"Awareness of a problem does not mean much, particularly when you have special interests and self-serving institutions in play.” - Nassim Nicholas Taleb
The term population health is how new medicine should be able to identify a population and predicting what their health needs may be via constant intervention to improve health in a better healthcare system environment. The idea is to produce a healthcare service which does not start and finish at the hospital door, although intertwines all aspects of community and primary care.
We utilize enterprise level platform systems within structured optimization services settings. From a non technical perspective these often presented as systems which is able to integrate data (weight maintenance, exercise regimes, etc.) from a variety of sources. These sources may be primary care, secondary care and even information gained from patient web portals that the patient can enter remotely in order to create an observational study of the same variables over long periods of time to gather holistic patient record. We then apply the findings to algorithms to the record to identify those at risk of disease and subsequently alert the physician – rather like a very sophisticated early warning score which we all are familiar with. This approach required the necessity of a role as health coach within the optimization services setting – someone who is able to keep an eye on a patient’s EHR and help to make behavioral changes when the system shows that someone is going off track and is therefore at risk of representing to hospital.
We often utilize the records of weight, diet and exercise which the health coach able to tell from the weight readings by the home scales. Once they are automatically synced to the health record we track that the patient was putting on weight. As the projected next level we apply the data to a model of chronic disease; asthma, cardiovascular disease, chronic pain, COPD, diabetes, glaucoma, multiple sclerosis, and stroke. The data will help patients to feel more empowered about the management of their condition. Neurologists or clinical nurse specialists could use this tool to manage the patient’s condition from home, to treat relapses, or even more importantly to predict them, and therefore ensure early treatment with DMT/immunosuppressant and perhaps enrolment in appropriate clinical trials.
Moving Forward Technology is necessary but changing behavior is really hard. We are where we are, and getting to where we must be will take time. Provider systems are designed to get the results they get under a heavy fee-for-service influence. Currently most providers are ill equipped to provide population-based care or manage risk. Health plan systems are designed to perform the tasks they do while fee-for-service has strongly powering them as well. Core administrative systems and processes are ill equipped to support population-based care. Regulatory environment evolved from a policy point of view that ‘more-is-better’ and competition ‘is essential’ to reduce costs . Anti-trust barriers to physician integration such as Stark Law is an obstacle.
Positive program outcomes within population health technology
- Acquire data from all sources (Medicaid Claims, EHR Clinical, etc.)
- Bring insight to providers similar to dashboards
- Develop and deploy predictive algorithms
- Drive strategy for resource allocation and clinical program implementation
- Collect Supporting Data
- DHA provider outreach and care coordination
- Deploy programs and services to providers and the communities
- EMR training and support
- Pre-diabetes/diabetes screenings
- Maternal health initiatives (Parents as Teachers, Parent Educators)
- Readmission prevention (Health Coaches)
- Digitization of clinical records in the Delta
An Example of a Process Flow - Predictive algorithm for pre-term births:
- Mine the Data
- Number of providers capture semi-annual or annual data.
- Note the trend towards common clinical features
- Calculate weighting Apply regression model or machine learning.
- Define the high-risk factors
- Maternal age Multiple pregnancies or short intervals between Anxiety or depression Smoking Race Vaginal infections High cholesterol Asthma Chronic and gestational diabetes.
- Validate the algorithm
- Study subpopulation of pre-term births and trends.
- Ascribe score to a patient
- For subsequent pre-term births Establish threshold for action/intervention.
Creating Shared Goals & Initiatives...
