Lorraine argues that a universal patient identifier isn't the answer to data exchange.

Recently the Wall Street Journal posed a very timely question: “Should every patient have a unique ID number for all medical records?” Michael F. Collins, chancellor of the University of Massachusetts Medical School, wrote the “Yes: It means better care” response, while Deborah C. Peel, founder of Patient Privacy Rights, wrote the opposing view, “No: Privacy would suffer.”

While this debate is not new, recent emphasis on the value and need for data exchange, adoption of electronic medical records, and the number of data breaches have re-ignited the discussion.

Neither writer articulated that patient identification requires a comprehensive solution. This surprised me. Based upon my work in many countries around the world, I can say that a universal patient identifier (UPI) will not guarantee accurate patient identification, nor will it produce seamless data exchange. And, as both writers explained, UPIs come packaged with a whole host of issues.

A UPI isn’t a cure-all for the problems of healthcare. Instead, the industry and healthcare organizations need a comprehensive solution and approach to patient identification. Classic management tenets are at the core: people, process and technology. In fact, I presented this topic at the HIMSS Virtual conference in early December, and shared highlights in my December 15 blog post. This solution should include:

People: Currently, registration and patient access staff are among the lowest paid in most healthcare systems. We must invest in the people who are creating data. Those at the front line need a deeper understanding of the value of the data they collect. We need to clearly define – and demonstrate – how their work impacts patient care. Make them see the link between the data they collect and the power of future data analytics.

Process: While it may be obvious, it bears repeating. We must identify the data elements that are critical for patient identity and data exchange. These data deserve special attention. Multi-site organizations should standardize their processes for data capture.

Technology: Staff should use the best technology to ease patient identification, including probabilistic algorithms that can overcome the differences and errors in data capture. High-performing organizations that use this technology see error rates of less than 1%, not the 7-10% quoted in a RAND study. Additionally, the WSJ discussion overlooked the challenges of backporting a UPI to legacy records and the cost to assign a UPI, whether done by a private organization or a governmental agency. Nor can we forget the long-term costs and challenges of maintenance, as many countries with a UPI have learned.

The world’s thorniest issues, from patient identification to world hunger, don’t have silver bullet solutions. Having a UPI will help with identification, but it’s not a cure-all. Let’s open the debate and fully educate citizens, providers, and officials about all viewpoints, risks, and benefits of a UPI. Let’s learn from other countries that have faced similar challenges.

In the meantime, let’s make sure we’re investing in the management fundamentals of people, process and technology.

When analytics turns data into information, healthcare can be transformed.

We’re swimming in data, but are we transforming it into usable information?

As we embark on 2012, we’re looking ahead at the next steps for transforming healthcare. Josh Constine of TechCrunch got in the spirit with 6 Big HealthTech Ideas that Will Change Medicine in 2012. Constine named Artificial Intelligence (citing IBM Watson and Siri) and Big Data as two of the six.

Both concepts are particularly timely. Mandates require more and more data to be collected and stored in electronic health records. But all that data collection and expense is ill used if it gets trapped in silos.

As Lorraine Fernandes, IBM’s Global Healthcare Ambassador, recently asked, “How do we harness the power of all this electronic data?”

Fernandes and Dr. Bill Rollow, GBS Solutions Leader for Healthcare Value and Transformation, discussed the promise of Watson-inspired analytics in their recent video.

Transforming healthcare comes with ambitious goals: improving the quality and safety of healthcare while controlling costs and creating new efficiencies for patients, providers, and payers.

The challenge is that the vast majority of healthcare data is unstructured, whether doctors’ notes, x-rays or other test results. But a longitudinal view of patients and providers paves the way for incredible potential rewards.

Deep analytics – like those powered by IBM Watson – present a world of possibilities. The data previously stuck in silos can be translated into information that underpins better outcomes, best practices and more cost-effective solutions. Patients could save copays or time by avoiding duplicate, unnecessary tests that may create safety risks. Providers gain on both sides of the equation, as they can provide better care while streamlining their interactions with payers.

As Dr. Rollow explained, “The paradox is, there is a relatively large amount of data, or potential data, out there, but the amount of information that we have that’s usable in clinical decision making is small.” Analytics aims to change this.

Watch the video to hear more about how analytics can transform healthcare. What do you predict for healthcare analytics in 2012?

How can you get your house in order next year? Chad discusses building a trusted health information platform

In December, people tend to assess what they’ve accomplished in the past year while looking ahead to the next year. The same holds true for healthcare organizations that are assessing how they’re progressing on various initiatives.

