Measuring patient engagement is a 'science,' not a 'dark art'

A new collaboration announced at HIMSS14 aims to rank all of the nation's hospitals on their patient engagement abilities, much like hospitals are now ranked for their health IT acumen or their beauty.

"The best hospitals realize the patient gets well outside the hospital," said Joanne Rohde, CEO of Axial Exchange. "They've been doing this long before Meaningful Use 1, 2 or 3 … and now it's time for the rest to catch up."

Axial Exchange, a Raleigh, N.C.-based developer of mobile engagement tools for hospitals and their patients, has been creating so-called Patient Engagement Indexes (PEIs) for specific states. At HIMSS14 last month in Orlando, the company announced a partnership with Becker's Hospital Review to expand that system to a national stage, with the rankings set to be released in May.

"Patient engagement is increasingly at the center of healthcare reform, and achieving excellence in clinical outcomes has been proven dependent upon enhanced patient involvement," said Lindsey Dunn, editor-in-chief of Becker's Hospital Review, in a press release. 

Speaking to mHealth News at HIMSS 14, Rohde said many hospitals rely on a patient portal that's nothing more than a "view into a back-office system designed by a vendor for regulatory obligations." Likewise, she said, hospitals often create websites that offer information they want to share with the public, rather than offering a link to information that patients want to see. If that's a mobile version – a huge advantage in this day of mobile consumers and health pricing transparency – the site is often clunky and underwhelming.

Rohde said hospitals need to realize that two-way communications with the patient outside the hospital – no matter where they are or what device they're using – is crucial to ensuring that patients are satisfied with the care they're getting. That translates into better Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which are used by the Centers for Medicare and Medicaid Services to determine reimbursement for Medicaid patients.

Established in 2013, the Axial Exchange PEI evaluates hospitals using publicly available data in three categories and gives each a score of 1 to 100. For example, while a hospital is expected to offer electronic access to patient health records, it would score extra points for offering resources for disease management support, including mobile tools.

The categories are defined as:

• Personal health resources (representing 50 percent of the score), based on an aggregate score for hospitals that provide any of the following: read-only Internet access to health information, mobile applications or interactive tools for managing ongoing health.

• Social engagement (25 percent of the score), based on a weighted score of hospital ratings on leading social media and consumer ratings sites.

• Patient satisfaction (25 percent of the score), measured by the HCAHPS survey, a standardized instrument for measuring patients' perspectives on hospital care that has been endorsed by the National Quality Forum.

Matt Mattox, Axial's vice president of products and marketing, said in a July 2013 interview with mHealth News that healthcare executives were mindful of the value of patient engagement, but were too busy implementing EMRs to devote the time, money and staff. Now they're feeling pressure and seeing the value.

"Patient engagement is strategic ground that the best health systems will claim in order to thrive in a profit-from-quality world. Mobile devices are quickly making an impact on how patients manage their health," he noted in a May 6, 2013 blog titled "How to Generate a 15X Return on Patient Engagement." "For a health system, not having a mobile engagement offering in 2013 may be similar to not having a corporate website in 2003. Whether healthcare systems and practices are motivated by higher margin patients, professional reputation, payment incentives – or all three – they have everything to gain from enabling superior patient engagement and everything to lose if they do not."

Rohde said healthcare executives have to understand that patient engagement can be measured.

"It's a science, not a dark art," she said. 'There's a real correlation between patient satisfaction and social media, and mHealth plays a big role in this."

Rohde is critical of hospitals and health systems who "make patient engagement the responsibility of the IT department," because that creates a separation between the patient and the clinician. She's also critical of Meaningful Use standards that compel hospitals to "just check things off a list."

She sees a national PEI as a means of shining the spotlight on innovative and successful patient engagement programs, while establishing benchmarks for hospitals and health systems looking to improve.

"At the end of the day, it's all about the patient," she said. And that may be the missing factor in many a health system's path to success.

http://www.govhealthit.com/blog/measuring-patient-engagement-science-not-dark-art

Medicaid ACO Looks Promising

By Christine Kern

Coalitions in New Jersey continue preparations as they await state rules allowing launch of new healthcare model

New Jersey Spotlight writes, “A new model for providing healthcare to low-income New Jerseyans has the potential to achieve some of the savings called for by Gov. Chris Christie, but healthcare leaders also say there are significant limits to what it can achieve.” The Medicaid ACO was highlighted at the recent "Accountable Care Organizations and Healthcare Delivery System Reform" conference on healthcare.

A Trenton Health Team press release stated that the conference explored ways primary healthcare providers, hospitals, and clinics are rising to meet the challenges of a costly and possibly outmoded healthcare delivery system using an ACO.

Since the law creating a demonstration project was enacted in New Jersey in 2011, ACOs have been under development. With the final state regulations allowing the project to move forward anticipated later this year, the planning for implementation is gathering momentum.  State officials have said there isn’t a timeline for publishing these rules.

This pilot project, like other ACOs such as the Medicare Shared Savings Program, rewards providers by granting them incentives to achieve cost efficiency while at the same time improving patients’ health. This program, however, unlike other programs, will include all patients in a particular geographical region.

