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5 Ways in which Big Data is Advancing Telemedicine

Posted on December 12, 2018 I Written By

The following is a guest blog post by Rahul Varshneya, Co-Founder and President of Arkenea and Benchpoint.

The healthcare industry is rapidly incorporating changes in technology. There is a gradual shift from the service based model of healthcare which primarily focused on curing the ailments, to a more holistic outcome-based approach which not only involves exploring different treatment modalities but actually aims at understanding the causative factors behind various ailments and eliminating them.

There has been a significant increase in health data, both structured and unstructured that is being generated. The high complexity level of this data requires it’s processing by big data analytics to come up with relevant and applicable inferences. Telemedicine is also harnessing the power of big data to improve the existing healthcare facilities.

The market size for Telemedicine is expected to increase to 41.2 billion dollars by 2021 and Big Data analytics is going to play a major role in this surge.

Here are the ways in which Big Data is contributing to the advancement of Telemedicine.

1. Patient Health Tracking and Predictive Analytics

The biggest benefit of the application of Big data in Telemedicine is the identification of potential health problems before their transformation into aggravating conditions. This has become a reality with the advent of the Internet of Medical Things (IoMT) in the form of wearable fitness trackers and other wearable health monitors which collect patient data on a real-time basis.

Application of Big data analytics techniques to this data ensures that patients vitals and statistics are constantly monitored. Telemedicine facilitates regular interactions with healthcare professionals without having to visit the doctor’s office. It also ensures that the physicians are constantly updated about the patient’s health status resulting in early detection of any anomaly.

The historical data collected is used for predictive analytics of the possible future outcomes. Creating risk scores on the basis of data from various sources is important for the identification of individuals at elevated risks of developing chronic ailments at the early stage of disease progression.

2. Remote Patient Monitoring and Post Discharge Prophylaxis

Post-discharge monitoring of patients and appointments with the physicians via telemedicine saves unnecessary visits to the doctor’s clinic. This is also a boon in the case of elderly and debilitated patients who cannot make frequent trips to the hospital for regular checkups. Vital patient stats like blood pressure and heart rate are collected by the use of health devices which have advanced sensors attached to them.

The data collected is processed using analytics techniques to compute the effective dosage of medication to be administered and helps the physician decide the course of treatment to be prescribed.

The clinicians are able to make use of numerous healthcare based apps to remotely monitor the patient condition and be on the lookout for signs of disease progression. This helps keeping the patients out of the hospitals, ensures that healthcare providers’ effort are focused on caring for patients in critical condition and also keeps the cost of healthcare relatively low by avoiding unnecessary hospitalization.

3. Accurate Diagnosis and Precision Medicine

Historically, the diagnostic process relied solely on patients relaying the symptoms to the doctor and doctor noticing the clinical signs of disease. The tests ordered further confirmed the doctor’s diagnosis and a treatment plan was prescribed. Now instead of subjective symptoms reported by the patient, the doctors can base their diagnosis on the patient data collected regularly by the wearable devices. Furthermore, the benefit of telemedicine is that the doctor and the patient don’t even need to be in the same geographical location for the diagnosis to take place!

Application of Big data in Telemedicine not only results in a more accurate diagnosis, but it also is a giant leap from traditional generic medicine into the realm of precision medicine curated specifically for each individual. The data collected from patients’ wearable devices, healthcare based apps, patients’ electronic health records, and genomics data can be tapped into for developing a medication that caters to patients individually.

Precision medicine takes into account the variation in lifestyles, genetic makeup, and environmental conditions for each individual. Big data makes it possible to compute the relevant data collected from various sources and helps the healthcare professionals come up with a treatment plan specific to each individual.

4. Cloud Computing and Specialist Outreach

The sheer volume of health data generated has led to the storage of patients EHRs and EMRs on the cloud. The benefit of telemedicine is that the patient data can be remotely accessed and treatment can be prescribed irrespective of the geographical location of the patient and the healthcare provider. It is of great advantage in case of a referral to the specialist who may be at a different location than the patient.

