I’m writing this late on Sunday afternoon of Labor Day weekend. It’s peaceful and serene and the weather in the northeast is just about perfect. I’m sitting in a rocker on my front porch savoring a good cigar with my favorite dog at my side. He’s working on his eighth nap of the day, and I’m enjoying the peace and quiet, reflecting on the meanings of Labor Day.

Labor Day, a celebration of work, in all its virtue, and those who toil.

Labor Day, the unofficial end of summer. I find my thoughts turning to summer. Ah, the feeling of sand between the toes; the aroma of food on the grill; the sound of waves breaking, kids in the pool, or a fishing line softly breaking the silence of a still lake. None of these evokes thoughts of meaningful use, ICD-10, or hitting one’s numbers.

Although summer is a time of vacations and fun, most of us spend the majority of the summer working. Some love to work, and others pretend to. But for most of us, work is … well, work. Until we may have the good fortune to achieve some state of retirement, the trick seems to be in finding the right balance of working and not working, and keeping it all in perspective. Unfortunately, thanks to technology, some of us are more emotionally tethered to our work and less likely to have a clear “on / off” switch.

Sadly, as this summer was beginning, we lost a role model of balance. A quiet hero, in my book.

When he passed in June, much was written about John Wooden, the player, coach, and man. Wooden achieved a level of success rarely seen in the sports world before or since. He was the first person to be inducted into the Basketball Hall of Fame as both a player and coach. His teams at UCLA won 10 national championships in 12 years, including 7 in a row. He was a coach, mentor, and father figure to some of the best to ever play the game.

Yet, Wooden considered all this secondary to living a good life and being a good person. He was all about using one’s gifts to fully realize his or her potential. He knew this sincerity of effort and dedication brings peace of mind and self-respect. Combined with an unwavering sense of compassion, this enables anyone to be a real success: a role model, mentor, and good human being, both on and off “the court.” A comforting thought.

Finishing my cigar as the pooch beside me begins to stir, I feel grateful for vacations, the opportunity to work, and the quest to keep it all in balance. And for our friends who are temporarily between jobs, I pray that they soon get the chance to return to work and that same challenge of balance. And I redouble my commitment to doing what I can to help them.

Jim Gibson has been in healthcare for 25 years. In 2002 he founded Gibson Consultants after several years in healthcare IT and group health insurance. Gibson Consultants is a national search firm specializing in healthcare IT companies. Like Jim, the other professionals of Gibson Consultants enjoyed successful healthcare careers before turning to executive search. Follow Jim on twitter http://twitter.com/jim__gibson or reach him at (203) 431-5729 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Multiple trends are pushing the healthcare delivery system in the direction of population health management (PHM). These include the “meaningful use” requirements for government health IT subsidies, patient-centered medical home pilots, the prospect of payment bundling and Medicare’s incentives for accountable care organizations. But the familiar obstacles to this approach still exist: the fragmentation of healthcare providers, poor communication across care settings, misaligned financial incentives, the difficulty of tracking and managing healthcare outside of office visits and the inability of providers to keep track of all the services that patients need.

Electronic health records (EHRs) can help physician practices and healthcare organizations overcome these barriers by making information more accessible at the point of care. If EHRs are interfaced with labs, pharmacies, and other providers, and they include some degree of decision support, they can be even more useful.

But to achieve the goals of population health management, care teams also need a new generation of tools that automate routine PHM tasks. For example, the EHR can be enhanced to deliver Web-based health-risk assessments and educational tools that stratify patients and help them manage their own health. Electronic registries can help physicians monitor patients’ health status and the services that have been provided to them, and evidence-based protocols in those registries can trigger automated interventions with patients when they’re overdue for care. Powerful new applications for analyzing EHR data can help care managers improve care for both individuals and populations. By using these techniques in conjunction with EHRs, providers can reduce the cost and increase the effectiveness of population health management.

To do PHM properly, physicians and their care teams must strengthen their relationships with patients in a variety of ways, including making sure that they come in for needed preventive and chronic care. Care teams must optimize the services they provide to patients before, during and after office visits. And they must extend their reach beyond the four walls of their offices to provide a continuous healing relationship. The appropriate IT tools can facilitate achievement of all three goals while lessening the burden on practices.

Combining an electronic registry with an automated method of communicating with patients who are overdue for preventive and/or chronic care services will provide solid inroads to strengthen the doctor-patient relationship. Patient demographic and clinical data in the registry can come from billing systems and electronic health records, as well as hospitals, labs and pharmacies. Advanced registry dashboards identify patients with particular health conditions and deliver insights into improving care across a population. By using evidence-based clinical protocols, the registry can trigger outbound messaging to patients who need to make an appointment with their doctor for particular services at specific intervals.

Optimization of visits requires preparation by both the patient and the care team. Patients that complete health risk assessments – either online or at a computer kiosk in the office – can show the state of their health and how they’re managing it. After they have completed an HRA, automated tools can provide educational materials tailored to their conditions; these tools can also direct them to appropriate self-help programs for, say, smoking cessation or losing weight.

