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Software Marks Advances at the Connected Health Conference (Part 2 of 2)

Posted on October 31, 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 first part of this article focused on FDA precertification of apps and the state of interoperability. This part covers other interesting topics at the Connected Health conference.

Presentation at Connected Health Conference

Presentation at Connected Health Conference

Patient engagement

A wonderful view upon the value of collecting patient data was provided by Steve Van, a patient champion who has used intensive examination of vital signs and behavioral data to improve his diabetic condition. He said that the doctor understands the data and the patient knows how he feels, but without laying the data out, they tend to talk past each other. Explicit data on vital signs and behavior moves them from monologue to dialogue. George Savage, MD, co-founder and CMO of Proteus, described the value of data as “closing the loop”–in other words, providing immediate and accurate information back to the patient about the effects of his behavior.

I also gained an interesting perspective from Gregory Makoul, founder and CEO of PatientWisdom, a company that collects a different kind of data from patients over mobile devices. The goal of PatientWisdom is to focus questions and make sure they have an impact: the questionnaire asks patients to share “stories” about themselves, their health, and their care (e.g., goals and feelings) before a doctor visit. A one-screen summary is then provided to clinical staff via the EHR. The key to high adoption is that they don’t “drill” the patient over things such as medications taken, allergies, etc. They focus instead on distilling open-ended responses about what matters to patients as people, which patients like and providers also value.

Sam Margolis, VP of client strategy and growth at Cantina, saw several aspects of the user experience (UX) as the main hurdle for health IT companies. This focus was reasonable, given that Cantina combines strengths in design and development. Margolis said that companies find it hard to make their interfaces simple and to integrate into the environments where their products operate. He pointed out that health care involves complex environments with many considerations. He also said they should be thinking holistically and design a service, not just a product–a theme I have seen across modern business in general, where companies are striving to engage customers over long periods of time, not just sell isolated objects.

Phil Marshall, MD, co-founder and chief product officer of Conversa Health, described how they offer a chatbot to patients discharged from one partnering hospital, in pursuit of the universal goal by US hospitals to avoid penalties from Medicare for readmissions. The app asks the patient for information about her condition and applies the same standards the hospital uses when its staff evaluates discharged patients. Marshall said that the standards make the chatbot highly accurate, and is tuned regularly. It is also popular: 80 percent of the patients offered the app use it, and 97 percent of these say it is helpful. The chat is tailored to each patient. In addition to relieving the staff of a routine task, the hospital found that the app reduces variation among outcomes among physicians, because the chatbot will ask for information they might forget.

Jay V. Patel, Clinical Transformation Officer at Seniorlink, described a care management program that balances technology and the human touch to help caregivers of people with dementia. Called VOICE (Vital Outcomes Inspired by Caregiver Engagement) Dementia Care, the program connects a coach to family caregivers and their care teams through Vela, Seniorlink’s collaboration platform. The VOICE DC program reduced ER visits by 51 percent and hospitalizations by 18 percent in the six-month pilot. It was also good for caregivers, reducing their stress and increasing their confidence.

Despite the name, VOICE DC is text-based (with video content) rather than voice-based. An example of the advances in voice interfaces was provided at this conference by Boston Children’s Hospital. Elizabeth Kidder, manager of their digital health accelerator, reported using voice interfaces to let patients ask common questions, such as when to get vaccinations and whether an illness was bad enough to keep children home from school and day care. Another non-voice app they use is a game that identifies early whether a child has a risk of dyslexia. Starting treatment before the children are old enough to learn reading in school can greatly increase success.

Nathan Treloar, president of Orbita, reported that at a recent conference on voice interfaces, participants in a hackathon found nine use cases for them in health.

Pattie Maes of the MIT Media Lab–one of the most celebrated research institutions in digital innovation–envisions using devices to strengthen the very skills that our devices are now blamed for weakening, such as how to concentrate. Of course, she warned, there is a danger that users will become dependent on the device while using it for such skills.

Working at the top of one’s license

I heard that appealing phrase from Christine Goscila, a family nurse practitioner at Massachusetts General Hospital Revere. She was describing how an app makes it easier for nurses to collect data from remote patients and spend more time on patient care. This shift from routine tasks to high-level interactions is a major part of the promise of connected health.

I heard a similar goal from Gregory Pelton, MD, CMO of ICmed, one of the many companies providing an integrated messaging platform for patients, clinicians, and family caregivers. Pelton talks of handling problems at the lowest possible level. In particular, the doctor is relieved of entering data because other team members can do it. Furthermore, messages can prepare the patient for a visit, rendering him more informed and better able to make decisions.

Clinical trials get smarter

While most health IT and connected health practitioners focus on the doctor/patient interaction and health in the community, the biggest contribution connected health might make to cost-cutting may come from its use by pharmaceutical companies. As we watch the astounding rise in drug costs–caused by a range of factors I will cover in a later article, but only partly by deliberate overcharging–we could benefit from anything that makes research and clinical trials more efficient.

