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Medicine The Almighty Buck

Former Red Hat COO Helps Health Care Providers Work Together (Video) 74

Posted by Roblimo
from the better-communication-can-lead-to-better-medical-care dept.
Do you remember the worries about getting different health care software systems to work with each other as health care providers starting moving away from paper? It's still a problem, but Joanne Rohde's company, Axial Exchange, is working to cure that problem not only as an entrepreneur but also because she has personal reasons to see health care providers communicate better with each other. In a 2012 interview for Huffington Post, she said, "While I was working for Red Hat, I got very sick... I ultimately had to go to 10 doctors to be diagnosed. Going from doctor to doctor, I could not believe I had to start over each time. No one actually talks to each other I became convinced that if I had had all the information, I probably would have been able to figure it out faster." In fact, Joanne got so sick that she quit her job as Red Hat COO after four years with the company. Once she started getting decent treatment for her Fybromyalgia and started getting better, she decided to apply open source principles to health care IT -- and to start a new company to do it. Opensource.com talked with Joanne in September 2013, and in January 2014 she talked with Health Care Finance News for an article titled Patients key to reducing readmissions. A phrase Joanne seems to be using a lot lately is "patient engagement," which has become a major part of Axial Exchange's work to improve communications not only between different health care providers but also between those providers and their patients. Update: 02/05 20:16 GMT by T : If you're seeing this post on beta.slashdot.org, note that we're still ironing out the details of video display here. You can view the video on tv.slashdot.org, instead. Please pardon our dust.

Robin Miller:This is Joanne Rohde who is the Founder and CEO of Axial Exchange a company that’s busily working to make it easier for healthcare providers to share healthcare records, that is your patient records safely, securely and quickly. She was recently quoted as saying “patients are the key to reducing readmissions” How is that? What does that mean?

Joanne Rohde:Well, I think that we are moving from what I call the myth of the Dr. Welby healthcare system, and I think it was always a myth that there is this all-knowing physician that’s going to take care of you and your family to the reality that we are a nation of chronic disease. As we jokingly say sometimes ‘no one gets well in the hospital’, what do we mean? You might be diagnosed in the hospital, you might get patched up in the hospital, you might get your tests taken, but you get well once you leave. If you get well. And healthcare really hasn’t recognized that yet. And so they don’t really meet the patients where they live and where they improve

The second thing in this parochial view of patients is this idea that patients really can’t understand what they need to take care of their health. And that is just a myth, because any sick person I’ve ever talked to wants nothing more than to get better. And they are much more vested in that than the healthcare provider, I don’t care what economic incentives we change in this country, your physician is not living your life.

And then thirdly, I think the healthcare organizations have not done the minimal job of trying to see the world through the lens of the patient. So even though we’re starting to make progress in selling to healthcare organizations I often hear the patient relationship referred to as the last mile. So what’s their view of the world? Their view of the world is: Here is the hospital, we are theheartof the world, you’re going to come in here and we’re going to fix you up. First we’re going to fix what’s going on that’s wrong in our hospital, then we’re going to fix what’s going wrong between the hospital and the other docs.

And then when we think we’ve got that, we’re going to talk to you, the patient.” Instead of going the other way around and going, “Well, wait a minute, this just isn’t working, it isn’t working where we are first place in costs, we are37th place inresults—how are we going to really check this? We are a nation of chronic diseases, there’s nothing anybody can do in my care that’s going to change that. That’s the question that we got to be able to answer as a country. And it is with the patient.

But where it is supposed to be a relationship between the healthcare providers and the patient gets to I think three different things: Teach me, engage me, and track me. And what that means is essentially is starting with the teaching, ‘tell me what I need to know about my disease, let me learn, I might not have been reading it before I got sick, probably not, but now that I am sick, if you give it to me in a way that I can understand it I will learn it. ’So the big phrase there is ‘in a way that I can understand it’. Everybody has had that experience of standing in a doctor’s office with them going through the language of Grey’s Anatomy and you go ‘What?’, that’s why part of the reason why we only maintain 8% of what we hear in a hospital situation when we get home.

The second is we don’t do normal teaching even if we have the ability to get the phrases we don’t teach that, we don’t use testing, we don’t use any of the things that we know get people to learn, so we don’t employ any of those techniques. So it is not surprising that people don’t really understand about their illnesses because they do not really talk about them when it comes right down to it.

The second in terms of engage me, comes to the, ‘how are we going to work together’, and that has everything to do with building a care team. So it’s not just the doctor you see, but do I have a physical therapist, do I have a mental health professional, have I seen a nutritionist—all the pieces that you’re going to need to get engaged in taking care of your own health and how do they share information.

