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The Healthcare IT Field is Unique, Yorktel Discovers

Posted on September 11, 2017 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.

Health care professionals love to vaunt the uniqueness of the medical industry, and tend to demand special, expensive treatment on that basis. Reformers tend to discount this special status. (For instance, the security problems in health care are identical to those in other industries, and are caused by the same factors of insufficient investment and training.) Yet telecommunications in hospitals and clinics really is special, and video giant Yorktel has spent the past five years adjusting to that reality. On September 5, Yorktel announced that it has enhanced its solutions for patient telemedicine with Univago HE that includes robust video connections, monitoring, and analytics as a service.

To learn how the company enhanced their video teleconferencing for healthcare, I recently talked to Peter McLain, Senior Vice President of Healthcare, and John Vitale, Senior Vice President of Project Management. They disassembled the various features of Univago that deal with hospital environments, which require reliable 24/7 connectivity, deal with a good deal of noise (both audible and electronic), and demand fast, faultless authorization to protect privacy.

Directional audio

The triangular table-top sets, familiar to so many of us from business teleconferencing, are omni-directional in order to facilitate use by people seated around the table. In a hospital, they pick up the whirr of carts going by, the chatter in the hallway, and the beeps and gurgles of machines in the patients’ rooms themselves. So Yorktel had to substitute directional microphones.

Camera positioning

Remote monitoring requires much more detail than talking heads in a teleconference. For instance, a remote nurse may want to check whether an IV bag is getting empty. So the person on the remote end of the video connection can direct the camera at particular points in the room and zoom in. Originally offering joystick-like controls for this purpose, Yorktel found them too confusing and cumbersome, so they created a system where a user can just double-click on her own screen to focus in on the place she indicated.

Infrared cameras

Remote monitoring takes place continuously, including when the room is dark. The staff don’t want to wake the patient while monitoring him, so Yorktel cameras support the display of scenes scanned from infrared light. A mild alert, such as a soft buzz, lets an awake patient know that he’s being monitored, without disturbing a sleeping patient.

Integration with dashboards

Yorktel software can be seamlessly integrated with other applications so that staff can see vital signs and other data while in a video call. The developers have made the systems adhere to relevant standards, including Skype, Web RTC, and H.323.

Robustness

Conventional business teleconference systems are used for a few hours each day; hospital systems are used 24/7 and must promise long mean times between failures. Yorktel addressed this on both a hardware and a software level. In hardware, they broke down large, integrated components into modules that would be easy to replace. In software, they built a custom operating system on Unix, feeling that would offer maximum reliability. They use artificial intelligence techniques to detect whether the camera has frozen (a common failure) and reboot the system before it interferes with a video session. Components can still fail, but McLain says they can be replaced within 15 minutes instead of 3 to 6 hours.

Security

Yorktel has hardened its authentication and authorization process to make sure that no one at random can dial into a system and see a patient in his bed. At the same time, they have integrated that process into mobile devices so the physician can check in from home or the road in case of an emergency.

The systems follow industry best practices, as specified by the ISO 27001 security standard and HIPAA. In order to expand into UK’s National Health Service and the European Union, Yorktel achieved Privacy Shield certification. They also get penetration testing from a third party expert, and incorporate anti-microbial technology into their systems. The systems are pending approval as Class 1 medical devices (the most reliable level of use) by the FDA.

Following security by design principles, Yorktel maintains no information for a patient. A physician finds the right room through an external service and calls that room. (If the patient wants to be called, he presses a button by the bedside, and a message is sent through some appropriate alert, such as a text message or a flashing screen.) No information on the traffic is preserved, and the call records have no personally identifying information.

Specialized services

Each department in a hospital has different needs, and Yorktel has provided specific enhancements to make their systems more useful in various settings.

For instance, family visits are an excellent use case for videoconferencing. A session can be shared with family members who can’t get in to the hospital. It can also be recorded and saved by the hospital (as mentioned earlier, Yorktel does not preserve session traffic) so it can be viewed again or brought out to prove that the hospital fulfilled its responsibility. To enable family visits, Yorktel allows the staff to designate members of the call as guests. The visitors are called “guests” because they have no control over the systems, but can see and hear what goes on during the session.