Three existing organizations – Trenton Health Team, Camden Coalition of Healthcare Providers, and Greater Newark Healthcare Coalition – are teaming up to apply for the Medicaid ACO project in New Jersey. Trenton Health Team’s executive director, Dr. Ruth Perry, believes that ACOs help patients attain the tools they need to navigate the array of challenges that they face.

Although the final legislative pieces are not yet in place, the groups in Newark, Trenton, and Camden have already made progress, laying the groundwork for the ACO project. John Koehn, CEO of Amerigroup New Jersey, said the Medicaid ACO is a model worth trying and that he expects insurers to participate, although there are potential stumbling blocks. For example, some patients may never interact with ACO nurses, but if they contribute to lowered healthcare costs, the savings may be inaccurately attributed to the ACO. He also pointed out that the project doesn’t include a provision to punish the ACO if it fails to lower costs.

And of course, the project may not be replicable in every county across the state. Nevertheless, the coalition believes that ACOs are a great place to start. Frank Winter, regional partnership manager for the federal Centers for Medicare and Medicaid Services, emphasized the uniqueness of the project in New Jersey. He said it was an example of valuable experimentation in care delivery.

The federal government is trying to implement coordination between different programs that receive federal funding, and Winter added that the Medicaid ACOs will likely work closely with these programs. “When you’re working together, you’re going to see a lot better results,” Winter said, adding that he’s optimistic about the projects’ chances for success.

http://www.healthitoutcomes.com/doc/medicaid-aco-looks-promising-0001

Google Glass could be a powerful tool for disruptive innovation in healthcare.

I joined the Glass Explorer Program and have started using Google Glass with a focus on finding medical uses for this type of wearable computing technology. While I believe that it is analytics capabilities that will allow us to realize the value of health information technology, the convergence of hardware and software combined with an explosion of wearable sensor technology is providing powerful opportunities for some disruptive innovation in the healthcare marketplace and the practice of medicine.

Charles Webster, MD got me really interested in the potential with his presentation Google Glass and Healthcare Information and Workflow at the 2014 Healthcare Systems Process Improvement Conference held immediately before HIMSS 2014. Chuck has been posting about Google Glass for some time and one of his posts on the HIMSS Future Care blog is well worth reading. Some of the insights he brought in the post are:

"There’s lots of interest in Glass use by surgeons, EMTs, and nurses, for hands-free and real-time access to critical information. It’s justified. But there’s also been negative speculation about threats to patient privacy. What will patients think when they see their physician wearing Glass. In my opinion, it will become just another tool they associate with healthcare workers (less obtrusive than the head mirror that used to be a symbol of the medical profession). The bigger question should be, what will physicians and others think when they see a patient wearing Glass?"

I decided it was finally time to take the plunge and become a Google Explorer and got my Google Glass just in time for the annual HIMSS conference to end. For those who have not yet seen Google Glass or don't understand how they work, it is basically a computer strapped to your head in the form of a pair of glasses. It has a heads up display, voice activation and growing number of apps. Check out the Google Glass homepage to learn more. When you think about having all of the technology of a smartphone, and then some, incorporated into a pair of glasses it boggles the mind as to the various use cases for healthcare. I want to outline just a few and then think about what other innovative possibilities this type of technology could bring to the industry.

Last year Dr. Rafael Grossman, a surgeon and one of the Google Explorers based in Maine, used Google Glass during a Percutaneous Endoscopic Gastrostomy procedure. He was careful to not stream any sensitive data out via Google Glass and wrote about theexperience on his blog. He said, "Obviously, the one of the main concerns regarding the use of Google Glass during surgery, with live streaming of data, would be to take every measure and to ensure the privacy of the patient’s health information." Using Glass in healthcare certainly faces some serious privacy and security considerations. But this technology also seems to be very well suited to solving some vexing industry problems such as emergency medicine, some surgery applications, and telemedicine to name a f.

Steven Horng, MD MMSc at BIDMC
John Halamka, MD pointed out to me that over the past few months, Beth Israel Deaconess Medical Center has been the pilot site for a new approach to clinical information technology, wearable computing. In the Emergency Department, they have developed a prototype of a new information system using Google Glass, a high tech pair of glasses that includes a video camera, video screen, speaker, microphone, touch pad, and motion sensor. When a clinician walks into an emergency department room, he or she looks at a QR code on the wall. Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient that is in that room to Glass. The clinician can speak with the patient, examine the patient, and perform procedures while still seeing problems, vital signs, lab results and other data in view on the Glass screen. Beyond the technical challenges of bringing wearable computers to BIDMC, there were other concerns: protecting security, evaluating patient reaction, and ensuring clinician usability. I appreciate the measured approach BIDMC has taken in developing the potential for Google Glass and am looking forward to seeing how this works out.

