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Four benefits of electronic health records

Leaders from industry, academia, and health care discuss the rollout of this technology at The Atlantic’s sixth annual Health Care Forum

Today The Atlantic Health Care Forum brought together leading policymakers and industry experts in medicine, public health, and nutrition to have conversations about the state of the nation’s health care system. The event was sponsored by Siemens, Surescripts, WellPoint, GSK and PhRMA. Real World Health Care attended to share insights from the panel “Health Care Tomorrow: Examining the Tools and Technologies that Will Revolutionize the Future Health Care System.”

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Much of the discussion centered around electronic health records, which are increasingly being rolled out in huge hospital systems after the federal government incentivized their adoption to the tune of billions of dollars five years ago. Four themes emerged from the panel, which included top executives from Johns Hopkins Medicine, athenahealth, PhRMA, and Carolinas HealthCare System.

 

1. Enhancing collaboration.

Electronic health records facilitate a team-based approach to hospital care, as well as allowing for better coordination between hospital systems. “What we’re going to see is it’s going to drive team-based clinical care because everyone in the system will have access to the same medical records,” said Dr. Paul Rothman, Dean of the Medical Faculty and Vice President for Medicine at The Johns Hopkins University and Chief Executive Officer at Johns Hopkins Medicine. “You’re going to see an [increased] level of collaboration not only between delivery systems, but also between the patient and the health care provider.”

However, Ed Park, Executive Vice President and Chief Operating Officer, athenahealth, warned that the decades-old technologies that many hospital systems are using are limited in their capabilities. “The current crop of [electronic health records] are documentation tools instead of care management tools,” he said, adding that they are primarily for use by insurers and lawyers. “What I fear is health systems beginning to buy their way into their own prisons that are built of their own IT…as opposed to dealing in an open environment,” he said.

 

2. Enabling patient-centered care.

Electronic health records enable patients to reap greater benefits from telehealth. “Having your information on your iPhone: that’s not far away,” Dr. Rothman said. “[Patients are] going to do EKG’s at home. They’re going to be measuring their blood sugar at home. The patient will have control of the data.”

Electronic records also hold the promise of helping to solve age-old problems in the U.S. health care system, including keeping contact with patients to encourage them to take prescribed treatment regimens. “There is almost $350 billion a year in inefficiency because of lack of compliance and adherence with medications,” said John Castellani, President and Chief Executive Officer, PhRMA. “If you could just get an improvement in whether patients take the medicines that are prescribed, you could capture this great savings.”

“You have kids who have kidney transplants, and you can give them reminders on Facebook that they have to take their medications,” Dr. Rothman added.

 

3. Targeting therapies for increased success.

Electronic medical records can help health care providers ensure that they prescribe the treatments most likely to work for their patients.

“What I think is the promise of electronic medical records is our ability to find subsets of diseases through the broad diseases we treat,” Dr. Rothman said. “Asthma isn’t one disease. Obesity isn’t one disease. Diabetes isn’t one disease. We are going to be able to find subsets of diseases and target therapies [that work]. That’s when you’re going to see efficiency and return on investment.”

 

4. Harnessing the power of big data.

Our health care system has already begun to see the benefits of ‘big data’ with examples such as the discovery of drug side effects and interactions through mining consumer web search data. “We have to use the technologies to bring down the cost of the drug discovery process,” Castellani said.

“Just taking care of the patient, we capture data,” said Dr. Roger Ray, Executive Vice President and Chief Medical Officer, Carolinas HealthCare System. “That allows us to know when a patient…may be at risk for hospital readmission. Having the ability to mine [data]…makes a difference for patients.

“We all, each of us, remember with longing a simpler time when we could scribble and walk off and our job was done,” he added. “What we know now is that’s not very good for the patient. We had no standardization allowing us to help patients avoid lots of different bad outcomes they could have.”

 

Have electronic medical records impacted your health or that of your patients? Share your thoughts in the comments section.

Patient Advocacy Group Shares Solutions to Fuel Greater Participation in Workplace Wellness Programs

Workplace wellness is not a new concept, but it is definitely one that is recently gaining more importance.

With non-communicable diseases on the rise, many people are becoming more concerned about what lifestyle choices can be made to avoid them and stay healthy. Furthermore, businesses recognize the cost of stressed, out of shape, non-productive employees: increased health insurance costs,absenteeism, retention problems, and loss in productivity. Trying to take a more active role in the health of their employees, employers are creating and implementing wellness programs that encourage healthy behavior. Through incentives and rewards, companies are encouraging their employees to make healthy lifestyle choices like eating well and exercising regularly.

Melissa Kostinas

Melissa Kostinas

Despite the benefits of these programs, their success and sustainability can only be achieved through employee participation – which has been a challenging feat for many employers.  Without high participation, programs will result in limited return on investments for employers and might discourage them from implementing other programs in the future.  Because of this risk and the tug of war between cost and benefits, some companies find it too difficult and futile to implement workplace wellness programs.

Fortunately, there are solutions that help employers increase participation. First and foremost, companies should be focusing on the employees themselves – their needs, schedules, and interests – and design programs tailored to these considerations.

Employers should ask their employees: What gets you healthy? What motivates you to do what everyone knows is healthy behavior? We all have reasons for not doing what we know we should – time, access, knowledge, and cost. All these factors contribute to our denial.

Employees are busy, so the more a company can incorporate healthy eating and activity into existing schedules the more likely they are to embrace them. Easy access to workplace wellness programs makes a big difference. Onsite, or nearby programs offered during breaks or outside work hours also are great ways to tackle the time and access excuses.

Information and knowledge, while seemingly obvious, helps to motivate employees too. Of course we know we should exercise, but do your employees know that physical activity helps to prevent back pain?  It increases muscle strength and endurance, and improves flexibility and posture. With this knowledge, maybe the next time they get that twinge in their lower back they might think about exercise instead of painkillers. Providing reduced or no-cost programs will also boost participation rates. Coupled with incentives, like bonuses or rewards (e.g. allowing employees to trade in some of their unused sick days at the end of a year for an extra vacation day), rates of participation are likely to increase.

There are also management steps that can be taken to increase and maintain participation.

Unless employers are committed to employee wellness, the workplace wellness program becomes another ineffective plan that sounded good on paper but never achieved the anticipated results. The executives at Valley Health System understood the importance of managerial commitment. When they created Valley Health Workplace Connection the program managers worked closely with the health system’s managers to make sure all higher-level staff understood the importance of their involvement. Today, Valley Health Workplace Connection is a very successful workplace wellness program with high participation and employee satisfaction.

To ensure such success, workers from all levels should be actively engaged in programs. Planning should include processes to maintain communication with staff and the creation of program committees to guide intervention, observe participation, and adjust programs accordingly.

Additionally, program designers should consider all the major health risks in their targeted population as well as their business’ needs. Different programs should be offered at different levels, depending on characteristics of the recipients. The key is integrating health into the business. Policies governing the workplace wellness program should align with the organization’s mission, vision and values. They must affirm and communicate the value of good health and show commitment to engage workers in health enhancement. Again, a program is only effective if it reaches the intended audience and motivates them.

Pfizer recognized this and found that using programs like Keas got their employees more involved because it was engaging but less invasive. By making wellness a challenge and incorporating games and goals into the plan, Pfizer overcame the primary challenge in any wellness program — participation.

The bottom line is that wellness programs are gaining steam, but there are challenges. Having the support of management and creating a program that meets your employees’ needs will allow your program to overcome those challenges.  Be creative and remember: Wellness can be fun.

August Health Awareness Days Provide Opportunities to Take Action

As young people across the country go back to school, patient advocates and government stakeholders are leveraging awareness days to help communities learn about health issues impacting children, prevention strategies and efforts to improve care. Here are some examples:

Children’s Eye Health and Safety Month
Each August organizations including the Envision Foundation underscore the need for screenings and examinations to promote early detection, intervention and prevention of vision problems in children.

