Category Archives: e-health

par8o and IRCDA team to automate clinical assessment with SCAMPS

Scamp meet SCAMP

Scamp meet SCAMP

par80 and the Institute for Relevant Clinical Data Analytics (IRCDA) have teamed up to enable sophisticated clinical decision support at the point of care using SCAMPS. I asked Dr. Adam Sharp,  par80’s cofounder, president and chief medical officer to explain.

  1. What are SCAMPs? How do they differ from evidence-based protocols?
    • SCAMPs are Standardized Clinical Assessment and Management Plans. SCAMPs outline a data-backed, consensus-based, care pathway for a diverse patient population with a particular diagnosis or condition. Data is collected on the treatment and outcomes of that population, analyzed, and then used to improve the care pathway
    • While evidence based protocols can answer highly specific medical questions, the traditional methods are inadequate to address the interdependent questions related to defining effective care
    • SCAMPs aim to bridge the gap with a method that is integrally linked to continuous improvement
    • Additionally, SCAMPs aim to reduce the cost of delivering care to patients while improving quality by focusing on standardization of care and reduction of unnecessary utilization
  2. What are some examples of SCAMPs? What value do they provide?
    • There are a wide variety of SCAMPs, ranging from the inpatient to outpatient to ER settings. Some examples of SCAMPs are the Congestive Heart Failure SCAMP (inpatient) Distal Radius Fracture (outpatient), and Acute Kidney Injury (ICU)
    • They reduce variability in care. The algorithm drives consistency among participating providers. In addition to providing a layer of liability protection, organizations want to drive towards best practice guidelines. SCAMPs do so from the grassroots level
    • SCAMPs gain support from providers because in spite of a foundational algorithm driving decisions, providers are free to diverge from the SCAMP recommendation, so long as they provide a reason. This empowers providers to use their own intelligence alongside the best practice guidelines laid out by the SCAMP
    • Finally, a SCAMP is never perfect. After using it in the field for a given amount of time, the data is collected and analyzed by IRCDA’s analytics team. The output is then used to reevaluate the SCAMP and to change the algorithm to account for the decisions doctors made. These iterations ensure care pathways are constantly improving based on the latest empiric evidence
  3. And what is IRCDA? How does it relate to SCAMPs?
    • IRCDA is the Institute for Relevant Clinical Data Analysis. In 2006, clinicians in the Cardiology Department at Boston Children’s Hospital began to toy with a new methodology. This methodology would ultimately create SCAMPs
    • As success grew and institutions around the world became interested, IRCDA was created in 2010 to spread and promote SCAMPs to interested institutions
  4. You’re a founder of par8o, which you describe as a healthcare operating system. You’re partnering with IRCDA to implement SCAMPs. How does all of this fit together? If par8o is the operating system, what does that make IRCDA, SCAMPs, and hospitals?
    • IRCDA, SCAMPs, and hospitals in many ways represent a microcosm of the healthcare system as a whole. A major benefit of working with IRCDA is that it touches so many major components of the healthcare industry
    • It ranges across healthcare settings (inpatient, outpatient, ER) in addition to focusing on the most important players in the industry – the providers
    • As healthcare’s operating system, par8o wants to layer itself onto as many aspects of care as possible. Doing so will allow us to bring efficiency to all parts of the industry
    • Finally, pathways in healthcare are manifold. From taking a patient through the right care pathway, to following a pathway created by an insurance company for specialty pharma, to finding eligible patients for clinical trials, the foundation par8o builds with care pathways will have many implications for driving efficiencies in other aspects of healthcare
  5. How are EMRs involved in this initiative?
    • par8o integrates with all EMRs via the Direct protocol developed by HHS Office of the National Coordinator (ONC). SCAMPs can be initiated out of an EMR using a direct message – the direct message will trigger a draft SCAMP to be created in par8o and will notify the provider that they must complete the SCAMP
    • Therefore, so long as the EMR supports Direct messaging, par8o can use that functionality to integrate
  6. What impact will this partnership have for patients?
    • Patients will benefit because par8o’s technology will address two key pain points currently in the SCAMP process. The first is unwieldy data entry – par8o will enable providers to complete SCAMPs from their mobile phone. Using decision support, the forms will seem less onerous
    • Additionally, by leveraging form versioning technology, par8o will enable faster iterations on SCAMPs. Faster iterations means the data gathered during SCAMP collection can be leveraged sooner, resulting in enhanced care for affected patient populations
  7. This is clearly a first step. How do you see development rolling out over the next few years?
    • Over the next few years, par8o has a big vision. To start, our aim is to successfully launch a pilot program at a single institution. We hope to ease data entry issues and therefore increase adoption. Additionally, we hope to see faster iterations between SCAMP versions
    • In the future, in addition to expanding to more member institutions, we would like to see a social element brought to SCAMPs where providers are able to participate in chat forums and share the latest literature concerning that area of care
    • par8o also plans to build a SCAMPs “Editor”, which would enable the IRCDA team to build and version their own SCAMPs, greatly increasing the iteration process

By healthcare business consultant David E. Williams, president of Health Business Group.