An internal communication at BIDMC states that staff has definitely noticed them and responded with a mixture of intrigue and skepticism. Those who tried them on briefly did seem impressed. I would be very interested in knowing how patients respond. Already, even bars in San Francisco are banning Google Glass so I can imagine that as word gets out there will be some consternation among certain patients visiting the ER. However, they have fully integrated with their EHR's ED Dashboard using a custom application to ensure secure communication and privacy safeguards. They also replaced all the Google components on the devices so that no data travels over any Google servers and all data stays within the BIDMC firewall. They will soon begin a trial of Google Glass for all providers in the Emergency Department and study patient and clinician impressions, and the usage patterns of staff.

"Over the past 3 months, I have been using Google Glass clinically while working in the Emergency Department. This user experience has been fundamentally different than our previous experiences with Tablets and Smartphones. As a wearable device that is always on and ready, it has remarkably streamlined clinical workflows that involve information gathering," said Steven Horng, MD MMSc who teaches at Harvard Medical School and works in the ED at BIDMC. After a patient presented with a massive brain bleed and was unable to communicate information concerning medications and allergies, there was serious danger to the patient. "Google glass enabled me to view this patient’s allergy information and current medication regimen without having to excuse myself to login to a computer, or even loose eye contact. It turned out that he was also on blood thinners that needed to be emergently reversed. By having this information readily available at the bedside, we were able to quickly start both antihypertensive therapy and reversal medications for his blood thinners, treatments that if delayed could lead to permanent disability and even death. I believe the ability to access and confirm clinical information at the bedside is one of the strongest features of Google Glass," said Dr. Horng via email.

Google Glass is also being used at Rhode Island Hospital’s emergency department. As reported in the Providence Journal they will use Google Glass technology to stream live images of a patient’s medical condition to a consulting specialist located elsewhere. If this pilot is successful, project coordinator Dr. Paul Porter envisions an ambulance crew someday responding to a stroke victim, using the eyeglass technology to provide real-time video and audio to a neurologist back at the hospital who could then order a clot-busting, brain-saving drug immediately. "That would be like the Holy Grail," says Porter."“But we’re just at the beginning; you have to start somewhere."

Hospital spokeswoman Ellen Slingsby says the emergency room sees about 100 patients a month with skin afflictions who require a dermatological consult. That should be a sufficient pool of prospective volunteers, Porter says, to adequately test Glass in the next six months. The team proposed the research to the hospital and later received funding for the project and so far the results are encouraging. They are using a solution from start-up technology company Pristine which created a Google Glass application that protects patients and meets federal laws for privacy so that no images or videos can be saved to the device.

RI Hospital begins using Google Glass technology

Pristine makes the app EyeSight, which enables physicians and nurses to transmit live video and audio of wound patients from Google Glass to authorized computers, smartphones and tablets. Since last October, Pristine has also been testing EyeSight through a pilot program with surgeons and anesthesiologists at UC-Irvine. The technology allows for more effective communication between UCI anesthesiologists and surgeons in the OR and allows for greater supervision of doctors-in-training. "We could be supervising two residents at the same time," says anesthesiologist Leslie Garson. Garson also said Glass has proved useful during the 15 or so surgeries he has worked on so far, especially because he often monitors two or even three surgeries simultaneously.

"A resident could have Google Glass on, they could be looking at a monitor, and I could have a tablet down the hall and could see exactly what they're seeing," he said. "They can send me an alert -- 'Take a look at this,' 'Is this something I should be concerned about?'"

Dr. Patrick Hu (pictured at left) is an anesthesiologist at UC-Irvine and can share EKG information with other doctors via Google Glass. UCI Medical Center's anesthesiology department has been instrumental in pushing for this technology, according to the hospital.


At UC San Francisco cardiothoracic surgeon Pierre Theodore, MD is using Google Glass during surgery. pre-loads CT and X-ray images needed for a procedure, and calls them up in his Google Glass to compare a medical scan with the actual surgical site. "Often one will remove a tumor that may be deeply hidden inside an organ – the liver, the lung – for example," said Dr. Theodore, who’s also an associate professor in the UCSF School of Medicine. "To be able to have those X-rays directly in your field without having to leave the operating room or to log on to another system elsewhere, or to turn yourself away from the patient in order to divert your attention, is very helpful in terms of maintaining your attention where it should be, which is on the patient 100 percent of the time." 

He is the first surgeon to receive clearance for the use of the tech device as an auxiliary surgical tool in the operating room by a local Institutional Review Board (IRB), an independent ethical review board designated to approve, monitor and review biomedical research involving human subjects. He was introduced to the idea by Nate Gross, M.D., co-founder and medical director of Rock Health, a San Francisco-based digital health accelerator. Last summer Rock Health's 5th class had a few winners who are focused on Google Glass and the digital health sensor market.Other uses for this technology begin to stretch the bounds of my imagination. Just about anything we are using mobile devices for in providing healthcare could be possibilities for using this type of technology. Bedside medication verification, accessing patient health information, and overlaying information at the point of care, as well as all of the interesting pilots underway now. I am just getting started using my pair of Google Glasses and connecting with folks in the healthcare industry who are pioneering this technology. The next couple years will be some exciting times on this front. I'd love to get your thoughts on what some of the challenges and opportunities are in using Google Glass in healthcare.

http://www.ahier.net/2014/03/google-glass-in-medicine.html

Virtual College’s Lean Healthcare Awards recognise efficiency and improvements in patient experience.