Secure access to the cloud ensures that physical location is no longer a variable in availing the best treatment possible. It is also beneficial to the healthcare providers as it allows for better scheduling of the doctor’s time increasing the effectiveness of care. Cloud storage is a precursor to the emergence of big data and acts as its facilitator.

5. Predicting Infection Trends and Timely Interventions

Application of deep learning algorithms across healthcare related data can be instrumental for prediction of infectious diseases and studying the patterns and trends of infection spread. The importance of data-based infectious disease surveillance studies has been recognized by a number of researchers across the world. These studies are important for supplementing the existing systems and designing of newer models of disease progression.

Big data in the form of Internet search queries are also being utilized for understanding disease trends, predicting the spread of infectious diseases. Once the regions affected by the infection are identified, the benefits of telemedicine come to light. Physician interactions with the affected populations and deployment of treatment modalities to the infected patients by use of tools like teleconferencing result in timely intervention and prevent the further spread of infection.

Conclusion

Big data analytics gives the physicians access to massive volumes of information which increases the diagnostic accuracy and results in efficiency in healthcare delivery. Combining the power of Telehealth with Big data has the potential to transform the healthcare delivery system and is of immense benefit to both the patients as well as healthcare providers.

Data security and privacy concerns are the biggest threats to this advancements. Enforcement of appropriate security measures need to ensured so that the vast reservoir of healthcare data can be harnessed to its full potential.

About Rahul Varshneya
Rahul Varshneya is the co-founder and President of Arkenea and Benchpoint. Rahul has been featured as a business technology thought leader in numerous media channels such as Bloomberg TV, Forbes, HuffPost, Inc, among others.

Carely – Helping Family Caregivers Partner with Providers

Posted on November 30, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have met many entrepreneurs who are or have created an app designed to help families better coordinate the care of loved ones. These apps all have similar features:

  • A Facebook-like interface that allows multiple family members to post medical/care updates and add comments
  • A calendar feature for important appointments and for coordinating care coverage by family members
  • An iMessage/Whatsapp-like messaging tool to communicate one-on-one with members of the family

Caring for a loved one and trying to coordinate family members is a daunting task so I applaud all of these efforts to make it easier.

However, I must admit that I come away after meeting these enthusiastic entrepreneurs a little disappointed. Their apps, while impressive, are stand-alone and are isolated from the rest of the healthcare ecosystem. For example, manual entry is often the only way to incorporate medical information from a provider and any communication with a healthcare organization needs to be rekeyed into the app.

Because of this, I was very excited when I ran into Michael Eidsaune, Founder and CEO of Carely at a recent conference. His company is taking a unique approach – instead of just focusing on family caregivers, his company is trying to bring caregivers and healthcare providers closer together so that BOTH benefit.

Below is a summary of our conversation.

What makes Carely different than other family caregiving apps?

With Carely, we didn’t stop at just trying to make things easier for families to care for a loved one. What we want to do is recruit families to be an active part of the care team alongside the healthcare provider. We don’t want families to be passive observers waiting for the next bit of news or have to log into those terrible “family portals” that don’t really give you any useful information or allow you to communicate effectively with the healthcare organization. We all hate using portals, it’s so one-sided.

For us it’s ultimately about getting the best care for your loved one not just about making things easy. In order to do this you need to get providers involved and not just families.

So why would a healthcare provider adopt Carely? What’s in it for them?

The provider-side of Carely is something we call Carely Community. This is something we built specifically for healthcare providers. It allows them to interact with families of the loved ones they are caring for. They can share information like when appointments are, what activities their loved one has been involved in and get feedback on those things from family members.

