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Nuance Communications Focuses on Practical Application of AI Ahead of HIMSS18

Posted on January 31, 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.

Is there a hotter buzzword than Artificial Intelligence (AI) right now? It dominated the discussion at the annual RSNA conference late last year and will undoubtedly be on full display at the upcoming HIMSS18 event next month in Las Vegas. One company, Nuance Communications, is cutting through the hype by focusing their efforts on practical applications of AI in healthcare.

According to Accenture, AI in healthcare is defined as:

A collection of multiple technologies enabling machines to sense, comprehend, act and learn so they can perform administrative and clinical healthcare functions. Unlike legacy technologies that are only algorithms/ tools that complement a human, health AI today can truly augment human activity.

One of the most talked about applications of AI in healthcare is in the area of clinical decision support. By analyzing the vast stores of electronic health data, AI algorithms could assist clinicians in the diagnosis of patient conditions. Extending this idea a little further and you arrive in a world where patients talk to an electronic doctor who can determine what’s wrong and make recommendations for treatment.

Understandably there is a growing concern around AI as a replacement for clinician-led diagnosis. This is more than simply fear of losing jobs to computers, there are questions rightfully being asked about the datasets being used to train AI algorithms and whether or not they are truly representative of patient populations. Detractors point to the recent embarrassing example of the “racist soap dispenser” – a viral video posted by Chukwuemeka Afigbo – as an example of how easy it is to build a product that ignores an entire portion of the population.

Nuance Communications, a leading provider of voice and language solutions for businesses and consumers, believes in AI. For years Nuance has been a pioneer in applying natural language processing (NLP) to assist physicians and healthcare workers. Since NLP is a specialized area of AI, it was natural (excuse the pun) for Nuance to expand into the world of AI.

Wisely Nuance chose to avoid using AI to develop a clinical decision support tool – a path they could have easily taken given how thousands use their PowerScribe platform to dictate physician notes. Instead, they focused on applying AI to improve clinical workflow. Their first application is in radiology.

Nuance embedded AI into their radiology systems in three specific ways:

  1. Using AI to help prioritize the list of unread images based on need. Traditionally images are read on a first-in, first-out basis (with the exception being emergency cases). Now an AI algorithm analyzes the patient data and prioritizes the images based on acuity. Thus, images for patients that are more critical rise to the top. This helps Radiologists use their time more effectively.
  2. Using AI to display the appropriate clinical guidelines to the Radiologist based on what’s being read from the image. As information is being transcribed through PowerScribe, the system analyzes the input in real-time and displays the guideline that matches. This helps to drive consistency and saves time for the Radiologist who no longer has to manually look up the guideline.
  3. Using AI to take measurements of lesion growth. Here the system analyzes the image of lesions and determines their size which is then displayed to the Radiologist for verification. This helps save time.

“There is a real opportunity here for us to use AI to not only improve workflows,” says Karen Holzberger, Vice President and General Manager of Diagnostic Solutions at Nuance. “But to help reduce burnout as well. Through AI we can reduce or eliminate a lot of small tasks so that Radiologists can focus more on what they do best.”

Rather than try to use AI to replace Radiologists, Nuance has smartly used AI to eliminate mundane and non-value-add tasks in radiology workflow. Nuance sees this as a win-win-win scenario. Radiologists are happier and more effective in their work. Patients receive better care. Productivity improves the healthcare system as a whole.

The Nuance website states: “The increasing pressure to produce timely and accurate documentation demands a new generation of tools that complement patient care rather than compete with it. Powered by artificial intelligence and machine learning, Nuance solutions build on over three decades of clinical expertise to slash documentation time by up to 45 percent—while improving quality by 36 percent.”

Nuance recently doubled-down on AI, announcing the creation of a new AI-marketplace for medical imaging. Researchers and software developers can put their AI-powered applications in the marketplace and expose it to the 20,000 Radiologists that use Nuance’s PowerScribe platform. Radiologists can download and use the applications they want or that they find interesting.

Through the marketplace, AI applications can be tested (both from a technical perspective as well as from a market acceptance perspective) before a full launch. “Transforming the delivery of patient care and combating disease starts with the most advanced technologies being readily available when and where it counts – in every reading room, across the United States,” said Peter Durlach, senior vice president, Healthcare at Nuance. “Our AI Marketplace will bring together the leading technical, research and healthcare minds to create a collection of image processing algorithms that, when made accessible to the wide array of radiologists who use our solutions daily, has the power to exponentially impact outcomes and further drive the value of radiologists to the broader care team.”

Equally important is the dataset the marketplace will generate. With 20,000 Radiologists from organizations around the world, the marketplace has the potential to be the largest, most diverse imaging dataset available to AI researchers and developers. This diversity may be key to making AI more universally applicable.

“AI is a nice concept,” continued Holzberger. “However, in the end you have to make it useful. Our customers have repeatedly told us that if it’s useful AND useable they’ll use it. That’s true for any healthcare technology, AI included.”

From Makerspaces to Virtual Spaces: How 3D Changes Everything… – #HITsm Chat Topic

Posted on January 30, 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, 2/2 at Noon ET (9 AM PT). This week’s chat will be hosted by Chuck Webster, MD (@wareFLO) on the topic of “From Makerspaces to Virtual Spaces: How 3D Changes Everything…”

What do makerspaces, 3D-printing, and virtual & augmented reality have in common? Three-dimensional objects! Makerspaces, and their 3D printers, make 3D objects in the real world. Virtual & augmented reality are populated by virtual models of objects from physical real world.

At the recent RSNA meeting in Chicago, the same 3D models, of wounds, tumors, and proposed implants, could be viewed in either virtual or physical reality (via 3D printing). 3D printed models can be designed in virtual reality. Physical objects can be scanned and viewed in virtual reality.

What are the implications of this 3D printing / virtual reality connection? Well, for one thing, you’ll find a lot of virtual reality meetups in makerspaces (as occurs here in Columbus, at The Idea Foundary). Microsoft co-locates a “Mixed Reality” (VR + AR) space in its corporate makerspace.

But here is where I want to drive this. Makerspaces are inherently social, based on communities of peer-to-peer teaching and learning. However virtual reality has a loner stereotype, someone covering their eyes with electronics, and withdrawing from social interaction to explore, alone, fantastical, artificial landscapes.

The exception, in a big, big way, is social virtual reality. I wrote about this recently in my blog post Shared Social Virtual Reality Networking for Health, Healthcare, and Health IT Marketing. I won’t belabor the point here, except to say I am as excited about social virtual reality as a I was, and still am, about Twitter. In some ways, I’m reminded of the Blab and Firetalk group social video platforms (RIP!). A bunch of people, from anywhere in the world, can get together, virtually, to, well, do almost anything. Party in space. Watch movies underwater. Customize their avatars however they wish (yes, it can get freaky!)

If above seems like a bit of mishmash, I admit it does seem that way to me too. However, I didn’t want to call this HITsm tweet chat something like “Stuff @wareFLO Thinks Is Cool at The Moment.” So I thought hard, and came up with some connections!

PS. I’m bring my makerspace and virtual reality gear to HIMSS18! Look me up and check out this video preview!

Now for the topics we’ll be discussing during this week’s #HITsm chat. I hope you’ll join in on the discussion.

Topics for This Week’s #HITsm Chat:
T1: Did you ever make something (perhaps out of readily available household items!) that solved YOUR unique problem. How did you feel? Is there something there, about everyday people making stuff, that healthcare needs? #HITsm

T2: Have you tried out a virtual reality headset yet? Which one? What did you see? What was exciting? What was disappointing? How about augmented reality? (Lots of AR apps now on iOS) Same questions… #HITsm

T3: I’m basically an engineer who happened to go to med school. It’s how I got interested in workflow. But now I’m getting back into “mechatronics” (building robots, for example) I’m happy to share my expertise. Anyone wanna build something together? What? #HITsm

T4: What if all of us, in this Twitter chat, right now, by just pushing a button, could appear to each other, in real time, as holograms (think Star Trek or Star Wars) anywhere in the real or imaginary world, what place & setting would you chose? #HITsm

T5: What questions would you like to get answered about 3D printing and virtual/augmented reality? #HITsm

Bonus: How might 3D printing and virtual (or augmented) reality be used for health IT marketing & PR purposes? #HITsm

Upcoming #HITsm Chat Schedule
2/9 – The Role of HealthIT in Driving Payer Provider Employer Collaboration
Hosted by Heather Lavoie (@HSLavoie) from @Geneia

2/16 – TBD

2/23 – #HIMSS18
Hosted by #HIMSS18 Social Media Ambassadors

3/2 – Machine Learning and AI in Healthcare
Hosted by Corinne Stroum (@healthcora)

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.

5 Drivers of Digital Change in Healthcare

Posted on January 29, 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.

Hospital CIO (or as he prefers, CDO – Chief Digital Officer), David Chou, recently asked the question “What Is the Main Driver of Digital Health?” and then he shared this image from Cognizant.

These results are pretty interesting since the main driver of digital change in healthcare is the consumer. That’s right. Patients are asking for healthcare to go digital. However, health reforms, health insurance exchanges, and new risk accountability are influencing it pretty heavy as well.

While these drivers are interesting, the real message here is that digital change in healthcare is going to be required. The future consumer is not going to accept a healthcare organization that doesn’t embrace digital. This is going to be true in so many different forms.

For example, I can’t imagine my children going to a healthcare organization that doesn’t do telemedicine or that doesn’t support some sort of text messaging or similar digital communication. The idea of not communicating this way will be completely foreign to them. Those organizations that embrace it will be the big winners.

One thing that might hold this back is that in some cities healthcare organizations have near monopolies. Since healthcare is local, these near monopolies are really only competing with themselves when it comes to their digital health options. It won’t matter much that another hospital or health system across the country offers something better. Or will it matter?

We’d all love to have our normal doctor be the one doing our telemedicine visit. However, given the option of an in-person visit with our normal doctor or a telemedicine visit with a doctor across the country, I think we’ll start seeing many people opt for the later. We need a few more laws to change to make this a reality, but changes to those laws would certainly open up a new competition to own the online relationship with a patient.

What’s clear to me is that digital will dominate the future. What’s not clear to me yet is who will own that digital health relationship with patients. Will it be local? Will it be national healthcare organizations? Will it be some other large company?

What do you think about this digital change in healthcare? What’s making this a reality? How do you think this change will play out?

Federal Advisors Say Yes, AI Can Change Healthcare

Posted on January 26, 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.

The use of AI in healthcare has been the subject of scores of articles and endless debate among industry professionals over its benefits. The fragile consensus seems to be that while AI certainly has the potential to accomplish great things, it’s not ready for prime time.

That being said, some well-informed healthcare observers disagree. In an ONC blog post, a collection of thought leaders from the agency, AHRQ and the Robert Wood Johnson Foundation believe that over the long-term, AI could play an important role in the future of healthcare.

The group of institutions asked JASON, an independent group of scientists and academics who advise the federal government on science and technology issues, to look at AI’s potential. JASON’s job was to look at the technical capabilities, limitations and applications for AI in healthcare over the next 10 years.

In its report, JASON concluded that AI has broad potential for sparking significant advances in the industry and that the time may be right for using AI in healthcare settings.

Why is now a good time to play AI in healthcare? JASON offers a list of reasons, including:

  • Frustration with existing medical systems
  • Universal use of network smart devices by the public
  • Acceptance of at-home services provided by companies like Amazon

But there’s more to consider. While the above conditions are necessary, they’re not enough to support an AI revolution in healthcare on their own, the researchers say. “Without access to high-quality, reliable data, the problems that AI will not be realized,” JASON’s report concludes.

The report notes that while we have access to a flood of digital health data which could fuel clinical applications, it will be important to address the quality of that data. There are also questions about how health data can be integrated into new tools. In addition, it will be important to make sure the data is accessible, and that data repositories maintain patient privacy and are protected by strong security measures, the group warns.

Going forward, JASON recommends the following steps to support AI applications:

  • Capturing health data from smartphones
  • Integrating social and environmental factors into the data mix
  • Supporting AI technology development competitions

According to the blog post, ONC and AHRQ plan to work with other agencies within HHS to identify opportunities. For example, the FDA is likely to look at ways to use AI to improve biomedical research, medical care and outcomes, as well as how it could support emerging technologies focused on precision medicine.

And in the future, the possibilities are even more exciting. If JASON is right, the more researchers study AI applications, the more worthwhile options they’ll find.

9th Annual New Media Meetup During #HIMSS18 Sponsored by CareCognitics

Posted on January 25, 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.


For those of you planning to attend the HIMSS 2018 conference in Las Vegas, I’m excited to share the details of the 9th Annual New Media Meetup at HIMSS. For those who’ve missed the last 8 events, it’s a unique meetup that brings together healthcare IT bloggers, media professionals, tweeters, and other social media influencers at the mecca of Healthcare IT conferences.

We’re excited to continue in our 9th year the tradition of bringing together some of the most influential people in healthcare IT in one space. While social media continues to change, what hasn’t changed is how many incredible connections happen on social media and how much fun we have meeting in person at the New Media Meetup during HIMSS. We’re lucky to have CareCognitics supporting our efforts to bring together the best HIMSS18 healthcare IT influencers at this incredible event. I hope everyone will spend some time checking out CareCognitics and thank them for sponsoring the event.

If you’d like to attend the event, please make sure you register.

Here’s a quick summary of the event details:
When: Wednesday 3/7 6:00-8:00 PM
Where: Senor Frogs, 3300 S Las Vegas Blvd, Las Vegas, NV 89109 MAP (Senor Frogs is inside Treasure Island Casino, a short walk across the street from the Venetian/Sands.)
Who: Anyone who uses or is interested in New Media (Blogs, Twitter, Social Media, YouTube Live, Facebook, etc) or works in media
What: Food, Drinks, Dance Floor, Giveaways, and Amazing People

Register Is Now Closed!  See you in Las Vegas!

Sponsored by CareCognitics

CareCognitics is a digital health company with a focus to improve quality of care for people with chronic conditions through the use of data science and patient engagement. We provide turnkey solution where our experienced clinical teams, augmented by our patented technology platform uses machine learning algorithms that enables physicians to deliver personalized care at scale. We transform patients into active participants with monthly care summaries, personalized care recommendations and encouragement when they take preventative steps to stay on plan.

The net result is better health outcomes, lower administrative costs and a more enduring connection between physicians and their patients. As a result, our customers (Physician groups) have experienced:

  • 70% enrollment in the chronic program versus industry average of single digits.
  • 30% increase in the quality scores (GPRO) in the first 6 months
  • 20% to 85% on average increase in annual wellness visits
  • 75% open rate on patient communication versus industry average of 22%
  • 200K net revenue increase for physician group with 1000 eligible CCM patients

Learn more at: CareCognitics.com

Those interested in the New Media Meetup at HIMSS will want to check out the 3 day Healthcare IT Marketing and PR Conference that we’re hosting in New Orleans April 4-6, 2018. It’s a special 3 days devoted to health IT marketing and PR professionals.

Plus, we’re excited to announce a brand new healthcare IT conference called Health IT Expo. This conference is focused on practical health IT innovation and is happening May 30-June 1, 2018 in New Orleans.

A really big thank you also goes out to all the members of Healthcare Scene that help promote the New Media Meetup. This event was originally brought together through social media and is still largely organized thanks to social media.

Let me know if you have any questions and I look forward to welcome you to Las Vegas very soon!

A Learning EHR for a Learning Healthcare System

Posted on January 24, 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.

Can the health care system survive the adoption of electronic health records? When the HITECH act mandated the installation of EHRs in 2009, we all hoped they would propel hospitals and clinics into a 21st-century consciousness. Instead, EHRs threaten to destroy those who have adopted them: the doctors whose work environment they degrade and the hospitals that they are pushing into bankruptcy. But the revolution in artificial intelligence that’s injecting new insights into many industries could also create radically different EHRs.

Here I define AI as software that, instead of dictating what a computer system should do, undergoes a process of experimentation and observation that creates a model to control the system, hopefully with far greater sophistication, personalization, and adaptability. Breakthroughs achieved in AI over the past decade now enable things that seemed impossible a bit earlier, such as voice interfaces that can both recognize and produce speech.

AI has famously been used by IBM Watson to make treatment recommendations. Analyses of big data (which may or may not qualify as AI) have saved hospitals large sums of money and even–finally, what we’ve been waiting for!–make patients healthier. But I’m talking in this article about a particular focus: the potential for changing the much-derided EHR. As many observers have pointed out, current EHRs are mostly billion-dollar file cabinets in electronic form. That epithet doesn’t even characterize them well enough–imagine instead a file cabinet that repeatedly screamed at you to check what you’re doing as you thumb through the papers.

How can AI create a new electronic health record? Major vendors have announced virtual assistants (See also John’s recent interview with MEDITECH which mentions their interest in virtual assistants) to make their interfaces more intuitive and responsive, so there is hope that they’re watching other industries and learning from machine learning. I don’t know what the vendors basing these assistants on, but in this article I’ll describe how some vanilla AI techniques could be applied to the EHR.

How a Learning EHR Would Work

An AI-based health record would start with the usual dashboard-like interface. Each record consists of hundreds of discrete pieces of data, such as age, latest blood pressure reading, a diagnosis of chronic heart failure, and even ZIP code and family status–important public health indicators. Each field of data would be called a feature in traditional AI. The goal is to find which combination of features–and their values, such as 75 for age–most accurately predict what a clinician does with the EHR. With each click or character typed, the AI model looks at all the features, discards the bulk of them that are not useful, and uses the rest to present the doctor with fields and information likely to be of value.

The EHR will probably learn that the forms pulled up by a doctor for a heart patient differ from those pulled up for a cancer patient. One case might focus on behavior, another on surgery and medication. Clinicians certainly behave differently in the hospital from how they behave in their home offices, or even how they behave in another hospital across town with different patient demographics. A learning EHR will discover and adapt to these differences, while also capitalizing on the commonalities in the doctor’s behavior across all settings, as well as how other doctors in the practice behave.

Clinicians like to say that every patient is different: well, with AI tracking behavior, the interface can adapt to every patient.

AI can also make use of messy and incomplete data, the well-known weaknesses of health care. But it’s crucial, to maximize predictive accuracy, for the AI system to have access to as many fields as possible. Privacy rules, however, dictate that certain fields be masked and others made fuzzy (for instance, specifying age as a range from 70 to 80 instead of precisely 75). Although AI can still make use of such data, it might be possible to provide more precise values through data sharing agreements strictly stipulating that the data be used only to improve the EHR–not for competitive strategizing, marketing, or other frowned-on exploitation.

A learning EHR would also be integrated with other innovations that increase available data and reduce labor–for instance, devices worn by patients to collect vital signs and exercise habits. This could free up doctors do less time collecting statistics and more time treating the patient.

Potential Impacts of AI-Based Records

What we hope for is interfaces that give the doctor just what she needs, when she needs it. A helpful interface includes autocompletion for data she enters (one feature of a mobile solution called Modernizing Medicine, which I profiled in an earlier article), clear and consistent displays, and prompts that are useful instead of distracting.

Abrupt and arbitrary changes to interfaces can be disorienting and create errors. So perhaps the EHR will keep the same basic interface but use cues such as changes in color or highlighted borders to suggest to the doctor what she should pay attention to. Or it could occasionally display a dialog box asking the clinician whether she would like the EHR to upgrade and streamline its interface based on its knowledge of her behavior. This intervention might be welcome because a learning EHR should be able to drastically reduce the number of alerts that interrupt the doctors’ work.

Doctors’ burdens should be reduced in other ways too. Current blind and dumb EHRs require doctors to enter the same information over and over, and even to resort to the dangerous practice of copy and paste. Naturally, observers who write about this problem take the burden off of the inflexible and poorly designed computer systems, and blame the doctors instead. But doing repetitive work for humans is the original purpose of computers, and what they’re best at doing. Better design will make dual entries (and inconsistent records) a thing of the past.

Liability

Current computer vendors disclaim responsibility for errors, leaving it up the busy doctor to verify that the system carried out the doctor’s intentions accurately. Unfortunately, it will be a long time (if ever) before AI-driven systems are accurate enough to give vendors the confidence to take on risk. However, AI systems have an advantage over conventional ones by assigning a confidence level to each decision they make. Therefore, they could show the doctor how much the system trusts itself, and a high degree of doubt could let the doctor know she should take a closer look.

One of the popular terms that have sprung up over the past decade to describe health care reform is the “learning healthcare system.” A learning system requires learning on every level and at every stage. Because nobody likes the designs of current EHRs, they should be happy to try a new EHR with a design based directly on their behavior.

Patient Portals and Chronic Disease Management – #HITsm Chat Topic

Posted on January 23, 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, 1/26 at Noon ET (9 AM PT). This week’s chat will be hosted by Monica Stout (@MI_turnaround) from Medicasoft on the topic of “Patient Portals and Chronic Disease Management.”

The Centers for Disease Control and Prevention posted a statistic stating that roughly 117 million people have one or more chronic health conditions. One in four people has two more chronic conditions. That is so many people! It’s 2018 and there are tons of innovative technologies out there. Why aren’t we doing a better job of managing our health conditions?

In a recent blog, I posted that chronic disease management represents one of the best opportunities for a personal health record or patient portal to link wellness and healthcare together to affect positive health outcomes. What changes in healthcare technology need to be made to more effectively treat and manage patients with chronic conditions?

Join us to talk about patient portals and chronic disease management during this week’s #HITsm chat.

Topics for This Week’s #HITsm Chat:
T1: Would you (or do you) use technology to help manage your health and wellness? Why or why not? #HITsm

T2: Effectively managing chronic disease can involve changing habits and forming good habits. What are some ways IT can help patients form and maintain good habits? #HITsm

T3: What’s a feature you wish patient portals had that they currently do not? #HITsm

T4: If patient portals collected data so providers could participate in MACRA/MIPS more seamlessly, would you be more apt to encourage their use in your organization? #HITsm

T5: Does your employer provide you a PHR as an employee benefit? If so, does it motivate you to be an engaged patient? #HITsm

Bonus: What are the benefits of having a complete personal health record that you can access anywhere? #HITsm

Upcoming #HITsm Chat Schedule
2/2 – From Makerspaces to Virtual Spaces: How 3D Changes Everything…
Hosted by Chuck Webster, MD (@wareFLO)

2/9 – The Role of HealthIT in Driving Payer Provider Employer Collaboration
Hosted by Heather Lavoie (@HSLavoie) from @Geneia

2/16 – TBD

2/23 – #HIMSS18
Hosted by #HIMSS18 Social Media Ambassadors

3/2 – Machine Learning and AI in Healthcare
Hosted by Corinne Stroum (@healthcora)

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.

UPMC Sells Oncology Analytics Firm To Elsevier

Posted on January 22, 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.

Using analytics tools to improve cancer treatment can be very hard. That struggle is exemplified by the problems faced by IBM Watson Health, which dove into the oncology analytics field a few years ago but made virtually no progress in improving cancer treatment.

With any luck, however, Via Oncology will be more successful at moving the needle in cancer care. The company, which offers decision support for cancer treatment and best practices in cancer care management, was just acquired by information analytics firm Elsevier, which plans to leverage the company’s technology to support its healthcare business.

Elsevier’s Clinical Solutions group works to improve patient outcomes, reduce clinical errors and optimize cost and reimbursements for providers. Via Oncology, a former subsidiary of the University of Pittsburgh Medical Center, develops and implements clinical pathways for cancer care. Via Oncology spent more than 15 years as part of UPMC prior to the acquisition.

Via Oncology’s Via Pathways tool relies on evidence-based content to create clinical algorithms covering 95% of cancer types treated in the US. The content was developed by oncologists. In addition to serving as a basis for algorithm development, Via Oncology also shares the content with physicians and their staff through its Via Portal, a decision support tool which integrates with provider EMRs.

According to Elsevier, Via Pathways addresses more than 2,000 unique patient presentations which can be addressed by clinical algorithms and recommendations for all major aspects of cancer care. The system can also offer nurse triage and symptom tracking, cost information analytics, quality reporting and medical home tools for cancer centers.

According to the prepared statement issued by Elsevier, UPMC will continue to be a Via Oncology customer, which makes it clear that the healthcare giant wasn’t dumping its subsidiary or selling it for a fire sale price.

That’s probably because in addition to UPMC, more than 1,500 oncology providers and community, hospital and academic settings hold Via Pathways licenses. What makes this model particularly neat is that these cancer centers are working collaboratively to improve the product as they use it. Too few specialty treatment professionals work together this effectively, so it’s good to see Via Oncology leveraging user knowledge this way.

While most of this seems clear, I was left with the question of what role, if any, genomics plays in Via Oncology’s strategy. While it may be working with such technologies behind the scenes, the company didn’t mention any such initiatives in its publicly-available information.

This approach seems to fly in the face of existing trends and in particular, physician expectations. For example, a recent survey of oncologists by medical publication Medscape found that 71% of respondents felt genomic testing was either very important or extremely important to their field.

However, Via Oncology may have something up its sleeve and is waiting for it to be mature before it dives into the genomics pool. We’ll just have to see what it does as part of Elsevier.

Are there other areas beyond cancer where a similar approach could be taken?

Health IT and ROI (Release of Information) Vendor Sues HHS Over Patient Records Fees

Posted on January 19, 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.

Now here’s one for the ages – a vendor taking HHS head-on. The vendor, CIOX Health, has sued HHS in an effort to stop the agency from enforcing HIPAA rules limiting how much providers and business associates can charge patient records. While the vendor may not get anywhere, the lawsuit raises the important question of what patient record retrieval should cost.

According to Becker’s Hospital Review, the suit focuses on changes to the privacy law put into place in 2013 and 2016. The article notes that these modifications broadened the type of information providers and BAs must send while capping the fees vendors could charge for doing so. Specifically, the changes made in 2016 require that vendors that the costs associated with record requests for a reasonable or flat rate of about $6.50.

In its complaint, CIOX says the flat fee “was drawn from thin air and bears no rational relationship to the actual costs associated with processing such requests.” It contends that the HIPAA provisions in question established the limits “unlawfully, unreasonably, arbitrarily and capriciously.”

It’s hard to tell whether CIOX will get anywhere (though my guess is “not very far”). Government agencies are all but immovable, and HHS particularly so. I appreciate the spunk involved in filing the suit, the premise of which actually sounds reasonable to me, but I think the company has about as much chance of prevailing as a gnat fighting a combine harvester.

That being said, I think this suit focuses on an important issue, which is that the fee limits imposed by states and the federal government for providing medical records are all over the map. While such limits may be necessary to protect consumers, it’s probably fair to say that they aren’t exactly based on actual estimates of provider and vendor costs.

The truth is, the healthcare industry hasn’t come to grips yet with the cost of delivering healthcare information to patients. After all, while basic information delivered by a portal may be good enough for patients, these aren’t real medical records and they can’t be used as a basis for care.  And delivering an entire medical record can be expensive.

Plus, this issue is really complicated by the number of records requests that healthcare organizations are receiving from parties other than the patient. The number of records request from insurance companies, lawyers, and other third parties has increased dramatically. Not to mention how much of the record these organizations want to get. If it were just patients requesting their records, this question would be much simpler.

I can only think of a few ways to handle this problem, none of which are really satisfactory. For example, HHS or the states could create some sort of system which permits different fees depending on the difficulty of retrieving the information. Providers and business associates could submit their fees to some kind of review board which would approve or reject the proposal. Or perhaps we could just allow vendors to charge whatever the market would bear. None of these sound great to me.

If we want patients to manage their health effectively, they need to be able to share their records, and they must be able to access those records without paying a fortune for the privilege. At the same time, we can’t ask providers and business associates to share records at their own expense. Given the importance of this problem, I think it’s high time that healthcare leaders look for solutions.

Hospitals Still Lagging On Mobile

Posted on January 18, 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.

One would think that these days, when the desktop computer is an extension of mobile devices rather than the other way around, hospitals would have well-defined, mature plans in place for managing mobile technology. But according to one survey, that’s definitely not the case.

In a study sponsored by Spok, which provides clinical communication services, many healthcare providers are still in the early years of developing a mobile strategy.

The study, which drew on contacts with more than 300 healthcare professionals in the US, found that 21% had had a mobile strategy in place for less than one year, 40% for one to three years,14% for 3 to 5 years and 25% for more than five years. In other words, while one-quarter of organizations had settled in and developed a mobile approach, an almost equal amount were just getting their feet wet.

Not only that, many of those who do have a mobile strategy in place may be shooting from the hip. While 65% of those surveyed had a documented mobility strategy in place, 35% didn’t.

That being said, it seems that organizations that have engaged with mobile are working hard to tweak their strategy regularly. According to Spok, their reasons for updating the strategy include:

* Shifting mobile needs of end-users (44%)
* The availability of new mobile devices (35%)
* New capabilities from the EHR vendor (26%)
* Changes in goals of mobile strategy (23%)
* Challenges in implementing the strategy (21%)
* Changes in hospital leadership (16%)

(Seven percent said their mobile strategy had not changed since inception, and 23% weren’t sure what changes had been made.)

Nonetheless, other data suggest there has been little progress in integrating mobile strategy with broader hospital goals.

For example, while 53% wanted to improve physician-to-physician communications, only 19% had integrated mobile strategy with this goal. Fifty-three percent saw nurse-to-physician communications as a key goal, but only 18% had integrated this goal with their mobile plans. The gaps between other top strategies and integration with mobile plans were similar across the strategic spectrum.

Ultimately, it’s likely that it will take a team approach to bring these objectives together, but that’s not happening in the near future. According to respondents, the IT department will implement mobile in 82% of institutions surveyed, 60% clinical leadership, 37% doctors, 34% telecom department, 27% nurses and 22% outside help from consultants and vendors. (Another 16% didn’t plan to have a dedicated team in place.)

The whole picture suggests that while the hospital industry is gradually moving towards integrating mobile into its long-term thinking, it has a ways to go. Given the potential benefits of smart mobile use, let’s hope providers catch up quickly.