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mHealth Scores High With Consumers in Boosting Medication Adherence 

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

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

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

 

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

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

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

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

That’s where mHealth comes in.

 

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

 

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

 

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

 

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

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

 

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

 

The survey also shed some interesting light on prescription habits.

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

 

Among other results:

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

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

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

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

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

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

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

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


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


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


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

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


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


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Ebola Vaccine Appears Safe, Effective

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

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


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

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


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Google Builds a New Tablet for the Fight Against Ebola

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

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

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

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

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

The Tablet You Dunk in Chlorine

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



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

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

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

Fighting Disease Like a Tech Company

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

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

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

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


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Eduardo Vaz's curator insight, March 25, 2015 10:33 AM

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

Jared Stewart's curator insight, March 27, 2015 3:12 AM

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

Louisa ROQUE's curator insight, April 23, 2015 5:59 AM

When technology is useful.

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

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


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

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

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

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

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

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

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

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jean marc mosselmans's curator insight, March 22, 2015 8:02 AM

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

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House Republican Budget Overhauls Medicare and Repeals the Health Law

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

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

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

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

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

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

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

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

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

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

Congressional budgets do not have the force of law and are largely advisory documents, but they represent the broadest statement of governing philosophy each year and set overall spending levels for the coming fiscal year. And in coming months, this one may contain language easing passage of taxation and entitlement legislation.
Continue reading the main story

Under congressional rules, a budget cannot be filibustered in the Senate, so Republicans would bear most of the responsibility if they failed to pass one.

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

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

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

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

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

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

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

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

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

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

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

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

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


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Tyson continues effort to cut antibiotics from chicken production

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

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

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

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

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

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

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

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

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

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

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

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


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Can Apple's ResearchKit Really Change Medical Research?

Can Apple's ResearchKit Really Change Medical Research? | Healthcare and Technology news | Scoop.it

Apple made some grand claims for ResearchKit, a software platform it promises will turn the iPhone into a powerful tool for biomedical research. In a synchronized release, independent researchers also rolled out five apps to study an assortment of complicated diseases. It’s an interesting shift in strategy for the world’s most popular smartphone. For the first time, instead of you using the phone to do (nominally) useful stuff, other people will be using your phone, and the useful stuff will be you—or at least, data you generate.

The problem ResearchKit hopes to solve is the difficulty in getting big data about disease. Typically, you want as many people as possible involved in a study about, say, how heart disease develops. And indeed a few big, prospective, multi-year studies with thousands of subjects do exist, and have produced famously useful data. But they’re rare, because they’re hard to do, and thousands of subjects is nothing compared to, say, the 700 million or so people who own iPhones. “It really is a new way of doing business,” says Euan Ashley, a doctor at Stanford who helped create MyHeart Counter, an app designed to monitor physical activity and other risk factors for heart disease. “We’re going to start to see patterns that we weren’t able to see before. Hopefully we can represent all the different subgroups and have tremendous diversity across the population.” Other diseases under investigation—Parkinson’s, asthma, diabetes, and breast-cancer treatment recovery—also have apps available.

Even though the data will, by definition, come only from people who can afford an iPhone, researchers building the apps say the relatively large number of iPhone users nationwide—estimated at 63.2 million in 2014—will help reduce what’s called “selection bias,” the problem of research studies looking only at one kind of person. “If you can do something at scale, then the challenges of selection bias becomes smaller,” Ashley says. Biases never go away completely, but current studies already suffer from plenty of problems. For example, studies may only include people who happen to live near a research center or have the time to participate. Because the apps are open-source, researchers hope to eventually expand to Android and other platforms. Still, regardless of platform, smartphone users skew toward the young, wealthy, and Asians and whites. Not exactly representative.

Also, data used in scientific research is supposed to be more accurate than what your typical wearable gives you. “From a research perspective, it’s a little challenging,” says Errol Ozdalga, a physician at Stanford who wrote a review article about smartphone apps for physicians and medical students. “You have to be aware that a smartphone is not going to give you all your tracking activity.” In other words, any researcher hoping to use iPhone-gathered data will have to be cautious about the accuracy of what they’re getting. “We don’t know how these are going to work and if they’re really going to advance research,” says Eric Topol, director of the Scripps Translational Science Institute and author of The Creative Destruction of Medicine.

All of the ResearchKit apps use a combination of questionnaires and basic data your phone collects—for example, using your phone’s accelerometer to count how many steps you’ve taken as a measure of physical activity. If you have a wearable like the Apple Watch, it can measure how your heart rate changes while exercising. The mPower app, which tracks Parkinson’s disease, uses the iPhone touch screen to measure hand tremors and the microphone to gauge voice trembling.

