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HealthIT Can Benefit From Internet of Things

HealthIT Can Benefit From Internet of Things | Healthcare and Technology news | Scoop.it

Healthcare technology is growing leaps and bounds and with the inclusion of Internet of things in the equation, both patients and providers will benefit from it.  In a report by Forbes, by 2020, 40% of IoT-related technology will be health-related, more than any other category, making up a $117 billion market.  Internet of things can make a huge impact on the healthcare industry by increasing efficiency, focusing on patient care and also reducing costs. Internet of things in healthcare can help create an intelligent system that can capture real time, life critical data.

 

How internet of things has benefited Healthcare

 

The potential of internet of things in healthcare is wide; there is already a huge market for fitness tracking and soon the patients will be able to take more responsibility of their health. With the use of IOT devices, there will be a focus on taking hold of preventive measures thereby disrupting current care delivery and also help shape the future of healthcare.

 

Below are the three most important uses of IoT in Healthcare

 

  • Chronic care management: Internet of things in healthcare has made a major impact especially in the chronic care management sector.  Healthcare technology has helped increase longevity with the tracking of health and chronic care conditions. Any change in vital or any questionable change in the health can quickly be reported to eth provider. Newer applications are now easily connected to wearables that can help transmit information to the a mobile application and thereby help stay connected to the provider. There are many new applications in the market like Healthkey that help in the management of chronic conditions.  Health Key monitors & tracks blood pressure, heart rate, blood glucose, BMI, body fat and a host of other measures using home health devices from FitBit, Withings and iHealth. Providers get real-time alerts and allow timely intervention.
  • Assisted living and remote monitoring: Assisted living and costs in nursing homes are rising and therefore pushing the providers to help encourage elderly to live independently while being monitored . This can be done in the comfort of the home and also helping in reducing the risk of staying alone. With the advent of sensors attached to the skin, clothing and other wearables. As per BCC Research  , in 2010 the healthcare global market for biosensors was $15.4 Billion and is expected to grow due to a rise is demand for point-of-care diagnostics and monitoring, aging of the population with its concomitant increase in the prevalence of chronic disease, increasing healthcare costs and unmet healthcare needs. It is predicted that this number is bound to increase, and the demand for biosensors in the United States alone will grow by 7.7% annually. 
  • Preventive care: The preventive healthcare is another benefit of Internet of things in healthcare . A lot of diseases and ailments can be managed with the touch of button, diseases like chickenpox; measles etc. can be easily managed with software applications setting reminders about the same. Also since the vitals are being constantly monitored, a lot many chronic diseases can also be prevented.
  • The only issue and problem at hand is the security of data that is being captured from devices connected to the patient monitoring system. The security of IoT is serious enough that a contractor for the Department of Homeland Security spoke about it at HIMSS 2015.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

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How Physicians Must Practically Prepare for Retirement

How Physicians Must Practically Prepare for Retirement | Healthcare and Technology news | Scoop.it

In a broad survey of U.S. physicians by Merritt Hawkins in 2014, nearly 42 percent of those surveyed aged 46 and older said they plan to accelerate their retirement due to current changes in the healthcare industry. In the same survey, more than 55 percent of physicians reported their current morale as somewhat or very negative.


Numbers like those suggest some physicians could be rushing for the exits before their retirement ducks are in a row, which can lead to some regrettable outcomes, experts say. Among them: nest eggs that are too small or too heavily invested in risky assets, missed opportunities for disposing of practice assets, and depression resulting from a lack of purpose once work ends.


Ophthalmologist Arnold Pearlstone retired nearly five years ago at age 80, not because he failed to plan for retirement, but precisely because he planned so well for so long.


He and his practice partners started up a 401(k) plan decades ago when the concept was still new, and Pearlstone learned all he could about investments.


"We were all pretty conscientious about saving and we really had a pretty good amount put away, so we didn't have to worry," he says.

What did concern him was how he was going to spend his time in retirement. He loved practicing medicine and knew he wanted to do it as long as possible.


And so 23 years ago, about the time many people start retiring, Pearlstone and his wife, Marion (now deceased), established a foundation they called Eye Care for the Underprivileged. Through that foundation they received donations in addition to their own and established a clinic in Jamaica while Pearlstone was still actively practicing.


"I didn't limit the foundation's scope to Jamaica, because I thought I might one day need it for other clinics I wanted to open," he says. "I didn't know what I was going to be doing, so when I set up the fund I left it open-ended in case later on I wanted to volunteer and needed to purchase equipment."


Sure enough, as Pearlstone finally started winding down his practice, he contacted AmeriCares, a humanitarian aid organization. He began working at an AmeriCares free clinic in Bridgeport, Conn., two weeks after he retired in 2010, taking most of his office equipment with him and donating it to the clinic. Later, he used money from his foundation to add equipment to other AmeriCares clinic locations. He keeps his Connecticut medical license current with 50 hours of continuing medical education every two years.


"My advice is to not just quit when you retire," he says. "Find someplace to use those skills where they can make a difference. It's good for you to keep the brain going."


Practical Planning


As for the more practical aspects of retirement planning, getting going on those is equally important, experts say.


"Start early, because everything seems to take longer than you think it will," says Roy Bossen, a partner at Hinshaw & Culbertson LLP, with experience in medical office sales and acquisitions.


Increasingly, finding a junior partner willing to buy you out and continue the practice as it was is a rare find, Bossen says. Instead, you might have to consider a multi-year process where you join a hospital network for a few years at the end your career.


"If a hospital really wants a physician, it will often assume the lease or buy the building as part of the transaction," says Bossen. "They won't pay more than fair-market value," but having that obligation off your plate before you retire could be worth it if finding and keeping a tenant is difficult in your market, he says.


"These are issues you want to resolve going into a lease, not out, but if you're in a lease, for example, be aware that you may have to go to a condo board to get a tenant approved," he says, which can mean more delays and missed opportunities.


Near the end of his career, Pearlstone was the last of four partners in his office. He assumed the patient records of two colleagues who were retiring, closed down the office, and rented a new space from a friend who had another practice nearby for the last few years of practice. That doctor then paid Pearlstone a small fee for the patient records, which offset a portion of his rent, he says.


Preparing your nest egg to begin pumping out income at retirement is also a process that can take some time. A significant market correction in the first few years of retirement could doom an income system that relies on an initial withdrawal rate with automatic yearly increases — the oft-cited "4 percent" rule.


Be aware that because of stock market valuations and the low-yield bond market, projections for returns in coming years have market experts saying a more realistic safe withdrawal rate could be more like 2.5 percent to 3 percent.


If you're concerned you might not have saved enough to make it through retirement with just a systematic withdrawal plan, longevity insurance — or fixed deferred annuities — are beginning to be introduced for retirement accounts by insurers including The Principal and MetLife.


Recent federal regulations paved the way for these policies, called qualifying longevity annuity contracts (QLAC). Inside retirement accounts, the annuities allow owners to defer required minimum distributions on the amounts invested in the annuities.


Also, think strategically about how you want to receive Social Security income. You can now get an 8 percent bump-up in monthly benefits for every year you delay claiming benefits past full retirement age, up to 32 percent at age 70. Do this first before purchasing longevity annuities because it's the cheapest annuity available, many financial advisers say.


It's important to reconsider your risk tolerance now that retirement is looming. A decade before he retired, Pearlstone says he began shifting his savings to more fixed-income investments and away from stocks.


"Today I'm about two-thirds in income investments and one-third in equities," he says, noting that he spent considerable time throughout his career learning about financial planning and investments.

If you haven't put in that much time and don't expect to, at least thoroughly check out the financial adviser you plan to use to help tap your nest egg. Online financial management services such as Personal Capital and Betterment are beginning to offer retirement spend-down strategies.  They do so for a fraction of what traditional advisers charge — and they won't approach you with obscure land deals only available to "accredited" investors.

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Could On Demand Medical Services Be Good for Doctors?

Could On Demand Medical Services Be Good for Doctors? | Healthcare and Technology news | Scoop.it

I’ve been seeing a lot of discussion lately about the peer sharing economy and how it applies to healthcare. Some people like to call it the Uber of healthcare, but that phrase has been applied so many ways that it’s hard to know what people mean by it anymore. For example, is it Uber bringing your doctor to your home/work or is it an Uber like system of requesting healthcare? There are many more iterations.


I’ll to consider doing a whole series of posts on the Peer Sharing Economy and how it applies to healthcare. There’s a lot to chew on. However, most recently I’ve been chewing on the idea of on demand medical services. In most cases this is basically the Skype or Facetime telemedicine visit on a mobile device. These models are starting to develop and it won’t be long until all of us can easily hop on our mobile device and be in touch with a doctor directly through our phone. In some cases it will be a telemedicine visit. In other cases it might be the doctor coming to visit you. I’m sure we’ll have a wide variety of modalities that are available to patients.


Every patient loves this idea. Every insurance company is trying to figure out the right financial model to make this work. Most doctors are scared at what this means for their business. Certainly there are reasons for them to be concerned, but I believe that this new on demand medical service could be very good for doctors.


In our current system practices do amazing scheduling acrobatics to ensure that the doctor is seeing a full schedule of patients every day. They do this mostly because of all the patient no shows that occur. This makes life stressful for everyone involved. Imagine if instead of double booking appointments which leads to all sorts of issues, a doctor replaced no show appointments with an on demand visit with a patient waiting to be seen on a telemedicine platform. Basically the doctor could fill their “free time” with on demand appointments instead of double booking appointments which then causes them to get behind when both appointments do show up.


