Baby boomers have started reaching their retirement age in 2011, and with over 78 million of them as patients they will require care during their senior years.  Baby boomers are commonly known as the more self-reliant, gadget early adopters, and active individuals.  But with their high population number they are bound to put demand more from our health system.

In the current care delivery model we have today for senior citizens, nursing homes, hospital visits and assisted living are costly to both payers and patients.  And for that reason payers are looking to see what cost benefits would caring for patients at home and support their independences bring.

There are many reasons for the increase in demand for home health services and following is a short list to name a few:

Lower costs:  As patients are being treated at home, this alternate care location eliminates the costs associated with transport, and beds associated with charges inside a healthcare facility.

Telemedicine:  Baby boomers are known for being early adopters of technology and gadgets.  And with many of the capabilities of today’s electronic medical devices and smart phones, patients are able to remotely transmit data and have a care giver review it as part of their care. In addition, patients can even have access to a nurse and physician through video conferencing and be able to discuss their health issues from the comfort of their home.

Active life style:  As more baby boomers continue to enter retirement at a rate of 7,000 a day, many are continuing to stay active.  This most likely influences their decision to try to seek receiving care in the home instead of in a healthcare facility.

Technology:  In this area, we see that both patients and care providers benefiting from some of the technological advancements.  For home health service providers, mobile devices, and tablets have provided many much needed improved efficiencies.  Some of the examples are accessing records remotely, and transmitting information on the patient’s visit real time.

As we to see a shift toward keeping patients healthier and out of hospitals, it will become more critical for patients to receive care, participate in wellness programs and receive preventable care that can help ensure a healthier life.  Homecare services will play a significant role in helping patients with their health needs and keep healthcare costs down by reducing long/short term stays in nursing home and other assisted facilities.

More independent physicians are being solicited to connect to a community, local, or state HIE.  Since many of these entities have gone live in higher numbers this past year, and continue to see an increase especially due to the meaningful use stage 2 proposed ruling, physicians will continue to find themselves with several vendors and options from which to choose. Below are a few important areas of considerations for all providers taking the next steps forward in data exchange:

Connectivity with other existing community based (private HIEs) and state or national (NHIN):

One of the core components and purposes of an HIE is to provide continuous availability to medical records, enabling physicians to make better treatment decisions and deliver a higher quality of care in a more efficient manner.  When joining an HIE, providers must also consider what other entities the HIE can use to locate charts electronically.

Contracts:

When joining an HIE, a physician would be subscribing to the services that will be offered.  They will also be agreeing to local state laws around HIEs as well as specific liability and data security requirements set forth by the HIE. These contracts must be reviewed in great details, as they are very complex. The binding legal document will address privacy, security concerns, technical issues, as well as any obligations that maybe associated with early termination.

Usability of system and patient information:

There are several different methods of accessing a patient’s chart through an HIE.  One of the most commonly used and simplest method is via the HIE’s web portal which allows the physician to connect securely and perform record searches for patients.  This set up does not require any special software or interfacing to gain access to the record information.  Another access method that provides a seamless and common interface is through the use of physician’s EHR to request and process incoming patient’s summary chart.  This allows for some of the outside patient information to be combined with current physician’s patient records.  It is important to consider the connectivity model that can help create efficiencies for the organization, so both must be evaluated to ensure the right option is selected.

Value added services:

A great example of how some of the HIE are providing subscribers value added services is what a NC based HIE is doing.  CareConnect Carolinas a local HIE through Carolinas Health System is providing the following services:
·         Comprehensive medication list from SureScipts as well as many other local and national pharmacy networks.
·         Access to patient’s imaging records available through the hospital Information System
·         Access to Lab reports, Transcriptions, letter, Encounter details, Patient facesheet
·         Advanced alerting capabilities such as flags for drug seekers
·         Downloadable CCD (Continuity Care Document)
·         An EHR Lite to assist physicians with Meaningful Use
·         Referral management to digitize the information exchanged during the referral process
·         Web orders for certain labs at some of the health system facilities

There are other health systems that are also providing a PHR access feature for the patients.  This feature provides another method for the patient to be engaged and actively maintain their health record.  It also encourages up to date information even it is manually entered.

Pricing model:

Similar to many of the online subscription based services, HIEs fees are monthly.  Whether it is the physician or health system, they pay a reoccurring monthly fee for the length of the agreement. There is some setup fee associated with most and possibly additional third party charges when interfacing or integrating with an EHR.

