Saturday, June 15, 2013

JumperCut Launches Personalized Video Platform to Drive Patient Engagement

JumperCut Launches Personalized Video Platform to Drive Patient Engagement

Portland, OR (PRWEB) June 11, 2013

JumperCut, an innovative provider of personalized video technology, announced a Beta Program for Health Plans, Health Systems, and Other Care Coordination Organizations.

JumperCut Video
JumperCut, an innovative provider of patent- pending interactive media and personalized video technology to drive patient engagement, today announced the launch of a beta program based upon the early success of its initial pilot programs. The beta program will be made available to select health plans, health systems, and other care coordination organizations that are struggling to facilitate and sustain digital conversations with patients, but who are simultaneously striving to meet the standards associated with Stage 2 Meaningful Use as defined by the Centers for Medicare and Medicaid Services (CMS).
Through an expanded deployment, JumperCut will be positioned to further gauge the effectiveness of personalized video as a complement, or alternative to more traditional patient education models through the evaluation of particular end- points, including information retention, goal-setting, and satisfaction across a variety of patient types. Dr. Philip Marshall, co-founder and CEO of JumperCut, observes, “Healthcare is in transition. And because there are now well-defined quality metrics that have been adopted nationally and regionally, we have the ability to focus patient engagement efforts around supporting those metrics. It’s important to payers and providers, not just because those metrics are driving reimbursement, but also because taken together they offer the promise of a better human experience, higher quality care, and lower overall costs.” Supporting this point-of- view, one finding from an article recently authored by the Robert Wood Johnson Foundation was that patients with the lowest engagement scores incurred 21 percent higher costs than patients who were highly engaged.
The JumperCut technology platform employs novel algorithms and utilizes a patient’s health information to assemble personalized video sequences that address a patient’s unique attributes and needs—providing a rich user experience, delivering relevant educational content, and enhancing the physician-patient relationship while supporting greater engagement. “We are pleased to be a participant in JumperCut’s early innovator program and have been excited by the results of our pilot,” stated Dr. Barry Wolcott, Chief Medical Officer at expert-24. “We are focused on developing and integrating patient-focused decision support systems for our healthcare clients. JumperCut’s ability to leverage de-identified patient data and deliver dynamic, personalized video conversations certainly aligns with, and augments, the solutions we offer.”
For more information about JumperCut, or to inquire about participating in its personalized patient education beta program, please e-mail information(at)jumpercut(dot)com or call 971.229.1942.
About JumperCut
JumperCut is a privately funded company that was founded in 2012 by a small team of dedicated technologists and healthcare professionals passionate about bringing new social and mobile video technologies to the market. The company is focused on delivering personalized experiences that more effectively engage patients, facilitate informed exchanges, and that help address escalating healthcare costs. Its advisory board is composed of industry thought-leaders and distinguished innovators.
Patient Engagement through Personalized Video

DATA, the Adapting of a New Currency

Todd Gifford, MBA      6/13/2012

“US warns of cyber-attacks on medical devices”

A man uses a robot to practice surgery in Melle on April 15, 2013. US authorities on Thursday warned makers of medical devices and hospital networks to step up efforts to guard against potential cyber attacks.

A man uses a robot to practice surgery in Melle on April 15, 2013. US authorities on Thursday warned makers of medical devices and hospital networks to step up efforts to guard against potential cyber attacks.

Can you imagine the next episode of Criminal Minds you encounter, experiencing the plot twist of the often overlooked, angry underling rising up to reach out and commit murder by causing the wireless malfunction of the CEO’s perfectly working internal cardiac device” internal defibulator”.It would prove disarming if a medical device could be manipulated to cease performing it’s incredibly important function being turned into an instrument of murder. The malfeasant would soon be caught by the electronic foot print, for this I am sure but the possibility is frightening none the less in light of the world in which we live .

I am comfortable with the math of Big Data, two plus two can equal 3.9 or 4.1.  We accept these parameters not because we rely on big data for the sole factor in our decision making but as reinforcement for our collective theories toward improvement.

I find it unnerving that Target a massive retailer can send correspondence to a man that causes strong anger and resentment due to the giant retailer sending a congratulations on being pregnant to his home targeting “no pun intended” his teenage daughter barely out of Jr. High ,not even 16 years old yet for Heaven’s Sake . The much upset father called the corporate office and complained at length about the mistake.                                    