Long-Term and Post-Acute Care providers in particular have found that listening to family feedback can help them deliver better care. Through Carely they can get messages like “Mom seemed to have a little less appetite than usual today” or “Uncle Joe seemed a bit more confused than normal and had trouble getting to the toilet”. When the provider sees these messages in combination with the medical record, they can quickly make a determination as to whether this was something expected or something they need to look into. Having observations from family members over a period of time, helps to paint a better picture for everyone. A better picture equals better care.

The reverse is also true. If the provider can share updates with families, they can help reduce the number of phone calls they get. Imagine how relieved you would feel if the long-term care facility let you know that “Aunt Mary took part in the garden walk today” or “Dad ate everything at dinner tonight”. Those simple updates can help take worries away.

Is that what families get out of Carely? Less worry?

Carely Family is the app side of our business. That’s where all the tools are for families to coordinate and track their loved one’s care. Here you can see upcoming appointments, who will be visiting, etc. But the real power comes when the healthcare provider gets added to family’s care circle. Now the entire family can get updates on what’s happening and they can make better decisions together.

Take for example, Home Care. Typically Home Care is needed as a result of an unexpected event – maybe a fall or a minor accident. Arranging for Home Care puts a lot of stress on families and they all have to come together to make decisions. Without coordination there would be a lot of phone calls and texts flying around. If it were me I wouldn’t want to be getting 5 phone calls a day from people asking me how I was doing. So by bringing everyone together onto a single platform, including the Home Care provider, now all the information is up-to-date and the family can make the best decision possible.

Let’s talk about integration for a moment. Have you integrated with any EHR or other healthcare system?

We are currently working with PointClickCare. They have an API interface that will allow us to pull updates from their system and feed it through Community and onto Family. This makes everything seamless for the healthcare organization – they just continue to use PointClickCare and families get updated behind the scenes. Down the road we will look at how we can push information or notifications into PointClickCare. As well, we plan to begin integrating with the many other systems that exist in healthcare today.

What’s next for Carely?

I wish we could still be operating in stealth mode, but we’ve had such great feedback and interest in our product that we’re operating out in the open now.

We are continuing to iterate our product based on feedback from families and healthcare providers. We’re really making an effort to incorporate their requests. People want to use tools that they love to use. No one wants to use a tool that makes their life harder or that’s confusing. That’s why we’re spending so much time iterating our product. On one side it’s got to fit into the daily lives of families and on the other it’s got to fit into the workflow of the healthcare provider.

At the end of the day, our mission and vision is to drastically improve the caregiver experience and it’s our core belief that in order to do that we have to create an industry-wide solution, eliminate silos, get rid of useless “family portals”, and continue to innovate. This NEEDS to be done and I’m confident we’ll be the ones to successfully do it.

Black Friday in Healthcare

Posted on November 23, 2018 I Written By

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

As we were heading into Black Friday, I wondered if anyone in healthcare was doing something for Black Friday. It’s such a big shopping day, I had to think that someone was getting involved. Turns out, I found a few things.

The first thing I found was a Medical Uniform Boutique in Downtown Lancaster, PA. They were promoting 10% off scrubs:

This actually felt pretty reasonable. Scrubs is something that makes a lot of sense for medical professionals to buy on Black Friday. Of course, the JustScrubz account only had 1 follower, so I’m not sure that promotion did very well. I did just feature it in this post. So, your welcome citizens of Lancaster.

Next up, I found a health insurance company offering a Black Friday special:


The tweet does seem to be advertising their online visits which could be a pretty valuable thing for people who might be traveling over Thanksgiving. It’s never fun to get sick while traveling, but always a pain to get care on the holidays. So, I’d say this online visit offer could be a pretty good one.

The next Black Friday deal I found for healthcare was from GE Healthcare Life Sciences. You can see the Black Friday landing page here. Looks like this is going to be a great place for you if you’re interested in Bioprocess, Genomics, Western Blotting & Imaging, Biacore chips and reagents, Purification: AKTA, columns and media, and Cell Culture. Sounds like some hot sellers to me. Who wouldn’t want to buy some genomics on Black Friday?

