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Why 2014 was a groundbreaking year in digital health

Why 2014 was a groundbreaking year in digital health | Healthcare and Technology news | Scoop.it

2014 was the most exciting year in digital health since 2000, when the human genome was cloned. In February 2001, The Human Genome Project and Craig Venter’s Celera Genomics published the hallmark event. What followed was over a decade of glimmers of the potential for personalized medicine and new insights into disease, but also realistic mitigations in expectations, as is wont to happen in health care.


There is every indication that the next decade will be different — there will be an acceleration in innovation and development of devices to assess our healthy and ailing selves. What happened in 2014? A huge increase in funding and corporate investment in digital health technology (e.g., mobile, social media, genetics and big data), and massive growth in the accessible population, and the amount of open data:

  • Funding in digital health startups, tracked by an accelerator Rock Health since 2011, has grown steadily at double digit growth until this past year, when records were shattered with $4.1B in funding, more than double the 2013 amount.
  • Almost every major consumer technology company announced a large health initiative, notably Google, Apple, and Samsung.
  • Electronic health record and sensors were positioned to join or actually entered the “Internet of Things”. The partnership between Apple and Epic alone could reach 20 percent of patients entering a health care system in the U.S. An estimated 10M activity monitor units were sold in 2014 and phones became personal health monitors with the release of Apple’s HealthKit and Google’s Google Fit.
  • Lastly, the number of large data sets that opened in health care and the tools to analyze them came of age in 2014. For example, the FDA launched openFDA in June 2014, which made it easier to analyze data about adverse events, drug and medical device recalls, prescription and over the counter product labeling, and to access open source code for analyzing this data.

What does this mean for our health? Funding will help drive innovation, and greater connectivity between patients and the people and systems that deliver their care will help drive efficiencies. Both of these will enable developers to more easily amass huge data sets to advance personalized diagnosis and treatment, and support efforts to prevent disease.

Innovation. The last five years have been a “wild west” of digital health startups with greatly varying business rationales and user adoption. We are now beginning to see some sound inventions that make economic sense and will be used by patients, providers, and systems. Activity monitors will go stealth, such as the contact lens being developed by Google and Novartis that detects blood glucose levels. Quantification of conditions will advance so that we have a better understanding of the level and type of disease we are dealing with, such as Oculogica’s brain injury detection system for concussion and other brain afflictions. (Disclosure: The author is a consultant to Oculogica.)

Efficiencies. One of the most needed, but most difficult to realize, implications of health care systems partnering with technology companies, are changes that reduce time and costs for health care systems and patients — from the simple check in at a clinic or hospital, to the number and nature of tests ordered, to smarter follow-up. For example, the first Epic Apple integration at Ochsner Health System in Louisiana estimated a 40 percent decrease in readmissions based on a pilot study with 100 heart failure patients.

Personalization and outcomes. 2014 won’t be the end of guidelines and recommendations based on the general population, but we are at a turning point to eventually achieve ubiquitous genomic assessments of individuals and prediction for optimal treatment. The interim step will be larger data sets — ideally from clinical records and recorded from sensors — which will allow segmentation of patients by age, gender, stage of disease, and other factors. This enables providers to tailor care based on individuals or small segments, rather than large swaths of the population.

Prevention. Prevention is the holy grail in health care with significant impact on health and cost. Programs have been difficult to implement because adoption has been too onerous. Return on investment is difficult to quantify and is often not realized by one hospital or payer. Less obtrusive sensors and more connected systems lower or even remove barriers to adoption. Return on investment will be more quantifiable as individuals, rather than health systems, are followed and quantified.

What do we need in health care? Fewer people who get ill in the first place. When they do, they should receive better care, tailored to who they are and the specifics of their disease, delivered at a lower cost. The challenges notwithstanding, we moved a step closer to this fantastic vision for health care in 2014.


