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Will Healthcare Interoperability Become The Next Health IT Mandate? 

Will Healthcare Interoperability Become The Next Health IT Mandate?  | Healthcare and Technology news | Scoop.it

Lack of healthcare interoperability continues to throw its weight in the road of progress, stopping much traffic in its tracks.

 

But you know that already, don’t you; you work in healthcare IT. That electronic health records lack the ability to speak with their counterpart systems is no surprise to you. In fact, it’s probably caused you a great deal of frustration since the first days of your system implementation.

From my perspective, things are not going to change very soon. There’s not enough incentive for vendors to work together, though they can and in many cases are able to do so. The problem, though, is that vendors are not sure how to charge physicians, practices, hospitals and healthcare systems for the data that is transferred through their “HIE-like” portals that would connect each company’s technology.

 

The purpose of this piece is not to diverge into the HIE conversation; that’s a topic for another day. However, this is a piece about what have recently been listed as the biggest barriers physicians face when dealing with the concept of interoperability.

According to a recent report by Internal Medicine News, “Technical barriers and costs are holding back electronic sharing of clinical data.”

 

The magazine cites a study in which more than 70 percent of the physicians said that their EHR was unable to communicate electronically with other systems. This is the definition of a lack of interoperability that prevents electronic exchange of information, and ultimately will fuel health information exchanges.

 

It is notable that 30 percent of physicians said that their EHRs are interoperable with other systems. That makes me wonder if this is a verified fact or perception only verified by a marketing brochure.

Another barrier, according to the report, is the cost of setting up and maintaining interfaces and exchanges to share information. According to this statement, physicians are worried about the cost of being able to transmit data, too, which puts them in line with vendors, who, like I said, are worried about how they can monetize data transfer.

 

An interesting observation from the piece: “Making progress on interoperability will be essential as physicians move forward with different care delivery models such as the patient-centered medical home and the medical home neighborhood.”

What amazes me about this conversation is that given the purported advantage employees gain from the mobile device movement and how BYOD (bring your own device) seems to increase a staff’s productivity because it creates an always-on mentality. I don’t think it’s a stretch to think the same affect would be discovered if systems were connected and interoperable.

An interoperable landscape of all EHRs would allow physicians and healthcare systems to essentially create their own always on, always available information sharing system that would look a lot like what we see in daily lives with the devices in the palm of our hands.

 

Apparently, everyone wants and interoperable system; it’s just a matter of how it’s going to get paid for. And moving the data and the records freely from location to location opens up the health landscape like a mobile environment does.

Simply put, this is one issue that seems to resemble our current political landscape: a hot button issue that needs to be addressed but neither side wants to touch the issue because no one wants to or is able to pay for it.

 

One of the problems with this approach is that if we wait long enough, perhaps interoperability also will be mandated and we’ll all end up on its hook.

 

So, let’s take a lesson from the mobile deice world and allow for a greater opportunity to connect healthcare data to more care providers on behalf of the patients and their outcomes.

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Going From Paper To Paperless 

Going From Paper To Paperless  | Healthcare and Technology news | Scoop.it
Can Your Office Truly Be A Paperless Office?

Although many of us dream of a truly paperless office, the reality is that our world still revolves in large part around information printed onto physical documents. And even with a sizable number of medical practices transitioning to electronic medical records every year, most have still not taken the plunge (and, at this rate, may never do so). So when correspondence is received from an ‘analog’ practice, that paperwork must be converted to a digital format.

 

I’ll discuss some options for scanning equipment below but it is important to realize that the physical act ofscanning is only part of the process of digitization of paper documents. A real person, usually with at least a basic clinical understanding, must categorize and organize the scanned files into their proper place: within the right patient’s chart, within the right folder, and perhaps with the right tags or labels.

Scanning options For Small Practices 

A small medical practice may be able to use a consumer level scanner. If you use EMR, you’ll need a way to get the scanned files into the patient records, and then someone will need to put the files in their proper place. These should be sheet-fed scanners, not the flat-bed type of scanners used for copying books and bulky objects; the latter would be painfully slow way to scan paper documents.

 

NeatDesk scanner  This is a nicely-designed scanner with included proprietary software that can scan documents, business cards, and receipts – using three different chutes – and automatically categorize them into different folders. If you don’t want to think too much when scanning, the software can do the work for you; however, I found it a little too inflexible.

 

Also, the auto image adjustment that straightens images that were scanned crooked is usually needed because the central rollers don’t consistently pull documents straight through. NeatDesk has recently added the ability to scan to Dropbox.

 

Fujitsu ScanSnap ix500 This has become my scanner of choice for the home office. It always pulls documents through straight and does so quickly. Unlike the NeatDesk, it does not have separate chutes for cards and receipts, so the guides have to be adjusted manually for those. But consistently straight scans makes up for that.

 

Another cool feature is the ability to scan directly to your phone or iPad via a wireless connection, in addition to Dropbox or email. I use this device to scan every piece of paper I receive, from bills to magazine articles to receipts (before shredding them).

Document scanning services

For those practices that are overwhelmed with the sheer volume of paperwork that needs to be scanned, the services of a document scanning company can be employed. They can be especially helpful in the beginning of EMR conversion, to give the practice a running start.

 

They can either simply scan paper documents into digital files or facilitate the actual conversion of paper patient charts directly into their electronic medical records. Some medical practices continue using their paper records and then scan them into a digital format at the end of each day, foregoing the EMR system altogether. While this is technically an electronic record of the document, realize that this is not a true electronic medical record system and thus would not qualify for Meaningful Use incentives.

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Wireless Monitoring During Labor Offers Patients More Mobility, Eases Burden For Nurses

Wireless Monitoring During Labor Offers Patients More Mobility, Eases Burden For Nurses | Healthcare and Technology news | Scoop.it

A study of wireless monitoring of inpatient pregnant women yielded results similar to usual care, and both patients and nurses approved of the program, according to research published in Telemedicine and e-Health.

 

The study involved 30 women at Massachusetts General Hospital who wore the wireless monitors for 30 minutes. Their heart rate, respiratory rate and core temperature were captured and transmitted to a central monitor.

