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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.

Will The Fitbit Care Program Break New Ground?

Posted on September 21, 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.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.

 

Latest Apple Watch to Cure Heart Disease (Yes, That’s the Sarcasm Font)

Posted on September 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.

By this point, I think that most people have seen the big announcement coming out of the Apple event that the Apple Watch 4 now has ECG and other heart monitoring capabilities built in. The watch will notify you if your heart rate is too low and instances of atrial fibrillation that it detects. Plus, all of this is done as an FDA cleared device (some are reporting that Apple got their FDA clearance in 30 days which is crazy fast for a medical device).

The response to this announcement has been quite interesting. Most aren’t surprised that Apple has been moving more and more into healthcare. Plus, there have been a lot of reports that have mistakenly called this the first consumer ECG which it’s not. AliveCor deserves that credit and I recently wrote about another consumer ECG which is just one of many that are coming. However, many are suggesting that the Apple Watch will be the first time that many younger, healthier people will be regularly using an ECG like this. That’s an interesting idea.

As you might have assumed by the title of this post, I think the Apple Watch announcement isn’t much ado about nothing, but it’s also not the announcement of “sliced bread” being invented either. Let’s dive into what this announcement really means for healthcare.

As I mentioned when I wrote about the other consumer ECG, there’s currently somewhat limited value in what can be done with a single lead ECG. So, it’s important to keep this Apple Watch announcement in the right perspective even though I’m sure most consumers won’t understand these details. One person even commented on how Apple created messaging that calls it an “intelligent health guardian” to confuse people while still avoiding liability:

Perception sells and Apple is as good at creating perception as anyone. Will many more people buy an Apple Watch if they perceive it as something that will help them monitor their health better? Definitely. However, there are some other consequences that many doctors are warning about when it comes to this type of tracking hitting the masses.

First up is Dr. Nick van Terheyden who provides a comparative example of why all this “testing” could lead to a lot of incidentloma’s (Nice word I assume he made up to describe false positives in health tests):

A nephrologist at Cricket Health, Carmen A. Peralta, chimed in with this perspective:

The problem with these devices is that it’s not in Apple’s best interest to truly educate a patient on what the device can and can’t do. If a single lead ECG like this was a reliable arbitrator of when to go to the ED or when to not go, then it would be extremely valuable. However, many doctors I’ve talked to are suggesting that a single lead ECG isn’t sufficient for this type of information. So, a false negative or a false positive from the Apple Watch can provide incorrect reassurance or unfortunate anxiety that is dangerous. Who’s going to communicate this information to the unsuspecting Apple Watch buyer? My guess is relatively no one.

Another doctor made this ironic observation when it comes to the false positives the Apple Watch will produce:

You can just imagine the Apple Watch template in an EHR system. I wonder if it will include an Apple Watch education sheet. Maybe the EHR could send that education sheet to their watch instead of the portal. Wishful thinking…I know.

Another doctor made this poignant observation about the announcement:

We could go on for a while about prevention versus diagnosis. However, I don’t think it’s really an either or proposition. Prevention is great, but detection and diagnosis are as well since we can’t prevent everything.

This MD/PhD student summed up where we’re at with these consumer health devices really well:

I agree completely. The Apple Watch is directionally good, but still far away from really making a significant impact on health and/or our healthcare sysetm.

Top 5 Ways to Create a Stellar Patient Experience

Posted on August 13, 2018 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Patient experience has always been something healthcare delivery organizations should strive to improve. However, in the past couple of years, patient experience has received a necessary focus as health consumers are presented with more choice, transparency, and data to navigate their healthcare journey. But with so many choices available, what can health providers do to drive loyalty?

I recently had to schedule a visit for my annual mammogram, a much dreaded experience for most women. I’m lucky to have many imaging options around me, making it easy to get in on a day that was convenient for me. However, the choice was very simple after the exemplary experience I received last year. One facility in particular made me into a loyal patient, and they did so in five key ways.

1. Convenience of access: Consumer-centric businesses like Amazon and Starbucks have made it so seamless and easy to get what you need from them when you need it, that it makes waiting in healthcare more painful than it used to be. Now, we expect to handle business transactions on our own terms and to receive immediate results. Even Amazon Prime’s two-day shipping wasn’t enough for us, and now we have Amazon Now. When it was time to schedule with the facility, it was simple to connect and get care when convenient for me. They offer online scheduling, which enabled me to browse open appointments and choose an option that fit my busy schedule. They have a phone number as well if you prefer to schedule that way, but I prefer doing most business transaction from my phone.