Last week, Sean Cassidy, Director of Healthcare Products for Information Management, hosted a webinar, “Building a Trusted Healthcare Information Platform.” The process starts with acquiring data from inside and outside the healthcare enterprise and transforming it into reliable information.

External forces are dramatically changing the way healthcare provider organizations will deliver care to their communities. As new payment models loom and Meaningful Use and other regulatory requirements begin to take shape, forward-thinking healthcare executives are readying their systems by shifting to a patient-centric technology infrastructure, which is better for patients, physicians and the business.

Others have delayed infrastructure investments until pending regulations around Meaningful Use and Accountable Care are finalized, fearing that new technologies may not comply with final legislation or support future requirements.

The reality is that organizations can benefit today without having to worry about replacing their investments in the future once regulations or requirements have been finalized.

In fact, delaying can be more costly in the long run because it could result in compliance penalties. By getting their houses in order, organizations will improve data quality, gain significant competitive advantage and become more agile, which will assist them in adapting to changing requirements.

As Sean discussed, for HIT organizations to get their house in order, they need several things:

• A well-defined information strategy
• A deep understanding of their data assets
• The ability to integrate that content with other systems
• The ability to govern their information to produce real insight

Achieving a house in order is not a destination. Rather, it is a journey that evolves from managing transactional data, such as in EMRs and HIS systems, to interacting with that data, and integrating it into the enterprise allowing for improved collaboration and personalization.

Getting your house in order requires a trusted platform for healthcare information. That platform must manage, integrate and analyze the data.

After all, you can’t leverage data that you don’t understand. Since 80% of clinical information is unstructured, and data is distributed in organizational silos across multiple applications, databases and platforms, the challenge is real.

If you missed the webinar, watch the replay to hear Sean explain how to build a trusted platform and get your house in order. My colleague Michelle Blackmer also wrote a post on this very topic, linking to a new white paper.

What steps are you taking to get your house in order?

Lorraine shares 3 best practices in identity management that help identify the right patient

As many people do in December, I’ve been reflecting on what we’ve accomplished in 2011 while planning for the New Year. This helped me prepare for yesterday’s HIMSS Virtual Briefing webinar presentation, “Best Practices in Identity Management,” which I presented with Nancy Farrington and Barbara Demster.

Healthcare has probably embraced the importance of data quality longer than any other industry. Yet as we march towards electronic records, Meaningful Use, analytics and research, data quality gains new meaning and importance. We’ve learned that establishing and maintaining the integrity and effectiveness of patient (and provider) identification process requires a pragmatic and programmatic approach. Here are some themes from my presentation:

Pragmatism Reigns: In today’s over-worked, time sensitive world, we must allocate resources to the highest priorities. We must also articulate a clear return on investment. This means the “old days” of one-off master patient index data integrity projects are gone.

Instead, we must programmatically implement a strong program that ensures robust patient identification in terms of technology, process, policies and execution. Short-changing the patient identification process means systems, data and payments tied to identity will be compromised.

Not investing in managing patient identity data can higher business costs, lower reimbursement and adverse patient care outcomes. Invest wisely and early in the identification process.

Multi-Stakeholder Approach: Also gone are the days when patient identity integrity was viewed as a health information management/medical record function. Today, multi-stakeholder steering committees are the norm. Health information, registration/patient access, information technology and compliance have seats at the table, along with finance and quality improvement.

Over a decade ago, a client said to me, “Lorraine, if we think identifying and correcting a patient identity error is difficult today, it will be worse than finding a needle in a haystack when we have full-scale electronic records.” He was SO right in his prediction. He was even more right by having a broad organizational focus that included all the involved departments, along with strong executive sponsorship.

Patients interact with many departments in establishing their demographic and financial data. That data is used by even more departments. Both data creators and data users should be represented in the multi-stakeholder program.

It’s about Stewardship and Governance: Over the years as I’ve talked with customers and industry leaders, I’ve heard the cadence and tone of “patient data integrity” change markedly. Today people who lead these activities, or consult to organizations wanting to adopt a programmatic approach, highlight the need to view data quality as a data stewardship and data governance function.

More people are using and relying on electronic patient data for care delivery, outcomes measurement, reimbursement and research. Therefore, we must be wise stewards of this data by assuring integrity of the patient identification data. This will be even more important in 2012 as Accountable Care Organizations are launched, and integrating data from a variety of caregivers becomes a prerequisite to securing the additional funding.

To hear more of this discussion, access the session I presented with Nancy Farrington and Barbara Demster on the HIMSS Virtual site. It will be available through January 13, 2012, along with several other sessions from yesterday’s conference.

