integrated patient view of all services you provide."

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@Whit Day 2 kicks off with an interoperability discussion

More from #WHIT World Health Care Innovation and Technology Congress 6.0

8:15 am -
8:30 am
Co-Chairperson’s Welcome and Opening Remarks
Jennifer Covich Bordenick
Chief Executive Officer
eHealth Initiative 

 View Biography

We have come a long way. 
10-15 years ago very little support for EHRs. Consumers not interested. 

How many kids coming out of med school in the next few years will put up with an EHR that doesn't come up on their iPhone/iPad?

The Opening Panel will discuss interoperability

8:30 am -
10:00 am
KEYNOTE PANEL DISCUSSION: Interoperability – Establishing an Infrastructure to Support a Connected Health Environment
  • Key components to creating a truly interoperable health care system
  • The role of regulatory and certification bodies
  • Evaluate standards and adoption
  • Identify new approaches to integration
  • Evaluate the cost of interoperability
  • The future of interoperability: The relationship between PHRs and the consumer movement with RHIOs, HIEs, and NHIN – how will they all coexist?
Moderator:
Aaron Seib
Chief Executive Officer
National eHealth Collaborative 

 View Biography

Panelists:
Bill Beighe
Chief Information Officer
Physician Medical Group of Santa Cruz and Santa Cruz Health Information Exchange 

 View Biography

Tom Burns
Executive Vice President
Alcatel-Lucent;
President
Enterprise and Strategic Industries organization 

 View Biography

Gwendolyn Lohse
Deputy Director and Managing Director, Committee on Operating Rules for Information Exchange (CORE)
CAQH 

 View Biography

Charles (Chuck) Parker
Executive Director
Continua Health Alliance 

 View Biography

Bill Spooner
Senior Vice President and Chief Information Officer
Sharp HealthCare 

 View Biography

Aaron Seib is moderating the panel.

Bill B: Real adoption of EHRs is low. The apps are not very good and they are not interoperable. Clinical and Billing are typically separate.

Santa Cruz HIE has 95% inclusion of 270,000 county population in the Master Patient Index. This has been built since 1996. 100k documents exchanged each month. 400+ MDs and 700+ Users.

The average practice size in Santa Cruz is 3 Physicians.

Gwen L: CAQH Non profit alliance of Health Plans and trade associations. CORE Committe on Operating Rules for Information Exchange (CORE)
UPD: Universal Provider Datasource. A database of providers. 870,000 unique providers. 600 participating plan, hospitals and others use UPD. 12 States and DC have adopted the CAQH Standard Provider application.

CORE rules have a connectivity requirements. Aligned with MHIP.

IBM analysis - CORE Phase 1 could yield $3B of savings over 3 years across the industry

Chuck P: Continua - pushing market in one direction for devices. Develop industry standards. Creating an ecosystem of interoperable Health Devices.

Certification program for interoperability of devices and the collective power of the organizations to encourage market standardization.

Tom B: Alcatel - Improve people's lives by helping them communicate. 

HealthCare - investing in Telemedicine, remote care. Most investment in healthcare has been about admin and moving paper. Not in advancing the care of patients.

Bill S: Sharp HealthCare of San Diego. Interoperability has focused internally on patients in the network.  Sharp's approach is to connect everyone in network in to their IT Network and provide the link to the San Diego HIE and on to the National HIN

Low adoption of EHR in small practices. 

Everyone needs a Patient Consent Framework.

By 2020 Patients will EXPECT alerts, to use their phone to access information.

Bill B: Providers want to share information. so much benefit comes from sharing. But there needs to be confidentiality. 

Bill S: the emergence of the PHR means the patient owns their data.

Gwen L: How do we start building trust in to the system. Transparency and Trust are two critical building blocks. 

Tom B: You have to work across the silos to convince people of the benefits of sharing.

Bill B: we need to build a medical grade network. One that can reach out to insecure endpoints.

Bill S: Devices are ahead of the business models. 

Question from the Audience: What is happening to move forward the issue of Unique Patient Identifier

My thoughts: Why is this an issue? Is there a Universal ID for the Internet - No - Yet things work. We are seeing Facebook, Google, OpenID and others that provide the ability for an INDIVIDUAL to connect multiple personae together. 

Tom B: Consent will become less of an issue with Gen Y. They are sharing on their wall anyway.

"it's the network"  (stoopid!)

Chuck P: Connectivity creates value. Microsoft anf Google need apps and devices that give life and meaning to the PHR.

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Monday, November 08, 2010

#Whit Kaiser HealthConnect - Louise Lang's experience from the trenches of integration

Closing Session from Day 1 of WHIT: 

4:45 pm -
5:45 pm
CLOSING KEYNOTE ADDRESS: KP HealthConnect – Strategic and Tactical Considerations, Ongoing System-Wide Innovations and Results to Date
  • Evaluate strategic and tactical considerations important to any organization confronting the challenges of large-scale health IT deployments
  • Short-term and long-term benefits enabled by technology in the areas of patient safety, patient satisfaction, resource utilization and clinical quality improvement
  • Ongoing system-wide innovations aimed at major transformations in the delivery of primary care, specialty care, and population care management
  • Examine the technology’s impact on patient engagement and self-care with detailed usage metrics derived from kp.org
Louise Liang, MD
Senior Vice President
Quality and Clinical Systems Support
Kaiser Permanente 

 View Biography

Using the EHR to transform Care Delivery

Kaiser Permanente viewed this as a one shot opportunity. 