The registry-based technology, meanwhile, can provide care managers and coordinators with actionable reports that combine data from their EHRs with data from registries, other providers, and HRAs to show what has been done for the patient and the gaps in their care that need to be filled. Care managers can also supply this information to physicians prior to a patient visit and expand the care plan for the patient after they receive care.

For the global approach to population health management, providers need a sophisticated rules engine that combines disparate types of data with evidence-based guidelines, generating reports and dashboards that provide many different views of the information. For example, the entire patient population could be filtered by activity center, provider, health condition and care gaps. The same filters could be applied to patients with a particular condition, such as diabetes, to find out where the practice needed to improve its diabetes care.

Reports on individual patients could be generated the same way. A diabetes report, for instance, would show the patient’s blood pressure and body-mass index, whether they had had an HbA1c test within a certain period of time, and their HbA1c level, among other data points. By combining these reports with an integrated registry and the patient messaging software, the physician or midlevel practitioner would be able stratify their population and invoke the correct treatment plan and intervention across the right communication channel, changing patient behavior and improving the overall health of their community.

Technology is not a substitute for the physician-patient relationship, which is the basis of continuous care and can have a major, positive effect on health behavior. But to the extent that automation tools are used to strengthen that relationship and enable physicians to provide value-added services that help patients improve their health, this type of technology can help drive population health management.

Richard Hodach, MD, MPH, Ph.D., is the chief medical officer of Phytel.

Good news, you are not alone.   

Healthcare providers across the United States are inundated with data and suffer from poor data management policies and techniques. Regardless of the number of beds, revenue and payer mix, healthcare provider organizations have evolved their reporting immensely in the last 30 years, but still are hamstrung by their inefficiencies in data management, lack of analytic capabilities and information distribution challenges.

Now for the bad news: It’s about to get worse … a lot worse.

Healthcare data management challenges will multiply in the next three to five years, placing organizations at great financial risk. Numerous healthcare initiatives will spawn a healthcare data evolution, the likes of which the industry has never seen. With the healthcare industry experiencing a paradigm shift in reimbursement, whereby provider organizations will be reimbursed based on the quality and efficiency of care provided, it’s essential that provider organizations address their existing data management challenges and understand the data implications of upcoming health IT projects.

Several health IT initiatives and programs are now underway, which will generate volumes of critical healthcare data. Electronic medical records (EMRs), health information exchanges (HIEs) and meaningful use reporting are three health IT initiatives that will not only exacerbate the existing healthcare data management challenges, but will shine a spotlight on the disconnect between data management, analytics and information distribution. To compound the problems, the various health IT projects and initiatives will generate a tidal wave of reporting challenges and data integration, management and governance issues.   

The underlying challenge starts with how to manage and integrate data from disparate systems that typically contain data in different formats and are stored in proprietary databases, reports or spreadsheets. Questions often arise regarding who owns the data and therefore maintains the “single source of the truth” when data is replicated and contained in multiple source systems. Despite the logistical nuances and challenges of data management, there are numerous software tools, techniques and resources that can assist healthcare organizations unlock the value of their data assets. Without a doubt, healthcare organizations faced with limited budgets, financial risks and constantly evolving needs often forget to step back and create a roadmap for how analytics can be used within their organizations. Despite the glaring spotlight on the healthcare industry today, healthcare organizations continually miss the opportunity to define a vision and plan for both their short and long-term reporting and analytic needs.  

A significant problem for healthcare organizations is that valuable data is locked in disparate clinical, financial, and operational information systems. To unlock and capitalize on this critical data, organizations have been taking two distinct approaches to address their data management, analytic and information distribution challenges. Each approach has its pros, cons, cost implications and risks, but is valid in the data management challenge. Whether at the enterprise or departmental level, data integration and analytic reporting capabilities are required, but future needs are constantly evolving. Two widely adopted approaches are:

• Enterprise data warehouse (EDW) – The EDW integrates data from several disparate data sources into a common data model and is used in conjunction with business intelligence (BI) software solutions to develop reports, key performance indicators (KPIs) and dashboards. The EDW approach provides a single source of the truth and comprehensive analytic possibilities for healthcare organizations because it integrates clinical, financial and operational data.
• Report mining – Utilizes existing reports (e.g., revenue cycle) as the data source and allows end users to integrate disparate data (e.g., reports, databases and spreadsheets).   This approach provides an alternative method for data management and allows for a newly integrated view of the data to be consumed by BI software for development of metrics, KPIs and dashboards.

Despite the differences, the healthcare organizations that benefit most from tackling their data management issues have utilized both approaches in conjunction. Data management solutions range in complexity, cost, performance and the required level of support. Although complex, data management is just a stepping stone to developing the analytic capabilities required to support healthcare organizations. The value in healthcare data can only be truly realized when analytic capabilities are developed via reports, metrics and KPIs that allow end users to identify and act upon trends and patterns within their data. 

