Life, The Universe & Healthcare in India

Vidhana Soudha - Bangalore's Capital

It’s been more than a month since I came back from Bangalore, India. When I was last in Bangalore during the month of December, the year was 1994. The internet had not yet really come to the city, no mobile phones, many more trees and no high rise apartments, you could get across the city in about 45 minutes and there were no flyovers,  people rarely, if ever traveled overseas for vacations and the vast majority of people were either engineers or doctors (if their parents wanted their children to be perceived as doing well career wise). You could at least call an ambulance and possibly get to one of the small clinics that were around and hope that the doctor there knew how to take care of you (there were only a couple of private hospitals around then.

That’s not the Bangalore (or Bengaluru as it is now called when the city officials changed the name of the city to reflect the state’s Kannada language pronounciation) that I saw this past December. Everybody uses their mobile smart phones for everything, you need to use Ola or Uber, even if you live here because the number of cars in the city is unbelievable and growing more by the minute, many flyovers across the city and some of them even have stops at the top of the flyover (because someone in government didn’t plan properly), there’s a metro that the government has been working on for a decade (similar to Boston’s Big Dig of old) and if you get into an Ambulance, you may want to say your farewells to your family…as 9 out of 10 times, you will not make it to the hospital in time to save your life. See the YouTube video here for some perspective on what I’m talking about.

There are some solutions to these issues; air ambulances (visions of M*A*S*H) have been touted as one of the ways in which India can get some of their critical patients to their provider facilities.


These though may be only available for the upper middle class to rich and may not be something that regular people can avail of. Tele-Medicine or Tele-Health is an option. One of the premier solution providers talks about “Telemedicine as a service” that has been touted as possibly being able to be offered by local telecom service providers, who can bundle the service along with bandwidth. Healthcare providers can use the tele-health solution as a managed service by paying a monthly subscription fee or on a per event basis.They further say that these providers can market this service to a wide cross section of provider organizations who may be able to offer affordable tele-health services to their populations. Providers can also offer this as a value added service to their patients, and charge them on a subscription basis. An added advantage to this is that healthcare providers do not need to make any upfront capital investment in the technology infrastructure. The challenge is that nearly 70% of India’s population lives in rural areas and there will be vast differences when it comes to access to basic healthcare facilities and capabilities for different regions as well as languages (India became one country in 1947 when different kingdoms, princely states and former British India joined together to become one country…all of these places had different languages, culture and traditions).

The United States’ 911 protocols and procedures as well as the infrastructure that backs it up is probably the best in the world by far. Our country needs to be proud of itself for maintaining this edge on the world. While we still need to improve our value for money, we are making headway, I am positive about that fact. Our Healthcare Information Technology professionals are working hard to continuously improve our provider organizations and their delivery systems as we never accept that we have done our best but continually strive for process improvement. I appreciate our providers more than ever, though we must do a better job of containing costs. My belief is that we may treat many times to avoid litigation rather than do what’s best for the patient. This belief stems from recent personal experience with providers both in India and the US and the vast differences in cost structure administering the same treatment.I had the good fortune of visiting Cisco’s offices in their multi acre campus in the heart of Bangalore and I was extremely impressed with their ability to put tele-health solutions into practice for their own employees. The picture below was taken on their campus at one of the rooms where employees can visit on site for tele health visits with their care provider. The opportunity to save millions of lives in India through basic healthcare facilities is tremendous and many organizations are trying to figure out ways in which they might be able to achieve that objective. Kudos to all those who are working hard to make that happen. image

Happy Earth Day – Healthcare’s Green Initiatives

Earth DayCaring for our environment should be everyone’s responsibility. My Grandfather was what he called a ‘Forestry Consultant” and focused on reforestation in the 1970s and the 1980s. He founded a
National Park in the southern Indian city of Bangalore my family’s home town where he was very interested in the cultivation and use of bamboo for use in everyday life. The ability for us to think of ways use less plastic and have more biodegradable products will give future generations an opportunity to live a better life.

