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Healthcare Technology Trends for 2019 and Beyond

Healthcare Technology Trends for 2019 and Beyond | Healthcare and Technology news | Scoop.it

The healthcare industry is moving from products and services to solutions. Just a few years ago, medical institutions relied on special equipment and hardware to deliver evidence-based care. Today is the time of medical platforms, big data, and healthcare analytics. Healthcare institutions are focused on real-time results. The next decade will be focused on preventive care, and here new healthcare technology trends will come into play.

Artificial intelligence

The modern healthcare industry has already introduсed AI-based technologies like robotics and machine learning to the world. For example, IBM Watson is an AI-based system that’s making a difference in several areas of healthcare. The IBM Watson Care Manager was produced to enhance care management, accelerate drug discovery, match patients with clinical trials, and fulfill other tasks. Systems like this can help medical institutions save a big deal of time and money in the future.

 

It’s likely that in 2019 and beyond, AI will become even more advanced and will be able to carry out a wider range of tasks without human monitoring. Here are some predictions of AI trends in healthcare:

Early diagnosis

This healthcare technology trend can accurately and quickly process a lot more data than the human brain. So AI tools can reduce human errors in diagnosis and treatment and allow doctors to work with more patients. For example, image recognition technology will help to diagnose some diseases that cause changes to appearance (diabetes, optical deviations, and dermatological diseases). It’s also likely that in future people will be able to diagnose themselves. DIY medical diagnosis apps will probably ask some questions, process a patient’s care history, and then show possible diagnoses based on the current symptoms. But as this technology isn’t advanced yet, patients should be careful with DIY medical apps and self-medication.

Medical research and drug discovery

The future of drug discovery and medical research lies in deep learning technology. Deep learning is a field of machine learning that’s able to model the way neurons interact with each other in the brain. This allows medical systems to process large sets of data to quickly identify drug candidates with a high probability of success. A Pharma IQ report says that about 94 percent of pharma specialists believe that AI technologies will have a noticeable impact on drug discovery over the next two years. Even today, pharmaceutical giants such as Merck, Celgene, and GSK are working on drug discovery in collaboration with AI platforms, predicting AI to be the primary drug discovery tool in the future.

Better workflow management and accounting

There are a lot of routine and tiresome tasks that medical workers have to do apart from caring for patients. AI can reduce staff overload by automating monotonous tasks such as accounting, scheduling, managing electronic health records, and paperwork.

IoMT

The Internet of Medical Things (IoMT) includes various devices connected to each other via the internet. Nowadays, this technology trend in healthcare is used for remote monitoring of patients’ well-being by means of wearables. For example, ECG monitors, mobile apps, fitness trackers, and smart sensors can measure blood pressure, pulse, heart rate, glucose level, and more and set reminders for patients. One recently introduced IoMT wearable device, the Apple Watch Series 4, is able to measure heart rate, count calories burned, and even detect a fall and call emergency numbers. The FDA has recently approved a pill with sensors called Abilify MyCite that can digitally track if a patient has taken it.

IoMT technology is still evolving and is forecasted to reach about 30 billion devices worldwide by 2021 according to Frost & Sullivan.

  • IoMT will contribute sensors and systems in the healthcare industry to capture data and deliver it accurately.
  • IoMT technology can reduce the costs of healthcare solutions by allowing doctors to examine patients remotely.
  • IoMT can help doctors gather analytics to predict health trends.

 

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Information Risk Management Still Needs Improvement

Information Risk Management Still Needs Improvement | Healthcare and Technology news | Scoop.it

Cybersecurity threats and attacks across various business sectors are on the rise pressuring for organizations to continuously assess the risks to any information. While the General Data Protection Regulation (GDPR) has garnered a lot of buzz in 2018, many standards and regulations in the United States also require cybersecurity.

 

But what are the technical details and operational steps needed to meet the high level guidance on cybersecurity risk? A recent Advisen survey revealed some interesting statistics:

 

  • 35% of respondents rated data integrity risks as “high risk” versus only 22% that of rated business continuity risks, or cyber related business interruption
  • Only 60% of the risk professionals surveyed said their executive management team viewed cyber risk as a significant threat to the organization, down 23% from the previous year.
  • Only 53% knew of any updates or changes even after the 2017 high profile attack

 

In short, these statistics paint a grim picture over the state of cybersecurity in the United States. While organizations are aware of the high risk of cyber attacks, management team involvement may be decreasing, and organizations may not be evolving their cybersecurity programs quickly enough.

 

Creating a Security First Risk Mitigation Posture
Many organizations have moved to a risk analysis security first compliance posture to enable stronger risk mitigation strategies and incorporate senior management oversight. However, identifying the potential risks to your environment only acts as the first step to understanding your overall risk. In order to identify all potential risks and engage in a full risk analysis that appropriately assesses the overall risk facing your data, you need to incorporate vendor risk as part of your risk management process.

 

That’s a lot of risk discussion, but you also have a lot of places in your overarching ecosystem that create vulnerabilities. Using a risk management process that establishes a security-first approach to your organization’s data environment and ecosystem means that you’re locking down potential weaknesses first and then backtracking to ensure you’ve aligned controls to standards and regulations. This approach, although it seems backward from a traditional compliance point-of-view, functions as a stronger risk mitigation program by continuously monitoring your data protection to stay ahead of hackers. Standards and regulations mean well, but as malicious attacks increasingly become sophisticated the best practices within these documents may be outdated in a single moment.

 

What is an Information Risk Management (IRM) Program?
An information risk management (IRM) program consists of aligning your information assets to a risk analysis, creating IRM policies that formalize the reasoning and decisions, and communicating these decisions with senior management and the Board of Directors. The National Institute of Standards and Technology (NIST) and the International Standards Organization (ISO) both provide guidance for establishing an IRM.

 

For example, the September 2017 NIST update to NIST 800-37 focuses on promoting information security by recognizing the need for organizational preparation as a key function in the risk mitigation process.

 

In fact, the core standards organization, ISO, updated its ISO 27005 in July 2018 to focus more on the information risk management process.

 

Specific to the United States, the Committee of Sponsoring Organizations of the Treadway Commission (COSO) updated it enterprise risk management framework to minimize data threats while requiring organizations to detail potential risks and manage risks more proactively.

 

As risk analysis increasingly drives information security practices, you need to focus on a risk treatment program that begins with risk identification, establishes an acceptable level of risk, defines your risk treatment protocols, and create risk mitigation processes.

 

Create an Information Risk Management (IRM) Team
In order to appropriately manage risk, you need to create an IRM Team consisting of stakeholders across the organization. Relying solely on your IT department may leave gaps in the process. To determine the stakeholders, you should explore the departments integral to risk identification. For example, you might want to ask yourself:

 

  • What departments hire vendors?
  • What departments can help with the overall risk process?
  • What stakeholders are legally required (in the United States) to be informed of the risk process?
  • Who brings unique insights into the risks that affect my data environment and ecosystem?

 

For example, while your IT department sets the controls that protect your information, your human resources department handles a lot of sensitive data. You need to incorporate stakeholders who understand the data risks unique to their role in your organization so that they can work with your Chief Information Officer and Chief Information Security Officer. Additionally, many United States regulations, such as the Sarbanes-Oxley Act of 2002 (SOX) require senior management and Board of Director oversight so they should also be included as part of your IRM team.

 

Begin with Business Processes and Objective
Many organizations forget that businesses processes and organizational business objectives should be the baseline for their risk analysis. Senior management needs to not only review the current business objectives but think about the future as part of the risk identification process. Some questions to ask might include:

 

  • What businesses processes are most important to our current business objectives?
  • Do we want to scale in the next 3-5 years?
  • What business processes do we need to meet those goals?

 

Understanding the current business objectives and future goals allows organizations to create stronger risk mitigation strategies. Many organizational goals rely on adding new vendors whose software-as-a-service products enable scalability. Therefore, you need to determine where you are as well as where you want to be so that you can protect the data that grows your organization and choose vendors who align with your acceptable level of risk.

 

Catalogue Your IT Assets
The next step in the risk analysis process requires you to look at all the places you transmit, store, or access data. This step often becomes overwhelming as you add more cloud storage locations that streamline employee workflows. Some questions to ask here might include:

 

  • What information is most critical to my business processes?
  • What servers do I store information on?
  • What networks does information travel over?
  • What devices are connected to my servers and networks?
  • What information, servers, networks, and devices are most essential to my targeted business processes?
  • What vendors do I use to management my data?

 

Review Your Potential Risks from User Access
Once you know what information you need to protect and where it resides, you need to review the users accessing it. Using multi-factor authentication and maintaining a “need to know” access protocol protects your information.

 

  • Who accesses critical information?
  • What vendors access your systems and networks?
  • Does each user have a unique ID?
    Can each user be traced to a specific device?
  • Are users granted the least authority necessary to do their jobs?
  • Do you have multi-factor authentication processes in place?
  • Do users have strong passwords?
  • Do you have access termination procedures in place?

 

These questions can help you manage risks to critical information because employees lack password hygiene or decide to use the information maliciously upon employment termination.

 

Establish An Acceptable Level of Risk
Once you’ve completed the risk identification process, You need to review what risks you want to accept, transfer, refuse, or mitigate. To determine the acceptable level of risk, you may want to ask some questions such as:

 

  • What is an acceptable level of external risk to my data environment?
  • What is an acceptable level of risk arising out of vendor access?
  • How do I communicate the acceptable level of risk to senior management?
  • How can I incorporate my acceptable level of risk in service level agreements (SLAs) with my vendors?
  • Can I quantify the acceptable level of risk I have assumed as part of my risk analysis?

 

Your information risk management (IRM) process needs to incorporate the full level of tolerances and strategies that protect your environment. In some cases, you may decide that a risk is unacceptable. For example, you may want to limit consultants from accessing your corporate networks and servers. In other instances, you may need to find ways to mitigate risks with controls such as password management or a Bring-Your-Own-Device policy.

 

Define the Controls That Manage Risk
Once you’ve set the risk tolerance, you need to define controls that manage that risk. This process is also called risk treatment. Your data ecosystem can leave you at risk for a variety of data breach scenarios, so you need to create information risk management (IRM) policies that outline your risk treatment decisions. In doing this, you need to question:

 

  • What firewall settings do I need??
  • What controls protect my networks and servers?
  • What data encryption protects information in transit across my networks and servers?
  • What encryption protects the devices that connect to my systems and networks?
  • What do I need to make sure that all vendor supplied passwords are change?
  • What protects my web applications from attacks?
  • What do I need from my vendors as part of my SLAs to ensure they maintain an acceptable level of security?

 

Defining your controls includes everything from establishing passwords to requiring anti-malware protection on devices that connect to your systems and networks. Creating a clearly defined risk treatment program enables a stronger security-first position since your IRM policies focus on protecting data proactively rather than reactively changing your security controls after a data event occurs.

 

Tracking the Risks With IRM Policies
Creating a holistic security-first approach to risk treatment and management means using IRM policies to help create a risk register. A risk register creates a tracking list that establishes a mechanism for responding to security threats. Your IRM policies, which should outline the entire risk management process, help establish the risk register by providing the list of risks monitored and a threat’s impact.

