HIMSS11: Laying the Foundation for Data-Driven Applications

The HIMSS conference was in Orlando, the home of DisneyWorld, last week and it was indeed like an amusement park for health IT professionals.  So many attractions: vendor demos to view in the exhibit hall, concurrent education sessions, and so many colleagues, clients and prospects in one place that it’s difficult to not suffer information overload.  And, I didn’t even mention the receptions and parties (most of which I was too drained to attend).

Meaningful Use = Content + IT

Unlike some of the IT professionals at the conference who felt that HIMSS11 lacked the level of creative innovations on display in past years, I was excited by the progress made in building the infrastructure that will enable a new class of data-driven innovations.  Granted, it was a bit repetitive to have so many vendors touting their ability to help providers meet Meaningful Use requirements and demonstrating what looked like the same dashboard for reporting core quality measures.  But looking beneath the surface to consider how much progress has been made in the past 12 months in shifting the focus from the technology to what can be done once content flows through the technology platform gave this data geek reason to be optimistic about the future.  In fact, I use the word “exciting” twice in this video interview I did with Liza Sisler from Proficient at HIMSS.

Interoperability

Among the highlights for me at HIMSS11 was the Interoperability Showcase, which I found both extremely useful and rather mind-blowing.  The Showcase was useful in understanding a variety of use cases where standards are being applied—mostly in pilot programs—to exchange, aggregate, and analyze data.  The mind-blowing aspect relates to the sheer number of agencies and IT consulting firms working on pieces of the overall infrastructure and regulations, coupled with the realities of our not-so-united states that result in lack of nationwide master indexes and formats.  See Keith Boone’s post called Putting the Lego Together to get a sense of the current state of standards for HIE.

Translating research for clinical decision support tools

I was also pleased to attend the Elsevier press briefing at HIMSS11 where they demonstrated their Smart Content system that builds automated bridges between Elsevier’s extensive body of research information and their clinical decision support (CDS) tools.  Reconfiguring existing research knowledge that largely resides in textual formats for use in clinical applications is a major undertaking and it’s encouraging to see that the largest publisher of research journals has made significant progress in this regard.  On a wider scale, the research community is making progress in reporting results that can more easily be extracted for further analysis (e.g., ClinicalTrials.gov current reporting formats), but crosswalks between research specialties and different types of media will be needed for the foreseeable future, especially as more collaboration occurs between researchers.

Social, mobile, local

The HIMSS conference itself is a perfect use case for the value of social and mobile media. (See Jane Sarasohn-Kahn’s terrific presentation at HIMSS on this topic.)  Without my smart phone and Twitter, I would never have been able to connect with as many people as I did.  Even with these social, mobile and local tools, I managed to miss a few people due to meeting overruns and technical glitches (i.e., connectivity problems in the massive convention center).  But, being able to connect with dozens of people from my online community at an event that had over 31,000 attendees — and share information with the broader online community who weren’t at the conference—clearly demonstrated the value of social, mobile and local media. 

Needed: New Collaborative Models in Medical Research

In a talk I gave in 2009[1], I addressed the challenge of turning the enormous quantities of digital data that will be produced by EHR systems into “reliable, usable” information and emphasized the importance of creating new models of medical research and statistical techniques for dealing with these large universes of new outcomes data.   I went out on a limb at the time –since my training in statistics was in business school, not medical school—but have since found many who support my position among the best and brightest in the medical community. 

Weaknesses of current research methods

Currently we use the term “translational medicine” for the process of taking the results from research studies, typically Randomized Control Trials (RCTs), and transforming them into data that can be used in a clinical setting.  The process includes writing articles for publication to describe the research findings in medical journals (after peer review), which then get further interpreted by clinical teams at medical societies/associations/public health authorities to produce guidelines or other clinical applications.  At the same time, published research results get disseminated in the mass media by healthcare journalists.    Many of the difficulties and inadequacies of this approach have come to light as the health IT infrastructure in the US struggles with integrating clinical evidence into electronic health records (EHRs).   The two toughest issues are:  1) the difficulty of extracting data from journals (print or electronic format) because the journal format wasn’t designed for data extraction, integration or machine analysis and 2) the lack of collaboration between research institutions that leads to an enormous number of research results that don’t build on previous studies and are sometimes contradictory.   As a result, even elaborate data mining engines—or a redesign of journal formats—won’t by themselves solve core problems with our current research system. 

