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Key Articles in Health IT from 2017 (Part 2 of 2)

Posted on January 4, 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 set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.

A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.

An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.

A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.

A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.

In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.

Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.

Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.

No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.

The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:

Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.

A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.

Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.

The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.

A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.

To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.

Specific technologies

Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.

Lots of intriguing devices are being developed:

Remote monitoring and telehealth have also been in the news.

Natural language processing and voice interfaces are becoming a critical part of spreading health care:

Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.

Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.

A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.

3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.

A number of other interesting companies in digital health can be found in a Fortune article.

We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:

I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.

Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 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.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

When Will Digital Health Concepts Reach the Doctor?

Posted on May 10, 2017 I Written By

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

The always insightful Joseph Kvedar, MD, has a great post up where Joe gets a wake-up call from one of his advisors:

“Joe, when are we going to take all of these digital health concepts from the 30,000 foot level and get them into that 10 minute window that the doctor has with the patient?” It is not hyperbole to say that this put the last 20+ years of my career in a whole different perspective.

This is a good wake-up call for all of us in the space. Pushing digital health solutions down to the 10 min window a doctor has with a patient is the nirvana of what we’re doing and is incredibly challenging.

Dr. Kvedar suggested that we’ve already started to do this when he shared an example of how his PCP offered an eVisit option for follow-up to his in-person visit. I think that is a good example, but his insights into the 2nd phase offered a great look into where all of this is headed [emphasis added]:

Phase two will be the integration of tools like remote monitoring of diabetes and blood pressure. This is more tricky. The front-end work of monitoring remotely-derived values is done by either a non-physician clinician or, in some cases, a software algorithm. The doctor gets involved only when there is a complex medical judgment required. When deployed at scale, this approach extends the doctor across many more patients due to the one-to-many nature of the intervention.

Taking the recent interaction with my PCP as an example, remote monitoring would be considered a whole new channel of work, which doesn’t easily fit in to his workflow like an evisit does. It is hard to estimate its value, hard to predict how much impact it will have and hard to envision how to integrate it into clinical practice.

There are some real gems in this quote. My favorite is “The doctor gets involved only when there is a complex medical judgment required.” The future of healthcare IT is going to be built on this concept. When does a doctor need to get involved and when can another staff member or software algorithm address the situation? It will take us at least a decade or more to figure out this balance. Not to mention the workflow that will make sense.

Could the Future of Healthcare Not Include Telemedicine?

Posted on May 3, 2017 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.

Recently the ATA (American Telemedicine Association) held their annual conference which looks at the telemedicine and telehealth industry. I’ve always wanted to attend the event, but they’ve never had it at a time or a location that worked out well for me. One of these days I’m going to add it to my schedule of healthcare IT conferences. Until then, at least I can follow along with the conference on Twitter.

Coming out of the opening plenary session was this really interesting quote about telemedicine tweeted by the ATA twitter account:

I’d probably add that Telemedicine is the natural evolution of healthcare and technology. In fact, it’s clear to me that there’s no practical reason we shouldn’t be doing telemedicine for a large portion of our interactions with the healthcare system. It won’t replace all of them, but it should replace a lot of them.

The title of this post asks the question “Could the Future of Healthcare Not Include Telemedicine?”

My answer to that question is that I see no healthcare future where telemedicine doesn’t play a major role. It’s taken us forever to figure out telemedicine reimbursement. We’ve made progress but still have a long way to go. However, I don’t see any reason why telemedicine would not be a part of the future of healthcare.

Or as Andrew Watson, MD said, “Telemedicine is the natural evolution of healthcare.” We’re going to naturally go there whether people like it or not. It’s hard to kick against evolution and that’s true for telemedicine too.

Digital Health, Mobile Health, mHealth, etc Is Just Health?

Posted on April 26, 2017 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.

Last week, the big news in the world of healthcare IT was that HIMSS acquired Health 2.0. You can check out the great writeup of the acquisition by Andy Oram. This acquisition was interesting since Health 2.0 had largely tried to be the anti-HIMSS for so long. There were others doing so as well like the mHealth Summitt and the Connected Health Conference, but those have all been acquired by HIMSS as well.

It’s no surprise that running a conference focused on startup companies doing innovative things in healthcare is a hard business. Startup companies have no money and so they can’t spend on oversized booths like the large vendors at HIMSS do. Indu and Matthew did what they could with Health 2.0, but it’s a challenging business. It will be interesting to see how things go under the HIMSS umbrella.

I know that Matthew Holt who started Health 2.0 has been beating the drum for a long time that there’s no such thing as mobile health or mHealth or Digital Health. There’s just healthcare. So, in some ways it makes sense for something like Health 2.0 to be part of a healthcare IT organization like HIMSS.

For the most part, I agree with Matthew on there not being a difference. However, I think that what this misses is that within the healthcare IT world there are companies at different stages of development. I divide these companies into 3 categories: Large Enterprise Companies, Middle Tier Companies, and Startup Companies. We could slice and dice some more, but I think this is a good framework for thinking about the industry.

Whether you liked the description of digital health or mobile health or mHealth, those terms came to represent what most people would consider startup healthcare IT companies. That’s what Health 2.0 and a few other conferences came to represent. Despite many efforts on their part to expand in other ways, HIMSS has largely come to represent the large enterprise companies. They’ve done so in a really fantastic way, but these large enterprise companies kind of suck the wind out of events like the HIMSS Annual conference.

What’s interesting to me is that the middle tier healthcare IT companies haven’t really had a place to go. Sure, they might go to HIMSS, but they generally do smaller booths and they go to show they’re a player in the space versus going to attract customers and do business deals. Same goes for Health 2.0. They might attend Health 2.0 to see what’s happening in the market, but it’s not a great event for their businesses generally either.

Along those same lines, I think that most middle tier hospitals and healthcare organizations get left out as well. They’re too small to be able to be the pilot site for a startup company and they get lost at an event like HIMSS. These middle tier healthcare organizations are interesting because they have money to spend if they can find something that works. However, they don’t have the bandwidth to be someone’s innovation center for something that might work.

No doubt, digital health is just becoming part of the overall healthcare system. However, the division between size of companies and the maturity of their products is not going to change. Not to mention the needs of the various sized healthcare organizations. It will be interesting to see what happens to Health 2.0 under HIMSS and how the market continues to evolve to better serve its stakeholders.

LEVL – Measuring Fat Burning

Posted on March 9, 2017 I Written By

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

I’ve been sitting on this story since CES and just hadn’t had the time to write it. Plus, it dives into some deep biology and chemistry that really isn’t my wheel house, but I think the concept is too interesting not to write about it. Plus, I think this is an illustration of the larger trend I’ve been writing about which is that sensors are arriving to measure every aspect of our body.

While at CES, I had the chance to talk with LEVL. LEVL creates a device which measures the acetone level in your breathe. Here’s the science they shared with me about why the level of acetone in your breathe matters:

Previous clinical research demonstrates a correlation between the amount of acetone detected in the breath and body fat burned, giving you a reliable indicator of fat loss. LEVL is designed to detect trace amounts of acetone in your breath when your body is burning fat. LEVL Clinical Scientist, Joe Anderson Ph.D. emphasizes the significance of breath acetone measurement as it applies to the weight loss in his review, Measuring Breath Acetone for Monitoring Fat Loss in Obesity – A Research Journal.

If you want more details of how this should work, check out this video that LEVL created:

I’ll admit that the science seems interesting, but not totally definitive. Especially when it comes to actually moving the needle on people using weight. LEVL is still early in the process of figuring out how to take the data and make it actionable for the consumer. However, the concept of being able to answer the question “Are your actions helping you burn fat?” is a very interesting take that I think could be effective for many people if it’s framed the right way.

I asked the person I met from LEVL which things influenced acetone and he said “The things you’d expect” and then listed off fatty foods, sugar, no exercise, etc. Not really shocking since we have so much experiential data that knows the impact of those things on weight. That said, I could see the LEVL data being another element that at trainer or health coach could use to help motivate a patient. In fact, personal trainers are one of their big target markets to start.