 

Although this process seems intuitive, the larger your environment and ecosystem, the more information you need to track. As you add vendors and business partners, you increase the risk register’s length making threat monitoring cumbersome.

 

How SecurityScorecard Enables the Information Risk Management Process
SecurityScorecard continuously monitors threats to your environment across ten factors: application security, DNS health, network security, patching cadence, endpoint security, IP reputation, web application security, cubit score, hacker chatter, leaked credentials, and social engineering.

 

Using these ten factors, organizations can streamline the risk management process. A primary hassle for those engaging in the risk management process lies in defining risks and establishing definitions for controls that mitigate overall risk. The ten factors remove the burden of identifying both risks to the environment and ecosystem as well as controls that mitigate risk. Moreover, you can use these same ten factors to quantify your risk monitoring and reaction, as well as the security of your vendors.

 

SecurityScorecard’s continuous monitoring tool can help alleviate bandwidth problems and help facilitate a cybersecurity program more in line with the sophisticated cyberthreat landscape.

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Top 6 Benefits of Adopting a Phone System 

Top 6 Benefits of Adopting a Phone System  | Healthcare and Technology news | Scoop.it

In the modern medical era of robot surgeries, drones, and telemedicine, it’s easy to overlook basic communication platforms like your phone system. But your phone system is still a critical method patients and providers rely on for communication. If your organization is using a legacy phone system, it’s time to discover the benefits of voice over Internet protocol (VoIP).

 

VoIP is the transmission of phone calls over the Internet instead of traditional telephone lines, and this technology is rapidly transforming how healthcare organizations across the country communicate with their providers, patients, and counterparts.

 

No matter if your organization is a large medical system, behavioral health group, small doctor’s office, public health department, or rural clinic, VoIP systems can provide numerous benefits that legacy phone services just can’t deliver. Here are the top six benefits of adopting a VoIP phone system.

 

Enhanced Productivity and Efficiency

It’s no secret healthcare organizations are slammed in our current fast-paced climate. Healthcare administrators and providers alike are watching their responsibilities increase while the amount of time to meet them stays the same. According to IT Toolbox, switching gears throughout the day to tackle tasks like managing contacts and voicemail leads to a 40% reduction in staff productivity.

 

With a VoIP phone system, you can get your day back with productivity-enhancing features that legacy phone systems can’t support, and the integration of those features creates seamless, time-saving communications among your staff members. Simple-to-configure call routing and self-routing auto attendant features are easy for staff to navigate, improves staff availability to callers who need them, and decreases time spent on routing calls. And, if your goal is to reduce the time physicians and medical staff spend on voicemails, VoIP systems offer voicemail transcribing features that will automatically transcribe messages and deliver them to your email inbox.

 

Additionally, advanced reporting data gives your team an inside look into the traffic loads of your system. This data is extremely valuable and can be used to make intelligent routing and configuration decisions to balance call loads across your organization.

 

Cost Savings

With costs escalating and reimbursement rates shrinking, it’s more important than ever for healthcare providers to find innovative ways to save money without sacrificing efficiency.

 

VoIP is a cost-effective solution because calls are made and received over your organization’s Internet rather than traditional phone lines. This means your organization isn’t being charged for local and long distance calls on a minute-by-minute basis, cutting down your costs by a huge margin.

 

VoIP systems are also affordable to install. Because VoIP is cloud-based, most of the equipment a healthcare organization needs is already in place, making installation fast and seamless. Typically, the only capital expenditure needed is the cost for the phones themselves. VoIP allows your organization to save time and effort that otherwise would have been spent on additional infrastructure, project management, and staffing. These critical savings can be reallocated to other needed services that directly save lives.

 

Delivers a Better Patient Experience

At any healthcare establishment, the quality of care provided and patient experience delivered is paramount to success. Adopting a VoIP phone system can help elevate the communication experience your patients have with your facility.

 

With a VoIP phone system, you enjoy enhanced audio quality and clarity, making it easier to decipher and respond to a patient’s questions and concerns. Additionally, several features can be implemented to ensure your patients and callers are routed to the correct point of contact. Some of these features include:

 

  • Prioritized calling for medical emergencies
  • Call forwarding
  • Click-to-call
  • Routing calls based on caller ID
  • Routing calls with option sets for billing, scheduling, care, etc.
  • Custom messages based on day and time
  • Custom hold music or announcements
  • Integration with patient account information systems

 

These advanced features work together to ensure your callers are able to reach their destination and gather or relay information quickly and painlessly.

 

Online Portals Put You in Control

With legacy phone systems, changing system settings can be a difficult task and can even require multiple calls to the vendor. That’s time your providers and staff simply can’t afford to waste.

 

Cloud-based VoIP platforms deliver complete organization and control to your staff through easy-to-use online portals. These portals give your staff advanced features that allow easy day-to-day management of your voice services without ever having to call the service provider. Authorized administrators can change call-forwarding settings, manage call groups, update contacts, reset passwords, configure phones, listen to transcribed voicemails, and more, all through their online portal. Your staff can easily and quickly update and configure settings instantaneously anytime from any web browser.

 

Flexibility Allows You to Scale

Another advantage cloud-based VoIP services offer is simple scalability, allowing you to transition as slowly or as quickly as needed. Healthcare organizations vary in size and complexity and your phone system should be able to scale to your needs. With traditional phone systems, this is incredibly difficult and can cost you more money in the long run. Flexible designs enable healthcare organizations to deploy VoIP at one site or multiple sites if you’re looking to consolidate multiple voice platforms. Additionally, VoIP systems allow you to scale your system to only include features your organization truly utilizes.

 

Streamlined Communications on the Go

With a mobile VoIP capability, such as an app on your smartphone, your staff and providers are always reachable on their mobile phones. Missing important calls or information can create a lot of added work and decrease efficiency. Thanks to the mobility provided by many VoIP applications, staff members can stay connected by using their mobile devices to receive and make calls to and from their work extensions, as well as access voicemail, call logs, and contact lists.

 

 

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mHealth Scores High With Consumers in Boosting Medication Adherence 

mHealth Scores High With Consumers in Boosting Medication Adherence  | Healthcare and Technology news | Scoop.it

Consumers are looking to mobile health tools, such as mHealth apps and wearables, to improve their medication adherence.

A recent study of some 800 prescription medication users, conducted by Russell Research for Express Scripts, finds that roughly half believe mHealth technology would help them become more adherent – and one-third of those would be more likely to use them if the tools were set up for them.

 

With experts suggesting at least half of the nation’s medication users aren’t taking their drugs as prescribed – costing some $300 billion a year in avoidable healthcare expenses, or $1,000 per person – medication adherence is a significant issue and one that healthcare experts have vowed to tackle more aggressively.

“This survey shows that while patients with chronic diseases know that medication is critical to their treatment and health, they don’t always act on that knowledge,” Snezana Mahon, PharmD, vice president of St. Louis-based Express Scripts Clinical Solutions, said in a press release. “Given the huge cost of nonadherence to an individual patient’s health, as well as to the country as a whole, it’s essential for patients and clinicians to work together to find solutions to help overcome barriers to adherence.”

Those taking medications would seem to agree. Almost half of those surveyed said taking their drugs as prescribed is the most important part of their health regimen, a percentage higher than those selecting a routine check-up (30 percent).

And they seem interested in improving their habits: 56 percent said reminders would more likely help them improve adherence, and 19 percent said those reminders would definitely help them.

That’s where mHealth comes in.

 

“The three main drivers of non-adherence come from cost, clinical or behavioral reasons,” said Kyle Amelung, PharmD, BCPS, a senior clinical consultant on Express Scripts. “All three can be solved for through mobile health tools.”

 

Younger consumers are particularly interested in mobile health technology: 74 percent of those between the ages of 18 and 34 believe such tools would help them, and half would be more likely to use the technology if it was set up for them. Among those age 35-54, the percentages were 62 and 46, respectively.

 

“We believe success comes from getting within the patient’s flow and reminding them about their health when and how the patient prefers,” Amelung said. “Most people view mobile devices as a personal productivity tool that can be used to check the news, connect with friends or get the score of the game. Incorporating these devices into taking better care of yourself is a logical position – but people still don’t want to be ‘nagged’ by family or friends about their health.”

 

That point was also made in the survey: 27 percent said they would most not want to be reminded to take their medications by a health device, while 40 percent said a spouse or partner would be most bothersome and 31 percent said the same of a friend. In each case, respondents felt that they’d be nagged by those prods and end up resenting the reminders.

Amelung emphasized that mHealth alone won’t solve the medication adherence issue.

 

“The key to mHealth tools is partnering them with a live clinician that can oversee the data, flag high-risk patients, and intervene as appropriate,” he said. “Technology is not the solution; technology is the means to an effective solution. To truly affect change, any proposed solution must be partnered with live clinical support to answer any questions and provide specialized guidance to the patient.”

 

The survey also shed some interesting light on prescription habits.

More than half of those surveyed feel they’re doing better at sticking to their prescriptions than others – including 60 percent of seniors. And more respondents were unconcerned about missing a medication (31 percent) than were extremely or very concerned (29 percent).

 

Among other results:

  • 67 percent would be motivated by a reward to take their medications as prescribed.
  • 82 percent would be motivated to take their medications by a financial reward, while 15 percent chose points toward a merchandise purchase and 3 percent selected a charitable contribution.
  • Only 33 percent understand the financial significance of medication adherence; 35 percent believe the annual cost to healthcare runs about $150 billion (or $500 per person), while 19 percent put that figure at $25 billion ($75 per person) and 12 percent said the cost was around $8.3 billion, or $25 per person.
  • 44 percent cited side effects as the primary reason for not taking medications as prescribed; 28 percent picked inconvenience and 21 percent said they stopped taking their drugs because they were feeling better and felt they didn’t need to continue the prescription.

Amelung said some of the survey’s results surprised him.

“One of the most surprising findings was that two-thirds of those polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts,” he noted.  “We all want to be in optimal health, but this data point supports the long-standing belief that only the potential of better health outcomes is not sufficient in getting patients to make the best decisions and take the appropriate actions for their health.”

“In today’s world, the distractions of the moment often get in the way of pursuing what’s in the best interest of our care. We sometimes forgo scheduling or keeping doctor appointments. We skip necessary lab tests or our annual flu shot. Many of us forget to refill our medication or we don’t remember to take it every day.  … For most of us, engaging in the right daily behaviors to improve our health is a challenge because these actions fall out of our normal routines and habits – and so, we skip them. Knowing that there must be something more for the patient to obtain and that financial rewards are an effective way to motivate patients, we can offer specific carrots to incentivize healthier actions and lead to decrease costs in the healthcare system.”

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5 Amazing Health IT Trends In 2016 

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

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

 

 

Cybersecurity will become even more important

 

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

 

 

IoT will get a dose of reality

 

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

 

 

Interoperability will become a business requirement

 

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

 

 

Telemedicine will grow rapidly

 

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

 

 

Specialty EHRs will boom

 

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

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

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Digital Solutions the Key to Behavioral Health's Future

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

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


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


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


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


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


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


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

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Snap-n-Eat nutrition app calculates nutritional info from a picture of food

Snap-n-Eat nutrition app calculates nutritional info from a picture of food | Healthcare and Technology news | Scoop.it

A group of researchers with the nonprofit SRI Internationalhave developed a nutrition app that can detect the caloric and nutritional content of food from a picture that you snap with your smartphone.

