Archive for September, 2005

DMC Live: Disaster Proves EMR’s Future is Now

September 23rd, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

Note: This week, HIN reports live from the Disease Management Congress in Orlando, Florida.

Orlando --- Electronic medical records (EMRs) for all Americans may be years away from fruition, but the recent Gulf Coast disasters have moved this issue up on the national agenda. With most medical records destroyed and many of the one million persons displaced by Hurricane Katrina in need of medical care, the Intel Corporation and other companies rapidly fashioned rudimentary EMRs from health claims databases.

Mark Blatt, director of global healthcare strategies, Digital Health Group for Intel, described the process for the 10th annual Disease Management Congress today. “We quickly scanned claims databases to put something in place. There were many individuals being moved from one rescue center to another without any medical records. Some individuals would receive a tetanus shot at each center. Things were so chaotic the individual did not know which shots they were receiving. After three tetanus shots, some were getting sick.” The EMRs helped give some order to the process, he said.

Broadband wireless---also known as WiMax--- is another technology on the horizon that has been instrumental in improving communications in the aftermath of recent disasters. WiMax can cover areas of up to 35 kilometers (approximately 15 miles), he explained. Communications companies set up WiMax towers during relief efforts on the Gulf Coast and in the recent Indonesia tsunami disaster.

These disasters and the associated loss of medical records have been a wake-up call for both the government and the healthcare industry, Blatt continued. The movement toward a national health information network is accelerating; the federal government just six days ago announced the formation of a committee to develop standards for this effort. With public pressure on, Blatt expects that this network will be viable in the next five or 10 years, if not sooner.

Technological advances are also changing the face of healthcare delivery. We will soon see the use of “smart tools”---wireless patient monitors, IV pumps, even hospital beds---that can talk to each other and provide a “closed loop feedback system.” This technology will change the way a hospital room looks and can be transferred to homes for continued patient monitoring, he said. We may even see these monitoring capabilities as a value-added offering at many hotels, Blatt predicts.

“These tools can get real-time data and process the data into meaningful information for the patient, family and caregivers,” he said.

Some tools being piloted by Intel to improve quality of care and get and keep patients healthy include the “presence lamp”---a light that goes on in one home when a friend or relative arrives at another home; “contextual caller ID” that provides a caller's photo, background and even a summary of the last telephone conversation with the caller to aid recall for the elderly and early stage Alzheimers' patients; and a “social health solar system,” a PC-based network to track family members' contact with elderly parents.

In the face of rising healthcare costs, these monitoring tools are designed to allow the sick and/or elderly patient to remain in their home longer, limiting nursing home stays and the depression that may accompany it, he concluded.

DMC Live: Fostering Innovation in Healthcare

September 22nd, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

Note: This week, HIN reports live from the Disease Management Congress in Orlando, Florida.

Orlando --- With more than 8 million members, Kaiser Permanente has been lauded for raising the bar of excellence in care management. But these days, Paul Wallace, MD, the executive director of Kaiser's Care Management Institute, is thinking a lot about Kaiser's own employees and the type of healthcare they receive. Respecting the different perspectives of value of each healthcare stakeholder---patients, providers and payors---and finding common ground is key to improving the overall healthcare experience, he says.

Dr. Wallace offered a three-part strategy for “Encouraging the Spread of Innovation to Make the Right Thing Easier to Do,” which formally opened the 10th annual Disease Management Congress. His presentation underscored the theme of this year's congress, “Innovation – Driving Change to Achieve Sustainable Outcomes.” In addition to respecting stakeholders' definitions of value, Dr. Wallace recommended making the right things easier to do by focusing on service delivery and information technology. “And if you make something easier to do,” he said, “Make sure it is the right thing to do.” It's easier to identify the “right thing” when you employ evidence-based clinical practices, identify successful practices, and offer member-centered and culturally competent care.

“The patient should be at the center of care, with the patient's home as the hub,” he continued. “We need to make the best use of the patient's time.” He called upon providers to re-think traditional physician-patient contact. Instead of scheduling a finite number of 15-minute patient visits each day, he suggested increasing the number of daily “patient contacts” by utilizing U.S. mail, email, phone contact, and group visits. “By thinking outside the box, this might enable a provider to schedule several 45-minute office visits a day for needier patients,” he said.

The United States needs to move the focus from “sick care” to “health care.” Employers, too, are in a prime position to improve workers' health while they are at the office. “The average patient spends about two hours annually with their doctor, 2,000 hours in the workplace and the rest of the time at home. We are betting everything on this two hours in the healthcare system, when we really need to do more in the workplace.”

DM Outcomes: Is That Your Final Answer?

It was billed as the “DM Reality Show,” but was actually an exercise in behavior modification. This entertaining session used technology---web-based surveys and electronic voting tools---to gauge and then sway public opinion. Attendees were asked to electronically respond to questions on disease management---its economic value, future, validity of ROI measurements, and whether improved DM outcomes are due to changes in clinical practices or in patients' own behavior. As they entered responses on individual electronic keypads to the strains of the Jeopardy theme song, real-time results were displayed on conference screens.

After two industry experts debated the pros and cons of each issue, audience members were asked to vote again. In several cases, the results showed that debaters managed to influence a sizeable percentage of neutral responses. While primarily entertaining in nature, the session afforded a lively discussion of a hot industry topic and left no doubt about the role of IT in the healthcare marketplace.

DMC Live: World Health Systems Under Pressure

September 21st, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

Note: This week, HIN reports live from the Disease Management Congress in Orlando, Florida.

Orlando --- An aging population that is driving healthcare spending to new levels and impacting worker productivity and the gross national product is not a concern unique to the United States. That's why representatives from nine countries have gathered at the first annual International Disease Management Summit to share strategies for implementing disease management programs worldwide.