He felt all the worst when he had to pick up the phone and call the individual he reamed and apologized because it seems his young daughter was indeed pregnant. Kindly explain how Target can know more about a Fathers Household than the Patriarch himself. How do they have the ability to know so much about us? Data mining big data is the easy answer.

To truly understand the scope is beyond my humble mind , but it does make for a genuinely Scary Story.

AFP - US authorities on Thursday warned makers of medical devices and hospital networks to step up efforts to guard against potential cyber attacks.

The US Food and Drug Administration said implanted devices, which could include pacemakers or defibrillators, could be connected to networks that are vulnerable to hackers.

An FDA warning notice was sent to medical device manufacturers, hospitals, medical device user facilities, health care technical staff and biomedical engineers.

It said the agency has recently "become aware of cybersecurity vulnerabilities and incidents that could directly impact medical devices or hospital network operations."

"The FDA is recommending that medical device manufacturers and health care facilities take steps to assure that appropriate safeguards are in place to reduce the risk of failure due to cyberattack," the warning said.

These devices or systems could be compromised "by the introduction of malware into the medical equipment or unauthorized access to configuration settings in medical devices and hospital networks," the FDA said.

"This may sound like it is out of a science fiction movie, but the threat is conceivably a serious one," said Jon Ogg at 24/7 Wall Street.

"Can you imagine a device being retooled maliciously, like an inserted pacemaker/defibrillator? Or imagine if a robotic surgery system was maliciously recalibrated in even a slight manner for surgeries.

"The list of threats is endless."

The FDA said it was "not aware of any patient injuries or deaths associated with these incidents" nor does it have any specific information on targeted devices.

The FDA said it had been working with other federal agencies as well as manufacturers, which it said are "responsible for remaining vigilant about identifying risks and hazards associated with their medical devices."

Among the measures that should be taken, the FDA said, are limiting unauthorized device access, "particularly for those devices that are life-sustaining or could be directly connected to hospital networks."


Is big data the new oil?

June 12, 2013 | Tom Sullivan, Editor

Paul Lambert, president emeritus, Point B, Inc. speaking at the Government Health IT Conference
“This is a story about oil and data,” Paul Lambert, president emeritus of Point B Inc., began, “two resources basically useless in their raw state but that can be very valuable when refined.”
Data has striking similarities to oil, namely in how you store it, transform it, make sure to use it in the right way, Lambert continued during a session at the Government Health IT Conference and Exhibition on Tuesday afternoon.
“Healthcare in general really needs this tool,” he added. And as industry moves from the current five zetabytes (one zetabyte is a billion petabytes) to an order of magnitude, and beyond. “There seems to be a lot of convergence on what we need do to but not a lot on how. We’re seeing a lot on the e-commerce side, but there’s not a lot of big data going on in healthcare.” 
And while common pitfalls include adoption, psychological, and technology barriers, Lambert said “we’re seeing a lot of venture investment in patient engagement, and that’s the absolute first step in putting data to work for the healthcare industry...The second step is data liquidity – both transparency and the interoperability of it.”
Though few and far between, early examples of what Lambert called “quasi-Big Data” in healthcare include evidence-based medicine on real-world validation of research, predictive analytics like Kaiser’s Healthconnect, which saved it a cool $1 billion by reducing visits via telemedicine and a trend similar to the law enforcement practice known as hotspotting. In hotspotting, police departments use data to look at high crime areas and focus resources accordingly on those — some healthcare organizations are delving into correlations in environment, behavior or patient history for population health management purposes.
An oncologist in attendance continued the analogy by saying that unlike a farmer sitting on an oil field, he really wants to share his data and, likewise, many of his cancer patients would be happy to contribute if it helps other people with cancer, but industry has not stepped up to the plate to make that reasonably achievable and the regulatory minefield around sharing patient data poses its own risks. In other words: He cannot even give health data away.
“There’s a buyer beware situation going on that kind of reminds me of when I got out of college,” Lambert said. “Companies were buying a lot of IBM hardware and the joke was that they’d buy a mainframe but not know what they were going to use it for.” 
Just as oil transformed our economy not so long ago, Lambert added data holds a similar promise, and getting there will be more evolution than revolution.
“The U.S. government felt so strongly that about the importance of oil that it created a strategic oil reserve,” Lambert said. “For Big Data, we should treat it as an asset that, as a country, is there for us when we need it.”

