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Strong Statements from Vinod Khosla at HLTH

Posted on May 16, 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.

Last week I had the opportunity to attend a small piece of the new HLTH conference in Las Vegas. My time at the event was cut extremely short as I had to head to Science Camp with 80 5th graders (including my daughter), but I was able to hear the opening keynotes on Sunday. I was most interested in hearing from Vinod Khosla who I don’t always agree with, but he often causes me to look at something a little different or to see the future in a new way. As usual, that’s what he delivered on stage (Between pitches for his companies of course). Here’s a look at some of the pictures and tweets I shared from Vinod’s talk at HLTH.


Needless to say, HLTH was a big event. When you pour $5 million into an event, it better be big. Not to mention the marketing they did for the event. I’m glad to not see HLTH ads on every website I visit now. The turnout for the event seemed good. I saw a lot of social media people there that I know. I was surprised by how many young people were at the conference. Maybe the CEOs they reference in their marketing were a lot of startup CEOs.


This was an extremely powerful and thought provoking statement for me. His assertion is that instead of treating people based on their symptoms, the devices and sensors we use to monitor and measure our health will be so good that these health measurements will drive medicine and not the symptoms we experience. Chew on that concept for a while and you’ll see how it’s not that far fetched even if it is still a ways away.


I’m no expert on medical education, but this does bring up some challenging questions for medical schools. In many ways, it’s similar to what I feel about elementary school for my kids. Sure, there’s a baseline of knowledge that is helpful to understand. However, when it comes to diagnosis, treatment, etc, we’re going to have to seriously consider how we train future doctors. New skills are going to be required to effectively treat a patient. I can’t imagine most medical schools are going to be ready to adapt to this change.


I tweeted this after Vinod talked about all the various tests, labs, etc he’s getting. He sees it as research and suggests that it’s not something that other people should be doing. Vinod seems to have a similar view of health testing as Mark Cuban. Mark Cuban controversial suggested that those who can afford it should do regular blood tests. Opponents argue that it drives unnecessary procedures, unnecessary health fears, and plenty of other issues from over testing. I’ve always felt like there was a balance and it was important for Vinod and Mark to understand these possibilities as they test regularly. However, having this baseline of information could be extremely valuable in discovering what really influences our health.

Some pretty interesting things to think about. Is it very practical for a health IT professional? Probably not and that’s probably why I didn’t see any health IT professionals, CIOs, or other people like that at the HLTH conference. That’s not the goal of the conference really. It seems like there will be another HLTH in 2019. Will be interesting to see what vendors return and who doesn’t.

Of course, some people got distracted at HLTH by the wedding chapel:


Then again, maybe a HLTH Wedding might be a great outcome for some people.

Google And Fitbit Partner On Wearables Data Options

Posted on May 7, 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.

Fitbit and Google have announced plans to work together, in a deal intended to “transform the future of digital health and wearables.” While the notion of transforming digital health is hyperbole even for companies the size of Google and Fitbit, the pairing does have plenty of potential.

In a nutshell, Fitbit and Google expect to take on both consumer and enterprise health projects that integrate data from EMRs, wearables and other sources of patient information together. Given the players involved, it’s hard to doubt that at least something neat will emerge from their union.

Among the first things the pair plans to use Google’s new Cloud Healthcare API to connect Fitbit data with EMRs. Of course, readers will know that it’s one thing to say this and another to actually do it, but gross oversimplifications aside, the idea is worth pursuing.

Also, using services such as those offered by Twine Health– a recent Fitbit acquisition — the two companies will work to better manage chronic conditions such as diabetes and hypertension. Twine offers a connected health platform which leverages Fitbit data to offer customized health coaching.

Of course, as part of the deal Fitbit is moving to the Google Cloud Platform, which will supply the expected cloud services and engineering support.

The two say that moving to the Cloud Platform will offer Fitbit advanced security capabilities which will help speed up the growth of Fitbit Health Solutions business. They also expect to make inroads in population health analysis. For its part, Google also notes that it will bring its AI, machine learning capabilities and predictive analytics algorithms to the table.

