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

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

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

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

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

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

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

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

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

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

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

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

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

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America is Still the Land of Opportunity for Doctors

America is Still the Land of Opportunity for Doctors | Healthcare and Technology news |

Like many of you I've recently taken some time off to enjoy and reflect on the most American of holidays, July 4th. Despite the politically charged climate and other social and economic challenges we currently face together as a nation, the United States offers physicians a combination of opportunities and resources that are hard to duplicate anywhere else.

1. American doctors have unmatched professional resources.

The United States provides the modern physician and her practice with a good supply of educated and well-trained healthcare workers and great external support and resources as well. Very few countries have the large number of specialized and well-trained lawyers, accountants, marketing experts, coding and collections teams, compliance managers, and all the others we take for granted. Add to that our exceptionally well-developed CME system, peer networks, and low-cost or free resources and expert information provided by Physicians Practice and its affiliate publications, and the extent of the support available to all doctors who make an effort to take advantage of these resources becomes clear. Very few other countries can compete with the U.S. in these areas and many turn to our materials and standards for this help.

2. America loves a winner.

By this I mean that Americans value ethics, service, and excellence; and this gives you a chance to compete on a relatively level playing field by running the best practice you can. Sure, there are always competitors with bigger offices and budgets, but it's been my experience that even small practices with committed and passionate owners and managers can still retain a loyal patient base and thrive and grow. We are a culture that values people, relationships, and results.

3. We have an infrastructure that supports business and progress.

Yes, we've all seen the reports about our aging roads, bridges, etc., and we probably can all name one specific example in our own town. That said, the availability of regular and dependable mail, Internet service, dependable sanitation, power, water, untainted drugs, labs and diagnostic facilities that turn around results in mere hours in an affordable way, and the protection of first responders are just a minute example of things we all take for granted in this country. Those of you that may have been born outside this country or who have traveled internationally understand that these are advantages not enjoyed by the majority of the people on this planet. How would you like to be running a practice in Greece this week?

4. We generally follow the rules.

The rule of law provides protection and predictability in many areas that other countries still can't offer. You have the protection and guidance of laws in many areas that are meant to protect you, the public, and your employees. Your property is yours and you can use the law to make sure it stays that way, and to limit the unreasonable claims of others, and to protect your own rights. We also have the protection of the rule of law ensuring that all of our citizens have equal protection and freedoms, in areas ranging from consumer protection laws that enforce professional licensing and prosecute those who act recklessly or fraudulently to simple issues like preventing the public from being exposed to counterfeit drugs — a problem that plagues millions of doctors and patients worldwide.

Sure, there are examples of bad actors and criminals in every city and state; the difference is that we have the resources and a system to deal with and actually prosecute them. The United States allows us the freedom and stability to make long-term plans for our businesses, families, and futures relatively free of threats from roving drug gangs, the collapse of our currency, mass civil insurrection, civil war, and countless other issues that billions of people in other parts of the world (some right next door) currently face every day. Are we perfect? No, we never will be, but we strive to be, and have a massive team of local and national civic and professional leaders that are working to protect and better us.

I couldn't possibly address all the things that make America great for you and your patients in a single column, and of course we have many issues that need improvement and reform. But, the thing that gives me comfort (and what I hope you choose to focus on today), is that we have the will, freedom, and resources to so improve our personal circumstances.

Sophia Nguyen's curator insight, 18 July 2015, 12:45

This was an interesting read because this gives me more confidence in my decision to go into the medical field as a potential career in the future. It's also reassuring to know that America is still a good place to want to become a doctor.!

Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news |

Sometime in the not-so-distant future, getting a checkup will be very different.

When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.

This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.

But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”

Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.

In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.

Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.

Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.

And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.

“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.

For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.

Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.

“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.

And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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Under Healthcare Reform, Where Do Practicing Physicians Go From Here?

Under Healthcare Reform, Where Do Practicing Physicians Go From Here? | Healthcare and Technology news |

It’s a fascinating time these days in healthcare, on so many levels. And discussions in the past week—mine and others’—have only underscored that fact.

First, there was my breakfast and interview with Scott Weingarten, M.D., the senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles. Reconnecting with Scott Weingarten reminded me once again of what a vortex we’ve been flying into and through, lately in our industry. Southern California is one of the more advanced managed care markets in the U.S., and yet even there, change has proven to be challenging for physicians. And if anyone is in a position to know just how challenging all this is, it is Dr. Weingarten. As he told me a week-and-a-half ago, when asked what the key to helping physicians move forward to optimize care is, “It’s a combination of things. I think physicians want to do the right thing. They went to med school to help patients; they’re trained in the scientific method. And they need to know that what they’re doing is scientifically valid. If you can’t convince physicians that something is the right thing to do for patients, they’re not going to do it.”

Weingarten, who practiced for years as an internist before he went into administration at Cedars, then co-founded Zynx Health (which provides evidence-based guidelines), and then came back to Cedars two-and-a-half years ago,  told me this: “ I used to be a practicing physician; and if someone couldn’t convince me something was right for my patients, I wouldn’t do it, either. So they need to understand that all of this is good for their patients; and they need to understand all the changes taking place at the national and local level; and also to understand how change will help them better take care of their patients.”

Weingarten believes that the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law that eliminated the SGR (sustainable growth rate) problems under Medicare, and which mandates either participation in the new Merit-based Incentive Payment Program, or MIPS, or participation in alternative payment models, which push practicing physicians forward quickly, once they figure out their options. “We provide them with those resources to help them, because it’s very hard for physicians in small practices,” he noted, of his organization’s clinical transformation and performance improvement work at Cedars-Sinai, because “with MIPS—in 2019, physicians will either need to participate in alternative payment models, or in MIPS. Beginning 2019, they’ll get a 5-percent annual bonus for participating, whereas there could be up to a 9-percent downside under MIPS in Medicare reimbursement over time, and that could be very difficult for the physicians.” And of course, “A lot of physicians are trying to figure out what alternative payment models mean for them,” he noted, “so we try to explain to them what’s going on and what it means.”