2. Patient-first in clinic experience: Everything at the facility was set up to make something no woman really wants to do, an enjoyable experience. I was greeted with a warm smile when I walked in and promptly taken back to the changing rooms. Their rooms are finely decorated with warm lighting and comfortable dressing rooms. I never sat idle for more than 10 minutes. They have even taken the extra step to provide lockers for your personal belongings with the names of famous amazing women so you can remember where your belongings are. I chose to be Eleanor Roosevelt one year, and Jane Austin this year.

3. Putting data in the patients’ hands: Both times I have been in for a screening, I receive my secure results within 24 to 48 hours and they send the results to both my OB/Gyn and my primary care provider. Armed with information contained in my profile, I can choose to have a more in depth conversation with my care providers regarding the risks and results, or I can keep them and compare year after year. Knowledge and education are the first two steps in patients having the ability to manage their health.

4. Proactive engagement in care: Patients can be very forgetful (especially when managing the care of four additional family members). If there is something I need to do in order to take better care of myself, it’s better to be proactive and ping me instead of assuming I’ve got it covered. This facility let me know several months in advance that it was time to reschedule. I knew the exact date I was eligible per my insurance, so it made it easy to take the best step to keep on top of my health.

5. Ease of doing business: No one wants to spend hours filling out paper forms. When looking for a repeat appointment for this year, I saw that there was a clinic closer to my office. I arrived a few minutes early to fill out the insurance forms since I scheduled online and there was no place for me to put the card information. When I walked in and gave my name at sign in, they had everything: my address, insurance, birthdate, records from the last visit at a different facility. This is imperative for healthcare organizations to prioritize as mergers and acquisitions mean multiple EHRs, billing systems, and contact centers. The experience and ease of doing business with your team before and after care will affect patient loyalty. Make it easier to do the small things, and watch your patient satisfaction increase.

The facility has gone to great lengths to ensure their patient experience is above par and their efforts have definitely paid off. And they will have my loyalty for it as long as they serve my area. Their mission states:

“Our promise is to provide an exceptional experience, exceptionally accurate results, and Peace of Mind to everyone we serve. Our purpose is to be the National Leader in Mammography and imaging services, helping patients achieve and maintain optimal health.”

What is your promise to your patients? Is your number one to provide an exceptional experience? Are you meeting the above five areas of the patient experience beyond the clinical face to face interaction? What are some additional ways you ensure the best experiences for everyone in your care?

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Alleviating “Pregnancy Brain” With Appointment Reminders

Posted on July 12, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - Stericycle

Picture this: I’m standing on the tradeshow floor watching as people try to grab as much swag as possible. I’m speaking to someone who really isn’t listening to my spiel because they are only in it for the free pen. Then, I get someone who is fairly interested in our appointment reminder service. Thinking I’ve hooked, lined and sunk them, I am met with a familiar objection: “We don’t need an appointment reminder service for our OBGYN clinic because women, especially pregnant women, don’t forget when their appointments are.”

Thinking back, I wish I knew then what I know now and could have countered that argument with some cold hard facts.

You may have heard about little bouts of forgetfulness during pregnancy. According to most experts, pregnancy does not change a woman’s brain, but some women don’t feel as sharp as usual when they’re pregnant. Although the science is still out on whether “pregnancy brain” is truly myth or reality, being seven months pregnant, I can testify that I am definitely not at the top of my game.

I have to check that I’ve locked the door three times. I forget simple words. I have a hard time remembering anything if I don’t write it down. Of course, I remember that I am due at the doctor once a month (I’m not an animal) and enter the date and time of future appointments into my phone. But between work meetings, presentations, ultrasounds, and other appointments, I inevitably forget when I’m supposed to go in and begin to question myself. Did I write down the date correctly? Did I already miss my appointment?

Every month, this confusion and second guessing always leads me to call my doctor’s office before my appointment to check the appropriate date and time.