Integration capabilities with existing system:

Not all HIEs provide integration with all EHR systems.  Ideally an HIE can provide a strong and tight integration with an EHR product and allow end users to simply use their electronic medical records application which they are already familiar with.  This will enable physicians to simply use the same application to manage patient charts as well as request medical records from an HIE.  But unfortunately, not all HIEs or EHRs allow for this integration.  So for some access to an HIE web portal that provides the ability to print/save the summary record is as far as the system will go.

With the proposed meaningful use stage 2, and 3 there is a stronger emphasis on the electronic exchange of medical records through a qualified Health Information Exchange.  And more physicians and organizations will begin to review some of the available HIEs in their community and state.

For several years now I have benefited from using a centralized to-do list integrated with my Outlook calendar.It offers a complete view of what activities and items I needed to accomplish everyday in an easy to use integrated fashion. But as I started relying more and more on mobile devices and tablets to conduct everyday business, I found out quickly that I needed to begin utilizing different apps that would allow me to easily view my tasks and calendars from any device, at any time.

Fortunately there were several mobile apps that allow me to maintain all my devices in sync with my Outlook tasks, with one of my favorites being toodledo. The toodledo app allows me to apply some of the principles of proper time management outlined in Steven Covey’s “The four discipline of execution,” and allows all of my “toys” to maintain the same list.

But one challenge that some face lies in deciding when to separate and manage multiple to-do lists. For example, for those physicians who are still practicing and also participating in leadership roles, managing their calendar requires a tremendous amount of discipline and time management skills. In a perfect world, a physician’s EHR messages should be able to easily integrate and populate with their Outlook tasks and calendar (securely and without any patient info). Unfortunately, not all systems integrate or sync with Outlook tasks, which means that many times users need to manage multiple lists or else rely on manual synchronization between different systems.

The good news is that many can still successfully and efficiently manage their time even when having to work with multiple lists. Best practice should always be to review your to-do list(s) daily and stick to deadlines, as this will ensure that you are continually monitoring progress are are aware of changing priorities.

ACOs have become quite a hot topic among health care leaders today, with some of the main concerns being governance, payment structure, infrastructure and architecture challenges. Some feel strongly that ACOs will require a more complex and advanced technology infrastructure than the ones currently being employed in HIEs, and many are left wondering just what that will mean to providers in terms of moving forward.

The goal of an ACO, or a set of health care organizations that work together and collaborate on and coordinate care for a set of patients, is to not only reduce costs and increase efficiencies in the system, but also improve patient outcomes and the overall coordination of care. But while ACOs are still evolving and taking shape, it is important to dive into some of the core infrastructure components that will be required to ensure success and long-term sustainability.

In order for an ACO to succeed, it must operate a provider network that will enable the electronic exchange of information, provide a platform for care management and offer a payment distribution system. Underlying all of these attributes, of course, are the technology implications, some of which are the following:

Health Information Exchange (HIE): This is a standards based exchange for electronic health records. The current standard being used is the HL7 CDA or CCR (Continuity Care record), which is the format in which health information is stored and exchanged across systems. The HIE is the facilitator that will enable systems to identify patients as well as locate their chart and route it to the requestor. This does not necessarily mean that an ACO will need to operate its own HIE, however. In fact, most ACO will likely connect, or have the option to connect, to one or more HIEs, especially when working across state lines.

Certified Electronic Health Records (EHRs): For participating caregivers, having EHRs to view and document care during a visit is a must. An ACO might offer a hosted EHR or patient tracking system to help boost participation, though it is not required to have one common EHR system for all the members simply due to the fact that most certified products do have the capability to exchange medical information in a standardized format.

Patient portals: In order to improve patient engagement, an ACO will need to provide a patient portal to facilitate secure electronic communication. This will provide the patients with web based and interactive personal healthcare records. The ACO should also offer integration with all major PHR providers.

Data warehousing and business intelligence (BI): There are over 65 measures in the proposed ruling for ACOs. All these quality measures must be reported on in order to be eligible for shared savings. The measures cover everything from care coordination and preventative health to patient experience. Much of the information will be submitted via GPRO tools. In addition, each measure has a minimum attainment threshold and performance benchmark, which requires the ACO to continuously monitor its performance over time.

IT support: In order to ensure system uptime and reduce disruptions to data flow, an ACO will need to provide IT support not only to support the connectivity amongst the members, but will also need a team of HIT specialists to maintain the internal ACO platform.

Unified communications: In a recent article, I discussed the need for sites or platforms that will facility coordination of care similar to Facebook , except more business oriented (similar to Chatter). These solutions will not only allow caregivers to communicate with each other regardless of distance, but it can provide them cost effective ways to have video conferencing, including telehealth services, and a platform for discussing patient cases.

