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More patients could soon be seeing a virtual "doc in a box"

More patients could soon be seeing a virtual "doc in a box" | Healthcare and Technology news | Scoop.it

For many people, getting an appointment to see their doctor can be challenging. And if you don’t have a doctor but need to see one, it can take weeks to months to get one of those coveted new patient slots.

As a result, “Doc in a box” and urgent care clinics have taken off across the country. And as with everything else in healthcare, that trend has gone digital. And this year, the success of two companies in particular could make this a breakout year for the virtual doctor visit.

Teladoc

Teladoc made headlines this week with a very successful IPO that saw share prices go up 50% in the first day of trading. Teladoc is a company that offers on-demand doctor visits to patients through their smartphones, computer, or regular old phone for under $50. Basically, you put in a request for a consultation to Teladoc and they connect you with a board certified internal medicine, pediatrics, or family practice physician. Teladoc boasts that patients get connected with a physician in under 10 minutes.


Teladoc offers members an EHR that is basically a patient-provided medical history. Consulting physicians review that record and get a history from the patient. If needed, they can e-prescribe medications to a local pharmacy.


Patients can sign up directly for Teladoc and pay out of pocket if they want. Health plans and companies are also contracting with Teladoc to provide this service to their members and employees in the hopes of averting more expensive urgent care and ER visits.

Doctors on Demand

One of this years most successful digital health companies is Doctors on Demandwhich, according to StartUp Health, has raised $50 million in just the first six months of 2015.


Doctor on Demand offers video visits to patients through their smartphone or computer. Like Teladoc, Doctor on Demand offers consults in general medicine and pediatrics. They are more varied in their physician pool; for example, their highlighted medical physicians include preventive medicine, emergency medicine, and internal medicine physicians. A really interesting feature here though is that they also offer mental health consults with psychologists and lactation support with certified lactation consultants.


Patients sign up directly with Doctor on Demand. Visits with a medical physician or pediatrician cost $40; visits with a psychologist or lactation consultant range from $40 to $95. And as with Teladoc, companies and health plans are signing directly with Doctors on Demand to provide that service to their employees and members.


The support that these two companies have garnered this year is a strong sign that this area is poised for some serious growth.

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Foundation Launches $100M Initiative to Improve Public Health Data Collection

Foundation Launches $100M Initiative to Improve Public Health Data Collection | Healthcare and Technology news | Scoop.it

Bloomberg Philanthropies, a foundation created by former New York City Mayor Michael Bloomberg, and the Australian government, are launching a $100 million initiative aimed to improve public health data collection in 20 low- and middle-income countries.

The project, Data for Health, seeks to provide governments, aid organizations, and public health leaders with tools and systems to better collect data—and use it to prioritize health challenges, develop policies, deploy resources, and measure success. Over the next four years, Data for Health aims to help 1.2 billion people in 20 countries across Africa, Asia, and Latin America live healthier, longer lives, officials say.

Each year the World Health Organization estimates that 65 percent of all deaths worldwide go unrecorded. Millions more deaths lack a documented cause. This gap in data creates major obstacles for understanding and addressing public health problems. “Reliable data is absolutely essential to problem solving, and nowhere is it more important than in public health,” Bloomberg said in a statement. “This new program will greatly enhance our understanding of the public health challenges we face—and greatly improve our ability to address them. We’ve set an ambitious goal, and working together with the Australian government, we believe we can meet it.”

In addition to improving the recording of births and deaths, Data for Health will aim to support new mechanisms for conducting public health surveys. These surveys will monitor major risk factors for early death, including non-communicable diseases (chronic diseases that are not transmitted from person to person such as cancer and diabetes). Data for Health will also look to take advantage of the widespread use of mobile phone devices in developing countries to enhance the efficiency of traditional household surveys, which are typically time-consuming and expensive.

What’s more, to assist governments with translating data into policy change, Bloomberg Philanthropies will support training programs for local officials that are led by organizations specializing in data use. This training will enable officials to better interpret data and use it to inform program and policy decisions.