Lorraine shares her birthday wish of better care coordination

The long-awaited final regulations for Accountable Care Organizations (ACOs) were released in late October. Key points of the ACO regulations, as well as other components of the Patient Protection Accountable Care Act (PPACA, aka Healthcare Reform bill), speak volumes to the importance HHS is putting on controlling healthcare costs and emphasizing the importance of care coordination.

Inherent in this cost containment and quality improvement drive is the need to escalate care coordination for chronic illnesses, as opposed to the siloed, fee-for-service approach that today frequently results in ineffective,   episodic care delivery. Instead, we must create programs and processes that support preventive care, data sharing and timely communication which are foundational to care coordination and cost control.  Recently Sue Hyatt and I authored a paper, Reducing Chronic Disease with Better Informed and Coordinated Care, that explored some of the obstacles and potential solutions.

Sadly, especially considering the costs associated with chronic illnesses, we have historically spent little to design a system (medical and financial) that treats a patient and their associated data holistically. Thus repeat tests and avoidable hospitalizations for chronic illness patients are common. The costs extend far beyond just the unnecessary or ineffective medical care, as the social and economic costs include untold hours spent by family members in transportation, phone calls, and unnecessary repeat appointments.

Patient Center Medical Homes, as one model of care coordination, show much promise, as my colleague Dr. Paul Grundy has explained. The bottom line is that chronic illness is complex and requires a multi-faceted solution approach that includes homecare, technology, payment incentives for quality and coordination, just to mention a few components, not the band-aids we’ve seen previously. And, this solution should include a greater emphasis on community-based services that can prove more cost effective and more readily available than a decade ago given advances in mobile devices and telehealth services.

Both of my elderly parents in rural America have what I’d call “minor” chronic illnesses. As I participate in their car from afar, I see firsthand some successes in care coordination, but also major frustrations with the gaps in care coordination. I shudder to think how frustrated I’d be if my parents (or me) had to address the “big ticket” chronic illnesses of diabetes, congestive heart failure or dementia.

Today is my birthday, and I’ve decided my birthday wish is for everyone to embrace the need for care coordination and take demonstrable steps to make this a reality. By the time I turn 65 (or dare I hope for 60?) I will no longer use this as one of my birthday wishes.

Are you seeing successes in care coordination – or gaps? Share your comments below, and read the new white paper, Reducing Chronic Disease with Better Informed and Coordinated Care, for more.

Healthcare organizations and the government can collaborate on four key components for success

With last Thursday’s announcement by the Department of Health on ‘Dismantling the NHS Programme for IT (NPfIT),’ the King’s Fund event sponsored by IBM last week in London was very timely and engaging. Approximately 50 people from the clinical, financial and IT areas of the U.K.’s National Health Service (NHS) gathered to discuss the need to collaborate on a local level, making full use of available information to design a more sustainable and cost-effective healthcare delivery.

In line with its reputation for providing high quality speakers and content for its members, the King’s Fund featured thought leaders from the Department of Health, Royal Colleges, GP Practices, NHS Trusts and IT suppliers to share their experiences, challenges and recommendations for providing more cost-effective healthcare services in a time of great economic pressure.

I was pleased to participate in the discussion with Peter Dyke from the Department of Health, Ailsa Claire from Commissioning Development Yorkshire & Humberside, Michael Parker from the Royal College of Surgeons, Dr. Amir Hannan from the NHS North West Clinic and Ruth Colburn-Jackson from Basingstoke NHS Trust.

I’d like to share some key points I captured from this engaging half-day meeting and welcome others to join in the discussion. A significant challenge we have today in the U.K. is how to build on what has already been delivered by the NPfIT to achieve results on a local level in order to reduce costs, improve efficiencies and really expand our ability to care for the growing aging and chronically ill population.

How can we get from being reactive to patients and their care to a more proactive approach promoting health and wellness?  Based on the discussion with this esteemed panel and attendees at this event, as well as what IBM has learned in working with healthcare and government organizations around the world, I summarize what I think are four key components to help drive success.

1)      Adoption of open industry standards (technical, semantic, terminology, etc.) is critical to information sharing and needs multi-stakeholder involvement. To achieve the system interoperability required for local, national and international health information sharing we must have a standards-based infrastructure. Many other countries are adopting this approach, and we can learn from them and benefit from the work already done by the international standards bodies.

2)      Records need to be linked from many different care settings, so correct identification is essential. This is a complex process and one that requires complex matching algorithms to identify and link records that exist in many different formats. This is a problem that a national identifier simply won’t solve on its own, as even countries with a long history of using citizen identifiers have found.

