Porter’s wish list matches perfectly with our vision at CMT Corp, and our existing physician collaboration platform is poised to play a significant role in transforming health care into the value-focused system we all wish we had. Here is a look at the six components of Porter’s value-based health system and how we can make it happen:

1. Integrated practice units (IPUs)
For the most part, care today is delivered from silos based around medical specialties—orthopedics, endocrinology, nephrology, etc. But organizing care around a patient’s medical condition in IPUs—teams of coordinated providers—offers a better way to manage illness and prevent complications.

2. Measurement of outcomes and costs
Health care systems can no longer survive by providing treatments without knowing how effective they are or how much they really cost. To effectively deliver care, they need to continuously track outcomes and improve diagnostic and treatment protocols to provide effectual treatments at affordable prices without wasting resources.

3. Bundled payments
Instead of billing for every test, pill, and procedure—the traditional “fee-for-service” model—health care providers should receive “bundled payments” that cover the full cycle of care. This payment approach promotes team work and quality of care.

4. Integrated care delivery systems
While multi-site health organizations are frequently called health “systems,” they don’t all truly integrate care from facility to facility. Real integration ensures continuity of care, makes health delivery less fragmented, and eliminates costly duplication.

5. Geographic expansion
Innovative health systems are using “hub-and-spoke” arrangements—managing complex cases at a main facility and relegating more routine treatments to a growing number of satellite facilities or affiliated centers where care is cheaper to provide. This structure also allows broader coverage and reduces travel for physicians and patients.

6. A supportive information technology platform
According to Porter, the ideal HIT platform must have:
–  common data definitions,
–  templates that make entering, accessing and reading data easy,
–  EHRs that everyone (including referring physicians and patients themselves) can see,
–  the ability to collect all types of patient data—from lab tests to x-rays
–  and a system architecture that allows for measuring outcomes and tracking costs.

This vision for HIT is a perfect match with our Physician Collaboration Platform. CMT Corp’s platform provides every one of the elements outlined as necessary for an ideal system, which in turn support several essential factors in the Value Agenda and inspire a transformation in data-driven, collaborative healthcare.

As Health 2.0 founder Matthew Holt wrote in 2006, “If the Porter/Teisberg concept is to succeed, for technology to bring the expertise of centers of excellence virtually to patients in any setting requires an easy, secure method of combining patient records, workflow information, images, and conferencing technologies online…Possibly using technology like CMT C’s, that promise could become reality sooner rather than in some pie-in-the-sky futures.”

Seven years later we’re no longer just talking about the ideal platform, we have it. Most HIT platforms have focused on digitizing existing healthcare delivery processes and payment systems with in the walls of a hospital or healthcare network, rather than improving cross-enterprise physician collaboration and patient care. At CMT Corp, we have honed our product to meet the needs physicians have for improving patient care, matching the list outlined by Porter and his collaborators, and exceeding it.

In our next blog, we’ll delve into more detail about our Physician Collaboration Platform and how it aligns to Porter and Lee’s #6: Building an Enabling Information Technology Platform. We believe that starting with a capable, adaptable collaboration technology, we can support and inspire the rest of the Value Agenda and foster a transformation in healthcare.

Simon Schurr
CEO & Chairman
Collaborative Medical Technology Corporation

Here’s how the CMT Corp platform lines up to the requirements for the “ideal HIT platform”:

Common data definitions

The Physician Collaboration Platform is continuously updated to respond to medical terminology, allowing physicians to use their preferred terms while the system properly classifies the information by its meaning. This capability allows collaboration between physicians from different institutions and even different parts of the world using different medical terminology and classification standards.

CMT Corp has borrowed from the Semantic Web Initiative playbook when it comes to data architecture. We created an innovative clinical document architecture that allows information to be understood by both humans and machines using standardized medical terminology vocabularies.

We have set a high bar for data and data architecture so that it meets the following requirements:

– Meaning (semantics): clinical documents need to retain their semantics over both time and distance.
– Communication: reliable information delivery to the point of care.
– Knowledge Management and Workflow: leverage investment in information through re-use. The information stored in numerous clinical documents physician notes, observations, orders, claims, clinical trials shall be re-used for decision support, guidelines and protocols, rules, document templates.
– Interoperability: exchange information and use the information that has been exchanged.

This built-in “intelligence” can facilitate physician/clinician alerts to relevant data, ensuring that urgent patient situations or conditions are elevated promptly.

Templates that make entering, accessing and reading data easy

The CMT Corp Physician Collaboration Platform uses “intelligent” templates and workflows to present data so that it is logically organized and prioritized for physicians following standard (or customized) diagnostic process and treatment evaluation protocols

EHRs that everyone (including referring physicians and patients themselves) can see

The CMT Corp platform is designed for access. It enables physician collaboration in a logical and seamless way, ensuring continuity of care with HIPAA-compliant data sharing on any internet-enabled device. In a future roll-out, the technology will allow widespread patient communication, data entry and viewing.

Today, with their data organized and structured in a prioritized template, patients can act as their own referral manager to request a consultation or apply for access to clinical trials. (We’ll give an example of this capability in a future blog.)

The ability to collect all types of patient data—from lab tests to x-rays

CMT Corp. has spent more than a decade honing the technology that makes it easy to move patient images and data. The data is arranged in a patient-centered schema, ensuring that the information is not presented out of context. Lab tests and x-rays are the easy part! The challenge comes with digital images—sonograms, CT scans, MRIs, PET scans, etc.—where even after the file is transferred, it may not be accessible using the recipient’s software. The Physician Collaboration Platform eliminates the issues of platform compatibility by embedding all the desired readers into a single system.

The CMT Corp. platform will also facilitate the formation and management of Accountable Care Organizations (ACOs), bringing all of a patient’s information into a single system even if the caregivers are not on one technological platform.

And a system architecture that allows for measuring outcomes and tracking costs.

As more data becomes part of the Physician Collaboration Platform, outcome and cost measurements can be computed for one health care system, locally, regionally, nationally or across seas. The ability to assess performance and value to support evidence-based medicine is clear, especially for rare conditions in which sufficient data can only be collected across geographical distances.

If you think your EHR can do all of this, think again.

Even if you are using the most common EHR on the market and the specialist you refer to uses the same one, you don’t have all of the capabilities Porter and Lee described as critical. The CMT Corp. Physician Collaboration Platform provides true interoperability between doctors anywhere. Traditional EHRs include customizations and other technological differences that prevent seamless data sharing. We’ve solved that problem by normalizing data allowing systems to “talk” to each other with ease.

Also, an EHR is an historical health record that is not designed to facilitate an episode of care, such as a referral or second opinion. The EHR stores information, but does not structure it along protocol guidelines to deliver all the relevant data a physician needs in an organized workflow. Our Physician Collaboration Platform does just that, ensuring that any missing data is highlighted and putting the most useful information front and center to assist the clinician’s work. In this way, the system supports regional doctors to perform with the same protocols as top doctors at renowned medical centers, helping ameliorate the shortage of specialists and geographic variations in the quality of care.

Now that’s progress!

Simon Schurr
CEO & Chairman
Collaborative Medical Technology Corporation

These topics need urgent attention as a growing number of American patients are seeking care outside the U.S., according to Patients Beyond Borders, a resource organization for medical tourism. The number of American medical tourists has been rising by 20 to30 percent annually—with 900,000 Americans expected to go overseas for care this year. And that doesn’t include tourists who get sick while traveling.

The U.S. receives its own share of medical travelers. Bloomberg News deemed it the 3rd leading health destination with 800,000 international patients seeking help with the most complicated health conditions.

One key driver is cost. Procedures done abroad offer savings up to 70 percent, according to a report from Deloitte. In one case recently described in The New York Times, an American who flew to Belgium for his hip replacement slashed his costs from about $78,000 to $13,660.

Patients aren’t the only ones looking for a bargain. Employers and health insurers are outsourcing some health procedures to overseas facilities. For example, Anthem Blue Cross and Blue Shield in Wisconsin offers to send employees of their corporate client Serigraph to India for some elective procedures, while Blue Cross Blue Shield of S.C. covers patients’ surgeries done in Thailand.

Concerns about quality are waning as a growing number of foreign health hospitals and clinics are owned by or affiliated with elite health U.S. centers, including the Mayo and Cleveland Clinics, Duke, Johns Hopkins, Harvard, and Tufts Universities. More than 220 healthcare facilities in other countries have been accredited by the Joint Commission International (JHI), an affiliate of the Joint Commission, the main hospital accrediting organization in the U.S.

Medical tourists may get bargains on quality care and enjoy the perks of travel, but seeking care far from home is a complex undertaking. In addition to navigating the travel itself, patients need to find healthcare providers near home who are willing to coordinate care such as pre-op testing and rehabilitation.

The American Medical Association (AMA) has created guidelines for medical tourism, including advice about coordinating follow-up care to ensure continuity of care and the transfer of health records following HIPAA guidelines. EHRs and add-on technologies can facilitate physician collaboration and continuity of care. Tools such as the CMTCorp Physician Collaboration Platform can be a valuable resource for medical tourists and their physicians. Providers and insurers can use these tools to expedite communication and the secure transfer of records. Those who use such a system can better help the growing number of patients seeking care abroad, establishing an expertise in coordination with overseas medical centers.

Medical tourism offers an increasingly attractive healthcare option and a growing trend. Patients and providers need solutions that make it easier and safer than ever, and we’re excited to be a part of that.

Simon Schurr

CEO & Chairman

Collaborative Medical Technology Corporation

After nearly 20 years in the healthcare IT space, some of the vital technology and common terminology building blocks have been constructed, implemented and evolved – but our healthcare system still needs a radical breakthrough in order to survive the next decade. As Michael Porter and Thomas Lee warned in their October 2013 Harvard Business Review article ‘The Strategy That Will Fix Health Care’, “Providers that cling to today’s broken system will become dinosaurs.”

The good news is we are witnessing early success of transforming our health care systems, networks and culture of care to be patient-centric and outcomes-driven. Plus, we have watched how fast change can happen with online commerce (eBay, Amazon), travel booking (Travelocity, Expedia, Kayak), social networks (Facebook, LinkedIn) and communications (Skype, Twitter, GoToMeeting). But NOW the challenge is accelerating the adoption of proven advancements while the existing healthcare model is being forced to adapt.

Some ideas to consider:

Collaboration. More and more, medicine is being defined as a team sport. Delivering appropriate care hinges on the nimble exchange of information, from second opinions to expert consults, and the ability to make the right referrals to the right doctor the first time. Today’s health systems, doctors, and the patients they serve are beginning to benefit from affordable broadband, new communications and collaboration platforms, expanded geographies and new medical teams focused around patients’ conditions – which Porter/Lee describe as “integrated practice units”.

Semantic Web. World Wide Web pioneer Tim Berners-Lee envisioned a web of data that could be processed by machines, and health data may be where the dream is first realized. The proliferation of medical ontologies provides the building blocks and we’re nudging closer to truly intelligent search and data-mining paradigms. That represents a huge leap forward for doctors aiming to identify referrals and consults with precisely the right experience.

Intelligent Templates and Workflow. These advances hold the promise of revolutionizing workflow and increasing interoperability by making EHRs more sharable. Clinicians and their patients stand to reap benefits from the outcomes research the data generates and the diagnostic protocols and treatment algorithms that result. Healthcare will be safer, more efficient, and more effective.

Professional Social Networks. More doctors are connecting and sharing information on professional social networks like Doximity, QuantiaMD, and ShareCare. Recent data show that more than 65% of doctors use some form of social media for professional purposes, though the potential for physician collaboration is still much greater than these platforms can allow.

Mobile. Doctors are increasingly incorporating online medical information into their daily workflow — researching patient conditions on a cell phone or tablet before, during and after patient consults. Some health systems are even devising “Twitter”-like services that connect the members of a patients’ care team, helping ensure continuity of care as patients move through the system.

Patient Empowerment. Meaningful use provisions require deeper patient engagement, and it is coming. According to a recent study, more than 50 percent of hospitals have a patient web portal and increasing numbers plan to offer patients the chance to view, download, and transmit their own data and send their doctors secure messages by 2014. More health consumers are using social media to get health care information. The use of social media for healthcare research among patients rose 21 percent in the last two years, research shows.

So — it is with optimism and curiosity that I plan to participate in the days ahead. Through joining our efforts we can more rapidly achieve our common goals of appropriate care, better outcomes, and healthier people.

Simon Schurr

CEO & Chairman

Collaborative Medical Technology Corporation

The reality is not as bleak as the headlines. Americans still get remarkably high-quality healthcare, in general. Despite the alarmist nature of these media stories, they do point to some important areas that need improvement. Today, we are on the verge of significant changes with the potential to bring improvements.

Here is information from four recent reports that caught my attention:

Problem #1: Unnecessary Surgeries

“Tens of thousands” of unnecessary surgeries were performed, according to a USA Today review of medical databases and government records. They also found that “Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures.”

A few specifics they cited:

• Spinal fusion: About 10% of surgeries covered by Medicare in 2011 were not necessary.
• Back and neck pain: More than 17% of patients were told they needed surgery when they did not, according to another 2011 study.
• Implantable cardiverter-defibrillators: 22.5% of the patients in a 2011 study did not need the one they got.
• Angioplasty: A 2011 review of cardiac patients who were not having heart-attack symptoms found that 12% who had angioplasty did not need it. Many also had stents inserted.
• Hysterectomy: A 2000 study of women in nine southern California managed care organizations found that 70% of the procedures were inappropriate; non-surgical treatments were not tried first.

Problem #2: Overtreating Back Pain

Earlier this month, The New York Times reported that doctors were not following guidelines when caring for patients with back pain, according to a new study from the Journal of the American Medical Association. Rather than starting treatment as recommended—with NSAIDs or acetaminophen and physical therapy—many physicians ordered pricey scans, prescribed strong painkillers and sent patients to specialists. The study discovered that this overtreatment has become increasingly common, even though it is rarely necessary or helpful. Back pain usually gets better within a few weeks with little or no treatment .

Problem #3: Mistreating Ovarian Cancer

Earlier this year, a disturbing study was presented showing that just slightly more than one-third of ovarian cancer patients receive the right care. In their coverage of the study, The New York Times reported: “Most women with ovarian cancer receive inadequate care and miss out on treatments that could add a year or more to their lives.”

The report blames much of the mistreatment on doctors’ lack of experience and suggests that women fare better seeking treatment at major cancer centers. There, they are more likely to be treated by a gynecological oncologist who has experience with the lengthy, complicated surgery necessary to remove as much of the cancer as possible, giving chemo drugs a good chance at getting rid of the rest.

Problem #4: Outdated Procedures

Just a few weeks ago, The New York Times reported that many patients are receiving the wrong medical care in general. “More than 40 percent of established practices studied were found to be ineffective or harmful, 38 percent beneficial, and the remaining 22 percent unknown,” they cited, from a study in the August issue of Mayo Clinic Proceedings. On the list: hormone therapy in postmenopausal women, high-dose chemotherapy and stem cell transplant for breast cancer, and intensive glucose lowering in Type 2 diabetes patients in intensive care. At the same time, outdated ideas persist that prevent patients from appropriate care, such as the fear that oral contraception will harm lupus patients, that vaccines might harm people with multiple sclerosis, or that epidurals increase rates of C-sections. The study author, Dr. Vinay Prasad, said old treatment beliefs take about 10 years to die out after they are proven wrong.

The Causes and Cures

The causes of inappropriate care are complex, but often the root is simply lack of knowledge, an honest mistake, or a healthcare provider who simply wants to help a patient when treatment isn’t working. Sometimes, profit-driven decision-making or fear of malpractice claims lead to over-testing and overtreatment.

Thankfully, a few forces are driving medicine in the direction of increasingly appropriate care. To name a few: Healthcare reform (The Affordable Care Act) and Accountable Care Organizations emphasize adherence to evidence-based medicine and approved protocols. Insurance companies often join in; ultimately, appropriate care should be less costly and more effective than unproven, outdated or unnecessary treatments. The push toward electronic medical records and e-prescribing should enhance continuity of care and reduce errors due to missing charts or illegible handwriting. Using EMRs generates a wealth of patient data, which could provide more evidence upon which to create and update appropriate care protocols.

But if Dr. Prasad is right, it could still take 10 years for new medical evidence to become broadly followed. In the near term, the best approach may be a combination of well-informed patients asking the right questions and seeking top doctors who stay abreast of the latest research, and rigor in using second opinions. The last point may be the most useful. Consider this evidence from the USA Today report:

A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.

These numbers provide the strongest hope for rapidly improving the rates of appropriate care. Insurers often insist on a second opinion prior to surgery. Patients and doctors should, too.

Additional Sources:

http://www.niams.nih.gov/Health_Info/back_Pain

http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Low%20Back%20Pain.aspx

http://www.aafp.org/afp/2000/0315/p1779.html

Here at Collaborative Medical Technology Corporation (CMTC), we’ve been dedicated to one thing for the past decade: Developing the disruptive and innovative information technology solutions necessary to facilitate a sustainable global healthcare system.

Our mission is ultimately to advance patient experience and outcomes by improving the effectiveness and efficiency of healthcare delivery.

We haven’t shifted from that core mission, but as the transformation of the U.S. healthcare system accelerates, it’s inspiring us to transform as well. We’ve been busy innovating to keep up with the changing healthcare environment and technological advances.

With the rapid advancement of technology over the past three years, CMTC has re-engineered its entire solutions suite to operate from secure, cloud-based computing. We developed the Physician Collaboration Platform (PCP), on which we’ve built five applications designed to help close some vital gaps in the current healthcare system:

• Gaps in compatibility between hospital systems
• Gaps that prevent physicians from getting the right clinical data and images when they need them
• Gaps in easy physician and clinician collaboration
• Gaps in easy physician and clinician collaboration
• Gaps in getting fast, accurate second opinions
• Gaps between doctors’ expertise in different geographic areas
• Gaps in patient access to the right specialist

– and the list continues.

Our vision at CMTC is to support “Medicine Without Boundaries”. We offer a secure and simple system that allows physicians and patients to connect with each other anywhere, using tools and protocols that help ensure each physician has all the relevant information and expert consultations to offer each patient the appropriate care.

As we embark on the launch of our new website to showcase our cloud-based platform and applications, we’re excited to share how we’re helping accelerate the transformation of healthcare for patients and providers everywhere.

We’ll be using our blog to talk about the latest news, including advances in the CMTC suite of solutions as well as the healthcare transformation in general. We look forward to hearing your thoughts, too. Send us an email using our Contact page to share your ideas and inspiration.

Simon Schurr
CEO & Chairman
Collaborative Medical Technology Corporation