The massive HIMSS 2016 Annual Conference is just around the corner and I’ll be participating in it in a big way like usual. I already posted about the 7th Annual New Media Meetup at HIMSS and my sessi
As I get ready for @HIMSS 2016, I’ve been thinking a lot about value-based healthcare. The New England Journal of Medicine defines as value-based healthcare as the ability to improve outcomes per dollar spent. In theory, this idea means that physicians should be able to devote more time to patients as the doctor’s financial performance is linked to the patient’s outcome (not the number of times the doctor sees the patient).
My hypothesis is that the implementation of value-based healthcare will be tough because providers are used to a system that rewards them on the number of transactions they conduct. I also believe that the investment into cutting edge health care technology is a function of how much revenue (e.g., transactions) a provider can generate.
To see if I could validate my hypothesis I chose simple X-rays provided Medicare and Medicaid physicians. I selected a simple x-ray machine
(show below). According to the author this machine new retails for about $200,000. Given that a provider must invest $200, 000 for the machine and probably another 25% annually for maintenance, the machine has an upfront cost of $250,000 and a yearly cost of $50.000. The average cost of a radiologist (according to Glassdoor) is another $290,000. Now I would agree that not all providers would have a radiologist, but for our purposes let’s assume that they do. If one adds the staff to support the radiology activity, let’s suppose that staff adds another $100.000. So all in, in the first year the radiology investment is $250k for equipment +$390 for staff.
Now the next step to understanding the impact or possibility of value-based health care is to look at the number of x-rays conducted by CMS practitioners. I chose the states of TX, FL, SC, and CT as representative states to analyze. According to my analysis more than 912 x-rays only were conducted in these jurisdictions (see graphic). What this graphic depicts is the total number of x-rays claimed in these four states and the many locations where they were given.
So the next question I asked was how many beneficiaries were provided x-rays, how much the providers submitted claims for those x-rays, and how much CMS paid on those claims.
So in these four states alone in the calendar year of 2012 CMS paid more than $1.8m in reimbursements. Now the tricky question is how many of the facilities within these states have actual x-ray equipment and to what degree of technical status the equipment is. Based CMS data it is not easy to determine if providers provide enough x-rays to pay for the equipment and staff. It is possible, however, to determine if a provider were to use simple equipment and read the x-rays them selves then it is possible that most providers requesting more than $10,000 in CMS x-ray reimbursements may have enough transactions to support the use of an x-ray machine.
What is evident from the CMS data (certainly having private insurance data available would help) is that most providers who invest in x-ray machines need to generate volume to pay for the equipment and supporting staff. If value-based care impacts the number of x-rays, they take how do they support the use and implementation of such conventional diagnostic equipment?
I invite anyone reading this blog to comment and provide alternative ideas.
I had the opportunity to travel over the past couple of days and during my travels used UBER several times. Now, I love UBER and this by no means an anti-uber blog post. During several of my UBER trips, I got to talking with the drivers. Turns out several of them were LPNs that had left more clinical duties for home health care services. Both drivers usually worked two or three days a week as a nurse and then used UBER to supplement their income.
As we continuously use data to understand and drive the cost of healthcare, I think it is important to recognize that healthcare cost includes people, and we need to pay the people who take care of us a livable wage.
If you came to this site expecting some hot and steamy story than I’m happy to say that I have some good information and ideas to communicate on the use of informatics. Informatics represents the intersection of technology and data. Informatics is a disciplined approach by which one uses data to make and test a hypothesis.
As I continue to work with health customers and pursue my masters in health informatics, it has become apparent to me that informatics can apply to any question. Informatics and the study of data are used to determine sexual attraction and the activities that contribute to sexual arousal. Pfizer in the development of Viagra most likely used informatics and informatics-based approaches to analyze the data generated from each step in the drug’s development.
I am convinced that the use of informatics and informatics-based approaches will one day help us to understand why some humans commit crimes more than others. Informatics will enable us to understand why Alzheimers occurs and treatments that can be applied to stop the deadly diseases progression.
