OR WAIT null SECS
Forget about meaningful use and ICD-10. The deep talk at HIMSS 2012 was about iPads, data mining, game-like patient apps, and - what's that? - more EHR products?
Amid the bright lights of Las Vegas and a lot of chatter about meaningful use and possible delays to ICD-10 implementation, there were a few threads common to nearly every conversation I had at HIMSS.
Apple is setting the standard for all healthcare technology. Quick start-up, high resolution screens, and touch navigation are fast becoming de rigueur. Siri, Apple’s voice-based “information navigator” is especially setting a new standard for germ-phobic, full-handed clinicians. Physicians may have bought their iPhone or iPad for personal use, originally, but now they are used to it, and expect more of the same. Vendors called it “the consumerization” of healthcare IT.
I did speak to some vendors imaging a future where CIOs and CTOs would wrest iPads from the reluctant hands of their physicians out of concern for security. HIPAA and even breakability are worries for the devices, according to conversations I had at Fujitsu and HP booths. A Fujitsu rep said despairingly of the iPad, “It’s a retail product.” But it’s just plain unlikely that, in some ill-defined future, a Windows 8 device will see the same adoption rates. The Apple cat is out of the bag, and it’s not going back in without a fight.
In the inestimable advice of Athena Health CEO Jonathan Bush to those who want to keep the status quo, “Pack your lunch, baby, it’s going to be a long haul.”
Using Data - For Good?
In years past, there was much talk at HIMSS about getting data into EHRs, and this year’s show still featured players like Nuance and Anoto which use advanced speech recognition software or digital pens to get information into the record.
But the bigger trend was improving the quality of the information that comes back out of the system, and expanding the way physicians (and others) can use it. “The issue is no longer archival; it’s retrieval,” as Teo Dagi, MD, CMO for Aventura put it.
At its simplest level, better retrieval means getting practicing physicians just the information they ned, not every single data point in a given patient’s history. “If I’m an orthopedist, say, I want the report just this way, and you can get just that,” explained HP’s Christopher Mertens, vice president, healthcare, personal systems group. He envisioned the huge time-savings created by such specialized reporting.
Similarly, Louis Lannum, director of enterprise imaging at Cleveland Clinic, pointed out that radiologists need to see only images related to a given diagnosis. “What they don’t want to see is every image in chronological order,” but that’s too often what they get now.
So physicians can expect more efficient and specialty-focused reporting from their EHRs. But they can also expect hospitals and payers to mine the data to improve outcomes and even do marketing. Imagine a world where data from a hospital’s records is able to accurately predict whether a given 70-year-old with chest pain and diabetes is likely to go into cardiac arrest based on how many 70-year-olds previously seen with the same symptoms did so. Imagine getting recommendations for prescribing based not on guidelines published by your medical society but by effective patterns recognized in a health information exchange database. Imagine hospitals identifying and working to eliminate variability in care. It’s powerful – and scary.
“It’s now about what we do with data. It’s becoming statistically relevant. … You can now start to look at trends and say whether there is an impact,” explained Rob Kenney, lead for marketing strategy, telehealth, Philips.
Data-driven, behavioral-focused marketing is the rage outside healthcare. The New York Times Magazine recently ran a wonderful story detailing how Target is using buying habits to identify pregnancy in customers. A new mother is vulnerable to offers to change her buying habits – the rest of her life has changed, after all – but once she starts buying diapers, it’s too late. The customer is bombarded by other offers. So Target used it’s scads of purchasing data and figured out that women buying more unscented lotion and supplements, for example, were likely in their second trimester. That’s when they sent them coupons for car seats and baby wipes.
In healthcare, of course, companies need to be a little more cautious about sharing and using health information connected to individuals. But, at Humana, patients already are getting coupons and referral suggestions on their EOBs related to their diagnosis code, according to Laurie Eldridge-Shanaman, healthcare market development consultant at HP. With an increased focus on population-based outcomes and accountable care, more invasive – if helpful – data mining feels inevitable.
Home-Based Care and Games
The same outcome-related goals have created a boom in gadgets and apps meant to change patient behavior, often in ways linked to their physician.
For example, at HIMSS, Allscripts announced a new diabetes management system, integrated with MyCareTeam, that allows patient to manage diabetes in between physician visits and share glucose readings, caloric intake and exercise patterns with their physician.
Philips is working on a product that will actively monitor patients post-discharge to reduce re-admissions. Patients and their families will be more responsible to track compliance with prescriptions, for example.
Analyte Health, with its award-winning STD testing site even goes so far as to let patients find a lab for testing and diagnosis of STDs without visiting a physician at all.
Many developers are employing concepts from gaming to help people get healthier. A prime example is Jane McGonigal’s SuperBetter, an online game that lets users establish their own health goals while teaming up with friends and family, using the principles that keep people hooked on video games to keep them hooked on health.
If we are looking to improve health, the trend is inevitable. Physicians don’t have time or skills to help people exercise more or eat well. But it’s better fitness and diet (along with safe sexual habits) that will most rapidly improve the health of a community. Someone’s got to do it, and it’s not going to be a primary care physician seeing 40 patients a day and not trained in behavioral motivation techniques.
Even More EHR Choices?
Finally, there were at least two new entrants in the EHR race at HIMSS. MazikCare relies on the basics of Microsoft’s ERP software. ImagineMD is an affordable, cloud-based solution, basically built around meaningful use checklists.
Given recent consolidation in the field and the number of EHR options already out there, it’s surprising to see any new products. But it remains true that most private practice physicians don’t yet have a system, and that’s partly because the bigger, lead players apparently haven’t made a strong enough case that their products are worth the investment of money and time required. There’s a certain, not all-consuming, anti-physician attitude that expects medical professionals to buy the products because otherwise Medicare will cut payments, not because the products are so incredibly fabulous. But physicians are hardly anti-technology. The rapid uptake of the iPad demonstrates how fast they will adopt technology when they see a clear benefit to doing so.
Some of the heritage players are singing a slightly different tune, though. Vitera, formerly known as Sage, is increasing field force by 40 percent and investing $25 million this year on improving customer service, according to CEO Matthew Hawkins. Allscripts’ chief marketing and strategy officer, Dan Michelson, referred to a “value-based inevitability” shift in his marketing messaging. The focus in the future will be on “'How do we reduce admissions?’ versus ‘Do I buy this EHR or that one?’”
If physicians can get more hands-on help and service and see the bigger picture, we might see adoption grow after all.
Pamela L. Moore, PhD, is senior vice president, content and strategy, for UBM Medica, Physicians Practice's parent company. She can be reached via email@example.com.