MITRE, a non-profit that began in the defense industry but recently has created a lot of open source tools and standards for health care, presented their Synthea platform, offering synthetic data for researchers. The idea behind synthetic data is that, when you handle a large data set, you don’t need to know that a particular patient has congestive heart failure, is in his sixties, and weighs 225 pounds. Even if the data is deidentified, giving information about each patient raises risks of reidentification. All you need to know is a collection of facts about diagnoses, age, weights, etc. that match a typical real patient population. If generated using rigorous statistical algorithms, fake data in large quantities can be perfectly usable for research purposes. Synthea includes data on health care costs as well as patients, and is used for FHIR connectathons, education, the free SMART Health IT Sandbox, and many other purposes.

Telemedicine

Payers are gradually adapting their reimbursements to telemedicine. The simplest change is just to pay for a video call as they would pay for an office visit, but this does not exploit the potential for connected health to create long-range, continuous interactions between doctor, patient, and other staff. But many current telemedicine services work outside the insurance system, simply charging patients for visits. This up-front payment obviously limits the ability of these services to reach most of the population.

The uncertainties, as well as the potential, of this evolving market are illustrated by the business model chosen by American Telephysicians, which goes so far as to recruit patients internationally, such as from Pakistan and Dubai, to create a telemedicine market for U.S. specialists. They will be starting services in some American communities soon, though. Taking advantage of the ubiquity of mobil devices, they extend virtual visits with online patient records and a marketplace for pharmaceuticals, labs, and radiology. Waqas Ahmed, MD, founder and CEO, says: “ATP is addressing global health care problems that include inaccessibility of primary, specialty, and high-quality healthcare services, lack of price transparency, substandard patient education, escalating costs and affordability, a lack of healthcare integration, and fragmentation along the continuum of care.”

The network is the treatment center

We were honored with a keynote from FCC chair Ajit Pai, who achieved notoriety recently in the contentious “net neutrality” debate and was highlighted in WIRED for his position. Pai is not the most famous FCC chair, however; that honor goes to Newton Minow, who as chair from 1961 to 1963 called television a “vast wasteland.” More recently, Michael Powell (who became chair in 2001, before the confounding term “net neutrality” was invented) garnered a lot of attention for changing Internet regulations. Newton Minow, by the way, is still on the scene. I heard him talk recently at a different conference, and Pai mentioned talking to Minow about Internet access.

Pai has made expansion of Internet access his key issue (it was mentioned in the WIRED article) and talked about the medical benefits of bringing fast, continuous access to rural areas. His talk fit well with the focus many companies at the Connected Health conference placed on telemedicine. But Pai did not vaunt competition or innovation as a solution to reaching rural areas. Instead, he seemed happy with the current oligopoly that characterizes Internet access in most areas, and promoted an increase in funding to get them to do more of what they’re now doing (slowly).

The next day, Nancy Green of Verizon offered a related suggestion that 5G wireless will make batteries in devices last longer. This is not intuitive, but I think can be justified by the decrease in the time it will take for devices to communicate with the cloud, decreasing in turn the drain on the batteries.

Devices that were just cool

One device I liked at Connected Health coll was the Eko stethoscope, which sends EKG data to a computer for display. Patients will soon be able to use Eko devices to view their own EKGs, along with interpretations that help non-specialists make sense of the results. Of course, the results are also sent to the patients’ doctors.

Another device is a smart pillbox by CUEMED that doubles as a voice-interactive health assistant, HEXIS. Many companies make smart pill boxes that keep track of whether you open them, and flash or speak up to remind you when it’s time to take the pills. (Non-compliance with prescription medications is rampant.) HEXIS is a more advanced innovation that incorporates Alexa-like voice interactivity with the user and can connect to other medical devices and wearables such as Apple Watch and blood pressure monitors. The device uses the data and vital signs to motivate the user, and provides suggestions for the user to feel better. Another nice feature is that if you’re going out, you can remove one day’s meds and take them with you, while the device continues to do its job of reminding and tracking.

I couldn’t get to every valuable session at the Connected Health conference, or cover every speaker I heard. However, the conference seems to be achieving its goals of bringing together innovators and of prodding the health care industry toward the effective use of technology.

Health Tech Startups, Innovations, & Consumers – What’s the Future for HealthIT? – #HITsm Chat Topic

Posted on October 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, 11/2 at Noon ET (9 AM PT). This week’s chat will be hosted by Jessica DaMassa (@jessdamassa), host of WTF Health on the topic of “Health Tech Startups, Innovations, & Consumers – What’s the Future for HealthIT?”.

Is the ‘tech revolution’ – you know, the one that started with smartphones changing the way we live our daily lives – finally about to overthrow healthcare? For years, tech giants and tech startups alike have fought for their piece of our $3 trillion dollar industry. They’ve battled for more open access to data, suffered through years of Interoperability Showcases, and waited for patients transform into a market of ‘healthcare consumers’ with dollars and expectations that demand more from healthcare than fax machines and siloed patient portals can ever provide.

Is 2018 the year that tech has finally arrived? Busted the borders and crossed over to the other side?

