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Editor's note: This is the first segment of Roy Smythe’s four-part series that takes a deeper look at healthcare innovation from the perspective of four Contemporary Provider Challenges: Chronic and Behavior Care, Operations 2.0, Patient as Consumer and Post-Acute Care. HX360, co-developed by HIMSS and AVIA, was established to advance innovation in these four areas through the thoughtful use of emerging technologies. Though not exhaustive, this series is designed to advance the dialogue among healthcare stakeholders and begin clearing the way for innovation in care delivery. Part one focuses on Chronic and Behavioral Care. The opportunities to improve the delivery of health care are evident, but how do we more effectively engage patients in their health and wellness? A recent study by the RAND Corporation demonstrates the massive challenge that chronic diseases pose to healthcare. It reports about 141 million U.S. citizens lived with one or more chronic conditions in 2010. Citing another study, the RAND Corporation projects this number to increase to 171 million by 2030, with diabetes and cardiovascular disease as two leading drivers: By 2034, the number of people with diabetes in the United States will double to 42 million with a healthcare price tag of $336 billion. The American Heart Association projects that by 2030, 40 percent of the U.S. population will have some type of cardiovascular disease. Healthcare costs will triple to $818 billion. In the face of such a large, industry-wide challenge, as might be expected, there is a wide spectrum of interests motivating healthcare systems and providers to respond to the chronic care challenge. RAND’s 2011 Health Plan Survey shows the top reasons health plans implement chronic care management programs include: Contain Cost – 96% Respond to market demands – 92% Improve patient health – 76% Improve clinical care – 64% Empower patients – 44% Respond to demographic changes – 32% Increase patient satisfaction – 20% So, what can be done, in the words of the World Health Organization, to face this “invisible epidemic”?  Pitfalls to Avoid in Chronic Care One established approach to chronic care uses individual risk identification and population risk stratification to drive care management program content and intensity that is matched to patients’ risk profiles.  Many health systems are using this approach, but two potential pitfalls can derail these efforts: Pitfall 1: Underutilizing emerging technologies to enhance and scale current services. Many care management programs use phone calls and home visits to monitor patient progress. This high-touch, low-tech option can be highly effective but difficult to scale to support a broader population. Pitfall 2: Bypassing the first two steps of risk stratification and care management infrastructure and jumping directly to patient engagement. Technology doesn’t solve internal workflow challenges; it amplifies what is already set up. It is important to ensure patients are stratified with the right focus; to clarify the role of care providers and how they interact with patients; and to define the information flow from provider to care manager to patient and vice versa before incorporating technology to engage patients. Promising Areas for Innovative Technology Emerging technologies have enormous promise in the care management and patient engagement stages, especially in relation to the EMR. Care Management Strategy and Programming Developing strong chronic patient care leaders, teams and programs is top priority. For health systems and hospitals with resources, this is straight-forward. Specific challenges for hospitals in this category, center on taking an existing workforce and building in efficiency and scale. Care management platforms such as CipherHealth's View, allow providers to streamline care coordination, improve patient engagement with automated touch points and assign evidence-based care plans. For smaller hospitals with more modest budgets or healthcare organizations with limited resources and internal staffing, creating a care management program may be out of reach. Turnkey solutions that include outsourced care management resources, in addition to patient engagement applications, such as MD Revolution, may be the best option to consider. Patient Engagement The good news is that there is a cornucopia of technologies that can be used for increasing patient engagement and satisfaction, but each takes a different approach. For example, all communicate with the patient but do so through different channels, like mobile, web, text, email, chat or EMR patient portals. Engagement solutions are also enabling a customized patient experience by translating patient data into more tailored insights and messaging, which can lead to better self-care management and patient satisfaction. Learn more about the chronic and behavioral provider challenge and emerging technology solutions at HX360 during HIMSS16. Don’t miss the HX360 Innovation Pavilion plus cutting-edge programming led by world-class healthcare thought leaders, investors, innovators and leaders.

