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A New Meaning for Connected Health at 2016 Symposium (Part 4 of 4)

Posted on November 8, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article continued our exploration of the integration of health care into daily life. This section wraps up the article with related insights, including some thoughts about the future.

Memorable moments
I had the chance to meet with Casper de Clercq, who has set up a venture capital plan devoted to health as a General Partner at Norwest Venture Partners. He recommends that manufacturers and clinicians give patients a device that collects data while doing something else they find useful, so that they are motivated to keep wearing it. As an example, he cited the Beddit sleep tracker, which works through sensors embedded (no pun intended) in the user’s bed.

He has found that successful companies pursue gradual, incremental steps toward automated programs. It is important to start with a manual process that works (such as phoning or texting patients from the provider), then move to semi-automation and finally, if feasible, full automation. The product must also be field-tested; one cannot depend on a pilot. This advice matches what Glen Tullman, CEO of Livongo Health, said in his keynote: instead of doing a pilot, try something out in the field and change quickly if it doesn’t work.

Despite his call for gradual change, de Clercq advises that companies show an ROI within one year–otherwise, the field of health care may have evolved and the solution may be irrelevant.

He also recommends a human component in any health program. The chief barrier to success is getting the individual to go along with both the initial activation and continuing motivation. Gamification, behavioral economics, and social connections can all enhance this participation.

A dazzling keynote on videogames for health was delivered by Adam Gazzaley, who runs Neuroscience labs at the University of California at San Francisco. He pointed out that conventional treatments get feedback on patient reactions far too slowly–sometimes months after the reaction has occurred. In the field of mental health, His goal is to supplement (not replace) medications with videogames, and to provide instant feedback to game players and their treatment staff alike. Videogames not only provide a closed-loop system (meaning that feedback is instantaneous), but also engage patients by being fun and offering real-time rewards. Attention spans, anxiety, and memory are among the issues he expects games to improve. Education and wellness are also on his game plan. This is certainly one talk where I did not multitask (which is correlated with reduced performance)!

A future, hopefully bigger symposium
The Connected Health symposium has always been a production of the Boston Partners Health Care conglomerate, a part of their Connected Health division. The leader of the division, Dr. Joseph Kvedar, introduced the symposium by expressing satisfaction that so many companies and organizations are taking various steps to make connected health a reality, then labeled three areas where leadership is still required:

  • Reassuring patients that the technologies and practices work for them. Most people will be willing to adopt these practices when urged by their doctors. But their privacy must be protected. This requires low-cost solutions to the well-known security problems in EHRs and devices–the latter being part of the Internet of Things, whose vulnerability was exposed by the recent attack on Dyn and other major Internet sites.

  • Relieving the pressures on clinicians. Kvedar reported that 45 percent of providers would like to adopt connected health practices, but only 12 percent do so. One of the major concerns holding them back is the possibility of data overload, along with liability for some indicator of ill health that they miss in the flood of updates. Partners Connected Health will soon launch a provider adoption initiative that deals with their concerns.

  • Scaling. Pilot projects in connected health invest a lot of researcher time and offers a lot of incentives to develop engagement among their subjects. Because engagement is the whole goal of connected health, the pilot may succeed but prove hard to turn into a widespread practice. Another barrier to scaling is consumers’ lack of tolerance for the smallest glitches or barriers to adoption. Providers, also, insist that new practices fit their established workflows.

Dr. Kvedar announced at this symposium that they would be doing future symposia in conjunction with the Personal Connected Health Alliance (Formerly the mHealth Summit owned by HIMSS), a collaboration that makes sense. Large as Partners Health Care is, the symposium reaches much farther into the health care industry. The collaboration should bring more resources and more attendees, establishing the ideals of connected health as a national and even international movement.