I can already hear doctors complaining about them being “mercenaries” and shouldn’t they be allowed free time to grab a coffee. I’d argue that in the current system they are mercenaries that are trying to fill their schedule as full as possible. The current double booking scheduling approach that so many take means that some days the doctor has a full schedule of appointments and some days they have more than a full schedule of appointments. If doctors chose to back fill no-shows with on demand appointments, then their schedule would be more free than it is today. Plus, if they didn’t want to back fill a no show, they could always make that choice too. That’s not an option in the double book approach they use today.


In fact, if there was an on demand platform where doctors could go and see patients anytime they wanted to see patients, it would open up a lot more flexibility for doctors much like Uber has done for drivers. Some doctors may want to work early in the morning while others want to work late at night. Some doctors might want to take off part of the day to see their kid’s school performance, but they can work later to make up for the time they took off (if they want of course).


Think about retired doctors. I’m reminded of my pharmacist friend who was still working at the age of 83. I asked him why he was still working at such an advanced age. He told me, “John, if I stop, I die.” I imagine that many retired doctors would love to still see some patients if they could do it in a less demanding environment that worked with their new retirement schedule. If there was an on demand platform where retired doctors could sign in and see patients at their whim, this would be possible. No doubt this is just one of many examples.


Currently there isn’t an on demand platform that doctors could sign into and see a patient who’s waiting to be seen. No doubt there are many legal, financial and logistical challenges associated with creating a platform of this nature. Not the least of which is that doctors are only licensed to practice in specific states. This is a problem which needs to be solved for a lot of reasons, but I think it will. In fact, I think that legal issues, reimbursement changes, and other logistical challenges will all be solved and one day we’ll have this type of on demand platform for healthcare. Patients will benefit from such a platform, but I believe it will open up a lot more options for doctors as well.

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7 ways physicians can improve health care quality

7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

But let me come back to the report itself in a minute.


The quality conundrum


A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


That may explain why keeping track is such a challenge for all parties involved.


Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


7 actions physicians can take


That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


Fortunately, medical practice today is far more science than art.


What patients should do


The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

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National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare

National Quality Forum Urges Providers Forward on Data and Analytics in Healthcare | Healthcare and Technology news | Scoop.it

On Aug. 6, the Washington, D.C.-based National Quality Forum released a white paper, “Data Needed for Systematically Improving Healthcare,” intended to highlight strategies to help make healthcare data and analytics “more meaningful, usable, and available in real time for providers and consumers.”


According to a press release issued on that date, “The report identifies several opportunities to improve data and make it more useful for systematic improvement. Specific stakeholder action could include the government making Medicare data more broadly available in a timely manner, states building an analytic platform for Medicaid, and private payers facilitating open data and public reporting. In addition, electronic health record (EHR) vendors and health information technology policymakers could promote “true” interoperability between different EHR systems and could improve the healthcare delivery system’s ability to retrieve and act on data by preventing recurring high fees for data access.”


The press release noted further that “The report identifies actions that all stakeholders could take to make data more available and usable, including focusing on common metrics, ensuring that the healthcare workforce has the necessary tools to apply health data for improvement, and establishing standards for common data elements that can be collected, exchanged, and reported.”


The report emerged out of an initiative supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, and spurred by a 2014 report by the President’s Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.


The press release included a statement by Christine K. Cassel, M.D., president and CEO of NQF. “Data to measure progress is fundamental to improving care provided to patients and their outcomes, but the healthcare industry has yet to fully capture the value of big data to engineer large-scale change,” Dr. Cassel said in the statement. “This report outlines critical strategies to help make data more accessible and useful, for meaningful system wide improvement.” 

Following the publication of the report, Rob Saunders, a senior director at the National Quality Forum, and one of the co-authors of the report, spoke with HCI Editor-in-Chief Mark Hagland about the report and its implications for healthcare IT leaders. Below are excerpts from that interview.


What do you see as the most essential barriers to moving forward to capture and correctly use “big data” for clinical transformation and operational improvement in healthcare?

There are sort of two buckets we looked at through this project. We looked at the availability of data, and we’re seeing more availability of electronic data. Interoperability remains a major challenge. But it wasn’t just about interoperability between electronic health records, but also being able to link in data from elsewhere.


Does that mean data from pharmacies, from medical devices, from wearables?

Some of these may be kinds of data from community health centers, or folks offering home-based and community-based services. So, getting a broader picture of people’s health, as they’re living their lives in their communities. And there are exciting things on the horizon, too, like wearable devices. But the first barrier we heard about was just getting more availability of data. Perhaps the harder problem right now is actually using more data, and turning that raw data into meaningful information that people can use. There’s so much raw data out there, but it so often is not actionable or immediately usable to clinicians.


So what is the solution?

That is an excellent question. Unfortunately, there’s no silver bullet. We’ve looked at a wide range of possible solutions, but it will take action from healthcare organizations trying to improve their internal capacity, for example, creating more training for clinicians to use data in their practices, or even state governments taking action. I think it will require a lot of action from all the stakeholders around healthcare to make progress.

 

The white paper mentioned barriers involving information systems interoperability, data deidentification and aggregation, feedback cycles, data governance, and data usability issues. Let’s discuss those.

I think one of the challenges with all of those is that there are some big strategic issues around all of those, and some large national conversations around all of those, esp. interoperability, but there are also just a lot of large technical details to iron out. And unfortunately, that’s not something we can just solve tomorrow. But there’s opportunity with these new delivery system models, and that will hopefully be helpful.


How might all this play out with regard to ACOs, population health, bundled payments, and other new delivery and payment models?

What we’ve heard is that those new models are becoming increasingly more common, and because of those, clinicians and hospitals have far more incentive to look far more holistically at the entire person, and think about improvement, and to really start digging into some of this data.


Marrying EHR [electronic health record] and claims data for accountable care and population health is a very major topic for our magazine and its readers right now. Let’s talk about those issues.

We didn’t necessarily go into great depth on that particular challenge. But clearly, that’s one of the big issues in trying to link all these different data sources together, and it also speaks to the challenge in getting this data together.


Is there anything that healthcare IT vendors need to do better?

And we actually called out healthcare IT vendors and EHR vendors, because they’re a really important sector here. Promoting interoperability speaks to both policy and technical challenges.


Are you also concerned about data blocking?

Yes, that’s how ONC and HHS have characterized it. But yes, we’re really talking about data access. Clearly, that’s a barrier. And then there are still some technical pieces here around how to create APIs that can really start to allow more innovative ways to analyze the data that’s already in a lot of these EHR and health IT systems, and that will allow some customization and capabilities.


What’s your vision of change for the use of data in healthcare?

There are a number of folks doing really exciting work using data for systemic improvement. So we showcased Virginia Mason as a model. And some of their work involves manual collection of data. And that can produce really remarkable results; and as you become more sophisticated, you’re able to incorporate that data collection into the EHR [electronic health record]  and other systems. That speaks to what we said earlier, that availability of data is a good thing, but it’s the use of data that seems to be more of an issue. Premier Inc. has done some really good things, collecting data through some of their groups, to share; and oftentimes, that was data people didn’t even have before.  You can also activate clinicians’ professional motivation—many physicians, nurses, really want to make care better for their patients. And data really can make a difference in that.

And the last point is the fact of the important role that brings this down to patients and consumers, involving the broader public in this. What we’ve talked about so far has been very technical. But patients have a lot of data about themselves, and they’re also able to help out with a lot of this.

 

So you’re talking about patient and consumer engagement in this?

 

Yes, I am, but it’s not just that. I’m also talking about patients as an untapped data resource, and an untapped resource in general of folks who are highly motivated and who want to make care better, if they have the tools available and are able to do so.

 

The “blessed cycle” of data collection, data analysis, data reporting, the sharing of data with end-users and clinician leaders for clinical and operational performance improvement, and the re-cycling into further data collection, reporting, etc., is very important. Any thoughts on that concept?

 

We didn’t necessarily talk about that concept per se, but we did talk about the general idea of this all being a process. And improvement needs to start somewhere, and oftentimes, you need to start small. And your data will be rough and dirty when you start; and that’s not necessarily a bad thing. The real pioneers in this area started out with rough, dirty data, and learned by using that data, and were able to increase their sophistication over time. So that’s part of the issue—bringing data together, oftentimes, you don’t know what data you need, until you start to use it.

 

So what should CIOs, CMIOs and their colleagues be doing right now, to help lead their colleagues forward in all these activities?

 

We really want to encourage more organizations to start doing this type of system improvement work. There’s more that can be done, so we want to encourage that. And the second message that permeated the entire project was not only making sure that more data should be made available, but also building up use, and to encourage more folks to get into systematic improvement.

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lucy gray's curator insight, August 17, 2015 11:35 AM

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Study Links Polluted Air in China to 1.6 Million Deaths a Year

Study Links Polluted Air in China to 1.6 Million Deaths a Year | Healthcare and Technology news | Scoop.it

Outdoor air pollution contributes to the deaths of an estimated 1.6 million people in China every year, or about 4,400 people a day, according to a newly released scientific paper.


