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Key Articles in Health IT from 2017 (Part 2 of 2)

Posted on January 4, 2018 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.

A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.

An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.

A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.

A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.

In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.

Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.

Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.

No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.

The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:

Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.

A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.

Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.

The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.

A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.

To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.

Specific technologies

Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.

Lots of intriguing devices are being developed:

Remote monitoring and telehealth have also been in the news.

Natural language processing and voice interfaces are becoming a critical part of spreading health care:

Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.

Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.

A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.

3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.

A number of other interesting companies in digital health can be found in a Fortune article.

We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:

I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.

Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 2018 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

Scanadu to Shut Down Scout Medical Device Per FDA Regulation

Posted on December 14, 2016 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.

The famous Qualcomm Tricorder prize winner and IndieGogo crowdfunding success, Scanadu, has just hit some major bumps in the road. In fact, you might say they lost their engine completely. After winning the X Prize foundation’s tricorder competition, they went on to raise more than $1.6 million on IndieGogo from 8509 backers.

After shipping the product, Techcrunch just broke the news that Scanadu was now planning to disable the Scout’s functionality. Yes, that’s right. People paid $149-269 for the Scanadu Scout and now Scanadu is going to brick all of the devices. Here’s their official comment to Techcrunch:

“From the beginning of the campaign, this was an investigational device that was part of a study which has now reached its endpoint with data collection for the study ending in November 2016. FDA regulations require that all investigational studies be brought to closure and their respective devices be deactivated. As a result, we will deactivate the Scanadu Scout® devices by May 15, 2017.

Interestingly, the Scanadu website, Twitter, Facebook, etc are all quiet. In fact, most of them have been quiet since April. What hasn’t been quiet is customers anger towards Scanadu. That’s true on social media, but also in the IndieGogo comment section where Scanadu had raised $1.6 million.

You can imagine people’s anger. Their expensive device will now be useless. As one commenter pointed out, someone bought 100 of them. That person will now essentially have 100 expensive bricks. In the comments, people are calling for a class action lawsuit, refunds from IndieGogo and outrage at the company doing this to them. The most salient point is that it’s hard to imagine anyone ever buying a product from Scanadu again after something like this occurs. One commenter suggested the following:

The consent doc also says: “If you have any questions about your rights, call the Scripps Office for the Protection of Research Subjects at (858) 652-5500. ” [Note: Scripps is performing the study based on the Scanadu data.]

Some people in the comments are even commenting that there’s no such FDA regulation. I’m not an expert on FDA regulation, but my gut tells me there’s more to this story than we know today. I could easily see how there could be an FDA regulation that required a company to shut down devices that made claims they couldn’t achieve and therefore put people’s health in danger. I’m not sure if this is what’s happening with Scanadu, but when there’s smoke there’s usually fire.

I think we all loved the romanticized idea of a medical tricorder. Haven’t we all wanted one since we first saw it portrayed on Star Trek? Scanadu was trying to make it a reality, but it seems their efforts have fallen flat. This is a good warning to everyone else out there. FDA compliance is no joke. Even winning an X Prize, a successful crowd funding campaign, and raising $35 million in funding doesn’t guarantee success.

Innovation in healthcare is hard!

The $5 Billion Eye and Gesture Tracking Sensor Market

Posted on August 3, 2016 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.

Eye Tracking and Gesture Tracking Sensors

$5 Billion is a huge number for the eye and gesture tracking sensor market. It’s amazing how these markets slowly creep up until they become something huge. There are a number of really interesting startups that are working on eye and gesture tracking sensors.

This news is particularly interesting as Samsung just announced the Galaxy Note 7 will include iris scanning. It will help secure the device, but will also be available in other apps in the phone so that you have a true single sign on with your iris. We’ll see if they open it up for eye tracking applications as well.

As you look at the development curves of these technologies, we’re still in the very early stages. That’s what gets me most excited. The eye is indeed a window into our health in many ways. I can’t wait to see the new health innovations that come from it. At $5 billion, that market is really starting to mature.

Virtual Reality and Treating Dizziness

Posted on July 20, 2016 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.