Informatics combined with precision medication will eventually lead to the cure for cancer and other diseases. As an aside, I am currently working on an article on precision medicine for HIMSS so if your are interested in contributing send me an email at email@example.com.
Each of these areas represents breakthroughs in medicine. Why is it that the advances are taking so much time to occur. There is some truth to the fact that testing and review take time but my believe is that medical culture has to change. I explicitly call on the medical industry to adopt several tenants:
- Not every person engaged in informatics has to have an RN or MD. We need to consider that personnel with informatics degrees, MBAs, and other degrees can and have contributed to the advancement of informatics.
- We must invest in informatics and data analytics. HIMSS publishes many guides on establishing and informatics or data analytics group but if we truly we to evolve healthcare we have to dedicate people to the use and analysis of health data.
- We need to figure out how to share data. Data, no matter how good it is, is useless if it can’t be shared and used by multiple stakeholders. I’m not suggesting that we share patient-level data, but we need to figure out how to share aggregated data.
I welcome any thoughts or comments.
I am starting to work on an article for HIMSS on the future and impact of precision medicine. If you have an interest in participating simply leave me a comment. My hypothesis us that no only do we not have a clear definition of what precision medicine is we don’t really have a Stragey for how it will be used . Send me a comment if you wish to participate .
Dear Governor Hogan @larrryhogan, State of Maryland @statemaryland, and Maryland Transportation @MDTA As I was driving my daughter to college this weekend, I was faced with traffic jams like this at the MD toll plaza –
and traffic jams like this at the DE state line –
and traffic jams like this at the Delaware-NJ Turnpike bridge –
and then traffic jams like this at the Holland Tunnel –
While I recognize you can’t control all of these jams, I think you start them and do nothing to alleviate them. As I suffered through these traffic jams, it got me thinking how more data and more data analytics could alleviate this situation. My first thought was that many of the Maryland Toll Plaza traffic Jams seem to start as far back as the rest area –
Clearly @theMDTA and @larryhogan you know these bottlenecks are occurring as these images are from your cameras. Here is my suggestion, I know you just lowered rates (and that is great) but couldn’t you use some of the $160K in revenues generated at this toll plaza to open the toll plaza for free until the traffic jam dies down? According to your site, http://www.mdta.maryland.gov/About/Finances/Traffic_and_Toll_Revenue.html 2 axle vehicles make up about 70-80% of the $160k, which amounts to about $500 on average over a 365 day period. Let’s suppose that the amount you would have to forgo is $5000, I’d argue that the quantity of hassle and gas you would save Maryland drivers would more than makeup for the $5000 in revenue you would have to forgo. I hope organizations like @baltimoresun, @wbaltv11, @abc2news, and @foxbaltimore pick up my blog and take a look at this. How can our economy even hope to prosper when it takes one almost 3.5 hours just to get from Baltimore to DE? Imagine the cost savings if the State opened up the tolls during high traffic periods/
With the recent announcement of the Department of Defenses Electronic Health Record system and The United States Women’s recent soccer win it occurred to me that there is a relationship between the use of
electronic health records (EHR) and a direct improvement in soccer players health. If an EHR is just a system that can collect and share health records how can it help to improve a soccer player? Consider this scenario A Soccer player complains of breathing problems while playing in the hot humid fields of Washington DC. She initially seeks treatment at a local urgent care clinic since it is Saturday and her general practitioner is not open. The urgent care physician initially treats for heat exposure and dehydration but enters the player’s diagnostic data in their EHR system and orders a series of blood tests. The player returns to play and plans on playing in her upcoming tournament. The following Monday morning the player’s primary care physician receives an alert on his EHR system and reviews the urgent care’s diagnosis and blood test results. Upon review, the primary care physician determines that the player should undertake a treatment of asthma medication and if the problem doesn’t improve seek out an additional opinion from a pulmonologist. Because the urgent care’s systems is integrated with the primary care’s system the primary care provider was able to quickly treat the player, get her back on the playing field, and possibly avoided a repeat episode. The ability to provide the best care with the best information is the promise of EHR and I encourage all working with these systems to continue your good work.
