Health IT in an Era of Accountable Care: Update from the Beacon Communities

The Engelberg Center hosted a forum highlighting the Beacon Community Program, a major project of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. Panelists focused on health IT implementation strategies to accelerate clinical transformation, and discussed how various Beacon communities are advancing broader healthcare reform efforts. The event featured keynote remarks from Aneesh Chopra, U.S. Chief Technology Officer at the White House Office of Science and Technology Policy; Farzad Mostashari, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services; and Joseph McCannon, Senior Advisor to the Administrator and Group Director, Learning and Diffusion, Innovation Center, Centers for Medicare & Medicaid Services. In addition, the event highlighted various Beacon Community accomplishments and plans for upcoming years, shared health IT implementation strategies to accelerate clinical transformation, and communicated how various communities are advancing broader healthcare reform efforts. Presenters focused on how health IT and related delivery system improvements are being utilized to increase care coordination and accountability in order to demonstrate feasible paths to higher-quality and lower-cost healthcare.



Panel I: U.S. Chief Technology Officer Aneesh Chopra, National Coordinator for Health IT Farzad Mostashari, and CMS Senior Advisor Joe McCannon discuss the federal health IT strategy.



Panel II: Beacon Community Program Director Aaron McKethan moderates a session on priorities for health system improvement.



Panel III: Mark McClellan moderates a session on harnessing health IT for payment reform





Closing remarks: from Mark McClellan and Farzad Mostashari


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Moving Providers from AIU to Meaningful Use

Below is a wonderful presentation from Joshua J. Seidman, PhD at the recent 3rd Annual CMS Multi-State Medicaid HITECH Conference entitled "Moving Providers from AIU to Meaningful Use."

 

New Report: The Social Life of Health Information

"Data will help you make better decisions. Data will chart your course. Data will show you what really works." Data makes all the difference in the world...

Susannah Fox, Associate Director at Pew Research Center’s Internet & American Life Project has published a new report "The Social Life of Health Information, 2011," which is an update on her excellent "The Social Life of Health Information, 2009." This latest report is even better and I highly recommend it to anyone interested in the intersection of healthcare and technology. This new report posits that online conversation about health is being driven forward by two forces: 1) the availability of social tools and 2) the motivation, especially among people living with chronic conditions, to connect with each other.

Susannah is the former editor of the website for U.S. News & World Report, winner of the 2001 National Magazine Award for General Excellence in New Media. She has also worked as a researcher for RealNetworks and for The Harwood Group. Her research is consistently wonderful and I also encourage all of you to immediately follow her on Twitter @SusannahFox ~ I promise you won't be disappointed. Her tweets and blog posts along with her research are a national treasure.
One of the best summaries of Fox's research can be found in the video when Susannah spoke in September 2010 at Mayo Transform 2010 : Thinking Differently About Health Care:



This new report shows that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant and growing source of health information. One interesting new data point this survey collects for the first time is that 25% of internet users have watched an online video about health or medical issues. And the statistics for Internet users with one or more chronic conditions are even higher.

The report notes that 1 in 4 Internet users (1 in 5 adults) is a self-tracker:

Carol Torgan, a health science strategist, points out that anyone who makes note of their blood pressure, weight, or menstrual cycle could be categorized as a "self-tracker." Add an online component, and you have the ingredients for a social health application or an electronic health record. Our survey finds that 15% of internet users have tracked their weight, diet, or exercise routine online. In addition, 17% of internet users have tracked any other health indicators or symptoms online. Fully 27% of adult internet users say yes to either question.

In the earlier published report "Health Topics" it was revealed that fully 80% of Internet users reported looking online for health information. This can be broken down into the following topics:

There is a much larger number of users on the Internet since the last report, but the percentage of those accessing health information online is also growing. And the typical search for health information online is on behalf of someone else so the reach is even further extended. The report states:

Half of internet users (48%) who go online for health information say their last search was on behalf of another person, 36% say their last search was on behalf of themselves, and 11% say it was both for themselves and someone else. Thus, while eight in ten internet users go online for health information, the impact of their inquiries may be even broader. And while some groups, such as the chronically ill and those living with disability, are less likely to be online and searching for health information, it does not mean that this information does not reach them through a surrogate of some kind.

Social network sites are popular, but used only sparingly for health updates and queries. But it is interesting to note that people caring for loved ones are more likely than other adults to use social network sites to gather and share health information and support. Also people living with one or more chronic conditions and those living with disability are significantly more likely than other social network site users to gather health information. Social network sites lend themselves well to building community, so I expect we will see this type of trending continue.