New Data, New Models

Beyond lack of collaboration, there is a more fundamental issue about the appropriateness of RCTs as a source of clinical guidance.   Marya Zilberberg, MD, MPH writes in JAMA that we have an “avalanche of published research” yet the “data generated in an RCT are frequently irrelevant because of their limited generalizability” [2].  The cause of the limited generalizability is the “hetereogeneous treatment effect” and I won’t go into details of what that means here; for that, read Dr. Zilberberg’s blog series on Reviewing Medical Literature, which is now at part 5 and is highly recommended reading.   But, as you can probably guess from the word “heterogeneous”, the problem relates to the fact that we don’t all respond to a specific treatment in the same way.

Another recent article published in New England Journal of Medicine (NEJM)[3] buttresses my position that we need new research models and new incentives for collaborating.  This article presents some stark data on how little emphasis – and financial support – has been placed on outcomes research, best practices, new care models, quality, comparative effectiveness or service innovations relative to total biomedical research (0.1% v. 4.5% of total health expenditures).   The 0.1% will increase to 0.3% in 2010 according to the authors, but that’s still a small percentage considering that we are facing a huge pool of new outcomes data that will be generated by EHRs and haven’t yet agreed upon the best statistical methods for organizing and analyzing these collections of data that hold so much promise for enhancing the clinical value of medical research. 

There are models that have been developed for analyzing outcomes data, especially within the payer segment.  Registries of patient data have existed for some time, but have been limited in scope or the  reliability of the data sources (e.g., claims data).   But, in order to achieve a “higher standard” of clinical value, more collaboration and “development of more robust analytical techniques for ascertaining clinical value”[4] are needed.  

This emerging field offers opportunities for data publishers that understand how to apply master data management (MDM) principles and data analytics/predictive analytics companies in biomedical research that can adapt their models for clinical applications. Perhaps the biggest opportunity is for standards organizations and data publishers to build a collaborative infrastructure for better aligning biomedical research and clinical decision support systems. 

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[1] http://www.slideshare.net/janicemc/epatientconnections2009-health-content-for-epatients

[2] The Clinical Research Enterprise; Time to Change Course?, JAMA, February 9, 2001—Vol 305, No. 6, Marya D. Zilberberg, MD, MPH,: http://jama.ama-assn.org/content/305/6/604.short.

[3] Biomedical Research and Health Advances, NEJM, February 9, 2011, Hamilton Moses, III, MD, and Joseph B. Martin, MD, PhD: http://healthpolicyandreform.nejm.org/?p=13733.

[4] Ibid.

HIMSS11 Conference Planning

I could spell out what HIMSS stands for, but if you have to ask, you probably aren’t planning to attend this major gathering for the healthcare industry.  HIMSS (okay, it stands for Health Information Management Systems Society) is a membership organization that was established 50 years ago for IT professionals working in healthcare, but has grown to include adjacent segments with interests in health IT.  The annual conference attracts close to 30,000 attendees (about 28,000 last year in Atlanta, but I expect a higher number in Orlando this year) and requires advanced planning to arrange meetings and optimize one’s route to minimize miles walked per day. 

Last year, I was pleased to see so many “traditional” healthcare publishers with a presence in the exhibit hall.  My blog post last March mentioned many of them.   This year, I expect to see even more publishers in the exhibit hall, on the program, and sitting in education sessions.  Better yet, I expect to see more progress in creating point-of-care clinical decision support tools and care management tools that build on the best-of-breed authoritative content and data sources. 