What I do know is that this seconding guessing and additional effort could be completely eliminated if my clinic were to provide more patient-focused engagement before my appointments with the help of simple appointment reminders. With so many other things to worry about, I have come to appreciate these gentle reminders from places like my hair stylist, masseuse, and even prenatal class instructor, all of who send me a quick note including the following:

  • Appointment date
  • Appointment time
  • Location
  • Preparation instructions and,
  • Any additional “need to knows.”

Although it may seem like pregnant women would never forget an appointment that has to do with something as pivotal as bringing a child into this world, I can firmly say it happens. And something as simple as an appointment reminder goes a long way to ease a patient’s mind and elevate their overall patient experience. Now if only I could remember the name of the OBGYN clinic from that tradeshow I was at…..

Click here, to learn more about how Stericycle Communication Solutions is helping to create the optimal patient experience through our customized automated messaging solutions.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality answering services, online scheduling solutions, and messaging solutions. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

A Missed Opportunity For Telemedicine Vendors

Posted on June 29, 2018 I Written By

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

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

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

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

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

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

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

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

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

One likely buyer for this service would be health plans.

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

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

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

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

Stanford Survey Generates Predictable Result: Doctors Want EHR Changes

Posted on June 11, 2018 I Written By

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

I know you’re going to have trouble believing this, but many PCPs think EHRs need substantial changes.

Such is the unsurprising conclusion drawn by a survey conducted by The Harris Poll on behalf of Stanford Medicine. The poll, which took place between March 2 and March 27 of this year, surveyed 521 PCPs licensed to practice in the U.S. who have been using their current EHR system for at least one month.

The physicians were recruited via snail mail from the American Medical Association Masterfile. Figures for years in practice by gender, region and primary medical specialty were weighted where necessary to bring them into line with their actual proportions in the population of PCPs in the U.S.

According to the survey, about two-thirds of PCPs think EHRs have generally improved care (63%). Two-thirds said they were at least somewhat satisfied with their current systems, though only 18% were very satisfied.

Meanwhile, a total of 34% were somewhat or very dissatisfied with their system, and 40% of PCPs said that EHRs create more challenges than benefits. Also, 49% of office-based PCPs reported that using an EHR detracts from their clinical effectiveness.  Forty-four percent of PCPs said that primary value of EHRs is data storage, while just 8% said that the biggest benefits were clinically-related.

To improve EHRs’ clinical value, it will take a lot of effort, with 51% saying they think EHRs need a complete overhaul.  Seventy-two percent of PCPs said that improving user interfaces could best address their needs in the immediate future.

Meanwhile, 67% of respondents said that solving interoperability problems should be the top priority for EHR development over the next decade, and 43% reported wanting improved predictive analytics capabilities.

Nearly all (99%) of PCPs said that EHR capabilities should include maintaining a high-quality record of patient data over time, followed closely by providing an intuitive user experience. Also, 88% said that providing clinical decision support at the moment of care was important, followed by identifying high-risk patients in their patient panel (86%).

When asked what EHR features they found most satisfying, they cited maintaining a high-quality patient record (73%), offering patients access to medical records (71%), sharing information with providers across the care continuum (65%) and supporting practice/revenue cycle management needs (60%).

However, EHRs still have a long way to go in offering other preferred capabilities, including changing and adapting in response to user feedback, improving patient-provider interaction, coordinating care for patients with complex conditions and engaging patients in prescribed care plans through mobile technologies. Vendors, you have been warned.

“Shadow” Devices Expose Networks To New Threats

Posted on June 4, 2018 I Written By

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

A new report by security vendor Infoblox suggests that threats posed by “shadow” personal devices connected to healthcare networks are getting worse.

The study, which looks at healthcare organizations in the US, UK, Germany, and UAE, notes that the average organization has thousands of personal devices connected to their enterprise network. Including personal laptops, Kindles and mobile phones.

Employees from the US and the UK report using personal devices connected to their enterprise network for multiple activities, including social media use (39%), downloading apps (24%), games (13%) and films (7%), the report says.

It would be bad enough if these pastimes only consumed network resources and time, but the problem goes far beyond that. Use of these shadow devices can open up healthcare networks to nasty attacks. For example, social media is increasingly a vector of malware infection, where bad actors launch attacks successfully urging them to download unfamiliar files.