It might be worth a small caution here. Google makes a point of saying it is “committed” to meeting HIPAA standards, and that most Google Cloud products do already. That “most” qualifier would make me a little bit nervous as a provider, but I know, why worry about these niceties when big deals are afoot. However, fair warning that when someone says general comments like this about meeting HIPAA standards, it probably means they already employ high security standards which are likely better than HIPAA. However, it also means that they probably don’t comply with HIPAA since HIPAA is about more than security and requires a contractual relationship between provider and business associate and the associated liability of being a business associate.

Anyway, to round out all of this good stuff, Fitbit and Google said they expect to “innovate and transform” the future of wearables, pairing Fitbit’s brand, community, data and high-profile devices with Google’s extreme data management and cloud capabilities.

You know folks, it’s not that I don’t think this is interesting. I wouldn’t be writing about if I didn’t. But I do think it’s worth pointing out how little this news announcement says, really.

Yes, I realize that when partnerships begin, they are by definition all big ideas and plans. But when giants like Google, much less Fitbit, have to fall back on words like innovate and transform (yawn!), the whole thing is still pretty speculative. Just sayin’.

Privacy Fears May Be Holding Back Digital Therapeutics Adoption

Posted on May 3, 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.

Consumers were already afraid that their providers might not be able to protect the privacy of their health data. Given the daily news coverage of large data breaches and since the Facebook data scandal blew up, consumers may be even less likely try out new digital health approaches.

For example, a new study by innovation consultancy Enspektos has concluded that patients may be afraid to adopt digital therapeutics options. Many fear that the data might be compromised or the technology may subject them to unwanted personal surveillance.

Without a doubt, digital therapeutics could have a great future. Possibilities include technologies such as prescription drugs with embedded sensors tracking medication compliance, as well as mobile apps that could potentially replace drugs. However, consumers’ appetite for such innovations may be diminishing as consumer fears over data privacy grow.

The research, which was done in collaboration with Savvy Cooperative, found that one-third of respondents fear that such devices will be used to track their behavior in invasive ways or that the data might be sold to a third party without the permission. As the research authors note, it’s hard to argue that the Facebook affair has ratcheted up these concerns.

Other research by Enspektos includes some related points:

  • Machine-aided diagnosis is growing as AI, wearables and data analytics are combined to predict and treat diseases
  • The deployment of end-to-end digital services is increasing as healthcare organizations work to create comprehensive platforms that embrace a wide range of conditions

It’s worth noting that It’s not just consumers who are worried about new forms of hacker intrusions. Industry CIOs have been fretting as it’s become more common for cybercriminals to attack healthcare organizations specifically. In fact, just last month Symantec identified a group known as Orangeworm that is breaking into x-ray, MRI and other medical equipment.

If groups like Orangeworm have begun to attack medical devices — something cybersecurity experts have predicted for years — we’re looking at a new phase in the battle to protect hospital devices and data. If one cybercriminal decides to focus on healthcare specifically, it’s likely that others will as well.

It’s bad enough that people are worried about the downsides of digital therapeutics. If they really knew how insecure their overall medical data could be going forward, they might be afraid to even sign in to their portal again.

#HIMSS18: Oh The Humanity

Posted on April 2, 2018 I Written By

The following is a guest blog post by Sean Erreger, LCSW or @StuckonSW as some of you may know him.

It was a privilege to attend the 2018 HIMSS global conference this year. Having blogged and tweeted about Health IT for a couple of years, it was great to finally live it. By taking a deep dive, attending presentations, demoing products, and networking; I came to a greater understanding of how Health IT tackles the problems I hope to solve. From a social work perspective, I continue to be fascinated with the idea that technology can facilitate change.  Getting lost in artificial intelligence, machine learning, natural language processing, and predictive analytics was easy. It was exciting to learn the landscape of solutions, amount of automation, and workflow management possible. As a care manager, I believe these tools can be incredibly impactful.