ACO management technology: Since an ACO is the result of the collaboration of cross-disciplinary services and multi organizations collectivity accountable for the total patient care, it is critical to have a system that will support governance and management of the ACO care-delivery model.

Document management: While this may not be obvious at first, the reality is that there are still patients that bring their medical information in paper format. This may require the ACO to provide tools to digitize that information and make it available to everyone. The ACO may be forced to identify alternatives such as cloud-based document management system to be able to provide easy to use and widely accessible system to retrieve and review paper based documents.

Preventative health: In order for an ACO to have a proactive role in the population’s health, the organization must ensure that it is continuously working with patient through reminders and alerts for preventative care. This is especially important for patients with chronic disease.

Clearly an ACO will require a lot of technology as part of its foundation. This means significant capital upfront as well as resources and a strong strategic plan to ensure sustainability. Some hospital led ACOs may have some of the infrastructure components already available to them, while other ACOs may integrate with a payer system which has most of the components. Either way, the ACO and medical home models are not going away, and health IT leaders will continue to be faced with a unique set of challenges as the industry leaders continue to pave the way toward true coordination of care through health IT collaboration.

To date, over 900 EHR applications have been certified through an ONC-Authorized Testing and Certification Body (ATCB). While this has added a plethora of choices for physicians in terms of which to choose and how to attain meaningful use, given the tight deadlines and limited timeframe, the high number of vendors and technology options can prove to create more challenges and added layers of complexity for many health care organizations still working to identify the best-fit solution for their needs.

For many products in the EHR market today, there are actually only subtle differences in terms of their capabilities and functionality. But at times, these are the exact features that can be the key to a successful implementation of the EHR, or not. One could almost apply the Pareto principle here, or the 80-20 rule, where approximately 20% of the features possess the key differentiators and and critical success functions, while the remaining 80% comprise the common features found in most EHR systems.

Some areas of consideration that have spurred conversations among decision makers regarding EHR package evaluation are:

• How effective would some of the products be when interacting with HIEs?
• How are the different EHR solutions going to take ACO models?
• What are some of the different mobile capabilities would be available?

As we’ve been privy to watching unfold, technology has been playing an increasingly important role in the effective, efficient delivery of health care, and continues to present opportunities for innovation and offer a measurable value to both physicians and patients. From utilizing an HIE for better coordinated care to adopting mobile technology and integrating mHealth devices for the viewing of radiology images, lab results or e-prescribing, we are going to continue to see adoption of tools that will not only prove to drive down costs, but also improve the overall quality of care.

The increasing popularity of smartphones and demand for broadband data access across all types of carriers has set the stage for major growth in the mobile application’s arena. Many vendors who have already taken steps to sieze this opportunity have apps on the market that are making a notable difference in the lives of both physicians and patients, with the end-user action and results to prove it.

And many patients have begun to see the benefits and payoff themselves, utilizing mHealth apps for better care coordination and increased engagement. Whether it’s through apps that offer health coaching for the management and promotion of a healthier lifestyle, or those that allow for better treatment of chronic illnesses, we’re seeing new, patient-driven options truly start to make an impact.

For diabetes care, for example, the assistance can be found in many forms, such as the bant app that was unveiled at the ATA 2011 conference earlier this year, which focuses on increasing patient engagement in teens via the interaction of social media and an iTunes reward system. And at the University of Maryland School of Medicine, researchers have concluded that the use of mobile technology helped patients manage their type 2 diabetes, with results to back it up. Patients who used the app had their A1c levels drop significantly over the course of a year, results of which have helped increase consumer confidence in the app and help illustrate the efficacy of their usage in various patient populations.

There are several other solutions that have helped patients manage their chronic conditions. Asthma patients now have the ability to use a mobile app called Asthma Tracker, which can provide information on common medications, treatments, asthma triggers to avoid and additional resources and tools. Patients with high blood pressure or hypertension can also get assistance in tracking and measuring their BP over time, which allows for the constant monitoring of their levels and enables them to submit their data to their physicians electronically and in real time.

As we continue to monitor the mHealth arena and the many advancements to come, it is just as important for vendors to continue to strive for innovation and develop mobile devices with the patients in mind. Applications and devices that increase patient interaction and engagement are not only a win for the patients themselves, but are also a win for the market and industry as a whole, as they will continue to help drive the shift toward accountable care and frameworks that support and reward for qulity through care coordination.