Lessons Learned from a Medical Trip to Ecuador


Post by Ron Reis


Field Marketing Manager-EMEA, Caradigm

Recently, fellow Caradigm employee, Larry Nicklas, and I travelled to Tena, Ecuador to take part in the volunteer Timmy Global Health medical trip. Several members of the Caradigm team had volunteered in the past, and it was upon hearing about their experiences that I was inspired to volunteer. Timmy’s volunteer ‘brigades’ visit regions where there is very limited or no access to healthcare and set up makeshift clinics in a number of communities.

Most of the volunteers’ journeys involved 15+ hours travel time and several flights. Doctors, nurses, dentists, an ophthalmologist and general-purpose volunteers converged in the Amazon basin from other areas in Ecuador and as far as North America and Europe to volunteer their time and expertise.

A Clinic Under a Tin Roof

Being a Spanish speaker, I had the unique opportunity to rotate through various stations as an interpreter and engage with patients. The stations were small areas often separated by cords and hanging sheets. They included patient history and registration, vitals, consultation rooms and a working area for dentists, an ophthalmologist and in some cases a counsellor was also available. I found working alongside the doctors and nurses eye-opening as I was blown away by the level of care and compassion displayed to each patient despite the sometimes rudimentary conditions.

Even though Timmy Global Health and the local partners did an excellent job of preparing the community for our visit, I can only imagine how unusual it must be to see a bus load of international volunteers descend upon a community and set up a makeshift clinic for the day. For this reason, I made sure to welcome patients like I would a family member. The crux of my role was to engage with the patients so I would take a knee, crouch to eye level and verbally walk them through what the clinician was about to do and why. For example, I would say “we are about to put this around your arm to measure your blood pressure” or “we are going to check your baby’s temperature to see if he or she is running a temperature.” Especially when helping dispense medicine at the pharmacy station, it was extremely gratifying to see when patients had a sense of ownership of their treatment and gained an understanding of what each pill was for and when it was appropriate to take it.

Working with mothers and young children was especially endearing. One day one of the doctors requested a blood sample from a young girl who was about 5 years old. She could tell straight away what was coming and cried loudly as the nurse pricked her finger. After the blood was collected, we countered the girl’s sobs by clapping and cheering enthusiastically, and she eventually gave the nurse a big hug and smiled. Her mother looked on with a huge smile as well, and I think was reassured that we were there not just to provide healthcare, but to care.

Lasting Impact

Having lived in developing nations before, I was conscious of flying in, doing my part and flying out, having only made a short-term impact. I’m glad to say that Timmy Global Health does an excellent job of balancing short-term medical needs while also referring more complex cases to local medical centres or the capital. Even in such a remote location, it was also clear that basic prevention and patient engagement is essential in order to create a sustainable health system. The teams worked with the locals on prevention programs such as employing fluoride varnish to protect against tooth decay, teaching songs to children about the benefits of brushing their teeth regularly, and giving advice to older patients on how to better cope with arthritis pain. Timmy Global Health are also implementing safe drinking water projects in communities where there is limited access to drinking water and plumbing, which should help decrease some of the most common ailments we saw.

After I returned home to London, I realized that I was much more cognizant of the increasing number of homeless in the city. Thinking back to my time in Tena prompted me to talk with an elderly lady one cold rainy day and provide her with a hot meal. Some would describe volunteering as a selfless act, I tend to regard it as an investment, in me as a person and our collective wellbeing. Volunteering with Timmy Global Health and working at Caradigm, a population health company, have changed me for the better. In both cases, I am proud to be part of something bigger than myself and being able to make what I hope is a valuable contribution to the world we live in.

Larry Ecuador 2015

Larry Nicklas supporting the Pharmacy Station

 

Ron Ecuador 2015      

Me in the “Kids Corner”, where children received preventive treatments

 

Building a Culture of Physician Engagement in Population Health


Post by Sameer Bade, MD


Vice President of Clinical Solutions, Caradigm

In population health management, the role of physicians has evolved because the care of chronically ill patients requires a coordinated effort between members of a multi-disciplinary team. However, a team approach does not diminish the role of primary care or specialist physicians. Rather, it should engage and support physicians directly to address quality, outcomes and cost. As provider organizations seek to scale their population health and value-based care efforts, effective engagement of primary care and specialty physicians is critical.