It looks like LEVL is currently only available in Seattle and they are offering a LEVLhome and a LEVLpro device. The former is obviously for home use and the later is for health and wellness professionals. The product isn’t cheap. The home version is $699 and $49/mnth and the pro version is $699 + $149/month. That includes the device, app, sensor refills and calibration gas. The pro version also includes a client dashboard, training and education, and special support.

As I mentioned at the start, this is some pretty heavy science that I’ll leave to other people with more experience. However, the concept is quite interesting and I still expect we’ll see a wave of these types of devices that measure every aspect of our health.

Fewer But Better – Connected Health at #HIMSS17

Posted on March 3, 2017 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.

Since I go to so many connected health related conferences, seeing the latest in connected health at HIMSS is not really a huge deal. In most cases, I’ve already seen it somewhere else in a less hectic environment. With that said, I thought I’d see a real explosion of these devices at the conference. Certainly, there were many there, but I didn’t see the explosion that I had expected.

While there was a concentration of them in the Connected Health area, most of the rest of the show floor didn’t have many that I noticed. No doubt we each have our own unique experience at a 40,000 person and 1200 exhibitor conference. So, I’d be interested in hearing what other people’s experiences were at the event.

Even though I didn’t see an explosion of connected health devices (In fact, I may have seen fewer!), I do think that the devices that were being demonstrated are going a lot deeper and doing much more than previous years. That’s a good thing because these devices need to be medical relevant for the healthcare establishment to really care about them.

One example was a demo I saw at the DellEMC booth. They had an incredible dashboard of data that was pulling in a number of different health devices. One tracking pill that you swallow was particularly intriguing. The pill showed that the guy demoing the software had been pretty stressed that morning when the demo wasn’t working quite right. Luckily when I was there he was doing better.

Another feature of these connected health devices that hit me was how far they could reach. At the same demo with DellEMC, they had devices that could be tracked for nearly the entire HIMSS Exhibit hall (All of the Orlando Convention Center). While that’s not needed for home applications where wifi is basically ubiquitous, this is a very valuable tool to connect devices in a hospital setting.

As I mentioned, I hadn’t seen many new things, but we’re seeing the natural evolution of these connected health devices. They haven’t really broken out at HIMSS, but they are definitely getting more mature and that’s a good thing.

Connected Health at #HIMSS17

Posted on February 17, 2017 I Written By

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

One of the big growth areas at the HIMSS Annual Conference has been around digital and personal connected health (Formerly called mHealth or Mobile Health or Digital Health, etc). At HIMSS 2017 we see that trend continue. If you’re interested in connected health, then you’ll be busy at HIMSS this year.

To start off, they have an entire specialty education summit on the Sunday before the regular conference and the Monday of the conference that’s focused on Digital and Personal Connected Health (Costs $545 to attend now). You can find more details on this event and other education, exhibition and networking around Connected Health here. This Connected Health social hour looks pretty interesting.

Along with the Connected Health Summit, HIMSS Attendees can browse through a wide variety of Connected Health sessions on the education schedule and programming at the Connected Health Experience in the exhibit area.

If you’re looking for exhibitors working on Connected Health solutions, you can check out this list of HIMSS 2017 exhibitors. No doubt there are other exhibitors at HIMSS that just didn’t classify themselves that way, but they’re working on Connected Health solutions.

Along with the Connected Health sessions and exhibits, they also have a Wellness Challenge for all HIMSS attendees. If you’ve ever wanted a Free Apple Watch, then you might want to participate. I always love the idea personally but wish that the competition was virtual. I can never make it at the time specified.

Finally, if you’re not going to be at HIMSS or if you’re there and you want to share in the Connected Health conversation, there’s a special #Connect2Health hashtag you can follow and use.

I know in the past the Connected Health vendors have been some of the more interesting and innovative companies at HIMSS. I’ll be sure to report back on any that I find.