Entries in Data & Technology (68)


Perhaps Accenture’s Surveyed Consumers So Willing To Share Healthcare Data Should Read Accenture’s CyberSecurity Survey Report

Perhaps Accenture’s Surveyed Consumers So Willing To Share Healthcare Data Should Read Accenture’s CyberSecurity Survey Report

By Clive Riddle, March 9, 2018


Accenture has just released a 12-page report with findings from their 2018 Consumer Survey on Digital Health in which they conclude that “Growing consumer demand for digital-based health services is ushering in a new model for care in which patients and machines are joining doctors as part of the healthcare delivery team, and that  “consumers are becoming more accepting of machines — ranging from artificial intelligence (AI), to virtual clinicians and home-based diagnostics — having a significantly greater role in their overall medical care. “


Here’s some survey response highlights shared in the report:

·         19% have already used AI-powered healthcare services, with 66% of these consumers likely to use AI-enabled clinical services

·         Consumer use of mobile and tablet health apps has increased from 16% in 2014 to 48% currently.

·         44% have accessed their electronic health records in patient portals over the past year, with 67% of these consumers seeking information on lab and blood-test results; 55% viewing physician notes regarding medical visits, and 41% looking up their prescription history

·         The use of wearable devices by consumers has increased from 9% in 2014 to 33%t currently.

·         75% view wearables  as beneficial to understanding their health condition; while 73% cite them helping engage with their health, and 73% also cite monitoring the health of a loved one

·         90% are willing to share personal data with their doctor, and 88% are willing to share personal data with a nurse or other healthcare professional.

·         72% are willing today to share with their insurance carrier personal data collected from their wearable devices has increased over the past year, compared to from 63% in 2016.

·         47% are willing so share such data and with online communities or other app users today, compared with 38% in 2016.

·         38% are willing to share data with their employer  and 41% with a government agency


Interestingly while consumers seem to trust sharing their data most with their doctor and clinical professionals much more than their health plan, another Accenture survey recently released on healthcare cybersecurity found that while overall 18% of healthcare organization employees were willing to sell confidential data to unauthorized parties for as little as between $500 and $1,000; there was considerable disparity between plans and provider offices: 21% from provider organizations would sell confidential data compared to 12% from payer organizations.


Five Questions for Patrick Horine, CEO DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, March 2, 2018

This week, Patrick Horine, CEO DNV GL Healthcare, participated in a Healthcare Web Summit webinar panel discussion on Leveraging Hospital Accreditation for Continuous Quality Improvement webinar. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

1. What is ISO 9001 and how is this closely related to strategic goals for hospitals?

Patrick Horine: Goals are just goals unless there are objectives in place to be measured and met to achieve them.   The ISO 9001 quality management system (QMS) is the means for managing the objective to determine the needs of and desires for customers.    The ISO 9001 QMS is customer focused and to ultimately enhance patient satisfaction.    Engaged employees means more patient satisfaction.   Enhance patient satisfaction increase HCAHPS scores.   Increased HCAHPS scores are what provide the financial and reputational incentives for hospitals.    Given the current challenges with reimbursement and the competitive climate it is imperative for hospitals to ensure the patient experience and satisfaction is best as it can be.  Quality objectives are at every level of the organization.  They may apply broadly across the organization or more narrowly.   The goal may be the result but there are a lot of contributors to ensure the goal is attained.    Quality objectives are specified and aligned with the goals to enable the measuring and monitor of progress to evaluate progress.

2. What are some of the benefits and challenges associated with implementing ISO 9001?

Patrick Horine: In short, I would note the following:

  • Improving consistency
  • Added accountability
  • Increasing efficiency
  • Engagement of Staff

What drove us to consider integrating this within the accreditation process was because the hospitals we were working with could make improvements or address compliance but they had a more difficult time sustaining what they put in place.    ISO 9001 requires such things as internal auditing and management review are two of the most impactful aspects for the ISO 9001 requirements.  