This weekend I had the privilege of seeing the awesome reboot of Jurassic Park, Jurassic World. If you haven’t seen the movie, don’t worry I am not going to give any of it away. Seeing the film, however, got me to thinking about informatics. Why, you might ask would I think about informatics while seeing Jurassic World. I think it has something to do with the millions of Neurons firing in my brain similar to this image borrowed from Boston Magazine. My brain is constantly in motion, and it got me to thinking could informatics promote Michael Crichton’s original genetics nightmare?
Using many of the DNA sampling kits currently on the market, it would be possible to collect dinosaur DNA and sample it so as to represent a DNA model. Now here is where my stretch thoughts about informatics come into play. I today’s world informatics along with a great deal of research has helped us to isolate the specific genes that cause cancer (as shown in this image from Softpedia).
I would argue that informatics is one of the disciplines that enables our researcher and practitioner community to collect and understand the data necessary to conduct research experiments and draw conclusions that may ultimately lead to a cure for a particular type of cancer. It is informatics that also helps pharmacists and providers understand the effectiveness and side effects that a particular drug might have a certain kind of patient. In this new world. We are beginning to call personalized medicine it is the informaticist that provides the capabilities to help physicians, patients, and researchers to understand the data they are collecting.
The same case could be made for understanding the DNA of a dinosaur. Using technologies we have today, we can certainly model the DNA for a particular dinosaur. But, what about those gaps in the DNA that prove so terribly troublesome in the book and movies? With our understanding of data informaticists can work with the researchers to understand the gaps, evaluate the type of DNA that would best fit the holes, and even hypothesize on what the Dinosaur’s disposition might be given the various mixes of DNA. Now I am not arguing that this process is possible, and if possible should happen; my point is that it is the informaticist that helps to understand the data.
I’ve come across many HCOs who consider informaticists to be just coders. I hope that with the points I made above folks within and outside the industry will begin to think of informaticists as professionals with significant technology and data manipulation capabilities.
If you are like me, you probably see an article every week on the need for information technology positions within the healthcare community. As a current informatics student and a mentor to other informatics students. I can safely say that there are many people with highly developed information technology and informatics skills ready and waiting for these positions. Would a large healthcare organization release the statistics around their open positions for those of us who are informaticists and data geeks to review? I’d like to know how long these positions stay open, what sorts of education and certifications are required, and what are the characteristics that describe people who are hired into open informatics positions? Many of my fellow students and folks that I interact with complain that they never hear anything from these large healthcare organizations. Those of you who have read my previous blogs know that I am an open data advocate and I’d like to use the power of open data to try and figure out why there is such a gap in the hiring of informatics professionals.
As an enterprise architect and budding informaticist, it occurred to me the other day do the two disciplines intertwine?
There are many definitions and uses for enterprise architecture (EA). From my perspective having worked on the first versions of the Federal Enterprise Architecture Framework, EA is a framework for describe how systems, data, and business process work together. EA is used by many organizations to represent current day and future day representations. EA is an excellent tool for describing the interworkings of technology within an organization. Regardless of the framework and methodology that one uses to create and manage an EA if the EA is adopted throughout the organization it will prove tremendously powerful to the organization’s management.
So what does EA have to do with informatics? Indiana University has an interesting definition that Informatics turns data into knowledge. Understanding and finding data is directly related to having a valid and useful EA.
Let’s take a real example of how EA and Informatics intertwine. According to the Journal of Bone and Joint Surgery, the number of hip replacements is expected to increase by 174% to 574,000 by the year 2030. If one considers the many systems and knowledge required to support these surgeries, it is easy to see how EA and informatics intertwine. From an EA perspective there are systems that support the supply chain necessary to deliver HIP replacements, there is data that is mined to determine the quality of the HIP replacements and the per unit cost of each replacement. Furthermore, there are business processes that diagnose the need for hip replacements, place orders for the particular parts required to support the surgeries, and many processes leveraged to manage the operating rooms where the replacement parts are inserted.
