ENTREVESTOR: Exploring medical innovation

May 15, 2013 - 6:20pm BY PETER MOREIRA | ENTREVESTOR

In the midst of interviewing ABK Biomedical’s new CEO Pat O’Connor on the Halifax company’s direction, I realized that the story I should write was about O’Connor himself.

Last October, the company announced it had raised $1.25 million in funding from a variety of sources, and co-founder and chief scientific officer Daniel Boyd said, almost parenthetically, that it had also hired a new chief executive from Ireland, a man called Pat O’Connor, a former executive with Boston Scientific Corporation, a worldwide developer, manufacturer and marketer of medical devices.

When I finally interviewed him this month, I was astonished by his savvy and industry knowledge as he explained that ABK is at a critical juncture. The company, which is mainly focused on treating uterine fibroids, or benign tumours in a woman’s uterus, is now completing important development testing in preparation for applying for regulatory approval in Europe, the U.S. and/or Canada.

With the support of Springboard Atlantic, an organization that aids commercialization of university research, ABK a few years ago developed OccluRad — tiny bio-compatible glass beads that can treat uterine fibroids. About 40 per cent of women over 35 worldwide develop these tumours, and many require a hysterectomy. Yet radiologists are now tackling this problem in a minimally invasive manner by injecting beads into a target area and essentially blocking the area around the fibroid and starving it of blood.

The problem is that the beads now used in this procedure aren’t visible under fluoroscopy (an imaging technique that uses X-rays to obtain real-time moving images), so the radiologists have to introduce a dye that is visible to confirm that the right blood vessels are blocked.

ABK Biomedical’s innovation is the development of new particles, or to use the clinical term, radiopaque embolic beads, that are visible under fluoroscopy so the dye is no longer needed. That reduces costs, makes the procedure quicker and eliminates the risk of a toxic reaction from the dye.

O’Connor explained that the company now has its corporate structure in place, has lined up manufacturers and partners and is now assessing where it should first seek regulatory approval. The options being assessed are the U.S., Canada and the European Union, or any combination of the three.

The company will begin design verification testing, which includes such things as pre-clinical study, bio-compatibility testing and design verification bench testing, in August, for completion around January 2014.

Preliminary indications reveal the company may be able to receive approval for some applications with rigorous pre-clinical tests rather than full clinical trials. That means regulatory approval in whatever market it chooses first could come in mid-2014.

However, O’Connor added that that does not mean the company won’t proceed with clinical trials later in 2014 — depending on a couple of factors. “Even if you don’t need it (a clinical trial) for regulatory approval, it’s very powerful in gaining market approval,” said O’Connor. Also, patients with uterine fibroids are otherwise healthy and this will drive the requirement for ABK to generate clinical data for regulatory approval in some regions.

What O’Connor was displaying was a knowledge of the medical device development understood by few people — if any — in the Halifax medical device community. For example, when we discussed the continuing research that Boyd and his team was doing at Dalhousie University, and how this could lead to new products, O’Connor explained the challenges of bringing a product from the R&D stage to the market. These include not only safety and efficacy, but the market opportunity, the routes to market, the cost of making the product and what price it could bring in.

The trick, therefore, is not just to develop a device that improves health outcomes and is safe, but also one that can be manufactured and sold with acceptable margins. Any technology selected for development within ABK will be assessed with all those factors in mind.

O’Connor, who has worked for such medical device giants as Boston Scientific and Stryker Orthopaedics, is happy to share his knowledge with others in the medical device community. He hopes to be involved in a biotech mentoring session to be held by Springboard Atlantic and First Angel Network, June 12 and 13, at the Innovacorp Enterprise Centre in Halifax.

Do You Practice in a "Virtual World"?

If you are involved in the “Digital Delivery” of Medicine in anyway, please share your thoughts, Ideas and Experiences on the following:

 

·        Patient Centered Care

·        Best Practices

·        Consumer Engagement

·        The Experience of Care

·        Frustrations / Inspirations

·        Further Integration

·        Lessons Learned

·        Future Resources Need

Consumers want an alternative. Taxpayers are tired. Patients want privacy.

How Do We Integrate Digital Health into America’s New Delivery System?

OIG: Flaws in CMS databases threatens integrity of Medicare

The inaccuracy, incompleteness, and inconsistency of provider data maintained by the Centers for Medicare & Medicaid Services (CMS) could put the integrity of the Medicare program at risk, according to findings from the Office of Inspector General (OIG).

The office with the Department of Health & Human Services (HHS) reviewed information of Medicare providers stored in the National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain and Ownership System (PECOS). As the OIG notes, providers are required to supply CMS with their National Provider Identifiers (NPIs), which are maintained in NPPES, in order to enroll in PECOS. Programs such as the EHR Incentive Programs require that eligible professionals and hospitals to have active NPIs to qualify and participate.

So what did OIG find?