Representatives from NHS hospital trusts and private healthcare organisations gathered at the Marriott Hotel in Leeds on Thursday 6th February for the Annual Lean Healthcare Conference and Awards.

Providing a platform for healthcare organisations to celebrate and share best practice, the conference and awards is the only event of its kind in the country dedicated to Lean working methodologies in healthcare.

The Lean philosophy, traditionally associated with Japanese car manufacturing, has evolved from a tool designed to improve operational shop-floor performance. Now, a growing number of forward thinking hospitals, community health services, back office workers and senior healthcare executives are increasingly applying Lean, waste reduction techniques and continuous improvement in their everyday work.

Over 100 entries from healthcare organisations went through the independent judging process, which saw a total of twenty four short-listed healthcare organisations exhibiting and presenting their Lean projects in a series of workshops throughout the day.

Judith Clarkson, Director of the Health and Social Care Division of Virtual College said: "The quality of submissions we saw this year is a great demonstration of the commitment and passion in healthcare, despite a difficult year. All projects have made a positive impact on patient experience."

Ashford and St. Peter’s NHS Foundation Trust, winners of The Productive Series Award,, focused strongly on ward processes. The project resulted in 11 minutes more in every hour for nurses to spend directly caring for their patients, representing an average increase in direct patient care time by 18%. Other side-effects have been increased staff satisfaction leading to improved patient experience, the key driver for change in Francis’ Recommendations.

Central Manchester University Hospitals NHS Foundation Trust, (CMFT) winners of Improving Services through Training and Development created a bespoke online training programme for international doctors recruited to the UK, providing information and knowledge on social, ethical, legal, professional and patient safety aspects of patient care and clinical practice in the UK before any new international doctor joins the trust. 95% of doctors found the training useful in enhancing the patient care they provide. The online training also proved to be an efficient way of delivering training, again, releasing more time for patient care.

The event closed with an awards dinner speech from Nick Rich, Professor of Operation Management at Swansea University, who spoke passionately about high performance Lean operations and how they enhance patient safety. The Lean Healthcare Academy runs free quarterly Lean Healthcare sharing forums. For more information visit the Lean Healthcare Academy website. www.leanhealthcareacademy.co.uk

HealthStream buys New York Online Training Company for $15.4 Million

Nashville-based HealthStream has acquired Jericho, N.Y.-based Health Care Compliance Strategies, a company focused on interactive and engaging online compliance training for health care organizations, according to a news release.

HealthStream, which provides workforce development solutions for the health care industry, purchased HCCS for approximately $13 million in cash and $2.4 million in shares of HealthStream's common stock in a private placement, the release says. In addition, up to $750,000 in cash will be paid over a 12-month period following closing subject to the achievement of certain performance milestones.

The following are excerpts from today's news release:

Healthcare is one of the most highly regulated industries in the U.S. and the number of regulations continues to grow, which results in growing demands for compliance training. HealthStream has long been the leading provider of workforce development solutions in healthcare, which has included itsOSHA & accreditation compliance training in U.S. hospitals with its 3.7 million subscribers to its platform. With its added capabilities, courseware, and expertise from the acquisition of HCCS, HealthStream now has a comprehensive compliance solution—with a full continuum of services and training programs that addresses the broad range of compliance priorities.

"HealthStream is a perfect fit for HCCS to further support development of the healthcare workforce," said Ben Diamond, president, HCCS. "We are both focused on providing exceptional compliance solutions that, in turn, help to improve patient outcomes and promote compliance with ethical, legal, and accreditation guidelines. HealthStream has pioneered compliance solutions in healthcare and we are excited to play a role in building their robust compliance offering."

Through the acquisition of HCCS, HealthStream adds a comprehensive curriculum of premium compliance courseware and training programs, which include several bundled offerings—like the Quality Improvement Suite, Workplace Compliance Suite, General Compliance Suite, and the Research Compliance Suite. HCCS' courses use fast, rich content, with full motion video and interactivity. Examples of the diverse compliance topics in HCCS' courseware include HIPAA Compliance, Bioterrorism & Disaster Preparation, Patient Rights, Reducing Medication Errors, and Health Plan Compliance. Helping organizations comply with the training requirements of Corporate Integrity Agreements (CIAs) is another specialty area of HCCS that adds to HealthStream's overall compliance solution strategy.

HealthStream's workforce development solutions are also expanded with HCCS' SaaS-based application for tracking potential conflicts of interest disclosures, known as the COI-SMART system. Cumbersome manual processes are automated with COI-SMART as the system tracks and manages potential conflicts of interest among hospitals' physicians, executives, and other healthcare professionals. Correspondingly, courses are also offered in "Conflicts of Interest and Research Misconduct." COI-SMART will be offered on a subscription basis to healthcare organizations, adding another powerful, healthcare-specific application, which will be integrated with HealthStream's workforce development platform.

