Health Content on Stage at Data Content 2010

InfoCommerce Group’s annual conference, Data Content 2010 is coming up soon (Oct 26-28).  This is our 18^th annual gathering of data-centric publishers and we include a healthy dose of health content programming this year.  Our speaker line-up includes Dr. Sanjaya Kumar, CEO, Chief Medical Officer of Quantros, a software and services company that works with hospitals to improve quality, performance and patient safety. Quantros’ MEDMARX database and reporting system for adverse drug events and medical errors has been nominated for a Model of Excellence Award from InfoCommerce Group.

Dr. Katrina Firlik, co-founder and Chief Medical Officer, HealthPrize Technologies, joins Dr. Kumar on the agenda and as a Model of Excellence Award nominee.  HealthPrize is an innovative new company that embraces the concept of participatory medicine where patients become actively involved in their own health care.  The initial HealthPrize implementation focuses on medication adherence and its features go beyond providing a smart device that serves as a reminder to take medications; HealthPrize offers a complete system with awards to patients for meeting goals.  From the health content perspective, we are impressed that HealthPrize incorporates relevant information to help patients understand their condition and their medication care plan, along with custom data analytics displays that help put a patients’ health monitoring in perspective.  

We are also pleased to announce that Jason Brown from Canon Communications will speak on the Best Practices panel about Canon’s recently launched Qmed medical device marketplace.  Medical devices play a critical role in producing and connecting health data and we look forward to learning more about Canon’s directory of qualified suppliers to the medical device industry.

Data Content will wrap up with break-out roundtable discussions led by InfoCommerce principals.  I will lead a discussion on Connected Health Data and will kick off the discussion with a revised version of the diagram I used last year to represent the health content industry. 

On another note, I want to announce to the readers of this newsletter that I am now a guest blogger for the HealthTap.  HealthTap is a new company whose objective it is to create a Personal Health Utility that enables individuals to access relevant information, manage data that affects their lives, and make more informed data-based choices about their health and well-being.  Read my first entry, Health IT is Breaking Through on HealthTap.

We are at an important threshold in how medicine is practiced and how healthcare is delivered in the US (and elsewhere).  We at Health Content Advisors are thrilled to include a distinguished group of health industry visionaries on our program at Data Content 2010 this year.  Please join us!

Consequences of Market Concentration in Healthcare

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, wrote in his blog about dangers of market concentration in the provider segment earlier this week.   Levy’s main point is that large provider groups can negotiate better rates from payer organizations and put smaller provider organizations at a disadvantage and that the accountable care organization (ACO) model could exacerbate the negotiating power.  Furthermore, there are consequences to consumers when market power is highly concentrated.  Also this week, John Moore of Chilmark Research wrote about the recent acquisition of Axolotl by Ingenix, a healthcare data analytics company.  In this post, I connect and extend these two topics and address issues related to vertical market concentration in healthcare with Ingenix as the example.

Ingenix is a wholly-owned subsidiary of UnitedHealth Group, an $87 billion (2009 revenue) company with approximately 80,000 employees in its four major divisions:  health benefits, benefits management, data and information services, and pharmacy benefits management (PBM).   The health benefits (insurance) segment is the largest by far with 2009 revenue of $81.3 billion, and Ingenix (the data and information services segment) is the smallest with 2009 revenue of $1.8 billion.

However, Ingenix has an operating margin of 13.5% vs. the health benefits margin of 5.9% and Ingenix’s recent top line growth is stronger than the other segments.  Considering the number of acquisitions made by Ingenix, it’s not a surprise that revenue is growing.  According to Ingenix’s careers page, the group has acquired over 50 companies in the past 10 years.  See Alacra’s headlines and timeline of the Ingenix acquisitions since 1998 (as well as their offer to sell you more information).

A few notable acquisitions include The Lewin Group, a healthcare consulting company, QualityMetric, a health outcomes measurement company, and PICIS, a clinical workflow IT vendor to hospital emergency departments.  I find these deals of note because they clearly extend Ingenix’s purview beyond the payer and pharma analytics segment into the clinical analytics segment. 

The Lewin Group, for instance, received a contract from HHS last year to develop the framework for comparative effectiveness research.