 

During labor, vital signs traditionally are taken every 30 minutes during active labor and every 15 minutes following delivery, which can be labor-intensive for staff. Wireless monitoring can maintain surveillance yet ease that burden while allowing flexibility and mobility for patients.

 

Patients found the device--sensors attached to the chest with two standard adhesive electrodes--comfortable (78 percent), likeable (81 percent) and useful (97 percent). Nurses rated the system easy to use (80 percent) and 84 percent would recommend it to a patient.

 

In this study, repeaters were used to extend the range and ensure transmission throughout the labor and delivery unit.

 

"Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical," the researchers wrote.

 

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 Experience Digital Health Here.

 Experience Digital Health Here. | Healthcare and Technology news | Scoop.it

Digital health is experiencing what I would characterize as its adolescence.  The rudimentary pieces are in place for adoption; Awareness of the technologies, the progressing maturation of mobile technologies, realization of its critical need in the marketplace, interest by large companies (though with widely variable levels of commitment and material projects), and development of breakthrough technologies. Changes occur slowly in healthcare but they need to accelerate because of the increased urgency.  There was once a time when patients would refuse to see a physician assistant or nurse practitioner. These providers are now integral parts of the healthcare team and patients value them. I will now touch on missing puzzle pieces which, if addressed, can substantially impact the mission of digital health.

 

 

  1. Comprehensive and standardized telehealth laws. According to The National Business Group on Health’s 2016 Health Plan Design Survey (free with sign up)  employees can expect “…More resources and tools to help…navigate the health care system: Care shopping tools, care decision support resources, and telehealth.” This increased acceptance and expansion of telehealth services must be preceded by regulatory and legislative changes addressing payment and professional licensing issues. Telehealth itself speaks to society’s mobility, direct and indirect costs of in-person care, and healthcare professional shortages. The time has come for telehealth to become the norm and in-person visits to supplement this under-appreciated and underutilized modality of interaction.  The immediate expansion of telehealth into mainstream care by all payers, public and private is necessary.  Healthcare professional licensing reform is also necessary to decease the red tape and expenses of telehealth. Patient safety will benefit with the increased transparency of professional  conduct bought about with a Federal license.
  2. Wearables as remote monitoring. The utilization of remote patient monitoring (RPM) is increasing.  RPM has entered the spotlight as a means of decreasing hospital readmissions which now result in Medicare payment penalties. However, the benefits in this regard to have not been demonstrated on a large-scale and the success might very well be tied to other factors mentioned in this piece. In addition, the reduction of readmission rates has not translated to improved patient outcomes. The proliferation of wearable sensor technology in the consumer realm has accelerated exploration in the traditional healthcare market for this technology, yet there are substantial differences between these markets.  Bolstering interest in wearables by strange bedfellows as sports equipment companies and medical device manufacturers is the desire of the healthy aging population of baby boomers for unobtrusive monitoring technologies.  Wearables can easily fill that order but according to a  survey on wearables by AARP as part of a six-week trial, “…participants also said the devices’ design and utility are lacking in features that would encourage long-term use or adoption. The gap between expectations and reality indicates a significant opportunity to better serve the 50-plus market, the study concluded.”
  3. Better payer-enterprise partnerships driving needed sharing of analytics and data.As the healthcare payment model in the USA shifts from fee for service to value- based (which considers quality performance measures, outcomes, and patient satisfaction), the importance of data analytics becomes clear. We will see a shift of responsibility for the collection and analysis of patient and care management data from the payer to the provider. Analytics will be the best way a provider can track performance quality, efficiency, and interventions affecting patient outcome. This de-identified data will benefit both payers and providers and might ultimately become a commodity sold to multiple payers by providers. This scenario dovetails with the massive consolidation we are seeing in healthcare. It remains to be seen how this all benefits the patient/subscriber. However, the hope is that the more available and granular the data, the more transparent the costs of care vs outcomes might become.
  4. Incorporation of social media in healthcare. Social media is the most underutilized resource available to all stakeholders in healthcare. While there are understandable concerns and barriers to unbridled participation in social media by healthcare enterprises, payers, Pharma and other stakeholders, there remain huge opportunities to help patients and caregivers via social media which can direct them to other sources of disease-specific educational content. The current focus on population health management as public policy as well as basis for payment could greatly benefit from data derived from social media discussions on healthcare. How that is designed and processed is a potentially powerful collaborative project among many stakeholders including patients.

 

Plans for improvement of the current healthcare system must consider technology a critical component.  Public healthcare initiatives and market stresses require it. All of the asks above are doable now. It is up to patient advocates to demand them and decision makers to implement them.

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Healthcare Through The Looking Glass; Smarter Use Of IT

Healthcare Through The Looking Glass; Smarter Use Of IT | Healthcare and Technology news | Scoop.it

As a physician it pains me to say this, but the future of healthcare appears to be one of increasing consolidation of facilities, employment of physicians, and strategic staff reductions. It must also necessarily be a future work environment that is much better supported than it is today by technology.

 

As an industry, healthcare has been slow to transform itself with information communication technologies (ICT) as compared to other segments of the economy. Yes, the industry has made massive investments in information technology over the last few years thanks to an infusion of federal money to “digitize” our medical records. This was a necessary step, but by itself is hardly transformational. It’s what we do next that counts.

 

If you’ve been paying attention, you have likely noted an increasing number of large consolidations of hospitals, clinics and health systems around the country. If you are a practicing physician, you can’t help but notice how many practices, not only primary care physicians but specialists too, have been gobbled up by hospitals and health systems as they ring-fence their networks. If you’ve talked with newly graduating medical residents, you’ll note that nearly all of them are looking for the security, and perhaps more predictable lifestyle, of an employed position. These trends are irrefutable.

 

In the midst of all this, I’ve also been watching some financially strapped healthcare organizations begin to trim staff. While that might seem paradoxical in a time of increasing demand for healthcare services, it speaks to the cost constraints these organizations face as both private and public payors put the screws on reimbursement and start shifting from volume based payments to payments coupled to value.

 

So, if you are a leader of a healthcare organization faced with these shifting sands, where do you turn for help? How do you do more with less, or better said, how do you start doing new with less?