Mobile is becoming another area with significant increase in activity. Looking just at the 85% of adults who own a cell phone, 9% say they have software applications or "apps" on their phones that help them track or manage their health. But there is a large gap between rural users at 4% and urban users at 12%. There are also disparities in mobile use of healthcare apps based on race, age and education.

But even with these increases in mobile and online access to health information most people still turn to a professional, friend or family member when they have a health question. The majority of these interactions happen offline: just 5% of adults say they received online information, care, or support from a health professional, 13% say they had online contact with friends and family, and 5% say they interacted online with fellow patients. But people turn to different sources for different kinds of information. As the chart below shows, when seeking emotional support in dealing with a health issue fellow patients, friends, and family win by a landslide.

The Internet is a very powerful tool and it is becoming even more useful in healthcare. Whether searching for a quick answer, taking a deeper dive into research, or joining a community of patients for support and to share information, the Internet will continue to be a growing part of the healthcare landscape.


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Health IT Could Help Reduce Impact of Staff Shortages

More fragmented and uncoordinated healthcare may be on the horizon thanks to a growing shortage of U.S. healthcare workers. That’s the message from a new poll of healthcare quality experts conducted by ASQ, the world’s largest network of quality resources and experts.  
Poll respondents indicate the biggest quality issues patients will face in light of a staffing shortage are:

• Spotty care.
• Longer waits for primary care physician appointments.
• Medical errors.

The online poll was conducted with 475 U.S. healthcare quality professionals who are part of the ASQ quality community. Respondents say healthcare quality will be most impacted by the following shortages:

• Primary care physicians – (44 percent of respondents).
• Nurses and nursing assistants (27 percent of respondents).
• Laboratory professional shortages were also mentioned as an area of concern.

The U.S. Department of Health and Human Services predicts that healthcare staffing shortages will increase significantly after 2014. That’s when approximately 32 million more people will be insured, as mandated by the healthcare reform law, and as baby boomers become Medicare-aged. 

“This trend is real and could have a negative impact on a patient’s experience as heavier demands are placed on the system,” said Joe Fortuna, chair of ASQ’s Healthcare Division. “That’s why it is imperative that healthcare organizations focus on enhancing their ability to prevent errors, remove waste and improve the clinical and operational quality of the services they provide.”


Prevention Tips

How can healthcare organizations prevent these shortage-related quality issues? Respondents ranked the following solutions in order of priority:

• Create fast track units. These units allow patients with less serious needs to be seen, assessed and treated faster and released in a timely manner. This frees emergency room staff to focus on urgent cases and improves a patient’s access to emergency services overall.
• Install and use healthcare IT systems.
• Implement checklists in the ER and other hospital departments.
• Establish more care teams of doctors, nurses, physician assistants and disease educators.
• Implement a scribe program to improve productivity. Hospital scribes trail doctors from bed to bed, taking detailed notes for a patient’s electronic medical record.

Fortuna believes that healthcare IT systems can be helpful in a number of ways to reduce errors, improve care coordination and enhance access to needed medical information. “Innovations like fast track units and scribe programs are also useful.” He adds, “Process redesign coupled with culture change, however, can have a huge impact on cost and quality while at the same time ensuring the sustainability of the changes once made.”


Impact of Healthcare Technology

Poll respondents identified patient electronic medical records as the IT system that will provide the most value in reducing the impact of staff shortages. Respondents ranked other useful IT methods by priority:

• Computerized order entry system for medications.
• Clinical decision support systems. DSS is a computer-based information system that supports an organization’s decision-making activities.
• Telemedicine or remote monitoring systems.
• Automated dose dispensing.
• Disease registries. Registries are collections of secondary data related to patients with a specific diagnosis, condition or procedure.

Cost-cutting Measures 

Respondents said that increased use of quality and process engineers should be the top priority for hospitals to reduce costs in light of shortages. Other methods identified by the ASQ poll include:

• Implement mandatory process improvement training for healthcare.
• Create financial incentives to deliver more efficient care.
• Redesign hospital care spaces to be more efficient.
• Changes in malpractice laws.

ASQ quality improvement experts work in a diverse range of healthcare organizations from hospitals to public health departments. Quality improvement methods have proven increasingly successful in healthcare organizations. For example, lean emphasizes removal of wasteful processes and focuses on delivering more value to patients.  

ASQ is a global community of people dedicated to quality who share the ideas and tools that make our world work better. With millions of individual and organizational members of the community in 150 countries, ASQ has the reputation and reach to bring together the diverse quality champions who are transforming the world’s corporations, organizations and communities to meet tomorrow’s critical challenges. ASQ is headquartered in Milwaukee, Wis., with national service centers in China, India and Mexico. Learn more about ASQ’s members, mission, technologies and training at www.asq.org.