HealthStream's comprehensive compliance solution will be offered primarily to corporate compliance officers in hospitals, who represent an increasingly important role in healthcare organizations. At this time, 98 percent of healthcare organizations have a corporate compliance officer (CCO) with a staff, on average, of three full-time employees. The Health Care Compliance Association now has over 9,000 active members. Alongside the growing number of federal and state regulatory requirements, the industry-wide focus on improving patient safety has further contributed to the importance of compliance programs in healthcare organizations. The addition of HCCS brings a sales team dedicated to this channel, which will be immediately expanded to cover HealthStream's 10 sales regions.

"I would like to extend a warm welcome to HCCS' clients and employees," said Robert A. Frist, Jr., chief executive officer, HealthStream. "Providing OSHA & accreditation compliance solutions to healthcare organizations has been a core offering for HealthStream for over a decade and we are excited to expand the scope of our solutions in this important area. HCCS' premium content and thought leadership add important dimensions to our compliance solution strategy."

http://m.bizjournals.com/nashville/blog/2014/03/healthstream-buys-new-york-based.html?r=full

32 Recently Announced ACOs

The following accountable care organizations or value-based care delivery arrangements were covered by Becker's Hospital Review within the past month.

1. Humana struck up three new accountable care agreements.

• One is with Miramont Family Medicine, a medical group practice based in Denver. It covers Humana's Medicare Advantage HMO members in the area. 
• Another is with Edgewood, Ky.-based St. Elizabeth Healthcare.
• The third new agreement was formed with The Christ Hospital Health Network in Cincinnati.

2. Cigna was also very active, partnering with several provider organizations for collaborative accountable care initiatives, the payer's version of ACOs.

• One agreement is with Baton Rouge (La.) Clinic, a multispecialty group with about 90 physicians.
• The partnership between the payer and Springdale, Ark.-based PremierCare Northwest, a provider-owned network and collaborative effort between physicians and Northwest Health System, covers roughly 5,000 Cigna members.
• A third CAC initiative is with Brewer, Maine-based Beacon Health, a subsidiary of Eastern Maine Healthcare Systems, which covers 7,000 Cigna beneficiaries.

3. Anthem Blue Cross and Blue Shield in Missouri partnered with Esse Health, a St. Louis-based independent physician group, for an accountable care model.

4. LHS Health Network, which includes physician practices, hospitals and other providers and is affiliated with Camden, N.J.-based Lourdes Health System, partnered with Horizon Blue Cross Blue Shield of New Jersey for anACO.

5. Blue Cross Blue Shield of Michigan expanded its pay-for-performance initiative by signing value-based reimbursement contracts with 24 hospitals.

http://www.beckershospitalreview.com/accountable-care-organizations/32-recently-announced-acos-0314.html

Presidential Innovation Fellows Round 3: Serve. Create. Innovate.

Today, we are very excited to announce that applications are now being accepted  for the third round of the Presidential Innovation Fellows program. This initiative pairs talented, diverse individuals from outside government with top Federal innovators to implement game-changing projects that make the Federal Government work better for the American people. 

At its core, the Presidential Innovation Fellows Program is as strong as the incredible people that are willing to join this effort and serve their country. That’s why we want the best and brightest individuals—original thinkers, gifted designers, tech-savvy strategists, private-sector doers, inventors, entrepreneurs, and talented developers and engineers—to offer up their skills and expertise to create huge value for the American public.

Round 3 will include 14 projects that focus on addressing three high-impact initiatives:

• Making Digital the Default: Building a 21st Century Veterans Experience: The U.S. Department of Veterans Affairs is embarking on a bold new initiative to create a “digital by default” experience for our Nation’s veterans that provides better, faster access to services and complements the Department’s work to eliminate the disability claims backlog.
• Data Innovation: Unleashing the Power of Data Resources to Improve Americans’ Lives: This initiative aim to accelerate and expand the Federal Government’s efforts to liberate government data by making these information resources more accessible to the public and useable in computer readable forms, and to spur the use of those data by companies, entrepreneurs, citizens, and others to fuel the creation of new products, services, and jobs.
• By the People, for the People: Crowdsourcing to Improve Government: Crowdsourcing is a powerful way to organize people, mobilize resources, and gather information. This initiative will leverage technology and innovation to engage the American public as a strategic partner in solving difficult challenges and improving the way government works—from helping NASA find asteroid threats to human populations to improving the quality of U.S. patents to unlocking information contained in government records.

More information on each project is available here.

Since the initiative launched two years ago, Presidential Innovation Fellows, along with their government teammates, have been delivering impressive results—at start-up velocity. Fellows have unleashed the power of open government data to spur the creation of new products and jobs; improved the ability of the Federal government to respond effectively to natural disasters; designed pilot projects that make it easier for new economy companies to do business with the Federal Government; and much more. Their impact is enormous. 

For example, Fellows recently helped expand the Blue Button Initiative, which is helping Americans across the country gain secure, online access to their own healthcare information. Through the work of Fellows and their government teammates, the Blue Button Initiative has expanded its reach to more than 150 million Americans who are today able to use Blue Button-enabled tools to access their own health information from a variety of sources including healthcare providers, health insurance companies, medical labs, and state health information networks.