However, despite all the technology and solutions, came the reminder that Health IT is a human process. There were two presentations that argued that we can’t divorce the humanity from health information technology process.  First was on the value of behavioral science and secondly a presentation on provider burnout and physician suicide.

The Value Of Behavioral Science

This was a panel presentation and discussion moderated by Dr. Amy Bucher of Mad*Pow including Dr. Heather Cole-Lewis of Johnson and Johnson, Dr. David Ahern of the FCC, and Dr. John Torous of Harvard Medical school. All experts were a part of projects related to Personal Connected Health Alliance. They asked attendees to consider the following challenges and how behavior science play a role…

Questions like how do we measure outcome and defining what “engagement” look like are key to how we build Health IT.  Yes, things like apps and wearables are cool but how do we measure their success. This can often be a challenge. It often feels like health IT is trying to outdo each other about who is coming up with the coolest piece of technology. However, when we get down to the nuts and bolts and start to measure engagement in technology, we might not like the results…

This presentation reminded me that technology is not often enough. Valuing the importance of “meeting people where they are”, may not include technology at all. We have to challenge ourselves to look ethically at the evidence and ensure that digital health is something a patient may or may not want.

Technology as a Solution to Physician Burnout and Suicide

It was reassuring to know even before I got to HIMSS that suicide prevention was going to be part of the conversation. Janae Sharpe and Melissa McCool presented on physician suicide and tools to potentially prevent it. This presents another human aspect of Health IT, the clinicians that use them. The facts about physician suicide are hard to ignore…

As someone who has done presentations about burnout and secondary trauma, I am acutely aware of how stressful clinical care can be.  It is unclear whether technology is a cause but it is certainly a factor, even in physician suicide. The research on this complex, but to blame the paperwork demands for burnout and physician suicide is tricky. To attribute a cause to things is always a challenge but my take away is that the Health IT community might be part of the problem but the presenters made a compelling case that it should be part of the solution. That not only reducing clicks and improving workflow is needed but providing support is critical.

They talked about the need to measure “burnout” and see how the Health IT community can design technology to support those at risk.  They have created a scale called the Sharp Index to try to measure physician burnout and also build technology to provide support. This seems to be striving for that right mix between measurement in the hopes of making space for human processes in a complex technology space.

Cooking The Mix Between Tech and Human Care

These presentations leave Health IT with many questions. Apps to provide a means of clinical care exist but are they working? How can we tell we are getting digital health right? How can we tell if technology is making a difference in patients’ lives? How do we define “success” of an app? Is technology having a negative impact on clinical care and clinicians themselves? If so, how do we measure that?

These questions force us to take an intentional look at how we measure outcomes but more importantly how we define them. Both presentations stressed the multi-disciplinary nature of health information technology development.  That no matter what the technology, you need to ask what problem does it solve and for who? As we consider building out AI and other automation we need to keep the humanity in healthcare.  So we can better care for ourselves as providers and ask what patients need in a human centered manner.

For a deeper dive into each presentation, I have created twitter recaps of both the Behavioral Science Panel and the presentation on Physician Suicide.

About Sean Erreger
Sean is Licensed Clinical Social Worker in New York. He is interested in technology and how it is facilitating change in a variety of areas. Within Health IT is interested in how it can include mental health, substance abuse, and information about social determinants. He can be found at his blog www.stuckonsocialwork.com.

The Win-Win of Today’s Telemedicine Technology for All Practices

Posted on March 22, 2018 I Written By

The following is a guest blog post by Sean Brindley, Product Development Manager, Kareo Telemedicine

The healthcare profession has been talking about telemedicine and its potential benefits almost as long as there have been phones. Over the last five years, adoption of telemedicine programs has increased steadily, but for some practices, particularly smaller, independent offices, the questions loom larger. How disruptive will adopting telemedicine be to office workflow? Will telemedicine overburden office staff? What are the risks involved in trying it? How will they get reimbursed for the investment? And, most important, what benefits can telemedicine bring to the individual practice that offset the impact of the learning curve?