(SPONSORED) How to rise above all the marketing chatter is perhaps one of the most difficult marketing questions to tackle.

  Health leaders are now thinking beyond their EMR to the next phase of health IT. This post-EMR phase is commonly being referred to as “the second race.” So, what is this second race? It’s really about moving from foundational technologies that replicate existing processes in healthcare to transformational technologies that enable entirely new ways of doing things—technologies that will help the health system evolve to a more proactive and predictive approach. We are excited to hear HIMSS16 presenters and participants share their key areas for the second race. We, at Microsoft, see the following areas as the primary opportunities in front of us. 1. Increasing collaboration among health professionals. Caregiver teamwork has always been important, but it’s even more vital as health services delivery becomes increasingly multidisciplinary. This recent blog highlights a couple of examples of how today’s cloud and mobile technologies are enabling healthcare professionals to work together in real time. 2. Gaining meaningful insight from data. Today’s advanced health analytics in the cloud can empower people to glean actionable and predictive insights from the vast amount of data in the health industry and beyond to improve the quality and efficiency of care. Read about how Dartmouth-Hitchcock is ushering in a new era of proactive and personalized healthcare, what a Brazilian hospital is doing to reduce length of stay, and how European health systems are transforming healthcare with advanced analytics. 3. Enabling virtual care. By virtual care, I mean not just telemedicine but a plethora of new ways that technologies can enable health organizations to provide care and follow up with patients anywhere, anytime. Health systems are evolving to provide people with personal health interactions more proactively and consistently. A couple of examples are described in this blog post. What’s more, when all three of these key areas come together, healthcare can be approached more holistically. One of the many interesting topics of discussion at the conference will be around the need to not just treat people’s conditions, but help them manage their overall health—and the interdependencies of physical health and mental health. For example, helping people prevent Alzheimer’s disease means encouraging them to exercise and meditate regularly. Finding ways to inform and empower people to take better care of themselves is part of what the next phase in health IT will involve. I couldn’t be more excited about where we’re headed in health and technology. We’re on the threshold of incredible transformation. I look forward to seeing it unfold with innovative new ways to make a real impact for better health. How are you using technology to transform healthcare? Share in the comments below. Be sure to share your unique story and vision for healthcare at HIMSS16 Video Booths: Microsoft  #3832 and GE Healthcare #3055.

(SPONSORED) Two physicians working at the intersection of healthcare and technology recently chatted about what FHIR will mean to practitioners at the point of care.