Lewin describes how the resources of its sister companies within Ingenix position it well to develop the framework that will be used to determine the relative effectiveness of treatments on its own site as follows (emphasis mine):

The Lewin Group Center for Comparative Effectiveness Research has unique capabilities for conducting and supporting CER, combining The Lewin Group’s broad and widely recognized record of independent analysis of health information technology, evidence-based medicine, health care policy and other issues; affiliate company i3’s expertise in clinical trials and study design, drug safety, health economics and outcomes research; and Ingenix data.  Through Ingenix, the Center will have access to robust longitudinal de-identified patient data sets including integrated medical, disability, laboratory results and pharmacy claims data.  The staff available to the Center includes more than 1200 health services researchers, clinicians, clinical trial design experts, epidemiologists, biostatisticians, health data experts, health economists, and others.

In John Moore’s post, Ingenix’s EVP for provider solutions states that he “sees a convergence of administrative and clinical processes”.  I agree that analytic processes and platforms that have been developed for the payer market are being adapted for use in clinical settings, and I’d add that the same type of convergence is occurring between life science research analytic platforms and clinical platforms.  In fact, I’ve drawn a 3 circle Venn diagram illustrating the convergence in healthcare data analytics between these three domains in recent client reports.  

Should we be concerned that a large payer analytics company (Ingenix), owned by one of the largest health insurance providers, is on a path toward becoming a dominant clinical data analytics company?  I think so.  There are so many reasons to be optimistic about the benefits of data analytics in healthcare applications that can lead to improved personalized care and drug treatments.  But, like Levy, I have concerns about the concentration of power in large organizations and the implications of such market power on the future of clinical decision support systems.

TEDx Boston: It's Not Just About Information

I had the great pleasure of spending last Thursday at the TEDxBoston conference.  TED stands for Technology, Education, and Design. From my vantage point as a publishing industry consultant, I’d say  that the value of content is a function of technology, education, and design:  Content=f(T,E, D). 

Three talks at TEDxBoston that held the most for publishers were those by César Hidalgo, Seth Priebatsch, and Eric Mongeon.  Hidalgo spoke of the benefits of incorporating more complex relationships in predictive modeling.   He used the example from his studies of development economics, but on his website he also describes his collaborative research project related to predictive modeling of human diseases: HuDiNe.   Advances in computer technology and analytics have enabled his work that models complex relationships between a large number of variables.   Underlying his research are cross-discipline data sets, a trend that data publishers in all industry should take note of. 

Priebatsch, who is founder of SCVNGR, a game platform for completing place-based challenges, addressed how engaging users through interactive learning experiences that offer tangible or virtual rewards can guide behavior.  He referred to the medication compliance problem in healthcare where patients don’t take their prescriptions as directed and mentioned Cambridge-based Vitality that has a partial solution with its smart device GlowCaps.  Too bad he wasn’t aware of HealthPrize, [1]  another start-up that is targeting the same medication compliance issue with a solution that embraces the gaming mentality and rewards positive behavior.

Eric Mongeon, who includes the line “Denier of the death of print” in his Twitter profile, underscored how design can transform a publication into a multi-dimensional experience.   In his 4 by Poe series, design isn’t an afterthought, it’s an integral part of the publication.  The same thinking should hold for digital publishers that want to rise above commodity status.  Another lesson from Mongeon’s talk: publishers won’t enhance the lifetime of their print publications by scrimping on design and quality. 

TEDxBoston included an imaginative collection of speakers from academia, industry, non-profits, start-ups, students, musicians, artists, and journalists.  Every talk and performance was inspiring and passionate.   Filtering it for to B2B and healthcare publishers, the message was: always consider the three TED elements when planning content products and services.  Think beyond the informational value of your content to consider how to optimize the experience of consuming your content—that is, if you want to rise above commodity status. 

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1 HealthPrize’s  CMO, Dr. Katrina Firlik, will be speaking. at our upcoming Data Content 2010 conference.

Full text of the section of the meaningful use final rule from the CFR

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, 422, and 495

NPRM EP/Eligible Hospital Objective: “Provide access to patient-specific education resources upon request.”

In the proposed rule, we discussed this objective, but did not propose it. We stated that there was a paucity of knowledge resources that are integrated with EHR, and that also are widely available. We also noted that the ability to provide education resources in multiple languages CMS-0033-F 182 might be limited. We stated our intent to further explore the objective in subsequent stages of meaningful use.

Comment: We received many comments, including comments from both the HIT Policy Committee and MedPAC, to include this measure in the final rule. These commenters disagreed with our assertion in the proposed rule that “there is currently a paucity of knowledge resources that are integrated within EHRs, that are widely available, and that meet these criteria, particularly in multiple languages.” Specific examples of the availability of knowledge resources integrated with current EHRs were provided. The HIT Policy Committee amended their recommendation in their comments on the proposed rule to:

- EPs and hospitals should report on the percentage of patients for whom they use the EHR to suggest patient-specific education resources.