What we know is the initial key in order to make a greater impact on Population Health. Therefore we needed to segment our patients into key focused groups. Also identify gaps in the care planning process rather than anecdotal case findings. Assess root cause to readmissions more timely. As the next step identify what we have such as: Pieces of internal data (demographic, clinical data, medication); historical Data; foundations for Transitions of Care, cross continuum collaboration. Then we have to focus on where we need to go by starting with risk stratification. Continue with acknowledging method to track care processes in order to drive improvement around interdisciplinary team processes. Recognizing the value in data analytics, flags, workflow design, automation, and dashboards will improve provisioning of data for cross continuum care partners and enhance post hospital follow up. Finally how do we get therewhich must fundamentally change how care is delivered. We have to move from a primary focus on volume: Full census; busy MRI; booked OR; hips, knees, tests, procedures… We have to move to a greater emphasis on value: care that measures up to best systems on cost and quality metrics; patients who are engaged in their healthcare; providing the right care at the right time to the right patient.
At the end Population Health at its core is the merger of financing and the delivery of healthcare. "Patient engagement" is a broad concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior where EHRs are becoming commodity platforms. The winner will be the EHR vendor that provides the best platform for innovation – the most open and most extensible platform.
Foundations for the Next Decade
As the main goal monitor and improve quality to measure and achieve quality targets; providers need the ability to integrate EBM, document processes, monitor and report on quality markers.
Coordinate care and engage patients to effectively decrease costs and keep patients well, clinical data must be fluid, usable and have consumer accountability. Since payor decisions will be made across large populations, providers must have the ability to generate population-level reports and analytics as accurately as possible.
EMR vendors must be able to understand how each provider is delivering care and manage the payment distribution to incent the correct outcomes. Unlocking the full potential of the digital age in health care will require access to an efficient use of the population management data.
Also published @ http://hitconsultant.net/2015/08/21/what-is-the-future-impact-of-population-health-management/
Looking for a JOB - How to Be the Next Hire
Making You the Most Viable Next Hire
Being flexible, creative and adaptable in today’s economy is the cornerstone to survival. The job search is no different and, with unemployment rising, requires just as much vigilance. One way you can keep your options open and make yourself even more marketable is by considering Consulting in addition to your quest for full-time employment. Often perceived as an “either-or” scenario, Consulting offers you just as many benefits as it does your “would be” employer:
Track record of Fixing Problems?
Career wise, people typically fall into one of two categories: those who thrive on problem solving and the prospect of a new challenge –or- someone who is exceptionally good at steering the ship once it is on course. If the thought of fixing something that is broken appeals to you (versus has you thinking about reaching for the Tylenol), then Consulting might be an avenue to explore.
A More Flexible Interview
Quite often, what a company needs is someone to tackle a specific problem, not a new full-time employee. Identifying this in the interview and being able to present yourself as the solution to their problem (at a lower cost), can ultimately create a job tailor made for you and your skill set. No one can compete against that.
Dating Before Marriage
A consulting engagement can give you the opportunity to see if this company is a nice place to visit or a great place to live. The only thing worse than a prolonged job search, is ending up in a position that results in you being unemployed again in 6-12 months. Consulting lets you do more due diligence than you could ever accomplish in an interview.
“Consulting” on Your Resume
To many recruiters, seeing “consulting” as your current role without any clients/engagements is just a way to dress up being out of work. But, with a list of key accomplishments at those engagements, you show that you are in demand, have more control over your search and are broadening your experience. The latter is extremely important if you are looking to transition industries.
Change Agent
For companies looking to make some sort of change internally (and you should like this if you have a track record of fixing problems), consulting is a more preferred approach versus hiring a permanent employee. It is much easier to come in as a consultant, effect the course correction and then hand it off to the internal leadership.
Money
Besides the obvious benefit of having income during your search, it also gives you breathing room to be more objective in selecting your next job.
It’s Easier to Find a Job When You Already Have One
So much of what makes this true is that fact that when you are employed, you tend to be a bit more objective because you have a “bird in hand.” Consulting (in addition to easing that financial strain, which helps here) can provide the self-assurance that comes along with being employed, which can get whittled away while unemployed.
Presenting yourself as a viable consultant or full time employee isn’t mutually exclusive. Rather, they are simply two sides to the same coin. For the companies where you interview, this will only make you more viable and versatile in your eyes. For you, there is nothing to lose. The worst thing that happens here is you generate some income to inevitable financial strain of your job search. On the other hand, you might just find through this process that you discover your next career move.