Another recent example of the Fellows in action is their work at the Smithsonian Institute to develop a crowdsourcing platform that allows the public to transcribe handwritten historic documents and records. This kind of innovative approach will not only support important research, but provide an important avenue for the public to help preserve our Nation’s history.  In just six months, Fellows developed and launched an end-to-end solution for creating digital records for historic files, which in turn engaged thousands of volunteers who have helped to transcribe and review more than 3,000 historic and scientific records —which are now easily accessible to the public for the first time.  

Looking ahead, the next round of Presidential Innovation Fellows will continue to build on these successes as well as tackle a new set of challenges.

This is an opportunity to truly transform how government works for the people it serves. The work will be challenging, but promises to be tremendously rewarding. The first step is to apply here. We can’t wait to see what the third round of Fellows will do!

Todd Park is Assistant to the President and U.S. Chief Technology Officer 

Dan Tangherlini is Administrator of the U.S. General Services Administration

http://www.whitehouse.gov/blog/2014/03/06/presidential-innovation-fellows-round-3-serve-create-innovate

What decides the success of ACO, population health models?

Not all health systems, hospitals, or physician practices succeed at implementing accountable care organizations.

More recent results published by the Centers for Medicare & Medicaid Services (CMS) showed returns within range of the federal agency’s expectations for the first year of the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. However, that news came nearly half a year after CMS revealed that nine accountable care organizations (ACOs) would be leavingthe more aggressive Pioneer ACO Program, two for good with the other transitioning to MSSP.

So what determines the likelihood of a healthcare organization and its providers making a successful goal of an ACO? According to the leaders of the MMSP ACO, TriState Health Partners (THP)-Meritus ACO, the answer to that question is a combination of two elements: a physician culture of accountability and an organizational structure built on collaboration and data sharing.

Historically, THP has had strong physician engagement as a result of its setup as a physician hospital organization (PHO) owned jointly by more than 200 physician and Meritus Medical Center. What’s more, its physicians were well versed in care coordination and clinical integration well in advance of ACO programs being made available.

“We’ve had data presented to the doctors so when the ACO opportunity came on the radar physicians felt that they had an understanding of what the global ideas were,” says THP CMO Robert Cirincione, MD. “There was very little ‘sell’ that had to be done. We went to our physicians were already part of THP and presented them with the various contracts.”

As a physician himself already espousing alongside his fellow physicians the key components of accountable care in his practice, Cirincione encountered little resistant when selling the concept of an ACO.  “From the physician’s standpoint it is: what does it cost to join (nothing); what is the downside risk (none); what do you want me to do (practice more efficient and patient-based medical care and achieve increased outcomes)?” he adds.

iStock/Thinkstock

According to ACO Program Director Shelley Grant, the organization was likewise primed for embracing the MSSP ACO model. “We were very well positioned from with our Tristate Health Partners organization — from a governance structure to a network of providers to reach out to — so we had more of an infrastructure already in place because of some of our previous work that we had done around clinical integration,” she reveals.

Because of the ownership structure of THP, many of the initial hurdles facing other aspiring ACOs were simply not there. “Unlike organizations that are starting out and just trying to pull providers together to educate them on the concept and then gain the trust to do the actual contracting, we already had a foot in the door,” Grant notes.

The challenge for the organization actually centered on its health IT infrastructure and the data being used to manage a patient population.

“We knew right away that the solution that had been in place was not going to be sufficient moving into the Shared Savings Program, and that’s where we really started to venture out,” Grant explains. “Through years of doing this, the technology that we had been using was solely claims-based and claims-based solutions will only get you so far in the management of a population and also when you’re looking at the overall performance of the healthcare provider community.”

The organization needed to be able to integrate its patient and provider data in a fashion similar to how THP had been coordinating and integrating care among its physicians for close to two decades. “We needed a system that would pull in those disparate data systems and be able to map those quality data elements and provide a more unified picture of how we were performing as an ACO,” says Grant.

While these two components are key to a successful ACO, they must be driven by the right philosophy — one that recognizes the value of the individual patient within the entire patient population.

“When we talk about population health, we tend to use very broad buckets — five percent of people in this bucket, twenty percent of people in that bucket,” Cirincione observes. “Practicing physicians tend to glaze over with discussions like that at some point because they really want to know about their patients who are in one of the buckets.”

What’s important to physicians in ACO or population health management is aligning views of a population with the needs of the individual. “Our challenge is to take what we can know from the segmenting of risk and then translate that into what that means to patients as they are going through the care so that the primary care physician or medical specialist is focusing on that patient relative to an evidence-based protocol and meeting the needs of the patient,” concludes Cirincione.

http://ehrintelligence.com/2014/03/04/what-decides-the-success-of-aco-population-health-models/

A Primer on Meaningful Use and HISPs

The Massachusetts State government offers low cost HIE services including Direct transport to all the stakeholders of the Commonwealth.    Recently. Micky Tripathi wrote this FAQ which is so good that I wanted to share it on my blog.   Feel free to use it with your stakeholders.