But gathering data isn’t the same as understanding it. “What needs to happen is more evaluation about how these apps are going to be used to achieve these meaningful changes in health,” says Mitesh Patel, a health researcher at the University of Pennsylvania who studies wearables and health-related smartphone apps. ResearchKit will certainly give researchers more access, he says. And that’s good—it at least means a start at finding ways to use it. “This allows us an easier way to access that data and to be able to critically evaluate what data is useful or what data is not,” Patel says.

Yet Patel and Ozdalga both think that despite those caveats, apps represent the future of medicine. Apps that motivate people to change their behavior—to eat better and to exercise more, say—may still have a huge impact, Patel says. “The most important thing is how to use this data to create behavior,” he says. “If you’re not changing someone’s behavior, what’s the point?”


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Accenture report highlights digital health priorities for tech-savvy seniors

Accenture report highlights digital health priorities for tech-savvy seniors | Healthcare and Technology news | Scoop.it

Nearly 70 percent of seniors said technology is important to managing their health, according to a new report by Accenture. The survey of more than 10,00 people in 10 countries included 350 American seniors aged 65 and older.

The majority of people interested in these devices are already actively managing their health, which rings true with the quantified self movement. Of those who said they considered technology “very important” in health management, 75 percent monitored their weight, 50 percent monitored their cholesterol and 41 percent tracked their physical activity last year. Those rates are much higher than seniors who say they see no value in using technology to manage their health, according to the report.

Here were the five biggest priorities identified in the survey:

  • Self-care technology to independently manage health. (67 percent)
  • Wearables to track vital signs, such as heart rate and blood pressure. (62 percent)
  • Online communities to gauge reactions to a doctor’s recommendation (60 percent)
  • Patient navigators (33 percent)
  • Electronic health record management  (25 percent)

About 57 percent of seniors aged 65 and older used their electronic health record to access outcome-related health
data such as lab work and blood test results compared to just 46 percent of younger peers, the report said. Although a little more than one in four said they relied on EHRs for this information, about 42 percent said they expected to rely on EHRs to access health data in the next five years.

Despite the report’s outlook that seniors will embrace digital health in wider numbers, it emphasizes that its power to amplify in-person appointments with doctors, not replace them.

“Ehealth is poised to help increase engagement opportunities and support complex care coordination of the Medicare population. It is a complement, not a substitute, for the human touch in healthcare—at a time in people’s lives when they often need it the most.”

Seniors are a particularly interesting demographic to consider for digital health for a few reasons. They account for a significant portion of the population (40.3 million, according to 2010 U.S. Census data) and a hefty portion of medical expenses as their health declines. But the report’s focus on tech-savvy seniors also reveals its bias towards seniors that enjoy higher incomes. It cites the Pew Internet and American Life Project that of the seniors 65 and older with an annual household income of $75,000 or more, 90 percent go online and 82 percent have broadband at home, both of which are much higher rates compared to this age group overall.

Accenture’s report underscores the need for digital health tools that not only respond to seniors interest in aging in place, but also respond to the broad variety of technology skill levels in such a large, aging population.


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Edward Wisniowski's curator insight, March 10, 2015 5:47 PM

Seniors are getting more tech savy

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A billion at risk for hearing loss from exposure to loud music

A billion at risk for hearing loss from exposure to loud music | Healthcare and Technology news | Scoop.it

"Hey dude -- can you turn your music down?"

If anyone says this to you while you're wearing your earbuds, take note: You are probably endangering your hearing.

More than one billion teens and young adults are at risk of losing their hearing, according to WHO (that's the World Health Organization, not the rock band).

It's not just old folks who suffer hearing loss. Just by listening to music at what you probably think is a normal level, or hanging out in loud bars, nightclubs and music and sporting events, you can permanently damage your hearing.

By analyzing listening habits of 12- to 35-year-olds in wealthier countries around the world, WHO found nearly 50% of those studied listen to unsafe sound levels on personal audio devices and about 40% are exposed to damaging levels of music and noise at entertainment venues.

It doesn't take much time to damage your hearing at a sports bar or nightclub. According to the WHO, "exposure to noise levels of 100 dB, which is typical in such venues, is safe for no more than 15 minutes."

You can't get it back

Once you lose your hearing, it won't come back.

Rapper Plan B and Coldplay lead singer Chris Martin know that all too well. They both suffer from tinnitus, hearing loss that causes a permanent and irritating ringing in the ears, because they didn't protect their hearing. Now they've joined forces with a British hearing loss association to warn others.

"I suffer from tinnitus," says Plan B on actionhearingloss.org. "When I first developed it, I thought it was trains rushing by my house as I live near a railway line. It was really loud and an extremely high pitched ringing in my ears. I now have to wear special earplugs when I go to bed to help stop my ears from ringing."