Mark Cuban has a pretty amazing post that talks about his experience as an active, engaged patient in his care and how he found virtual reality helped him achieve the desired relief from dizziness that he desired. If you’ve stayed up with the virtual reality space, you’ll find this quite intriguing since virtual reality is often condemned because of the dizziness it causes. Obviously, what you’re watching on VR matters a lot.

Go ahead and read Mark’s full post to see his experience as an active patient trying to deal with his Dizziness. We’ll be here when you get back. You can also watch this video he made:

It’s pretty amazing how active Mark Cuban was in his care. Sure, he has the money to be as active as possible. He literally was looking at buying a massive medical device or even investing in a business to bring the treatment he wanted to Dallas. That’s extraordinary and something that most of us can’t do as patients.

For those who haven’t read the whole story, Mark Cuban was getting treatment in California that was helping him with his dizziness from Dizziland.com. However, he couldn’t stay in California to finish the treatment. That’s when he discovered that the Samsung VR set he had might be the solution to creating a portable solution for him. Turns out, it did the trick for him. As a true businessman, he’s now working with the company to commercialize the product.

To be clear, this device setup is not FDA approved. It’s something that Mark found and tried that worked for him. We won’t be seeing doctors prescribing this for a while to come. Although, it will be interesting to see if and how solutions like this do go to market. Will they need to be FDA approved? Will they be regulated? How much will they cost? Lots of interesting questions since the videos and technology to watch them are quite cheap.

I love the story of technology making an impact on someone’s health for good. I also love seeing an active patient taking a serious interest in their care. Although, it’s amazing how a billionaire’s interest in their health is similar to any person with a major health issue.

The Balance of Moving Fast and Not Breaking Things

Posted on July 13, 2016 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.

The right path forward for the digital health industry begins with a significant shift in the Silicon Valley mindset: “Move fast and break things” just won’t work. Source

That’s a powerful quote from Vic Gundotra, CEO of AliveCor. He’s right that you have to be much more careful in healthcare. That’s not always true. You can experiment on certain parts of healthcare without damaging a patient or a physician. However, you do have to be careful because it can quickly move into a regulated portion of healthcare. It’s a challenging balance.

Plus, even if you’re working in a regulated portion of healthcare we need to have more people who move fast and break things. They just need to do it within the regulations. While this is a challenge, it’s still possible. Plus, it becomes a massive competitive advantage when you do finally comply with all the regulations and provide value to the end user.

Vic offers this added insight:

What has been seen as a burden needs to be seen as a benefit. It’s time that we stop viewing regulatory bodies as obstacles and start viewing them as valuable partners.

In healthcare, entire industries are created around regulation. Regulations can be an enormous opportunity for entrepreneurs. That’s certainly a shift in mindset for many of those in silicon valley. Maybe that’s why so many big health IT companies come from places other than the valley.

The Promise of Wearables for Healthcare

Posted on June 29, 2016 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.

In a recent interview I did with Dr. Rhew, Chief Medical Officer of Samsung, and Dr. Nick, CMO of Dell, we got this great insight from Dr. Rhew on the promise of wearables for healthcare (only takes 45 seconds):

It’s worth listening to the full discussion with Dr. Rhew and Dr. Nick so you have context, but I love how he framed the promise of wearables for healthcare. I especially like how he talks about these devices just being integrated into our lifestyle.

The challenge with this promise is that many of the current wearables have fallen short. They don’t integrate well with our lifestyle. They’re a pain to connect to get the data (although, that’s gotten better). The data they collect has questionable accuracy. The data they collect isn’t clinically relevant. I could keep going, but you get the idea.

While many of the wearables have fallen short, that’s a necessary part of the learning process. We’re going through a wearable revolution and that requires a product evolution. Many of the things we see as failings today will be considered laughable in the future.

Like Dr. Rhew, I think the promise of wearables is extremely exciting for healthcare. The integration of wearables into your lifestyle is happening. It’s not going to happen overnight, but each of these products will lay the groundwork for wearables that will become invisible to our day to day life.

FDA Mobile Health Regulation Cartoon

Posted on December 30, 2015 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.

FDA Mobile Health Regulation

This takes it a bit too far (like most cartoons do), but it sometimes feels like this is reality. As I read yesterday, the FDA isn’t designed to regulate the digital health technologies that are hitting the market today. I think that’s the biggest challenge they face. They have to remake who they are if they’re going to start regulating all that’s happening.

