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Has Amazon Brought Something New To Healthcare Data Analytics?

Posted on November 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.

Amazon’s announcement that it was getting into healthcare data analytics didn’t come as a major surprise. It was just a matter of time.

After all, the retail giant has been making noises about its health IT ambitions for a while now, and its super-sneaky 1492 team’s healthcare feints have become common knowledge.

Now, news has broken that its massive hosting division, Amazon Web Services, is offering its Comprehend Medical platform to the healthcare world. And at the risk of being a bit too flip, my reaction is “so?” I think we should all take a breath before we look at this in apocalyptic terms.

First, what does Amazon say we’re looking at here?

Like similar products targeting niches like travel booking and supply-chain management, the company reports, Comprehend Medical uses natural language processing and machine learning to pull together relevant information from unstructured text.

Amazon says Comprehend Medical can pull needed information from physician notes, patient health records and clinical trial reports, tapping into data on patient conditions and medication dosage, strength and frequency.

The e-retailer says that users can access the platform through a straightforward API call, accessing Amazon’s machine learning expertise without having to do their own development or train models of their own. Use cases it suggests include medical cohort analysis, clinical decision support and improving medical coding to tighten up revenue cycle management.

Comprehend Medical customers will be charged a fee each month based on the amount of text they process each month, either $0.01 per 100-character unit for the NERe API, which extracts entities, entity relationships, entity traits and PHI, or $0.0014 per unit if they use its PHId API, which only supports identifying PHI for data protection.

All good. All fine. Making machine learning capabilities available in a one-off hosting deal — with a vendor many providers already use — can’t be wrong.

Now, let’s look coldly at what Amazon can realistically deliver.

Make no mistake, I understand why people are excited about this announcement. As with Microsoft, Google, Apple and other top tech influencers, Amazon is potentially in the position to change the way things work in the health IT sector. It has all-star brainpower, the experience with diving into new industries and enough capital to buy a second planet for its headquarters. In other words, it could in theory change the healthcare world.

On the other hand, there’s a reason why even IBM’s Watson Health stumbled when it attempted to solve the data analytics puzzle for oncologist. Remember, we’re talking IBM here, the last bastion of corporate power. Also, bear in mind that other insanely well-capitalized, globally-recognized Silicon Valley firms are still biding their time when it comes to this stuff.

Finally, consider that many researchers think NLP is only just beginning to find its place in healthcare, and an uncertain one at that, and that machine learning models are still in their early stages, and you see where I’m headed.

Bottom line, if Google or Microsoft or Epic or Salesforce or Cerner haven’t been able to pull this off yet, I’m skeptical that Amazon has somehow pole-vaulted to the front of the line when it comes to NLP-based mining of medical text. My guess is that this product launch announcement is genuine, but was really issued more as a stake in the ground. Definitely something I would do if I worked there.

The Global Impact of Health IT – #HITsm Chat Topic

Posted on November 27, 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, 11/30 at Noon ET (9 AM PT). This week’s chat will be hosted by Vanessa Carter (@_FaceSA) on the topic of “The Global Impact of Health IT”.

Global health pandemics like antibiotic and antimicrobial resistance are among the most critical issues to tackle and in future will require robust, harmonious data surveillance systems along with mass co-operation between the animal, human and environmental health sectors across every country [1]. This is known as One Health [2]. WHO initiatives like GLASS (Global Antimicrobial Resistance Surveillance System) have been implemented to work towards these goals [3].

To help understand the topic of antibiotic resistance, let me start by saying that antibiotics treat bacterial infections whereas antimicrobials are a much broader term used to describe medicines that treat other types of microorganisms that cause infection. These other types of microorganisms include parasites (e.g. Malaria), fungi (e.g. Candida) and viruses (e.g. AIDS). All of these microbial infections are categorised as Communicable Diseases or Infectious Diseases. Antibiotics fall under the antimicrobial umbrella and they kill a microorganism known as bacteria. Antimicrobials, and particularly antibiotics are the cornerstone of modern medicine because they are used in all areas of disease treatments where the immune system is compromised including HIV/AIDS and Tuberculosis, as well as Non-Communicable Diseases like Cancer and Diabetes where acquiring an infection is common such as during Chemotherapy. Antibiotics are also used for your everyday Strep throat, Gastrointestinal Infections (e.g. “Tummy bug”) or Urinary Tract Infections. They are also prescribed daily by dentists when we have tooth infections or for routine surgeries. Unfortunately, we are overusing antibiotics and bacteria are evolving resistance fast. This means that antibiotics are no longer working to treat common bacterial infections for many of these health conditions. What is even more frightening is that there are very few antibiotics in the pipeline. Some big pharma companies having abandoned research and development due to a lack of global data which helps to report prescribing and consumption behaviours which are contributing to resistance [4].

Antibiotic resistance is caused in various ways including through the overprescribing and misuse of antibiotics in both humans and animals. Resistant bacteria can also spread through bad hygiene practice (e.g. hand washing) or food production. The continual rise of antimicrobial resistance was recognised by the United Nations in 2016 in a high-level meeting as a serious threat to global health and human development [5] because of its severity and complexity. It has further been compared to climate change by UK economic experts like Lord Jim O’Niell [6] and invested in excessively by organisations including The Bill and Melinda Gates Foundation and Wellcome Trust [7], particularly in Low-to-Middle-Income Countries (LMICs) where health systems are distressed and disease burdens are high.

This world has become increasingly more connected through trade and travel too, therefore tracking the spread of antibiotic resistance will probably remain impossible until we leverage the benefit of today’s digital technology to collect, process and analyse surveillance data at a national and global level. Whether or not and how health IT companies design solutions in the future taking this into consideration remains to be understood. For example, does it mean technology like EHRs should travel with us so that we improve our ability to capture holistic data, even when we’re out of our own country? What happens if we take a course of antibiotics and it never gets captured on our medical record, or worse, we pick up a disease and travel back afterwards with no data and that bacteria is a threat to our community. Shouldn’t we be considering these data gaps in all our systems? One thing is certain, without global surveillance, we couldn’t possibly begin to tackle this deadly pandemic that affects us all.

Join us for this week’s #HITsm chat where we talk about this global health challenge and how IT could potentially help with the problem.

Topics for this week’s #HITsm Chat:
T1: What do you think makes global health IT difficult to achieve? #HITsm

T2: What technologies do you think could collect global data for antibiotic resistance? (e.g. EHRs) #HITsm

T3: How do you think global health IT could benefit other medical conditions? #HITsm

T4: What are you seeing locally that you would like to see spread globally? #HITsm

T5: Why do you feel global health IT is important to achieve? #HITsm

Bonus: With global health barriers like culture, education & language, how do we overcome that with technology? #HITsm

Upcoming #HITsm Chat Schedule
12/7 – Healthcare Leadership
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.

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.

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.

The Importance of Nurses in Healthcare – #HITsm Chat Topic

Posted on October 9, 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, 10/12 at Noon ET (9 AM PT). This week’s chat will be hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network (@HMNwriters) on the topic of “The Importance of Nurses in Healthcare”.

It’s time for #NursingNow. Nurses need to have a solid place at the table – from the C-Suite to Management, Entrepreneurs to Digital Health Innovators.  In collaboration with the World Health Organization and the International Council of Nurses, Nursing Now aims to raise the status and profile of nursing globally.  Nursing Now works to empower nurses to take their place at the heart of tackling 21st Century health challenges.

In this #HITMC chat, Carol Bush (@TheSocialNurse) and Janet Kennedy (@GetSocialHealth) will lead a discussion on Nurse Leadership and how every part of healthcare needs nurses to be present and actively involved.

Resources:

Topics for this week’s #HITsm Chat:
T1: Nurses have always been the backbone of healthcare. Do you think they have a large enough role in healthcare leadership? Why or why not? #HITsm

T2: Should the push to get more nurses in leadership come from nurses or other members of the healthcare team? Why do you think so? #HITsm

T3: Traditional concepts of a nurse’s role have changed over the past decade. What new career paths have you seen nurses take? #HITsm

T4: In a health system or practice setting, in what ways have nurses expanded their roles? #HITsm

T5: Nurses have been embracing entrepreneurship, both inside and outside of healthcare. What characteristics of nursing lend themselves to entrepreneurship? #HITsm

Bonus: Share your favorite nurse story. #HITsm

Upcoming #HITsm Chat Schedule
10/19 – Government Regulations for Healthcare – Where Are We At and Where Are We Headed?
Hosted by John Lynn (@techguy)

10/26 – TBD
Hosted by @bigdatadavid13

11/2 – TBD
Hosted by TBD

11/9 – TBD
Hosted by @technursejon

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.

Medication Compliance & Drug Monitoring – #HITsm Chat Topic

Posted on October 3, 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, 10/5 at Noon ET (9 AM PT). This week’s chat will be hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth) on the topic of “Medication Compliance & Drug Monitoring”.

One of the most effective medical interventions to significantly improve the health of patients doesn’t require the latest technology or expensive medication but simply involves helping them take their existing medication as prescribed.

It’s not a light topic, but we believe that people can benefit from more awareness about their actual risks, as opposed to sensationalized risks that make good stories for the popular media.

  • Between 41% and 59% of mentally ill patients take their medication infrequently or not at all.
  • Examples of common non-adherence behaviors include:
    • 1 in 2 people missed a dose
    • 1 in 3 forgot if they took the med
    • 1 in 4 did not get a refill on time

Medication non-adherence is an enormous problem that is still largely unaddressed by the healthcare system, but it’s not totally out of our control. Join us for this week’s #HITsm chat as we talk about medication compliance and drug monitoring.

Topics for this week’s #HITsm Chat:
T1: In what ways has medication non-compliance affected you or anyone you know? Professional or Personal. Can be acute or episodic… #HITsm

T2: Why didn’t the patient adhere? Was there a social determinant? An issue with side effects, access or money? Possible Rx abuse? #HITsm

T3: We know communication with healthcare professionals is key in patient’s adherence and that Medication Reconciliation is gaining traction with MIPS, etc., but are providers going into this level of detail (see example) to ensure patients truly understand why they need to take the meds they are prescribed? Why or why not? #HITsm

T4: Beyond condition management, what impact do you think medication non-compliance has on society as a whole? #HITsm

T5: What ideas & thoughts do you have around strategies for improving medication compliance? Have you come across any impactful strategies or workflows? #HITsm

Bonus: What technology do you think could help with these challenges? #HITsm

Upcoming #HITsm Chat Schedule
10/12 – The Importance of Nurses in Healthcare
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

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.

Healthcare AI Could Generate $150B In Savings By 2025

Posted on September 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.

Is the buzz around healthcare AI solutions largely hype, or can they deliver measurable benefits? Lest you think it’s too soon to tell, check out the following.

According to a new report from market analyst firm Frost & Sullivan, AI and cognitive computing will generate $150 billion in savings for the healthcare business by 2025.  Frost researchers expect the total AI market to grow to $6.16 billion between 2018 and 2022.

The analyst firm estimates that at present, only 15% to 20% of payers, providers and pharmaceutical companies have been using AI actively to change healthcare delivery. However, its researchers seem to think that this will change rapidly over the next few years.

One of the most interesting applications for healthcare AI that Frost cites is the use of AI in precision medicine, an area which clearly has a tremendous upside potential for both patients and institutions.

In this scenario, the AI integrates a patient’s genomic, clinical, financial and behavioral data, then cross-references the data with the latest academic research evidence and regulatory guidelines. Ultimately, the AI would create personalized treatment pathways for high-risk, high-cost patient populations, according to Koustav Chatterjee, an industry analyst focused on transformational health.

In addition, researchers could use AI to expedite the process of clinical trial eligibility assessment and generate prophylaxis plans that suggest evidence-based drugs, Chatterjee suggests.

The report also lists several other AI-enabled solutions that might be worth implementing, including automated disease prediction, intuitive claims management and real-time supply chain management.

Frost predicts that the following will be particularly hot AI markets:

  • Using AI in imaging to drive differential diagnosis
  • Combining patient-generated data with academic research to generate personalized treatment possibilities
  • Performing clinical documentation improvement to reduce clinician and coder stress and reduce claims denials
  • Using AI-powered revenue cycle management platforms that auto-adjust claims content based on payer’s coding and reimbursement criteria

Now, it’s worth noting that it may be a while before any of these potential applications become practical.

As we’ve noted elsewhere, getting rolling with an AI solution is likely to be tougher than it sounds for a number of reasons.

For example, integrating AI-based functions with providers’ clinical processes could be tricky, and what’s more, clinicians certainly won’t be happy if such integration disrupts the EHR workflow already in existence.

Another problem is that you can’t deploy an AI-based solution without ”training” it on a cache of existing data. While this shouldn’t be an issue, in theory, the reality is that much of the data providers generate is still difficult to filter and mine.

Not only that, while AI might generate interesting and effective solutions to clinical problems, it may not be clear how it arrived at the solution. Physicians are unlikely to trust clinical ideas that come from a black box, e.g. an opaque system that doesn’t explain itself.

Don’t get me wrong, I’m a huge fan of healthcare AI and excited by its power. One can argue over which solutions are the most practical, and whether AI is the best possible tool to solve a given problem, but most health IT pros seem to believe that there’s a lot of potential here.

However, it’s still far from clear how healthcare AI applications will evolve. Let’s see where they turn up next and how that works out.