3)      With the National Programme for IT drawing to a conclusion, regional health information exchanges will need to emerge to ease the challenges around information sharing. Similar organizations have been formed in the U.S. and European countries, so we can learn from these examples and develop solutions that meet our unique needs.

4)      Data capture (timeliness, accuracy, avoiding re-keying) remains a big problem, which, if solved, could really help with data quality and consistency. To instill confidence in the system and increase user adoption, we must be diligent about capturing data for the patient pathway, not just business outputs. Improving the quality of data in the system will help care givers make informed decisions, and allow them to have more confidence in the system itself.

Governments and large hospital groups around the world have achieved interoperability of their electronic patient records and are experiencing returns on their investment. The first and most important element among them is a multi-faceted strategy that includes the health IT infrastructure, governance policies and multi-stakeholder support. In a country of 50M people, we in the U.K. must think globally and plan for long term requirements, as well as act locally to drive efficiencies now closer to home.

I’m looking forward to continued discussion on this topic and welcome additional thoughts. You can join IBM at other health IT events in the coming months.

Enable your health system to effectively share patient information

Proactive management and access to complete and reliable provider information is top of mind across private and public healthcare entities as a foundational step to meaningful health information sharing.  But making decisions about how to make that dream a reality are not easy.

Health systems often have difficulty interacting with their physician community. This is particularly true among high value non-owned physicians because these physicians are managed outside of the systems’ internal processes and systems. Because of this, health systems do not always have the most accurate or reliable provider information and are unable to exchange information efficiently and consistently with them.

Regional HIEs, including states and provinces, are equally challenged to easily assemble the correct subset of provider data necessary to support the contextual and purposeful physician communications and exchange required for large scale initiatives being planned.

Required for successful information sharing is an infrastructure strategy for managing provider identity that makes providers more productive by improving the way you capture information about them and the way you share information about their patients with them.

Next week, IBM will be at HIMSS Summit of the Southeast, where I will be presenting a session. In this session, Engaging the Provider for Exchange: Navigating the Many Guidelines for Provider Directories, we will review how IBM Initiate Provider enables the creation of a trusted provider registry and introduce IBM Initiate Provider Direct - a new interface which improves the collaboration and efficiency of managing provider data. The session is on Thursday, Sept 29 at 11 AM.

Join us for this discussion in Nashville, or drop by IBM booth 401 for a longer discussion on analytics, asset location, security, ICD 10, Smart Room or any other health information exchange topics.

Health plans can enjoy great benefits from information governance

On Tuesday, September 27, we will be speaking about Information Governance at the Blue Cross Blue Shield Information Management Symposium in Dallas, TX.

Sunil will also be publishing a book, Selling Information Governance to the Business: Best Practices by Industry and Job Function, at IBM's Information on Demand conference in Las Vegas in October. The book includes a chapter on healthcare. We have done a lot of work helping health plans establish their information governance programs.

One of the major challenges with any information governance program is quantifying the financial benefits to the business. The table describes a sanitized set of business benefits from the implementation of a 360-degree view of the member at a health plan.

Table: Sanitized hard-dollar business benefits from the implementation of a 360-degree view of the member at a health plan.

Foundational to any realization of business value is semantic reconciliation across the organization. Information governance needs to establish a common definition for the term “member.” For example, some departments (such as actuarial) might want to define “members” as currently-enrolled individuals, while marketing might want to include prospects and leads within the definition.

The business benefits exclude soft-dollar business benefits.

Let us consider an example of the soft-dollar business benefits associated with the governance of health and wellness information such as biometrics (blood pressure, cholesterol, height, and weight) and preventative care (flu shots, colorectal examinations, pap smears and childhood immunizations). This information is especially interesting to medical informatics and health services because they can identify trends that lower medical costs.

One U.S. health plan was looking to improve the percentage of flu shots within their Medicare population to increase incentive payments from the Centers for Medicare and Medicaid Services. The health plan could only determine that a member had a flu shot if they submitted a claim. However, many members received flu shots at convenient locations and paid for the service out of pocket. The information governance program started to explore text analytics technology to review doctors’ notes to see if the patient had received a flu shot.
Information governance maturity assessments, charters and councils are important. However, it will be hard, if not impossible, to build a sustainable information governance program without strong business sponsorship. You need the business to assign stewards, and attend meetings.

A credible statement of the soft- and hard-dollar financial benefits is a good start to establishing a sustainable information governance program. Additionally, when information governance is tied to key strategic imperatives, it creates the link to help justify the necessary participation by the business.  Once established, a set of metrics will keep the value in front of the organization’s key stakeholders.  Business value can then be reevaluated periodically and metrics adjusted as the organization matures in its information governance practices.

We look forward to meeting you in Dallas and Las Vegas.