Other recommended language for the objective includes

- Provide patients educational information that is specific to their health needs as identified by information contained in their EHR technology such as diagnoses and demographic data, and

- The original HIT Policy Committee objective of “Provide access to patient-specific education resources upon request.”

Response: We are convinced by commenters that the availability of education resources linked to EHRs is more widely available than we had indicated in the proposed rule. Therefore, for the final rule we will include this objective for the Stage 1 of meaningful use.

We note that the new recommendation of the HIT Policy Committee is a hybrid of a measure and an objective, whereas in developing the meaningful use criteria we consistently identify both an objective and associated measure. However, we agree with the HIT Policy Committee and others CMS-0033-F 183 that the objective and associated measure should make clear that the EP, eligible hospital or CAH should utilize certified EHR technology in a manner where the technology suggests patient-specific educational resources based on the information stored in the certified EHR technology. Therefore, we are including a revised version of this objective in the final rule for Stage 1 of meaningful use.

We also believe it is necessary to state what level of EP, eligible hospital and CAH discretion is available when deciding whether to provide education resources identified by certified EHR technology to the patient. Therefore, we include the phrase “if appropriate”, which allows the EP or the authorized provider in the eligible hospital or CAH final decision on whether the education resource is useful and relevant to a specific patient.

After consideration of the public comments received, we are including this meaningful use objective for EPs at §495.6(e)(6)(i) and eligible hospitals and CAHs at §495.6(g)(5)(i) of our regulations as “Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate”.

NPRM EP/Eligible Hospital Measure: Not applicable

Comment: CMS received a comment requesting an 80 percent threshold of appropriate patients and/or caregivers receiving patient-specific educational materials. In addition, the HIT Policy Committee’s revised objective suggests a patient based percentage.

Response: As with the addition of the recording of advance directives, we are able to relate this measure to one that is based on patients and can be accomplished solely using certified EHR technology. As this objective requires more than just the recording of information in certified EHR technology, we adopt a lower threshold of 10 percent.

CMS-0033-F 184

After consideration of the public comments received, we are including this meaningful use measure for EPs at §495.6(e)(6)(ii) and eligible hospitals at §495.6(g)(5)(ii) of our regulations as “More than 10 percent of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources”.

We further specify that in order to meet this objective and measure, an EP, eligible hospital, or CAH must use the capabilities Certified EHR Technology includes as specified and standards at 45 CFR 170.302(m). The ability to calculate the measure is included in certified EHR technology.

To calculate the percentage, CMS and ONC have worked together to define the following for this objective:

* Denominator: Number of unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. A unique patient is discussed under the CPOE objective.

* Numerator: Number of patients in the denominator who are provided patient education specific resources

* Threshold: The resulting percentage must be more than 10 percent in order for an EP, eligible hospital, or CAH to meet this measure.

We do not believe that any EP, eligible hospital, or CAH will not have more than 10 percent of their patients eligible to receive patient specific education resources and therefore do not believe an exclusion is necessary for this objective.

Final Meaningful Use Rules Provides Boost to Publishers

The final rule for meaningful use of electronic health records was provided by the HHS Office of the National Coordinator (ONC) last week. The rule spells out the minimum requirements that EHR implementations must meet in order for the provider to be eligible for incentive payments.

I’m pleased to see that objectives related to patient access to information from his/her record are emphasized in the final rule. Offering incentives for doctors to provide patients with a clinical summary at each visit will improve doctor-patient relationships and help patients become more involved in their own health care and almost certainly will improve patient compliance with care instructions. But what really caught my attention is the rule that relates to using “certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate” [i.] This objective wasn’t included in the interim certification criteria, so its addition to Stage 1 of the final rule was a pleasant surprise.

The rule only requires that >10% of patients receive patient-specific education resources. Still, it is a start and will provide encouragement to more healthcare publishers to invest in creating high quality timely information for patients that can be incorporated into EHRs.

Already, clinical information publishers including EBSCO, Thomson Reuters Healthcare, Elsevier and Wolters Kluwer are in various stages of customizing patient education information for use within electronic records via Infobuttons.[ii]  The new meaningful use rule will be a boost to all publishers of evidence-based medicine to continue to fund expansion of their information sources and clinical decision tools for patients. And, once consumers get a taste for the personally relevant education materials that help them understand their conditions and their care plans, I predict that demand for more patient education resources will skyrocket.

i Full text of the patient education section from the final rule is appended below.

ii For more on Infobuttons, see: http://www.informatics-review.com/wiki/index.php/Infobuttons .