First, nearly half of all records (48%) in NPPES contained inaccuracies with close to one-tenth (9%) of records being incomplete. The most common inaccuracies were found to be the provider’s or practice’s mailing address (34.1% and 33.3%, respectively). Based on a survey of 126 providers, most indicated that their mailing addresses were outdated (51; 53%), followed by those indicating that information was never correct at all (27; 28%) or only partially correct (18; 19%).

Second, PECOS was also plagued by inaccuracies, mostly in the area of address data with less than four percent of provider records missing data. Fifty-percent of Medicare-enrolled providers in PECOS had records that were inaccurate, with the most common inaccurate variable being their primary mailing address (46.8%). Similar to findings for NPPES, the largest number of the 126 providers surveyed reported that this information was outdated (60; 57%), followed by those reporting that their information was partially correct (25; 24%) and never once correct (21; 20%).

These findings in particular pose a significant threat to Medicare’s integrity. “Addresses, which are essential for contacting providers and identifying trends in fraud, waste, and abuse, were the source of most inaccuracies and inconsistencies,” writes the OIG.

Third, the OIG found that provider data between NPPES and PECOS were inaccurate for nearly all records, a whopping 97 percent:

Of the 987,266 records for providers listed in both NPPES and PECOS, 961,634 contained at least 1 variable that did not match. Only 11,682 records (1.2 percent of the mismatches) could potentially be attributed to the timelag between updates of the databases. Only 3 percent of records contained information that matched across all selected provider variables. More than half of the records were inconsistent between the databases for provider contact information, such as practice location address (89 percent), telephone number (59 percent), and mailing address (51 percent).

Fourth, the OIG is reporting that CMS fell short of properly verifying provider information in both NPPES and PECOS although the federal agency has processes in place to do so. “CMS had processes in place to verify the accuracy of provider data in NPPES and PECOS; however, the manner in which CMS implemented these processes impeded efforts to ensure that the databases contained accurate information,” states the report.

The OIG is recommending that CMS work closely with its Medicare Administrative Contractors to implement program integrity safeguards and require greater verification of NPPES enumeration data and PECOS enrollment data. Additionally, the federal agency should review and correct data for new and established records. CMS agreed with all the OIG’s recommendations.

Volunteering Benefits Patients, Communities and the Docs Who Do It

FRIDAY MAY 31, 2013

Are you safe?

Have you eaten today?

Did you take your medication?

Those questions can be heard every day in any primary care clinic in the country, but they stopped me in my tracks when I heard them recently on a sidewalk in Washington, D.C.

In town to lobby Congress about physician payment and in the shadows of the U.S. Capitol, I heard those words spoken by a primary care physician tending to a homeless man on the city streets. For Catherine Crossland, M.D., medical director for homeless outreach services at Unity Health Care, working the streets of Washington with a backpack full of medical supplies is a regular part of her job. My brief glimpse of her inspiring work brought to mind how much good primary care physicians do every week through volunteering.

The AAFP's vision is to transform health care to achieve optimal health for everyone. Health care reform has expanded coverage to millions of people who previously were uninsured or underinsured. But even after the Patient Protection and Affordable Care Act is fully implemented, the number of Americans without insurance will still stand at 15 million to 30 million, depending on how many states fail to expand Medicaid coverage.

In other words, there are people who are falling through the holes in our health care safety net today and who will continue to do so for our foreseeable future.

We still have a job to do, in D.C. and in all our communities.

The uninsured and underinsured receive primary care in three places: community health centers, free clinics and through the generosity of physicians in private offices. In fact, the average family physician provides free or discounted care to eight patients per week.

The years I spent volunteering at the Stout Street homeless clinic in Denver were tremendously challenging and rewarding. Caring for the homeless raises questions we never had to consider in my then suburban practice. How do you dose insulin when the next meal is uncertain?

Of course, volunteering doesn't have to be anything as time-consuming as providing care at a free clinic. Family physicians make a difference every day in their communities, from making time to see the extra uninsured patient to teaching medical students in the office or presenting Tar Wars in the local schools.

During my Academy travels, it always amazes me to meet the innumerable family docs who make a difference even beyond their medical expertise by coaching youth sports or getting involved with their local school boards.

And the interesting thing is, when we help others, we are also helping ourselves. Volunteering enriches our lives in many ways. It connects us to others, refreshes our souls and even has medical benefits. Research has shown that people who volunteer have less depression and less stress than those who do not volunteer.

So, have you made a difference in the life of another today?

Thank you for what you do every day. Your patients, your community and you are healthier for it.

CMS Estimates Medicare Physician Payment Cuts, Outlines Cost-Containment Steps

CMS estimates that Medicare payments to physicians will decline by 10.6% below current levels on July 1 and by 15.4% below current levels on Jan. 1, 2009, under the current payment formula, CQ HealthBeatreports. The estimates were released on Friday in a letter from Jeffrey Rich, director of the CMS Center for Medicare Management, to the Medicare Payment Advisory Commission. The cuts reflect an increase in the volume of services provided by physicians that exceeds growth targets. 

