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Health System began exploring telemedicine as a way to connect its physicians and specialists with patients 

Health System began exploring telemedicine as a way to connect its physicians and specialists with patients  | Healthcare and Technology news | Scoop.it

In 2005, Tift Regional Health System began exploring telemedicine as a way to connect its physicians and specialists with patients in the rural area surrounding its Tifton, Georgia, home base.

At that time, telehealth technology largely consisted of a hub-and-spoke network, based out of large tertiary care centers or academic medical centers.

 

"We understood [telehealth] was the future and we needed to be a part of this technology that could get our patients to the specialists that they needed to see 200 or more miles away," said Jeff Robbins, MD, director of telehealth and neurodiagnostics at Tift Regional Medical Center.

 

The virtual visits idea was starting to be discussed in rural parts of the country. The Internet was slow, but the tech was getting close to making distant encounters possible.

 

"In the early days, every encounter was basically a telehealth network within itself," Robbins said. "The technology only allowed us to connect to one endpoint at a time. The technology didn't allow us to network to a new endpoint or customer without a lot of IT involvement. Internet was slow and the devices used to conduct a patient-to-provider encounter were primitive compared to what we have today."

 

These issues prevented Tift Regional from achieving the outcomes it knew were possible but staff understood, given its track record at other hospitals, that telehealth could play a very important part in delivering healthcare in the near future.

 

Tift at that point partnered with the Global Partnership for Telehealth, a nonprofit with a 12-year track record in developing and implementing sustainable, cost-effective telehealth programs.

 

The Global Partnership for Telehealth markets telehealth systems to hospitals and other medical facilities in 11 states. There are a variety of telemedicine technology vendors with varied offerings on the market. These include American Well, Avizia, Cisco Systems, HealthTap, InTouch Health, MDLive, SnapMD, TeleHealth Services and Tellus -- many of those are in the Healthcare IT News Buyers Guide: Comparing 11 top telehealth platforms.

 

GPT's network of caregivers and its technology gave Tift Regional the ability to connect to nursing homes, school clinics, emergency rooms, stroke teams, specialized wound care teams and advanced critical care teams hundreds of miles away from its rural location in South Georgia.

 

"I like to say the miracle of telehealth is that it gives us the ability to erase time and distance," Robbins said. "Our patients benefit with virtually no travel time or expenses, decreased time waiting for an appointment, reduced medical costs, and extra value to the patient encounter and extended access to consultations with specialists not offered in their area and usually hundreds of miles away."

 

The partnership with GPT also allows Tift Regional's employed physicians to increase revenue because they can see patients outside their area, reducing missed appointments, and giving them the tools to treat more patients over time and have better patient follow-ups that improve outcomes, which also cuts down on readmissions, he added.

 

Telehealth carts generally include a monitor, camera, keyboard and remote control. Peripherals give physicians the ability to monitor vital signs, use a digital stethoscope, and use high-definition cameras for specific types of care such as dermatology or wound care.

 

Telehealth has become a critical component in Tift Regional's ability to deliver quality healthcare, and the healthcare organization has seen success in using the technology.

 

"Telehealth has increased access to healthcare within our organization by making it easier for our patients to obtain clinical services," Robbins said. "It also allows our hospital to provide emergency services that we cannot always provide like advanced/emergency stroke care. We have also seen an increase in improved health outcomes."

 

Telehealth allows Tift Regional to get its patients seen, diagnosed and treated earlier. This leads to improved outcomes and less costly treatments, Robbins explained.

 

"Telehealth has allowed us to have advanced ICU support and that has reduced mortality rates, reduced complications and subsequent hospital stays," he added. "We are seeing a reduction in healthcare costs through home monitoring, which is lowering costly hospital visits. Our stroke program is reducing the high cost of transferring stroke and other emergencies."

 

And Tift Regional has used telehealth to address the shortage in healthcare providers by allowing its patient population to see specialists outside Tift's area, also enabling Tift's own specialists to serve more patients, he said.

 

Before telemedicine, a virtual encounter meant both the presenter and the provider had to switch between many different programs. This presented issues when programs failed and data didn't link up correctly.

 

"The provider can now see who is waiting to be seen in the virtual waiting room, and data entry has been streamlined to allow patient data and notes to be uploaded into our existing EHR," Robbins said. "And maybe the best improvement is the ability to switch programs, going from Pathways to the stethoscope then the cameras within the same encounter."

 

 

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Using telemedicine to treat chronic disease 

Using telemedicine to treat chronic disease  | Healthcare and Technology news | Scoop.it

Flash back to the brink of the Patient Protection and Affordable Care Act. On the cusp of the passage of the ACA, more than 41 million Americans were uninsured or underinsured, driving one of the largest health care overhauls in history. While controlling costs was an important consideration, the main focus of the ACA was expanding coverage. To increase accessibility to affordable health insurance options, the law employs a mixture of mandates, subsidies, tax credits, and penalties to increase coverage of the uninsured, spur health care innovation, and provide for new payment models to reward quality of care and improved health care outcomes.

 

More than five years into the ACA era, the White House touts that the number of people without health insurance continues to decline and has dropped by 15.8 million since 2013. Of the roughly 11 million people who enrolled in state or federal Marketplaces in 2015, about 4.2 million were auto-renewals or renewals, indicating that roughly half of all 2015 enrollees kept their 2014 Marketplace insurance plan.

 

The rurally ignored

 

Despite the widely publicized successes of the ACA, many rural Americans were forgotten by health care reform. Although the ACA proclaimed a renewed focus on rural America, little was accomplished for rural populations outside of Medicaid expansion. A policy brief published by the National Advisory Committee on Rural Health and Human Services stressed the importance of coverage in rural areas, where the population is disproportionately older, more chronically ill, lower in income, and less insured compared to urban areas.

 

Where are the rural communities? "Rural" encompasses all populations, housing, and territories not included in an urban area; essentially, it is defined by what it is not. In 2010, the U.S. Census estimated that 59.5 million people – 19.3 percent of the population – lived in rural areas.

 

Rural residents tend to be poorer, earning a per capita average income of $19,000, which is nearly $7,000 less than what their urban counterparts earn. Although rural Americans account for only 22 percent of the population, rural residents account for 31 percent of the nation's food stamp beneficiaries. Only 64 percent of rural residents are covered by private insurance, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts (45 percent versus 49 percent, respectively). Compounding the issue of obtaining affordable coverage, rural areas rarely have access to the same types of coverage. According to the National Rural Health Association, only about 10 percent of physicians practice in rural America, even though nearly 25 percent of the population lives in rural areas. There are only 401 specialists per 100,000 people, compared to 910 in urban areas.

 

"Rural Americans face a unique combination of factors that create disparities in health care not found in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators, and the sheer isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life."

 

Perpetuated by the inability to find and afford care, rural populations face higher incidences of chronic disease. Obesity, diabetes, heart disease, and alcohol and substance abuse are all chronic conditions that disproportionately affect rural populations.

 

Turns out, chronic disease is costly

 

In the U.S., chronic diseases and the health risk behaviors that cause them account for highest health care costs. In fact, 86 percent of all health care spending in 2010 was for people with one or more chronic medical conditions. The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who are obese were $1,429 higher than those for people of normal weight in 2006. Of the top 10 states with the highest rural populations, half fell on the list of the states with the highest rates of adult obesity and diagnosed diabetes

 

So what is the government doing? Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services recently awarded $2.7 million to improve rural health, however, those grants will support 3-year pilot programs designed to train health professionals and expand health insurance coverage in rural areas, rather than impact rural health directly. Essentially, the 20 recipients of the grants (ranging from $75,000 to $200,000) are community colleges, hospitals, health education centers, individual counties, and other various providers, which are to use the money for formal training programs for health professional students. To put it in perspective, HRSA responded to the outcry by millions of rural Americans by awarding grants equal to the price of 17-year-old Kylie Jenner's first home, after spending hundreds of millions of dollars implementing the ACA and federal and state Marketplaces.

 

Is telemedicine the perfect solution? Maybe

 

Although the ACA does not specifically link telemedicine to rural populations, "telehealth" or "telemedicine," which is using telecommunication and information technologies to provide clinical health care at a distance, is a critical component of transitioning to value-based treatments, and to better serving rural communities and chronic conditions.

 

For rural populations, telemedicine has the potential to increase accessibility to providers and specialists who can remotely monitor and treat chronic disease, without the hassle or costs associated with traveling. In many states, telemedicine services are covered by insurance to the same extent as in-person services. It helps eliminate distance barriers to medical services that would often not be consistently available in distant rural communities.

 

Although it seems like a catch-all, it is important to note that telemedicine is not a replacement for an annual, in-person physical; it is used most effectively to manage chronic condition and preventive health care costs. Even the best physicians in the world cannot take the blood pressure of a patient or press on the abdomen of a sick patient remotely. While certainly this represents a drawback, it also presents an opportunity. The rules governing the practice of medicine do not need to be the same rules that govern the practice of telemedicine. By linking patients with doctors either via telephone or video chat, barriers of distance can be eliminated, which proves crucial for rural areas.

 

Telemedicine snapshot: Mississippi

 

To address the prevalence of chronic conditions, Mississippi became the 16th state to pass advanced telemedicine provisions. In 2014, the American Telemedicine Association (ATA) graded existing state telemedicine programs based on reimbursement and physician practice standards, rating Mississippi with the highest possible composite score. Evidence of a collaborative landscape accommodating telemedicine, Mississippi requires telemedicine services to be a 'real-time' consultation, which does not include the use of audio-only telephone, email, or fax. Additionally, the Mississippi legislature also required that telemedicine services are covered to the same extent as in-person services, although a health plan may limit the number of telemedicine providers to a local network.

 

With the highest prevalence of adult obesity and diabetes in the country, Mississippi prioritized remote patient monitoring services to coordinate primary, acute, behavioral, and long-term social service needs for high-need, high-cost patients. For telemedicine services to be reimbursed, patients must be eligible for remote patient monitoring and specific patient criteria must be met. For example, qualifying patients for remote patient monitoring must be recommended by their physician, be diagnosed in the last 18 months with a chronic condition like diabetes or heart disease, and have a history of costly services because of that condition.

 

Initial barriers to telemedicine implementation

 

Although Mississippi has faced relatively little resistance incorporating these laws, many states still need to consider a number of issues or barriers when developing telemedicine programs and policy.

 

1. Requiring coverage for telemedicine under private insurance, state employee health plans, and public assistance


Reimbursement continues to be a barrier to telemedicine adoption in some states. Medicare, which typically sets reimbursement standards, reimburses for telehealth services with relatively stringent requirements. Medicare pays for telemedicine services only when patients live in Health Professional Shortage Areas (HPSAs) and those who engage in "face-to-face" interactive video consultation services and some store-and-forward applications (e.g., teleradiology, remote electrocardiogram applications). As stated in a report by the American Hospital Association, "Without adequate reimbursement and revenue streams, providers may face obstacles in investing in these technologies."

 

Plan administrators and providers need to work together to discuss telemedicine benefits and determine coverage options and reimbursement policies, similar to the Mississippi State Legislature passing a bill requiring private insurance to pay for telemedicine services at the same rate as it does for in-person care. States considering telemedicine will have to wrestle with similar decisions about what to cover (e.g., video consultations, asynchronous store-and-forward platforms, patient monitoring) and review technology guidelines that determine reimbursement eligibility to ensure maximum reimbursement. To put it simply, if providers are not getting paid, they cannot provide.

 

2. Patient consent and education

 

Consent is a vital component of health care and is more complicated with a telemedicine platform. States must consider requirements for how to approach and obtain patient consent. The risk of consent-based claims for providers is a concern, and malpractice laws are currently geared toward face-to-face interactions; if consent-based claims become rampant, the willingness of providers to administer health care via telemedicine will likely decrease. Nebraska, for example, requires written informed consent, while California and Arizona law permit verbal consent to satisfy the statutory informed consent requirement. Since telehealth is a new and emerging field, patient education is critical to patients' health and providers' ability to practice.

 

Ideally, patients need to understand details about the expected risks and benefits of telemedicine, available alternatives, and how telemedicine fits into their personal wellness plan.