Informatics is the ability to mine the data and processes described in the EA to improve the hip replacement experience. Informatics helps hospitals control the costs of the procedures. Informatics help physicians accurately diagnose and treat a particular patient. Informatics helps the nursing staff to understand the types of services and needs patients with hip replacements will need before, during, and after their hospital stay.
Those of us who work with EA or Informatics tend to focus only on our particular discipline, but it is important to remember that each discipline fits together and that one can not properly exist without the other.
As I work on my UIC knowledge management homework this weekend, it occurred to me that health data and health knowledge are the answers to all our healthcare woes. I know it is silly to say that #knowledge and health data are the answers to our healthcare woes but they are. To support this hypothesis let’s look at cigarette usage.
Health data leads to Knowledge that influences policy and ultimately results in improved patient outcomes. As an example, I’d propose that the degree of taxation applied towards cigarettes has been one of the major factors in its dramatic decrease in usage. Take this chart from the CDC, it displays the decline in cigarette use from 2011-2013.
What does this chart show us? It shows us that cigarette smoking has decreased in most states from 2011-2013. Now combine the fact that cigarette smoking has declined with this graphic from the BLS showing that as cigarette prices go up, consumption goes down.
I would argue that because of the research the CDC conducted on cigarette smoking that #healthcare knowledge was developed showing just how dangerous cigarette consumption is not just for the smoker but for the entire healthcare system. Over time, policymakers began to take knowledge of the CDC knowledge and enacted policies to limit the use of cigarettes through the use of taxes. With the theory that the taxes would dissuade smokers and fund treatment options.
Would love to hear from you
As I continue to advocate for expanded use of informatics and the data necessary to drive it I find myself does any of it really matter. As we get ready for this week’s health data Palooza and look back the many data sets published by CMS like Open Payments. Now while one might be apt to dismiss open payments they shouldn’t. Open Payment is a powerful set of data. It tells you which providers are receiving payment from which pharmaceutical companies. Now I don’t think there is anything inherently wrong in a pharmaceutical representative taking a physician out-to-lunch to explain the latest in pharmaceutical capabilities. Where I get concerned is when Open Payments shows the payments between the provider and the pharmaceutical company are much larger than a single lunch or two. I also have to ask myself is there any correlation between these payments and the prescriptions that the provider writes. I’m encouraged to see agencies like CMS continue to publish data but would like to see the private industry follow. Surely there is a way to share health data in such a way as not compromise privacy and protect intellectual rights?
But, back to my original question. Yes, I think health data and informatics matter. The challenge is to find data that is relevant and put it together to answer previously unanswered questions or to identify new questions that one hasn’t thought about. So if you are an open data, open health data, health data, informatics, or electronic health record advocate I hope you join me in the fight to make our industry relevant and useful.
Today I was listening to a story on a large Pill Mill bust that had the unintended consequence of depriving patients of their pain medicine. Law enforcement officials arrested more than 200 doctors, physicians, and patients across four states. It got me thinking, why not use Marijuana?
What’s interesting about the piece is that we (as a nation) continue to see spikes in the use of prescription painkillers with a recognition that law enforcement can barely hold back the tide in terms of illegal use of these medications. Even legal uses of these medications have become so difficult to obtain that I suspect many patients give up and go to the black market. As one can see from the following chart the total number of painkiller prescriptions continues to increase.