The paper maps the geographic sources of China’s toxic air and concludes that much of the smog that routinely shrouds Beijing comes from emissions in a distant industrial zone, a finding that may complicate the government’s efforts to clean up the capital city’s air in time for the 2022 Winter Olympics.


The authors are members of Berkeley Earth, a research organization based in Berkeley, Calif., that uses statistical techniques to analyze environmental issues. The paper has been accepted for publication in the peer-reviewed scientific journal PLOS One, according to the organization.


According to the data presented in the paper, about three-eighths of the Chinese population breathe air that would be rated “unhealthy” by United States standards. The most dangerous of the pollutants studied were fine airborne particles less than 2.5 microns in diameter, which can find their way deep into human lungs, be absorbed into the bloodstream and cause a host of health problems, including asthma, strokes, lung cancer and heart attacks.


The organization is well known for a study that reviewed the concerns of people who reject established climate science and found that the rise in global average temperatures has been caused “almost entirely” by human activity.


The researchers used similar statistical methods to assess Chinese air pollution. They analyzed four months’ worth of hourly readings taken at 1,500 ground stations in mainland China, Taiwan and other places in the region, including South Korea. The group said it was publishing the raw data so other researchers could use it to perform their own studies.


Berkeley Earth’s analysis is consistent with earlier indications that China has not been able to successfully tackle its air pollution problems.


Greenpeace East Asia found in April that, of 360 cities in China, more than 90 percent failed to meet national air quality standards in the first three months of 2015.


The Berkeley Earth paper’s findings present data saying that air pollution contributes to 17 percent of all deaths in the nation each year. The group says its mortality estimates are based on a World Health Organization framework for projecting death rates from five diseases known to be associated with exposure to various levels of fine-particulate pollution. The authors calculate that the annual toll is 95 percent likely to fall between 700,000 and 2.2 million deaths, and their estimate of 1.6 million a year is the midpoint of that range.


The Chinese government is sensitive about public data showing that air pollution is killing its citizens, or even allusions to such a conclusion. Though the authorities have gradually permitted greater public access to air quality readings, censors routinely purge Chinese websites and social media channels of information that the ruling Communist Party worries might provoke popular unrest. In March, after a lengthy documentary video about the health effects of air pollution circulated widely online, the party’s central propaganda department ordered Chinese websites to delete it.


Much of China’s air pollution comes from the large-scale burning of coal. Using pollution measurements and wind patterns, the researchers concluded that much of the smog afflicting Beijing came not from sources in the city, but rather from coal-burning factories 200 miles southwest in Shijiazhuang, the capital of Hebei Province and a major industrial hub.


Promises to clean up Beijing’s air were a centerpiece of the nation’s bid to host the 2022 Winter Olympics. The mayor of Beijing, Wang Anshun, championed restrictions on vehicles in the city, and state news media outlets lauded projects to replace coal-fired heating systems in urban areas with systems that use natural gas and generate far less particulate pollution.


“We will improve the air quality not only for the Games, but also for the demand of our people,” said Shen Xue, an Olympic gold medalist and ambassador for the 2022 bid, according to a report last month by Xinhua, the state news agency.


The Berkeley Earth paper showed, however, that to clear the skies over Beijing, mitigation measures will be needed across a broad stretch of the country southwest of the capital, affecting tens of millions of people. “It’s not enough to clean up the city,” said Elizabeth Muller, executive director of the organization. “You’re going to also have to clean up the entire industrial region 200 miles away.”

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Where big data falls short

Where big data falls short | Healthcare and Technology news | Scoop.it

Big data and analytic tools have not yet been harnessed to bring meaningful improvement to the healthcare industry.

That's according to a new report from the National Quality Forum outlining the challenges to making health data andanalytics more usable and available in real time for providers and consumers.


Whereas big data has supported improvement in certain settings, such as reducing ventilator-acquired pneumonia, data analytics has been largely overlooked in the area of healthcare costs, even though this data can inform and assess efforts to improve the affordability and quality of care.


What's more, effective data management is necessary for the success of other incentives to enhance care, such as payment programs, as providers need timely information to understand where to improve and track their progress.


NQF found multiple challenges to making better use of health information, such as interoperability and linking disparate data sources, leveraging data for benchmarking, providing the ability to gather data directly from patients and de-identify it to generate knowledge, and the need to ensure that the data itself is trustworthy.


Then there's the matter of electronic health records software. "While greater EHR adoption is positive, these records do not contain all of the data needed for improvement," the report said. NQF pointed to operational or clinical data not captured in an EHR, such as the time a nurse spends caring for a particular patient or the time to transfer a patient from surgery to a post-operative recovery unit to a hospital room, as common examples.


The report noted there have been many ongoing attempts to develop interoperability between EHRs and clinical data sources recording patients' experiences and outcomes. Beyond linking healthcare data, however, "there is a need to learn from data spanning other determinants of health, as the most significant and sustained individual and population healthimprovements occur when healthcare organizations collaborate with community or public health organizations."


NQF also highlighted a widespread need to appreciate the value of nonfinancial incentives, such as peer and public reporting, in improvement initiatives.


"Overall, there was a desire to move from a retrospective approach of quality metrics and analytics to one that uses real-time data to identify potential challenges and gauge progress," the report said.


The report was supported by the Peterson Center on Healthcare and the Gordon and Betty Moore Foundation, the initiative was spurred by a 2014 report by the President's Council of Advisors on Science and Technology that called for systems engineering approaches to improve healthcare quality and value.

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What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market?

What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market? | Healthcare and Technology news | Scoop.it

As if everyone’s heads in healthcare IT weren’t already spinning like that of Linda Blair in 1973’s “The Exorcist,” here comes yet another acquisition in healthcare IT, this time the Armonk, N.Y.-based IBM announcing on Thursday its acquisition of the Chicago-based Merge Healthcare.


All mergers and acquisitions are interesting, but this one offers particular facets worth pondering. First of all, of course, its timing, less than four months after that giant company had just swallowed up the Dallas-based Phytel and the Cleveland-based Explorys back in April, a move announced during the HIMSS Conference.


That double acquisition is one of the reasons that we editors at Healthcare Informatics made IBM one of our “Most Interesting Vendors” this year, as its trajectory has encapsulated some of the mergers and acquisitions that have taken place in order to give some vendors a particular edge as competition intensifies in the healthcare IT world. As Senior Editor Rajiv Leventhal wrote regarding IBM’s analytics push, “Enter the Watson Health Cloud, which IBM will sell to doctors, hospitals, insurers and patients. That offering will be the centerpiece of a new dedicated, Boston-area business unit, IBM Watson Health, which now includes both Explorys and Phytel.” Leventhal quoted Anil Jain, M.D., chief medical officer (CMO) for Explorys, as saying that “[IBM] is complimenting much of what we do around traditional analytics using machine learning algorithms with some of the cognitive computing and the Watson analytics that Watson Health group will be leveraging. We became the content that will fuel some of the next generation analytics that Watson has become famous for.”


In a blog published today on AuntMinnie.com, staff writer Erik Ridley wrote this: “For IBM's new Watson Health unit, the deal gives the company access to Merge's image management and analysis software and its installed base of more than 7,500 U.S. institutions, clinical research institutes, and pharmaceutical companies. IBM is adding Merge to other recent acquisitions, such as population health firm Phytel and cloud-based healthcare intelligence company Explorys.”

Ridley went on to note that “IBM plans to offer Watson Health Cloud to analyze and cross-reference images against lab results, electronic health records (EHRs), genomic tests, clinical studies, and other health-related sources. In aggregate, these represent 315 billion data points and 90 million unique records, according to the company. This could provide Merge's installed base with a useful consolidated, patient-centric view of current and historical images, EHRs, data from wearable devices, and other related medical data.”


So far, so good. I think that IBM is gaining clear advantage in acquiring Merge Healthcare at this time., as it brings imaging informatics into the fold and potentially will integrate elements of imaging informatics with its already-advancing work in analytics. Indeed, Joe Marion, a Wisconsin-based consultant who blogs regularly for Healthcare Informatics and who is one of the most knowledgeable observers of the imaging informatics sector around, sees clearly the advantages to this pairing. As Joe wrote Thursday in a blog on this site, “Today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.”


Joe further noted that, “In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS [radiology information system/picture archiving and communications system (issues)] previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And,” he added, “the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.”


I agree completely with Joe’s perspective on this. Now, what about Merge Healthcare itself? I’ve been following Merge very closely as a company for several years now. Merge has some very talented senior executives, and solutions that are respected and appreciated by providers. The challenge for the company’s senior management has been facing is the shifting landscape of the imaging informatics market right now. PACS solutions have become almost totally commoditized; I’m sure there are PACS systems that are at last marginally better than others, but, given the accelerating demands facing patient care organizations, the need to move quickly into accountable care- and population health-based arrangements, and clinicians’ demands for always-available computing, even significant solution quality differentiation is simply no longer enough (and let’s not even talk about how commoditized RIS solutions have become).


So, clearly, for senior executives at Merge, a respected company that has been going through some major management changes and has been treading water in a rapidly shifting imaging informatics vendor landscape, this deal makes a lot of sense, too.


The challenge now will be to make this pairing work for current Merge Healthcare customers and for IBM customers—and customers of the former Phytel and Explorys, too. We all know about the trajectories of healthcare IT vendors that have grown too rapidly through acquisition and that have ended up becoming a jumble of unintegrated parts.