Unlike even one or two years ago, today’s answers are mostly positive.

Reimbursement Is Real

Let’s tackle the big question first – reimbursement. Starting at the simplest point, most practices today give away a lot of practitioner time in telephone consults that are not reimbursable. Finding a way to generate revenue on even some of those would be a boon to most practices. But the news is far more positive than that. Thirty-five states, plus eight more pending, have enacted telemedicine parity requiring certain payers to pay for telemedicine consultations just as they would reimburse face-to-face visits. Private payers have been at the forefront of telemedicine adoption, likely recognizing telemedicine as a highly cost-effective delivery system for healthcare.  At the same time, a recent bill (The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017), has relaxed the restriction on Medicare reimbursements for telemedicine, and while Medicaid reimbursement varies substantially from state to state, there are places where the reimbursement practices go further than Medicare. All practices should carefully review the rules and regulations in their states. Parity doesn’t always mean parity. This is why it’s an advantage to have a telemedicine visit option that’s built into the EHR and practice management system, not a separate application. This ensures a smooth reimbursement process. For example, in Kareo when a video appointment is scheduled, the system automatically verifies that the patient is covered for telemedicine. This removes much of the burden from the office staff and greatly increases the chances that the telemedicine program will provide a revenue stream for the office.

What’s In It For Practices?

Beyond the potential for reimbursing telemedicine visits, how will telemedicine impact the operation of offices? First, telemedicine can increase the number of daily or weekly visits without increasing the practitioner’s work hours because visits conducted via most well-designed telemedicine systems take less time than an in-person visit. For example, a practice with three providers who each add two video visits per day, at an average reimbursement of $72, will earn an extra $103,680 in revenue over the course of a year. Telemedicine also greatly reduces the number of no-shows and cancellations. Patients with a telemedicine appointment are less likely to cancel because of work issues, transportation, child care, or just plain forgetting. An office appointment that has to be cancelled at the last minute can even be changed to a video visit, keeping the patient on track and not wasting the practitioner’s time. Having telemedicine available makes a practice more competitive against the rising number of “convenient” healthcare outlets like urgent care, walk-ins and on-demand care.

What’s In It For Patients?

Perhaps most important, telemedicine has the potential to improve patient health and increase quality outcomes since it provides an easy way to stay in ongoing touch with patients. The best use cases are for routine follow-up care where the appointment does not require a physical examination. For example, ideal cases for video visits are ongoing care for chronic conditions, observing treatment plans, reviewing slightly abnormal lab results, providing prescription updates, and discussing lifestyle changes for weight loss, smoking cessation and much more. Better quality outcomes also mean better reimbursement under today’s quality-driven healthcare system. Some of the specialties regularly using telemedicine are:

  • Primary Care
  • OB/GYN
  • Neurology
  • Nephrology
  • Mental/Behavioral Health
  • Gastroenterology
  • Endocrinology
  • Cardiology
  • Dermatology
  • Pulmonology
  • Infectious Disease
  • Urology
  • Hematology/Oncology

How Much Impact on Staff?

Traditionally, many providers have offered separate applications for telemedicine, which required additional steps and training for office staff, making it more difficult to implement, especially for small practices. However, telemedicine is now more feasible for all practices because new technology from Kareo integrates telemedicine seamlessly into the EHR platform. For example, our customers can schedule telemedicine appointments directly in their practice management system, maintaining current office workflow for scheduling, charting and billing with no extra steps or training required. The automatic eligibility verification removes much of the financial burden and produces on average 10 times the provider’s cost per visit.  Patients can request appointments online and conduct the visit through a mobile device or desktop.

