For or Against – Which Side Will Providers Choose in the Big Data Revolution?

The healthcare industry, and specifically the healthcare provider segment, is moving towards a rather interesting and potentially dangerous intersection in the near future.  As electronic health records expand and allow for more digitized patient data to be analyzed by an ever-increasing array of analytical processing power, we’re going to see a huge growth in the amount of “information” that can be returned to healthcare providers.  At the same time, we’re seeing the well-known-but-often-ignored issue of “alert fatigue” and EHR workflow frustration becoming a major problem for healthcare providers.

Just browsing through any healthcare industry websites or taking a quick look at the PR coming from healthcare software companies, you can easily see what the McKinsey Company outlines in a recent article, “The big data revolution in healthcare: Accelerating value and innovation”: big data is on its way. 

Building Walls vs. Building Doors

A book came out several years ago that has continued to resonate with me and that I still reference in conversations and discussions.  The book, What Would Google Do?, by Jeff Jarvis, delves into how the Internet has evolved, and continues to evolve, and why some companies like Yahoo and AOL became has-beens while Google has flourished.

If you think about how Google operates, they focus on giving their users control, while other internet companies focus on trying to control users.  The example that illustrates Google’s strategy most clearly is to just go to www.google.com and look at what you see, and then go to www.yahoo.com or www.aol.com and compare these two to Google.

Go ahead, check it out.

EHRs and Vendors: Is Bigger Better?

Who has recently logged in to Facebook to see what your friends are up to?  (Anyone still have a MySpace account?) Anyone purchased something online at Amazon this holiday season?  When’s the last time you searched for something online and didn’t “Google” it?

It’s interesting that there are a select group of companies who have come to dominate our online, internet lives, and as a recent December issue of The Economist (1) points out in “Survival of the Biggest,” this comes with some positives and negatives.  Facebook owns the world of social media, aside from the Twittersphere, and is looking to capitalize on all that personal information and preferences it knows about us.  Amazon is dominant in online retail, with a third of online buyers starting their product search on Amazon, and two-thirds of all e-books downloaded coming through Amazon as well.  Apple dominates online music sales and the growing tablet market.  Google has long been the far and away leader in search and online advertising, though it is now under scrutiny having been accused of favoring search results to promote its own products and services.

EMR Workflows Leading to a Paper Revolution?

In the August 1^st issue of the Journal of the American Medical Association, Robert E. Hirschtick, MD, wrote an article entitled “John Lennon’s Elbow.” In the article, Dr. Hirschtick writes about how the quality of progress notes created within EMRs during patients’ hospital stays has consistently declined as these notes have become longer and longer from carry-forward and copy/paste usage.  Progress notes have lost most of their value in updating other providers about the current status of the patient, and no one seems overly concerned about this.

Computer-Assisted Healthcare: Making the Right Moves

A couple of years ago, I read a news article about an unusual kind of chess competition. This competition allowed teams of up to two competitors to use any chess computer software they chose in order to play against other teams of two with their own chess software. This may sound like an unusual competition, and it was, but the goal was interesting: to see which team of humans could best utilize technology to their advantage.

Most teams bought off-the-shelf software and just plugged their opponents’ moves into their chess program and then made the moves that their own program churned out. The winning team, however, actually developed their own software, leveraging machine learning and feeding their program the moves and results of thousands of games in order to “teach” it different strategies and moves. The really interesting part was that in some crucial situations this team actually made moves that went against their program’s suggested moves. They let the machine guide their overall strategy but were not afraid to make their own moves when they felt it was to their advantage. In the end, they walked away champions, with man-plus-machine being superior to just machine alone.

In Search of Intelligent Workflow Solutions for Physicians

Now that it looks like ICD-10 implementation will be postponed only one year, the already hot-topic of computer-assisted coding will get even more attention. Hospitals obviously need to ensure they have a strategy in place to deal with ICD-10 and the highly anticipated, but often misunderstood, ramifications of ensuring appropriate reimbursement under the new coding standard. Most hospitals I’ve come across have an “ICD-10 Committee” working overtime to determine what the right strategies, solutions and processes are for their organization.

With all of this focus on how to add intelligence and automation to the coding workflow, and mainly the output of that workflow, there has been a lack of attention given to inputs that feed the coding workflow: physician clinical documentation. ICD-10 at its root is a documentation problem. The best computer-assisted coding solution in the world is still dependent on the content of the documentation that it analyzes for the quality of codes that it produces. If key information is missing, you’ll never achieve appropriate reimbursement or accurate profiling and reporting.

3M and CodeRyte

Today, 3M HIS announced it has acquired CodeRyte. As division scientist, this is exciting news from a technology perspective. Here’s my take on what it means for NLP:

The distinctive feature of CodeRyte’s technology is its strong statistical NLP capability. As I discussed in the 3M white paper, Auto-coding and Natural Language Processing, statistical machine learning systems offer the possibility of significant accuracy improvements in data-rich environments, compared to traditional rules-based approaches. A good example is in the outpatient coding environment, where data volumes are large, and CodeRyte has a history of performing very well compared to other systems.

There are multiple ways to boost the accuracy of statistical NLP, and the combination of 3M and CodeRyte will allow us to pursue several paths to the direct benefit of end users. 

Beyond the Buzzwords: Making Analytics Actionable

In last week’s blog from HIMSS, I talked about the need to go beyond the buzzwords and “look under the hood” to understand what’s driving all of these new analytics and intelligent automation solutions that are making their way to market. A lot of questions still remain about how to make the outputs of all of this analysis actionable.  As healthcare slowly enters the digital age, hospital by hospital and EMR implementation by EMR implementation, the wealth of data now available to be analyzed, dissected, quantified, and modeled is spurring plenty of new ideas and solutions.  Healthcare is shifting from a pay for procedure to a pay for quality/pay for performance model, which is driving the need for actionable data that can be presented to clinicians and care teams at the point of care where they can make use of that data to improve outcomes for their patients.

Are Templates the Answer?

By: Jeremy Zasowski

What happens when clinical documentation strategies to meet Meaningful Use requirements don’t line up with an organization’s strategies to improve clinical documentation for coding and profiling?

In my interactions with our customers, we’re seeing an increasing number of hospitals moving to increase their physicians’ adoption of template-based EHR documentation workflows. The primary reasons include: the need to move away from hand-written, paper-based notes; the need to leverage the huge investment made in an EHR; and, the requirement to meet Meaningful Use criteria for their EHR.

ICD-10 for Busy Physicians: Why the number of ICD-10 codes is not a big deal

By: Rhonda Butler

Believe it or not, you do not need to know or care about how many ICD-10 codes there are.  I know this goes against the grain. It is almost the only thing that gets said about ICD-10. Apologies in advance to all of you who already understand that the total number of codes in the system: (1) doesn’t dramatically affect your job, (2) isn’t inherently any more disruptive or costly than any other software upgrade, and (3) is mentioned by consultants and commentators because it is an easy score.

First, a question or two:  Did you know how many codes there were in ICD-9 before everyone started comparing? There are roughly 17,000 ICD-9 codes. Do you know and care about each one of them? Of those 17,000, how many get coded every day by your coders?

Here are three reasons why the increased size of ICD-10 will not be an overwhelming burden on your practice.

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