Nancy Nielsen, president-elect of theAmerican Medical Association, in a statement on Friday said that lawmakers should "replace 18 months of looming Medicare physician payment cuts ... with funded payment updates that reflect medical practice cost increases," adding, "This sensible approach will give Congress time to work with physicians to legislate a solution to the long-term Medicare physician payment problem." Nielsen said that if the 10.6% cut goes into effect on July 1, about 60% of physicians say they will have to limit how many new Medicare beneficiaries they can treat, and more than half say they will have to reduce office staff.

Congress is working on a Medicare package that would block the cuts, according to CQ HealthBeat. One plan by the Senate Finance Committee would block all cuts in 2008 and 2009.

Rich in the letter also outlined steps CMS is taking to improve quality and efficiency, including:

• Continuing and expanding the Physician Quality Reporting Initiative, which pays physicians an additional 1.5% of their billed charges for reporting quality-of-care data;
  
• Implementing "structural measures," which include purchasing and using electronic health record systems;
  
• Intensifying efforts to collect and share data on physicians' comparative costs to improve efficiency; and
  
• Testing pilot programs, which currently include one that pays for efficiency in treating chronic conditions and another that develops medical homes for beneficiaries.

Rich in the letter wrote, "The real issue is how Medicare can rapidly transform itself from a passive payer for services into an active purchaser of high-quality care by linking payment to the value of care provided" (Reichard, CQ HealthBeat, 3/3).

HHS Denies Request To Halt Competitive Bidding 
In related news, HHS last week denied a request by the American Clinical Laboratory Association to suspend a pilot program that tests competitive bidding for Medicare clinical laboratory services, CQ HealthBeat reports. The three-year program will be tested in the San Diego market and affects any laboratory that has Medicare revenues above $100,000. The trade group requested that the pilot be suspended for a minimum of 180 days. Meanwhile, a lawsuit brought by clinical labs that aims to halt the program is pending (CQ HealthBeat, 3/3).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery athttp://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. 

Family Physicians Group Improves Patient Experience through Use of PatientPoint® Care Coordination Platform

Published: May 31, 2013 

Read more here: http://www.heraldonline.com/2013/05/31/4907352/family-physicians-group-improves.html#storylink=cpy

PatientPoint plays key role in strategic patient engagement initiative

By PatientPoint

CINCINNATI, MAY 31, 2013 — /PRNewswire/ -- PatientPoint®, the leader and innovator in mobile-enabled care coordination and patient engagement solutions, today announced that Family Physicians Group (FPG), a multi-specialty group and CMS shared-savings ACO, has launched the first phase of its strategic patient engagement initiative. The initiative will improve the patient experience and strengthen patient-physician relationships of this leading managed care practice through the use of the PatientPoint Care Coordination Platform. The program supports the group consisting of more than 120 physicians across 25 NCQA PCMH Level III-accredited sites in eight Florida counties.

(Logo:http://photos.prnewswire.com/prnh/20120911/NE71505LOGO)

In April, FPG completed the first phase of implementation across all locations to automatically update patient records such as demographics, medical history and pharmacy information into GE Centricity, FPG's EMR platform, via PatientPoint electronic check-in tablets. With more than 90 percent of FPG's patient population consisting of elderly, Spanish-speaking Medicare patients, usage adoption rates are already as high as 70 percent for the intuitive and multi-lingual electronic check-in and check-out feature. PatientPoint facilitated multi-lingual preventative health screenings during the electronic check-in to trigger care gap closures with the patient and increase practice revenues. During the four months of initial implementation for FPG, more than 2,000 depression screenings were administered through the electronic check-in.

The vision for FPG is to expand and enhance point-of-care engagement by using the PatientPoint Care Coordination Platform to address gaps in care, ensure preventative screenings and increase medication adherence.  Addressing these areas pre-visit and providing additional information at the point of care allows physicians to treat their patients holistically. FPG's goal is to create an environment that supports a more meaningful visit and a stronger physician-patient relationship, ultimately resulting in better health outcomes. 

Khalid Moidu, MD, CIO at Family Physicians Group, states, "A critical component of our strategy to build and sustain new healthcare delivery models is to apply innovative technology and care coordination solutions and support strong engagement practices with care providers. PatientPoint solutions bring information together from multiple sources to engage patients in their own care and enhance care management. We are pleased with our partnership with PatientPoint and are seeing excellent results. Since the PatientPoint Care Coordination Platform is prevalidated by NCQA for medical home, we are able to achieve our goals of continuing to transform our practice and to improve patient engagement while keeping costs in check."

Recognized for innovation in patient engagement by the Microsoft Health Users Group, the Care Coordination Platform integrates with practice management software and EMRs, streamlines the clinical process at the point of care, automates outreach to noncompliant patients on behalf of the physician and reconciles gaps in care. In addition, the provider organizations gain clinical and administrative efficiencies, resulting in increased revenues and reduced care management costs. As the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the NCQA for 2011 PCMH criteria, PatientPoint allows practices utilizing the platform's prevalidated functionality to gain automatic credit of up to 15 percent of total points required to achieve NCQA PCMH Level III.