Obesity is a major problem in the United States – we’ve all seen the powerpoint slides showing CDC maps of obesity prevalence spreading over the past fifty years. Apps like MyFitnessPal and LoseIt let you track the food you eat in a very detailed way. We also recently reviewed Rise, a platform that lets you snap pictures of your meals and get feedback from certified nutritionists.


Researchers with the nonprofit SRI international recently published a paper describing Snap’n’Eat, an app that lets you snap a picture of your meal and calculates nutritional information like caloric content automatically for you.


Basically, the app figures out which segments of the picture contain food and then tries to figure out what type of food is in each segment. Based on that determination, it estimates the caloric content and other nutritional information.


They found that when dealing with a limited set of samples (fifteen in their tests), they were able to achieve 85% accuracy. But when expanding to a larger sample set, the app did not work as well.

They do note that it may be possible to improve the system by having users “train” the app early on; if the app can be taught about the users typical diet, then its accuracy could be improved.


In some ways, the ability to automatically detect nutritional information from a picture is the “holy grail” of diet apps. It would make diet tracking incredibly easy. However, this study highlights the current challenges and limitations of available technology. Further work is certainly needed but it’s a goal worth working towards given the scope of the problem it seeks to address.


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Why Wearable Technology is Good for your Health

Why Wearable Technology is Good for your Health | Healthcare and Technology news | Scoop.it

The Apple Watch and Adidas’s plans for including wearable technology in its shoe and clothing lines have been drawing attention recently, as the age of always-accessible information is upon us. In the era of the Internet of Things — when our homes are linked to our smartphones and everything else is linked to a network — it’s still somewhat surprising to realize that entire industries have yet to be transformed by increased connectivity. Until recently, one of those areas was arguably the health field. Yes, files have been switched to online servers for some time now. But it’s only been in the past year or so that the health industry has begun to be revolutionized by the possibilities technology offers.

With an increase in the number of apps and medical devices that patients can use on their own, the challenge becomes providing a way for that information to be shared seamlessly, said Liat Ben-Zur, senior vice president and digital technology leader at Philips. Ben-Zur spoke with The Next Web at SXSW about how the company is attempting to create a platform that could share numerous data points about a person’s health with their doctors.
 
 
Health solutions at your fingertips

“Right now, what we’re seeing is there’s a general health care problem on the horizon that we want to be focusing on,” she said in the interview. The aging population in America is seeing an uptick in chronic diseases, Ben-Zur said, and almost 70% of the health care costs in the industry right now are going toward managing those diseases. As patients seek to monitor those, they’re using more apps and devices that monitor diet, blood pressure, weight, and all sorts of data that can help doctors to determine the best course of treatment. And while that allows consumers to take their health into their own hands, much of that data is still scattered and fragmented, because of the framework of how the data is collected.

“All of these different wearables … they’re all sending their information to their own databases, and nothing’s being shared,” Ben-Zur said. Patients might track their biological data over time, but it’s not easily combined with x-rays taken by a specialist, a list of medications they’re currently taking, and the environmental factors like air quality that could also affect their prognosis.

The benefit of all sorts of “smart” technology is that doctors could start to get a better picture of what is actually affecting a patient’s health by looking at a myriad of factors. Some health devices are already HIPAA-compliant for medical use and regulated by the government, Ben-Zur said. Not only is there a potential to collect traditional health data, she added, but there’s a possibility that non-regulated home devices like HVAC systems, refrigerators, and coffee makers could be connected to an open-cloud platform that could provide a wealth of contextual information. If all the devices are truly “smart” and are able to connect to the Internet but also share information, “we can start to actually leverage the benefits of wearables devices, of home monitoring devices.”

So the company, in a partnership with salesforce.com, created HealthSuite, a secure cloud-based platform that aggregates all sorts of health data that is accessible for patients and health care providers. If a patient is wearing a device that transmits their vital sign information to the cloud, a doctor can view that data on an app and monitor the person’s health even when they’re not in the same room. The video above gives an overview of how HealthSuite works.

Philips isn’t the only brand to offer real-time medical collaboration, though the idea is still rather novel. Though perhaps not as comprehensive as Ben-Zur describes as the potential for Philips, drchrono.com offers one-stop health care services with its Electronic Health Record, or EHR, platform. Patients can upload health information, make appointments with their doctors, and receive electronic prescriptions through one website and app. Apple also began offering a Health app with its iOS8 launch in September 2014, which can track all sorts of data such as calories consumed, sleep data, vital signs, and more. Along with that launch, Apple also created HealthKit for app developers, which enables independent fitness apps to share their data with the Health app dashboard. All of that information can be shared with medical professionals, directly through the app.


Security’s role in connected health care

So what’s the catch with all of this seemingly great cooperation? According to Federal Trade Commission Chairwoman Edith Ramirez, it’s security. In her statements at the International Consumer Electronics Show in January 2015, Ramirez said that addressing security issues is paramount to ensure that consumers truly benefit from the Internet of Things. “That data trove will contain a wealth of revealing information that, when patched together, will present a deeply personal and startlingly complete picture of each of us – one that includes details about our financial circumstances, our health, our religious preferences, and our family and friends,” she said. Later in the speech, she elaborated on the specific threat that data breaches have, the probability of which increases with the more connected devices people use. “Moreover, the risks that unauthorized access create intensify as we adopt more and more devices linked to our physical safety, such as our cars, medical care, and homes,” Ramirez said.

The health care industry is particularly at risk in the current digital environment. The Global State of Information Security Survey for 2015, administered by PricewaterhouseCooper, shows that “information security incidents” (read: breaches) jumped 60% in 2014 compared to 2013, and the costs attributed to those incidents increased by 282%. A growing number of health providers are reporting that they are investing more in security, especially at an executive level, according to the study. However, there’s a disconnect in bringing those discussions to a board of directors level.

The potential for adding health care initiatives to the Internet of Things is a huge benefit, because it can allow consumers and doctors to become more proactive, instead of reactive to a current health need. Ben-Zur praised this, as did the Atlantic Council and Intel Security in a report titled, “The Healthcare Internet of Things: Rewards and Risks.” According to a separate Intel Security survey of more than 12,000 adults in 2013, a large majority of people are receptive to using this form of sharing information to improve their health. Of the respondents, 70% of adults said they would be willing to use swallowed monitors, prescription bottle sensors, and even toilet sensors to improve personal care.


How does the field move forward?

With that in mind, it’s likely that the biggest obstacle for widespread use is the potential for data theft. While that might always be a concern with online files, several of the companies are already addressing the issue. Apple’s information is encrypted and drchrono’s data is under HIPAA protections. Philips doesn’t discuss the security details of its HealthSuite, but in every announcement about it, including a press release to publicize the launch, the company emphasizes the platform has built-in security to create a secure cloud environment.

The risks are still present. “Since the IoT is still in its infancy, no one yet knows all the ways this information can be used for malicious purposes,” the Atlantic Council and Intel Security wrote. However, with companies continuing to try to improve their security measures, while also providing new tools to monitor health, it’s likely that the health field will become the next industry reshaped by the Internet of Things.

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The High Cost of Reducing Waste in US Healthcare

The High Cost of Reducing Waste in US Healthcare | Healthcare and Technology news | Scoop.it

Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the President, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after presentation, which found a tumor so extensive that the patient needed an amputation.

The case is instructive at multiple levels. It shows a tense dialectic between the individual and society. It also highlights a truism that many don’t understand or don’t acknowledge – missed/ delayed diagnosis and waste are reciprocal. They’re birds of a feather. You can’t have less of one without more of the other.

The patient presented with back pain. MRI for back pain is the poster child of waste. Why so? Because so many are negative. Even more are meaninglessly positive –disc bulges which simply mean “I’m Homo sapiens and I wasn’t intelligently designed to be sitting at the desk.”

High quality doctors don’t order MRI for back pain immediately, reflexively and incontinently. Think about this. A high quality doctor should say “I don’t think you need an MRI because it won’t change the management and doesn’t improve outcomes.” That’s the resounding message from the top. If it doesn’t improve outcomes it’s not a worthy test. High quality doctors will, once in a while, cost their organization a lot of money.

But quality is still not settled. Quality doctors must satisfy patients. If a patient asks for an MRI for back pain the quality doctor must acquiesce, if that refusal dissatisfies. I’m confused. Ordering an MRI for back pain is poor care. But not ordering an MRI for back pain is poor care. Which is it?

We don’t know the facts of the case. It’s possible that the patient had a neurological deficit that should have raised the urgency. It’s possible that the physician didn’t examine the patient and had he/ she examined, the tumor might have been detected. We don’t know. We shouldn’t judge (1).

But we know that the delay in getting the MRI was 3 months. Three months are an eternity. Right? The wait time for MRI in Canada is 18 months (eighteen, BTW, is six times three). Many yearn for the Canadian healthcare system like I yearn for a Bentley. Many believe, and I’m disposed to that camp, that the Canadian system is equitable, just, fair and efficient. Swallow those words one at a time, particularly justice, social justice.

Social justice means equality. Equality means that we can’t throw bundles of cash chasing rare events, particularly if, like Canada, when we chase rare pelvic tumors there’s less change for public education for the poor.

Still want social justice? No, I didn’t really think so. Yes, you protest. Then put your tort where your mouth is. But please don’t pander the individual whilst making false pretenses about the population. Which one is it, individual or society? Decide.

Three months. In 3 months did the tumor change from curable to ‘unresectable without amputation’? Unlikely.

Sorry I didn’t ask you about the probabilities I asked you is it conceivable that had the MRI been done immediately and the tumor detected, and the diagnosis not delayed by 3 months, patient might not have lost her leg? Possible, doctor, possible. Don’t you understand the meaning of possible?

Yes, it’s possible. Possible encompasses probabilities from 0.00001 % to 100 %. Here we have another tension. FDA wants probabilities. Medicare wants outcomes and probabilities. Insurers want any excuse not to pay, and lack of probable will do. In courts possibility delivers a knock-out punch to probability.

Doctors must be guided by probability, the essence of evidence-based medicine (EBM), but be mindful of possibility. Cognitive dissonance, anyone? Probability screws possibility. Possibility nullifies probability. Which one? Make up your minds.

The award might not have been as high if the defendant wasn’t an integrated system such as KP. In the era of shared risk, ACOs and shared savings this merits introspection.

Remember that equation: value=quality/ cost? Bonuses will be doled out for high value care. High value is moderate quality/ super low costs.

Excited, are we, to be incentivized to reduce waste? Think about the denominator. Think how it sounds to the jury as the plaintiff attorney grills the CEO of a cost-cutting, highly successful integrated system.

“Ms Thrifty, your organization prides itself on cost cutting. Was my client’s life not as important as the bonuses of your doctors? You apply principles of Lean. Do you treat people like widgets?”

“Ladies and gentlemen of the jury, I submit to you that my client would have lived were it not for the doctors and their greed for the bonuses from Medicare for restricting care. They chose their pockets. I urge you to teach them a lesson.”

Money for thrift doesn’t sound good. Still excited about shared savings? You may retort that doctors should decline an MRI for the right reason. The “right reason” is determined after the fact by the jury, who will find it offensive when doctors don’t do a test, ostensibly, to save money, particularly when there are CAT scans and MRIs every nook and corner.