When I first heard about Earth Day (and bought a T-Shirt with that on it back in the 90s), it didn’t have as much meaning to me as it does now. As the world’s population grows and we need to think about how we can better utilize our limited resources to nourish and clothe the people of the world, we need to think about better conservation methods. Healthcare is also not immune to this, though going green in Healthcare IT is not a straight forward process. One way that healthcare has been better at conservation is the implementation and use of electronic health records, the biggest Go Green initiative ever by healthcare provider organizations. Tele-Health initiatives means that now, people in rural populations or anywhere for that matter, do not have to drive to a specific location for things such as specialist referrals and can cut gas emissions and improve population health. Data centers have leveraged the concept of server virtualization and reducing the carbon footprint of those data centers and also reducing hardware costs and power consumption. (Don’t forget to join us at our CSO HIMSS Spring Conference focused on mHealth and Tele-Health. Click here to see the agenda and register for the event – Not to be missed)

I’ll take this opportunity again to wish everyone a very Happy Earth Day!

We don’t “Lobby” in Healthcare IT, we “Advocate”

As someone who grew up in other countries before becoming a naturalized American, there’s always been some kind of fascination when it comes to what is called “lobbying” in the United States. I’ve never been able to understand it as it always seems that it goes against the grain of what I’ve always thought of the United States through history books and the Founding Fathers, whom I so admire for their simple vision that has overcome the tests of time. Yet, hiring professional lobbyists in the United States is perfectly legal and healthcare has been leveraging this legal loophole for sometime now. Just this year as an example, lobbying has come into the news through the change in the regulatory date for ICD-10 from October 1st, 2014 to October 1st, 2015. Most believe that this was the result of pressure from care delivery professionals that wanted more time to get their act together (I for one was against this).

Recently, it was reported in “Modern Healthcare” (September 10th, 2014) that Epic retained a lobbyist and as it was reported the filing said that it was “to educate members of Congress on the interoperability of Epic’s healthcare information technology.”

Last week, HIMSS delegates from across the country had their yearly visit to Washington D.C. for their HIMSS Policy Summit, held during National Health IT week where (as reported by Healthcare IT News) HIMSS had certain asks of the nation’s representatives, which were:

  • Minimize disruption in our nation’s health delivery system emanating from federally mandated health IT program changes.
  • Fund the National Coordinator for Health IT to achieve interoperability, improve clinical quality and ensure patient privacy and safety.
  • Expand telehealth services to improve patient access and outcomes and decrease healthcare costs.

The role of politics and healthcare will remain inextricably tied to one another. As we continue to move through this paradigm shift, these areas will ultimately focus on the future of our country’s care delivery and outcomes and the way that we, the patient, will receive our care.

Healthcare’s sign of the times – Big Data, Analytics and Patient Profiling.

To profile or not to profile.Analytics and Big Data are in everything now. They are used for online couponing to analyze your buying patterns, in your (sic) email  and what your likes and dislikes are, in your browser with pop ups and in your social media. It has been in healthcare by the industry leaders, but was going to get more penetration as soon as the industry realized that they would have to get to know their patients through Patient Engagement initiatives as part of Meaningful Use Stage 2 where it is mandated that 5% of patients view, download and transmit their own health data, healthcare provider organizations who are concerned about that percentage of their patient population, can leverage analytics to help drive that engagement. Now that predictive modeling is the hot button topic of our healthcare IT times, I have given a lot of thought towards patient profiling and how that will progress over the years through better ways to collect, transform and present patient engagement data.

Building an enterprise data warehouse within a healthcare delivery organization brings together the many disparate systems that hold data become integrated into a single source of truth for operations, clinicians and the consumers of the data or analytics. The ability and focus now by many in the healthcare ecosystem that the way to progress is through the process of integration of disparate data, much also from legacy systems where the data was never was never clean and easy, but organizations now think that having this data will give them an edge in a newer, more cost conscious care delivery ecosystem

How much of a risk are you really and how effectively can a care dlivery organiation manage their costs and quality of care when dealing with a patient that may have the likelihood of hospitalization and possibly be re-admitted in the near future and a risk to the organization, especially for an ACO?