"The results FPG has realized in a short period of time by using the PatientPoint Care Coordination Platform are increased proof of the impact patient engagement has on improving patient outcomes and keeping costs down," said Raj Toleti, president and founder of Coordinated Care Solutions and CTO of PatientPoint. "As a result, physicians can be more proactive in prescribing their care plans, and patients have more information and knowledge to make better decisions regarding their own care." 

FPG is using the PatientPoint solutions to address common ACO challenges such as: attribution loss, care coordination, operational burdens and cost containment. Join Dr. Moidu in a webinar on June 4 at 12 p.m. ET on "How to leverage patient engagement and retention strategies for ACOs."

About Family Physicians Group

With more than 120 physicians from Jacksonville to St. Petersburg, Orlando-based Family Physicians Group is a leader in primary care physician services in Florida. The group, which was established in 1987, has received a Patient-Centered Medical Home NCQA accreditation. Its delivery of health services focuses on a model with emphasis on the integration and coordination of care for illness prevention and management of diseases, such as diabetes, heart disease and others. For more information, please visit www.fpg-florida.com

About PatientPoint

PatientPoint® is the leader and innovator of patient and physician engagement solutions at the point of care. PatientPoint award-winning patient education programs and care coordination platform drive meaningful outcomes for patients, healthcare providers and program sponsors. The PatientPoint Care Coordination Platform is the first mobile-enabled care coordination and patient engagement platform to be prevalidated by the National Committee for Quality Assurance (NCQA) for 2011 patient-centered medical home (PCMH) criteria. PatientPoint serves more than 61,000 physicians across all programs and more than 570 hospitals throughout the U.S., and impacts over 456 million patient and caregiver exposures annually. Learn more atwww.patientpoint.com.

PatientPoint® Contact: Davida Dinerman/Pauline Louie Schwartz MSLpatientpoint@schwartzmsl.com 781-684-0770

Read more here: http://www.heraldonline.com/2013/05/31/4907352/family-physicians-group-improves.html#storylink=cpy

Will missing data affect physician P4P scores?

WRITTEN BY: JASON SHAFRIN - MAY• 30•13

The answer is yes, but maybe not as much as you may thought.

A paper by Ryan and Bao use data from a randomized controlled trial (RCT) called IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) to determine if errors in physician quality  profiling are due mostly to random variation or missing data.  For this report, the authors outcome of interest is remission of depression symptoms at 6 months after the start of treatment.

The IMPACT data include both a clinical registry used by care managers in the trial to document exposure to the intervention and to track patient outcomes (“registry data”) as well as longitudinal research interviews, which independently assessed patient outcomes at regular intervals (“research data”).  The authors use both the registry and research data to to generate parameters for the simulation.

The authors describe their simulation model as follows:

To initiate the Monte Carlo simulation, we assigned each provider a true quality score and a rate of missingness, each drawn randomly from distributions shown in Table 1. On the basis of data from the IMPACT trial, we assumed a correlation between missingness and true quality that was common to all providers. Then, 200 patient-level random draws, first determining whether an observation was missing or nonmissing and then determining patient remission (conditional on missing status), were taken for each provider. We then aggregated information from these draws, calculating provider-level “observed” quality scores under one of the two conditions: (1) using remission outcomes only from patients with nonmissing data, so that profiling error was a combination of error from missing data and from random sampling; and (2) using remission outcomes from patients with both missing and nonmissing data, so that all profiling error was due to random sampling. 

The authors reached a number of findings:

• Measuring quality using relative rather than absolute measures had lower error rates.  In fact, relative profiling approaches had profiling error rates that were approximately 20 percent lower than absolute profiling approaches.
• Most profiling error is due to random sampling, not missing data.  Between 11 and 21 percent of total error was attributable to missing data for relative profiling, while between 16 and 33 percent of total error was attributable to missing data for absolute profiling.

There is an important caveat to these findings, however.  The reason the missing data error is so small is due to the observation that in IMPACT data, missing data were not strongly related to the remission outcome in the IMPACT data.  If patients with observations missing from the data were much more (or less) likely to experience remission, then the missing data error would have made up a much larger share of the overall profiling error.

Source:

• Ryan, A. M. and Bao, Y. (2013), Profiling Provider Outcome Quality for Pay-for-Performance in the Presence of Missing Data: A Simulation Approach. Health Services Research, 48: 810–825. doi: 10.1111/1475-6773.12038

http://healthcare-economist.com/2013/05/30/will-missing-data-affect-physician-p4p-scores/

Corporate Innovators at the cusp of the next iteration

THURSDAY, MAY 30, 2013

The more I read innovation surveys and comments from analysts and executives, the more I wonder about management thinking.  Recently Accenture published a nice survey of 519 executives in firms in the US and in Western Europe.  The survey repeats what many of us have known for years:  executives recognize the importance of innovation and are frustrated with the results.  According to the survey 93% of the executives surveyed felt their firms would depend on innovation for growth, but less than 20% believe their innovation strategy is delivering a competitive advantage.  These two critical points identify what is perhaps the most significant trap in corporate innovation:  the unrealistic expectations of return on innovation.