 

3. Geographical restrictions on telemedicine services


Although many states are ironing out provisions for health professional licensure requirements, including implementing special telemedicine licenses, border state and consultation exceptions, and interstate reciprocity and endorsements, little research has been done regarding restrictions on limitations for patient location while receiving telehealth services. For instance, can a patient on vacation in another state or country meet with his or her physician for an appointment? If the physician prescribes medication, can the patient fill his or her prescription outside of state lines?

 

Consideration needs to be placed on not just where the provider is operating from but also where the patient is located at the time of treatment and how treatment is administered.

 

4. Establishing the provider-patient relationship


Trust is an essential factor in a provider-patient relationship. It has been historically built during face-to-face interactions. States need to consider whether an in-person examination component is necessary or telemedicine can be used instead of an initial in-person patient evaluation.

 

The face of health care is changing, but prioritizing relationships is at the core of what creates value and better outcomes in health care. When implementing telemedicine programs, it is essential to consider the health of the patient first and design an interaction model that will create the most effective patient-provider relationship.

 

Overwhelmed? Here's what we know, and where we're going. We know that there are a significant number of rural Americans in the U.S. who have a difficult time accessing and affording health care. We know that many of these Americans are the ones who really need it, given their higher incidence of chronic disease. We know that chronic disease costs a lot and that most rural Americans cannot afford to treat it conventionally. We know that on its face, telemedicine may be one solution to solving the problem of rural health care.

 

A continued focus on this population of Americans and a renewed sense of urgency will allow for thoughtful state legislation and progressive development. Using Mississippi as a model of telemedicine implementation that is more thorough than many of its counterparts, other states can review their successes and challenges, with specific focus on the issues identified in this piece. For instance, considering where a patient must be located to receive care from providers, as well where they are legally able to fill a prescription from that provider are critical considerations for every state developing and amending telemedicine laws. There are a number of stakeholders involved in the telemedicine field. To ensure comprehensive, thoughtful laws and reforms, state legislature should reach out to local health care providers, nonprofit research centers, state insurance and Medicare/Medicaid departments, private insurance companies, state legislators, and patients to evaluate needs and requirements, and implement suitable legislation.

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Adoption of Telehealth Can Generate Cost Savings for Hospitals 

Adoption of Telehealth Can Generate Cost Savings for Hospitals  | Healthcare and Technology news | Scoop.it

The adoption of telehealth technologies in rural areas can result in significant cost savings for hospitals and their communities due to transportation cost savings, lost wages savings, hospital cost savings and increased revenues for local labs and pharmacies, according to a white paper by the NTCA-The Rural Broadband Association.

 

In the white paper, titled “Anticipating Economic Returns on Rural Telehealth,” Rick Schadelbauer, manager, economic research and analysis at the organization, outlines the case to be made for increasing adoption of telehealth in rural areas, and throughout the country, by keeping patients using local health care services rather than traveling to bigger, nearby cities for health care services. Schadelbauer noted that within the United States, there is a distinct health disparity between rural and non-rural Americans, primarily as a result of demographics and limited access to health care.

 

Telehealth and telemedicine, or the remote delivery of health care services and clinical information using telecommunications technology, holds potential to improve the quality, cost and availability of health care in rural areas. However, telemedicine is not viable without access to robust, reliable broadband service, Schadelbauer wrote. “Rural areas currently lag in broadband deployment, but continue to make impressive gains due in large part to the efforts of small telecommunications providers. Wireless applications require wireline infrastructure in order to be viable options,” he wrote.

 

The white paper examines the rural health care challenges, telehealth adoption and the potential benefit of telehealth technologies, both non-quantifiable and quantifiable. And the white paper drills down into challenges for rural health, such as reimbursement, cost, patient privacy and licensing.

 

According to the paper, the non-quantifiable benefits of telehealth are numerous: improved access to specialists, speedier treatment, the comfort of remaining close to home, eliminating the need for long-distance transportation, the ability for health care providers to sharpen their skills, and improved patient outcomes.

 

The white paper also quantifies several categories of quantifiable benefits of telehealth: transportation cost savings (median cost savings: $5,718 per medical facility, annually); lost wages savings ($3,431 per medical facility, annually); hospital cost savings ($20,841 per medical facility, annually); and increased revenues for local labs ($145,109 per medical facility, annually) and pharmacies ($8,558 per medical facility, annually.)

 

More specifically, hospitals in rural communities could potentially save more than $81,000 a year on employing doctors, and the white paper presented as one example a hospital that reduced its use of a full-time radiologist from five days a week to one. And, at the same time, hospitals could potentially generate revenue from lab work and pharmacy services that would remain local as a result of telemedicine, according to the white paper. For example, the authors estimated that tens of thousands of dollars could generated by local MRIs, CTs and other lab and pharmacy billings.

 

“The decision to implement telemedicine is unique to each medical facility, and should take into account not only costs but also non-quantifiable benefits and quantifiable benefits accruing to parties other than the medical facility, such as the patient and local labs and pharmacies located in the communities where telemedicine takes place,” the authors wrote.

 

As potentially significant as the potential benefits to telehealth—both non-quantifiable and quantifiable—may be, , Schadelbauer wrote that “it is critically important to remember that rural telehealth’s role in addressing the significant health problems inherent to rural areas will depends upon the availability of an underlying, future-proof, fiber-based broadband infrastructure. Further investment in, and expansion of, broadband infrastructure is a critical need not only for rural Americans but also our country as a whole.” Further, he noted, “Absent access to such an infrastructure, the benefits of telemedicine will remain merely theoretical.”

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How telemedicine is transforming treatment in rural communities? 

How telemedicine is transforming treatment in rural communities?  | Healthcare and Technology news | Scoop.it

There's no denying it: rural hospitals are in trouble.

 

More than 48 rural hospitals have closed since 2010, according to the National Rural Health Association, and another 283 are in danger of closing.

 

The malaise effecting rural healthcare comes from several vectors. Reduced populations, higher percentage of uninsured and elderly patients, equipment underuse, and the absence of high-margin specialty services makes for a bleak economic outlook. A shortage of doctors willing to work in remote areas creates quality of care and a staffing issues. Then, there is the challenge of getting patients into rural hospitals in a timely manner because travel distances sometimes are too great.

 

Many believe that telemedicine and mHealth offer a way out for struggling rural hospitals, however.

 

A 2012 report by the Institute of Medicine for the National Academies, entitled The Role of Telehealth in an Evolving Health Care Environment, found that telehealth drives volume, increases quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Through telemedicine, rural hospitals can serve rural patients at better costs and help cut down on the time it takes rural patients to receive care, particularly specialty care.

 

"When rural patients know their hospital is using telemedicine, they have higher regard for that hospital and are less likely to bypass it for treatment at an urban facility," noted James Marcin, director of the UC Davis Children's Hospital Pediatric Telemedicine Program, a pioneer in remote medicine.

 

The ways that rural hospitals can take advantage of telemedicine and mHealth technology advancements are many, and include remote consultations, in-home monitoring, outsourced diagnostic analysis, and remote specialist consultations.

 

Instead of waiting days or weeks for a healthcare professional to travel to a remote area, or traveling into a hospital and waiting for an appointment, telemedicine enables remote physician consultations that are faster, cheaper and more efficient than traditional healthcare appointments. For consultations on simple health concerns, or follow up on existing conditions, remote consultations can dramatically improve the patient experience while helping rural hospital economics at the same time.

 

The Georgia Partnership for Telehealth, for instance, assesses and treats students so that they do not need to travel to a clinic for healthcare, and currently has replaced more than 350 locations where a traditional doctor's visit was formerly required.

 

A second way that rural hospitals are leveraging telemedicine is through in-home monitoring. One example is decreased hospitalization rates for seniors enrolled in the FirstHealth Home Care Chronic Disease model in North Carolina. Patients previously diagnosed with heart failure, diabetes, or COPD and who experienced frequent hospitalizations are monitored by telehealth at home between periodic visits from nursing staff. Response and intervention times have improved substantially, according to the program.

 

Another benefit to struggling rural hospitals is outsourced diagnostic analysis and access to remote specialists. It is difficult for many rural communities to staff their own diagnosticians, but mobile imaging centers and lab specimen kiosks that can take X-rays and perform collections can work in conjunction with remote analysis labs in larger urban areas to bridge the gap.

 

One study that looked at 24 hospitals in four rural states in the Midwest including Kansas, Oklahoma, Arkansas, and Texas found that telemedicine brought an annual economic impact of at least $20,000 per year, with an impact of up to $1,300,000. The majority of these savings came from increased lab and pharmacy revenues due to additional work performed locally.

 

In addition to outsourced diagnostics, telemedicine also enables consultation with remote specialists at larger, urban hospitals instead of the need for having these specialists on staff. This can be particularly good for attracting doctors to rural hospital settings.

 

"Telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town," noted Dr. Wilbur Hitt in a report, Telemedicine: Changing the Landscape of Rural Physician Practice. "With telemedicine, it's like having one foot in the city but being able to live and practice out in a rural area. It's also reassuring to know that you're on the right track with the treatment plan and are staying current."

 

Still, roughly 66 percent of rural hospitals had no telehealth services or were only in the process of implementing a telehealth application when the RUPRI Center for Rural Health Analysis reviewed 4,727 hospitals in the 2013 HIMSS Analytics database. Part of the reason comes from broadband access challenges.

 

Rural communities not only suffer from a population shortage and a lack of resources, they also typically have trouble with the necessary broadband infrastructure for telemedicine. The benefit of remote consultation by video conference for rural patients is clear, for instance, but these remote consultations amount to nothing if there isn't the broadband infrastructure to support it.

 

"The ability for physicians to connect with those in areas that don't have much of a wireless connection is the biggest problem when trying to treat these patients," noted Tony Zhao the CEO of Agora.io, a video SDK company that provides easy video conferencing with quality-of-service guarantees so telemedicine and e-learning initiatives work even in rural settings.

 

"With weak connections, video streams for telehealth are blurry, choppy or just won't work," he added. "Implementing technology that doesn't rely on the general internet but which relies on an infrastructure that strengthens signals in the most remote areas is crucial."

 

Another barrier for rural hospitals is the challenges that surround reimbursements. Medicare reimbursement is a major challenge for telemedicine, with states each having their own standards by which their Medicaid programs will reimburse for telemedicine expenses.

 

There is no single standard telemedicine reimbursement system for private payers, either. Some insurance companies value telemedicine and will reimburse for a wide variety of services while others do not.

 

These and other challenges put a drag on rural telemedicine at the same time as the need for it grows. Rural hospitals have a path toward recovery in the form of telemedicine, but obstacles still remain.

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Continuous Learning in Healthcare and Technology

Continuous Learning in Healthcare and Technology | Healthcare and Technology news | Scoop.it

What was the last webinar you participated in? What was the last podcast you listened to? What was the last book or in-depth article you read to learn something new? The bigger question is do you have a continuous learning plan?

 

One of the things I love about working in healthcare and technology is the pace of change and that there is always something new to learn. But that is also one of the challenges. So how do we keep up?

 

Don’t doubt that having a continuous learning plan is important for your career. The most recent This Week in Health IT podcast was interviews with six CIOs. Bill Russell asked them each the same five questions. The last question was what did they wish they knew or had done before they started their current role. A theme in the answers was around staff development – needing their staff to develop new skills and developing their leadership teams.

 

There are many different options and formats for ongoing training and learning to consider. You may prefer reading or webinars or podcasts or classroom training. Most likely you need a combination of all.

 

A few observations and tips from my own experience:

 

Reading: What used to be a stack of publications piled up in my office to read has now become a lot of bookmarked articles to read online. I read a lot of articles each week and add more to my list, even though I may not get to them. Having a few good “go to” resources and knowing your key areas of interest help manage and filter out the noise.

 

Webinars: You could spend several hours a week just doing webinars. Focus on a few “go to” resources and register for the ones that are most relevant to what you need to know. Or register for something new that you want to learn about. Once you put it on your calendar, consider it like any meeting. Too often we register with good intentions and then decide we don’t have the time when that day comes. But, if you really can’t make the time, many webinars are archived and available later.