For general use in medical settings, Yorktel also allows sidebar conversations. The patient can be put on hold while physicians discuss treatment candidly and privately among themselves.

Via these enhancements targeted at hospitals and clinics, Yorktel has expanded its business in health care. It started with a common application, remote monitoring in the ICU, but expanded to telestroke care, family health, behavioral health, and translational services. They also knew that hospitals already have expensive, dedicated systems for many of these tasks, and don’t want to throw them away, especially if the outcome is to be locked in yet again to some proprietary system. Hence Yorktel’s dedication to standards.

Currently, video conferencing in the hospital is so expensive that it tends to be restricted to ICUs and a few other applications. Ultimately, Yorktel’s subscription plans should offer systems at a low enough cost that they can be deployed universally in hospitals and clinics.

What can other technology developers, outside of two-way video, learn about health care from the Yorktel experience? Most of all, go into the environments where you want your systems used and get to know the needs and workflows of the participants. Systems must be flexible, because each user is different. The systems must also be secure from the ground up, robust, and conformant to standards. Cost is also an important issue in most settings, particularly given the cuts in reimbursement that are widespread.

As it designs systems to interact along standards with other vendors, Yorktel’s strength in software has grown exponentially. This parallels trends throughout many industries, from manufacturers through retailers. Marc Andreessen famously said in 2011 that software is eating the world, and along these line, many analysts say that all companies will soon be software companies–or be drowned by their more agile competition. In this sense, we can all learn from Yorktel.

Both US And International Doctors Unimpressed With Govt Telehealth Adoption

Posted on May 25, 2017 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 survey by physician social network SERMO has concluded that both US and foreign physicians aren’t impressed with national and local telehealth efforts by governments.

The US portion of the survey, which had 1,651 physician respondents, found that few US doctors were pleased with the telehealth adoption efforts in their state. Forty-one percent said they felt their state had done a “fair” job in adopting telehealth, which 44 percent said the state’s programs were either “poor” or “very poor.” Just 15 percent of US physicians rated their state’s telehealth leaders as doing either “well” or “very well” with such efforts.

Among the various states, Ohio’s programs got the best ratings, with 22 percent of doctors saying the state’s telehealth programs were doing “well” or “very well.” California came in in second place, with 20 percent of physician-respondents describing their state’s efforts as doing “well” or “very well.”

On the flip side, 59 percent of New Jersey doctors said the state’s telehealth efforts were “poor” or “very poor.” New York also got low ratings, with 51 percent of doctors deeming the state’s programs were “poor” or “very poor.”

Interestingly, physicians based outside the US had comparable – though slightly more positive — impressions of their countries’ telehealth efforts. Thirty-eight percent of the 1,831 non-US doctors responding to the survey rated their country as having done a “fair” job with telehealth adoption, a stronger middle ground than in the US. That being said, 43 percent said their country has done a “poor” or “very poor” job with adopting telehealth programs, while just 19 percent rated their countries’ efforts as going “well” or “very well.”

As with state-by-state impressions in the US, physicians’ impressions of how well their country was doing with telehealth adoption varied significantly.  Spain got the best rating, with 26 percent of physicians saying efforts there were going “well” or “very well.” Meanwhile, the United Kingdom got the worst ratings, with 62 percent of doctors describing telehealth efforts there as “poor” or “very poor.”

Of course, all of this begs the question of what doctors were taking into account when they rated their country or state’s telehealth-related initiatives.

What makes doctors feel one telehealth adoption program is effective and another not effective? What kind of support are physicians looking for from their state or country? Are there barriers to implementation that a government entity is better equipped to address than private industry? Do they want officials to support the advancement of telehealth technology?  I’d prefer to know the answers to these questions before leaping to any conclusions about the significance of SERMO’s data.

That being said, it does seem that doctors see some role for government in promoting the growth of telehealth use, if for no other reason than that that they’re paying enough attention to know whether such efforts are working or not. That surprises me a bit, given that the biggest obstacles to physician telehealth adoption are generally getting paid for such services and handling the technology aspects of telemedicine delivery.

But if the study is any indication, doctors want more support from public entities. I’ll be interested to see whether Ohio and California keep leading the pack in this country — and what they’re doing right.

More Vendors, Providers Integrating Telemedicine Data With EHRs

Posted on April 27, 2017 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.

One of the biggest problems providers face in rolling out telemedicine is how to integrate the data it generates. Must doctors make some kind of alternate set of notes appropriate to the medium, or do they belong in the EHR? Should healthcare organizations import the video and notate the general contents? And how should they connect the data with their EHR?

While we may not have definitive answers to such questions yet, it appears that the telehealth industry is moving in the right direction. According to a new survey by the American Telemedicine Association, respondents said that they’re seeing growth in interoperability with EHRs, progress which has increased their confidence in telemedicine’s future.

Before going any further, I should note that the surveyed population is a bit odd. The ATA reached out not only to leaders in hospital systems and medical practices, but also “telehealth service providers,” which sounds like merely an opportunity for self-promotion. But leaving aside this issue, it’s still worth thinking a bit about the data, such as it is.

First, not surprisingly, the results are a ringing endorsement of telemedicine technology. The group reports that 83 percent of respondents said they’ll probably invest in telehealth this year, and 88 percent will invest in telehealth-related technology.

When asked why they’re interested in delivering these services, 98 percent said that they believe telehealth services offer a competitive advantage over those that don’t offer it. And 84 percent of respondents expect that offering telehealth services will have a big impact on their organization’s coverage and reach.

(According to another survey, by Avizia and Modern Healthcare, other reasons providers are engaging with telehealth is because they believe it can improve clinical outcomes and support their transition to value-based care.)

When it comes to documenting its key thesis – that the integration of EHR and telehealth data is proceeding apace – the ATA research doesn’t go the distance. But I know from other studies that telemedicine vendors are indeed working on this issue – and why wouldn’t they? Any sophisticated telemedicine vendor has to know this is a big deal.

For example, telemedicine vendor American Well has been working with a long list of health plans and health systems for a while, in an effort to integrate the telehealth process with provider workflows. To support these efforts, American Well has created an enterprise telehealth platform designed to connect with providers’ clinical information systems. I’ve also observed that DoctorOnDemand has made some steps in that direction.

Ultimately, everyone in telehealth will have to get on board. Regardless of where they’re at now, those engaging in telehealth will need to push the interoperability puck forward.

In fact, integrating telehealth documentation with EMRs has to be a priority for everyone in the business. Even if integrating clinical data from virtual consults wasn’t important for analytics purposes, it is important to collecting insurance reimbursement. Now that private health plans (and Medicare) are reimbursing for telemedical care, you can rest assured that they’ll demand documentation if they don’t like your claim. And when it comes to Medicare, arguing that you haven’t figured out how to document these details won’t cut it.

In other words, while there’s some overarching reasons why integrating this data is a good long-term strategy, we need to keep immediate concerns in mind too. Telemedicine data has to be seen as documentation first, before we add any other bells and whistles. Otherwise, providers will get off on the wrong foot with insurers, and they’ll have trouble getting back on track.

Healthcare CIOs Focus On Optimizing EMRs

Posted on March 30, 2017 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.

Few technical managers struggle with more competing priorities than healthcare CIOs. But according to a recent survey, they’re pretty clear what they have to accomplish over the next few years, and optimizing EMRs has leapt to the top of the to-do list.

The survey, which was conducted by consulting firm KPMG in collaboration with CHIME, found that 38 percent of CHIME members surveyed saw EMR optimization as their #1 priority for capital investment over the next three years.  To gather results, KPMG surveyed 122 CHIME members about their IT investment plans.

In addition to EMR optimization, top investment priorities identified by the respondents included accountable care/population health technology (21 percent), consumer/clinical and operational analytics (16 percent), virtual/telehealth technology enhancements (13 percent), revenue cycle systems/replacement (7 percent) and ERP systems/replacement (6 percent).

Meanwhile, respondents said that improving business and clinical processes was their biggest challenge, followed by improving operating efficiency and providing business intelligence and analytics.

It looks like at least some of the CIOs might have the money to invest, as well. Thirty-six percent said they expected to see an increase in their operating budget over the next two years, and 18 percent of respondents reported that they expect higher spending over the next 12 months. On the other hand, 63 percent of respondents said that spending was likely to be flat over the next 12 months and 44 percent over the next two years. So we have to assume that they’ll have a harder time meeting their goals.

When it came to infrastructure, about one-quarter of respondents said that their organizations were implementing or investing in cloud computing-related technology, including servers, storage and data centers, while 18 percent were spending on ERP solutions. In addition, 10 percent of respondents planned to implement cloud-based EMRs, 10 percent enterprise systems, and 8 percent disaster recovery.

The respondents cited data loss/privacy, poorly-optimized applications and integration with existing architecture as their biggest challenges and concerns when it came to leveraging the cloud.

What’s interesting about this data is that none of the respondents mentioned improved security as a priority for their organization, despite the many vulnerabilities healthcare organizations have faced in recent times.  Their responses are especially curious given that a survey published only a few months ago put security at the top of CIOs’ list of business goals for near future.

The study, which was sponsored by clinical communications vendor Spok, surveyed more than 100 CIOs who were CHIME members  — in other words, the same population the KPMG research tapped. The survey found that 81 percent of respondents named strengthening data security as their top business goal for the next 18 months.

Of course, people tend to respond to surveys in the manner prescribed by the questions, and the Spok questions were presumably worded differently than the KPMG questions. Nonetheless, it’s surprising to me that data security concerns didn’t emerge in the KPMG research. Bottom line, if CIOs aren’t thinking about security alongside their other priorities, it could be a problem.

E-Patient Update: Naughty, Naughty Telehealth Users

Posted on March 17, 2017 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.

Wow. I mean, wow. I can’t believe the article I just read, in otherwise-savvy Wired magazine yet, arguing that patients who access telemedicine services are self-indulgent and, well, sorta stupid.

Calling it the “Uber-ization” of healthcare, writer Megan Molteni (@MeganMolteni on Twitter) argues that telemedicine will only survive if people use it “responsibly” – apparently because people are currently accessing care via direct-to-consumer services because their favorite online gambling site was offline for system maintenance.

In making this claim, Molteni cites new research from RAND, published in the journal Health Affairs, which looked at the impact direct-to-consumer telemedicine services had on overall healthcare costs. But the piece goes from acknowledging that this model might not reduce costs in all cases to attacking e-patients like myself – and that’s where I got a bit steamed.

In structuring the piece, the writer seems to suggest that if consumer behavior doesn’t save the health insurance industry money, we need to stop being so gosh-darned assertive about getting help with our health. Then it goes further, arguing that we should just for-Pete’s-sake control ourselves (apparently we’re either hypochondriacs, attention-seekers or terminally bored) and just step away from the computer.  Why can’t we just say no?

First, the facts

Before we take this on, let’s take a look at the journal article which the writer drew upon as a primary source and see what assertions it makes. Facts first.

In the abstract, the authors note that demand for direct-to-consumer telehealth services is growing rapidly, and has the potential to save money by replacing physician office and emergency department trips with virtual visits.

To see whether this might be the case, the authors gathered commercial claims data over 300,000 patients covered by CalPERS Blue Shield, which began covering telehealth services in April 2012. During the next 18 months, 2,943 of those 300,000 enrollees came down with a respiratory infection, one third of which sought services from direct-to-consumer telehealth company Teladoc.

Once they had their data in hand, the research looked at patterns of care utilization and spending levels for treatment of acute respiratory illnesses.

