Porter Research Industry News Porter Research RSS Feed http://porterresearch.com/ <![CDATA[What Does the Future Hold for Innovation in Healthcare?]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/May/Tweet_Chat_Storify.html May 10, 2012 location.href="http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/May/storify.html" ]]> <![CDATA[IBM’s Watson Moves from Boardroom to Bedside]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/April/IBMxs_Watson_Moves_from_Boardroom_to_Bedside.html April 25, 2012
After announcing healthcare partnerships last year with Nuance and WellPoint that, respectively, served to advance Watson's back-end advanced analytics capabilities and front-end commercialization opportunities, the company announced a formal advisory board earlier this year that will help steer Watson's role in changing clinical outcomes for the better.

watson

"The purpose of the Watson Healthcare Advisory Board is to provide IBM with insights on healthcare issues that could be positively impacted by Watson technology adoption," explains Stephen Gold, IBM Watson Solutions' Global Strategist. "The advisory board will specifically look at medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows.

"While IBM has a global team of healthcare industry professionals including 4,000 professionals and 60 medical doctors, we felt it was important to actively engage the medical community, especially as it relates to best practices, incorporating IBM Watson into physician workflow and understanding in what specialties Watson could be most effectively applied."

Their first challenge will likely be weighing in on IBM's recently announced Watson project with Memorial Sloan-Kettering Cancer Center. The initiative will enable MSKCC to develop "a powerful tool built upon Watson to provide medical professionals with improved access to current and comprehensive cancer data and practices," according to IBM's recent press release. "The resulting decision support tool will help doctors everywhere create individualized cancer diagnostic and treatment recommendations for their patients based on current evidence."

In a press release announcing the initial nine board members - who include industry experts from the fields of academia, primary care, oncology, biomedical informatics and medical innovation - IBM noted they will "specifically focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows."

Porter Research recently talked with three of the newly appointed board members about why they chose to lend their expertise to this project, and what specific areas of care they'll help Watson to focus on.

Informing New Cancer Care Models
The focus on oncology is certainly imperative, as cancer is currently the second-leading cause of death in America. "Vast volumes of cancer treatment information and clinical research being generated every day," says Gold. "However, not every oncologist has access to the latest treatment information and evidence-based guidelines, and not every oncologist can focus on sub-specialties of the disease."

Dr. Steven Shapiro, Chief Medical & Scientific Officer at the University of Pittsburgh School of Medicine, has worked collaboratively with IBM for a number of years via UPMC, and took a seat on the board because of the great potential he sees artificial intelligence and analytics bringing to healthcare, including cancer treatment.

"I am an internist and pulmonary and critical care physician by training," Shapiro explains. "However, as CMSO, I have a broad palette that includes changing our primary care system to become patient-centered and accountable.

"We also have a large cancer center for which we are also developing new care models aimed at improving outcomes and decreasing costs," he adds. "Our new models are built on good science and smart technology. That is, we are building a central data warehouse with all of our clinical provider, payer, financial and genetic/genomic information. We hope to apply advanced analytics, including Watson, to test and optimize our clinical models and develop personalized medicine matching genotype and phenotype to develop biomarkers.

"These biomarkers will be used to segregate benign from severe disease. These biomarkers will give us insight into disease susceptibility, course and treatment. This will benefit healthcare reform by preventing overdiagnosis and overtreatment in those with benign disease, allowing us to focus on developing new therapy for those with severe disease."

Shapiro will likely be paying close attention, and perhaps even weighing in, on health insurer WellPoint's intent to utilize Watson as part of its recently announced work with Indiana University's Melvin and Bren Simon Cancer Center to develop new diagnosis and treatment solutions. The project seems similar in scope to the MSKCC initiative, with a goal of creating commercial clinical solutions utilizing Watson's capabilities that will enable clinicians to evaluate evidence-based treatment options that can be sent to a physician for assessment in a just a few seconds.

Creating New Clinical-Decision Support Tools
Shapiro's colleague, Dr. Herbert Chase, Professor of Clinical Medicine (in Biomedical Informatics) at Columbia University and director of the Medical Decision-Making curriculum at Columbia's College of Physicians and Surgeons, is a big believer in the impact clinical decision support tools like Watson can have on quality care outcomes.

"The possibilities of sophisticated clinical-decision support or personalized medical therapy are now within our reach because of Watson's breakthrough technology that nearly instantaneously retrieves best and salient evidence," says Chase. "By joining the advisory board, I can both help IBM develop the projects that will have the greatest impact on outcomes, as well as feel that, at some level, I played a role in improving the health of patients worldwide."

"What tools can we build to assist physicians in making the correct diagnosis as soon as possible, or finding the appropriate treatment for a complex patient with several illnesses, often on numerous medicines," Chase asks. "Watson will assist in both areas (diagnosis and personalized treatment) by retrieving the relevant information, either from the literature or the electronic medical record, essential to a sophisticated clinical-decision support tool."

Prioritizing Patient-Centered Medical Homes
Dr. Michael K. Magill, Professor and Chairman of the Department of Family and Preventive Medicine at the University of Utah School of Medicine, is like Chase, an educator eager to incorporate resources like Watson into the curriculum of future healthcare professionals.