"the Future is here, it's just not evenly distributed" - William Gibson 

The Kaiser numbers:
8 Regions
8.6M members
14,000 Physicians
166,000 employees (41k nurses)
36 medical centers
431 medical office buildings
36 medical centers.
$42B Operating revenue

The vision for the future: "Blue Sky"

- Consumer centric 

- Home as the hub
- Secure and seamless transitions
- customized
- Integrated and Leveraged

Warm handoffs - Care is a human process

Member drives customization - KP responds

HealthConnect:
- World largest Private sector EHR deployment
- $4B to implement plus 10 years of maintenance

- In and Out patient clinical care
- Practice management
- Online access to a tethered PHR.

Introduction of KP HealthConnect in to Hawaii in 2005

Between 2006-2007 saw:
- Office Visit drop by 26.2%
- Primary Care - 25.3%
- Specialty Care -21.5% 

KP had to build their own clinical content to support evidence based medicine.

The Importance of Patient Engagement:

over 80% of medical issues are self-diagnosed and self-medicated.

Kp.org and MyHealthConnect

Patients like to:
- email doctor/specialist/Primary care team
- View lab results
- refill prescriptions
- Act for a family member

>50% of members are engaged online with their health

47% of members 65 and over are using online services. so it is in line with the general population.

3Million registered users.
21.7M test result views
8.6M email
6.8M prescription refills

HealthConect was NOT an IT Project.

Fundamental redesign of daily work is required.

Kaiser is looking at realtime consultations - leveraging remote specialists.

Question from Ryan Tarzy (HealthLine)  What's next for Kaiser?

- Better integration
- More focus on home based support  
- Better patient support - especially for patients with chronic conditions
- Continuing to add specialized clinical content (e.g oncology, cardiology) 

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#WHIT Megatrends on a collision course - Sustainable consumer payment solutions through innovation

More from WHIT: 

4:00 pm -
4:45 pm
Megatrends on a Collision Course – How Can Leaders Ensure Lasting Innovation and Sound Solutions?
  • The confluence of enhanced regulation, consumerism and technology in health care – impacts on the future of health care delivery
  • Core market trends and how they will drive future solutions
  • How leaders can ensure lasting innovations and sound solutions
Ralph Bernstein
Senior Vice President and Business Leader
U.S. Bank's Healthcare Payment Solutions 

 View Biography


Jeff Hancock
Business Development
TSYS Healthcare 

Jeff Bakke
EVP, Strategic Planning & Business Development
Lighthouse1
Kirsten Trusko
President and Executive Director
Network Branded Prepaid Card Association

Trends:
- Employers driving Consumer Directed Health Plans
- Self Pay is increasing (expected to rise to $356B by 2012) (20% of total HealthCare spending

What is consumerism?

Healthcare consumerism is the well considered participation by the consumer in their healthcare buying experiences resulting in the proper balance between health outcomes and cost.

Increasing recognition that health and wellness is ultimately a personal responsibility.
Unintended consequences:
- Receivables
- Collections
- Bad Debt
 - Fraud

Health Savings Accounts - Eligibles reach 10Million.

Wellness  is coming to the fore:
- 80% of employers will increase employee communication/education aimed at reducing cost or improving health
- 45% will implement programs to improve treatment and medication compliance.

Consumers want to participate in CDH but are fearful. Do I have a cure or a bill?

Jeff Bakke: LightHouse1 - a cloud based solution to deliver HRA/HSA/DEbit/Credit card services.

Regulatory and consumerism changes are converging. Health and Cost are being tied together.

Privacy: Key protections but stunts integration and engagement

Jeff Bakke - used the mint example but said too many vested interests in HealthCare makes it a daunting task to do a Mint in the HealthCare industry.

He is missing one point. Mint didn't require the industry to give them the information. They just needed an integrator and the trust of the consumer to let them act on their behalf.

The newly insured have the lowest Healthcare IQ but are most responsive to simplification.

Reform is no longer clear. Clarity and Flexibility is a key factor to look for in partners. Build to be scalable. Cloud Computing will come in to play to provide fast scalability.

Mobile has a big future because it offers the opportunity to get in the Rhythm of daily life with members/patients/consumers.

Jeff Hancock: TSYS HealthCare payment processor.

The Patient is the New Payer.

Physicians and Hospitals typically collect 50% of billed charges. and only 10-20% for self-pay patients. This is almost $60B annually.

Patient Payments are rising to represent 15% of Provider Revenue.

Communication Innovation:

Print & Maik Per Payment $8.00

ERA.EFT: $3.20

Savings with ERA./EFT 60^

A health plan with 10k provider payments per month with 30% adoption can save $172.8K per year.

Payment by Credit Debit card by Patient reduces transaction cost to $0.59/0.53 for Credit/Debit payments.

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#WHIT Post election scan - Michael McRaith IL Dept of Insurance

More from #WHIT:

2:45 pm -
3:30 pm
KEYNOTE ADDRESS: Post Election Scan: States as Labs for Innovation – Implementing Reform Mandates while Driving Innovation and IT Adoption
Director McRaith Chairs NAIC’s Exchanges Working Group of the Health Insurance and Managed Care Committee and has been a key figure involved with NAIC’s efforts surrounding implementation of insurance exchange and other mandates required by the reform legislation. He will outline strategies for implementing reform mandates, progress to date, challenges and opportunities.
Michael T, McRaith
Director
Illinois Department of Insurance 

 View Biography

Illinois has the highest level of Recissions in the country.

Market Failure but the Affordable Care Act is a flawed bill but is a milestone in improvement for states like illinois.

Some companies in IL have Medical Loss Ratios as low as 50%.

How should Health Insurance Exchange have private sector approach?

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