Posts Tagged ‘Lifetime Health Diary’
Unraveling the US Healthcare Puzzle
It has been a couple of weeks since the last time I updated the blog – lots of going on here, traveling around the US, and uncovering new problems/opportunities in the US healthcare system, meeting new people and attending a few other conferences besides Health 2.0 in San Francisco.
A few days ago I attended some sessions at the AdvaMed Convention in Washington DC. Really enjoyed a session at the NZ Embassy with AdvaMed participants as well as attending the International Delegates Forum where 30 odd companies got a chance to introduce themselves and facilitate networking and possibilities of new partnerships. Even though most attendees were from the medical device industry, AdvaMed was an excellent place to learn about new emerging technologies, problems those devices are trying to solve and find possible synergies for LHD with some of them. Was impressed by how NZTE (New Zealand Trade and Enterprise) are doing an excellent job of helping NZ innovative companies attain entry into the US market, get them up to speed with current legislation and obstacles, and expand their networks.
After that was the NCPA Convention (National Community Pharmacists Association) in Philadelphia. It was an excellent expo and invaluable day spent walking around, talking with people, learning more about Medicare Part D and MTM (Medication Therapy Management), discovering that it is such a new and therefore quite flexible market with so many opportunities and ways to go particularly in MTM services and retail chains. Everyone I was talking to are seeing retail chains being a new “one stop shop” for all kinds of healthcare services including receiving healthcare and medication review/optimization services. Lots of going on in this area, though it still seems to be quite vague in terms of best practices (probably a good thing in terms of opportunities). The main problem though is still reimbursement, i.e. who pays the pharmacist or any other qualified care provider for MTM services? And how much ? (especially taking into account all the complex cases where chronic or elderly patients are on multiple medications, and the review/reconciliation/risk management, optimization for complex cases can take over 2 hours while providers are reimbursed maximum for 1 hour, etc). I was able to meet with a few market leaders in the industry, and got very good insights.
Last stop before I head back to NZ is San Diego. Seems like my company is moving in the right direction and I have some interesting developments to announce soon in terms of our US operations and business. On November 3 I arrive in Wellington, NZ to attend the annual HINZ conference - the major NZ exhibition for Health IT. I am very much looking forward to that. As some of you may know NZ is a very innovative country yet with a small market NZ companies need pipelines to enter the vast US market. These past 4 weeks in the USA have gone a long way to creating our own pipeline for LHD into the US market.
Yours in health,
Hamish
The Benefits of Medication Management & Optimisation
My post last week on Tools to help pharmacies manage medications has received comment in various places, so I thought I would extend it out a little more.
Last week I observed that both here in New Zealand and in the USA, pharmacies are increasingly moving into the field of medicine optimisation through medicine management. Why not? After all pharmacists are acknowledged experts at handling medications.
Dave Nazaruk in a white paper he produced for StayWell Custom Communications lists some revealing statistics on P.15 that show the cost of not managing medicines properly:
- The (US) healthcare system incurs more than US$177 billion annually in mostly avoidable health care costs to treat adverse events from inappropriate medication use.
- MRPs (medication-related problems) rival the costs of cardiovascular disease…for every dollar spent on prescription medications, we spent approximately the same amount treating MRPs associated with those medications.
These are pretty sobering statistics. Medication management and optimisation is currently a very ad-hoc system, full of loopholes and inefficiencies. GPs do not necessarily know where your prescriptions will be filled, and pharmacies do not know if you are on medications from other GPs in addition to the GP clinic that their pharmacy prescribing systems is directly connected to.
Apart from the inefficiencies, it is downright dangerous for people to be on multiple medications without having a systematic method of management. From my own anecdotal evidence, earlier this year a GP here in Dunedin told me that the worst case he had heard of in New Zealand concerning a lack of medication management resulted in an elderly lady being on 73 medications prescribed from 42 GPs! I asked him what safeguards were in place to prevent that kind of situation, and he replied, “Nothing!”.
So what might better risk assessment tools look like? Ultimately, such a tool needs to be wrapped around the patient, so the record can travel with them. In the short term however, a lot of efficiencies would be gained from community pharmacists and GPs and other providers being able to better comprehend a multi-medication patient’s medication regime. Currently, the data sources are not only disparate, but understanding them is non-intuitive, difficult and time-consuming.
