Mercy Health has been doing big things in digital health. Last year I interviewed EVP Shannon Sock after he spoke in Boston. And recently I met Mercy Virtual’s president, Randall Moore, MD at Qualcomm Life’s Connect2015 conference to ask him some follow-up questions after his talk.
(0:10) You came out on stage and said ROI isn’t a high enough bar to cross. You really have to consider cash flow. Say more about that.
(1:16) You showed a compelling video of a patient’s experience. How much of that is vision and how much is real? For example, do you really have ‘warm handoffs’ to the ER when someone arrives after calling ahead?
(3:34) Many people at the conference have been sanguine about the new ‘value based’ models. But you said hospital-based ACOs are likely to fail. Why?
(6:07) You discussed radically reducing length of stay and increasing market share to stay viable. Does your business model rely on putting your competitors out of business?
Consumer adoption and scale-up were big themes at last week’s Qualcomm Life Connect 2015 meeting in San Diego. Many digital health initiatives are still stuck in the concept, prototype and pilot stages, but Walgreens has been charging ahead. The presentation from Adam Pellegrini, Walgreens VP for digital health was refreshing and inspiring. I caught up with him afterwards to follow up on some key points:
(0:12) How does Walgreens use its Balance Rewards loyalty program to generate engagement with digital health?
(1:13) What is the role of Walgreens pharmacists in telehealth?
(2:49) What consumer friction points are you obsessing about in healthcare today?
(4:06) What is Walgreens doing with telehealth outside the US? Are you bringing lessons from abroad here?
par80 and the Institute for Relevant Clinical Data Analytics (IRCDA) have teamed up to enable sophisticated clinical decision support at the point of care using SCAMPS. I asked Dr. Adam Sharp, par80’s cofounder, president and chief medical officer to explain.
What are SCAMPs? How do they differ from evidence-based protocols?
SCAMPs are Standardized Clinical Assessment and Management Plans. SCAMPs outline a data-backed, consensus-based, care pathway for a diverse patient population with a particular diagnosis or condition. Data is collected on the treatment and outcomes of that population, analyzed, and then used to improve the care pathway
While evidence based protocols can answer highly specific medical questions, the traditional methods are inadequate to address the interdependent questions related to defining effective care
SCAMPs aim to bridge the gap with a method that is integrally linked to continuous improvement
Additionally, SCAMPs aim to reduce the cost of delivering care to patients while improving quality by focusing on standardization of care and reduction of unnecessary utilization
What are some examples of SCAMPs? What value do they provide?
There are a wide variety of SCAMPs, ranging from the inpatient to outpatient to ER settings. Some examples of SCAMPs are the Congestive Heart Failure SCAMP (inpatient) Distal Radius Fracture (outpatient), and Acute Kidney Injury (ICU)
They reduce variability in care. The algorithm drives consistency among participating providers. In addition to providing a layer of liability protection, organizations want to drive towards best practice guidelines. SCAMPs do so from the grassroots level
SCAMPs gain support from providers because in spite of a foundational algorithm driving decisions, providers are free to diverge from the SCAMP recommendation, so long as they provide a reason. This empowers providers to use their own intelligence alongside the best practice guidelines laid out by the SCAMP
Finally, a SCAMP is never perfect. After using it in the field for a given amount of time, the data is collected and analyzed by IRCDA’s analytics team. The output is then used to reevaluate the SCAMP and to change the algorithm to account for the decisions doctors made. These iterations ensure care pathways are constantly improving based on the latest empiric evidence
And what is IRCDA? How does it relate to SCAMPs?
IRCDA is the Institute for Relevant Clinical Data Analysis. In 2006, clinicians in the Cardiology Department at Boston Children’s Hospital began to toy with a new methodology. This methodology would ultimately create SCAMPs
As success grew and institutions around the world became interested, IRCDA was created in 2010 to spread and promote SCAMPs to interested institutions
You’re a founder of par8o, which you describe as a healthcare operating system. You’re partnering with IRCDA to implement SCAMPs. How does all of this fit together? If par8o is the operating system, what does that make IRCDA, SCAMPs, and hospitals?