Today, physicians are under escalating amounts of clinical, administrative, time, financial, and legal pressure to perform while their businesses are facing decreasing fee-for-service reimbursements. In increasing numbers, physicians are giving up the independence of private/small group practices and seeking employment with larger groups and health systems. This loss of autonomy coupled with administrative and regulatory pressures can lead to a decrease in physician satisfaction. We often speak about patient satisfaction but physician satisfaction is rarely addressed in a systematic fashion. Despite these pressures, most physicians rightfully view themselves as hard working, high-quality individual performers who care about patient outcomes. However, as organizations start to add the numerous requirements of value based care programs onto already over-burdened physicians, is it possible to maintain effective engagement?

Some larger physician groups and health systems are further along in their population health journey. These organizations have established patient-centered medical homes, continue to expand their multi-disciplinary care teams (nurse care managers, pharmacists, social workers, community health workers and non-clinical support staff) and are transitioning from basic registries to more sophisticated population health analytic and workflow tools. These investments have been made to both transform the care delivery process and simultaneously engage and support front line physicians and nurses. However, the majority of physician groups and health systems that I speak with are still fairly early on in their participation in value-based programs (e.g. planning to apply or in program year 1 of a Medicare Shared Savings Accountable Care Organization (ACO), grappling with the looming impact of the now mandatory  Comprehensive Care for Joint Replacement (CCJR) bundles, trying to effectively deal with the Readmissions Reduction program, participating in newly formed commercial ACOs or narrow networks, managing their own employees, etc.). In these early adopter settings, it is challenging to deeply invest in FTE’s, clinical programs, and technology.

Both physician and hospital organizations will also need to address the upcoming requirements of the 2015 Medicare and CHIP Reauthorization Act which will require participation in MIPS (Medicare Incentive Based Payment System) or APM’s (Alternative Payment Models). Not participating or performing poorly across these programs could result in a loss of 9% of reimbursement. The successful implementation of these programs is firmly dependent on the participation and performance of physicians.

In my travels and meetings with physician groups and health systems around the US, several best practices seem to be emerging around physician engagement:

Education: Frequent education on a variety of topics is critical. Physicians understand clinical care. However, concepts such as ‘benchmark’, HCC (Medicare’s Hierarchical Condition Category coding), minimum savings rate, discounting, two-sided risk, attribution, utilization management, multi-disciplinary care teams, etc. were not taught in medical school or residency. A mix of mediums such as conference calls, webinars, town halls and smaller group meetings are being employed. I’ve seen organizations with staff that travel from clinic to clinic on a rotating basis (much like a pharmaceutical rep) to provide 1:1 or small group education. Physicians need to clearly understand regulatory and industry changes, the organization’s shared goals, and the personal and professional impact of these changes.

Tools: It’s important to engage physicians with informatics tools to help them improve their performance on the metrics being measured. There are a variety of supporting capabilities which include easy to access longitudinal patient records, shared care plans, and gaps in care at the point-of-care. Physicians do not have time to log into multiple systems or read multiple reports while providing patient care. Analytics must be actionable at the point-of-care. Increasingly, physicians have an expectation that this enriched patient centric information should be available while seeing a patient or working in a patient chart. In contrast, the supporting care team may also need a population level view to help with pre-visit or day of visit planning and coordination.

Compensation: The satisfaction of being considered an efficient and high quality provider fosters engagement and can create healthy competition. However, compensation can also be a powerful adjunctive motivation. The most forward thinking organizations are not only rewarding primary care physicians and specialists, but also members of the care team when pay for performance or shared savings are achieved. Organizations are also putting a certain percentage of base and or bonus compensation at risk for actively participating and or achieving quality or targets.

Culture: Ultimately, creating the right organizational culture can accelerate achievement of meaningful physician engagement. Integrating physicians into governance is very effective as most of the top performing ACOs are organized by physician groups. Equally important is for organizations to provide the necessary multi-disciplinary team support and informatics investments. Physicians are competitive by nature, and will push each other to perform if provided a meaningful, mutually agreed upon set of goals and measures.

Measurement: In my next blog post, I will explore the importance and challenges of measuring physician performance further. I will also discuss how new analytics tools can help with measurement and support discussions between clinical leadership and individual physicians.

We have moved past the uncertainty of value based care programs initiated as part of the Affordable Care Act, and are entering the next phase of healthcare transformation anchored by the 2015 MACRA. While our transition from fee- for-service to value-based care is going to be challenging, it provides a real opportunity to decelerate the unsustainable growth in healthcare spending while improving patient outcomes. Physicians have a critical role in this transformation.

