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A Missed Opportunity For Telemedicine Vendors

Posted on June 29, 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.

Today, most direct-to-consumer telemedicine companies operate on a very simple model.

You pay for a visit up front. You talk to the doctor via video, the doctor issues as a prescription if needed and you sign off. Thanks to the availability of e-prescribing options, it’s likely your medication will be waiting for you when you get to the pharmacy.

In my experience, the whole process often takes 45 minutes or less. This beats the heck out of having to wait in line at an urgent care center or worse, the emergency department.

But what about caring for chronic illnesses that can’t be managed by a drive-by virtual visit? Can telemedicine vendors play a role here? Maybe so.

We already know that combining telemedicine with remote monitoring devices can be very effective. In fact, some health systems have gone all-in on virtual chronic care management.

One fascinating example is the $54 million Mercy Virtual Care Center, which describes itself as a “hospital without beds.” The Center, which has a few hundred employees, monitors more than 3,800 remote patients; sponsors a telehealth stroke program offering neurology services to EDs nationwide; manages a team of virtual hospitalists caring for patient around-the-clock using virtual visit tools; and runs Mercy SafeWatch, which the Center says is the largest single-hub electronic intensive care unit in the U.S.

Another example of such hospital-based programs is Intermountain Healthcare’s ConnectCare Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its purpose is to supplement existing staffers and offer specialized services in rural communities where some of the services aren’t available.

Given the success of programs that maintain complex patients remotely, I think a private telemedicine company managing chronic care services might work as well. While hospitals have financial reasons to keep such care in-house, I believe an outside vendor could profit in other ways. That’s especially the case given the emergence of wearable trackers and smartwatches, which are far cheaper than the specialized tools needed in the past.

One likely buyer for this service would be health plans.

I’ve heard some complain publicly that in essence, telemedicine coverage just encourages patients to access care more often, which defeats the purpose of using it to lower healthcare costs. However, if an outside vendor offered to manage patients with chronic illnesses, it might be a more attractive proposition.

After all, health plans are understandably wringing their hands over the staggering cost of maintaining the health of millions of diabetics. In 2017, for example, the average medical expense for people diagnosed with diabetes was about $16,750 per year, with $9,600 due to diabetes. If health plans could lay the cost off to a specialized telemedicine vendor, some real savings might be possible.

Of course, being a telemedicine-based chronic care management company would be far different than offering direct-to-consumer telemedicine services on an occasional basis. The vendor would have to have comprehensive health data management tools, an army of case managers, tight relationships with clinicians and a boatload of remote monitoring devices on hand. None of this would come cheaply.

Still, while I haven’t fully run the numbers, my guess is that this could be a sustainable business model. It’s worth a try.

An Interesting Overview Of Alphabet’s Healthcare Investments

Posted on June 27, 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.

Recently I’ve begun reading a blog called The Medical Futurist which offers some very interesting fare. In addition to some intriguing speculation, it includes some research that I haven’t seen anywhere else. (It is written by a physician named Bertalan Mesko.)

In this case, Mesko has buried a shrewd and well-researched piece on Alphabet’s healthcare investments in an otherwise rambling article. (The rambling part is actually pretty interesting on its own, by the way.)

The piece offers a rather comprehensive update on Alphabet’s investments in and partnerships with healthcare-related companies, suggesting that no other contender in Silicon Valley is investing in this sector heavily as Alphabet’s GV (formerly Google Ventures). I don’t know if he’s right about this, but it’s probably true.

By Mesko’s count, GV has backed almost 60 health-related enterprises since the fund was first kicked off in 2009. These investments include direct-to-consumer genetic testing firm 23andme, health insurance company Oscar Health, telemedicine venture Doctor on Demand and Flatiron Health, which is building an oncology-focused data platform.

Mesko also points out that GV has had an admirable track record so far, with five of the companies it first backed going public in the last year. I’m not sure I agree that going public is per se a sign of success — a lot depends on how the IPO is received by Wall Street– but I see his logic.

In addition, he notes that Alphabet is stocking up on intellectual resources. The article cites research by Ernest & Young reporting that Alphabet filed 186 healthcare-related patents between 2013 and 2017.

Most of these patents are related to DeepMind, which Google acquired in 2014, and Verily Life Sciences (formerly Google Life Sciences). While these deals are interesting in and of themselves, on a broader level the patents demonstrate Alphabet’s interest in treating chronic illnesses like diabetes and the use of bioelectronics, he says.

Meanwhile, Verily continues to work on a genetic data-collecting initiative known as the Baseline Study. It plans to leverage this data, using some of the same algorithms behind Google’s search technology, to pinpoint what makes people healthy.

It’s a grand and somewhat intimidating picture.

Obviously, there’s a lot more to discuss here, and even Mesko’s in-depth piece barely scratches the surface of what can come out of Alphabet and Google’s health investments. Regardless, it’s worth keeping track of their activity in the sector even if you find it overwhelming. You may be working for one of those companies someday.

How the Young Unity Health Score Company Handles The Dilemmas of Health IT Adoption

Posted on June 25, 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.

I have been talking to a young company called Unity Health Score with big plans for improving the collection and sharing of data on patients. Their 55-page business plans covers the recruitment of individuals to share health data, the storage of that data, and services to researchers, clinicians, and insurers. Along the way, Unity Health Score tussles with many problems presented by patient data.
Unity Health Score logo
The goals articulated for this company by founder Austin Jones include getting better data to researchers and insurers so they can reduce costs and find cures, improving communications and thus care coordination among clinicians and patients, and putting patients in control of their health data so they can decide where it goes. The multi-faceted business plan covers:

  • Getting permission from patients to store data in a cloud service maintained by Unity Health Score
  • Running data by the patients’ doctors to ensure accuracy
  • Giving patients control over what researchers or other data users receive their data, in exchange for monetary rewards
  • Earning revenue for the company and the patients by selling data to researchers and insurers
  • Helping insurers adjust their plans based on analysis of incoming data

The data collected is not limited to payment data or even clinical data, but could include a grab-bag of personal data, such financial and lifestyle information. All this might yield health benefits to analytics–after all, the strategy of using powerful modern deep learning is being pursued by many other health care entities. At the same time, Jones plans to ensure might higher quality data than traditional data brokers such as Acxiom.

Now let’s see what Unity Health Score has to overcome to meet its goals. These challenges are by no means unique to these energetic entrepreneurs–they define the barriers faced by institutions throughout health care, from the smallest start-up to the Centers for Medicare & Medicaid Services.

Outreach to achieve a critical mass of patients
We can talk for weeks about quality of care and modernizing cures, but everybody who works in medicine agrees that the key problem we face is indifference. Most people don’t want to think too much about their health, are apathetic when presented with options, and stubbornly resist the simplist interventions–even taking their prescribed medication. So explaining the long-term benefits of uploading data and approving its use will be an uphill journey.

Many app developers seek adoption by major institutions, such as large insurers, hospital conglomerates, and HMOs like Kaiser. This is the smoothest path toward adoption by large numbers of consumers, and Unity Health Score includes a similar plan in its business model, According to Jones, they will require the insurance company to reduce premiums based on each patient’s health score. In return, they should be able to use the data collected to save money.

Protecting patient data
Health data is probably the most sensitive information most of us produce over our lifetimes. Financial information is important to keep safe, but you can change your bank account or credit card if your financial information is leaked–you can’t change your medical history. Security and privacy guarantees are therefore crucial for patient records. Indeed, the Unity Health Score business plan cites fears of privacy as a key risk.

Although some researchers have tried distributed patient records, stored in some repository chosen by each individual, Unith Health Score opts for central storage, like most current personal health records. This not only requires great care to secure, but places on them the burden of persuading patients that the data really will be used only for purposes chosen by the patients. Too many apps and institutions play three-card Monte with privacy policies, slipping in unauthorized uses (just think back to the recent Facebook/Cambridge Analytica scandal), so Internet users have become hypervigilant.

Unity Health Score also has to sign up physicians to check data for accuracy. This, of course, should be the priority for any data entered into any medical record. Because doctors’ time is going more and more toward the frustrating task of data entry, the company offers an enticing trade-off: the patients takes the time to enter their data, and the doctor merely verifies its accuracy. Furthermore, a consolidated medical record online can be used to speed check-in times on visits and to make data sharing on mobile devices easier.

Making the data useful
Once the patients and clinicians join Unity Health Score, the company has to follow through on its promise. This is a challenge with multiple stages.

First, much of the data will be in unstructured doctors’ notes. Jones plans to use OCR, like many other health data aggregators, to extract useful information from the notes. OCR and natural language processing may indeed be more accurate than relying on doctors to meticulously fill out dozens of structured fields in a database. But there is always room for missed diagnoses or allergies, and even for misinterpretations.

Next, data sources must be harmonized. They are likely to use different units and different lexicons. Although many parts of the medical industry are trying to standardize their codings, progress is incomplete.

The notion of a single number defining one’s health is appealing, but it might be too crude for many uses. Whether you’re making actuarial predictions (when will the individual die, or have to stop working?), estimating future health care costs, or guessing where to allocate public health resources, details about conditions may be more important than an all-encompassing number. However, many purchasers of the Unity Health Score information may still find the simplicity of a single integer useful.

Making the service attractive to data purchasers
The business plan points out that most rsearch depends on large data sets. During the company’s ramp-up phase–which could take years–they just won’t have enough patients suffering from a particular condition to interest many researchers, such as pharma companies looking for subjects. However, the company can start by selling data to academic researchers, who often can accomplish a lot with a relatively small sample. Biotech, pharma, and agencies can sign up later.

Clinicians may warm to the service much more quickly. They will appreciate having easy access to patient data for emergency room visits and care coordination in general. However, this is a very common use case for patient data, and one where many competing services are vying for a business niche.

Aligning goals of stakeholders
In some ways I have saved the hardest dilemma for last. Unity Health Care is trying to tie together many sets of stakeholders–patients, doctors, marketers, researchers, insurers–and between many of these stakeholders there are irreconcilable conflicts.

For instance, insurers will want the health score to adjust their clients’ payments, charging more for sick people. This will be feared and resented by people with pre-existing conditions, who will therefore withhold their information. In some cases, such insurer practices will worsen existing disparities for the poor and underpriviledged. The Unity Health Score business plan rejects redlining, but there may be subtler practices that many observers would consider unethical. Sometimes, incentives can also be counterproductive.

Also, as the business plan points out, many companies that currently purchase health data have goals that run counter to good health: they want to sell doctors or patients products that don’t actually help, and that run up health care costs. Some purchasers are even data thieves. Unity Health Score has a superior business model here to other data brokers, because it lets the patients approve each distribution of their data. But doing so greatly narrows the range of purchasers. Hopefully, there will be enough ethical health data users to support Unity Health Score!

This is an intriguing company with a sophisticated strategy–but one with obstacles to overcome. We can all learn from the challenges they face, because many others who want to succeed in the field of health care reform will come up against those challenges.

Exec Tells Congress That New Health Data Threats Are Emerging

Posted on June 20, 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.

A senior security executive with a major academic health system has told Congress that in addition to attacks by random attackers, healthcare organizations are facing new threats which are changing the health security landscape.

Erik Decker, chief security and privacy officer with the University of Chicago Medicine, testified on behalf of the Association for Executives in Healthcare Information Security in mid-June. He made his comments in support of the reauthorization of the Pandemic and All-Hazards Preparedness Act, whose purpose is to improve the U.S. public health and medical preparedness for emergencies.

In his testimony, Decker laid out how the nature of provider and public health preparedness has changed as digital health technology has become the backbone of the industry.

He described how healthcare information use has evolved, explaining to legislators how the digitization of healthcare has created a “hyper-connected” environment in which systems such as EHRs, revenue cycle platforms, imaging and ERP software are linked to specialty applications, the cloud and connected medical devices.