A New Meaning for Connected Health at 2016 Symposium (Part 3 of 4)

Posted on November 7, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article paused during a discussion of the accuracy and uses of devices. At a panel on patient generated data, a speaker said that one factor holding back the use of patient data was the lack of sophistication in EHRs. They must be enhanced to preserve the provenance of data: whether it came from a device or from a manual record by the patient, and whether the device was consumer-grade or a well-tested medical device. Doctors invest different levels of trust in different methods of collecting data: devices can provide more objective information than other ways of asking patients for data. A participant in the panel also pointed out that devices are more reliable in the lab than under real-world conditions. Consumers must be educated about the proper use of devices, such as whether to sit down and how to hold their arms when taking their blood pressure.

Costantini decried the continuing silos in both data sharing and health care delivery. She said only half of doctors share patient data with other doctors or caretakers. She also praised the recent collaboration between Philips and Qualcomm to make it easier for device data to get into medical records. Other organizations that have been addressing that issue for some time include Open mHealth, which I reviewed in an earlier article, and Validic.

Oozing into workflow
The biggest complaint I hear from clinicians about EHRs–aside from the time wasted in their use, which may be a symptom of the bigger problem-is that the EHRs disrupt workflow. Just as connected health must integrate with patient lives as seamlessly as possible, it should recognize how teams work and provide them with reasonable workflows. This includes not only entering existing workflows as naturally as capillary action, but helping providers adopt better ones.

The Veterans Administration is forging into this area with a new interface called the Enterprise Health Management Platform (eHMP). I mentioned it in a recent article on the future of the VA’s EHR. A data integration and display tool, eHMP is agnostic as to data source. It can be used to extend the VistA EHR (or potentially replace it) with other offerings. Although eHMP currently displays a modern dashboard format, as described in a video demo by Shane Mcnamee, the tool aims to be much more than that. It incorporates Business Process Modeling Notation (BPMN) and the WS-Human Task Specification to provide workflow support. The Activity Management Service in eHMP puts Clinical Best Practices directly into the workflow of health care providers.

Clinicians can use eHMP to determine where a consultation request goes; currently, the system is based on Red Hat’s BPMN engine. If one physician asks another to examine the patient, that task turns up on the receiving physician’s dashboard. Teams as well as individuals can be alerted to a patient need, and alerts can be marked as routine or urgent. The alerts can also be associated with time-outs, so that their importance is elevated if no one acts on them in the chosen amount of time.

eHMP is just in the beginning stages of workflow support. Developers are figuring out how to increase the sophistication of alerts, so that they offer a higher signal-to-noise ratio than most hospital CDS systems, and add intelligence to choose the best person to whom an alert should be directed. These improvements will hopefully free up time in the doctor’s session to discuss care in depth–what both patients and providers have long said they most want from the health care field.

At the Connected Health symposium, I found companies working on workflow as well. Dataiku (whose name is derived from “haiku”) has been offering data integration and analytics in several industries for the past three years. Workflows, including conditional branches and loops, can be defined through a graphical interface. Thus, a record may trigger a conditional inquiry: does a lab value exceed normal limits? if not, it is merely recorded, but if so, someone can be alerted to follow up.

Dataiku illustrates an all-in-one, comprehensive approach to analytics that remains open to extensions and integration with other systems. On the one hand, it covers the steps of receiving and processing data pretty well.

To clean incoming data (the biggest task on most data projects), their DSS system can use filters and even cluster data to find patterns. For instance, if 100 items list “Ohio” for their location, and one lists “Oiho”, the system can determine that the outlier is a probably misspelling. The system can also assign data to belonging to broad categories (string or integer) as well as more narrowly defined categories (such as social security number or ZIP code).

For analysis, Dataiku offers generic algorithms that are in wide use, such as linear regressions, and a variety of advanced machine learning (artificial intelligence) algorithms in the visual backend of the program–so the users don’t need to write a single line of code. Advanced users can also add their own algorithms coded in a variety of popular languages such as Python, R, and SQL. The software platform offers options for less technically knowledgeable users, pre-packaged solutions for various industries such as health care, security features such as audits, and artificial intelligence to propose an algorithm that works on the particular input data.

Orbita Health handles workflows between patients and providers to help with such issues as pain management and medication adherence. The company addresses ease of use by supporting voice-activated devices such as Amazon Echo, as well as some 250 other devices. Thus, a patient can send a message to a provider through a single statement to a voice-activated device or over another Internet-connected device. For workflow management, the provider can load a care plan into the system, and use Orbita’s orchestration engine (similar to the Business Process Modeling Notation mentioned earlier) to set up activities, such as sending a response to a patient’s device or comparing a measurement to the patient’s other measurements over time. Orbita’s system supports conditional actions, nests, and trees.

CitiusTech, founded in 2005, integrates data from patient devices and apps into provider’s data, allowing enterprise tools and data to be used in designing communications and behavioral management in the patient’s everyday life. The company’s Integrated Analytix platform offer more than 100,000 apps and devices from third-party developers. Industry studies have shown effective use of devices, with one study showing a 40% reduction in emergency room admissions among congestive heart failure patients through the use of scales, engaging the patients in following health protocols at home.

In a panel on behavior change and the psychology of motivation, participants pointed out that long-range change requires multiple, complex incentives. At the start, the patient may be motivated by a zeal to regain lost functioning, or even by extrinsic rewards such as lower insurance premiums. But eventually the patient needs to enfold the exercise program or other practice into his life as a natural activity. Rewards can include things like having a beer at the end of a run, or sharing daily activities with friends on social media.

In his keynote on behavioral medicine, the Co-founder & CEO of Omada Health, Sean Duffy, put up a stunningly complex chart showing the incentives, social connections, and other factors that go into the public’s adoption of health practices. At a panel called “Preserving the Human Touch in the Expanding World of Digital Therapies”, a speaker also gave the plausible advice that we tell patients what we can give back to them when collecting data.

The next section of this article offers some memorable statements at the conference, and a look toward the symposium’s future.

A New Meaning for Connected Health at 2016 Symposium (Part 2 of 4)

Posted on November 4, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous section of this article talked about making health a routine part of everyday life, particularly where consumer devices are concerned. We’ll continue in this section with other considerations aired at the symposium.

Tullman’s principles of simplicity, cited in the previous section, can be applied to a wide range of health IT. For instance, AdhereTech pill bottles can notify the patient with a phone call or text message if she misses a dose. Another example of a technology that is easily integrated into everyday life is a thermometer built into a vaginal ring that a woman can insert and use without special activation. This device was mentioned by Costantini during her keynote. The device can alert a woman–and, if she wants, her partner–to when she is most fertile.

Super-compact devices and fancy interfaces are not always necessary for a useful intervention. In a keynote, John Dwyer, Jr., President of the Global Alzheimer’s Platform Foundation, discussed a simple survey that his organization got large numbers of people to take. They uncovered a lot of undiagnosed cases of mental decline. I imagine that the people who chose to take the survey were experiencing possible symptoms and therefore were concerned about their mental abilities. Yet they apparently had not expressed concerns to their doctors; instead they responded to the online suggestion to take a survey.

Most of us spend a large chunk of our day at work, so wellness programs there are theoretically promising. A panel on workplace-connected health solutions talked about some of the barriers:

  • Inadequate communications. Employees need to be informed regularly that a program is available, and its benefits

  • Privacy guarantees. Employees must feel assured of a firewall between their employer and the organization handling their sensitive data.

  • Clear goals. A wellness program is not just a check-off box. Employers must know what they want to achieve and design programs around these goals.

I would add that employers should examine their own environment honestly before setting up a wellness program. It’s pretty hypocritical to offer a wellness program on the one hand while subjecting employees to stress, overwork, and bad ergonomics on the other.

Telehealth is also likely to grow, and in fact, 200 bills to improve regulation of telehealth are pending in Congress. A speaker at a panel on preserving the human touch said that the Centers for Medicare & Medicaid Services are held back by uncertainty about how to measure telehealth’s value. Another speaker pointed out that we have a severe shortage of mental health professionals, and that many areas lack access to them. Telehealth may improve access.

It all comes down to the environment
Health care has to fully acknowledge the role of environmental factors in creating sickness. These include the marketing of fatty and sugary foods, the trapping of poor and minority people in areas with air and water pollution, the barriers to getting health care (sick leave, geography, insurance gaps, ignorance of gender issues, and so forth), the government subsidization of gambling, and much more. Similar issues came up during a keynote by David Torchiana, President & CEO and Partners HealthCare.

