About 8 years ago, I started Health System Ed as an educational portal about the value of health information technology. It started with a blog called “Imagine” that described the dream of having all relevant patient information, all the time, in real time, to make good decisions about the patient in front of you based on best practices that had been determined by measuring what treatments worked in which patients.

Lately, as I write about genomics and sensored medical devices, it is clear that we are oh-so-close to the dream. In 2010, I didn’t have a clue how long it would take to achieve lift-off. Today, all the pieces are in place for people (masquerading as patients to the healthcare system) to know what is going on inside their bodies even before they manifest illness sometimes.

• Scientists and researchers can peer inside the genetic code to see what has gone awry, and they can snip, delete and replace poor genetic codes.
• Doctors can measure results by getting information about the patient in real time – whether it is a glucose reading to track the efficacy of your medication dosage, a heart rate monitor looking for signs of trouble, or a sensored knee brace telling your orthopedic surgeon whether you are doing your rehabilitative exercises
• Patients can know how they are doing and adjust their behaviors
• Payers know what works, what to pay for, and when to implement resource utilization strategies to encourage best practices

The electronic patient record systems are mostly in place now to capture information. They may need to be tweaked, upgraded, or replaced with the next generation of software, but the infrastructure is in place today. Next, we will build the analytics to turn data into usable information.

One of the most beneficial aspects of capturing patient data – everywhere, all the time – is that ultimately people will get the most effective treatment first which will drive down costs to the system and extend the healthy human life span. When we know what works in whom, it is a much shorter trip from disease to health.

It is nothing but exciting. We aren’t there yet. But we can see “there” from here.

Peggy is an author and writer who specializes in healthcare.

I’ll be doing some promotions which you will hear about later, but for now here’s the description on Amazon:
Retaining Expert Knowledge: What to keep in an age of information overload covers two major topics central to capturing and transferring expertise in organizations:

• Methodology and best practices for interviewing subject matter experts (SMEs) to capture their knowledge
• Identifying the SMEs to interview

The more critical problem is identifying the SMEs and the knowledge that needs to be captured.

One reason identifying the right experts is now so important is that in the next 10 years, the largest recorded exit of talented and knowledgeable workers from organizations will occur as baby boomers retire. In their wake, they leave their former employers understaffed and, even scarier, under-informed. Identifying the right SMEs is also critical because of the rapid acquisition of new knowledge. Some estimates say knowledge now doubles every two years, so it is crucial each organization identifies its journey and catalogues it individually and collectively.

This book provides managers with answers to the following questions:

• Are we talking to the right subject matter experts?
• What knowledge should we capture?
• What knowledge needs to be captured immediately as opposed to eventually?
• If we have limited resources, which experts are most important to speak with first?

Every organization has a history, a culture, and knowledge that may have lost its current relevance but not its importance. It is that broader vision of capturing knowledge, which this book addresses. It guides readers on how to preserve corporate knowledge and provides tools to assess organizational circumstances and judge the value of the resources to capture.

Retaining Expert Knowledge is a training resource, but it is also a business resource. As knowledge proliferates and organizational culture rapidly changes, now is the time to step back and determine what has been important to your organization’s success, where the organization is today, and what it will take to stay in the game tomorrow.

Your company houses knowledge, skills, attitudes, intellectual property, trade secrets, company culture, and individuals who will never be replicated exactly as they are today. Because they have demonstrated value in the past and are demonstrating value today, these treasures are worth preserving. This book shows how to preserve these valuable assets today for tomorrow’s successes.
You can buy this wherever you normally purchase your books.

Here’s a link directly to Amazon. 

“Beware the Ides of March” –Soothsayer to Julius Caesar
“Fear not the Ideas of March” –Health Business Blog to the wonkosphere

Your friendly neighborhood drug dealer

Count on Drug Channels to make sense of even the most convoluted pharmacy business models –and convoluted they are. This time the topic is the emerging trend of point-of-sale (POS) rebates. Did you know that many pharmacy benefit plans act like reverse insurance, with the sickest members subsidizing the healthiest? POS rebates start to right this wrong and bring forth uncomfortable questions such as: Where have the rebates been going until now?