IBM Champion for Information Ced Bufton

Ced Bufton is founder and CEO of Bidetime Limited, one of the largest IBM Cognos partners in the UK, and a supplier to many in the healthcare market. Ced developed the “Performing Healthcare” model that won a “Powered by IBM Cognos Solutions” award in 2008 for helping the healthcare industry use information to get results.

My colleague, David Pittman, recently spoke with Ced, an IBM Champion for Business Analytics, about his work and the challenges facing healthcare around the globe.

The UK is experiencing a trio of linked problems: an aging population that needs more healthcare services, advanced clinical techniques that are more expensive than traditional treatments, and a government trying to rein in its budget. Bidetime provides its clients with an in-depth understanding of their data, which, in turn enables them to measure outcomes and navigate change.

Importantly, measuring outcomes must go beyond just activity and finance numbers. As Ced describes, the government’s National Health Service is trying to become a more autonomous, independent organization that can efficiently manage itself. That requires knowing how the organization is actually performing internally, not just how things such as costs and wait times are perceived externally. After all, Ced notes that fifteen years ago, “the health service was largely driven on the gut feel of the managers… Now they have the supporting information and they’re using that information to serve their decisions.”

As any business knows, making the best use of limited resources is an ongoing challenge. Setting up a BI platform helps accomplish this by letting staff concentrate on bigger issues while the system sorts out standard reports and queries.

However, Ced cautions against looking blindly at metrics, equating doing so as staring at the speedometer while driving. “People think [dashboards] are very pretty, and they seem to answer to all their ills. When you try to implement them, they don’t live up to that, really.”

Indeed, Ced explains that while metrics give managers something to look at, “the technology has got a bit ahead of the business.” Automated reports and analysis should help develop a metrics environment that focuses on performance management. Rather than staring at a speedometer, use your metrics to create the right dashboard that can serve as a GPS system that guides you to success. This goes far beyond traditional business intelligence.

The Performing Healthcare model uses a set of Cognos reports and analytics that help provide a single version of the truth in a self-service environment that helps healthcare workers make better decisions. Ced is eager to integrate SPSS predictive analytics into the model to gain a better grasp on things like capacity and resource planning.

So would Ced consider himself as a data geek or a management geek? When asked, he put himself in the middle, describing himself as “a systems geek,” noting he gets a thrill out of seeing how things work and how they interact.

“To see some automated reporting and analysis, taking a workload from the guys in the hospitals, and then to help them use their spare time to develop a metrics environment and look at performance management rather than just BI – that’s really good. And I must admit that’s where I get my buzz – to see things getting better.”

Hear more of Ced’s views on the changing healthcare industry and the role of analytics in efficient systems in the podcast below. Ced will also be attending IBM’s Information on Demand conference in October, along with several other Champions.

Listen to the podcast with Ced Bufton, IBM Champion for Business Analytics.

Join us Sept 14-15 in Chicago and learn how to share information towards smarter healthcare

Are you currently using IBM Initiate products to advance the information sharing needs of your healthcare enterprise? Perhaps you are evaluating IBM Initiate products and want to know more about how other organizations are using them to further their strategic initiatives?

Join us and other users of IBM Initiate sharing solutions at IBM Exchange 2011: Initiate Information Sharing, September 14-15, 2011 in Chicago for two days of information sharing, networking and activities designed to help you make the most of IBM Initiate healthcare solutions.

Attendees will learn how IBM is applying 100 years of innovation and experience to build sustainable healthcare systems, improve quality and patient safety with the Health Integration Framework. Also on showcase will be IBM’s current innovations, including an exciting discussion about how Watson and text analytics will unlock the power of information within the healthcare enterprise. (For a preview, read/watch our interview with Chlapathy Neti, IBM Research Director of Healthcare Transformation, as he discusses the implication of Watson’s analytics for healthcare.)

IBM executives will share IBM Information Management’s vision for healthcare, and will demonstrate that vision with presentations about supporting meaningful use and ACO queries using clinical data analytics and enabling an efficient and collaborative solution for managing provider data with IBM Initiate Provider Direct.

You will also have the opportunity learn from other IBM Initiate customers about how they use IBM technologies currently for provider management, improving clinical care while streamlining processes, and solve the challenges of Master Data Management (MDM) when they don’t own the data.

Perhaps most importantly, attendees will have the chance to talk with IBM executives and other IBM Initiate customers about the challenges on the horizon in 2012 and beyond and how IBM can help meet those challenges.

We’ll be meeting at the renowned Chicago Marriott Downtown , easily accessible to top Chicago attractions. Register today. We look forward to seeing you in Chicago.