Not every physician is practicing in an integrated health system like that of Cedars-Sinai, where senior executives are working assiduously towards clinical transformation—and even have a senior vice president for clinical transformation, in Scott Weingarten. Joseph Valenti, M.D., an obstetrician-gynecologist who practices at the Denton, Texas-based Caring for Women practice, recently told HCI Associate Editor Rajiv Leventhal, that physicians like himself are becoming stressed by some aspects of healthcare reform. Asked why he believes that some doctors are wary of joining accountable care organizations, Dr. Valenti said, “I think that a lot of physicians are not completely convinced that the data is out there to demonstrate that they could potentially develop the savings necessary, and prevent hospital admissions and readmissions. Much of the healthcare spending that is extreme right now is in hospitals, not clinician offices,” he said, “so the concern is, can you keep this person out of the hospital? Also in terms of Medicare ACOs, you’re going to be assigned 5,000 patients at least, and they could be the sickest patients out there, so there is no guarantee that you can make them well enough and be assured that they don’t need to come back to the hospital. So maybe you can’t demonstrate shared savings. And the ACO stats prove this; one-third of them are working, one-third are breaking even; and one-third are leaving the program. “

Meanwhile, electronic health records and other clinical information systems are fascinating in this context, because they are absolutely essential to moving forward on value-based care delivery and payment and clinical transformation, but the implementation of an EHR/EMR itself is really, as everyone says, “table stakes”—that go-live is only the first step in a very long process for physician practices. “As Dr. Valenti expressed it to Rajiv, “This is the story with EMRs—no one has compelled them to simply ‘come up to snuff.’ The concern is that I will put my whole future in the hands of this IT system, and maybe it will work but maybe it won’t. The cost of this for us was over a quarter of a million dollars, and we’re not as satisfied as we should be given the cost. We can’t believe the number of bugs and glitches with it,” he said. “There are eight providers in our group, and we do like the ability to access our EMR from anywhere when a patient calls middle of night. I wouldn’t go back to paper, even though I know a lot of doctors actually would—many have been jaded by EMRs that were not well supported and cost them a ton of money and time. I call these things unfunded mandates—things we must do but no one is funding anyone to do them.”

All these issues were definitely on the minds of the CMIOs and other medical informaticists gathered in Ojai, California last week for the annual AMDIS Physician-Computer Connection Symposium. There are so many “to-do’s” when it comes to optimizing the use of clinical information systems in order to really accomplish the clinical transformation that will be required to fundamentally reengineer the U.S. healthcare system in the coming years. As Doug Fridsma, M.D., Ph.D., of AMIA (the American Medical Informatics Association) noted in his AMDIS address, physician documentation processes need to be seriously revamped; regulations need to be made more focused in their approach; there needs to be greater transparency around EHR functions; and clinical IS innovation among vendors must be encouraged.

Referring to his association’s recently published “EHR 2020” report, Fridsma said of himself and his association with regard to the policy recommendations made in the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.”

I think that that comment will be very important going forward, particularly with regard to helping physicians in practice to do the very difficult work of transforming patient care to improve outcomes around both care quality and cost.

Certainly, Scott Weingarten and his colleagues at Cedars-Sinai know that. Their challenge is to figure out how to optimally leverage IT tools to support physicians in creating their own clinical transformations while also contributing to broader processes of transformation across their integrated health system. And they’re learning as they go, in terms of ACO and population health development.

So here’s the thing: Scott Weingarten, Joseph Valenti, and Doug Fridsma are all very, very smart doctors. They’re all trying to do what they can in their organizations to move their organizations forward, and in some way, to move the physician community, and U.S. healthcare, forward.

And all this change-making is inherently, and inevitably, messy. Because for U.S. healthcare to successfully move into its next phases of evolution, we will need for federal policy mandates, private health insurer initiatives, hospital, medical group, and health system efforts, and individual physicians’ delivery process changes, all to move forward, in some broadly coordinated way. And yet, the reality never matches the theory—thus Dr. Valenti’s legitimate complaints about some of the challenges facing practicing physicians. In particular, he is quite right that demanding accountability from physicians for outcomes that are partly actually the responsibility of patients, is problematic.

Yet it is still in everyone’s interest for individual physicians in practice, whether solo (though few are left in true solo practice anymore) or in organized groups, to feel themselves to be a part of change, and to be “self-change agents,” as it were. And good medical practice governance, and good IT governance, will be essential to any such advances.

So how physicians move forward under healthcare reform (public and private alike) is a question that concerns all of us in healthcare. But only time will tell as to exactly how it all plays out. So stay tuned, because the kinds of discussions that I and my fellow editors at HCI have been having in the past couple of weeks speak to some of the deeper issues facing our entire industry. Personally, I can’t wait to see exactly how everything plays out. It certainly will be a fascinating next couple of years!

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news |

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.

One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.

The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.

To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.

Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.

Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.

In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”

Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”

Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.

At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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Are Bigger MD Groups Better Prepared for Population Health?

Are Bigger MD Groups Better Prepared for Population Health? | Healthcare and Technology news |

It was fascinating to interview Donald W. Fisher, Ph.D., the president of the Alexandria, Va.-based American Medical Group Association (AMGA), earlier this spring, as I researched and reported our May/June cover story on population health and data analytics. For one thing, Dr. Fisher has been in the trenches in supporting the management of larger medical groups in the U.S. for decades now, so his perspectives are weighted with many years’ experience and understanding of the healthcare system at the physician group management level.

What’s more, anyone familiar with AMGA knows that the leaders of its member medical groups have been at the forefront of healthcare delivery and payment innovation for years now. It was in fact the participation of a number of a number of AMGA member medical groups whose involvement and learnings in several different Medicare-facilitated primary care and care management initiatives helped convince senior CMS (Centers for Medicare and Medicaid Services) officials to move forward to the go-live of the Pioneer ACO Program a few years ago.

And it has been not only in the Medicare accountable care organization sphere that the leaders of large medical groups have been trailblazers; large medical groups have been pioneers, with a “small p,” in private-sector ACOs, collaborating in very innovative ways with private health insurers nationwide.

So what has been learned? Among other things, as Dr. Fisher told me this spring, and as was revealed in our extended interview published this week, one key challenge remains that, as he put it, “Some medical groups still have gaps in their primary care base; and if you’re going to do population health, you need a very good primary care base. So some are still struggling in that area. And then,” he added, “there is the cultural piece, which encompasses reimbursement-related goals related to this. You can try to change your culture, but if you’re still being paid fee-for-service, and still mostly paying your doctors fee-for service, you need to change that, and that is something they’re trying to get over pretty quickly.”

Beyond those issues, there is this issue that Dr. Fisher brought up in our interview, and which I think goes to the heart of the question of how the leaders of larger medical groups are turbocharging their learning process around accountable care and population health: “The thing is,” he told me, “that you have to go beyond the data; you have to reengineer the care process. The way it is today, it’s a reactive kind of care process. If you’re using predictive analytics and data sets, you’ve got to be proactive, and reach out to patients in advance. And that requires different skill sets, different providers; it’s a very, very big job to work these data sets and predictive analytics, but,” he added, “it can make a very big difference in patients’ lives; patients are just doing so much better as a result.”

And therein lies one of the keys to unlocking the secret of population health and accountable care success—the interplay between the harnessing of data analytics and the continuous process change work that needs to undergird everything.

In other words, at the same time that the leaders of a medical group—or, for that matter, any patient care organization—are collecting data, analyzing that data, making determinations of how to act on their analyses, and moving forward to make changes based on those analyses, they need to be engaged in continuous clinical and operational performance improvement, whether using methodologies like Lean management, Six Sigma, and Toyota Production System for healthcare, or any combination of those or other methodologies, or developing their own.

It’s all about a virtuous cycle or “blessed cycle,” as some are calling it, in which process change and analytics work are all intelligently and strategically combined. Now, here’s a legitimate question: what size medical group might do this best?