I won’t argue that more technology is the only solution, but I will certainly make a case that better, more efficient, more contemporary, and more strategic technology is absolutely essential to the future sustainability of any healthcare organization.

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5 Amazing Health IT Trends In 2016 

5 Amazing Health IT Trends In 2016  | Healthcare and Technology news | Scoop.it

As we look back upon 2015, we can reflect, review and based on that and other factors, make some predictions about what next year will bring us. John Halamka had an interesting postthat reflect on the bigger challenges, such as ICD-10, the Accountable Care Act and its implications on data analytics, the HIPAA omnibus rule and its impact on cybersecurity and audits and the emergence of the Cloud as a viable option in healthcare. We can expect to see some of these trends continue and grow in 2016. So based on these key learnings from 2015, here are a few predictions for 2016.

 

 

Cybersecurity will become even more important

 

In 2015, insurers and medical device manufacturers got a serious wake up call about the importance and cost of cybersecurity lapses. Healthcare data will increasingly be looked at as strategic data because we can always get a new credit card but since diagnoses cannot change, the possibilities of misuse are significant. Just as the financial industry has settled on PCI as the standard, expect the healthcare industry to get together to define and promote a standard and an associated certification. HITRUST appears to be the leader and recent announcements are likely to further cement it as the healthcare security standard. Given all that, one can safely expect spending on cybersecurity to increase.

 

 

IoT will get a dose of reality

 

The so-called Internet of Things has been undergoing a boom of late. However, the value from it, especially as applied to quantifiable improvement in patient outcomes or improved care has been lacking. Detractors point out that the quantified-self movement while valuable, self selects the healthiest population and doesn’t do much to address the needs of older populations suffering from multiple chronic diseases. Expect to see more targeted IoT solutions such as that offered by those like Propeller Health that focus on specific conditions, have clear value propositions, savings, and offer more than just a device. Expect some moves from Fitbit and others who have raised lots of recent cash in terms of new product announcements and possible acquisitions.

 

 

Interoperability will become a business requirement

 

No matter the point of view on value or benefits of EHRs, the fact remains that EHRs are here to stay. And because the information is now electronic, the promise of easy data exchange should be a reality. That is, however, not the case. Realizing that EHRs cannot solve all problems, health systems anticipate working with external vendors to fill the “white space” in the EHR solution suites. This implies that integration is now a business requirement. Add to it innovations like outcomes based agreements between pharma companies and health systems, and the evolution of modern approaches such as FHIR, 2016 is likely to be the year of significant progress in interoperability.

 

 

Telemedicine will grow rapidly

 

With a looming shortage of general physicians and the uneven distribution of specialists across the country, telemedicine has a clear value proposition. And its flexibility allows for it to be applied to acute conditions such asstroke, simpler conditions such as flu and strep, specialities such as dermatology, pediatrics and even private conditions such as sexually transmitted infection (STI.) Millennials are comfortable with this approach, so are seniors and others with more severe conditions who don’t want to trek to the nearest hospital for care.

 

 

Specialty EHRs will boom

 

This YouTube video is hilarious and a simultaneously sad, but perception of the impact that EHR implementations have had on care. Physicians and nurses aren’t fans of EHRs despite being the target audience. A one-size-fits all approach to product development and a primary focus on billing rather than patient care is at the root cause of this problem. Innovative companies have taken this fight on but intelligently, have focused their attention on creating EHRs tailor made to specialties such as dermatology, plastic surgery, pain management etc. Since these are significant revenue drivers for health systems and the specialists using it swear by them, we can expect adoption to boom in 2016. This will also lead to increased demand around interoperability and the ability to connect to any EHR via API.

Healthcare is a $2.1 trillion industry so the above should obviously be considered only a small set of possible trends in healthcare IT, but things like interoperability and security have wide ranging implications. Those two in particular will be universally applicable across all of healthcare.

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10 Ways Document Viewing and Conversion Technologies Improve Healthcare IT Efficiency

10 Ways Document Viewing and Conversion Technologies Improve Healthcare IT Efficiency | Healthcare and Technology news | Scoop.it

It’s rare to find an organization where document management doesn’t play a major role in day-to-day operations, and healthcare is no exception. Advancements in patient record technology have revolutionized how healthcare systems operate and have greatly improved patient information sharing between different physicians, departments and even disparate organizations.

 

 

With recent HIPAA regulations and the impending Health Information Technology for Economic and Clinical Health (HITECH) mandates, which require electronic health records (EHR) adoption by 2015, the focus on technology in the healthcare space will only get stronger in the coming months, as more and more organizations put measures in place to achieve compliance.

 

 

Currently, typical phases of the document lifecycle (capturing, viewing, processing and archiving) carry significant costs in terms of both time and software investment. Integrating powerful document viewing and conversion technologies can help healthcare organizations avoid these costs and streamline every phase of the document lifecycle.

 

 

And because these technologies can be easily integrated into existing electronic content management systems, companies can enjoy these workflow improvements without investing in additional infrastructure. Below are just 10 of the ways that viewing and conversion solutions can improve workflow efficiency for healthcare IT.

 

 

From the E.R. to the pharmacy, view any document you need:

 

Successfully viewing the myriad different file types generated in the healthcare setting can be challenging to say the least. Sophisticated document viewing solutions address this challenge by supporting and providing access to virtually any document or image format (Word, Excel, DICOM, PDF, AFP, TIFF, JPEG, PNG and many more) and can be utilized on a variety of platforms (HTML5 web viewer, Windows .NET, and Java). 

 

 

Eliminate deliverability issues because of platform restrictions:

 

Organizations can reduce installation issues and support costs by avoiding the need to download and install cumbersome clients with a browser-based, HTML5 document viewer. Making documents and images viewable via any web browser regardless of operating system allows for seamless cross-platform support and trouble-free processing.

 

 

Get only what you Need:

 

Scrolling through large documents downloaded from a remote server can slow down workflow and impede efficiency. Page on Demand document viewing technology eliminates these issues, equipping web viewers with the ability to download only the relevant portions of a document within seconds. A doctor can download notes from a visit when you had the flu in 2001, instead of your entire medical chart from 2000-2013. 