"Looking after your ears is unfortunately something you don't think about until there's a problem," says Martin. "I've had tinnitus for about 10 years, and since I started protecting my ears, it hasn't got any worse (touch wood). But I wish I'd thought about it earlier."


Instead of earbuds, consider using earphones. And either way, place reasonable restrictions on your listening to music.
Turn down those earbuds

When it comes to personal listening devices, the level of damage you can cause to your ears is directly correlated to how long you listen and how loud the sound. "Unsafe levels of sounds can be, for example, exposure to in excess of 85dB for eight hours or 100dB for 15 minutes," says WHO.

Eighty-five decibels isn't all that loud. According to the Palo Alto Medical Foundation, it's about the level of city traffic that you'd heard from inside your car.

Some 360 million of us have already suffered moderate to severe hearing loss, according to the UN Health Agency Worldwide. While that number does include factors out of our control, such as aging, genetics, birth defects, infections and disease, about half of all cases were avoidable.

That's why WHO has launched the Make Listening Safe initiative. Part of the campaign is to encourage manufacturers to create audio safety features on devices and then educate consumers on how to use them. WHO is also calling on governments to create and enforce recreational noise legislation.

"Parents, teachers and physicians can educate young people about safe listening, while managers of entertainment venues can respect the safe noise levels set by their respective venues, use sound limiters and offer earplugs and 'chill out' rooms to patrons," says WHO.

In the end, it's up to each of us to protect our own hearing. The good news is that it's easy to do. When it comes to your personal audio devices, such as your smartphone:

-- Turn the volume down. Don't go above 60%.

-- Wear noise canceling earbuds, or better yet, headphones.

-- Take "listening breaks" or only listen for just an hour a day

-- Get an app for that. Download a smartphone app to help monitor safe listening levels.

And the next time you go to a bar, nightclub, sports event or concert, use ear protection. Martin does.

"Now we always use moulded filter plugs, or in-ear monitors, to try and protect our ears," says Martin. And his kids never go to a concert without big, noise-canceling headphones.


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Stéphane Tardivel's curator insight, March 11, 2015 10:12 AM

I should be deaf by now...

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Why 2015 is the pivotal year for #digitalhealth

Why 2015 is the pivotal year for #digitalhealth | Healthcare and Technology news | Scoop.it

While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.

The mainstream healthcare consumer in 2014 embraced the ALS Ice Bucket challenge and panicked (rightfully so) about the staggering wake-up call of the Ebola outbreak. While the politicians in US played the Obamacare ping pong game, and Brussels accepted its first applications for eHealth projects as part of Horizon 2020, there was also a major undercurrent in how digital health and health IT have penetrated our everyday lives.

In the US alone, digital health funding more than doubled from 2013, according to RockHealth, and even almost tripled according to StartupHealth. While the delta is not a rounding error, the key point is the exponential trajectory that showcases the fact that smart money believes this industry is ripe for significant disruption.

There are still many companies and investors that are sitting on the sidelines and watching the show from the balcony. As an example, there are many critics of wearable devices and even some hesitations on the value of big data. But, I want to remind everyone that Rome was not built in a day and the first generation or even second generation of devices, big data platforms, and decision support tools will improve care mainly driven by healthcare entrepreneurs, healthcare consumers and passionate scientists and clinicians – the “stormchasers”.

On February 2nd, I attended a local Singularity University lecture with a keynote from Gerd Leonhard, who is a thinker, futurist and a digital heretic. One of the statements he made really resonated with me: “Technology is exponential, humans are not”. The keynote was all about ethics in the age of exponential technology. But, leaving privacy and ethical issues aside, 2015 will be a pivotal year for digital health in an era of exponential technology:

1. Precision medicine

During the State of the Union Address, President Obama announced the precision medicine initiative.  

"I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time. In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier."

Precision, or personalized medicine, (I use the term interchangeably) is an approach to using medical and genetics data, body-generated data, biotechnology, and science, to first and foremost understand the root causes of the disease—but also come up with personalized and individualized treatments and therapies.

Due to forthcoming government funding, but more importantly smart money and brilliant entrepreneurs, we will certainly see more activity this year. After all “Health IS Personal”.

2. Genomics

As DNADigest describes it:

"The techniques for researching and characterizing genomics diseases are available to both researchers (next generation DNA sequencing) and the general public (in the form of personal testing), so we should soon be able to diagnose any genetic disease by sequencing a patient’s DNA."

Indeed, this is the future but the future is almost here: Illumina with $1,000 per full genome sequencing, Tute Genomics which is now allowing researchers and clinicians to interpret the entire human genome, and a big announcement for 23andMe regarding their entrance into the UK market.

As an industry, there are still a lot of hurdles, but we will see some significant moves this year in this space—including ways to actually analyze 150 zetabytes (1021) of data per full genome, begin integrating this data into evolving and ancient EMR platforms, and provide genetic counseling to offset the lack of knowledge by the masses.