He is also enthusiastic about the potential he sees Watson holding for patient-centered medical homes. "I am very involved in implementing redesigned healthcare delivery," he explains, "especially via Care by DesignTM, the University of Utah's model for what has become known as the patient-centered medical home. A key component to improve care quality and reduce cost is enhanced use of clinical information to improve our understanding and implementation of effective care. Watson has the potential to greatly increase our ability to learn from care of populations of patients, and more quickly incorporate new learning into care to benefit those patients."

Making an Immediate Impact
All three board members believe Watson's potential to immediately impact patient care and outcomes will be derived from the technology's ability to help physicians reduce the time it takes to make correct diagnoses, improve medical outcomes by providing current practice guidelines, and reduce medical costs by reducing the number of unnecessary procedures or the use of ineffective medicines."Watson can be a first responder, a triage agent for health plans and providers," adds Shapiro. "Watson can be used for education. I would love for it to participate in residents' reports, where tough cases are discussed with trainees. However, the big deal will be when Watson can be used to provide deep analytics and help improve clinical care models."







]]> <![CDATA[Retail Health Clinics on the Rise]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/April/Retail_Health_Clinics_on_the_Rise.html April 12, 2012
But with their increasing use of health information technology (HIT), RHCs are quickly moving from being clinics of convenience to being helpful partners in the overall healthcare system. This beefed-up use of technology makes it easier for patients to keep their doctors looped into their health history.  

Although these clinics aren't intended to be permanent or full-service medical homes, they do offer a wide variety of services that supplement the preventative care patients receive from their primary care providers. For example, patients can go to RHCs for routine cholesterol and blood pressure screenings; a variety of vaccinations; or treatment of respiratory infections, allergies, or some skin conditions.

The clinics are also a more affordable avenue for people who need care, but find themselves outside of the healthcare system. Data reported by the American Academy of Family Physicians has estimated a $40 service in an RHC could potentially cost more than double that in a doctor's office, $120 in an urgent care facility, and $325 in an emergency room. Given that 16 to 27 percent of clinic patients have no health insurance, based on a 2011 RAND report, and only 39 percent have an existing relationship with a primary care provider, the lower cost could be beneficial not only to the patient's pocketbook, but in the prevention of potentially future healthcare costs associated with developing chronic conditions.

"Retail health clinics are a huge convenience to patients," said Mary Griskewicz, senior director of health information systems with the Healthcare Information and Management Systems Society (HIMSS). "They can be screened, get their flu shot, have a rash examined, and all of this is usually within 20 feet of the pharmacy where they can get medication."

The Rise of the Retail Health Center
When RHCs first entered the market, some in the healthcare industry pushed back. Even though they are staffed by qualified nurse practitioners and physician's assistants, many physicians contended they were inadequate clinical settings that should only be used in the most extreme circumstances. 

Now, however, that opposition is disappearing, and RHCs are flourishing. In a healthcare environment where greater access is often the name of the game, a growing number of industry leaders now see these clinics as valued partners in providing preventative and primary care services.

"You are starting to see a newfound cooperation in the marketplace between retailers and their local hospital systems and physician groups," said Thomas Charland, chief executive of Merchant Medicine, a research and consulting firm that tracks retail medical care service growth, related in a New York Times blog post earlier this year. "Physicians' resistance is slowly melting away."

The population of RHCs seems to have ballooned after two years of near-stagnant growth. Between 2010 and 2011, the number of these clinics rose by 11.2 percent to 1,355 nationwide. And, this trend shows no signs of slowing.

To date, retail drug stores, including Walgreen's and CVS, have been the RHC leaders, with their Take Care Clinics and MinuteClinics, respectively. Currently, Walgreen's has 350 Take Care Clinics nationwide, as well as 350 worksite locations. In addition, Walgreen's announced last month that it will expand its relationship with the Tufts health plan in Massachusetts. CVS also has a considerable RHC presence - 650 MinuteClinics and a plan to add 500 more over the next five years.

Other retail giants, such as Walmart and the grocery store chains Kroger and Safeway, have launched RHC efforts within the last year.

Major hospitals and health systems are also adding clinics in retail areas in an effort to meet patients where they live and work. Recently, the Mayo Clinic opened its "Create Your Mayo Clinic Health Experience" in Minnesota's Mall of America."Mayo Clinic believes healthcare in the future won't be limited to doctors' offices and hospitals. Medicine needs to adapt to peoples' changing needs, including seeing people where they are and when it is convenient for them," said David Hayes, M.D., the clinic's medical director, in an interview with FierceHealthcare. "Mall of America is the ideal gateway for many of Mall of America's visitors to access Mayo Clinic in non-traditional ways."

Connecting Patient Information
Despite being exempt from most Meaningful Use requirements and ineligible to receive incentive payments, HIMSS' Griskewicz said implementing an electronic health record (EHR) is the most important HIT solution an RHC can employ. The nurse practitioner or physician's assistant won't complete the same level of patient history intake as a doctor's office does, but an EHR allows them to document the encounter in some way. Patients can also potentially leave the clinic with access to an electronic copy of the record meant for his or her primary care physician.

According to Gabe Weissman, external relations manager with Walgreen's, the company jumped head-first into HIT and developed its own EHR. The system allows any Walgreen's nationwide to access a patient's health records. For example, a provider in one of the Take Care Clinics can access the health records of a Pennsylvania resident who needs healthcare while on vacation in Florida. 

"We're working to ensure patients realize there are alternatives to the emergency room. We've formed relationships so nurse hotlines in hospitals are aware of Take Care Clinics and can route people there for services that aren't appropriate for the ER," he said. "We make sure we're sharing records with primary care providers in the appropriate health system while filling a niche for slightly less emergent care."