Program partners on this initiative include:

    The University of Melbourne, Australia
    CDC Foundation
    Union North America
    Johns Hopkins Bloomberg School of Public Health
    World Health Organization


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Ingredients for streamlining care management | Healthcare IT News

Ingredients for streamlining care management | Healthcare IT News | Healthcare and Technology news | Scoop.it

In an era where medicine is highly specialized and different specialties are involved in the care of a patient, intelligent use of information technology is essential to help providers, payers and patients achieve better care management outcomes while simultaneously improving cost and quality of care.

While some entities, such as the Department of Veterans Affairs, have implemented solutions where patients have the ability to view their personal health records online and offline, the majority of the healthcare industry continues to face multiple challenges while implementing care management processes. Care management for large, diverse populations is highly complex and subjective, largely because needs vary for each patient and encounters may span across multiple care settings and plans.

Although a large proportion of health information today is captured electronically, integrated data around patients and their underlying disorders is often not available to providers at the point of care. However, efforts to code clinical content with standard terminology has, to some extent, helped streamline information across applications. There is also a lack of alignment between payers and providers in regards to cost of care management services and shared risk arrangements, leading to sub-optimal care quality.

How organizations manage their healthcare data, and what they use this data for, therefore becomes extremely critical to the success of these programs. While technology plays a very important role in areas like decision support, care coordination and population health management, providers and payers are still faced with the challenge of managing both complex people and process challenges.

Effective use of patient data

Patient data adds value across multiple areas such as decision support, planned interventions and medical reconciliation. Such examples include:

  • Using CPOE Based Order Sets: Effective clinical decision support tools contained within an order set can help enforce the use of quality measures or meaningful use criteria by providers. An example would be the use of a venous thromboembolism (VTE) risk assessment and subsequent prophylaxis for high risk patients embedded within an order set. Monitoring the prophylaxis regimen based on the VTE risk score can help reduce incidence of venous thrombosis.
  • Clinical Information Exchange: Effective care coordination requires healthcare data to flow seamlessly across all parts of the healthcare ecosystem, including providers, payers and consumers. By aligning incentives, all parties can reduce costs and improve quality of care. By leveraging health information exchanges across radiology, laboratory, perioperative, inpatient and outpatient applications, healthcare organizations have the ability to access patient data in a timely and secure fashion.
  • Medical Reconciliation: This feature is commonly available in electronic health records (EHRs) and can play a very important role in preventing adverse drug reactions. For example, the use of over-the-counter (OTC) medications like acetaminophen may not get recorded in an EHR, but can be retrieved from the pharmacy or the medication management application. This is extremely critical information for a physician, given the hepatotoxic profile of the drug.
  • Patient Registries: A patient registry fed with data from EHR applications can show the treatment prescribed to patients and identify care gaps, based on evidence-based guidelines. Care management programs can use this kind of analysis to highlight areas of improvement, thus positively impacting cost and quality of care.

Promoting patient engagement

Patient education plays a very important role in effective care management. Patients who are actively focused on learning more about their conditions are more likely to participate in initiatives that promote preventive steps and healthy behaviour. The use of patient portals, for instance, allow patients to have anytime, anywhere access to their medical records, and the ability to schedule appointments, request medication reconciliation, etc.

Processes such as discharge management and preventive care can also provide strong opportunities to increase patient participation. Such processes play a crucial role in keeping readmissions and acute care costs to a minimum. Automated alerts informing patients to make appointments or follow up on lab visits can help prevent potential acute and chronic conditions.

Patients today are increasingly using consumer devices and mobile apps to store and monitor their health parameters. Wearable devices have the ability to change the way health data is collected and managed, and care management processes will soon need to incorporate consumer technology to enhance patient engagement and self management.

Managing Stakeholder Expectations

To drive a sustainable care management program, it is important to demonstrate value to key stakeholders including providers, payers and patients. However, the definition of value differs from one entity to another. For instance, providers and payers often do not see eye to eye on issues such as risk sharing and care management goals. It is essential to build consensus on many of these issues and agree on clearly defined goals around care objectives, processes and costs.

Addressing issues around provider and payer expectations could lead to significant advantages for the healthcare industry as a whole. According to the Center for Disease Control and Prevention, the government spends nearly three-fourths of its total healthcare expenditure on chronic disease, an area where care management programs can make a large impact. A concerted effort from all major stakeholders to streamline care management objectives and processes would have a very large impact on healthcare cost and quality.