 

Podcasts: I find several times a week when I can be listening and learning – driving a long distance, gym workout, or walking the dog. Find the podcast series that are most useful to you and subscribe. Then go to your Podcast library and pick one next time you have 30 minutes to listen.

 

Conferences: IT budgets have gotten tighter over the years and far fewer people are able to attend conferences. As a CIO, I encouraged the “divide and conquer” strategy. Plan in advance, coordinate attendance at sessions and hold staff accountable for sharing their learning when they return.

 

Online courses: This is a new one for me. I’ve thought of going back to school to get more current in healthcare and technology emerging topics, but I really would just like to take some specific courses. I am hearing about edX, an online learning destination offering a huge collection of online education courses, Also, there are MicroMasters programs, a series of graduate level courses from top universities.

 

Degrees and certificate programs: If you are considering going back to school for an advanced degree, more power to you. I got my MBA over a four-year period taking one course a quarter when my children were young, and I was already in management. It was hard to balance it all. But I had the long view on the value of getting my master’s degree and never allowed myself to say I was too busy to do it. I saw too many colleagues putting off starting a program and others skipping quarters – all because they thought they were too busy. A certificate program in a focused area is another option to consider. Most likely your company offers some form of tuition reimbursement. Make sure you understand the benefits and take advantage of whatever is offered.

 

I’m guessing that for those six CIOs who were interviewed and every CIO I know, one of their ongoing challenges when they review their IT budget is training and development. They want to invest in their staff and that takes time and money.

 

But far too often, the various institutional memberships we were paying for were way underutilized. I found the solution was to educate and promote the resources to my entire staff. If possible, try to work with the company to customize and target content that is most relevant to you. Organizational level subscriptions and memberships in HIMSS, Scottsdale Institute, Advisory Board, or Gartner to name a few should be leveraged to their fullest. If not, they will be the first line item to cut at budget time.

 

Some of the smartest and most successful people follow the “5 hours a week rule” – spending 5 hours a week learning. Busy people like former President Obama, Bill Gates, Warren Buffett, Oprah Winfrey follow it. So why can’t you?

 

Think about continuous learning like you do your gym workout schedule. Develop a plan that’s right for you. Make the time. And remember, it’s an investment in you.

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Up, down or out? Perspectives on artificial intelligence in health care today

Up, down or out? Perspectives on artificial intelligence in health care today | Healthcare and Technology news | Scoop.it

Two-thirds of the attendees polled at a recent innovation summit by The Economist agreed on one thing: health care is the sector that will benefit most from artificial intelligence (AI) technologies.

 

In health care, which is in the midst of an industry transformation and a digitalization of key aspects of patient engagement and care management, the role of data, analytics and AI are central to the organizational mission. However, it is easy to get caught up in one aspect or another when extolling (or decrying) the role of AI, while ignoring the near-term potential as well as the limitations of the technology.

 

How can AI play a role in health care today? In the words of S. Somasegar, a venture capitalist, there are three ways in which AI can impact a business today. Upwards, meaning that AI can take on intelligent capabilities that enable a higher level of interaction with humans; downwards, implying an ability to reduce costs; and outwards, which is to take AI to the edges of our computing infrastructure.

 

Voice recognition and natural language processing (NLP) technologies help us move up in health care by enabling remote-monitoring and home health care through a “natural” interface with humans. In the health care enterprise, NLP technologies can “read” complex medical literature and provide doctors and clinicians with intelligent choices for diagnosis and treatment options.

 

With the emergence of cheap computing and storage infrastructure, AI technologies help manage vast arrays of servers and networking equipment, detecting and remediating the most common problems without human intervention. “Purpose-built” hardware with inbuilt AI capabilities are becoming the norm in high-volume and time-sensitive operations that require running machine-learning algorithms on large data sets and doing it at low costs.

 

The notion of edge computing, a paradigm that takes analytics and AI to the edges of a computing infrastructure, has lately become important in the context of the Internet of Things (IoT) and smart devices. In health care, the proliferation of intelligent devices, in and out of hospital settings, has created many new opportunities. Tom Bianculli, Chief Technology Officer of Zebra Technologies, a firm that provides mobile devices, scanners and RFID-enabled tags used in hospital environments, talks about “digital diaries” that can log every minute and every second of a device’s operation in the context of patient care. Using a network of tags and near-field communication equipment, Bianculli is now able to track a mobile device in a caregiver’s hands as she makes her way through a hospital floor, recording and analyzing everything from her precise location to her pace of walking to the direction in which she is headed with the device. Extending it to outpatient or even home health care, the deployment of intelligent devices that can analyze data at the “end point” and sending it back to a back-end system can save lives by reducing the time involved in alerting caregivers to medical emergencies.

 

To some, all of this may sound futuristic. However, it doesn’t have to be complex use cases and high risk situations involving patient lives that determine whether AI is suitable for a health care institution. The vast majority of AI use cases involve “low-hanging fruit” that automates aspects of operations that are routine and repetitive in nature. AI can release humans from mundane tasks and enable them to work on more exciting and value-added tasks. In some industries with an acute shortage of skilled human resources such as health care, this may even be a necessity for long-term sustainability. 

 

The use of AI technologies comes with responsibilities as well. In the wake of recent disturbing news about a driverless car causing a fatal accident and the alleged misuse of Facebook profile data to influence the last presidential elections, there was a somber tone to the discussion at The Economist event. The gathering of AI technologists and industry leaders using AI to advance their business goals paused to reflect on how AI can be force for good and bad. Among the concerns: AI technologies by themselves may not reveal any inherent biases, but may unleash all manner of biases that reflect the biases of the humans who design the systems. There is a growing sense that AI should be used not just for the right predictions, but also to make predictions for the right reasons. While AI is coming on par with humans in aspects such as reading radiology images, the same neural network algorithms have potential for discriminatory profiling based on facial recognition and other decisions that have implications for society. The usefulness of AI models also depends on the data sets: as an example, selective representation of demographic profiles in a data set can give rise to biased conclusions on populations represented by that dataset.

 

The underpinning of success with AI lies in the underlying data. Fortune 500 companies are spending up to 50 percent or more of their IT budgets on information integration today, and no sector is more acutely aware of this than health care, with its complex environment of proprietary electronic health record (EHR) systems and emerging data sources. Unlike in other sectors such as consumer finance and retailing which are long used to multi-channel engagement with customers based on an omni-data capability that can aggregate and integrate data from a wide variety of sources, health care remains more siloed today than any other sector. The implications for AI adoption are clear: it will be slower than in other sectors.

 

Finally, having the data and the AI capability doesn’t ensure improved quality or reduced costs in health care. You need intervention models in place to do something with the data and have care plans for doing the preventive intervention, which can be challenging if the data is incomplete (as often the case with EHR data) or outdated (as with health insurance claims data). In an era of high-volume and high-velocity real-time data, these limitations will restrain the adoption of AI technologies.

 

As computing costs drop and AI technologies mature, health care and other industries will have to invest and catch up or get left behind in the great digital transformation under way. As someone said to me, there is a penalty for inaction. That penalty may be too big a cost to pay for most enterprises today. 

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5 Big Questions About Health Insurance

5 Big Questions About Health Insurance | Healthcare and Technology news | Scoop.it

In theory, most of the U.S. health care delivery system and most of the health care finance system could work about the same way in 2018 as they’ve worked in 2017.

 

Medicare and group health plans look as if they’ll continue on something like the same path.

 

Even the 2018 individual major medical market could go through some bumps and then settle down into looking like a creakier version of the 2017 market.

 

At press time, however, the future of the U.S. health care delivery and finance systems was up in the air.

 

Most of the Affordable Care Act was still in place. The Trump administration was administering the ACA system, including HealthCare.gov, about as well as possible, in some ways, but appeared to be working to block it in other ways.

 

The administration appeared to be close to working out a settlement with health insurers on billions of dollars in ACA cost-sharing reduction subsidy payments, but, whatever happens to the subsidy payments, the administration has made the point that it could change health insurance system administration procedures quickly, without much apparent concern for how the changes might affect health insurers.

 

Many nonprofit health insurers seem to be hunkering down and trying to stand up to the administration: they have elected chief executives from two of the most enthusiastic insurance company players in the ACA system to lead both America’s Health Insurance Plans and the Blue Cross and Blue Shield Association.

 

But some of the biggest, publicly traded health insurers seem to be coping by doing when they can to retreat from the individual major medical insurance market, and avoid talking too much about their role in the fully insured employer-sponsored health plan market.

UnitedHealth Group Inc., for example, is calling itself a health care company.

 

Aetna Inc. is trying to become a division of a drug store chain.

 

If the individual major medical market stays as unpredictable in 2018 as it’s been in 2017, and some of that upheaval spills over into other health insurance sectors, what then?

 

Trying to make anything as firm as a “prediction” for the health insurance system seems foolhardy, but here are some questions that might shape our coverage of health insurance in the coming year.

1. Will more companies could try to disguise more major medical insurance products as something else?

 

One symptom of a regulatory-driven market breakdown is participants’ efforts to escape from the official market, into black market or gray market alternatives.

 

Many insurers, agents and consumers have already been trying to sidestep the challenges plaguing the individual major medical market by focusing more on partial individual major medical substitutes, such as short-term health insurance or hospital indemnity insurance.

 

Up till now, fear of patients’ facing serious gaps in coverage, and lawsuits, have held down many agents’ sales of major medical substitutes.

 

The more the individual major medical market deteriorates, the less squeamish market players may be about trying to work around it. 

 

2. Will everyone get religion?

 

The Affordable Care Act includes a provision officially allowing the sale of a kind of arrangement that could, in theory, provide something like true individual major medical insurance: health care cost-sharing ministry memberships.

 

Ministries in effect when the ACA came along can continue to sell memberships without facing ACA mandates, or any other federal regulations or oversights whatsoever.

 

Rapid expansion of health care cost-sharing ministries could be another symptom of individual major medical market breakdown.

 

3. Will hospitals collapse?

 

Health insurers see hospitals as the biggest components in large sophisticated health care systems that tend to have much higher profit margins than health insurers.

 

S&P Global Ratings are predicting, in a look at top industry trends for 2018, that the big hospitals S&P rates should do reasonably well in 2018.

 

“We expect hospitals to see very low single-digit organic growth (consisting of near-zero volume growth and low-single-digit blended reimbursement rate increases), while companies providing outsourced services to hospitals and outpatient providers should grow slightly faster,” the S&P analysts write. “We expect industry participants to see modestly higher bad debt expense in 2018 (reflecting slightly lower insurance coverage levels and the increasing prevalence of high-deductible health plans, given difficulty in collecting amounts owed by consumers).”

 

But many small hospitals, especially those that treat many uninsured patients, and many patients who have Medicaid coverage, operate on thin margins.

 

If the individual major medical market goes through severe problems, or the Congress or the administration somehow impose sharp reductions in Medicare or Medicaid reimbursement rates, that could push some hospitals over the edge.

 

A wave of hospital failures could affect patients with group health coverage or Medicare coverage as well as those with individual major medical coverage and Medicaid.

 

4. Will doctors go fishing?

Consumers in many communities already see that psychologists have, in effect, dropped out of the market for insurance-paid behavioral health services.

 

Mental health care providers in those communities often refuse to provide care for the rates health plans are willing to pay them.

 

The S&P analysts say they expect to payers to continue to focus on containing costs.

 

If health plans try to cut costs too much, it’s possible that large numbers of medical doctors could follow mental health care providers out of the health plan provider network door. 


5. Will health savings accounts shine?

 

President Donald Trump promoted health savings accounts (HSAs) while he was on the campaign trail.

 

Most Republicans in Congress, and Trump’s nominees at the U.S. Department of Health and Human Services and other federal agencies, like HSAs.

 

The tax bill would leave the HSA intact.

 

If the Trump administration and Congress start to move past major budget reconciliation bill battles, efforts to promote and expand the HSA program could heat up.