Walgreen's also offers online appointment scheduling and recently launched an initiative through the social network Foursquare. Patients can use the smartphone application to electronically refill prescriptions, transfer prescriptions between Walgreen pharmacies, and schedule reminders to take medications.

The retailer's Take Care health system was recently awarded Pointclear Solutions' HIT Innovation Award for 2011 in recognition of its "innovation of online tools that allow patients, physicians and pharmacists to interact in near real-time, making patient health and wellness incredibly efficient for all participants, moving the healthcare industry dramatically forward," according to a recent Pointclear press release.

One big challenge to fully utilizing an EHR still remains. There is often limited coordination between the RHC and a physician's office or hospital. There simply are not enough resources available to safely and successfully link the RHC's system with the wide variety of EHRs used by other clinical settings in each geographic area.

"The one problem with this situation is that there isn't full EHR interoperability between pharmacies, hospitals and physicians," she said. "Even if retail clinics are using an EHR, if it isn't tethered to a physician's office, the doctors aren't getting the full picture."

The one exception is e-prescribing - the only Meaningful Use requirement that does affect RHCs. Using e-prescribing services, such as Surescripts' Clinical Interoperability, links provider, pharmacy and payer, and eliminates the need for pharmacies and physician offices to fax or mail prescription orders and patient information. Instead, with a few keystrokes, RHCs and providers can partner to compile more thorough patient histories that will lead to better, more efficient care in the future.

Griskewicz cautioned, however, that without proper staffing to fill the medication orders sent via an e-prescribing tool, the interoperability is ineffective.

More To Come
As quickly as RHCs are expanding, so are the HIT solutions to support them. Griskewicz predicted that most growth will occur with mobile technology, giving RHCs the ability to give patients their health information in easy-to-transport formats. The overall impact, she said, will be a positive effect on patient health and well-being.

"I encourage retail clinics. I encourage them to continue to use health information technology to work with outside organizations," Griskewicz said. "They should continue down this path as technology evolves to make these health services more convenient for patients. It's not just about bringing customers in and selling the candy on the shelves, but about improving the health of the patient."







]]> <![CDATA[Providers' Perceptions: AT&T's First CMIO a Big Believer in Mobile Health]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/March/Transforming_Healthcare_One_Mobile_Solution_at_a_Time.html March 20, 2012
Developments of note include the: AT&T Developer Center ForHealth - an open, cloud-based set of developer tools and infrastructure; AT&T Managed Tablets solution, which better enables enterprise or personal devices to be used in the healthcare space; and AT&T mHealth Solutions' Diabetes Manager, a patient self-management tool. Rounding out the list is the 2011 Frost & Sullivan Competitive Strategy Leadership Award, which the company won late last year for its work in the mHealth space.

Porter Research recently sat down with AT&T's first Chief Medical Officer Geeta Nayyar, MD, who still practices part-time and who was appointed by the company just last fall, to find out why the company, like one of its well-known competitors, has entered the healthcare space with such gusto, and how it is transforming the mHealth space.

attgeeta
Dr. Geeta Nayyar, CMIO at AT&T

Why has AT&T decided to place such an important focus on this particular area?
Dr. Geeta Nayyar: I think when it comes to our products and solutions, we're really looking to offer a technically integrated solution, as all the stakeholders in healthcare  position for an ACO-type model that's going to be fundamental to any sort of strategy going forward - whether they're trying to do policy mandates, or just become a better system and really make steps to advance care.

As we think about our role in healthcare, it's really about building off of our network. When you think about all of the problems we have in healthcare - disparate systems, providers that don't talk to each other, patients that don't have access, the need for more personalized medicine and more personalized care - we feel like our network really makes it possible to connect to all those points of care in a highly scaleable way.

Fundamentally, we have no infrastructure for any of it in healthcare right now - someone's building their own electronic medical record, someone's building their own health information exchange, or building their own apps. Just given the scale of our network, we believe we're able to put these in the cloud and bring these mobile devices to really connect at all points of care, so that when you as a patient go into a hospital setting, your providers are able to collaborate and actually get your information in real-time, and make that visit a better visit. Then when you go home, using a variety of our mobile health and telehealth solutions, you'll be able to use that information from the hospital to stay out of the hospital.

The whole idea here is that so many hospitalizations, so many adverse events, are happening today simply because of a lack of information. I think it's that simplicity - I don't think it has to be more sophisticated than that. It's really about connecting all those different data points.

It seems that AT&T is positioning itself as a strong advocate for open-source mHealth app development in order to bring about the connection of the different data points you spoke of. How do you foresee AT&T's Developer Center ForHealth impacting clinical outcomes?
When I see a diabetic patient, I follow a standard of care. I take care of them, make any adjustments that need to be made for their sugar that day, and then I say 'come back in six to eight weeks,' because that's the standard of care. I think the beauty of mobile apps is that they really help us as providers and patients go from just-in-case medicine to just-in-time medicine.

So if I'm able to have real-time insight into my patient's blood sugar through our Diabetes Manager app, or any other app that's built using our platform, and I can see that they're really high, then I'm gonna say 'no, I need you to come back in two weeks.' If I see that you're doing really well, I don't need to see you for another 12 to 16 weeks. So I think it's really changing the paradigm of practicing just in case.