If we were to stop for a minute and contemplate the timescales for innovation, things might become a bit more clear.  For many firms, regardless of when the idea is generated, it will take several years to develop a new product, prepare it for launch and provide it to customers.  Then, after the launch, it may take another year or two before the new product reaches break even and begins to generate real profits.  So, from the generation of a new idea till the recognition of profits and differentiation from the new product or service, it's reasonable to expect the timeframe to span three, four or even five years for fast turn products, and even up to seven or eight years for products with longer development cycles.

Add to this the fact that many companies don't "bet the farm" when they start innovation activities, for several reasons.  First, no one wants to take on too much risk on unfamiliar and untried innovation tools and systems.  There's always an argument for "low hanging" fruit as the first innovation initiative.  Second, many firms single thread innovation activities, due to resource constraints, budgetary issues and general change management.  This means that for many organizations, their first foray into innovation is by definition a line extension.  Further, many innovators conduct serial innovation activities rather than attempt to run several innovation activities in parallel, due to the constraints mentioned above.  This means that not only are the first attempts line extensions, but due to the limited number of initiatives, few products are developed.  Add to these the fact that it can take several years for even simple line extensions to move through a tightly constrained organization, and three to five years on the CEO may be scratching his or her head, wondering where all the innovations are that they demanded and were promised.

From the tiny acorn mighty oaks grow

There's absolutely nothing wrong with incremental, controlled experiments to test new philosophies and methods, and the innovation results we are seeing now are simply the first harvest of careful innovation activities.  What will be telling for future innovation is whether or not executives recognize the fruit of their planting, and decide to extend and expand the activities, and hopefully accelerate them, or deem the whole activity a failure.   The limited supply and constrained result of innovation activities to date is entirely predictable.  After all, the vast majority of corporations have spent 30 years building highly efficient business processes, cutting costs and eliminating risk and uncertainty.  Over the last few years some executives have planted tenuous innovation programs or activities that have trouble grafting on to the efficient working and activities of modern streamlined business models.  It's not unreasonable or shouldn't be unexpected that the first innovation harvests are small.  But, as the old saying goes, mighty oaks grow from tiny acorns.  All it will take is time.

Compare these results to the people who examined the possibilities of some of our most important inventions.  After the luster of manned flight by the Wright brothers wore off, I'm sure there were many people who argued that the plane only flew a couple of hundred yards and could barely carry a single person that distance.  A good horse could cover the same ground in less time!  What those naysayers failed to see, and what corporations are at risk of today, is that the first harvests are always thin, but continued investment and development can lead to far greater results and outcomes. 

From furtive experiment to critical capability

Corporate innovation is simply in its initial phases, in many cases as furtive, inexpensive experiment in one small corner of the business, underfunded and poorly resourced.  Expecting miracles from this small experiment is unreasonable, but not surprising.  Executives are realizing that while their organizations are exceptionally efficient, they cannot cut their way to growth and differentiation.  Innovation is vital because it adds to the top portion of the income statement, rather than cutting away at the bottom end.  What's important now is a continued investment, a growing investment and engagement in innovation, to shift the concept from a furtive experiment tucked away in a corner to a central, critical, consistent capability.  Just as a few Six Sigma "black belts" entered organizations years ago and now dominate corporate philosophy and thinking, innovation is a nascent experiment that must be expanded and must become a cultural phenomenon.

Many writers and analysts, this one included, hold up Apple as the arbiter of good innovation practice.  What people forget is that Apple was near bankruptcy in 1997, and had no other choice but to cut product lines and develop new innovation strategies for survival.  Today, Apple progressed through a series of innovation maturity phases, and is a relatively mature innovator.  Of course they should be good at innovating.  Apple has had almost 15 years of innovation experience to build on.  When executives look at Apple and wish their organizations could innovate like Apple, they fail to see the challenges, investments and time it took for Apple to become a viable innovator. 

Out of sight of the shoreline

The real question for many corporate innovators is this:  now that the first attempts have demonstrated some limited benefit, will they take the next step and expand their innovation efforts?  Will they define larger opportunities, provide more resources, funds and time?  Will they shift innovation activities from the periphery to the center of their organization?

Early sailor never sailed out of sight of the shoreline, because they lacked navigational skills and weren't sure what was out in the deeper ocean.  Sailing near the shoreline was safer but ultimately limiting.  It was only when they took the next step that new lands were discovered.  The same analogy applies for corporate innovation.  Small attempts have been made and they've been moderately successful.  More significant results await if the resources are available and if the organization continues to develop innovation skills and capabilities.  