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The Latest Trends in Nursing Technology

The Latest Trends in Nursing Technology | Healthcare and Technology news | Scoop.it

If trying to make sense of the stock market is enough to have you ready for a straitjacket. It is much easier to let your 401(k) do its thing and not think about it too often. The same can’t be said for those of us in the healthcare industry even though it feels like things are changing as rapidly as they do on Wall Street. Between the legislative changes, corporate mergers, innovative technologies, and everything else that is happening in our industry, it is enough to make your head spin. Let’s look at trends and technologies that will become more commonplace in 2018 and beyond.

 

Patient Engagement. As with most industry trends, nurses are on the front lines of patient engagement efforts. If you haven’t already been exposed to the concept, patient engagement is the practice of a patient taking more responsibility for their own health and well-being. When providers and patients work together, health outcomes are improved. New technologies are being developed to support patient engagement, and nurses are finding themselves more involved in helping evolve engagement efforts for their patients.

 

Precision Medicine. Another newer concept that will ultimately involve nurses providing direct care to patients, Precision Medicine, refers to the advancement of medical research that targets how certain diseases impact people differently based on their genetic makeup. It may include different treatments for certain types of cancers based on the genetics of the tumor. Precision medicine is an acknowledgment that healthcare is never one-size-fits-all and treatments are being adapted to the individual rather than the disease.

 

Centralized Command Centers. Inspired by NASA, many hospitals are implementing command centers that serve as a “mission control” for all of the services and functions related to patient care. Today’s nurses are finding themselves able to interact with the second set of eyes and also have help in managing daily bottlenecks. These command centers are also being utilized for central monitoring of patients to overcome alarm fatigue from the 90% of hospital alarms that aren’t actionable. The centers utilize complex algorithms and analytics to assist nurses in making real-time decisions to improve quality of care and reduce costs.

 

Smarter Smartphones? All of us are already using our smartphones for just about everything we track, post, and read lately, so nurses using them for their work is not surprising. One example of ways that nurses are able to use their smartphone is called Steth IO, which turns your phone into a modernized stethoscope. A special case is attached to your iPhone (not yet available for Android) and channels the sounds of a patient’s heart and breathing into the microphone. The Steth IO app then digitizes the heartbeat into a graph on the phone screen to record and enable easier detection of abnormal heart sounds.

 

Overcoming Language Barriers. As our nation’s population becomes more diverse, nurses are finding themselves in more frequent situations where patients speak a language other than English. This often leads to another nurse who speaks the language being brought in to translate. By September of this year, a hand-held, two-way voice translator, The Pocketalk, will be available to translate up to 63 languages in real time. Working via Wi-Fi, mobile data, or a personal hotspot, the translator transfers speech to text on the screen and relays responses verbally. Nurses will also be able to save up to 20 exchanges to assist with post-visit notes and charting.

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Who ‘owns’ the healthcare consumer of the future?

Who ‘owns’ the healthcare consumer of the future? | Healthcare and Technology news | Scoop.it

CVS and Aetna are merging. Amazon, JPMorgan Chase, and Berkshire Hathaway are forming a joint venture aimed at reducing health care costs and improving outcomes. Cigna is acquiring Express Scripts. The proposed mergers promise a revolution that could fundamentally alter the current healthcare landscape and the relationships between providers and patients. With these giant corporations betting big on healthcare, a logical question to ask is: What’s behind it all?

 

The answer is simple: ownership of the healthcare consumer experience, and by extension, the consumer.

Digitalization and healthcare consumerism

In the past few years, Amazon has reshaped the relationship between consumers and marketers. It has forged itself into being the preferred destination for consumers seeking convenience. Now, imagine Amazon applying this power to the healthcare sector. The company already offers a wide range of the over-the-counter drugs in their health and wellness section. Going from there to selling prescription drugs is not a big step. However, that step could become a big leap in terms of the shift in consumer loyalties if consumers are provided the option to order their 90-day medication refill and have it delivered to their doorstep (maybe even by a drone).

 

Recognizing the threat, many health systems are taking measures to digitalize their relationships with consumers by focusing on something they have long neglected: convenience. Virtual visits and e-visits are now becoming commonplace. A young mother of three no longer has to bundle her kids into the car and drive an hour each way to her hospital for a routine follow-up that takes all of fifteen minutes in the physician's office. A senior citizen in a wheelchair on multiple chronic-care medications no longer needs to "check in" by getting physically to a physician's office. They can both do their visits through secure messaging, or if required, through a virtual real-time consultation.

 

The above is just one example of how digitalization could reshape relationships between consumers and providers.

Data, analytics, digital

Here is another scenario that is already starting to play out. Consider a patient with high blood pressure. Technology is enabling patient-generated health data (PGHD) from wearables and sensors that include blood pressure, heart rate, glucose levels, and medication adherence to be transmitted seamlessly into the patient’s electronic health record (EHR). The combined data is being analyzed for trends and insights and made available to everyone involved in that patient’s care, enabling care teams to manage the patient more effectively. The patient can still control who can see the information by following an e-consent process through an app right on the mobile device. If a patient opts to participate in clinical studies, that person can be matched automatically with relevant opportunities. Both the individual patient and the population improve their health outcomes as a result.

 

Data-driven advancements are arriving in the form of both precision medicine and healthcare consumerism. Advancements in precision medicine are expected as the relationship between data from wearables, sensors, social determinants and other emerging sources is better interpreted through advanced artificial intelligence (AI), and yielding better outcomes. We are in the early stages of a new push toward patient-centered, consumer-directed care that is demonstrating strong growth potential.

 

What we are also starting to see is some redistribution of the in-person visits between traditional providers and emerging ones. As an example, CVS and Aetna are betting that consumers may prefer to visit one of their many walk-in clinics for minor conditions instead of waiting to schedule an appointment with their primary care physician in the hospital down the road. Urgent care is already shifting out of hospitals, and in many cases, going virtual altogether. The rise of companies such as Teladoc and Doctor-on-demand is clear evidence of this.

Bricks and mortar is not going away

None of this suggests that the traditional healthcare setting is fading into obscurity. Health systems, especially those with strong brands in their local and regional markets, have an unassailable lead today as trusted healthcare partners in their communities. Many of them are already making big investments in digitalization programs that will enable consumers to get the best of both worlds, namely a virtual experience for routine healthcare and urgent care needs, and an in-patient experience for acute care needs. For a high-quality patient journey, these two worlds must be tightly integrated. Only traditional hospitals can provide that truly integrated experience today.

The future of healthcare consumerism is not an either/or

If Big Data’s relationship to precision medicine has been on a more or less predictable trajectory, the explosive growth of healthcare consumerism has opened up options for healthcare consumers seeking convenience in addition to the quality of care. The healthcare leaders of tomorrow will ideally sit at the intersection of these two critical aspects of healthcare delivery. A reputation built on high-quality care alone will no longer be enough; neither will a reputation for slick user interfaces and transactional convenience.

 

A friend, who is also the CIO of a large health system, recently suffered a heart attack during a race. As he felt it coming on, he wisely checked himself into the medical tent from where he was rushed to a nearby hospital. A stent was put into his chest that saved his life. Imagine a scenario where with the help of real-time, advanced analytics and AI technologies, his imminent heart attack could have been predicted. Imagine, too, if he had not had access to one of the most experienced and qualified cardiologists in the country to attend to him during the emergency. Digitalization can ensure that the cardiologist's knowledge, wisdom, and experience are still accessible no matter the current physical location of the patient.

 

Ownership of the healthcare consumer experience requires a mixture of convenience and quality enabled by a robust data and analytics capability. No one sits precisely at that happy intersection today. However, the race is already underway to get there.

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Digital health’s last mile problem

Digital health’s last mile problem | Healthcare and Technology news | Scoop.it

In my book, The Big Unlock, I describe the four major categories of technology providers as Custodians, Enablers, Arbitrageurs, and Innovators. Each of these categories of providers has staked a claim to reimagining the digital future of healthcare.

 

First, the Custodians: These are the big electronic health record (EHR) vendors like Epic and Cerner who have the data and the workflow. As systems of record, they enjoy the long-term strategic commitment of the health systems they serve and are the first port-of-call whenever a health system decides to enable new functionality for enhancing the patient and caregiver experience. 

Systems of record have certain limitations and are arguably weak in several areas, such as advanced analytics, which is critical for a digitally reimagined healthcare experience. Along came the Enablers to address this problem. Big technology firms such as Google, GE Healthcare, Microsoft, Salesforce and IBM’s Watson Health business have built technology stacks that integrate multiple emerging and traditional data sources, including EHR systems, and have incorporated some proprietary data sources as well, such as images in the case of GE Healthcare.

 

These big technology stacks include inbuilt advanced analytics capabilities that can deliver insights to power digital health experiences. Google’s Deep Mind, for instance, recently analyzed eye scans from over 125,000 patients to build an algorithm that could detect diabetic retinopathy, the number one cause of blindness in some parts of the world, with over 90 percent accuracy. The company claimed the accuracy of the analysis was on par with board-certified ophthalmologists.

 

The Arbitrageurs are mostly technology agnostic consulting firms such as Accenture and Deloitte, as well as India-heritage firms such as Wipro and Infosys, that rely on information and labor-arbitrage models to build digital experiences from scratch using the preferred technology tools that exist in health systems.

The Last Mile problem

All three categories of technology providers described above have stopped short of building ready-to-deploy digital health experiences, which leads us to the Last Mile problem in healthcare. Despite the powerful computing and data analytics infrastructure that big technology firms have invested in, there is a shortage of viable, proven digital health experiences for health systems and their key stakeholders in healthcare delivery i.e. patients and caregivers. The challenge – and the opportunity – has fallen to the fourth category of technology providers, namely the Innovators.

By definition, the Innovators are typically startups that have come up with a whole new way of addressing an existing problem with technology-enabled healthcare experiences, or for filling a gap in the current healthcare experience with technology. Digital health startups raised an estimated 11.5 billion in 2017, and money continues to pour into the sector, despite the slow pace of exits. Despite the promise, a report by IQVIA indicates that while over 318,000 health apps and 340 consumer wearable devices are now available worldwide, 85 percent of the apps had fewer than 5000 installs. The few apps that did reach critical mass demonstrated strong clinical evidence, robust integration with the established workflow integration, and high user ratings – prerequisites for any digital health solution looking to break into the health systems marketplace.

Addressing the bottleneck

The need for last mile applications is enormous, and yet the innovation ecosystem has not built and implemented viable applications fast enough and at scale to meet the demand. Common challenges include:

  • Extended cycles to hit prime time usage: most health systems follow a traditional approach that takes promising new solutions through the phases of a free pilot, paid pilot, and enterprise adoption. The process could take years, and many solutions remain in "pilot purgatory" for an extended period, often failing to break through to enterprise adoption. Health systems need a newer, more agile model, to assess and deploy promising solutions more quickly and efficiently
  • Too many standalone solutions: the digital health landscape is littered with thousands of point solutions that stand in isolation, with no established connectivity to systems of record which is the price of entry for any new solution. Health systems are loath to sign up dozens of point solutions and take on the burden of integrating and managing these solutions. They prefer to default to the many solutions that EHR vendors have built or are actively building (or claim to be building) that effectively make stand-alone solutions redundant, despite the superior experience architectures that startups are known for. A potential approach for startups is to align with one of the big Enabler companies who, through established relationships with health systems, can create a pathway to adoption and growth.
  • An absence of scale: No single platform addresses all the needs of a digital health enterprise today, unlike the mature enterprise resource planning (ERP) systems of the manufacturing and financial sectors. There is a significant opportunity for Enables companies to build ready-to-deploy innovation ecosystems through partnerships with digital health startups. However, Enabler platforms too have increased and are at risk of becoming too fragmented to present a real alternative to health systems looking for scale and velocity in the digital transformation journeys.

The digital transformation of healthcare is in its early stages, and the gold rush is underway. Wanted: creative approaches to solving the Last Mile problem and unifying the fragmented ecosystem of point solutions and stand-alone technology enablement platforms.

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Health IoT creates huge opportunities for public health and software companies 

Health IoT creates huge opportunities for public health and software companies  | Healthcare and Technology news | Scoop.it

Connecting smart biological sensors to the internet is not a new idea. There are already dozens of products in the market that continuously monitor blood glucose and heart function, for example, and enable secure remote management for clinicians and caretakers. The safety of life implications are enormous, and the commercial opportunities untold. Some analysts predict a $100 billion-plus market for the healthcare segment of the “internet of things” (IoT).

