Monday, November 22, 2010

Ingenix's V.P. Strategic Initiatives: Kim LaFontana and the Ingenix Expert Physician Advisory Board

“Using technology in your office should not impede your cash flow, should not slow clinicians down and it should not prevent you from having information. It’s a radical change to your world and the workflow, but what our teams have been focusing on, as we have introduced CareTracker EHR— is how to do it in a way that actually works for the physician and makes them feel like they are delivering better, more efficient care”. –Kim LaFontana

What I would like to begin with is how Ingenix’s recent formation of an independent expert physician advisory board will be tackling the dynamics of health information exchange?

Given our history, our legacy strengths and capabilities are certainly on the software side, specifically on the data and analytics side. We have an incredible legacy of teams of clinicians, who are constantly thinking about using clinical data to help drive better care decisions. Meaningful use— which is the government’s position on the right way to use an EHR, certainly provides some required specifics. However, we feel like there is quite a bit of room within meaningful use on how to execute the requirements. One goal of the board is to figure out how to marry the government objectives in meaningful use and Ingenix strengths and capabilities in a way that actually solves the problems of the clinicians out there in the real world, seeing real patients. So one could construct a beautiful product that meets the government guidelines, but it won’t necessarily be adopted in the “Real-World” because it isn’t practical.

So you mention a disconnect between the meaningful use rules and actual EHR utilization, as the driver in formation of the independent advisory board. What kinds of metrics are you thinking of implementing to insure Ingenix is “Real-World” beyond ONC guidelines?

Using technology in your office should not impede your cash flow, should not slow clinicians down and it should not prevent you from having information. It’s a radical change to your world and the workflow, but what our teams have been focusing on, as we have introduced CareTracker EHR— is how to do it in a way that actually works for the physician and makes them feel like they are delivering better, more efficient care. Getting to meaningful use is a demonstration to us that our product is highly usable and adopted. It also is a demonstration to us that we are helping clients make good decisions along the way.

So we have introduced a series of fields, reminders and dashboards to help CareTracker users know where they are, against any of the meaningful criteria, at any point in time. They can look at it from the group level or they can look at it from the individual clinician level. So, it is a sort of real-time pulse-check… If we see some of our customers falling behind and not hitting certain metrics; or are not able to execute certain functions, we can see that and they [customers] can see that as well. So the nature of our technology makes this issue something we can monitor and help them with; and do so in a relatively unprecedented way.

There are many flavors of guarantees out there for EHR performance and conformance. We feel that our’s is crystal clear…”if you don’t get your meaningful use check from the government then you don’t pay for our EHR”

There is another edition of meaningful use rules in the pipeline. What other “Real-World” usability issues might the advisory board look into for electronic medical record companies?

Stage 1 is really about capturing structured data and being able to report it out in various ways. It contains a few things outside the walls of your clinic—but not too much (interoperability initial requirements).

Stage 2 is when it starts to get more interesting. We have completed a string of acquisitions related to enhancing our capabilities in delivering information end to end. So if you think about Axolotl, which is the health information exchange company we acquired this year… when you are required to share information, share clinical summaries, do more robust reconciliation of patient’s medication lists— having a clinical backbone in place to exchange information is key.

Many acquisitions we have done this year are with an eye two and five years out— Axolotl is certainly one of them. When we start to think about how to acquire customers, and CareTracker is a piece of our customer base, being prepared to start exchanging clinical information, and just having clinical capability in place to both move information around and start thinking beyond stage 2 to stage 3 for decision support systems(DSS).

It is incredible to think about what will be in the next ten years. When I read through the stage 3 requirements…where you are starting to think about actual decision support in the workflow and the use of evidence to drive care decisions.

Just like now, where right now the barrier is usability—and that will continue to be the case. Usability barriers are just going to be prevalent in a different way. What we see now when clinicians receive DSS today what it usually involves is a whole series of alerts most of which are not useful and some of which are not accurate. So clinicians often ignore some alerts.

Why do you think the data are currently represented in that way?

We are still at the infancy of taking data and transferring it into advice. Most analytics are performed on 90 day post adjudicated basis, so by definition, it’s a lagged system. Therefore, if claims are based on information that is 90 days old, in the clinician’s mind, the credibility of alerts is very low.

With so many parties involved in the data stream… what will the board be discussing regarding gray or black-hat data mining; including any other data security issues?

One of the things we are going to ask the board to do, is to ensure we are performing at the level expected and that we—and our clients would require us to be. In terms of data integrity and security, of how we are performing to the standards of data integrity, we have invested an extraordinary amount of time and energy in building redundancy and privacy into the system. This advisory board should take a deeper look at these issues. Ingenix’s hope is that new eyes on this topic will help bring us beyond feature function; to data integrity and governance itself.

Are you planning on collaborating directly with other public or ONC oriented organizations or are you just “taking care of your own house” right now?

The Board is brand new. I can see doing more public outreach in a year, when we have a more defined series of topics that we are deeply engaged in. As you know, these individual board members are esteemed individuals. Ingenix wanted people who both practice medicine regularly and are participating in associations in important ways. We expect the board to become a singular voice on these topics eventually, but there is definitely some forming and norming to do.

How are you working with Regional Extension Centers (RECs)?

Ingenix is actively engaged in all of the discussions when possible. Recently, we have been selected as an endorsed vendor by Rhode Island and Alabama. You can expect a series of further decisions coming out shortly. We are deeply engaged in REC development and we try to “get docs to meaningful use fast.” Therefore, we believe that we offer a great solution and a very competitive product.

EHR Scope would like to give a big thanks to Kim LaFontana and Kyle Christiansen for their time and cooperation.

About Kim LaFontana

Kim LaFontana is Vice President, Strategic Initiatives at Ingenix where she is leading the development of health IT strategies that improve the way physicians access information, manage their practices and enhance patient care.

Ms. LaFontana brings 18 years of health care leadership and business development and consulting experience to Ingenix. Prior to joining Ingenix, she served in key operations and business development positions at AthenaHealth, Inc., a provider of health IT solutions. She also held senior management positions at FirePond, a software development firm; at Accenture, a leading business consulting firm; and at The Wilkerson Group, Inc.

Ms. LaFontana earned her B.A. in Psychology from Cornell University College of Arts & Sciences, and her M.B.A. from The Tuck School of Business at Dartmouth.

About The Ingenix Physician Advisory Board

The Ingenix Physician Advisory Board, a multidisciplinary group of experts, will work with the company’s innovation teams to address the quality and cost challenges confronting today’s health care delivery system. In addition, the Board will provide input that enhances the capabilities of current Ingenix products and processes to help clinicians improve quality and outcomes. Further, the Board will facilitate ongoing dialogue between physicians and the company to ensure that Ingenix products operate effectively in clinicians’ workflow.

About Ingenix

Ingenix was founded in 1996 to develop, acquire, and integrate the world’s best-in-class health care information technology capabilities. Ingenix invests significantly in research and development, and have grown significantly in size, strength, and capabilities to become a leader in health information. Ingenix’s current EHR is CareTracker.

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