3. Smart Data and Data Science

Well actually, data itself is not smart, people are! And while there is huge promise in big data analysis, collecting and hoarding zetabytes (yes this term again) of data does not bring any value.

People need to ask the right questions of the data. We are at an age where collecting data is easy with body-generated data, environmental data, and traditional medical data—but it is the data scientist combined with sharp business and clinical skills that will empower the healthcare system to make all this data actionable, with the healthcare consumer at the center.

"If you torture the data long enough, it will confess to anything" - Ronald Coase
4. Next Generation EMR is personal

Let’s face it—and this is not news to anybody—core medical data is already becoming a small percentage of the overall personal health record. Existing EMR platforms are over two decades old and some are struggling to keep up with archaic architectures, millions of lines of code, and minimal-to-no differentiation to their client base today.

The smart ones are looking to open up their APIs, integrate body-generated and genomics data, and even combine that with environmental data at a personalized level to be able to provide that precision medicine at point of care.

5. Design and Aesthetics

Our bodies are complex, and therefore the medical profession is complex. Once again, an unprecedented amount of content is generated daily—and for both consumers and clinicians alike, dealing with this information overload is becoming yet another full time job.

The aforementioned smart data discussion is only one piece of the puzzle. User experience is another.

At the core of our health is human behavior. Hence, incentivizing healthcare consumers (patients), making their treatment pathways clear, and presenting stupid data in a smart and actionable way are all key to improving our healthcare system.

Global health care transformation is still in its infancy. While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.


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CDC investigates deadly bacteria's link to doctors' offices

CDC investigates deadly bacteria's link to doctors' offices | Healthcare and Technology news | Scoop.it

The Centers for Disease Control is raising a red flag that a potentially deadly bacteria may be lurking in your doctor's office.

The bacteria, C. difficile, is typically found in hospitals, but a study out Wednesday reports a substantial number of people contracted the bug who hadn't been in a hospital, but had recently visited the doctor or dentist.

The bacteria can cause deadly diarrhea, according to the CDC, with infections on the rise. The new report shows nearly half a million Americans infected in various locations in one year, with 15,000 deaths directly attributed to C. diff.

In a 2013 study, researchers found C. diff present in six out of seven outpatient clinics tested in Ohio, including on patients' chairs and examining tables.

The CDC is so concerned that they're starting a new study to try to assess nationally whether people are getting C. diff in doctors' offices.

"This is really an important issue. We need to understand better how people are getting C. diff," said Dr. Cliff McDonald, a medical epidemiologist at the CDC.

In the meantime, patients should wash their hands after visiting the doctor's office -- with soap and water, because alcohol-based gels don't get rid of C.diff.

Another tip: Question your doctor whenever you're prescribed an antibiotic. Powerful broad-spectrum antibiotics wipe away good bacteria in your gut that fight off the bad bacteria, which leads the way to C. diff.

Johns Hopkins safety expert Dr. Peter Pronovost recommends asking your doctor if you really need an antibiotic, if there's a less powerful one that will treat your infection, and if you're being prescribed the antibiotic for the shortest time possible.

The CDC study, published Wednesday in The New England Journal of Medicine, said 150,000 people who had not been in the hospital came down with C. diff in 2011. Of those, 82% had visited a doctor's or dentist's office in the 12 weeks before their diagnosis.

The CDC is hoping its new study will help determine cause and effect, because it's possible the patients had C. diff to begin with and went to the doctor to get help. It's also possible that antibiotics prescribed during the doctor's visit, and not microbes at the doctor's office, caused the infection.

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You Will Feel Better's curator insight, February 26, 2015 3:56 PM

This is why PureWorks foam is an absolute necessity! 

https://youwillfeelbetter.buyygy.com/90forLifeStore/en/pureworks

4CalebWalker's curator insight, March 12, 2015 10:11 AM

CDC/ I did not realize that they investigated things that did not apply to a general population/ I agree with them taking their time to investigate and control the situation

Ashley Maddox's comment, March 12, 2015 3:00 PM
1 scoop plus 1comment =20
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Superbug linked to 2 deaths at UCLA hospital; 179 potentially exposed

Superbug linked to 2 deaths at UCLA hospital; 179 potentially exposed | Healthcare and Technology news | Scoop.it

Nearly 180 patients at UCLA's Ronald Reagan Medical Center may have been exposed to potentially deadly bacteria from contaminated medical scopes, and two deaths have already been linked to the outbreak.

Update: FDA issues warning on contaminated medical scopes

The Times has learned that the two people who died are among seven patients that UCLA found were infected by the drug-resistant superbug known as CRE — a number that may grow as more patients get tested. The outbreak is the latest in a string of similar incidents across the country that has top health officials scrambling for a solution.