Health IT directors responding to the study also said there were a significant number of non-business IoT devices connected to their network including fitness trackers (49%), digital assistants like Amazon Alexa (47%), smart TVs (46%), smart kitchen devices such as connected kettles of microwaves (33%) and game consoles such as the Xbox or PlayStation (30%).

In many cases, exploits can take total control of these devices, with serious potential consequences. For example, one can turn a Samsung Smart TV into a live microphone and other smart TVs could be used to steal data and install unwanted apps.

Of course. IT directors aren’t standing around and ignoring these threats and have developed policies for dealing with them. But the report argues that their security policies for connected devices aren’t as effective as they think. For example, while 88% of the IT leaders surveyed said their security policy was either effective or very effective, employees didn’t even know it was in effect in many cases.

In addition, 85% of healthcare organizations have also increased their cybersecurity spending over the past year, and 12% of organizations have increased it by over 50%. Most HIT leaders appear to be focused on traditional solutions, including antivirus software (60%) and cybersecurity investments (57%). In addition, more than half of US healthcare IT professionals said their company invests in encryption software.

Also, about one-third of healthcare IT professionals said the company is investing in employee education (35%), email security solutions and threat intelligence (30%). One in five were investing in biometric solutions.

Ultimately, what this report makes clear is that health IT organizations need to reduce the number of unauthorized personal devices connected to their network. Nearly any other strategy just puts a band-aid on a gaping wound.

How Technology Helped My Family Receive a Better Healthcare Experience

Posted on May 10, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - Stericycle

When was the last time you had a truly outstanding patient experience? For my family, two healthcare facilities located hours apart recently teamed up to make our lives significantly more convenient. Without modern technology, however, our new reality may never have been possible. Let’s start from the beginning.

A few years ago, my family member suffered a heart attack that caused a traumatic brain injury. He was treated at a major facility about two hours away from his home for speech therapy, occupational therapy, neurological care, cardiologist support, and more. After a year of hard work, he was discharged from the hospital and was able to move back to his home town.

Unfortunately, his community hospital was not equipped to provide the specific care he required. So for the next two years, he and his wife, who is now his primary care giver, commuted to the city multiple times a week to ensure he received the care he needed.

Eventually, we all wondered the same thing: Isn’t there a better way?

After many meetings with the facility that treated my relative and our local hospital, we started discussing how digital health experiences and virtual care could augment my family’s patient and caregiver experience. We were determined to find a solution that provided care options and choice, and allowed them to continue receiving the necessary care without the exhaustion of “living on the road.”

A recent study by Accenture said it best: “Finding the best combination of traditional in-person services and making those same services available virtually can offer consumers the choice they want in deciding when and how they receive care and support.”

Fortunately, we learned that our local hospital was equipped to provide virtual care. However, many patients had not yet taken advantage of these technologies. After some coordinating between facilities, we were able to set up ongoing virtual appointments. These appointments enabled my family member to receive care in a much more convenient setting.

With virtual appointments, they can even:

  • Easily schedule virtual appointments
  • Participate in the appointments from the comfort of a boardroom at the hospital
  • Consult with the first hospital’s specialist and also an in-person care facilitator
  • Receive follow-up health reminders and education directly after the appointment

Now, almost half of his appointments have transitioned to virtual appointments. And my family is not the only one taking advantage of this care capability. Recent research explores the many reasons why healthcare consumers are making this virtual shift:

  • One of the top three reasons why consumers tried virtual health was convenience. 37% said it was more convenient than traditional, in-person health services
  • 76% of people would have a follow-up appointment (after seeing a doctor or healthcare professional)
  • 74% would get virtual follow-up care services in their home after being hospitalized
  • 73% would discuss a specific health concern virtually with a doctor or other healthcare people and
  • 72% would be open to getting virtual daily support to manage an ongoing health issue

Consumer willingness to demand choice and becoming more involved in their health is rising. Like my family, more patients are ready to collaborate with clinicians, embrace new technologies, and explore digital health experiences that can help manage our health and create more convenient and engaging patient experiences.

Learn more about how Stericycle Communication Solutions is helping create the optimal patient experience through a combination of human and tech-enabled communication services. Check out our service overview here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality live agent services, scheduling solutions, and automated messaging solutions.  Stericycle Communication Solutions provides unified human & tech-enabled communication solutions for optimized patient experiences.  Connect with Stericycle Communication Solutions on social media: @StericycleComms