Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

HealthTap Announces a Comprehensive Health App Platform

Posted on November 10, 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.

For the past five years, HealthTap has been building a network of doctors and patients who exchange information and advice through information forums, messaging, video teleconferencing, and other integrated services. According to CEO Ron Gutman, all that platform building has taught them a lot about what health app developers need–knowledge that they’ve expanded by listening to hospitals and third-party app developers over the years. On Tuesday, November 1, HealthTap announced a comprehensive cloud platform pulling together all these ideas. The features in the press release read like a wish list from health app developers:

  • Text, voice, and video messaging

  • Telemedicine

  • Population health

  • Predictive modeling

  • Device input and other patient-generated data

  • Handling clinical data from electronic health records

  • Aggregated data on patient groups, such as the frequency of concepts in the population

  • The ability to view timelines on patients

  • Searchable content from the huge library of clinical advice posted to HealthTap by its roster of more than 100,000 doctors

  • Identity management, so that patients and clinicians can verify who they are and connect securely

  • Customer relationship management through messaging

Many of the APIs covering these topics are covered in the developer documentation, and others are available by application from qualified developers.

Gutman told me that three to four years of work went into this platform, and that he hopes it can reduce the multi-year developments efforts his team had to deal with to just weeks for other developers hoping to innovate in the health care field. Transparency is promoted as a key value, because the developer terms required developers to “Clearly inform users what data you collect (with their consent) as well as and how you use the data you collect or that we (HealthTap) provides to you.” Even so, some items are restricted even more, such as adherence data and health goals.

In addition to RESTful APIs, the platform has SDKs for iOS, Android, and JavasScript. CTO Sastry Nanduri says that these SDKs permit apps to incorporate some workflows, such as making virtual appointments. His philosophy is that, “We do the work and make it easy for the developers.”

HealthTap has created its own formats and APIs instead of using existing standards such as the Open mHealth defined for medical devices (described in another article). A diversity of formats may make adoption harder. But the platform does harmonize diverse data from different sources into predictable formats, so that things such as blood glucose and body weight are shown in fixed units. Nanduri points out that most of their work has not been done by other organizations in an open, API format.

In any case, central to HealthTap’s goals and efforts is the sharing of data among organizations. If Partners Healthcare or Kaiser Permanente can open their data through HealthTap’s APIs, it can all be combined with the aggregated data from millions of records HealthTap has built up over time.

Offering this platform in HealthTap’s cloud gives it many advantages. Foremost is the enormous data repository of both patients and content served up by the platform. Second, identity management is automatically provided through the secure and robust platform HealthTap has always used for signing up patients and clinicians. Clinicians are carefully validated. Theoretically, a developer could also use an independent means of authenticating patients, so that someone can use apps built on the platform without a HealthTap account.

They are also exploring a blockchain solution for tracking permissions and contracts.

The proof of this huge undertaking will be in its adoption. I’m sure HealthTap’s partners and many other organizations will play with the platform and try to bring apps to life through it, either for internal use or for widespread distribution. Nanduri says that they are ramping up carefully, reviewing applications one by one, and will talk to each of their early developers to find out their goals and offer guidance to creating a successful app. Time will tell whether HealthTap has, as Gutman says, created the platform their developers wish they had when they started the company.

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.

Telemedicine Startup Offers Providers A Shot At Equity

Posted on April 22, 2015 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 couple of years, the number of telemedicine vendors out there fighting for business has exploded.  These include DoctoronDemand, GoTelecare, HealthTap, MDLIVE, American Well and many, many more.

Health plans are jumping on the bandwagon too. For example, United Healthcare  has been running a popular national television campaign advertising its “virtual clinic” services. UHC is my plan, so I can attest that this service — shown as embedded in its member site — hasn’t been rolled out yet, but that only makes its desire to get out in front of the trend more noteworthy.

Telemedicine models in play include companies that recruit providers and sell them to consumers, vendors who enable telemedicine via proprietary platforms and firms that lead with community building. At present the direct-to-consumer players seem to be somewhat ahead, simply because they’ve already begun developing a national brand, but the story doesn’t end there.

Though consumer-facing telemedicine companies probably have a viable business model, they’ll have to build a memorable consumer brand to make it, something that takes a great deal of  time and money.  On the other hand, vendors that offer white-label telemedicine technology to hospitals and health plans have at least as much to gain, without having to win the loyalty of fickle consumers.

One telemedicine player doing just that is Nashville-based PointNurse, which has developed a distributed collaboration and communications platform providers can use to deliver telemedicine services. I just spoke to CEO Cyrus Maaghul, who gave me a company overview, and was interested to hear that his venture is taking things in some new directions.

PointNurse is different than most companies in the telemedicine space for a few reasons.

For one thing, the platform includes block chain capabilities, which allow providers to accumulate credits for both community participation and actual care delivery. (In case you aren’t familiar with block chain technology, which powers crypto currency Bitcoin, you may want to click here.)

These credits aren’t just for fun. Eventually, when providers accumulate enough credits, they get a pro-rata share of a dedicated pool of equity.

Consumers, for their part, are given a multi-signature wallet which stores both their personal and clinical information, resulting more or less in a PHR with added capabilities. PointNurse hasn’t yet devised a way to share the data with provider EMRs, but that’s a short-term goal.

A wide range of providers can participate in PointNurse, including not only MDs but also nurse practitioners, pharmacists, RNs, LPNs and elder advocates.

A sister venture, HealthCombix, will license the technology underlying PointNurse to hospitals and payers. HealthCombix will provide APIs and tools to build their own distributed applications.

As Maaghul sees it, it’s critical for providers to realize more than a short-term benefit from participating in telemedicine. “I wanted to make providers feel highly motivated — that they can gain from this [arrangement],” Maaghul said. “This creates value for the patient.”

Of course, there’s no proof yet that this or any particular telemedicine business model is going to capture its market niche.  In fact, it’s not even clear what niches will emerge in this space; after all, though it’s moving fast it’s far from mature.

That being said, this approach has some intriguing aspects. I’ll be interested to see whether its business model and and unusual underlying technology work out.

Telemedicine A Critical New Approach To Primary Care

Posted on August 15, 2014 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.

Telemedical treatment has been a tantalizing possibility for many years, for reasons including a failure of health plans to pay for it and too little bandwidth to support it, but those reasons are quickly being trumped by the need for quick, cheap, convenient care.

In fact, according to research by Deloitte, 75 million of 600 million appointments with general practitioners will be via telemedicine channels this year alone.

While one might assume that this influx is coming from traditional primary care practices which are finding their way online, that doesn’t seem to be the case.

Instead,a growing number of entrepreneurial startups are delivering primary care via smart phone and tablet, including Doctor on Demand and HealthTap, which offers videoconferences with PCPs, and options like Healthcare Magic and JustAnswer, which offer consumers the opportunity to get written responses to their healthcare queries from doctors.

Primary care doctors going into direct primary care are also joining the primary care telemedicine revolution; a key part of their business is based on making themselves available for consultation through all channels, including Skype/Facetime/Google Hangout meetings.

To date, most of the thinking about telemedicine have been that it’s an add-on service which is far to one side of the standard provision of primary care. However,with so many consumers paying out of pocket for primary care — and virtual visits typically priced far more cheaply than on-site visits — we may see a new paradigm emerge in which victims of  high-deductible plans and the uninsured rely completely on telemedical PCPs.

Rather than being merely a new technical development, I believe that the delivery of primary care via telemedical channels is a new form of ongoing primary care delivery.

It will take some work on the part of the telemedicine companies to sustain long-term relationships with patients, notably the use of an EMR to track ongoing care. And telemedicine PCPs will need to develop new approaches to working with other providers smoothly, as coordination of care will remain important. Health IT companies would be wise to consider robust, unified platforms that allow all of this to happen smoothly.

Regardless, the bottom line is that primary care telemedicine isn’t an intriguing sideline, it’s the birth of a new way to think about financing and delivery of care. Let’s see if traditional providers jump in, or if they let the agile new virtual PCP companies take over.

EHR and Mobile Health News Around the Country

Posted on February 24, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

It may come as a surprise to some, but according to a study by eClinicalWorks, the majority of physicians like EMR-connected apps, and mHealth apps in general. 2,291 healthcare professionals were surveyed, and 649 were physicians. Over 90 percent of physicians feel it’s valuable to have their EMR connected to an app. The study also revealed other interesting things concerning physicians and medical apps.

And EHR vendors may want to consider this when developing and updating their EHR. From the Black Book Rankings, here is a list of top EHR vendors among hospitals. I bet some of these ones definitely have.

On a similar topic, there was a recent study about physican EMR use in the United States. Apparently, they are behind other countries. While usage has definitely increased recently, with 69 percent of doctors using some type of EMR in 2012, it’s still well-below the rates in the Netherlands, Norway, New Zealand, the U.K, Australia, and Sweden, all that have EMR usage rates above 88 percent.

For anyone that is interested, there is quite a bit of legislation on telemedicine this year across the United States. This chart shows all that’s going on in three different categories — legislated mandate for private coverage, legislated medicaid coverage (primarily interactive video,) and other proposed bills affecting medicaid coverage.

There’s always a lot going on in the mHealth world. Have you heard of FilmArray? It’s a device that was developed by a company in Utah. So what does it do? Well, it can detect 20 respiratory diseases in less than an hour. This will definitely make it easier for people to get their illnesses diagnosed quickly. In other news, HealthTap has released a new program called TipTaps. The program sends tips, created by health professionals, and personalized for a person’s lifestyle.