Every era has its David vs. Goliath. Once it was Erin Brokovich vs. greedy polluting capitalists. The greedy capitalists are hiding in corporate clothes. Who’s the next Goliath? There must be a Goliath. We need good vs. evil narrative. Who better a Goliath than a cost-cutting integrated healthcare system endorsed by POTUS?

KP is efficient, you say. Six sigma, reduced variation, reduced waste, improved outcomes, population health. Efficient like Toyota.

Bring it on! Any skilled plaintiff attorney will reframe waste reduction, population health, EBM, and that hilariously Orwellian term, resource stewardship, as soulless, greedy rationing. And will find a bunch of MDs willing to muddy the case. There’s a reason Health Maintenance Organizations (HMOs) failed. HMOs are not American (2). I’m not American. I get it. I’m amazed 47 % don’t (3).

As a foreigner I’m frequently awed and sometimes puzzled. Awed because the system often achieves a Lazarus-like feat. Puzzled because people ask why healthcare is so expensive.

Why so expensive? Must you ask? Because everyone must live. There can be no harm. There can be no outlier. We chase possibilities. Canada and Britain are garrisoned by probabilities. Possibility costs. Probability can be demonized – Mrs. Jones is a person not a statistic. I’m not saying people get the healthcare system they deserve. I’m saying the system makes perfect sense, given the ethos, culture and expectations of the people.

As a radiologist, physicians chasing possibilities have often frustrated me. Deep down, though, I’ve known two things. First, they’re patient-centered. Yes, that dull cliché. Sorry, I couldn’t avoid it. Second, I might have done the same thing in their shoes.

I have sympathy for the patient. The lottery of life was unfair to her. In her position I would have sued as well. Juries compensate for cosmic injustice as much as they restitute medical negligence. I know that.

The patient said that she hoped the verdict would “teach doctors a lesson.” Doctors don’t need to be taught a lesson. We know when it comes to thrift and waste reduction we’re on our own. If we stick our neck out no one will rescue us when something goes wrong. We know that the same physicians who write editorials in high impact journals promising utopia and waste reduction will testify that we so patently missed a red flag. We know that in the muddy world of uncertainty the charlatans in our midst proliferate disingenuity faster than fecund rabbits on ginseng.

Yet I refuse to practice defensive medicine. I know there’s a risk I’ll be sued. But what of the thousands I stop from going down anxiety-provoking imaging rabbit holes? They’re people, too. I’m patient-centered as well.

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Obamacare subsidies likely expanded insurance coverage

Obamacare subsidies likely expanded insurance coverage | Healthcare and Technology news | Scoop.it

Early evidence suggests that the tax credit subsidies at the core of President Barack Obama's healthcare reform law likely helped expand U.S. health insurance coverage last year, Congress's non-partisan research arm said on Monday.


The subsidies - which can be paid by the federal government to insurers in advance to lower monthly insurance premiums - significantly reduced the premium costs, the Government Accountability Office (GAO) said in a report.


"Surveys GAO identified estimated that the uninsured rate declined significantly among households with incomes eligible for the APTC (Advanced Premium Tax Credit)," the GAO said.


For example, one survey, conducted by Washington, D.C.'s Urban Institute, found the uninsured rate declined 5.2 percent between September 2013 and September 2014 among those eligible for the tax credit subsidies, the report said.


The GAO also said its findings on the first year of the Obamacare insurance exchanges could not be generalized to future years because other factors, including health care costs, could affect the affordability of insurance going forward.


The subsidies - aimed at making insurance more affordable for low-income people under Obama's Affordable Care Act - are being challenged in a Supreme Court case, King v. Burwell.

In a ruling expected in June, the high court could bar the federally run insurance marketplace from providing the subsidies in at least 34 states.


The plaintiffs contend the Affordable Care Act allows subsidies to be distributed only through state-based exchanges. Thirteen states and the District of Columbia set up their own exchanges from October 2013.


The subsidies are available to people making between 100 percent and 400 percent of the federal poverty level. They can reduce insurance premiums dramatically - cutting them by 76 percent on average for people who picked an insurance plan on the federal exchange or on one of two state-based plans, the GAO said.


Nearly 11.7 million people have either signed up or re-enrolled for insurance coverage under the U.S. healthcare reform law. The GAO said about 16 percent of non-elderly adults remain uninsured.


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Data-based medicine: The end of evidence-based medicine?

As all kinds of information are being collected about every aspect of our lives, the data generated at this exorbitant rate can lead to advancements in research and health care.  That is the idea behind big data” and it’s disruptive benefits for the health care industry.  The term encompasses a searchable vast data collection for relative information in order to quickly identify trends.  Like all other disruptive innovations, the focus is speed.  However, medicine, unlike most industries, has never been quick to adapt to trends.


The history of medicine started out based on the knowledge of religious or spiritual theories.  The process for medical decision-making was highly subjective, and a few thousand years later the advancements in clinical judgments were based on individual preference.  Today, we would consider this an example of clinical-based medicine, practice based on individual or group observations.  It wasn’t until the later in the 20th century that doctors and health care researchers began to use the limited data that had been collected and evaluate the effectiveness of individual patient treatments.  Epidemiological methods were then devised to track explicit evidence of the effectiveness clinical practice guidelines and policies.  This disruption in medicine would lead to policies and practice guidelines being anchored on experimental evidence gathered from data rather than expert opinions.

Big data is a huge collection of data that is unmanageable by traditional evidence-based means and is a seismic disruption in the field of medicine.  One of the first published incidents of using big data to affect doctor decision-making was in 2011 at Stanford Lucile Packard Pediatric Hospital, where Dr. Frankovich searched through her medical records of pediatric lupus patients to determine whether or not to prescribe anticoagulant medication.  Because there were not any published guidelines and scant literature on the subject, she resorted to analyzing the patterns revealed in her collection of medical charts.

Lloyd Marino, CEO of Avetta Inc., a global strategy company, says big data is not a quick fix for immediate answers, especially in health care.  Unlocking the value of big data requires an ongoing process of the three A’s: automation, analytics, and action.

Automation sorts through and cleanses the data from numerous sources.  By normalizing the collected data, it can be integrated with current health care models on a continuous basis in order to produce real-time outcomes.  For example, medical records are filled with dozens, if not hundreds, of data points per patient and can be routinely updated inside an electronic medical record.  Beyond just collecting information, medical records can be combed through by robust learning machines for patterns and filtered based on disease, risk factors, or outcomes.

However, machine-learning algorithms from auto-generated data needs to be built and mastered.  Big data analytics explores deeper into the stream of healthcare information and finds solutions undiscoverable by traditional search means through moving beyond just managing data to mastering it.  Analytics does not just offer insight but can help create efficient better hospital infrastructure and streamline drug testing.

Most importantly, the action taken must be deployed wisely and rapidly to achieve a high return on investment (ROI), and this would speed the pharmaceutical industry’s notoriously slow pace.  Success also depends on how these solutions are aligned with key health care objectives, how easy for practitioners and invested health care workers to make use of solutions, and how well it integrates with existing protocols and procedures.

Evidence-based medicine is facing a disruptive force. However, it will never be fully uprooted; much like clinical-based medicine continues to exist today.  Big data has the advantages of size and speed compared to evidence-based medicine.  However, big data alone will not solve any issues for health care problems that exist for individual patients and communities.  Proper implementation of automation, analytics, and action, can help properly leverage big data for new solutions to health care models.

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jean marc mosselmans's curator insight, 22 March 2015, 12:02

the major danger is to forget the difference between observational studies and intervention studies. Modern medicine is full of very promising observational studies and hypothesis, unfortunately not confirmed by interventional dubble blind studies

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House Republican Budget Overhauls Medicare and Repeals the Health Law

House Republican Budget Overhauls Medicare and Repeals the Health Law | Healthcare and Technology news | Scoop.it

House Republicans on Tuesday will unveil a proposed budget for 2016 that partly privatizes Medicare, turns Medicaid into block grants to the states, repeals the Affordable Care Act and reaches balance in 10 years, challenging Republicans in Congress to make good on their promises to deeply cut federal spending.

The House proposal leans heavily on the policy prescriptions that Representative Paul D. Ryan of Wisconsin outlined when he was budget chairman, according to senior House Republican aides and members of Congress who were not authorized to speak in advance of the official release.

With the Senate now also in Republican hands, this year’s proposal is more politically salient than in years past, especially for Republican senators facing re-election in Democratic or swing states like Pennsylvania, Wisconsin, Illinois and New Hampshire, and for potential Republican presidential candidates.

Mr. Ryan’s successor, Representative Tom Price, Republican of Georgia, promised on Monday “a plan to get Washington’s fiscal house in order, promote a healthy economy, protect our nation and save and strengthen vital programs like Medicare.”

Democrats — and those Republicans who support robust military spending — will not see Mr. Price’s “Balanced Budget for a Stronger America” in those terms. Opponents plan to hammer Republican priorities this week, as the House and Senate budget committees officially begin drafting their plans on Wednesday, and then try to pass them through their chambers this month.

On Monday, President Obama tried to get ahead of the debate by criticizing Republican plans to abide by strict domestic and military spending caps.

“I can tell you that if the budget maintains sequester-level funding, then we would actually be spending less on pre-K to 12th grade in America’s schools in terms of federal support than we were back in 2000,” the president said in a speech to the Council of the Great City Schools. “The notion that we would be going backward instead of forwards in how we’re devoting resources to educating our kids makes absolutely no sense.”

But Republican aides said they have weathered those attacks ever since Mr. Ryan released his first budget plan in 2011. They said the easiest way to prevail in the House, at least, is to put forward the budget plan most House members have voted on multiple times.

“We’ve had House people vote on these four years in a row. We’ve held on to our majority and even expanded it,” said Representative Tom Cole, Republican of Oklahoma and a Budget Committee member. “The idea you’re going to lose an election on this is more political theater than political reality.”

Congressional budgets do not have the force of law and are largely advisory documents, but they represent the broadest statement of governing philosophy each year and set overall spending levels for the coming fiscal year. And in coming months, this one may contain language easing passage of taxation and entitlement legislation.
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Under congressional rules, a budget cannot be filibustered in the Senate, so Republicans would bear most of the responsibility if they failed to pass one.

House Budget Committee members previewed their plans in an unusual, campaign-style video on Monday. The plan envisions a remaking of the federal government. Future recipients of Medicare would be offered voucherlike “premium support” to pay for private insurance rather than government-provided health care.

Spending on Medicaid would be cut substantially over 10 years, with the money turned into block grants to state governments, which in turn would have much more flexibility in deciding how it is allocated.

The budget “repeals all of Obamacare,” Representative Diane Black, Republican of Tennessee, said the same day the Obama administration announced that the law had provided coverage to 16.4 million previously uninsured people.

To placate advocates of the military who say strict budget caps are hurting national defense, the House budget adds “emergency” war spending through the “overseas contingency operations” account, which does not count against the spending limits.

The budget will also include language that orders members of the tax-writing Ways and Means Committee to draft a “fairer, simpler tax code,” said Representative Todd Rokita, Republican of Indiana.