Through these internal audits and then reflecting the success of the actions taken with the management reviews will lead to more consistent practices through the organization.   It is not uncommon see multiple versions of similar policies all throughout the hospital.  Are they really different?   Likely not, so reducing these to one practice will improve consistency.    I often ask groups “How many of you think you follow your policies and procedures exactly as they are written?”   Rarely, if ever, would you see anyone state they did.   So, if we don’t then why do we have them?   If we need to have them, as we really do, then they should be written, communicate, implemented and measured to ensure they are being consistently followed.   Without fail, doing so will lead to better results in some manner.

Simplification and consistent processes lead to more efficient operations of the hospital.   Hospitals or any organization for that matter that considers the quality management to be an integral part of their business operations will commonly achieve more efficiency than those that do not.

Gaining this understanding of the processes and getting to the efficiency is not possible without the involvement of those closest to them.    As an organization, if we strive to improve every day, it is imperative that the staff are engaged so they can be directly involved to improve their work to be more satisfied with what they do and their contribution to the success of the organization.   

Happy wife = Happy life, the same holds true with Happy employees = Happier patients.    Those who are more involved with improving of the processes they work with are happier and more engaged employees. Engaged employees are more productive when they are identifying improvements to be made and how to go about making them.  


  • Culture not conducive to change
  • Making it more complicated than it needs to be
  • Too many details

Can an organization implement ISO 9001 overnight?  No.   This is something that will leadership commitment, engagement of staff, willingness to be self-critical, ability to break with traditional thinking.    More easily described, the culture of the organization must be such that you are open to change, making improvements and have patience to know the quality management system will mature over time.   

What seems to be more universal thinking among us healthcare people, if it is not difficult then we will find a way to make it so somehow.    In my opinion, I think the ISO 9001 standard has evolved with each revision to be more and more befitting to healthcare than other industry sectors.    Process thinking, sequence and interactions, risk-based, competence of staff, customer expectations and satisfaction.   It fits.   We have much of what ISO requires already in place but still some work to be done.   This does not require wholesale changes so we don’t have to make it more difficult.   What is working and what is not working is a critical step because we must understand where improvements or change need to be made.  

Like I mentioned, policies and procedures are rarely followed exactly as they are written, but some are written as works of literature with elaborate detail.   Simplify, a 30-page policy is more effective when adapted to a 2-page work instruction.   More likely that one would read it, better opportunity for it to be consistently applied.    That is not to say that some we rid ourselves of all policies and procedures but rather don’t add complexity to what we already have and ask what we need to really keep.   

3. How does ISO 9001 hold hospitals accountable for meeting CMS requirements?

Patrick Horine: ISO 9001 itself does not address the CMS Conditions of Participation (CoPs).    All hospitals are accountable for compliance if they want to bill and be reimbursed under Medicare & Medicaid.   All CMS approved accreditation organizations must develop standards that meet or exceed the CMS CoPs.  Some choose to have more extraneous requirements, others apply the minimum.   DNV GL Healthcare wanted to have a standard that would meet the CoPs but we have integrated the ISO 9001 to the accreditation process and made this a requirement for hospitals under our program.  Compliance to the CMS requirements should be the by-product of a good quality management system and this is where ISO 9001 can be most effective. 

The ISO 9001 helps organizations have a more robust quality management system in place where compliance should be more of a by-product then the end goal.   Our thinking was that hospitals are often not complying with the minimum requirements to be met and these are what are fundamental to the organization to have provide safe and effective care.    To be more consistent meeting the fundamental requirements is the first challenge.   Going beyond, rather than more prescriptive requirements, the CoPs can be the parameters and the organization can me innovative to put practices in place.  We can still hold the hospital accountable meeting the CoP and then see how they demonstrate the effectiveness and outcomes of what they have in place.  

4. While the accreditation process for hospitals is part of Medicare / CMS program requirements, are there any plans to accredit hospital labs, physician clinics, or long term care organizations?