Crocodile tears

Managed Care Matters shares its perspective that the Administration’s efforts to undermine the ACA have yielded bitter fruit on the marketplaces. Some premiums are up by 30% and meanwhile Congress is doing little or nothing.

Two years ago you couldn’t read the news without hearing about the disastrous premium increases due to “Obamacare,” but the media is silent now.

So what’s going on? Our blogger has a theory: The media is being manipulated and chasing bright, shiny objects.

Skimpy is as skimpy does

InsureBlog likes CMS’s proposal to restore the maximum policy length of short-term medical plans to 12 months from three. That’s even though some news outlets call the plans “skimpy” and some healthcare policy analysts consider such plans to be leeches on Obamacare, because they may siphon the healthiest people out of the marketplace risk pool and drive up premiums.

Location location location

When my son was a toddler, we trained him to say “location location location” when asked, ‘what are the three most important things about real estate?’ I still remember him driving a realtor crazy when one tried to pitch us on a house we didn’t like.

Now, Workers Comp Insider has decided that location is destiny in healthcare, too, declaring ‘It’s the Zip Code Stupid.’ Insider cites a recent JAMA Internal Medicine study that shows geography is “the biggest X-Factor in today’s American Hellzapoppin version of healthcare.”

Location: Wonk zone

The Hospital Leader (not to be confused with the Dear Leader) helpfully explains that “We need creative solutions” really means “the problem we are trying to solve has no answer.” Case study: Hospitals, hospice and SNFs – The big deceit.

A pending bill seeks to establish a state-based individual mandate in New Jersey. But a provision targeting employees of small businesses could inhibit Association Health Plans from selling insurance that does not comply with small group rules. Xpostfactoid explains.

Who knew? Health Care Renewal informs us that the ostensibly libertarian Washington Legal Foundation has become a front for healthcare corporate leaders –and leaders from other fields— to operate with impunity. The foundation’s campaign to abolish the Responsible Corporate Officer Doctrine failed, but the damage was done. (Hat tip to Health Care Renewal for anticipating today’s theme by including “methinks” in its cover note.)

Local talent

The Health Business Blog is now a teenager. I ran the annual round-up of favorite posts by month.

CareCentrix CEO John Driscoll and I rant and rave about Amazon and innovation in the latest monthly episode of #CareTalk.

Singing from the himmnal

Health System Ed shares results from the 2018 US HIMSS Leadership and Workforce Survey, a survey of providers and vendors.

Top themes: privacy and security, process improvement and workflow, data analytics, business intelligence to inform clinical decision-making remain top of mind. 

Well that’s it for the Ideas of March edition. Watch your back today!

—

By healthcare business consultant David E. Williams, president of Health Business Group.

The 2018 U.S. HIMSS Leadership and Workforce Survey provides some insights about the state of health IT today and where its efforts will be focused for the next 12 months. With input from 369 hospital/health system and vendor respondents, the survey revealed that privacy and security, process improvement and workflow as well as data analytics and business intelligence to inform clinical decision-making remain top of mind.

For a glimpse of the 2018 priorities of the HIMSS respondents, this chart shows the Top 10 concerns of hospital leaders and the correlating priorities of the vendors who serve them. While there tends to be agreement about the top 10 issues facing health IT today, vendors and their customers do not always have alignment about their relative importance.

TOP 10 HEALTH IT PRIORITIES FOR HOSPITALS AND VENDOR CORRELATION (click to enlarge)

A Saturation Point

One of the most telling discrepancies between hospital and vendor respondents was the fact that hospitals overwhelmingly either anticipated stagnation or reduction in hiring in 2018 while vendors are still showing aggressive hiring practices. Vendors may be responding to last year’s demand and this survey indicates a need for them to adjust their projections to align with their customers.

CURRENT WORKFORCE VACANCY (click to enlarge)

This trend may show a saturation point for hospitals regarding how much more change and expense they are currently willing to incur to play the expanding health information technology game to the level that the government, innovators and vendors would like to push them.