And it will include parliamentary language — called “reconciliation” — aimed at allowing legislation to repeal the Affordable Care Act to pass the Senate with a simple majority. If that bill is passed, it will still be subject to a presidential veto.

Conservative groups insist Republicans must keep their promise and repeal the Affordable Care Act.

“Republicans owe their majorities to their unwavering opposition to Obamacare, a reality that must be reflected in the budget,” declared Heritage Action, the political arm of the conservative Heritage Foundation. “A throwaway line that the budget ‘repeals Obamacare in its entirety’ is not enough.”

House Republicans conceded on Monday that the Senate was not likely to propose such extensive cuts. Even before the Senate plan is unveiled, deep rifts are appearing. Senator John McCain of Arizona, chairman of the Senate Armed Services Committee, reiterated his demand on Monday that any budget raise military spending well above the statutory caps. And he said he would not accept an approach that raised spending through the war-fighting emergency account or by shifting money from already squeezed domestic programs.

Last year, Mr. Ryan called “emergency spending” increases “a backdoor loophole that undermines the integrity of the budget process.”

Republican leaders worry that the Republican senators making moves to run for president — Ted Cruz of Texas, Rand Paul of Kentucky, Marco Rubio of Florida and Lindsey Graham of South Carolina — will never find a budget to their liking. At the same time, Republican senators from Democratic states, such as Mark S. Kirk of Illinois, will be hard-pressed to agree to the House’s conservative vision.

In 2013, when the Senate was presented an amendment to prohibit replacing Medicare’s guaranteed benefits “with the House passed budget plan to turn Medicare into a voucher program,” 96 senators agreed. Only three, Mr. Cruz, Mr. Paul and Senator Mike Lee, Republican of Utah, supported the House’s vision.

“Historically, the Senate has been less willing to take on the tough issues, and the early sounds are they’re not going to do a Ryan-type Medicare-Medicaid plan,” Mr. Cole said. “They face a very difficult election atmosphere next year.”


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Tyson continues effort to cut antibiotics from chicken production

Tyson continues effort to cut antibiotics from chicken production | Healthcare and Technology news | Scoop.it

Tyson Foods Inc has removed gentamicin, a key antibiotic for human use, from company hatcheries, the company told Reuters on Tuesday.

Arkansas-based Tyson, the nation's largest chicken producer, said the drug and other antibiotics have not been used at its 35 hatcheries since Oct. 1, 2014. The company had not previously given details of what drugs were used at the hatcheries, where chicks are born and kept briefly before being moved to poultry farms.

Gentamicin is a member of an antibiotic class considered "highly important" in human medicine by the federal Food and Drug Administration.

The poultry industry has long been under pressure to stop feeding medically important antibiotics to otherwise healthy livestock. Meat companies have used the drugs both to stave off disease and to promote more rapid growth.

Last week, McDonald's Corp said its U.S. restaurants will gradually stop buying chicken raised with antibiotics vital to fighting human infections. Tyson Foods is a major chicken supplier to McDonald's.

Tyson told Reuters this week it is also testing alternatives to medically-important antibiotics for use on the farms that house its chickens after they leave the hatcheries. It says it does not use antibiotics for growth promotion on the farms, but does use them, according to its website, "when prescribed by a veterinarian to treat or prevent disease."

Rival chicken producer Perdue Farms announced last summer that it had stopped using all antibiotics in its hatcheries, including gentamicin, because it wanted "to move away from conventional antibiotic use" due to "growing consumer concern and our own questions about the practice."

Gentamicin has been commonly used in hatcheries to fight off infection or prevent disease, including in fertilized eggs, livestock veterinarians and other poultry producers say.

Tyson sees the policy shift as "a significant first step toward our goal of reducing the use of antibiotics that are also used in human medicine," according to its website.

Tyson has reduced the volume of medically-important antibiotics used in its chicken business by 84 percent since 2011 and the "vast majority of the antibiotics used to raise our chickens are never used in humans," according to a company statement.

While veterinary use of antibiotics is legal, the risk is that overuse could spur the creation of so-called superbugs that develop cross-resistance to antibiotics used to treat humans. Reuters found last year that major U.S. poultry firms were administering antibiotics to their flocks on the farm far more pervasively than regulators realized.


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Optimize Your Sales Team's Productivity with 10 Cisco IP Phones

Optimize Your Sales Team's Productivity with 10 Cisco IP Phones | Healthcare and Technology news | Scoop.it

Ten Cisco IP Phone Options for Your Sales Team

1) The Cisco 8865. Sales organizations seeking the latest in cutting-edge HD video communications will find the 8865 to their liking. Designed to function flawlessly in shared work environments, the 8865 offers a comprehensive collection of VoIP features. Key characteristics of 8865 include the following:

  • A 5-inch widescreen VGA color display
  • High-quality 720p two-way HD video for a superb visual experience
  • Superb video and VoIP clarity
  • An optional key expansion module that facilitates dialing
  • Flexible deployment options

Additionally, the 8865 is compatible with a variety of USB headsets, including models made by third-party vendors. This advantage enables companies with offshore call centers to easily and affordably replace headsets through local suppliers.

 

2) The Cisco 8845. The 8845 was designed for optimum user productivity. In addition to offering basic calling features such as transfer, conference, and hold/resume, the 8845 allows sales reps to employ its multi-call-per-line feature to handle multiple calls for each directory number. The most pertinent features for sales and customer service agents are as follows:

  • A 5-inch high-resolution widescreen backlit color display
  • High-quality 720p two-way HD video
  • Five programmable lines
  • Outstanding audio acoustics
  • One-touch access to applications

In addition to these key features, the 8845 is known for its integrated digital camera and outstanding encryption of voice and video communications.

 

3) The Cisco 7945G. Like 8845, the Cisco 7945G possesses an adaptable, dynamic design that facilitates organizational growth. Regular, unobtrusive software updates help to ensure that sales and customer service representatives maintain a competitive edge in efficiency and productivity. Key characteristics of the 7945G include the following:

  • A 5-inch graphical TFT color display with backlight and 16-bit color depth
  • High-quality 720p two-way HD video for a superb visual experience
  • Five programmable lines
  • Wideband support, including speakerphone, handset, and headset
  • One-touch access to applications

The 7945G is also known for its integrated support for over 30 languages, making it an excellent choice for organizations with employees in multiple countries.

 

4) The Cisco SPA303G. The SPA303G IP phone was constructed with utility and affordability in mind. It is the perfect option for organizations that do not require a large color display or other sophisticated features present on recently designed IP phones. Key characteristics of the SPA303G include the following:

  • A backlit monochrome LCD screen (128 x 64 pixels)
  • Three voice lines
  • Caller ID
  • A menu-operated user interface
  • Automatic redial of the most recent number called

Two final points to consider are the SPA303G’s simple installation process and secure remote provisioning tools. Software upgrades are easy to make and do not interfere with regular business, giving sales and customer service managers peace of mind.

 

5) The Cisco SPA504G. The SPA504G IP phone possesses the same robust collection of features as the 303G. However, the SPA504G also includes an additional voice line, Power over Ethernet (PoE) support, and other upgrades that make it a more attractive option for sales professionals who field a lot of calls. Key characteristics of the SPA504G include the following:

  • A backlit monochrome LCD screen (128 x 64 pixels)
  • Four voice lines
  • Illuminated buttons to signify on/off for audio mute, headset, and speakerphone
  • A menu-operated user interface
  • Support of optional features such as Cisco XML and VoiceView Express

 

6) The Cisco SPA514G. With its dual gigabit ethernet switched ports and secure remote provisioning, the SPA514G is a logical choice for call centers with single or multiple locations. Key specifications include:

  • A backlit monochrome LCD screen (128 x 64 pixels)
  • Four voice lines
  • Supports Power over Ethernet (PoE)
  • A menu-operated user interface
  • Automatic redial of the most recent number called

Like other models in Cisco’s SPA line, the SPA514G is known for its ease of installation and simple station moves, making it a favorite among sales managers and IT staff alike.

 

7) The Cisco 7940G. Designed with the needs of transaction-type employees in mind, the Cisco 7940G is a model for call center managers to consider. Additional benefits for call center agents include categorization of incoming messages for users and customizable network configuration preferences. The 7940G boasts a robust collection of capabilities, including the following:

  • The ability for hands-free changes, facilitating moves to any new network location without system administration
  • The availability of a variety of user accessibility methods, including soft keys, buttons, or direct access
  • More than 24 unique ringer sounds and volume settings
  • A dedicated headset port that allows the handset to remain in its cradle
  • Easy access to a variety of information, including stock market updates, weather, and other web-based news

In addition to these advantages, the 7940G features an ADA-compliant dial pad and HAC handset, facilitating compliance with industry regulations. The 7940G also has a foot stand that can be adjusted up to 60 degrees for optimum viewing and comfort.

 

8) Cisco 7912G. The 7912G offers outstanding value to companies facing tight budgetary constraints. A snapshot of the basic features of the 7912G is as follows:

  • Single voice line support
  • A monochrome, pixel-based display that displays the caller’s name and number
  • Call forwarding and call waiting
  • On-hook dialing
  • Four speed-dials

Because the 7912G is an older model phone, it is no longer available for purchase directly through Cisco, but may be purchased through online resellers.

 

9) The Cisco CP-8831-K9. The CP-8831-K9 is distinct from the other Cisco phones on this list because it is designed specifically for conference calls. The CP-8831-K9 provides an acoustically pleasing experience for a large group of sales representatives and call center agents. Boasting the following five strengths, the CP-8831-K9 is particularly beneficial to companies that regularly hold audio conference calls with customer groups or vendors:

  • High-definition audio performance
  • 360-degree coverage
  • Scalability to optimize conference calls in rooms and offices of every size
  • Flexibility and convenience through a mobile control panel
  • Expandability through the use of wired or wireless extension microphones

The CP-8831-K9 also includes a number of subtly impressive features such as echo suppression, noise reduction, and silence suppression. The inclusion of these premium features makes the CP-8831-K9 an excellent choice for sales organizations that require a dependable conference phone.

 

10) The Cisco 8800 Key Module. While this module is not a telephone in and of itself, it deserves inclusion in this list because of its progressive ability to transform Cisco’s 8851, 8861, and 8865 telephones. In addition to greatly enhancing productivity for phone users, the 8800 key module offers busy sales representatives one-button access to the colleagues with whom they communicate with the greatest frequency. Notable features of the 8800 key module include the following:

  • 18 programmable LED lines per module
  • A backlit, high-resolution 4.3-inch color display for easy viewing
  • Users can choose between Power over Ethernet (PoE) or a local power cube
  • A power save plus option to help companies save money and conserve energy.
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Top 3 Third Party Risk Management Challenges

Top 3 Third Party Risk Management Challenges | Healthcare and Technology news | Scoop.it

Since the massive Target data security breach in December 2013, third party cyber security stopped being an afterthought and started becoming one of the top security priorities for CISOs and Risk Departments. As a response, Third Party Risk Management (TPRM) underwent a transformation in early 2014, and continues to reverberate today.

 

With attackers finding new ways to break into third parties in hopes of infecting a larger organization, the third party ecosystem is more susceptible than ever before. Meanwhile third party usage is growing fast in large organizations and enterprises. Many critical business services such as HR functions, data storage, and modes of communication are the responsibility of cloud-based third parties.