IBM’s moves so far seem thoughtful and precisely judged. Only time will tell how everything turns out ultimately—and clearly, that will depend on execution. Skillful execution is to healthcare IT what location is to real estate—a fundamental element of success. And this trajectory for IBM is a fascinating one. So stay tuned—because this is going to be an interesting path ahead.

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Three Tips for Hiring Better Front-Desk Staff

Three Tips for Hiring Better Front-Desk Staff | Healthcare and Technology news | Scoop.it

Many practices really struggle with hiring and training a front-desk person (the person who will create that all-important first impression for your practice). The struggles are real; most offices budget near-minimum wage for this position and seem to have difficulty finding the right person to handle the huge responsibility of this position.


My go-to answer for this problem is to pay a little more in salary to recruit for this position. It's true; you often get better quality applicants if you can raise the hourly rate of pay for this vital position. It can be difficult to find a professional with the type of experience you are looking for if you only pay a low hourly rate.


But if you can't find the extra money to increase salary, what other options are available that won't necessarily cost more? Here are some options:


1. Rearrange responsibilities.

Perhaps you should take away appointment scheduling from the front desk, as there are often face-to-face patients requiring more attention. Calls could be redirected through an automated PBX system to another staff member.


2. Search for candidates with a high attention to detail.

This is as simple as giving applicants specific instructions to follow. If they don't follow those instructions in the application process, exactly, then don't even give them a second look. After all, if they are responsible for the first impression in your office, they should be diligent in making the optimal first impression to you.


3. Hire for personality and train the skills.

You can't train someone into a bright, sunny, and welcoming demeanor. So hire for personality, attitude, and work ethic — the skills and other aspects of the job can be taught.


It doesn't have to cost you more money to find the perfect front-desk staff member. There are great candidates out there to meet every budget, who will help you create stellar front-desk first impressions.

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NIH is asking for feedback on using smartphones and wearables to collect medical information

NIH is asking for feedback on using smartphones and wearables to collect medical information | Healthcare and Technology news | Scoop.it

The NIH is currently asking for pubic feedback on using smartphones and wearables to collect health and lifestyle data for its Precision Medicine Initiative — an initiative that hopes to collect data on more than 1 million individuals. The NIH’s Precision Medicine Initiative is described as:


a bold new enterprise to revolutionize medicine and generate the scientific evidence needed to move the concept of precision medicine into every day clinical practice


What exactly that means is a bit nebulous, but a New England Journal of Medicineperspective sheds some light:


Ultimately, we will need to evaluate the most promising approaches in much larger numbers of people over longer periods. Toward this end, we envisage assembling over time a longitudinal “cohort” of 1 million or more Americans who have volunteered to participate in research.


Qualified researchers from many organizations will, with appropriate protection of patient confidentiality, have access to the cohort’s data, so that the world’s brightest scientific and clinical minds can contribute insights and analysis.


The NIH is specifically asking the following:


  • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
  • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
  • How often people would be willing to let researchers collect data through devices without being an inconvenience.
  • The kind of information participants might like to receive back from researchers, and how often.
  • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.


It’s exciting to see the NIH see the potential of digital health. They specifically mention how smartphones and wearables can be utilized to collect a wide variety of data: location information, mobile questionnaires, heart rate, physical activity levels, and more.


There is already a robust discussion taking place in the comments section at the NIH website, and we encourage our readers to contribute.

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Richard Platt's curator insight, July 30, 2015 7:37 PM

The NIH is specifically asking the following:

  • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
  • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
  • How often people would be willing to let researchers collect data through devices without being an inconvenience.
  • The kind of information participants might like to receive back from researchers, and how often.
  • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
Lionel Reichardt / le Pharmageek's curator insight, July 31, 2015 1:31 AM

The NIH is specifically asking the following:

  • Willingness of participants to carry their smartphone and wear wireless sensor devices sufficiently throughout the day so researchers can assess their health and activities.
  • Willingness of participants without smartphones to upgrade to a smartphone at no expense.
  • How often people would be willing to let researchers collect data through devices without being an inconvenience.
  • The kind of information participants might like to receive back from researchers, and how often.
  • Other ways to conveniently collect information from participants apart from smart phones or wearable devices.
Heather Taylor's curator insight, August 31, 2015 10:33 PM

#wearables #healthcare #wearabledevices

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White House Announces New Precision Medicine Commitments

White House Announces New Precision Medicine Commitments | Healthcare and Technology news | Scoop.it

The Obama Administration has announced new commitments to its precision medicine initiative (PMI) that it unveiled six months ago.

The initiative, which President Barack Obama touched on in his State of the Union address in January, aims to pioneer a new model of patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.


This week, the Administration launched new commitments, which include:


Guiding Principles for Protecting Privacy and Building Trust: The White House is unveiling draft PMI guiding principles that seek to build privacy into the design of the PMI research cohort, which will include one million or more Americans who agree to share data about their health. The White House is seeking public feedback on the privacy and trust principles online through August 7, 2015.


New Tools for Patients: In collaboration with federal partners, the Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) and Office for Civil Rights (OCR) will work to address barriers that prevent patients from accessing their health data. OCR will develop additional guidance materials to educate the public and health care providers about a patient’s right to access his or her health information under the Health Insurance Portability and Accountability Act (HIPAA).


Research Awards to Unlock Data Insights: The Department of Veteran Affairs (VA) is announcing awards to support four research projects on key questions relevant to precision medicine using the rich data from the Million Veterans Program (MVP), the largest U.S. repository of genetic, clinical, lifestyle and military exposure data.

Additionally, private sector commitments related to the initiative launched this week include:


Duke Center for Applied Genomics and Precision Medicine: Duke has developed a platform called MeTree that helps individuals have challenging but necessary conversations with loved ones and care providers about family health histories, so that physicians can tailor care to patients’ unique risk profiles.


Flip the Clinic: Flip the Clinic, a project of the Robert Wood Johnson Foundation, is announcing a collaboration with more than 160,000 clinicians and staff practicing at sites across the United States, who have pledged to inform patients about their right to get digital copies of their medical records.


Genetic Alliance: Along with collaborators, such as Cerner, Genetic Alliance is launching new capabilities for Platform for Engaging Everyone Responsibly (PEER), a data registry that empowers participants to share their data with medical researchers, advocacy groups, and others.


GetMyHealthData: The GetMyHealthData campaign is pledging to help thousands of consumers over the next 12 months access and download their own clinical health data, so they can use it to understand and improve their health, their care, and the system as a whole—including donating their data for research.


Sage Bionetworks: Recognizing the importance of health-data liberation, and the role of data in driving research studies, Sage Bionetworks is announcing that it will support clinical studies that import electronic health-record information to its open source research platform and that it will release open-source informed-consent prototypes to support these studies.


The White House also is honoring "Champions of Change" in precision medicine, which includes nine individuals who are working to use data and innovation to improve healthcare.

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Sophia Nguyen's curator insight, July 24, 2015 7:55 AM

I found this interesting because it shows how important the world of healthcare and how the president has taken notice that it's important for consumers to understand their health and take charge of it.

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Four Unique Healthcare Apps

Four Unique Healthcare Apps | Healthcare and Technology news | Scoop.it

The last seven years has seen the rise of the smartphone and tablet as personal technology devices utilized by almost all professions in some capacity or another. The healthcare industry is no different and the veritable volume of applications or "apps" that have been developed and utilized by physicians and patients in the last few years has skyrocketed. Inevitably, the large volume of apps makes it difficult for individuals looking to make an impact to stand out in the crowd, as certain conventions become standard. Having a unique "hook" definitely helps to boost such apps into the spotlight, but it also serves to help physicians and patients look at new ways to utilize software (and the devices they run on).


CARROT Fit


Sometimes, "unconventional" is as simple as looking at something in a different or even humorous way. For example, CARROT Fit is an app developed by Brian Mueller that provides you with a sarcastic and merciless "fitness overlord" (modeled after his mother, sister, and wife) who motivates you through such innovative techniques as referring to you as "meatbag" and threatening you with "squirrel attacks" (yes, you read that right) when you fail to exercise. Mueller started out by writing alarm clock and to-do apps and received such a positive response about the personality of the Carrot A.I. (artificial intelligence) that a workout app seemed like the next logical step.


'"The CARROT series of apps are all about taking things that people hate doing … and making them fun and rewarding," said Mueller. "I think most people feel upset when they step on a scale … but CARROT's humor turns that around and makes it a positive experience they can laugh about — and because they connect with the character so much, they're actually motivated to do better the next day."


Bowel Mover Pro and Autism Tracker Pro


Another way to stand out in a field of "me too" health apps is to focus on areas of health that may be less common or more challenging to discuss. Case in point is developer Uwe Heiss. His company, Track & Share, developed Bowel Mover Pro and Autism Tracker Pro to empower patients with self-tracking tools that would make the patient-care team encounter more effective.


Any physician who has ever had to discuss bowel habits with an IBS patient knows how frustrating it can be to get vague feedback on patient symptoms. "All of my apps are designed to help people to spot trends, patterns, and how things might be related to each other," said Heiss. "For example, 'Does stress appear to aggravate my IBS symptoms?' 'Since I started Yoga, did my daily average stress level go down?' 'Was I able to avoid peak stress …?'"


Heiss stresses that three things which guided the design of his apps were the ability to highly customize what patients tracked, to provide powerful graphing options to identify patterns over time, and the ability to share data via external tools such as Excel, increasing the physician's ability to use the data in a meaningful way.


Symple


Developer Natasha Gajewski echoes some of these thoughts and developed her symptom-tracking app around one basic concept that also gave the app its name, "Symple." "I developed this app when I became a patient … one of my most important duties was to deliver an accurate symptom history between doctor visits," she said. "I had limited use of my hands and fingers … so I designed the touch interactions to be as simple as possible. We also worked hard to keep the cognitive load to a minimum."


One thing is certain. Regardless of the reason for defying convention, all developers believe the future of medicine will involve more integration of such apps and more active user interaction in an effort to enhance the patient-doctor encounter. At the end of the day, if visionaries succeed in this lofty endeavor, it will be because of the conventions they chose to modify or ignore in an effort to stand out and stand up for a better healthcare experience.

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CVS Health quits U.S. Chamber of Commerce over tobacco stance

CVS Health quits U.S. Chamber of Commerce over tobacco stance | Healthcare and Technology news | Scoop.it

CVS Health Corp said it was withdrawing its membership from the U.S. Chamber of Commerce after media reports that the trade group was lobbying globally against anti-smoking laws.


The No. 2 U.S. drugstore chain said it was "surprised" to read recent reports on the chamber's position on tobacco products outside the United States.


The New York Times reported last week that the chamber and its foreign affiliates were lobbying against anti-smoking laws such as restrictions on smoking in public places and bans on menthol and slim cigarettes, mainly in developing countries. 


"CVS's purpose is to help people on their path to better health, and we fundamentally believe tobacco use is in direct conflict with this purpose," CVS spokesman David Palombi said in an emailed statement on Tuesday.


The chamber, however, said that it did not support smoking and it called the report "a concerted misinformation campaign."


"... we support protecting the intellectual property and trademarks of all legal products in all industries and oppose singling out certain industries for discriminatory treatment," the trade group said in an email.


CVS was the first major U.S. drugstore chain to stop selling tobacco products last year.

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CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.


“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.


  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
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How one health system tightened security

How one health system tightened security | Healthcare and Technology news | Scoop.it

St. Elizabeth Healthcare in Northern Kentucky has added security muscle targeted at its network-connected medical devices by rolling out technology that monitors the devices for cyber vulnerabilities.

The health system tapped Tenable Network Security for nonstop network monitoring via the company's SecurityCenter Continuous View, which makes it possible to keep watch over the devices without taking them offline.


Through this deployment, hospital executives say, St. Elizabeth's IT security team has tackled one of the biggest security challenges in the healthcare industry – securing "smart" medical devices that cannot be interrupted for active vulnerability assessments.


"Everything we do at St. Elizabeth, including our security program, is based on the principle of putting patients first," Harold Eder, director of IT infrastructure and security at the hospital, said in a news release. "CT scanners, MRIs, smart IV pumps – any of these endpoint devices may be running on outdated systems that leave the entire network vulnerable to attack, but you can't perform traditional vulnerability assessments because taking the systems offline is risky and could diminish patient care."


St. Elizabeth's security team uses Tenable's SecurityCenter CV to gain complete visibility into medical device security and overall network status through a combination of active and passive scanning as well as advanced analytics. With the technology, Eder and his team assess 9,600 IP addresses and more than 300 medical device endpoints across five main campuses and more than 60 remote facilities.


Continuous network monitoring gives Eder a better understanding of cyber risk for the entire St. Elizabeth enterprise,  and it gives him the opportunity to focus his security team on the tasks that will have the most impact, he added.


With guidance from HealthGuard Security, a cyber risk management provider and a partner that St. Elizabeth has worked with for more than 10 years, Eder said he chose the platform for St. Elizabeth because it delivered the right combination of advanced analytics, real-time reporting and increased visibility into the health system's hard-to-see medical devices.


"When I looked at the challenges St. Elizabeth faced, I knew they needed a comprehensive solution that would help with HIPAA compliance, improve visibility into critical systems and deliver high-level analytics and reporting capabilities," said Apolonio Garcia, founder and president, HealthGuard Security, in a statement. "After seeing the success of Tenable's products with many customers over the years, SecurityCenter CV was clearly the right fit and the best product for St. Elizabeth."


The platform, as Eder continued, "gives me a much more holistic view into what my priorities should be, so I spend less time figuring out the problems and more time fixing them," he said. "The best part is that as our network evolves and our security program matures, we will continue to get additional value out of (the platform) along with the continued assurance that our infrastructure and patients are well protected."


St. Elizabeth Healthcare operates six major facilities throughout Northern Kentucky and more than 110 primary care and specialty office locations in Kentucky, Indiana and Ohio. 

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Readmissions Penalties Get Very, Very Real

Readmissions Penalties Get Very, Very Real | Healthcare and Technology news | Scoop.it

It was quite bracing to read the August 3 Kaiser Health News report entitled “Half of Nation’s Hospitals Fail Again to Escape Medicare’s Readmission Penalties.” As Jordan Rau wrote in the article, “Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge—this time losing a combined $420 million, government records show. In the fourth year of federal readmission penalties,” Rau reported, “2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital—readmitted or not –starting in October. The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged. Since the fines began,” he added, “national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.”


What’s more, Rau noted, “Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found.”


As hospital executives already know, the fines for failure to meet the criteria of the Centers for Medicare & Medicaid Services (CMS) focus on five conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), as well as elective hip and knee replacements, and are based on readmissions between July 2011 and June 2014.


And these reimbursement cuts are everywhere—indeed, the penalties will be assessed on hospitals in every state except for Maryland, as that state has a special payment arrangement with Medicare. And the cuts will affect three-quarters or more of hospitals in the following states: Alabama, Connecticut, Florida, Massachusetts, New Jersey, New York, Rhode Island, South Carolina, Virginia, and the District of Columbia.


What’s more, the readmissions-driven reimbursement cuts are hitting hospitals on top of cuts coming out of the mandatory value-based purchasing program and the mandatory healthcare-acquired conditions (mostly hospital-acquired infections) program.


 Meanwhile, the average penalties by state are being found to vary tremendously. Nationwide, 54 percent of hospitals (2,592 organizations) are being penalized, with an average Medicare pay cut of 0.61 percent. But those nationwide averages encompass huge variations. On one end of the spectrum, in North Dakota, where only three hospitals, or seven percent of the state’s hospital organizations, are being penalized this year, the average penalty is just 0.14 percent of Medicare payments. But in Kentucky, where 62 organizations, representing 65 percent of the state’s hospitals, are being penalized, the average penalty amounts to a full 1.19 percent of Medicare revenues—that’s an 850-percent spread.


And as everyone knows, many not-for-profit community hospitals in the U.S. are surviving on operating margins of between 1 and 3 percent; and for those with a majority of their revenues coming from Medicare reimbursement, a penalty of more than 1 percent could potentially be devastating.


Five years ago when the U.S. Congress passed he Affordable Care Act, and President Obama signed it, I predicted that the mandatory readmissions program would be one of the healthcare system reform provisions in the ACA that would be one of its most impactful; and it already has been. As we all know, ten years ago, if you were talk walk into the office of the average CFO in the average inpatient hospital in the U.S. and were to ask that CFO what her/his hospital’s average 30-day readmissions rates were for patients with documented congestive heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), s/he could likely not have told you. Now, that CFO needs to know that number—and needs to be working with all levels and disciplines of leadership in her/his hospital to reduce that number.


What’s more, private health insurers are absolutely moving forward to implement similar programs in their hospital contracts, since, as is nearly always the case with such things, once the Medicare program, the U.S. healthcare system’s proverbial 800-pound gorilla, moves forward in an area, all the major private health insurers quickly follow Medicare’s lead and design their own versions of the same initiative.


Industry experts have long noted that many, if not most, readmissions that occur within 30 days are relatively easily predicted. Research, and the experiences of pioneering hospital organizations, have found that the key gaps in this area have to do with care management on multiple levels—ensuring effective discharge planning, including really robust patient and family member education; and then, very importantly, case manager/care manager nurse follow-up with the discharged patient in a day or two at most following discharge, via phone communication, which must involve the scheduling of a follow-up primary care physician appointment; and then of course, that follow-up PCP visit, along with further coaching, education, and care management.


And all of those processes must be strategically directed, excellently executed, and very strongly facilitated by robust information systems run by hospital and health system leaders with commitment to strategic goals and to success over long periods of time and across large groups of patients. Now, clearly, the leaders of many patient care organizations are moving forward with alacrity to develop accountable care organizations (ACOs), either under the aegis of one of Medicare’s ACO programs, or in collaboration with private health plans; as well as implementing population health management programs, and developing patient-centered medical homes.


But here’s the thing about the Medicare readmissions reduction program: because it’s mandatory, it is forcing action on the part of every hospital that receives regular Medicare payment, regardless of whether or not that hospital is also pursuing ACO, population health, or PCMH strategies, or not.


So the same “blessed cycle” of performance improvement is called for on the part of all regular U.S. hospitals receiving Medicare reimbursement, at this point. And that means creating really good data collection and reporting mechanisms, reporting the data, developing continuous clinical performance improvement processes to reduce predictable 30-day readmissions, making those improvements, and continuously sharing with clinicians, clinician leaders, and administrative executives and managers the ongoing results of those efforts, for further improvement work.