 

What is new and emerging is the physical scale of the devices on the one hand, and the need to aggregate, reconcile, and consolidate those data streams for downstream clinical care services. Advances in semiconductor device manufacturing will relentlessly drive down the price and the size of these electrophysiological sensors, literally to the nanometer scale, which will ultimately be able to do more than detect, they will be able to intervene. At the same time, our ability to make sense of the torrents of information is catching up to our ability to create them.

We believe that these are tremendous opportunities for public health and software companies like ours. It is why we are investing so much of our own resources to promote the open design, secure exchange, and value-added analysis of health data systems. Perhaps the largest inhibitor to a promising future of longer, healthier, less expensive life are the software merchants and device manufacturers who still and astonishingly insist on keeping data closed, isolated, and trapped in proprietary systems. We believe this is about to change too.

 

The interoperability troubles with electronic medical records are legion, and we won’t waste our page space or your attention lamenting the deeply ignorant and the nearly criminal. The immortal words of Forest Gump’s assessment about doing dumb things find purchase here.

 

What we can do, however, is find clever ways leverage of IoT as yet-another, and maybe decisive, the fulcrum of connected care. For what is today true in isolation – progressive plans, concerned parents, engaged patients – will soon-enough be more the ubiquitous standard of coordinated care; that coordination will reach deeply into pocketbooks as well as bodies.

We know that there are legitimate concerns about individual privacy and device safety and that some people would literally rather die than compromise on either. We respect that, even as we actively promote more automation and digital services in health care.

 

Some of us believe that the existential benefits of independence and longevity outweigh the potential risks of intrusion and malfunction, some of us don’t. The point is that everyone should have the choice and that no one should be coerced or manipulated into choosing one side of the argument. Fear mongering (about privacy) and fabrication (about intrusion) are forms of manipulation. In the case of health care, they cost lives and money.

 

Let’s, instead, imagine a world of seamless, secure, and reliable health data interoperability. Let’s find a better way to safely liberate data at its source – labs, pharmacies, hospital and clinics, insurance claims, as well as implantable and wearable devices – pass it through hygienically sealed pipes, and receive it in places where it does the most good. That may be during a clinical care or remote telemedical encounter (to give you the best possible advice based on evidence and your personal health history), it may be when you pick up your medicines (to check for interactions with other medicines), or it may be to help your insurance company help you (because they have always had a bird’s eye view of your services, and they can’t kick you out for pre-existing conditions anymore).

 

Because of changes in the law, it may be with a loved one or trusted caretaker. It may be you.

The data could be as simple as a reminder message about an upcoming appointment, a warning message that a clinical value seems out of range, or an answer to a securely-texted question to your doctor. We have imagined that future and it is, as Ray Kurzweil likes to say, near.

 

There are two challenges, and they are slowly receding.

The first is that the data holders are still reluctant to share, even though it isn’t “their” data.  This will become less of a problem, as forward-looking providers like VA and DoD have shown, as well as payers like CMS, Aetna, and HCSC among many others have demonstrated.  All are outspoken supporters of the Blue Button program, now in its fifth year, and still growing.

 

The second falls squarely on our shoulders:  we need to make the user experience attractive, convenient, and useful.  The health IT community has made terrific strides recently – we-two have worked on the InCircleand a soon-to-be-announced medication management app, for example –  and there are many companies that target data-driven patient-provider interactions, including AmericanWell and covers health.

 

The beautiful thing is that IoT fits so neatly into this conversation. The goal, of course, is to help us achieve our best-possible health. The best way to do this is with data. And the best data is coming at us in ever more granular packages, from patient-hosted sensors that monitor, detect, interact, and intervene. Weaving those into the tapestry of your personal health history is the next vanguard of coordinated and managed care.

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Why is Telehealth so Important in Our Healthcare System? 

Why is Telehealth so Important in Our Healthcare System?  | Healthcare and Technology news | Scoop.it

Telehealth is emerging as a critical component of the healthcare crisis solution. Telehealth holds the promise to significantly impact some of the most challenging problems of our current healthcare system: access to care, cost-effective delivery, and distribution of limited providers. Telehealth can change the current paradigm of care and allow for improved access and improved health outcomes in cost-effective ways.

 

Telehealth increases access to healthcare:

  • Remote patients can more easily obtain clinical services.
  • Remote hospitals can provide emergency and intensive care services.

Telehealth improves health outcomes:

  • Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.
  • Patients with Telehealth supported ICU’s have substantially reduced mortality rates, reduced complications, and reduced hospital stays.

 

Telehealth reduces healthcare costs:

  • Home monitoring programs can reduce high cost hospital visits.
  • High cost patient transfers for stroke and other emergencies are reduced.

 

Telehealth assists in addressing shortages and misdistribution of healthcare providers:

  • Specialists can serve more patients using Telehealth technologies.
  • Nursing shortages can be addressed using Telehealth technologies.

 

Telehealth supports clinical education programs:

  • Rural clinicians can more easily obtain continuing education.
  • Rural clinicians can more easily consult with specialists.

 

Telehealth improves support for patients and families:

  • Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.
  • Many telehealth applications empower patients to play an active role in their healthcare.

 

Telehealth helps the environment:

  • Reducing extended travel to obtain necessary care reduces the related carbon footprint.

 

Telehealth improves organizational productivity:

  • Employees can avoid absences from work when telehealth services are available on site or when employees can remotely participate in consultations about family members.
  • These examples illustrate the some improved outcomes and cost savings being achieved by Telehealth and telehealth programs:
  • Home monitoring of chronic diseases is reducing hospital visits by as much as 50% by keeping patients stable through daily monitoring.
  • The national average for re-admission to hospitals within 30 days following a heart failure episode is 20%. Telehealth monitoring programs have reduced that level to less than 4%.
  • Timely provision of treatments that effectively reverse the consequences of a stroke have risen from 15% to 85% due to the availability of telestroke programs.

 

Telehealth support to Intensive Care Units (often called eICUs) is reducing mortality rates by 15 – 30% and substantially reducing complications and length of stay.

 

Telehealth retinopathy screening programs support early identification of serious eye disease and reduce the incidence of blindness in diabetic patients.

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StrongBox: Your Medical/Dental Billing Software Solution

StrongBox: Your Medical/Dental Billing Software Solution | Healthcare and Technology news | Scoop.it

In today’s modern world, revenue cycle management and intuitive billing software are essential aspects
of any successful healthcare practice. Together, these tools can help reduce bad debt expense, increase
collections, and reduce overall costs. Here, our team at StrongBox explores how our medical/dental
billing software can be an invaluable asset to your practice. Once our software is in place, our clients
enjoy a number of benefits, all while making more money and working less.


#1: Increase Practice Efficiency
Administrative and billing tasks often take up a shocking amount of time. In fact, according to The
Commonwealth Fund, 20.6 hours are spent every week on health plan-related tasks. [1]  With better
organization, StrongBox can help your practice increase its workflow efficiency. Our proprietary
software integrates seamlessly with your practice management software, not only enabling faster note-
taking, but also helping your entire team stay organized throughout the work day.


#2: Decrease Practice Overhead
Many practice owners assume their billing headaches will go away if they hire more employees. On the
contrary, fewer staff members can actually streamline the process and keep costs down. The best way
to achieve this is to employ a reliable medical/dental billing software. At StrongBox, we design our
software to be user-friendly and intuitive. As a result, your staff spends less time on billing and more
time getting new patients through the door.


#3: Billing Transparency
Part of workflow efficiency is complete billing transparency. You need to know which claims have been
processed and if any have been denied. You also need to keep track of every charge and every
transaction. StrongBox’s medical/dental billing software can help you quickly assess the financial status
of every patient and catch any billing errors in the process.


#4: Increase Your Return on Investment (ROI)
If you’ve been in healthcare for a while, you know how quickly billing costs have risen, and continue to
do so. A positive return on investment is absolutely essential for a successful practice. By keeping
revenue up and keeping costs down, StrongBox medical/dental billing software can help you run your
practice efficiently and reap the rewards for your hard work.


#5: Best Practice Training
When choosing a medical/dental billing software, you want a company that can help train your team
and address any technical issues. At StrongBox, we not only have a team of IT experts, we also partner
with several experts in the dental and medical fields. This gives us a full understanding of your unique
needs as a practice, so we can build a software solution that will enhance your productivity.


Seamless Integration

 

We understand that shopping for new software solutions can seem daunting, especially since you likely
have a number of programs installed already. StrongBox’s billing software seamlessly integrates with
your practice management software of choice, making the transition as simple and as smooth as
possible. Furthermore, StrongBox also offers revenue cycle management as well as a patient payment
portal, making administrative tasks that much easier.

 

Learn More about StrongBox Medical/Dental Billing Software
If you are currently in the market for healthcare billing software, request a free demo from StrongBox.
We can help you assess your needs so we can deliver a fully customized software solution for your
practice. To learn more, contact our Boca Raton, FL office by calling (855) 468-7876.

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5 Ways Telemedicine Is Helping Hospitals & Their Communities 

5 Ways Telemedicine Is Helping Hospitals & Their Communities  | Healthcare and Technology news | Scoop.it

Change has been hard on rural hospitals and their communities. Since 2010, more than 48 rural hospitals have closed and much more are on the brink of the same fate. Patients are seeking higher levels of specialized care from urban hospitals while rural communities are struggling to find top-notch providers willing to reside in remote areas. Lack of resources, provider shortages, and all-time low patient censuses are causing more and more hospitals to consider closing their doors.

But according to a Becker’s Hospital Review article, many believe that virtual health could be the answer to much of the woes rural hospitals are experiencing.

 

1- Patients are looking for more specialized services
When patients within rural communities contract long-term illnesses that require more extensive testing and monitoring, they’re often forced to spend additional time and resources on traveling to larger hospitals and health systems that are more equipped to provide the care they need. This could include regular check-up appointments with specialty physicians or more in-depth tests that require equipment their rural hospital doesn’t have access to. This can cause a snowball effect by taking away the same patient for general care needs that they can certainly receive from their community hospital.

 

Rural hospitals have quite a number of options when it comes to providing telemedicine to their patients and all are helpful in their own ways to combat the potential churn of a patient.

 

Remote specialist consultations can allow a rural hospital to connect with the nearest urban hospital and their physicians for specialized services while still retaining the patient and making their care more convenient and low-cost.

 

Outsourced diagnostic analysis allows patients to receive diagnostic tests followed by top-notch care depending on the outcome. Patients no longer need to travel for hours just to have an x-ray or specialty lab work performed.

 

Remote consultations allow doctors to perform routine check-in appointments with patients from home. Not only do they get to skip the long drive to their nearest urban hospital, they can even avoid the short commute to their rural hospital while still seeing their same physician.

 

Direct-to-consumer telemedicine allows rural hospitals to expand their services to new patients. Patients who don’t typically take the time to see a doctor can now have virtual consultations for urgent care needs without making an appointment, driving to an urgent care, or spending time waiting in the emergency department.

Telemedicine consultations of any kind save time for both the patient and the doctor, leaving room in the physician’s schedule for more appointments with other patients who do require in-person care. Patients in rural areas benefit by removing the barrier of transportation, long drive times and the costs associated with both.

 

2- Rural hospitals are experiencing provider shortages
There is expected to be an overall shortage of 46,000 to 90,000 physicians by the year 2025 and rural hospitals will feel it. Rural communities are having a hard time attracting physicians who are willing to live in remote areas. Rural communities have about 68 primary care doctors per 100,000 people compared with 84 in urban areas.

 

Rural hospitals who are experiencing provider shortages can utilize telemedicine platforms that come completely staffed with physicians who are fully trained in providing virtual care, and at a much less expensive rate. Telemedicine platforms who come staffed with 24/7 physician coverage are the perfect solution for small rural hospitals whose emergency departments get overwhelmed with patients not experiencing a true emergency. Patients can access a doctor from home and leave the resident physicians available for truly urgent conditions. Most physicians who staff a telemedicine platform are not primary care physicians, so there is no risk of losing patients to outside providers. In most cases, the physicians can help refer patients back to the hospital for other medical needs.

