POSTED ON JUNE 6, 2012:
Can millions in spending on health care technology help cure what ails Tulsa?
The $12 million in stimulus funds handed over for Tulsa to improve health care technology can also improve the region's abysmal health rankings, said Dr. David Kendrick, chief executive officer of the MyHealth Access Network, which was awarded the grant in 2010.
Without an easy way for doctors to share medical information about patients, "it's a public utility we were missing," said Kendrick.
Like a bridge connecting two communities, Kendrick and his group say technology networks can overcome the lack of communication between hospitals, doctors and free clinics in Tulsa.
And, like electricity from a newly built power plant, the effort will soon be flowing into medical offices across Tulsa -- with patients sharing directly in what Kendrick says will be a clearer, more comprehensive picture of their health.
They may get a jolt.
"Right now, the way the health care system works is, patients go to the doctor when they feel sick, generally. And prevention just doesn't happen as often as it should," Kendrick said. "So, one of the primary objectives here is to make sure that opportunities for prevention are identified right away."
Enter a data analysis tool touted as capable of handling the many medical data points that make up someone's health profile -- like family history, for example -- and providing both doctors and patients with an estimate on the risk of heart attack or stroke within the next three years. Or the likelihood of breast, lung or colon cancer.
"We're really just trying to raise the level of knowledge and understanding about what risk is, and to lower the bar patients and providers have for talking about prevention," Kendrick said.
When will it be available? Kendrick said a pilot group of doctors are now testing out the program, known as IndiGO.
"In the next few weeks," Kendrick said. "As I say, we're pilot accounts now. As soon as those pass muster, then we throw open the doors. We've got 1,100, 1,200 doctors under participation agreements right now."
The San Francisco-based company behind the product, Archimedes, is a subsidiary of health-care giant Kaiser Permanente (which was founded in part by Henry Kaiser, who is unrelated to Tulsa philanthropist and oilman George Kaiser).
The company's promotional materials describe how their model "uses public databases and clinical trial results to develop the algorithms to calculate the risk of adverse events and the impact of interventions on reducing that risk."
In his office on East 16th Street, Kendrick used his laptop computer to demonstrate how the IndiGO product works. A colorful bar graph showed a fictional patient's risk of heart attack or stroke. By clicking on a box that corresponds to a recommended treatment, the risk bar decreased in size.
Kendrick said research has shown that people will be more likely to follow recommended treatment by using the tool.
It also can simplify the idea of risk for both patients and doctors.
"It pulls those numbers together for me and gives me one score for a patient, and it's something that's pretty easily digestible for both of us," Kendrick said.
Kendrick touts the app as just a part of a much larger plan to use technology to make doctor visits more efficient, saving both time and money.
Ken King, president of the Oklahoma State Medical Association, said doctors statewide see the benefit in technology that allows them to share patient information.
But change isn't always embraced.
"I think the concern probably is, on the physician end, in the sense that embracing the technology is causing quite a bit of change within the office," King said.
As far as exchanging information electronically, doctors have little choice but to forge ahead, said Melissa Johnson, the association's director of healthcare policy.
It's all tied to payments and penalties from the Centers for Medicare and Medicaid Services, commonly referred to as CMS, the group that oversees health care reimbursements to doctors for elderly patients receiving Medicare benefits and needy patients relying on Medicaid.
"If you see Medicare or Medicaid patients right now, there is an incentive" to upgrade electronic records, Johnson said. "Eventually, you will be penalized if you're not exchanging information the way CMS wants you to."
From the point of view of many doctors, this technology is "sort of being pushed on them," Johnson said. "And its cost and time and I don't know that it's been proven that you really get a big return on your investment."
Kendrick said the health care policies make it even more sensible for doctors, hospitals and health care providers to pay to sign up and utilize the technology networks, known as health information exchanges, being developed by MyHealth Access Network.
"Our goal was to launch the health information exchange and this effort and then make it financially sustainable," Kendrick said. "We know that we achieve financial sustainability with a certain number of doctors and hospitals, and so that becomes a target for us. And we're nearing our target now."
Tulsa is one of only 17 communities nationally to receive an award known as a Beacon grant supporting such a boost in health care information technology.
In April, Tulsa was also selected as one of only seven regions where a new payment model will be tested for Medicare and Medicaid patients.
Participating health care providers will be paid a monthly care management fee on behalf of their normally fee-for-service Medicare beneficiaries, in exchange for primary care doctors coordinating a wider range of services and making themselves available around the clock.
It's a concept that not every physician will embrace in Oklahoma.
"A lot of doctors that have been around for awhile remember the HMOs," said Johnson, referring to health maintenance organizations. Designed to save money, the HMOs led many doctors to complain about infringements on their clinical independence.
Of course, for the information networks being built with the stimulus funds, Kendrick said the ultimate goal is to improve the health of Tulsa-area residents. He described studies that have consistently shown the state to be lagging when it comes to the quality of health care for residents.
In March of this year, for example, a report by the Commonwealth Fund tabbed Tulsa as tied for 281 out of 306 among hospital referral regions ranked based on overall health-care system performance, including health care access and prevention and treatment.
Kendrick said the tools will help in many ways, with computer apps that will allow patients to share blood pressure readings taken at home with their doctor, for example. Or an app that allows doctors to view on a computer screen a patient's "problem list" and "potential care gaps."
"There are a lot in this region who are walking around with a high risk and aren't even aware of it," Kendrick said.
Kendrick said that many are committed to making the effort a success, pointing, for example, to big-time corporation QuikTrip's presence on the group's board of directors as an indicator of business support. After all, employers face rising employee health-care costs.
Considering the group's short history -- what would become MyHealth Access Network began to form only in 2008 -- Kendrick said that "there's no question the $12 million dollar from Beacon has accelerated it."
Kendrick stated grand ambition of the group: "What we're really trying to do is fix those bad health outcomes and become the community that healed itself. And there aren't many of those."
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