Willingness is only part of the equation. The next generation of health information products in development will move information and technology to further integration and greater utility for patients, providers and payers. This trend is a juggernaut that will take both hospital and vendors with it in the next few years. Guaranteed.

Source: https://www.healthinsurance.org/blog/2018/02/15/health-wonk-review-for-february-15-2018/
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Sophie’s Choice was an award-winning 1983 movie based on the William Styron novel about a Nazi concentration camp survivor who was forced to choose which of her two children to send to the death camps. In this most heart-wrenching scene ever filmed, the woman must choose and begs to choose “neither”.

For healthcare providers who are caught in a regulatory net by participating in government-funded programs, they were given a choice between installing an electronic health record system, attesting to meeting a list of nearly-impossible targets to get reimbursement for their multi-million dollar investments, or choosing not to participate which resulted in losing participation in said government-funded programs and incentives.

Most providers bit. They had no choice. And when it came time to collect the Meaningful Use incentive dollars, they attested to meeting at least the minimum requirements. The government bit back.

Department of Human Service auditors in the Office of Inspector General most recent review estimated that the Centers for Medicare and Medicaid Services has overpaid more than $729 million to providers whose paperwork didn’t pass muster. That’s more than a big whoops for many organizations. That can be an organizational nightmare to reconstruct and prove that your claims were accurate.  Click here to read the story.

Here’s an excerpt from the HealthcareITNews story reporting the overpayments:

All of these providers should begin – if they haven’t already – gathering the required documentation. While it varies by the program, [Erin} Whaley [partner at international law firm Troutman Sanders]  explained it will range from security risk assessments to screenshots. For other measures, providers will need a patient list of an audit log.

And documentation is required for every year attestations are made.

[Matthew] Fisher [partner at corporate law firm Mirick, O’Connell, DeMallie & Lougee] recommended that healthcare providers run an internal audit or review to ensure all documentation and information resides in one place and can be easily accessed.

Financial and Administrative Burdens

Yesterday, I met a young physician at a barbeque. Our conversation led to the typical “what do you do?” When I asked her what specialty she was most interested in, she said she was considering geriatrics or ob-gyn but that the business of medicine had become so dominant that instead she was thinking about getting her MBA and switching her focus completely. This woman spent her early career as a trauma nurse. She loves medicine and loves patient contact. She is currently doing toxicology research and interested in Alzheimer’s Disease research.  But her experience in the medical field is leading her to the conclusion that her brain and talents might better be used analyzing spreadsheets and business plans.

I used to think that healthcare was a positive driver of gross domestic product and a thriving sector of the economy. Now, I wonder if our focus on healthcare as a business isn’t costing us our focus on patients and causing us to lose some of our talented and dedicated medical professionals to regulation and bottom-dollar mentality. Loss for the patient. Loss for the doctor. Loss for society.

This is not a new thought.  But this is a problem that is becoming so acute that to save medicine, we need to reprioritize what we incent, how we incent it and whether the recordkeeping is worth the price of time, focus and energy toward the business rather than the medicine.

Health technology – like all technology – is making quantum leaps forward while we are looking backward to reconstruct Meaningful Use criteria that are quickly becoming meaningless.

In this article on the future of Precision Medicine here, architects of the future of healthcare at the Precision Medicine Summit in Boston last week said that the future of Precision Medicine is more accurately Precision Health. Precision Medicine was about the use of system data to help doctors make decisions about patients; Precision Health is about patient access to their own data to make good decisions about their own health.

This one move from focus on the system to focus on the individual calls into question the future value of the content of the electronic health record stored in your health system database as it relates to patient care. After all, we knew all along that the patient record was, at best, incomplete. It also further calls into question the value of the Meaningful Use criteria as they relate to the practice of medicine where it is today.

Perhaps CMS needs to call a timeout on the HHS auditors, call the MU money well-spent where it incented progress, sunk costs where it impeded progress, and walk away from this program that was as well-designed as it could have been nearly 10 years ago before we knew what we know now.