Of course, every physician group has a different organizational structure, specialty and clinician composition, history, culture, and set of IT and other tools, at its disposal. And it goes without saying that every medical organization has a different set of personalities. But, given sufficient leadership capability, and the taking on of personal-professional risk on the part of leaders in an organization committed to transformational change, anything is possible. But it does seem that larger medical groups—those with enough management skill individuation that they have not only a chief medical officer but also probably a CMIO, as well as someone who serves as a chief quality officer, and with each of those leaders having some team with at least part-time responsibility to participate in robust change management—it does seem that larger medical groups are more fully advantaged in the context of this kind of work.

And even though Medicare’s Pioneer ACO Program in particular has been facing challenges as of late, what is clear is that larger medical groups are moving forward with alacrity to pioneer, again with a “small p,” a lot of the innovations that are beginning to emerge as groundbreaking for the population health/accountable care path ahead for all of us. So it will be important for everyone to keep their eyes on all these developments in the next few years, as the ramp-up towards broader innovation is going to be both rapid and challenging. But as the leaders of some of the most innovative larger medical groups know, their organizations are continuing to be amazing test-beds of real innovation along all dimensions, in healthcare, and that combination of continuous process change around care delivery and the intensive, strategic leveraging of healthcare IT and especially data analytics, is bound to reap major rewards in the coming months and next few years.

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Why Doctors Are Quitting -- And Why It's Not Obama's Fault

Why Doctors Are Quitting -- And Why It's Not Obama's Fault | Healthcare and Technology news |

In September 2009, Terry Jones wrote in Investor’s Business Dailythat the United States was barreling toward catastrophe: Nearly half the nation’s physicians were on the verge of hanging up their stethoscopes.

“Four of nine doctors, or 45%, said they ‘would consider leaving their practice or taking an early retirement’ if Congress passes the plan the Democratic majority and White House have in mind,” Jones warned.

“Projecting the poll’s finding … 360,000 doctors would consider quitting.”

Well, Congress did pass that plan six months later. (You might have heard: It’s called the Affordable Care Act.)

But our doctors didn’t go away.

In fact, rather than lose 360,000 physicians, the nation’s gained nearly 100,000 practicing doctors in the past six years.

Time and again, surveys have predicted that physicians’ anger over Obamacare, over regulations, over declining reimbursement is driving them out of the industry. That doctors’ gloom will lead to doom for American health care.

“Six in 10 physicians say that it is likely that many physicians will retire earlier than planned in the next one to three years,” Deloitte warned in 2013.

“Recent anecdotes suggest more physicians may be retiring earlier than in the past and [in] a large cohort,” the Lewin Group concluded — in 2004.

But we see again and again: Intent doesn’t equal action. At least, not on a national scale.

For instance, the Wall Street Journal in 2013 implied that doctors were leaving Medicare en masse. It wasn’t true.

Last Friday, the latest high-profile pessimist popped up — Charles Krauthammer, a Harvard Medical School-trained doctor and a columnist for the Washington Post.

In an essay carried in hundreds of newspapers, and originally called “Why Doctors Quit,” Krauthammer argued that the Obama administration has “demoralized doctors and degraded care” by pushing providers to quickly adopt electronic health records, known in shorthand as EHRs.

In Krauthammer’s telling, EHRs have turned out to be “ health care’s Solyndra” — they haven’t justified the $27 billion in incentive payments that the White House used to get doctors to go digital.

“Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized,” Krauthammer wrote.

The stress of EHRs is so bad that many of his Harvard classmates from 1975 are thinking about quitting medicine, Krauthammer added. He writes:

Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

It’s true that doctors — especially older ones — are frustrated about the shift to electronic health records.

And understandably so! EHRs have added a burden to a busy workday. The added value of digitized data isn’t always obvious. There’s evidence they hurt productivity.

As a journalist, I’ve heard these complaints over and over again from doctors. And as a patient, I’ve witnessed doctors’ anger firsthand.

A few years ago, I was in the office of a middle-aged neurologist, one of the greatest diagnosticians I’ve ever met. It was a routine check-up, but he spent more time looking at his computer screen than at me.

“This gets in the way of patient care,” he groused, his eyes locked on the screen.

“Why don’t you hire a medical scribe?” I asked the doctor. “Someone who can keep the notes while you see patients?”

He swiveled around and scowled. “The hospital doesn’t want to pay,” he said, as his eyebrows scrunched. “I don’t know how much longer I can keep doing this.”

But that doctor didn’t go anywhere. He’s got kids in Ivy League colleges and a D.C.-area household to fund. He’s got years invested in building a practice. And walking away from that will take more than frustration over a computer system.

In fact, the real reason why doctors are quitting is less dramatic: They’re aging.

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The Female Physician Perspective on Healthcare Today

The Female Physician Perspective on Healthcare Today | Healthcare and Technology news |

I'm not a doctor, but I've represented their interests for more than 18 years working for a professional association of physicians from all specialties and every type of practice setting. It wasn't too long ago that the stereotypical association member was akin to the fictional Marcus Welby, MD, an elderly male private-practice physician. Times certainly have changed.

Shifting Physician Workforce Demographics

Today, there are more women in medicine than at any point in history. In fact, according to The Physicians Foundation, females comprise 33 percent of the physician workforce in the United States, a number that continues to rise as women enter medical schools in record numbers.

Responses from 20,000 physicians in a recent Physicians Foundation survey  revealed the angst many in the profession feel about the state of medicine. The survey sheds some light on changing workforce demographics and the diversity of attitudes and perspectives among America's doctors; specifically, it provides insight into the viewpoint of female physicians today.

Issues Facing Physicians Today: The Female Perspective

According to the survey, female physicians are slightly more optimistic than their male counterparts about healthcare today, yet despite this optimism, trepidation still exists among female physicians in regards to elements of reform, such as accountable care organizations (ACOs) and insurance exchanges. The survey reveals that:

• 63.9 percent of female physicians give the Affordable Care Act a passing grade, while only 49 percent of male physicians stand by the reform;

• 41 percent of female physicians are unsure about structure and purpose of ACOs, compared to 28 percent of their male counterparts; and

• A smaller percentage of female doctors participate in exchanges and more females compared to males are unsure of whether the exchanges feature a restricted network of providers.

The Changing Healthcare Landscape

All physicians today are feeling the pressure of rising costs and the plethora of new regulations as the industry moves from fee-for-service to pay-for-value. While the reform law did provide access to health insurance coverage for more Americans, it did little to ensure a stable physician workforce — a vital piece of the healthcare equation.

On the positive side, with a focus on prevention and disease management, care delivery has become more patient-centered. The Physicians Foundation survey showed that 80 percent of physicians describe patient relations as the most satisfying factor of practicing medicine.

When I started working at the Washington State Medical Association in the mid-1990s, 38 percent of our members were in solo practice; today the figure has plummeted to 8 percent. According to the survey, less than 20 percent of physicians nationwide are in solo practice, while the number of physicians in employed practice has jumped to over 50 percent. For the female demographic, 26.7 percent are in solo practice, 26 percent are employed by a medical group, and 32.5 percent are employed by a hospital.