 

 

Update and add forms:

 

Page manipulation support makes it easier for users to create and modify server-based documents from the client. Users across an enterprise can add, delete, and move pages—all while preserving the original files and saving newly created documents back to a repository or forwarding them along as part of the workflow process.

 

 

Leave your two cents:

 

The typical collaboration process of authoring, sharing, reviewing, editing and approving documents can be time-consuming and tedious. With annotation capabilities, users can expedite this process by adding or removing notes and mark-ups as the document moves across the enterprise. A variety of annotation types (rubber stamps, sticky notes, etc.) make this communication and collaboration easy.

 

 

Redact content securely:

 

It’s important for an organization to share information while also protecting sensitive content based on security standards and user permissions. Redaction technologies enable users to redact confidential data, like credit card information and social security numbers, to ensure sensitive document data is removed before it changes hands throughout the organization. 

 

 

Search documents quickly:

 

The ability to search text is essential for quickly accessing critical information and speeding up the workflow process. A server-based search provides enterprises with powerful capabilities, allowing users to efficiently navigate through text-based documents (Microsoft Office, PDF, AFP, and PCL) displaying only pages with matching results. For example, users can easily scan for any instance when a certain drug was used or be able to check if a patient has ever received a certain type of vaccine. This cuts down on time wasted sorting through multiple files, or worse, missing an important document entirely.

 

 

Save to a wide variety of formats:

 

From dentists to primary care to physical therapy, total healthcare incorporates a variety of disparate offices, all of which store documents in a diverse range of file formats. It’s important for users to not only be able to view numerous file types, but also be able to convert and save files to a variety of mission-critical output formats like JPEG, TIFF, PDF, PNG, and AFP.

 

 

High-speed image and document conversion:

 

While a powerful viewing solution can often satisfy document management requirements, sometimes batch conversion of files is needed when an organization moves to a new document storage system. For companies with large repositories, this can often be an expensive and tricky process. A reliable, high-speed image and document conversion solution allows an organization to safely convert and archive millions of files to a specified output like TIFF or PDF. 

 

 

Easily retrieve archival documents and images:

 

Many organizations have large archives of legacy documents (like AFP, PCL, or proprietary TIFF) from old content systems that they have since jettisoned. The files still contain critical information, but unfortunately often cannot be read with standard office document software. With the right viewing or conversion technology, an organization can easily view the legacy format or convert it to a more modern format like PDF. This allows users to easily keep X-Rays and medical notes all in one easy to access place.

 

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Researchers Take 'First Baby Step' Toward Anti-Aging Drug – WebMD

Researchers Take 'First Baby Step' Toward Anti-Aging Drug – WebMD | Healthcare and Technology news | Scoop.it

Researchers could be closing in on a "fountain of youth" drug that can delay the effects of aging and improve the health of older adults, a new study suggests.

Seniors received a significant boost to their immune systems when given a drug that targets a genetic signaling pathway linked to aging and immune function, researchers with the drug maker Novartis report.

The experimental medication, a version of the drug rapamycin, improved the seniors' immune response to a flu vaccine by 20 percent, researchers said in the current issue of Science Translational Medicine.

The study is a "watershed" moment for research into the health effects of aging, said Dr. Nir Barzilai, director of the Institute for Aging Research at Albert Einstein College of Medicine in New York City.

Rapamycin belongs to a class of drugs known as mTOR inhibitors, which have been shown to counteract aging and aging-related diseases in mice and other animals.

Barzilai, who wasn't involved in the study, said this is one of the first studies to show that these drugs also can delay the effects of aging in humans.

"It sets the stage for using this drug to target aging, to improve everything about aging," Barzilai said. "That's really going to be for us a turning point in research, and we are very excited."

The mTOR genetic pathway promotes healthy growth in the young. But it appears to have a negative effect on mammals as they grow older, said study lead author Dr. Joan Mannick, executive director of the New Indications Discovery Unit at the Novartis Institutes for Biomedical Research.

When drugs like rapamycin are used to inhibit the effects of the mTOR pathway in mice, they "seem to extend lifespan and delay the onset of aging-related illnesses," Mannick said.

Mannick and her colleagues decided to investigate whether a rapamycin-like drug could reverse the natural decline that elderly people experience in their ability to fight off infections.

In the clinical trial, more than 200 people age 65 and older randomly received either the experimental drug or a placebo for several weeks, followed by a dose of flu vaccine.

Flu is particularly hard on seniors, with people 65 and older accounting for nine out of 10 influenza-related deaths in the United States, according to background information provided by the researchers.

Those who received the experimental version of rapamycin developed about 20 percent more antibodies in response to the flu vaccine, researchers found. Even low doses of the medication produced an improved immune response.

The researchers also found that the group given the drug generally had fewer white blood cells associated with age-related immune decline.

Mannick called this study the "first baby step," and was reluctant to say whether it could lead to immune-boosting medications for the elderly.

"It's very important to point out that the risk/benefit of MTOR inhibitors should be established in clinical trials before anybody thinks this could be used to treat aging-related conditions," she said.

Barzilai was more enthusiastic. Research such as this could revolutionize the way age-related illnesses are treated, he said.

"Aging is the major risk factor for the killers we're afraid of," he said, noting that people's risk for heart disease, cancer and other deadly illnesses increases as they grow older. "If the aging is the major risk, the way to extend people's lives and improve their health is to delay aging."

Until science focuses on aging itself, "you're just exchanging one disease for another," Barzilai said. For example, he said, a person receiving cholesterol-lowering treatment to prevent heart disease likely will instead fall prey to cancer or Alzheimer's disease.


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Getting Value From Technology In Healthcare Is All About People

Getting Value From Technology In Healthcare Is All About People | Healthcare and Technology news | Scoop.it

It was Steve Ranger’s piece on “Predicting the next decade of tech: From the cloud to disappearing computers and the rise of robots”. For anyone interested in technology, it’s a good read. I particularly enjoyed the back half of the article and its focus not on the predicted hardware and software breakthroughs of the next decade, but rather on what is all too often forgotten–how people factor into the equation.