Removing the Risk

In busy practices, all changes can feel risky in terms of impact on staff, patients and investment costs. The integration of telemedicine with popular EHR platforms removes much of the impact on staff. Since more than 64 percent of patients say they would be happy to have a telemedicine video appointment, the offering to patients is far more positive than negative. Finally, the investment risk has dropped to minimal. EHR providers that offer software-as-a service, such as Kareo, are now giving practices a chance to pay per telemedicine visit, thereby being charged only for what they use. These low per-visit fees reduce the start-up burden on small practices, so the financial risk drops to negligible. In this way the office can implement a telemedicine practice at its own pace, allowing reimbursements to keep pace with usage.

Chances are good that even the overworked independent practice can use today’s telemedicine technology as an opportunity to increase revenue, unburden staff, and enhance patient satisfaction with the most minimal of investments. After years of promise, telemedicine has become a win-win

About Sean Brindley
Sean Brindley is product development manager for Kareo Telemedicine. More information can be found on Kareo’s Go Practice blog.  Kareo is a proud sponsor of Healthcare Scene.

Hopes for Big Impact from Validic: Making Use of Consumer Device Data

Posted on March 20, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Validic, a company that provides solutions in data connectivity to health care organizations, came to HIMMS this year with a new platform called Impact that takes a big step toward turning raw data into actionable alerts. I talked to Brian Carter, senior vice president of product at Validic, about the key contributions of Impact.

Routinely, I find companies that allow health-related monitoring in the home. Each one has a solution it’s marketing to doctors: a solution reminding patients to take their meds, monitoring vital signs for diabetes, monitoring vital signs for congestive heart failure, or something else fairly specific. These are usually integrated solutions that provide their own devices. The achievement of Validic, built through years of painstakingly learning the details of almost 400 different devices and how to extract their data, is to give the provider control over which device to use. Now a provider can contract with some application developer to create a monitoring solution for diabetes or whatever the provider is tracking, and then choose a device based on cost, quality, and suitability.

Validic’s Impact platform actually does many of the things that a third-party monitoring solution can do. But rather than trying to become a full solutions provider for such things as hospital readmissions, Validic augments existing care management systems by integrating its platform directly into the clinical workflow. With Impact, clinicians can draw conclusions directly from the data they collect to generate intelligent alerts.

For instance, a doctor can request that Impact sample data from a sensor at certain intervals and define a threshold (such as blood sugar levels) at which Impact contacts the doctor. Carter defines this service more as descriptive analytics than predictive analytics. However, Validic plans to increase the sophistication of its analysis to move more toward predictive analytics. Thus, they hope in the future not just to report when blood sugar hits a dangerous threshold, but to analyze a patient’s data over time and compare it to other patients to predict if and when his blood sugar will rise. They also hope to track the all too common tendency to abandon the use of consumer devices, and predict when a patient is likely to do so, allowing the doctor to intervene and offer encouragement to keep using the device.

Validic has evolved far beyond its original mission of connecting devices to health care providers and wellness organizations. This mission is still important, because device manufacturers are slow to adopt standards that would make such connections trivial to implement. Most devices still offer proprietary APIs, and even if they all settled on something such as FHIR, Carter says that the task of connecting each device would still require manual programming effort. “Instead of setting up connections to ten different devices, a hospital can connect to Validic once and get access to all ten.”

However, interconnection is slowly progressing, so Validic needs to move up the value chain. Furthermore, clinicians are slow to use the valuable information that devices in the home can offer, because they produce a flood of data that is hard to interpret. With Impact, they can derive some immediate benefit from device data, as the critical information is elevated above the noise while still being integrated into their health records. They can contract further with other application developers to run analytical services and integrate with their health records.

New Study Suggests That HIEs Deliver Value by Aggregating Patient Data

Posted on March 5, 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.

Historically, I’ve been pretty skeptical about the benefits that HIEs offer, not because the concept was flawed, but that the execution was uncertain. Toss in the fact that few have figured out how to be self-supporting financially, and you have a very shaky business model on your hands. But maybe, at long last, we’re discovering better uses for the vast amount of data HIEs have been trading.