Many corporate innovators stand at the cusp of important decisions.  In one direction is additional investment to build innovation capabilities and expand the breadth and depth of innovation projects.  In the other direction is the safe and familiar efficient business model, where cutting costs and achieving greater efficiencies lie.  Successful firms will recognize that both capabilities are required, and will invest in developing and maturing an innovation capability.  These firms recognize that corporate capabilities don't grow overnight, and investment is required for multiple years before significant results are achieved.  Many executives will blanch at the investment and decide to "acquire" innovation by purchasing smaller, more nimble competitors or seeking out third party technologies, not realizing the bidding war that will unfold as the number of firms choosing these options increases.

http://innovateonpurpose.blogspot.com/2013/05/corporate-innovators-at-cusp-of-next.html

Tracking healthcare innovation at the world's end

May 30, 2013 | Benjamin Harris, New Media Producer

Afghanistan doesn't come to mind when you ask me to list some of the top crucibles of innovation in healthcare right now. With a majority of the population living in incredibly remote areas and a dearth of basic necessities such as medications and supplies, one would be hard pressed to think that game-changing strategies and techniques are being developed there. Adversity, however, can be a prerequisite for change.

"Sometimes it takes going to the edges of the earth, as it were, to be able to develop stuff you can use at home," says Peter Killcommons, MD, CEO of MedWeb.

We spoke at the American Telemedicine Association’s annual trade show  a few weeks ago, where I saw his presentation on using mHealth to serve rural and isolated populations. By focusing on the bare bones, setting up jury-rigged and low-power satellite networks to link remote clinics with the world at large, Killcommons' efforts show the effects that even a basic cell phone connection can have.

In many ways, the problems to overcome in Afghanistan are a mirror of the problems in our own health care system.

"When patients go to the hospital, somebody gets sick in a village, they pretty much wait until they're almost dead," says Killcommons. "Then they'll throw them on the back of a bike or motorcycle... they wait until the last, last minute until they're really terrified that something bad is going to happen if they don't do something."

Sound familiar? There may not be donkey traffic jams in front of your local ER, but the space in our hospitals reserved for the most threatening situations is increasingly becoming the first point of contact for people with health questions. People access health care when they can, where they can. Killcommons looked at the situation in Afghanistan and realized that before breaking out the advanced surgical machines well-intentioned donors had given to hospitals in the region, some less fancy steps needed to be taken first.

That basic infrastructure was communication. Killcommons worked with locals to source and set up solar powered satellite and cell phone networks to bring telemedicine programs to remote areas of Afghanistan.

"A cell phone is like $5 from China. That's all they need really," says Killcommons. "There's some cell phones with a solar panel on the back, we wouldn't consider it reasonable to use that because it takes 30 hours in sunlight to give it a full charge. However, for them, that's freakin' perfect because the phone will last for two weeks - it's not like they're getting a hundred calls a day."

Getting people access to the information they need in a timely and sustainable fashion was his first priority, and it translates from the mountains of Afghanistan to anywhere in the world. Speaking about a telehealth program his company has developed for pregnant women, Killcommons sees the technology's potential to assist people anywhere.

"In the United States we have exceptional healthcare, but still it may be inconvenient if someone is living in a rural area and they can't get in to see their obstetrician as often as they would like, and a tool like this can be used," Killcommons says.

Access to reliable information is the first step in lowering costs and keeping patients more engaged in their care. In a world awash with resources (many not so reputable), communities, and the technology to link pretty much anything to anything else, providing robust and simple channels of access for some of the most remote and at risk will become an increasingly important mission in reforming health care.

"We need practitioners who can counsel us on how to be discerning readers of what we come across, to assist us as we wade through the snake-oil cures and the potential conflicts of interest, and who can help us put newly published research into context with what it mean for us as individuals," writes Laurie Edwards in a recent story on WBUR.

It's easy to lose sight of the little stuff. We like to get carried away over the newest and the flashiest technology. In the case of a remote village in Afghanistan or even America, though, having access to a cell phone and someone at the other end who can offer some educated advice can be worth more than the most advanced ER. The more you know, they say.

Benjamin Harris is Editor of Future Care, where this post was originally published. To learn more about the site read Harris' introductory post, Welcome to Future Care.

MyMD365.com - Taking us to the "Next Generation of Patient Centered" Care

Description

Our Mission
A unique opportunity currently exists for stake holders to improve the way our nation delivers care to its citizens. The current environment of regulatory reform, shrinking budgets and increasing patient populations has created the “the perfect storm”, thus setting the stage for the  greatest disruption in the history of the healthcare industry. There has to be a delivery system that is flexible enough to meet to the needs of every consumer on their own terms. How do we provide a valuable alternative for the 26 year old waitress without health insurance, the 46 year-old lawyer who doesn't trust the system and the 63 year old self-employed artist? I believe there is, and it is MyMD365.com 

MyMD365.com
MyMD365.com  seeks to connect patients, providers, researchers, educators and tech companies through an innovative mobile network. This collaboration will provide a direct connection at the point of care through a flexible digital platform.  The end result will be  “on demand” care delivered on any internet enabled device or through ERM’s proprietary Automated Community Health Machines (ACHM). These “mini-clinics”, about the size of a photo booth will private access to primary care, preventive screenings and disease management education to anyone anywhere anytime. When all you need is power and the internet the possibilities are endless. ERM believes that shared decision making relies on patient engagement and the only road to meaningful engagement is through education. A sustainable healthcare system will only be achieved through a partnership with the consumer. Value is in the eye of the beholder and MyMD365.com provides meaningful solutions to every consumer. A positive patient/physician relationship is the greatest factor in compliance with treatment. The decision to seek or not to seek treatment is a personal one. Not one that can be dictated by big business. Thanks to the ACA, we have brought attention to the needs of certain populations like the elderly and the uninsured, but what about the insured who are turned off by the system? What are we doing to address the growing number of consumers who choose privacy over healthcare? 