 

I won’t belabor the technology predictions. Those are well enumerated in the ZDNET article complete with the obligatory Gartner Hype Cycle. But I do want to elaborate a bit on the human factors. The article quotes one of my Microsoft colleagues, Dave Choplin, who holds the title of chief envisioning officer. He says, “What we really need to figure out is the relationship between humans and technology, because right now humans get technology massively wrong.” He goes on to reflect on the fact that most people use technology to do things the way we’ve always been doing them. He says the point of new technology is to enable us to “do things fundamentally differently”.

 

While the focus of the ZDNET article isn’t about healthcare, I find what is being said is perhaps more true of healthcare professionals and the healthcare industry than perhaps most other sectors of the economy. In healthcare right now, the very ground underneath those who work in the industry is shaking violently. Clinicians are being asked to improve quality, see more patients, and lower the costs of care. Payment systems are shifting away from volume (getting paid for what you do) to value (getting paid for the quality outcomes you achieve). That means clinicians must be able to measure every thing they do and continuously improve upon it without adding to cost. The only way to do that is to also improve workforce productivity, and that likely involves an increasing reliance on technology. However, as Mr. Choplin points out, most people think productivity is just about improving processes when instead it should really be leading us to better outcomes.

 

I’ve been saying for some time now that information technology has matured to the point where it can actually add tremendous value in health and healthcare. It’s far from perfect, of course, but I don’t think it is technology that holds us back. What holds us back are the human factors. As stated by ZDNET, “the big stumbling block to IT’s bright future in any organization is their own staff and their ways of working. Figuring out where to invest in technology is a lot easier than persuading staff, and whole organizations, to change how they operate.” I find that particularly true in healthcare and especially for physicians. We spend our young adulthood immersed in the scholarly pursuit of a medical degree. We take four or more years in specialty training. We are indoctrinated in how to approach the patient, assimilate information, organize our thoughts and reach a diagnosis.

 

It’s all about following a certain process, a definitive kind of workflow. And, all too often today when we deploy technology into clinical workflow we are using it simply to “do things the way we’ve always been doing them” instead of doing things “fundamentally differently”.

Fortunately, many healthcare organizations around the world are beginning to use technology to do things differently. They are getting value from the digital data they are capturing by applying advanced analytics to deliver actionable insights to patient care. They are embracing mobile devices and applications to improve clinical workflow.

 

They are applying universal communications technologies to deliver care outside the walls of the organization. They are using these same technologies to train healthcare professionals how to think and do things differently, including how technology can improve the ways care teams communicate and collaborate. They are embracing cloud technologies to streamline IT resources and focus more of those limited resources on that which healthcare systems are all about—providing care to patients and increasingly, focusing on ways to improve population health and disease prevention.If you are deploying technology in your healthcare organization, ask yourself first if your people are ready.

 

If they are not, you are setting the stage for failure. Getting value from technology goes hand in hand with having a workforce that has been well prepared and is ready to improve the changes that technology will bring about. 

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Improving Health & Healthcare, A Global Perspective

Improving Health & Healthcare, A Global Perspective | Healthcare and Technology news | Scoop.it

If you live in America and work in the healthcare industry it is easy to assume that the issues we face in providing care to our population are uniquely American. While it is true that we spend more per capita on healthcare than other nations, and many would argue that we spend too much for what we get in return compared to other nations, our problems are anything but unique.

 

In my role at Microsoft I travel the world engaging with healthcare executives, clinicians, health ministries, government leaders and others who focus on health and healthcare. When I’m not traveling, I’m meeting with people in similar roles at our executive briefing center in Redmond. It doesn’t matter whether I’m in discussions with someone from Singapore, Sweden, Korea, Indonesia, Australia, or Japan; I hear the same themes over and over again.

 

Only the scale is different. It doesn’t matter whether a nation is spending 4 percent of GDP on health as they do in Singapore, or nearly 20 percent as we do in the U.S., industry leaders and executives tell me they must figure out how to provide their populations with greater access to care, while improving the quality of care, and lowering the costs. The only nuance is sometimes additional emphasis, as I hear from places like Singapore or Japan, on extra pressures coming from a rapidly growing population of elderly persons in countries with low birth rates and little immigration.

 

While technology alone does not address every issue on the plate, these same leaders are very focused on ways to leverage new technologies in their quest to achieve the so-called triple aim of access, quality and lower costs. In America, it seems most of the focus these past few years has been on “digitization” of health information via electronic health records and hospital information systems. Many countries I visit in Western Europe and Asia accomplished this “digitization” some years ago. They already know what we in America are slowly beginning to appreciate, that electronic records only lay a foundation for health and healthcare delivery system transformation.

 

The real transformation begins to happen when we use all that digital information we are capturing to inform us, and provide actionable insights to improve the quality of the care delivered by our health systems. Equally important is technology that improves access to information and care, as well as mobile technologies that improve clinical workflow and productivity. Finally, we must find ways to reduce the cost of technology (computing and storage) while making it ever more scalable, private, secure and compliant.

 

If you follow the industry (both tech and healthcare) as I do, you are fully aware of the investments being made that will help us truly transform and modernize health and healthcare delivery.

 

It’s a big job that involves making deep investments in massive data centers and “cloud” computing, analytics & business intelligence, universal communication and collaboration tech, mobile devices, wearable sensors, artificial intelligence, machine learning, machine vision, robotics, and health industry research. That is why almost every day you hear about a new startup or a well established company making health and healthcare a focus of their business. Some of the names you already know, other names are yet to be created.

 

One thing is for sure. Improving health and healthcare is a global mission with very similar themes no matter where you live. If I’ve learned anything during my tenure at Microsoft it is how that fact rings true around the globe.

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Myth, Truths & Trends In Health IT For 2016 

Myth, Truths & Trends In Health IT For 2016  | Healthcare and Technology news | Scoop.it

There is a floating myth out there that healthcare providers are unwilling to adopt new technology. It's just not true. In the last few months, I have spoken to dozens of healthcare leaders at hospitals small and large, and I am amazed at their willingness to understand and adopt technology.

 

Pretty much every hospital CEO, COO, CMIO or CIO I talk to believes two things:

 

They have to do more with less. With growing demand, rising costs and constrained supply, healthcare is facing a looming crisis unless providers figure out how to "do more with less."