And then finally track me, and I think there is a lot of proof coming that’s not just for triathletes, I think that whether we like it or not anytime you ever written down everything you eat all day long, and it’s a pain to do so, anytime you’ve ever tracked how many steps you take, it really teaches you about yourself. And normally you can just ignore it, but if you’re sick you might want to change it. So the measurement is very key. So those are really the three buckets, I think that we have to address if we are going to get patients to take responsibility in a way removed from a lose-lose situation, which is where I think healthcare is today, to a win-win situation where there’s something in it for both the patients and the providers.

Robin Miller:Okay. So let me just talk about money for a second. Costs—will a more engaged patient, pay less, help say the continuous rises in healthcare costs. Can that happen?

Joanne Rohde:Well, I think it’s the only way we’re going to get rid of the rise in healthcare costs. But, here’s the rub that it is only now, I think last year will go back in history as a bellwether year, as the first year that we actually sort of flattened out the expense for patients forever. But I think that up until now the reason that’s been the case is there’s been no incentives to rein in costs—in fact the opposite is true. And when I first got into this business, I thought that was a very cynical view of the world.

Surely people get into this business to save people. And they do , they get into this business to save people. But if you start looking at where your healthcare dollars go and how little of it that actually ends up lining the pockets of the doctor you’re having the relationship with, you’ll see that there are a lot of vested interests between you and your wallet. And the sad truth is at the hospital level and so a few years ago, maybe, say 18 months ago, if you went for a heart attack and then you went out and went to Kentucky Fried Chicken and then the next day you’re in a for a heart attack, that was a good event for your hospital. And so that’s what’s changed. So I think the first thing is, that’s where incentives make a difference and payment model make a difference. And I think we’re already beginning to really address the key aspect of that and I think at a macro level you’re beginning to see that information and I personally don’t believe last year was a fluke, as some people suggest, I think that’s the beginning of changing the cost per head, so that’s first.

So the second is to the heart of what you asked me, I think really at the end of the day, what everyone is looking for that I talked to in the healthcare provider spaces, is show me the ROI, show me that if I invest more money in my patient, I will make more money. And so really that comes down to three things for a healthcare provider. To have a win-win, everybody has to win, you got to get your health back at a reasonable cost, they have to be able to make money. And so, let’s look at their side, not your side, individual side. So there’s basically three ways that they start to make money.

The first is affinity and loyalty. As we move from a society of chronic disease into where I think we’ll hopefully move to a society of ‘get me well, keep me well’, are you going to pick all your downstream providers be it a physical therapist, be it a nutritionist, are you going to pick it with a health system? Or are you going to out and be on your own? So there is going to be a dollar shift from this acute care setting to chronic care to long-term health. And if they want to capture your wallet they have to make that move. So you have to as a health system not just have a good doctor, you have to have all the offerings all the service. That’s a tall order given what healthcare is today, but we believe that they’re ways to help with that. But the hard ROI really comes from reduced admissions and increased patient satisfaction today.

And then down the road it comes from lower utilization of the healthcare system in total. So today a healthcare system can make more money by increasing what is known as their age cap or patient’s satisfaction score. Patients have proven time and time again to be more satisfied when they are taught, when there are ways to interface with their physicians when they are not with them, thanks to electronic. And that in turn translates into hard dollars today for healthcare systems. Because if they see any Medicare patients, and who doesn’t? Everybody sees Medicare patients, they drive most of our care costs in this country, they get more from our federal government per patient if they have higher age cap scores, another positive incentive. The second thing is more of a stick than a carrot, which is you may have heard a lot of talk about reducing readmissions.

Robin Miller:Yes.

Joanne Rohde:So the conversation is, if you’re in the bottom third, the penalties are still increasing but the way they are going to level off in the next year or two, is that you can end up losing up to 3% of your total Medicare billings, if you end up in the bottom third.

Robin Miller:Well, by you , you mean the hospital, right?

Joanne Rohde:The hospital. Yeah, I’m sorry, the hospital, the hospital. And that a several years ago when I first started in this business and the law was sort of coming down, down, they could see it from the distance, the conversations in hospitals often run, ‘how can they do that to us, I can’t control what the patient eats, I can’t help if they don’t do any of the things I tell them to do’. And I think there’s a lot of that reaction still, but there’s a recognition from the leading hospitals that the model isn’t working. Thatthere needs to be an exchange of information—that’s our name, AxialExchange—on an ongoing basis, and that outcomes matter, and that the healthcare system has to have a stake in the ground, and that only the winners in the long term are going to exist because they have good results.

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Former Red Hat COO Helps Health Care Providers Work Together (Video)

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  • by girlintraining (1395911) on Wednesday February 05, 2014 @03:08PM (#46164725)

    Upmod if you agree: Beta is shit. Keep it the way it is.