Whether you’re trying to measure financial performance, clinical quality or operational efficiency, healthcare organizations often develop reporting and analytic capabilities that are limited in two ways. First, the reporting and analytic capabilities are laser focused on a particular subject area and therefore do not allow for the incorporation of disparate data, which can provide insightful views into financial, clinical and operational performance. Second, reporting and analytic capabilities are often built without defining the information distribution requirements. As a result, end users are left frustrated because they are still unable to interact and receive their data in a meaningful and timely manner. 

Moving forward, the healthcare industry and its various initiatives will only further compound the data management, analytical and information distribution challenges. Successful healthcare organizations will realize the relationship between data management, analytics and information distribution and will only develop or implement solutions that incorporate the requirements from each area.

Contributed by: Tom Callahan, healthcare product manager, Datawatch

After I returned from the HIMSS conference in March, a few colleagues asked what stood out most for me at the event. Without hesitation I said it was the speed at which the mobility and portability of healthcare is developing. Walking through the HIMSS exhibit hall it became readily apparent that the technologies, devices and other innovations that we always knew would transform the delivery, consumption and administration of healthcare — but that always seemed years away — are in fact now here. 

It’s kind of like that car commercial from a few years ago that asked why we’ve never actually seen the cool and futuristic concept cars that auto manufacturers have teased us with over the years, except in this case all of the neat and futuristic stuff is right there just waiting for us to put it to good use. It’s called telemedicine, at the risk of oversimplifying, and combined with the change that has actually been legislated for healthcare over the past year, it’s putting the system on the threshold of an entirely new era.

For example: remember the dark ages of, say, 1998 or 2000 when patients were given heart monitors to wear and then had to phone their doctor to report the various data? Well, it’s pretty safe to say that we can relegate those to the same time capsule as the VCR and the rotary telephone. Fast forward to today and you’ll find wireless, Blue Tooth-enabled devices that can deliver the same information — and a lot more, in fact — in real time, 24/7. How about unlimited geographic boundaries for the delivery of medicine? Think of a lung specialist in Philadelphia rendering his expertise to a patient in rural Australia without leaving the comfort of his desk chair. Tired of being handed a clipboard and then interrogated about your medical history every time you see a new doctor? What if that information — in more breadth and detail than you can remember or are probably even aware of — was delivered to your doctor long before you even showed up for your appointment? And how about if, afterward, it was updated automatically and then followed you to your next specialist appointment?

These are just a few very small, very simple examples of the transformative powers of telemedicine and how it will (or, more accurately, has already begun to) change virtually everything about healthcare by putting information wherever we need it, whenever we need it and however we want it. This seemingly boundless availability of data isn’t simply a phenomenon unto itself, either. It’s going to impact all stakeholders in some way, which is precisely what we’ll need it to do if we’re to meet the mandates of reform.

Effecting large scale change of any sort in a system as massive and complex as healthcare seldom comes without a certain degree of trial and tribulation. It also often results in tremendous opportunity. In this respect all of the constituents in our industry stand to benefit greatly from the proliferation of telemedicine, and healthcare IT in general. Consider the previous examples and how having immediate, real-time access to more thorough data from a variety of sources can impact brand scalability and growth, market reach, operational efficiencies, cost controls and myriad other business-related factors. More importantly, imagine how the ubiquity of digital information will impact patients and their care — faster and more accurate diagnoses, better treatment plans, a generally more navigable system and, ultimately, healthier lives.

My previous two blogs were about being prepared from a technology standpoint to accommodate the forthcoming conversion to ICD-10 standards and the eventual adoption of personal health records. I’m going to continue that theme here too.

The sooner- and faster-than-expected telemedicine boom and the many opportunities associated with it mean IT professionals in all sectors of healthcare don’t have much time to react. It is important to begin assessing your organization’s existing capabilities and eventual needs now in order to be able to accommodate new and changing requirements as they arise.

As it has in virtually every other aspect of business and life in the 21^st century, technology isn’t likely to slow itself down so we can get on board — we’re going to need to be ready to jump on when the opportunity presents itself. It’ll be important to have a running start. Consider how your organization will need to handle input from additional data sources, and what it can do with all of that information once it arrives. How will it impact programs and procedures? How will its real-time immediacy change your approach? What exactly can you do with it to get the most out of it?

The proliferation of telemedicine is also increasing the need for health information exchange. As all of these cutting edge gadgets and gizmos work their way into the medical mainstream, it is crucial that they be able to receive and transmit data from throughout the healthcare ecosystem. It’s important to investigate the best means for your company to share information with multiple entities in order to stay in sync with these real-time exchanges. It’s no longer a one-way, or even two-way, transaction. Will your organization be able to deliver data to multiple users in different formats for different devices?

If this all seems like a lot to consider, well, it is. Making the digital conversion in healthcare is likely to be cumbersome at first. The good news is that, based on what I saw, heard and experienced at HiMSS, there are a lot of options out there for not only managing but capitalizing on the trend. It’s best for us all to start kicking the tires on them now, because just as we’ve gotten to this point seemingly overnight, the next step is likely to happen even faster. Technology waits for no one.