 

For hospitals who need an extra benefit to attract physicians from urban areas, according to Dr. Wilbur Hitt in an NEJM career resources article, “telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town,” he said. “With telemedicine, it’s like having one foot in the city but being able to live and practice out in a rural area. It’s also reassuring to know that you’re on the right track with the treatment plan and are staying current.” In addition, it gives rural physicians the opportunity to specialize in something high-tech and innovative that will surely be the way of the future.

 

3- A high percentage of a rural hospital’s patients receive Medicare
Medicare and the subject of reimbursement often hinder the way a rural hospital can deploy telemedicine to their patients, especially in North Carolina where telemedicine parity doesn’t exist.

 

Currently, patients in rural areas who are covered by Medicare Part B can be reimbursed for telemedicine services, like office visits and consultations, as long as they are located at one of these places during the telemedicine consultation:

  • A doctor’s office
  • A hospital
  • A critical access hospital
  • A rural health clinic
  • A federally qualified health center
  • A hospital-based or critical access hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center


An additional advantage of telemedicine for any patient, including those on Medicare, is that the cost of a visit is much less expensive compared to an urgent care facility or an emergency department visit which often tend to be the first choice for unscheduled care. With most virtual consultations costing less than $50 per visit, patients are able to save on both routine and urgent medical care costs. The savings also applies where insurance isn’t concerned. Non-existant commutes save on the cost of transportation and allow those without means of reliable transit to see a doctor from the comfort of their home.

 

4- Helping rural hospitals reduce readmissions
Telemedicine is already a proven tool for helping rural hospitals lessen the penalties they receive from value-based reimbursement policies. Rural hospitals who are using telemedicine in addition to implementing care coordination and patient experience improvement strategies are receiving fewer penalties than their urban counterparts.

 

While rural hospitals are already excelling, there is always room for improvement. According to RevCycle Intelligence, rural hospitals still have ways to go under the Hospital Readmissions Reduction Program. 79% of participating rural hospitals faced value-based penalties in 2015 under the program. This year, hospitals will see a 3% maximum rate of penalty and CMS estimates that will total $528 million dollars in penalties across the US.

 

A big factor in reducing readmissions is providing better preventive care, this is where telemedicine excels. Remote monitoring allows patients to check in more frequently with their physicians or nurses and also increases the chance that they’ll seek advice when experiencing an unscheduled medical care need before it advances to a more serious condition. By catching a sudden change in status, a patient can be seen by a primary care physician rather than being readmitted to the hospital, thus impacting a hospital’s penalties.

 

For some patients managing at-home care can be the challenge, especially when dealing with lengthy discharge instructions. When patients aren’t following their discharge instructions correctly, disease symptoms can flare, causing a trip back to the hospital. With remote monitoring via a HIPAA secure video connection, physicians and nurses have the ability to check in on a patient to see if they’re following their discharge instructions correctly and can also administer help remotely for patients who need a little extra hand-holding, this is especially useful for those who do not have at-home care or someone to assist with the fine details.

 

Prescriptions can also cause problems. Elderly patients may have trouble remembering to fill a prescription, especially when it involves scheduling an additional doctor appointment. By communicating via telemedicine, prescriptions can be refilled during a regular, virtual consultation and can be ready for pick-up at their preferred pharmacy in just a few short hours.

 

5- Increase patient census & reach the remote and underserved
As mentioned under section #1, direct-to-consumer telemedicine increases a hospital’s reach by attracting patients who otherwise wouldn’t seek care from a rural hospital’s network. Those who live and work in the corners of rural areas have the longest drive time and those who are underserved and do not have reliable transportation usually go without medical care. Even established patients will find value in seeing a doctor from home, greatly increasing their satisfaction of care received.

 

Telemedicine providers today are able to provide a white-labeled app, meaning they can design both the desktop and mobile interface where patients receive care to use a specific hospital’s brand standards- allowing a patient to seek care from a known and trusted healthcare provider. But, the branding isn’t the most important part. You should also consider how a patient is recognized when using telemedicine provided by your hospital and how their PHI is delivered back to your EHR. While most telemedicine providers can white-label the app, some cannot connect the patient back to your hospital, this creates a fragmented patient record contributing to disparate care coordination.

 

In addition to being able to tell where a patient is coming from, it also allows the physician providing the virtual care to help the patient determine where they should receive follow-on, in-person care, if necessary. Patients who are linked to one rural hospital can be referred back to that hospital’s network if it makes the most sense.

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Time to End ‘Wild West’ of Health Data Usage in HIPAA-Free Zones 

Time to End ‘Wild West’ of Health Data Usage in HIPAA-Free Zones  | Healthcare and Technology news | Scoop.it

In a recent conversation, a CMIO described the era of Meaningful Use and ICD-10 to me as the “doldrums of regulatory reform” that “sucked up all the oxygen” in the industry, leaving little room for innovation. So I can see why there would be little appetite for more regulation related to health data, and obviously the current administration prefers market-based solutions to regulatory ones.

 

Yet the Oct. 22 meeting, “Data Min(d)ing: Privacy and Our Digital Identities,” put on by the U.S. Department of Health & Human Services, made it clear to me that as more health data is gathered (and sold) outside the clinical setting, there is a “Wild West” atmosphere in which pretty much anything goes in terms of what companies not covered by HIPAA can do with our health data.

 

As an example, an April 2018 CNBC article noted that Facebook “has asked several major U.S. hospitals to share anonymized data about their patients, such as illnesses and prescription information, for a proposed research project. Facebook was intending to match it up with user data it had collected in order to help the hospitals figure out which patients might need special care or treatment.” (That project is currently on hiatus, Facebook said.)

 

The HHS meeting brought together industry leaders and researchers for some thought-provoking presentations about the many ways genetic, wearable and EHR health data is being used. For instance, James Hazel, Ph.D, J.D., a research fellow at the Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center, presented his research that involved a survey of the privacy policies proffered by U.S. direct-to-consumer genetic testing companies. Hazel noted that there has been huge growth in direct-to-consumer genetic testing, with an estimated 12 million people tested in the United States. Beyond offering consumers the services, these companies doing the testing wish to monetize that data through partnerships with pharmaceutical companies and academic researchers. There is also value to government and law enforcement officials – to solve cold cases, for instance.

 

There is a patchwork of federal and state laws governing disclosure of secondary data usage to consumers, but the industry is largely left to self-regulate, he said. In his survey of 90 companies offering these genetic data services, “10 percent had no policies whatsoever,” he said. About 55 companies had genetic data policies, but there was tremendous variability in policies about collection and use. Less than half had information on the fate of the sample. In terms of secondary use, the majority of policies refer to internal uses of genetic data. However, very few addressed ownership or commercialization. And although almost all made claims to being good stewards of the data, 95 percent did not provide for notification in case of a data breach. The provisions for sharing de-identified data are even less restrictive. Hazel noted that 75 percent share it without additional consent from the consumer.

 

Hazel’s take-home message: “We saw variability across the industry. Also, we had a group of law students and law professors read the policies and there was widespread disagreement about what they meant,” he said. “Also, nearly every company reserves the right to change the policy at any time, and hardly any company provided for individual notice in event of a change.” He finished his presentation with a question. “What is the path forward? Additional oversight by the Federal Trade Commission? Or allowing industry efforts to take the lead before stepping in?”

 

In a separate presentation, Efthimios Parasidis, J.D., a professor of Law and Public Health at the Ohio State University, spoke about the need for an ethical framework for health data.

 

Parasidis began by noting that beyond data security and privacy, consent and notice are inadequate ethical markers. “If one looks at regulations, whether it is HIPAA, the European Union’s GDPR, or California’s recently enacted consumer privacy law, the regulatory trend has been to emphasize consent, deletion rights and data use notifications,” he said. While these are important regulatory levers, missing is a forum for assessing what is fair use of data.

 

“Interestingly, few areas of data collection require ethics review,” he stressed. HIPAA does not speak to when data use is ethical but rather establishes guidelines for maintaining and sharing certain identifiable health information. Even those protections are limited. HIPAA only applies to covered entities, he noted. It does not apply to identifiable health information held by a wide variety of stakeholders, including social media, health and wellness apps, wearables, life insurers, workers’ compensation insurers, retail stores, credit card companies, Internet searches, and dating companies.

 

“While the volume of identifiable health information held in HIPAA-free zones engulfs that which is protected by HIPAA and may support more accurate predictions about health than a person’s identifiable medical records,” Parasidis said, “the limits of HIPAA’s protections go beyond scope. For data on either side of the HIPAA divide, an evaluation of ethical implications is only required for human subject research that falls under the Common Rule. Much of data analytics falls outside the Common Rule or any external oversight.”

 

Citing the Facebook example mentioned above, Parasidis noted that tech giant Amazon, Apple, Google, Microsoft and Uber are entering the digital health space. “The large swathes of identifiable information that these entities hold raise a host of ethical questions,” he added, “including widespread re-identification of de-identified health information, health profiling of individuals or groups and discrimination based on health conditions.”

 

Policies and guidelines can supplement the small subset of data covered under legally mandated ethics review, he explained. For instance, federal agencies sometimes use internal disclosure review boards to examine ethical implications of data disclosure. But it is not clear this type of review is happening in the private sector.

 

Parasidis described work he has done with Elizabeth Pike, director of Privacy Policy in the Office of the Chief Information Officer at HHS, and Deven McGraw, who served as deputy director of health information privacy at HHS, on a framework for ethical review of how health data is used.

 

One way to think about more robust ethics review is the use of data ethics review boards, he said. Their structure can be modeled on institutional review boards or disclosure review boards. “This new administrative entity is necessary because much of contemporary data analytics falls outside existing frameworks,” he said. “We argue that these boards should focus on choice, responsiveness, accountability, fairness and transparency — a CRAFT framework. For instance, choice goes beyond consent. Individuals have an ongoing interest in their health data and should be able to specify how it is collected, analyzed and used.”

 

Reasonable minds can disagree on the relative weight of ethical principles or how they should be enacted into the context of data use deliberations, he said. “We nevertheless believe there remains an urgent need to craft an ethical framework for health data.”

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Advancing healthcare through technology

Advancing healthcare through technology | Healthcare and Technology news | Scoop.it

Healthcare is personal. Each of us knows stories of friends and family dealing with difficult medical issues. We hear how hard it can be to navigate the health system. It seems that one fills out the same information over and over and wonders why the physicians and hospitals don’t have it already. We hear how people must research their own conditions to make tough decisions about treatment options. We know there are access and affordability issues for many people.

 

As National Health IT week comes to an end, we must renew our commitment to make a positive impact on health care through technology.

 

I am fortunate to have worked with many passionate, committed people in healthcare over the past 30+ years. And I’m grateful to have a team of advisors working with us at StarBridge Advisors. Each has made an amazing and lasting impact on healthcare.

 

In our most recent StarBridge Advisors blog, “NHIT Week: 6 Leaders on the Value of HIT”, we discussed the value of health IT with six of our advisors. Their perspectives provide a lens into how technology is transforming healthcare though there is much more to do.

 

I encourage you to check out the perspectives shared by these CIOs and clinical leaders here. And if you like what you see, read more of our “View from the Bridge” posts and subscribe to receive notifications of new posts from our team of industry leaders.

 

Together, we all make a difference!

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Digital transformation and the law of small numbers

Digital transformation and the law of small numbers | Healthcare and Technology news | Scoop.it

A recent survey indicates that health care has made little progress toward value-based care (VBC) since last year, with more than two-thirds (67 percent) of physicians and health plan executives indicating that U.S. health care is still predominantly a fee-for-service system.

 

The findings come at the same time that the Center for Medicare and Medicaid Services (CMS) has announced a slew of proposals that have, among other things, reduced the amount of total incentives available for redistribution to eligible physicians who meet quality thresholds under the Merit-Based Incentive Systems Program (MIPS) for Medicare beneficiaries.

 

According to Dr. L Patrick James, Chief Clinical Officer of Quest Diagnostics, who conducted the survey, a majority of physicians believe they do not have the tools or the data to succeed in a value-based contracting environment. 

 

 

The slowdown in the shift towards value-based care has several ramifications.