Technology is a key enabler. The technology is out there to help save more lives, deliver better care, reduce costs and achieve a healthier America. If a technology solution solves a real problem and has a clearly articulated ROI, healthcare isn't that different from any other industry and is willing to adopt it.

Given my conversations, here are the five biggest IT trends I see in healthcare going forward:

 

1. Consumerization of the EHR. Love it or hate it, the EHR sits at the center of innovation. Since the passage of the HITECH Act in 2009 – a $30 billion effort to transform healthcare delivery through the widespread use of EHRs – the "next generation" EHR is becoming a reality driven by three factors:

  • Providers feeling the pressure to find innovative ways to cut costs and bring more efficiency to healthcare delivery
  • The explosion of "machine generated" healthcare data from mobile apps, wearables and sensors
  • The "operating terminal" shifting from a desktop to a smartphone/tablet, forcing providers to reimagine how patient care data is produced and consumed

 

The "next generation" EHR will be built around physician workflows and will make it easy for them to produce and consume data. It will, of course, need to have proper controls in place to make sure data can only be accessed by the right people to ensure privacy and safety. I expect more organizations will adopt the "app store" model that Kaiser pioneered so developers can innovate on their open platform.

 

2.Interoperability. Lack of system interoperability has made it very hard for providers to adopt new technologies such as data mining, machine learning, image recognition, Internet of Things and mobile. This is changing fast:

  • HHS's mandate for interoperability in all EHRs by 2024, so patient data can be shared across systems to enable better care at lower cost.
  • HITECH incentives and the mandate to move 50 percent of Medicare payments from fee-for-service to value-based alternatives by 2018 imply care coordination, and therefore, interoperability will become imperative.
  • Project Argonaut, an industry-wide effort to create a modern API and data/services sharing between the EHR and other systems using HL7 FHIR, has already made impressive progress.
  • More than 60 percent of the proposed Stage 3 meaningful use rules require interoperability, up from 33 percent in Stage 2.

 

3. Mobile. With more than 50 percent of patients using their smartphone to monitor health and more than 50 percent of physicians using or wanting to use their smartphone to monitor patient health – and seamless data sharing on its way –the way care is delivered will truly change.

Telemedicine is showing significant gains in delivering primary care. We will continue to see more adoption of mobile-enabled services for ambulatory and specialty care in 2016 and beyond for three reasons:

  • Mobile provides "situational awareness" to all stakeholders so they know what's going on with a patient in an instant and can move the right resources fast with the push of a button.
  • It radically reduces communication overhead, especially when you're dealing with multiple situations at the same time with urgency, and communication is key.
  • It can significantly improve the patient experience and reduce operating costs. Studies have shown that remote monitoring and mobile post-discharge care can reduce readmissions and unnecessary admissions significantly.

The key hurdle here is regulatory compliance. For example, auto-dialing 9-1-1 if a phone detects a heart attack can be dangerous if not done right. As with the EHR, mobile services have to be designed around physician workflows and pass regulatory compliance.

 

4. Big data. Healthcare has been slower than verticals like retail to adopt big data technologies mainly because the ROI has not been very clear to date. With more wins on both the clinical and operational sides, that's clearly changing. Of all the technology capabilities, big data can have the greatest near-term impact on the clinical side and operational side for providers and will be one of the biggest trends for 2016 and beyond. Successful companies providing big data solutions will do three things right:

  • Cleanup data as needed: There's lots of data, but it's not easy to access it and not quite primed "or clean" for analysis. There's only so much you can see, and you spend a lot of time cleansing before you do any meaningful analysis.
  • Meaningful results: It's not always hard to build predictive analytic models, but they have to translate to results that enable evidence-based decision-making.
  • Deliver ROI: There are a lot of products out there that produce 1-2 percent gains; that doesn't necessarily justify the investment. 

5. Internet of things. While hospitals have been a bit slow in adopting IoT, three key trends will shape faster adoption:

  • Innovation in hardware components (smaller, faster CPUs at lower cost) that create cheaper, more advanced medical devices, such as a WiFi-enabled blood pressure monitor connected to the EHR or RTLS for smoother patient care coordination.
  • General purpose sensors are maturing and becoming more reliable for enterprise use.
  • Devices are becoming smart, but making them all work together is painful. It's good to have bed sensors that talk to the nursing station, and they will become part of a top level "platform" within the hospital. More sensors also means more data, and providers will create a "backend platform" to collect, process and route it to the right place at the right time and create "holistic" value propositions.
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Developing An App Or Solution For The Healthcare Enterprise?

Developing An App Or Solution For The Healthcare Enterprise? | Healthcare and Technology news | Scoop.it

Over the years, I’ve worked with dozens of startups as well as established companies that focus on developing apps and IT solutions for the healthcare industry. I’m always amazed, particularly in the startup world, how naïve developers sometimes are about very basic business principles.

 

A common example is how often bright young developers confuse a great idea with something that can actually be monetized. This is especially true in the healthcare industry where so many good ideas die because they just don’t fit well in clinical workflow, or because they are viewed as so disruptive that clinicians won’t embrace them. Then too, there are the rather unique business and reimbursement models in healthcare that don’t follow the usual rules of supply and demand. It is often very hard to figure out who pays, when and why in healthcare.

 

Add to all of this the unique privacy, security and regulatory mandates in the industry and you have an unruly mix of obstacles, behaviors, and cultures that must be tamed if you hope to develop a sustainable, scalable, mobile app or IT solution for the healthcare industry.

 

In a recent article in HealthcareITNews, Sherree Geyer explores the status of some mobile apps and other IT solutions in healthcare. While there’s plenty of action in the enterprise healthcare mobile app space, the proof points for many of these apps on scalability, efficacy and safety remain to be seen. Scientific proof is an obstacle that must be overcome for any company developing solutions that touch enterprise healthcare and patients. Proving that what you offer can improve care quality, safety, or lower costs in clinical care settings requires disciplined, and often costly studies. In clinical medicine there just aren’t any shortcuts for this.

 

So, what’s a developer to do? For starters, pay attention to the rules and be prepared to buckle down and do the hard stuff. If you do, the rewards can be immense.