    • agree (Score:5, Insightful)

      by evilRhino (638506) on Wednesday February 05, 2014 @03:14PM (#46164803)
      It is definitely worse. The screen real estate is not used very well.
      • I think nothing less than having similar comments as the top-rated for each story will convince them of that. Let us start here. Spread the word: Our dice overlords must hear of the nerdy wrath!

        • by OzPeter (195038)

          I think nothing less than having similar comments as the top-rated for each story will convince them of that. Let us start here. Spread the word: Our dice overlords must hear of the nerdy wrath!

          Also .. send them an email saying what you think.

          Hell, imagine what 100,000 physical postcards from users saying "Bye" would do!

          • I agree, but it's too easy to ignore email, so we should also all repost it to our journals with "publicize"checked (and be sure to vote for others doing the same); if enough of us do that, our angry complaints will fill the queue and hopefully part of the front page. That would be much harder for /. Admin & Dice to shrug off, especially as Idoubt advertisers will be happy at seeing the userbase openly planning to implode.

    • by Anonymous Coward

      No "Load All Comments" button. Fuck Beta till this is fixed.

    • I had to reset my phone yesterday to opt out.

      Couldn't login to even reset it as beta CSS assumed I had a big screen. I couldn't even scroll to login and change WTF!!

    • beta does suck (Score:3, Insightful)

      by Xaemyl (88001)

      I know I'm one voice among many (and only have a 5 digit uid), but yeah. If there isnt an option to keep classic, then fuck this site.

      • by OzPeter (195038)

        I know I'm one voice among many (and only have a 5 digit uid), but yeah. If there isnt an option to keep classic, then fuck this site.

        I'll be right behind you

    • Are they going with for same shit yahoo did just recently? I see many similarities. Did they bought the same engine, or what? Good lead by Win8...
    • Fuck it up it's stupid ass.

      • by denzacar (181829)

        Clearly what I meant to say there is "Fuck it up ITS stupid ass".

        • by tqk (413719)

          Clearly what I meant to say there ...

          If it was clear, why did you need to clarify? As for the "Re-design", I feel so left out. I see nothing that's much changed from what I'm used to seeing. Do you need to be using a toy computer (cell phone) to be offended?

          What a bunch of whiney babies! :-P

          • by denzacar (181829)

            If it was clear, why did you need to clarify?

            It's a figure of speech.

            An opening to a sentence, used to point out that the speaker finds the information in the rest of the sentence to be self evident.
            In this case, it implies that the author is aware of the typo, so you grammar Nazis can go look for trouble elsewhere.
            CLEARLY, it was not enough for you.

            As for the "Re-design", I feel so left out. I see nothing that's much changed from what I'm used to seeing. Do you need to be using a toy computer (cell phone) to be offended?

            Oh! Sorry about that. Didn't realize you were blind.

            Clearly then you'd find words like "clearly" annoying since you probably hate that concept the same way a deaf person may hate someone saying that a part

            • by tqk (413719)

              If it was clear, why did you need to clarify?

              It's a figure of speech. An opening to a sentence ...

              Pardon me. I was unaware that you're a moron. You could have just said, "Yeah, there really was no reason why I inserted that "clearly" other than to try to make myself look like I was a Great Writer." Instead, you lash out with the ubiquitous "Grammar Nazi" crap when cornered. I'll try not to bother you in the future, possibly upsetting that lovely apple cart you've built.

              • by denzacar (181829)

                Apple cart? Bah!

                That's for hipsters with more money than sense.
                Real men use potato sacks.

                Also, fuck beta to you.

    • by Nivag064 (904744)

      I agree, the beta looks worse than current, and why are there so many new sites I have to allow (I use noscript, to control JavaScript)?

    • Almost everything about slashdot UI is unideal. Look at that top bar. Whould you click on any of that?

    • by caddy1071 (562954)
      Not a fan - classic, please.
  • by Billly Gates (198444) on Wednesday February 05, 2014 @03:19PM (#46164857) Journal

    But a very expensive and difficult to administer system made in India with no UX considerations requiring obsolete browsers and ultra expensive RDBMS licenses that small doctors offices can't afford is the way to go forward.

  • by Anonymous Coward

    Some places are already doing stuff like that. You also need money to get the ball rolling.

    These folks [ehealthontario.ca] even provide some of supporting the components (HAPI [sourceforge.net] and SAML solution as open source SW). [sourceforge.net]

  • This type of Electronic health record keeping has been partially introduced in the Netherlands, yet not without enormous backlash. There are, amongst others, concerts about privacy and knowledge of insurance agencies. See: http://en.wikipedia.org/wiki/E... [wikipedia.org]
    • We are trying in Quebec, but in typical fashion, it's a massively corrupt, hilariously over-budget boondoggle of epic proportions. It's how things are done here.
  • fibromyalgia (Score:3, Interesting)

    by mrchew1982 (2569335) on Wednesday February 05, 2014 @04:13PM (#46165415)

    is doctors speak for, "We don't know what the hell is wrong with you but you won't leave us alone, so heres a vague diagnosis to get rid of you"

  • Making it easier to shear info makes it easier to get on the black list.