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Healthcare Predictions For 2015

Healthcare Predictions For 2015 | Healthcare and Technology news | Scoop.it

Next year will be big for healthcare. We felt small tremors in 2014 of the seismic changes underway. In 2015, I predict five changes to the core of the U.S. healthcare system: insurance, pharmaceuticals, supplies, medical services and payments. Let’s take a look at each of these trends, what they mean for the healthcare sector, and what they mean for you.

Walmart becomes your healthcare insurer

This October, Walmart tipped its hand by launching a healthcare insurance exchange online. However, the insurance products currently sold on its exchange do not have Walmart as the carrier, which will change in 2015.

Walmart’s public announcements thus far provide a clear preview of the insurance plan’s future design. Primary care through retail clinics and $4 generic drugs at the pharmacy will drive traffic into stores. For specialty care, the plan will leverage the Centers of Excellence program that Walmart already offers to its 1.2 million insured employees. In this program, consumers pay little to nothing out-of-pocket for knee, hip surgery, and cancer treatment if they go to a short list of high-quality medical centers like Mayo, the Cleveland Clinic, Mercy and Geisinger.

With a store within five miles of 95 percent of all Americans and retail transactional data from its consumers, Walmart can provided tailored population health services and incentivize healthier shopping decisions to prevent diabetes and heart disease.

Startups sell into big pharma and become profitable

Despite a 5x increase in venture investments, most digital health companies are not profitable.  Digital health CEOs should look at pharma as its paying customer. Despite their vast differences, pharmaceutical manufacturers are starting to pay tech startups to solve their complicated problems.

One major issue pharma wants your help with is accessing and selling to physicians. In person detailing by trained sales representatives has been the core of pharma’s sale strategy for decades.

Yet, one-fourth of all MD’s offices and two-fifths of all offices with 10 or more MDs refuse to see pharmaceutical sales reps in their offices. The Sunshine Act, which compelled every pharma company to disclose what it spends on each MD, accelerated the problem. The problem of customer awareness and engagement is ripe for tech companies, particularly those focused on social media, mobile advertising and video, to capitalize on.

Next year is going to be a tipping point, because spending and hiring within pharma’s commercial organizations are changing fast. Plus, the FDA published draft guidance on social media in July 2014. Suddenly, these corporations have large eMarketing teams and VPs of digital health. We are seeing CIOs from companies like Dell working at Merck. These indicators tell me that 2015 will be the year when pharma is willing to shop for best-in-breed companies that address their business problems.

Amazon undercuts the medical supply chain

Amazon sells a dizzying array of products. Catheters and surgical gloves are not on the market yet, but they will be soon. Doctors and practice managers are just like the rest of us — they love Amazon Prime for their homes, so why not for their practices?

Amazon will first target small practices and cutout group-purchasing organizations that take an undeserved cut of savings that could be passed on to physicians. If Amazon can ship you toilet paper in two hours, it can supply a small practice with gloves and gowns. The volume from these accounts will justify free shipping, especially when Amazon moves upstream into higher-margin products such as sutures, syringes and other commoditized supplies.

While medical professionals and business managers will be driven by price and convenience, Amazon’s motivations will be financial. General surgical supply company Owens & Minor generated $9 billion in annual revenue last year. Amazon isn’t known for letting glaring business opportunities go untouched, especially those that can move its stock price.

Hospitals become a channel for peer-to-peer lending

If you understand the flow of payments in healthcare, you can predict the trends. Consumers and employers are purchasing insurance plans with high deductibles. As a result, the first dollar that hospitals earn is now coming from consumers. Actually, the first $17,000 is coming from consumers. With an average income of $55,000, most American consumers simply can’t pay their medical bills.

When they don’t pay, it hurts providers financially. What consumers don’t pay shows up as accounts receivable on hospital balance sheets and eventually turns into bad debt. Since many hospitals are financed by debt and their credit worthiness is partially determined by the health of their balance sheet, the problem of getting patients to pay is urgent.