New 'Game-Changing' Rules for Innovation Grants From the Feds

June 14, 2013

 Federal grants to start small businesses don’t exist, despite popular perception that they do. What the government does fund are research grants for small businesses developing technology innovations that benefit certain federal agencies, such as the Defense Dept. The decades-old Small Business Innovation Research program was reauthorized in December 2011 amid controversy over the level of venture capital-backed small business participation allowed.
Now, with new commercialization requirements taking effect—and less private investment capital going to startup ventures—SBIR may become more relevant than ever to entrepreneurs, says David P. Metzger, one of the original drafters of SBIR in the late 1970s, who is now a partner at the Washington (D.C.) law firm Arnold & Porter. The push toward commercializing SBIR research grants was fueled by government cost cutting and renewed focus on job creation, he says, as well as complaints about awards going to purely academic researchers who should be funded by universities and other organizations.
In the past month, officials at the Defense Dept. and the National Institutes of Health have announced that their commercialization regulations will be finalized by the end of this year, putting the impetus on small companies to move away from early-stage research and into more product-focused ventures. The law establishes commercialization benchmarks and allows for companies that have won multiple early-stage awards to be dropped from the program if they are not following through on developing products for use.
“In this time of limited venture capital, [SBIR is] the only place to go that has large amounts of money to take ideas and technology and move them down the road,” Metzger says. The commercialization aspect of the law’s reauthorization “is a game-changing aspect that makes it stronger and more likely that the government will buy [entrepreneurs' products] and put them in their systems.”
Among the roughly 15,000 beneficiaries of the program is Richard McNeight, president of 80-employee Modus Operandi. His Melbourne (Fla.) business has received $40 million in research awards over the past decade through SBIR. He says he isn’t allowed to identify the specific Defense Dept. agencies that use his company’s semantic software tools, which scan disparate databases and homogenize the information found there to help analysts develop predictions about potential terrorist activity.
The SBIR program requires the 11 federal agencies with research and development budgets that top $100 million to allocate 2.5 percent of those budgets to small businesses. Early research projects can get up to $150,000 in funding; follow-on awards max out at $1 million; and final tier (so-called Phase III) awards have no monetary limits.
Over the years since it was authorized in 1982, the SBIR program has become increasingly important in funding entrepreneurial innovations, says Jere Glover, a former SBA official under President Bill Clinton who is now executive director of the Small Business Technology Council, an arm of the National Small Business Association. “Big business, in the 1970s, was doing over 40 percent of the key innovations in America, but they checked out. They’re acquiring now, but not innovating. Universities come up with 6 percent to 10 percent of the innovations. The SBIR firms make up nearly a quarter of the total firms that win R&D awards,” he says, citing a 2008 study (pdf) from the University of California, Davis.
Jenny C. Servo is president of Dawnbreaker, a consulting firm near Rochester, N.Y., that has worked with small companies to commercialize their SBIR projects since 1990. She sees the increased push for commercialization as part of a positive long-term trend. “Each time the legislation comes up for reauthorization, a greater emphasis has been placed on commercialization, and more clarification has been provided,” she writes in an e-mail. “More and more agencies feel comfortable in providing commercialization assistance to help small businesses meet the increased emphasis on commercialization.”
M.L. Mackey, chief executive of Beacon Interactive Systems in Cambridge, Mass., is not so sure. A renewed discipline on commercialization may prove to be a good thing or a bad thing, she says. Her software company, like McNeight’s, will likely profit from the commercialization requirements because getting software products to market is far cheaper and simpler than doing projects in the material sciences that have physical components. “I applaud the intent of rewarding commercialization and focusing on that, but I am concerned that if those guidelines are not carefully applied or thought through, they will become punitive to innovation and more in line with rewarding engineering,” Mackey says.
Glover is not worried: Companies will have plenty of notice before they have to concern themselves about being kicked out of the program for lack of commercialization, he says. And if the requirements spur more practical innovations, that’s a good thing.
At Modus Operandi, McNeight has already hired an employee to develop and market the company’s semantic software for use in the health-care industry. “It’s not just because of the SBIR commercialization question, but because we see that semantic technology that was developed under SBIR is a perfect match for the big data that is coming out of electronic health records and the [Affordable Care Act],” he says.
Klein is a Los Angeles-based writer who covers entrepreneurship and small-business issues.

Q&A: John Glaser's 4 facets of patient engagement

June 10, 2013 | Tom Sullivan, Editor

John Glaser, CEO of Siemens Health Services
Having enrolled in a clinical trial — as a healthy participant, no less — Siemens Health Services CEO John Glaser gained a unique perspective on the long, hard journey to patient engagement.
That is only part of what Glaser plans to discuss this week at the Government Health IT Conference and Exhibition in Washington, DC.
Leading up to the show, Glaser spoke with Government Health IT Editor Tom Sullivan about what to expect at his session, why technology is likely to be the easy part of patient engagement, and the four facets of behavior change that will convert people to engaged patients.
Q: What is the overarching theme of your presentation, 'The IT Ramifications of the Era of Accountability'?
The basic premise is that we’re entering into an era of significant changes to the payment system. Bundled payments, episodes, accountable care organizations, all of which are intended to improve the quality, efficiency and safety of care. Now, when you step back and look at this, it’s going to evolve over the course of this decade you see not only new types of applications that people will need, care management systems and things like that, but you’re also likely to see some fundamentally profound changes to the nature of these systems because of the changes that are coming and by that I mean, for example, as the pressure grows to follow the evidence, to master the incredibly broad and growing base of medical knowledge, we’ll see more intelligent EHRs. In other words: Greater use of workflow engines and rules engines and advanced decision and therapeutic treatment algorithms. So we’ll take a bunch of systems that have traditionally supported transactions – write a prescription, document care – we always have to do that but they will become much smarter. We’re going to see a series of fundamental changes to the nature of the IT that businesses put out along with some applications that really haven’t been all that common up until this point.
Q: What’s an example of such a new application that you can envision?
 Some of them are kind of prosaic. So if you look at what percent of the US population today has a personal health record, about 6 percent, that’s tiny. That’ll become 60 percent, so in comes cases it’s that they’ll go from rare to relatively common. In addition, things that are new, if you and I are going to manage a population or a region as an accountable care organization by contract, rather than buy everybody I have a contract with you, you have a contact with me and we bring in, say, two other colleagues and each of us has different technologies. You might use eClinicalWorks, somebody else uses Siemens, somebody else Greenway and the other party Epic. We’re going to need a care management system sitting between all these, and leverage HIE and health analytics to determine who’s off the care plan they have and use workflow technologies to ensure the subsequent care action that need to be taken are taken. So this is the natural evolution, sort of the next step for the progress of disease registries. There will be a new category but you’ll be able to see the predecessors in them; it’s not so radical as to be unrecognizable but it will really be a different order of sophistication that we’ve seen before.
Q: Which is a good way to segue into my next question. Even a modicum of vision points toward a future wherein the digitized healthcare system in America, alongside those more intelligent EHRs you mentioned, big data and hefty analytical tools, creates a world where we can more effectively manage patient populations. But how far away is that, really?
In some ways we do it today. There are Medicare programs for managing people in high-risk populations, people who have multiple chronic diseases or are old or fragile, for example. There are organizations today that manage populations of diabetics, asthmatics, etc., so population management goes on today. Providers do it, health plans do it. We don’t do it as often as we should. And the way that we do it is way too labor intense and is really only achieving fairly modest gains. So it’s not a matter of going from no population management to highly-mature population health, but we don’t do it consistently, we don't do it across enough of the aggregate population and in a way we do it in a very immature fashion. So as we get smarter about putting interoperability in place, or adoption of EHR increases, and we begin to understand what’s behind the hype of big data, we will get better at it and more sophisticated. I think much more like walking up steps or escalators: You don't take on giant steps, you take a series of modest-sized steps and get there eventually.
Q: Which ties into your talk slated for the conference. Among the themes in your sessions description is predictive analytics. What will be your message around that?