He also told them about the increasing need for healthcare organizations to share data smoothly, and the impact this has had on the healthcare data infrastructure. “There is increasing reliance on these data being available, and confidential, to support these nuanced clinical workflows,” he said. “With the adoption of this technology, the technical ecosystem has exploded in complexity.”

While the emergence of these complex digital health offers many advantages, it has led to a growth in the number and type of cybersecurity problems providers face, Decker noted. New threats he identified include:

* The development of underground markets and exchanges of sensitive information and services such as Hacking-as-a Service
* The emergence of sophisticated hacking groups deploying ransomware
* New cyberattacks by terrorist organizations
* Efforts by nation states to steal intellectual property to create national economic advantages

This led to the key point of his testimony: “We can no longer think of preparedness relative only to natural disasters or pandemics,” Decker said. “It’s imperative that we acknowledge the criticality of cybersecurity threats levied against the nation’s healthcare system.”

To address such problems, Decker suggests, healthcare organizations will need help from the federal government. For example, he pointed out, HHS efforts made a big difference when it jumped in quickly and worked closely with healthcare leaders responding to WannaCry attacks in mid-2017.

Meanwhile, to encourage the healthcare industry to adopt strong cybersecurity practices, it’s important to offer providers some incentives, including a financial subsidy or safe harbors from enforcement actions, he argued.

Alexa Voice Assistant Centerpiece Of Amazon Health Effort

Posted on June 1, 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.

I don’t know about you, but until recently I had thought of the Amazon Echo is something of a toy. From what I saw, it seemed too cute, too gimmicky and definitely too expensive for my taste. Then I had a chance to try out the Echo my mother kept in her kitchen.

It’s almost embarrassing to say how quickly I was hooked. I didn’t even use many of Alexa’s capabilities. All I had to do was command her to play some music, answer some questions and do a search on the Amazon.com site and I was convinced I needed to have one. Its $99 price suddenly seemed like a bargain.

Of course, being a health IT geek I immediately wondered how the Alexa voice assistant might play a part in applications like telemedicine, but I was spending too much time playing “Name That Song” (I’m an 80s champ) to think things through.

But I had the right instincts. It’s become increasingly clear that Amazon sees Alexa as a key channel for reaching healthcare decision-makers.

According to a story appearing on the CNBC website, Amazon has built a 12-person team within the Alexa voice-assisted division called “health & wellness” whose focus is to make Alexa more useful to healthcare patients and providers. Its first targets include diabetes management, care for mothers and infants and aging, according to people who spoke anonymously with CNBC.

Of course, this effort would involve working through HIPAA rules, but it’s hard to imagine that a company like Amazon couldn’t buy and/or cultivate that expertise.

In the piece, writers Eugene Kim and Christina Farr argue that the mere existence of the health & wellness group is a clear sign that Amazon plans to bring Alexa to healthcare. As long as the Echo can share and upload data in a secure, HIPAA-compliant fashion, the possibilities are almost endless. In addition to sharing data with patients and clinicians, this would make it possible to integrate the data with secure third-party apps.

Of course, a 12-person unit is microscopic in size within a company like Amazon, and from that standpoint, the group might seem like a one-off experiment. On the other hand, its work seems more important when you consider the steps Amazon has already taken in the healthcare space.

The most conspicuous move Amazon has made in healthcare came in early 2018, when it announced a joint initiative with Berkshire Hathaway and J.P. Morgan focused on improving healthcare services. To date, the partnership hasn’t said much about its plans, but it’s hard to argue that something huge could emerge from bringing together players of this size.

In another, less conspicuous move, Alexa took a step towards competing in the diabetes care market. In the summer of 2017, working with Merck, Amazon offered a prize to developers building Alexa “skills” which could help people with diabetes manage all aspects of their care. One might argue that this kind of project could be more important than something big and splashy.

It’s worth noting at this point that even a monster like Google still hasn’t made bold moves in healthcare (though it does have extraordinarily ambitious plans). Amazon may not find it easy to compete. Still, it will certainly do some interesting things, and I’m eager to see them play out. In fact, I’m on the edge of my seat – aren’t you?

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.