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The Good News About Patient Portals …

Posted on January 14, 2014 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

I recently wrote that it’s not clear whether patient portals do much to improve health care.

Now a new study suggests they help in at least one area: medication adherence.

The research involved diabetic patients who were using cholesterol-lowering statin drugs and had registered for online portal access. Among those who started using the system’s online refill function as their only method of getting the medication, “nonadherence” dropped 6 percent.

LDL or “bad” cholesterol also decreased.

The researchers concluded that “wider adoption of online refills may improve adherence.” No decline in nonadherence was seen in patients who didn’t use the online refill function.

The Kaiser Permanente study was published in the journal Medical Care.

The study included plenty of subjects — 8,705 people who used online refills and 9,055 who didn’t. But if there’s a cause-effect relationship at work in this study, you have to wonder in which direction it might run. Might the people who tend to take their medicine as prescribed be more likely to sign up for online refills in the first place?

Still, the study is an intriguing hint that patient portals might be worth at least some of the attention they’re getting. Nonadherence to medication regimens is a huge issue for health care because of both the human toll it takes and the inefficiency it fosters in the system.

Typical nonadherence rates are in the 30-60 percent range, depending on the condition, the medication and other factors, according to Medscape. It’s especially easy to slack off when symptoms disappear.

The study builds on another piece of good news for health IT. Researchers recently found that EMRs can make diabetes care better by rendering care coordination more efficient, as Katherine Rourke wrote here at EMR and HIPAA.

Portals are, of course, experiencing tremendous popularity because they help health care providers to meet Meaningful Use Stage 2 patient-engagement requirements. But, as I wrote earlier, in a review of 46 studies related to portals, researchers didn’t find evidence for much in the way of patient benefits.

Physicians have a major job ahead of them if they’re to make full use of patient portals and receive the available federal incentives. Perhaps this study, modest as its results are, suggests that their efforts will have some benefit for the patients they serve.

 

ROI for EMR: Does It Even Make Sense Now?

Posted on December 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

There’s a new data point to add to the debate over EMR return on investment.

Norton Healthcare Inc. in Louisville, Ky., has experienced a $12 million increase in federal reimbursement since it started using Epic, Louisville Business First reported. The health system, which operates five hospitals and a network of outpatient sites, is three years into a five-year, $200 million implementation.

Sounds like the beginning of some pretty good ROI. Or does it?

It’s hard to say.

ROI for records systems is notoriously hard to pin down. The word is that many hospitals don’t even try. And they might be onto something.

A revenue boost is a good sign. It’s often a result of improved coding and lower claims denial rates, as Colin Konschak of health care consulting firm Divurgent and Garrett Blair of Norfolk, Va.-based health system Sentara Healthcare recently wrote. And of course, there are the federal incentives for using an EMR — for hospitals, as much as $11 million over four years.

There’s also the rise in productivity that EMRs are expected to cause. At first, an EMR can slow down clinicians’ workflow and cost them and their organization money. But in time, the system could increase productivity.

But revenue is only part of the equation. Cost savings are the more important — and harder to calculate — factor.

Here are a few ways, as described by Konschak and Blair, that EMRs can help hospitals to save:

  • Less need for transcription.

  • Reduced use of staff time for copying and filing.

  • Reduced — often by 50-70 percent — use of preprinted forms.

  • Potentially lower malpractice premiums because of more complete documentation.

Many other potential benefits are probably real but are even less straightforward to measure. Features such as clinical decision support and electronic medical administration records, for example, could lead to reductions in medical errors — the types of mistakes the federal government no longer pays for. But measuring the money you saved from the errors you didn’t make is fairly abstract.

Many hospitals do little if anything to measure the return on their EMR investment, according to a study released by Beacon Partners last year. Healthcare Scene’s John Lynn wrote a few months ago that CIOs likely view the systems as a “necessary requirement of being a hospital today,” somewhat like cleaning supplies. So they don’t see the need to measure ROI.

To me, the “investment” part of ROI suggests that you have a choice. You put money into something now with the hope — but no guarantee — of a payoff later.

Building an imaging center on the edge of town or buying a surgical robot would probably be considered investments. Maintaining your buildings or upgrading your phones would not.

Doing something the government is making you do is not an investment. Given the reimbursement penalties that will eventually kick in for organizations that stick with paper, it’s hard to imagine that many hospital executives see EMR adoption as a matter choice.