There are two messages here. One is we’ll see more and better use of predictive analytics because if you’re at risk, and it’s not just at risk of readmissions, let’s say a well-managed diabetic all of the sudden tanks, for example. You’re going to be at risk for populations, readmissions populations, disease populations, and when you’re at risk you want to know who out of those hundreds of people poses the greatest risk, so point number one is we’ll see greater use of analytics to predict that. The other point here we take traditionally, and business intelligence analytics is not a new idea, where you took transactions from systems, cleaned them up, put them in a repository, put some good on top to slice and dice and graph — and that’s been our definition of analytics. But that definition in the coming years, it will become much broader to include big predictive algorithms, workflow engines, people trying to slice big data looking for new patterns. So predictive analytics is an example of the expansion of the range of analytics tools we’ll use in the years to come.
Q: Patient engagement is another theme of the show and President George W. Bush’s publicly stated goal of getting every American an electronic personal health record by 2014. Do you anticipate we will succeed in that and once we do, what is the best way to engage patients?
A: No. I think if you look at the meaningful use attestation for Medicare that have occurred to date, 45 percent of the hospitals and 36 percent of the docs, so to assume we’ll get to 100 percent in the net 16 months, I don't think that’s possible. So the 2014 goal put forth by President Bush I don't think is within reach – but if we do it by the end of the decade we ought to feel pretty good. It’s a slow hard journey and lots of things have to happen but it doesn't mean we have to wait for that to engage patients, get them to leverage personal health records now. Things like wearing a Fitbit to monitor your exercise rates, your calorie intake, your sleeping habits, all these help people become more engaged in their health.
Q: And in some ways actually getting most patients engaged in their own care might be the hardest part. All the technology in the world doesn’t mean they’ll necessarily use it. What is the best way to get patients actively engaged?
 In time, this industry will look at it from a technology stance when it’s not obvious how critical the technology is. And I’ll give you an example, Tom. A couple years ago I enrolled in a clinical trial with the Dana Farber Cancer Institute. They were looking at what behavioral strategies are useful in helping people who are fundamentally healthy, that was me, adopt four fundamental behaviors: multi-vitamin a day, eat three or fewer servings of red meat a week, eat five to seven fruit or vegetable servings a day, and walk 10,000 steps. And I did that for 6 six months, made it part of my routine and still do it today even though the trial was over about 3 years ago. So what occurred to me is that I was more engaged in my overall health. Why did I do this? Since I didn't need to, what caused me to do that?
There were four things. One is that there’s a medical rationale, understanding the relationship between walking and health, that doesn’t need much explanation. The second: I had tactical knowledge. In other words, one of the questions for me was what constitutes a serving of fruits or vegetables, for example, do onion rings count? [Chuckle]But I just had to know that very sort of tactical knowledge. The third was technology, a pedometer and web site to record this stuff. So at day’s end I’d record this and if I missed my goals I’d get a call from the health coach asking if I needed some help. And then the fourth was that I had to have a motivational structure. In my case, I’m so Type A that I was going to do it just because I wanted to get an ‘A’. My wife goes to exercise class because she likes the collegiality of her friends.
I look at that trial and think I was an engaged patient, engaged in my health, engaged in changing my behaviors. And the technology piece was perhaps trivial, a $40 pedometer and web site – there’s nothing all that cosmic. The major things were a motivational structure, education, someone who could help with this that or the other. Engaging patients will take all four. What’s unclear to me is how critical the technology will be. And maybe it will be critical but it will be things like Fitbit or pedometers rather than something elaborate.
Q: It’s an interesting point that the technology involved was not, as you said, all that cosmic…
 I went down to my local CVS and bought a pedometer. That said, behavior change is complicated. I think as a country we’re at risk of getting to certain geographies where obesity is so common that nobody worries about it because everybody’s fat. And then it will be even harder to make behavioral change.
Q: Now, the burning question: Did you figure out a way to pull onion rings into the fruits and vegetables category?
My health coach would have nothing to do with that. I struggled and used to say ‘that’s a lot of bananas. I can’t eat that many bananas in a day.’ She vetoed the onion rings so I went for broke and said ‘coffee grows in the ground, how about a cup of coffee?’ No, no, no, no. I was pulling at straws, that’s for sure.
Related conference coverage:

3 patient engagement lessons

June 12, 2013 | Anthony Brino, Associate Editor

Patient engagement is a term Jan Oldenburg, Aetna’s VP of patient and provider engagement in accountable care, didn’t first hear until 2009. But she remembers the concept gradually coming to the fore in the mid-1990s and the early 2000s, as her former employer, Kaiser Permanente, launched a personal health record, and as the importance of active chronic disease management became more apparent.
Fast-forward to 2009, and the HITECH Act-created 17 Beacon Communities set out to experiment with digital health tools and patient engagement in a variety of urban and rural settings, focusing on patients with co-morbidities.
With those experiments wrapping up after three years, the Office of the National Coordinator and the providers and health organizations that worked in those communities have a fair understanding of what can work, and what might not, for using a patient engagement as a route to better care and lower costs. Clinicians and program mangers from two of those Beacons and the ONC shared lessons-learned at the HIMSS Government Health IT Conference.
Bring the right technology to the right patients – and docs
Nancy Maloney, a clinical operations manager with the Western New York Beacon Community, worked with a 40-organization team that was trying to coordinate care for patients in some of the poorest areas of the country, in the eight counties around greater Buffalo. Although the Beacon had some notable successes, such as with nutrition programs, a web-based medication adherence program ended up not working out.
“We started a medication adherence program that we thought was fabulous: web-based, written at a fifth grade level, videos for how to use a glucometer,” Maloney said.
Many of the patients, though, were not computer literate, not confident using the web or didn’t have adequate access. Another problem the Beacon encountered, Maloney said, was with doctors. The web-based medication service wasn’t accessible from EHRs, so physicians would have to use a separate web app for patient medication instructions – another step in the work flow that, however minimal, created extra tasks for already time-strained doctors.
Likewise in rural central Pennsylvania’s Keystone Beacon Community, Geisinger Health System community engagement manager Teresa Younkin ran into the limits of consumer health technology.
Younkin and Geisiner went to health fairs with laptops and wireless cards to try to help show mostly senior patients how to find reputable health information on the internet. “We couldn’t get anybody to touch it,” Younkin said.
“If I come to you with some kind of IT tool, I cannot dictate to you how it’s going to work in your community.”
Use ‘beer and pretzel language’
“Patient-centered outcomes.” “Patient engagement.” “Population health.” What do those terms mean to the typical Beacon Community patient or the typical American patient – say, someone with multiple chronic conditions, like diabetes, asthma and heart disease?
Not much necessarily. And possibly the word population may actually trigger fears of rationing or bring to mind an elitist bureaucracy, because patients want to be treated as individuals, as Aetna’s Oldenburg said.
Geisinger and the Keystone Beacon Community, learned firsthand the importance of clinicians – doctors or nurses – having conversations with patients about chronic disease management, and doing so in “beer and pretzel language,” said Younkin.
One huge for opportunity in patient engagement is for clinicians – and also community organizations partnering with providers – to explain things like nutrition, metabolism and exercise and counsel patients on their habits.
In this and other cases, Younkin said, the phone call – midway between email and in-person visits – may be preferable for some patients, especially those who may be more comfortable talking frankly over the phone as opposed to in-person.
Clinicians entering the realm of health coach may be huge challenge, too, particularly for patients that may never have learned basic nutrition science. But if the nation is going to curb the diabetes epidemic, providers are going to have to contribute to health education and engagement. (And as Aetna’s Oldenburg noted, some are already doing this, such as by hosting farmers markets and healthy cooking demonstrations.)
For HIE authorization, avoid registration overload
A key foundation of accountable care (and care coordination in general) is information exchange, which under HIPAA requires patient consent.
Health systems and HIEs have experimented with opt-in or opt-out consents – framing the choice as either being able to sign up or being automatically signed up unless otherwise opting out. But one variable that may not have been widely considered is how and when the consent is offered.
Doreen Salek, director of case management at the Keystone Beacon Community and an RN at Geisinger, ended up testing a few methods of obtaining consent. She found that universal authorizations at registration, selling the form and cold calling didn’t work.
What did work was using a trusted care team member to explain what the consent form actually meant – that a patient’s information will follow them the next time they seek or need healthcare.