Despite the changes and apparent anxiety in regards to the future of healthcare, 72 percent of female physicians believe that medicine is still a rewarding profession. It's clear that women will play a prominent role in helping to shape the future of healthcare.

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What value do primary care doctors offer to our health care crisis?

What value do primary care doctors offer to our health care crisis? | Healthcare and Technology news |

When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics that diminish the complex needs and wants of the person sitting in front of us. Primary care doctors who care for the elderly and chronically ill confront a plethora of medical problems in virtually every patient who walks through our doors. To solve them all is not possible and may not be what the patient wants. As my mentor told me, unless you address the patients’ concerns, they will hear nothing else that spews from your mouth.

Sometimes it’s difficult to allow a patient to walk out of the room without addressing her high blood pressure, need for a mammogram, decision to stop taking statins, and lack of exercise. It can be painful to watch them leave without fulfilling any of Medicare’s quality indicators, which will be sent to the Centers for Medicare & Medicaid Services (CMS) through our computers and may cause our payments to suffer. Sometimes talking about the patient’s incontinence and back pain seems insufficient in light of all of the other medical issues. But as the patient leaves the room, I tell her that during the next visit, which will be soon, we will talk about those issues. I may encourage her to look over some data in the meantime about statins and mammograms. Many patients choose not to pursue many interventions after they see real data about them. That is their choice, as long as they make it rationally. Much of what we try to “fix” in our patients can harm them as easily as it can benefit. Their choices can lead to fewer tests and drugs and improved outcomes, even though it may mean failing grades for our quality indicators or ramifications for our pocketbooks.

What value do primary care doctors offer to our health care crisis? Conversation. It is our ability to look people in the eyes, allow them to set the agenda, converse with them about medical issues and interventions using reliable data and base decisions on their interpretation of personal risks and benefits. However, when we are forced to stare at computers and enter data, when CMS and the Affordable Care Act (ACA) have set much of the agenda by compelling us to adhere to their often perverse quality indicators, when visit times continue to shrink to pay for the escalating overhead, then none of the value we offer can exist. Being a primary care doctor is one of the most satisfying professions on this planet. We come to know our patients well over many years and live through their peaks and valleys. They rely on us to help them with some of the most difficult decisions they will ever be forced to make. We do our best to keep them healthy, active and happy. I get as much value as my patients do from a conversation that works well. Our health care system gets value, too. The bond between doctor and patient, when it allows for meaningful conversation, leads to fewer tests, fewer medicines, fewer referrals, less hospitalization, lower cost and greater satisfaction.

The ACA and CMS are trying to measure value and quality in all the wrong ways. They are talking about shared savings, incentives and disincentives that rarely work and typically decrease both patient and physician satisfaction. They throw metrics at us that have no correlation with our patients’ wants and needs and only squander our time in the exam room. The value we must insist on as primary care doctors is the ability to have a conversation, which is more difficult to measure but ultimately what will work. It brings greater satisfaction to our patients and to us. And it saves the health care system money while enhancing our patients’ health and well-being. It’s what we do best.

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Insurers take 1st steps to alter how doctors, hospitals paid

Insurers take 1st steps to alter how doctors, hospitals paid | Healthcare and Technology news |

A nationwide initiative to make the fragmented and costly health care system more efficient could affect the more than 340,000 people in Wisconsin enrolled in Medicare Advantage plans.

Most probably are unaware that anything has changed. But there's a chance their care could be more coordinated, adhere more closely to clinical guidelines and cost less because of the initiative.

Humana and UnitedHealthcare — two of the largest health insurers that offer Medicare Advantage plans — are striking agreements with what are known as accountable care organizations.

The organizations, also known as ACOs, have become one of the key levers in the effort to improve the quality of care and slow the rise in costs.

In an accountable care organization, health systems, physician networks or both are responsible for the cost and quality of care for a defined group of patients. If they provide care at a lower cost while meeting certain benchmarks for quality, they can receive bonuses. Under some of the agreements or contracts, they can pay penalties when they don't.

At the start of this year, there were 744 accountable care organizations nationwide, up from 64 at the beginning of 2011, and an estimated 23.5 million people are covered by health plans with contracts with the organizations, according to Leavitt Partners, a consulting firm.

That included 7.8 million people covered by traditional Medicare.

Medicare Advantage plans — private health plans that are an alternative to traditional Medicare — are adding to those numbers.

Humana, which has 72,000 people enrolled in its Medicare Advantage plans in Wisconsin, has signed contracts with accountable care organizations run by many of the large health systems in Wisconsin.

It entered into an agreement with Aurora Health Care this year. It has agreements with ProHealth Care, United Hospital System in Kenosha, Prevea Health in Green Bay and Aspirus in Wausau.

It also has agreements with accountable care organizations run by Bellin Health in Green Bay and ThedaCare in the Fox Valley as well as Integrated Health Network of Wisconsin, which includes Froedtert Health, Wheaton Franciscan Healthcare, Columbia St. Mary's and other health systems.

UnitedHealthcare entered into a similar agreement this year with Integrated Health Network for more than 30,000 of the 123,000 people in the state enrolled in its Medicare Advantage plans.

The agreements vary and for now start with paying bonuses for meeting certain quality measures, such as reducing emergency department visits.

"We don't have a one size fits all," said Caraline Coats, a Humana vice president.

Payment system overhaul

The goal is to revamp the way doctors and hospitals are paid and in the process improve a health care system too often marked by inefficiencies, lack of coordination, poor quality and high costs.

Accountable care organizations are seen as one of the ways to move away from the system in which hospitals and doctors are paid for the services they provide rather than improving health — what often is described as moving from paying for "volume" to paying for "value."

The system provides few incentives to provide quality care or control costs. In many cases, health systems stand to make more money when they don't.

The results can be seen throughout the health care system.

The Institute of Medicine, the health arm of the National Academy of Sciences, estimates that excess costs accounted for 31% of total health spending in 2009. The sources include:

■Unnecessary services: $210 billion.

■Inefficiently delivered care: $130 billion.

■Missed prevention opportunities: $55 billion.

Humana's and UnitedHealthcare's agreements for their Medicare Advantage plans are a long way from the ultimate goal of changing the way hospitals and doctors are paid. Both know that health systems will need time to change the way care is delivered.

Think of the challenge just in lessening the variation in how hundreds or thousands of physicians, each making dozens if not hundreds of decisions a day, practice medicine.

"This stuff doesn't happen overnight," said Ryan Catignani, who oversees contracting for Humana in Michigan and Wisconsin.

Humana nonetheless wants to have 75% of the people in its Medicare Advantage plans covered by contracts at least partly tied to performance by 2017.