 

In the HealthITNews article, Dr. Andrey Ostrovsky, CEO of a company that has developed an app-base care coordination system for the health industry, offers some sage advice to those who purchase health

IT apps and solutions for the enterprise. He says such technology should:

 

  • be evidence-based
  • validate quality improvement claims within six months of deployment;
  • support National Quality Forum Committee measurements;
  • produce positive outcomes for reimbursement;
  • identify risk factors for patients;
  • improve workforce quality and satisfaction;
  • be platform agnostic;
  • adhere to interoperability standards;
  • sustain long-term supports and services and
  • provide technical assistance for baseline capacity.

 

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The Medical Technologies That Are Changing Health Care

The Medical Technologies That Are Changing Health Care | Healthcare and Technology news | Scoop.it

Not long ago, people started wearing wristbands that recorded the number of steps they took, their heart rates and sleep cycles. But if the now-ubiquitous bands and accompanying apps that stored biorhythms started out as novelties, they paved the way for a new generation of gadgets that have become serious tools to improve health care delivery and outcomes. These newfangled contraptions will change how and where care is delivered and will enable providers to stay continuously connected with patients wherever they may be — or at least connected to the devices that indicate whether a patient is abiding by prescription protocols, getting up and about safely, and eating regularly. In some cases, they may even provide an early-warning system for serious degenerative conditions like Alzheimer’s and Parkinson’s disease.

 

The scope of these emerging technologies is breathtaking. High-tech sensors soon will monitor the at-home cardiac patient’s heart every minute of every day. A new type of chip, embedded in a pill will be activated at the precise moment it reaches a patient’s stomach, and will confirm for the medical record that he’s taking his medications. Straight out of science fiction, new gizmos will emerge that can scan a body for a host of symptoms without poking or prodding and, in seconds, they’ll make a diagnosis.

 

They may sound futuristic, but many of these devices already exist and, in fact, are being supplanted by a new generation of products that do it all faster and better.

 

For instance, wearable techno patches now can monitor a person’s heart rate, body temperature and other vital signs — a big leap over monitors that have to be hooked up — and their results read by the patient. The data are more robust and valuable because the patches provide “continuous monitoring instead of taking a periodic snapshot,” says Sean Chai, director of innovation and advanced technology services at Kaiser Permanente.

 

Another sensor under development will be capable of reading biomarkers, blood-borne chemical clues that signal the levels of stress and anxiety, which can affect health as much as disease, diet and daily activity do. If the stress-level data can be synchronized with vitals such as pulse and blood pressure, a patient will receive personalized feedback on what makes her tense and which relaxation techniques work for her. Steven Steinhubl, M.D., who directs the digital medicine program at Scripps Translational Science Institute, San Diego, calls this aid to stress control “the most exciting aspect of wearables, and I’m convinced it will happen. There are a lot of hurdles to overcome before it becomes extremely functional, but the capability is remarkable.”

Heart failure

This is Medicare’s most costly diagnosis, and the mortality rate is comparable to a new cancer diagnosis. The Scripps institute is testing three types of sensors — necklace, wristband and watch — that give both the patient and the care team continuous information on how a compromised heart is functioning. Medications can be adjusted and dietary recommendations can be made in real time that are specific to the individual. The sensors replace once-daily routines such as measuring a patient’s weight for signs of water retention, an indirect rather than direct measure of heart function.

 

Medication compliance

An ingestible — and digestible — sensor is being rolled out to record whether and when a patient takes a medication. Developed by Proteus Digital Health, London and Redwood City, Calif., the chip uses gastric fluids as a power source, which means it turns on when it reaches the stomach. The sensor transmits the identity of the medication and the time it was taken to a skin patch, which then sends that info to an app on the patient’s mobile device. The patch also detects and transmits heart rate, activity and rest.

3-D printing

Every geek’s jaw dropped at the sight of the 3-D printer when it first came to market. These days, medical researchers are harnessing its potential to vastly improve patient care. For example, Kaiser Permanente’s Los Angeles Medical Center is perfecting the use of 3-D printers to produce exact, multidimensional models of trouble spots inside patients. Surgeons can scrutinize and handle the models, then simulate a variety of possible procedures before ever going into the operating room.

 

The innovation “allows us to develop a more specialized, personalized, precise treatment plan,” Chai explains. “Ultimately, that improves the quality and affordability of care.” The patient, by the way, came through the procedure fine and is recovering.

The potential and how to reach it

Much of the emerging technology is aimed at getting inside the body without actually goinginside it. “There is already significant interest in noninvasive data acquisition, whether that’s light imaging or infrared or sound waves,” says Peter Reinhart, director of the Institute for Applied Life Sciences, University of Massachusetts, Amherst.

 

Longer-range research is focused on capturing much more sophisticated information than current products can, Reinhart says. A promising example is a patch that uses a combination of electrical and chemical signals to identify either the predisposition to or the existence of a particular disease.

 

The promise of personalized medicine to meet the unique needs of individuals depends on establishing baselines for each patient. To assess anxiety, for example, “One person’s stressor is another person’s idea of just an average day,” Reinhart says. “So just differentiating across individuals will be huge.”

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The Medical Internet of Things: What You Need to Know

The Medical Internet of Things: What You Need to Know | Healthcare and Technology news | Scoop.it

Gartner has estimated that some 6.4 billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. There’s been a clear boom in health and fitness wearables, with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement – and the MedTech industry has jumped on this in a big way.

 

Fascinating IoT applications are being developed today, often through unlikely partnerships. For example, medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. And Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients. These are exciting examples of how technology and analytics can support personalized medicine.

 

 

However, there are a couple of big issues that the IoT movement has to contend with when it comes to the Medical Internet of Things (IoT). These issues concern us as consumers, and they also concern our employers and our healthcare providers equally.

 

 

Data security:

 

The medtech industry is widely seen as unprepared for the security risk and vulnerability to hacking that their devices can cause for the rest of the healthcare system. This has im

Gartner has estimated that some 6.4 billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. There’s been a clear boom in health and fitness wearables, with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement – and the MedTech industry has jumped on this in a big way.