A dampening effect on the pace of digital transformation in health care

Many of the components of value-based care, namely data and analytics, remote monitoring, enhanced patient engagement and improved caregiver communications are all part of the ongoing digital transformation of health care. Investing in these programs continues to make economic sense only when there is money to be made doing so, and cease to have any meaning when the system of incentives diminishes the monetary benefits of these programs.

A slowdown in technology investments

With the stalling of the shift to value-based care, health systems are likely feeling the impact of margin compression as reimbursements under the traditional fee-for-service model continue to fall. Discretionary dollars are more likely to go towards maintaining and upgrading essential infrastructure, and in optimizing existing IT investments. The appetite for big-ticket technology investments, especially for digital initiatives, is likely to be low, except for targeted investments with clearly identifiable returns on investment.

Renewed debates on the state of data and analytics

It’s safe to say that the debate on health care’s future in data has been put to rest. However, as indicated by the Quest survey, it appears that physicians are overwhelmed by the flood of data, and making the data actionable is a crucial challenge today. Poor data, along with a lack of adequate tools, impact the ability of physicians to qualify for incentives under the MIPS scheme, forcing them to stay with fee-for-service payment models even in an era of declining reimbursements.

 

Across industries, there is more downbeat news on digital transformation. A recent study by consulting firm Capgemini and the MIT Center for Digital Business concludes that organizations are struggling to convert their digital investments into business successes. The reasons are illuminating and many: lack of digital leadership skills, and a lack of alignment between IT and business, to name a couple. The study goes on to suggest that companies have underestimated the challenge of digital transformation and that organizations have done a poor job of engaging employees across the enterprise in the digital transformation journey.

 

These findings may sound surprising to technology vendors, all of whom have gone “digital” in anticipation of big rewards from the digital bonanza (at least one global consulting firm has gone so far as to tie senior executive compensation to “digital” revenues). Anecdotally, “digital” revenues are still under 30 percent of total revenues for most technology firms, which further corroborates the findings of market studies on the state of digital transformation.

Relax, digital is alive and well

Despite the somber survey findings, health systems continue to invest in initiatives that deliver tangible, near-term benefits. An example of a high priority investment area is patient access. At Providence St Joseph Medical system, a focus on online scheduling has delivered savings of $3 to 4 per appointment booked, producing over $300,000 in total savings to the health system. As a bonus, there are fewer no-shows when patients book online, which results in additional bottom-line benefits to the hospital. Since labor is around 60 percent of a hospital’s costs, any digital solution that has a labor substitution component and increases productivity is a target for health system executives. The rising popularity of voice-enablement in caregiver communications is a case in point. 

 

Which leads me to the title of this blog: is digital a game of small numbers?  The point solutions referred to above seem to suggest that to be the case, at least as it relates to digital. Health care is no stranger to big numbers, considering the many millions each hospital has invested in implementing electronic health record (EHR) systems over the last decade. However, it seems unlikely that we will see such investment levels in digital, at least in the short term. Part of the reason is that there no single, monolithic digital platform that can perform the tasks at the scale and scope of a foundational transaction system like EHR. The digital health solution provider market is highly fragmented, and there is a shortage of ready-to-deploy “last mile solutions” which I have discussed in an earlier column.

 

The momentum for digital transformation, while it has slowed down, is still positive. In the short term, there is ample opportunity to leverage existing investments to stay on the path of digital transformation and transition to value-based care. As Dr. James of Quest Diagnostics says, “Measures that optimize EHRs, make data more accessible and insightful and reduce the complexity of quality measurement are much-needed steps to accelerate this transition.”

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Healthcare Technology trends to watch out 

Healthcare Technology trends to watch out  | Healthcare and Technology news | Scoop.it

The healthcare industry is on the cusp of a digital revolution. People are empowered with health information, thanks to technological innovations in digital health. It’s vitally important that healthcare professionals continue to stay up to date on advances in technology that will improve not only their internal systems but also patient treatment and care.

 

In this article, we’ll focus on top healthcare technology trends for 2018 in three main areas, namely Patient Engagement, Hospital Workflow, and Treatment.

 

Patient Engagement


2018 will witness more developments in the arena of patient-centric care. Mobile health is gaining prominence, pointing us to the fact that individuals are taking a more active role in their own health. Wearables and fitness trackers are gaining mass adoption by people of varying demographics. About 50% of healthcare consumers are expected to be active digital health tech adopters in 2018. Now, more than ever, patients will begin to have a say in their choice of treatment and expect transparency of information exchange from healthcare providers.

 

Telemedicine is another model of healthcare that is gaining traction in this hyper connected world. Get ready to see a rise in demand by consumers for health advice and information in the coming months. Adoption of telemedicine will connect patients and doctors like never before. The digital health empowered individual will pose a challenge to traditional healthcare services that are slow in adapting to the digital transformation happening around. The quality of service from healthcare providers will be measured by the ease of access to information by patients.

 

Hospital Workflow


Technology continues to advance as people become more and more accustomed and able to access information in seconds rather than hours or even days. Because of this, slow-paced administrative processes in hospitals are becoming increasingly frustrating to patients. This includes things as simple as difficulties of scheduling an appointment, to accessing medical reports, or even trouble in exchanging information between providers.

 

Hospitals are expected to make use of digital platforms and cloud computing services as part of their patient engagement measures. The motto of 2018 will be data access, anywhere, anytime.

 

Mobile health, telemedicine, and Electronic Health Records (EHR) will produce a plethora of data that healthcare providers can utilize to improve patient care. One of the challenges that many providers will face is the issue of storing and securely transmitting sensitive patient health information (PHI). Many organizations still depend on legacy fax equipment to securely transmit documents despite the criticism of relying on this ancient technology. Thankfully, 2018 will be the year hospitals decide to choose alternative technologies like online faxing that is secure, cost-effective, and environmentally friendly.

 

Other exciting news awaiting us as we talk about secure transmission of data is the blockchain. Utilization of the blockchain will disrupt the way data has been handled until now. IDC Health Insights predicts that 20% of healthcare organizations will actively develop systems utilizing the blockchain to keep data secure and enable easy exchange of information between trusted partners.

 

Treatment


Robots are coming - Not Terminators, but life savers.

 

Experts suggest that practitioners will make use of Artificial Intelligence (AI) for better diagnosis, surgeries, assistants, and more. Virtual Reality and Augmented Reality will become common tools at the hands of doctors for educating patients. AI bots will slice and dice data to help doctors make more accurate clinical decisions. The combined force of blockchain and AI will open a new realm in healthcare which will ultimately help provide better patient care. Use of AI will increase the efficiency and productivity of doctors as well. For those who fear a robotic conquer of the world, be assured that AI in healthcare is not going to replace doctors, but empower them.

 

These technological developments will help to fuel a positive change in the healthcare industry in 2018. It’s impossible to predict the pace of these implementations in hospitals, as these require not only capital and training but also an open-minded and forward thinking CIO that’s willing to adopt new and innovative technologies. The pertinent question is, are you ready to embrace the change?

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Digital Technologies can Address Cancer

Digital Technologies can Address Cancer | Healthcare and Technology news | Scoop.it

There have been remarkable strides in prevention and treatment of disease in the past 5 decades.  Few have rivaled targeted cancer therapies based on digital health, specifically genomics in scope and breadth.  I’d like to touch on a few ways in which digital technology is impacting cancer.

 

1. Targeted therapies. One only has to watch the avalanche of television commercials for cancer centers both local and national to appreciate the role genomics now plays in choosing therapies today for cancer. In simple terms, cancers have genetic fingerprints which are becoming specific targets of newer drugs. Different types of cancers may share similar genetic markers. Getting more layered in complexity, the same cancer may experience genetic changes during its course.  The National Cancer Institute offers a more in depth discussion of genomics and cancer.  An ambitious initiative with far-reaching implications is the National Cancer Institute’s NCI-MATCH (Molecular Analysis for Therapy Choice) trial. IBM Watson Health has recently partnered with Quest Diagnosticsto provide clinicians with recommended “… unbiased, evidence-based approaches based on a detailed view of the tumor’s mutations, scientific journals, and MSK’s OncoKB, a precision oncology knowledge base..” The possibilities are indeed many in this space and the use of digital tools like genomics and artificial intelligence are accelerating our knowledge and successes.

 

2. Registries.The traditional collection of information on cancer has been with the collection of limited data derived from patient demographics, health history and episodic office encounters. There are now digital technologies now which incorporate raw data from pathology, genomics, imaging studies, patient reported symptoms and follow-up and more. In a previous post I describe ways in which a well-designed registry can address multiple stakeholder needs. The value of an excellent tech-based registry is best appreciated in oncology and rare diseases. As someone who has a family member with a very rare cancer, I have seen first-hand the potential benefits of and resistance (primarily ‘political’) to such registries which would expedite decision-making via pooled experiences.

 

3. Connected care: apps: Connected care today includes such technologies as wearables and mobile health apps. Benefits of connected care include triangulating the transmission of information (among clinicians, patients and caregivers), convenience, and timeliness. Three impressive mobile apps in the oncology space are:

 

a. Pocket Cancer Care Guide. Helps patients and caregiver obtain information about specific cancers, understand medical terminology, builds lists of questions to ask physicians, and provides the ability to record and save clinicians’ answers to questions.

 

b. Cancer Side-Effects Helper by pearlpoint. “…offers trusted nutrition guidance and practical tips to help survivors feel better, maintain strength, and speed recovery from common cancer side effects…”

 

c. My Cancer Genome. Managed by the Vanderbilt-Ingram Cancer Center, this award-winning app has both clinician and patient-facing information on cancer genomes, targeted therapies, and provides updated appropriate available clinical trials.

 

4. Connected clinical trials. The rising cost of clinical trials, the increasingly recognized importance of patient reported outcomes, and the transformation of trials with electronic data capture all suggest the value proposition of digital tech in clinical trials. Obtaining real-time vital sign trends, patient-reported adverse events (drug side effects/toxicities, unplanned ER or office visits), and outcomes data will make clinical trials more relevant (by recruiting a larger and more diverse patient population via digital tools), less costly and safer.

 

5. Social media support. The convergence of social media and healthcare was both inevitable and beneficial for patients. The advantages of online support groups over traditional in real life organizations are many. Access to information, governmental agencies, empathy, and convenience are some of them. Twitter has contributed greatly in this regard. TweetChat groups focusing  on specific diseases abound.

 

Critics of digital technology in healthcare raise valid issues regarding accuracy and reliability of information, privacy and security, and patient safety. There are existing regulatory guidelines addressing these, arguably not comprehensively enough.  Accurate and reliable information about cancer is available via many digital avenues. Digital technologies are an integral part of cancer diagnosis and treatment today.  We are living in an age where they might be among the most important tools we have as clinicians, patients, and caregivers. Hats off to those dreamers who make it possible!

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How blockchain can address the two biggest challenges in healthcare IT

How blockchain can address the two biggest challenges in healthcare IT | Healthcare and Technology news | Scoop.it

A recent study on blockchain adoption in health care by Blackbook Market Research indicated that a large percentage of payers surveyed, and a small but growing percentage of providers, were either considering deploying or were in the process of implementing, some blockchain solution sets. Blockchain appears to have moved from the awareness and education phase to actual deployment of solutions.

 

“Blockchain can solve two of the biggest problems in health care today," says Lidia Fonseca, CIO of Quest Diagnostics, a leader in lab testing services. She is referring to the gnarly issues of interoperability and data quality. While data quality has long been an issue in health care, the interoperability challenge is a legacy of the massive digitization of patient medical records over the past eight years which have left us with proprietary electronic health record (EHR) systems that don't "talk" to one another. The result is inefficiency and waste, as stand-alone information systems slow down processes and create redundant work. 

Taking a look at the healthcare blockchain pioneers

Some technology solution providers, including IBM and Change health care, along with a number of other companies listed in the Blackbook Research study, have made initial moves in establishing blockchain capabilities and launching solutions. Federal agencies such as FDA and CDC have expressed interest in applying blockchain to find solutions for public health issues.

