Slides from September 26, 2018 eHealth Initiative Prior Authorization Workshop by Heather McComas, Director of Administrative Simplification Initiatives, American Medical Association (AMA).

The presentation reviews the current state of prior authorization, overview of recent AMA prior authorization research, grassroots prior authorization stories, and AMA's prior authorization and utilization management reform principles.

Increased private and public investment in analytics and “Big Data” is driving patient generated health data (PGHD). Due to its real-time nature, and rich information enabled by new technologies, big data science potentially offers advanced intelligence, with the aura of truth, objectivity, and accuracy. This report from eHealth Initiative and Validic explores PGHD and remote patient monitoring.

U.S. National Health IT Week (NHIT Week) is a nationwide awareness week focused on catalyzing actionable change within the U.S. health system through the application of information and technology. Founded by HIMSS and the Institute for e-Policy in 2006, the week-long celebration is comprised of partner-driven activities and events led by the efforts of national health stakeholders. Participants range from the Administration, congressional, federal and state agencies, providers, non-profit organizations and more. Virtually, in Washington DC and beyond, National Health IT Week stakeholders collaborate towards actionable outcomes which demonstrate the power information and technology has to transform health in the U.S., and its wide-reaching global impact.

A Quantitative Observational Study of Physician Influence on Hospital Costs

Physicians serve as the nexus of treatment decision-making in hospitalized patients; however, little empirical evidence describes the influence of individual physicians on hospital costs. In this study, we examine the extent to which hospital costs vary across physicians and physician characteristics. We used all-payer data from 2 states representing 15 237 physicians and 2.5 million hospital visits. Regression analysis and propensity score matching were used to understand the role of observable provider characteristics on hospital costs controlling for patient demographics, socioeconomic characteristics, clinical risk, and hospital characteristics. We used hierarchical models to estimate the amount of variation attributable to physicians. We found that the average cost of hospital inpatient stays registered to female physicians was consistently lower across all empirical specifications when compared with male physicians. We also found a negative association between physicians’ years of experience and the average costs. The average cost of hospital inpatient stays registered to foreign-trained physicians was lower than US-trained physicians. We observed sizable variation in average costs of hospital inpatient stays across medical specialties. In addition, we used hierarchical methods and estimated the amount of remaining variation attributable to physicians and found that it was nonnegligible (intraclass correlation coefficient [ICC]: 0.33 in the full sample). Historically, most physicians have been reimbursed separately from hospitals, and our study shows that physicians play a role in influencing hospital costs. Future policies and practices should acknowledge these important dependencies. This study lends further support for alignment of physician and hospital incentives to control costs and improve outcomes.

The full article can be downloaded below.  

Characteristics of Mail-Order Pharmacy Users: Results From the Medical Expenditures Panel Survey

This study has identified several key factors that affected the use of mail-order pharmacies, such as age, race, marital status, income level, education level, insurance status, and having a prescription with at least a 30-day supply. Living in rural areas did not affect the use of mail-order pharmacies. Insurance policy makers should consider those characteristics in promoting the utilization of mail-order pharmacies.

The full article can be downloaded below.  

Clinical Research and Data: HIPAA, the Common Rule, the General Data Protection Regulation, and Data Repositories

The inexorable march of Moore’s Law has resulted in changes in all areas of our lives, including how we do clinical research. Researchers and patients are more connected. We store, access, and manipulate data in different ways; we conduct studies in multiple countries sharing data and samples around the world; and cybersecurity and hacking are a reality. This article touches on different legal aspects arising at the intersection of technology, data, and clinical research— specifically HIPAA (the Health Insurance Portability and Accountability Act), human subjects research, the European data law (the General Data Protection Regulation), and data repositories. It attempts to explain how two different law-making bodies, the US and the EU, have tried to balance the necessity of using data for research purposes that benefit society with the privacy issues and risks of that same data.

The full article can be downloaded below.  

