The numbers are in for “patient engagement” at North Carolina’s hospitals – and they aren’t good.

Rex Healthcare lead North Carolina hospitals with a score of 75 on the engagement index as compiled by Raleigh-based healthcare software firm Axial Exchange.

The top hospital scores in other states: California (91), Florida (89) and Texas (84) out of 100.

So in the second part of WRALTechWire’s Q&A with Axial founder and CEO Joanne Rohde say about the state of hospital care in her home state. She does see signs of encouragement, including a couple of Durham health IT startups.

  • North Carolina’s top hospitals score a lot lower than those in California and Florida as well as Texas. Is this in indicator that North Carolina hospitals are behind the healthcare IT trend?

I have to be careful here, because this is my beloved home state. We’ve got some real leaders in the state. But as I now go to to nearly a hundred hospitals a year, I can say yes, on the whole we are behind. I’m not sure why.

Part of it may be that compared to other states, we have relatively small amount of capitated population–in other words, the fee-for-service world is still alive and well in North Carolina compared to most states I visit. In this model, there is no incentive for healthcare institutions to keep people out of the hospital. But if you live in Massachusetts, and someone is readmitted for a condition, it comes right out of the hospitals profits. So the incentive is to keep people out of the hospital. And for that to happen, you need to keep people engaged in their own care. The most effective method for doing that is health technology, particularly mobile technology, because it allows you to move the point-of-care to the patient at all times.

Secondly, I see very little coming together of hospitals and the state government to spur Health IT. I just came back from Health 2.0. an international forum for what is hot and new in Health IT. Interestingly, the best new innovations were coming out of New York; where they had put together a public/private partnership to create more Health IT jobs. In the process, hospitals and public institutions committed to work with carefully selected entrepreneurs to become their initial customers.

And then the entrepreneurs solved some amazing problems, like improving medication adherence with electronic pill bottles that were aware of whether or not you took pills based on volume, and alerted you or your caregiver when it was time. It cost everyone very little and they got huge results, stealing the innovators mantle from California in one short year. Now maybe that hasn’t made it’s way broadly through New York hospital systems yet, but it will with that kind of strong partnership.

The other irony is that I met two really hot IT companies (Validic and Polyglot)at Health 2.0 in Silicon Valley, only to find they were from Durham!

We need more community involvement. We have the talent, and we have nationally renowned institutions that believe its their civic duty to support local innovation.

  • The Obamacare healthcare exchanges are taking an awful lot of criticism. Not in a political sense but from an IT perspective, did the government err and if so will people be more distrustful of electronic interaction with health care providers as a result?

Honestly, I think it’s a bunch of news for page-filler sake. Given the magnitude of what happened, it went relatively well. It’s less than a week later, and most are working well. I mean this is a new concept happening at a massive scale. I think it certainly went better than say, NC’s Medicaid payment system launch. The other reason I think the emphasis is on the wrong issue is that one of the main reasons they didn’t work was the sheer unexpected volume–which says to me that it can’t be all reporters hitting the website. People must want to understand how they can get insured.

  • What can hospitals learn from the Obamacare problems?

Much of the current focus of the Affordable Care Act is on having access to insurance. The real issues affecting the hospitals are new CMS payment methodologies (some of which are part of the ACA) that are driving changes in reimbursement based on quality outcomes at a reasonable price. I think the main thing hospitals should learn is that the train has left the station and there’s no turning back–a patient centric revolution has started. There will be no additional revenue based on creating more billable code lines. Winning hospitals have known this for a long time.

  • How do you make money/revenue from these 50-state surveys – or do you?

No, we don’t make any money from this. This is purely as a public service to shed some light on an issue we believe is critical to getting the country on the right path. But if any hospital wants to know how to improve their scores, we do have some excellent software that they can use to help engage their patients and improve patient satisfaction..

Note: part one of the interview can be read online.

Axial Exchange is privately held and has raised some $7 million in venture capital.