CEO and Co-founder, AdhereTX Corporation

It has taken decades for the manufacturing and retail supply chain to realize the actual benefits of implementing global data standards, including better tracking of products, collaboration with partners, and reduction of administrative costs. And that was in a market space relatively free of regulation and pricing constraints, where early adopters like Proctor &Gamble on the supply side and Wal-Mart on the buy side had enough leverage to shift the entire supply chain in the direction of global synchronization. Data interoperability minimizes the time a product spends in the supply chain and maximizes value for stakeholders. But patients are not products  While there are some important lessons that healthcare can learn here, there are significant differences that will make the achievement of global interoperability in healthcare an even longer row to hoe. A patient’s journey through the continuum of care is inefficient  because payment models and incentives to improve care and reduce costs are mis-aligned.

Through the American Recovery and Reinvestment Act 2009, the federal government has attempted to accelerate interoperability where market models do not exist currently, by funding the formation of regionally organized Health Information Exchanges (HIEs) to allow hospitals, laboratories, pharmacies and physicians to share electronic health records (EHRs) across a region, community or health system. To date, successes have been few and far between and there are no emerging winners among several models . A recent Beacon Partners Report (January 2012) “Health Information Exchange Study: Assessing the Value and Participation in HIE” cites a number of reasons that HIEs have stalled after the initial push.  Most organizations have no budgets to participate once the grants run out, or the HIE initiative has a much lower priority than those around basic care delivery. Another is that CIOs are given responsibility for initiatives that are more about collaboration and less about technology.

It seems to me that the evolution of HIEs will be rate limited until EHRs have greater penetration, specifically  in the ambulatory world and physicians’ offices. Like HIEs government incentives for Medicare/Medicaid based practices encouraged adoption but most estimates place penetration of ambulatory EHRs around 40%, and that includes many that are only partially functional. Still interoperability is one of the critical success factors for transformation of healthcare into a system that is sustainable and can improve the quality and delivery of healthcare. The good news is that huge challenges like these also bring new opportunities for the creation of new innovative solutions based on both technology and process , as well as new roles. Remember a decade ago when every large enterprise had an “e-commerce Czar” to figure out how it would capitalize on the internet?

I learned many lessons from the Supply Chain as a co-founder and CEO of my first startup RedTail Solutions, a software-as-a-service company that supports the underlying transactions of the order life cycle between supplier and buyer. It is important to keep pace with technology thought leaders and work with the early adopters – but just as important to provide solutions that can support existing workflows that  offer customers a bridge to the future changes they will inevitably face.  At my new startup, KnowMyMeds, we are not waiting for the HIEs or even for the EHRs for that matter. We have designed our automated medication management solution for high-risk patients to be standards-based and interoperable, but at the same time we are also focused on supporting existing processes in a care continuum that still struggles with fragmented and incomplete data.

High-risk patients, such as dual-eligible Medicare/Medicaid as well as other patients with disabilities, often have multiple chronic conditions that can lead to a prescription cascade for drugs to treat the diseases, as well others to treat side effects of the drugs themselves. Multiple providers, out of network prescriptions, as well as patients’ self-medication behaviors can also result in a proliferation of unnecessary medications and compounded risk.

The ability to reconcile medications for these complex patients as they transition through the healthcare system can improve outcomes and reduce hospitalizations, readmissions and emergency department visits. Unfortunately, one of the most critical pieces of the process, patient self-medication information, is rarely captured, and other medication information in insurance or prescription databases is fragmented and disconnected. Healthcare providers waste time collecting/validating it in order to reconcile medications. Healthcare plans end up paying for duplicate, contra-indicated or unnecessary drugs that do not improve or negatively affect patient outcomes.

KnowMyMeds enables healthcare practitioners to perform clinically validated and cost-effective comprehensive medication review for high-risk patients, reconciling their therapeutic regimen and eliminating unnecessary medications. The system simplifies and streamlines data collection from the patient. Provider tools include a mechanism to scan packaging bar codes for prescriptions and over-the-counter medication, coupled with a structured interview tool to capture other important patient self-medication information. Together with other information imported from claims and electronic medical records, the KnowMyMeds rules engine performs automated medication reconciliation and identifies other risks that may be present. Healthcare providers save time and can take action to improve patient outcomes. Payers save immediately when unnecessary or duplicate drugs can be eliminated, and realize additional cost savings over time as patient outcomes improve with medication management that can guide more effective intervention.

http://www.metlife.com/mmi/?WT.mc_id=vu1243

The Adheretx Profiler, View and Manager collects drug therapy data, demographic data and therapy risk factors as structured data which will help providers and EMR vendors achieve several of these measures including:

Implement drug-drug, drug-allergy, drug- formulary checks

Using web and mobile based motivational interview techniques The Adheretx View module collects as structured data a complete list of Rx, OTC and Supplement therapies the patient is using and can collect information on allergies enabling the provider or the EMR vendor to achieve this criteria. The Adheretx rule set identifies potential problems that could result in drug induced illnesses such as adverse reactions or patients who are at risk for degraded therapy.

Maintain active medication list.

As with the prior critera, the Adheretx View module is designed to collect as structured data a complete list of Rx, OTC and Supplement therapies which can populate the EMR using HL7 formats.

Maintain active medication allergy list.

Using web and mobile based motivational interview techniques The Adheretx View module can collect self reported information on allergies as structured data.

Record demographics.

Adheretx View collects demographic data as structured data which can be loaded into the EMR.

Record and chart changes in vital signs.

Adheretx View collects self reported biometric data via the web or mobile or via Continua compliant devices and stores as structured data.

Send reminders to patients per patient preference for preventive/ follow-up care

The Adhertx Manager enables self management of chronic disease therapy remotely enabling the provider a continuous view of patient adherence, compliance and allows monitoring of the results of therapy. Gaps in care, adverse drug events or degraded therapy can be immediately recognized by the provider who can intervene.

Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.

Adheretx uses HL7 standards to store and communicate data enabling integration with HIEs.

Perform medication reconciliation at relevant encounters and each transition of care.

Adheretx collects and stores a complete list of Rx, OTC and Nutritional Supplements enabling a complete reconciliation at care transition points.

Increasing rates of chronic disease and polypharmacy, and increasing use of over-the-counter and nutritional supplements are adding significant but avoidable costs to the health care system through increased potential for therapy interference and increased potential for adverse drug reactions. Over 175,000 ER visits each year among older adults are due to adverse drug reactions. Other articles suggest that 80% of drug side effects are treated with additional medications. Providers often have little or no visibility on their patients OTC and nutritional supplement therapies. Consumer tools such as Adheretx, which continuously provide visibility to these therapies can enable patients and providers to identify potentially unsafe concurrent therapies and avoid these costs.