In her keynote, Jo Ann Jenkins, the CEO of AARP, quoted Atul Gawande as saying that we have medicalized aging and are failing to support the elderly. We have to see them as functioning individuals and help to support their health instead of focusing on when things go wrong. This includes focusing on prevention and ensuring that they have access to professional health care while they are still well. It also means restructuring our living spaces and lifestyles so the elderly can remain safely in their homes, get regular exercise, and eat well.

These problems call for a massive legislative and regulatory effort. But as a participant said on the panel of disruptive women in health care, plenty of money goes into promoting the interests of large hospitals, insurers, and device manufacturers, but nobody knows how to actually lobby for health care. Look at the barriers reached by Michelle Obama’s Let’s Move campaign, which fell short of ambitious goals in improving American’s nutrition.

Grounding devices on a firm foundation
A repeated theme at this symposium was making data collection by patients easier–so easy in fact that they can just launch data collection and not think about it. To be sure, some people are comfortable with health technology: according to Costantini, 60 percent of US smartphone users manage their health in some way through those devices. Nevertheless, if people have to consciously choose when to send data–even a click of a button–many will drop out of the program.

At a break-out session during the 2015 Health Datapalooza, I heard prospective device makers express anxiety over the gargantuan task of getting their products accepted by the industry. The gold standard for health care adoption, of course, is FDA approval based on rigorous clinical trials. One participant in the Datapalooza workshop assured the others that he had gotten his device through the FDA process, and that they could to.

Attitudes seem to have shifted over the past year, and many more manufacturers are treating FDA approval as a natural step in their development process, keeping their eyes on the prize of clinical adoption. Keith Carlton, CEO of HUINNO, in a panel on wearables, said that accuracy is critical to stand out in the marketplace and to counter the confusion caused by manufacturers that substitute hype for good performance.

Clinical trials for devices don’t have to be the billion-dollar, drawn-out ordeals suffered by pharma companies. Devices are rarely responsible for side effects (except for implantables) and therefore can be approved after a few months of testing.

A representative of BewellConnect told me that their road to approval took 9-12 months, and involved comparing the results of their devices to those of robust medical devices that had been previously approved. Typical BewellConnect devices include blood pressure cuffs and an infrared thermometer that quickly shows the patient’s temperature after being held near his temple. This thermometer has been used around the world in situations where it’s important to avoid contact with patients, such as in Ebola-plagued regions.

What’s new over the past three years is Bluetooth-enabled devices that can transmit their results over the network. BewellConnect includes this networking capability in 17 current devices. The company tries to provide a supremely easy path for the patient to transmit the device over a phone app to the cloud. The patient can register multiple family members on the app, and is prompted twice to indicate who was using the device so as to prevent errors. BewellConnect is working on an alert system for providers, a simple use case for data collection.

Many products from BewellConnect are in widespread use in France, where the company is based, and they have launched a major entry into the US market. I asked BewellConnect’s CEO, Olivier Hua, whether the US market presents greater problems than France. He said that the two markets are more similar than we think.

Health care in the US has historically been fragmented, whereas in France it was unified under government control. But the Affordable Care Act in the US has brought more regulation to the market here, whereas private health care providers (combining insurance and treatment) have been growing in France. As of January 1 of this year, France has required all employers to include a private option in their health care offerings. For the first time, French individuals are being hit with the copays and deductibles familiar to Americans, and are weighing how often to go to the doctor. Although the US market is still more diverse, and burdened by continuing fee-for-service plans, it is comparable to the French market for a vendor such as BewellConnect.

The next section of this article will continue with a discussion of barriers in the use of patient data, and other insights from the Connected Health symposium.

A New Meaning for Connected Health at 2016 Symposium (Part 1 of 4)

Posted on November 3, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Those of us engaged in health care think constantly about health. But at the Connected Health symposium, one is reminded that the vast majority of people don’t think much about health at all. They’re thinking about child care, about jobs, about bills, about leisure time. Health comes into the picture only through its impacts on those things.