As I speak with physicians around the US, they share different and insightful perspectives on their participation in population health and value-based programs and the engagement of their colleagues. If you would like to discuss how Caradigm can help you with physician engagement, then please send a note here.

 

The Paradox of Population Health


Post by Brad Miller


Vice-President of Clinical Solutions, Caradigm

By and large, the healthcare industry talks about Population Health as care across populations of people. While Pop Health has evolved to drive the IHI Triple Aim across those populations, successful Pop Health efforts depend on care given on a patient-by-patient basis. From a clinical care perspective, Pop Health drives care at the Person level – the second “P” in the 3Ps of Pop Health. The paradox in Pop Health lies in that how we deliver care on an individual and personalized basis actually drives population results.

Pop Health is driven on a person-by-person basis. A patient, by definition, is a person receiving care. However, in reality, external and personal factors greatly affect how a person maintains their health and gets their healthcare. This all-encompassing understanding of the person is becoming more important to drive clinical outcomes and Pop Health successes. No longer can providers afford to view people solely as patients – providers who want to drive true global results will have to understand the patient as a person. Ironically, Pop Health has forced us as an industry to get better at data and care on a personal level.

Understanding the Patient as a Person First and foremost, personal factors like financial and family concerns play a large role in how people interact with the healthcare system. The Patient Protection and Affordable Care Act (ACA) has increased the number of covered individuals and also has created more narrow networks, high deductibles and increased healthcare utilization. High deductibles mixed with lower incomes could become a barrier to care, particularly if those individual patients need to obtain services and goods outside the clinical setting (think wheelchair ramps, dietary advice, a divorce or family death and how those factors can affect a person’s ability to get proper care). Even a family dog that a person does not want to leave alone at home during a hospitalization can prevent such a person from getting recommended preventive care. I have personally experienced these as barriers for patients, and I continue to hear those stories as I meet providers and systems across the country. All too often as providers, we are guilty of treating patients, when we really need to be treating the person. Until socio-demographic issues are better understood and addressed, they can hamper the benefits that Pop Health can provide.

A Person’s Personal “Big Data” The world of truly personalized medicine will also continue to evolve. On top of sensor data (Fitbits, Apple Watches, Bluetooth Scales, Bluetooth Glucometers), we are also seeing an explosion in genomic and proteomic data. All of this creates a more detailed, intricate and nuanced picture of a person as a patient. Collecting, analyzing and integrating this intelligence into clinical care will be one of the next large challenges healthcare faces. As an industry, healthcare may need to consider this information as a critical part of a person’s foundation that will guide personal care.

High Quality and Value Care at the Personal Level Many providers have contracted via ACNs, ACOs, MSSPs and the like to deliver care for a certain dollar value and to a quality standard. Those quality measures vary from population-by-population and contract-by-contract. Ultimately though, each person receiving care in the health system has a set of quality measures and gaps in care that need to be addressed. Put another way, there is no way for a gap in care to be closed without working at a patient level. This may seem obvious, but all too often providers talk about Pop Health and care metrics and gaps in care at a high level (i.e., how is our quality as a system?) vs. a patient-person level (i.e., how are our patients doing?).

Making it Personal Overall, understanding a person and his or her personal situation is critical to their clinical care and therefore paramount to Pop Health achieving the Triple Aim. The practice of Pop Health has a foundation in technology and data. Traditional systems like EMRs and other hospital-based technologies have not been designed to capture the full picture of a person and oftentimes these systems struggle to create a unified clinical record – a longitudinal patient record (LPR) – for a patient’s clinical information. Health systems, in the future of the risk-based model, will need to not only understand the LPR and the complete socio-demographic situation of a patient in order to drive to the desired results. I will address a vision for that technology in my next post. In the meantime, the paradox of Pop Health – that it truly is all about the individual, the person, remains of utmost importance in the current evolution of Pop Health and healthcare at large.

 

Expanding Your Population Health Data Foundation to Claims and Beyond


Post by Niranjan Sharma


Director of Engineering for Healthcare Analytics Platform & Applications, Caradigm

Healthcare is traditionally thought of as the care of patients by healthcare providers. Clinical data is generated during that care, and payers reimburse providers for the services rendered based on submitted claims. For providers engaging in population health, working solely with clinical data only tells part of the population health story. Most healthcare organizations are striving to derive more value and population insight by including claims and other types of data so that they can better stratify their populations, drive other analytics efforts, and improve care coordination among many activities. 

Payer Pic1

Siloed Data Challenges

Payer Pic2 v3

The challenge is that it is complicated to ingest, normalize and model different types of healthcare data. Healthcare organizations often have many disparate information systems, and many work with partners who in turn also have many disparate systems. Most providers are still working towards harmonizing all of their data so they can view a single picture of their populations and make the best use of it in a timely manner to meet their clinical and financial goals.

 

Harmonize Data, Analyze & Compute

Payer Pic3

One of Caradigm’s hallmarks as an enterprise population health company is that we are experts in healthcare data management infrastructure and processes. We help our customers remove the complexity and manual processes associated with data management through the Caradigm Intelligence Platform (CIP), an enterprise data warehouse designed specifically for healthcare. CIP enables organizations to harmonize their data, and then perform a rich array of analysis (e.g. predictive risk stratification, utilization), as well as computations on data (e.g. quality compliance, gaps in care, display last glucose results, display last PCP visit for a patient, etc.).

 

Modeling Claims Data Using Entities

Payer Pic5

 

Caradigm has a proprietary methodology that structures data as specific healthcare entities. On the outer ring in the diagram above are examples of core payer entities that we can introduce with our customers. Seeing payer data organized in this fashion is often eye opening because it provides a harmonious view of the care delivered to patients. What is even more exciting is when payer data is combined with clinical and other data to show a complete picture that can then feed other integrated applications.

 

Lighting Up Applications With Payer Data

  • Risk Management Analytics
  • Accountable Care Organization compliance
  • Gaps in Care
  • Gaps in Billing
  • Network Utilization Analytics
  • LOS Analytics
  • Post-Acute Care Analytics
  • PMPM Analytics
  • In-Patient Analytics
  • ED Visit Analytics
  • Ambulatory Visit Analytics
  • Drug Utilization Analytics
  • Conditions Analytics
  • Bundled Payments Analytics
  • EMR Only Analytics
  • Claims Only Analytics
  • Harmonized Data Analytics

The beauty of a complete and reusable data asset is that it can light up all kinds of analytics applications. You can forecast clinical and financial risk, identify gaps in care, and analyze utilization or network steerage in order to uncover opportunities for financial improvement.

The amount of data available in our industry is growing exponentially. It is time for healthcare organizations to augment their ability to harness all of that data and realize more value. If you would like to discuss how your organization can harmonize its data and better leverage claims data as part of population health efforts, then please send us a note here.

FHIR Up Population Health


Post by Neal Singh


Chief Technology Officer, Caradigm

It’s a fantastic sign for the healthcare industry that the Fast Healthcare Interoperability Resources (FHIR) standard is garnering a lot of recent attention. I’ve had conversations with several CIOs who are hearing that FHIR could be the next-generation standards framework that can help innovate data sharing at their organizations. I can understand why they’re excited. EMRs have been closed systems for a long time, which creates major challenges for organizations wanting to share data between disparate systems. The challenge is even greater for organizations engaging in population health initiatives because the open sharing of data between different systems and providers is a must. Provider organizations want to learn more about FHIR because it has the potential to help overcome these interoperability challenges.

Let’s explore FHIR a little deeper. There are a few important details to know in order to understand its potential to help:

FHIR is an evolving standard

Up until September 2015, there were two active versions – DSTU1 & DSTU2. DSTU2 is the new version, but some technology vendors are still using DSTU1. HL7, the creator of FHIR, is still working on a final standard expected to be released in 2017. Once the final standard is in place, it will likely take a few years for broader adoption.

Vendor approaches vary

Solution vendors are in the early stages of developing FHIR strategies. Some EMR vendors are prototyping the use of FHIR APIs to enable read access of certain resources from patient charts. Others are working on the ability to read and write data back into systems. The types of data models that can be accessed using FHIR APIs also vary. For example, one vendor may support Patient, Allergy and Medication data models, but may not support Family History, Immunization, CareTeam or PlanofCare data models. Vendors can also vary whether they enable just read or read and write for each of the data models.

The use case is discrete data sharing

FHIR was designed for discrete data sharing, i.e., sharing of small batches of patient data. If you need to share one or two or ten bits of data, then FHIR can help. It is not intended for high volume data ingestion required for large scale aggregation.