Q&A: 3 pillars of population health

June 07, 2013 | Tom Sullivan, Editor
The overarching concept of population health management continues taking shape amid an American healthcare system undergoing feverish digitization — and while some of the larger, IT-savvy health networks may more effectively be managing patient populations within two years, for most it will likely take six to eight years.
To that end, Daniel Newman, MD chief medical information officer of MEDfx, is slated to outline the triptych of population health pillars during a session next week at the Government Health IT Conference and Exhibition in Washington, DC.
Ahead of the show, Government Health IT Editor Tom Sullivan interviewed Newman via email about those puzzle pieces, how far the country is from widely employing such technologies and practices, and why true population health management looks at the whole person rather than merely their disease state.
Q: You list the 3 pillars of population health management as analytics, care improvement, and patient engagement. Are the technologies already available and, if so, what are the hard parts of each?
Analytics:  Analytics can be thought of in two buckets: 1) Deductive analytics, which includes reporting and retrospective stratification and 2) Inductive analytics, which includes predictive modeling and stratifications.  The technologies to do retrospective reporting and stratification are available and have been for some time. One of the major difficulties is getting the data into a form that can be easily used for reporting. Gathering data from multiple systems (PM, EMR, Lab, radiology, etc.) both within and across systems and then normalizing the data to standard terminologies so you can run queries is labor intensive and difficult to accomplish. Unfortunately, much of the data in healthcare applications is often unstructured, meaning not codified to a standard, due to usability issues for clinicians and/or not having a standard coding scheme available. The more accurate data you have, the more the outputs can be trusted. Predictive modeling and inductive analytics are being developed by several groups right now. Predictive modeling will be able to tell us where patients’ health will be given their current status. These models will need to be thoroughly tested and have continuous improvements to ensure their accuracy.
Care Improvement: The biggest issue with care improvement is that patients move around so frequently and to do care management well you need the data from all of these sources. While some systems have enough data to adequately perform well at this step, many patients care is too fractured between EMR systems to make this feasible. Technologies like private Health Information Exchanges coupled with the national eHeatlh Exchange will be able to begin closing this gap. Once you have the right data, the next step is developing rules and systems that will enable clinicians to use this data in real time. While there are some systems out there that do this, a comprehensive system has not yet been brought to market.
Patient engagement: Most people think of patient engagement and go right to the idea of a patient portal. Patient engagement is a set of actions one takes to improve patient activation. Patient activation is how educated, informed and involved patient are in managing their own health issues. Patient engagement is not just a patient portal issue. Every step in the care of a patient — be it inpatient, outpatient, care management etc. — has an opportunity for patient engagement. Making sure we consider patient engagement to not just be a technology but a series of activities with a goal is essential to having a good strategy. Portals can be excellent ways to engage a patient, but too many are flat views of a patient’s information or are not implemented with the full concept of an engagement strategy. Without understanding and measuring the effect of your patient engagement strategy, patients will be less likely to use your portal. From a technology perspective, portals are easy to find, however most sit on top of a single instance of a database and do not show comprehensive information. Expanding the data in these portals and making sure they are aligned with a strategy are the most difficult parts of patient engagement.
Q: Even optimistically here, how far is the US from being able to put those pillars into nearly ubiquitous practice?
Many years. I would expect some of the larger systems to have pieces of this in place in the next 1-2 years. I would not expect this to be ubiquitous for 6-8 years at best. These systems will need continuous cycles and measure and improvement to reach their optimal states.
Q: When the topic of population health management arises, many people point to diabetes, obesity and blood pressure as the sort of de facto standard examples of conditions we could, and should, be managing better in patient populations. What are some of the less well-known?
While the management of these diseases is essential to population health management, it’s important to not limit population health management to just disease management. True population health is looking at the entire person, not just their disease states. It’s important to realize that it isn’t just diseases and medical management, but social and environmental issues and barriers that affect care. For example, someone with asthma that is poorly controlled due to environmental factors in their house or patients that are not well controlled because they don’t have the money to pay for transport to the clinic. Population health is about looking at all these variables and making sure you know the right interventions to improve health. That being said, there are definitely diseases that are focused on because they have good evidence that optimal management leads to improved quality of life and lower costs. These include COPD, Asthma, CHF and Ischemic heart disease. While these are well known, there are less well-known examples like Rheumatoid Arthritis and HIV and mental health. Though these will obviously be a focus, hopefully we will be able to institute a global view of each patient and understand the many complex reasons people do poorly.