APIs Aren't For Integration or You're Barking Up the Wrong Tree

In the usual ritual this morning I stumble across "Sansoro Hopes Its Health Record API Will Unite Them All.” Kudos to Sansoro.

Waiddaminit.

An API is not what you need. A database is what you need.

Here is a ten second intro to what I mean:

"Get me a rock," your Drill Sergeant says

"What kind of rock?” you say, having heard this one before.

"Any kind of rock,” he says, "Just about the size of a quarter.”

There are two ways to solve this problem, first, you can go pick up every rock and examine it and toss out ones that don’t fit the criteria. This is painfully slow and goes by the Name RBAR (Pronounced 're-bär, like the stuff that reinforces the concrete their little developer heads are made from), meaning 'Row by Agonizing Row.'

The better way is to build two boxes, one with holes slightly bigger than a quarter, and one with holes slightly smaller than a quarter and sift all the rocks through both, leaving you with a pile of rocks that fit the description.

Why do I bring this up? The first method, pick up and discard, is called procedural programming, and it is what the startling preponderance of programmers (with concrete heads) use and what Sansoro is proposing. There are about 7,400,000,000 people in the world and procedural just won’t work with that kind of volume. The second is called set based programming. Its what we do here at Sentia and it is the prescribed method for handling data. This is why your "Big Data" guys are not too bright. They use procedural code to sift thorugh large amounts of unordered data. The better way is to order the data, then run queries against it in your database. This is the set based way.  ...and the procedural way takes orders of magnitude more time.

Another problem is that you have to know where the data sits before you can access it. "So you mean Carolinas Medical in Huntersville or Cornelius?” The patient probably doesn’t know where his or her doctor is even if he or she is even conscious at that point.  Worse, is that you can’t get the insights that a single data store can give you (remember the "Big Data" chowderheads, above?). You don't see emerging trends, you can’t link symptoms to diagnoses on a large scale, and your local practitioner/hospital certainly isn’t going to hire someone to give him or her those nuggets of information. Even worse, what Sansoro has isn’t hooked up to anything out of the box, you have to point it at your EMR and hope they have a way to read and write to it or you have to hire someone with that kind of knowledge to figure it out. Basically they just stuck their flag in the sand and said "this is the way to do it.” Ask Sony how that works out.

So yes, the only way to do this is to have one repository and have an integration tool that feeds the repository in the background. Then we can do the searches and run the queries to find the emerging trends and have one place for everyone in the United States (world?) to look for medical records. Look at the blog from 06/03/2016 to see an example of the integration tool we designed, developed and use. Even worse, what happens when the medical community finally wakes up and starts to use SNOMED (look at previous blogs), that is designed to do what they are doing, instead of ICD codes, which aren't? Sansoro will be left in the dust.

Good job, Sansoro, but you’re barking up the wrong tree.

Real Solutions

The Role of Technology In Healthcare

Yesterday, my internet buddy John Lynn posted a new blog titled "Technology is Just a Tool, It's Not the Solution to Healthcare's Problems."

Maybe. Maybe not.

First, we have to understand what he means by problems. He makes the usual metaphor about driving a nail with a screwdriver and building a table with the blueprints for a chair, and I'll bet his blueprints still smell like ammonia like they did in the 60's, and yes, John, I'm making fun of you. The point is, he never defines what he means by 'problems.' So let's see if we can define those for him.

1. Healthcare is too expensive.
2. There is no standardization of care.
3. There is no coordination of care between facilities.
4. There is too much paperwork, filling out of forms and questionnaires, both internally and by the patient.
5. Documenting the encounter is cumbersome and time consuming.
6. Payment (insurance) is cumbersome and time consuming.
7. Lack of avenues of communication between practitioner and patient without an encounter.

Assuming that the doctors know what they are doing, and years of schooling and internship tell us this is so, all these problems can be addressed with technology that automates processes. Instead of a screwdriver and table, let's look at the manufacturing industry. Decades ago I was trained to use a machine that did the whole machining process from blank to finished and tested product all by itself. The machinist didn't even have to load the machine; just keep a pallet of blanks handy. That's what we've done to the medical and insurance industry here at Sentia. We already know we can cut 1/3 from the cost of healthcare tomorrow, but we can also coordinate between facilities (see previous blog post), allow the practitioner to design and build their own questionnaires without having to fill out paper(ok that is still in prototype stage, but its coming in a couple of weeks), document the encounter in the fastest way possible (maybe faster than paper), completely automate the payment process, and allow written communication between practitioner and patient. These are all accomplished through technology. Our goal is to free the practitioners from anything but saving lives. Maybe I am using the old Cincinnati Milacron (or whatever the latest and greatest is in the manufacturing industry) as intended instead of a screwdriver to hammer a nail, but that's what we geeks are for. We here at Sentia have the keys to a better future right here in our pockets. John Lynn, You have it wrong. We even have ways to help diagnose tough cases,(see here). So tell me again why we are expecting too much from technology?

Real Solutions

 
 
 This post originally appeared at https://sentiahealth.com/WebLog/Details/13 on 6/17/2016.


 
 
 

Who Do You Trust With Your Healthcare Dollars?

So I'm cruising around this morning, doing the normal, reading the health insurance blogs, when I normally would be reading the Health IT blogs. It occurs to me why you all are jaded. I get it. At InsureBlog I find a 'Throwback Thursday' to when Obama was claiming a 300% decrease (how is that possible? Are they paying you twice the old premium?) in health insurance premiums posted March 16, 2010 (and also claiming that if your health insurance was through your employer you'd get a raise). Flash forward six years and the author, Henry Stern, shares several anecdotes where patient's premiums rose an average of 33% just this year (2016). Clearly you can't trust the government to help your skyrocketing insurance costs.

Then I click on over to Helth Insurance: Keep It Simple and find a rant about how Obamacare makes the consumer the villain by saying "The damned human consumer daring to make unhealthy choices like eating fatty foods, or smoking, or inheriting bad genes, or aging, or…well, being human.” Actually, Some of these I agree with. What you can't do is tell the consumer he or she has to get his or her cholesterol down, and NOT tell them how to do it. Drugs are not the answer. But with these conflicting opnions, I can certainly see why most of you would be confused.

At Health Care Renewal we are treated to a lambasting of the pharmaceutical industry AND the Media. The former for showing up in a Transparency International report showing them to be corrupt and the latter for not shouting it from the rooftops. The Media didn't shout it from the rooftops because we already know we are getting screwed, and we don't really care about the mechanics of the screwing.

So what do you do? Who do you believe? We here at Sentia can't (yet) help you with the Pharmaceutical Industry. But we have some ideas. What we can do today is to automate the entire insurance industry out of existence. We will provide you with coverage comparable to what you have now for about 1/3 less (that is a 33% decrease, and it makes sense) than what you pay. We are doing this by providing the doctor or practitioner with the knowledge of what is covered and what is not and paying him or her in real time at the time of service delivery. No medical coding, no back and forth with the insurance company, no big buildings with thousands of employees wasting time and money and adding absolutely nothing to the process and no huge corporate profits. If we collect more than we pay out in premiums, we will turn the excess back over to you. We will write you a check.

As far as big Pharma, we will simply have to start our own company and NOT hire all the highly paid, worthless MBAs, hire the best and the brightest scientists at say, time and half their current salary and go forth and make great strides in helping and healing people and do away with huge corporate profits. Maybe we incetivize the scientists by giving them a portion of the profits for the things they invent and the problems they solve. I know it isn't quite that simple, but the MBAs are running the world. We need the PhDs and MDs running at least that little part of it. Heck we automated the insurance industry out of existence, you tell us how to fix big Pharma in the comments.

Yes, we here at Sentia like profit. We are a for profit company and that's what we do. We think with automating processes and eliminating waste we can make as much or more than a BlueCross/BlueShield with a Netflix kind of business model. It's 2016. Bob Cratchit is just as dead as Jacob Marley's business model . BlueCross/BlueShield still uses Jacob Marley's business model too. Be like Netflix. Do amazing things in amazing ways. Heck, call your congressperson or senator and show him or her this site.

Real Solutions

This post originally appeared on https://sentiahealth.com on 6/16/2016.
 

Ideas Without Execution Are Worthless: How to Tie The Bell On the Cat

Frequently on this blog, I refer to "Belling the Cat." What I mean by that is a bunch of self-important people sitting around trying to solve a problem they don't understand using methods that may as well be magic. Arthur C. Clarke states in his third law "Any sufficiently advanced technology is indistinguishable from magic." We prefer "Any sufficiently advanced incompetence is indistinguishable from malice (Grey's law; compare Hanlon's razor)." Recently in these very pages we lambasted Dr. Karen DeSalvo, The Acting Assistant Secretary for Health, HHS, for saying 'we are doing this and we are doing that and we need these things to happen and these good things are happening,' while she has no idea what is happening, who is doing them, and how they are getting done. This is precisely how we end up in some technological dead end tunnel like we did with HL7. A bunch of doctors who know nothing about technology get together in the 60s and come up with this marvelous protocol that doesn't work. The cheapest way to hack around it is to call Iguana and have them decode the first five ‘channels' of your HL7 message is around $20,000, last time I checked (what the heck is a channel???). In the tech world, we use several methods to get this same thing accomplished, the most prevalent is XML which is free and works just fine for transferring data in a file in a platform agnostic kind of way.

Why do I bring all this up? All of these problems have been solved elegantly and simply and if you've been following along, you've seen lots of the solutions. We, collectively, feel a little like Leonard (yes Hofstadter, from The Big Bang Theory, sue me for using pop culturing my simile) when confronted by Jimmy Speckerman. Jimmy has an idea to build glasses that turn regular movies into 3D movies. Of course this is impossible but Jimmy is so ignorant of science that he doesn't realize that you can't just manufacture information (like the behind portion of an image required for 3-D). This is how I see the Medical/Insurance/Health IT/Government bumbling about and doing things. They are just like Clarke's villagers. When they need magic, they call a magician and expect miracles (and complain when they don't get them).

We here at Sentia not only have these problems solved, elegantly and simply, we have EXECUTED the plans to build them and actually produced the solution.

Interoperability.

Cutting the cost of healthcare by 1/3.

Streamlining the insurance process.

Emailing your doctor.

Eliminating paper with doctor configurable questionnaires.

Getting rid of the extra expense of medical coding.

We belled the cat. (Almost) literally.

Real Solutions

This post originally appeared on https://sentiahealth.com/WebLog/Details/11 on June 14,2016

The new FHIR and Why It's Just Going To Make Things Even More Complicated and Expensive.

Today, after a looooong weekend driving around the country, I was cruising around, back to my usual, when I came across this at EMR and HIPAA. The article details the hubbub around the new FHIR (they pronounce it "FIRE" I think "FEAR" is far more appropriate) standards. Basically, FHIR is a web service that allows the remote user to log in and add/update/delete medical information.

Great Idea.

You know there is a ‘but' coming. Yes, but where is the data housed? Who writes the application, the web service, to manage the data? What kind of security does it have? We'll discuss those in a second, but first, let's dig into who came up with this. More than a decade ago, the now defunct LivingWell Health Solutions, that I worked for, was looking for a way to import medical information. The protocol of the day was called HL7. They were going to buy a tool called Iguana for about $20,000 to get five channels of data. Don't ask what a channel is, it's just more of the HL7 "standard's" stupidity. To read medical data you had to buy an amazingly expensive product. So I went looking at the HL7 standard. You have got to be kidding me. The "standard" mixes several types of data in one file and just ships it off in a pipe delimited format. Each line in the file has an identifier as to what type of data is in the line, then you just have to know what data elements each of the delimited elements maps to. If you've had any exposure to database design, this is just insane, but at least we see why Iguana's data transfer application is/was so expensive. Sentia's Information Integrator was modified at that time to handle this "standard" because we were forced to. The rest of the world, even a decade ago, was using XML (look it up) and doing just fine, but this organization came up with this amazingly stupid set of rule for this one subset of data transfer. The mind boggles at not only the stupidity, but the arrogance.

Flash forward to 2016 and this same organization brings us FHIR. I'm going to go ahead and pronounce if FEAR. I have some questions about FHIR. First, who writes it and in what language? Web services are supposed to be like an egg. You don't know how eggs are produced, you don't know what eggs are going to be used for. You need an egg you go to the chicken and get one. Who builds the chicken though? Down the line, someone may boil it for egg salad or scramble it for breakfast. Heck they may even keep it warm and make a new chicken. You don't care. This is good, but this web service is going to be brought to you by the same people who bring you the current crop of stupendously expensive, astoundingly difficult to maintain and use EMR software like Cerner and Epic which in several environments have simply failed after spending a couple of hundred million dollars and more than a year on implementation. These are the same people that can't do something that our new insurance company is giving away for free. (if that sentence didn't make sense, go read the previous blogs)

First and foremost, if you are going to write a new application for add/update/delete functionality, it's going to be onesies and twosies, meaning they are either entering one record or looking for one record to update. That means that people are going to be typing in searches and getting back a list of results, not a wholesale transfer of data. If that is that case, put a user interface on it and let them do the typing, instead of hiring a programmer, designing and building an interface, testing, rewriting, retesting, buying servers, buying bandwidth, deploying this new application and THEN having them type searches and get results using this dumb web service.

Who writes this new web service? Who hosts this new web service? How is security managed? Nope, this is going to be an unmitigated train wreck. The better way to do it, and we Sentia have meetings scheduled to discuss this very topic with five major hospitals/hospital systems in North Carolina, is to let the data reside where it sits and transfer the changes only to a new format (in our EMR of course) that has an interface for looking up and viewing data. That way, whatever system your hospital uses, we just install one little desktop box to transfer your data to our EMR. Securely. All the pieces are already built and deployed. We will probably even supply the desktop. This isn't the new insurance company we have been talking about, but it is a start, and a step toward it. This isn't a mandate. This isn't a new protocol or standard. We have already done the work in the best way possible without having a bunch of rules and regulations that everyone ignores anyway. Actually doing the work gives you

Real Solutions

Originally posted on https://sentiahealth.com/WebLog/Details/9 on 6/7/2016

Coordinated Healthcare or Accessing your Medical Records When You Break Your Leg Skiing In Switzerland

I was cruising along the other day working on the new Mail System that will be integrated into Sentia's EMR when the phone rings. It was one of my business associates, Bill Sykes and he was so excited he could barely speak. Seems he had been attending a conference that had five CEOs of North Carolina Hospitals or Hospital Groups in attendance. They got a little off topic, but the subject came up that the biggest problem they faced was coordinated care. They have no way to see what a practitioner at one facility does from another facility. They groused about this for a little while and old Bill just stands right up and yells "Sentia can do that!"

He's right, Sentia can do that. We have a repository for medical information based on the SNOMED_CT medical terms and it includes translations to and from ICD-10, which is undoubtedly what the hospitals use. We can translate their codes with a little work and at least show them the procedures performed in English. That's not the neat part though. We still have to get their data into our centralized, web based system so they can perform searches across facilities and geographic regions. Luckily we have just such an application.

The Information Integrator (originally written by Sentia Systems) is a tool developed for the mortgage industry in 2006. Yes, I know, those are the clowns that caused the Great Recession in 2008 and we were unwittingly duped into helping them. They needed an application that would look at aggregates of loans in loan definition files called "loan tapes." Usually these "loan tapes" were just spreadsheets of loan details with one loan per line. They needed a way to standardize these spreadsheets and import them into their proprietary database automatically with no code required. They mandated a Microsoft Access application for this import. Later, thinking that was a great idea, I wrote a similar application in a real, modern programming language (C#) and database engine (SQL Server). The Integrator today can take any data format, DB2, Oracle, SQL Server, Text, Excel, Access, whatever, transform it according to a visually generated specification and then import/export it into any other format. We can schedule transfers and we can specify "only get the new data" as well. One of our practices wants their medical records available as a spreadsheet so we use the integrator to load their patients and medical records at the end of every day. They can download this spreadsheet from out secure FTP Server (look it up) at any time. Here's a sample of the integrator:  

In this instance we are importing Health Risk Assessment information collected from a client where there was no internet connection. These lines represent the flow of information from the source to the destination database. Notice the '38' between the 'Name' source field and the 'Entered By' destination. This is a conversion that we designed to transform the data as it comes across. We can do any transformation, but in this case we are just telling the destination database to put the '38' in the 'entered by' field. This tells our system that the data was entered by the Integrator and not typed in by a user. There is also a facility to translate discrete values, graphically. Discrete values are ones you might pick from a list, as opposed to continuous values you would type in. A good example is Male and Female. Most systems use an M or an F but we keep separate lookup tables because if we hard code anything we might have to go back and change the code instead of simply updating the table. You might think that male and female are the only choices, but in 2016, you would be dead wrong. In our system male is 136 and female is 137, so we translate the 'M' or 'F' the same way we would the fields, by drawing a little line between them.

So yes, having one EMR to rule all healthcare systems and control costs (remember the $10/month to manage the data?) is the ultimate goal, we here at Sentia also have the tools to take the intermediate steps to bring that to reality by integrating all other disparate systems into Sauron's EMR. One ring to rule them all, right? 

Waddaminit.

Sauron was an evil overlord who's desire was to dominate the minds an wills of his minions. We don't want that, we just want to make people better. Let's try it this way: Yes, Virginia, there is a Santa Claus, or at least someone who has your warm, fuzzy interests at heart.

See we can make fun of ourselves too, not just everyone else.

Real Solutions

Patient Engagement May Be The Biggest Element to Changing Healthcare Delivery Systems

I'm reading this morning and one of my favorite blogs The Healthcare Guy had posted a short blurb about HHS Acting Assistant Secretary Karen DeSalvo who said that patient engagement could be the biggest element to changing healthcare. We here at Sentia said loudly and collectively "duh."

Until everyone becomes responsible for his or her own health, we are going to have people sitting around on the sofa, watching Maury, eating bon bons, 36 hours per day and being 100 pounds overweight with Type 2 diabetes. The only way to stop this behavior is to educate the patient about what they should be doing, the consequences of not doing it and they are facing death and dismemberment by not doing it. Worse than that, they make my insurance go up and I'm a carrot eating gym rat

I had ready Dr. DeSalvo's comments at my buddy Brian Ahier's blog article here and passed it up as another "We have to do these things" without any clue as to how to get them done. A wise man once said "execution is everything, ideas are a dime a dozen." A stupid mouse once said "Let's tie a bell on the cat so it can't sneak up on us." Great idea, no execution. I have never seen, nor heard of, a cat with a bell around its neck, either.

So what do we do? First, we have to educate the patient. In most cases, the individual has the means to avoid chronic disease through diet and exercise. We just have to teach them how to do it. Then we have to hit them where they live: the wallet. Adults who show no increase in weight, waist/height ratio, lipid panel, HbA1c or fasting glucose get discounts on his or her insurance. That discount might literally be the amount they collectively saved the group by being healthy. We here at Sentia have the ability to generate reports that detail population health in seconds. That discount would be significant. If your numbers go up (or down in the case of HDL Cholesterol or 'good cholesterol') you pay more for insurance. Period. Your bad decisions will no longer negatively affect the cost of my health insurance.

How do you educate the patient, though? We can't make fun of the cat bell people and then not trot out a real solution, so here it is: Automatically generate patient education for every measured criteria that the patient is out of range on detailing how to fix it . That is exactly what we do here at Sentia. (See an example of patient education here for a sample patient. You might have to zoom in.) Every year at most, three months for patients with critical problems, an Individual Health Assessment (see it here and notice that our patient's body age is 37 while his chronological age is 12. Exaggeration for effect.) can be done and a report detailing the results put in the patients hands along with the ability to log in to the EMR that his or her doctor uses, and look at what the real measurements are, see X-rays, see symptoms and diagnoses and yes read about how to affect the above criteria with diet and exercise. Even better, we can tell if the patient has read the prescribed education and with evidence based care see if they are following the recommendations. Those who aren't pay more for their insurance, maybe almost as much as they are paying their old, rickety, self-important, money grubbing, do nothing insurance now. For the carrot eating gym rats, health insurance will be far, FAR less expensive. Pay for performance? You bet.

Thanks for the heads up Dr. DeSalvo. We have been doing precisely that since 2009.

Real Solutions

Posted originally at https://sentiahealth.com/WebLog/Details/7 on 6/2/2016

Legislation is Not the Solution to Better Healthcare or Better Healthcare Funding

Like I do most mornings recently, I'm clicking around trying to find out what has happened while I was resting overnight. On Monday (05/30/2016) conoutofconsumer (he? she? Can't find out anything about this blogger) posted Health Insurance, Keep It Simple that likened Obamacare to a dating relationship where your lover promised love and respect and gifts but a week in you had to start jumping through progressively smaller hoops to avoid punishment. We here at Sentia completely understand this. Go Read it, we'll wait.

We aren't going to have a scathing commentary about government waste and corruption, we talk about healthcare and how to pay for it. What we are going to do is beg the powers that be to just leave us alone to use our "American Know How" and "Get it done attitude" to well, get it done.

In the late 60s California introduced legislation for gas mileage and emissions standards that crippled the automotive industry. Their little black hearts were absolutely in the right place, good gas mileage and low emissions are wonderful goals. These standards were implemented nationwide in the early 70s and gave us such stellar examples as the Mustang II. It wasn't until 1982 when the Ford (since we picked on the abject failure of the "Little Jewel" Mustang II) introduced the Taurus with Electronic Fuel Injection (EFI). EFI, with some other things did the trick. The technology to accomplish the goal was a decade behind the legislation. In fact, the legislation had absolutely nothing to do with the solution and since the laws put a stranglehold on the United States automobile industry, were counterproductive in achieving their stated objective. In short, auto makers were too busy to trying to downsize cars and comply with stupid regulation to think and innovate and come up with a real solution. Yes, putting a bell on the cat is a great idea, President Mouse. Let's pass a noble law that mandates all cats must wear bells. Here is a list of 12 ridiculous government regulations that are idiotic and mostly unenforceable. NC's bathroom law didn't make the list. You that are familiar with this blog see where I am going with this.

Since we've now proven that complex problems require innovative solutions from bright people, and can't be wished away with idiot laws forcing us to first be aware of the new laws and then comply with them, what do we do? I think that in the late 60s, if California wanted better gas mileage and clean air, they should have ponied up and given a bunch of smart guys a grant to research the problem and come up with several solutions. The budget for the California Air Resources Board (CARB), the agency that strangled the US auto industry, now has an annual budget of $581 million. In their defense, they do research now to actually come up with a way to achieve their mandates, but they didn't then. I heard it said once that "If they (CARB) took every ten year old car off California Roads and replaced it with a brand new Cadillac, they'd be ahead in both cash and air quality." ...and have happier people.

Flash forward to March 23, 2010 when the Affordable Care Act AKA Obamacare, was signed into law. I remember exactly where I was and exactly what I was thinking: "You can't DO that." Legislation is almost never the answer; we just want to be left alone to pursue our happiness. Go put a man on Mars or something. So now that Obamacare is proven to be a miserable failure (my own personal health insurance is about 50% higher now and I only go to the doctor for the annual physical (which the insurance company ALWAYS finds a way to wriggle out of paying for(and admit it, you like the nested parentheses))), what do we do? Luckily, we saw all this coming and wrote our own EMR which became the basis for Sentia Health. You have read the landing page at Sentia Health, so you know what we are capable of. We use advanced technology to build an insurance company that basically has no people and therefore no people to pay for and only charges the user $10 per month to house the data, similar to Netflix or or Pandora. This is the technology that solves the problem. Legislation is not and never will be the answer to this problem.

Real Solutions

This post was originally published at https://sentiahealth.com/WebLog/Details/6 on 6/1/2016

 

Legislation is Not the Solution to Better Healthcare or Better Healthcare Funding

Like I do most mornings recently, I'm clicking around trying to find out what has happened while I was resting overnight. On Monday (05/30/2016) conoutofconsumer (he? she? Can't find out anything about this blogger) posted Health Insurance, Keep It Simple that likened Obamacare to a dating relationship where your lover promised love and respect and gifts but a week in you had to start jumping through progressively smaller hoops to avoid punishment. We here at Sentia completely understand this. Go Read it, we'll wait.

We aren't going to have a scathing commentary about government waste and corruption, we talk about healthcare and how to pay for it. What we are going to do is beg the powers that be to just leave us alone to use our "American Know How" and "Get it done attitude" to well, get it done.

In the late 60s California introduced legislation for gas mileage and emissions standards that crippled the automotive industry. Their little black hearts were absolutely in the right place, good gas mileage and low emissions are wonderful goals. These standards were implemented nationwide in the early 70s and gave us such stellar examples as the Mustang II. It wasn't until 1982 when the Ford (since we picked on the abject failure of the "Little Jewel" Mustang II) introduced the Taurus with Electronic Fuel Injection (EFI). EFI, with some other things did the trick. The technology to accomplish the goal was a decade behind the legislation. In fact, the legislation had absolutely nothing to do with the solution and since the laws put a stranglehold on the United States automobile industry, were counterproductive in achieving their stated objective. In short, auto makers were too busy to trying to downsize cars and comply with stupid regulation to think and innovate and come up with a real solution. Yes, putting a bell on the cat is a great idea, President Mouse. Let's pass a noble law that mandates all cats must wear bells. Here is a list of 12 ridiculous government regulations that are idiotic and mostly unenforceable. NC's bathroom law didn't make the list. You that are familiar with this blog see where I am going with this.

Since we've now proven that complex problems require innovative solutions from bright people, and can't be wished away with idiot laws forcing us to first be aware of the new laws and then comply with them, what do we do? I think that in the late 60s, if California wanted better gas mileage and clean air, they should have ponied up and given a bunch of smart guys a grant to research the problem and come up with several solutions. The budget for the California Air Resources Board (CARB), the agency that strangled the US auto industry, now has an annual budget of $581 million. In their defense, they do research now to actually come up with a way to achieve their mandates, but they didn't then. I heard it said once that "If they (CARB) took every ten year old car off California Roads and replaced it with a brand new Cadillac, they'd be ahead in both cash and air quality." ...and have happier people.

Flash forward to March 23, 2010 when the Affordable Care Act AKA Obamacare, was signed into law. I remember exactly where I was and exactly what I was thinking: "You can't DO that." Legislation is almost never the answer; we just want to be left alone to pursue our happiness. Go put a man on Mars or something. So now that Obamacare is proven to be a miserable failure (my own personal health insurance is about 50% higher now and I only go to the doctor for the annual physical (which the insurance company ALWAYS finds a way to wriggle out of paying for(and admit it, you like the nested parentheses))), what do we do? Luckily, we saw all this coming and wrote our own EMR which became the basis for Sentia Health. You have read the landing page at Sentia Health, so you know what we are capable of. We use advanced technology to build an insurance company that basically has no people and therefore no people to pay for and only charges the user $10 per month to house the data, similar to Netflix or or Pandora. This is the technology that solves the problem. Legislation is not and never will be the answer to this problem.

Real Solutions

This post was originally published at https://sentiahealth.com/WebLog/Details/6 on 6/1/2016

 

Automating Difficult Diagnoses. Been There, Done That.

On The Healthcare Guys News this morning they write about predicting odds of a disease. Dr. Thomas McGinn is betting that he can predict strep, pneumonia and other ailments by calculating probabilities with a software program.

We here at Sentia Health have had all these thoughts before, during the first season of House in 2004. What Dr. McGinn is going to realize is that there isn’t a direct correlation between reported symptoms and correct diagnoses. After he realizes there is no direct correlation, he is further going to realize that correlation is not causality. There is a 100% correlation between wet sidewalks and rain, but wet sidewalks only cause rain in a very roundabout way and are only a small component of the larger engine that does cause rain. Then there is the problem of correct diagnoses. Some of the time, and nearly all the time until about one hundred years ago, the patient gets better in spite of the doctor or care given. As a white male, when I go to the GP with the sniffles, I get told go to bed, drink plenty of fluids (Glenfiddich doesn’t count) and just wait. Another problem is that Dr. McGinn only has symptoms typed in by whatever practitioner, in whatever way, from which to pull. Common diagnoses like the ones he is mentioning aren’t worth doing the search for, much less writing the software. So we conclude the Dr. McGinn is barking up the wrong tree.

A better idea is to focus on the difficult diagnosis, like the fictional Dr. House. Week after week for eight years he racked his brain to come up with a diagnosis that fit the symptoms. This is where the predictive model shines. Pick out the odd symptom and do a search for it. Look at those diagnoses. Computers don’t discern the quality of the match (usually anyway, look up full text indexes in SQL Server) but they will give an odd match that maybe Dr. House (or Dr. McGinn back in the desert of the real) hadn’t considered. Maybe we could type in all the observed symptoms and see if there was one diagnosis that some brilliant clinician had come up with and cured in a patient in Botswana. This requires a database that correlates discrete symptoms with discrete diagnoses (discrete means values you could pick from a list). The only database we have today that will do that is SNOMED_CT (go back in the blog archives or do a search for it) and Dr. McGinn’s fiasco isn’t built on that. The second thing we need is a web based EMR (again do the search or go back in the archives if you don’t know the term) that has a lot of world wide data to mine. Maybe Dr. McGinn has one large hospital. Maybe he has several. He needs them all.

So yes, this vision is already a reality and Sentia already has a tool with which to do the searches we described above. It is targeted more at managing chronic disease, but is just as effective at finding Dr. House (not Dr. McGinn) style correlations. We can literally generate a list of patients who are pregnant, with systolic blood pressure above 120 triglycerides between 120 and 150 and diagnosed with Dengue Fever. Or any of these. Or all of these. Or who do NOT have Dengue Fever. We tested for that and ruled it out. In fact, here is a screen shot of the criteria generation tool in production today:

Notice the concept text box with the ellipses to the side. That pops up a search window where you can do a SNOMED search right on the page. So, yeah, Dr. McGinn, good thought, bad execution. Too bad we’ve been doing this particular piece of magic since 2009 and doing it better than you can. Don’t feel badly, we are doing it better than anyone else can too. Once we cut the cost of health insurance by 1/3 (that again?!?) and open our EMR to anyone who wants to use it for free, we’ll have all the patients there are world-wide. We already have thousands.

Real Solutions

 





Show Me the Money or Can't Buy Me Love

So I'm doing my normal daily research and I come across one of my usual haunts HISTalk (according to the site owner most people pronounce it HIZZTALK while he prefers H-I-S talk. Go fig.). Anyway, there were two articles about money. In the first, a billionaire doctor Dr. Patrick Soon-Shiong (No, not Noonien Soong, ‘Often Wrong' and no Commander Data jokes, please), offers his company NantHealth for IPO. He claims there is a $50 billion market opportunity, yet he's burned through $324 million already with no profit in sight. His other company, NantKWest is down 70% since it's IPO. Basically this guy is fabulously, filthy, stinking, RICH by offering ‘technology' to the healthcare industry that doesn't work. I'm pretty sure that the way he is connected and with the money he's raised, if his stuff had ANY redeeming value, the market would bow at his feet and lick his boot heels.

Another story (read it for yourself) on HISTalk was about a Cerner (I assume this is them, the site was down) implementation at a regional hospital in Vancouver, Nanaimo Regional General Hospital. This particular hospital spent $174 million on implementing Cerner. Implementing. Not writing, just implementing. After a year of testing they finally started up on March 19. After nine weeks the Emergency and ICU departments have gone back with paper records due to “our concern for patient safety.” Doctors complain that the system is slow, overly complicated and inefficient. “Tests are being delayed, Medications are being missed or accidentally discontinued.” Staff from Cerner itself was brought in to enter orders and even they made eight drug mistakes one day and ten the next.

Why do I bring all this up? Just like anything else, you can't just throw money at this problem. Sure there are people out there who will take every last red cent we can possibly toss their direction, but they have not and very obviously can not solve the problem. What we need is someone who isn't interested in the money, we need someone who is interested in saving lives. If Soon-Shiong was interested in saving lives, he'd be penniless sticking to his ideals while championing a company he really believed in, instead of his companies going down the toilet while he eats caviar and lights his cigars with hundred dollar bills. Likewise, if Cerner was really interested in anything but the almighty buck, they'd tuck their collective tail, refund Nanimo's money (the patients will end up footing that bill anyway) and start over and make a product that works as advertised.

So you were waiting on the plug. Here it is. We here at Sentia Health don't care about your money. We need enough to write the code that practitioners need to do their jobs and maintain the servers it runs on and maybe buy a pizza now and again. We see efficiencies in combining services so our insurance company gives the use of our Electronic Medical Records (EMR) management system away for free. If we do things the right way, the money will take care of itself. Cerner is an EMR. Cerner is not doing things the right way. I could build a jetliner for $175 million. Are they trying to tell me that setting up their crappy software is worth more than an entire jetliner? How about a couple grand in setup fees per hospital and then nothing else? Further, out of the $3 trillion Americans will spend on healthcare this year $1 trillion will be completely and unapologetically wasted by fat cat insurance companies. That $1 trillion doesn't include Soon-Shiong nor Cerner nor entities like them. We can replace that whole ugly mess with a pay per use fee of $10 per user per month. If there are 270,000,000 insured people in the United States (there are) and their insurance companies are wasting $1,000,000,000,000 (they are) that means that every insured person in the United states is paying over $3700 per year or about $310 per month average for health insurance. Let's get back to our original thesis: You can't solve this problem with money. You need smart, motivated people who care about making the world a better place, not cashing in. For the $174,000,000 that Nanaimo alone spent, we could automate most of the planet using a software generation tool built by our parent company Sentia Systems.

That $10/month for managing the data of your health insurance sounds pretty good now doesn't it?

Real Solutions





The Patient Side of Value Based Care or Changing Health Behaviors in a Large Population

The day before yesterday we discussed the "How tos" of health insurance. We are talking about nuts and bolts of how to effect healthcare reform from insurance to individual behavior modification. Yesterday, we talked about value based healthcare, or paying doctors who are effective at keeping people healthy, not just seeing more patients, doing more tests, and performing more procedures. Today, we are going to discuss how to actually engage the patients and educate them in such a way that will cause them to act in a way that promotes health.

Obviously, simply scaring people by saying "you are going to die" is not so effective or we wouldn't still have people who smoke. We come at it a little differently, from a three pronged approach. The first is history and lifestyle questions. We let the patient tell us things like how many cavities they've had filled or how often they eat out, or how many 'touches' they get in a day. These are things that they don't normally think about and some they wouldn't even know could be a problem. The second plank of our approach is, of course, hard science. Respiration, heart rate, lipid panel, height and weight, glucose and/or A1c along with several others. These show the patient specific measurements that his or her behavior is affecting. We rank each of these measurements as normal, watch, or critical, with watch and critical highlighted in yellow or red. The third part of our approach is to combine all this data into one easy to understand number representing the patient's "Body Age" based on the Uth Sørensen VO2 uptake equation and modified with the patient's answers to the lifestyle questions. When the patient naturally compares his or her chronological age with the body age and comes up lacking, they get the message that "you've burned x number more years than you've lived," or as I prefer, "hard living puts you in an early grave."

So that's all well and good, but we haven't done a thing to modify behavior, and that was the original premise. For the lifestyle questions, we think that simply making the patient aware is enough. If you don't brush your teeth, you increase your risk for a heart attack (remember us making reference to that question and you wondering what that had to do with the price of tea in China? Now you know.). Improving BMI, blood lipid levels and other hard measurements is a little more complicated. What we do is prescribe patient education that shows exactly what the patient's measurement was what the aceptable levels are, how the former relates to the latter, and how to bring that measurement back into the normal range. Sure, most of the advice prescribed is "eat better and exercise more" but it't also WHAT to eat HOW MUCH to eat and HOW and HOW MUCH to exercise.

Back to the thesis: how does this affect the health of the patient? If they don't do the reading, and we can tell, it won't affect anything. If they don't modify the behavior, and we can tell, it won't affect anything. We end up going back to the old saw that you will learn to love to hate: The new breed of insurance company described at https://sentiahealth.com. This insurance company will offer discounts to people who maintain a healthy lifestyle. In precisely the same way we incentivized doctors yesterday (...or Friday is you were REALLY playing along), we will incentivize patients today, with cold, hard cash. If you as a patient increase your health, as measured with our hard science, or maintain your health, you get discounts. If your health gets worse, you don't get discounts and we hit you square in the wallet. The more you go off course, the more you pay. Before any of you bleeding hearts start wailing "not fair" remember YOUR insurance premiums are predicated on everyone's behavior, good bad or indifferent. Today, literally, they smoke and sit on the couch eating bonbons and watching Maury 36 hours a day and you pay for their bad behavior.

Again, all of this happens automatically with no human intervention, the way we have been talking about this new breed of insurance company since we began. There is no judgement, there is simply the consequence of your actions. This is absolutely fair as well. We aren't asking everyone to be Mr. Universe, just don't get any worse and we are showing you what to correct and how to correct it as well. This will yield:

Real Solutions

Making the Transition to Value Based Care

First, what is value based care and what isn't. Currently we live in a pay-for-play world, much like the Warner Brothers (and the Warner sister, Dot). That means that when you go to the Doctor or the hospital you are charged based on what procedures they perform. The more patients they see, tests they order and procedures they perform, the more money they make.

A value based system measures patient health over time and pays the practitioners accordingly. The healthier the population is, the more money they make. The goal then is to deliver effective care or quality care not volume of care.

The only organizations who currently have any data on which to judge effectiveness of care are the insurance companies. While they have a vested interest in keeping you and yours healthy, and thusly paying out less in claims, they don't. Maybe they aren't smart enough. Maybe they just don't care. Maybe they figure you are the author of your own fate and can keep yourself healthy. Maybe it's just too much work. Whatever the reason is, they simply don't do it.

I guess we need a new type of insurance company (As if you didn't see that coming). Assuming everyone reading this has already read the front page of the Sentia Health site, I am going to explain what we here at Sentia have already done to manage the health of a population..

We have come up with an Individual Health Analysis that is based on bloodwork, physical measurements like blood pressure and heart rate, and lifestyle questions to come up with an individual report that shows the patient what kind of physical condition he or she is in. This data is analyzed instantly by the system and appropriate patient education is prescribed on the spot and is available for the patient to read right on that site.

That doesn't have anything to do with the population though, does it?

This individual data can be rolled up into a Population Health Analysis that details the number of people with any of the tested conditions, any of the answers to the lifestyle questions and any answer in patient history. These Population Health Analyses can be compared year over year to see if a practitioner's population (or a practice or a hospital or a geographic region) is getting healthier or less healthy over time. There is also a Current versus Prior Health Assessment that aggregates the health of individuals against themselves in their own most recent Individual Health Analysis and shows the results side by side. That makes it even easier to gauge the efficacy of a practice.

What should this new insurance company DO with this information (that is currently available, by the way, use the Contact Us page to request a example copies of both)? We should come up with a scheme to reward doctors who are most efficacious based on the number of procedures and the healthiness of the population to reward those who are doing well. Let's call that state 'art with a minimum of steel.' Those who order more tests, perform more procedures and generally try to game the system will have to squeak by on whatever it is we negotiated to pay them, and not a penny more. This new insurance company will not mind making these extra payments either, since it decreases costs of healthcare altogether and makes it more affordable for everyone. We get paid either way, our nominal $10 per month is going to cover the cost of our operation but a healthier United States benefits us all.

All of the things in today's blog are already in place on the Sentia Health site, can be produced in under one second by clicking a button, and being used currently. I know it sounds like an advertisement, but we really are doing things better. We have:

Real Solutions

Why Does the Doctor Always Hand You a Ream of Forms To Fill Out, and How Do You Make Them Stop?

So I get my usual email this morning from my buddy John Lynn over at EMR and HIPAA and one of his acolytes, Anne Zieger, is recounting a recent experience where she went to her primary care physician and was handed a sheaf of paperwork to fill out. Anne has Parkinson’s Disease and it is difficult and painful for her to hand write on forms. Even worse, when the practitioner finally saw her, she had to answer all the same questions a second time. Even worse, I’m absolutely positive (I’ve seen it happen and heard more about it) the same practitioner has to type the hand written responses into their EMR, wasting time, effort and money.

We here at Sentia can’t help with being asked the same questions verbally a second time. What we have done is given your practitioner the ability to come up with their own questionnaires so that first, you don’t have to write your name address and phone number a thousand times (hyperbole, the sign of good literature, or at least of reading Bloom County in the 80s) and second that your responses don’t take up a valuable practitioner’s time to re-type into his or her EMR

Here is how it works: You come in, see the receptionist and he or she assigns whatever prebuilt questionnaire is appropriate and hands you a tablet or directs you to a kiosk to fill it out. Alternatively, since you already have access to Sentia Health’s EMR, you as a patient can go in and fill it out ahead of time, from home. Not to mention that you can see all of your medical records right there in the system, including notes, x-rays and whatever else the practitioner wants to put in there.

From the practitioner's point of view, he or she doesn't have to keep up with paper, make copies that get skewed and blotchy over time, and only has to build them once with our questionnaire building tool.  He or she doesn't have to provide pens, paper, copies and can tell you to access your records and take the questionnaire from home so you aren't sitting there for half an hour sucking up air conditioning and making everyone else sick/getting sick from everyone else in the waiting room.

We have solved problems you didn’t even know you had. Contact us at info@sentiahealth.com or visit us on the web at http://sentiahealth.com. We provide

Real Solutions

Healthcare IT: a 'How To'

In the coming weeks, we are going to explore several topics relevant to healthcare and specifically Information Technology(IT).  while you digest yesterday's installment, think about all the little things that are going to be affected by redesigning the way we pay for healthcare, like, say, data security in a healthcare environment.  

 I have been reading the Health IT and Insurance blogs for years and sometimes commenting but never written my particular views on the subject from scratch. So here we are. My goal is to bring the expertise of development to the conversation. I see lots of "we should do this or that" but no real plan to move forward. Until now.

A few mornings ago, I was clicking around and it seemed that the general topic of conversation in the Health IT blogosphere was security. On the Chilmark Research site they are shouting about Happtique shutting its doors because they found some glaring security holes. I did a search and found that Wellpoint was fined $1.7 million for exposing health and demographic information and Social Security numbers across the internet (for details click here) while Cignet Health is fined $4.3 million for not providing patients their own records (for details click here). What is the takeaway? You have to give your patients access and that access has to be secure.

I know from my experience as a software developer for more than two decades that security is an add on in 99% of all development situations and clearly that is what is going on here. If you go to Dice.com or Monster.com you can see thousands of jobs for "Senior Security Architect" or "Information Security Specialist – Cloud Technology." Making your specialty security in the IT world is a little like a chef who calls his specialty boiling water. Security is part and parcel of any application.

So how do WE do it? I’m glad you asked. First, we have one user that has access to the database from the internet. On our production sites (that have completed development) there is that user and one more, the System Administrator. I know this because that System Administrator wears my underwear and shaves my face in the morning. The internet user is denied privileges on all data tables and can only "see" the procedures we give it access to. Because we do everything exactly the same way every time, we have a procedure that programmatically grants that user the privileges it needs to get the job done. This one internet user is a proxy for the end users, meaning that they supply their own username and password that is passed into the application over https (secure sockets, SSL, is ultra-secure unless the NSA is looking and we can foil even them, more on that later) where the end user is issued a Globally Unique Identifier(GUID) that identifies that sessions and a LastActivity, so we can time out inactive users. This GUID not only identifies the session but also the user in the session and the session’s machine name and Internet Service Provider (ISP). We check all of this every time the user makes a request to the database to make sure that the session is live, has access to the records they are trying to view and hasn’t been hijacked by a "man-in-the-middle." Just as important as limiting access to need-to-know users is auditing. Inside the procedures the internet user sees, is logic (again same way every time) to validate the end user’s session and to document what they are doing. In Sentia’s Electronic Medical Record Management System (EMR) we can tell you who looked at a patient, what they saw, if they changed anything, what the old values were, what the new values are and when it was done. So far, we have kept every record of every change made in the production environment for thousands of patients.

on our sister site http://sentiasystems.blogspot.com, we are discussing the right way to build software with Part I of the intro: Software as a commodity.  Check it out!

Maybe this doesn’t really make sense to anyone but us, and that is ok. Before YOU Mr. or Ms. Healthcare IT User spend another dime on technology, make sure your vendor has at least as good an answer as we do.

Getting Started: A Treatise on Cutting One Trillion Dollars From the Cost of Healthcare in the United States Without Sacrificing the Amount of Care or the Payment to the Care Givers.

How To Cut 1/3 From the Cost of Healthcare

Without affecting payment amounts to facilities or providers at all.

This page is going to briefly demonstrate a way to accomplish the following:

• Cut a significant portion of the cost of medical care with tools that exist and are in production today (in this very site)
• Reduce the cost of healthcare by improving the health of every person by automatically interpreting medical data and prescribing education tailored to that individual on how to live a healthier lifestyle
• Improve every facet of the business of medicine by streamlining processes and eliminating waste
• Reduce the cost of healthcare by giving the patient access to his or her own medical records (in this very site)
• Reduce the cost of healthcare by providing a no cost Electronic Medical Records Management System (EMR) already in place. (at Sentia Health)
• Show the impact of the program and reduce fraud with detailed aggregate reporting already in place (at Sentia Health)
• Show how to integrate all legacy medical data into one repository.

The current state of affairs

Insurance

Insurance companies don’t make a product, they provide a service. The service is to provide their clients with a collective fund from which to pay for the population’s health care. In other words, clients pay into a large fund and the managers of the large fund pay for the individual’s healthcare. Insurance seems fairly simple, so why is it so expensive? Netflix provides a service which is similar to insurance: they take a pool of money from their clients, use that money to purchase the rights to television, movies and even original programming and charge about $10 per month. They accept search requests from users, they display a list of movies and shows that match that request, and then they deliver the movie or show digitally. They keep track of what episode or movie you have seen, what you want to see and how much you have watched. In a nutshell, they manage data. Insurance may be a little more complicated, but not as much as you would think. When you, as a patient, visit your doctor, several things happen. The doctor or nurse practitioner makes notes, written, dictated or otherwise. These notes go to a coder who translates them into ICD-10 (International Classification of Disease) codes that are transmitted to the patient’s insurance company. The insurance company then checks the codes against the patient’s particular policy, and pays (or rejects) the claim. If rejected, the coder recodes the claim and negotiations ensue until a suitable code is found. Otherwise, you, as the patient take over these negotiations, wasting your time, the practice’s time and the insurance company’s time. Usually, a rejected claim is simply paid by the patient.

Why we need change

The insurance companies have no way to inform doctors, nurse practitioners and caregivers what procedures they will actually pay for, nor the amount they will pay on any given policy. Further, not only is there no way to get this information without actually making a claim, we have to have a medical coder to even ask if they will pay for services already delivered. In the example above, if Netflix ran its business that way, we’d need a highly trained, highly paid individual to search for our movies before we could even see if they were available.

The Solution

From the above descriptions, it looks like Netflix is doing it right and insurance companies are doing unnecessary work and charging outrageous amounts for it. What we need is an insurance company that realizes that they are only managing data, like Netflix does.

Eliminate Paper

In most practices (and every one I’ve been to) the first thing you do even AS you are being greeted is to be handed a clipboard with a sheaf of papers that you fill out, with this same information over and over. You probably write your name, address, phone number and social half a dozen times. As tedious as that process is, someone at that practice has to come in and key it into their Electronic Medical Records Management System (EMR). This monumental waste of effort (anecdotally) is costing between $25 and $35 per patient per visit. That may not seem like a lot until you think about all the patients in all the practices in the entire country, it adds up. Let’s also think about the amount of time that the practice is going to spend looking for the pieces of paper you filled out last time. Let’s also consider the time you personally spend filling out the same information, over and over. Let’s put the cost of that at a proprietary 10% of the cost of your average visit. Our new insurance company would have to eliminate all paper, and publish the necessary things in an internet application for the patient to fill out once ahead of time.

Medical Coding

The first thing this new breed of insurance company is going to accomplish is to provide a set of procedure codes suitable for both documenting the patient encounter and paying the claim. While ICD-10 is great improvement over ICD-9, neither was ever intended to do what they are being asked to do. Luckily, the National Institutes of Health (NIH) provides a rich set of codes designed to do exactly that. It is called the Systematic Nomenclature of Medical Terms – Clinical Terms (SNOMED-CT). This is a database that is intended to code patient encounters in English, and we here at Sentia have made it easily searchable by category and corrected for spelling. This will eliminate the need for a medical coder and the associated costs of that medical coder. Let’s put that savings at an arbitrary 10%. That makes sense when we roll in the negotiation of what is covered and what isn’t.

Assign Dollar Values to SNOMED-CT Procedures

This is very straightforward. The designers of the SNOMED-CT have "crosswalk" information included in the database that loosely translates SNOMED-CT procedure codes down to ICD-10 codes so we will have a good place to start assigning dollar values to the SNOMED-CT procedures. There is no reason to do this work a second time.

Assign SNOMED-CT procedures to Policies

Once the dollar values are assigned, we can create insurance policies that mimic the procedures currently covered by the polices the old insurance companies provide now, according to government guidelines, simply substituting the more granular SNOMED-CT codes for ICD-10 codes. There is no reason to do this work a second time.

Price the New Policies

Pricing is the key in this new solution. We want our actuaries to come up with a Total Cost for a population and price the policy at that cost. We want no profit from this. We simply want to pay for medical services provided.

Provide a Free Portal

The new insurance company will provide an application that is suitable for both documenting the patient encounter and paying the claim with no other human intervention. Any medical practitioner will be invited to create a log in and use this application free of charge. Any patient that has insurance with our new insurance company will automatically have his or her particular policy information instantly available so the practitioner knows what is covered, what is not and how much the insurance pays. Let’s reiterate that. Practitioners See Coverage Before Service is Rendered. Once a diagnosis has been made, the practitioner can see exactly what the patient’s insurance covers. This eliminates not only the medical coder, but the negotiation between Practice Management (billing) and insurance. That means that the practice can be paid before the patient leaves the facility.

Provide a Free Patient Portal

One of the benefits of an internet based solution is the ability to give the patients themselves access to all medical records. If the patient is away from home and needs medical attention, they or a family member can give access to medical records including all services rendered, images, x-rays, growth charts and more.

Insurance as Data Management

Now that we have eliminated the inefficiencies, and priced our policies at true, dead cost, we can think about the business of insurance. Sentia can (and currently does for thousands of clients) manage the data for a nominal fee. We would be thrilled with $10 per user per month, comparable to say, a Netflix subscription. This Data Management fee would replace ALL the fees, charges, mishandling, inefficiencies and miscellany that insurance companies charge currently. The Affordable Care Act mandates a Medical Loss Ratio (MLR) provision of 80% payout ratio of premiums to healthcare providers. This is also known as the 80/20 rule. They are allowed to keep at least 20% (in many cases 25%) of the premium for overhead and profits.

Eliminating Inefficiency

Eliminating paper will save approximately 10% of the cost of healthcare. Eliminating medical coding and negotiating will net an approximate 10% reduction in cost alone. Seeing the payment process as data management and eliminating the overhead we will eliminate another 20%-25% of the cost of healthcare. That means that in lieu of a $10 monthly subscription to manage the data, this new insurance company can cut out a conservatively estimated 30%-35% from the cost of healthcare.

Total Savings

A patient currently paying $300 per month for health coverage would now be paying $210 per month ($200 plus the $10 subscription) with no other changes to the medical system. Further, if the pool of money used to actually pay for the care grows, this new insurance company can and will turn the excess back over to the policy holders. If you are paying $1200 for a family policy we will cut that down to $810. We earn the subscription fee and that is all we are interested in.

Health and Wellness

Included in the patient portal is a health and wellness program that is completely automated. The patient is prescribed patient education based on a lipid panel and either a blood glucose test or an A1c test and lifestyle questions. The main focus of chronic disease management is diet and exercise, and a ‘Body Age’ is calculated based on heart rate that is simple enough for everyone to understand. The lifestyle questions are geared toward causing people to think about the decisions they make and how they affect health and therefore the cost of everyone’s insurance. This information is available online and is detailed in the Individual Health Analysis provided to each patient.

Aggregate Reporting

Since we are already collecting medical data, we can instantly report on the health of a population. We can also report on the trend of the population based on their current and previous medical data. These reports are written and published currently and are in use by our clients. They are available to users who have sufficient privileges and contain no personally identifiable medical information. They can be used to compare the health of populations over time.

Integrating Historical Data

Importing legacy (and paper via scanned images) data into the new system will be paramount for existing patients. Sentia vends an integration tool that will easily and graphically move this data from its old repositories, whatever they are, to its new home. This data will then be available for the aggregate reports and for practitioners to access when making treatment decisions.

No cost Electronic Medical Records

The new insurance company’s EMR will be available to all. If a client does not purchase insurance through us, the practitioner can still sign up for, and use it free of charge. This should cut costs even further. An Epic or Cerner installation at even a medium sized hospital can run tens of millions of dollars and rarely gets fully implemented. The practitioner will still have to code the encounter for traditional insurance companies with ICD codes, but Sentia will agree to manage that data at no cost.

Considerations

Let’s look briefly at the risks associated with this new way of funding healthcare.

Security

Sentia identifies every session with a globally unique identifier that is never transmitted across the internet. This identifier is necessary to access the database in any way and is generated anew with every login. We are pioneers in security and have industry best in this and many other regards. Sentia is working with security professionals all over the country to help them secure medical and other forms of data.

Fraud

While it’s rare, fraud does happen. Daily, weekly and monthly Sentia can produce reports detailing which practitioners have dispensed a proprietary percentage more than the average of his or her peers. This report will include practitioners who ‘game’ the system by reporting false complexity to procedures (SNOMED-CT allows that) or who perform the same procedure multiple times on the same patient. You only have one spleen for example. This report will flag these practitioners to not be paid in the future or be sent to law enforcement for further investigation.

HMOs, PPOs and Indemnity

The current models are sufficient for the short term. We don’t want to introduce several large changes at once, so we would leave updates here for a later date.

Scalability

Sentia’s EMR is super lightweight and extremely scalable. The entire application can run on a desktop class machine. There will be no issues with maintaining a database of several hundred million. Even with the risks defined above, this new way of funding healthcare has far fewer risks than the way it is being funded now.

Conclusion

• We can cut at least 1/3 of the cost of medical care with tools that exist today without affecting the care or the compensation currently provided.
• We can improve every facet of the business of medicine by streamlining processes and eliminating waste.
• We can improve the health of every person by giving access to his or her own medical records
• We can improve the health of every person by automatically interpreting medical data and prescribing education tailored to that individual on how to live a healthier lifestyle with an application already in place.
• We can reduce the cost of healthcare by providing a no cost EMR access based on the SNOMED-CT that is already in place.
• We can show the impact of the program and reduce fraud with detailed aggregate reporting already in place.
• We can integrate all medical data into one repository using tools that are in production currently.

Since we are obviously in the software business, visit our sister blog at Sentia Systems blog site and read our older blogs at Sentia Health and navigate to the Web Logs section.