  • I'm of the opinion that, alongside making it easier for medical providers to exchange information, it needs to be standard for the patient to get that information in a standard form that they can keep and give to medical providers directly. I know a lot of the data's complex, but in most cases it's written down in free-form text in the notes in the file and most other physicians can grok what the notes say. It should be feasible to have a standard XML format (UCSD allows me to download my record in a standa

    • adding it to a file on the patient's USB flash drive

      You don't want random flash drives being plugged into the networks that store health info.

      e-mailing to the patient

      And you really don't want it going out over the Internet in plain text.

      it's not that complicated

      If you think it's not that complicated, then you do not understand the magnitude of the problem.

      • by Todd Knarr (15451)

        Plugging random flash drives in is entirely safe. It's just not safe to run content that's on them. But no system I build will run content from a removable drive when the volume's mounted, and for an application like a medical office system users wouldn't be given the opportunity to run anything directly either (they're running the medical office application, they have no reason to access the desktop at all). As for going through e-mail in plaintext, a) that's what the S/MIME and/or PGP encryption built int

        • Plugging random flash drives in is entirely safe.

          Assuming there are no zero-day exploits you haven't yet found.

          Within the doctor's office the information's already secured.

          I wouldn't be too sure about that. Doctors are not security experts, and neither are most of the people they hire.

          S/MIME and/or PGP encryption built into every major e-mail client

          How many average people do you think actually have an email client, as opposed to using webmail?

          • by Todd Knarr (15451)

            Even if there's a zero-day exploit, how is it going to attack the machine if the exploit code isn't run? I suppose theoretically there could be a bug in the filesystem code that could be exploited by a suitably-malformed filesystem structure to cause code to be run when the filesystem driver tries to interpret the filesystem structure when mounting the volume, but I haven't heard of one of those in ages. Beyond that, unless you've misconfigured your system to automatically execute code from a just-mounted r

            • Let's just say that your experience is several standard deviations beyond the mean. I don't know anyone who uses an email client (even I don't, but I also treat email as completely insecure). I'm probably the only person I work with who even knows how to set up an email client with encryption. Most people are completely in the dark about security.
  • I hope that something like a 'greasemonkey' script can be made to combat this if Dice keeps pushing this abomination.

    This is one of those times when I kinda wished I had learned some programming when younger. As it is now, I would not even know where or how to start on something like the above, much less actually be able to complete it.

    Oh well, I guess that is one to add to my near future projects list.

  • When AxialExchange first launched, it appeared to be open source. They released an Apache Licensed project called axial360 (see Google Code), but it hasn't seen a commit since 2010. There web site has no information about the actual technologies they use. Anyone have the scoop?
    • by Eskarel (565631)

      Given that something like Axial Exchange can't actually work regardless of the technologies in place, they're either insane or fishing for a VC buyout or large government grants. There's a crap load of money to be made in failing to solve eHealth.

  • Update: 02/05 20:16 GMT by T : If you're seeing this post on beta.slashdot.org, note that we're still ironing out the details of video display here. You can view the video on tv.slashdot.org, instead. Please pardon our dust.

    Seriously??! What is wrong with you douches? Why would you push^H^H^H^Hforce this on people when things don't even work... No post button... Sorry... This doesn't work correctly... Sorry, you can't see a video (not that I could care LESS ABOUT A *&%$#@ VIDEO!! )... WTF??!

    crap, Crap, CRAP, CRAP!, CRAP!!, CRAPP!!!

    What happened to you, dear /. ???!

    RIP, my darling... May you find peace... :( Sniff... Sniffle....

    As long as it's been, I guess it's time to finally say... "Good, riddance, /." :(

  • Yeah, right. What she says is *dead* on. Before I relocated here, I had a *really* good, actual family practitioner, who did *everything*. Now, I've got four? five? different doctors, and allegedly they're my "team" (for values of team approaching zero as a limit). I had to rant to make sure doc #3 talked to my "primary care". and they appeared to be annoyed.

    They're all friggin' "specialists" who have no interest whatever in the human being in front of them, only in the one subset of that person's body that

  • A) VERY few EHR/EMR systems are capable of talking to one another. It is not "still" a problem. It is a very fundamental problem, caused by a Federal Government deciding to offer a candy free-for-all to data companies under the guise of physican reimbursement for Meaningful Use of Certified EHR systems.... then the Government deciding "eh, we'll write the interchange standards later." B) Much better to have a patient fill out new paperwork with every provider every time, than to input data entered inc

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