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

Electronic health records (EHRs) have emerged among health information technology as "meaningful use" to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records’ use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose. Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE (PubMed), 10/02/2012–10/02/2017, core clinical/academic journals, MEDLINE full text, English only, human species and evaluated the articles that were germane to our research objective. Each article was analyzed by multiple reviewers. Group members recognized common facilitators and barriers associated with EHRs effect on population health. A final list of articles was selected by the group after three consensus meetings (n = 55). Among a total of 26 factors identified, 63% (147/232) of those were facilitators and 37% (85/232) barriers. About 70% of the facilitators consisted of productivity/efficiency in EHRs occurring 33 times, increased quality and data management each occurring 19 times, surveillance occurring 17 times, and preventative care occurring 15 times. About 70% of the barriers consisted of missing data occurring 24 times, no standards (interoperability) occurring 13 times, productivity loss occurring 12 times, and technology too complex occurring 10 times. The analysis identified more facilitators than barriers to the use of the EHR to support public health. Wider adoption of the EHR and more comprehensive standards for interoperability will only enhance the ability for the EHR to support this important area of surveillance and disease prevention. This review identifies more facilitators than barriers to using the EHR to support public health, which implies a certain level of usability and acceptance to use the EHR in this manner. The public-health industry should combine their efforts with the interoperability projects to make the EHR both fully adopted and fully interoperable. This will greatly increase the availability, accuracy, and comprehensiveness of data across the country, which will enhance benchmarking and disease surveillance/prevention capabilities.

The full article can be downloaded below.  

Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research

People and health systems worldwide face serious challenges due to shifting disease demographics, rising population demands and weaknesses in healthcare provision, including capacity shortages and lack of impact of healthcare services. These multiple challenges, linked with the global push to achieve universal health coverage, have made apparent the importance of investing in workforce development to improve population health and economic well-being. In relation to medicines, health systems face challenges in terms of access to needed medicines, optimising medicines use and reducing risk. In 2017, the International Pharmaceutical Federation (FIP) published global policy on workforce development (‘the Nanjing Statements’) that describe an envisioned future for professional education and training. The documents make clear that expanding the pharmacy workforce benefits patients, and continually improving education and training produces better clinical outcomes.

The opportunities for harnessing new technologies in pharmacy practice have been relatively ignored. This paper presents a conceptual framework for analysing production methods, productivity and technology in pharmacy practice that differentiates between dispensing and pharmaceutical care services. We outline a framework that may be employed to study the relationship between pharmacy practice and productivity, shaped by educational and technological inputs.

The analysis is performed from the point of view of health systems economics. In relation to pharmaceutical care (patient-oriented practice), pharmacists are service providers; however, their primary purpose is not to deliver consultations, but to maximise the quantum of health gain they secure. Our analysis demonstrates that ‘technology shock’ is clearly beneficial compared with orthodox notions of productivity or incremental gain implementations. Additionally, the whole process of providing professional services using ‘pharmaceutical care technologies’ is governed by local institutional frames, suggesting that activities may be structured differently in different places and countries.

Addressing problems with medication use with the development of a pharmaceutical workforce that is sufficient in quantity and competence is a long-term issue. As a result of this analysis, there emerges a challenge about the profession’s relationship with existing and emerging technical innovations. Our novel framework is designed to facilitate policy, education and research by providing an analytical approach to service delivery. By using this approach, the profession could develop examples of good practice in both developed and developing countries worldwide.

The full article can be downloaded below. 

New tool helps doctors determine which patients are most likely to forget or skip their appointments

Patients who don't show up for their scheduled medical appointments drain health care providers' time and resources, reducing appointment availability, increasing wait times, and reducing patient satisfaction.

In an effort to solve this problem, a team of researchers from the Johns Hopkins University's Malone Center for Engineering in Healthcare has developed a new algorithm that can reduce no-show rates and increase appointment availability.

The full article can be viewed at this link.