Certainly, some people who have suffered catastrophic traumas–severe accidents, cancer, or the plethora of unfortunate genetic conditions–become obsessed about health to the same extent as health professionals. These people become e-patients and do all the things they need to do regain the precious state of being they enjoyed before their illness, often clashing with the traditional medical establishment in pursuit of health.

But for most people with chronic conditions, the opposite holds true. A whimsical posting points out that we willingly pay more to go to a masseur or hairdresser than to a doctor. I appreciate this observation more than the remedies offered by the author, which fall into the usual “patient engagment” activities that I have denigrated in an earlier article.

Understanding health as a facet and determinant of everyday life becomes even more important as we try to reverse the rise of costs, which in many nations are threatening economic progress and even the social contract. (Witness the popular anger in the current US election over rising insurance premiums and restrictions on choice.) We have to provide health solutions to people who are currently asymptomatic. The conventional focus on diagnosed conditions won’t serve us.

It’s thus commendable that the Connected Health symposium for 2016 has evolved to the point where participants can think not only of reaching out to patients, but to embedding their interventions so deeply into patient life that the patient no longer has to think about her health to benefit. This gives a new meaning to the word “connected”. Whereas, up to now, it referred to connecting a patient more closely with their clinicians and care-takers (through data collection, messaging, and online consultations), “connected” can also mean connecting our healthful interventions to the patient’s quotidian concerns about work, family, and leisure.

We can do this by such means as choosing data collection that the patient can enable and then stop thinking about, and integrating care with the social media they use regularly. In her keynote, Nancy Brown, CEO of the American Heart Association, pointed out that social connections are critical to health and are increasingly taking place online, instead of someone dropping by her neighbor for coffee. The AHA’s Go Red For Women program successfully exploited social connections to improve heart health.

If you want an overview of what people mean by the term “connected health,” you would do well to get The Internet of Healthy Things, by Dr. Joseph Kvedar, leader of Partners Connected Health and chief organizer of this symposium. For a shorter overview, you can read my review of the book, and my report from an earlier symposium. Now in its 13th year, the annual symposium signed up 1200 registered attendees–the biggest number yet. This article looks over the people and companies I heard from there.

Exhausting the possibilities of passive data collection
Glen Tullman, CEO of Livongo Health, offered basic principles for consumer health in a keynote: it must be personal, simple, context-aware, and actionable. As an example, he cited Livongo’s own program for sending text messages to diabetes patients: they are tailored to the individual and offer actionable advice such as, “Drink a glass of water”.

A panel on consumer technology extolled the value of what analysts like to call data exhaust: the use of data that can be collected from people’s everyday behavior. After all, this exhaust is what marketers used all the time to figure out what we want to buy, and what governments use to decide whether we’re dangerous actors. It can have value in health too.

As pointed out by Jim Harper, Co-Founder and COO of Sonde Health, providers and researchers can learn a lot from everyday interactions with devices–diagnosing activity levels from accelerometers, for instance, or depression from a drop in calls or text messages. Similarly, a symposium attendee suggested to me that colleges could examine social connections among students to determine which ones are at risk of abusing alcohol.

Lauren Costantini, President and CEO of Prima-Temp, said in a keynote that we can predict all kinds of things from your circadian rhythm–as measured by a sensor–such as an oncoming infection, or the best way to deliver chemotherapy.

Spire offers a device that claims to help people suffering from anxiety, with a low barrier to adoption and instant feedback. It’s a device worn on the body that can alert the user in various ways (buzzes, text messages) when the user’s anxiety level is rising.

Does the Spire device work? They got a partial answer to this in a study by Partners Health Care, where people had an option of using the device on its own or in conjunction with a headband from Muse that helps train people to meditate. (There was no control group.) Unlike the Spire device, which one can put on and forget about, the Muse purchaser is expected to make a conscious decision to meditate using the device regularly.

