Christina's Considerations

Will RECs Deliver on their Mission?

Eight months have passed since the Office of the National Coordinator for Health IT (ONC) began funding Regional Extension Centers (RECs). Sixty RECs have been created, $662 million has been awarded and electronic health record (EHR) software negotiations are under way.

These steps mobilize the ONC’s mission to help 100,000 priority primary care providers become “meaningful users” of EHRs by 2011. It also advances President Obama’s goal to improve quality and efficiency of health care using technology (as outlined in the American Recovery and Reinvestment Act of 2009).

However, some don't think RECs will be able to deliver on their mission or that they are the most effective solution for the difficult task of getting providers to adopt EHRs.

Software Advice, a website that reviews EHR software, thinks there are five fundamental flaws with RECs:

1) Doctor’s aren’t moving as fast as the money is flowing

 2) The market already delivers on what RECs promise

 3) “Preferred vendor lists” limit choice and free markets

 4) RECs won’t get doctors to “meaningful use” fast enough

 5) The REC model leads to under-staffed, ephemeral entities

They have asked health IT insiders, medical professionals and bloggers to weigh-in on the matter, so cast your vote in their poll at: "Will Regional Extension Centers Deliver on their Mission?”  I'll share the results when they come out and we will see what everyone really has to say about RECs.

Reasons for rising cost of healthcare

There have been questions lately (from CMS) about whether costs of hospital care are really rising so I'd like to weigh in on the issue since an article in Modern Healthcare recently caught my eye.  The Making Adjustments article was about higher costs related to equipment and supplies needed to care for the large number of extra large patients.

A UCLA Center for Health Policy Research study reveals that we can also anticipate growth in the number of obese, so the issue does need to be addressed out in the open.  Why, because it will impact our healthcare economy.

When I first went back to work fulltime as a hospital administrator in 2006, I remember walking down a hallway and seeing a wheelchair in the hall.  One of my hats was safety officer, so the chair caught my eye first for that reason.  But, secondly, it caught my eye because it was no regular wheelchair - it was a bariatric (extra large) wheelchair. 

I had been a bit sheltered here in Santa Barbara for a few years only noticing the epidemic when I visited family in Louisiana or left town.  Over time, I had to make decisions about purchasing more lifts to help obese patients out of bed and wider OR tables so that they could accommodate the larger patients in the community.  There is an additional cost to bariatric equipment and supplies -- which hospitals must absorb.

Then, there are the injuries to workers caring for and managing such heavy patients, not to mention to higher rates of chronic disease -- requiring additional care and treatment.

I've posted on the pain I feel when I see obese children.  As a society, we must turn this trend around and each of us take responsibility for our own weight, and the weight of our children.

Yes, Virginia(CMS), it does cost more to treat more and more obese patients.

Social Media Applications in Healthcare: Beyond Marketing and Public Relations

On Thursday, October 21, I'm presenting on the topic of social media to my local chapter of the American College of Healthcare Executives.  I'd like to also invite any of my readers who may be interested in joining us via webinar here in Southern California. 

Details and registration information Social Media Application in Healthcare:  Beyond Marketing and Public Relations

If you are a healthcare leader, consider membership in ACHE.  And, if you are a Southern California healthcare leader, or working toward becoming one, I recommend you consider membership in Healthcare Executives of Southern California, as well.

Dartmouth Atlas of Healthcare

A friend sent me a link to a really cool tool for anyone involved in healthcare planning.  The Dartmouth Atlas of Healthcare presents some of the data that is out there in a really accessible and customizable manner.  I tried it out a little yesterday on my local community, but look forward to seeing what is out there for some of my northwestern states.

Thank you, Dartmouth!

Socialized Health Surveillance

Government Health IT has an article addressing social media use by the CDC and FDA .  I had included the CDC as one of the best practices in my book's companion because of their broad success with various aspects including widgets, blogger outreach, metrics, virtual worlds and more.

The ending of the Gov HIT article really does put social media into perspective for public health, who always seems to want/need to reach more and more people ... faster.  So, I'll leave you with it

"But in spite of the potential risks, agencies view social media as the future of mass communication. “Many social media channels provide amazing reach and new ways to target and tailor information to diverse audiences,” Aikin said. “Using social media also allows us [to deploy] tools that are already being used by a growing segment of the population, which helps us ensure that increasing numbers of people have access to our messages.”"