After completing the analysis, the authors found that 12% of direct-to-consumer telehealth visits replaced visits to other providers, while the remaining 88% represented new care utilization. Net annual spending on acute respiratory illness grew $45 per telehealth users, researchers found.

The researchers concluded that because it offers more convenient access, direct-to-consumer telehealth may increase utilization and healthcare spending.

It should be noted that Molteri’s article doesn’t look at whether increased utilization was excessive or ineffective. It doesn’t ask whether patients who accessed telemedical care had different outcomes than those who didn’t and if those new patients saved the health system money because of the interventions that wouldn’t have happened without telehealth. It doesn’t address whether patients who used telehealth in addition to face-to-face care were actually sicker than those who didn’t, or had other co-existing conditions which affected overall costs. It just notes a pattern for a single group of patients diagnosed with a single condition.

Also, it’s worth pointing out that we don’t know whether Teladoc’s performance is better or worse than that of rivals like HealthTap, MDLive and Doctor on Demand. And if there are meaningful differences, that would be important.  But the piece doesn’t take this on either.

So in summary, all we know is that using one provider for one condition, a health plan paid a little bit more for some patients’ care when they had a telemedicine consult.

Consumer indictment

But in Molteri’s analysis, the study offers nothing less than an indictment of consumers who use these services. “For telehealth to fully deliver on its promise, people have to start treating their health care less like an Uber you summon in a thunderstorm,” she asserts, while citing no evidence that people do in fact access such services too casually.

All told, the piece suggests that the people are accessing telehealth for trivial reasons such as, I don’t know, kicks, or as an easy way to find an online buddy. Really? Give me a break. Even when it’s delivered online, people seek care out because they need it, not because they’re lazy or, as I noted above, stupid.

To be as fair as I can be, the article does note that direct-to-consumer healthcare models have unique flaws, particularly a lack of integration with patients’ ongoing care. It also concedes that some providers (such as the VA, which has slashed costs with its telehealth program) are using the technology effectively.

It also notes that telemedicine can do more to meet its potential if it’s used to manage chronic disease and engage people in preventive care. “Telehealth has to be integrated fully into a total care system,” said Mario Gutierrez, executive director of the Center for Connected Health Policy, who spoke with Molteri. As a patient with multiple chronic conditions, I couldn’t agree more. Anything that makes care access easier on one of my bad days is a winner in my book.

Ultimately, though, the author unfortunately bases her article on the assumption that the real problem here is patients accessing care. Not the gaps in the system that prompt such usage. Not the unavailability of primary care in some settings. Not the 15-minute fly-by medical visits that perforce leave issues unaddressed. Not even the larger issues in controlling healthcare costs. No, it’s e-patients like me who use telehealth to meet unmet needs.

Please. I can’t even.

E-Patient Update:  Can Telemedicine Fill Gap For Uninsured Patients?

Posted on February 24, 2017 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.

As someone who will soon will need to buy insurance through an ACA exchange – but doesn’t know whether that will still be possible – I’ve been thinking about my healthcare needs a lot, and how to meet them effectively if I’m ever uninsured.

Being an e-patient, the first thing that crossed my mind was to explore what Internet connectivity could do for me. And it occurred to me that if I had access to a wider range of comparatively-affordable telemedical services, I just might be able to access enough doctors and advanced practice clinicians to survive. (Of course, hospital and prescription drug costs won’t be tamed that easily, but that’s a subject for a different column.)

I admit that video visits aren’t an ideal solution for me and my husband, as we both have complex, chronic health conditions to address. But if I end up without insurance, I hold out hope that cheaper telemedicine options will get me through until we find a better solution.

Right now, unfortunately, telemedical services largely seem to be delivered on a hit-or-miss basis – with some specialties being easy to find and others almost inaccessible via digital connectivity – but if enough people like me are forced to rely on these channels perhaps this will change.

What’s available and what isn’t

This week, I did some unscientific research online to see what kind of care consumers can currently access online without too much fuss. What I found was a decidedly mixed bag. According to one telehealth research site, a long list of specialties offer e-visits, but some of them are much harder to access than others.