Physicians have the opportunity to prevent these patient readmissions utilizing profiling techniques that currently, may be exactly what large CPG or retail organizations already do well. Making sure that the ED (Emergency Department) as one of the most expensive locations for care that an organization has the ability to be increasingly efficient without losing the high quality of care that it requires to be for the community. Being able to keep patients away from using the ED’s facilities and be able to have regular ambulatory visits by identifying their conditions or health characterists early on and leverage newer technologies such as tele-health (Ohio HB 123 was recently passed here in Ohio covering just that topic and effective 5.20.2014) can lower the costs for an ED and make the delivery of care more efficient and target care for specific, previously identified patients more pro-actively.

Profiling can allow a physician to help lower the cost of medications that a patient is prescribed by reviewing and substituting equivalent, lower costs medications for the patient based on the information at hand. Medications account for one of the highest areas of healthcare costs today.

I sum up today’s blog post by reminding everyone that whether you work for or are a healthcare provider, a vendor, a professional services firm or a consumer of healthcare services, you have your work cut out for you. My encouragement goes out to everyone as I know and have seen how busy your day to day lives are and I have also seen how EMR teams, reporting and analytics teams and functional managers are tasked with many times doing the seemingly improbable tasks of getting all of the work effort completed in the short time frames that they have and somehow, it all comes together. For those of you in a state (clue, NC) the South East coast, United States who I know have gone Big Bang at all locations with everything live this past Friday morning with your EMR, my hats off to you, for you are one of those teams that have worked countless hours to make the seemingly impossible, seem doable. Collaboration and good team dynamics is the key. Don’t forget that!

Oh, and if you are viewing this from an XP machine after April 8th, well, you better unplug your computer from the internet because Microsoft has stopped supporting XP. Talk to your IS&T team if you are in an organization and think about options for a different platform.

MU gets a Breather! Healthcare Providers heave a sigh of relief!

MU breather1 Marilyn Tavenner, the CMS Adminstrator announced last Thursday at HIMSS ’14 in Orlando that CMS would be flexible on “hardship exemptions” for meaningful use requirements, which I am sure the healthcare industry heaved a collective sigh of relief.

Expectations were high for this to happen as it had been suggested earlier that this was to come.

In reviewing the CMS document titled “Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals” that was last updated in  October 2013 has hardship exemptions for eligible professionals with the following information:

EPs can apply for hardship exceptions in the following categories:

*Infrastructure — EPs must demonstrate that they are in an area without sufficient internet

access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).

 New EPs

— Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus EPs who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.

Unforeseen Circumstances

—Examples may include a natural disaster or other unforeseeable barrier

Patient Interaction:

1.  Lack of face-to-face or telemedicine interaction with patients

2.  Lack of follow-up need with patients

Practice at Multiple LocationsLack of control over availability of CEHRT for more than 50% of patient encounters 

With the number of initiatives currently under way at every single care delivery organization, ICD-10, optimization, Patient Portals, Patient Engagement, workflow optimization and so on, we continue to move at, what can only be considered, lightening pace through this decade as we regain American dominance in the healthcare technology sector and then shift our focus to lowering the cost of care delivery and leverage process improvements, better preventative care options.

With current clinician retirement trends the way that they are, I also foresee a great need for qualified physicians and clinicians over the next few years and migration to the United States for technology savvy medical professionals from other countries could assist with this demand in major population centers across the country.

Your Smartphone App will see you now! Has Telemedicine come of age?

Welcome to 2014 and the future of healthcare IT.

My blog has been about how to make understanding healthcare and the information and technology that surrounds it as easy to understand as I can make it! Whether you are from IT, healthcare or an interested stakeholder as only a patient can be.

One of the areas that has taken on new life is telemedicine. Formerly reserved for the likes of NASA or inter-governmental assistance such as helping far away earthquake disaster victims get medical attention, telemedicine is taking on new life due to the pervasiveness of smartphone and secure messaging technology.

An article recently published about how patients are using an application on their smartphone to be able to find a community physician, securely communicate with them, share photos of an injury for instance and then get advice, such as scheduling an MRI for a potentially broken ankle, from the comfort of their homes.

One question that comes to mind is how will these patient encounters get billed (or will there be a certain number of “free encounters”) before a claim get generated? How will patients react to being billed for these encounters as this will relate directly to the patient experience and patient engagement initiatives?

This is the next frontier of healthcare IT.

Welcome again to 2014!