In case you’re interested in the GE Healthcare Life Sciences offer, they’ll be donating $10 to Seeding Labs for every purchase made during their Black Friday event. They have a goal of raising $10,000 which if my math is correct, that means they expect this Black Friday deal will be taken advantage of by at least 1000 people. Who knew that cell culture, genomics, and protein purification would be so popular on Black Friday.

I’ll admit that I’m not sure if I love or hate the use of Black Friday in healthcare. Certainly it’s a big shopping day and it makes sense for marketers to use it if they can effectively. No doubt we’ll see plenty of action from consumer health devices like 23 and Me and Fitbit. However, at some point the Black Friday tag doesn’t seem to fit.

I think my friend Grace Cordovano put it best:

I hope you’re enjoying your Black Friday and not spending too much money on Amazon. They get me every year.

Value Based Care: Successes, Challenges, and Changes – #HITsm Chat Topic

Posted on November 13, 2018 I Written By

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

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 11/16 at Noon ET (9 AM PT). This week’s chat will be hosted by Matt Fisher (@Matt_R_Fisher) on the topic of “Value Based Care: Successes, Challenges, and Changes”.

The transition of the healthcare industry from fee for service to value based care (or alternative payment methodologies) garners significant attention from regulators, providers, vendors and many others in the industry. To frame the discussion, value based care generally refers to payment for quality, or in other words trying to focus on outcomes. The change represents a substantial shift in the approach to paying for healthcare services in the United States.

While value based care refers to payment for quality as an overarching concept, there are a multitude of means of structuring payment arrangements for quality. Examples include capitated agreements, bundled payments, pay for quality, and others. Common themes around the structures are not paying based on the volume of services, which arguably drives collaborations to break down siloes.

With a few years of value based care under the belt, how have efforts gone and where are those efforts heading? Join the chat to weigh in with your thoughts.

Topics for this week’s #HITsm Chat:
T1: Which value based care models have been successful to date and how do you define success? #HITsm

T2: How are new and/or developing #healthIT tools helping or hindering the ability to transition to value based care? #HITsm

T3: What are misperceptions that have developed around value based care models and how are they inaccurate? #HITsm

T4: What role do Medicare and Medicaid programs have in pushing the industry to value based care and how does the recommitment of CMS impact the change? #HITsm

T5: What changes do you see on the horizon for value based care programs? #HITsm

Bonus: What type of value based care program not currently existing should be developed or implemented? #HITsm

Upcoming #HITsm Chat Schedule
11/23 – No Chat – Thanksgiving Break

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

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

12/14 – TBD
Hosted by Claire Pfarr (@clairepfarr) from @OneViewHC and the @Savvy_Coop Community

12/21 – Holiday Break

12/28 – Holiday Break

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

AI in Healthcare – #HITsm Chat Topic

Posted on November 6, 2018 I Written By

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

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 11/9 at Noon ET (9 AM PT). This week’s chat will be hosted by Jon White @technursejon on the topic of “AI in Healthcare”.

The idea of Artificial Intelligence (AI) isn’t new. We’ve seen robots and intelligent computers in film and on television for decades, and read about them in science fiction novels for even longer. As the processing power of computers and computing devices has taken off, and more and more data is captured from all facets of our lives, the science fiction from our parents’ generation is becoming the reality of today.

Though we may be far from witnessing the androids popularized in film and TV, there are elements of AI that are currently in use in many industries. AI has the potential to drastically change the way we live and work.

In this #HITsm chat, Jon White (@TechNurseJon) will lead a discussion on AI in healthcare, exploring its potential and pitfalls.

Check out the questions for this week’s #HITsm chat below.