In other words, we’re talking about a continuous learning system in U.S. healthcare. And guess what? It’s no longer optional.

The reality is that healthcare IT leaders are playing and will continue to play, an extremely important role in all of this work; indeed, their contributions will be vital to success, at the data and information level, the process improvement level, and the strategic level, organization-wide. The one thing that neither healthcare IT leaders nor any other leaders can do is to sit any longer in denial about what is happening. Because, along with the mandatory value-based purchasing program under Medicare, and to a lesser extent as well, the mandatory healthcare-acquired conditions reduction program under Medicare, continuous clinical performance improvement is in effect now a core component of federal policy.


In other words, folks, this is happening.


The good news is that leaders at the most pioneering hospitals and health systems are lighting the way for others to follow. The bad news is that anyone waiting for further “clarity” on all this is going to be waiting so long as to potentially endanger the future of their hospital organization. So as the readmissions reduction program under Medicare—and inevitably under many, if not most, private health insurers as well—expands and ramps up, it will be incumbent on healthcare IT leaders and on all healthcare leaders to get ahead of the curve, because the penalties are only going to get more and more real—and won’t ever be reversing.

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Hospitals work on allowing patients to actually sleep

Hospitals work on allowing patients to actually sleep | Healthcare and Technology news | Scoop.it

It's a common complaint — if you spend a night in the hospital, you probably won't get much sleep. There's the noise. There's the bright fluorescent hallway light. And there's the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws and the rest.

Peter Ubel, a physician and a professor at Duke University's business school, has studied the rational and irrational forces that affect health. But he was surprised when hospitalized at Duke -- in 2013 to get a small tumor removed -- at how difficult it was to sleep. "There was no coordination," he said. "One person would be in charge of measuring my blood pressure. Another would come in when the alarm went off, and they never thought, 'Gee if the alarm goes off, I should also do blood pressure.'"

"From a patient perspective," he added, "you're sitting there going, 'What the heck?'"

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted.

The American Hospital Association doesn't formally track how many hospitals are reviewing their patient-sleep policies, though it's aware a number are trying to do better, said Jennifer Schleman, an AHA spokeswoman.

And, though few studies specifically link quality of shut-eye and patient outcomes, doctors interviewed said the connection is obvious: patients need sleep. If they get more of it, they're likely to recover faster.

    Traditionally, hospitals have scheduled a number of nighttime activities around health professionals' needs — aligning them with shift changes, or updating patient's vital signs so the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

    "The reality for many, many patients is they're woken up multiple times for things that are not strictly medically necessary, or...multiple times for the convenience of staff," said Susan Frampton, president of Planetree, a nonprofit organization that encourages health systems to consider patient needs when designing care.

    Changing that "seems like kind of easy, low-hanging fruit," said Margaret Pisani, an associate professor at Yale School of Medicine. She is working with other staff at the Yale hospital to reduce unnecessary wake-ups, using strategies like letting nurses re-time when they give medicines to better match patient sleep schedules, changing when floors are washed or giving nurses checklists of things that can and should be taken care of before 11 p.m.

    Not only is the push for better patient sleep part of a larger drive to improve how hospitals take care of their patients, but it is fueled in part by measures in the 2010 health law tying some Medicare payments to patient approval scores. As more hospitals try to improve those numbers, experts said, more will likely home in on improving chances for a good night's sleep.

    "There's a movement toward patient-centered care, and this is definitely a part of it," said Melissa Bartick, an assistant professor at Harvard Medical School.

    That focus makes sense, since federal patient approval surveys specifically ask about nighttime noise levels. A number of hospitals initially struggled to get good scores on that, said Richard Evans, chief experience officer at Boston-based Massachusetts General Hospital.

    His hospital instituted quiet hours -- a couple of hours in the afternoon and between six and eight hours at night, depending on the hospital unit, in which lights are turned low and staff encouraged to reduce their noise levels. It also encourages staff members to consider whether patients really need particular care at night before waking them. "We're trying to [increase awareness] that patients need to rest, and we need to structure our care as much as possible to allow that to happen."

    It's hard to delineate the degree to which such efforts have affected patient approval scores, Evans said. Anecdotally, though, patients have expressed appreciation, he added.

    The Department of Veterans Affairs New Jersey Health Care System is taking this concern even further. In addition to quiet-time restrictions, in which they try to reduce the use of noisy equipment, staff chatter and things like phone volume, patients can opt to have lavender oil sprayed in their rooms or an evening cup of herbal tea to facilitate sleep.

    All of these kinds of changes can help, said Planetree's Frampton. But they don't get at the real problem for most patients.

    "Low scores on quiet-at-night [questions on patient suarveys] are not because it's overly noisy...but because patients are woken up repeatedly," she said. "Their sleep is disturbed so they're lying awake."

    To address that, hospitals may need to look at less obvious questions. At New York's Mount Sinai Hospital, doctors are rethinking when they prescribe medicines as well as what kind, said Rosanne Leipzig, a professor of geriatrics and palliative medicine and who practices at the hospital. For instance, some antibiotics can be given at six-hour intervals rather than four-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every six hours can instead be given four times a day during the hours patients are usually awake.

    The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Leipzig said. But not every patient's condition requires that they be roused every four hours, she added.

    About half of all patients woken up for vitals checks probably don't need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests waking those patients may contribute to bad patient results and dissatisfaction, and could increase the odds of patients having to come back to the hospital.

    Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep — particularly by rescheduling activities, nighttime checks and overnight medication doses so as not to wake patients. That paper, co-written by Bartick, the Harvard professor, found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous side effects such as falling or hospital delirium or confusion.

    "Sleep disruptions are actually not benign as far as patients are concerned," said Dana Edelson, an assistant professor of medicine at the University of Chicago and an author on the 2013 study. "We're putting them at unnecessary risk when we're waking them up in the middle of the night when they don't need to be." And possibly making the recovery a bit more difficult.

    "Patients will tell you, 'I was so exhausted, I couldn't wait to get home and go sleep,'" said Yale's Pisani.

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    Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare?

    Could Well-Implemented IT Help Reverse Primary Care Physicians’ Skepticism Over the New Healthcare? | Healthcare and Technology news | Scoop.it

    It was fascinating to read a new issue brief from the New York-based Commonwealth Fund published August 5, on primary care providers’ (both primary care physicians’ and mid-level practitioners’) perceptions of new payment models in healthcare.


    The Commonwealth Fund, a “private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” had issued the brief, entitled “Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment,” based on a survey of 1,624 primary care physicians and 525 mid-level clinicians (nurse practitioners and physician assistants).


    The abstract to the issue brief notes that “A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”


    The core findings of the survey were that primary care physicians, far more than mid-level practitioners, expressed considerable skepticism about the new healthcare delivery and payment models, in particular the two that were asked about specifically—accountable care organizations and patient-centered medical homes; though those PCPs who had worked under ACO or PMCH arrangements were far more likely to agree that they offered the potential for improving the quality of care delivery to patients being cared for under those types of arrangements.


    As to why a strong plurality of primary care physicians have negative perceptions of the potential for the value-based outcomes measures embedded in ACO and PCMH arrangements to improve quality and efficiency, Melinda Abrams, The Commonwealth Fund’s vice president for delivery system reform, told me, “To be honest, we don’t know why they don’t like the quality measures; we only know there’s a fair bit of dissatisfaction with the quality measures. When we asked physicians whether they thought the increased use of quality measures was impacting their ability to provide high-quality care, 50 percent were negative on that, and only 22 percent were positive. We also asked, are you receive quality incentive-based payments? That reflected the entire group, but even among those receiving incentive payments based on quality, 50 percent felt it was negative, and only 28 percent felt it was positive.”


    Still, as the issue brief’s abstract noted, “The survey results indicate that primary care providers’ views of many of these new models are more negative than positive. There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care providers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records.8 Our survey results also may reflect clinicians’ earlier exposure to certain models and tools. National adoption of electronic health records received a boost from the Health Information Technology for Economic and Clinical Health (HITECH) Act of the federal stimulus package of 2009, while the four primary care specialty societies announced a joint statement regarding medical homes in February 2007, several years before passage of the Affordable Care Act.”


    “Our results show that 50 percent of primary care providers say that healthcare IT is improving the quality of care they provide,” Abrams told me. “And what we’ve learned from other studies is this: other studies have found that providers generally accept the promise of HIT as a concept, even as they dislike the process of transitioning to electronic from paper. Our specific question was on the impact of their ability to provide high-quality care to their patients. It’s a more general question than about the transition. We weren’t asking about the transition. So half of physicians and two-thirds of mid-level providers see the advance of health IT as having a positive impact,” she noted.

    What is inevitable is that clinicians, but most especially primary care physicians, will be demanding a great deal from the clinical and other information systems that are being implemented now to facilitate accountable care, population health management, and patient-centered medical home-based care.


    As Abrams put it to me, “There’s nothing in the survey findings that would indicate that increased success with IT would improve their views of ACOs and medical homes; our findings don’t show that. But I would suspect that, to fulfill the promise of ACOs and PCMHs requires ease of use of IT and the data from that technology, the more they learn to use technology effectively to optimize patient care, yes, I believe they will become more positive about ACOs and patient-centered medical homes, yes. And more pieces will help them embrace ACOs and PCMHs.”