FHIR is not the only game in town

Web services with REST-based APIs can already accomplish what FHIR seeks to achieve. Our customers don’t have to wait for FHIR, they can solve their data sharing challenges today using our rich and open web services data connectors that include role-based security controls and auditability. Caradigm has built unique applications like Knowledge Hub that can share real-time data and information from third-party applications directly within clinician workflows in their EMR. In the UK population health market, we have built mobile applications using REST-based APIs that can share patient data pulled from multiple sources to a mobile application at the point-of-care.

Caradigm fundamentally believes in open standards, data sharing, and in democratizing information to drive innovation in healthcare. That’s why we support an extensive number of data models, and have always been on the cutting edge of supporting emerging models such as NLP, unstructured models and now FHIR. We are able to engage services for FHIR API integrations, and will continue to build access to entities in the Caradigm Intelligence Platform including deeper integrations with specific EMRs. Caradigm also collaborates with other industry leaders on emerging standards by participating annually in events such as the IHE North American Connectathon Week (see this post about last year’s event). We look forward to participating in the next Connectathon in January.

Ultimately, there are many ways to approach population health, and Caradigm partners closely with our customers to understand their goals and challenges in order to help them develop strategies. We’re excited at the prospect of FHIR being part of the solution for our customers. If you’d like to discuss FHIR more and how it fits into your population health strategies, then please reach out to us here.

Go Big or Go Home: The Importance of Scale in Population Health


Post by Scott McLeod


Director of Product Marketing, Caradigm

In a recent article, “Why Dartmouth Ditched the Pioneer ACO Program”, Rene Letourneau for HealthLeaders Media described Dartmouth-Hitchcock Health System’s exit from the Pioneer ACO program. While the article notes Dartmouth’s defection was “unsurprisingly” prompted by financial concerns related to the CMS targets, it also revealed an often-overlooked factor in success or failure of accountable care initiatives—the size of the population served.

Robert A. Greene, MD, executive vice president and chief population health management officer for Dartmouth-Hitchcock, touched on this concern. “We would have to go it alone if we stayed in the program, which means our population would have been smaller, said Greene, “If we stayed in for 2015, we would have expected to owe another $3 million to $4 million.” Estimates place the size of Dartmouth-Hitchcock’s at-risk population at 23,500 lives in 2013.

As healthcare delivery organizations seek sustainability under risk contracts, they should look to the experienced health plans and insurance companies. Health payers range in size from local plans with ten thousand covered lives to national carriers covering millions. Many of those at the lower end of this scale struggle financially, and as a result, also with attaining the clinical outcomes desired for their members.

While smaller size can create a number of challenges, I will call out two—the cost of variability and critical mass for programs.

Utilization and costs of healthcare services vary from year to year. In a larger population, the overall variation is less noticeable because there is typically enough patients with lower utilization to balance those that incur higher costs. In a smaller population, a relatively small set of patients can have a negative impact on the average utilization and per capita spend. This is why insurers are concerned about adverse selection, resulting in a larger-than-desired proportion of higher-risk individuals among its members.

Population health initiatives need a certain number of patients to be sustainable. For example, focusing on preventive care targeted at high-risk diabetics requires a sufficient number of members that qualify and enroll in a program for it to be successful at the population level. Smaller payers often do not have the necessary membership. Adding to this, on the other side of the equation, is the fact that lower revenues makes it difficult to allocate resources for these programs.

In my experience working with payer organizations, the minimum size for long-term sustainability is 80,000 – 100,000 covered lives. It will be some time before a significant portion of ACOs and other at-risk organizations achieve that size. Until then, in addition to some success stories, I expect we will see more developments like those occurring at Dartmouth-Hitchcock.

Technology to Understand the “Pop” in Population Health


Post by Brad Miller


Vice-President of Clinical Solutions, Caradigm

My last post detailed the “Pop” in Population Health. As an industry, we think about patients when we think about the “population” in Pop Health, and indeed patients are at the core of Pop Health. Providers, however, are facing a new set of populations – the collective group of sub-populations they care for. Put another way, the evolution of Pop Health and risk-based care has generated a complex business landscape for healthcare providers. Providers will need to lean increasingly on technology and data to enable the clinical and business cases around healthcare.