Paul DeMiglio

Paul DeMiglio

Vision disorders in children cost Americans more than $5.7 billion in direct and indirect expenses each year, while the overall cost of vision problems nationwide soars to an estimated $139 billion (includes long-term care, productivity loss and medical bills), according to Prevent Blindness America. Treating eye disorders and vision loss early in life helps protect children from developing chronic, lifelong conditions that become more expensive to treat because of long-term, indirect costs that increase as populations age.

“The beginning of a new school year is an exciting time in a child’s life,” Hugh R. Parry, President and CEO of Prevent Blindness America, said in a statement.  “By working together with parents and educators, we hope to give all our kids a bright and healthy start!”

National Immunization Awareness Month
According to the Centers for Disease Control and Prevention (CDC), the National Public Health Information Coalition (NPHIC) highlights the need to improve national immunization coverage levels throughout August. To communicate the importance of immunizations now and throughout the year, NPHIC also developed a toolkit tailored to various populations including babies and pregnant women, pre-teens and teens, young adults, and adults. The toolkit seeks to:

  • Encourage parents of young children to get recommended immunizations by age 2.
  • Help parents ensure older children, preteens and teens have received all recommended vaccines by the time they return to school.
  • Remind college students to catch up on immunizations before they move into dormitories.
  • Educate adults, including health care workers, about vaccines and boosters they may need.
  • Urge pregnant women to get vaccinated to protect newborns from diseases like whooping cough.
  • Raise awareness that the next flu season is only a few months away.

The CDC also makes a wide array of resources available for those who want to learn more about the importance of immunizations or spread the word.

Neurosurgery Outreach Awareness Month
The American Association of Neurological Surgeons (AANS) is among the organizations that underscores why the beginning of the school year is a great time to educate communities about strategies to prevent sports-related head and neck injuries like concussions. AANS provides tools to help others more effectively identify symptoms of potentially serious head/neck injuries and take preventive steps to ensure safety, also offering the following tips:

  • Buy and use helmets or protective headgear approved by the American Society for Testing Materials for sports 100 percent of the time.
  • Remain abreast of the latest guidelines and rules governing sports with a high prevalence of head injuries including cheerleading, volleyball, and soccer.

“Concussion awareness, understanding the symptoms of a potential concussion or other traumatic brain injury, is critically important in all sports,” AANS Public Relations Committee chair Kevin Lillehei, MD, FAANS, said in a statement. “Educating the public is one of the best weapons we have when it comes to combating these types of injuries. That is why it’s so important to raise awareness in the community and explain just what some of the effects are that these injuries have.”

Psoriasis Awareness Month
Sponsored by The National Psoriasis Foundation each year, Psoriasis Awareness Month is dedicated to “raise awareness, encourage research and advocate for better care for people with psoriasis.”

The most common autoimmune disease in the US affecting 7.5 million Americans, Psoriasis occurs when the immune system sends out faulty signals that speed up the growth of skin cells and produce red, scaly patches that itch and bleed. About 20,000 children under 10 are also diagnosed, often experiencing symptoms that include pitting and discoloration of the nails, severe scalp scaling, diaper dermatitis or plaques.

As part of Psoriasis Awareness Month, NPF is creating a community of “Pscientists” to “answer real‑world questions about psoriasis and psoriatic arthritis.”

Spinal Muscular Atrophy Awareness Month
Although it’s considered a “rare disorder” with approximately 1 in 6000 babies born affected by it, Spinal Muscular Atrophy (SMA) is a motor neuron disease that causes voluntary muscles to weaken and in some cases can lead to death, according to the National Institutes of Health’s (NIH) National Institute of Neurological Disorders and Stroke (NINDS). Types I, II and III belong to a group of hereditary diseases that weaken the voluntary muscles in the arms and legs of infants and children, contributing to breathing issues, difficulty eating and drinking, impaired mobility and orthopedic complications.