This is easier said than done, gathering medication sources is not just difficult technologically, but involves an exercise of covering up data gaps and assumptions behind members of the care providing team that are often not captured systematically. And then reconciliation of all the data take the challenge to a new level altogether! However, the rewards in terms of better health outcomes for individuals, as well as system savings as a result greater efficiencies make this space an imperative for innovation.
Yours in health,
Hamish
Our First Community Group Meeting! (Part 2: Question & Feedback Session)
The participants from various organizations definitely saw the idea as an innovative way forward. Some great examples were brought up on why and how such a system could contribute to creating better health outcomes, provide economical advantages and prevent mistakes and oversights, and halt a growing inequality of health care access, stress and disengagement.
It was a great learning experience to see how lack of adequate health information for those disadvantaged such as the blind, deaf, sick children, people with chronic diseases, parents and caregivers ethnical groups leads to inability to manage, monitor or even access appropriate health care. For use by the blind the tool would need integration with ‘talking data’ but it was considered to be very positive for the hearing-impaired, as a very needed communication tool with health professionals. Also some noted this would be a great tool for recording children’s health – as children`s complete information is usually only known by the parents, but when the child reaches adulthood this information can be forgotten, or not passed on etc.
Almost 40 minutes discussion among 13 participants brought up lots of issues. The main ones examined were privacy and security. Some participants made the counter point that Lifetime Health Diary can be useful for privacy issues. Additionally some commented that privacy waivers are common place. The consensus seemed to be that perfect privacy and security are an ideal that must be strived for, but that it is even more important to simply start.
One example was given where deaf people health consultations often result in shouted conversations in front of other people, whereas this kind of Diary could act as a mediation tool.
Some barriers in uptake were identified as well. Computer literacy, access to the internet, cultural readiness and acceptance were those listed by participants.
Everybody`s involvement was definitely a sign of a great need to address current problems in a fast and cost efficient manner. The bottom-up approach was seen as the way to go, as community-based solutions are needed. Although many questions were fielded, there was a huge recognition and understanding that the Diary is a positive way forward and although there are no perfect solutions to some of the issues, a start needs to be made.
Funding
The participants suggested a couple of funding opportunities including the Tindall Foundation and Working Together More Fund, the Health Innovation Fund at the ACC, The Ministry of Health and some internal programmes run by participating organisations expressed their readiness to work together.
First steps forward
First step needs to be taken! The opportunity to do so will be in a study run by a team of Ignite Consultants. From Monday 23rd of August, five highly motivated, talented and hand-picked students will start to explore how Lifetime Health Diary™ can be helpful for different community groups. Study will be concentrated on the readiness of particular communities, including examining the motivation, perception, potential barriers, as well as looking into the usability of the technology which needs to be adjusted to the specific needs of people on the ground. The team of students will be working for 8 weeks under the guidance of Alec Holt, the Director of the Health Informatics programme at Otago University as well as mentors from the not-for-profit community
We believe that by working collaboratively on enabling the most disadvantaged in our communities and their caregivers to have better access to relevant and needed health information (which they can share with their doctors and other health professionals) can truly lead not only to better health outcomes, but significantly improve the quality of lives, engage and empower people to take charge of their health.
The Project is about to start…!
Are you ready to find out what your doctor is saying about you?
I personally like the idea of a doctor sharing his notes with the patient. So many other people do. That is why a year-long OpenNote project kicked in few weeks ago to find out if this transparency can facilitate doctor-patient communication, educate individuals about their own health and improve health outcomes. The team of nurses, physicians and 25,000 patients at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle got seriously involved in the project. Peer-review evaluation by both doctor and patient is to come.
There are two sides of this “coin” being discussed. One is sharing the notes with the patients will improve their understanding of health, empower, educate and engage them more while adding transparency. Another is sharing the notes may lead to confusion and panic on the patient side. Thus, because of a specific terminology and abbreviations, individuals may take doctor’s notes in a wrong way. For example, OD does not mean overdose, but rather oculus dexter, or right eye.
It is said this system of sharing the notes will benefit those who have many medical problems and visit doctors quite frequently. It will let them be well informed about their health, ask questions and follow the medication and lifestyle regime prescribed by the doctors. Yet, I quite disagree with that. I do believe it will benefit those who do a general once-a-year check up – someone like me. If I do not understand the term I always can go online and check it, so other can.
More information on OpenNote project:
