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The House Call of the Future – Breakaway Thinking

Posted on July 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer_web
The closest I’ve come to experiencing a house call was watching Dr. Baker on “Little House on the Prairie” visit the good folks of Walnut Grove. Today, most people have no choice but to trek to their doctors’ offices and hospitals for health maintenance, diagnoses and check-ups. But new technologies are returning the personalized attention of the house call and will need to be adopted to retain the convenience and accessibility they offer.

I haven’t met anyone with a practice like Dr. Baker’s, though I recently read a news article that highlights the comeback of the house call. Some practitioners are banding together to provide round-the-clock care to patients who benefit from the fast response and lower cost: If a deductible or copay is higher than the price of the doctor’s visit, the patient may opt for the home visit.(1) The updated versions of the house call, however, are born of the technology used for telehealth, mobile health and health stations.

Telehealth allows a person to connect with a provider via the Internet. Patient and doctor can video conference, share informational media, and experience a face-to-face interaction without either party traveling from his or her home or office.(2) This allows patients better access to specialists who may have been too far away to visit and more frequent care at the right time to reduce the chances of serious complications or hospitalization. For patients who require frequent care over time, telehealth enables them to receive the medical attention they need while staying near their support network.(4) For providers, access to networks of specialists who can provide remote consultation helps them retain and ensure the highest level of care for patients rather than refer patients to another location.(3)

Both patients and providers also save time and money when there is no commute to an office or to a patient’s home. This is especially true of patients who live in rural areas and have to travel long distances for care. The quicker a patient can connect with the right specialist to treat or prevent serious illness, the lower the overall cost of care. (3)

Mobile health, or mHealth, takes technology one step further by allowing providers to track and monitor patient health on mobile devices such as tablets or phones. This includes monitoring devices that measure heart rate, blood pressure, oxygen levels, blood glucose and body weight. mHealth can be used in the office or taken on the road the way mobile clinics do. When healthcare is mobile, the ability to bring a doctor’s office to a neighborhood gives access to communities that otherwise wouldn’t seek or know how to find care. Currently, all 50 U.S. states have mobile clinics.(4)

Another trend in the making is the health kiosk. These look like private pods, about the size of four phone booths side by side. Think of it as telehealth combined with a mobile clinic. HealthSpot, a provider of health kiosks, describes them as “the access point to better healthcare.”(5) In addition to providing interaction with healthcare professionals via video conferencing, each station has an attendant and an automatic cleaning system. HealthSpot aims to give patients a private, personal, efficient experience.

Healthcare is on the move to better accommodate our lives, schedules, family structures and communities, which have vastly evolved from the “Little House on the Prairie” days and even from a decade ago. At the same time, our industry faces challenges in making the new technologies simple to use in order for them to be effective. With telehealth, for example, people typically need help setting up a home system and technical assistance. Meanwhile, providers face communicating and documenting in a new environment.

As we enter this new, modern, faster era of healthcare, both patients and providers will need to learn how to implement and adopt new systems, technologies and ways of interacting. Easing adoption is what we are prepared to do at The Breakaway Group. Once the learning-and-comfort curve is overcome, patients can experience the convenience of Dr. Baker’s updated home visit.

References:
(1) Godoy, Maria, (December 19, 2005). A Doctor at the Door: House Calls Make Comeback.
(2) Health Resources and Services Administration Rural Health, (2012). Telehealth.
(3) Hands on telehealth, (2013). 15 Benefits of telehealth.
(4) Hill, C., Powers, B., Jain, S., Bennet, J., Vavasis, A., and Oriol, N. (March 20, 2014). Mobile Health Clinics in the Era of Reform.
(5) The HealthSpot Station.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Connecting Smart Mobile Devices to the EHR

Posted on January 9, 2014 I Written By

Katherine Rourke 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.

My colleague, John Lynn, posted a hilarious CES marketing video advertising a new product it calls the iOximeter.  The iOximeter, which operates on both the iOS and Android platforms, is an independent device which attaches to smart phones, turning the phone into a pulse oximeter.

I strongly suspect that an i-glucose meter, i-scale and i-blood pressure cuff designed for the mass consumer market are starting to make major headway.

Not to be Scrooge at the Christmas party — I think such devices are a very positive development — but I’m left wondering what the purpose of getting the data onto the phone really is.  After all, unless the data gets to a physician conveniently, and ideally comes to live in their EMR, just how much good does it do?

On the consumer side, it does little but add bells and whistles to products consumers are increasingly used to using anyway, given that the price point for these devices is low enough that they’re sold in consumer pharmacies.

On the provider side meanwhile, you’re left with data that, while it might be arranged in pretty charts, doesn’t integrate itself easily into clinicians’ work flow.  And with EMRs already dumping huge volumes of data into their laps, some physicians are actively resisting integrating such data into the records.

No, the existing arrangement simply doesn’t do anything for clinicians, it seems.  Yes, consumers who are into the whole Quantified Self movement might find collecting such data to be satisfying, but the truth is that at this point many doctors just don’t want a ton of consumer-driven data added to the mix.

To make such phone-based devices useful to clinicians, someone will probably have to create a form of middleware, more or less, which accepts, parses, and organizes the data coming in from mobile health app/device combos like these.  When such a middleware layer goes into wide use, then you’ll see hospitals and doctors actively promote the use of these apps and devices.  Until then, devices like the iOximeter aren’t exactly toys, but they’re not going to change healthcare either.

Healthcare Pricing, Wiki Style EMR Editing, and Quantified Self Data – @nickdawson Edition

Posted on August 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time again for my roundup of interesting EMR, EHR, and Healthcare IT tweets. Today’s tweets all come from Nick Dawson. I don’t know Nick really well, but see him online quite a bit. Plus, I did a Google Plus hangout with him after TEDMED. He’s a very interesting guy and these tweets illustrate some of his thinking.


I’ve been hearing more and more of these cases and many of them are not even international. I’m not sure if the shift is because of the growth in high deductible plans, but there’s definitely a shift happening as far as awareness of what healthcare really costs. I hope we see a sea change in this regard.

Also, don’t underestimate the medical tourism part of this. I think there are going to be regions of this country and around the world that are going to battle for medical procedures. Eventually we’ll know that certain regions of the country are known for certain medical specialties just the same way we know Texas has oil and Nebraska has corn.


Just the thought of this will make many doctors stomach’s churn, but I like the concept. It would definitely need to be refined so there was a well defined chain of who edited what and when. Not to mention some sort of method for knowing when something was modified and by who. A novel concept, but not one I think we’ll find anytime soon.


I love to read stuff like this. I wonder if Nick pays for the action that happens. This is what really has doctors scared. Nick saved a visit, but the doctor missed out on the revenue that visit would have generated. It’s also why we need to start reimbursing doctors for online visits.

mHealth Notification Averts Hospitalization

Posted on August 2, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I usually save most of my mHealth specific blogging for my Smart Phone Healthcare blog (subscribe to it if you haven’t already), but this story was too interesting to not share with a larger audience. This story comes from Gerald Theis of MCR Global. Gerald is one of the most patient people you’ll meet in the mhealth space. He’s working across international lines, but this story is where I love seeing Gerald’s work the most. It’s also a great illustration of the power of mHealth.

Last week a patient started to self mutilate (multiple cuts to legs). Her daily severity scores were consistently high (3 = severe). The MCR SMS message Alert was sent to her primary caregiver who made a health check home visit followed by a psychotherapy visit within 24 hours.

This mobile health program helped to engage the primary caregiver and may have averted a hospitalization. The patient was able to use her support system and crisis management psychotherapy session to utilize coping strategies to deal with her internal conflicts and has not harmed herself since the session.

This testimonial demonstrates how we can achieve patient and caregiver engagement via mobile health technology and avoid unnecessary hospitalization.

EMPOWERMENT. All 15 patients are very satisfied with this unique program and are tracking their scores consistently. This self report program is helping them identify triggers and early warning signs as they score each symptom for severity – Mild-Moderate or Severe. Each are shown their graph results that provide a visual way to see their pattern of distress. One asked for an appointment sooner than scheduled because her symptoms were escalating. All like the SMS feature that makes them feel secure.

Health IT Interoperability, HIE, and mHealth — #HITsm Chat Highlights

Posted on June 8, 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.

A couple of the Health IT regulars got together again this week to video chat during the #HITsm Chat Highlights. Here are some of their thoughts. If you want to participate, be sure to comment!


Topic One: How far off is a solution to the problem of #healthIT interoperability? Is one actually within reach?

Topic Two: Is patient consent being overshadowed by sustainability as the most significant obstacle to #HIE?

Topic 3: What is the role of #telehealth and #mHealth in #healthcare reform and patient engagement?


Topic Four: Are competing deadlines (e.g., Stage 2 Meaningful Use v. ICD-10) going to be responsible for undermining healthcare reform?

 

Topic Five: Who or what will be most influential in determining the next phase in the evolution of #healthIT?

This Week in Health Innovation and The Coming Mobile Health Startup Revolution

Posted on April 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After the great experience many of us had at the Dell Healthcare Think Tank event, Gregg Masters asked if Shahid Shah (my partner in Influential Networks) and I would take part in an online interview he does called This Week in Health Innovation. This is one element of the Health Innovation Broadcast Consortium that Gregg and a few others have put together. We had a great 30 minute conversation about some of the major trends we saw happening in healthcare IT and then we even went into an overtime discussion for another 10 minutes. The time flew by in our discussion, but I think there were some really good nuggets shared in the interview. You can listen to the full interview in the embed below.

Listen to This Week in Health Innovation on Blog Talk Radio

I was also recently asked to do a guest blog post for the NYEC (New York eHealth Collaborative) blog. First, I have to say that I love that their blogging. Second, as many of you know, I’ve been participating in the Digital Health Conference in NYC that the NYEC puts on every year. It is a really great event.

With that background, I think that many of my readers will enjoy my guest post titled “The Coming Mobile Health Startup Revolution.” This is really coming, but I don’t think it’s going to come as most current mobile health people expect. A long series of incremental technology advancements have us prepped for an explosion of innovation in healthcare. I just hope that the healthcare structure doesn’t slow it down.

What Can We Do Today That We Couldn’t Do Five Years Ago in Health IT?

Posted on January 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been seeing the flood of creativity and innovation that can be seen at the CES (Consumer Electronics Show) in Las Vegas, I’ve often been witness to the amazing things that are possible today that wouldn’t have been possible five years ago.

There are so many examples of this happening throughout the IT world. A simple example is how many things are now possible with a mobile device that has always on mobile internet access (3G and 4G), an accelerometer, GPS, video camera, and voice recognition. 5 years ago we had little pieces of each, but now we have all of those items easily packed into one device. Think of the innovation that is happening that would have never happened if we didn’t have those technologies available.

I started thinking about how this applies to healthcare. What things can we do now that we couldn’t do five years ago?

Some of the technologies above are perfect examples of technology we have now that wasn’t available five years ago. A company like AirStrip Technologies wouldn’t even exist without the technologies mentioned above. Yet, because of those technologies, they’re now taking healthcare data mobile.

Five years ago we were at a pitiful EHR adoption level (10-20% depending on who you talked to). Now we’re at a much higher EHR adoption level. What is healthcare doing to capitalize on this increased adoption of EHR? What amazing things can we do now with EHRs in place that we couldn’t even consider before?

One example might be patient portals to access your clinical information. Before an EHR, the patient portal didn’t make sense because it didn’t have the EHR data to back up the portal. Once you have an EHR, it’s much easier to put up a portal that’s integrated with a patient’s record. That’s a simple example, but hopefully we’re going to see a lot more dramatic options. If we don’t then something’s wrong.

I guess the key message is that incremental progress in multiple areas combined together can lead to extraordinary breakthroughs. We need more of those in healthcare.

Mobile Health Trends and Technology

Posted on December 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at the mHealth Summit 2012 in DC, I captured a couple videos to try and get an idea of the various mHealth trends that we’ve been seeing in 2012 and what we can expect from mobile health in 2013. Each video is quite short, but full of interesting thoughts on the mHealth industry.

The first two videos are with David Collins from mHIMSS. David has a unique insight since HIMSS has made a big entry into the mHealth space with their acquisition of the mHealth Summit.

In the first video, David Collins talks about the various mobile health trends he’s seen at the mHealth Summit.

In this second video, David Collins discusses some of the key findings from the recently published HIMSS Analytics mHealth survey results.

I also thought it was interesting to hear from Jonathon Dreyer from Nuance Communications to learn what trends he was seeing. Jonathon and Nuance have an interesting perspective since so many mHealth applications could benefit from voice integration. So, they have a unique view at what mHealth applications exist.

Plus, I have to throw in this video that Jonathon made that demonstrates the Nuance voice integration with mobile devices. Nuance actually created this “dummy” EMR system to demonstrate the capabilities of their mobile voice recognition API. I think this was a really smart move since the demo really does illustrate some of the voice capabilities that could be built into EMR software and all sorts of mobile health applications. The video isn’t the perfect demo of the product, but it definitely does give a great window on what could be done with voice recognition when integrated properly.

An Example of EHR as Database of Healthcare

Posted on December 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my favorite interviews at mHealth Summit was with Alan Portela, CEO of AirStrip Technologies. I’d definitely heard good things about AirStrip, but I must admit that before our meeting I didn’t have a very good understanding of what AirStrip was really all about. I was pleased to learn that they are well deserving of the hype. I believe AirStrip will do wonderful things to help make healthcare data mobile and AirStrip is lucky to have Alan Portela leading the company. Alan is unique when it comes to healthcare IT leaders in that he understands the healthcare culture, but also has a unique vision for how healthcare can embrace the future.

The core of what AirStrip has done to date has been in OB and Cardiology. In fact, each of those areas is worthy of their own post and look into how they’ve changed the game in both of those areas. The OB side speaks to me since we recently had our fourth child. I can imagine how much better the workflow would have been had my wife’s OB had access to the fetal waveforms (CTGs) on her mobile device. Instead, it was left to the nurse to interpret the recordings and communicate them to the OB. There’s real power for an OB to have the data in the palm of their hand.

Similar concepts can be applied to cardiology. Timing is so huge when it comes to the heart and there’s little doubt that mobile access to healthcare data for a cardiologists can save a lot of time from when the data is collected to when the cardiologist interprets the results.

The real question is why did it take so long for someone like AirStrip to make this data mobile. The answer has many complexities, but it turns out that ensuring that the data displays to clinical grade quality is not as easy as one might think. An ECG waveform needs to be much more precise than a graph of steps taken.

While both of these areas are quite interesting, since I’m so embedded in the EHR world I was particularly interested in AirStrip’s move into making EHR data mobile. They’ve started with Meaningful Use Tracker, but based on my conversation with Alan Portela this is just the beginning. AirStrip wants to make your important clinical information mobile.

I pushed Alan on how he’ll be able to do this since so many EHR companies have created big barriers to being able to access their data. Turns out that Alan seems to share my view that EHR is the Database of Healthcare. This idea means that instead of the EHR doing everything for everyone, a whole ecosystem of companies are going to build amazingly advanced functionality on the back of the EHR data and functions.

In AirStrip’s case, they want to take EHR data and make it mobile. They don’t want to store the data. They don’t want to do the advanced clinical decision support. Instead, they want to leverage the EHR data and EHR functionality on a mobile device.

One key to this approach is that AirStrip wants to be able to do this for an organization regardless of which EHR you use on the backend. In fact, Alan argues that most hospital organizations are going to have multiple EHR systems under their purview. As hospitals continue to consolidate you can easily see how one organization is going to have a couple hospitals on Epic, a couple on Cerner, a couple on Meditech, etc. If AirStrip can be the consistent mobile front end for all of the major EHR companies, that’s a powerful value proposition for any hospital organization.

Of course, we’ll see if AirStrip gets that far. Right now they’re taking a smart approach to mobilizing specific clinical data elements. Although, don’t be surprised when they work to mobilize all of an organization’s healthcare data.

AirStrip is just one example of a company that’s using EHR as their database of healthcare data. I’m sure we’re going to see hundreds and thousands of companies who build powerful applications on the back of EHR data.

Skype HIPAA Risks Not Given Enough Attention

Posted on December 5, 2012 I Written By

Katherine Rourke 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, I don’t imagine too many providers use Skype to communicate with patients, if for no other reason than I haven’t heard my wired physician friends mention it.

But even if the numbers are small, it seems we may not have been paying enough attention to services like Skype, whose security may be good enough for personal conversation, but not for patient communication.

A recent item on a legal blog offers a reminder that Skype — and other Web-based communications platforms — pose security risks that may compromise a provider’s ability to comply with HIPAA.

Why should providers be concerned about using Skype and its kin to conduct free videoconferences with patients?  Well, a quick look at the security requirements HIPAA imposes, as cited by Epstein Becker Green attorney Rene Quashie, offers an idea:

  • Access controls.
  • Audit controls.
  • Person or entity authentication.
  • Transmission security.
  • Business Associate access controls.
  • Risk analysis.
  • Workstation security.
  • Device and media controls.
  • Security management processes.
  • Breach notification.

I have no in-depth knowledge of the Skype infrastructure, but my guess is that it fails most of the tests above.  And given that it’s a proprietary platform, it’s not as though hospitals or medical practices can build these controls onto Skype with any ease.

However, Mr. Quashie does offer a series of procedures to help mitigate the risks associates with Skype and its relatives:

  • Request audit, breach notification, and other information from web vendors.
  • Have patients sign HIPAA authorization and separate informed consent as part of intake procedures when using web-based platforms.
  • Develop specific procedures regarding the use of Skype and similar platforms (interrupted transmissions, backups, etc.).
  • Train workforce regarding the privacy and security risks associated with these platforms.
  • Exclude the use of these platforms for vulnerable populations (i.e., severely mentally ill, minors, those with protected conditions such as HIV).
  • Limit to certain clinical uses (i.e., only intake or follow up).

All of that being said, this clearly suggests the need for HIPAA-compliant videoconferencing services via the Web. And while they may exist, I’m certainly not aware of any market leaders. Your turn, readers?  Do you agree that there’s a need for such services?  Do any exist already that have traction in the arena?