Future of Health IT: Trends and Scenarios

Cielo Clinic, Meaningful Use, and ACOs: My New Obsessions

As regular readers probably already know, I've been hiding out for several months now, getting up to speed in my new position as Chief Technology Officer at Cielo MedSolutions LLC. It's a natural next step for me, because Cielo is commercializing a University of Michigan Health System spinoff technology with which I was intimately involved in my previous position as a research informatician.

The spinoff technology was ClinfoTracker, a relatively simple and straightforward prompt and reminder system for primary care providers (PCPs). Now it has evolved into Cielo Clinic™, a clinical quality management system that can dramatically accelerate a practice's ability to participate in pay-for-performance (P4P) and pay-for-reporting (P4R) programs.  Participation in P4P/R programs translates directly into additional revenue for the practice, and it does so by facilitatinbetter quality care through delivery of evidence-based medicine in situ in the PCP-patient encounter.

There are other applications that support P4P/R participation, of course; some of these also provide alerts that are crude equivalents of Cielo Clinic's prompts and reminders. By "crude"

Cielo's compelling advantage stems from its focus on capturing and using clinical data rather than relying on billing data to drive its rules engine.  Rather than rely on ICD-9, the standard for coding problems in the US third-party payer world, Cielo Clinic employs ICPC and ENCODE, which are specifically designed for the primary care setting. Billing data has been shown to be unreliable for quality management in primary care.

Moreover, Cielo Clinic tracks clinician's response to the prompts. This ensures that, for example, if a physician has already advised a patient to undergo a colonoscopy based on a prompt driven by current clinical guidelines for colorectal cancer screening, and the patient refused, that prompt will not reappear for one year (or at a longer or shorter interval of the clinician's choosing, based on their knowledge of the patient).

We've been working on a new product that will soon become manifest in the marketplace, focused in part on the obvious buzzword of the day: Meaningful Use (MU), the benchmark the HITECH Act will use with its implications for direct patient care providers of $44K in incentives to adopt health IT.

However, we see HITECH and MU as blips on the strategic radar. The real opportunity -- and challenge -- in primary care health IT is in the development of Accountable Care Organizations (ACOs).

Lisa Bielamowicz, MD, Managing Director with the Health Care Advisory Board, the research division of The Advisory Board Company (ABC), recently posted a video entitled Keys to Success With Accountable Care Organizations on the MedPulse Business of Medicine newsletter from Medscape (free membership required to access). It's an 8-minute video that gives some good insights into how PCPs, their local hospitals, and the specialist practitioners with whom they collaborate can work together to improve patient care while reducing costs under the aegis of ACOs.

Blogger Survey by Envision Solutions

If you have your own blog on any health-related topic, please take The Envision Solutions blogger survey at  http://www.envisionsolutionsnow.com/survey2.html.  Fard Johnmar, principal of Envision Solutions, ran this survey once before and the results were very interesting. He is very aware of the pitfalls a survey can encounter, and has done this and its predecessor in a very professional manner. I look forward to the results, to be released this winter (this summer for you folks in the Southern Hemisphere).

Healthcare Blogging Summit

I know everybody who was there loved it, but I was extremely unhappy that the Healthcare Blogging Summit held yesterday in Washington, DC occurred at a time when I was unable to join in either as speaker or attender. The logjam in my schedule was my fault, not theirs, which makes me even more unhappy. I have to learn not to say "yes" so much...) From all accounts it was a great success, which only increases my disappointment at not being able to attend. I do, however, feel joyful about two things:

1. From what I have heard so far, the attendees came away with a lot of new insights and inspiration about healthcare blogging.
2. There will be not one but three Healthcare Blogging Summits next year, and I will plan in advance to participate as actively as I can, whether that participation be speaking, moderating or sitting in on panel discussions, or simply attending and networking with others present.

The three conferences next year were verbally announced but are not yet online anywhere that I can find. From what I'm hearing, the dates and locations are:

• April 30, 2007, Venetian Hotel, Las Vegas NV
• September 17-18, Hilton Hotel, Chicago, IL
• December 3, 2007, Crystal City Hyatt, Washington DC (actually the Hyatt is in Crystal City VA, just across the Potomac from DC and even closer to Reagan National Airport)

I'll post more news on these summits as it becomes available.

Interactive Health Communication Applications for people with chronic disease (Cochrane Review)

I just noticed one of Cochrane Collaboration's Cochrane Review documents entitled Interactive Health Communication Applications for people with chronic disease:

People with chronic disease have multiple needs, including information about their illness and the various treatment options; social support; support with making decisions; and help with achieving behaviour change, for example, changes in diet or exercise. Computer-based programmes which combine health information with online peer support, decision support, or help with behaviour change may be one way of meeting these needs, and of helping people to achieve better health. This review sought to find out how such computer programmes, known as Interactive Health Communication Applications (IHCAs), might affect people with chronic disease. The reviewers found that IHCAs improved users' knowledge, social support, health behaviours and clinical outcomes. It is also more likely than not that IHCAs improve users' self-efficacy (a person's belief in their capacity to carry out a specific action).

The Cochrane Collaboration is a well-regarded UK-based publisher of information on evidence-based healthcare (a superset of evidence-based medicine). This report struck home because at our Centere we are supporting a project called Internet-Enhanced Management of Fibromyalgia, headed by University of Michigan investigators David Williams PhD and Daniel Clauw MD and operated onsite by the Avera Research Institute in Fargo, ND.  This project overview reads as follows:

Fibromyalgia (FMS), a condition marked by pain, fatigue, and memory complaints, is considered a chronic condition, and is most commonly treated or managed using symptom-based pharmacological interventions.

Previous studies have found benefit in adding cognitive-behavioral therapy (CBT), a non-pharmacological intervention, to standard pharmacological care in order to obtain better outcomes in terms of improved functional status and symptom reduction. While the addition of CBT to standard care has been shown to be beneficial, it is not a form of therapy that is widely available to patients with FMS. This protocol will examine the relative merits of adding CBT to standard care in an experimental format.

The experimental format uses an informational website. The website will contain the content of CBT, a social support capability, and data transfer capabilities.

The experimental CBT format will be compared to standard care alone. The researchers are interested in assessing improvements in physical functional status, the symptoms of FMS, and the relative costs of the interventions as compared to the savings in healthcare utilization over a 12-month period.

To me this sounds very much like the US equivalent of an IHCA as described in the Cochrane paper. I'm especially eager to see the outcome of this because the Web technology underneath it is pre-Web 2.0, though somewhat prescient for its time in including some social networking capabilities.

If this study proves Web-based CBT is beneficial, I'm hoping the next round will explore in more detail the new communications media invented in the past four years that fall into the admittedly loose category called Web 2.0. I'm writing a series of books on business blogging for professionals, the first one being Business Blogging for Heath Professionals Using TypePad™: A Jump-Start Approach, which has just been released today. A major part of the mission of the book is to explore how healthcare practice can be improved through the use of business blogging. Business blogging is a code word for blogging done deliberately for a serious business or professional purpose, as opposed to the idiosyncratic musings, ramblings, and rants one often finds in personal blogs.  The book is a first step in my explorations of how the Web 2.0 paradigm can best be put to use delivering evidenced-based healthcare (including but not limited to medicine).

This all seems to fall under the rubric of health marketing, which is not about marketing particular health products, but rather about selling the general public on the idea of better health and ways to attain it. I think it's a great idea, and I want to help in any way I can.

---

Shameless Commerce: You can see the Website for the book at http://hunscher.typepad.com/bizblogging4professionals. In fact, you can even buy a copy while you're there. ;-)