 

Without a modern TPRM program, many of these third parties are left behind in security risk management, putting organizations in a vulnerable position.

 

Over 60% of data breaches can be linked either directly or indirectly to a third party (per Soha Systems, 2016) but TPRM programs don’t often take a risk-first perspective when it comes to risk management. Security and Vendor Risk departments are often solely focused on compliance. That’s important, but doesn’t get at the heart of the risk posed by your third parties. To shift the approach of your TPRM program to measure true risk, you’ll need to make some adjustments in how you manage third parties.

 

Here are the three top TPRM challenges and the actions you and your organization can take in order to bolster your TPRM program.

 

1. Automate Your TPRM Process to Reduce Unmanaged Risk
With the rise in SaaS, businesses are now using cloud-based third parties more than ever. Gartner predicted that SaaS sales will nearly double by 2019, and that SaaS applications will make up 20% of the growth rate in all public cloud services, a $204B market. Last year, Forrester had already predicted that enterprise spend on software would reach $620B by the end of 2015.

 

As businesses engage in IT and infrastructure digital transformation, the need to manage vendors is more pronounced. Over 60% of respondents from a Ponemon Institute’s survey on Third Party Risk Management believe that the Internet of Things increases third party risk significantly. 68% believe the same is true for cloud migration.

 

However, as more third parties are brought in, they’re often not managed to match the level of cyber security risk they carry. Worse, they may not be managed at all due to a lack of resources. This creates unmanaged security risk. If these third parties have access to your network, your employees’ PII, or your customers’ sensitive data, shouldn’t they be subject to rigorous risk management assessments?

 

Unfortunately, as the number of third parties swell to the hundreds, it’s often not feasible for every vendor to be assessed in the same critical fashion. That’s why having an automated risk assessment tool for assessing vendors is a way to ensure you’re minimizing unmanaged risk from both new and existing vendors.

 

Automating your TPRM process is one of the major steps towards having a mature TPRM department capable. Its benefits include:

 

  • Improved third party management flexibility
  • Standardized processes and thirdparty management
  • Metrics and reporting consistency
  • Improved data-driven decision making
  • Further structuring the TPRM organization
  • Increased third party responsibility
  • Increased overall risk assessment and mitigation

 

By automating the TPRM process, you’re creating a standardized structure that can be applied to all third parties, whether existing or onboarded.

 

You can automate your TPRM process by finding new technologies or tools that will automate the assessment and information gathering process for your third party vendors. This helps to ensure that you’re optimizing your resources and spending company time on what is most impactful.

 

2. Augment and Validate Self-Reported Questionnaires Through Independent Risk-Based Assessments
Third parties are often assessed through questionnaires, onsite assessments, or via penetration tests. Each has its own advantages and disadvantages. Onsite risk assessments and penetration tests are resource-intensive, requiring time, money, and staff in order to carry out the assessments. Because of the costs, these kinds of assessments cannot be used for all third parties, and should be reserved for the most risk-critical third parties.

 

That leaves questionnaires to fill the void for most of the other third parties. However, questionnaires are self-reported, which makes using a ‘trust, but verify’ approach to risk management difficult to accomplish.

 

In a 2016 Deloitte Study on Third Party Risk Management, 93.5% of respondents expressed moderate to low levels of confidence in their risk management and monitoring mechanisms. With numbers like that, it’s easy to see why TPRM programs need increased attention. Without a way to independently verify the security posture of your third parties, you can only rely on the word of your third parties who are, for obvious reasons, incentivized to report positively.

 

Organizations should find independent third parties that can provide risk-based assessments of their third parties to validate that the findings from questionnaires are a realistic portrait of the state of third party security.

 

There are a number of cyber security solutions that provide risk-first third party assessments. To find the right solution, you should research whether or not those solutions:

 

  • are accurately assessing third parties
  • can facilitate communication between you and third parties
  • are focusing on key cyber security areas that are indicative of a potential breach


3. Utilize Continuous Monitoring to Assess Third Parties Beyond Point-In-Time Assessments
The assessment methods mentioned in the previous section all have one glaring flaw in common – they assess third parties at a single point in time. Many times, the information gathered by security risk assessments is outdated by the time it falls into your hands. The speed at which hackers are developing new attacks and exploiting vulnerabilities is too fast for point-in-time assessments or annual reviews to provide any insight into the real security posture of a vendor.

 

A PWC Third Party Risk Management report on the finance industry noted that 58% of companies using ad hoc monitoring experienced a third party service disruption or data breach, compared to only 37% of those that regularly monitor their providers and partners. Without having a way to know the security posture of your third parties on-demand, you’re managing risk with a blindfold on for most of the year. By only having point-in-time information that is quickly outdated, your ability to react to new vulnerabilities, or worse, a potential third party cyber security incident, is negligible.

 

Through continuous monitoring, you’re bolstering the security of your third party by keeping them consistently accountable, which in turn, minimizes your overall risk to a potential security incident.

 

How to Get Started Revamping Your VRM
We covered how to implement continuous monitoring in your TPRM program in part 2 of our How to Revamp Your VRM Program article series. Start by establishing a central TPRM office if you don’t already have one, prioritize and identify your most risk-critical and business-critical vendors, and then define your third parties’ security controls and processes that you’ll monitor on an ongoing basis. If you have the resources, look for automated risk healthassessment tools and solutions that offer continuous monitoring for your third parties.

 

Conclusion
Updating your TPRM program doesn’t have to be a complete overhaul of your department. Instead, you should use a risk-first perspective to define the aspects that are the most criticalto update. The three we highlighted here will yield the most dramatic changes in a TPRM program, reducing your unmanaged risk, and reducing your reaction time should a security incident occur.

 

By automating aspects of your TPRM program, using independent third party assessments, and adopting continuous monitoring, you’re not far from having a mature TPRM program that can easily assess any new third party as it comes, keeping your organization safe.

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4 Things to Know About Telehealth

4 Things to Know About Telehealth | Healthcare and Technology news | Scoop.it

Telehealth has emerged as a critical tool in providing health care services. [1] The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.

 

The Changing Face of Telehealth Law
Today’s competitive health care marketplace has created an environment where patients demand lower costs, higher service quality, and convenient access to services. [2] Telehealth is an innovative and valuable mechanism that provides patients with efficient access to quality services. Lowering costs and removing barriers to service access, are critical components in promoting patient wellness and population health. Convenience and cost-effectiveness are important commodities in the modern health care marketplace, as patients tend to avoid treatment that is difficult to access or too expensive. As a result, telehealth technology is emerging as a preferred choice among patients and providers. Telehealth has also attracted the attention of US legislators. They utilize this tool for improving the competitiveness of American health care services. This is especially important, seeing as health care represents 17 percent of the nation’s gross domestic product (GDP). In fact, the resource has helped to define the role that lawmakers play in ensuring that patients benefit in a competitive health care market.

 

Reimbursement for Services Delivered by Telehealth
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.

 

Telehealth or Telemedicine?
The term ‘telehealth’ is gaining popularity among medical professionals, compared to the original term, ‘telemedicine.’ [4] Some medical professionals use the names interchangeably. However, telemedicine is a term that may apply to the application of any technology in the clinical setting, while telehealth more distinctly describes the delivery of services to patients. Telemedicine is a familiar term, but telehealth more appropriately describes the latest trends in using technology to deliver treatments to patients. Depending on the organization, service providers may use a different definitions of telehealth. Although the basic premise remains similar, the context may change according to factors such as organizational objectives, and the needs of the patient population being served. Medical experts do agree on one point; telehealth is an innovative way of engaging patients, and it is highly beneficial for both providers and patients.

 

The Road Ahead
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma. [5] The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.

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A Path to Putting Patients at the Center 

A Path to Putting Patients at the Center  | Healthcare and Technology news | Scoop.it

I remember when visiting a city required paper maps and often actual guidebooks. Today, I tap on a map app on my phone, enter my destination and review options for getting from point A to point B. In recent years, these applications have expanded to integrate ride-sharing, bike-sharing, and public transit information. Map apps provide two key real-time data points to help me compare the different options: the time it will take to get to my destination and the cost.

Behind those data points are elegant algorithms that analyze traffic patterns and conditions, as well as the real-time data exchange between multiple apps through modern, Representational State Transfer (RESTful) application programming interfaces (APIs). What makes our smartphones so powerful is the multitude of apps and software programs that use open and accessible APIs for delivering new products to consumers and businesses, creating new market entrants and opportunities. There is nothing analogous to this app ecosystem in healthcare.

ONC’s interoperability efforts focus on improving individuals’ ability to control their health information so they can shop for and coordinate their own care. While many patients can access their medical information through multiple provider portals, the current ecosystem is frustrating and cumbersome. The more providers they have, the more portals they need to visit, the more usernames and passwords they need to remember. In the end, these steps make it hard for patients to aggregate their information across care settings and prevent them from being empowered consumers.

Just as consumers can see the time to destination and costs using their map apps, they should be able to see quality indicators and costs of their care. As Health and Human Services (HHS) Secretary Azar recently stated, “putting the healthcare consumer in charge, letting them determine value, is a radical reorientation from the way that American healthcare has worked for the past century.” I certainly recognize that issues around pricing for healthcare services and measuring quality are complex, but I am confident that ONC’s efforts will complement new policies across HHS to encourage transparency, leverage Medicare and Medicaid to drive value-based transformation, and reduce regulatory burden on the health system.

As part of ONC’s role in coordinating health information technology (health IT) nationally, we are working with innovators to develop modern APIs that support the use of mobile apps to help individuals manage their own health or the health and care of a loved one. A robust health app ecosystem can lead to disease-specific apps and allow patients to share their health information with researchers working on clinical trials to test a drug or treatment’s efficacy, or monitoring outcomes like those in the National Institutes of Health’s All of Us Research Program.

ONC took a practical step to accelerate the use of APIs in healthcare with the 2015 Edition of the certification criteria adopted as part of the ONC Health IT Certification Program. Specifically, the 2015 Edition includes updated technical requirements that were not available in the prior edition and—to the benefit of the provider and the patient—to support further innovation in APIs and interoperability-focused standards. The 2015 Edition includes “application access” certification criteria that require health IT developers to demonstrate their products can provide application access to core medical and patient information via an API.

The 21st Century Cures Act (Cures) builds on ONC’s 2015 Edition and calls for the development of APIs that do not require “special effort” for developers to access and exchange health information. ONC will address this requirement through rulemaking expected to be issued later in 2018. Ensuring that APIs in the health ecosystem are standardized, transparent, and pro-competitive are the central principles guiding our work. These goals should allow new business models and tools that will expand the transparency of all aspects of healthcare. New tools should allow patients to comparison shop for their healthcare needs like they do when hailing a ride.

In recent years, the health IT industry has made positive strides. The HL7 Argonaut Project, a private sector initiative, has been developing a core set of Fast Healthcare Interoperability Resources (FHIR) implementation specifications. These specifications will enable expanded information sharing for electronic health records and other health IT solutions based on modern computing standards (i.e., REST, Javascript Object Notation (JSON), and FHIR). Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics have been leading the development of SMART Health IT, an open, standards-based technology platform that already is showing success in enabling innovators to create apps that seamlessly and securely run across the healthcare system.