Bağdat Caddesi
Gel de parmaklara hakim ol, yapma bir Caddebostan, Bağdat Caddesi nostaljisi şimdi!...diğer bir deyişle 'Karşı taraf' . Cok uzun seneler yazları gittiğim, son yıllarda ise her Türkiye'ye gittiğimde kaldığım Istanbul'un bir başka eşşiz köşesi.
1960'lı 70'li yıllarda köşkleriyle, bahçelerinden salkım salkım sarkan ortancalarıyla, billur gibi denizliyle, 'sayfiye' yeri olmasıyla meşhur Erenköy, Suadiye, Caddebostan.
Dükkanların az, ağaçların çok olduğu, bunca yıl geçmesine rağmen hala güzelliğini koruyan Bağdat Caddesi. On, onbir yaşımdan itibaren yazlarım geçti oralarda. Sokaklarda oynanırdı o zamanlar, öyle pek araba filan geçmezdi. Doyasıya bisiklete binilir, el birakarak gitmek büyük marifet sayılır Erenköy, Saskınbakkal, Göztepe bisikletle rahat rahat gidilir dönülürdü. Deniz için bazı sokakların denize vardıkları noktalarda bulunan kayıkhanelerden saatlik ücretle kayık kiralanır, kadın erkek kürek çekmeyi bilir, kayıktan denize girilirdi. Bazı gençler dalıp iskele ayaklarından midye toplar bazıları ise sığ kumda zıpkınla vatos avlarlardı. Sokaklardan dondurmacılar geçerdi o zamanlar. Simdiki gibi binbir çeşit ne gezer 'Dondurma, Kaymaaak' diye bağıran dondurmacının küçücük arabasında sadece kaymaklı ve limonlu dondurma olur, bazen ise çeşit olsun diye vişneli bulunurdu.
Caddebostan Plajı'nın yanı sıra bir de üyelikle girilebilen klüpler vardı. Marmara Yelken Klubü başta olmak üzere, Balıkadamlar, Caddebostan Yat Klübü ve İstanbul Yelken. Eğer bunlardan birine üyeyseniz veya üye bir arkadaşınız varsa bazı sporları yapma veya izleme olanağınız olur, voleybol, ping pong oynar, kıyıdan yelkenlilerin yarışlarını izlerdiniz. Denizin ortasında ise köfteciler vardı. Bunlardan aklımda kalanı ise mayomuzun kenarına sıkıştırdığımız parayla yüzdüğümüz, veya kayıkla yanaştığımız 'Fıştak'tı. Dönerken yüzülüyorsa demirlemiş kayıklara tutuna tutuna, dinlene dinlene yüzülürdü.
Akşamüstüne doğru herkesi bir 'piyasa' heyecanı alırdı. Saçlar yıkanır, bildiğımız ütüyle ütülenerek düzeltilir, ve (Bağdat) Cadde'ye binbir tur atmaya çıkılırdı. Bir aşağı, bir yukarı. Parkur ise genellikle Santral Durağı'ndan Saşkınbakkala kadardı. O zaman 'cafe' adeti bir elin parmaklarını geçmez, 'Borsa'da yer bulabilmek için hızlı davranmak gerekir, 'Divan' ise gençlere çok pahalı geldiğinden ancak hafif 'yaşı geçmiş'lerin duraklama mekanı olurdu. Hali varaba sahiakti oldukça yerinde olan birkaç genç ise bir aşağı bir yukarı arabayla giderek Mustang veya Corvette'leriyle gelene geçene hava atarlardı.