The Partners study showed modest benefits to these devices, but had mixed results. For instance, fewer than half the subjects continued use of the devices after the study finished. Those who did continue showed a strong positive effect on stress, and those who discontinued use showed a very small positive effect. Strangely there was a small overall increase in tension for all participants, even though they also demonstrated increases in “calm” periods. There is no correlation between the length of time that individuals used their devices and their outcomes.

Jonathan Palley, CEO & Co-founder of Spire, said participants often liked their devices, but stopped using them because they have learned from the devices how to identify stress and felt they could self-regulate and no longer needed the devices. I believe this finding may apply to other consumer devices as well. The huge rate at which devices are abandoned after six months, the subject of frequent reports and agonized commentaries, may simply indicate that users have reached their goal and can continue their fitness programs on their own. Graeme Moffat, VP of Scientific & Regulatory Affairs at Muse, reported that many purchasers use their headband for only three months, but come back to it over time to refresh their training.

We’ll look at some more aspects of integrating devices into patient lives in the next section of this article.

Study: Health IT Costs $32K Per Doctor Each Year

Posted on September 9, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study by the Medical Group Management Association has concluded that that physician-owned multispecialty practices spent roughly $32,500 on health IT last year for each full-time doctor. This number has climbed dramatically over the past seven years, the group’s research finds.

To conduct the study, the MGMA surveyed more than 3,100 physician practices across the U.S. The expense number they generated includes equipment, staff, maintenance and other related costs, according to a press release issued by the group.

The cost of supporting physicians with IT services has climbed, in part, due to rising IT staffing expenses, which shot up 47% between 2009 and 2015. The current cost per physician for health IT support went up 40% during the same interval. The biggest jump in HIT costs for supporting physicians took place between 2010 and 2011, the period during which the HITECH Act was implemented.

Practices are also seeing lower levels of financial incentives to adopt EHRs as Meaningful Use is phased out. While changes under MACRA/MIPS could benefit practices, they aren’t likely to reward physicians directly for investments in health IT.

As MGMA sees it, this is bad news, particularly given that practices still have to keep investing in such infrastructure: “We remain concerned that far too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing patient care,” the group said in a prepared statement. “Unless we see significant changes in the final rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.”

But the MGMA’s own analysis offers at least a glimmer of hope that these investments weren’t in vain. For example, while it argues that growing investments in technologies haven’t resulted in greater administrative efficiencies (or better care) for practices, it also notes that more than 50% of responders to a recent MGMA Stat poll reported that their patients could request or make appointments via their practice’s patient portal.

While there doesn’t seem to be any hard and fast evidence that portals improve patient care across the board, studies have emerged to suggest that portals support better outcomes, in areas such as medication adherence. (A Kaiser Permanente study from a couple of years ago, comparing statin adherence for those who chose online refills as their only method of getting the med with those who didn’t, found that those getting refills online saw nonadherence drop 6%.)

Just as importantly – in my view at least – I frequently hear accounts of individual practices which saw the volume of incoming calls drop dramatically. While that may not correlate directly to better patient care, it can’t hurt when patients are engaged enough to manage the petty details of their care on their own. Also, if the volume of phone requests for administrative support falls enough, a practice may be able to cut back on clerical staff and put the money towards say, a nurse case manager for coordination.

I’m not suggesting that every health IT investment practices have made will turn to fulfill its promise. EHRs, in particular, are difficult to look at as a whole and classify as a success across the board. I am, however, arguing that the MGMA has more reason for optimism than its leaders would publicly admit.

Improving Clinical Workflow Can Boost Health IT Quality

Posted on August 18, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

At this point, the great majority of providers have made very substantial investments in EMRs and ancillary systems. Now, many are struggling to squeeze the most value out of those investments, and they’re not sure how to attack the problem.

However, according to at least one piece of research, there’s a couple of approaches that are likely to pan out. According to a new survey by the American Society for Quality, most healthcare quality experts believe that improving clinical workflow and supporting patients online can make a big diference.