Caption FDA attributes spread of superbug to endoscope
More than may have encountered 'superbug'

UCLA said it discovered the outbreak late last month while running tests on a patient. This week, it began to notify 179 other patients who were treated from October to January and offer them medical tests. By some estimates, if the infection spreads to a person's bloodstream, the bacteria can kill 40% to 50% of patients.

At issue is a specialized endoscope inserted down the throats of about 500,000 patients annually to treat cancers, gallstones and other ailments of the digestive system.

These duodenoscopes are considered minimally invasive, and doctors credit them for saving lives through early detection and treatment. But medical experts say some scopes can be difficult to disinfect through conventional cleaning because of their design, so bacteria are transmitted from patient to patient.

These instruments are not the same type used in more routine endoscopies and colonoscopies.

The procedure in question is known as ERCP, or endoscopic retrograde cholangiopancreatography. The superbug is carbapenem-resistant Enterobacteriaceae.


UCLA said it immediately notified public health authorities after discovering the bacteria in one patient and tracing the problem to two of these endoscopes. The university said it had been cleaning the scopes “according to standards stipulated by the manufacturer,” and it changed how it disinfects the instruments after the infections occurred.

Dale Tate, a university spokeswoman, said “the two scopes involved with the infection were immediately removed and UCLA is now utilizing a decontamination process that goes above and beyond the manufacturer and national standards.”

Tate declined to provide details on the two people who died, citing patient confidentiality.

State and federal officials are looking into the situation at UCLA as they wrestle with how to respond to the problem industrywide.

Since 2012, there have been about a half-dozen outbreaks affecting up to 150 patients in Illinois, Pennsylvania and most recently at a well-known Seattle medical center, according to experts.

These outbreaks are raising questions about whether hospitals, medical-device companies and regulators are doing enough to protect patient safety. Some consumer advocates are also calling for greater disclosure to patients of the increased risks for infection before undergoing these procedures.

Lawrence Muscarella, a hospital-safety consultant and expert on endoscopes in Montgomeryville, Pa., said the recent number of cases is unprecedented.

“These outbreaks at UCLA and other hospitals could collectively be the most significant instance of disease transmission ever linked to a contaminated reusable medical instrument,” he said.

Officials at the U.S. Centers for Disease Control and Prevention said they were assisting the L.A. County Department of Public Health in its investigation of the UCLA infections.

Dr. Alex Kallen, an epidemiologist in CDC's Division of Healthcare Quality Promotion, said the outbreaks are serious given how difficult this superbug can be to treat and the fact that additional cases might be going undetected.

“This bacteria is emerging in the U.S. and it's associated with a high mortality rate,” Kallen said in an interview. “We don't want this circulating anywhere in the community.”

Last month, Virginia Mason Medical Center in Seattle acknowledged that 32 patients were sickened by contaminated endoscopes from 2012 to 2014 with a bacterial strain similar to CRE. Eleven of those patients died.

But Virginia Mason said other factors may have contributed to their deaths because many of them were already critically ill.

The duodenoscopes typically involved in the outbreaks have an “elevator channel” that doctors use to bend the device in tight spaces and allow for attachments such as catheters or guide wires. Experts suspect bacteria build up in that small area.

This bacteria is emerging in the U.S., and it's associated with a high mortality rate. We don't want this circulating anywhere in the community

Kallen, the CDC official, said he hasn't found any breaches in cleaning protocol at hospital outbreaks he has investigated, but he said the problem probably is more complicated than just a design issue.

“There isn't an obviously easy solution to employ,” Kallen said. “There is action on a lot of different fronts.”

Virginia Mason instituted a new quarantine process that sets the endoscopes aside for 48 hours so evidence of any bacterial growth can be found before reusing them.

That has increased the time for equipment cleaning from a couple of hours to more than two days. Virginia Mason said it had to purchase 20 additional endoscopes to compensate for that down time.

“There is either a design issue to be addressed or a change to the guidelines for the cleaning process,” said Dr. Andrew Ross, section chief of gastroenterology at Virginia Mason. “It's the role of the federal government to make some of those decisions.”

In the wake of the Seattle cases, Sen. Patty Murray (D-Washington) pressed the FDA to issue guidelines for hospitals on how best to sanitize these scopes and devise a way to better track infections.

Some patient-safety advocates say regulators and industry officials have been too slow to respond.

“Hospitals and manufacturers often take months to assess what to do, with the infected patients being the last to know,” Muscarella said. “Bringing patients into the loop and answering their questions is important for hospitals to prevent outbreaks.”

A spokeswoman for the FDA said the agency was working to reduce the incidence of infections while maintaining access to a crucial medical tool.