Already, investment in digital health startups has blown past last year’s record-breaking $5.7 billion total to $6.8 billion invested through Q3 alone. Apple Health Records are deployed in more than 75 health systems, and Amazon up and decided to just start its own healthcare company with Berkshire Hathaway and JP Morgan. The FDA is evaluating and approving digital therapeutics. Uber rides are reimbursed by Medicare. Even the AMA, who just two years ago condemned digital health as the “snake oil of the 21st Century,” has moved past their fears to issue a Digital Health Playbook that proactively helps clinicians make sense of the way tech is transforming care. Oh, Healthcare, our world is on FHIR…

With responsibility for data privacy, data exchange, security, and a slew of other issues that need to be resolved before our upgrade-to-a-better-tomorrow can start downloading, Health IT is on the front line (or is it bleeding edge?) of our industry’s transformation. In this #HITsm chat, Jessica DaMassa, the executive producer and host of the health innovation interview series ‘WTF Health – What’s the Future, Health?’ asks us to take a look at how health tech startups and consumer tech companies are starting to change WTF is going on in Health IT.

Topics for this week’s #HITsm Chat:
T1: For myriad reasons, healthcare is struggling to keep pace with tech innovation. From your perspective, is the tech industry failing healthcare by not doing more to meet the system where it’s at? Or, is it the healthcare system that’s failing technology by being unable to adapt? What’s the hold up? #HITsm

T2: As Apple, Amazon, Google, and Uber bring their consumer-focused thinking and design into healthcare, what are you most excited to see change? #HITsm

T3: I’ve interviewed 100s of health tech startups, and each one has their own take on how to engage with patients, use data to identify trends, etc. With so many different needs, systems, and solutions, do you think health tech startups are helping change Health IT for the better, or is this just the beginning of ‘interoperability 2.0’? Why? #HITsm

T4: Whether it’s a big tech company or a seed-funded health startup, what’s your best advice for successfully integrating new tech into the established healthcare system? #HITsm

T5: Last year’s fervor about blockchain has turned into confusion, AI and machine learning are seeing real uses cases, and voice is THE thing everyone is buzzing about this week. What tech do you think has the greatest chance of being integrated at-scale in the near term? (In healthcare, ‘near term’ being next 5 years.) #HITsm

Bonus: What’s hot and what’s not? What’s the coolest health innovation you’ve seen so far this year? What current tech trend do you think will be a non-factor 5 years from now? #HITsm

Upcoming #HITsm Chat Schedule
11/9 – AI in Healthcare
Hosted by Jon White @technursejon

11/16 – Value Based Care: Successes, Challenges, and Changes
Hosted by Matt Fisher (@Matt_R_Fisher)

11/23 – No Chat – Thanksgiving Break

11/30 – The Global Impact of Health IT
Hosted by Vanessa Carter (@_FaceSA)

12/7 – TBD
Hosted by Michelle Currie (@mshlcurrie)

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.

Software Marks Advances at the Connected Health Conference (Part 1 of 2)

Posted on October 29, 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 precepts of connected health were laid out years ago, and merely get updated with nuances and technological advances at each year’s Connected Health conference. The ideal of connected health combines matching the insights of analytics with the real-life concerns of patients; monitoring people in everyday settings through devices that communicate back to clinicians and other caregivers; and using automation to free up doctors to better carry out human contact. Pilots and deployments are being carried out successfully in scattered places, while in others connected health languishes while waiting for the slow adoption of value-based payments.

Because I have written at length about the Connected Health conference in 2015, 2016, and 2017, I will focus this article on recent trends I ran into at this year’s conference. Key themes include precertification at the FDA, the state of interoperability (which is poor), and patient engagement.

Exhibition floor at Connected Health conference

Exhibition floor at Connected Health conference

Precertification: the status of streamlining approval for medical software

One of the ongoing challenges in the progress of patient involvement and connected health is the approval of software for diagnosis and treatment. Traditionally, the FDA regulated software and hardware together in all devices used in medicine, requiring rigorous demonstrations of safety and efficacy in a manner similar to drugs. This was reasonable until recently, because anything that the doctor gives to the patient needs to be carefully checked. Otherwise, insurers can waste a lot of money on treatments that don’t work, and patients can even be harmed.

But more and more software is offered on generic computers or mobile devices, not specialized medical equipment. And the techniques used to develop the software inherit the “move fast and break things” mentality notoriously popular in Silicon Valley. (The phrase was supposedly a Facebook company motto.) Software can be updated several times a day. Although A/B testing (an interesting parallel to randomized controlled trials) might be employed to see what is popular with users, quality control is done in completely different ways. Modern software tends to rely for safety and quality on unit tests (which make sure individual features work as expected), regression tests (which look for things that no longer work they way they should), continuous integration (which forces testing to run each time a change is submitted to the central repository), and a battery of other techniques that bear such names as static testing, dynamic testing, and fuzz testing. Security testing is yet another source of reliability, using techniques such as penetration testing that may be automated or manual. (Medical devices, which are notoriously insecure, might benefit from an updated development model.