    So such interpretations of survey data only help to reinforce what seemed apparent already: that healthcare IT leaders are facing a gigantic opportunity/risk proposition ahead of them, when it comes to clinical and other information systems supporting accountable care and population health management. Physicians, and primary care physicians in particular, are looking to those systems to carry them to the “promised land” of greater clinical effectiveness and practice efficiency, and to help them master the intricate challenges of succeeding in carrying out risk-based contracting in a high-pressure, high-stakes environment.


    And this is in an environment in which we all know that the IT solutions offered by vendors, both major and smaller, still leave some things to be desired, and that tremendous amounts of customization are being required to make population health, analytics, clinical decision support, and other systems needed to make pop health and accountable care work, are being poured into those systems.


    So the next few years inevitably are going to be filled with tension for healthcare IT leaders, as healthcare IT professionals work to get all the foundations, and the details, right, with those systems. But the light at the end of the tunnel is this: that, as primary care physicians become adept at using the increasingly-adept solutions that will be applied to population health- and accountable care-based clinical practice, primary care physicians’ perceptions not only of those tools, but of value-based care delivery and payment itself, will get better over time. And that will definitely significant for all of us, as we pursue the new healthcare in earnest.

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    Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC

    Premier, Inc. acquires healthcare analytics leader Healthcare Insights, LLC | Healthcare and Technology news | Scoop.it

     Premier, Inc. (NASDAQ: PINC), a leading healthcare improvement company, today announced that it has acquired Healthcare Insights, LLC for $65 million in cash. Healthcare Insights is a privately-held,integrated financial management software developer that provides hospitals and healthcare systems with budgeting, forecasting, labor productivity and cost analytic capabilities.


    “As the healthcare industry becomes more complex, value-driven, and data-dependent, the need for health systems to clearly understand their performance in every arena is a top concern,” said Keith J. Figlioli, Premier’s senior vice president of health informatics. “It is not enough to have financial, operational and clinical data. Health systems must understand how to translate that information into effective cost containment strategies, as well as superior clinical outcomes.”


    The industry’s increased focus on cost is largely driven by the Affordable Care Act, which reduces overall reimbursement, and increasingly holds providers accountable for the total costs and quality of the care delivered. Coupled with the growing movement to value-based payments such as bundling or shared savings, healthcare providers need solutions that can help them understand cost drivers and opportunities for improvement in detail. Healthcare Insights is expected to enable Premier to offer a more complete solution that delivers additional value by adding budgeting, clinical financial management and productivity analytics to existing cost and quality applications, including the company’s enterprise resource planning (ERP) solution.


    Thomas Johnston, Healthcare Insights’ chief executive officer, said, “This strategic combination will allow us to offer a more complete ERP solution with an end-to-end view of cost management. We expect this to increase our hospitals’ and health systems’ understanding of their clinical, operational and financial performance, and help them deliver more efficient, higher quality care.”


    Founded in 2000, Healthcare Insights’ current customer base includes over 7,500 users across 200 facilities associated with 94 health systems, 49 of which do not currently have a relationship with Premier. KLAS, a leading research firm that provides ratings for more than 900 healthcare products and services, has ranked Healthcare Insights first place in budgeting for the past four years.


    The Healthcare Insights acquisition, which was effective July 31, is currently projected to be modestly accretive to Premier’s fiscal 2016 revenue growth and adjusted EBITDA. Expected revenue and adjusted EBITDA contributions from the acquisition will be incorporated into Premier’s fiscal year 2016 guidance, which is scheduled to be announced on August 24, when the company reports fiscal fourth-quarter and full-year 2015 financial results.

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    IBM and Merge: Here We Go Again!

    IBM and Merge: Here We Go Again! | Healthcare and Technology news | Scoop.it

    Today’s announcement of IBM’s acquisition of Merge Healthcare might be called a deal changer.  In today’s rapidly changing healthcare environment, it would seem that merging IBM’s deep pockets and technological talent with Merge’s clinical technology and applications capabilities would be a good thing.  And, it may prove to be given the current environment. 


    On the other hand, this is déjà vu, as I have personally seen IBM try to play in the healthcare space several times before.  Years ago, IBM developed a product and attempted to be a player in the Radiology Information System (RIS) business.  Eventually it was sold off.  IBM teamed with GE in the early 80’s to integrate RIS and PACS (Picture Archive and Communication System), only to exit amidst the company’s financial woes in the early days of Lou Gerstner’s chairmanship. 


    There were also several failed attempts in the dictation/transcription business.  There was the IBM Executary line.  Then came the IBM VoiceType system.  And finally, there was IBM MedSpeak/Radiology, the first product to exploit IBM’s speech recognition technology.  Each time, IBM realized that the total medical market for such products could be measured in the thousands, not the hundreds of thousands of potential users.  In the end, IBM sold off these products on the basis of market dynamics versus disproportionate development and support costs.  It was unfortunate, as IBM had some of the best technology in the business!  Another part of the argument always was that IBM sold product to other healthcare vendors, and competing with them would jeopardize that business.


    So, will the past repeat itself?  Or, have IBM and the market changed enough to make this a winning proposition for IBM?  I would have to say, only time will tell.  But, today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.


    In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And, the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.


    Both IBM and Merge have sufficient technical expertise to make it work.  But, the glass is only half full.  Imaging informatics is a growing market, but it pales in comparison to the general healthcare IT market such as for EMR’s (Electronic Medical Record).  How well the market is willing to play with an IBM-Merge entity will be interesting to see.  Or, does IBM have more companies in its sights?  It’s ironic that an IBM spinoff (Lexmark) has positioned itself to be a formidable competitor in this space as well.  What will be the reaction of others such as HP and Dell that have had evolving healthcare strategies over the years?  IBM’s forays into the consumer market (remember the PC Junior or OS/2?) have not proven all that successful either. 


    Here’s hoping that IBM has evolved and learned from its past, and will find ways to make this one work!  As always your comments and perspective are welcome.

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    Digital Solutions the Key to Behavioral Health's Future

    Digital Solutions the Key to Behavioral Health's Future | Healthcare and Technology news | Scoop.it

    Behavioral health is often regarded as the Cinderella of healthcare. It’s a specialty that is poorly funded and rarely at the cutting edge of service innovation or therapeutic breakthroughs. The health economic burden is huge and the life expectancy of people with a serious mental illness is substantially reduced. Behavioral health conditions are difficult to treat, monitoring outcomes is challenging and, if treatment is sub-optimal, risk is high. All in all, it’s not a very happy story.


    Behavioral healthcare has been hampered by many things, including the clinical consultation process. Compare a psychiatric consultation with the clinic visit of a respiratory physician; he listens to a patient’s chest and takes a spirometer reading to assess progress. The cardiologist checks the patient’s heart murmur and blood pressure, and the gastroenterologist runs some labs and examines the patient on the couch. Behavioral healthcare lacks comparable quantitative measures to assist diagnosis, assess disease severity, and monitor treatment response. Clinicians can use rating scales to evaluate psychiatric symptoms, but they take time to administer in the clinic. So, we talk to our patients to assess progress and to detect subtle signals and changes. Of course, we complete a physical examination from time to time and we watch our patients as we talk to them, but the backbone of a routine psychiatric follow-up is a structured conversation and questions — not a physical exam, not labs.


    It’s this characteristic of behavioral healthcare that will enable Cinderella to shed her rags and step into the limelight. Health informatics is providing a unique and wonderful opportunity for psychiatric care, and it’s a break-through that is not available on the same scale to other specialties because they don’t “just talk.”


    Digital health technologies offer the potential for close and cost-effective, long-term remote monitoring of patients with mental health disorders. Smartphone applications and patient-facing Web portals enable patients and caretakers to assess and report status to the clinical team on a regular basis from home. Behavioral health is ideally suited also for telehealth assessments and therapeutic interventions; enabling rapid, cost-effective, efficient, and convenient care delivery.


    The potential impact of a digitally-enabled behavioral health ecosystem is enormous.


    Remotely collected data, or patient reported outcomes (PRO), using apps and Web portals allow clinicians to intervene early in response to signs of deterioration or troublesome side effects. This reduces relapses and avoids the associated events that are hugely costly in human and economic terms; hospital admissions, absence from work, suicide, violence, breakdown of social networks and relationships, and so on. Data collected in “real-time” is not subject to the biases of how the patient is feeling at the time of the three monthly clinic visits when the clinician asks, “How have you been since I last saw you?” Rich and detailed information can be collected longitudinally that would be impossible to obtain retrospectively, and it can be automatically plotted, analyzed, and summarized to support decision making. Technologies that empower patients improve engagement. A patient caseload can be triaged to prioritize appointments according to the “live” clinical need, facilitating population-based care.


    All this is based on talking and answering questions. No labs, no physical exam. So, all you innovative behavioral healthcare professionals out there, prepare to go to the ball. We may even marry the prince.

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    Do doctors really hate Obamacare?

    Do doctors really hate Obamacare? | Healthcare and Technology news | Scoop.it

    Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

    Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

    There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.


    A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

    And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:


    • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
    • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
    • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
    • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”


    When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).


    • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
    • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
    • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
    • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
    • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.


    However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

    The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:


    “Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”


    Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).


    I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.