The idea of ROI for EMR is probably outdated, a holdover from the days when having a system was optional. Hospital leaders are shopping for EMRs with an eye toward getting the best value for their money — just the way they shop for cleaning supplies, furniture or legal services.

You could say that as a society we’ve invested in the idea of EMRs and that we’re hoping for a payoff in terms of better outcomes and lower costs. But that doesn’t predict much about whether any particular hospital or doctor will see a dollar-and-cents ROI.

At Norton in Louisville, it sounds like they’re happy just to be recovering some of what they’re spending.

“It really does improve the continuity of care,” Norton’s chief medical officer, Dr. Steve Heilman, told Business First.

For now, it sounds like Norton is on track.

(Note: I work for Business First as a freelancer but didn’t write the story linked here.)

It’s Not The Health IT You Choose, But The Way You Talk About It

Posted on December 13, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

With system upgrades taking shape across the country, IT is no longer just another another department in the hospital. More than ever, it’s integral to how healthcare organizations work and get paid.

But you don’t always see this shifting landscape reflected in hospitals’ leadership structures or practices.

That’s unfortunate. Getting the most out of  the billions being spent on health IT will require clear vision and skillful communication at the top levels, according to a December article in the Journal of the American Health Information Management Association.

Doctors, nurses and other team members “must understand the nature of the changes—what the result of the changes will be, how their roles and work will be different, and why change is important,” author Tiankai Wang wrote.

Thoughtful language can go a long way toward minimizing staff resistance and making an implementation successful, explained Wang, a professor of health information management at Texas State University.

Leaders should practice “framing” by promoting the benefits of the technology, such as improved outcomes, lower costs and greater efficiency, Wang wrote. They should also use “rhetorical crafting” by using stories, analogies and other devices to make their message resonate.

Rhetorical crafting, according to Wang, “leverages a ‘show, don’t tell’ approach to frame leaders’ message in a form that will connect more easily with staff and help them to embrace the possibilities of the coming change.”

He also advises using words such as “we” and “should” rather than “you” and “must” when talking about IT changes.

At a more fundamental level, though, IT leadership isn’t always valued in healthcare to the extent that other roles are. In 2013, average total cash compensation for chief information officers was eighth-highest of all hospital titles at about $316,000, Modern Healthcare reported.

And despite the growing importance of health IT, it’s also uncommon for hospital CIOs to be promoted to the roles of chief operating officer, president or CEO.

It does happen, though, as David Raths wrote in Healthcare Informatics. In perhaps the best known example, Cincinnati-based Mercy Health, which operates several hospitals, earlier this year named Yousuf Ahmad, who had previously served as CIO, to the chief executive role. Ahmad had also held other management roles, including president of the system’s physician group.

It’s likely a sign of the front-and-center role that IT is now taking at healthcare organizations everywhere.

Are Patient Portals Really Helping Patients?

Posted on December 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

One thing’s for sure about patient portals: They’re a hot commodity.

What’s less clear is how much good they’re doing for health care.

The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.

Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.

But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.

In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”

Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.

Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.

Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.

The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.

When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.

The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.

Is Your EMR Compromising Patient Privacy?

Posted on November 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Two prominent physicians this week pointed out a basic but, in the era of information as a commodity, sometimes overlooked truth about EMRs: They increase the number of people with access to your medical data thousands of times over.

Dr. Mary Jane Minkin said in a Wall Street Journal video panel on EMR and privacy that she dropped out of the Yale Medical Group and Medicare because she didn’t want her patients’ information to be part of an EMR.

She gave an example of why: Minkin, a gynecologist, once treated a patient for decreased libido. When the patient later visited a dermatologist in the Yale system, that sensitive bit of history appeared on a summary printout.

“She was outraged,” she told Journal reporter Melinda Beck. “She felt horrible that this dermatologist would know about her problem. She called us enraged for 10 or 15 minutes.”

Dr. Deborah Peel, an Austin psychiatrist and founder of the nonprofit group Patient Privacy Rights, said she’s concerned about the number of employees, vendors and others who can see patient records. Peel is a well-known privacy advocate but has been accused by some health IT leaders of scaremongering.

“What patients should be worried about is that they don’t have any control over the information,” she said. “It’s very different from the paper age where you knew where your records were. They were finite records and one person could look at them at a time.”

She added: “The kind of change in the number of people who can see and use your records is almost uncountable.”

Peel said the lack of privacy causes people to delay or avoid treatment for conditions such as cancer, depression and sexually transmitted infections.

But Dr. James Salwitz, a medical oncologist in New Jersey, said on the panel that the benefits of EMR, including greater coordination of care and reduced likelihood of medical errors, outweigh any risks.

The privacy debate doesn’t have clear answers. Paper records are, of course, not immune to being lost, stolen or mishandled.

In the case of Minkin’s patient, protests aside, it’s reasonable for each physician involved in her care to have access to the complete record. While she might not think certain parts of her history are relevant to particular doctors, spotting non-obvious connections is an astute clinician’s job. At any rate, even without an EMR, the same information might just as easily have landed with the dermatologist via fax.

That said, privacy advocates have legitimate concerns. Since it’s doubtful that healthcare will go back to paper, the best approach is to improve EMR technology and the procedures that go with it.

Plenty of work is underway.

For example, at the University of Texas at Arlington, researchers are leading a National Science Foundation project to keep healthcare data secure while ensuring that the anonymous records can be used for secondary analysis. They hope to produce groundbreaking algorithms and tools for identifying privacy leaks.

“It’s a fine line we’re walking,” Heng Huang, an associate professor at UT’s Arlington Computer Science & Engineering Department, said in a press release this month “We’re trying to preserve and protect sensitive data, but at the same time we’re trying to allow pertinent information to be read.”

When it comes to balancing technology with patient privacy, healthcare professionals will be walking a fine line for some time to come.

Will Google Use Health IT To Make You Immortal?

Posted on November 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When Google Health, an attempt at a personal health record, turned out to be an unqualified failure, the consensus was that people just weren’t interested.

But health care is too big, important and data-ridden a field for Google to ignore. And now the company has moved on to a concept sure to be in demand: It wants to help you live forever. Google’s new anti-aging initiative, Calico, will apparently treat mortality as a big-data problem.

But is data the path to eternal life — or even a few more good years? I’d feel a little more comfortable booking a cruise for the year 2199 if Google had accomplished something in health care already.

Google officials, including cofounders Larry Page and Sergey Brin, haven’t said much about what Calico will actually do. But the project seems to take inspiration from 23andMe, a firm that Google helped to start and whose goal is “to make it possible to create a massive genomic database and thereby understand the permutations and mutations that happen to the human genome during the aging process,” according to the Washington Post.

Time explained in a feature article that medicine “is well on its way to becoming an information science.”

“Doctors and researchers are now able to harvest and mine massive quantities of data from patients,” the magazine continued. “And Google is very, very good with large data sets.”

When you put it that way, it sounds kind of reasonable. And if Google invents a medication, an app or a device that brings about a longer lifespan, then I will certainly take it, download it, wear it or whatever is required. But I doubt the human lifespan is quite that reducible.

The rich and powerful have often hoped to use their resources to overcome their mortality. And as Pete Shanks wrote, “immortality and transhumanist ideas generally have long been a source of fascination in Silicon Valley.”

Ray Kurzweil, Google’s engineering director, is a noted futurist who believes we’ll upload our minds to computers and achieve digital immortality by 2045. It’s not clear what role, if any, Kurzweil will have in Calico.

The human lifespan doesn’t seem to have budged in 100,000 years, but that’s not to say it’s impossible. I don’t doubt that humans’ maximum time on Earth could be increased. Maybe. Someday. For the longest time, humans didn’t fly or play Minecraft, either. And it’s been done in other species.

But Shanks was right when he wrote of Calico that “what’s most aggravating is the hubris involved.” A common fallacy among highly successful people is to think that expertise in one area will apply to other fields.

Google is great at search. Its map service is also ubiquitous, and I’ve heard that its driverless car works well. But when it comes to chaotic human data, the company’s algorithms might not work as well. Take free-form language, for example. When I use Google Translate to decipher the Chinese-language Wikipedia entry for “immortality,” I get sentences like this: “If you can maintain Chang Heng unchanged, it is possible to ‘live forever,’ but before the observation Everything in the world is now, whether living or heartless thing, and both are changing all the time.” It’s an app that can be helpful, but it doesn’t give me confidence that Google can overcome the limitations of our mortal coils. It can barely understand what we’re talking about.

And Google’s track record in health care is, of course, not so strong. Google Health, introduced in 2008 as a way for consumers to collect their health records online, was defunct by the end of 2011. Few consumers found it worth the effort of entering their data, given Google Health’s lack of capabilities such as appointment scheduling, InformationWeek reported.

Let’s hope that whatever Calico comes up with proves more useful. If it can be packaged as a free download, even better.

But I’d rather see Google invest its considerable resources in something with a higher chance of a payoff.

7 Health Tech Accelerators You Should Know About

Posted on November 6, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

You don’t have to look far to find a health IT accelerator. At least, not as far as you used to.

Programs to give healthcare entrepreneurs a boost are appearing throughout the country, providing opportunities for innovators who don’t live in a major tech hub — and don’t want to move to one.

Here are a few accelerator programs to know about, with special attention to those away from the coasts:

  • The Iron Yard is based in Spartanburg, S.C., and seeks companies involved in areas such as wellness apps and enterprise software. It provides $20,000 in seed capital and three months of mentoring and workshops in areas such as fundraising, user interface development and lean startup methodology.
  • Healthbox is operating programs in Chicago, Nashville and Jacksonville, Fla., in addition to Boston and London. (OK, technically, Jacksonville is on the East Coast, but still.) It’s a four-month program that provides startups with $50,000 in seed capital along with office space, mentoring and training. Healthbox asks for 7 percent in equity. According to the accelerator’s website: “Competitive applicants will address a specific and pressing challenge in the healthcare industry. For example, solutions of interest may improve patient engagement, provider effectiveness or preventative health and wellness.”
  • DreamIt Health started in Philadelphia and has expanded to Austin and Baltimore. The Baltimore version, which will last four months, is selecting as many as 10 firms from around the world and offering as much as $50,000 in stipend money and professional services. Applicants should be “working to use IT to solve significant industry problems faced by key healthcare stakeholders including providers, payers, public health, biopharma, device makers, employers and patients themselves.”
  • The Sprint Accelerator, powered by Techstars, is a program launching in Kansas City with a focus on mobile health technology. The three-month intensive mentorship program will begin in March, with startups receiving as much as $120,000, including $20,000 in seed funding and an optional $100,000 convertible debt note.
  • Health Wildcatters is a new accelerator in Dallas that invests as much as $35,000 in each firm. It’s open to a broader range of startups than some of the other programs, stating on its website: “Many healthcare IT, SaaS, digital health and mobile health companies are a fit, but we also encourage medical device, diagnostic and even pharma companies to apply.” Wildcatters takes an 8 percent equity stake. The site explains that in Texas parlance, wildcatters are “independent oil entrepreneurs willing to take chances with regard to where they drill” and that their success comes from “low operating costs and the ability to mobilize quickly.”
  • XLerateHealth runs a 10-week program in Louisville, Ky. Selected teams get a $20,000 stipend and donated professional services worth an estimated $50,000. The goal is to “help early stage healthcare companies build out their commercialization strategy, which includes their intersection with Payers, Providers (hospitals, ACOs, nursing homes, home health and group practices), and customers (employers and/or consumers).” XLerateHealth receives a 6 percent equity stake.
  • Innov8 for Health operates several programs in Cincinnati. This month it’s holding a Health Startup Showcase in which firms present their solutions to entrepreneurs, potential customers and investors and compete for $5,000 in cash and in-kind services. Last year it helped to launch seven companies in a 12-month accelerator program providing each firm with $20,000 in seed funding.

There are, of course, plenty of other programs. Paul Sonnier has compiled a more comprehensive list at Story of Digital Health.

With the rise of open platforms and the growing number of support networks, health IT entrepreneurship has become a viable career option for many.

And, now more than ever, it’s possible to innovate close to home.

China’s EMR Market

Posted on October 30, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Last week I wrote about what’s not happening in China: American firms getting a slice of the EMR market.

This time I thought it’d be interesting to look at what is happening with health IT in the world’s most populous country.

As I mentioned, that’s often easier said than done. The healthcare system has peculiarities, and the government doesn’t necessarily say what it’s planning. Some research firms have shied away from reporting on China’s EMR scene altogether.

But a case study released over the summer provides some fascinating market intelligence. The work by Arthur Daemmrich, associate professor at the University of Kansas School of Medicine, follows Shanghai Kingstar Winning Software Co. Ltd. as its founder seeks to increase its growth rate.

Three options that Zhou Wei was considering as the first quarter of 2013 drew to a close included continuing to grow organically, merging with another company and expanding into other geographies, including South Asia or even the United States.

Points worth noting:

  • Winning, with 1,000 employees, competed for hospital IT projects with five other large firms. A few hundred smaller companies provided more specialized offerings.
  • The government owned more than 90 percent of the country’s hospitals.
  • Winning had achieved 50 percent revenue growth in 2012 and expected the same in 2013, but Zhou was not satisfied. He felt that even more rapid growth was needed.
  • In 2008, 1 percent of China’s hospitals were using EMRs. By 2012, about 32 percent of higher-ranked hospitals — tier-II and tier-III institutions — had EMRs.
  • Medical record-keeping in China came nearly to a halt during World War II and the country’s civil war. Many leftover records were destroyed during the Cultural Revolution of the 1960s and 1970s. The country then began rebuilding its records infrastructure. Daemmrich wrote, “Outpatient visits and prescriptions were recorded on small booklets that patients kept and brought with them to the hospital or other specialized clinic. Most hospitals issued their own booklets, so patients could end up with several different sets of medical records at home.”
  • Zhou’s firm undertook a project at an 850-bed Chinese traditional medicine (TCM) hospital. At such institutions, treatments such as acupuncture and therapeutic massage are common. The company’s R&D director, Ma Wei Min, explained, “The interfaces of western medicine and TCM EMR systems are alike, because the patient flow paths at both kinds of hospitals are almost the same. But going back to the software writing stage, TCM EMRs required a different logic and very different terminology.”

It’s easy to get immersed in the health IT considerations of our own country and forget that other regions are undertaking similar efforts. In China, the goals of the EMR push are largely the same as they are in the United States, but it’s interesting how much local flavor comes into play. The fact that Winning’s founder was seeing 50 percent revenue growth but still expected more was amazing and speaks to the country’s pace of economic development. And the background on China’s record-keeping shows that the country’s task is not just to digitize processes that have long been in place, but to define exactly what a medical record is and how it should work.

4 Reasons U.S. EMR Firms Won’t Try China

Posted on October 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

If you have something to sell, chances are you’ve thought about selling it in China.

With a population of 1.35 billion, it’s become an attractive market for U.S. companies pushing everything from athletic shoes to light trucks to Tide. Given the natural limits of their home market, you’d assume that American EMR firms would eventually size up China’s nascent health IT scene.

And it’s likely they have. In a report a few years ago, 100 percent of vendors surveyed told the consulting firm Accenture that they saw global markets as an opportunity in the long term.

But health IT doesn’t export quite as easily as Pringles and KFC. I’ve seen China’s healthcare system up close several times, and if you ask me, making headway in the world’s most populous nation will be beyond difficult.

China, which is in the midst of its own health care reform, could certainly be tempting for companies such as Epic, McKesson and Cerner. As Benjamin Shobert wrote for Forbes, the country in 2009 extended basic health coverage to 97 percent of its citizens. It also promised to build 31,000 hospitals, upgrade 5,000 existing ones and train 150,000 new primary-care doctors.

McKinsey & Co. last year said health care spending in China would grow to $1 trillion in 2020 from $375 million in 2011.

Meanwhile, U.S. EMR companies are going to need new markets to conquer. Estimates of how much growth potential is left are many and varied. But no matter how you look at it, at some point every American healthcare organization of any size will have an EMR. Millennium Research Group last month predicted declining EMR-industry revenue from this year on because of “market saturation.”

Of course, plenty of IT firms, including Oracle and IBM, have a major presence in China. But the China market won’t happen in a significant way for U.S. health IT companies any time soon, and here’s why:

  • China’s healthcare is different. The private physician’s office that Americans are used to is more or less nonexistent. You go to a hospital-based clinic and see the doctor who’s available. Patient privacy hasn’t taken hold, so there could be other clinic-goers and family members milling about near — or in — your exam room. Chinese traditional medicine is practiced alongside the “Western” variety. Even with insurance, you typically pay up front and get reimbursed later. A U.S.-centric EMR would not map neatly onto China’s workflows. There’s an overview of China’s system here. I’ve written about a Chinese dental clinic here.
  • No one understands China’s health IT. OK, I’m sure some people do, and I hope they comment. But it’s a challenge. The health information firm KLAS Enterprises isn’t even attempting to cover China. A KLAS executive vice president, Jared Peterson, told Modern Healthcare, “The Chinese market, that’s a big mystery.” Meanwhile, Accenture omitted China from its 2010 report “Overview of International EMR/EHR Markets” because of “conflicting opinions of overall EMR maturity.”
  • The language barrier will be formidable. Epic CEO Judith Faulkner told Modern Healthcare how her company had adapted its system for another language. “We’ve only done it once, for Dutch,” she said in January 2012. “It’s a lot of mapping. It’s a task, but it hasn’t been that bad of a task.” But Dutch is not Chinese, and Chinese doesn’t use the Roman alphabet. I’m betting that when you throw Chinese characters into the mix, the conversion will be “that bad of a task” and then some.
  • Cloud-based systems could raise security issues. Some experts expect cloud-based services to play a significant role as health IT spreads to developing countries. But according to a U.S.-China Economic and Security Review Commission report, “Regulations requiring foreign firms to enter into joint cooperative arrangements with Chinese companies in order to offer cloud computing services may jeopardize the foreign firms’ information security arrangements.”

It’s worth mentioning that three years ago, China was mentioned as Cerner announced plans to develop global markets. It wanted to get into emerging regions before its U.S.-based competitors did.

There’s not much sign of life now in any China-related plans the company might have had, though. According to a message from Chad Haynes, managing director for Cerner Asia, on the firm’s website: “We look forward to improving the health of communities in ASEAN, China, and beyond.”

In the case of China, that could be a while.

Is the ‘Internet of Things’ Health IT’s Next Big Thing?

Posted on October 17, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Gartner Inc. has come out with a bullish report on the “internet of things,” which it predicts will add nearly $2 trillion in value to the economy by 2020 and transform the way all businesses operate.

As many as 30 billion devices with unique IP addresses will be connected, the majority of them being products, according to Gartner. That’s compared with a 2009 figure of 2.5 billion, 80 percent of them being devices such as laptops and phones.

One of the most often quoted descriptions of the internet of things comes from Helen Duce, director of the RFID Technology Auto-ID European Centre at the University of Cambridge: “We have a clear vision: to create a world where every object — from jumbo jets to sewing needles — is linked to the Internet.”

Health care would, of course, be part of the vision, which Gartner, a Stamford, Conn.-based IT research and advisory firm, calls the Digital Industrial Economy. The sector receives prominent billing, along with retail and transportation, in Garner’s latest news release on the topic.

The thinking is that physical objects — “from roadways to pacemakers,” as McKinsey & Co. put it in one report — will produce constant data streams that can be analyzed and acted on. The possibilities for systems such as inventory control are obvious enough, as the inventory would report on itself.

In health care, a major application could be in patient monitoring. Marketplace has quoted Dr. Anthony Jones of Philips Healthcare on the possibilities: “If I now have a continuous monitor, and I have that data going up into a central repository, I can write algorithms and put some intelligence into that repository that allows me to look for trends. So part of what the Internet of things will allow is much more sophisticated, much more continuous monitoring.” Sounds a bit like what John described in his post “Every Organ Will Have an IP Address.”

It sounds promising. But it also sounds much more incremental than it’s being portrayed by Gartner and other consultants.

Consider how Peter Sondergaard, senior vice president at Gartner, explained the future in a recent talk covered by ZDNet:

“The Digital Industrial Economy will be built on the foundations of the Nexus of Forces (which includes a confluence and integration of cloud, social collaboration, mobile and information) and the Internet of Everything by combining the physical world and the virtual.”

The predictions — Sondergaard said every object costing more than $100 will be smart by 2020 — look optimistic. Or pessimistic, depending on how you look at it: Gartner also estimates that one in three knowledge workers will be displaced by the new technologies.

About 60 percent of respondents to Gartner’s own recent CEO survey said the idea that the internet of things would replace millions of workers over the next decade-and-a-half was a “futurist fantasy,” according to SiliconANGLE. In health care, it’s hard to imagine that CIOs have much attention to devote to the internet of things amid the Meaningful Use and ICD-10 requirements they’re up against, although, as Jennifer Dennard wrote, health IT nowadays is much more than that.

The internet of things will get here. But it will probably develop in a piecemeal fashion, not in the dramatic way that Gartner envisions. Lots of “things” will get connected as companies see business reasons to put sensors in and bring them online. It will arise ad hoc from existing projects, with some industries joining the trend earlier than others.

When it does get here, there’s a good chance it won’t even be called the internet of things. In 2005, after all, Gartner was calling it the “real-world web.”

It was also predicting: “By 2015, wirelessly networked sensors in everything we own will form a new Web.”