More Short Takes at #HIMSS18 – Harlow On Healthcare

While at the HIMSS annual conference this year I spoke with many healthcare technology company leaders. I am pleased to share some of those conversations here. This selection focuses on collecting and understanding data, using it to create information that can be used to improve health and healthcare. Please check out some of my other short takes from #HIMSS18 as well.

Win Whitcomb – Chief Medical Officer, Remedy Partners

I spoke with Win Whitcomb about Remedy Partners’ work as a convener for CMMI’s Bundled Payments for Care Improvement initiative. The company supports provider organizations participating in the BPCI program, having gone live in Fall 2013. Thus far, Remedy Partners has been involved in managing about half a million episodes of care, representing $12 Billion in medical spending, in 48 different DRG-based episodes – working with many hospitals, physician groups, skilled nursing facilities, home health agencies, all of which may bear risk in the program. Remedy and its partners manage patients through episodes of acute illness and through recovery from that acute illness.

Win is enthusiastic about the opportunities for care improvement both at the point of handoff and also within each care setting’s “silo.” Without something like the BPCI initiative, a hospital or orthopedic surgeon may not have had “line of sight” for 90 days post-discharge to see what happens to their patients – now they do, tied to reimbursement, and that can lead to improvement as well.

Michael Nissenbaum – President & CEO, Aprima

I discussed the current state of the EHR with Michael Nissenbaum of Aprima.

The EHR has always been a data collection tool, a mechanism for data aggregation. Now, as Michael said, the EHR is taking in data, analyzing it, and enabling its use back in the practice as an adjunct to the physician decisionmaking process, using data to diagnose and treat. The other significant change is that patients can now be in a constant and continuous relationship with their providers. Patients have access to data through their records and are providing additional information through activity monitors and other sensors.

In addition, the EHR can now provide patient access to data, and can serve as a conduit of data coming from the patient, via activity monitors and otherwise, since care is no longer just episodic, but, rather, constant and continuous through patients’ relationships with providers. In addition, the system alerts clinicians when a patient fills a prescription.

With better information, clinicians can make better judgments; quoting Ronald Reagan, Michael suggested jokingly that clinicians can “trust but verify.”

Michael sees the persisting lack of interoperability as something that harms the patient, harms the provider, and raises cost. Aprima belongs to CommonWell, has done some FHIR development, and Michael would like to see Congress condition Medicare reimbursement on real interoperability.

When I suggested that the 21^st Century Cures Act may be the vehicle for future interoperability developments, Michael closed with: “From your lips to God’s ears!”

Eric Sullivan – SVP, Innovation & Data Strategies, Inovalon

Inovalon has been around for about 20 years. SVP Eric Sullivan noted that it started out collecting and analyzing data from health plans: Claims data, PBM data, lab results when available. “Fast forward” and Inovalon has de-identified data on 230 million patients – health plan data, plus EHR data, plus patient-reported data, plus socioeconomic data. The goal is to compile the most complete patient profile possible, for the benefit of health plans, pharmacy, life sciences, ACOs, providers.

The consultative work that Inovalon does with its clients (now including the Avalere Health team) benefits from this longitudinally linked database, de-identified at the patient level. As Eric noted, without that sort of database, each client would end up using its own data to set its benchmarks – which is ultimately not nearly as useful.

Inovalon uses the data to train analytic engines – AI, predictive analytics – and the connectivity of its platform is an important part of its partnerships with its clients. Eric noted that the company is connected with 130,000 different providers through EHR interfaces.

Eric drove home the point that Inovalon is bringing data, connectivity and insight to bear on the clinical and financial challenges faced by its clients.

Bonus short take – available via Soundcloud, iTunes, etc., but we couldn’t fit it into our HIMSS short takes Harlow On Healthcare radio show episodes:

Simon Beulah – Senior Director of Healthcare, Linguamatics

Linguamatics is mining free-text notes in order to identify high-risk patients. Surprisingly to some, approximately 70% of electronic health record information is unstructured. Simon Beulah suggested in our conversation that physicians want to tell their patients’ stories. Predictive risk models can extract data regarding social determinants of health, which can be used in conjunction with structured data. Real-time mining of radiology reports can lead to prioritizing of reads and follow-up. For example, Linguamatics can flag a report of a pulmonary nodule overnight and trigger needed follow-up the next day. This approach allows care coordinators to focus on the cases that require more attention.

Whether it’s individual patient care issues or provider quality measures, Linguamatics is able to help its users by filtering the signal from the noise. The company is also working with payors on risk models.

Simon said that Linguamatics is distinguished from many purveyors of machine learning algorithms in that Linguamatics uses a transparent, auditable process, thus allowing end users to have greater confidence in the outcomes, be they clinical or financial.

The company’s platform allows its users to develop their own analytical tools. One customer built a tool to analyze cardiac data — 34 million clinical notes over a three-year period — to track ejection fraction over time. That project took two people with no previous experience with the Linguamatics platform just three months.

The FDA is interested in the platform as well, for post-market surveillance applications.

I spoke with Win, Michael, Eric and Simon as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting