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Will The Fitbit Care Program Break New Ground?

Posted on September 21, 2018 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.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.

 

Open Source Software and the Path to EHR Heaven (Part 2 of 2)

Posted on September 20, 2018 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 segment of this article explained the challenges faced by health care organizations and suggested two ways they could be solved through free and open source software. We’ll finish the exploration in this segment of the article.

Situational awareness would reduce alert fatigue and catch errors

Difficult EHR interfaces are probably the second most frustrating aspect of being a doctor today: the first prize goes to the EHR’s inability to understand and adapt to the clinician’s workflow and environment. This is why the workplace redounds with beeps and belches from EHRs all day, causing alert fatigue and drowning out truly serious notifications. Stupid EHRs have an even subtler and often overlooked effect: when regulators or administrators require data for quality or public health purposes, the EHR is often “upgraded” with an extra field that the doctor has to fill in manually, instead of doing what computers do best and automatically replicating data that is already in the record. When doctors complain about the time they waste in the EHR, they often blame the regulators or the interface instead of placing their finger on the true culprit, which is the lack of awareness in the EHR.

Open source can ease these problems in several ways. First, the customizability outlined in the first section of this article allows savvy users to adapt it to their situations. Second, the interoperability from the previous section makes it easier to feed in information from other parts of the hospital or patient environment, and to hook in analytics that make sense of that information.

Enhancements from outside sources could be plugged in

The modularity of open source makes it easier to offer open platforms. This could lead to marketplaces for EHR enhancements, a long-time goal of the open SMART standard. Certainly, there would have to be controls for the sake of safety: an administrator, for instance, could limit downloads to carefully vetted software packages.

At best, storage and interface in an EHR would be decoupled in separate modules. Experts at storage could optimize it to improve access time and develop new options, such as new types of filtering. At the same time, developers could suggest new interfaces so that users can have any type of dashboard, alerting system, data entry forms, or other access they want.

Bugs could be fixed expeditiously

Customers of proprietary software remain at the mercy of the vendors. I worked in one computer company that depended on a very subtle feature from our supplier that turned out not to work as advertised. Our niche market, real-time computing, needed that feature to achieve the performance we promised customers, but it turned out that no other company needed it. The supplier admitted the feature was broken but told us point-blank that they had no plans to fix it. Our product failed in the marketplace, for that reason along with others.

Other software users suffer because proprietary vendors shift their market focus or for other reasons–even going out of business.

Free and open source software never ossifies, so long as users want it. Anyone can hire a developer to fix a bug. Furthermore, the company fixing it usually feeds the fix back into the core project because they want it to be propagated to future versions of the software. Thus, the fixes are tested, hardened, and offered to all users.

What free and open source tools are available?

Numerous free and open source EHRs have been developed, and some are in widespread use. Most famously is VistA, the software created at the Department of Veterans Affairs, and used also by the Indian Health Service and other government agencies, has a community chaperone and has been adopted by the country of Jordan. VistA was considered by the Department of Defense as well, but ultimately rejected because the department didn’t want to invest in adding some missing features.

Another free software EHR, OpenMRS, supports health care in Kenya, Haiti, and elsewhere. OpenEMR is also deployed internationally.

What free and open source software has accomplished in these settings is just a hint of what it can do for health care across the board. The problem holding back open source is simple neglect: as VistA’s experience with the DoD showed, institutions are unwilling to support open source, even through they will pay 10 or 100 times as much on substandard proprietary software. Open Health Tools, covered in the article I just linked to, is one of several organizations that shriveled up and disappeared for lack of support. Some organizations gladly hop on for a free ride, using the software without contributing either funds or code. Others just ignore open source software, even though that means their own death: three hospitals have recently declared bankruptcy after installing proprietary EHRs. Although the article focuses on the up-front costs of installing the EHRs, I believe the real fatal blow was the inability of the EHRs to support efficient, streamlined health care services.

We need open source EHRs not just to reduce health care costs, but to transform health. But first, we need a vision of EHR heaven. I hope this article has taken us at least into the clouds.

Open Source Software and the Path to EHR Heaven (Part 1 of 2)

Posted on September 19, 2018 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.

Do you feel your electronic health record (EHR) is heaven or hell? The vast majority of clinicians–and many patients, too, who interact with the EHR through a web portal–see it as the latter. In this article, I’ll describe an EHR heaven and how free and open source software can contribute to it. But first an old joke (which I have adapted slightly).

A salesman for an EHR vendor dies and goes before the Pearly Gates. Saint Peter asks him, “Would you like to go to heaven or hell?”

Surprised, the salesman says, “I didn’t know I had a choice.”

Saint Peter suggests, “How about this. We’ll show you heaven and hell, and then you can decide.”

“Sounds fair,” says the EHR salesman.

First they take him to heaven. People wearing white robes are strumming harps and singing hymns, and it goes on for a long time, till they take him away.

Next they take him to hell. And it’s really cool! People are clinking wine glasses together and chatting about amusing topics around the pool.

When the EHR salesman gets back to the Pearly Gates, he says to Saint Peter, “You know, this sounds really strange, but I choose hell.”

Immediately comes a clap of thunder. The salesman is in a fiery pit being prodded with pitchforks by dreadful demons.

“Wait!” he cries out. “This is not the hell I saw!”

One of the demons answers, “They must have shown you the demo.”

Most hospitals and clinicians are currently in EHR hell–one they have freely chosen, and one paid for partly by government Meaningful Use reimbursements. So we all know what EHR hell look like. What would EHR heaven be? And how does free and open source software enable it? The following sections of this article list the traits I think clinicians would like to see.

Interfaces could be easily replaced and customized

The greatest achievement of the open source movement, in my opinion, has been to strike an ideal balance between “let a hundred flowers bloom” experimentation and choosing the best option to advance the field. A healthy open source project encourages branching, which lets any individual or team with the required expertise change a product to their heart’s content. Users can then try out different versions, and a central committee vets the changes to decide which version is most robust.

Furthermore, modularization on various levels (programming modules, hooks, compile-time options, configuration tools) allows multiple versions to co-exist, each user choosing the options right for their environment. Open source software tends to be modular for several reasons, notably because it is developed by many different individuals and teams who want control over their small parts of the system.

With easy customization, a hospital or clinic can mandate that certain items be highlighted and that safe workflow rules be followed when entering or retrieving data. But the institution can also offer leeway for individual clinicians and patients to arrange a dashboard, color scheme, or other aspect of the environment to their liking.

Many of the enablers for this kind of agile, user-friendly programming are technical. Modularity is built into programming languages, while branching is standard in version control systems. So why can’t proprietary vendors do what open source communities routinely do? A few actually do, but most are constrained in ways that prevent such flexibility, especially in electronic health records:

  • Most vendors are dragging out the lifetime of nearly 40-year old technology, with brittle languages and tools that put insurmountable barriers in the way of agile work styles. They are also stuck with monolithic systems instead of modular ones.
  • The vendors’ business model depends on this monolithic control. To unbundle components, allow mix-and-match installations, and allow third parties to plug in new features would challenge the prices they charge.
  • The vendors are fundamentally unprepared for empowered users. They may vet features with clinically trained consultants and do market research, but handling power over the system to users is not in their DNA.

Data could be exchanged in a standard format without complex transformations

Data sharing is the lifeblood of modern computing; you can’t get much done on a single computer anymore. Data sharing lies behind new technologies ranging from the Internet of Things to real-time ad generation (the reason you’ll see a link to an article about “Fourteen celebrities who passed out drunk in public” when you’re trying to read a serious article about health IT). But it’s so rare in health care–where it’s uniquely known as “interoperability”–that every year, reformers call it the most critical goal for health IT, and the Office of the National Coordinator has repeatedly narrowed its Meaningful Use and related criteria to emphasize interoperability.

Open source software can share data with other systems as a matter of course. Data formats are simple, often text-based, and defined in the code in easy-to-find ways. Open source programmers, freed from the pressures on proprietary developers to reinvent wheels and set themselves apart from competitors, like to copy existing data formats. As a stark example of open source’s advantages, consider the most recent version of the Open Document Format, used by LibreOffice and other office suites. It defines an entire office suite in 104 pages. How big is the standards document for the Microsoft OOXML format, offering roughly equivalent functionality? Currently, 6,755 pages–and many observers say even that is incomplete. In short, open source is consistently the right choice for data exchange.

What would the adoption of open source do to improve health care, given that it would solve the interoperability problem? Records could be stored in the cloud–hopefully under patient control–and released to any facility treating the patient. Research would blossom, and researchers could share data as allowed by patients. Analytical services could be plugged in to produce new insights about disease and treatment from the records of millions of people. Perhaps interoperability could also contribute to solving the notorious patient matching problem–but that’s a complicated issue that I have discussed elsewhere, touching on privacy issues and user control outside the scope of this article.

The next segment of this article will list three more benefits of free and open source software, along with an assessment of its current and future prospects.

Human Centered Design in Healthcare #askpatients – #HITsm Chat Topic

Posted on September 18, 2018 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/21 at Noon ET (9 AM PT). This week’s chat will be hosted by Jen Horonjeff (@jhoronjeff) from @Savvy_Coop on the topic of “Human Centered Design in Healthcare #askpatients“.

I, Jen Horonjeff, have a confession – I’m one of the dreaded “non-compliant” patients you hear about. I have been living with juvenile arthritis and other autoimmune diseases for 33 years, so I often have a complex treatment plan. One of my biggest offenses is I don’t get my blood work done every four weeks, which is the regularity for which my doctor has ordered my labs.

I don’t have a fear of needles, it’s also relatively quick to drop into the lab and do, so why don’t I do it?

Because every time I do, the system fails me. The lab inevitably sends me a bill for an exorbitant amount of money claiming my insurance won’t cover it. That’s incorrect, they will, it’s just been billed incorrectly. Yet it’s up to me as a patient to sit on the phone for hours with the lab, the insurance company, my doctor’s office, and probably a friend to vent about it…again.

Healthcare, its systems, products and services, are supposed to improve the lives of patients and families, not create more headaches. But the problem is, until recently, no one really ever asked the patients what they were going through, what mattered to them, or their input how to fix it. Patients have been the recipients of the systems we develop, rather than the co-creators.

This is where human-centered design comes in. Human-centered design is about taking the time to #askpatients and design solutions to fit them, rather than continually have them navigate systems and tools that, at times, feel like a cruel joke. I’m not a bad patient because I don’t get my labs done. I am just exhausted by a system that did not incorporate proper human-centered design.

We all have a role to play to improve this. After a lifetime of stumbling through the healthcare system, I decided to do something about it and started Savvy Cooperative. Savvy is a patient-owned co-op that provides a marketplace for patient insights. Our goal is to make it so easy to connect and work with patients and healthcare consumers there is no excuse not to. I believe the future of healthcare is co-designed with patients.

As you go about your work or interface with the healthcare system, I hope you’ll be on the lookout for all the hoops patients jump through and think, “did anyone #askpatients about this?”

If you need examples where lack of human-centered design affects patients, check out some of our #MessedUpPtExp videos, featuring our friendly Savvy Puppets. Then, join us for this week’s #HITsm chat where we’ll discuss it in further detail.

Topics for this week’s #HITsm Chat:
Ice Breaker: We’ve got a Spotify playlist going of song titles that describe the current state of healthcare – what would you add to our #HealthcareSoundtrack? #HITsm

T1: Everyone has one, what’s one of the messed up patient experiences you’ve personally gone through or heard someone else go through that showed lack of human-centered design? #HITsm

T2: How can technology help to ease these headaches and improve the patient experience, rather than make it worse (feel free to use responses from T1 for inspiration!)? #HITsm

T3: Do you think patients can bring unique and valuable perspectives to the table that can make these technologies even better, and how so? #HITsm

T4: Let’s lay it out there, what are the reasons you have heard for why people or companies don’t work more directly with patients? #HITsm

T5: Some of the big consumer brands have mastered the user experience, but what do they need to do to truly improve the patient experience? #HITsm

Bonus: Who are some of the companies or individuals you feel are winning at human-centered design in healthcare, and what are they doing to show that? #HITsm

Upcoming #HITsm Chat Schedule
9/28 – How Does Interoperability Affect Technology Adoption in Healthcare?
Hosted by Niko Skievaski @niko_ski from @redox

10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

10/12 – TBD
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Applying AI Based Outlier Detection to Healthcare – Interview with Dr. Gidi Stein from MedAware

Posted on September 17, 2018 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.

Most people who receive healthcare understand that healthcare is as much art as it is science. We don’t expect our doctors to be perfect or know everything because the human body is just too complex and there are so many factors that influence health. What’s hard for patients to understand is when obvious human errors occur. This is especially true when technology or multiple layers of humans should have caught the obvious.

This is exactly why I was excited to interview Dr. Gidi Stein, CEO and Co-founder of MedAware. As stated on their website, their goal is to eliminate prescription errors. In the interview below, you’ll learn more about what MedAware and Dr. Stein are doing to achieve this goal.

Tell us a little about yourself and MedAware.

Early in my career, I worked in the Israeli high-tech industry and served as CTO and Chief Architect of several algorithm-rich startups. However, after many years working in technology, I decided to return to school and study medicine. In 2002, I graduated from Tel Aviv University Medical School with a specialization in internal medicine, treating patients and teaching students and residents in one of Israel’s largest hospitals.

After working as a physician for several years, I heard a heartbreaking story, which ultimately served as my motivation and inspiration to found MedAware. A physician was treating a 9-year-old boy who suffered from Asthma. To treat the symptoms, the physician entered the electronic prescribing environment and selected Singulair from the drop-down menu, a standard treatment for asthma. However, unfortunately, he accidentally clicked Sintrom, an anticoagulant (blood thinner). Tragically, neither the physician, pharmacist nor parent caught this error, which resulted in the boys’ untimely death. This avoidable, medication-related complication and death was caused by a typo.

Having worked as a physician for many years, I had a difficult time understanding that with all the medical intervention and technological support we rely on, our healthcare system was not intelligent enough to prevent errors like this. This was a symptom of a greater challenge; how can we identify and prevent medication related complications before they occur? Given my combined background in technology and medicine, I knew that there must be a solution to eliminate these types of needless errors. I founded MedAware to transform patient safety and save lives.

Describe the problem with prescription-based medication errors that exists today.  What’s the cause of most of these errors?

Every year in the U.S. alone, there are 1.5 million preventable medication errors, which result in patient injury or death. In fact, medication errors are the third leading cause of death in the US, and errors related to incorrect prescription are a major part of these. Today’s prescription-related complications fall into two main categories: medication errors that occur at the point of order entry (like the example of the 9yr old boy) and errors that result from evolving adverse drug events (ADEs). Point of order entry errors are a consequence of medication reconciliation challenges, typos, incorrect dosage input and other clinical inconsistencies.

Evolving ADEs are, in fact, the bulk of the errors that occur – almost 2/3 of errors are those that happen after a medication was correctly prescribed. These are often the most catastrophic errors, as they are completely unforeseen, and don’t necessarily result from physician error. Rather, they occur when a patient’s health status has changed, and a previously safe medication becomes unsafe.

MedAware uses AI to detect outlier prescriptions.  It seems that everything is being labeled AI, so how does this work and how effective is it at detecting medication errors?

AI is best used to analyze large scale data to identify patterns and outliers to those patterns. The common theme in industries, such as aviation, cyber security and credit card fraud, is that they are rich with millions of transactions, 99.99% of which are okay. But, a small fraction of them are hazardous, and these dangers most often occur in new and unexpected ways. In these industries, AI is used to crunch millions of transactions, identify patterns, and most importantly, identify outliers to those patterns as potential hazards with high accuracy.

Medication safety is similar to these industries. Here too, millions of medications are prescribed and dispensed every day, and in 99.99% of cases, the right medication is prescribed and dispensed to the right patient. But, on rare occasions, an unexpected error or oversight may put patients at risk. MedAware analyzes millions of clinical records to identify errors and oversights as statistical outliers to the normal behavioral patterns of providers treating similar patients. Our data shows that this methodology, identifies errors and ADEs with high accuracy and clinical relevance and that most of the errors found by our system would not have been caught by any other existing system.

Are most of the errors you find obvious errors that a human could have detected but just missed or are you finding surprising errors as well?  Can you share some stories of what you’ve found?

The errors that we find are obvious errors; any physician would agree that they are indeed erroneous. These include: prescribing chemotherapy to healthy individuals, not stopping anticoagulation to a bleeding patient, birth control pills to a 70-year-old male and prescribing Viagra to a 2-year-old baby. All of these are obvious errors, so why didn’t the prescribers pick these up? The answer is simple: they are human, and humans err, especially when they are less experienced and over worked. Our software is able to mirror back to the providers the crowdsourced behavioral patterns of their peers and identify outliers to these patterns as errors.

You recently announced a partnership with Allscripts and their dbMotion interoperability solution.  How does that work and what’s the impact of this partnership?

Today’s healthcare systems have created a reality where patient health information can be scattered across multiple health systems, infrastructures and EHRs. The dbMotion health information exchange platform aggregates and harmonizes that scattered patient data, delivering the information clinicians need in a usable and actionable format at the point of care, within the provider’s native and familiar workflow. With dbMotion, all of the patient’s records are in one place. MedAware sits on top of the bdMotion interoperability platform as a layer of safety, accurately looking at the thousands of clinical inputs in the system and warning with even greater accuracy. MedAware catches various medication errors that would have been missed due to a decentralized patient health record. In addition to identifying prescription-based medication errors, MedAware can also notify physicians of patients who are at risk of opioid addiction.

This partnership will allow any institution using Allscripts’ dbMotion to easily implement MedAware’s system in a streamlined manner, with each installation being quick and effortless.

Once MedAware identifies a prescription error, how do you communicate that information back to the provider? Do you integrate your solution with the EHR vendor?

Yes, MedAware is integrated with EHR platforms. This is necessary for error detection and communication of the warning to the provider. There are two intervention scenarios: 1) Synchronous – when errors are caught at the point of order entry, a popup alert appears within the EHR user interface, without disturbing the provider’s workflow, and the provider can choose to accept or reject the alert. 2) Asynchronous – the errors/ADE is caught following a change in the patient’s clinical record (i.e. new lab result or vital sign), long after the prescription was entered. These alerts are displayed as a physician’s task, within the physician’s workflow and the EHR’s user interface.

What’s next for MedAware?  Where are you planning to take this technology?

The next steps for us are:

  1. Scale our current technology to grow to 20 million lives analyzed by 2020
  2. Create additional patient safety centered solutions to providers, such as opioid dependency risk assessment, gaps in care and trend projection analysis.
  3. Share our life-saving insights directly to those who need it most – consumers.

Epic to Hold Startup Competition at App Orchard Conference

Posted on September 14, 2018 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 know it’s Friday and we usually do a Fun Friday post, but while this might look like a joke I assure you it’s not. Epic has recently announced to their App Orchard community that they’ll be doing a startup competition. The prize is $5k and “an opportunity to share their pitch with a senior Epic executive to get feedback and advice, and bragging rights.”

The startup competition is being held at the Epic App Orchard Conference happening Oct 24-26th at Epic’s headquarters in Verona. For those not familiar with App Orchard, it’s basically Epic’s partner program. The Founder or CEO of the startup is required to be there to be part of the Startup Pitch competition.

The contest is a little confusing because all tiers of App Orchard members are eligible to participate. However, companies don’t have to have to have an app in the app store yet. This would have been even more interesting if they opened it up outside the App Orchard community as well. However, given the short time frame to submit and then be on stage at the conference, I have a feeling this was a kind of last minute idea that they’re making happen and so they wanted to keep it simple.

Who would have thought that Epic would hold a startup competition? Is Epic finally seeing that there’s a lot of value to them and more importantly to their customers to have a more open approach to working with partners? Ok. A startup competition is a small step, but it feels like a huge one for Epic given past history.

The deadline to apply for the competition is Sep 28th, so it might be tight for companies that aren’t already a member of App Orchard to become a member and take part, but I’d be interested to hear if any company tries. I’ll be interested to hear what companies choose to take part in the competition and what ideas they pitch. Epic is currently displaying 111 apps in their App Orchard gallery.

Times are a changing at Epic. What’s next for Epic? They’re going to start acquiring companies? Let’s not get too crazy.

Latest Apple Watch to Cure Heart Disease (Yes, That’s the Sarcasm Font)

Posted on September 13, 2018 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.

By this point, I think that most people have seen the big announcement coming out of the Apple event that the Apple Watch 4 now has ECG and other heart monitoring capabilities built in. The watch will notify you if your heart rate is too low and instances of atrial fibrillation that it detects. Plus, all of this is done as an FDA cleared device (some are reporting that Apple got their FDA clearance in 30 days which is crazy fast for a medical device).

The response to this announcement has been quite interesting. Most aren’t surprised that Apple has been moving more and more into healthcare. Plus, there have been a lot of reports that have mistakenly called this the first consumer ECG which it’s not. AliveCor deserves that credit and I recently wrote about another consumer ECG which is just one of many that are coming. However, many are suggesting that the Apple Watch will be the first time that many younger, healthier people will be regularly using an ECG like this. That’s an interesting idea.

As you might have assumed by the title of this post, I think the Apple Watch announcement isn’t much ado about nothing, but it’s also not the announcement of “sliced bread” being invented either. Let’s dive into what this announcement really means for healthcare.

As I mentioned when I wrote about the other consumer ECG, there’s currently somewhat limited value in what can be done with a single lead ECG. So, it’s important to keep this Apple Watch announcement in the right perspective even though I’m sure most consumers won’t understand these details. One person even commented on how Apple created messaging that calls it an “intelligent health guardian” to confuse people while still avoiding liability:

Perception sells and Apple is as good at creating perception as anyone. Will many more people buy an Apple Watch if they perceive it as something that will help them monitor their health better? Definitely. However, there are some other consequences that many doctors are warning about when it comes to this type of tracking hitting the masses.

First up is Dr. Nick van Terheyden who provides a comparative example of why all this “testing” could lead to a lot of incidentloma’s (Nice word I assume he made up to describe false positives in health tests):

A nephrologist at Cricket Health, Carmen A. Peralta, chimed in with this perspective:

The problem with these devices is that it’s not in Apple’s best interest to truly educate a patient on what the device can and can’t do. If a single lead ECG like this was a reliable arbitrator of when to go to the ED or when to not go, then it would be extremely valuable. However, many doctors I’ve talked to are suggesting that a single lead ECG isn’t sufficient for this type of information. So, a false negative or a false positive from the Apple Watch can provide incorrect reassurance or unfortunate anxiety that is dangerous. Who’s going to communicate this information to the unsuspecting Apple Watch buyer? My guess is relatively no one.

Another doctor made this ironic observation when it comes to the false positives the Apple Watch will produce:

You can just imagine the Apple Watch template in an EHR system. I wonder if it will include an Apple Watch education sheet. Maybe the EHR could send that education sheet to their watch instead of the portal. Wishful thinking…I know.

Another doctor made this poignant observation about the announcement:

We could go on for a while about prevention versus diagnosis. However, I don’t think it’s really an either or proposition. Prevention is great, but detection and diagnosis are as well since we can’t prevent everything.

This MD/PhD student summed up where we’re at with these consumer health devices really well:

I agree completely. The Apple Watch is directionally good, but still far away from really making a significant impact on health and/or our healthcare sysetm.

Execs Say Silicon Valley Has The Jump On Healthcare Innovation

Posted on September 12, 2018 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.

Lately, it’s begun to look as though the leading lights of Silicon Valley might bring the next wave of transformation to healthcare. But can they work big changes in the industry on their own, or are they more likely to succeed by throwing their extremely considerable muscle behind existing healthcare players? That’s one of the many questions at issue as companies like Google, Amazon (Yes, I know they’re in Seattle), and Facebook shoulder their way into the business.

According to a new survey by Reaction Data, many healthcare execs think Amazon, in particular, has the potential to change the game.  When asked which outside entrants were most likely to disrupt the healthcare industry, two-thirds of respondents said the that the online retailing giant topped the list. “Amazon is ahead of the game in many ways compared to the other companies,” a chief nursing officer told Reaction Data.

There’s little doubt that there’s an opening for a company like Amazon to solve some pressing problems. As an industry outsider – unless you count its recent big-ticket acquisition of PillPack, which happened about a minute ago – Amazon may be able to bring fresh eyes to some of healthcare’s biggest problems. For example, what health exec wouldn’t kill to benefit from the e-retailer’s immense logistics capabilities? The mind boggles.

Facebook and Google aren’t making as many healthcare headlines, but they too are moving carefully into the business. For example, consider Google’s partnership with Stanford aimed at creating digital scribes. The digital scribe initiative may not seem like much, but I wouldn’t underestimate what Google can learn from the effort and how effectively it can operationalize this knowledge. It isn’t 2010 anymore, and I think the search giant has come a long way since its Google Health PHR effort collapsed.

Facebook, too, has made some tentative steps toward building a healthcare business, such as its recent agreement to collaborate with the NYU School of Medicine on speeding up MRI scanning using AI. The social networking giant hasn’t shown itself capable of much diversification to date, but I wouldn’t count it out, if for no other reasons than the massive profits to be made. Even for Facebook, we’re talking about serious money here.

If you’re wondering what these companies hope to accomplish, it’s not surprising. There are so many possibilities. One place to start is rethinking the EHR. Maybe I’m a starry-eyed dreamer, but I agree with observers like Dale Sanders, an executive with HealthCatalyst, who argues that Silicon Valley disrupters might be poised to bring something new to the table. “I keep hoping that the Googles, Facebooks and Amazons of the world will quietly build a new generation EMR,” Sanders writes in a recent column.

EMR transformation is just one of many potential targets of opportunity for the Silicon Valley gang, though. There’s obviously a raft of other goals healthcare leaders might like to see realized, The truth is, though, that it matters less what the Silicon Valley giants do than the competitive scramble they kick off within the industry. Even if these behemoths never succeed in leading the charge, they’re likely to spur others to do so.

Video Games and Healthcare IT – #HITsm Chat Topic

Posted on September 11, 2018 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/14 at Noon ET (9 AM PT). This week’s chat will be hosted by John Lynn (@techguy) from @HealthcareScene on the topic of “Video Games and Healthcare IT“.
I’ve been thinking a lot about the #HITsm chat and it’s evolution since the beginning. As my colleague Colin Hung knows, I’ve long been asking what the future of the chats will be and what’s the value the community can receive from these chats. I’ll admit that I’m still not sure all the answers to those questions, so I’d love to hear your thoughts.

With that said, I do think Twitter chats have been great for two things: connections and learning.

I think the #HITsm chat has served me and many in the community well on both accounts. In the beginning, Twitter chats were an excellent way for us to discover and connect with new and interesting people who were working in the field of healthcare IT. No doubt many of us found hundreds of new friends who were as passionate about the user of technology in healthcare as us. It was an amazing thing and provided so much value to everyone involved. This led to in person meetups that took all of those connections to new levels.

While this still happens today, there is a bit of a diminishing returns that happens now that so many of us know each other so well both online and in person. I’ll be interested to see how this evolves since we still do get new people who join these chats, but even then I wonder how they feel entering a community that kind of already knows each other.

The other clear goal from Twitter chats is learning. It’s always great to take part in a topic where so many experts come together and share knowledge. However, is this the best way to learn? Is there a way we could leverage the community more for learning? Is there a way we could involve more experts to increase the learning and sharing even more? These are all open questions that I’m trying to figure out and would love your thoughts.

As I thought about these things, one thing I realized is that some of the best parts of Twitter chats is connecting around common pieces of humanity. Things like travel, music, geek stuff, and food were always tangential topics that often revealed a different side of people in the community. I loved these tangents (as many people likely realized) because it created a new type of connection with someone in the community. Long story short, I wondered if we could create more of this type of interaction to strengthen bonds in the community in ways we couldn’t plan.

That’s the genesis of this week’s #HITsm chat. Let’s talk about a topic that no doubt many in the community know and love: video games. Most of us have gone through multiple generations of video games. Let’s spend some time sharing some nostalgic moments from video games to connect with others in the community. Then, we’ll also look at how our experience with video games could inform our work in healthcare IT.

We hope you’ll join us for this week’s #HITsm chat on video games. I’m sure we have some passionate memories that will be shared and possibly some new ideas and perspectives on how we can make healthcare better.

Topics for this week’s #HITsm Chat:
T1: What was your first video game system? How’d you get it? What games did you have? #HITsm

T2: Name your top 5 video games and why you loved them. Any memories or special moments with those video games are welcome too. #HITsm

T3: What did video games teach you (good or bad)? #HITsm

T4: Where would you like to see video game principles included in healthcare IT? Share some examples of how healthcare would benefit if it was more like video games. #HITsm

T5: Analogies are fun. What parallels can you draw between video game experiences and healthcare IT? #HITsm

Bonus: If you could create a special power (like they do in video games) what would it be? #HITsm

Upcoming #HITsm Chat Schedule
9/21 – Human Centered Design in Healthcare #askpatients
Hosted by Jen Horonjeff (@jhoronjeff) from @Savvy_Coop

9/28 – How Does Interoperability Affect Technology Adoption in Healthcare?
Hosted by Niko Skievaski @niko_ski from @redox

10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Are EHR Companies Difficult to Work With?

Posted on September 10, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

There is an entrenched myth that EHR companies are difficult to partner with – more interested in up-front partner fees and revenue sharing than actually collaborating with 3rd party companies. Two companies are working hard to be different.

Early in the spring, I had a lengthy conversation with a group of vendors at HIMSS18 about partnering with EHR companies. I had stopped at a booth and somehow we got onto the topic of collaborating with EHR companies as a way to accelerate product development and sales. The person I was speaking with was very frustrated at the lack of response from three of the larger EHR companies. I’m paraphrasing, but her statement was essentially this: “All they want is to charge me their 5K partnership fee and then take 10% of everything I sell to their customer base. It’s ridiculous.”

At that point, several representatives from surrounding booths joined in our conversation. All of them had similar frustrations and shared similar stories of being shunted to the partnership team – which in their opinion was just a sales team in disguise – where they were told about all the wonderful benefits they would receive in return for an upfront partnership fee. I’m sure many Healthcare Scene readers can identify with these vendors.

This conversation stuck with me and over the spring and summer, I decided to dive deeper into the world of EHR partnerships. I wanted to know if the myths were true and I wanted to see if there were any companies that were operating differently. Over the past several months at every conference I have attended, I have made it a point to find out as much as I could about the various partnership programs and spoke with dozens of vendors who were proudly displaying partnership badges on their booths.

The good news is that there are at least two companies working hard to build a thriving partner ecosystem. The bad news is that many EHR companies do not have a well-defined partnership strategy and many vendors do not feel they are getting full value for their participation in EHR ecosystems.

One of the key things I learned is that there is a distinct difference between working with an EHR company on interoperability vs being part of their partner ecosystem. There have been many articles over the past few years about the difficulty of extracting data from EHRs in order to share it with other organizations involved in the care for patients. Headlines like “How disparate EHR systems, lack of interoperability contribute to physician stress, burnout” are common.

Many of the EHR companies I spoke with separate their interoperability efforts from their partnership programs. The ability to share data with others, they said, was not related to how well/not well they worked with 3rd party companies. So while it may be true that EHR companies have a lot of work to do on interoperability, partnership for some is something a few companies are doing well.

One company is Allscripts.

After HIMSS18, I had the opportunity to drop in on the fourth annual Allscripts Developer Summit in Chicago. I honestly did not know what to expect and I was pleasantly surprised at how intimate the event was. The rooms were smaller and had people sitting at round tables listening to presenters and asking lots of questions. The level of interaction between the speakers and the developers at the tables was refreshing to see.

Most of the attendees at the Summit were developers and product managers from companies that were Allscripts partners. Most of the discussions in the sessions and in the hallways centered around the latest APIs and FHIR initiatives.

The Summit is part of Allscript’s Developer Program (ADP). Allscripts recently announced that its ADP partners have together processed more than 4 Billion API data exchange transactions since the company started tracking it in 2013. In the announcement Tina Joros, VP and General Manager, Open Business Unit at Allscripts had this to say:

“We are trying to create a new mentality of innovation for our clients so that they view innovation as a path to improve overall workflows and connect with patients. We have made our API platform easily accessible and cost-effective for developers to use so that they can develop and test their solutions. This includes the ability for developers to use our FHIR APIs to meet regulatory requirements for our shared clients at no cost.”

I had the chance to sit down with Joros during the Summit and she shared with me that Allscripts does more than just provide access to their APIs. “We help companies with sales and marketing as well,” said Joros. “We coach partners that are new to the space how to ‘talk healthcare’. We help them craft and tell their stories to their target buyers. We spend a lot of time on the phone and in the field with our ADP partners. Our goal is to reduce the risk for clients to adopt new technology.”

With more than 8,000 registered developers in ADP, I asked Joros why so many companies had joined. “One of the key differentiators is the ADP Integrator tier of our program; most competitors have programs that make it easier to sign up for the FHIR APIs but they also have a vetting process in place to review companies for partnership,” said Joros. “In our ADP Integrator tier, however, companies can sign up immediately to access all our FHIR and proprietary API functionality – there is no wait or vetting by Allscripts and no fee to get started. The pricing model is designed so that companies only pay Allscripts when they are ready to go to market via a testing fee and usage-based fee. The ease of signing up and no fee to get started are unique in the industry.”

One company that has been very successful at working with Allscripts is Relaymed – a company that makes connectivity software that sends point-of-care test results directly into EHRs. RelayMed has been part of ADP for four years and had nothing but good things to say about the program.

“Many EHR companies have rigid cultures that actually bias them against partnerships – the ‘not invented here’ syndrome,” commented Neil Farish, CEO of Relaymed who spoke with me over the phone. “Allscripts isn’t like that. They had a vision of an open and vibrant ecosystem. That vision is ingrained into their culture and there is support right from the top. It’s become part of their DNA. If anything, senior management at Allscripts has been paying even more attention to partners this year. They are present. They interact with us. Help from their marketing & sales teams has been easy to get and really welcomed.”

The team at Relaymed has been working with the Allscripts team to tighten and improve the level of integration between their two systems. As well, the companies together are looking at ways to expand the breadth of devices that connect to Allscripts through Relaymed.

Another company that has invested in their partnership program is Cerner.

Cerner takes a different approach when working with partners. Although they have a centralized team that helps on-board partners (legal, contracting, etc), the ongoing relationship with partners is handled directly by the team/department that works most closely with that partner. Sometimes that is the Cerner sales team. Often times it is the product team. It just depends on where most of the interactions will occur.

“No partnership looks the same,” John Gresham, Senior Vice President, DeviceWorks & Interoperability at Cerner told Healthcare Scene. “So we have to ask the key question – How does that partnership bring differentiated value to the customer? We will work with partners the way that works best for our customers. That may mean embedding someone else’s solution within our solutions, co-market their solution as part of a bundle or we may simply go-to-market together.”

It was surprising to learn that a company as large as Cerner did not have a cookie-cutter approach to partnering with 3rd parties. It would have been easy for them to put in a rigid framework but instead they adapt themselves to best suit the partnership. DellEMC, Kofax and Nuance were cited by Gresham as examples of Cerner partnerships that were flourishing.

“Customers want something seamless and not just in terms of Cerner being a systems integrator for them,” continued Gresham. “They want everything to be smooth and simple – buying it, contracting it, deploying it, integrating it and supporting it. Cerner is willing to do all those things, something that isn’t common in the EHR space.”

During our conversation, Gresham repeatedly referenced Cerner’s laser focus on delivering better patient care and better outcomes – and how that focus guided their partnership decisions. In fact, that is key to attracting the attention of an internal champion at Cerner: a clear line from the product or service being offered to customer or patient benefit.

That is exactly what happened with Goliath Technologies, a provider of IT operations software that enables IT Teams to anticipate, troubleshoot and prevent infrastructure performance issues. The team at Goliath had successfully implemented their solution at a Cerner customer. That customer spoke about their experience at a Cerner event and Jay Savaiano, Senior Director of Business Development at Cerner took notice.

“It was because of Jay and his vision that Goliath got into the program,” explained Thomas Charlton, Chairman and CEO at Goliath Technologies. “He was the first person we had a conversation with and from there everything went smoothly. He was with us every step of the way and we’re still working with Jay today. But it all started because we were able to demonstrate a clear positive impact on a Cerner customer.”

“Once Cerner decided that Goliath would benefit their customers, the process of formalizing the relationship was very straightforward and smooth,” continued Charlton. “They moved really fast. They have a fantastic team of people, very competent and focused. Everyone from contracting to legal to sales was great to work with.”

Because of the success, they have enjoyed with Cerner, Goliath has begun to put a lot of focus on their partnership with Cerner. They have begun working with Cerner developers to refine and tune their combined solutions and Goliath recently hired a new VP of Corporate Development who had left Cerner a few years ago, to help strengthen the relationship [side note the VP was referred to Charlton by people at Cerner]

“Cerner brings healthcare knowledge to Goliath,” said Charlton. “They know patient care and healthcare systems management. That deep understanding of healthcare has helped us with product development. Cerner has really helped to reshape our thinking on healthcare, patient care and Healthcare IT Operations management.”

*****

It is interesting to note that neither Relaymed or Goliath were put forward by Allscripts or Cerner respectively as example partners to speak with. Both Relaymed and Goliath were referred to me by different people who are not affiliated with either EHR company.

So if you are a software provider that is looking to partner with an EHR company what can you do to attract their attention? All four individuals I spoke with offered sage advice.

Neil Farish (Relaymed): “Avoid the transactional models of partnership where it is just an exchange of $$$. Look to the value that you as a partner are getting, the value the EHR company is getting and the value you can provide together to their end-customers. If there is value all around then the fees should be dwarfed by the value. If not, then you seriously have to rethink that potential partnership.”

Thomas Charlton (Goliath): “Have a very clear understanding of how your product or service helps deliver better care to patients. Can you show a direct line to customer or patient benefit? If you can’t then you need to figure that out before approaching an EHR company looking for a partnership. Also, joint customers are important. The more joint customers you have the more momentum you will get behind the initiative.”

John Gresham (Cerner): “The key to making partnerships work is mutual respect. That’s the starting point. Next comes a key question – do you have a ‘what’s best for customers’ mindset. If you have that then we have a foundation for conversation. I would strongly encourage companies to build solutions for the highest possible reliability, scalability and security.  Cerner customers expect that. Oh, and you have to have proof points to back that up.”

Tina Joros (Allscripts): “Be persistent. Come talk to us at conferences. Connect with us online. I would encourage any company signed up for the program and does not feel like it is providing value, to speak with a member of our team and let us know.  In some cases, we can find a tier that is a better fit for the company or make introductions to other associates at Allscripts, so additional areas of the business can evaluate their solution.”

Myth busted.