The Empirical Benefits

• Greater Consumer Experience ·  

• Transparent Pricing

• Flexible Delivery

•  Access at the Point of Care ·         

• Shared Decision Making ·

• Whole System Change ·         

• Data, Data, Data    

How We Got to This Point… 
Empirical Risk Management began as an “experiment” to prove the positive impact that education could have on reducing costs, engaging patients and improving the overall experience of care.  Our pilot was a huge success and the ROI was incredible, but the greatest achievement of all was seeing the hunger for knowledge and the positive impact on human life that was reflected in patient centered whole system change. Please visit our website to find out more about our pilot: www.ermconsultinginc.com 
This project extends that valuable patient/physician relationship to every consumer in the healthcare market. MyMD365.com will provide the platform necessary to launch this disruptive innovative technology into the hands of every consumer for $300 a year and as little as $25 A “virtual visit”. Consider the benefit this would allow employers to provide to their employees on any "job site". 
We know that our emotions play a significant role in the healing process. Could we reduce the time of recovery by allowing patients the comfort and security of their own bed? What about disease management? Could this be the tool that primary care providers have been looking for to encourage healthier decisions? What about monitoring changes in medication? What about the benefit of reducing of hospital admissions and re-admissions through earlier identification and prevention of exacerbations in chronic disease? 
The individual voice of a patient or a provider will never be enough, but together we can move mountains. Join our revolution, help fund the “Next Generation of Patient Centered” Care. 

The Minds Behind The Movement… 
Kameron Gifford, CPC 
Over the last twelve years, I have worked with physicians to develop efficient billing practices, implement value added processes and improve the entire experience of care for their patients. What can this knowledge contribute to developing compliant, engaging and transparent care delivery systems? 

Todd Gifford, MBA
My husband is a managed care executive with one the country's largest health plans. To him, this project represents a solution; an answer to some of healthcare's greatest barriers. But most of all he envisions a way to connect providers with their patients in real time outside of the “clinic”... a tool for chronic disease management. 

JM McCullough, MD 
My father celebrated his 70th birthday last week. He is the inspiration behind ERM's work and our proprietary model of care "The Preventist". His primary care practice is still located within 15 miles of where he completed his Residency and our average patient is an 83 years old male with 3 or more chronic conditions. His career in managed care began shortly after Reagan left office and continues today as an Associate Medical Director for a managed Medicaid plan in addition to seeing patients everyday.  His leadership and guidance was essential in creating a vehicle for the  “Next Generation of Patient-Centered”.

Render unto Cesar What Is His

By Todd Gifford, MBA    /    Political Writer   /   5.30.2013

Congressman Paul Ryan (Wi.) who sits on the House Ways and Means Committee was interviewed on Fox news last night discussing the House's subpoena power in relation to the latest scandal whereas the IRS has acknowledged the improper targeting of conservative groups applying for 501C4 tax exempt designations for political action committees and the levels of scrutiny placed on these right wing groups far surpass the levels of examination  political organizations that lean to the left or liberal groups experienced.
This action if proven true, attacks the heart of our governance and political system. The IRS is the body of government that should never show favoritism toward one party over another even if the bureaucrat has his own interest at heart, the illusion of transparency and an expected policy of non-bias treatment is non-negotiable.
The ability for a group to organize and fundraise is completely dependent upon the tax exempt status of the given group, if the tax exempt status is delayed this will have an apparent effect on that parties ability to mobilize supporters into a better directed coalition.
There seems to be great variation toward those who received scrutiny for requested tax exempt status. I am not Nostradamus, but I predict we have a special investigative council looking into this matter, at the very least it seems gross malfeasance has occurred and the origins of the directive must be revealed.
A visible chink has developed in the armor of Obamacare, now in its most vulnerable state, with the enforcement powers lying within the IRS. Many Americans already suffer from a fear of an Orwellian society. The very fabric that binds our great country together is unraveling before our eyes. That sacred trust in our leadership has been damaged, and we must act now.
Paul Ryan might be our last vestige of hope. Does he have the power to repeal Obamacare through his position in the House Ways and Means Committee?  In my opinion, he is our single greatest hope of preventing the machine of government from taking sole control of 17% of our Nations GDP. Stopping the eventual progression to a single payor system. Could this IRS scandal be the impetus that Republicans have been so desperately searching for?
Americans want answers. President Obama's approval and trust ratings are dropping. Three-quarters of U.S. voters (and 63% of Democrats) want a special prosecutor to investigate the IRS’s targeting of Tea Party groups. All eyes should be on Ryan in the common weeks and months. If he finds success here, he will find himself center stage among the Republican nominees for President in 2016.