Topics for this week’s #HITsm Chat:
T1: Artificial intelligence (AI) is a broad term, covering a variety of technologies. What does “AI” mean to you? How do you define it? #HITsm

T2: What impacts can AI have on healthcare, and how soon do you expect to see it? #HITsm

T3: What impacts do you see AI having on the healthcare and health IT workforce? #HITsm

T4: How can AI be integrated with other technologies to improve the delivery and effectiveness of healthcare? Where would you like to see it integrated? #HITsm

T5: AI relies on a significant amount of data. For many applications in healthcare, much of that data is derived from patient records. How will privacy concerns affect adoption? #HITsm

Bonus: What barriers are there to full-scale AI adoption in the healthcare environment? #HITsm

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

11/23 – No Chat – Thanksgiving Break

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

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

12/14 – TBD
Hosted by Claire Pfarr (@clairepfarr) from @OneViewHC and the @Savvy_Coop Community

12/21 – Holiday Break

12/28 – Holiday Break

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Scripps Research Translational Institute Partners To Develop AI Applications

Posted on November 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 Scripps Research Translational Institute has agreed to work with graphics processing unit-maker NVIDIA to support the development of AI applications. The partners plan to forge AI and deep learning best practices, tools and infrastructure tailored to supporting the AI application development process.

In collaboration with NVIDIA, Scripps will establish a center of excellence for artificial intelligence in genomics and digital sensors. According to Dr. Eric Topol, the Institute’s founder and director, AI should eventually improve accuracy, efficiency, and workflow in medical practices. This is especially true of the data inputs from sensors and sequencing, he said in an NVIDIA blog item on the subject.

Scripps is already a member of a unique data-driven effort known as the “All of Us Research Program,” which is led by the National Institutes of Health. This program, which collects data on more than 1 million US participants, looks at the intersection of biology, genetics, environment, data science, and computation. If successful, this research will expand the range of conditions that can be treated using precision medicine techniques.

NVIDIA, for its part, is positioned to play an important part in the initial wave of AI application rollouts. The company is a leader in producing performance chipsets popular with those who play high-end, processor-intensive gaming which it has recently applied to other processor intensive projects like blockchain. It now hopes its technology will form the core of systems designed to crunch the high volumes of data used in AI projects.

If NVIDIA can provide hardware that makes high-volume number-crunching less expensive and more efficient, it could establish an early lead in what is likely to be a very lucrative market. Given its focus on graphics processing, the hardware giant could be especially well-suited to dominate rapidly-emerging radiology AI applications.

We can certainly expect to see more partnerships like this file into place over the next year or two. Few if any IT vendors have enough scientific expertise in-house to make important gains in biotech AI, and few providers have enough excess IT talent available to leverage discoveries and data in this arena.

It will be interesting to see what AI applications development approaches emerge from such partnerships. Right now, much AI development and integration is being done on a one-off basis, but it’s likely these projects will become more systematized soon.

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

Posted on October 31, 2018 I Written By

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

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

Presentation at Connected Health Conference

Presentation at Connected Health Conference

Patient engagement

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

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

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

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

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

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

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

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

Working at the top of one’s license

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

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

Clinical trials get smarter

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

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

Telemedicine

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

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

The network is the treatment center

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

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

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

Devices that were just cool

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

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

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

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

Posted on October 30, 2018 I Written By

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

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 11/2 at Noon ET (9 AM PT). This week’s chat will be hosted by Jessica DaMassa (@jessdamassa), host of WTF Health on the topic of “Health Tech Startups, Innovations, & Consumers – What’s the Future for HealthIT?”.

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

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

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

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

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

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

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

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

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

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

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

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

11/23 – No Chat – Thanksgiving Break

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

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

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

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

Posted on October 29, 2018 I Written By

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

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

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

Exhibition floor at Connected Health conference

Exhibition floor at Connected Health conference

Precertification: the status of streamlining approval for medical software

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

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

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

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

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

Making devices first-class players in health care

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

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

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

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

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

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

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

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

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

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

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

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

Posted on October 26, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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