As ASQ noted, providers are spending massive amounts of case on IT, with the North American healthcare IT market forecast to hit $31.3 by 2017, up from $21.9 billion in 2012. But healthcare organizations are struggling to realize a return on their spending. The study data, however, suggests that providers may be able to make progress by looking at internal issues.

Researchers who conducted the survey, an online poll of about 170 ASQ members, said that 78% of respondents said improving workflow efficiency is the top way for healthcare organizations to improve the quality of their technology implementations. Meanwhile, 71% said that providers can strengthen their health IT use by nurturing strong leaders who champion new HIT initiatives.

Meanwhile, survey participants listed a handful of evolving health IT options which could have the most impact on patient experience and care coordination, including:

  • Incorporation of wearables, remote patient monitoring and caregiver collaboration tools (71%)
  • Leveraging smartphones, tablets and apps (69%)
  • Putting online tools in place that touch every step of patient processes like registration and payment (69%)

Despite their promise, there are a number of hurdles healthcare organizations must get over to implement new processes (such as better workflows) or new technologies. According to ASQ, these include:

  • Physician and staff resistance to change due to concerns about the impact on time and workflow, or unwillingness to learn new skills (70%)
  • High cost of rolling out IT infrastructure and services, and unproven ROI (64%)
  • Concerns that integrating complex new devices could lead to poor interfaces between multiple technologies, or that haphazard rollouts of new devices could cause patient errors (61%)

But if providers can get past these issues, there are several types of health IT that can boost ROI or cut cost, the ASQ respondents said. According to these participants, the following HIT tools can have the biggest impact:

  • Remote patient monitoring can cut down on the need for office visits, while improving patient outcomes (69%)
  • Patient engagement platforms that encourage patients to get more involved in the long-term management of their own health conditions (68%)
  • EMRs/EHRs that eliminate the need to perform some time-consuming tasks (68%)

Perhaps the most interesting part of the survey report outlined specific strategies to strengthen health IT use recommended by respondents, such as:

  • Embedding a quality expert in every department to learn use needs before deciding what IT tools to implement. This gives users a sense of investment in any changes made.
  • Improving available software with easier navigation, better organization of medical record types, more use of FTP servers for convenience, the ability to upload records to requesting facilities and a universal notification system offering updates on medical record status
  • Creating healthcare apps for professional use, such as medication calculators, med reconciliation tools and easy-to-use mobile apps which offer access to clinical pathways

Of course, most readers of this blog already know about these options, and if they’re not currently taking this advice they’re probably thinking about it. Heck, some of this should already be old hat – FTP servers? But it’s still good to be reminded that progress in boosting the value of health IT investments may be with reach. (To get some here-and-now advice on redesigning EMR workflow, check out this excellent piece by Chuck Webster – he gets it!)

Prescription Benefits’ Information Silos Provide Feedstock for RxEOB

Posted on June 7, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In health care, silos between industries prevent synergies like in the travel industry, where you can order your hotel, flight, rental car, and tourist sights all in one place. Interoperability–the Holy Grail of much health care policy, throughout the Meaningful Use and MACRA eras–is just one sliver of the information hoarding problem. There is much more to integrated care, and prescriptions illustrate the data exchange problems in spades. Pharmacist Robert Oscar recognized the business possibilities inherent in breaking through the walls, and formed RxEOB 15 years ago to address them.

RxEOB helps patients and their physicians make better decisions about medications, taking costs and other interests into account. Sold to health insurance plans and benefits managers, it’s an information management platform and a communication platform, viewing patients, health plans, physicians, pharmacists, and family members as team members.

It’s instructive to look at the various players in the prescription space, what data each gives to RxEOB, and what RxEOB provides to each in return.

Payers

These organizations have lots of data that’s useful in the RxEOB ecosystem: costs, formularies, and coverage information. What payers often lack is information such as price, benefit status, and tier for drugs “similar to” one that is being prescribed.

The “similar to” concept is central to the pharmaceutical field, from the decision made by drug companies to pursue research, through FDA approval (they want proof that a new medication is substantially better than ones it is similar to), to physician choices and payer coverage. There may be good reasons to prescribe a medication that costs more than ones to which it is similar: the patient may not be responding to other drugs, or may be suffering from debilitating side effects. Still, everyone should know what the alternatives are.

Physicians

One of RxEOB’s earliest services was simply to inform doctors about the details of the health care coverage their patients had. This is gradually becoming an industry function, but is still an issue. Nowadays, thanks to electronic health records, most physicians theoretically have access to all the information they need to prescribe thoughtfully. But the information they want may be buried in databases or unstructured documents, jumbled together with irrelevant details. RxEOB can extract and combine information on available drugs, formularies, authorization requirements, coverage information, and details such as patient drug histories to help the doctor make a quick, accurate decision.

Pharmacies

These can use RxEOB’s information on the benefits and cost coverage offered by health insurance for the patients they serve.

Benefits managers

These staff know a lot about patients’ benefits, which they provide to RxEOB. In return, RxEOB can help them set up portals and use text messaging or mobile apps to communicate to patients.

Consumers

Finally we come to the much-abused patients, who have the greatest stake in the whole system and are the least informed. The consumer would like to know everything that the rest of the system knows about pricing, alternatives, and coverage. And the consumer wants to know more: why they should take the drug in the first place, for instance, how to deal with side effects. RxEOB provides communication channels between the patient and all the other players. Thus, the company contributes to medication adherence.

RxEOB is a member of the National Council of Prescription Drug Programs (NCPDP) which works on standards for such things as prior authorizations and communications. Thus, while carving out a successful niche in a dysfunctional industry, it is helping to move the industry to a better place in data sharing.

Keep It Simple, Stupid!

Posted on February 28, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

There are an enormous number of startups trying to solve the medication adherence problem. Broadly speaking, these startups are trying to solve the problem through three avenues:

1) Hardware, i.e. smart pill bottles

2) Semi-intelligent software driven reminders

3) Patient education

The most effective solutions are likely to incorporate all three.

The hardware space has been the most interesting simply because of the variety of solutions cropping up. AdhereTech and CleverCap have developed unique pill bottles that control and monitor dispensing via proprietary smart pill bottles. They also incorporate software for notifications. Unfortunately, all smart pill bottle makers are bounded by FDA regulations because they physically control medications through a combination of hardware and software. FDA regulations will slow time rollout of these solutions to market and create enormous new expense.

I recently learned about PillPack, a startup that just raised $4M. They compete asymmetrically in the medication adherence by not making any hardware at all!

The problem with the pill bottle is that there are dozens of pills in a single container. Measuring and controlling output and consumption is intrinsically a difficult problem. PillPack solves these problems by simply averting the issue entirely. PillPack pre-packs pills by dose. This is particularly valuable because they pre-pack multiple kinds of medications that need to be taken at the same time.

PillPack doesn’t yet have any intelligent software that monitors when medications are taken. But with granular packaging, sensing and controlling the medications becomes dramatically easier than ever before. I suspect this will the marquee feature of PillPack 2.0. Once they add the ability to detect when a pack is opened, they can begin adding intelligent software alerts and reminders to patients and their families.

PillPack has a far more lucrative distribution strategy than companies who have to produce and distribute hardware. PillPack can scale their customer base incredibly quickly through B2C marketing. B2C marketing isn’t easy; Pillpack faces a significant challenge in terms of patient and provider education, but it’s one that’s definitely addressable. If PillPack’s service is as good as I think it is, they should develop incredibly happy customers, which will lead to recurring revenues and strong referrals.

The moment I saw Pillpack, I immediately recognized it as one of those “duh” business. We’re going to look back in 10 years and wonder why this wasn’t always around. Their solution solves so many of the pain points around taking medications on time and is coupled with a lucrative business model that feeds off of recurring revenues from long term customers.

The genius of their business is that they are tackling the medication adherence problem from a unique angle: packaging and distribution. They’ve bundled that solution into a simple and elegant package (pun intended) that helps patients avoid the pain of the modern US healthcare system: going to the pharmacy, fighting with the pharmacist, and manually tracking when to take how much of each medication.

Full disclosure: I have no relationship(s) with PillPack.