Let’s consider an example of a provider managing a group of sub-populations. A provider could be participating in a Clinically Integrated Network (CIN) that runs a Medicare Shared Savings Program  (MSSP) ACO and also has an Medicare Advantage (MA) plan. They could also be participating in two bundled payment programs, have Accountable Care Network (ACN) relationships with three employers, and their state could be remaking their Medicaid program. On top of everything is their traditional Fee-For-Service population. That adds up to at least nine sub-populations amongst the provider’s complete population – that’s their “population of populations.” That group is dynamic and evolving – as needs and times change, so too will these populations and how they are measured and cared for.

Caradigm Technology Driving the Pop Health Revolution

At Caradigm, we live for this type of healthcare complexity. We designed our data foundation, the Caradigm Intelligence Platform (CIP), from the ground up to be both transactional and analytical, which not only allows for powerful analysis, but drives real-time intelligence to applications so that the intelligence mined in the data can be put to use. Most platforms are either one or the other – transactional to power applications (e.g. EMRs are built on transactional databases) or analytical (many “big data” solutions to date are analytical platforms). Each and every piece of relevant data from the provider system – from clinical records, labs to claims can be ingested into CIP. This means all of a provider’s data can be located in one place and can be used together to generate highly functional intelligence for patient care. From baseline risk-adjustment to contracted clinical quality and outcomes, today’s providers and CINs require real-time intelligence to manage such diverse populations.

At a population level, Caradigm looks to the analytical applications in its product suite to drive real insight into a provider’s populations and to manage to contracted quality and financial arrangements. The Caradigm Risk Management application is built upon a partnership with MEDai, a LexisNexus company, to drive industry-leading prospective risk profiles of populations and individual patients. Most risk applications only look retrospectively or only in a clinical vein, however our risk management application distinguishes itself on the broad set of big data available in CIP and the 25 year history MEDai has in predictive analytics. Further, Risk Management looks at six key predictive indexes on a patient-by-patient basis. This means that a provider can not only understand clinical and financial risk on a patient basis, but also the patient’s specific “Motivation” and “Mover” risks. The Motivation Index details a patient’s likeliness to respond to any intervention. The Mover Index corresponds to a patient’s likelihood of becoming more ill during the next 365 days. This means that a provider can more accurately assign care management and follow-up assistance to patients in an efficient manner that up until now could not be provided. Providers would have to use more blunt force and address a population of the top 10% of A1cs or 10% highest cost patients without any insight as to whether the patient would or could respond to any intervention. This leads to much more precise care and financial outlay in a risk-based system. Targeted insight means highly actionable and effective pop health care.

The Caradigm Quality Improvement application, built directly on top of CIP, highlights the current quality measure status for a provider across each population and contract. For example, the QI application tracks ACO33 measures, allowing for the identification of up to date gaps in care on a patient-by-patient basis that via CIP can be surfaced directly at the point-of-care to drive quality improvement in the appropriate setting. Caradigm’s Utilization Management Analytics application takes a look at some of the costliest medications, procedures and providers to help pinpoint areas of high spending.

Together, these applications help our customers manage not only their total population, but their sub-populations as well. Each risk-based contract – whether MSSP, ACN, bundled payment or direct-employer purchasing – brings a population with its own unique clinical and financial risk factors and gaps in care. Caradigm not only drives success in these early days of Pop Health, but because of CIP and the nature of the suite of applications, will enable health systems to rapidly expand their risk-based contracting and arrangements to drive true value-based population health.

The Rise in Electronic Prescription of Controlled Substances (EPCS)


Post by Mike Willingham


Vice President of Quality Assurance and Regulatory Affairs, Caradigm

Healthcare organizations are facing a serious societal problem that has become more pronounced in the last 15 years – the widespread abuse of prescription drugs. Controlled substances now account for approximately 10% to 11% of all prescriptions in the United States.[1] Deaths from prescription painkillers have quadrupled since 1999, killing more than 16,000 people in the United States in 2013.[2] Nearly two million Americans, aged 12 or older, either abused or were dependent on opioids in 2013.[3] More than 12 million people reported using prescription painkillers non-medically in 2010 (i.e. without a prescription or for the feeling they cause).[4] The misuse and abuse of prescription painkillers was responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years.[5] High profile news stories involving prescription drug abuse (e.g. Brett Favre, Heath Ledger) have also seemingly become more common.

