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The Future Of Telemedicine Doesn’t Depend On Health Plans Anymore

Posted on December 6, 2017 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.

For as long as I can remember, the growth of telemedicine depended largely on overcoming two obstacles: bandwidth and reimbursement. Now, both are on the verge of melting away.

One, the availability of broadband, has largely been addressed, though there are certainly areas of the US where broadband is harder to get than it should be. Having lived through a time when the very idea of widely available consumer broadband blew our minds, it’s amazing to say this, but we’ve largely solved the problem in the United States.

The other, the willingness of insurers to pay for telemedicine services, is still something of an issue and will be for a while. However, it won’t stay that way for too much longer in my opinion.

Yes, over the short term it still matters whether a telemedicine visit is going to be funded by a payer –after all, if a clinician is going to deliver services somebody has to pay for their time. But there are good reasons why this will not continue to be an issue.

For one thing, as the direct-to-consumer models have demonstrated, patients are increasingly willing to pay for telemedical care out-of-pocket. Customers of sites like HealthTap and Teladoc won’t pay top dollar for such services, but it seems apparent that they’re willing to engage with and stay interested in solving certain problems this way (such as, for example, getting a personal illness triaged and treated without having to skip work the next day).

Another way telemedicine services have changed, from what I can see, is that health systems and hospitals are beginning to integrate it with their other service lines as a routine part of delivering care. Virtual consults are no longer this “weird” thing they do on the side, but a standard approach to addressing common health problems, especially chronic illness.

Then, of course, there’s the most important factor taking control of telemedicine away from health plans: the need to use it to achieve population health management goals. While its use is still a little bit lopsided at present, as healthcare organizations aren’t sure how to optimize telehealth initiatives, eventually they’ll get the formula right, and that will include using it as a way of tying together a seamless value-based delivery network.

In fact, I’d go so far as to say that without the reach, flexibility and low cost of telehealth delivery, building out population health management schemes might be almost impossible in the future. Having specialists available to address urgent matters and say, for example, rural areas will be critical on the one hand, while making specialists need for chronic care (such as endocrinologists) accessible to unwell urban patients with travel concerns.

Despite the growing adoption of telemedicine by providers, it may be 5 to 10 years or so before it has its fullest impact, a period during which health plans gradually accept that the growth of this technology isn’t up to them anymore. But the day will without a doubt arise soon enough that “telemedicine” is just known as medicine.

FDA Announces Precertification Program For Digital Health Tools

Posted on October 5, 2017 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 FDA has recruited some the world’s top technology and medical companies to help it pilot test a program under which digital health software could be marketed without going through the through the agency’s entire certification process.

The participants, which include Apple, Fitbit, Johnson & Johnson, Samsung and Roche, will give the agency access to the measures they’re using to develop, test and maintain their software, and also how they collect post-market data.

Once armed with this information, the FDA will leverage it to determine the key metrics and performance indicators it uses to see if digital health software meets its quality standards.

Companies that meet these new standards could become pre-certified, a status which grants them a far easier path to certification than in the past. This represents a broad shift in the FDA’s regulatory philosophy, “looking first at the software developer digital health technology developer, not the product,” according to a report previously released by the agency.

If the pilot works as planned, the FDA is considering making some significant changes to the certification process. If their processes pass muster, pre-certified companies may be allowed to submit less information to the FDA than they currently must before marketing a new digital health tool.  The agency is also considering the more radical step of allowing pre-certified companies to avoid submitting a product for premarket review in some cases. (It’s worth noting that these rules would apply to lower-risk settings.)

The prospect of pre-certifying companies does raise some concerns. In truth, the argument could be made that digital health software should be regulated more tightly, not less. In particular, the mobile healthcare world is still something of a lawless frontier, with very few apps facing privacy, security or accuracy oversight.

The fact is, it’s little wonder that physicians aren’t comfortable using mobile health app data given how loosely it can be constructed at times, not to mention the reality that it might not even measure basic vital signs reliably.

It’s not that the healthcare industry isn’t aware of these issues. about a year ago, a group of healthcare organizations including HIMSS, the American Medical Association and the American Heart Association came together to develop a framework of principles dressing app quality. Still, that’s far short of establishing a certification body.

On the other hand, the FDA does have a point when it notes that a pre-certification program could make it easier for useful digital health tools to reach the marketplace. Assuming the program is constructed well, it seems to me that this is a good idea.

True, it’s pretty unusual to see the FDA loosen up its certification process – a fairly progressive move for a stodgy agency – while the industry fails to self-regulate, but it’s a welcome change of style. I guess digital health really is changing things up.

 

Health IT Group Raises Good Questions About “Information Blocking”

Posted on September 8, 2017 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 21st Century Cures Act covers a great deal of territory, with provisions that dedicate billions to NIH funding, Alzheimer’s research, FDA operations and the war on opioid addiction. It also contains a section prohibiting “information blocking.”

One section of the law lists attempts to define information blocking, and lists some of the key ways healthcare players drag their feet when it comes to data sharing. The thing is, some industry organizations feel that these provisions raise more questions than they answer.

In an effort to nail things down, a trade organization calling itself Health IT Now has written to the HHS Office of Inspector General and ONC head Donald Rucker, MD, asking them to issue a proposed rule answering their questions.  Parties signing the letter include a broad range of healthcare and health IT organizations, including the American Academy of Family Physicians, athenahealth, DirectTrust, AMIA, McKesson and Oracle.

I’m not going to list all the questions they’ve asked. You can read the entirety yourself. However, I will share two questions and offer responses of my own. One critical question is:

  • What is information blocking and what is not?

I think most of us know what the law is trying to accomplish, e.g. foster the kind of data sharing needed to accomplish key research and patient care outcomes goals. And the examples of what it considers information blocking make sense:

  • Practices that restrict authorized access, exchange, or use [of health data] under applicable State or Federal law
  • Implementing health information technology in nonstandard ways that are likely to substantially increase the complexity or burden of accessing exchanging or use of electronic health information
  • Implementing health information technology in ways that are likely to lead to fraud, waste, or abuse, or impede innovations and advancements health information access, exchange, and use

The problem is, there are many more ways to hamper the sharing of electronic health data. The language used in the law can’t anticipate all of these strategies, which leaves compliance with the law very much open to interpretation.

This, logically, leads to how businesses can avoid running afoul of the law:

  • The statute institutes penalties on vendors to $1 million per violation. How should “per violation” be defined?

    Given the minimum detail included in the legislation, this is a burning question. Vendors need to know precisely whether they’re in the clear, violated the statute once or flouted it a thousand times.

After all, vendors may violate the statute

  • When they refuse data access to one individual within a business one time
  • When they don’t comply with a specific organization’s request regardless of how many employees were in contact
  • When a receiving organization doesn’t get all the data requested at the same time
  • When the vendor asks the receiving organization to pay an administrative fee for the data
  • When individuals try to access data through the web and find it difficult to do so

Would a vendor be on the hook for a single $1 million fine if it flat out refused to share data with a client?  How about if it refused twice rather than once? Are both part of the same violation?

Does the $1 million fine apply if the vendor inadvertently supplies corrupted data? If so, does the fine still apply if the vendor attempts to remedy the problem? How long does the vendor have to respond if they are informed that the data isn’t readable?

What about if dozens or even hundreds of individuals attempt to access data on the web can’t do so? Has the vendor violated the statute if it has an extended web outage or database problem, and if so how long does it should have to get web-based data access back online? Does each attempt to access the data count as a violation?

What standard does the statute establish for standard vs. non-standard data formats?  Could a vendor be cited once, or more than once, for using a new and emerging data format which is otherwise respected by the industry?

As I’m sure you’ll agree, these are just some of the questions that need to be answered before any organization can reasonably understand how to comply with the law’s information blocking provisions. Asking regulatory agencies to clarify their expectations is more than reasonable.

Will ACOs Face Tough Antitrust Scrutiny?

Posted on August 2, 2017 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.

For some reason, I’ve always been interested in antitrust regulation, not just in the healthcare industry but across the board.

To me, there’s something fascinating about how federal agencies define markets, figure out what constitutes an unfair level of market dominance and decide which deals are out of bounds. For someone who’s not a lawyer, perhaps that’s a strange sort of geeking out to do, but there you have it.

Obviously, given how complex industry relationships are, healthcare relationships are fraught with antitrust issues to ponder. Lately, I’ve begun thinking about how antitrust regulators will look at large ACOs. And I’ve concluded that ACOs will be on the radar of the FTC and U.S. Department of Justice very soon, if they aren’t already.

On their face, ACOs try to dominate markets, so there’s plenty of potential for them to tip the scales too far in their favor for regulators to ignore. Their business model involves both vertical and horizontal integration, either of which could be seen as giving participants too much power.

Please take the following as a guide from an amateur who follows antitrust issues. Again, IANAL, but my understanding is as follows:

  • Vertical integration in healthcare glues together related entities that serve each other directly, such as health plans, hospitals, physician groups and skilled nursing facilities.
  • Horizontal integration connects mutually interested service providers, including competitors such as rival hospitals.

Even without being a legal whiz, it’s easy to understand why either of these ACO models might lead to (what the feds would see as) a machine that squeezes out uninvolved parties. The fact that these providers may share a single EMR could makes matters worse, as it makes the case that the parties can hoard data which binds patients to their network.

Regardless, it just makes sense that if a health plan builds an ACO network, cherry picking what it sees as the best providers, it’s unlikely that excluded providers will enjoy the same reimbursement health plan partners get. The excluded parties just won’t have as much clout.

Yes, it’s already the case that bigger providers may get either higher reimbursement or higher patient volume from insurers, but ACO business models could intensify the problem.

Meanwhile, if a bunch of competing hospitals or physician practices in a market decide to work together, it seems pretty unlikely that others could enter the market, expand their business or develop new service lines that compete with the ACO. Eventually, many patients would be forced to work with ACO providers. Their health plan will only pay for this market-dominant conglomerate.

Of course, these issues are probably being kicked around in legal circles. I’m equally confident that the ACOs, which can afford high-ticket legal advice, have looked at these concerns as well. But to my knowledge these questions aren’t popping up in the trade press, which suggests to me that they’re not a hot topic in non-legal circles.

Please note that I’m not taking a position here on whether antitrust regulation is fair or appropriate here. I’m just pointing out that if you’re part of an ACO, you may be more vulnerable to antitrust suits than you thought. Any entity which has the power to crush competition and set prices is a potential target.

Providers Work To Increase Patient Payments By Improving RCM Operations

Posted on June 29, 2017 I Written By

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

A growing body of research on healthcare payment trends is underscoring a painful fact: that consumers are footing a steadily growing share of their medical bills, and sometimes failing to pay. In response, providers are upgrading their revenue cycle management systems and tightening up their collections processes.

A new analysis by payment services vendor InstaMed has concluded that consumer spending on healthcare services should grow to $608 billion by 2019. This is a fairly substantial number even given the high volume of U.S. healthcare spending, which hit $3.4 trillion in 2016.

The growth in patient spending has been fueled by the emergence of high-deductible health plans, which are saddling consumers with increasingly large financial obligations. According to CMS figures cited in the report, the average deductible for covered workers with single coverage has doubled over the past several years, from $735 in 2010 to $1.487 in 2016.

But despite the increasing importance of consumers as healthcare payers, providers don’t seem to be doing enough to inform them about costs. More than 90% of consumers would like to know what the payment responsibility is prior to a provider visit, but they often don’t find out what they owe until they get a bill. What makes things worse is that very few consumers (7%) even know what a deductible, co-insurance and out-of-pocket maximum are, so they’re ill-prepared to understand bills when they receive them, studies have found.

Providers are waiting longer to collect what they are owed by patients, with three-quarters waiting a month or longer to collect outstanding balances from patients. And problems with collecting patient accounts are getting worse over time.  In fact, a new study from TransUnion Healthcare found that about 68% of patients with bills of $500 or less didn’t pay off the full balance during 2016, up from 49% in 2014.

Meanwhile, patient financial responsibility for care has risen from 10% to 30% of costs over the last few years, with more increases likely. This has led to expanding levels of consumer bad debt for medical expenses.

In attempt to cope with these issues, providers are buying new revenue cycle management systems. A survey released last year by Black Book Research, which included 5,000 management and user-level RCM clients, found that many healthcare organizations are rethinking RCM technology and demanding better performance.

Forty-eight percent of responding CFOs told Black Book that they weren’t sure they had the budget they needed to upgrade to an end-to-end RCM system this year.  Nonetheless, 93% of CFOs said they planned to eliminate RCM vendors, financial and coding technology firms, that are not producing a return on investment, up from 79% with similar plans in Q4 2015.

In addition to investing in newer RCM technology, providers are making it easier for patients to pay via whatever medium they choose. Not only are providers issuing bill reminders via text, and accepting payments online and by phone, they’re also adding new channels like PayPal payments, bank transfers and mobile payments.

Scenarios for Health Care Reform (Part 1 of 2)

Posted on May 16, 2017 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.

All reformers in health care know what the field needs to do; I laid out four years ago the consensus about patient-supplied data, widespread analytics, mHealth, and transparency. Our frustration comes in when trying to crack the current hide-bound system open and create change. Recent interventions by US Republicans to repeal the Affordable Care Act, whatever their effects on costs and insurance coverage, offer no promise to affect workflows or treatment. So this article suggests three potential scenarios where reform could succeed, along with a vision of what will happen if none of them take hold.

Patients Forge Their Own Way Forward

In the first scenario, a tiny group of selfer-trackers, athletes, and empowered patients start a movement that ultimately wins over hundreds of millions of individuals.

These scattered enthusiasts, driven to overcome debilitating health problems or achieve extraordinary athletic feats, start to pursue self-tracking with fanaticism. Consumer or medical-grade devices provide them with ongoing data about their progress, and an open source platform such as HIE of One gives them a personal health record (PHR).

They also take charge of their interactions with the health care system. They find that most primary care providers aren’t interested in the data and concerns they bring, or don’t have time to process those data and concerns in the depth they need, or don’t know how to. Therefore, while preserving standard relationships with primary care providers and specialists where appropriate, the self-trackers seek out doctors and other providers to provide consultation about their personal health programs. A small number of providers recognize an opportunity here and set up practices around these consultations. The interactions look quite different from standard doctor visits. The customers, instead of just submitting themselves to examination and gathering advice, steer the conversation and set the goals.

Power relationships between doctors and customers also start to change. Although traditional patients can (and often do) walk away and effectively boycott a practice with which they’re not comfortable, the new customers use this power to set the agenda and to sort out the health care providers they find beneficial.

The turning point probably comes when someone–probabaly a research facility, because it puts customer needs above business models–invents a cheap, comfortable, and easy-to-use device that meets the basic needs for monitoring and transmitting vital signs. It may rest on the waist or some other place where it can be hidden, so that there is no stigma to wearing it constantly and no reason to reject its use on fashion grounds. A beneficent foundation invests several million dollars to make the device available to schoolchildren or some other needy population, and suddenly the community of empowered patients leaps from a miniscule pool to a mainstream phenomenon.

Researchers join the community in search of subjects for their experiments, and patients offer data to the researchers in the hope of speeding up cures. At all times, the data is under control of the subjects, who help to direct research based on their needs. Analytics start to turn up findings that inform clinical decision support.

I haven’t mentioned the collection of genetic information so far, because it requires more expensive processes, presents numerous privacy risks, and isn’t usually useful–normally it tells you that you have something like a 2% risk of getting a disease instead of the general population’s 1% risk. But where genetic testing is useful, it can definitely fit into this system.

Ultimately, the market for consultants that started out tiny becomes the dominant model for delivering health care. Specialists and hospitals are brought in only when their specific contributions are needed. The savings that result bring down insurance costs for everyone. And chronic disease goes way down as people get quick feedback on their lifestyle choices.

Government Puts Its Foot Down

After a decade of cajoling health care providers to share data and adopt a fee-for-outcome model, only to witness progress at a snail’s pace, the federal government decides to try a totally different tack in this second scenario. As part of the Precision Medicine initiative (which originally planned to sign up one million volunteers), and leveraging the ever-growing database of Medicare data, the Office of the National Coordinator sets up a consortium and runs analytics on top of its data to be shared with all legitimate researchers. The government also promises to share the benefits of the analytics with anyone in the world who adds their data to the database.

The goals of the analytics are multi-faceted, combining fraud checks, a search for cures, and everyday recommendations about improving interventions to save money and treat patients earlier in the disease cycle. The notorious 17-year gap between research findings and widespread implementation shrinks radically. Now, best practices are available to any patient who chooses to participate.

As with the personal health records in the previous scenario, the government database in this scenario creates a research platform of unprecedented size, both in the number of records and the variety of participating researchers.

To further expand the power of the analytics, the government demands exponentially greater transparency not just in medical settings but in all things that make us sick: the food we eat (reversing the rulings that protect manufacturers and restaurants from revealing what they’re putting in our bodies), the air and water that surrounds us, the effects of climate change (a major public health issue, spreading scourges such as mosquito-borne diseases and heat exhaustion), disparities in food and exercise options among neighborhoods, and more. Public awareness leads to improvements in health that lagged for decades.

In the next section of this article, I’ll present a third scenario that achieves reform from a different angle.

E-Patient Update: Reducing Your Patients’ Security Anxiety

Posted on March 31, 2017 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.

Even if you’re not a computer-savvy person, these days you can hardly miss the fact that healthcare data is a desirable target for cyber-criminals. After all, over the past few years, healthcare data breaches have been in the news almost every day, with some affecting millions of consumers.

As a result, many patients have become at least a bit afraid of interacting with health data online. Some are afraid that data stored on their doctor or hospital’s server will be compromised, some are afraid to manage their data on their own, and others don’t even know what they’re worried about – but they’re scared to get involved with health data online.

As an e-patient who’s lived online in one form or another since the 80s (anyone remember GEnie or Compuserve?) I’ve probably grown a bit too blasé about security risks. While I guard my online banking password as carefully as anyone else, I don’t tend to worry too much about abstract threats posed by someone who might someday, somehow find my healthcare data among millions of other files.

But I realize that most patients – and providers – take these issues very seriously, and with good reason. Even if HIPAA weren’t the law of the land, providers couldn’t afford to have patients feel like their privacy wasn’t being respected. After all, patients can’t get the highest-quality treatment available if they aren’t comfortable being candid about their health behaviors.

What’s more, no provider wants to have their non-clinical data hacked either. Protecting Social Security numbers, credit card details and other financial data is a critical responsibility, and failing at it could cost patients more than their privacy.

Still, if we manage to intimidate the people we’re trying to help, that can’t be good either. Surely we can protect health data without alienating too many patients.

Striking a balance

I believe it’s important to strike a balance between being serious about security and making it difficult or frightening for patients to engage with their data. While I’m not a security expert, here’s some thoughts on how to strike that balance, from the standpoint of a computer-friendly patient.

  • Don’t overdo things: Following strong security practices is a good idea, but if they’re upsetting or cumbersome they may defeat your larger purposes. I’m reminded of the policy of one of my parents’ providers, who would only provide a new password for their Epic portal if my folks came to the office in person. Wouldn’t a snail mail letter serve, at least if they used registered mail?
  • Use common-sense procedures: By all means, see to it that your patients access their data securely, but work that into your standard registration process and workflow. By the time a patient leaves your office they should have access to everything they need for portal access.
  • Guide patients through changes: In some cases, providers will want to change their security approach, which may mean that patients have to choose a new ID and password or otherwise change their routine. If that’s necessary, send them an email or text message letting them know that these changes are expected. Otherwise they might be worried that the changes represent a threat.
  • Remember patient fears: While practice administrators and IT staff may understand security basics, and why such protections are necessary, patients may not. Bear in mind that if you take a grim tone when discussing security issues, they may be afraid to visit your portal. Keep security explanations professional but pleasant.

Remember your goals

Speaking as a consumer of patient health data, I have to say that many of the health data sites I’ve accessed are a bit tricky to use. (OK, to be honest, many seem to be designed by a committee of 40-something engineers that never saw a gimmicky interface they didn’t like.)

And that isn’t all. Unfortunately, even a highly usable patient data portal or app can become far more difficult to use if necessary security protections are added to the mix. And of course, sometimes that may be how things have to be.

I guess I’m just encouraging providers who read this to remember their long-term goals. Don’t forget that even security measures should be evaluated as part of a patient’s experience, and at least see that they do as little as possible to undercut that experience.

After all, if a girl-geek and e-patient like myself finds the security management aspect of accessing my data to be a bummer, I can only imagine other consumers will just walk away from the keyboard. With any luck, we can find ways to be security-conscious without imposing major barriers to patient engagement.

Healthcare CIOs Focus On Optimizing EMRs

Posted on March 30, 2017 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.

Few technical managers struggle with more competing priorities than healthcare CIOs. But according to a recent survey, they’re pretty clear what they have to accomplish over the next few years, and optimizing EMRs has leapt to the top of the to-do list.

The survey, which was conducted by consulting firm KPMG in collaboration with CHIME, found that 38 percent of CHIME members surveyed saw EMR optimization as their #1 priority for capital investment over the next three years.  To gather results, KPMG surveyed 122 CHIME members about their IT investment plans.

In addition to EMR optimization, top investment priorities identified by the respondents included accountable care/population health technology (21 percent), consumer/clinical and operational analytics (16 percent), virtual/telehealth technology enhancements (13 percent), revenue cycle systems/replacement (7 percent) and ERP systems/replacement (6 percent).

Meanwhile, respondents said that improving business and clinical processes was their biggest challenge, followed by improving operating efficiency and providing business intelligence and analytics.

It looks like at least some of the CIOs might have the money to invest, as well. Thirty-six percent said they expected to see an increase in their operating budget over the next two years, and 18 percent of respondents reported that they expect higher spending over the next 12 months. On the other hand, 63 percent of respondents said that spending was likely to be flat over the next 12 months and 44 percent over the next two years. So we have to assume that they’ll have a harder time meeting their goals.

When it came to infrastructure, about one-quarter of respondents said that their organizations were implementing or investing in cloud computing-related technology, including servers, storage and data centers, while 18 percent were spending on ERP solutions. In addition, 10 percent of respondents planned to implement cloud-based EMRs, 10 percent enterprise systems, and 8 percent disaster recovery.

The respondents cited data loss/privacy, poorly-optimized applications and integration with existing architecture as their biggest challenges and concerns when it came to leveraging the cloud.

What’s interesting about this data is that none of the respondents mentioned improved security as a priority for their organization, despite the many vulnerabilities healthcare organizations have faced in recent times.  Their responses are especially curious given that a survey published only a few months ago put security at the top of CIOs’ list of business goals for near future.

The study, which was sponsored by clinical communications vendor Spok, surveyed more than 100 CIOs who were CHIME members  — in other words, the same population the KPMG research tapped. The survey found that 81 percent of respondents named strengthening data security as their top business goal for the next 18 months.

Of course, people tend to respond to surveys in the manner prescribed by the questions, and the Spok questions were presumably worded differently than the KPMG questions. Nonetheless, it’s surprising to me that data security concerns didn’t emerge in the KPMG research. Bottom line, if CIOs aren’t thinking about security alongside their other priorities, it could be a problem.

Could Patents Freeze Blockchain’s Progress?

Posted on March 6, 2017 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.

Everywhere you look, somebody’s talking about blockchain technology and its amazing future. In fact, the healthcare industry is engaging in perhaps the most aggressive blockchain deployments of any industry, according to Deloitte.

Originally, blockchain was an open-source platform, freely available to anyone who wanted to use it. But that could soon change, if a new item from Reuters is any indication.

According to the news service, Aussie computer scientist Craig Wright – who claims to be the pseudonymous “Satoshi Nakamoto” responsible for the technology – is working with Canadian online gambling entrepreneur Calvin Ayre to patent aspects of bitcoin/blockchain tech.

To date Wright, who’s being funded by the wealthy Canadian, has filed more than 70 patent applications in Britain in cooperation with associates. This may not sound like a big deal, but it is, considering that only 63 blockchain-related patents were filed globally last year, according Reuters.

Not only that, Wright plans to file many more, Reuters research has concluded. The patent applications include approaches specific to healthcare, including storage of medical documents. Ultimately, Wright and his partners plan to file as many as 400 patent applications, the news service reports.

Ayre is investing in blockchain largely because he sees it as a good fit with the gambling business. And that serves Wright’s interests, which have included online gambling for decades. In fact, Reuters notes that the bitcoin code base contains unimplemented functions related to poker. So it makes sense that he wants to lock it down and own it.

That being said, it seems unlikely that well-funded corporate interests – including healthcare organizations – are going to just sit back and ignore these developments. After all, companies spent more than $1.5 billion on blockchain technology during 2016, and they’re likely to scale up further this year. In other words, they’re not going to let go of blockchain technology without a fight.

Also, it’s worth noting that none of the 70 existing patent applications have been granted to date, and according to Reuters it’s not clear if they’ll even be enforceable if they are.

Finally, Ayer’s history in the U.S. raises questions as to whether he’s completely above-board. In the past, most of his online gambling revenue came from the U.S., a highly-lucrative business which made him extremely rich. But offering such a platform was and is illegal in many states, and as a result one of the states (Maryland) indicted his online gambling network Bodog, Ayer himself and four other people. The case is still pending.

All told, it doesn’t seem likely that health IT organizations need to drop their blockchain plans anytime soon. But it’s worth bearing in mind that blockchain development may be more complicated – and more expensive – in the future.

HIMSS17: Health IT Staff, Budgets Growing

Posted on March 1, 2017 I Written By

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

A new study announced last week at the HIMSS17 event concludes that demand for health IT staff continues to grow as employers expand their budgets. Not surprisingly, given this growth, the healthcare employers are having trouble recruiting enough IT staffers to meet their growing needs.

Results from the HIMSS Leadership and Workforce Survey reflect responses from 368 U.S. health IT leaders made between November 2016 and early January 2017. Fifty-six of respondents from vendors and consulting firms were in executive management, as compared with 41% of providers.

The survey concluded that the majority of health IT respondents have positions they’d like to fill, including 61% of health IT vendors/consultants and 43% of providers who responded. Only 32% of vendor/consultant organizations and 38% or providers said they were fully staffed, HIMSS said. We’ve seen this challenge from many of the healthcare IT companies which post their jobs on Healthcare IT Central.

Demand for IT recruits grew last year, as well. Researchers found that 61% of vendors/consultants responding and 42% of providers responding saw IT staffing increases over the past year, and that the majority of respondents in both groups expect to increase their IT staffing levels or at least hold them steady next year.

Of course, someone has to pay for these new team members. HIMSS researchers found that IT budgets were continuing to rise over time. Roughly nine out of ten vendors/consultants and 56% of providers said they expected to see increases in their IT budgets this year.

As often happens, however, vendors and consultants and providers seem to have different HIT priorities. While vendors seem to be addressing new technology issues, providers are still focused on how to manage their existing EMR infrastructure investments, HIMSS said.

That being said, the survey found, health IT stakeholders have many overlapping concerns, including privacy and security, population health, care coordination and improving the culture of care.

One of the key insights from this study – that vendors/consultants and providers have different views on the importance of enhancing existing EMRs – is borne out by another study released at the HIMSS event.

The study, which was backed by voice recognition software vendor Nuance Communications, found that providers are broadly interested in implementing new technologies that enhance their EMR, especially computer-assisted physician documentation, mobility and speech recognition tools.

However, when asked to be specific about which tools interested them, they were less enthusiastic, with 44% showing an interest in mobility tools, 38% computer-assisted physician documentation and 25% speech recognition. Documentation tools that enhanced existing functions were especially popular, with 54% of respondents expecting to see them support a reduction in denied claims, 52% improved performance under bundled payments, 38% reduced readmissions and 38% better physician time management which improves patient flow.

This survey also found that the most popular strategy for enhancing physician satisfaction with health IT tools was providing clinician training and education (chosen by 82%). Since their EMR is probably their biggest IT investment, my guess is that the training will focus there. And that suggests that EMRs are still the center of their universe, doesn’t it?