The convergence of these actions, the new authorities granted to ONC by Congress in the Cures Act, and efforts by HHS, the Centers for Medicare & Medicaid Services (CMS), the National Institutes for Health (NIH), and the Veterans Administration (VA) with the MyHealthEData initiative are helping promote more consistent data flows, inject market competition in healthcare, and return individual control of their care to the American public.

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Health risk assessments may benefit elderly

Health risk assessments may benefit elderly | Healthcare and Technology news | Scoop.it

When healthy elderly people fill out health risk questionnaires and get personalized counseling, they have better health behaviors and use more preventive care, according to a new study.


Eighteen percent of firms ask working-age employees to complete health risk assessments, but the use of these tools in older persons is relatively new, said lead author Andreas E. Stuck of University Hospital Bern in Switzerland.


The personal health risk assessments covered multiple potential risk factors relevant in old age, and participants received individualized feedback and health counseling, lasting two years, Stuck said.


“Thus, prevention in old age is likely effective, but only if risk assessment is combined with individualized counseling over an extended period of time,” Stuck told Reuters Health by email.


In his team’s study, conducted in Switzerland between 2000 and 2002, 874 healthy adults over age 65 filled out questionnaires and received individualized computer-generated feedback reports, which were also sent to their doctors.


Additionally, for two years, nurse counselors visited patients at home and called them every three to six months to reinforce what health behaviors they should be pursuing or preventive care they should be obtaining based on their individualized reports.


About 85 percent of those assigned to the health risk assessment group returned their questionnaires, the researchers reported in PLoS Medicine.


Counselors identified the most important risk factors for each person, and the interaction between risk factors was taken into account. For example, for a person with low physical activity who was having pain, the first step was to intervene on management of pain, then on physical activity, Stuck said.


At the end of two years, the researchers compared the risk assessment group to another 1,000 similar adults who did not get the questionnaires or counseling.


Seventy percent of those who completed the health-risk assessments were physically active and 66 percent had received a seasonal flu vaccine, compared to 62 percent and 59 percent of the comparison group, respectively.


Long-term outcomes like nursing home admission or functional status were not available, but the researchers estimated that almost 78 percent of the adults in the health risk assessment group were still alive after eight years, compared to almost 73 percent in the comparison group.


The health assessment, data entry and individualized feedback report takes patients about one hour to do and costs about $30, Stuck said, not including the cost of individualized counseling by the nurse counselor or a primary care physician.


Health risk assessment should be offered to all older people starting between age 60 and 65, he said.


“The authors report promising evidence that a complex intervention might improve longevity and functioning in older adults,” said Evan Mayo-Wilson of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who was not part of the new study.


“The team provided many services in addition to standard care, and we cannot tell if all of those services were important or if only certain activities would be necessary to achieve good outcomes,” Mayo-Wilson told Reuters Health by email.


But only half of the people assessed for the trial were enrolled, while many weren’t eligible or refused, and some who were assigned to the health risk assessments didn’t return their questionnaires or otherwise didn’t engage with the program, he noted.


“We should be cautious in interpreting the results of this study because previous studies found inconsistent effects of mortality and other health outcomes,” Mayo-Wilson said.

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Fixing health care really depends on the economy

Fixing health care really depends on the economy | Healthcare and Technology news | Scoop.it

Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday.

For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The main opposition, the Labour Party led by Ed Miliband (the same party previously led by Tony Blair), were battling to return back to power.


Most opinion polls for the last few months had the Conservatives and Labour neck and neck. The electoral math, however, appeared to favor the challengers. The Conservatives had campaigned on a message of continued economic stability and preserving the Union, painting the Labour Party as the reason why the country was in dire economic straits when they first came to power in 2010.


They also pressed home the message that in order to form the next government, the Labour Party would need to form an unholy alliance with the Scottish National Party — leading to unfair influence from Scotland into English affairs. The Labour Party, on the other hand, campaigned on a platform of fairness and equality, painting the Conservatives as a party who hurt the working classes with their austerity measures and favored only the rich. (Sound familiar in U.S. politics too?)


Before the election, nobody appearedto know which way the country would vote. I performed my civic duty and cast my vote at our local polling station in the afternoon. When the polls closed at 10 p.m., the first network predictions surprised everyone: The Conservatives would comfortably be the largest party. As the results started coming in, the trend was obvious, and there were considerable percentage swings away from Labour to the Conservatives. In the end, the Conservatives outperformed even their own wildest expectations, gaining a working majority in the House. By the following morning, David Cameron was on his way to meet the queen and declare that he would be able to form the next government. The three other main party leaders had all resigned.


So what happened? Pundits agree that a couple of main factors were at play. By far the most important, however, was that the U.K. economy had stabilized, and people generally felt like the current administration had been solid in this area. It had posted satisfactory growth rates, was adding jobs, and was generally seen as the envy of Europe. In the end, this trumped everything else. In fact, David Cameron became one of the few sitting prime ministers in history to increase both his vote share and win more seats.


Years ago, Bill Clinton’s campaign strategist James Carville coined the phrase “It’s the economy, stupid.” The saying has since gone down in political folklore, and the U.K. election perfectly illustrated the reasons why this statement is so true. Simply put, the economy trumps everything else. Outside of any unusual situation, such as a war, people’s economic security will decide how they are going to vote. It’s a simple fact of life. This holds true for everyone, whether you are on benefits or a multi-millionaire. In fact, I would go as far to say that a leader or party can be unpopular in almost every other way, but if they preside over a booming economy — their position is secure.

Let me draw a parallel with the situation that health care systems face (at a time when virtually every system across the world is facing challenges). When we debate health care and talk about new policies, budget constraints, and future philosophies — they all also ultimately boil down to one thing: How much health care can the economy afford? The National Health Service, a cornerstone of the U.K. and a huge political issue, featured relatively low on the agenda this time round compared to the economic debate.


In the United States, those of us in health care like to point fingers and take our sides, but the reality is that we are totally at the mercy of the economy. It’s pretty certain that the majority of our problems over the last few years are a direct result of the economy tanking in 2008. These include a general feeling of increased scrutiny, a heavy push towards value-based care (with “value” often appearing to be more important than the “care”), and health care consolidation. When the economy is doing well, things tend to take care of themselves. This may sound like a gross oversimplification, but if the monetary squeeze is present, the pressure piles on and filters through to all levels of medical professionals. We may want to assign blame to individual politicians, policymakers, and small systems for many of our daily frustrations in health care. But really, it’s the economy, stupid.


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Docs in NYC to use tele-robotics to treat Chicago patients

Docs in NYC to use tele-robotics to treat Chicago patients | Healthcare and Technology news | Scoop.it

As part of a new clinical trial, physicians in New York City are seeing whether they can perform complex ultrasounds on patients in Chicago via a new telemedicine platform.    The new study, spearheaded by researchers at New York's Icahn School of Medicine at Mount Sinai together with Rush University Medical Center in Chicago, will integrate a tele-robotic ultrasound for distance imaging, or TRUDI, technology developed by co-founders of TeleHealthRobotics.    The study involves cardiovascular specialists at Mount Sinai utilizing a personal computer over the Internet to control a small, robotic TRUDI arm to conduct a four-minute scan of Rush patients' carotid arteries. About 100 Rush patients are currently participating in the study, which aims to determine whether these tele-ultrasounds are as effective as in-person ultrasounds. 


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New technology has been created by TeleHealthRobotics that may allow doctors to perform ultrasounds on patients that are hundreds of miles away from them. 100 patients will be participating in this study, in which doctors will involve specialists in Mount Sinai using a tele-robotic ultrasound for distance imaging (TRUDI) to view the patients organs. If the long distance ultrasound proves to be just as effective as an ultrasound in person, the distance barriers for long distance operations performed by doctors will have been broken and will lead the way for more technology like this to be developed.

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Ebola Vaccine Appears Safe, Effective

Ebola Vaccine Appears Safe, Effective | Healthcare and Technology news | Scoop.it

Tests of an experimental Ebola vaccine have found that 100 percent of vaccinated people mounted a promising immune response and incurred no serious side effects, according to results published this morning in The New England Journal of Medicine. A large, international group of researchers report that between two studies, all 200 subjects in the United States, Switzerland, and Germany who were given the recombinant vesicular stomatitis virus-based vaccine (rVSV) vaccine developed an immune response that should be effective in warding off future infection.


The subjects in today's studies were not actually exposed to the Ebola virus after vaccination, so the appraisal of effectiveness is based on primate studies that give researchers an idea of how many antibodies are required to prevent infection. Some people who received the vaccine did develop fatigue, chills, and muscle aches, but no serious complications, and based on the formulation of the rVSV vaccine—which is a mixture of some Ebola Zaire viral proteins inside another more innocuous virus—it carries no risk of infecting patients with Ebola.

At least 10,000 people have died in West Africa as a result of the ongoing epidemic. Based on the findings reported today, this Ebola vaccine formulation has been incorporated into recently initiated human trials in Liberia and Guinea, and will be introduced in Sierra Leone in the near future.


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Google Builds a New Tablet for the Fight Against Ebola

Google Builds a New Tablet for the Fight Against Ebola | Healthcare and Technology news | Scoop.it

Jay Achar was treating Ebola patients at a makeshift hospital in Sierra Leone, and he needed more time.

This was in September, near the height of the West African Ebola epidemic. Achar was part of a team that traveled to Sierra Leone under the aegis of a European organization called Médecins Sans Frontières, or Doctors Without Borders. In a city called Magburaka, MSF had erected a treatment center that kept patients carefully quarantined, and inside the facility’s high-risk zone, doctors like Achar wore the usual polythene “moon suits,” gloves, face masks, and goggles to protect themselves from infection.

With temperatures rising to about 90 degrees Fahrenheit, Achar could stay inside for only about an hour at a time. “The suit doesn’t let your skin breathe. It can’t,” he says. “You get very, very hot.” And even while inside, so much of his time was spent not treating the patients, but merely recording their medical information—a tedious but necessary part of containing an epidemic that has now claimed an estimated 10,000 lives. Due to the risk of contamination, he would take notes on paper, walk the paper to the edge of the enclosure, shout the information to someone on the other side of a fence, and later destroy the paper. “The paper can’t come out of the high-risk zone,” he says.

Looking for a better way, he phoned Ivan Gayton, a colleague at the MSF home office in London. Gayton calls himself a logistician. He helps the organization get stuff done. In 2010, he tracked down someone at Google who could help him use its Google Earth service to map the locations of patients during a cholera epidemic in Haiti. As part of its charitable arm, Google.org, the tech giant runs a “crisis response team” that does stuff like this. So, after talking to Achar, Gayton phoned Google again, and the company responded with a new piece of tech: a computer tablet that could replace those paper notes and all that shouting over the fence.

The Tablet You Dunk in Chlorine

Over the next few months, drawing on employees from across the company, Google helped build a specialized Android tablet where Achar and other doctors could record medical info from inside the high-risk zone and then send it wirelessly to servers on the outside. Here in everyday America, a wireless tablet may seem like basic technology. But in the middle of an Ebola epidemic in West Africa, which offers limited internet and other tech infrastructure, it’s not.