1. What is a HISP?
A Health Information Services Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport.  There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules.  The term HISP was coined to describe specific message transport functions that need to be performed to support scaled deployment of the Direct standard in the market.  HISP functions can be performed by existing organizations (such as EHR vendors or hospitals or HIE organizations) or by standalone organizations specializing in HISP services.

HISPs perform two key functions that support scalability of exchange using the Direct standard. 

a. Issue security certificates.  HISPs establish trust networks by defining policies for network participation and issuing security certificates tied to a HISP anchor certificate to enforce such policies
b. Issue direct addresses.   HISPs issue direct addresses tied to the HISP anchor certificate in accordance with conventions defined by the Direct standard

2. Do I need to use a certified HISP to attest for Meaningful Use Stage 2?
No, because there is no such thing as a certified HISP.  Meaningful Use certification applies to technology, not to organizations.  In order to attest for Meaningful Use Stage 2, you need perform certain activities using certified EHR technology (CEHRT).  For most EHR users, their EHR is certified for all of the functions that they need.  If it is not, you will need to incorporate specific additional certified technology solutions to fill the remaining gaps.  It doesn’t matter whether that additional technology comes from an EHR company or a HISP company – the only thing that matters is that the technology is certified.

3. Doesn’t DirectTrust certify HISPs?
DirectTrust is a private, non-profit organization that voluntarily certifies HISPs through its EHNAC DTAAP program.  This private, voluntary certification often gets confused with Federal Meaningful Use certification.  DirectTrust is NOT a Federal certification entity, and its EHNAC DTAAP certification process is purely private and voluntary and has no relationship with Meaningful Use Stage 2 attestation or certification requirements.

4. What role does a HISP play in Meaningful Use Stage 2?
A HISP provides specialized network services that connect your EHR to other EHRs that are also using the Direct standard for communications.  You don’t need a HISP in order to create Direct-compliant messages, but you do need to be connected to a HISP in order to send and receive Direct messages with other parties.  Using an email analogy, you may have Microsoft Outlook installed on your computer, but if it isn’t connected to an email network, your emails can’t go anywhere and none can get to you.  Similarly, your CEHRT can send and receive Direct-compliant messages, but those messages won’t go anywhere unless you and those who you are communicating with have valid
Direct addresses and are connected to a secure network that can get the messages safely and reliably from one endpoint to another.  These are the message transport functions that HISPs perform.

There are two Meaningful Use Stage 2 attestation requirements that require Direct transport:

• Summary care record for transitions of care (TOC)
• Patient ability to view, download, transmit their medical record (VDT)

Most HISPs (including the Mass HIway) do not yet have the ability to connect directly with patients, so they are not able to assist with the VDT requirement.

For the purposes of attestation, the Meaningful Use Stage 2 TOC requirement specifies that you must electronically send a standardized summary care document to another care setting, and that you must have reasonable assurance that the other care setting actually received the document.  The HISP performs the message transport functions to provide you with the assurance that your messages have been delivered to their intended recipients.

In order to attest for the TOC requirement, you need to send CCDA care summaries containing at least problem lists, medications, and medication allergies.  These summaries must be transmitted with your CEHRT using either the SMTP/SMIME or XDR/SOAP protocol.  There is no Federal certification for HISPs, so you can send your message to its intended recipient using any HISP or any number of HISPs, as long as you have assurance that the message will get delivered.  The only certified system that you need to use is the one that creates the Direct-compliant SMTP or XDR message – after that, your message may take any number of “hops” between your EHR and its final destination, and as long as you’re confident that the message will get delivered, you will have completely fulfilled your Meaningful Use Stage 2 attestation requirement.

5. How do I get assurance that my messages are delivered?
Meaningful use attestation requirements do NOT specify how you get assurance of delivery, they specify only that you have taken reasonable steps to be confident of delivery.  The most robust way for you to be assured of message delivery is for your system to receive message disposition notifications (MDNs) for each message sent by your EHR to the intended recipient.  However, not all receiving systems or HISPs can generate MDNs, and not all EHR systems can consume MDNs even if they are returned. 

Fortunately, you are not required to receive MDNs in order to be assured of delivery.  Other acceptable methods of assurance are through HISP guarantees of delivery after successful setup testing and/or notification of failure of delivery (like emails) and/or HISP central maintenance of delivery logs that can be made available as needed. 

The Mass HIway provides you with assurance of delivery through rigorous setup testing, and maintenance of a central log of delivery successes and failures.  This log is made available to participants as necessary in the event of an audit.  The Mass HIway will also return any MDNs or application-specific responses or acknowledgements generated by receiving endpoints, however, the Mass HIway cannot guarantee that any receiving endpoint will generate notifications, acknowledgements, or responses.

The one exception where delivery notification is available and required is public health.  The Massachusetts Department of Public Health requires that participants receive delivery notifications in order to satisfactorily meet the Meaningful Use Stage 2 public health requirements.  Massachusetts DPH does generate automated acknowledgements, which are sent automatically via the Mass HIway in response to each message successfully received.

6. Is the Mass HIway a HISP?
Yes.  The MA HIway is a trust community that issues security certificates and Direct addresses to eligible participants and provides Direct-compliant message transport services for its participants.