CIOs Seek Tech Prescription to Patient Privacy Rule

• May 28, 2013, 4:59 PM ET

Clint Boulton

Reporter

A new federal rule that gives patients more control over healthcare information they choose to share with insurance companies pose challenges for CIOs who must build out technology to support it. One CIO said software can be fashioned to filter out information before it is passed to another party. But such software raises the sticky issue of who is best positioned—the patient, the physician or another party–to decide when such data is best withheld.

A revision to the Health Insurance Portability and Accountability Act requires doctors and hospitals not to disclose medical information to a patient’s insurer if the patient requests it and pays for services themselves. Doctors frequently make notations in their patients’ medical file, which could include information that allows insurers to make inferences about the patient’s health that patients may prefer to keep private. CIOs say that stopping the information from being revealed in notes is difficult, potentially setting up their organizations for paying millions of dollars in compliance penalties.

Beyond compliance issues, the new law brings into question whether patients would be informed enough to know the repercussions of their decisions. Speaking on a hypothetical software solution that would give patients the power to select data they didn’t want to share, Scott Joslyn, CIO of MemorialCare Health System, cited safety concerns. Clinicians would “lack a complete medical picture for the patient,” he said. Patients could check a default box that blocks potentially life-saving information from physicians providing them treatment.

The challenge of data segmentation isn’t limited to healthcare organizations. CIOs in retail and other industries offer consumers services that aim to take advantage of the glut of data people create on social software and mobile devices. Consumers often blindly opt-in, or agree to receive notifications or have their information shared with other service providers without realizing the implications of who they are allowing to do what with their data.

Given the topic, the stakes are higher when it comes to data segmentation and one’s own health records.

Physician notes about treatments provided and medications administered to patients’ healthcare records can help physicians better treat the patient in the future. But this is not always the case. For example, while it might be helpful for a dermatologist to read a note referencing a patient’s allergy to penicillin, a note that he had been treated for alcohol abuse at a clinic 20 years ago may not be germane to the treatment, said John Halamka, CIO of Beth Israel Deaconess Medical Center.

Under the new rule, a patient paying out of pocket for the service can choose that hospitals and physicians block service records from their insurer. This would provide patients more privacy and the peace of mind that insurance providers won’t use the notes as causes to increase health insurance premiums for patients they believe pose increased risks. “I, the patient, want to control data transferred for a specific purpose to a specific person,” said Mr. Halamka. Mr. Halamka equated the concept to the sharing on social networks where the user controls what information to share and with whom.

Mr. Halamka, a co-chair of a federal advisory committee on data standard, said healthcare CIOs need software that can identify potentially sensitive medical annotations in an electronic medical record (EMR), and redact them before the record is transferred. He said the problem could be addressed with an algorithm that automatically tags notes for removal before the record is passed to an insurer. The application would present check boxes that allow users to decide with whom what information gets shared.

Although such software is technically feasible — Facebook Inc. has built something similar for its social graph of over 1 billion users — it raises a significant question: who is best positioned to decide how data is segmented?

Martin Harris, CIO of the Cleveland Clinic, said such data segmentation is a “tricky area” because it is unclear whether the pathologist, a physician or a patient would have to set up the application to keep certain information private. Physicians might have to meet with patients to explain the potential outcome of selecting rules that would block information from the eyes of insurers and others. Even then, trying to account for every single nuance in who can see what is challenging. Mr. Harris said “many people need to be involved in understanding the nuances” of this issue.

These challenges will make it hard for hospitals to meet the Sept. 23 deadline for complying with the Congressional rule revision, which will be enforced by the U.S. Department of Health and Human Services Office for Civil Rights, the agency that oversees HIPAA. HHS declined to make a spokesperson available to comment in time for this article. But a spokesperson for the office told the Wall Street Journal earlier this month that HHS’ “hands are tied” with the out-of-pocket rule because it was mandated by Congress. That puts the onus squarely on CIOs at hospitals charged with implementing technologies and workflow processes that adhere to HIPAA rules.

Judy Hanover, an analyst tracking healthcare for IDC, said the issue is so complex that the only way she could think this could possibly work is if the patients paid cash, used an assumed name and a fake birth date. “It doesn’t fit the workflow in any way… it’s going to be hard to do it,” Ms. Hanover said.

Meanwhile, healthcare CIOs must brace for the fact that more patients may seek to eliminate paper trails by paying for healthcare services out of pocket. And they will reserve their right to have healthcare information stricken from their records. “There will always be a segment of the population that cares about granular control,” Mr. Halamka said.

http://blogs.wsj.com/cio/2013/05/28/cios-seek-tech-prescription-to-patient-privacy-rule/