The beauty of being able to do this just in time is that you're potentially averting an urgent care visit, an ER visit or a hospitalization. We all know about the costs in healthcare. We all know about the quality outcomes in healthcare, so it's really along those lines that I think mobile health is going to be valuable.

Obviously, not every physician, nurse or patient has access to the latest mobile health solutions. Many patients may not even be aware of them. How do you envision bridging this gap?
The reality is healthcare is so far behind so many industries. You can use your mobile device to get on Facebook, Twitter, make dinner reservations, basically look up anything you want. For healthcare, we can't even make an appointment in most cases. I think healthcare is still very much behind, but the opportunity I think for all of us is to just look at a lot of the lessons learned. There's often parallels made between the banking industry and a revolution happened there. People had similar concerns regarding their financial information that we're now hearing about healthcare - security, not wanting to put personal health information out on the web - and now I can't imagine banking any other way, doing everything online, through an app.

Healthcare is going to get there, but like some of the other industries who already went through this revolution, it's going to take some time. This idea of putting paper information into electronic form is revolutionary if you think about it, because it brings with it a host of other tools that can really transform healthcare. It's more than just getting a paper-based system scanned into a PDF. There's ample opportunity. There's room to have really big success, really quickly.







]]> <![CDATA[Porter Research / Billian's HealthDATA Form Strategic Alliance with Dodge Communications]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/March/Dodge_Partnership.html March 13, 2012
"Research and analysis are central components to any integrated communications campaign and are therefore vitally important to any client," said Brad Dodge, president and CEO of Dodge Communications. "Through this partnership, we are able to offer additional value-added services that will contribute to successful market awareness and stronger branding strategies as clients develop new products and comprehensive communications campaigns."

"Our partnership with Dodge Communications will allow us to continue to innovate and educate the healthcare IT market on the importance of communications research and measurement," said Cynthia Porter, president of Porter Research, which has conducted market research in the healthcare industry for more than 20 years.

About Porter Research
Porter Research - a Billian Inc. company - has for over 20 years worked diligently to understand and assess each client's unique needs and build a customized business-to-business research program to achieve desired goals. Combining unparalleled experience, proven methodologies and knowledge-based analysis, Porter provides the unbiased results that healthcare clients need to make informed strategic business decisions. For more information, visit www.porterresearch.com or call 678-282-1033.

About Billian's HealthData
Billian's HealthDATA - a Billian Inc. company - is the leading provider of comprehensive market intelligence on the healthcare industry, covering facilities across the continuum of care - from Hospitals to Long Term Care. Billian's dedication to providing high-quality data via products like the Portal, coupled with partner company Porter Research's custom market research services, provides customers with healthcare business intelligence about multiple markets in scaleable formats. For more information, visit www.billianshealthdata.com or call 678-569-4872.

About Dodge Communications
Dodge Communications is a full-service public relations and marketing agency serving the healthcare industry. Dodge's award-winning programs help companies build brand awareness, establish thought leadership and generate demand. For more information, visit www.dodgecommunications.com or call (770) 998-0500. The Dodge Communications Blog provides insights on the latest healthcare industry, marketing and public relations news and issues.

Contact
Jennifer Dennard
Porter Research / Billian's HealthDATA
678 569 4872
jdennard@billian.com







]]> <![CDATA[HIMSS12 Wrap Up: Healthcare IT Heads to Las Vegas]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/March/HIMSS12_Wrap_Upx_Healthcare_IT_Heads_to_Las_Vegas.html March 7, 2012
Following are some of our favorite shots from the show. View the full image gallery at our Facebook page.

HIMSS12 was a great show for healthcare IT market research. HIMSS12 was a great show for healthcare IT market research.

HIMSS12 was a great show for healthcare IT market research. HIMSS12 was a great show for healthcare IT market research.

John Lopex from Fox Rehabilitation wanted to learn more about healthcare IT market research at the Billian's HealthDATA party.

John Lopez from Fox Rehabilitation (above) and Matthew Browning from YourNurseIsOn.com (not pictured) were the big winners at our reception.

HIMSS12 was a great show for healthcare IT market research.

The HISTalk party was a great place for Porter Research to talk with folks about its bulletin board focus groups..

Lisa Reichard of Billian's HealthDATA, Greg Wilson of Salar, and Cynthia Porter of Porter Research had a great time at the HISTalk party. Billian's HealthDATA is proud to be a sponsor of HISTalk.com

The HISTalk party was a great place for Porter Research to talk with folks about its new bulletin board focus groups. The HISTalk party was a great place for Porter Research to talk with folks about its new bulletin board focus groups.

Micky Tripathi of the Massachusetts eHealth Collaborative wore a custom beauty sash to the HISTalk party; while Elvis entertained Erin Sweeney and Beth Friedman, both of the Friedman Marketing Group. Be sure to check out Porter Research's recent interview with Tripathi, " Massachusetts Looks to Medicaid for a Truly Sustainable HIE."

Jennifer and Amanda talked Elvis and healthcare IT market research at the New Media Meetup. Meaningful Use and healthcare IT market research were hot topics at HIMSS12.

Jennifer Dennard of Billian's HealthDATA and Porter Research, with Amanda Woodhead of emdeon, which had one of the cleverest giveaways at the show.

Don't forget to check out the rest at the Porter Research Facebook page!