7. Is the Mass HIway certified as an EHR module for Meaningful Use Stage 2?
No, the Mass HIway is not certified as an EHR module for Meaningful Use Stage 2.  Most providers will not require the Mass HIway to be certified in order to use it to help fulfill their Meaningful Use Stage 2 attestation requirements.  (See discussion above in FAQ on HISP roles.)  As long as your CEHRT delivers a Direct-compliant SMTP or XDR message to the Mass HIway (either to the LAND appliance or directly to the central site), you do not need the Mass HIway to be certified.

If your CEHRT does not send a Direct-compliant SMTP or XDR message to the Mass HIway (for example, if you are sending messages to the LAND appliance in a format other than SMTP or XDR), then you will need to change your interface to send Direct-compliant SMTP or XDR to the Mass HIway (including the LAND appliance) in order to count any of these transactions for Meaningful Use Stage 2 TOC requirements.

Even though you do not need the Mass HIway to be certified for Meaningful Stage 2 in most cases, you will still need to have assurance of delivery of messages sent over the Mass HIway to meet your Stage 2 TOC attestation requirements.  The Mass HIway provides this assurance by delivery after successful setup testing.

8. Must I be connected to the Mass HIway in order to attest for Meaningful Use Stage 2?
Yes, you need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 public health requirements for immunization and cancer registries, and syndromic surveillance.  The Massachusetts Department of Public Health will accept public health transactions only through the Mass HIway.  Thus, though there is no Federal requirement that you be connected to the Mass HIway for Meaningful Use Stage 2, you will not be able to meet core public health requirements for Meaningful Use Stage 2 without being connected to the Mass HIway.

You do not need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 TOC requirement.  However, over 100 providers and payers are already live on the Mass HIway HISP.  Thus, connecting to the Mass HIway will likely make it easier for you to meet your TOC requirements because you will be immediately connected with many of the providers you share patients with.

9. The Meaningful Use Stage 2 rules refer to the eHealth Exchange – is that the same as the Mass HIway?

No.  The eHealth Exchange is a health information exchange network comprising federal agencies and other large non-federal organizations.  The Mass HIway is not connected with the eHealth Exchange in any way.

10. Do I have to be connected to the eHealth Exchange in order to meet my Meaningful Use Stage 2 attestation requirements?

Absolutely not.  While the Meaningful Use Stage 2 rules do allow special dispensation for eHealth Exchange members, few providers will attest using this mechanism.  No Massachusetts providers or payers are currently members of the eHealth Exchange.

11. Who are the other HISPs in Massachusetts, and can I join any HISP that I want?
There are a wide variety of HISPs operating in the Commonwealth.  Whether you join any particular HISP depends on a number of factors.  The biggest factor is which HISPs your EHR vendor allows you to join.  Some vendors require that you use a specific HISP (either their own or the one they are integrated with), while other vendors (such as Meditech and Epic) allow the provider to choose which HISP they would like to connect to.  CMS and ONC do not require that you use any particular HISP for meaningful use, but in practice, your EHR vendor will dictate which HISP options are available to you.

If your vendor allows you to choose which HISP to connect to, you can connect directly to the Mass HIway HISP.  If your vendor requires that you use their designated HISP, you will have to connect to the Mass HIway through their HISP, as long as their HISP is connected to the Mass HIway.
Please contact the Mass HIway (http://www.masshiway.net) if you have any questions about your connection options.

12. Is the Mass HIway part of DirectTrust?
No, the Mass HIway is currently not a member of DirectTrust.  DirectTrust is a voluntary private non-profit collaborative that is helping HISPs to connect with each other.  The Mass HIway is connecting directly with the major HISPs operating in the Massachusetts market.  The Mass HIway may join DirectTrust at some point in the future if it provides additional value to participants.  Providers, EHRs, or HISPs do NOT need to be part of DirectTrust in order to meet their Meaningful Use Stage 2 certification and attestation requirements.

13. If I’m in another HISP, can I still be on the Mass HIway?
Yes.  You can connect to the Mass HIway even if you are a member of another HISP.   The Mass HIway is actively connecting with the major HISPs operating in the Massachusetts market so that messages can be sent between HISPs.  You do still have to join the Mass HIway by signing a participation agreement even if you are in another HISP.  As a member of another HISP, you will pay whatever fees are charged by your local HISP and your Mass HIway fees will be waived.  Once you have joined the Mass HIway, your local HISP will configure your system to enable access to the Mass HIway network.  Your local HISP will still provide you with your security certificate and your Direct address, but you will be able to send and receive messages over the Mass HIway network. 

Below is a current list of HISPs that are expected to be connected to the Mass HIway.  The HISP market is evolving rapidly so more HISPs will be added as demand grows.  Please contact the Mass HIway (http://www.masshiway.net) if you would like to discuss your connection options.

HISP Live date
eClinicalWorks April 2014
Surescripts April 2014
eLINC/SES April 2014
Allscripts/MedAllies TBD
Athenahealth TBD
Wellport/Alere TBD

http://geekdoctor.blogspot.com/2014/03/a-primer-on-meaningful-use-and-hisps.html