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Building Effective Patient Education Programs

Building Effective Patient Education Programs | Healthcare and Technology news |

Patient education programs have been around for a long time, but typically these programs have been geared toward only the chronically ill and those that needed extensive management. In this era of the Patient-Centered Medical Home patients and insurers are looking more to physician practices to provide effective patient education in all aspects of their care. In fact, many insurance companies are actively measuring physicians' performance on quality metrics. Current accountable care models factor in patient utilization of emergency rooms, hospital visits, and prescriptions, and attribute that cost to the patient's primary-care doctor, which may also include specialties such as cardiology.

So what does this mean to your practice? With more accountability comes the need to manage patient populations more effectively to be able to hold the line on costs. If you are not doing a good job in actively engaging patients to "self manage" their own care, and utilizing lower-cost opportunities for managing your patients' care, then you may soon find yourself failing to achieve a targeted level of care and cost utilization, and that will cost you money.

Creating and implementing effective programs

The most effective education programs are those that are customized to each patient. But don't let that daunt you. You can define general care plans and then customize those on a patient-by-patient basis.

• First, determine what conditions to tackle. Get to know your patient population. What are the most complex and costly conditions that you manage? What conditions apply to the most patients across your practice? Hone in on those areas to begin with, set up and fine-tune a program or two, and then you can replicate successful programs across your entire patient base from there.

• Second, assess your patients' needs. Determine what actual resources and help is needed by your particular patients. Do not hesitate to poll your patients by asking them directly what their specific needs and challenges for self-management may be. If you make assumptions about your patients' needs, you may only meet the goals of a small part of your population, which can be counterproductive and result in poor compliance with the program. In addition to assessing needs, assess the challenges (such as lack of family support) and skills (Internet use, reading ability etc.) of your patients and build a program that can adequately meet them where they are coming from.

• Third, use what's available. Don't reinvent the wheel. There are lots of good materials, courses, and programs available. It's OK to adopt a program you like; just make sure to thoroughly review all of the material and adjust the sections, ideas, concepts, and so forth to fit with your specific patients' needs and your style of practicing medicine.

• Fourth, communicate effectively and set small targets. Let your patients know about these programs and educate them about what they are expected to do. Priorities should be clearly stated, mutually understood, and mutually agreed upon, and patients should be provided with information about what to do if they go "off the plan." That will help to keep them empowered and engaged in their own care, and keep them communicating effectively with you and the office when there is a problem. Keep the goals small and manageable to begin with and don't overload the patient with information. Tip sheets and goal targets should be the core of the program; then add in more information as the patient progresses. Keeping material simple, clear, and to the point will help with comprehension.

Setting one target per visit is a manageable way for patients to begin working a program. For example, set a new diabetes patient the goal of reducing his intake of sweets to three desserts per week, and provide a cheat sheet of desserts that are diabetes-friendly to choose from on the plan. At the next visit, you identify a new goal to add to the first one, and repeat. While it may take a while to turn a patient's health around, research confirms that small, incremental changes are much more likely to be lasting changes, so think in terms of a marathon rather than a sprint to the finish line.

Lastly, make the plans, goals, materials, and office staff highly available to the patient. Post the educational material on your site, mail follow-up materials to patients, place outbound follow-up calls and/or e-mails to patients to check on how they are doing between visits. These touch points matter and can be the difference between a successful program and good patient engagement or wasted effort and time.

And don't forget, as of January 2015, you can now bill a monthly, per patient code for chronic care coordination, CPT 99490. Just make sure to check the guidelines for this code to adhere to the description of services before you bill it.

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US patients want a deeper digital relationship with their doctors

US patients want a deeper digital relationship with their doctors | Healthcare and Technology news |

As digital health becomes more of a reality, a recent survey of over 2,000 US adults finds that most of us -- 84 percent to be exact -- see doctors who provide patient online portals.

One of the survey's most surprising findings is that 61 percent of older adults -- aged 55 and up -- access their health information through the portal, while just 45 percent of their younger counterparts in the 18 to 54 age group do so.

The survey found that 37 percent of those who own a wearable fitness tracker wear it everyday.

Of wearable users, 78 percent who use their devices more than once a month say it's practical for their doctors to access that information.

Sixty-four percent of adults would choose telehealth visits over in-person visits at least some of the time, especially for follow-up visits and for minor concerns such as eye infections and skin checks.

More than one quarter, or 27 percent said they would always choose a telehealth visit instead of an in-person visit.

Of parents with children under the age of 18 living under their roof, 76 percent said they would sometimes choose telehealth visits, whereas only 61 percent of those without children under the age of 18 said they would.

Sixty percent of respondents said they would use the online portal for appointment scheduling if it wasn't already available for this purpose.

The survey was conducted by eClinicalWorks, which also surveyed a group of 2,922 US healthcare professionals separately.

Seventy-five percent of healthcare professionals surveyed said online portals made it easy to share patient information with other doctors and allowed patients to access their medical health record with more ease than before.

Automated alerts and reminders about appointments were among the other benefits they cited at a rate of 75 percent.

Fifty-six percent of healthcare professionals said a top benefit of online portals is the ease of appointment scheduling.

Sixty-one percent of healthcare professionals said they would recommend telehealth visits to patients at least some of the time.

More than half of healthcare professionals said they found it useful to be able to access the information collected by patients' wearable devices.

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Can doctors afford to ignore the changes in medical practice?

As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other docs will simply ignore what is being played out right before their very eyes, expressing the same willful blindness that some of my breast patients would, presenting with huge, fungating cancers.

It is understandable that doctors would want to hang on to a health care belief system that they embraced in medical school. But many of the beliefs of years past do not work today; try not to believe everything you think. Consider these five examples.

1. I am too busy to learn how to improve. Actually, you can’t afford to not learn. As we have discussed multiple times in these pages, our current system of health care finance is unsustainable. We are broke. For that reason, fee-for-service is going away. This means you will be at financial risk for populations of patients. You can’t just change one day. You need to learn how to improve quality and reduce costs. This requires new skills.

2. I make a lot of money, and that means I am really smart. Yeah, right. Like that failed limited partnership that cost you $500,000? Or how about both of those alimony checks that go out every month, regardless of your income? We know folks who have had stellar careers who still work in some capacity because they squandered their money. Anybody can learn how to do a colonoscopy or fix a hernia, so don’t get on a high horse because you have been blessed to have a good income. The future comes with significant uncertainty. Be a good steward and be grateful. If you think that you can win going against the forces that be, it could be disastrous.

3. My hospital loves me because I make them tons of money. Really? How do you know that? You would be surprised. I have a friend who was bragging about how much money he made for the hospital doing MRIs. It turns out that they lost $150 every time they turned the machine on. Or what about the $46M service line that cost $48M to run? I guess they will make it up on volume, right?

4. My performance benchmarks are OK, so that means my quality is good. You are two clicks to the green side of the benchmark, but that doesn’t mean you have good quality. It just means you are better than 52 percent of your peers. Plenty of people will stay there at 48 percent. Time to go to #1 above and learn how to get better outcomes, and in the process, you will also reduce costs. Your patients deserve it.

5. I will always have my choice in where I work. Don’t bet on it. Everyone is replaceable. You need to protect your career. Embrace team concepts of care. Develop leadership skills. I recommend that you start thinking now about how your work will change when you and your hospital or clinics take on more financial risk. Remember that lower costs of care are becoming indicators of higher quality. Don’t be the jerk that gets fired.

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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 |

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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In Colorado, a Collaboration Around Healthcare Technology

In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news |

Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.

 In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.

To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.

In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.

UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”

Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.

Bringing the Data to the Doctor

For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.

Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.

Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”

Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.

 This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”

Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.

As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.

Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.

Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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Many docs come to work sick

Many docs come to work sick | Healthcare and Technology news |

Many doctors, nurses, midwives and physicians assistants come to work sick even through they know it puts patients at risk, a new survey suggests.

Many said they don’t call in sick because they don’t want to let colleagues or patients down by taking a sick day, and they were concerned about finding staff to cover their absence.

At the Children’s Hospital of Philadelphia, Julia E. Szymczak and colleagues analyzed survey responses collected last year from 536 doctors and advanced practice clinicians at their institution.

More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year.

About 9 percent had worked while sick at least five times over the previous year. Doctors were more likely than nurses or physicians assistants to work while sick.

Analyzing their comments, the researchers found that many report extreme difficulty finding coverage when they’re sick, and there is a strong cultural norm to come in to work unless extraordinarily ill.

The findings are reported in JAMA Pediatrics. The researchers were not able to respond to a request for comment by press time.

Sick health care workers present a real risk for patients, especially ones who are immunocompromised, like cancer patients or transplant patients, said Dr. Jeffrey R. Starke of the Baylor College of Medicine in Houston, who coauthored a commentary on the new study.

“Most of us have policies restricting visitation by visitors who are ill, we screen them for signs or symptoms,” Starke told Reuters Health by phone. “Yet we don’t do the same thing for ourselves.”

Most hospitals do not have a specific policy restricting ill healthcare workers, and developing and enforcing these policies may help address the issue, he said.

These policies should put the decision about who is well enough to come into work into someone else’s hands, not the doctor’s, Starke said.

Aside from spreading illness in the hospital, sick doctors likely perform worse on the job than healthy ones, he said.

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Mobile has put patients in the driver's seat. Here's how.

Mobile has put patients in the driver's seat. Here's how. | Healthcare and Technology news |

Many people used to believe that Facebook was an extremely defensible business and that it would be almost impossible for another social network to compete.

It has grown to an enormous scale with massive troves of data and more than 1.5 billion monthly users. The thinking around their defensibility was that because all of your friends and photos and updates are already stored on Facebook, it would be tedious and unnecessary to switch to another social network. Everything you need is there. Why go somewhere else?

Facebook did have quite a bit of defensibility back when the predominant access point to the service was the desktop web. Moving your data to a new social network was painful and impractical. But now that the main access point to social is our mobile phone (more than half of Facebook’s traffic comes through mobile) things have changed dramatically.

We now carry around all of the key elements of a social network on our cell phones. Our phones carry our location, our photos, and our address book and allow us to message anyone at no cost from anywhere in the world. With the click of the touchscreen, we can view and connect with all of our friends on a new social network and instantly recreate our social graph. We can take a photo and instantly send it to a multiple social networks. We can easily join different social networks with different groups of friends focused around different needs. The friction of leaving Facebook and joining a new network has disappeared. This wasn’t possible with the desktop web, or it was at least much more difficult.

As a result of the increasing use of mobile, we’ve seen lots of new social networks emerge. (There are now dozens of social networking apps with 1 million+ downloads in Apple’s App store, including Kik, WhatsApp, Tumblr, Google+, Instagram, Snapchat and many others.)

This increased use of mobile has reduced the friction of launching a new social network to near zero and, as a result, has shifted ownership of data away from the network and back to the individual. Trying to own the data and lock-in the consumer is no longer a viable strategy.

Facebook is well aware of this and has adjusted by rapidly buying up many of these new networks. We’ll likely see more acquisitions like these in the months to come.

Over the last several years, large health care provider organizations and health care software vendors have been employing a similar strategy to that of Facebook. Health systems have been growing by buying up ambulatory, community-based sites and employing doctors to build out giant systems that can offer clinical services across the entire continuum of caregiving the patient no reason to go anywhere else. In parallel, providers and software vendors have been creating a single patient record (including blood tests, physician notes, imaging and other data) that flows across the entire provider organization and can be easily shared with providers across the system. This avoids all of the classic frustration associated with having to fax your x-rays from one provider to another. Everything exists on the web in one single record. Providers then roll out a patient-facing portal that lays across the patient record where the patient can access all of their data (mostly through the desktop Web).

The strategy is simple. Providers are telling the patient to 1) stay with us because we do everything, and you don’t need to go anywhere else; and, 2) you can’t go anywhere else because we have all of your data.

But as we saw with Facebook, now that a consumer’s primary entry point to the web is their mobile phone, this strategy has some flaws.

Not only do our phones enable messaging and carry our location and address book and photos, they can also carry data on our movement, our sleep, our heart-rate, the prescriptions we’re taking, our body temperature and, with the use of implanted devices, much, much more. This real-time data that we carry on our phones is arguably more valuable than the data stored in our clinician’s patient record that only gets refreshed while we’re sitting in the examination room.

Increasingly, providers will own some patient data but the patient will own more data and better data.

Like Facebook, health care providers are trying lock in their customer by owning the data. But the increasing use of mobile has changed the game. Just like social network users can effortlessly syndicate their own data out to multiple social networks, a patient will be able to syndicate their real-time clinically relevant data out to multiple providers, regardless of which system they’re associated with.

Mobile has put patients in the driver’s seat.

Meanwhile, with the emergence of home care and telehealth and urgent care clinics and apps and implants that manage more serious and chronic conditions, in many ways health care has actually become more fragmented. The traditional providers may be consolidating, but new players are creating new channels for care and causing more fragmentation across the industry. Where and when and how care is delivered is being completely reshaped.

But unlike Facebook, large health care providers can’t buy their way out of this conundrum. First, because they don’t have enough cash (most are non-profits with microscopic profit margins) and second because health care is local. Health systems are no longer just competing with the hospital across the street; they’re competing with web services that are available to the global market.

As a result, large provider organizations are going to have to consider new ways of providing value and will have to select which segments of patients they want to serve.

In short, they can’t own the patient because they can’t own the data.

The idea of locking the patient into one network of providers was always a bit flimsy. But the strategy was somewhat understandable. A lot of this was driven by the trend towards value-based payments and the convenience of ‘owning’ a patient under that model.

But the lessons of Facebook are clear. Locking up the data is not a path to success.

Social networks and health care providers must focus on what they do best and focus on serving the consumer they want to serve and abandon their attempts to win by owning data that isn’t theirs to own.

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IT could save $100B for US healthcare

IT could save $100B for US healthcare | Healthcare and Technology news |

New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.

In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.

Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.

It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).

"A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.

Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.

Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.

Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.

The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.