As you might have guessed, primary care – or more accurately, urgent care — is readily available. In fact one such provider, HealthTap, offers consumers unlimited access to its doctors for $99 a month. Such unfettered access could be a big help to patients without insurance.

And some specialties seem to be well-represented online. For example, if you want to get a dermatology consult, you can see a dermatologist online at DermatologistOnCall, which is partnered with megapharmacy Walgreens.

Telepsychiatry seems to be reasonably established, though it doesn’t seem to be backed yet by a major consumer branding effort. On the other hand, video visits with talk therapists seem to be fairly commonplace these days, including an option provided by HealthTap.

I had no trouble finding opportunities to connect with neurologists via the Web, either via email or live video. This included both multispecialty sites and at least one (Virtual Neurology) dedicated to offering teleneurology consults.

On the other hand, at least in searching Google, I didn’t find any well-developed options for tele-endocrinology consults (a bummer considering that hubby’s a Type 2 diabetic). It was the same for tele-pulmonology services.

In both of the former cases, I imagine that such consults wouldn’t work over time unless you had connected testing devices that, for example allow you to do a peak flow test, spirometry, blood or urine test at home. But while such devices are emerging, I’m not aware of any that are fully mature.

Time to standardize

All told, I’m not surprised that it’s hit or miss out there if you want to consult your specialists via an e-visit. There are already trends in place, which have evolved over the last few years, which favor some specialties and fail to address others.

Nonetheless, particularly given my perilous situation, I’m hoping that providers and trade groups will develop some standardized approaches to telemedicine. My feeling is that if a specialty-specific organization makes well-developed clinical, technical, operational and legal guidelines available, we’ll see a secondary explosion of new tele-specialties emerge.

In fact, even if I retain my health insurance benefits, I still hope that telemedical services become more prevalent. They’re generally more cost-efficient than traditional care and certainly more convenient. And I’m pretty confident that I’m not the only one champing at the bit here. Let’s roll ‘em out, people!

Consumers Want Their Doctors To Offer Video Visits

Posted on February 6, 2017 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 survey by telemedicine provider American Well has concluded that many consumers are becoming interested in video visits, and that some of consumers would be willing to switch doctors to get video visits as part of their care. Of course, given that American Well provides video visits this is a self-interested conclusion, but my gut feeling is that it’s on target nonetheless.

According to the research, 72% of parents with children under 18 were willing to see a doctor via video, as well as 72% of consumers aged 45-54 and 53% of those over age 65. Americal Well’s study also suggests that the respondents see video visits as more effective than in-person consults, with 85% reporting that a video visit resolved their issues, as compared with 64% of those seeing a doctor in a brick-and-mortar setting.

In addition, respondents said they want their existing doctors to get on board. Of those with a PCP, 65% were very or somewhat interested in conducting video visits with their PCP.  Meanwhile, 20% of consumers said they would switch doctors to get access to video visits, a number which rises to 26% among those aged 18 to 34, 30% for those aged 35 to 44 and and 34% for parents of children under age 18.

In addition to getting acute consults via video visit, 60% of respondents said that they would be willing to use them to manage a chronic condition, and 52% of adults reported that they were willing to participate in post-surgical or post-hospital-discharge visits through video.

Consumers also seemed to see video visits as a useful way to help them care for ill or aging family members. American Well found that 79% of such caregivers would find this approach helpful.

Meanwhile, large numbers of respondents seemed interested in using video visits to handle routine chronic care. The survey found that 78% of those willing to have a video visit with a doctor would be happy to manage chronic conditions via video consults with their PCP.

What the researchers draw from all of this is that it’s time for providers to start marketing video visit capabilities. Americal Well argues that by promoting these capabilities, providers can bring new patients into their systems, divert patients away from the ED and into higher-satisfaction options and improve their management of chronic conditions by making it easier for patients to stay in touch.