The agency said it was “actively engaged with the manufacturers of duodenoscopes used in the U.S. and with other government agencies such as the CDC to develop solutions to minimize patient risk associated with these issues.… The FDA believes the continued availability of these devices is in the best interest of the public health.”

Olympus Medical Systems Group, a major manufacturer of these endoscopes and UCLA's supplier, said it was working with the FDA, physician groups and hospitals regarding these safety concerns.

The company said all of its customers who purchase Olympus duodenoscopes “receive instruction and documentation to pay careful attention to cleaning.”

UCLA said it moved quickly to protect patients once the problem surfaced. It said it alerted state and county health officials as soon as the bacteria were detected.

It is notifying 179 patients and their primary-care doctors by phone and letter. UCLA said it was offering to send patients a free home testing kit for a rectal swab, or they could come in to be tested.



Even before this incident, UCLA has struggled at times with patient safety. An influential healthcare quality organization gave the Ronald Reagan Medical Center a failing grade on patient safety in 2012.

The hospital's score improved to a C in the latest ratings from Leapfrog Group, a Washington nonprofit backed by large employers and leading medical experts.

Meanwhile, some doctors worry the outbreaks might deter patients from seeking care they need.

“ERCP is a common and critical procedure in most hospitals today,” said Dr. Bret Petersen, a professor of medicine at Mayo Clinic's division of gastroenterology and hepatology in Rochester, Minn. “It's not a procedure we can allow to be constrained, so this is a serious issue we need to address.”


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Digital Solutions the Key to Behavioral Health's Future

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

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


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


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


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


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


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


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

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

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

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


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Christopher Mathew's curator insight, May 1, 2015 6:20 PM

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

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The High Cost of Reducing Waste in US Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Obamacare subsidies likely expanded insurance coverage

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

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


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


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


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


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


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

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


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


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


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


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Obamacare Cut The Ranks Of The Uninsured By A Third

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

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

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

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

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

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

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

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


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

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


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

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

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

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

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


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Health Care Rox's curator insight, April 27, 2015 11:45 AM

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

EG

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Thinking of retiring? Learn about Medicare options

For those who are celebrating their 65th birthday, or have surpassed age 65, and are contemplating retirement, it’s time to think about Medicare and coverage options. Understanding Medicare and transitioning to new medical coverage can be confusing, and even seem overwhelming To help people understand their options, Sharp HealthCare is conducting free Medicare educational meetings.

Medicare expert Alicia Flynn will host the meetings, discuss commonly asked questions, and explain how to avoid financial penalties for delayed enrollment. The meetings will take place once monthly from 6-7:30 p.m. on Wednesdays at the Sharp Corporate Office Auditorium, 8695 Spectrum Center Blvd., San Diego.

Learn about Medicare Parts A and B, special enrollment requirements if you start using Medicare after age 65 and the difference between Medicare Advantage and Medicare Supplement Insurance plans. Experts will guide you step-by-step to enrollment and answer questions.

To register, call (800-827-4277) from 8 a.m.-6 p.m. Monday thru Friday. Free visitor parking is available from the lot entrance on Spectrum Center Boulevard.

For a full schedule of the sessions, go online to sharp.com/health-classes/understanding-how-medicare-works-1618.


Tips for controlling high blood pressure

High blood pressure or hypertension increases the risk of heart disease and stroke. Following are some tips to control high blood pressure:

• Aim for a healthy weight. Extra weight raises the risk of high blood pressure. Talk to your doctor to find out if you’re at risk.

• Increase your physical activity to at least 30 minutes of moderate activity such as walking on most days.

• Read nutrition labels and reduce sodium intake. Almost all packaged foods contain sodium. Use spices and herbs for seasoning foods at home in place of salt.

• Eat more fruits, vegetables, grains and low-fat dairy products.

• Consume alcohol in moderation.


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Medicine and Health Care Will be Personalized Thanks to Technology

Medicine and Health Care Will be Personalized Thanks to Technology | Healthcare and Technology news | Scoop.it

From wearable fitness trackers to virtual doctor visits to smartphone apps and attachments that can collect sophisticated medical information, new technology is giving users unprecedented direct access to their own health data. In his new book, “The Patient Will See You Now: The Future of Medicine Is in Your Hands,” Eric Topol, a cardiologist, professor of genomics and director of the Scripps Translational Science Institute, explores how this “great inversion of medicine” will transform the future of health care. He recently spoke with U.S. News about how new capabilities might impact the quality and cost of care, as well as what some of the barriers will be. Excerpts:

What have been some of the drivers of technology changing the world of health care?

I equated the impact of the smartphone in medicine to parallel the Gutenberg printing press in terms of how it affected civilization. That sounds like a reach, but in fact, when you think about it, you will have sensors measuring almost any medical metric known to man; you would be able to check the cost of any procedure, scan, visit, hospitalization; and you could contact a doctor at any moment, 24-7, through your phone. It’s almost kind of limitless how this little device, which changed the rest of our lives so dramatically, is now going to have a similar analogous effect on our health.