“There is lots of confusion around the world between the prevention of disease (wellness), and true disease management,” said Warren E. Todd, the executive director of the International Disease Management Alliance (IDMA), which is sponsoring the summit. “But the dual world crisis of chronic disease and obesity is forcing countries around the world to investigate the benefits of disease management.”

Despite the positive impact disease management has had on ROI in the United States, the variety of healthcare programs, differences between physician- and patient-centric programs and the confusion between wellness and disease management worldwide has made many countries resistant to the idea of disease management, he continued.

Four factors that determine a country's receptiveness to disease management are that country's political agenda, healthcare market, IT maturity and readiness to accept the concept of disease management, according to Simone Christiane Seiter, MD, of Germany who is leading a CapGemini-sponsored effort to increase awareness of disease management. “Some regions of a country that are autonomous may be better prepared than the country as a whole,” she stated.

Based on these factors, the United Kingdom, the Netherlands and Sweden have been designated “fast movers,” she said. In England, the National Health Service has launched several pilot initiatives that test the efficacy of pay for performance and quality improvement efforts. “The results have not been very well publicized, but there has been a lot of work in this area,” according to Dr. Rick Botelho, who has conducted training for UK-based doctors. Dr. Botelho, a frequent speaker on the effect of behavior modification in disease management, has presented at several Healthcare Intelligence Network-sponsored audio conferences.

Because the European Union has ruled that it is up to individual member countries to regulate healthcare, the idea of a union-wide program is a long way off, said Dr. Seiter. “But we hope to introduce the idea of a healthcare card that can be used in several countries to access patient healthcare information.”

“There is also the NIH---Not Invented Here---syndrome that exists in Europe,” contributed one participant. European countries are often skeptical of concepts developed outside their country.

During the daylong summit, which is co-located with the 10th annual Disease Management Congress, participants will share how they have adapted and expanded upon successful DM models to address the unique needs of their countries.

When Health Coaches Draft Reluctant Players

September 12th, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

Health coaches appear to be the MVPs of healthcare these days, supporting physicians in management of chronic illnesses and helping selected members devise a self-management plan. It would seem to be a win-win situation all around---healthier members and reduced costs for chronic care.

However, I've heard a couple of gripes from the peanut gallery. Two people I know have recently been contacted by health coaches, and neither of them was pleased. One woman barely out of her twenties was identified as a potential candidate for a healthy lifestyles program after her insurance company reviewed her medical records---including her weight. And not too long ago, a family member diagnosed with a chronic condition several years ago received a letter from her health plan's health coach. The coach said she was now available to answer any questions about this condition, and would contact this relative whenever new information in the treatment of this illness became available.

So far, so good, right? In the younger woman's case, she was somewhat embarrassed to be contacted about her weight issues, but ultimately agreed to participate in the program. My family member, however, found the contact worrisome. She is proactive about her healthcare and has a great relationship with her doctor, who sees her immediately whenever her condition flares up and monitors her medication intake.

This relative is concerned that the health coach will ultimately become the first line of defense, putting her doctor-patient relationship at risk. She's fearful that if she establishes a rapport with a coach, her insurance company may one day refuse to cover some of her doctor visits, something she's not willing to risk. She also believes she is knowledgeable enough about her condition to know that changing her behavior is not going to make her condition go away.

She feels she's become a name and an illness on a list somewhere, and is being unfairly targeted for her health condition. She is scared and angry and for now has decided to ignore the letters from the health coach. But she's worried about the future ramifications of this new approach.

I admit I hadn't really thought about it from this perspective—how it feels to get a call from the coach. Health coaches are doing a wonderful job of recruiting that 20 percent of the population who generate 80 percent of healthcare costs, often by refusing to adopt healthy lifestyles. You'd think most people would be happy to have an additional line of support. But if the patient is succeeding as a free agent, must we force them to be a team player? I'm interested to hear how coaches---and health plans---are reassuring members about this issue.

Incentives for Helpful Lifestyles?

September 6th, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

Given the desperate conditions in the southeastern part of the country, it is trite to grouse about rising gas prices. Paying $3 to $6 per gallon is painful, but a mere pinch compared to the despair and devastation engulfing our southern neighbors. However, we all feel powerless in the wake of conditions beyond our control. We are chastened as we watch the fallout from Hurricane Katrina, situated as we are less than two miles from the Atlantic Ocean and perhaps a nor'easter away from a similar catastrophe.

Most of us will be moved to contribute financially and maybe even personally to the Hurricane Katrina relief effort. But perhaps there's a little something more the average person can do in response to this disaster to send a message. Maybe we can leave the gas guzzler (which with current gas prices pretty much includes all makes and models) in the driveway, open our garages and dust off our bikes. Maybe we can turn off the computers and take our children for a walk downtown, to the park or just down the street. Maybe we can skip our daily latte or Friday night pizza and movie for the next month or two and throw the resulting savings in a jar to send to the relief effort.

A by-product of this effort might be just what the doctor ordered---some healthy lifestyle changes. With childhood obesity increasing at alarming rates, it's the right time for everyone to up their daily exercise quota. Substituting a healthy home-cooked meal for that pizza can't hurt, either. Perhaps healthcare organizations already offering incentives for healthy lifestyles can up the ante for those motivated to change right now---for example, by making a contribution to the hurricane relief effort in the name of each member who pledges to stop smoking and start walking.

And while we're modifying our behaviors, we should take a moment to talk with the people in our lives---our children especially---about caring for their neighbors and the importance of knowing right from wrong, even in the most dire circumstances. We never know when disaster---natural or otherwise---is going to strike. Because after the loss of lives, the most devasting effect of Hurricane Katrina is the failure of the human spirit.