Patrick Horine: We currently have CMS deeming authority for acute care and critical access hospitals.   Next, we will complete the process for securing deeming authority for Psychiatric Hospitals and then Ambulatory Surgery Centers.   Most likely will not purse approval under CLIA for laboratories, but always possible.   There is desire to be more certification programs with physician/medical clinics and other providers.   Presently these would be self-governed as there is no deeming authority for such medical offices nor long term care.   I believe additional quality measures and oversight would make an impact in these environments.

5. How is DNV GL different from the Joint Commission and are there other accrediting organizations?

Patrick Horine: The more evident differences would be:

  • Annual surveys vs. once every 3 years
  • Less prescriptive standard more closely aligned to the CoPs – but inclusive of some additional requirements as well as maintaining compliance with ISO 9001
  • Demeanor of our surveyors
  • No types of accreditation; preliminary denial, conditional accreditation, double secret probation

It is better to describe those differences as told to us by those we have accredited, so I will use some of their quotes;

 “With DNV GL the surveys have been more meaningful and more consistent”

  • “It is nice get away from an inspection oriented approach but still be thorough”
  • “DNV GL is not easy but is easier to get along with”
  • “We have appreciated more of a collaborative process rather disciplinary one”
  • “We want to learn from the surveyors and how we can do better”
  • “The annual surveys help keep us focused on compliance and we do less getting ready for surveys”

“Doing things for the right reason not because of … have to”


Elon, Do We Have a Disaster for You!

By Kim Bellard, October 18, 2017

One of the most interesting twists resulting from Hurricane Maria striking Puerto Rico was Elon Musk's offer that Tesla could help Puerto Rico solve its energy crisis, with a long-term, 21st century fix. 
It is telling that we don't have similar offers to rebuild the Puerto Rico's health care system, which is similarly devastated.  Or, for that matter, our system, which is its own kind of disaster.

Mr. Musk was asked on Twitter if Tesla could help Puerto Rico using solar and battery power, and he responded in the affirmative, saying it had done so on smaller islands but faced no scalablity issues.  Next thing we knew the Governor of Puerto Rico and he were talking.  Now Tesla is starting to deliver their battery systems to the island, so we'll see.

Maybe it is a marketing stunt on Mr. Musk's part -- if so, you have to give him credit for it -- but the idea has merit.  A disaster like Maria is a once-in-a-lifetime opportunity to try bold new ideas instead of blithely rebuilding what was there before.

Still, even Elon Musk isn't bold enough to offer to rebuild their health care system, much less ours.

Sometimes disasters do make us rethink our health care system.  Katrina, for example, has often been credited with creating the impetus for electronic health records (EHRs), since it destroyed countless paper records, wrecking havoc on care for thousands of patients.

But we didn't pay enough attention to even that very visible crisis.  We do have a lot more EHRs now, but less than 30% of hospitals self-report being interoperable.

The records themselves remain largely physician-centered and exclusively medical, although Epic, the nation's largest EHR vendor, is finally saying they will move to a "comprehensive health record" (CHR). . 

I'm glad that in 2017 EHRs vendors are finally realizing there is health outside a medical facility.

It shouldn't take a hurricane -- or an earthquake, or a bickering Congress -- to realize that we have an in-progress disaster with our health care system. 

Let's say we were starting from scratch.  Let's reset what our health care system could be.  Let's say we didn't have all these hospitals, hadn't trained any physicians, hadn't deployed any medical devices or used any prescription drugs, although we could start with the knowledge of what each of those could accomplish.

Would we remake the system as it is, or would we design something new?

In a previous post I enumerated several things about our health care system I was dying to redesign, and in another I gave some specifics about how a re-engineered system might work.  Even those, though, didn't start from entirely scratch, still focusing more on the medical than on the broader health perspective.

We should be spending more on our health needs -- broadly defined -- than on our medical care.  We should be more worried about if people are going to the park than if they are going to the doctor's office.  And when we do get medical care, we should make sure it is care that has solid evidence of working, rather than too often accepting care that might work.