In response to the rapid increase in both the prescribing and abuse of controlled substances in recent years, the Drug Enforcement Agency (DEA) has set a number of regulatory requirements for healthcare practitioners and organizations that want to prescribe those controlled substances by electronic means. In order to be able to prescribe controlled substances electronically, the DEA requires a secure, auditable chain of trust for the entire process. In addition, several states are mandating the use of EPCS, including Ohio, Florida and New York (with its I-STOP law).

Overall, it’s hard to argue that EPCS is anything but a positive for the healthcare industry. E-prescribing is a tool that increases efficiency and reduces risk of fraud and errors. A study has estimated that e-prescribing resulted in a decrease in the likelihood of prescription errors by 48%.[6]

So far though, healthcare providers have been slow to adopt EPCS thus far because most states have not had a mandate for it yet, and there are no penalties for non-compliance. However, it is inevitable that more mandates are coming, and I believe that EPCS will inevitably become the de facto standard of prescribing controlled substances. While overall adoption is currently low, it is growing fast as an average of 287 clinicians are adding this capability every month.[7]

Caradigm offers a comprehensive EPCS solution that is a seamless extension of our industry leading Identity and Access Management portfolio. We are actively working with our customer base to help them address EPCS, and are looking forward to partnering with more organizations to help them do their part in tackling this important societal issue. In a follow-up blog post, I will dive deeper into the technical solutions required for EPCS. For additional information, please visit our EPCS page.

[1] Meghan Hufstader Gabriel, PhD; Yi Yang, MD, PhD; Varun Vaidya, PhD; and Tricia Lee Wilkins, PharmD, PhD, Adoption of Electronic Prescribing for Controlled Substances Among Providers and Pharmacies. The American Journal of Managed Care. 11.17.14. http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies
[2] Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from URL: http://www.cdc.gov/nchs/deaths.htm.
[3] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series
[4] http://www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html
[5] https://www.atrainceu.com/course-module/2270162-118_oregon-pain-module-11
[6] Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013; 20(3):470-476.
[7] Meghan Hufstader Gabriel, PhD; Yi Yang, MD, PhD; Varun Vaidya, PhD; and Tricia Lee Wilkins, PharmD, PhD, Adoption of Electronic Prescribing for Controlled Substances Among Providers and Pharmacies. The American Journal of Managed Care. 11.17.14. http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies

Four Steps To Make Population Health Analytics Actionable


Post by Neal Singh


Chief Technology Officer, Caradigm

Last week, I had the pleasure of moderating an analytics roundtable at the Caradigm Customer Summit (CCS), which took place on the Seattle waterfront. CCS was a fantastic event where provider organizations from around the country came to learn and share best practices as they lead the way with population health. You can read more about CCS in these posts – Day 1 recap and Day 2 recap. As this week is National Health IT Week, it’s an ideal time to share some of the discussion points from the roundtable to help raise awareness on the impact of data and analytics in transforming healthcare.

There were four key recommendations that came up during the discussion:

1. Build a Data Foundation

A population health analytics strategy starts with a data foundation. We heard in the roundtable that population health forces organizations to bring together a variety of data types including clinical, claims data from multiple payers (CMS and commercial payers), internal billing data, lab, pharmacy, etc. Aggregating clinical data continues to be a challenge as large health systems often are using dozens of EMRs and or are part of a clinically integrated network (CIN) that will likely always utilize many EMRs. Attendees said that while all EMR vendors publicly claim neutrality, it continues to be a challenge to get all the data that they need. Using a vendor neutral solution to aggregate data from disparate systems is one way to help overcome interoperability issues.

2. Increase Use of Predictive Analytics

The group also talked about how they are taking steps to evolve analytics efforts beyond retrospective reporting to predictive analytics that can have greater impact of patient outcomes. Most providers are still in the early stages as they have been focused on being able to report on and attain required quality metrics. Some are now starting to leverage predictive analytics in order to proactively impact patient care. For example, one attendee explained that they are giving care managers a patient readmission risk score along with the reasons for the score, which helps them take action with high-risk patients before they are discharged.

3. Surface Analytics in Workflows to Make Them Actionable

One of the most important considerations in a population health analytics strategy is to embed analytics in clinician workflows at the point-of-care. We heard repeatedly at CCS that clinicians are already faced with too much information, and that it’s not effective to present them with yet another report. What clinicians want is additional information presented in their existing workflow and tool that can help support clinical decisions. A great example of this that we heard about was surfacing a predictive Sepsis risk score for clinicians to see at the point-of-care. The Sepsis algorithm calculates a risk score based on real-time data (vital signs, lab results, medications and dates/times) and then stratifies patients as “At Risk”, “High Risk” and “Very High Risk”. Clinicians see the risk score including aggregated clinical data in their customary EMR and then examine at-risk patients to determine if they meet the criteria for severe sepsis treatment according to established protocols.