Ultimately, of course, providers will need to integrate video into the rest of their workflow if this channel is to mature fully. And providers will need to make sure their video visits meet the same standards as other patient interactions, including HIPAA-compliant security for the content, notes Dr. Sherry Benton of TAO Connect. Providers will also need to figure out whether the video is part of the official medical record, and if so, how they will share copies if the patient request them. But there are ways to address these issues, so they shouldn’t prevent providers from jumping in with both feet.

Time To Treat Telemedicine as Just “Medicine”

Posted on October 25, 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.

Over the last year or two, hospitals and clinics have shown a steadily growing interest in offering telemedicine services. Certainly, this is in part due to the fact that health plans are beginning to pay for telehealth consults, offering a new revenue stream that providers want to capture, but there’s more to consider here.

Until recently, much of the discussion around telehealth centered on how to get health insurance companies to pay for it. But now, as value-based purchasing becomes more the norm, providers will need to look at telemedicine as a key tool for managing patient health more effectively.

Evidence increasingly suggests that making providers available via telemedicine channels can help better manage chronic conditions and avert needless hospitalizations, both of which, under value-based payments, are more important than getting a few extra dollars for a consult.

Looked at another way, the days of telehealth being a boutique service for more-sophisticated consumers are ending. “It’s time to treat telemedicine as just ‘medicine,’” one physician consultant told me. “It’s no different than any other form of medicine.”

As reasons for treating telehealth as a core clinical service increase, barriers to sharing video and other telemedical records are falling, the consultant says. Telemedicine providers can already push the content of a video visit or other telehealth consult into an EMR using HL7, and soon information sharing should go both ways, he notes.

What’s more, breaking down another wall, major EMR vendors are offering providers the ability to conduct a telehealth visit using their platform. For example, Epic is offering telemedicine services to providers via its MyChart portal and Hyperspace platform, in collaboration with telehealth video provider Vidyo. Cerner, which operates some tele-ICUs, has gone even further, with senior exec John Glaser recently arguing that telehealth needs to be a central part of its population health strategy.

Admittedly, even if providers develop a high level of comfort delivering care through telehealth platforms, it’s probably too soon to rely on this medium as an agent of change. If nothing else, the industry must face up to the fact that telemedicine demand isn’t huge among their patients at present, though consumer plays like AmWell and DoctoronDemand are building awareness.

Also, while scheduling and conducting telemedicine consults need not be profoundly different than holding a face-to-face visit — other than offering both patient and doctor more flexibility — working in time to manage and document these cases can still pose a workflow challenge. Practical issues such as how, physically, a doctor documents a telehealth visit while staring at the screen must be resolved, issues of scheduling addressed and even questions of how to store and retrieve such visit records must be thought through.

However, I think it’s fair to say that we’re past wondering whether telemedicine should be part of the healthcare process, and whether it makes financial sense for hospitals and clinics to offer it. Now we just have to figure out where and when.

What Do You Think Of Data Lakes?

Posted on October 4, 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.

Being that I am not a high-end technologist, I’m not always up on the latest trends in database management – so the following may not be news to everyone who reads this. As for me, though, the notion of a “data lake” is a new one, and I think it a valuable idea which could hold a lot of promise for managing unruly healthcare data.

The following is a definition of the term appearing on a site called KDnuggets which focuses on data mining, analytics, big data and data science:

A data lake is a storage repository that holds a vast amount of raw data in its native format, including structured, semi-structured and unstructured data. The data structure and requirements are not defined until the data is needed.

According to article author Tamara Dull, while a data warehouse contains data which is structured and processed, expensive to store, relies on a fixed configuration and used by business professionals, a data link contains everything from raw to structured data, is designed for low-cost storage (made possible largely because it relies on open source software Hadoop which can be installed on cheaper commodity hardware), can be configured and reconfigured as needed and is typically used by data scientists. It’s no secret where she comes down as to which model is more exciting.