How will this impact the cost and quality of care?


That’s a really important unproven concept. Work needs to be done to certainly shore that up. There’s a lot of promise. There’s a big change from having physical office visits to see doctors to these virtual visits, and that has already been shown to reduce in a striking way the costs per visit. Hospital rooms will not be necessary in the future. You could have all monitoring done for very inexpensively in the comfort and safety of one’s home. There’s so much waste in our system. The patient is driving things much more and is alerted to the unnecessary aspects and trivial costs.


Who will resist this change the most?


The medical community, especially in the U.S. This challenges all aspects of reimbursement. There’s also the other issue of the loss of control. This is a very paternalistic profession. This is the greatest challenge it will ever face. Also there are knowledge gaps. This will be the case with sequencing data – for example, matching up drugs and a person’s DNA interactions – and even a lot of the ways that wireless devices can be used to do things like the physical exam. These things are not in the comfort zone of many physicians and health care professionals.

What role will the Affordable Care Act play?


It’s kind of in a different orbit. The only thing where there’s some overlap is it is trying to promote the concept that the patient has access to their medical information. But it needs to go much further. Patients have a hard time getting their data, and it isn’t right. The Affordable Care Act doesn’t get to the core issues here of the democratization of medicine. I’m hoping, of course, that in the future we’ll get governmental support. That’s essential. No one’s suggesting that we don’t need doctors and the infrastructure that exists today, but in a very different way, in a more equitable partnership model going forward.


What should policymakers do?


The hope is that we recognize the fact that this is an inevitable progression of medicine, and while it represents quite a radical change, it’s time to grant [patients] rights ownership and acknowledge that the flow of information is going to be completely different than in the past. These data are going directly to one’s own devices, that they own, about their own body, for services that they pay for; it’s about time that we adopt this new philosophy. This is something that is not in our culture, not in the medical culture. But I do think that it can be fostered, it can be embraced, and eventually consumers will demand it.

What risks should patients be worried about with new technology?

I think privacy and security is one of the greatest factors that will potentially prevent this from moving forward in a catalytic way. We’ve seen all these various hacks and breaches. People’s health data is quite precious. It isn’t even just the privacy. This whole concept that one’s medical data is being sold – for example, one’s prescription use is being sold to pharma companies. This can’t go on. We’ve got a lot of work to do.


What can consumers expect ahead?


You can have your child’s ears examined through your own smartphone attachment and get a diagnosis of whether they have an ear infection, or get a skin lesion diagnosed immediately through a picture and an algorithm. Can you imagine getting data while you’re sleeping or while you’re in traffic? We have the exciting potential to get involved with pre-empting disease for the first time. By having all that data on populations of people, then that affords new ways to foster better treatments and preventions. That takes the information era to new heights.


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Cameron's curator insight, March 26, 2015 10:25 PM

The author carefully explains how healthcare apps can change our lives. Even with a paragraph dedicated to the risks of healthcare apps, the 'beneficial paragraph' is directly after it, giving the readers a choice to weigh out the bad with the good. 

Ben Simpson's curator insight, March 27, 2015 5:19 AM

This source provides great in depth detail and explanation on how technology will impact the future of medicine.

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HealthCare.gov isn't perfect, but it's a whole lot better

HealthCare.gov isn't perfect, but it's a whole lot better | Healthcare and Technology news | Scoop.it

Management of HealthCare.gov isn't perfect, but it's far better off than it was a year-and-half ago.

Much of a new report from the Government Accountability Office rehashed all the problems that caused the initial rollout of HealthCare.gov to be a mess. But it also pointed to the current state of the website as much improved.

How so? In the immediate aftermath of the debacle, the Centers for Medicare and Medicaid Services doubled the number of servers for systems supporting HealthCare.gov, added virtual machines for the Enterprise Identity Management and Federally-Facilitated Marketplace, and replaced a virtual database with a high-capacity physical database, the GAO reported. All of that allowed more efficient system processing — going from 25 to 400 terabytes of monthly capacity.

The CMS also directed its development contractors at the time to, among other things, modify system software to increase the efficiency in system interactions and implement software fixes to address issues with users logging into their accounts. It documented data quality plans for the Enterprise Identity Management system in March 2014 and the FFM system in June 2014 that outline an approach for improving the quality of the systems' code.

And then, of course, it awarded a new contract in January 2014 to Accenture Federal Services in Arlington that "represents almost exclusively new development and major fixes to software already developed," the GAO reported.