The FDA has realized that reliable software can be developed within the Silicon Valley model, so long as rigor and integrity are respected. Thus, it has started a Pre-Cert Pilot Program that works with nine brave vendors to find guidelines the FDA can apply in the future to other software developers.

Representatives of four vendors reported at the Connected Health conference that the pilot is going quite well, with none of the contentious and adversarial atmosphere that characterizes the interactions between the FDA with most device manufacturers. Every step of the software process is available for discussion and checking, and the inquiries go quite deep. All participants are acutely aware of the risk–cited by critics of the program–that it will end up giving vendors too much leeway and leaving the public open to risks. The participants are committed to closing loopholes and making sure everyone can trust the resulting guidelines.

The critical importance of open source software became clear in the report of the single open source vendor who is participating in the pilot: Tidepool. Because it is open source, according to CEO Howard Look, Tidepool was willing to show its code as well as its software development practices to independent experts using multiple evaluation assessment methods, including a “peer appraisal” by fellow precert participants Verily and Pear Therapeutics. One other test appraisal (CMMI, using external auditors) was done by both Tidepool and Johnson & Johnson; no other participants did a test appraisal. Thus, if the FDA comes out with new guidelines that stimulate a tremendous development of new software for medical use, we can thank open source.

Making devices first-class players in health care

Several exhibitors at the conference were consulting firms who provide specific services to start-ups and other vendors trying to bring products to market. I asked a couple of these consultants what they saw as the major problems their clients face. Marcus Fontaine, president of Impresiv Health, said their biggest problem is the availability of data, particularly because of a lack of interoperable data exchange. I wanted to exclaim, “Still?”

Joseph Kvedar, MD, who chairs the Connected Health conference, spoke of a new mobile app developed by his organization, Partners Connected Health, to bring device data into their EHR. This greatly improves the collection of data and guarantees accuracy, because patients no longer have to manually enter vital signs or other information. In addition to serving Partners in improving patient care, the data can be used for research and public health. In developing this app, Partners depended heavily for interoperable data exchange on work by Validic, the most prominent company in the device interoperability space, and one that I have profiled and whose evolution I have followed.

Ideally, each device could communicate directly with the EHR. Why would Partners Connected Health invest heavily in creating a special app as an intermediary? Kvedar cited several reasons. First, each device currently offers its own app as a user interface, and users with multiple devices get confused and annoyed by the proliferation of apps. Second, many devices are not designed to communicate cleanly with EHRs. Finally, the way networks are set up, communicating would require a separate cellular connection and SIM card for each device, raising costs.

A similar effort is pursued by Indie Health, trying to solve the problem of data access by making it easy to create Bluetooth connections between devices and mobile phones using a variety of Bluetooth, IEEE, Continua, and other standards.

The CEO of Validic, Drew Schiller, spoke on another panel about maximizing the value of patient-generated data. He pointed out that Validic, as an intermediary for a huge number of devices and health care providers, possesses a correspondingly huge data set on how patients are using the devices, and in particular when they stop using the devices. I assume that Validic does not preserve the data generated by the devices, such as blood pressure or steps taken–at least, Schiller did not say they have that data, and it would be intrusive to collect it. However, the metadata they do collect can be very useful in designing interactions with patients. He also talked about the value of what he dubs “invisible health care,” where behavior change and other constructive uses of data can flow easily from the data.

Barry Reinhold, president and CTO of Lamprey Networks, was manning the Continua booth when I came by. Continua defines standard for devices used in the home, in nursing faciliies, and in other places outside the hospital. This effort should be open source, supported by fees by all affected stakeholders (hospitals, device manufacturers, etc.). But open source is spurned by the health care field, so Continua does the work as a private company. Reinhold told me that device manufacturers rarely contract with Continua, which I treat as a sign that device manufacturers value data silos as a business model. Instead, Continua contracts come from the institutions that desperately need access to the data, such as nursing facilities. Continua does the best it can to exploit existing standards, including the “continuing data” profile from FHIR.

Other speakers at the conference, including Andrew Hayek, CEO of OptumHealth, confirmed Reinhold’s observation that interoperability still lags among devices and EHRs. And Schiller of Validic admitted that in order to get data from some devices into a health system, the patient has to take a photo of the device’s screen. Validic not only developed an app to process the photo, but patented it–a somewhat odd indication that they consider it a major contribution to health care.

Tasha van Es and Claire Huber of Redox, a company focused on healthcare interoperability and data integration, said that they are eager to work with FHIR, and that it’s a major part of their platform, but they think it has to develop more before being ready for widespread use. This made me worry about recent calls by health IT specialists for the ONC, CMS, and FDA to make FHIR a requirement.

It was a pleasure to reconnect at the conference with goinvo, which creates open source health care software on a contract basis, but offers much of it under a free license.

A non-profit named Xcertia also works on standards in health care. Backed by the American Medical Association, American Heart Association, DHX Group, and HIMSS, they focus on security, privacy, and usability. Although they don’t take on certification, they design their written standards so that other organizations can offer certification, and a law considered in California would mandate the use of their standards. The guidelines have just been released for public comment.

The second section of this article covers patient engagement and other topics of interest that turned up at the conference.

Will UnitedHealth’s New Personal Health Record Make An Impact?

Posted on October 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.

Though the idea of a personal health record was a hot thing for a while, it didn’t become the fixture of the healthcare market that pundits had predicted. In fact, as many readers will recall, even deep pockets like Google and Microsoft couldn’t get their users to sign on to their PHRs en masse.

One of the main reasons the PHR model didn’t take is that people simply didn’t want to use them. In fact, at least at the time, the PHR was almost entirely a solution in search of a problem. After all, if a health data power user and patient advocate like myself didn’t want one, what hope did PHR backers have of interesting your average Joe Blow in aggregating their health data online?

Over time, however, the personal health data landscape has changed, with patient records becoming a bit more portable. While consumers still aren’t beating down the doors to get their own PHR, those who are interested in pulling together their medical records electronically have better access to their history.

Not only that, wearables makers like Apple and Fitbit are sweetening the pot, primarily by helping people pull self-generated data into their health record. Arguably, patient-generated data may not be as valuable as traditional records just yet, but consumers are likely to find it more interesting than the jargon-laden text found in provider records.

Given recent developments like these, I wasn’t entirely surprised to learn that UnitedHealth Group is picking up the PHR torch. According to an article in MedCity News, the giant payer plans to launch what sounds like an updated PHR platform next year to its 50 million benefited plan members.

Apparently, on an earnings call last week UnitedHealth CEO Dave Wichmann said that the company will launch a “fully integrated and fully portable individual health record” in 2019. Notably, this is not just a data repository, but rather an interactive tool that “delivers personalized next-best health actions to people and their caregivers.”

The new health record will be based on UnitedHealth’s Rally health and wellness platform, which the insurer picked up when it acquired Audax Health in 2014. The platform, which has 20 million registered users, works to influence members to perform healthy behaviors in exchange for the incentive dollars,

Over time, Wichmann said, UHG intends to build Rally into a platform which collects and distributes “deeply personalized” health information to individual members, MedCity reported. The idea behind this effort is to highlight gaps in care and help patients assess the care that they get.  Wichmann told earnings call listeners that the platform data will be packaged and presented to clinicians in a form similar to that used by existing EHRs.

UHG’s plans here are certainly worth keeping an eye on over the next year or two. I have no doubt that the nation’s largest commercial payer has some idea of how to format data and make it digestible by systems like Cerner and Epic.

But while patients have become a bit more familiar with the benefits of having their health data on hand, we’re not exactly seeing consumers stampede the providers demanding their own health record either, and I’m far from convinced that this effort will win new converts.

My skepticism comes partly from first-hand experience. As a recent UnitedHealth beneficiary, I’ve used the Rally application, and I didn’t find it all that motivating. Honestly, I doubt any online platform will make much of an impact on patient health on its own, as the reasons for many health issues are multifactorial and can’t be resolved by handing one of us a few Rally bucks.

Personal gripes aside, though, the bigger question remains whether consumers think they’ll get something valuable out of using the new UHG tool. As always, you can never count on them coming just because you built it.

AMA Releases Great Guide To Digital Health Implementation

Posted on October 25, 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.

In the past, I’ve been pretty hard on the AMA when it comes to digital health. Last year I gave the organization a particularly hard time when it rolled out its Physician Innovation Network platform, which is designed to help physicians network directly with health tech firms, as it seemed to be breaking little to no ground.

However, to be fair the AMA has been a relatively quiet but solid presence in health IT for quite some time.  Its health IT efforts include cofounding Health2047, which brings together doctors with established health IT companies to help the companies launch services and products, serving as one of four organizations behind mHealth app standards venture Xcertia and managing a student-run biotechnology incubator in collaboration with Sling Health.

But what it hasn’t done so far, at least to date, has been to offer physicians any hands-on guidance on using emerging health IT. Now, at long last, the AMA has taken the plunge, releasing a guide focused on helping physicians roll out digital health technology in their practice. At least this time around, I have to give the organization a high five.

The new guide takes a lifecycle perspective, helping practices work through the digital health implementation process from preparations to rollout to gathering data on the impact of the new technology. In other words, it lays out the process as a feedback loop rather than a discrete event in time, which is smart. And its approach to explaining each step is concise and clean.

One section identifies six straightforward steps for choosing a digital health technology, including identifying a need, defining success early on in the process, making the case for political and financial buy-in, forming the team, evaluating the vendor and executing the vendor contract.

Along the way, it makes the important but often-neglected point that the search should begin by looking at the practice’s challenges, including inefficiencies, staff pain points or patient health and satisfaction problems. “The focus on need will help you avoid the temptation to experiment with new technologies that ultimately will result in tangible improvements,” the guide notes.

Another offers advice on tackling more immediate implementation issues, including steps like designing workflows, preparing the care team and partnering with the patient. This section of the report differs from many of its peers by offering great advice on building workflow around remote patient monitoring-specific requirements, including handling device management, overseeing patient enrollment and interactions, and assuring that coding and billing for remote patient management activities is correct and properly documented.

The guide also walks practices through the stages of final implementation, including the nature of the rollout itself, evaluating the success of the project and scaling up as appropriate. I was particularly impressed by its section on scaling up, given that most of the advice one sees on this subject is generally aimed at giant enterprises rather than typically smaller medical practices. In other words, it’s not that the section said anything astonishing, but rather that it existed at all.

All told, it’s great to see the AMA flexing some of the knowledge it’s always had, particularly given that the report is available at no cost to anyone. Let’s hope to see more of this in the future.

Finding Quick Wins by Creating Amazing Patient Experiences

Posted on October 24, 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.

In this tight environment, it is important to demonstrate quick wins for your HealthIT projects. One of the best ways to do this is to demonstrate improvements in patient experience. Don’t worry, even infrastructure projects can help patients.

Patient experience is very important right now. Competition is intensifying and patient experience is one of the key factors influencing where people go to receive care. The better your organizations’ patient experience ratings, the more likely patients are to come through the doors. Improving patient experience is, therefore, one of the best ways to help your organization improve its bottom line.

There are many ways that patient experience can be improved:

  • Minimize wait times
  • Offer “consumer-like” conveniences – like online appointment booking, electronic communication with clinicians, video discharge instructions, etc.
  • Provide convenient access to medical records
  • Treat patients with empathy and respect
  • Streamline administrative workflows/processes
  • Reduce stress and frustration on clinical staff

The last two items in the list are often overlooked by healthcare organizations, yet I would argue they represent some of the biggest opportunities to improve patients’ experience. Luckily streamlining workflows and reducing staff frustration are two areas where Healthcare IT departments can have a positive impact.

With healthcare budgets under pressure from changing reimbursement models and rising operating costs, it is harder than ever to build and sustain support for HealthIT projects. IT leaders need to show that their project will have a positive impact and demonstrate quick wins or risk having their projects cut. Thankfully, linking your project to improved patient experience isn’t difficult. It just requires a little forethought and elbow grease.

As an example, consider the “lowly” single-sign-on project (SSO) – implementing a tool that consolidates user credentials into a single platform. In most organizations this type of project is met with glazed eyes and is viewed as purely an endeavor by IT to upgrade the hospital’s infrastructure. As such, it is an easy project to cut. However, this project does have an impact on clinical staff. SSO can eliminate the need for users to log into each application separately, a significant frustration and time waster. Even better, most SSO platforms today include biometric user log-on, eliminating the need to remember complex passwords, another common frustration. When you reduce staff frustration and save them time, it means they are in a better position to provide a better patient experience. It is therefore not a stretch to say that SSO can improve patient experience.

If you look at your HealthIT projects with a patient experience or staff-relief lens, my bet is that you’ll find many can have positive benefits on both. It may take a bit of digging to find the connection but I believe it is there.

Having said that, not all projects will have the same positive impact for your organization. Thus, what’s needed is a way to compare the relative impact of each project so that you can easily see which would provide the biggest bang for your investment.

One way to do this is to use a relative score to compare projects. Below is an example of a simple scoring mechanism you can use.

For each HealthIT project rate them on 0-5 scale with ‘0’ = no impact whatsoever and ‘5’ = a bottle of champagne will be waiting for you at your desk from end-users or patients who are ecstatic with the improvement. To what degree does this project:

  1. Improve patient wait times while in the facility?
  2. Increase access to medical records for patients?
  3. Help patients gain access to information or individuals on their care team?
  4. Promote empathy and/or respect for patients?
  5. Decrease the total length of stay in the facility?
  1. Decrease the paperwork required by staff?
  2. Eliminate unnecessary steps in an existing process?
  3. Remove a long-standing end-user frustration
  4. Give time back to clinicians that they can put towards more productive use?
  5. Help improve the work environment for staff?

The first set of numbered questions are directly related to the patient experience, while the second set of lettered questions are related to staff improvements. Each project should have two scores, one for direct patient impact and the other for staff impact.

The questions above are by no means exhaustive and you should include criteria that is most relevant to your organization. For example, if your organization has placed an emphasis on 5-star online ratings, then you should add that question to the set of numbered questions.

Please keep in mind that this scoring mechanism is only meant to help you compare projects relative to one another. It is not meant to be a universal standard for scoring IT projects in healthcare.

Once you have scored your projects, rank them in descending order and you will get a sense as to which ones potentially provide the biggest patient experience impact. Those are the ones that will be more easily justified AND are the ones most likely to gain inter-departmental support. PRO TIP: Don’t just evaluate the projects yourself, ask other department leaders/stakeholders to score your projects too and incorporate their scores into the overall rankings.

Assessing the impact on patient experience and staff stress is just the first step. Once your project gets green-lit you now have to show your project can produce quick wins. This is where the elbow grease comes in. Take the questions where the project scored 3 or higher and turn those questions into a survey. Have patients and staff use the same 0-5 scoring system to provide feedback to you BEFORE the project starts so that you have a baseline. Then use the same survey to get feedback on the project at appropriate milestones (you don’t always have to wait until the end).

You may encounter some resistance to polling patients, but the survey need not be a formal document. You could simply ask staff to ask patients what they think of the project (ie: Mr. Smith, on a scale of 0-5, what do you think of our new portal’s ability to give you access to your medical record?).

Use the collected data to show the progression of the project and the impact it is having on patients and staff. It is important to share as much information as you can about your project, even if the results aren’t glowing, show that you are taking the feedback and making adjustments.

To learn more about how to assess your HealthIT projects for quick wins and improvements to patient experience, join me on this free upcoming webinar Thursday November 8th at 2pm ET. This webinar is hosted by AAJ Technologies. Together, myself and Murry Izenwasser of AAJ will be diving deeper into this topic. Register today!

AAJ Technologies is a proud sponsor of Healthcare Scene.

The Health IT Education Landscape – #HITsm Chat Topic

Posted on October 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, 10/26 at Noon ET (9 AM PT). This week’s chat will be hosted by @bigdatadavid13 on the topic of “The Health IT Education Landscape”.

As the marriage of IT and healthcare continues to evolve, the workforce has to evolve with it. Today’s health IT professional has to be able to bridge technical knowledge with clinical application, care environments and boardrooms where numbers are crunched and technological solutions are scrutinized.

As that workforce evolves, educators are working on the front end to increase the size of the talent pool and develop professionals that can handle the challenges health IT faces. But measuring their success is easier said than done.

Many of you work in settings where new graduates of health IT programs, both undergraduate and graduate, are taking on roles within your organization. In this #HITsm chat, David Rice, a writer and editor working on behalf of the University of South Florida’s graduate informatics and healthcare analytics programs will lead a discussion that looks at where educators fall short and what they should be doing to create a workforce capable of handling health IT’s biggest challenges.

Join us for this week’s #HITsm chat where we’ll discuss the topics below.

Topics for this week’s #HITsm Chat:
T1: What areas are new workers in health IT lacking skills? i.e. understanding of tools or processes, misconceptions of regulatory landscape, etc. #HITsm

T2: Are universities positioned better for developing the health IT professional than professional associations or trade schools? Or vice versa? #HITsm

T3: Have you or anyone you work with received certification from professional association or certificate provider? Was the experience worth the investment in your opinion? #HITsm

T4: Is there an area of health IT that you think educators need to focus more when developing their students? i.e. operations, workflow, real world application, regulatory and compliance, etc. #HITsm

T5: In your opinion, do educators do a good enough job of helping people transition into health IT careers from other fields such as traditional IT, cybersecurity, project management, etc? #HITsm

Bonus: What’s a lesson you’ve learned in your work that no amount of education could have taught you? #HITsm

Upcoming #HITsm Chat Schedule
11/2 – Health Tech Startups, Innovations, & Consumers – What’s the Future for HealthIT?
Hosted by Jessica DaMassa (@jessdamassa), host of WTF Health

11/9 – AI in Healthcare
Hosted by Jon White @technursejon

11/16 – Value Based Care: Successes, Challenges, and Changes
Hosted by Matt Fisher (@Matt_R_Fisher)

11/23 – No Chat – Thanksgiving Break

11/30 – The Global Impact of Health IT
Hosted by Vanessa Carter (@_FaceSA)

12/7 – TBD
Hosted by Michelle Currie (@mshlcurrie)

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.

Infographic – Practical Interoperability in Healthcare

Posted on October 22, 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.

The team at HULFT sent me their new infographic that identifies the stakeholders that should be “at the table” to set your organization’s data sharing and interoperability policies.

There are a couple of things I really like about this infographic.

First, I like the mixture of disciplines and backgrounds that HULFT has identified as data stakeholders. There are people you would expect to see around the table like the CIO, CSO, Privacy Officer, COO, etc. But there are others who are a bit of a surprise: the Revenue Cycle Manager, Pharmacy Benefits Leader, Nurse Practitioner Informaticists, and Care Management Director.

The Care Management Director is an especially welcome inclusion. Without interoperability coordinating patient care is time consuming, frustrating for everyone involved and fraught with errors (medicine reconciliation anyone?). When I think about the need for interoperability, care coordination is what come springs to mind.

The second thing I like about this infographic is the consistency of the visual. The avatars seated at the miniature table at the top are the same as the enlarged versions underneath. This attention to visual detail appeals to the healthcare marketer in me.

Enjoy.

Mandatory Nurse Ratios – Good for Massachusetts?

Posted on October 18, 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.

On November 6th, Massachusetts will vote on mandatory nursing levels. Proponents cite burnout, injuries and patient safety as reasons to vote YES. Opponents claim ERs wait times will rise, small hospitals will close and patient bills will increase.

There is no better way to get a sense of what is on the minds of healthcare leaders than talking with fellow conference attendees. At the recent SHSMD18 event, I had the opportunity to attend a social gathering hosted by the New England Society for Healthcare Communications (NESHCo). There was one topic that dominated the discussion – the upcoming vote on November 6th on mandatory nursing levels in Massachusetts.

Mandatory nurse ration has been a hotly debated issue in the state. Voters will now decide if the state will forge ahead with plans to “limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities.”

The proposed MA law sets specific limits on the patient-nurse ratio. For example:

  • 3 patients per nurse in units with step-down/intermediate care patients
  • 1 patient under anesthesia per nurse in units with post-anesthesia care or operation room patients
  • 5 patients per nurse in units with psychiatric or rehabilitation patients

The vote has pitted the Massachusetts Nurses Association (the nurses union, MNA), which strongly supports mandatory nurse ratios, against the Massachusetts Health and Hospital Association (MHHA).

The MNA cites numerous studies, like this one from 2016, that shows for every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient. And  this one from 2017, that concluded “Exposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.”

The MNA has mounted a sizeable campaign to convince MA voters to vote YES. Their website, https://safepatientlimits.org/ is full of interesting articles, stories from frontline nurses and quotes from physicians that support the measure.

The MHHA, on the other hand, is encouraging a NO vote. They acknowledge that nursing levels need to be monitored but imposing strict limits based solely on the unit or patient type will cost nearly $900 million every year. According to the MHHA, patients would end up footing the bill through higher healthcare costs.

The MHAA also claims that specifying the maximum number of patients for each nurse, effectively puts a cap on the number of patients a hospital can accept in their ERs – resulting in longer wait times.

For an excellent overview of the law and the arguments both for and against Question 1, check out this excellent article by Boston’s local NPR station – WGBH. The article also has information about the impact mandatory nurse ratios has had in California which enacted a similar law back in 1999.

What I found fascinating about the discussions with NESHCo members was how hospitals in neighboring states were also voicing their concerns on Question 1. If MA was to mandate nursing ratios, that state’s hospitals would suddenly need to hire thousands of nurses in order to comply with the new law. Where would these nurses likely come from? You guessed it, neighboring states like New Hampshire, Maine, Vermont and Connecticut. It’s easy to see why hospitals in those states would be worried.

I honestly don’t know which way I would vote.

On one hand the current working condition for nurses is unsustainable. Nurses are often asked to work longer shifts because hospitals can’t fill open nursing positions fast enough and most are expected to work without breaks. Could you imagine working 12hrs or more without being able to eat or go to the restroom? 70% of nurses are already feeling burnt out in their current positions. Clearly the status quo isn’t working.

On the other hand, there is currently no provision in the law to adjust the nursing ratios as technology advances. New York Presbyterian Hospital, for example, has built a remote patient monitoring center that tracks patient vitals in real-time. Using a combination of AI, specialized technicians and remote nurses, this “command center” can alert the local nursing staff when a patient may be experiencing an issue. Armed with this technology, not only are patients safer but on-site nurses can spend more time with each patient in their unit. The MA law would have the unintended consequence of squashing investment in this type of technology since staffing levels could not be significantly adjusted.

For more on this topic, take a look at the transcript for this week’s HCLDR chat. Government regulation is also the topic for this weeks’ #HITsm chat hosted by John Lynn. Join the discussion Friday 10/19 at noon ET.

Nurses need help. Mandatory nursing ratios is one possible solution. However, I’m not sure legislation is the best way to improve the nursing situation.

Government Regulations for Healthcare – Where Are We At and Where Are We Headed? – #HITsm Chat Topic

Posted on October 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 10/19 at Noon ET (9 AM PT). This week’s chat will be hosted by John Lynn (@techguy) on the topic of “Government Regulations for Healthcare – Where Are We At and Where Are We Headed?”.

The one constant in healthcare is regulation. Healthcare is a highly regulated environment. There’s no way to get away from it. The best we can do is understand what regulations are coming, influence the rule making process so that good regulations are put in place, and learn to deal with the regulations as best you can.

Join us for this week’s #HITsm chat where we talk about some of the latest healthcare regulations. We’ll dive into regulation details and where those regulations could be headed. We’ll also discuss what other regulations might be coming that we should know about. Come and share your perspectives and insights on the important regulations in government.

Topics for this week’s #HITsm Chat:
T1: What government regulations take up the majority of a healthcare organization’s time? What has you concerned about those regulations? #HITsm

T2: How are MACRA and MIPS impacting your organization? What are you doing to make sure you’re compliant? #HITsm

T3: What regulations do you think will be changed soon or which regulations would you like to see changed/updated? #HITsm

T4: What’s happening with value based care and the shift from fee for service? What are you doing to make sure you’re ready for it? #HITsm

T5: What insurance regulations are hitting your organization? How are they impacting you? What other regulation changes should you be watching? #HITsm

Bonus: If you could make any healthcare regulation and have it instantly put in place, what would it be? #HITsm

Upcoming #HITsm Chat Schedule
10/26 – The Health IT Education Landscape
Hosted by @bigdatadavid13

11/2 – TBD
Hosted by TBD

11/9 – TBD
Hosted by @technursejon

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.