Wednesday, July 12, 2017

ONC Set to Address Information Exchange, Compliance Burden

Can too much information and/or data be a bad thing?

Reducing the burden of electronic health records (EHRs) on physicians and promoting health information sharing will be the major priorities of the Office of the National Coordinator for Health Information Technology (ONC) going forward, Donald Rucker, MD, the new national coordinator, told reporters at a news conference today.
Interoperability between EHR systems has long been at the top of ONC's agenda, but the emphasis on EHR usability and lowering the administrative burden on small practices has not. Dr Rucker noted that, along with interoperability, this goal is very important to Tom Price, MD, Secretary of Health and Human Services (HHS). In introducing John Fleming, MD, deputy assistant secretary for health technology reform, HHS, at the press conference, Dr Rucker also observed that Dr Fleming, a former solo practitioner in Louisiana, is the first senior-level HHS appointee "who represents small practices."
Dr Fleming said that he'd heard many complaints from doctors and patients about physicians' inability to focus properly on patient care because of the administrative requirements they had to meet, including EHR documentation. One reason for this regulatory burden, he said, is Medicare's guidelines for documentation of evaluation and  management (E/M) codes, which were formulated in the 1990s, before most physicians had EHRs.
"Now that EHRs are online, we see how the two [EHRs and E/M coding guidelines] create even more problems: we get voluminous, sometimes nonsensical health notes that can be unreadable or make it difficult to determine where the real information is," he noted.
The challenge of improving EHR usability, Dr Fleming continued, goes beyond the technology itself: it also involves the fee-for-service reimbursement system, which forces doctors to document their work in certain ways in order to get paid.
Dr Rucker agreed. "The CPT [Common Procedural Technology] rules were done in an era before computers, so it's time to rethink that," he said. ONC, he added, is working with the Centers for Medicare and Medicaid Services (CMS) to look at how the burden on physicians might be reduced.
However, Dr Rucker noted, CMS has to balance EHR usability against "honest fair payments" to doctors and program integrity. Later, responding to a question from Medscape Medical News, he said, "Part of what [CMS] is looking at is the interaction of the coding system with the provision of care and the burden of documentation."
While he declined to say whether changes in the E/M coding system were being contemplated, he said CMS is considering how it could help developers design smarter EHRs that would make it easier to document visits.

In addition, Dr Rucker said, ONC is looking at ways to ease the burden on practices of quality reporting in the Merit-Based Incentive Payment System (MIPS). "For a lot of practices, this has become a challenge," he pointed out. "At some point, the expense of complying with the quality measures is much greater than the value of the quality measures."
Interoperability between EHR systems has long been at the top of ONC's agenda, but the emphasis on EHR usability and lowering the administrative burden on small practices has not. Dr Rucker noted that, along with interoperability, this goal is very important to Tom Price, MD, Secretary of Health and Human Services (HHS). In introducing John Fleming, MD, deputy assistant secretary for health technology reform, HHS, at the press conference, Dr Rucker also observed that Dr Fleming, a former solo practitioner in Louisiana, is the first senior-level HHS appointee "who represents small practices."

ONC Set to Address Information Exchange, Compliance Burden

Thursday, May 25, 2017

A Diagnosis for Personalized Medicine

Eric Topol M.D., soon followed by Barak Obama coined the term 'personalized medicine' (PMx).  It’s been about 16 years since Genentech launched Herceptin, a drug for breast cancer patients with a specific genetic mutation. At the time, Herceptin seemed to usher in a revolution for how drugs would be developed and patients would be cured.

In that new version of care, drugs could be tailored to a patient’s specific biochemical profile, dramatically improving efficacy rates and reducing the system-wide costs and complications associated with one-size-fits-all medications. For pharmaceutical manufacturers, this approach had the potential to improve sales and profits through a radically new business model: differentiated products for segmented populations (see “A Strategist’s Guide to Personalized Medicine,” by Avi Kulkarni and Nelia Padilla McGreevy, s+b, Winter 2012).