The tablet is encased in polycarbonate, so that it can be dipped in chlorine and removed from the facility, and the server runs on battery power. “There was a real need for this,” says Dr. Eric D. Perakslis, part of the department of biomedical informatics at the Harvard Medical School, who has closely followed the project. “It’s very impressive, and it’s unique.”

The system is now used by Achar and other doctors in West Africa, where patients are still being treated. During the testing phase, the server ran off a motorcycle battery, but now it includes its own lithium ion batteries, much like those in your cell phone, which can charge via a portable generator. Then, inside the high-risk zone, Achar can not only wirelessly send data over the fence, but also readily access information he didn’t have before, including a patient’s latest blood test results. Plus, after dipping the thing in chlorine for ten minutes, he can take it outside the zone and continue working with it after removing his moon suit.

Yes, the Ebola epidemic appears to be wane. But the system provides a blueprint for future. After catching wind of the project, Perakslis says, he’s working to help MSF “open source” the technology, freely sharing the software code and hardware designs with the world at large. The hope is that system could also be used to battle others epidemics, including cholera outbreaks, and perhaps help with medical research, including clinical trials for drug-resistant tuberculosis. “You can think of other highly toxic environments, even laboratory environments, where this could really be helpful,” Perakslis says.

Fighting Disease Like a Tech Company

But it could also provide a path to all sorts of other new technologies for fighting disease and illness in developing countries. If tech is open source, you see, you can not only use it for free, but modify it. This is actually what MSF and Google themselves did in creating their system for the Ebola wards. In fashioning the software that runs on the tablet and server, they built atop an existing open source medical records tool called OpenMRS. One technology is just a starting point for another.

What’s more, says Ivan Gayton, the project offers a lesson in how organizations like MSF should operate. In the past, they operated according to carefully organized hierarchies of employees. And they were forced to use what came down from the big software and hardware sellers. But the tablet project was an almost ad-hoc collaboration. Achar phoned Gayton. Gayton phoned Google. Soon, Google sent about a dozen employees to London, including Google Drive project manager Ganesh Shankar, who was living in Australia. Later, Gayton says, MSF roped in several other volunteer techies from outside the organization, including a 19-year-old gaming entrepreneur.

Finally, various parts of the team, spanning multiple organizations, flew down to Sierra Leone to test and deploy the system in the real world. Organizations like MSF don’t typically work in this way, Gayton explains. And they should.

“We’ve learned new ways of doing things,” he says. “In the past, we used the Roman-legion, hierarchical, triangle structure. But Google and the tech volunteers we work with organize in different ways—ways more like what you see with open source projects like Linux, with more or less one manager and then a bunch of equal peers. That can have profound implications for the humanitarian field.”


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Eduardo Vaz's curator insight, 25 March 2015, 14:33

#Google created a new #Tablet, but you won't be seeing it on store shelves. #ygk

Jared Stewart's curator insight, 27 March 2015, 07:12

A application of modern Tablet technology to help the fight against the Ebola Virus. It also shows the possibilities of this technology being used in future epidemics.

Louisa ROQUE's curator insight, 23 April 2015, 10:59

When technology is useful.

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Nurses are the superheroes of health care

Nurses are the superheroes of health care | Healthcare and Technology news | Scoop.it

Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession — usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor may be in and out of the room in ten minutes or so, but the nurse is the one who will be right there by their patient’s side throughout their recovery.


Nurses work tirelessly for their patients and are their biggest advocates. They run around all day in and out of patient rooms, multitask to an unbelievable agree, constantly talk to patients and relatives, administer all the medications on time, and invariably pick up on any problems that the doctor hasn’t. Every doctor will have a story to tell about how a nurse has saved their patient, even if they don’t acknowledge it as much as they should.

Unfortunately, however, the sad reality is that for such a heroic profession, nursing seems to constantly be facing more than its fair share of administrative battles. It’s a very sad situation if hospital administration is ever perceived to not value their nurses. It’s also unacceptable for doctors to ever disrespect nurses, which frequently happens on a daily basis up and down the country.

Nurses are the foot soldiers of all patient care. Before the foundations of modern nursing were laid by Florence Nightingale in the 19th century, nursing care was often provided by people who practiced organized religious activities, including nurses and monks — which is a profound thing to reflect on (the fact that nursing was equated with religion and good work). That changed after Nightingale’s pioneering work helped established nursing as a more organized profession. The expansion of modern medicine over the last several decades has also allowed nurses to increasingly diversify and specialize. Today there are an estimated 3 million nurses in the United States and 500,000 in the United Kingdom, representing about 1 in every 100 people in each country.


The challenges faced by today’s nurses are surprisingly similar across the Western world. Here are 3 of the biggest:


1. Workload. It goes without saying that in no other profession does the workload need to be controlled and restricted more than with nurses and their patients (much more so than with doctors). Nurses cannot be expected to be competently taking care of excessive numbers of patients. These safe patient care ratios need to be agreed between nurse unions and administrators, and then strictly implemented.


2. Job duties. Nurses must be supported by the other professions around them and not be expected to do anything beyond the scope of their job. Examples include restraining, transporting, and even walking or feeding patients when there’s lots of other clinical work that needs to be done. Care assistants, transporters, sitters, physical therapists and hospital security—they must be present in adequate numbers to do what they need to do and free up nurses.


3. Pay. How much nurses should be compensated has been an issue for a long time, and is frequently debated in the media when nurse unions may threaten to strike. It’s a terrific shame that nurses should ever feel the need to strike, but at the same time they should be valued appropriately for the difficult job they do. Paying an hourly rate which is lower than other jobs which require only a high school education, or offering pay rises of only a few cents an hour — when nurses have debt to pay off and a family to support — is not an acceptable situation.

With the ever-changing health care landscape, the job of nurses is set to continue to evolve and expand. We need to attract the best and brightest students into the profession while keeping compassion at its core. The above three issues are widespread, and while there is no magic pill, there should be constant recognition of the vital work that nurses do. The medical world needs to support our nurses and treat them as what they are: the absolute heroes of frontline health care.


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Obamacare Cut The Ranks Of The Uninsured By A Third

Obamacare Cut The Ranks Of The Uninsured By A Third | Healthcare and Technology news | Scoop.it

A total of 16.4 million non-elderly adults have gained health insurance coverage since the Affordable Care Act became law five years ago this month. It's a reduction in the ranks of the uninsured the the Department of Health and Human Services called historic.

Those gaining insurance since 2010 include 2.3 million young adults aged 18 to 26 who were able to remain on their parents' health insurance plus another 14.1 million adults who obtained coverage through expansions of the Medicaid program, new marketplace coverage and other sources, according to the report from the department released Monday.

Officials say the percentage of people without coverage has dropped about a third since 2012: from 20.3 percent to 13.2 percent in the first quarter of 2015.

"The Affordable Care Act is working to drive down the number of uninsured and the uninsured rate," Richard Frank, assistant secretary for planning and evaluation at HHS, told reporters. "Nothing since the implementation of Medicare and Medicaid has seen this kind of change."

Latinos, who traditionally have been least likely to have health coverage, have seen the largest drop in their uninsured rate, according to the report. The Latino uninsured rate fell 12.3 percentage points, from 41.8 percent to 29.5 percent. The uninsured rate for African Americans fell by nearly half, from 22.4 percent to 13.2 percent. The rate for non-Latino whites fell by just over 5 percentage points.

States that expanded the Medicaid program to 138 percent of the poverty line also saw large reductions in their low-income uninsured populations – an average of 13 percent among people with incomes under the new Medicaid threshold. States that haven't expanded the program still saw a decline, though not as large, of about 7 percent.

HHS officials said they expect to have better state-by-state breakdowns and estimates of the number of children covered later this year. The ACA turns five on March 23.


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Providing health care to the poor: It's time to get creative

When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA’s originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that primarily serve low-income patients. (Disclosure: About 15 percent of my current practice’s patients have Medicaid.)


There is plenty of evidence that low-income residents of states that chose to opt out of Medicaid expansion will be worse off than those in states that have expanded their programs. Not only do people whose incomes are at or lower than federal poverty levels have less access to acute and chronic care, they receive less preventive care and are more likely to be sicker and die sooner than if they had Medicaid coverage. In addition, the Robert Graham Center has projected that fewer primary care physicians will practice in states that do not expand their programs, exacerbating existing workforce shortages. A study published in the New England Journal of Medicine reported that after Medicaid fee-for-service payments for primary care visits rose in 2013 by an average of 73 percent, it was significantly easier for simulated Medicaid patients to schedule appointments with doctors. Unfortunately, the federal Medicaid pay increase expired at the end of 2014, and only 15 states plan to continue the increased rates.

Most encouraging is a recent study in JAMA Internal Medicine that examined the association between patient-centered medical home implementation and breast, cervical, and colorectal cancer screening. Not only was having more characteristics of a PCMH associated with higher screening rates in general, larger screening increases in PCMH practices that served patients with lower incomes and educational backgrounds considerably reduced screening disparities between the rich and the poor.

All good news, but is this momentum sustainable, and is it nearly enough? Not a chance, say my colleagues in the other camp. In 35 states and the District of Columbia, Medicaid fees have reverted to their previous embarrassingly low levels, and the Supreme Court will rule this summer whether doctors and hospitals can sue state Medicaid programs for paying fees that are typically less than the cost of providing care. It gets even worse: In my practice, a large Medicaid insurer paid us nothing for several months, then negotiated a lump settlement with our parent institution that required the insurer to only to pay 40 percent of what it actually owed. If our practice had to rely exclusively on Medicaid for cash flow, it’s hard to see how we could keep our doors open. And low-income patients who earn between 138 percent and 400 percent of the federal poverty level and receive federal subsidies to purchase health insurance on the marketplaces often face several thousand dollar deductibles, making them pay out of pocket for everything except preventive care.

So family physicians and other primary care innovators are taking matters into their own hands. For example, the “Robin Hood” practice model is a viable solution for patients who remain uninsured or underinsured after the ACA. The most-read guest post of all time on my blog explained how a direct primary care model can benefit low-income patients. For those who worry that a $50 monthly fee for unlimited primary care could be too much for patients living paycheck to paycheck, a leading direct primary care practice in Washington State now serves thousands of Medicaid patients through a contract where regular monthly payments flow directly to the practice rather than passing through an administrative maze of insurance claims for individual visits. After being slow to recognize these types of practices or dismissing them as high-end “concierge care,” the American Academy of Family Physicians now offers a variety of helpful resources on direct primary care.

Given these developments, it doesn’t make sense to me for physicians and policy makers to squabble about the “best” way to provide health care to the poor or continue to pine for a pie-in-the-sky universal system for all. The U.S. health care environment has always been complicated, and is even more so nearly five years after passage of the ACA. Physicians who dedicate themselves and their practices to caring for underserved and vulnerable populations should be supported however they choose to do so, rather than rebuked for thinking outside of a politically correct health reform box. The more creativity we can bring to bear on this problem, the better.


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Health Care Rox's curator insight, 27 April 2015, 16:45

This article is about people in poverty and how to get them health care.  It says that we have to think differently (and creatively) about health care and that there are more than just two options of health care.  Another option, this article says, is that direct primary care is the best way to give health care to low-income people.  This really just highlights how the US needs to change and keep people in poverty in mind.  

EG