This raises the question — how can we find the money to help consumers finance their health care payments? Many consumers are able and willing to pay their medical bills, they just can’t do it all at once. Peer-to-peer lending companies have paved the way for unsecured structure notes, where an individual’s loan can be financed by others. These have shown impressive growth. Peer-to-peer lending is already being used to finance plastic surgery and other cash-pay procedures. Now it could be used for the majority of medical expenses in the U.S.

Latinos become the most desired healthcare segment in the U.S.

There are 54 million Latinos living in the United States, constituting 17 percent of the population. Politicians have taken notice and are paying attention to Latinos as an important voting demographic. Healthcare providers are beginning to do so, too.

Latinos have been disenfranchised by the U.S. healthcare system because of legal status, English language skills and financial constraints. Fewer than 4 percent of healthcare providers speak Spanish and most do not know how to approach the cultural and economic diversity within the Latino population. Even native English speakers can’t make sense of PPOs vs. HMOs.  As a result, Latinos are 1 out of every 5 uninsured individuals in the U.S. and leverage healthcare services differently than other demographic cohorts

As hospitals compete for volume, they cannot ignore 1 out of 5 Americans. In order to win the loyalty of this untapped customer segment, we will see Latino-branded services with evening and weekend hours to serve dual-income families. Since these services will be built from scratch to provide high-quality care at low prices, they might leap frog the care that the rest of the population currently receives.

Change has historically come slowly and reluctantly to the healthcare industry, but thanks to widespread demand from the government, payers, and consumers for improvement in coverage and care, it seems to be speeding up.

These five predictions represent a power shift in the world of healthcare, where new players emerge as forces to be reckoned with, and consumers gain greater control over their care. I predict, and hope, that 2015 will be the year when leaders across the healthcare spectrum will welcome innovation and embrace much-needed change.

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Connected Digital Health & Life's curator insight, May 24, 2015 3:33 PM

This is the business insight for digital health in the years ahead. Solve business problems and make money! A tad beyond just keeping people well!

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Major Health IT Events that Shaped 2014 - HITECH AnswersHITECH Answers

Major Health IT Events that Shaped 2014 - HITECH AnswersHITECH Answers | Healthcare and Technology news | Scoop.it

2014 was quite a year. Thinking back to December 2013, I cannot believe that so much has happened. Let’s take a look at the major HIT events that shaped 2014 and what they portend for 2015.

Affordable Care Act – despite challenges with healthcare.gov and state health insurance exchanges, the notion of moving forward with an open insurance marketplace and accountable care got traction. The IT needed to meet the needs of the patient centered medical home, the ACO, and Care Management spawned a new type of software – the care management medical record. Not many products exist and none are mature, but HIMSS was filled with promises of workflow engines, population health, and protocol driven care management tools. 2014 made it clear that the EHR is just a starting point and over time there will be a new generation of tools used by clinicians and non-clinician extenders to keep people healthy, not just record their encounters when they’re sick. Hopefully we’ll see maturing products in 2015.

Meaningful Use/Standards – 2014 was really the first year we could take a look back at the Meaningful Use program. I think we can conclude that Meaningful Use Stage 1 was generally perceived as a positive step, laying the foundation for EHR adoption by hospitals and professionals. Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee. At this point the only way out of the readiness/adoption challenge is to allow more time for the ecosystems to develop by changing the attestation period in 2015 to 90 days. Although Direct/CCDA was a reasonable starting point for 2014, the future belongs to FHIR/REST/OAuth, which are going to be much easier to implement. We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption.

HIPAA Omnibus Rule – 2014 saw increased federal and state enforcement of the HIPAA Omnibus Rule with record fines for security breaches at a time when the nature of security attacks became increasingly sophisticated – witness the Home Depot, JP Morgan, and Target breaches as well as denial of service attacks on numerous healthcare and non-healthcare organizations. Healthcare as an industry directed substantial resources toward improving the security protections of their networks in 2014. It will be interesting to look back at this era in several years and ask the question if million dollar fines for stolen laptops/smartphones was a helpful policy or if other enablers such as the evolution of security technologies and culture change were more effective.