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Medical providers should make health data free to patients

Medical providers should make health data free to patients | Healthcare and Technology news | Scoop.it

Technology makes patient access to medical records easier than ever, but the cost of such data prevents many from doing so, according to Niam Yaraghi and Joshua Bleiberg, fellows at the Brookings Institution.

Access to health information is beneficial for patients, allowing them to take a bigger role in their care and enabling them to share the information with other providers, Yaraghi and Bleiberg write at Brookings' TechTank. The latter is especially important because of the lack of interoperability of electronic medical records, they add.

But while there are virtually no costs of reproducing digital records, "many states still use the same regulatory model--which is based on the number of copied pages--for paper and digital records," they write.

Through a Google Survey, the two Brookings fellows asked 120 patients how much they would be willing to pay for their records. Sixty-eight percent said they wouldn't pay a dime to have access to the information; 10 percent said they would pay between 1 cent and $9.99; and 6.4 percent would pay between $10 and $19.99.


This is an area that involves not only healthcare professionals, but those on Capitol Hill, as well. Putting health information in the hands of patients has been one of the goals of the 21st Century Cures initiative. During a panel discussion that included lawmakers and industry professionals last June, the importance of giving patients a voice in their care was a primary focus.


To improve patient access, Yaraghi and Bleiberg say patient advocacy groups should educate patients on the value of their data, which may make them more likely to want access to the information.

In addition, because the cost is almost zero to reproduce medical information through electronic health records, "state regulations should undergo a major revision and require the medical providers to let patients have their medical data for free," they conclude.

Patient advocate Regina Holliday has been one voice in the industry calling for such change.


"You want to have access to that information before there is a crisis. You don't want to build that system up in a moment of need. [Y]ou want to be able to see the long tail of care, to be able to look for patterns," she told FierceHealthIT in an interview in October.

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How one health system is putting an end to insider snooping

How one health system is putting an end to insider snooping | Healthcare and Technology news | Scoop.it

Insider snooping into patient records is nothing to take lightly. It often ends in a compliance nightmare – costly and time-consuming – not to mention the patient trust levels that take a serious hit. By making patient privacy an utmost priority, executives at the West Virginia United Health System have tackled this issue head on through a variety of different avenues and have already seen marked success. 

There's no one magic bullet to ensuring patient record snooping doesn't happen, said Mark Combs, assistant chief information officer for the West Virginia United Health System. But by implementing a host of initiatives, comprehensive training and tapping into information technology for audits, Combs and his team have shown it can be done.

Combs, who will be presenting WVU Healthcare's privacy case study at HIMSS15 this April in the session "Stop Insider Snooping and Protect Your Patient Trust," says the six-hospital healthcare system goes far beyond the traditional computer modules that have a privacy component, as "there's no real learning that occurs in that; it's more of just a sign off," he said. Rather, they get to all employees as soon as they come on board with the organization. They have a privacy officer present to all new employees about the importance of patient privacy and what their responsibilities and expectations are.

What's more, the health system sends out monthly security reminders that come from the individual hospital's privacy and security officer. They also have digital media boards with privacy and security reminders; they present to enterprise management and leadership groups within the organization. And even more significant? They're not afraid to audit their employees.

There's an old saying Combs loves to use that describes his philosophy: "What's measured is what matters," he said. "So people know we're measuring and watching their access; it gives them pause when they start to consider to do something like this," he added. And it certainly doesn't hurt that the health system's HR department has been supportive of this all along.

Audits are done at the organization "almost daily," he said, amounting to several millions of accesses audited each year. The access audits from multiple applications enterprise-wide are consolidated, and then, as Combs described, WVU has an application that consolidates those and runs reports, which are analyzed by a special team.

And though their efforts have been successful, this holistic approach to curbing unauthorized access into patient medical records did not happen overnight, Combs explained. 

“It's been many years in the making. We keep striving to improve, and we keep looking at our risk assessments, and we keep looking at our surveys, and we keep looking at our incidences and situations that do occur in the organization that drive us to change,” he said. “And I think that's one of the most important things: it's an iterative process. You can't just set up a program and walk away and expect it to run. It takes people that are dedicated, people that are focused and people who really care about the privacy and security of the patient's information.”


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