But despite the occasional success story, PMx is largely seen today as the dog that did not bark. With a few exceptions, such as Herceptin, there are few PMx success stories. This is true for several reasons. 

Health insurers remain unconvinced of PMx’s merits. One would expect these companies to push hard for personalized medicine, considering that they are the main beneficiaries of more efficient healthcare. Yet most payors seem to believe that the economic benefits of PMx are relatively small. The few PMx-based therapeutics now on the market are much more expensive than conventional therapies—and the prices don’t always translate to proportionately better outcomes, such as higher survival rates. For example, Bristol-Myers Squibb released a new metastatic melanoma therapy called Yervoy in the U.S. in 2011. Yervoy costs US$120,000, but in Phase III trials, it added only about 3.7 months of survival time.
In addition, many pharma companies have been hesitant to make the necessary investments in personalized medicine. The steep costs required, including best-in-class PMx development and commercialization capabilities, seem out of proportion to the small markets for each drug. Cancer drugs are the exception, but pharmaceutical companies have focused less on the genetic causes of other diseases. That makes PMx a costlier and riskier proposition.

Finally, the reason success stories are so rare is a notable reluctance among physicians to adopt PMx. Medicine is a cautious discipline, understandably, and in some cases PMx requires practitioners to dispense diagnoses and treatments based on complex molecular changes. For example, in the 10 years since Genomic Health launched its pivotal Oncotype DX test, which can determine the recurrence risk of breast cancer and assess the likely benefit of certain types of chemotherapies, it has faced steep resistance from the medical community. Even though Oncotype DX has been proven as medically relevant technology, and been widely reimbursed by payors, analysts estimate that it is used on only half of all eligible patients.
Despite the promise of fewer and less serious complications than toxic chemotherapy using PMx to treat malignancy, they have other and even more serious side effects causing heart, and liver disorders.

There is much more to be done until this methodology enters the main stream.

A Diagnosis for Personalized Medicine

How to Choose the Right Digital Marketing Model

Every time you use a digital tool such as televideo, telehealth and remote monitoring it says something about your medical practice.  Investigate several companies to be certain you have the most useful system for your purposes.

Digital marketing can be as simple as a web site. Or it can be complex.

Modern consumer industries use techniques that seem foreign to health care.  However consumers (patients) are already conditioned to techniques used by retail sales such as  Amazon, Best Buy, or other players.  While foreign to physicians, patients are comfortable with digital media marketing.

It is well worth investigating, and it could mean a difference in the 'bottom line'.  Medicine has become entrapped in commerce.  Just about every vendor your practice interfaces has a digital marketing media presence, from advertising of devices, drug to purchases, and support.

A brief chart outlines a method of deciding what you need in designing your digital marketing media program.

Look at virtually any consumer industry and you’ll see how changes in digital technology are fundamentally altering the way that consumers engage with brands before, during, and after a purchase. Consumers today expect to browse, research, solicit feedback, evaluate, and push the “buy” button at their own pace, and at the time and place—and via the platform—of their choosing. Consumers also continue to engage with brands online after a purchase and to share experiences with one another. Much of this consumer journey is beyond the direct control of companies, and marketing organizations are sprinting merely to keep pace.
The difficulty is that there’s no one set of capabilities that applies universally. Companies must identify what kind of marketing organization they need to make their strategy a success, choose a digital marketing model based on their strategic objectives, and then focus on developing a handful of marketing capabilities that will allow them to bring that model to life and consistently excel.
This requires the physician to use both IT, perhaps social media and marketing techniques already in use.  Eventually the majority of marketing may become digital.  Change is inevitable, the Yellow Pages are long gone as a source of marketing.  Be prepared for change. Even modern new digital methods could be replaced by another innovation.   Keep current with market preferences.  Consumers (patients) will follow market leaders.  They are not going to use outmoded methodology in healthcare.