]]> <![CDATA[Providers’ Perceptions: Accountable Care White Paper Now Available]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/February/Providersx_Perceptionsx_Accountable_Care_White_Paper_Now_Available.html February 23, 2012
This definition does not differ much from that already generally accepted by the healthcare industry. It also closely matches that established by Porter Research and Billian's HealthDATA for their recent study, " Providers' Perceptions: Accountable Care Organizations." Porter Research and Billian's HealthDATA fielded a primary market research program aimed at understanding healthcare providers' perceptions regarding ACOs.

The study, which drew upon the opinions of C-level healthcare executives representing predominantly acute-care hospitals and healthcare systems, ranging in size from single-facility organizations to organizations with more than 20 hospitals, illuminated a number of concerns these organizations have regarding preparing for and participating in accountable care business models.

Key findings from the " Providers' Perceptions: Accountable Care Organizations" white paper include:
  • While providers realize the importance of laying a solid IT foundation for a new, accountable care business model, they are struggling to balance the need to deliver quality patient care while reducing costs and enhancing revenue.
  • Hospitals are by far the greatest drivers of ACO formation, with their main reason for participation cited as an opportunity to increase market share.
  • Hospital-employed physicians will be key participants in ACOs.
  • Coordination of care is one of the most important provider initiatives for improving the health of the patient population within an ACO model.
  • Business intelligence and analytics technologies will be key tools in successfully laying a foundation for an ACO, as well as measuring its outcomes.

Fill out the form below to download the Providers' Perceptions: Accountable Care Organizations whitepaper:



About Porter Research
Porter Research - a Billian Inc. company - diligently works to understand and assess each client's unique needs and build a customized business-to-business research program to achieve desired goals. Combining unparalleled experience, proven methodologies and knowledge-based analysis, Porter provides the unbiased results that clients need to make informed strategic business decisions. Over the past 20 years, Porter's research team has conducted over 150,000 interviews with executives in a variety of industries: banking/financial services; consumer goods; high tech; healthcare; life sciences; retail; and utilities. With significant experience working with Fortune 500 healthcare companies, the Porter executive team has built a significant practice in the healthcare technology, provider, payer and life sciences sectors.

About Billian's HealthDATA
Billian's HealthDATA - a Billian Inc. company - is the leading provider of comprehensive market intelligence on the healthcare industry, covering facilities across the continuum of care - from Hospitals to Long Term Care. Billian's dedication to providing high-quality data via products like the Portal, coupled with partner company Porter Research's custom market research services, provides customers with healthcare business intelligence about multiple markets in scaleable formats.

Contact:
Jennifer Dennard
Social Marketing Director
jdennard@billian.com
2100 RiverEdge Pkwy, Ste 1200
Atlanta, GA 30328
678-569-4872







]]> <![CDATA[Perfecting the Art of the User-Friendly EMR]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/February/PointClear_Feature.html February 21, 2012
A recent study from researchers at the Department of Veterans Affairs' Health Services Research & Development Center for Excellence highlights the fact that too many EMR-based alerts force providers to wade through irrelevant data. The authors come to the conclusion that "inefficiencies in information transfer required PCPs (primary care physicians) to read through large amounts of extraneous text to find relevant information." In other words, this issue, which directly impacts patient care, needs to be addressed by software developers in the context of user experience.

Dr. Wen Dombrowski, Director of Clinical Informatics at Morris Height Health Center, can relate to the importance the concepts behind UX and UCD have when it comes to ensuring that providers can use their EMRs efficiently and effectively.

"Currently in my role, I am responsible for re-designing the EMR templates/User Interface (UI) to streamline provider workflow and improve quality, safety, documentation and billing," Wen says. "Long story short, the poor UI/UX of many EMRs is a significant barrier to use, with the flipside being improved UX will be welcomed by users and likely show benefits in quality outcomes."

Government bodies, such as the The National Institute of Standards and Technology (NIST), have placed a national spotlight on the importance that UX plays in not only easing providers' transitions to electronic record-keeping, but in getting them engaged. A strong user experience is definitely becoming a differentiator in healthcare software, especially as it relates to meeting Meaningful Use requirements

"Now more than ever, we're seeing providers looking for electronic technologies that not only accommodate their workflows, but enhance them, while at the same time containing enough necessary infrastructure to ensure their facilities meet the various stages of Meaningful Use," says Cynthia Porter, President of Porter Research. "Vendors at the same time are paying more attention to these requests,or augmenting their offering by using firms with specific UX expertise in healthcare. So many of them are also beefing up the UX part of their development teams."

Some healthcare IT vendors, however, have always had a firm eye on the important role that UX has in the ultimate success of software applications. PointClear Solutions, for example, is a Southeastern firm that designs software for healthcare with an emphasis on the user's experience.

"When we started six years ago," explains Lee Farabaugh, CXO and Managing Director of the UX Practice at PointClear, as well as a member of the HIMSS EHR Usability Task Force, "it was Blaine Anderson, Donny Gooch, Neal Evans and myself.  We had three to one - developers to UX people, but as we've grown we are closer to 50/50. We've always had user experience at the core of our business offering."

In an effort to understand the crucial role UX plays in providers' adoption of healthcare IT, particularly EMRs, Porter Research spoke at length with Farabaugh about the changing scope of UX, and the overall trend in what providers need and want in today's world of Meaningful Use.