ICD10 – ICD10 was delayed until October 1, 2015 and it’s clear that stakeholders are divided about the concept. One the hand, professional coders correctly identify that ICD9-CM is incomplete and does not include several important disease states. On the other hand ICD10-PCS is so complex that it is unlikely clinicians will not be able to produce the documentation needed to justify a code. The cost to the country post implementation in lost productivity will be enormous. If I could ask for a “do over” I would suggest that clinicians use SNOMED-CT to record clinical observations and that in a world of global capitated risk, not fee for service, the notion of using ICD for billing is no longer relevant. ICD was intended as an epidemiological classification, not a billing vocabulary. Only the United States uses ICD for billing and only the United States has proposed ICD10-PCS. 2015 will give us the next chapter in the debate.

In all industries, the concepts of social networking, mobile technology, analytics, and cloud hosting became increasingly important in 2014 for business and personal applications. Healthcare has been slow to adopt these techniques but increasing cost pressures and new business models are motivating healthcare IT departments to embrace cloud services. I believe that 2015 will be a tipping point, with increasing use of social networking concepts for care team communication, smart phones/tablets becoming the preferred tool for clinical work, real time decision support based on analysis of similar patients becoming mainstream, and cloud-based EHRs becoming essential for the agility of merging/changing organizations.

2014 was a year of increasing stress for CIOs, accelerating workflow change, regulatory burden, unquenchable demand for automation, and rapid technology evolution. 2015 may see less new regulatory requirements, more mature products in the marketplace, and an increased role for the private sector to innovate. As always, I remain optimistic for the future and am ready for the challenges ahead.

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5 top healthcare trends of 2014 | Healthcare IT News

5 top healthcare trends of 2014 | Healthcare IT News | Healthcare and Technology news | Scoop.it

For healthcare, 2014 proved a most pivotal year, replete with big regulatory happenings. This past year, hospitals struggled with Stage 2; they dealt with breaches, ACA enrollments and big population health initiatives. All in all, it was a busy year. But among all the happenings, there were five big healthcare trends that really set themselves apart in 2014. This according to a list compiled by market research firm Kalorama Information.    Among the top five biggest trends? No surprise here: Health IT made the cut.    Kalorama officials identified an industry interest in remote patient monitoring solutions and telemedicine as one of the top trends this year. In fact, according to the firm's 2013 telemedicine market analysis, the sector is poised for some serious triple digit expansion over the next few years. We're talking a whopping 237 percent growth in the market. In 2007, the world's telemedicine patient monitoring market was pegged at $4.2 billion. In 2012, that number more than doubled to $10 billion.   And, although, researchers consider the telemedicine market to be "small-to moderate" in size, with aging populations, rising healthcare costs and as more providers go digital, it won't stay that way. In fact, experts project it to reach $29 billion by year's end, growing at a rate of 9 percent over the next four years.    Another trend identified? Medical device companies are also growing, Kalorama officials pointed out. They're out buying up other companies, signifying some serious mergers and acquisitions for the industry. Big deals inked this year included Medtronic's $42.9 billion acquisition of Covidien.    Other 2014 trends included:

 
  • Next-generation DNA sequencing moves into clinical medicine: Personalized medicine is taking off, representing serious interest to using lower cost, expedient DNA sequencing for better understanding of disease and specific abnormalities
  • Demand for biopharmaceutical production: There remains a market demand for new pharmaceutical drugs to be created, driving the 11 percent revenue growth of the biopharm production market this year, where it reached a $41 billion value. 
  • BRIC growth good but not great: In terms of economic growth, BRIC nations saw faster growth that the U.S. market, but it has slowed down from previous years.


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