As the number of prescriptions increases it only goes to figure that a patient’s dependence on these drugs only increases. Unfortunately, for patients dependent on Opiate painkillers it becomes increasingly more difficult to legally obtain the medication. As a result, patients with dependencies turn to the black market and over time migrate to Heroin because it is a cheaper (and in some cases) and a stronger high. I don’t think it is coincidence that if you look at the chart below you can see that Heroin use has decreased as has the use of Opioids
Now I’m not suggesting that there is a direct correlation from Opiate based painkillers to Heroin but the data seems to suggest that the issue warrants further study. So if we have an epidemic in the use of Opiate based painkillers that leads to an increase in the use of Heroin what can be done?
According to the Institute for Substance Abuse Evaluation “Many opioids are prescribed for their analgesic, or pain-relieving, properties. Morphine, codeine, and related drugs that fall within this class are sometimes referred to as narcotics. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), and meperidine (Demerol). In addition to their pain-relieving properties, some opioids – for example, codeine and diphenoxylate (Lomotil) – are used to relieve coughs and diarrhea.” Given these many uses of Opiate based painkillers it is no wonder that we are seeing increased addictions.
What if a drug such as Marijuana could help to relieve some of these conditions instead of the use of Opiate based painkillers? This graphic from NORML presents a view of the many ailments that if used properly Marijuana could help with. Now I’m not advocating that Marijuana is some new wonder drug or that it is the solution to our drug addiction problems, but what I am saying is that those of us working with health data and informatics need to take a hard look at Marijuana with legitimate data and studies that can help to better educate the public as to Marijuana’s benefits and impacts.
Just in the course of today’s media posts I saw articles that discussed using genetically modified lettuce to replace chemotherapy and another article on the importance of tracking incidents of cancer. These articles got me to thinking about a recent paper I completed on a notional cancer transparency portal. The Transparency Portal I envisioned in this paper provides a mechanism for cancer research and treatment centers to become more transparent in their use and publication of cancer data. When fully implemented a Transparency Portal can enable a cancer research center or provider to publish cancer-related data in an open and accessible way. A recent AMIA panel charged with developing a national framework for the use of secondary (e.g., use of data outside of the facility) use of health data has several relevant recommendations. The panel evaluated organizations currently engaged in publishing health data. Upon reviewing the current landscape the panel determined that organizations should be aware of and plan for the publishing of secondary health data(Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The first concept the panel identified centered around the recognition that health data is becoming widely (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The panel found that the use of secondary health data is widespread and should addressed by any organization engaged in the health ecosystem. The panel also found that many potential users of published health data are unaware that the data even exists (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The panel went on to recommend that organizations take care to promote properly and educate the public on the availability of this data (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). In another recommendation, the panel suggested that the access to secondary health data has become a national imperative (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tanc, et al., 2007). From these recommendations, we can draw the conclusion that making our data available in the way proposed in this paper not only is beneficial to the cancer provider or researcher but also is also beneficial to our entire health ecosystem.
The Transparency Portal is necessary to help cancer researchers and providers improve their reputation and research productivity evaluations in two ways. Through a Transparency Portal the organizations will begin to publish grants, clinical trials, and (de-identified) patient surveys. This data (when published) will help improve reputations by combating the perception that the Hospital is only focused on generating revenue and is not interested in conducting research that improves the health ecosystem. There is, unfortunately, a perception in the marketplace that Hospitals engage with a pure focus on revenue at the expense of driving up costs (Relman, 2013). Through the Transparency Portal, organizations will be able to demonstrate how they spend their precious resources in support of their mission and how that mission ultimately benefits the entire health ecosystem.
If you are interested in the full version of this paper email me at firstname.lastname@example.org
I will be posting additional portions in future blog posts.
As a graduate student in the University of Illinois at Chicago’s health informatics program I thought I would start a discussion that gives you my perception on this program and insights into classes that I’ve taken. As I publish my insights into the program I encourage you to comment and add your own insights. As an open-data evangelist, I believe in transparency and therefore I think it is critical to share information about this program.
During the Spring 2015 semester, I completed two classes, BHIS 520 Health Information Systems Analysis and Design and BHIS 530 Topics in Health Informatics. In the days to follow I will be publishing my feelings and observations on both of these classes.