We read a thoughtful piece by Lindsay Dunn in Becker’s Hospital Review blog (Disruption Overkill) questioning the necessity for “Disruptive Innovation” to make the changes we need in healthcare.
The much-ballyhooed buzzword — and debunking of the academic theory behind it — is the subject of a recent New Yorker article. (It’s great fun to read!) According to the author, historian Jill Lepore, hospitals are not purely profit driven, so business theories need not apply. While attacking her Harvard colleague Clay Christensen she notes:
Innovation and disruption are ideas that originated in the arena of business but which have since been applied to arenas whose values and goals are remote from the values and goals of business. People aren’t disk drives. Public schools, colleges and universities, churches, museums, and many hospitals, all of which have been subjected to disruptive innovation, have revenues and expenses and infrastructures, but they aren’t industries in the same way that manufacturers of hard-disk drives or truck engines or drygoods are industries.
Dunn seems inspired by Lepore when she describes the need for change and innovation without using the “D-word.”
Hospitals are in the midst of an era of significant — and perhaps unprecedented — change. We’ll have to innovate, and we’ll have to change our business models to better meet the demands of our payers and patients for higher-value, more transparent care.
How about #Constructive_Innovation for healthcare?
Most of the news we’ve seen on the topic of costs associated with EHRs relates to financial losses for hospitals, not cost savings. So a study published in the American Journal of Managed Care showing per patient savings of nearly 10% caught our eye.
The study (Association of Electronic Health Records With Cost Savings in a National Sample) looked at 5 million inpatient records at 550 acute care hospitals. The authors found savings per adult patient admission of $731, or 9.6%, in the 19% of hospitals using “advanced EHRs” (“consistent with the first requirements of Meaningful Use”). The study, conducted in 2009, concluded that patients, third party payers and hospitals could benefit from these lower costs.
In an interview in HealthLeaders, co-author Abby Kazley provided additional insight, including that similar studies on pediatric populations failed to show improvements. Work remains to truly assess the impact of EHRs and make the right adjustments to leverage the investment made. When asked “what’s next” she said:
We need to continue to look at the cost and the quality of the care associated with EHRs and we need to look at individual organizations and do system evaluations to see how well the EHRs themselves are working.
We applaud the use of EHRs and are happy to see these cost savings documented. Our mission at QPID Health is to see that hospitals achieve further cost savings while providing the best care possible – by activating the clinical intelligence that EHRs contain.
With the US continuing to outspend other industrialized nations by a long shot (17.6% of GDP versus 9.2%, or $8,745 versus $3,355 per the Commonwealth Fund) but failing to achieve better outcomes, we are headed in the right direction but have a long way to go.
We have often commented on studies that show low physician productivity and frustration with electronic medical records, and how difficult it is to quickly get the key facts needed in the clinical trench. These are common themes.
Now a new concern has emerged with this far-reaching technology: patient safety.
Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.
But human beings always have a role to play and are part of the complex equation leading to both good and bad care decisions.
Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns.
The article uses a great example of this: a pharmacist makes a data entry error and inputs a higher dose of a diuretic than normal. A warning appears on his screen that is known to have a high false-positive rating, so the pharmacist overrides the warning and the incorrect dose is subsequently administered to the patient.
Even the most sophisticated EHR implementations should continuously monitor for safety issues, the authors advise.
QPID Health’s Mike Doyle has been invited to join the panel on Big Data and Decision Making at the Connected Health Symposium 2014, to be held October 23-24, Boston, MA. The conference, which is in its 11th year, is organized by the Partners HealthCare Center for Connected Health. Joe Kvedar and his team create and study models for healthcare delivery that connect patients and providers using innovative technologies. We are pleased to support this annual meeting of 1200 physicians and other providers, health plan leaders, policymakers, patient advocates and technology innovators.
We find a lot of synergy with the observations and vision expressed by Dr. Donald Voltz in the article “Electronic Medical Records – Past, Present and Future” published on HITConsultant.net. Dr. Voltz sheds light on a pain that all of our clients (even those with the most advanced medical record systems) face:
Currently, I have to look in multiple places within EMRs to gather all of the relevant pieces of information to manage a patient’s complaint or condition. This reminds me of a scavenger hunt…. Switching between different locations to gather vital sign information, review past medical history, and laboratory studies is not only manual, but data can be entered in different ways, depending on the healthcare provider who entered the information in the system.
To solve this problem, Dr. Voltz prescribes a solution in which patient data is made “smart.” He sees a future in which systems align medical professionals with data that is “collaborative, not passive … delivered to those who need it, when they need it, with all the data in one place.”
We wholeheartedly agree and are delivering on this now. QPID’s Q-Guide solution in use at Mass General Hospital is a great example. It delivers the right data at the right time into the workflow for ordering, approval, and scheduling of surgical procedures.
Used during the pre-operative decision making process, the application aims to help clinicians apply complex guidelines-based decision criteria to each patient’s individual profile, and generates a recommended approach and risk score.
Q-Guide uses decision-making algorithms that are driven by combining the patient’s clinical evidence with the latest guidelines and personalized risk models. The first release of the software includes guidelines for high cost, high use and resource-intensive vascular, cardiac, and orthopedic surgical procedures.
Dr. Creagh Milford of Partners described the outcome to Leventhal: “Diminishing the number of inappropriate procedures and having a high rate of appropriateness is a phenomenal story.”
An article on Healthcare Informatics caught our eye. It summarizes a recent presentation by Johns Hopkins CMIO Peter Greene and concludes as follows:
Greene believes that once EHRs have been in place for a while, there will be an emphasis on improving their usability. “Our medical students have extraordinary expectations,” he said. “They want an app to use and if it’s no good, they want another app to try. That’s the bar we have now. The systems still are very hard to use. The vendor community is exhausted with trying to keep up with some of the requirements that they have,” he said. “But we really need to focus on this, because it has become a distraction from good care, and better is certainly possible.”
For our customers, the time is now for a better clinical experience and user interface, which is why they are working with QPID. QPID sits on top of virtually any EHR and delivers relevant patient intelligence directly into clinical workflows. This saves clinicians from scrolling through pages of notes or searching with inadequate tools for data that is inconsistently stored.
We look forward to hearing from you if you are ready to address what Greene calls “a distraction from good care” engendered by systems that are not designed to support care delivery.
Contact us to learn how QPID solves the problem of usability.
I’m delighted to let you know that QPID Health has closed its Series B round of funding. The $12.3m round was led by New Leaf Venture Partners and joined by all investors who participated in the Series A round. Proceeds will be used to accelerate the growth of our team and meet the demand from hospitals and practices to get clinical intelligence from the growing mass of digital patient data locked in EHRs. By “clinical intelligence” we mean the aspects of the patient’s history and status – including diagnoses, procedures, test results and potential safety concerns – that clinicians need to make the best decisions in the clinical trench, while avoiding the wasteful use of resources the comes from lack of access to information.
We are excited about the future of the company and look forward to the contribution of Philippe Chambon and his team at New Leaf, as well as the continued support of our initial investors. We are especially grateful to our customers who are true partners in innovation with QPID.
All of us members of the QPID team feel lucky to be able to contribute to improving healthcare in the U.S., and our funding gives us the means to accelerate our work.
Great article on KevinMD on the topic of NLP and EHRs. Author Phil Simon writes: “While turning unstructured data into something useful may not get your juices flowing, many people feel passionately about the subject.” Well, you can count QPID Health in! We are passionate about helping nurses, doctors, population health and quality managers and others in our healthcare system to get the most from that 80% of data that is buried deep in EHRs in unstructured/semi-structured data.
More from the post:
[This information is] referred to as ‘the text blob’ and is buried within electronic health records (EHRs). The inherent problem with ‘the text blob’ is that locked within it lies an extraordinary amount of key clinical data—valuable information that can and should be leveraged to make more informed clinical decisions, to ultimately improve patient care and reduce healthcare costs. To date, however, because it consists of copious amounts of text, the healthcare industry has struggled to unlock meaning from ‘the text blob’ without intensive, manual analysis or has chosen to forego extracting the value completely.
Contact us to learn how QPID Health helps “unlock meaning.”
QPID Co-founder Dr. Mike Zalis will participate in the 2014 Dartmouth Symposium on Health Care Delivery Science. The theme of the meeting, to be held April 4-5 in Hanover, NH, is “Leading Change in Health Care Delivery.”
Mike will share his unique “triple perspective” on the panel “From technology to information to action: How will technology advance the ability to deliver high-value health care?” Mike is a practicing radiologist, led the implementation of QPID applications in multiple departments at the Mass General Hospital and the Partners organization, and is now QPID’s product strategist.
Symposium attendees will learn innovative approaches to health care delivery that are emerging as a result of changes such as new payment models. Mike will highlight QPID’s Q-Guide, which is changing business as usual in health care and is particularly important as providers take on more financial risk. Q-Guide helps clinicians to attest to the appropriate use of ordered surgical procedures, keeping costs down and enhancing outcomes. Today, Q-Guide eliminates costly manual prior authorization processes, since Q-Guide gives payers the assurance that best practices and the patient’s risk factors have been considered. Q-Guide also promotes patient engagement by generating custom consent forms that incorporate the patient’s unique risk score.
QPID Health joined the “One Billion Rising for Justice” global action to raise awareness of violence against women on a cold and gray Valentine’s Day 2014 in Boston. Rallied and coached by Janine Powell – our VP Customer Care and de facto “Chief Cultural Officer” – a group of software engineers, QA specialists, customer support folks (and a few others who were not in customer meetings that day!) danced our way through the spirited choreography of Break the Chain.