Perhaps the only downside she identifies as an issue with data lakes is that security may still be a concern, at least when compared to data warehouses. “Data warehouse technologies have been around for decades,” Dull notes. “Thus, the ability to secure data in a data warehouse is much more mature than securing data in a data lake.” But this issue is likely to receive in the near future, as the big data industry is focused tightly on security of late, and to her it’s not a question of if security will mature but when.

It doesn’t take much to envision how the data lake model might benefit healthcare organizations. After all, it may make sense to collect data for which we don’t yet have a well-developed idea of its use. Wearables data comes to mind, as does video from telemedicine consults, but there are probably many other examples you could supply.

On the other hand, one could always counter that there’s not much value in storing data for which you don’t have an immediate use, and which isn’t structured for handy analysis by business analysts on the fly. So even if data lake technology is less costly than data warehousing, it may or may not be worth the investment.

For what it’s worth, I’d come down on the side of the data-lake boosters. Given the growing volume of heterogenous data being generated by healthcare organizations, it’s worth asking whether deploying a healthcare data lake makes sense. With a data lake in place, healthcare leaders can at least catalog and store large volumes of un-normalized data, and that’s probably a good thing. After all, it seems inevitable that we will have to wring value out of such data at some point.

One Example Of Improving Telehealth Documentation 

Posted on August 16, 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.

Over the past year or two, the pressure has risen for providers to better document telehealth encounters, a pressure which has only mounted as the volume of such consults has grown. But until recently, telemedicine notes have been of little value, as they’ve met few of the key criteria that standard notes must meet.

The fact that such consults aren’t integrated with EMRs has made such an evolution even trickier. I guess doctors might be able to squeeze the patient’s video screen into one corner, allowing the clinician to work within the existing EMR display, but that would make both the consult and the note-taking rather inefficient, wouldn’t it?  The bottom line is that if telemedicine is to take its place alongside of other modes of care, this state of affairs is unsustainable.

For one thing, health plans that reimburse for telehealth services won’t be satisfied with vague assurances that such care made a difference – they’ll want some basis for analyzing its impact, which can’t be done without at least some basic diagnostic and care-related information. Also, providers will need similar records, for reasons which include the need to integrate the information into the patient’s larger record and to track the progress of this approach.

All of which is to note that I was happy to stumble across an example of a telemedicine provider that’s making efforts to improve its consult notes. While the provider, Doctor on Demand, hasn’t exactly reinvented the telehealth record, it’s improving those records, and to my way of thinking that deserves a shout-out.

As some readers may know, Doctor on Demand is a consumer-facing telemedicine provider which offers video visits with primary care doctors, counselors and psychiatrists. Its competitors include HealthTap and American Well. Because the company works with my health plan, United Healthcare, I’ve used its services to deal with off-hours issues as they arise.

Just today I had a video visit with a Doctor on Demand doctor to address a mild asthma care issue, after which I reviewed the physician’s notes. When I did so, I was happy to see that those notes included a ICD-10 diagnosis code. The notes also incorporated a consumer-level summary of what the diagnosed condition was, what to do about it, what its prognosis was and how to follow up. Essentially, Doctor on Demand’s notes have evolved from a sentence of two of informal suggestions to a more-structured document not unlike a set of hospital discharge instructions.

Don’t get me wrong, I’m certainly well aware that these are just baby steps. Doctor on Demand will have to move a lot further in this direction before consult documentation offers much to other providers. That being said, adding a formal diagnosis code gives the company a better means for analyzing key patterns of utilization internally by presenting condition, which can help its leaders look at whom they serve. Doctor on Demand can also use this information to pitch deals with potential partners, by sharing data on its population and underscoring its capabilities. In other words, these changes should make an impact.

Ultimately, telehealth documentation will have to meet the same expectations that other healthcare documentation does. And it’s not clear to me how freestanding telemedicine firms like Doctor on Demand will bridge that gap. After all, generating complete documentation takes far more than a few useful gestures. Even if the company threw a high-end EMR at the problem, merging it with the existing workflow is likely to be a huge undertaking. But still, making a bit of progress is worthwhile. I hope Doctor on Demand’s competitors are taking similar steps.