 

Fascinating IoT applications are being developed today, often through unlikely partnerships. For example, medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. And Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients. These are exciting examples of how technology and analytics can support personalized medicine.

 

 

However, there are a couple of big issues that the IoT movement has to contend with when it comes to the Medical Internet of Things (IoT). These issues concern us as consumers, and they also concern our employers and our healthcare providers equally.

 

 

Data security:

 

The medtech industry is widely seen as unprepared for the security risk and vulnerability to hacking that their devices can cause for the rest of the healthcare system. This has immediate repercussions for consumers who may be unaware of the exposure of their personal medical information to cybercriminals. In addition, as healthcare providers start using medical information from these interconnected devices in a cloud-based environment, their enterprise IT, specifically electronic health record (EHR) systems, could be seriously compromised and vulnerable to hackers. And this brings us to the other, emerging issue that is beginning to get some attention in the exchange of IoT data.

 

 

Privacy and legal concerns:

 

While there are undisputable benefits for healthcare consumers as physicians gain access to medical information from a range of connected devices, there is a real threat to privacy as well. We start with the question of who owns the data. State law in the U.S varies when it comes to this question, and device makers and other software providers may lay claim to the data which can be used against consumers. At the same time, collecting personal data through devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.

 

Many healthcare providers are leery of collecting any IoT data because of a combination of these factors. In my recent conversations with CISO-level executives, I sensed a real concern around the potential for these connected devices to do harm to enterprises through cyberattacks. In addition, there may be unexpected consequences of collecting this data, such as employers being held accountable for wrongfully using the data in termination-related lawsuits.

 

Increasingly, these complex issues are drawing the attention of regulators who are mandated to protect consumer interests and safeguard privacy. Indeed, this may cause a dilemma to medical device manufacturers who want to provide consumers with a rich experience on the one hand but also need to comply with FDA rules and complex requirements. The recent case of FDA intervention in the case of lab test company Theranos is also a cautionary tale for companies looking to play “fast and loose” with new technologies that may put consumers at risk.

 

 

Eventually, all these challenges will need to be overcome, simply because the potential benefits of using IoT data for improving health and wellness far exceed the downsides and risks. However, the challenge we face is that technology is evolving at an explosive pace and the regulatory and legal infrastructures are unprepared for the sudden increase in complexity that all this causes. We are going to see very interesting times ahead.

mediate repercussions for consumers who may be unaware of the exposure of their personal medical information to cybercriminals. In addition, as healthcare providers start using medical information from these interconnected devices in a cloud-based environment, their enterprise IT, specifically electronic health record (EHR) systems, could be seriously compromised and vulnerable to hackers. And this brings us to the other, emerging issue that is beginning to get some attention in the exchange of IoT data.

 

 

Privacy and legal concerns:

 

While there are undisputable benefits for healthcare consumers as physicians gain access to medical information from a range of connected devices, there is a real threat to privacy as well. We start with the question of who owns the data. State law in the U.S varies when it comes to this question, and device makers and other software providers may lay claim to the data which can be used against consumers. At the same time, collecting personal data through devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.

 

Many healthcare providers are leery of collecting any IoT data because of a combination of these factors. In my recent conversations with CISO-level executives, I sensed a real concern around the potential for these connected devices to do harm to enterprises through cyberattacks. In addition, there may be unexpected consequences of collecting this data, such as employers being held accountable for wrongfully using the data in termination-related lawsuits.

 

Increasingly, these complex issues are drawing the attention of regulators who are mandated to protect consumer interests and safeguard privacy. Indeed, this may cause a dilemma to medical device manufacturers who want to provide consumers with a rich experience on the one hand but also need to comply with FDA rules and complex requirements. The recent case of FDA intervention in the case of lab test company Theranos is also a cautionary tale for companies looking to play “fast and loose” with new technologies that may put consumers at risk.

 

 

Eventually, all these challenges will need to be overcome, simply because the potential benefits of using IoT data for improving health and wellness far exceed the downsides and risks. However, the challenge we face is that technology is evolving at an explosive pace and the regulatory and legal infrastructures are unprepared for the sudden increase in complexity that all this causes. We are going to see very interesting times ahead.

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Apple's CareKit as an enabler for patient-generated healthcare data

Apple's CareKit as an enabler for patient-generated healthcare data | Healthcare and Technology news | Scoop.it

As we move from fee for service to alternative payment models/value-based purchasing we will increasingly measure our progress based on outcomes and total medical expense.

HealthKit was an enabler that led Beth Israel Deaconess to create BIDMC@Home, an iPhone and iPad app that uploads internet of things (blood pressure cuff, glucometer, scale, activity, sleep data etc.) to our electronic health record.

CareKit, announced by Apple this week, takes us one step further on our wellness-focused journey.

[Also: Apple unveils CareKit health tracking platform, first app is for Parkinsons]

Our vision is that objective data such as weight and blood pressure needs to be combined with subjective data such as activities of daily living, mood, and adherence to care plans in order to create a true measure of outcome.

If you take your beta blocker for blood pressure control but feel listless and unmotivated, that is not a good outcome.

Apple’s middleware (HealthKit, ResearchKit, CareKit) has enabled us to connect devices in BIDMC patient homes and this summer will enable us to collect answers to clinician generated questionnaires with dashboarding of the subjective and objective combined results.

We believe that mobile devices such as iPhones will become the predominant means by which patients interact with BIDMC. Your phone will be the repository of your medical record, the means by which you collaborate with your provider, and the vehicle for submission of data to your care team.

Today, 80 percent of all BIDMC publicly available resources (websites, portals) are accessed via mobile devices. The desktop is dead. The phone is the future.

Kudos to Apple for enabling simple integration of devices in the home, collection of patient provided questionnaires, and bidirectional exchange of care plans.

I know that the current FBI/Apple security issues are controversial, but if we’re going to use the phone as the means for patients to coordinate healthcare, we need to ensure data integrity. I support the idea of government entities obtaining cloud-based backups of devices when courts grant subpoenas.

I do not support the idea of compromising the integrity of phones when they are serving as the link between patient devices/patient sourced  healthcare data and providers.

 

 

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