Indeed, as I reported in October, a lot was involved with getting the website in working order — and it's come a long way since then. While some FFM system development activities are still in progress, the GAO noted the Centers for Medicare and Medicaid Services made progress in developing and implementing services related to eligibility and enrollment and plan management. Users can now "window shop" for plans, for example, and the CMS can validate plan application information and route the validated information to the appropriate system.

But there are still areas the Centers for Medicare and Medicaid Services, with Accenture (NYSE: ACN), could stand to improve to ensure they don't again land in hot water, the GAO noted. Even with its new requirements approval process, for example, the CMS has not consistently and appropriately approved requirements. And whether all requirements are properly approved before they're implemented is unclear. Also, the Centers for Medicare and Medicaid Services does not have the proper processes in place to ensure stakeholders fully understand system-wide effects as a result of changes to requirements.

"With the issuance of a new development contract … CMS has taken the opportunity to make improvements," the GAO reported. "However, until it ensures that it is fully implementing best practices for managing the development of HealthCare.gov and its supporting systems, it increases the risk that future development will experience additional problems."


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Survey: 76% of Patients Would Choose Telehealth Over Human Contact

Survey: 76% of Patients Would Choose Telehealth Over Human Contact | Healthcare and Technology news | Scoop.it

76% of patients would choose telehealth over human contact according to recent survey that highlights the increased trust in telehealth by consumers. 

Consumer trust in telehealth is growing with 76% of patients choosing access to care over human interaction with their care provider according to recent survey by technology vendor Cisco.

The survey studied the views of consumers and HCDMs on sharing personal health data, participating in in-person medical consultation versus remote care and using technology to make recommendations on personal health.  Views on these topics differed widely between the two groups (consumers and HCDMs) and the ten geographies surveyed.

“The patient and care provider experiences are top of mind in health care around the world.  Due to the increasing convergence of the digital and physical, there is an opportunity to provide increased collaboration and information sharing among providers to improve the care experience and operate more efficiently,”  said Kathy English, Public Sector and Healthcare Marketing, Cisco.

The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.  Additionally, consumers and HCDMs were polled from a wide variety of backgrounds and ages within each country.


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Harmony Balance's curator insight, March 8, 2015 10:15 AM

interesting....

Shamma khan's comment, April 14, 8:43 AM
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Tim Cook outlines Apple's role in health and wearables

“I think when you’re dealing with wellness, fitness and the proactive pieces of health. I don’t see Apple getting in to cancer research and this kind of stuff. That’s well beyond our expertise but I think in terms of things that you wear and things that you can know about your body and be able to proactively reach out to your doctor when certain things happen, I think that’s right up our alley and I think it’s something that the world needs. Apple is about making great products that enrich people’s lives.

“We wouldn’t build just a great product, we would only build it if it only enriched somebody. I think this is a fantastic example of something that enriches lives. So this is something that is highly interesting to us and you’ll notice that the watch has a health and fitness component. This is the area where we’re starting but where we go in the long term we’ll talk about later but it’s an area that I’m very excited about from multiple points of view. The opportunity and need for the world to have these types of products.”


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What Do Women Know About Obamacare That Men Don’t?

What Do Women Know About Obamacare That Men Don’t? | Healthcare and Technology news | Scoop.it

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  According to Inovalon, a company that tracks and analyzes data for health plans and providers, people who used the coverage they bought through the marketplaces last year tended to be older, sicker, and more female than the general commercially insured population. As of June 2014, 41 percent of females who purchased coverage through exchanges had face-to-face visits with health care professionals, versus 32 percent of males.

Those numbers are consistent with the notion that many women who signed up for coverage under the ACA had preexisting conditions or other health issues that led them to seek treatment.  In some cases, their pre-ACA insurance may have excluded those conditions, or the preexisting conditions may have prevented them from obtaining coverage at all.

What’s more, as HHS points out in a recent report, there are plenty of benefits in the ACA’s qualified health plans that are especially attractive to women. These include coverage at no out of pocket cost for many preventive measures, such as mammograms or screening for gestational diabetes.  An estimated 48.5 million are benefitting from that provision of the law alone.

Other data support the notion that many U.S. women are in disproportionately higher medical need, relative to men – even adjusting for the fact that they typically live longer.  According to an analysis of Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality, women constitute nearly 60 percent of people in the top tenth of medical expenditures in 2011 and 2012.  Most of those in the top tenth of spending are either ages 45 to 64, or 65 and older.

One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.

A case in point: Rosemary Forrest, 63, who lives in Augusta, Georgia.  Laid off from her job at a university science lab at age 55, she spent five years unemployed and without health insurance.   She now works as a contractor to a small nonprofit agency; battling painful osteoporosis, she sometimes earns less than $400 a month.  Last year, when the federal health insurance marketplace went live, she signed up for coverage.  This year, she re-enrolled, and after federal tax credits, pays $86 per month in premiums.


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