Geceleri ise açık hava sinemalarının keyfine doyulmazdı. Caddebostan'daki Ozan Sineması'nda genellikle Türk filmleri oynar, çıkınca biraz aşağıda, Caddebostan Maksim Gazino'sunun (MIGROS)yakınındaki büfe'de 'zümküfül' yenirdi (Bir çeşit sosisli sandoviç ) Yabancı filmlerin mekanı ise Budak Sineması'ydı (Şimdiki CKM). Yastıgını kapıp tahta iskemlelere yerleştirdikten sonra, çekirdeğini çıtlatarak izlenirdi filmler. Bazen bu sinemalarda Cem Karaca gibi o zamanın ünlü sesleri konserler verir, bazıları ağaç tepelerinden konser izlerdi.
Sonra sonra o köşkler birer birer yıkılmaya, yerlerin uzun uzun binalar dikilmeye, Cadde'deki evlerin yerlerini dükkanlar almaya, arabalar çoğalmaya, faytonlar yok olmaya, tekerlekli dondurmacıların yerini Algida'cılar almaya başladı. Ama ne mutlu ki tüm büyümeler, kalabalıklaşmalar rağmen 'Cadde'yi bozmayı başaramadı! O hala 'Cadde', İstanbul'un ,Türkiye'nin en güzide caddesi hala boydan boya yürümekten zevk aldığım, bir yerde oturup geleni geçeni izlemenin keyfini her yıl bir iki hafta yaşayabildiğim bir yer.
The best way to improve health care requires physicians and other stakeholders
My honest approach for how to improve the care is to support a methodology such as being self-serving. I would like to start a program to introduce a software-based point-of-care tool for obtaining patient feedback. This real time information can be used with clients to positively impact the patient experience, nurse engagement, physician (soft skills) competence and overall quality. In my perspective the criteria for fulfilling the demand for finding the best way to improve healthcare is that it need be simple to implement, impactful and cost effective. The most impact to healthcare improvement will come from process improvement and healthcare provider recruitment AND retention. The by-products will be reduced cost of care and improved patient satisfaction. This applies to hospitals and private practices. Based on current studies and the economy, supplying adequate healthcare to the community is already tough and is going to get more challenging. Recruiting sufficient healthcare coverage will boost revenue and provide some improvement to patient satisfaction (wait time and access). However, failure to retain the medical staff will significantly hurt the outcome. With high demand and low supply, it will be well worth the time and money to present "we have the greenest pastures here". The method mentioned above may be called such as point-of-care through successful implementations that may turn in to popular key parts of process improvement. You need to have some feedback from the patients and the physicians in order to measure the processes that should be or are currently being improved. In order to achieve this you have to create the acronym HOSPITAL to help those in Healthcare recall the numbers of different types of inefficiencies in any medical facility. Those who have been exposed to Six Sigma and Lean have an appreciation for improvement opportunities and generally view things through differently trained eyes that can see within all those facilities. Publishing the results of the similar programs online may offer a transparent access to the consumers to monitor these inefficiencies. Welcoming any feedback relative to this and encourage your staff to consider this method or similar training methods for their teams will be highly critical for the outcome. We have to understand that it is impossible to solve a problem that we are unaware of. By providing even the most basic tools at the lowest level possible, these problems have a way of surfacing. While everyone recognizes that healthcare systems and organizations need to improve, I think not enough time is spent on firstly identifying the key stakeholders, and secondly properly ENGAGING them. I strongly believe that not enough time is spent trying to engage physicians in this process. In my experience too many of these "improvement strategies" are top-down decisions by non-clinical managers who failed to conduct any research into what physicians might want or what stumbling blocks there are/were to get them to adopt the new technologies. EMR/EHR/CPOE are prime examples - all of these require a breakdown in the normal activity flow of providers, as it requires them to either find and log on to a terminal or carry a bulky instrument. Almost all clients and colleagues I have worked with resent and resist those methods. And look how few MDs are part of Healthcare consulting firm teams. IMHO, I believe more energy should be spent engaging rather than alienating MDs as a first step, then doing the same for patients in order to get buy in from the two key stakeholders as I see it. I've always found that engaging these stakeholders on projects from the beginning results in more buy-in and most importantly, better recommendations/outcomes (a better product).