Families of SMA, which has coordinated activities around SMA Awareness Month since 1996, and the Muscular Dystrophy Association (MDA), are two national organizations that support those living with SMA. Click here to learn about events this month, community networks and research projects for treatment and therapies.

What activities are taking place in your community to support one or more of these awareness days? What could the institutions in your neighborhood, workplace or at your school be doing year-round to more effectively engage populations about critical health issues?

Categories: Access to Care

Does More Data = More Accurate Results?

Every year U.S. News & World Report comes out with its “Best Hospitals” rankings, and providers wear them like a badge of honor. No doubt the recognition is prestigious. But how many people know why hospitals are ranked as they are? We decided to dig a little deeper and break down the methodology behind the rankings. What we found might surprise you.

Paul DeMiglio

Paul DeMiglio

“Best Hospitals” scores top hospitals across 16 specialties, from Cancer to Urology. For 12 of the 16 specialties, the rankings are based on performance measurements in structure, process and outcomes. Rankings in the remaining four specialties are based on hospital reputation as determined by a physician survey.

The methodology has evolved since the list was first published in 1990, transitioning from a heavy reliance on the reputation of hospitals (based on surveys of medical specialists) to incorporating more hard data to determine which providers make the cut. In an effort to increase accuracy and develop more objective, higher scoring methods, U.S. News & World Report moved away from expert opinion as a major factor of its criteria. Reputation now comprises only 32.5% of the overall score, except for hospitals in the areas of ophthalmology, psychiatry, rehabilitation and rheumatology.

The clinical data now used as the primary basis to rank hospitals measure patient outcomes and processes of care, based on factors including mortality, nurse staffing and advanced technologies. Hospitals also have to meet specific minimums for patient volume and are immediately considered high performing if they have a specialty like cancer or cardiology, among many others.

The power in this report lies in the objectivity as well as the information sharing from multiple, well-respected health care organizations and databases that exist as treasure troves for comprehensive patient information. The continuum of survey strategy — structure, process and outcome — defines essentially every step of the patient experience, from diagnosis to treatment to outcome.

For decades, much of patient care revolved around anecdotal teachings and recommendations. Hospital choices for individuals with complicated conditions often occurred subjectively and by word-of-mouth from both patients as well as caregivers. The strength in the “Best Hospitals” study design lies in the breadth of specialties, objectivity, number of hospitals, as well as the reachability and understandability of the results to the general public.  As the number of survey variables continues to increase by virtue of an aging population and the emergence of newer diseases and a greater number of treatment options, survey criteria will evolve and may correlate patient cost to outcome.  In other words, how much health care bang does one get for the buck?

For a detailed overview of the methodology behind “U.S. News & World Report’s Best Hospitals,” click here.

Is this system for ranking hospitals as objective as it could be? Does making the qualification guidelines more data-driven increase the reliability of the outcomes?

This is Not Your Father’s Oldsmobile, Nor Your Child’s Social Network

David Sheon

David Sheon

Does social networking conjure images of teenagers who share seemingly worthless online videos of watermelons dropped from atop buildings? Well get this:

Americans OVER age 45 represent the largest percentage increase in social media usage in the past year, now up to 38 percent in 2012, compared to 31 percent in 2011 (Source: Edison Research).

What does this mean for improving health care outcomes?  At least one analysis finds a prolific growth in online patient communities, where peers help one another find solutions, determine the right time to go to the doctor, and essentially crowd source solutions to their problems.

Many social networks specifically for patients have launched using a number of different business models.  Here are just a few:

  • Inspire has social networks for patients with various diseases and health conditions, each sponsored by health organizations.
  • The Mayo Clinic has created a platform for patients with various diseases, not limited to the 500,000 patients treated at the Minnesota-based hospital system annually.
  • Patients Like Me is a web-based portal for patient-to-patient communication that was started by two brothers at MIT.  They pledge complete transparency in terms of funding sources.
Are social networks resulting in better outcomes or improved access? Any success
stories out there you’d like to share? What are some of the best sites for connecting with others who have similar health conditions?

Categories: Access to Care