We’re in a funny spot right now where the doctors don’t trust many apps because the FDA hasn’t approved them and so they’re not sure if they can be trusted and the app makers largely don’t want to go to the effort and cost of FDA approval. In many cases, it would be like trying to fit a square peg in a round hole. Somethings gotta give.

Mobile Health Happenings

Posted on April 22, 2015 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.

It looks like I might have been wrong about mobile health really cropping up at HIMSS15. Then again, maybe I just missed a bunch of them in the mass of attendees that were at the event. Plus, I knew that I’d see the mobile health related companies at mHealth Summit, Connected Health Symposium, Health 2.0 or CES sooner or later. So, I was more interested in the non mobile health related companies at HIMSS.

With that said, every company has some approach to mobile health. Sure, the Apple Watch announcements from Vocera, Epocrates, and Medisafe (to name just a few that I saw) are going to get the headline. Press releases with Apple Watch in their title seem to get extra attention. Press love the latest shiny object even if we have no idea whether the Apple Watch is going to be adopted by the masses (Personally I think it will be a niche device for the rich). However, there are a few mobile happenings that are worth watching.

Text – Don’t underestimate the power of text. It’s amazing what you can do with 140 characters. Of course, in healthcare you need to use secure text (SMS is not HIPAA secure). Turns out that secure text can actually provide a lot of benefits beyond SMS. I’m still very bullish on the simplicity of a text. Feels like a simple solution, but that’s what makes it beautiful. The fact we haven’t fully leveraged it also illustrates how far behind healthcare is compared to other industries.

Mobile Apps – I think there are two kinds of mobile health apps that are breaking out. First is the mobile apps that are tied to enterprise systems. This could be an EHR app or increasingly we’re seeing the population health or analytics vendors pushing the data and communication channels to mobile devices. More innovative is the wellness gaming apps that I’ve seen. I don’t think anyone’s fully cracked the nut yet, but there are some people really working on wellness motivation and behavior change. I expect we’ll see a game changer in this regard in the next 1-2 years.

Sensors – The smartphone or an iPad are becoming the brain for all of these personal health sensors. In fact, the phone is becoming a health sensor itself. Reminds me of CapsuleTech which has been putting black boxes under hospital beds for years in order to get the data from a medical device. Now we all have a “black box” in our pocket that collects and communicates our health data. Personal health sensors are exploding. Implantables is next.

Telemedicine – We want out healthcare when we want it, where we want it. Telemedicine is going to be the solution that solves that problem. Katherine Rourke has a great post up on EMR and HIPAA about the various telemedicine solutions. So, I won’t rehash those options here. However, there’s a wide spectrum of telemedicine offerings and many of them are mobile.

Those are a few of the biggest trends I see in mobile health. I’m sure there’s something I’ve missed. So, I look forward to hearing what I’ve missed in the comments below.

Goggles Help Surgeons See Tumors

Posted on September 17, 2014 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.

I found this great article on the BBC news site which talks about a new Goggle technology that helps surgeons “see” cancer cells in their patients. The article is a bit old (April), but it’s a fascinating look at the amazing power of technology to transform healthcare.

Here’s a short excerpt of how the technology works:

In the study, patients are being injected with a dye before their surgery. The dye has a peptide – a small protein – attached to it that allows it to seek out and bind specifically to cancer cells.

The dyed cancer cells emit light at a wavelength that cannot be seen by the human eye, but can be detected by a sensor in the goggles worn by the surgeons.

“The sensor captures the fluorescence from the dye lodged in cancer tissue and projects the image into the surgeon’s [field of] view,” explained Dr Achilefu.

“This creates an augmented reality that allows the surgeons to see cancer cells glowing, providing real-time guidance during surgery.

The article does note that we still need a much larger set of patient trials for this technology to go mainstream, but it’s easy to see the potential.

I love these types of genius approaches to the use of technology in healthcare. The mix of technology with science is such a powerful combination. Unfortunately, we don’t have a lot of organizations that are doing a great job bridging both sides of the healthcare community. Are there other examples where you’ve seen the mix of science and technology in healthcare?