New research by one exchange suggests that some of the key value they offer is aggregating patient data from multiple providers into a longitudinal view of patients. The research, completed by the Kansas Health Information Network and Diameter Health suggests that the Qualified Clinical Data Registries promoted by MACRA/QPP could be a winning approach.

To conduct the research, the partners extracted data from the KHIN exchange on primary care practices in which more than 50,000 patients visited toward 214 care sites in 2016 and 2017. This is certainly interesting, as most of the multi-site studies I’ve seen on this scale are done within a single provider’s network. It’s also notable that the data is relatively fresh, rather than relying on, say, Medicare data which is often several years older.

According to KHIN, using interoperable interfaces to providers and collecting near real-time clinical data makes prompt quality measure calculation possible. According to KHIN executive director Laura McCrary, Ed.D., this marks a significant change from current methods. “This [approach is in stark contrast to the current model which computes quality measures from only the data in the provider’s EHR,” she notes.

FWIW, the two research partners will be delivering a presentation on the research study at the HIMSS18 conference on Friday, March 9, from 12 to 1 PM. I’m betting it will offer some interesting insights.

But even if you can’t make it to this presentation, it’s still worth noting that it emphasizes the increasing importance of the longitudinal patient record. Eventually, under value-based care, it will become critical to have access not only to a single provider’s EHR data, but rather a fuller data set which also includes connected health/wearables data, data from payer claims, overarching population health data and more. And obviously, HIEs play a major role in making this happen.

Like other pundits, I’d go so far to say that without developing this kind of robust longitudinal patient record, which includes virtually every source of relevant patient data, health systems and providers won’t be able to manage patients well enough to meet their individual patient or population health goals.

If HIEs can help us get there, more power to them.

Nokia May Exit Digital Health Business

Posted on March 2, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The digital health market has become phenomenally competitive over the last few years, with giants like Google and Apple duking it out with smaller, fast-moving startups over the choicest opportunities in the sector.

Even with a behemoth like Google, you expect to see some stumbles, and the Internet giant has taken a few. But seldom have we seen a billion-dollar company walk away from the digital health market, which arguably stands to grow far more. Still, according to a recent news report, that’s just what Nokia may be doing.

A story published in The Verge reports that the Finnish telecom giant has launched a strategic review of its health division. While Nokia apparently isn’t spilling the beans on its plans, the news site got a look at an internal company memo which suggests that its digital health business is indeed in trouble.

In the memo, The Verge says, Nokia chief strategy officer Kathrin Buvac wrote that “our digital health business has struggled to scale and meet its growth expectations… [And] currently, we don’t see a path for [the digital health business] to become a meaningful part of a company as large as Nokia.”

While it’s hard to tell much from a press release, it notes that Nokia’s digital health division makes and sells an ecosystem of hybrid smart watches, scales and digital health devices to consumers and enterprises. Its digital health history includes the acquisition of Withings, a French startup with a sexy line up of connected health-focused digital health devices.

This may be in part because it just hasn’t been aggressive enough or offered anything unique. In the wake of the Withings acquisition, Nokia doesn’t seem to have done much to build on Withings’ product line. Though much of the success in this market depends on execution, its current roster of products doesn’t sound like anything too exciting or differentiated.

It’s interesting to note that Buvac blames at least part of the failure of its digital health excursion on Nokia’s size. That doesn’t seem to be a problem for industry-leading companies like Apple, which seems to be carving out its digital health footprint one launch at a time and cultivating health leaders along the way. For example, Apple recently partnered with Stanford Medicine launch an app using its smartwatch to collect data on irregular heart rhythms. Arguably, this is the way to win markets and influence people — slow and steady.

In the end, though, Buvac is probably right about is digital health prospects. Nokia’s seeming failure may indeed be attributed to its sprawling portfolio, and probably an inflexible internal culture as well. The moral of the story may be that winning at the digital health game has far more to do with understanding the market than it does with having very deep pockets.

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.