Porter Research: How have you seen software developers, particularly healthcare IT, incorporate UX in recent years?
PointClear: Software development is getting to the point where it's a commodity business. You can offshore it to almost anywhere on the planet.  You can get people to develop your software applications for $25 an hour, and you might think this is a great thing.   What makes PointClear different is the fact that we take the time to fully understand the end user - designing software to help them accomplish their tasks and then collaborating closely, both literally and figuratively, with the development team to build software that is easy to use. Finally, we test the software with end users to ensure that what we've built is right for them.

The EMR vendors we work with are working hard to differentiate themselves from their competitors since qualifying to be "meaningful use" certified is a basic requirement today.  User experience is a big differentiator among some EMR companies.

What design issues are your clients wanting to address these days?
There are several challenges our clients are asking for our help to address.  They include easily entering data, easily finding information when they need it and interoperability of their software.  Let me expand on each of these.

Easily entering data:  We recently exchanged a flurry of emails around the idea of a medical scribe - a person that goes into the exam room with the physician to type all the information into the EMR while the physician interacts with the patient. That's pointing to a real problem - the doctor is entering data into the system and not looking at the patient, maybe not paying 100-percent attention.  That is another design problem to address. How do you get this data into the application as easily as possible, while still maintaining that human-to-human connection with the patient?

Oftentimes, people want to know why an EMR can't be designed to use as easily as you would an iPad.  I think one of the things that people overlook is that understanding physician workflows is integral to designing good interfaces for physicians and nurses. Physicians scribble something in a chart - you're just going to be hard pressed to put some things on an iPad any faster.

Easily finding data when they need it: There is a frustration that finding certain pieces of data in an EMR, or in a lot of healthcare software, takes too much time.  This may be a usability issue; but it may also be a data integration issue.  In order to increase the usage rate of healthcare software, such as EMRs, we need to make it extremely easy for providers to look up and find data that they need.  If they get utility out of the application, they'll use it, but not until then.

Interoperability: We might have a client that's creating an application, but it stands alone from an EMR. If you're asking a physician to do double work, to log into two different applications and enter the same data into two different places, they're not going to do it and that reduces the adoption of both pieces of software. Physicians want both software applications to talk to each other, to operate together.  Interoperability of software is a major challenge throughout healthcare today.  But the good news is that there has been a major shift in mindset from most points of the healthcare ecosystem in recognizing this issue and there are many software developers acting on it.

Do different types of providers have different type of user experience needs?
If you get to the microscopic level, yes. They have different data components that they're interested in. But if you step up to the 30,000 foot view, then no. Because they're all trying to solve what they want to do - order entry, chart problem lists, view medication history and visit history, all those kinds of things. Some want to see images depending on if it's a specialty or not.

Teasing out those differences is really important to understanding the physician workflow. That's where those differences will shake out.

I like to joke that if you've seen one workflow, you've seen one workflow. If you're trying to solve a problem, and you look at how one doctor does it, you're going to end up solving the problem for that one doctor. It's much more effective to study a decent enough sample size that gives you an idea of what the core issues are versus what this particular doctor is doing because the fax machine is on the fourth floor and he's on the second. There are certain things that are very specific to a certain practice, and you have to do enough research that you can filter those things out.

Since HITECH came about, have you seen user experience requests change in recent years? Has MU had an impact?
When it first came out, everything was around meeting those requirements for the different stages. Everybody was really focused on being able to do drug and drug allergy interaction, or recording smoking status, and providing patients with their history electronically.  Obviously the federal money had a huge impact on this whole industry.

Initially, everyone was just interested in meeting the requirements, because the race to be MU certified was so intense. Now that certification is "the cost of admission" so to speak, companies are looking for how to handle these required components in a more user-centric way. For example, what's the fastest and easiest way to populate a problem list? How do patients want to receive their medical history? How can we accomplish some of these goals on mobile devices?

Will Stage 2's release have an impact on what people want in their software?
My knowledge of Stage 2 is that it will be based on more of Stage 1, so I think we'll probably just see more of what we've seen so far. If there's some new feature, then I think people will chase that. But I certainly think we'll see providers having to do a larger percentage of their practice with electronic orders.

Is mobility a more requested feature?
Yes, absolutely. We've seen so much of that in our business. Mobile is really where it's going. We try to help our clients move to mobile not just for mobile's sake, but to utilize it in new and novel ways so that their new mobile app improves care and quality outcomes. We want our clients to focus on what makes sense to provide on a mobile device, based on the context of use, and to use the features unique to the phone, such as camera, GPS, microphone to allow interactions that aren't possible on the desktop.

Moving Innovation Forward
In an effort to recognize healthcare clients that have truly demonstrated innovation in technology, including the user experience, the company created its PointClear HIT Innovation Award.

"We're looking for initiatives from our clients that demonstrate true innovation in healthcare delivery through technology, disrupting current care delivery models, and novel ways of providing care and improving outcomes," explains Farabaugh. "This innovation may be specific to something we're working on with them, or it may have to do with their overall business model."

Just as PointClear strives to continually improve the experience of working with healthcare IT solutions such as EMRs - from both the vendor and provider perspective, so too does it seek to recognize colleagues that are doing the same. The result is a collective effort that will surely move healthcare forward.







]]> <![CDATA[Massachusetts Looks to Medicaid for a Truly Sustainable HIE]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/February/Massachusetts_Looks_to_Medicaid_for_a_Truly_Sustainable_HIE.html February 8, 2012
The state of Massachusetts, through its Massachusetts eHealth Institute regional extension center, is taking a unique approach to establishing a statewide HIE, and has enlisted the services of the Massachusetts eHealth Collaborative (MAeHC) - a nonprofit healthcare IT advisory and consultancy firm - to help it move this new model forward.

