Population Health

Eran Bellin, MD, of Montefiore Medical Center, discusses the tools and methods the organization implemented to track and use information for driving better population health outcomes.

HIMSS16 provided countless hours of must-see video content for Healthcare IT News, from fascinating interviews with thought leaders and speakers at the conference to in-depth panel discussions and show floor highlights throughout the week. We have compiled the top 5 videos to date for you to watch in case you missed them.

While mobile apps are new enough on the care delivery scene that many providers have only begun dabbling, consumers are sending a strong message that forward-thinking hospital executives can translate into an opportunity for improving population health management programs. Northwestern University's Feinberg School of Medicine is conducting clinical trials that use mobile health apps to do much more than just communicate with patients — the software teaches mental health patients cognitive behavioral therapy, or CBT, techniques designed to improve population health and reduce mental healthcare costs. This story is part of a reporting package on the rise of population in health in healthcare IT management. Stories include our analysis of health system strategies, an overview of the work done by Essentia Health and a look at how mobile apps are supporting initiatives. Designed by Northwestern's Center for Behavioral Intervention Technologies, the ThinkFeelDo website (a responsive design site built to render effectively on any device) and the IntelliCare suite of mobile apps (available in the Google Play store for Android devices, with Apple iOS apps in the works) break up the various CBT techniques into separate modules to make learning the techniques and applying them in situations an easier task. The modules include text, animation and video. Caregiver coaches, on the other end of the mobile site and apps, review patient progress and can intervene during lessons to help patients with any challenges or issues and to provide encouragement. "Costs can be saved by giving depressed patients these kinds of tools, decreasing overall health care utilization for an individual," said Kenneth R. Weingardt, scientific director at the Center for Behavioral Intervention Technologies. Weingardt also is a licensed psychologist. "We are now saving more money because the cost of the app is much lower than the cost of face-to-face. For some folks who are fairly well-functioning and can go it alone, these types of technology may provide them with what they need so they do not have a long depressive episode that impacts their health and costs a health plan money." ThinkFeelDo and IntelliCare are still in clinical trials at Northwestern, though CBITs is in discussions with Kaiser about deploying IntelliCare through its patient portal. "Mobile interventions have much farther reach than individual providers can have," Weingardt said. "They can reach many more people beyond those we can see in our clinic. And a health system that adopts these kinds of tools can improve their bandwidth and their ability to address these problems beyond the capacity of their workforce.” [Like Healthcare IT News on Facebook] In the Northwestern’s clinical trials, Weingardt added, that means giving participants tools to get symptoms under control and making it less likely they will come back with complaints. Providers such as Northwestern and other simply cannot ignore the trend toward mobile tools any longer, said population health management vendor Enli Health Intelligence chief medical officer Joseph Siemienczuk, MD. "We have to follow the communication preferences of the community and and it is clear that their communication preferences have moved to mobile technology,” Siemienczuk said. "As we pursue effectiveness, moving patient engagement activities to mobile technology is an imperative." Twitter: @SiwickiHealthIT

As 67 percent of healthcare organizations have population health management programs in place, experts say information technology is key in making them work.

First-mover health systems are already using telehealth services to successfully manage patient populations and lower healthcare costs. Take Essentia Health, for instance. The 16-hospital and 68-clinic system uses an Epic EHR and telehealth technology from Medtronic to focus on improving the health of congestive heart failure patients and enhancing the care surrounding this chronic health problem. This story is part of a reporting package on the rise of population in health in healthcare IT management. Stories include our analysis of health system strategies, an overview of the work done by Essentia Health and a look at how mobile apps are supporting initiatives. Whereas 25 percent of congestive heart failure patients in the U.S. are readmitted to the hospital within 30 days, according the Agency for Healthcare Research and Quality, Essentia said that less than 2 percent of those participating in its telehealth program return in that same timeframe. Indeed, telemedicine technologies at Essentia and other tech-savvy hospitals can help fill in care gaps, monitor at-risk patients and extend services to patients who might not otherwise receive them. Essentia, for its part, started the telemedicine work in 1998 and then instituted a formal population health management program several years ago. Today, of the 2,500 patients in Essentia's congestive heart failure program, about 300 who meet certain clinical criteria have been given tele-scales. The electronic scales digitally report via landline or cellular phone service a patient’s weight every day as well as how that person responds to questions the scale literally asks aloud. Tele-scales cost between $70-$110 per month to lease. Physician assistants and registered nurses, in turn, can deliver telehealth care under the guidance of cardiologists. "Weighing every day helps you identify the real problems," said Denise Buxbaum, heart failure program manager at Essentia Health. "When these patients actually come into the hospital, most of the times they outspend their diagnosis-related group, anyway. Now we have contracts, we are an accountable care organization. BCBS of Minnesota did one study and with this technology we saved them $1.25 million." Buxbaum said the combination of regular monitoring and the patient education that comes with it lead to improved patient health and, as a result, lower costs. "Patients need to understand the consequences of their lifestyle choices, and by showing them – when they see it with their own eyes – they are more likely to make a better choice the next time when they learn from ongoing education," she said. "With telemedicine, we are catching things early before patients have to visit an emergency room." [Like Healthcare IT News on Facebook] Additionally, Essentia Health built an interface between the telemedicine system and its EHR so patient data that congestive heart failure nurses see can be readily available to all members of a care team. "Our EHR allows caregivers to review the patient medical record to see what other care coordinators or providers have done when caring for our patients," Buxbaum explained. "This allows for a more seamless, higher level of quality care when we all know what the rest of the health care team is doing." Twitter: @SiwickiHealthIT

The technology pioneer offered his thoughts on funding new projects and keeping up with change at his HIMSS16 keynote earlier this month. Here are seven takeaways.

More than 100 member organizations have committed to participating in the effort to empower patients and improve care delivery.

Assistant U.S. Surgeon General Rear Admiral Michelle E. Dunwoody is taking on a temporary senior advisor role to Flint Mayor Karen Weaver as the Michigan city continues to grapple with a water crisis, HHS announced on Friday.  Dunwoody will work with Weaver to establish both short- and long-term goals for the City of Flint Public Health and Medical Recovery and work with city officials to outline the job description for a future full-time Flint-employed Public Health official, while providing insight to building and managing public health and medical infrastructure.  “My priority has always been, and will always be, that Flint’s families have the resources they deserve, as well a voice which allows them a say in how their community’s future is built,” Weaver said in a statement. The partnership is "an opportunity to continue building relationships, while ensuring some of our country’s best experts are working with us to find solutions.”  To that end, Dunwoody will also oversee a Corps-based community engagement team. "Admiral Dunwoody brings a wealth of expertise to expand the technical capability of the Mayor’s office and ensure Flint develops the local expertise needed to help the community recover in the days, months and years to come," HHS Assistant Secretary for Preparedness and Response Nicole Lurie said in a statement.  Nearly 500,000 residents of Flint have been exposed to water contaminated by lead, and currently much of the city is living off of bottled water rations. The appointment comes after a Commissioned Corps strike force cleared a backlog of blood lead level screening results in partnership with the Genesee County Health Department. HHS leaders have made several visits to Flint to assess the crisis, including Secretary Sylvia Burwell, Acting Assistant Secretary for Health Karen DeSalvo and U.S. Surgeon General Vivek H. Murthy. [Like Healthcare IT News on Facebook] "Ensuring the men, women and children of Flint have the same opportunity as all Americans to live healthy lives is a team effort, and I have seen first-hand just how dedicated city leaders, city and county health officials, and our Commissioned Corps officers have been to that cause,” said DeSalvo in a statement. The Commissioned Corps are made of up doctors, nurses, scientists and engineers. Over 30 officers have responded to the Flint water crisis; assisting with behavioral health training, supporting volunteers in community engagement efforts, helping to staff the Genesee County Health Department's information line and providing materials to answer callers' questions. “The people of Flint need clean water. They need medical care. And, above all, they need trusted voices to communicate the best available public health information in the midst of a crisis,” Murthy, Commissioned Corps commander, said in a statement. Twitter: @JessiefDavis

The federal government is pursuing a fistful of bold visions to transform healthcare including the Precision Medicine Initiative and the National Cancer Moonshot, and for those to succeed patients are going to need the ability to access and share health data in new ways, according to three federal officials. “When patients are engaged in research and voluntarily sharing their health data with the research community, the opportunities for new discoveries at the intersection of human biology, behavior, genetics, and data science are unlimited,” wrote U.S. Chief Data Scientist DJ Patil, Senior Advisor Claudia Williams and Precision Medicine Initiative project manager Stephanie Devaney. [Also: Obama taps Biden to lead cancer cure 'moonshot'] The authors cited President Barack Obama’s Precision Medicine Initiative, an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles in treatment and research, and the National Cancer Moonshot, which leverages Big Data to find solutions to genetic abnormalities, as examples of data sharing to accelerate research and translate findings into new treatments. HHS has been taking steps to enable the data sharing that PMI, the Cancer Moonshot, and key research projects will demand. The agency recently issued guidance to clarify patient rights to access a variety of health information, including personal health records, the information in their health records, clinical laboratory test results, and genetic data. And earlier this month, the Food and Drug Administration held a workshop with patients and providers to understand the best ways to return information that is usable, meaningful, and actionable. “We’ve worked hand-in-hand with the private sector (to provide patient access to health records) and together, last week, the companies that provide 90 percent of electronic health records to hospitals nationwide pledged to improve the flow of data across healthcare settings, provide people with easy and secure access to their information, and adhere to federally recognized standards that assure that patients can access their own data,” the authors explained. HHS is also encouraging the development of apps that use open, standardized application programming interfaces to help consumers aggregate their health information in one place that is under their control. And at the recent Precision Medicine Initiative Summit hosted by President Obama at the White House, six of the major electronic health record vendors announced that they will pilot the use of standard APIs for individuals to access and contribute their data to research. [Like Healthcare IT News on Facebook] The authors also pointed to the early traction Blue Button has gotten. Through the public-private effort some 150 million Americans can now access information from providers, medical laboratories, retail pharmacy chains, and state immunization registries. What’s more, three million veterans, service members, and Medicare beneficiaries have now accessed their personal health data more than 43 million times. “These are exciting steps toward ensuring individuals have access to their data,” Patil, Williams and Devaney wrote. “But we’re far from done.” Twitter: @HealthITNews

Before joining Cerner, Glaser was the longtime vice president and chief information officer at Partners HealthCare.