Get your Saints Gulf Coast Renewal Raffle tickets before the game tomorrow evening at www.celebritiesforcharity.org/raffle/Saints-Gulf-Coast-Renewal-Raffle/

Northwest Telestroke Survey Results

Acute stroke care capacity and services are lacking in many hospitals in the Northwest region, particularly in rural hospitals. Of most concern is access to acute stroke care personnel, especially in rural areas where only 1 in every 8 hospitals have access to a neurologist either in-person or by phone. This most likely contributes at least in part to only 53% of rural hospitals in the NW region having administered t-PA; the recommended treatment for strokes caused by blood clots -- even once in the past year. Emergency personnel often cite the lack of neurology consultation as one of the reasons for not giving t-PA more often.

In a recently released survey of hospitals and other healthcare providers in the Northwest (AK, ID, MT, OR, UT, WA, WY), an overwhelming 88 percent of respondents said their rural communities suffer from a lack of stroke neurologists. Sixty four percent are currently in the process or considering development of a telestroke program to address this lack of local neurology resources.

Telestroke is a form of telemedicine; using real-time telephone and/or video conferencing technologies.  Telestroke programs link hospitals to regional stroke centers, with specially trained neurologists, and increase patient access to specialized care; especially when travel and distance are an issue.

The Regional Telestroke Initiative (RTI) released the results of this comprehensive survey. It was designed to understand the capacity and use of telestroke care in the Northwestern United States. The results will help improve stroke care in the region by bringing attention to the rural-urban disparities in stroke treatment and increasing capacity of rural hospitals to treat stroke patients. 

There are upfront costs to providers who implement telestroke programs and professional consultations are not always covered by insurers, even though they may lead to reduced severity of impairment and future medical costs.  Of those organizations currently providing telestroke services, the leading sources of funding are stroke specialty tertiary (hub) hospitals (28%) and grant funding (21%).  When it comes to reimbursement for a neurologist’s on-call telestroke time, 32.6% report that the hub hospital covers the cost, and 32.6% report no reimbursement for the services they provide.

These results emphasize the need for the RTI to continue its efforts to help providers improve their telemedicine capacity and stroke care services. Survey findings will help providers recognize regional assets, so they can take advantage of broadband capabilities and expanding telehealth networks to support those communities without sufficient stroke specialists.  

Recent federal actions to reform the healthcare delivery system and emerging trends present new opportunities to highlight the real value offered by telestroke programs. The RTI will continue to address persistent barriers to telestroke development and leverage the considerable expertise and infrastructure in the region to standardized practices and improve interstate licensure, credentialing and reimbursement. This will lead to increased consideration of tPA administration with greater access for patients in rural communities, improved outcomes, and reduced morbidity and mortality due to stroke.

The RTI is now planning educational opportunities to respond to the needs identified by the survey and build upon progress that has already been made.  These educational opportunities will include best practices in the delivery of acute stroke treatment and successful telestroke solutions across the region.   Additionally, RTI members will participate in efforts to remove state, regional and national policies that create barriers at both the provider and system levels.  

To review the full survey results, visit http://strokeforum.doh.wa.gov/links/regional-telestroke-initiative.

For information on the warning signs of stroke visit the American Stroke Association.

ABC News Video -- Aging in Place with Technology

http://abcnews.go.com/Technology/video/aging-place-technology-11553676

mHealth Conference - Day 2

The day (for me) is starting with one of my board members presenting on Longitudinal Health for Diabetes Care.  Today's highlights include:

• Ohana Health - Feasibility study with 15 patients selected by outreach workers using modem connection of glucose uploads to an advanced web-based care management system.  Starting 5 patients with blue tooth enabled smart phone for glucose uploads.  Patients and physicians responding well to printed graphs and tables of the glucose reading - opportunity for talking point with patients.  Patients are able to use the technology as long as they receive some education.
• Longitudinal Health is a care delivery system that allow continuous interaction between the care team and the patient using mHealth technology and integrated with other health information technologies.  Includes contextually and temporally relevant decision support and use of social support networks for patients and their families, as well as, for health workers and care team members.
• Individualized care - pattern recognition application based on algorithm with responses and interactions with the application and care team are additional data points.  Over time, the patient relationship is improved by tailoring messages and contact based on the individual responses.
• Effective HIT systems move data from EMR to a clinical data repository (CDR), where additional data can be added from the mobile device.  In the CDR it is organized and data is sent back to the EMR and messages to the PHR.
• Watch for data overload and show value for physicians and other providers. 
• Chronic disease will be managed by a team, not just a physician.
• Need to educate health plans and government on understanding new technology.
• New relationships are coming:  Health plans and cell phone industry.
• As a society need to decide between motivating and medicating.
• Telehospice - (WA State and Missouri) Reimbursement is an issue -- Can CMS see value in care of patient in the home?  Patient prefer audio/visual, not just telephonic care.  Facilitates responding to patients (pain, suffering, etc) in the home - now!
• Social networking in palliative and end-of-life care is growing.
• Review of a planning template for starting a patient on remote monitoring.
• Mobile loop to reach the patient is an enabler.  Use of mobile technology requires new workflows, agreed goals, building a story between the patient and physician, creating guideposts and generate wisdom for both the patient and doctor.
• Community design - convert thoughts to achievable actions (silence is golden), organize service providers in a geography to create a footprint, and consider the delivery system.
• Outcome based measurement is more meaningful when it is noisy (dialogue vs. numbers)
• A lot of discussion about the role of social media.  :)
• Mobile apps are especially beneficial for rural physicians, wilderness medicine, home visits, disaster relief, emergency.
• At the end of the day, physicians are really going to care about the outcomes.
• Telemedicine drivers identified in Triple Tree  mHealth survey.
• Home telemedicine - keeping patients with chronic diseases in their home.

 

mHealth Conference Notes - Day 1

I'm at the San Diego mHealth Conference and thought I'd share some of my observations with readers.  If you have any questions or other perspectives, please leave a comment.

• Spyglass Survey: 90% of physicians using smart phones
• Telecare & Telemedicine, Connected Health and Wireless Health - all connected
• Doctors aren't going to wait to get back to their office to look up information
• Over 80% of patients consult the Internet for a second opinion and increasing numbers are using their smart phone
• Movie: Catfish premiers Sept 17 and it is the first social networking thriller
• Effective healthy changes will come from customizing apps to the person, engaging their existing social network of friends and family, extending their social network to peers combined with captivating and addictive rewards and incentives.
• Intimate digital relationship:  consumer must trust entity they are giving their information to.
• Need:  Premium to maximize your health vs. fee-for-service system.
• discovery of mirror neurons:  a neuron that fires both when an animal acts and when the animal observes the same action performed by another.
• Forrester Research: 95% of healthcare enterprises rely upon smart phones.
• mHealth - on the person
• Pricewaterhouse Coopers Survey:  Healthcare Unwired: New Business Models
• Providers want (and need) evidence at the point of care - can we create an app for mobile devices that will address:  access (search); tailor (if not found send when it exists); retrieve (download, highlight and annotate); archive (practice library with metadata, search and sort); share (output to video, email, export, EHR, send to professional network with annotation); write (use metadata to cite while you write to build reference list or pull data from EHR or article brought in by the patient to add)?  Lets create an integrated solution!
  • Safari is closest with access,tailor, share, write; but can't retrieve or archive.
  • Want Ping (for music) functionality in this app
• Security in uncontrolled environments - we really need to follow where the data goes between the mobile device and its destination. There are a lot of people/organizations involved in the process, so hospitals and other providers need to ensure that risk assessments are completed.
• Patch that not only measures calories burned, but also the number consumed which then triggers education!(ooohhh!)
• Need regulatory predictability because mHealth is moving so rapidly.
• Smart phones may not be needed for some of the 20% of patients who consume 80% of the care/costs.  Others, like boomers, may not want to look like a senior and want an app for their smart phone.
• Wireless networks do drop packets of data, so what safeguards are in place to ensure that data makes it to desired destination.
• Where does health and wellness leave off and the line to something that assists with diagnosis and treatment crossed (necessitating FDA approval).  Need to draw a brighter line between the two.  The mHealth Regulatory Coalition is forming to draft guidance and submit it to the FDA to facilitate this process. 
• Outcomes, predictability and data relevancy is essential.
• Automotive industry is a good place to look to see what is coming in the future.  One example is, people pay for OnStar to monitor the health of their car.  Should our health system support an OnStar for monitoring our health?
• Mobile health keeps coming back to patient behaviors.
• The role of telehealth and social networking were mentioned often.

 A lot of great things to think about as we look toward mobile health and remote monitoring.