I’ve been hanging around the virtual water cooler in healthcare for two decades, and now the promise of technology as it affects and improves our lives is beginning to come to fruition. With that, here is a roundup and just a few developments and their significance to the future of healthcare from a medical, business and financial perspective.

Med-Tech: At the head of the futurist pack is Dr. Peter Diamandis, known for oh-so-many things including a founder of the X-PRIZE, Singularity University and the Human Longevity Institute. In his May 19 Abundance Insider, he looks  at a bionic hand developed in the UK “capable of grasping objects without the wearer’s focused thoughts.  The researchers created a convolutional neural network training the hand and its algorithm on the images of over 500 objects in various orientation and lighting conditions with four programmed grasps that you might use to pick up things.”  Go to the link to see the video. Under that entry, you can read the next story about an 18-year-old Mexican student who designed a bra that detects breast cancer.

Health Biz-Tech: The business of healthcare is all about how we pay for medical services and the structure of the business model. Our current system is focused on an insurance-based payment model. Already, insurance companies are toying with issuing insurance policies in real time based on your current medical history that involves instantaneous analysis of your condition, the company’s risk and what it will cost you to be covered by them. This could blow all the regulations out of the water. It could also call into question the current model of trying to cover everyone with insurance and could instigate a movement to have us begin to look at a different business model completely, especially in light of the kind of Med-Tech advances in the pipeline that will completely alter our outcomes and lifespan.

Health Fin-Tech: How and why certain goods and services get paid keep many an insurance agent, claims administrator and government regulator up at night., not to mention the security people who need to lock down our data to maintain patient privacy. The blockchain has the promise of changing the financial world, and healthcare payments and security will be part of this revolution. I am attending a Meetup of blockchain people in my area this Saturday and I’ll report back at some point.

They say those in a movement need to either lead, follow or get out of the way.

At some point in the history of the evolution of healthcare, government was in a position to lead. In the past few years, it has been in the unfortunate position of having to follow as technical advances outpaced the ability of government to legislate and regulate at the pace of change. Now it is time for government to get out of the way. At some point, we’ll need to regulate for safety and security reasons. But this is not that time.

Julie Ferguson at Workers’ Comp Insider is our creative mistress of ceremonies this week. Here’s what she has to say:

It’s quite the day to be going to press with a new Health Wonk Review. We were trying to think of  a movie themed metaphor for today’s edition but can’t decide between Back to the Future, Groundhog Day or a zombie flick, so we’re going for a mashup.  Click here to read more.

Just when you thought things can’t get any weirder, they do. Combine staunch opposed ideologies held by fierce political warriors, and we find ourselves under the ancient curse of living in interesting times.

It seems our nation is transitioning from a government run on compromise – remember Ronald Reagan working with Tip O’Neill or Bill Clinton reaching across the aisle to Newt Gingrich? – to one run on diametrically opposed ideologies duking it out in unceasing, heated political and legislative battles. Maybe people will pull back the throttle on the ideological thrusters and land this thing safely. For now, both clearly defined sides in this fight seem to have refined the act of demonizing the opponent to an art form. But this isn’t art. It’s life, and it’s happening in real time. Welcome to interesting times.

Now, off to the land where hyperbole and rancor take a back seat to reason.

Let’s hear from the more tempered voices of the HWR crew’s civilized, balanced and informed debate.

Kicking off the discussions this week, we turn to the Health Affairs Blog where Timothy Jost presents a detailed analysis of the Republican legislation on the table to replace the ACA. In Examining the House Republican ACA Repeal and Replace Legislation, he compares the relatively lengthy ACA draft process to the 3-week run-up to the ACHA legislation. He points out what changes (mostly Medicaid), what doesn’t (pre-existing condition protections, coverage guarantees, etc) and looks at the revenue implications.

The ACA has been an employment driver, so repeal will hurt employment. Joe Paduda breaks out the math for us here at Managed Care Matters. Making healthcare more efficient will cost jobs and reduce incomes for a large segment of the economy. Joe asks, will this affect policymakers’ priorities?

