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.

Getting Direct with State Health Information Exchange

I have been working on a contract to help the Office of the National Coordinator (ONC) State HIE Program host a Direct Boot Camp in Chicago, IL on April 12 – 14, 2011. So I spent a few days this week working at the Boot Camp helping the ONC bring states up to speed on the Direct Project. But the Boot Camp went well beyond Direct basics to focus on implementation details to help States who are planning on implementing Direct learn from experiences in the field and take their next implementation steps. The Boot Camp was geared explicitly toward states that are implementing Direct as part of their strategic and operational plans under their cooperative agreement with the ONC. I was pleased to be part of the excellent team of ONC staff and consultants that organized and facilitated the event. The meeting agenda and materials are now posted on the Direct Project wiki and there was some good discussion using the #ONCDirect hashtag on Twitter. There was also some rich discussion during the Q&A portions of each session and I encourage you to read through the session notes available on the wiki.

Much of the impetus for incorporating the Direct Project into their state plans was the result of the Program Information Notice (Document Number: ONC-HIE-PIN-001), known as the PIN, sent to the states on July 6, 2010. One section of the PIN requires the states to:

Set Strategy to Meet Gaps in HIE Capabilities for Meaningful Use — Develop and implement a strategy and work plan to address the gaps in HIE capabilities as identified in the environmental scan with a focus on delivery of structured lab results, e-prescribing and sharing patient care summaries across unaffiliated organizations. Gap-filling strategies might include:

• Policy, purchasing and regulatory actions, such as requiring e-prescribing or electronic sharing of lab results in state or Medicaid contracts with pharmacies and clinical labs.

• Core services to reduce the cost and complexity of exchange including authoritative provider and plan directories and authentication services that would support both simplified and comprehensive interoperability.

• Targeted infrastructure for gap areas such as shared services for small labs or pharmacies, or to serve rural providers, which could utilize both simplified and comprehensive interoperability solutions.

In filling these gaps, the state is not required to directly provide or construct technology infrastructure or services. A key role for states can be to provide leadership and direction to public and private stakeholders. States may also use policy and purchasing levers to extend and enhance existing HIE activities in the state so as to encourage key trading partners such as pharmacies and clinical laboratories to participate in electronic service delivery and to enable providers to meet meaningful use requirements.

States shall also establish a strategy and immediate next steps to address the following over the course of the project:

• Building capacity of public health systems to accept electronic reporting of immunizations, notifiable diseases and syndromic surveillance reporting from providers.

• Enabling clinical quality reporting to Medicaid and Medicare.

To meet these requirements many states have plans to use direct messaging in a phased approach as an onramp towards more robust HIE services. But due to the flexible nature of a cooperative agreement, as opposed to being a straight grant, the states have been working with the ONC to fine tune their plans. Many of these states had their plans approved before the Direct Project was able to provide working code. As the Direct Project has developed, some of the states thinking around deploying direct messaging services has evolved. And there is also continuing maturity in the marketplace, with vendors offering services that have allowed the states to back away from providing centralized services themselves and moving towards a more market based approach.

Therefore, many states that were originally planning to to act as a Health Information Service Provider (HISP) themselves are now moving towards creating a preferred vendor list for HISPSs and monitoring the market to ensure coverage for all the providers in their state. A HISP is an entity that provides services that are required for Direct Project exchange, such as the management of trust between senders and receivers. Using the HISP model, offerings are emerging that provide some of these services:

1. Provisioning of health domain addresses
2. Certification issuance and management
3. Global routing services 

The Best Practices for HISPs posted on the wiki is an excellent document for those interested in knowing more about organization structures that will allow these services to be provided.

There are also states planning to use Direct to help with interstate exchange. This is an area that will need further development, as we weave through the spaghetti of various consent laws around the country, but ultimately getting exchange happening at a broad scale will obviously include interstate exchange. Some of the nation networks being launched, such as AAFP/Surescripts and Verizon presented during the boot camp and helped the states to shape some of their thinking in this area. There was a lot of discussion about Provider Directories as well, which I will leave to a future post. It was a very interesting experience to work with the ONC and the various states to further integrate the Direct Project into their plans and I expect we will see this help to drive further adoption and use of these standards and specifications.

The list below shows the currently approved state specific strategic and operational plans for creating health information exchange capacity. Not all of these states are incorporating Direct Project into their plans.