 

Amazon, with its long-awaited entry into health care, recently announced the launch of blockchain templates for health care, aimed at making it easier for developers to create blockchain-based projects and deploy blockchain networks via open source frameworks. In a sense, Amazon has started the democratization of the blockchain-enabled application development, something we saw before with machine learning algorithms in the wake of the big data and analytics hype a few years ago.

 

A group of large healthcare enterprises, including large payers such as Humana and United Health Group (UHG), along with Quest Diagnostics, UHG subsidiary Optum, and Multiplan Health recently came together to launch a blockchain pilot program to solve for one of the most significant data challenges in health care today – provider data management. Provider data, a fundamental enabler for all manner of healthcare transactions, is a key building block for processing claims and maintaining up-to-date provider directories. Today, most provider data is stored in siloed and independent databases. Provider data quality is estimated to be a $2.1 billion problem today, according to a report by CAHQ, a non-profit alliance focused on creating shared initiatives to streamline the business of health care. By streamlining the inefficiencies in provider data maintenance, participants can have a "single source of truth." It is estimated that up to 75 percent of provider data management costs can be eliminated using blockchain solutions.

What it will take for blockchain initiatives to succeed

While blockchain is coming of age in health care, we’re still in the early stages of the hype cycle for blockchain. The initial mania around bitcoin, the very first use case for blockchain, is now giving way to more carefully considered use cases for business with tangible benefits. Healthcare, a sector that generally lags in the adoption of technologies, is currently in a wait-and-watch mode; notwithstanding the high levels of interest among payer organizations, the Blackbook survey also points to low levels of interest among health systems, citing the undetermined cost of blockchain solutions as the major issue that stops health system executives from committing to a timeframe for deploying the technology. Our best hope is that the early pilots will bring tangible proof points and provide more confidence to the industry in the technology.

 

Health care is a team sport and so is blockchain. The more participants there are in a blockchain network, the better it is for the network and the industry. Pilot programs such as the provider data management initiative by Quest Diagnostics and others will need a much higher level of participation across the industry to reap the benefits of the network effects.

 

As with most transformative technologies, the big challenge is usually not the technology; it’s managing culture and workflow changes, driving collaboration, and an execution focus. In blockchain, there is an added dimension of a commitment and willingness to work across company boundaries, which is an entirely new paradigm for most health care enterprises.

In a unique development, a group of health care industry executives has come together to launch a peer-reviewed blockchain journal to share both the positive and the negative experiences with blockchain in health care.

 

The potential for blockchain to improve health care operating efficiencies is significant. High-value use cases include revenue cycle management, supply chain, clinical trials, and provider data management. The initial pilots will need to demonstrate the real benefits of the technology and lead to higher adoption of blockchain in the coming year.  

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Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success  

Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success   | Healthcare and Technology news | Scoop.it

Telemedicine is a growing part of modern healthcare and could play a pivotal role in the U.S.’s efforts to streamline and expand preventative services. Virtual, video-based doctor’s appointments can help alleviate the general practitioner shortage and encourage preventative care. They also offer a cheaper, more convenient alternative to in-person appointments for many patients. Unfortunately, there’s a lot of hype and misinformation being reported so I was pleased to see that TechnologyAdvice (TA) surveyed 504 U.S. adults about telemedicine and their willingness to use such services. I think the results shed important light on where healthcare providers and telemedicine vendors still need to gain acceptance with patients so I reached out to Cameron Graham, Managing Editor at TA to see if he can give us the facts on the ground. Cameron heads market research for healthcare IT, business intelligence, and other emerging technologies and is uniquely qualified to help shed some light on the subject. Here’s what Cameron said:

 

1. It’s not just about reimbursements

Despite the promise of telemedicine, the vast majority of Americans still aren’t using such services. One oft-cited reason for this is the lack of insurance reimbursement for many telemedicine procedures. While some private insurers will cover telemedicine, many only cover select types of visits or specific applications. Medicare, for instance, covers face-to-face interactions, but only when the originating site (point of care, not the patient’s home) is in a Health Professional Shortage Area (HPSA). Although coverage is slowly improving in many states, the American Telemedicine Association gives just five states (plus DC) an A grade in coverage and reimbursement.

 

However, the current hodgepodge of reimbursement rules is not the only thing holding back telemedicine from widespread use. An equally important factor is likely Americans general comfort with video-based platforms and their trust in remote appointments. According to our study, less than half of adults (44.9%) said they would be comfortable conducting a doctor’s appointment over video. Only 35.3% of respondents said they would choose a video appointment over an in-person one. Until patients are more comfortable with the notion of remote care, it is unlikely that telemedicine will gain significant traction.

 

In order to facilitate acceptance of telemedicine among Americans, providers and vendors need to work on educating patients about the benefits of such systems. Telemedicine vendors, in particular, should help patients navigate the complex reimbursement rules currently in place, and promote the cost-savings of remote appointments. By doing so they will not only gain brand awareness among patients but will be able to recruit patients as advocates for more comprehensive insurance reimbursement policies.

 

2. Trust is a key component of effective telemedicine

Americans are not only hesitant about scheduling telemedicine appointment, they are also sceptical about diagnoses made through video platforms. Forty-five per cent of respondents said they would trust a virtual diagnosis less than one made in person. An additional 29.3% said they simply would not trust a virtual diagnosis. This suggests there is a distinct lack of trust among Americans in the quality of medical services that telemedicine platforms can provide.

 

Much of this scepticism is likely due to a lack of familiarity with the services. It also reinforces the fact that telemedicine providers must earn patients trust before they can effectively increase adoption rates. Once that trust is established, it appears people are far more likely to consider using remote appointments. While initially, only 35.3% of respondents said they would choose a virtual appointment over an in-person visit, 65% of respondents said they would be more likely to conduct a virtual appointment if they have first seen the doctor in-person.

 

It’s unlikely that providers or vendors will be able to dramatically change such preferences given the personal nature of many medical visits. However, increased awareness about the qualifications of physicians could make potential patients more comfortable about conducting preventative care via video. Incorporating a rating system, or minimum quality threshold for participating physicians is one potential solution.

 

3. Personal and professional infrastructure is key

The personal infrastructure for telemedicine is already in place across much of the United States, in the form of video-enabled smartphones. According to the latest PEW research, 64% of Americans own a smartphone. In theory, this provides them with the basic means to access remote, video-based health care. Smartphones will likely serve as first means of exposure to such services for many people.

 

More advanced, capable systems (such as dedicated telemedicine kiosks) however are far from established. Aside from a few test programs in select areas, there is no nationwide, professional infrastructure or technology for telemedicine. This hinders adoption and limits the use of telemedicine to basic, preventative care that can be conducted entirely remotely. Dedicated kiosks can greatly expand the use-case for telemedicine, by incorporating sensors, multiple cameras, and other advanced technology. Further investment from telemedicine vendors and insurance companies could help to boost the nationwide profile of telemedical services and expand access for many Americans.

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Can technology break the silos in the healthcare sector?

Can technology break the silos in the healthcare sector? | Healthcare and Technology news | Scoop.it

Digital health or the use of information and communication technology (ICT) to provide health services, has the potential to advance the goal of universal health coverage and improve the quality and efficiency of health services, according to a new report published by the Broadband Commission for Sustainable Development’s Working Group on Digital Health.

 

But can technology also break silos between the technology and healthcare sectors? 

 

The study group, co-chaired by the Novartis Foundation and Nokia, noted that key challenges remain in making digital health a reality, including fragmentation in digital health solutions, risks to funding continuity and capital expenditure, workforce capacity constraints, and collaboration problems across the health and ICT sectors. 

“Despite the promise and potential of global connectivity, we cannot lose sight of the fact that nearly four billion people have no access to the Internet. We need to look at innovative cross-sectoral strategies that can leverage the power of high-speed networks to improve education, healthcare and the delivery of basic social services to everyone, especially the poorest people, who need healthcare most urgently,” said ITU Secretary-General Houlin Zhao.

 

The report, “Digital Health: A call for Government Leadership and Cooperation between ICT and Health,” recommends that the industry look into at least three things: the importance of senior government leadership with committed financing, effective governance mechanisms with defined roles, and a national ICT framework to facilitate alignment between the ICT and healthcare sectors.

 

“We need continuous committed leadership from government with sustained financial resources to ensure a strong national digital health strategy,” Ann Aerts, Head of the Novartis Foundation, and Chair of the Broadband Commission Working Group on Digital Health.

 

She said many technology-based health initiatives have been introduced in the past but they never reached scale or achieved long-term sustainability because more government support and intergovernmental collaboration are needed to take these initiatives past the pilot stage.

 

“To help solve these challenges and to uncover how we can truly harness the power of information and communications technology (ICT) for health, we need a better understanding of the key elements involved,” she explained in the report.

Rajeev Suri, CEO of Nokia and Chair, Broadband Commission Working Group on Digital Health, added that many technology companies are pushing the frontiers of healthcare to reach the remotest of locations, harnessing the power of mobile devices to help health professionals bring the most efficient medical techniques.

 

“The next step is to share the technology with every corner of the globe. To do that we need the leadership of national governments. Health and telecommunication should be united, working closely with regulators—to avoid potential roadblocks, change old practices and spread new knowledge on how to leverage technology for healthcare,” he said.

 

Case Study: Malaysia

With a population of 30 million, Malaysia is currently implementing the Health Information System Strategic Plan (11th MP). This plan builds on the first Health Information System Strategic Plan (10th MP) rolled out between 2010-2015. 

According to the report, the government is currently scaling of a hospital information system deployed in 25 percent of hospitals, in the process of integrating primary care and oral health clinical information system, rolling out a pharmacy information system and building the Malaysia Health Data Warehouse.

Because Malaysia began using digital health in the late 1990s when the Malaysian Ministry of Health (MoH) unveiled the first
telemedicine blueprint and created the first paperless hospital in the world, it has adopted a progressive approach.

“The MoH provides digital health leadership, strategy and program implementation in the form of three divisions: ICT, Planning and Telehealth,” the report noted. “MoH’s ICT strategic plan and ensures alignment with the national ICT strategic plan.”

However, even after years of digital health implementation, some challenges still remain. “Our biggest challenges are still the user, change management and training. And clinical leadership is so important! If you don’t get buy-in from the clinicians, the system won’t work. We learned from experience,” said Dr. Fazilah Shaik Allaudin, Director of Telehealth Division at MoH.  

 

Other challenges include monitoring, evaluation, and private sector engagement. “ “We’re still struggling with M&E and how to do it effectively. We haven’t really come up with a mechanism for this yet. We’ve seen hospitals give up on digital systems and go back to paper or situations where the core team involved in implementation leaves and the project dies or loses momentum. How do you keep this when the leader leaves? How to keep the fire burning?” he explained.

 

Case Study: Philippines

The Philippines launched the National eHealth Strategy in 2010. This was followed in 2014 with the release of the eHealth Strategic Framework and Plan for 2004-2020. The overall goal of the plans is to achieve universal health coverage, which means access to affordable health services for all citizens.

Some of the key performance indicators (KPIs) the 2014 eHealth framework set out to do include the increasing use of the DoH/PhilHealth eClaims, deployment of telehealth devices, the establishment of a government data warehouse and implementation of health data standards.

According to the report, a joint memorandum between the Department of Health (DoH) and the Department of Science and Technology (DoST) created the basis for a shared understanding of roles and responsibilities. Each agency has its own IT teams which make it hard to know which team is responsible for what. 

“In our country, the DoST was keen to start working on eHealth but realized that it needed to be led by the health sector as per the WHO-ITU Toolkit. Fortunately, our DoH also shared the same view. From this common ground, the seeds for the multisectoral approach emerged. The key is to get those two persons engaged, one from the DoH and one from the DoST, and involved in the development of the national eHealth strategy” Dr. Alvin Marcelo, Executive Director of AeHIN and former CIO of PhilHealth.

Meanwhile, the creation of advisory groups allowed universities and private-sector representatives to share their expertise and views. 

 

“Cross-sectoral collaboration is not easy. Players come from different backgrounds, with different approaches and priorities, and may understand different things on the basis of the same words or phrases,” affirmed Zhao in the report’s foreword. “Nowhere is this truer than in digital health, where the needs are great, the investments are significant and lives are at risk.”

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