"The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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Partners Goes With $1.2B Epic Installation

Partners Goes With $1.2B Epic Installation | Healthcare and Technology news |

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.

As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.

The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.

The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.

Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)

According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.

Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

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Physicians Need to Take Time for Themselves

Physicians Need to Take Time for Themselves | Healthcare and Technology news |

Doctors and their office staffs, like nearly everyone else, are living to ripe old ages. As such, they need to pace themselves for the long haul. A personal story helps illustrate the point: I worked with my friend Peter, for Smyth Manufacturing Company, the famed book binding equipment manufacturer, the summer before we entered college. It was my only time in a job shop, and I learned many lasting lessons, such as the importance of cleanliness in an industrial setting.

Before you left for the evening, you oiled your machine, wiped the floor and counters, and cleared away scraps and extraneous items so you could begin the next day without impediments. The craftsmen sometimes elaborately cleaned and reorganized items in the middle of the day as well, as they switched from one job to another. When you're working with potentially dangerous industrial equipment, you can't afford to have a stray bolt or paper clip lying around that could catch in a gear and fly across the factory floor into someone's face.

Control of their immediate environment

As deftly as these job shop professionals worked, they continually maintained control of their immediate environment because they understood its importance on many levels. In case you think they were being overly cautious or were paid some admirable hourly wage, guess again. These workers were paid by the piece, and they were known as "piece workers."

Any one of them could have easily increased their output on a given day by slacking off on cleaning and maintenance procedures. After all, if you can turn out seven pieces in a day spending 30 percent of your time cleaning and maintaining, you might be able to produce more than 10 pieces if you completely concentrate on your output. In the short-term, you could make more money. Longer term, you could injure yourself or others, create more waste, shorten the equipment's life, or get fired.

The lesson for us all: "pay as you go," clear the decks each night, arrive ready for the next day, and pace yourself for the long haul.

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As sensors shrink, watch as 'wearables' disappear

As sensors shrink, watch as 'wearables' disappear | Healthcare and Technology news |

Forget 'wearables', and even 'hearables'. The next big thing in mobile devices: 'disappearables'.

Even as the new Apple Watch piques consumer interest in wrist-worn devices, the pace of innovation and the tumbling cost, and size, of components will make wearables smaller - so small, some in the industry say, that no one will see them.

Within five years, wearables like the Watch could be overtaken by hearables - devices with tiny chips and sensors that can fit inside your ear. They, in turn, could be superseded by disappearables - technology tucked inside your clothing, or even inside your body.

"In five years, when we look back, everything we see (now) will absolutely be classified as toys, as the first very basic steps of getting this right," says Nikolaj Hviid, the man behind smart earbuds called the Dash.

Developed by Munich-based Bragi GmbH, the Dash is a wireless in-ear headphone that looks like a discreet hearing aid. Packed inside is a music player, 4 gigabytes of storage, a microphone to take phone calls - just nod your head to accept - and sensors that monitor your position, heart rate and body temperature.

Nick Hunn, a consultant who lays claim to the term 'hearables', reckons the Dash is just the start. He predicts smartwatches will dominate wearable sales for the next three years, hearables will then overtake and, by 2020, will account for more than half of a $30 billion wearable device market.

This rapid shift is being driven, he says, by a new generation of chipsets using Bluetooth wireless communication and using far less power than their predecessors. Designers now realize "the ear has potential beyond listening to music - it's an ideal site for measuring a variety of vital signs," Hunn wrote in a recent report.


A parallel revolution in sensors is making this possible.

Kow Ping, whose Hong Kong company Well Being Digital Ltd provides algorithms and reference designs on wearable sensing to companies like Philips, Motorola, Haier and Parrot, says chipmakers have invested heavily in reducing the power consumption and size of sensors.

An accelerometer, which measures things like position, motion and orientation, for example, is now 1 square millimeter. "A few years ago," he says, "it was two or three times as big and two or three times less refined."

When they can harvest energy from the body's heat or motion they'll be even smaller, autonomous and ubiquitous.

Andrew Sheehy of Generator Research calculates that, for example, the heat in a human eyeball could power a 5 milliwatt transmitter - more than enough, he says, to power a connection from a smart contact lens to a smartphone or other controlling device.

And Ping's company is working with a top Asian university to add sensors to a sports bra which could harvest energy from relative motion. In five years, he says, "there will be people building sensors into every existing wearable device or apparel."


Bragi's Hviid calls these 'disappearables'. And while medical and fitness top the list of what these devices might measure, he and others are looking beyond that. A dozen sensors in your pants, he suggests, could advise on how to improve your posture or gait when trying to impress a suitor.

"It's more like a butler ... they do some basic stuff that you really want, but there are deeper experiences in there," Hviid says.

Sheehy points beyond the personal, as parallel advances in machine learning and artificial intelligence "come together and lead to some remarkable use cases:" a politician's contact lens, for example, might provide real-time feedback from a sample of voters, allowing for a speech to be tweaked on the fly.

A lot of this technology is already here.

Google is working with Novartis on a contact lens to measure glucose levels in tears. The healthcare group has also invested in Proteus Digital Health, a biotech start-up which promises edible embedded microchips, the size of a grain of sand, which are powered by stomach juices and transmit data via Bluetooth.

"We're looking at a major technological revolution of a similar magnitude to the mobile revolution," says Sheehy.


Not everyone agrees that disappearables are necessarily just around the corner. Wearables still need to gain widespread acceptance - remember Google Glass - and the technology still needs to finessed.

While Bragi has raised more than $3 million from crowdfunding website Kickstarter and another $10 million from angel investors, Hviid says communication problems between the left and right earbuds have delayed launch of the Dash until September. It was originally due out late last year.

Ping's company has been working since 2006 on wearables, and owns more than a dozen patents, but he says bringing all the technical parts together, understanding the consumer and mastering manufacturing pose a real challenge.

BAM Labs's curator insight, 21 May 2015, 20:58

And under the mattress, turn any bed into a smart bed.!

Cedars-Sinai goes all-in on Apple HealthKit

Cedars-Sinai goes all-in on Apple HealthKit | Healthcare and Technology news |

Cedars-Sinai Medical Center in Los Angeles has become the latest provider organization to link its electronic medical records system to Apple's HealthKit software.

CIO Darren Dworkin, speaking to Bloomberg Business, said that information from HealthKit now will appear in health records for more than 80,000 patients. Several other hospitals, including the Mayo Clinic in Rochester, Minnesota, and New Orleans-based Ochsner Health System, as well as Stanford University Hospital and Duke University, also integrate with HealthKit.

"This is just another set of data that we're confident our physicians will take into account as they make clinical and medical judgments," Dworkin said, who added that use of HealthKit will be a learning experience.

"We don't really, fully know and understand how patients will want to use this," he said.

Dworkin added that HealthKit will be available for all patients throughout the system to use as they choose. 

"The opt-out is just don't use it," he said.