Forging alliances between the healthcare publishers and EMR/EHR/Health IT vendors is an important part of what we do at Health Content Advisors.  We’re not always the final dealmaker, but we get involved in identifying content and technology partners in nearly all of our client projects.  So, whether you are on the publishing side or the IT content integration or data exchange side, we’re interested in learning what is new among your offerings.  Please contact me @ jmccallum@infocommercegroup.com if you’d like to set up a meeting at HIMSS11.

On the “social” side, I’m looking forward to meeting up with the healthcare folks I interact with on a near daily basis on Twitter and via this blog.  It was terrific to connect with many so many of my social media contacts last year in Atlanta and I look forward to catching up with even more people this year-with better advanced planning-in Orlando.  HIMSS will have an expanded social media center in Exhibit Hall E, Booth 7981 , where I know I’ll see familiar faces.  I still remember getting a Twitter message from Liza Sisler @lizasisler who recognized me from my online photo when I sat in one of the social media sessions last year (“is that you across the aisle from me?”).   Also, I plan to attend the new media bloggers tweetup at the MEDecision booth #2563 on Tuesday, February 22 from 4:30-6pm. 

For more information on the HIMSS11 conference, see the conference home page.  Along with all the activities I mention above, there is also an impressive line-up of keynoters, including the who’s who of federal healthcare officials.  I look forward to seeing you there!

How Avvo is Connecting Patients and Doctors via Content

[Update: Avvo has sold its healthcare business to HealthTap as of November 29, 2012 to focus on its legal business.

In the business-to-business (B2B) sector, InfoCommerce Group[1] has been the leading consulting firm that has helped guide traditional directory publishers to transform themselves into online marketplaces that connect buyers and sellers. As my colleague Russell Perkins wrote last week, “Until quite recently, the gold standard was buying guides … that provided buyers with little more than a starting point’.[2]

The same holds true with physician directories-in print and online. Directories of medical professionals that follow the old-model compilations of profiles based on basic descriptive data–including specialty, education, board certifications, which insurance they accept, whether there are any complaints of misconduct–have represented the status quo for some time. The biggest differentiator between most of the competing doctor rating sites has been the availability and quality of user ratings.

Avvo = Blog Network + Doctor Profiles + Ratings 

Avvo, a young company in Seattle that has had success in the legal market, has just expanded into the healthcare market with a new approach to online physician directories.[3] Avvo has done the groundwork of compiling profile and related data from state and national medical boards and insurance company websites for 800,000 doctors, which is essential as a starting point in today’s competitive doctor ratings environment. But Avvo goes further and combines the model of existing doctor ratings sites and physician blog networks.

Content Marketing 

I especially like their use of content as a tool for attracting and engaging consumers. With Avvo, the content is contributed by the doctors who are profiled. Doctors can contribute health information by publishing health guides or by responding to questions submitted by consumers. Because the location of the person asking the question is listed, local doctors have an added incentive to respond to questions by local consumers. At this point in their development, there isn’t too much doctor-contributed content on which to rate the quality or likely success of this “content marketing” approach, but one can look at Avvo’s success in the legal market to gain a better idea of how content marketing helps consumers evaluate legal professionals.

Platform for Physician Blogs 

Physician created online content isn’t a new phenomenon. Leading edge physicians like Dr. Val Jones (DrVal) and Kevin Pho, MD (KevinMD) have been blogging for years and have leveraged their content on social media networks, too. (DrVal has over 4,700 followers on Twitter and KevinMD has over 27,000.) With their own content as anchors, they have built physician blogging networks, GetBetterHealth.com and KevinMD.com , respectively. The blogging networks have become destination sites in their own rite and are even attracting content partners who want to reach the audience that these entrepreneurial doctors have attracted. Just a couple of weeks ago, Harvard Health Publications announced an agreement with the Better Health blog to contribute content to GetBetterHealth.com.

With Aggregated Sites, Size Matters

With aggregators, bigger is better when it comes to findability and search engine optimization (SEO). Avvo excels at SEO and if it succeeds in building a large collection of credible health information, it will create a sort of virtuous circle for contributing doctors: they earn trust based on the good content they write, and over time, content from highly rated doctors gains more credibility. One downside of the content marketing approach to building exposure and credibility: not all good doctors are also good writers. For doctors who prefer to focus on other activities (including seeing patients face-to-face), Avvo could still serve as a platform for recommending content from other doctors or information sources. I’m not sure if this content mediation aspect is already incorporated into the Avvo model (I’ll ask them to respond), but I like the idea. We know from Pew Research that when seeking health information or assistance with medical issues more consumers turn to a health professional than to other sources such as family or the internet, so it follows that content recommended online by one’s physician or another credentialed health professional whose qualifications are readily available would be considered trustworthy by most consumers.

Overall, I see a lot of value in Avvo’s model of providing an aggregated platform for doctors to communicate health information to consumers. By offering SEO and content management services, Avvo relieves the physicians of the need to keep current with web technology and search marketing. Better yet, the content marketing approach provides a ’social media’ aspect that allows consumers to get a more complete picture of a physician than can be gleaned from static profile data. And, for those of you who are asking, “so what’s the business model”? , Avvo relies on contextual advertising and sponsored links, à la Google. By providing healthcare information from trustworthy sources (relevance) and broad coverage of healthcare professionals (size), Avvo clearly understands what it takes to succeed when contextual advertising is the sole revenue model.
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 [1]InfoCommerce Group is the parent company of Health Content Advisors.
 [2]See: http://infocommerce.typepad.com/my-blog/2010/11/buying-and-selling-40.html
 [3]http://avvoblog.com/2010/11/01/avvo-launches-doctors/
 [4]KevinMD is now part of the MedPage Today network of health information sites.
 [5]http://getbetterhealth.com/the-better-health-blog-partners-with-harvard-health-publications/2010.11.11.
 [6]86% of the consumers surveyed by Pew Internet said that they ask a health professional, such as a doctor, when they need information or assistance in dealing with a health or medical issue. See: http://www.pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information/02-A-Shifting-Landscape/3-The-internet-does-not-replace-health-professionals.aspx for more information.

How Is Healthcare Like Construction?

At the InfoCommerce Group’s Data Content 2010 conference last week, Per Lofving from McGraw Hill’s construction group, Sweets, described how a literal trailer-full of paper is left behind at the end of big construction projects.  Automated applications exist in construction, but they don’t speak to each other, so printouts are used to deliver information from one party to the next.  My immediate thought was “oh, there’s another industry besides healthcare that is still dead-tree based“. 

Lofving was joined by Mike Collins from Autodesk and they described how they partnered to integrate data from Sweets into Building Information Modeling (BIM) applications offered by Autodesk. Two key points stood out during this presentation:

1. Lofving described how B2B trade publishers have historically been very proprietary with the data they aggregate, even though it could be used to improve workflow in the industry if provided in the appropriate formats. 
2. Collins described Autodesk as a data business.  He said they get categorized as a software business, but in actuality, they should be classified as a data business because the modeling software integrates industry specifications and offers a data-driven workflow solution to builders.

In healthcare, the number of guideline publishers may exceed the number in the construction industry, but the construction case study illustrates how publishers could partner with “software” companies to create workflow solutions for their customers.  Yes, the information they provide may be useful in its current format, but it could be even more valuable to the industry if it were integrated with application software to provide true workflow solutions (e.g., clinical decision support systems).  Also, the health IT vendors need to become more aware of the existing sources of clinical information provided by healthcare publishers that aggregate, index, archive, update, and distribute clinical information.  There remains work to be done in formatting data for delivery to IT applications, but that level of detail can be worked out during partnering negotiations.  The healthcare industry and all of us will be better off when health IT and healthcare publishers create stronger partnerships.