Editor's note: This is the second segment in Roy Smythe’s two-part interview with Dr. George Day on the nature and application of science-based innovation to advance the new model of healthcare. A world class thought leader speaking at HX360’s Executive Program during HIMSS16, Dr. George Day is the Geoffrey T. Boisi Professor Emeritus and co-Director of the Mack Institute for Innovation Management at the Wharton School of the University of Pennsylvania. He is one of the leading global experts on the science of innovation. Dr. Day has studied many aspects of change and competitive advantage in businesses, including such topics as understanding how to leverage emerging technology, the importance of utilizing interdisciplinary partners to anticipate market needs, and most recently what differentiates non-healthcare corporate innovation leaders from “laggards” in his most recent book, “Innovation Prowess”. This interview has to parts. Part 1 focused on organizational structure around innovation. Part 2 below centers on innovation execution. (This interview was edited for clarity, readability or length.) Question [Smythe]: Healthcare organizations have a large number of areas where improvement could be beneficial – financial, technological, clinical and others. How do organizations that have an abundance of choice in this regard focus on the vital few initiatives that will create the biggest outside impact? Answer [Dr. Day]: I’ve never met any organization that didn’t have more opportunities than they can ever possibly pursue. The worst case is where you try to do a lot of different things, but do none of them well - hence the role of discipline in narrowing the set down. In any organization, having a clear strategic approach to looking at the possibilities ahead of you is critical. Everyone in your organization has to be aligned around the qualitative and financial objectives that will be accomplished (e.g. cost reduction, improving the patient experience). What is critical to the execution and discipline part is the (1) resource allocation and (2) the choice among innovation alternatives. Counter-intuitively it works better if you start in a divergent way and ask – what are all the things we could do? Start looking aggressively for ideas – not just the ones that come across your desk - but go out and canvas for ideas within the organization as well as peer hospitals, and spend time studying the patient experience. The idea is you diverge first and then converge –you are at risk of missing the best ideas if you don’t ask. This is something the Chief Innovation Officer or Chief Strategy Officer could orchestrate. Once you have your portfolio of possibilities, the discipline part comes in. Narrow down to the ones that are aligned with your strategy, technically feasible, and can deliver results in a realistic timeframe. Some techniques you can use to screen your portfolio include innovation tournaments, discovery-driven planning, and patient experience mapping. Question: Could you please explain further the importance of real options reasoning and how it could apply to efforts to generalize innovation in healthcare? Answer: The idea around real-options reasoning is akin to the experience in buying a house. You are not sure you want to buy that house, but you don’t want to lose it. So you put down $10,000 to get another month to consider it while continuing to look further. If at the end of the month, you don’t like the house, all you have lost is the $10,000. If you do like the house, you can exercise the option and apply the $10,000 to the purchase price. Buying a real option gives you the opportunity to learn but doesn’t commit you to big action. Think of it as a stepping-stone or a way to step into a major change. Some examples of this in the healthcare space would be doing a pilot or initial implementation, or taking a small stake in a start-up company – both actions do not require big commitments. Question: In an industry that is shifting towards a focus on measuring outcomes, some of which could take months or even years to show clinical benefit, how can an organization measure innovation progress and effectiveness? Should there be more focus initially on input, engagement and process measures? Answer: About six years ago, I did a project with McKinsey where we looked at all the innovation metrics. We found an upwards of 45 metrics that could be grouped into 3 buckets: Inputs – e.g. # of ideas (expanding before contracting), # of investment dollars, employee time, # of employees involved in innovation, balance of the portfolio Throughputs or intermediate steps – e.g. # of quality ideas, time to move idea from concept to prototype, satisfaction with prototype, # of pilots completed Outputs – e.g. how many reached the market, % of revenue derived from new solutions Outputs turn out to be of little to no value in situations where you are fixing a system that is broken. For example, failure rates on innovation are found to be really high, but you have no diagnostic insight into what to change. The challenge is to push back into the innovation funnel towards the intermediate stages and focus on inputs and throughputs. By tracking inputs you are able to uncover issues such as – are inputs being protected? Throughputs and intermediate stages of innovation is often where you see problems propping up. Here you can uncover issues such as: significant approval delays and people moving in and out of teams. Monitoring these earlier process problems can help tell you what to fix when issues arise. Discover more of Dr. Day’s critical healthcare innovation insights and applications at HX360’s Executive Program during HIMSS16, February 29 – March 3, 2016 in Las Vegas, Nevada.      

One of my all-time favorite Star Trek original series episodes is entitled "The Trouble with Tribbles." In this episode, Captain Kirk urgently races to a space station that's in distress. Once at the space station, he and the crew of the starship USS Enterprise encounter small furry creatures that purr and resemble something between a small cat and a cute guinea pig that are called Tribbles. Once these creatures are brought onto the Enterprise, they start immediately reproducing into litters of Tribbles and threaten to overwhelm the Enterprise and the crew. In much the same way that the cute and cuddly Tribbles start to overtake the USS Enterprise, so too have devices with ePHI overtaken and in some cases overwhelmed the hospital and healthcare technology ecosystems. The truly hard part is not simply containing the obvious devices and applications that store and transmit ePHI such as servers, computers, interface engines or electronic medical records. The real challenge are standalone devices, sometimes decades old, that unbeknownst to the users store and transmit ePHI. So where all can we look for these devices and how can we get in front of them so that they don't threaten your starship? First, it is critically important to conduct an ePHI data landscape analysis and document where and how ePhi data moves throughout your network. It is amazing how many times a network subnet or route takes a "hop" that is unaccounted for and could find its way to a device. For example, unassuming multi-function devices that users perceive to simply be photocopier / fax / printers can connect to your corporate network and can store documents on a network shared drive or email users on your behalf. Additionally, those multifunction devices can contain hard drives and copies of the print jobs or fax jobs that it has completed. One large health plan recently was penalized by the Office of Civil Rights to the tune of over one million dollars because the leased copy machines they returned contained hard drives that were unencrypted and had the ePHI information for over 300,000 individual's stored on them. Next, look for devices that do not connect to your corporate network but actually store and forward ePHI. There are a number of clinical modalities (hearing test machines, radiology systems, cardiology systems, etc.) that are considered clinical devices but connect to a standalone PC or laptop via a serial cable or some sort of connection from the instrument to the computer. An easy rule of thought is; if it has a hard drive on it then encrypt it! One of the most annoying tribbles that seems to have infiltrated organizations is the ever present 1980's style pager. Even more annoying is the fact that these pesky devices won't go away in the industry, much less that they can easily store hundreds of alpha numeric messages that surely could contain ePHI. If your organization has them, make sure that they are encrypted or better yet get rid of them for a smart clinical communication application that can take its place. There are a number of leading vendors out there that have clinical applications designed for the modern healthcare worker that take into account ePHI data storage and transmission. In the same sentence of a pager is the issue of healthcare workers texting each other patient information on their personal devices. While it's difficult to try and curtail behavior that occurs on a device completely out of the control of the organization, there must be thorough education, policy, and user attestation efforts to educate your healthcare worker population on why this must not occur. Convenience simply does not take precedence on what could be a major risk and issue for ePHI. Additionally, another legacy device that must be addressed is the standalone fax machine. Some fax machines have hard drives and can store the fax cover sheets for easy reprinting. If ePHI can be stored on those fax machines that could constitute a risk that needs to be addressed and mitigated. Another pesky tribble are automated batch and FTP jobs that "put" files onto network shares or distribution points for organizations to share information among each other. Make sure that these FTP jobs are secure and do not use network account credentials that are generic in nature or easy to guess. It's amazing how many of these jobs are setup by vendors when an application is initially installed, but are left on autopilot for years without audit. Lastly, work closely with your purchasing and finance departments to put controls into place that any electronic item coming into an organization is reviewed and has a proper ePHI risk assessment completed on it to ensure that there are appropriate ePHI controls in place. Beyond technology, it is the organizational culture that must be primed to understand the risks of ePHI proliferation and ensure all of the dimensions are addressed. Too often a tribble can quickly be introduced into an organization because it's the new cute and fuzzy creature that is admired and wanted by all. Captain Kirk ultimately saved the Enterprise by finding every single tribble and getting them off of the USS Enterprise. While that may not necessarily need to be the course of action for every tribble in your organization; you must try your absolute best to identify and remediate the risks before you suddenly realize one day that your starship has been overrun by what everyone assumed were cute and fuzzy innocent looking creatures.

Roy Smythe, MD, interviewed Dr. George Day to drill down into the science of innovation and give readers some flavor of the need to understand innovation at this level.

(SPONSORED) Two healthcare business strategists from McKesson explain how hospitals and retail pharmacies can work together to improve the health of their patients as well as their own financial health.

From population health management to meaningful use, cybersecurity to EHR usability, healthcare will face an array of challenges and opportunities over the next 12 months. Beth Israel Deaconess CIO John Halamka, MD, offers his predictions for 2016.

Windows 10, which Microsoft is positioning as an 'Operating System as a Service' model, offers several innovative new features that will be useful to healthcare users. Here are some things to know for a successful enterprise-wide migration.