Checking the symptom checkers

I have a small problem

I have a small problem

Online “symptom checkers have deficits in both diagnosis and triage, and their triage advice is generally risk averse,” according to a new study in BMJ by Harvard researchers. Some of the press coverage of the study has been pretty critical of the symptom checkers, but the study itself is quite balanced.

Symptom checkers are a lot better than “Google Diagnosing” (typing a list of symptoms into Google and seeing what comes up). They’re very similar to nurse triage lines used by health plans, which is no great surprise considering that many of the triage lines use the same logic that drives the symptom checkers. They’re inferior to a primary care physician, but of course physicians aren’t infallible either.

People use symptom checkers to self-diagnose and to figure out if they need to go the emergency department, doctor’s office or can treat at home. Not surprisingly, the symptom checkers err on the side of suggesting patients seek care. No producer of these tools wants to get sued for recommending self-care to someone who should have called an ambulance. But in this regard symptom checkers are similar to nurse triage lines and also –at least in my experience– to physicians who are covering call. Too often they suggest a trip to the ED.

There’s an opportunity to reframe the next generation of symptom checkers as tools for navigating the medical system. That means not just suggesting a diagnosis and level of care, but pointing to an appropriate specialty, facility, or individual clinician to follow up with. This could be especially useful for patients in areas with fewer specialists and sub-specialists, and those with rare or hard to diagnose conditions. Primary care physicians could use such a tool as well to help direct referrals.

Image courtesy of David Castillo Dominici at

By healthcare business consultant David E. Williams, president of Health Business Group.

ResearchKit webinar today

Curious about Apple’s new #ResearchKit and its potential for outcomes research? Digital healthcare consulting firm Medullan (where I’m an advisory board member) is hosting a free webinar from 2-2:30 today, EDT.

Topics will include:

  • The Current State 
  • What the Apple ResearchKit is and is not 
  • Apple software development kit overview 
  • FDA guidance and latest IRB ruling 
  • Implications for the Outcomes Researcher 
  • Challenges that Research Kit addresses
  • Getting started

If you miss it you can still catch the recording. So it’s worth visiting the registration page.

By healthcare business consultant David E. Williams, president of Health Business Group.

Welcoming back insurance exchange expert Dave Kerrigan

David J. Kerrigan

David J. Kerrigan

Health insurance exchange expert Dave Kerrigan is back in the private sector after three years working for the Massachusetts exchange. As a result he’s reviving his A Musing Healthcare Blog. The first new post is about the potential of health exchanges in a world where healthcare costs fall on employees.

Welcome back!

Meaningless Use: Pediatric portal example

I love my family’s pediatrician. He’s an old school guy who keeps up with the literature, is a great diagnostician, has an informative and comforting manner, and uses the hospital system’s medical records and phone calls to track the progress of his sicker patients as they deal with specialists. He’s available for a call-in hour every morning.

The practice’s patient portal from eClinicalWorks is another matter. The “PHR-View” has tabs for Allergies, Vitals and Immunizations. The information appears to be complete, which is nice, but where is the standard form that I need for school, camp, etc? It’s nowhere to be found and I have confirmed with the practice that it isn’t available. The practice doesn’t like to use the secure message system, which anyway doesn’t allow attachments.

Bottom line? I obtain the forms the same way I did close to 20 years ago: Call the practice and ask them to fax the form. They are always happy to do it, but it seems a little silly. Surely we can expect more from patient and family portals in 2015.

By healthcare business consultant David E. Williams, president of Health Business Group.

Financial services shows the way for healthcare (again)

Seven hundred million people worldwide have obtained access to financial services for the first time over the past three years, according to a Gates Foundation funded institute. The big increase is due largely to the banking industry figuring out how to leverage low cost mobile phones and digital payments to improve accessibility of the previously “unbanked.” I’d like to see healthcare do something similar.

The USA Today points out some of the benefits consumers reap when they gain access:

“Financial inclusion, such as the ability to save money, access credit and keep money secure, is considered critical for reducing poverty and increasing economic growth. World Bank Group President Jim Yong Kim called access to financial services ‘a bridge out of poverty.’

Visa is working with small merchants in developing countries to equip them with point-of-sale terminals that operate over mobile phones so they can process digital financial transactions, an endeavor that has good social impact but also makes business sense for Visa…”

Financial services was (and remains) way ahead of healthcare in applying technology and digital solutions to democratize the marketplace. Online customer portals at Vanguard and Fidelity are way ahead of what consumers can get from their hospitals and health systems.

I hope healthcare won’t take as long to take advantage of newer opportunities such as the spread of cellphones, the Internet, and the financial services industry itself. In the developing world the formerly “unbanked” and currently “untreated” could leverage technology for clinical decision support, remote monitoring, electronic prescribing and adherence, not to mention population health reporting and management.

By healthcare business consultant David E. Williams, president of Health Business Group.