Four Digital Marketing Models

Strategy& has identified four equally successful digital marketing models: Digital Branders, Customer Experience Designers, Demand Generators, and Product Innovators. A company’s focus for marketing investment might have elements of each, but odds are that one of these models represents the right marketing organization for your company.
• Digital Branders are most often consumer products companies or other marketers that focus on building and renewing brand equity and deeper consumer engagement. 
• Customer Experience Designers use customer data and insights to create a superior end-to-end brand experience for their customers. 
• Demand Generators (typically retailers) focus on driving online traffic and converting as many sales as possible across channels to maximize marketing efficiency and grow their share of wallet. 
• Product Innovators use digital marketing to identify, develop, and roll out new  products and services. 

For more specifics refer to:
 Summer 2014 / Issue 75 (originally published by Booz & Company)

How to Choose the Right Digital Marketing Model

Med2-Harnessing the Web: How E-Health and E-Health Literacy Impact Young Adults’ Perceptions of Online Health Information | Medicine 2.0

Harnessing the Web: How E-Health and E-Health Literacy Impact Young Adults’ Perceptions of Online Health Information


Background: The rise of technology has changed how people take control of their health, enabling individuals to choose to live healthier lives and make better treatment decisions. With this said, the Internet has emerged as the channel used by individuals for actively seeking or passively receiving health information.
Objective: To explore how young adults assess the quality of health information, and how they construct meaning of online health information in general. Through 50 in-depth interviews, this study aims to examine how and why young adults turn to the Web for health information, and what strategies they employ to ensure that they are getting credible information.
There is a dichotomy between young adults and senior citizens and how they seek out health information.  Although there was a huge difference between the young and mature or senior demographic, the gap of health literacy has diminished during the past five years..
Normal business transactions, shopping, bill paying, social media have drawn in common daily activities to the internet. Social media has also played a large part in this transaction. The findings of this study may well apply to other segments of the population.
Methods: A total of 50 in-depth interviews were conducted with young adults to explore how they make meaning of online health information. Depending on the geographic area of the participant, the interview took place face-to-face at a location convenient for them, over Skype, or over the telephone and lasted on average 40 minutes. The interviews were transcribed verbatim, fully retaining the speech style of the moderator and the participants. Data were analyzed using techniques from the grounded theory approach, using a constant comparative method to allow for themes to emerge from the transcripts.
Results: The participants shared several benefits to this mode of health information seeking, claiming that it made for more productive visits with doctors and made health information more readily accessible through a variety of different formats. Additionally, the participants demonstrated their e-health literacy levels by discussing how they assessed online health information, engaging in a series of strategies that encompassed different aspects of e-health literacy. Social media channels were brought up by the participants as relatively new tools that can be used to assist in the seeking, understanding, and sharing of health information. However, participants also cautioned about the use of social media in regards to its informal nature, warning users to evaluate sources accordingly and to use these channels as supplementary outlets of information for more traditional channels.
Conclusions: The use of the Internet and technology for health purposes is a growing area for both scholarship and practice that has strong implications for health consumers, medical professionals, and communicators alike. The findings that emerged from this research demonstrated that the online space is an acceptable channel through which young adults can find and share information. However, in spite of the rising usage of social media by this particular group, the findings showed that they were hesitant and wary of the channel, not seeing it as a resource for health information but more of a channel for networking and entertainment. In spite of this, this study shows that the online health information seeking behaviors is an area that warrants further exploration.

  1. Promoting Participatory Medicine With Social Media
    Linda M. Gallant, et al., Medscape, 2011
  2. Electronic Personal Health Records that Promote Self-management in Chronic Illness
    Beverly Mitchell, BScN, MSN, RN, et al., Medscape, 2010
  3. The Zeitgeist of Online Health Search 
    Daniel P. Lorence, PhD, JD, et al., Medscape, 2006
  4. Legislative: Nursing's Engagement in Health Policy and Healthcare Through Social Media
    Pamela Katz Ressler, BSN, RN, HN-BC, et al., Medscape,2010
  5. Psychiatry Via the Internet: Benefits, Risks, and Perspectives 
    Robert S. Kennedy, Site Editor/Program Director, Medscape Psychiatry & Mental Health, et al., Medscape,2001