I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)
This interview is with Xerox’s Tamara StClaire (Chief Innovation Officer, Commercial Healthcare) and Gail Croall, Chief Medical Officer, Healthspot.
In late 2014 Xerox invested in Healthspot a telehealth company that builds kiosks. That partnership is the main focus of this interview. Below the fold there’s another video which is a tour of the Healthspot hub that you can expect to see cropping up in RiteAid pharmacies across Ohio and later the nation.
The stories you’re hearing about lamp-lit, midnight pow-wows taking place in state offices are true. The states are working around the clock at a feverish pace to meet the Health Insurance Marketplace go-live date of Oct. 1, 2013. From conversations with my counterparts who are leading the marketplaces, I understand that some of the most significant concerns include:
System of Record: For states building their own marketplaces, the first design decision is around the system of record. Some states are electing to use the HIX itself as their eligibility system of record, funneling all eligibility determinations – tax credits, cost-sharing reductions, Medicaid, Children’s Health Insurance Program (CHIP) and Basic Health Plan – through one platform. Other states are designing their marketplaces as entry points, from which eligibility decisions flow to a legacy system for determination decisions. Either way, states are finding that the project is akin to remodeling a 747 while it’s in the air. The legacy systems need to be updated so they can coordinate and speak to the HIX. That’s a massive undertaking on its own, but it also has to be done while the HIX is still being designed.
The Federal Hub: State marketplace leaders are also considering the readiness and functionality of the federal hub. States will be required to check in with the federal hub for applicants’ immigration status, income level, etc. The federal hub is being built and rolled out at the same time that states are designing the rules for how their marketplaces will speak to and integrate with it. Again, it’s a bit like remodeling an airplane mid-flight.
Although healthcare providers are making progress in adopting health IT, Americans seem to be resistant to change to Electronic Health Records (EHRs). In fact, only 26 percent of Americans want their medical records to be digital, according to findings from the third annual EHR online survey of 2,147 U.S. adults, conducted for Xerox by Harris Interactive in May 2012.
Last month the Institute of Medicine issued a seminal report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health in America.” The report estimates the American healthcare system suffered a $750 billion loss in 2009 from inefficient services and administrative expenditures. The report is grounded on the principle that effective, real-time insights for providers and patients which result in collaborative and efficient care depend on the adoption and use of digital records.
As people are naturally resistant to change, education will be key in gaining support among Americans for the transition to EHRs. If providers can help patients understand “what’s in it for me,” that will likely go a long way in making Americans feel more comfortable with the switch to digital.
Let’s take a look at five ways EHRs directly impact the patient. For these examples, we’ll use a fictitious patient named “Joe”:
Health Information Exchanges (HIE): HIEs work on the principle of a network – they grow stronger as more participants join. If Joe’s primary care doctor switches to digital, that’s a great step in the right direction. However, it isn’t truly meaningful until his primary care doctor joins an HIE and begins sharing Joe’s patient health history, medication history, lab results, family and social history and vital statistics with his specialists, emergency care providers, and so on. This sharing of information helps ensure that Joe gets the best quality of care, because all of his providers will be in sync and have the most up-to-date information. It also helps reduce the amount of duplicate exams and labs Joe will be asked to give.
Both participants and caregivers in long-term care programs face a myriad of difficulties. Participants with long-term services and supports needs often have many health issues, meaning they are in constant transition between care environments and providers with their needs ever-evolving. As a result of visits to a number of doctors on a regular basis and the number of providers who support them, the participant’s information lives in multiple locations. This can lead to discrepancies between providers and the participant having to constantly provide the same information.
Caregivers, especially family members, are also facing great challenges. It’s a full-time job to care for someone in the home – it takes nearly 40 hours a week – and searching for a trusted service provider to take over can be another job in and of itself.
The root of the problem is that many long-term care programs are focused on the providers and not necessarily the people – those receiving the services and those providing them. Often, no one has the full picture of the participant’s health, which can lead to suboptimal care. An ideal situation is for everyone involved with the participant to be up-to-date and have a full-picture of their health and well-being at all times. When they are, services can be administered effectively with less risk for everyone involved.
Now that the Supreme Court has spoken and upheld the Affordable Care Act (ACA), how exactly does this impact state governments?
One of the biggest ramifications of this decision revolves around the ACA’s individual mandate requiring citizens to purchase some form of health insurance or face a penalty, and the subsequent requirement for each state to establish a health insurance exchange (HIX).