IRCDA, SCAMPs, and hospitals in many ways represent a microcosm of the healthcare system as a whole. A major benefit of working with IRCDA is that it touches so many major components of the healthcare industry
It ranges across healthcare settings (inpatient, outpatient, ER) in addition to focusing on the most important players in the industry – the providers
As healthcare’s operating system, par8o wants to layer itself onto as many aspects of care as possible. Doing so will allow us to bring efficiency to all parts of the industry
Finally, pathways in healthcare are manifold. From taking a patient through the right care pathway, to following a pathway created by an insurance company for specialty pharma, to finding eligible patients for clinical trials, the foundation par8o builds with care pathways will have many implications for driving efficiencies in other aspects of healthcare
How are EMRs involved in this initiative?
par8o integrates with all EMRs via the Direct protocol developed by HHS Office of the National Coordinator (ONC). SCAMPs can be initiated out of an EMR using a direct message – the direct message will trigger a draft SCAMP to be created in par8o and will notify the provider that they must complete the SCAMP
Therefore, so long as the EMR supports Direct messaging, par8o can use that functionality to integrate
What impact will this partnership have for patients?
Patients will benefit because par8o’s technology will address two key pain points currently in the SCAMP process. The first is unwieldy data entry – par8o will enable providers to complete SCAMPs from their mobile phone. Using decision support, the forms will seem less onerous
Additionally, by leveraging form versioning technology, par8o will enable faster iterations on SCAMPs. Faster iterations means the data gathered during SCAMP collection can be leveraged sooner, resulting in enhanced care for affected patient populations
This is clearly a first step. How do you see development rolling out over the next few years?
Over the next few years, par8o has a big vision. To start, our aim is to successfully launch a pilot program at a single institution. We hope to ease data entry issues and therefore increase adoption. Additionally, we hope to see faster iterations between SCAMP versions
In the future, in addition to expanding to more member institutions, we would like to see a social element brought to SCAMPs where providers are able to participate in chat forums and share the latest literature concerning that area of care
par8o also plans to build a SCAMPs “Editor”, which would enable the IRCDA team to build and version their own SCAMPs, greatly increasing the iteration process
Online “symptom checkers have deficits in both diagnosis and triage, and their triage advice is generally risk averse,” according to a new study in BMJ by Harvard researchers. Some of the press coverage of the study has been pretty critical of the symptom checkers, but the study itself is quite balanced.
Symptom checkers are a lot better than “Google Diagnosing” (typing a list of symptoms into Google and seeing what comes up). They’re very similar to nurse triage lines used by health plans, which is no great surprise considering that many of the triage lines use the same logic that drives the symptom checkers. They’re inferior to a primary care physician, but of course physicians aren’t infallible either.
People use symptom checkers to self-diagnose and to figure out if they need to go the emergency department, doctor’s office or can treat at home. Not surprisingly, the symptom checkers err on the side of suggesting patients seek care. No producer of these tools wants to get sued for recommending self-care to someone who should have called an ambulance. But in this regard symptom checkers are similar to nurse triage lines and also –at least in my experience– to physicians who are covering call. Too often they suggest a trip to the ED.
There’s an opportunity to reframe the next generation of symptom checkers as tools for navigating the medical system. That means not just suggesting a diagnosis and level of care, but pointing to an appropriate specialty, facility, or individual clinician to follow up with. This could be especially useful for patients in areas with fewer specialists and sub-specialists, and those with rare or hard to diagnose conditions. Primary care physicians could use such a tool as well to help direct referrals.
Curious about Apple’s new #ResearchKit and its potential for outcomes research? Digital healthcare consulting firm Medullan (where I’m an advisory board member) is hosting a free webinar from 2-2:30 today, EDT.
Topics will include:
The Current State
What the Apple ResearchKit is and is not
Apple software development kit overview
FDA guidance and latest IRB ruling
Implications for the Outcomes Researcher
Challenges that Research Kit addresses
If you miss it you can still catch the recording. So it’s worth visiting the registration page.