4. Establish Data Governance

Lastly, the group discussed how important it is to have a data governance structure with executive support representing all modalities of data such as quality measures, HCAHPS scores, fall risk, readmissions, hospital acquired conditions, etc. It’s critical to get different parts of the organization on the same page because there are inevitably many initiatives in motion at the same time. One attendee shared that they have built a dashboard for each modality, which helps align the different stakeholders.

CCS was an engaging event for industry leaders who are all striving to get to the same goal of population health. If you’d like to have a discussion about how to augment your population health analytics strategies or see the list of best practices we developed in conjunction with the analytics roundtable, then drop us a note here.

Leaning in on Population Health (Part 2): Caradigm Customer Summit 2015


Post by Christine Boyle


Chief Marketing Officer and Senior Vice President, Caradigm

On Day 1 of the Caradigm Customer Summit (CCS), we heard multiple provider organizations talk about how they are leaning in on population health, and are seeking to build the best practices and health IT to successfully scale their programs. On Day 2, we continued to explore the strategies and tools that can help organizations succeed with new value-based reimbursement models. Here are the highlights from another great day of learning at CCS.

Neal Singh Chief Technology Officer, Caradigm and Kendra Lindly VP, Global Product Management, Population Health and Analytics, Caradigm

Neal and Kendra provided insights into the overall vision of Caradigm’s product strategy as well as the collaborative development approach they take with customers. They also highlighted new applications and features that are in the roadmap across Caradigm’s four pillars of integrated solutions (Data Control, Healthcare Analytics, Care Coordination and Management, and Patient Engagement & Wellness).

Nicholas Greif, Project Manager Virtua and Jill Manz, System Integrator Virtua

Nicholas and Jill talked about how Virtua, a leading provider in South Jersey, is using Caradigm’s information security and population health tools to help improve patient care within their VirtuaCare ACO. They explained how over time, Virtua has continued to mature its population health IT infrastructure, and will be delivering actionable predictive analytics such as Sepsis risk scores to clinicians in their native EMR so they can take proactive action.

Federal and State Driven Programs Panel

Vicki Harter, VP of Care Transformation moderated a panel made up of John Supra from Greenville Health System, Scott Anderson from MyCareCoach and Todd Ellis from KPMG. They discussed how to succeed with the variety of Federal and State Funded programs that are available to providers today. The panelists agreed that although providers don’t have to have all the answers right now, they do need to start thinking about who they’re going to align and partner with, and how they’re going to get their hands on the right data and share it.

Michael Robinson SVP, Global Services, Caradigm and Mike Macedo Director, Application Services, Caradigm

The closing presentation was from Michael Robinson and Mike Macedo who talked about how to drive user adoption of new population health technologies. It’s an important consideration for providers when seeking new health IT because acquiring technology is only part of the journey. It takes deep collaboration between a technology partner and a provider to train and engage employees who are learning about new organizational strategies, workflows and IT systems. While it does take much effort to train users and drive adoption, Mike and Mike explained that the payoff is when employees become fully engaged in the process. They talked about the collective excitement that they’ve seen in recent customer deployments that energizes the entire organization. With that level of employee engagement, a provider is well positioned to succeed with their population health initiatives.

Day 2 also included more outstanding peer-to-peer discussion during roundtables on patient engagement, physician engagement and IT security organizational engagement. As mentioned in the Day 1 post, we’ll share best practices from those sessions in a upcoming blog series.

In addition to learning and sharing about population health, CCS is also about having fun and building relationships in the industry. It’s not always sunny in Seattle, but it always seems to be sunny during CCS. Our attendees were treated to a couple of beautiful days of weather on the Seattle waterfront, and were able to relax and get to know each other at evening events.

It was an amazing two days at CCS 2015. Caradigm is extremely proud to be collaborating with so many of the top provider organizations in the country and around the world. We look forward to helping our customers with their key initiatives as they continue to lean in on population health.

Wheel Cropped

The Seattle Great Wheel lit up in Caradigm mulberry.