At the Healthcare Information and Management Systems Society's mHealth Summit in the District of Columbia last December, Ochsner Chief Clinical Transformation Officer Richard Milani and Duke Medicine Director of Mobile Technology Ricky Bloomfield shared insight into their respective organizations' HealthKit integrations. Both facilities use Epic's patient portal, MyChart.

Milani said the amount of data patients could generate that could then go into their records was pretty small; he said about 50 to 60 discreet elements such as weight, sodium intake and blood pressure could be entered. Bloomfield, however, said that based on conversations with Apple healthcare executives, he expects that number to grow.

Bloomfield added that HealthKit integration will help to transform the use of EHRs for providers.

"This was finally something we could give them that would live up to the promise of what EHRs can provide, and what having access to this kind of data can provide," Bloomfield said at the Summit.

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Qardio blood pressure monitor will support Apple Watch

Qardio blood pressure monitor will support Apple Watch | Healthcare and Technology news |

Qardio announced Apple Watch support for their Bluetooh blood pressure monitor for the iPhone and Android devices.

We reviewed the QardioArm blood pressure monitor a few months ago. We were impressed by the elegant design of both the app and the device. The sharing functionality was also the best we found among any of the connected blood pressure monitors that we’ve reviewed. However, the lack of independent validation of the device and single cuff size kept the device from being our pick for the best connected (Bluetooth or WiFi) blood pressure monitor.

According to Qardio, the Apple Watch will let users both control the blood pressure monitor and also review data for themselves and their family,

QardioArm blood pressure monitors work seamlessly together with the Apple Watch, allowing users to take blood pressure measurements and monitor loved ones with the touch of a single button right off their wrist. Your blood pressure and heart rate data history are viewable at a glance, making heart monitoring even more effortless.

Qardio includes a really nice Family and Friends section in their app that lets you keep an eye on the blood pressure measurements of a loved one. The Apple Watch app will let users quickly check in on those loved ones. Hopefully, they’ll also include the ability to set notifications as well so that I could be alerted if, say, a parent checked their blood pressure and it fell outside of a certain range. For that to really work though, Apple will need to do a better job with letting users control notifications on the Apple Watch.

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Is health reform contributing to physician burnout?

Is health reform contributing to physician burnout? | Healthcare and Technology news |

Many physicians feel burnt-out from their careers

A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has increased since the last survey in 2013, with 46 percent overall reporting these feelings. When looking at specific specialties, the most burnt-out physicians are critical care and emergency doctors. Half of primary care physicians, family doctors, internists and general surgeons also felt burnt-out. These survey results are alarming as they reflect poor physician well-being.

Physician well-being is a burgeoning area of focus

A generation or two ago, few people talked about the physical and mental health of our doctors. However, in the last decade, researchers have begun to characterize professional burnout and associated problems. For example, physicians have one of the highest rates of suicide compared to other professions. Family physicians and internal medicine doctors are the most likely to say they would not choose their specialty again if they could redo their careers. Psychiatrists and anesthesiologists have a higher rate of substance abuse than other specialists. These studies have cast a spotlight on trying to improve physicians’ satisfaction, well-being, and mental health by addressing the unique challenges physicians face.

My residency program incorporates a wellness curriculum

Trainees face a unique set of circumstances, working long hours in stressful situations. The regulatory body for residency programs has put limits on the hours that interns and residents can work. However, simply changing our work hours is not enough to ensure our mental and physical well-being. In order to help us meet the unique challenges of being medical residents, my residency program developed a curriculum with lectures by psychologists, mediation sessions, reflective exercises and development of coping skills. Although our training is easier than that endured by physicians in the past, residents still develop depression, commit suicide and undergo divorce, and a wellness curriculum helps reduce these devastating consequences.

Burnout is everywhere

Even in my practice, I have colleagues, trainees and supervisors who report some degree of dissatisfaction, frustration and disappointment with their work. I know some physicians who left medicine to work in industry or consulting. Most of those who are burnt out feel that paperwork, bureaucratic tasks, and insufficient reimbursement for the hours worked are the main contributing factors. Unfortunately, changes like the Affordable Care Act or implementation of computerized health care may exacerbate these causes rather than ameliorate them. In pursuing some admirable goals, we cause other unintentional negative consequences.

We need to reduce burnout and improve well-being

Physician burnout affects patient care; burnt-out physicians cannot exhibit the compassion necessary to care for patients, and they are unlikely to go above and beyond their clinical duties. There is an urgent need for research in improving physician well-being, such as training in coping mechanisms, development of mindfulness techniques and restructuring the bureaucracy of medicine. I am early in my career and still go to work with excitement, curiosity, and engagement, but I am deeply aware of the risks of this profession and hope to maintain my well-being. What are your thoughts on physician burnout?

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Interoperability roadmap must 'better reflect' health IT realities

Interoperability roadmap must 'better reflect' health IT realities | Healthcare and Technology news |

In response to the Office of the National Coordinator for Health IT's interoperability roadmap, the Workgroup for Electronic Data Interchange conducted a survey on information exchange efforts and sent a comment letter to the agency on the results.

The survey was conducted last month, and respondents included 372 healthcare organizations--from vendors and providers to payers and health information exchange groups.

Most of the survey responses reflect a need to address barriers to interoperable electronic data exchange, WEDI says.

Some of those findings include:

  1. Electronic patient records are rarely successfully matched without manual intervention
  2. Encryption of health data lags when in-transit internally and when at-rest
  3. Most providers use Direct to exchange health information internally
  4. Providers are unable to easily exchange health data electronically with non-affiliated groups, such as pharmacies and labs, as well as with other health organizations
  5. Blending of structured and unstructured data remains a challenge

In addition, less than half of all of respondents (48 percent) say electronic health info exchanged has improved performance measures.

In its comments to the agency, WEDI adds that while it strongly supports the agency's efforts to advance interoperability, it urges that the roadmap "better reflect the realities, gaps, challenges, and opportunities across the current landscape."

The agency, WEDI says, must better prioritize actions that are achievable with "reasonable effort." In addition, the exchange of information must be "more harmonized" so data being sent and received is consistent.

When it comes to ONC's role in health IT going forward, WEDI says the agency should move from government-based oversight and shift to a role based more on coordination and guidance with private industry partners.

Other changes the workgroup stresses for ONC include:

  • A standardized patient ID matching process
  • More evaluation on the balance of burden and value of choice for patient access to data
  • Partnerships to improve HIT education and literacy within the industry
  • Interoperability needs to be driven not by financial incentives, but by market forces and value-based models of care

The College of Healthcare Information Management Executives and the Association of Medical Directors of Information Systems also recently wrote to ONC with comments on patient identification; they said it is "paramount" to the formation of an interoperable Learning Health System.

In addition, the American Hospital Association, in its comment letter, said "the federal government should fund a study of consumer attitudes about a patient identifier in the digital age."

The American Medical Association, meanwhile, criticized the roadmap, saying ONC must let punitive approaches to provider compliance with interoperability go by the wayside.

"This is simply a flawed and misguided means of removing the current barriers to interoperability," AMA said in its comments. "This approach will not work."

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