While many states have spent the last two years preparing themselves in some capacity to set up an exchange, the amount of progress made varies greatly from state to state. Some have taken measureable strides to ensure their exchange is up and running to meet the October 2013 enrollments and January 2014 coverage effective deadlines set forth by the ACA, while others have been waiting on the final decision from the Court. Now that it’s been made, we’re going to see these states in a scramble to build their HIXs in accordance with the ACA’s mandates and timeline.
What we’re hearing from our clients indicates the majority want to make health reform as state-specific as possible. In other words, they want to maintain control over their HIX rather than defaulting to the federal solution. But as the certification deadline looms, it’s increasingly important for states to consider a comprehensive solution that doesn’t require building a product and allows time for customization.
Data is only data until it is structured. Then it becomes powerful, relevant and insightful.
That was a key message from Ursula Burns, Xerox chairman and chief executive officer, on the first day of the World Health Care Congress in Washington, D.C. In opening the event with a fireside chat with Dr. Nancy Snyderman, chief medical editor for NBC News, Ursula talked about Xerox’s vision to improve health care including empowerment– ensuring that patients have a stake in their health, and realizing the true value of data. As Ursula said, “It’s not the data itself, but it’s recognizing actionable data.”
Here’s another way to think of it: Xerox provides the “smarts” around each aspect of health care such as:
·Turning information into insights through real-time clinical decision, patient behavior modeling, population management, and Meaningful Use reporting; and
·Putting insights into action, for example, through a health information exchange – connecting electronic medical records (EMRs) to give caregivers information, analytics and decision support tools that help improve patient care.
This three-part interview from World Health Care Congress with Markus Fromherz, chief innovation officer of Xerox Healthcare, covers some of the most exciting healthcare research and development going on at Xerox’s Palo Alto Research Center. Part one includes Markus’ thoughts on moving paper data to digital and describes the process in three layers – gaining access, drawing insight and taking action from what was learned.
Frequent readers of The Health Care Blog have probably noticed Xerox’s name around more and more often – we partner with THCB to provide content and cover events. Was it unexpected at first? Are you beginning to understand why Xerox is represented in an outlet where conversations are dedicated to discussing healthcare hot topics?
We hope so. This week, our CEO, Ursula Burns spoke at the World Health Care Congress, and I’m sure that some of the attendees were scratching their heads about that as well. To be clear for anyone still wondering, healthcare is a primary area of focus for Xerox. Today, Xerox touches the lives of nearly one in every three insured individuals in the U.S. as the largest provider to manage all documents and business process needs within healthcare organizations.
One of our priorities is to simplifying how work gets done for healthcare professionals now and in the future. We invest more that $50 million annually in healthcare R&D, allowing scientists at our company’s research centers around the world to advance healthcare innovation. At WHCC Burns showed a video that features two of the most interesting research projects we’re working on:
·Medication management: our researchers are developing “smart” medication packaging that will allow pharmacies to help patients manage their daily prescription regimen more easily. The system uses innovations in personalization, data collection and packaging to organize medication, provide individualized instruction and then track whether a patient adheres to the doctor’s orders.
Information is power, but sometimes it can be too much of a good thing. Information overload affects workers in every industry – this is particularly true for data-reliant and intensive industries like healthcare. And, it’s not getting any better – by 2020 the healthcare industry alone is estimated to have 25,000 petabytes of data – that’s equivalent to 500 billion four-drawer filing cabinets. With its complexity and breadth, and not least with its impact on our lives, healthcare has to be the poster child for how efficient management of data can improve productivity and help providers make better, more informed decisions.
A first trick, however, is getting at the relevant pieces of information. Today, a lot of manual work goes into accessing and cleaning up data that is siloed and unstructured. Too much information is still on paper, but even where it has been migrated to electronic medical records (EMR), practice management systems, or lab diagnostic systems, much of it is still unstructured. The majority of hospitals are finally implementing EMRs, and many of us are working to provide advanced analytics based on the information going online, but, at a recent Xerox healthcare client council meeting, several CIOs emphasized that there still remains a huge challenge in cleaning, standardizing, and integrating data before it can be used for decision making.
Fortunately, powerful methods are becoming available that can extract relevant events from physician narratives, intelligently aggregate data, customize information for clinicians based on context, and visualize information. For instance, in France, a number of hospitals are testing an emerging application based on Natural Language Processing technology developed at the Xerox Research Centre Europe in Grenoble, France. Researchers designed the solution to help prevent the spread of hospital-acquired infections by finding, extracting, and combining key information in physician narratives distributed in medical records. As another example, our Midas+ Live product accesses and integrates information from diverse hospital systems and puts them on a single dashboard, multiple patients at a time, hugely simplifying a physician’s task to monitor all of his or her patients.