State	Strategic /Operational Plans and State Summaries	Entity Responsible for Grant	Plan Approval Date
Alabama	Strategic and Operational Plans State HIE Plan Summary	Alabama Medicaid Agency	02/12/2011
Arizona	Strategic and Operational Plans	Arizona Governor’s Office of Economic Recovery	03/18/2011
Arkansas	Strategic and Operational Plans	Arkansas Department of Finance and Administration	02/24/2011
California	Strategic and Operational Plans To view the documents separately click here (easier download)	California Health and Human Services Agency	06/16/2010
Colorado	Strategic and Operational Plans	Colorado Regional Health Information Organization	12/3/2010
Connecticut	Strategic and Operational Plans	State of Connecticut Department of Public Health	03/18/2011
Delaware	State Summary	Delaware Health Information Network	05/17/2010
Florida	Strategic and Operational Plans	Florida Agency of Health Care Administration	02/04/2011
Georgia	Strategic and Operational Plans	Georgia Department of Community Health	03/23/2011
Hawai’i	State Summary	Hawaii Health Information Exchange	02/02/2011
Idaho	Strategic and Operational Plans	Idaho Health Data Exchange	12/07/2010
Illinois	Strategic and Operational Plans	Illinois Department of Healthcare and Family Services	12/10/2010
Indiana	Strategic and Operational Plans State Summary	Indiana Health Information Technology, Inc	01/21/2011
Iowa	Strategic and Operational Plans	Iowa Department of Public Health	01/25/2011
Kentucky	State Summary	Cabinet for Health and Family Services	02/17/2011
Maine	State Summary	State of Maine/Governor’s Office of Health Policy & Finance	08/16/2010
Maryland	Strategic and Operational Plans	The Maryland Department of Health and Mental Hygiene	05/14/2010
Massachusetts	Strategic and Operational Plans	Massachusetts Technology Park Corporation	11/03/2010
Michigan	Strategic and Operational Plans State Summary	Michigan Department of Health	11/29/2010
Minnesota	Strategic and Operational Plans	Minnesota Department of Health	02/24/2011
Mississippi	Strategic and Operational Plans	State of Mississippi	02/24/2011
Missouri	Strategic and Operational Plans	Missouri Department of Social Services	01/25/2011
Nebraska	Strategic and Operational Plans State Summary	Nebraska Department of Administrative Services	11/05/2010
New Hampshire	Strategic and Operational Plans State Summary	New Hampshire Department of Health and Human Services	12/10/2010
New Jersey	State Summary	New Jersey Health Care Facilities Financing Authority	01/13/2011
New Mexico	Strategic and Operational Plans State Summary	LCF Research, New Mexico	01/25/2010
New York	Strategic and Operational Plans	New York eHealth Collaborative	11/22/2010
North Carolina	Strategic and Operational Plans State Summary	North Carolina Department of State Treasurer	11/03/2010
Ohio	Strategic and Operational Plans State Summary	Ohio Health Information Partnership	01/25/2011
Oregon	Strategic and Operational Plans	State of Oregon	12/10/2010
Pennsylvania	Strategic and Operational Plans	Commonwealth of Pennsylvania	3/23/2011
Rhode Island	Strategic and Operational Plans	Rhode Island Quality Institute	12/06/2010
South Carolina	Strategic and Operational Plans	South Carolina Department of Health & Human Services	08/30/2010
South Dakota	Strategic and Opeational Plans	South Dakota Department of Health	02/24/2011
Tennessee	Strategic and Operational Plans State Summary	State of Tennessee	09/17/2010
Texas	Strategic and Operational Plans State Summary	Texas Health and Human Services Commission	11/03/2010
Utah	Strategic and Operational Plans	Utah Department of Health	05/12/2010
Vermont	Strategic and Operational Plans State Summary	Vermont Department of Human Services	10/26/2010
Virginia	Strategic and Opeational Plans	Virginia Department of Health	03/17/2011
Washington	Strategic and Operational Plans State Summary	Washington Health Care Authority	12/10/2010
West Virgina	Coming Soon	West Virgina Department of Health and Human Services	02/12/2011
Wisconsin	Strategic and Operational Plans State Summary	Wisconsin Department of Health and Family Services	12/10/2010
Wyoming	Coming Soon	State of Wyoming Office of the Governor	03/18/2011