Henry Stern at InsureBlog tells us that, if measured in numbers of lives saved, patients are faring worse under ObamaCare. In fact, InsureBlog reports that the ACA’s success regarding actual lives saved is a big goose egg.  Here’s the story at The ObamaCare Success Story: Zip, nada, and zilch.

Linda Bergthold, writing for Health Insurance.org, provides a dictionary to help decode the meaning behind the politicians’ words, a difficult task under any circumstances. In Decoding Republicans’ Language of Repeal, she cautions readers that seemingly innocuous language such as “patient-centered”, “access to care”, “freedom” and “choice” may not deliver on those promises quite as presented. She said much of the GOP language masks “ideas that are old and tired” that are being recycled. Read more here and decide for yourself.

Over at XPostFactoid, Andrew Sprung is a man looking for a compromise and a way out that saves face for everyone, something that might include a couple of frills like, say, oh, coverage for the vulnerable. In his post, Psst, Democrats: Help Republicans Out of the Repeal Box via Cassidy-Collins, he looks at the Patient Freedom Act as an alternative to the ACA and the AHCA. Read XPostFactoid here.

Over at Health Access California, Anthony Wright pays tribute to 94-year-old health care advocate Dorothy Rice who passed away this week. Of RIP Dorothy Rice, Pioneer in Health, Anthony says, “Rice was a lead economist in the Johnson Administration who made the case for Medicare. For an encore, she had a second career as a world-renowned academic where she dealt with issues from health reform to aging to tobacco control. We were pleased to work with her on our board during the effort to pass and then implement the ACA, providing a historical perspective to remind us these policy fights are not new – although she always thought after the passage of Medicare that the next reform to cover the rest of the population would come a lot sooner than it did.” This tribute details her considerable accomplishments.

Roy Poses at Health Care Renewal questions the integrity of Trump cabinet nominee for Labor Secretary based on some of his rulings as a former U.S. Attorney regarding pharmaceutical companies that favored the corporations. Roy asks, “What sort of swamp drainage process is this?” as he explores the decisions of the cabinet nominee “who had an important role in enabling the impunity of leaders of top health care organizations…he presided over three major settlements with pharmaceutical corporations. In none of them did any individual who enabled, authorized, directed, or implemented the alleged bad behavior suffer any negative consequences. The suits were settled by payments made by the companies.” The details of these cases are in the Health Care Renewal blog here.

David Harlow at HealthBlawg recently hosted a cybersecurity webinar with government experts. To view the webinar, click on this link to view the Second Annual Cybersecurity and Health Care Panel Discussion with Government and Industry Experts. This blog post includes David’s notes from his introductory remarks as well as the 1 hour and 21 minute presentation. Grab a cup of coffee and listen to this in-depth discussion.

After taking in the webinar, you can jump over to David Williams’ Health Business Blog and click on his podcast where he interviews iCardiac Technologies CEO Alex Zapesochny about his electronic clinical outcomes assessment platform. Electronic clinical outcomes assessment platforms collect data from patients, clinicians and caregivers to make clinical trials more efficient and accurate. In this 14 minute interview, they discuss some of the trends in clinical drug development and how they impact platforms such as eCOA.

At Healthcare Economist, Jason Shafrin discusses the evolving methods for evaluating cancer care. Shafrin asks, “How do you measure the quality of care patients with cancer receive? How long they live? Avoiding side effects? Patient satisfaction? Process measures?” The Healthcare Economist investigates here.

Finally, we’ll visit an issue that has begun to cross the ideological divide. At Worker’s Comp Insider, Tom Lynch reports on a recent study on the therapeutic use of medical marijuana as a treatment for chronic pain – and the impending clash between the states and federal government stances on legality.  Read the discussion in more detail here at Who Knew? Medical Marijuana Works (at least for chronic pain).

I also want to add my mea culpa that I have not been a good corporate HWR citizen and contributed lately. Writer’s Block? Actually, it’s been Writer’s Overwhelm…there is just so much I am still figuring out where to start. In the meantime, let’s all be thankful that the HWR crew remains faithfully on the job.