    But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.


    And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

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    Epic at work on new tech to avert falls

    Epic at work on new tech to avert falls | Healthcare and Technology news | Scoop.it

    Healthcare IT giant Epic is working on a clinical decision tool aimed at helping healthcare providers reduce the risk of falls in unsteady patients. The technology is expected to be ready and available to Epic's EHRclients by year's end.


    Longtime Epic customer Kaiser Permanente will roll out the tool at its facilities across the country and will also make its evidence-based falls prevention program widely available to other health systems and health plans.

    The technology is called STEADI, an acronym for Stopping Elderly Accidents, Deaths & Injuries. The tool is being designed based on CDC's guidelines for falls assessment. The goal is to make it easier for healthcare providers to screen for falls, intervene to reduce risk and provide follow-up care.


    The announcement came at the end of a White House Fact Sheet released this morning regarding The White House Conference on Aging, which President Barack Obama is hosting today.


    The sweeping conference agenda focuses on issues facing Americans as they plan for retirement. Many of the measures proposed build on the Affordable Care Act and on efforts to improve Medicare and Medicaid.


    "In a year that marks the 50th anniversary of Medicare, Medicaid and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging is an opportunity to recognize the importance of these programs, highlight new actions to support Americans as we age and focus on the powerful role that technology can play in the lives of older Americans in the decade ahead," the White House announced.

    Federal data to be released

    The Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans would be made easily available on Data.gov, the repository for the U.S. government's open data. This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety and education. 

    Health IT efforts

    Like Epic's several of the planned initiatives surrounding the aging initiative have healthcare IT underpinnings. These are put forward by the private sector:


    • As part of its annual HackFest, LeadingAge, an association of 6,000 not-for-profit organizations and businesses representing a broad field of aging services, will partner with Hewlett-Packard using HP's 3D immersive computing platform and Federal open data to challenge innovators to create technology-driven tools to improve the lives of older adults and their families.
    • The employer coalition ReACT (Respect a Caregiver's Time), Care.com and the Massachusetts Institute of Technology are joining forces to generate the tools employers need to effectively support employees who are caregivers. MIT and Care.com will jointly conduct a case study based on MIT's approach to employer-supported elder care. 
    • Uber is announcing pilot programs in Florida, Texas, Ohio, Arizona and California that will partner with senior community centers and other advocates to provide free technology tutorials and free or discounted rides to older Americans to increase access to transportation options and support mobility and independence.
    • Airbnb has conducted research to support and understand the experience of older Americans in their travels and in their use of technology and is partnering with communities to enhance accessibility and the user experience for older populations. 
    • Walgreens has made advancements in its digital technologies to connect individuals with its telehealth services provider, which offers 24/7 access to U.S. board-certified doctors.  Seniors also can track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.
    • Peapod has adopted "best in class" Web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications. 
    • Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans. 
    • The University of Washington's School of Nursing and the HEALTH-E (Home-based Environmental Assisted Living Technologies for Healthy Elders) initiative are introducing an Aging and Technology Laboratory, which includes hardware and software tools to support participatory design of technology for older adults.  The laboratory will allow scientists, engineers, and others to engage older adults and their families to accelerate the generation of new solutions to support aging.
    • The Stanford Center on Longevity will develop a State of Longevity Index to be released in early 2016 that will measure how well the U.S. is doing to improve the prospects for long-term well-being in financial security, physical health, social connectedness, educational attainment, and age-friendly communities. 
    • IDEO is announcing the launch of "The Powerful Now," a project to build a cross-sector collaboration around positive aging for all.


    Among the planned government initiatives are.


    • Facilitating state efforts to provide workplace-based retirement saving opportunities: About a third of the workforce lacks access to a workplace retirement plan, the White House notes. That's why, in every budget since taking office, the President has put forth proposals to provide access for 30 million Americans to workplace-based retirement savings by requiring employers not currently offering a retirement plan to automatically enroll their workers in an IRA.  But in the absence of Congressional action, the states are leading the charge.
    • Launching Aging.gov – today: The intent is to provide older Americans, their families, friends and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.
    • Modernizing federal rules that affect long-term care, healthy aging and elder justice: Steps announced today include: a new Centers for Medicare and Medicaid Services proposed rule to update, for the first time in nearly 25 years, the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities to improve quality of life, enhance person-centered care and services for residents in nursing homes, improve resident safety, and bring these regulatory requirements into closer alignment with current professional standards.
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    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate

    21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate | Healthcare and Technology news | Scoop.it

    On Friday afternoon, July 10, the U.S. House of Representatives passed the 21st Century Cures Act, H.R. 6, by a vote of 344-77, sending it to the U.S. Senate. The main focus of the legislation is an attempt to remove regulatory roadblocks in the review process for new pharmaceuticals and medical devices on the part of the Food and Drug Administration (FDA). In addition, according to Congress.gov, the federal government’s official legislation tracking service, “Requirements are established [in the bill] for interoperability and certification of health information technology. Practices that discourage the exchange of electronic health information are prohibited.”


    After the House’s passage of the bill, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement attributed to Leslie Krigstein, interim vice president of public policy, praising the bill’s focus on interoperability.  “The 21st Century Cures Act is a landmark piece of legislation that will move our nation closer to a 21st Century healthcare system,” Krigstein said in the statement. “As recognized in this bill, health information technology will serve as the foundation to foster many of the ideologies in delivering lifesaving cures to patients more rapidly.”


    Krigstein’s statement went on to say that “The Committee's choice to tackle the complex issue of interoperability is to be commended. Without nationwide interoperability, we will be unable to derive the value promised by the nation's $30 billion investment in electronic health records (EHRs). Expediting cures to patients will not be possible without a health information highway that allows providers and patients the data they need, when and where they need it.”


    Krigstein added that “CHIME appreciates the Committee's recognition that harmonizing standards adoption will exponentially move interoperability forward. We agree that clear, enforceable standards are necessary to foster nationwide interoperability. The inclusion of increased testing requirements for certified products, including 'real world' testing, is a priority for CHIME members as a means to bring value to the certification program. We appreciate the Committee's inclusion of the need to ensure the information in one's EHR belongs to the patient. We hope that this language will begin a sincere dialogue on the need to address the ongoing patient safety and care coordination challenges arbitrarily imposed by the lack of a national approach to patient identification. Without a patient identity matching strategy, patient data matching errors and mismatches will become exponentially more problematic and dangerous.”


    The CHIME statement concluded by stating that “We view this legislation as a starting point in the conversation on health IT reform. We hope to build on the language in 21st Century Cures Act to ensure the Meaningful Use Program, among other ongoing federal policy initiatives, enable the implementation and use of EHR systems to meaningfully improve patient care.”


    Additional praise for the House of Representatives’ passage of the bill came from the Charlotte-based Premier healthcare alliance. Attributed to Blair Childs, Premier’s senior vice president of public affairs, it said, “Members of the Premier healthcare alliance commend House leadership for the passage of new health information technology (HIT) interoperability requirements within the 21st Century Cures legislation that passed overwhelmingly today. Requiring free and secure exchange of health information among disparate IT assets will improve patient care, reduce costs, and unlock “big data” in healthcare.  This is also an essential ingredient in enabling providers to improve the health of a defined population health across the care continuum.” That statement concluded by stating that “We are encouraged by the Senate’s equal focus on achieving interoperability among EHR systems.”


    How did the legislation pass the House, and what are its chances in the Senate? Alex Lash, writing Friday in xconomy.com, wrote this: Passage in the House was due in no small part to the bill’s original sponsors, Reps. Diana DeGette (D-CO) (pictured) and Fred Upton (R-MI), whose work—appearances, town halls, info-gathering sessions—for more than a year leading up to the vote at times resembled a permanent campaign. But the Cures Act still must get through the Senate, where single opponents can often hold popular legislation hostage,” Lash noted. “And, despite the strong support in the House, critics are asking if the rush to approve new drugs might tilt away from traditional safeguardstoo much. Fiscal hawks will no doubt pick through the costs associated with the bill, as reported last month by the Congressional Budget Office.”

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    Will the smartwatch be the key that unlocks connected health?

    Will the smartwatch be the key that unlocks connected health? | Healthcare and Technology news | Scoop.it

    The market for wearable technology devices is still in its infancy but consumers are already favoring health and fitness applications.

    New Parks Associates research published Tuesday shows that just 9% of US broadband households intend to invest in a smartwatch in 2015 and that 40% of shoppers have set a price limit of $100-$250.


    This is "roughly equivalent to a high-end fitness tracker," said Harry Wang, director, Health and Mobile Research, Parks Associates. "We are in the early stages in the likely merger of smartwatch and fitness tracker product categories."


    Fitness applications are already proving to be the most popular use cases for smartwatch owners and this could have a huge impact on the future of digital health. 


    "The smartwatch is a key entry in the connected health market, which is rapidly becoming more oriented toward the end user," Jennifer Kent, Director, Research Quality & Product Development, Parks Associates, said. "The adoption rate for connected health devices among U.S. broadband households increased from 24% to 27% over the last year, opening the door for connected device manufacturers as well as service providers to take advantage of the growing consumerization in healthcare."

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    Gerard Dab's curator insight, July 16, 2015 8:32 PM

    Watches or Cell phones for the connected health market.. #medicoolhc #medicoollifeprotector