What started as an idea last summer for a nonprofit HIE quickly evolved into a strategic business plan that stakeholders hope to see result in a live HIE in mid-October 2012.

"The current plan has the state government, actually Medicaid, creating the infrastructure for the statewide HIE, and that's a significant shift from where the plan was even last summer," explains Micky Tripathi, MAeHC's President and CEO. "We reoriented the plan because the federal government is now offering subsidized dollars through the Medicaid program for the creation of HIE infrastructure that would benefit Medicaid network participants first and foremost.

"In Massachusetts, 100 percent of the hospitals and 80 percent of the physicians are Medicaid network providers, so if you build a HIE infrastructure to serve them, you're basically serving almost the entire state right away," Tripathi adds. "As you can appreciate with this kind of infrastructure, once it's created, anyone can use it."

Medicaid Money Hopefully Means Financial Stability
"One of the main drivers of moving the HIE over to the Medicaid side of the house was that Medicaid will subsidize to the tune of 90 percent - meaning that for every 10 cents we put in, they'll put in 90 cents to subsidize the creation of the infrastructure," Tripathi explains. "They'll subsidize something like 50-75 percent of the ongoing maintenance of the infrastructure once it's up and running.

"If we have Medicaid create and run it, that will take care of a lot of the [sustainability] problems," he adds. "It doesn't solve everything, because you still have to cover that last 25-50 percent. Medicaid, like any organization, is happy to pay for the piece of it that is a benefit to them, but if other organizations and people are benefiting from it, they'll be expected to pay their fair share, too. That will be the responsibility of all of us in the state to come up with that fair share piece of it. Right now, it's looking like that will be only something like 10-20 percent of its ongoing cost, which makes the sustainability question a lot easier."

Tripathi and his team estimate that contributions from private stakeholders will be less than a million dollars a year, collectively.

"In the state of Massachusetts, we have $6 billion to $7 billion in health claims every year, so figuring out how you get a million dollars from everyone in the state ... it does feel like it will be a problem that will be relatively easy to solve once there's a real service there," he says.

Medicaid Infrastructure Hopefully Means Provider Buy-In
"The idea of having Medicaid stand it up make a lot of sense from a variety of perspectives," Tripathi explains. "The Massachusetts Medicaid organization is one of the most highly regarded in the country. It's got a very sophisticated IT infrastructure that it didn't outsource like a lot of Medicaid organizations did. And more importantly, you've got people who already log onto the system for Medicaid claims processing. So if you say, 'Oh by the way, the thing you've been logging onto for the last 10 years now has HIE capability,' it starts to make a lot of sense."

Tripathi also feels that gaining provider buy-in will be that much easier because they've become accustomed to paying for HIE. Massachusetts has a few well-established HIEs, including the New England Health Information Exchange.

"They've been sustainable for a number of years," Tripathi says. "They have an $8 million budget, they're a nonprofit, and it's all been paid for by subscription fees from hospitals, health plans and physicians. That's been up and running and by some measure covering 50 percent of the state already.

"I think that's a significant difference, culturally, when you think about other parts of the country - you don't have that," he says. "But because people here are already paying for HIE services, when a statewide one is launched, people already understand its value."

Will Other States Follow Massachusetts' HIE Lead?
"My understanding is that there are three to five states that are going to be pursuing this strategy," Tripathi says. "These states, along with Massachusetts, submitted applications to Medicaid for this, and we've been given every indication that it's going to be approved along with the others. I suspect a lot of other states will jump on it as well - we just happen to be among the first to get into the pipeline.

"It certainly wasn't obvious to me a year ago that this was the right way to do it, but now that is has unfolded this way, it feels like, 'Oh wow, how obvious.'"







]]> <![CDATA[Regional Extension Centers: Moving Physicians Forward with Meaningful Use]]> http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/January/Regional_Extension_Centersx_Moving_Physicians_Forward_with_Meaningful_Use.html January 24, 2012
"Making the move to a new system seemed too complicated for a doctor nearing the end of her career," said Jennings, Primary Medical's office manager. "She didn't know if she wanted to invest the time and money into learning something new."

But that was before the office knew about the $44,000 incentive payment they could receive from the Centers for Medicare & Medicaid Services (CMS) for proving the office had fully implemented an accredited EHR and was using it efficiently. The problem, however, was finding the right one.

That's when Ohio Health Information Partnership (OHIP), Ohio's regional extension center (REC), took the lead. Not only did it help Primary Medical identify the best system, Jennings said, but it will also provide step-by-step guidance when the office goes live with its software of choice next month.

"From the provider's perspective, we want to meet meaningful use criteria," Jennings said. "So rather than the piecemeal approach to an EHR system, it's been very beneficial for us to take advantage of the work OHIP's already done and the information it has."

OHIP, also known as "The Partnership," isn't a one-of-a-kind group. Since 2010, the U.S. Department of Health & Human Services' Office of the National Coordinator (ONC) has invested $677 million in 62 RECs nationwide. Their goal is to guide more than 100,000 primary care providers to EHR meaningful use. The on-the-ground assistance they provide is particularly valuable now - it's crunch time for Stage 1 of meaningful use, which requires that eligible professionals meet 20 objectives related to their use of an EHR, as set forth by the CMS. As of last fall, only a small percentage of hospitals had achieved this first stage, and healthcare providers have only until Feb. 29, 2012, to prove they've reached this goal in order to qualify for incentive payments.

Where RECs Are Today
While substantial, REC funding is a drop in the bucket compared to projections in federal health information technology (HIT) growth. By 2016, software company Deltek Inc. predicts federal HIT expenditures will grow to $6.5 billion. But the millions flowing to RECs has been money well spent - many are already achieving their initial enrollment goals.

For example, OHIP recently hit its 6,000-physician goal. The Chicago Health Information Technology REC enrolled nearly 1,500 doctors by the end of December 2011, and the New York eHealth Collaborative REC passed its 5,100-physician goal around the same time. Last week, the Kentucky REC also announced it had reached its initial 1,000-doctor enrollment goal.

Currently, there isn't one model for how RECs should be organized or work. Each is designed differently, and ONC is watching to see which are successful.

"A lot of these models will fail, but the ONC is looking for the ones that work," said Gregg Alexander, M.D., a pediatrician at Madison Pediatrics in London, Ohio. "They're looking for the homerun hitters so they can replicate that model nationwide."

Alexander has been involved with OHIP since its inception and is currently a member of the Board of Directors. Early on, he said, OHIP decided to help providers identify the best EHR solution for their offices by offering an EHR selection tool. Originally priced at $1,800, OHIP makes the tool, produced by medical-device manufacturer Welch Allyn, available for $50.

In a further attempt to guide providers, OHIP staff analyzed the available vendors, starred five as preferred, and negotiated 15- to -20-percent discounts off the system's usual fees.

Early skeptics wondered whether RECs would be effective, but many on-the-ground leaders have been pleased with the progress. In fact, many say providers see RECs as a trusted advisor.

"The effectiveness of the RECs, in my opinion, is surprisingly high. I think the challenge in terms of the numbers in showing people meaningful use is not so much an efficacy of the RECs, but rather the complexity of getting people to meaningful use," said Sean McPhillips, Kentucky's REC project manager. "For example, some vendors may not have the immunization interface enabled to help information exchange, and that creates a huge obstacle. Or we had one vendor whose quality reporting module is not working properly for some reason, so all of their quality reports are coming up zero. That means the provider who wants to test for meaningful use right now can't."

Challenges RECs Face
Although the relationship between RECs and vendors has benefitted facilities and physician practices nationwide, that coordination has also been one of the biggest criticisms lobbed at the groups. Some industry leaders worry that rather than giving providers impartial advice, RECs will be little more than promotion mechanisms for certain vendors.

It's a delicate dance for RECs and vendors to avoid this perception, said Tom S. Lee, Ph.D., CEO and founder of cloud-based EHR software provider SA Ignite. By offering support services as a third-party, vendors can add value to a REC without solely pushing its own product offerings.

"Vendors play an important role," Lee said. "RECs can't drive the value of EHRs to 100,000 providers alone, and vendors can provide the information technology support that the physicians will need."

Another significant challenge is funding. Each REC currently has financial support from the ONC; however, that money will eventually evaporate. To supplement these monies, some RECs charge for their services, said McPhillips. For example, Kentucky providers who do not fall under Medicare can purchase the REC's tool kit and six hours of consultation for $500. Additional services are available at an hourly rate.

In some ways, though, the most significant roadblock RECs face is the physicians they're designed to help. As with Jennings' boss, many older physicians closer to retirement resist becoming EHR savvy. However, as they leave practice, Alexander said, EHRs will organically grow to be the dominant patient record system.

Primary Medical Specialist's Experience
From the moment Jennings contacted the closest REC to her office, located in Athens, the practice had a knowledgeable partner who could answer any EHR-related question, provide detailed information about preferred vendors, and secure a discounted price.

"After connecting with the REC, we stopped looking for a vendor independently," Jennings said. "We had an additional layer of confidence knowing the vendor we selected had received a stamp of approval from our REC."

Primary Medical used the Welch Allyn tool to weed through OHIP's preferred vendors, eventually pinpointing the electronic system that best fit their needs. Throughout the selection process, whenever she or a provider had a question ranging from software to vendor contracts, their REC representative provided timely, unbiased feedback either by phone or email. 

The one drawback to working with OHIP, Jennings said, has been how long it took her to find out about the organization. Knowledge of the group isn't widespread.

"I don't know how many doctors know that there's help from the government for this," she said. "But healthcare providers in general need as much help as we can get to select an electronic records vendor that is right for us."

Primary Medical has no plans to sever its relationship with its REC after it reaches EHR proficiency. Instead, the office intends to stay connected to the REC as it faces healthcare's next information technology challenge, the health information exchange (HIE).

What's Next For RECs?
Guiding providers to meaningful use proficiency is a time-limited responsibility. In order to maintain relevancy, RECs leaders are already considering what the groups' next steps might be.

For the Kentucky REC, the next big challenge will be integrating providers into the state's HIE. But there are other opportunities available, such as coding or patient privacy, to help providers and patients span the existing knowledge gap, McPhillips said. The goal, he said, will be to foster a better-educated and empowered patient population that can more actively participate in their own healthcare.

"There's a lot of transformation going on in healthcare today, whether it be health information technology, healthcare reform, patient-centered medical homes ..." he said. "It's a sophisticated industry in which the principle consumer, the patient, is really at a knowledge loss - so the challenge to empower the patient is health literacy. So we recognize that as a huge opportunity that is untapped."







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