Elon Musk has his hands full saving humanity, not to mention helping Puerto Rico, so we probably can't count on him to offer to reinvent our health care system too.  So who will it be?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting



Provider Data Accuracy – Continued Challenges for Health Plans

By Claire Thayer, September 27, 2017

Inaccurate provider directories continue to pose challenges for health plans both in terms of removing barriers to patient care as well as the monumental task of keeping track of network providers and managing all data elements associated with a single provider record.  Not only is the data constantly changing, consider this: documenting this information takes time as a detailed record can track up to 380 distinct line items, including service locations, billing locations, payment locations, specialties, certifications, affiliations, office hours, and languages spoken.  Regulations have been enacted on both the federal and state level on required data elements and timeliness of maintenance requirements, with penalties for non-compliance and regulations that vary widely from state-to-state.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, focuses on increasing challenges for health plans with data reporting and maintenance of provider directories:



MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.


Health Care's Juicero Problem

Health Care's Juicero Problem

by Kim Bellard, September 8, 2017

Bad news: if you were still hoping to get one of the $400 juicers from Juicero, you may be out of luck. Juicero 
announced that they were suspending sales while they seek an acquirer. They'd already dropped the juicer's price from its initial $700 earlier this year and had hoped to find ways to drop it further, but ran out of time. 

Juicero once was the darling of investors. They weren't a juice company, or even an appliance company. They were a technology company! They had an Internet-of-Things product! They had an ongoing base of customers!

The ridicule started almost as soon as the hype. $700 -- even $400 -- for a juicer? The negative publicity probably reached its nadir in April, when Bloomberg 
reported people could produce almost as much juice almost as fast just by squeezing the Produce Packs directly.


Moral of the story: if you want to introduce products that have minimal incremental value but at substantially higher prices, you're better off sticking to health care.

Take everyone's favorite target, prescription drugs. As Donald W. Light 
charged in Health Affairs, "Flooding the market with hundreds of minor variations on existing drugs and technically innovative but clinically inconsequential new drugs, appears to be the de facto hidden business model of drug companies."

As with prescription drugs, we regulate medical devices looking for effectiveness but not cost effectiveness -- and we don't even do a very good job evaluating effectiveness in many cases, according to a 
recent JAMA study

Take robotic surgery, hailed as a technological breakthrough that was the future of surgery. A robotic surgical system, such as da Vinci, can cost as much as $2 million, but, so far, evidence that they produce better outcomes is 
woefully scarce

Proton beam therapy? It's one of the latest things in cancer treatment, an alternative to more traditional forms of radiation therapy, and is 
predicted to be a $3b market within ten years. The units can easily cost over $100 million to buy and install, cost patients significantly much more than other alternatives, yet -- guess what? -- not produce measurably better results

Last year Vox 
used 11 charts to illustrate how much more we pay for drugs, imaging, hospital days, child birth, and surgeries than other countries. Their conclusion, which echoes conclusions reached by numerous other analyses: "Americans spend more for health care largely because of the prices."

We not only don't get a nifty new juicer from all of our health care spending, we 
don't even get better health outcomes from it.   

Health care's "best" Juicero example, though, may be electronic health records (EHRs). Most agree on their theoretical value to improve care, increase efficiency, and even reduce costs. But after 
tens of billions of federal spending and probably at least an equal amount of private spending, we have products that, for the most part, frustrate users, add time to documentation, and don't "talk" to each other or easily lend themselves to the hoped-for Big Data analyses. 

Many physicians might, on a bad day, be willing to trade their EHR for a Juicero. 

Jonathon S. Skinner, a professor of economics at Dartmouth,
 pointed out the problem several years ago: "In every industry but one, technology makes things better and cheaper. Why is it that innovation increases the cost of health care?" 

So we can make fun of Juicero all we want, but when it comes to overpriced, under-performing services and devices: health care system, heal thyself first.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting