Healthcare // Clinical Information Systems
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3/4/2014
10:42 AM
David F Carr
David F Carr
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The Quest For Population Health Management

Vendors large and small seek to prove they have the right tools for proactively managing patient health, coordinating care across providers, and supporting accountable-care models.

Veterans of the HIMSS health IT conference say the emphasis on population health management at this year's show was nothing new, except now the focus is shifting from theory to practice. Healthcare reform and shifting patterns of reimbursement are driving healthcare organizations to seek technology that can help the track, analyze, and predict care to individuals and that can coordinate care for higher quality at a lower cost.

Many hospital CIOs believe they are only a few years away from seeing more than half of their income come from value-based contracts in which making money depends on quality measures, such as superior prevention and management of chronic diseases, rather than the volume of services delivered. Already, hospitals are feeling the sting of penalties imposed on their Medicare and Medicaid contracts when too many of their patients are readmitted to the hospital within 30 days -- taken as a sign of failing to deliver the right care the first time.

(Image: Siemens Healthcare)
(Image: Siemens Healthcare)

Providing better follow up care and creating more cohesive care teams out of all the doctors, nurses, specialists, technicians, and social workers involved in the care of an individual is the new business imperative. There should be no "gaps in care" where information falls through the cracks and a patient winds up being neglected, or a medical error occurs, as the result of ignorance.

Population health management is as much about business and clinical process changes as it is about technology, but the technology element is big enough to have attracted the attention of all the biggest systems integrators and healthcare IT firms, as well as a lot of startups. The big challenge is not simply to provide data, but to make it understandable and help caregivers sort through it.

"Data is nice, and data is important -- however, data can be overwhelming," said Christopher Stanley, M.D., and VP of Care Management at Catholic Health Initiatives. "We need to package it into usable bits and formats, making it into knowledge so we can use it to make a difference."

He appeared at a McKesson-sponsored breakfast event as a customer of the McKesson Population Manager software he hopes will help accomplish that goal. As a national, non-profit healthcare organization that includes multiple hospitals, Catholic Health Initiatives expects to invest $1.5 billion during the next several years on better data integration, he said. But while the organization invests in developing its own analytics to differentiate itself through superior financial management, he said, it realized it needed help with the kind of predictive analytics needed for population health management.

Eliminating the gaps in care also means eliminating, or at least smoothing over, the gaps between information systems. Large healthcare organizations often use multiple electronic health records (EHR) systems. Even if they have settled on a single software vendor, they must cope with patients seeking care outside of their networks. This is the problem that Health Information Exchange (HIE) products and services are supposed to solve, and many of the population health technologies on display at HIMSS were extensions of HIE software. While public, community HIEs organized at the state and regional level have had uneven success, hospitals have been implementing their own HIE software for internal and external health data integration.

HIE vendors take that ability to gather data and add tools for making sense of it and taking action on it -- analytics and care coordination tools. That's the approach I saw from both Siemens, with its new CareXcell product, and Harris Corp., with FusionFX. The Siemens people told me their product could be used with competing HIE software, but they expect to seek business from their own installed base first.

"We've been an HIE supporter since 2009, but now the question is what do you do with all that data?" said Thomas Pacek, CIO at Inspira Health Network, an early test user of CareXcell. One of the first ways he plans to use the product is to inform Inspira's implementation of a Patient Centered Medical Home (PCMH), a model for tighter care coordination revolving around a primary care physician practice. In this incarnation, primary care is supposed to be about more than giving referrals and directing patients to other in-network providers. A PCMH is supposed to track whether patients follow through on the recommendations they are given and the drugs and therapies prescribed, as well as whether what the doctor ordered had the intended effect. CareXcell also promises to give doctors better access to evidence-based guidelines so they provide the right care in the first place.

Jim Walker, principal health informatician at Siemens, said he worked on a tight care coordination program for cardiac patients in his previous job at Geisinger Health System, which has a reputation for being one of the most advanced integrated healthcare delivery networks. The program was successful in raising the quality of care, but it was too labor intensive, requiring one care coordination manager for about every 125 patients. "It needed to be about one to 500 to be affordable," he said.

A population health platform like CareXcell can help by automating some of the basic tasks like appointment reminders, allowing patients to do more through self-service, and focusing care managers on the remainder requiring individual attention, Walker said. Siemens is employing business process management middleware from Tibco, which automates processes that can be handled automatically and tracks the workflow of those requiring manual intervention until they are complete. Siemens uses the same software in other industries, for example its Smart Grid for electric utilities. "Healthcare is among the last industries to get business process management," Walker said.

Harris is another big systems integration firm getting into population health management. While better known for its work in the aerospace industry, Harris has developed HIE software that is used by some of the public health data exchanges, such as the one for Florida, as well as by healthcare enterprises. Harris has also created Service Oriented Architecture middleware that it is using as part of a healthcare software integration project with the Veterans Administration and Department of Defense. It's also being used for systems integration at Intermountain Healthcare, according to Vishal Agrawal, president of Harris Healthcare Solutions.

For its FusionFX population health product, Harris adds Web portals for both providers and patients, along with workflow software for tracking the

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David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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David F. Carr
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David F. Carr,
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3/4/2014 | 3:27:33 PM
Have you found good tools for population health management?
What software or cloud tools have you found useful for managing the health of patients and specific categories of the population, such as diabetics and heart patients?
anon2181260208
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anon2181260208,
User Rank: Apprentice
3/11/2014 | 2:42:52 AM
Re: Have you found good tools for population health management?
A well-researched article highlighting the need for technology in the healthcare industry. Treading on these lines Summit Planners Technology of Singapore offers the medical & clinic software which has a proven track record of considerably improving the overall patient care in a clinic or hospital. Its host of cloud-based modules have simplified the operations & administrative functions of a medical office as well.
TumTum
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TumTum,
User Rank: Apprentice
3/11/2014 | 4:17:56 PM
Re: Have you found good tools for population health management?
Let's make sure we understand what "population health" means. It is not managing the health of populations.  The term was used because many of the factors that affect the health of chronic patients lay beyond the scope of health care and they are known as "social determinants."  Access to care, availability of open spaces to exercise are some of the examples of social determinants and these factors to gether with the health care factors of treatments etc. are collectively referred to as "population health".

As Dr. Dave Kindig of the University of Wisconsin has pointed out in one of his blogs, managing these elements of "population health (he even has an oft quoted diagram describing this) is not easy at all. How do you rate availability of "nutritious food", or value of bicycle paths in a quantitative manner.  Yet, that is what is needed for population health management.

I think the author is really referring to managing the health of "groups of people" with similar health issues.  Even with this restricted definition there is a serious problem.  What is a metric for determining health of populations?  Without such a metric you cannot even say whether the health of a group of people is improving or not. Even if you had lab data available how do you compare populations with thousands of individuals when there are two or more items in the data set for each person?

I have had to develop a completely new and patented method to accomplish this. It wasn't easy and it took over 6 years for a team of programmers to complete the work.  We are currently analyzing the Medicaid population in a state to understand disease burdens and their trends. 

 
David F. Carr
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David F. Carr,
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3/12/2014 | 5:46:55 PM
Re: Have you found good tools for population health management?
Conversations about population health management often start with talking about "groups of people" like diabetics -- by far, the most commonly used example -- who are subject to similar ills and need to be tracked and coached in similar ways to keep their conditions from deteriorating. Yes, I agree that part of the point is to go beyond what medications they're taking (or failing to take) and look at lifestyle choices that are as or more important in whether they stay relatively healthy.

Diabetes is a focused, practical example, but the longer range vision is of managing the health of entire populations -- maybe not everybody in the community but everyone included in an accountable care organization or other structure where the incentives are oriented to keeping everyone healthier. At this point, that may just be a dream -- really active care management programs are still too expensive to apply to everyone, and the chronic disease sufferers make sense to focus on first.
TumTum
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TumTum,
User Rank: Apprentice
3/12/2014 | 6:15:05 PM
Re: Have you found good tools for population health management?
I am sorry, you are wrong David. 

Your are confusing a type of chronic care management with population health.  The best definition of "population health management" is the one from Prof. D. Kindig and it is quoted widely in the book on "Population Health" edited by David Nash et al. 

Also, except in a few places like Joslyn, most chronic patients are treated singly and NOT in groups.   
JOHNS992
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JOHNS992,
User Rank: Apprentice
3/4/2014 | 4:13:21 PM
predictive technology
Great article regarding the need for more proactive technology.  SILVERSPHERE has this same focus in helping caregivers take a more proactive approach.  Babyboomers are more savvy and aware than the generations before them.  We need to provide them and the people that take care of them with the tools to maintain or improve their quality of life safely in whatever setting they call home. 

http://www.silversphere.com
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