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8 Signs of a strong security culture

8 Signs of a strong security culture | Healthcare and Technology news | Scoop.it

Cybersecurity incidents in healthcare are on the rise. Organizations are continuing to strengthen their security programs.

 

I am currently working with two clients who are focusing on security. One is a large regional organization that is hiring their first Chief Information Security Officer (CISO). They asked StarBridge Advisors to provide an interim CISO to help build the security program while they recruit. The other is a university health system that is consolidating their security program under the university CISO and hiring an associate CISO to focus on the health system. Both organizations recognize the importance of the CISO role and the need to continually strengthen their security profile.

 

While it may be surprising to see organizations hiring their first CISO in 2018, what matters is that they recognize the need and are making the investment.

 

When I served as CIO at Michigan Medicine for the hospitals and health centers, we crossed that bridge in 2015. The IT leader responsible for infrastructure had been responsible for security as well – not uncommon in healthcare organizations. I recognized that the security function needed a dedicated focus, so we hired a full-time CISO.

 

I engaged a third-party security expert to conduct an assessment using the NIST framework. As a CIO, I learned a great deal through that process. With the help of our consultant, I was able to educate the executive team as well. One component of the final assessment report was about creating a security culture.

Security cannot just be the job of the CISO. It is everyone’s job. These are the signs that an organization has developed a security culture:

 

  • Security is discussed at the senior executive level, with critical decisions about organizational security activities made by the CEO and other senior leaders;
  • Senior executives receive regular reports on the security posture of the organization, and incorporate them into overall organizational risk management;
  • The organization has a CISO, positioned to influence organizational activities, and who operates independent of conflicts of interest;
  • Security staffing levels are adequate to address the existing and future security issues;
  • Security is a defined budgetary item, with security spending sufficient to address identified risks;
  • Security is incorporated into overall organizational activities, including system acquisition, and data sharing with business partners;
  • The organization’s research arm views security as critical to research activities, even if the research involves information considered public; and
  • Workforce members are aware of their roles and responsibilities with respect to IT security and are held accountable to meeting them.

 

Can your organization check off all the boxes on this list? If not, you’ve got work to do.

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Continuous Learning in Healthcare and Technology

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

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

 

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

 

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

 

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

 

A few observations and tips from my own experience:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Innovation or disruption?

Innovation or disruption? | Healthcare and Technology news | Scoop.it

“You only call it a disruption because you didn’t create it – stop being disrupted, innovate.” That was just one of the messages in the opening keynote from Terry Jones at the fifth Annual Thought Leaders on Access Symposium (ATLAS) in Boston this week. His talk was titled “Turning Disruption OFF and Turning canstockphoto30429373 (1) innovationInnovation ON”.

 

As an entrepreneur with an impressive history, Terry Jones knows what he’s talking about. He is best known for founding Travelocity.com and serving as founding Chairman of Kayak.com. As consumers, we’ve experienced the disruptive innovations in the travel industry. As healthcare leaders, we were challenged by Terry to consider the innovations and disruptions yet to come in our industry.

 

ATLAS is a patient access conference for hospital and health system leaders sponsored by Kyruus for their customers and invited guests. Kyruus is a software firm that offers provider search, scheduling, and data management solutions to help health systems match patients with the right providers and enhance patient access enterprise-wide. This year’s theme was “Systemness. Ignited.” with excellent speakers on innovation and digital transformation in healthcare. The focus of the conference was on patient and consumer engagement. Health systems such as Banner Health and Piedmont Healthcare, leaders in transforming the patient experience, shared their stories.

 

It was inspiring to see so many healthcare leaders passionate about improving the patient experience. I’ve been in health IT management for decades and I was humbled to hear leaders from marketing, patient access, and innovation teams talk about getting things done in spite of roadblocks they sometimes face from IT.

 

I was in the invited guest category as a panelist for the session “Getting Buy-In for Digital Innovation at Your Health System”. My fellow panelists were Matt Roman, Chief Digital Strategy Officer at Duke University Health System; Don Stanziano, Chief Marketing Officer at Geisinger; and James Terwilliger VP Clinical Services at Montefiore. Judy Murphy, Chief Nursing Officer for IBM Global Healthcare, moderated.

 

We had a lively discussion on the structural approach to innovation and where it lives in an organization, how to scale innovation, and how to work with IT. I am a big proponent of IT leaders partnering with the health system’s leaders responsible for innovation if it’s not within the IT department. To be successful, innovation needs to happen from the bottom up. You need a culture that supports and encourages innovation. It can’t be one person or team’s responsibility. Having said that, support and funding must come from the top of the organization.

 

Edmondo Robinson, Chief Transformation Officer at Christiana Care Health System, did a presentation on “How to Drive Transformation in Healthcare Delivery”. He emphasized that it’s about people, process and culture first and lastly technology as an enabler.

 

Having served as CIO in four different healthcare organizations in the past several years, I’ve seen different models and approaches to innovation. There is no one size fits all model. But I think we all can agree that innovation means change and disruption. And as Terry Jones said, “If you don’t like change, you are going to like irrelevance even less.”

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Digital transformation and the law of small numbers

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

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

 

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

 

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

 

 

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

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

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

A slowdown in technology investments

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

Renewed debates on the state of data and analytics

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

 

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

 

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

Relax, digital is alive and well

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

 

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

 

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

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3 trends that will drive the future of technology in healthcare 

3 trends that will drive the future of technology in healthcare  | Healthcare and Technology news | Scoop.it

National Health IT week (NHIT Week). Healthcare IT has gone through dramatic changes in the past decade. Driven by a need to rein in runaway healthcare cost increases, the federal govt passed the Affordable Care Act (ACA) and its companion HITECH Act that used the Meaningful Use program of financial incentives to promote the implementation of electronic health record (EHR) systems. During this time, we have gone from what was largely a paper-based healthcare ecosystem to almost total penetration of digitized medical records. Health systems are now at the cusp of the next wave of IT-led transformation defined by these questions:

  • What do we do with all the EHR data?
  • What do we do about the explosion of new data?
  • How is the market changing on us?

The coming years will see the transformation of healthcare delivery, driven by three important trends as they pertain to the role of information technology:

Data, analytics and artificial intelligence (AI)

The first AI-powered diagnosis of images was approved by the FDA this week. The arrival of data-driven, algorithmic decision-making using advanced computing infrastructure augments and enhances the capability of human physicians in the delivery of care. As the volume and variety of data have exploded in the past few years, so have the opportunities to derive additional meaning to predict and manage disease conditions. The digital transformation of healthcare is predicated on harnessing the power of data and analytics, and billions of dollars in venture capital money are pursuing that goal. However, AI has a “black box” problem which will impact adoption rates, as will ongoing concerns about data privacy, security, and ransomware.

 

What to look for: Increased adoption and transparency with AI models, increased use of personal genomic data, and the use of advanced analytics to solve public health issues such as the opioid crisis.

Changing healthcare markets

The healthcare consumer has long suffered the rising costs of healthcare. However, we may be approaching an inversion point driven by the burning questions of affordability and accountability in healthcare. Employers are taking matters into their hands and underwriting their employee healthcare costs, as we are beginning to see from the examples of GM and Walmart. By plying employees with wellness screenings and preventive care models, and by contracting directly with healthcare providers, employers hope to bring healthcare expenses under control while keeping their employees healthy.  Other factors at play; high deductible health plans have sharply reduced healthcare consumption among the older population while the younger generation is eschewing traditional paternalistic healthcare provider relationships for convenience and virtual care models. Digital health upstarts are coming up with innovative new models, built largely on the premise of virtual, AI-enabled, superior experiences enabled on smartphones and powered by remote data collection. Healthcare providers, for their part, find themselves sandwiched between giant pharma companies and health insurance companies, struggling to consolidate to gain and maintain negotiating power.

 

What to look for: M&A, industry consolidation, and the emergence of non-traditional players, all looking to use technology to “own” the healthcare consumer of the future. Case in point: the new Amazon-Berkshire Hathaway-JP Morgan healthcare venture led by Dr. Atul Gawande.

The digital health platform of the future

The past decade has been an incredible windfall for a handful of dominant EHR vendors who hit the lottery when the ACA and HITECH Acts came into being. However, the rapid, large-scale implementation of EHR systems with poor user experience design created an epidemic of physician burnout even as hospitals digitized clinical workflows and patient medical records. The physician community has pushed back, even as the Office of the National Coordinator for Health IT (ONC) has waged war on the lack of data interoperability between proprietary vendor systems. While EHR maintenance and optimization continue to consume a significant portion of enterprise IT budgets, a new breed of challengers, including large tech firms with deep pockets and vast experience in building consumer-focused platforms, is looking to dominate the digital health landscape of the future. EHR vendors are rising to the challenge, enhancing their platforms and embracing the growing adoption of emerging industry standards such as Fast Health Interoperability Resources (FHIR).

 

What to look for: A breakout digital health platform by a big tech firm such as Apple or Amazon that will integrate EHR data and create superior experiences with last mile solutions while lowering healthcare costs through predictive and preventive care models.

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Digital Health Technologies for Alzheimer’s Disease

Digital Health Technologies for Alzheimer’s Disease | Healthcare and Technology news | Scoop.it

According to The Alzheimer’s Association, there are over 5 million Americans with Ad. It is the sixth leading cause of death. More than 15 million caregivers provided an estimated 18.1 billion hours of unpaid care at a value of approximately $221.3B. The impact of this disease is also well-illustrated in a recent  PBS documentary.  While it might seem incongruous on the surface to discuss digital technology and a population with significant cognitive challenges, I will illustrate how it can be beneficial at different stages of the disease’s course.

 

Cognitive Assessment Tools.  Most tools for assessing cognitive abilities have been of the traditional written form, as offered by the Alzheimer’s Association.  The ability of digital tools to detect early diagnosis of Ad is important in medical and social planning for the patient and family. Some have taken traditional diagnostic tools and transformed them into a digital platform. Such is the case with Quest Diagnostics’ CogniSense.  A more transformational approach is one seen with a utilization of the Anoto Pen which can measure the writing instrument’s position up to 80 times per second. An exciting study by the Lahey Medical Center and MIT’s Computational Science and Artificial Intelligence Laboratory looked at using the Anoto Pen versus traditional cognitive assessment tools for Ad and other diseases. This method has already shown advantages over traditional tools, described in an MIT News piece: “… while healthy adults spend more time on the dCDT [digital clock drawing test via Anoto] thinking (with the pen off the paper) than “inking,” memory-impaired subjects spend even more time than that thinking rather than inking. Parkinson’s subjects, meanwhile, took longer to draw clocks that tended to be smaller, suggesting that they are working harder, but producing less — an insight not detectable with previous analysis systems…”  A digital platform called Neurotrack claims it has the ability to detect Ad at its earliest stages by assessing recognition memory, a function specific to the brain’s hippocampal region which is affected early in the course of Ad. Digital assessment tools like these can also save clinician time and offer a better objective patient assessment.

 

Cognitive Improvement tools. A handful of small studies have shown that ‘brain exercise’ in the form of cognitive augmentation games decreases the risk in normal individuals of getting Ad. One would naturally ask if this carries over to those already diagnosed AD. Some earlier studies suggested this was the case. An older review of multiple small studies showed that while they suggest that brain exercises slowed progression of cognitive decay they did not affect mood or the ability to care for oneself.  It is worthy of noting that patients with larger baseline ‘cognitive reserve’ do better to a point then characteristically have a rapidly progressive course. In a previous post, I discussed the merits of music as an ideal digital health tool. Music should be considered as a potentially much appreciated and useful tool.  Relative to Ad specifically, I would reference the incredibly informative and moving award-winning film Alive Inside, documenting the response of patients with severe Ad to music relevant to their personal past. An intriguing interactive game/tool is Tovertafel, a Dutch technology which projects via suspended box visuals onto a table.  There are various exercises and games on the platform which are both enjoyable and mentally stimulating. Less sophisticated yet popular games are offered by the Alzheimer’s Association.

 

Tools for monitoring daily activities. Technologies have been developed to aid patients with mild to moderate disease and their caregivers to make daily activities easier and safer. SmartSole makes an innersole with a GPS locator with an associated smartphone app and call service for alerts. Silver Mother by Sen.se is a customizable digital tech platform (front door position, room temperature, and water and food containers) connecting caregivers with love ones’ activities of daily living.  For patients with early dementia or for caretakers to connect with loved ones at a distance, grandCAREis a very comprehensive platform and service.

 

While one might associate digital tools with those of us who are “connected,” their utility in the realm of Ad can be profound.  I would submit that the potential for digital tech to prolong independence and/or improve lives of caregivers in the home or at a distance must be the subject of clinical studies.  Public health policy might very well change as a result of such outcome studies.

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The Biggest Areas of Opportunity for Digital Health

The Biggest Areas of Opportunity for Digital Health | Healthcare and Technology news | Scoop.it

Digital health is unquestionably becoming part of healthcare lexicon and fabric. Electronic health records (EHRs) and personal fitness trackers have helped create awareness through use.  The entrepreneurial enthusiasm for the healthcare space is evident by the volume of digital health incubators, medical school innovation centers,  and angel investors.  Though there has been significant sector investment, the road to success of adoption in the healthcare enterprise has been challenging.  I’d like to discuss what I believe are five areas of significant opportunity for quality technologies.

 

  • EHRs. According to most recent statistics from the Office of the National Coordinator,use of EHRs has increased from 20% in 2004 to 87% in 2015. EHRs were designed as documentation centers for billing and regulatory purposes. Relevant clinical patient management data workflow was not a priority and remains a major pain point for clinicians today. According to a study in the American Journal of Emergency MedicineER physicians spend only 28% of their time in direct face to face patient contact and can go through 4000 computer mouse clicks in one shift.  From a provider standpoint. the regulatory and billing data entry should be performed by someone else and relegated to an (almost) invisible part of the EHR.  We need EHRs which are clinically oriented with good user interfaces. Interoperability [defined by the federal Office of the National Coordinator for health information technology (HIT) as the ability of information systems to exchange patients’ electronic health information and use information from other EHR systems without any special effort from the user] is another major pain point that needs to be addressed. .Six years into Meaningful Use we have yet to achieve any significant interoperability of EHRs. There are hospitals within the same healthcare system in many places with disparate EHRs which do not talk to each other or exchange information.  Increasing healthcare consolidation of hospitals has exacerbated the problem of lack of interoperability. Health Information Exchanges (HIEs) have been woefully underfunded and have fallen short of their vision. There remain many opportunities for technologies to assist in achieving true interoperability.

 

  • Clinical trials. CIOs are constantly inundated with requests to purchase new technologies which will “save money, improve patient satisfaction and outcomes and decrease readmissions.” What is in fact lacking in most cases is evidence for these claims.  The hesitation of many entrepreneurs to embrace the intuitive adoption requirement of proof of claim (which needs to be said should not differ from the adoption of product in any field of endeavor making claims) is the misconception that time-consuming large costly randomized clinical trials are what I am referring to. This should not however translate to “take my word for it” is all you need. I agree that traditional trials are neither practical nor necessary for most tools. Even the FDA has now recognized with thoughtful and cautious restraint a role for ‘real world evidence’(defined by the legislation as “data regarding the usage, or the potential benefits or risks, of a drug derived from sources other than randomized clinical trials,” including sources such as “ongoing safety surveillance, observational studies, registries, claims, and patient-centered outcomes research activities.” in the approval process of drugs. Thus, the opportunity for trials utilizing digital registries, mobile clinical trial platforms, quality communications and analytics tools is significant.

 

  • Artificial Intelligence (AI). One early definition of Artificial Intelligence (AI) in medicine (1984) was “…the construction of AI programs that perform diagnosis and make therapy recommendations. Unlike medical applications based on other programming methods, such as purely statistical and probabilistic methods, medical AI programs are based on symbolic models of disease entities and their relationship to patient factors and clinical manifestations.” Today a broader definition may be applied: “the simulation of human intelligence processes by machines, especially computer systems. These processes include learning (the acquisition of information and rules for using the information), reasoning (using the rules to reach approximate or definite conclusions), and self-correction.” The use of artificial intelligence in medicine has been the subject of intense and rapidly growing interest in medical, computer science, and business arenas.  The market growth of AI is based on its projected impact on both technology and non-technology sectors. There have been arguments for and against the inevitability of replacement of physicians by AI technologies for a while now. The debate continues. BASF declared “We don’t make the household product, we make the product better.” An analogy can surely be made with AI. It runs in the background of technologies already in use but will make them run faster and more importantly will add a dimension of relevance of incoming data.

 

  • Personalized medicine. The National Cancer Institute’s definition of personalized medicine is “a form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease…” Personalized medicine is medical care directed in whole or part from information specific to an individual.  Discoveries in the area of the genetics of cancer have resulted in the development of drugs no longer targeted towards an anatomical location but a specific genetic marker. A landmark clinical trial in which drugs are given solely on the basis of genetic markers identified in the cancer tissue itself is the NCI-MATCH Trial (Molecular Analysis for Therapy Choice). “Patients with advanced solid tumors, lymphomas, or myeloma may be eligible for MATCH, once they have progressed on standard treatment for their cancer or if they have a rare cancer for which there is no standard treatment.” The role of personally derived connected data (from sensors external or internal to the body) will also facilitate personalized medical care. Opportunities thus exist for life sciences and technology companies to develop products for this new therapeutic approach.

 

  • Social Media. An early observational study of synergistic impacts of healthcare and social media demonstrated that personal experiences and not data drive social media healthcare discussions. One early survey of physicians on their use of social mediafound that “85% of oncologists and primary care physicians use social media at least once a week or once a day to scan or explore health information. Sixty percent said social media improves the care they deliver.” The potential for social media to disseminate information from published clinical trials, the exchange of professional education among peers, and discussions surrounding disease states is invaluable.  To be sure there exist professional and regulatory guidelines for the use of social media for providers, vendors and other healthcare stakeholders.  Social media open platforms in healthcare have proven successful for patients, caregivers and others.  Examples areTreatment Diaries, patientslikeme, and WEGOHEALTH.  Potential opportunities here involve recruitment of patients for clinical trials, gleaning real world evidence data from discussions.

 

By no means is this a complete discussion of opportunities for digital health. These are what I consider the ‘biggest bang for the buck’ ones doable today. I look forward to comments and the sharing of experiences from others. As a consultant I am amazed on a daily basis at the high quality clinical, financial and personal experience energies devoted to the development and advocacy for digital health tools. Bring it!

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Who ‘owns’ the healthcare consumer of the future?

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

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

 

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

Digitalization and healthcare consumerism

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

 

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

 

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

Data, analytics, digital

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

 

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

 

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

Bricks and mortar is not going away

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

The future of healthcare consumerism is not an either/or

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

 

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

 

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

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Digital health’s last mile problem

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

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

 

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

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

 

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

 

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

The Last Mile problem

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

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

Addressing the bottleneck

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

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

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

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

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

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

 

1. It’s not just about reimbursements

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

 

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

 

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

 

2. Trust is a key component of effective telemedicine

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

 

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

 

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

 

3. Personal and professional infrastructure is key

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

 

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

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Digitally managed clinical trials will accelerate results and reduce costs 

Digitally managed clinical trials will accelerate results and reduce costs  | Healthcare and Technology news | Scoop.it

Digitally managed clinical trials have the potential to accelerate results report and reduce costs but workflow questions and regulatory questions remain. In many facets of our lives, digital data collection has improved services, eliminated errors, and reduced waste in time and resources. Think about the ticketing and check-in process at airports ten years ago vs. today: when airlines put the information in our hands we were able to do the check-in, seat selection, and other work for them. Plus, we were happy to do it. Also consider ATMs, online banking, and retail banking for how we are able to move money, get cash, and get loans by providing data ourselves and get immediate services. When we think about the medical industry, though, very little of the kind of automation created by self-service digital data collection exists. While we can see some patient portals and self-service triage apps appearing in limited uses, large-scale use seems very far away. One specific area that digital data collection can, potentially, literally save lives is in clinical research. The use of digital collection tools, primarily mobile devices, in clinical studies, is nascent but growing. Evidence indicates that these tools have the potential to significantly improve the quality of research outcomes and reduce the costs associated with such research, but there are still questions about how exactly these tools will work and some of the issues surrounding electronic data collection. To help answer some common questions, I spoke with James Emerson, who is a director of clinical research and helps run a variety of clinical trials.

How are mobile devices being used for digital data collection in clinical research?

For several years now, IT in the enterprise has been moving toward consumerization; that is, people are bringing their own devices to work and many of the same applications are used outside of the office. Clinical researchers have realized that same consumerization of IT that is revolutionizing the way that we work can do the same for research. Trial participants using clinical trial research technology are able to use their own smartphones, tablets, and other mobile devices, which makes it much more likely they will comply with the requirements of the study.

Essentially, depending on the setup of the study, patients simply need to input information into an application, eliminating the need for paper journals or surveys.

 

While research indicates that most patients actually prefer this technology over other forms of data collection, in particular, voice response systems, there are still some challenges. One thing that researchers need to overcome are the differences among devices themselves, and how applications actually function on different devices.  Training trial participants — and providers — in the use of the application is an important task. Connectivity issues are also a concern, as is privacy. Protecting sensitive personal information is of paramount importance, and researchers are cognizant of the need for data protection protocols and security, both in terms of protecting the devices themselves and in the transfer of data.

Why are digitally managed clinical trials ideal for clinical research?

Digital data collection has many significant benefits. For starters, it reduces costs. Major clinical studies often have thousands of participants, all of whom need to be trained in how to record data and submit it to their providers. That data also needs to be collected and analyzed, often manually. Digital data collection reduces or eliminates the need for many of those expensive tasks. When clinical trial participants are allowed to use devices that they already own and are familiar with, the complexity of the training and on-boarding decreases and compliance increases.

 

The simplified data collection process also has a significant impact on the overall quality of the study. Again, compliance is a major benefit. Studies have shown that patients vastly prefer mobile data collection over other options like paper journals or interactive voice response systems. It’s simply much easier to input your data into your mobile device and move on with your day than it is to navigate a complex menu of voice response options or fill out a paper questionnaire.

 

The accuracy of the data collected also improves; when patients use paper journals, for instance, they have a tendency to add additional extraneous information or skip questions, which can affect how the data is analyzed. Not to mention, when the researchers have access to real-time data, they can identify compliance issues earlier on and monitor patient safety more efficiently, improving the overall outcome of the trial.

 

While digital data collection can improve the accuracy of the data collected, there are some obstacles to overcome. Digital data collection protocols require that researchers consider facets of study design that they might not have otherwise. For example, what happens if a device is lost or stolen? How can we protect that data and the integrity of the study? We need to use a technology infrastructure that complies with regulatory protocols, but that is also easy for subjects to use.

 

Many researchers are also concerned about equivalence among the devices being used. In other words, are all of the subjects having the same experience when using the application, and how do differences affect outcomes? These are all questions that researchers are considering in their study design.

Can digitally be managed clinical trials really save that much money?

The short answer is yes. In 2014, the Department of Health and Human Services released a report estimating that using mobile technologies in clinical trials has the potential to save clinical research organizations (CROs) tens of millions of dollars. The greatest savings come in the later stages of trials, but even in the early stages, mobile saves money.

Are there regulatory issues related to the use of digital collection tools that CROs face?

The FDA is actually encouraging CROs to do as much electronically as possible. That being said, yes, there are some stringent regulations that CROs must adhere to that ensure the accuracy and protection of the data. The FDA has issued guidance on how CROs can capture and use data to maintain those protections.

Are there times when digital data collection isn’t ideal? What about barriers to participation?

While it might seem like everyone on the planet has a smartphone these days, the fact is that there are some people who either do not have access to the technology necessary to participate in a research study via a mobile device or have the skills to do so correctly. It’s important to carefully assess the target population of the study to determine whether digital data collection is appropriate or if more traditional methods would be a better choice.

 

For example, many older adults either do not have or do not use smartphones and aren’t interested in learning how to use the application to participate in the research. For someone who isn’t a digital native, using an application to record data could be intimidating or confusing.

 

Another issue is a lack of access to the internet or cellular service. In many rural areas of the country, access to broadband is still limited, and cell service is limited or nonexistent. Relying solely on digital data collection via smartphone has the potential to exclude viable candidates from research studies, simply because they cannot provide data efficiently. We need to be very careful in how we design studies, and the technological requirements, or risk inadvertently creating disparities within the study population based on economic or geographic situations.

 

And of course, not all studies lend themselves to self-reporting — and as with any self-reported data, there will always be a margin of error. Researchers need to carefully consider their reasons for choosing digital data collection, and evaluate whether they are ideal for an individual study.

Are digitally managed clinical trials really the future of clinical research?

Yes, we believe so. The fact is, the old ways of doing things are no longer infallible. Using digital tools has the potential to solve many of the long-standing problems within clinical research, including low study recruitment numbers, gender bias, accuracy, compliance, and more. By incorporating digital tools, new, more effective treatments can get to market faster while keeping patients safe and improving their overall health.

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Apple’s EHR: Why Health Records on Your iPhone is Just the Beginning? 

Apple’s EHR: Why Health Records on Your iPhone is Just the Beginning?  | Healthcare and Technology news | Scoop.it

Americans on average will visit a care provider about 300 times over the course of their lives. That’s hundreds of blood pressure readings, numerous diagnoses, and hundreds of entries into a patient’s medical record—and that’s potential with dozens of different doctors. So it’s understandable, inevitable even, that patients would struggle to keep every provider up-to-date on their medical history.

 

This issue is compounded by much of our healthcare information being fragmented among multiple, incompatible health systems’ electronic health records. The majority of these systems store and exchange health information in unique, often proprietary ways—and thus don’t effectively talk with one another.

 

Fortunately, recent news from Apple points to a reprieve for patients struggling to keep all of their providers up-to-date. Apple has teamed with roughly a dozen hospitals across the country, including the likes of Geisinger Health, Johns Hopkins Medicine, and Cedars-Sinai Medical Center, to make patient’s medical history available to them on their phone. Patients can bring their phone with them to participating health systems and provide caregivers with an up-to-date medical history.

 

Empowering patients with the ability to carry their health records on their phone is great, and will surely help them overcome the issue of fragmented healthcare records. Yet the underlying standardization of how healthcare data is exchanged that has made this possible is the real feat. In fact, this standardization may potentially pave the way for innovation and rapid expansion of the health information technology (HIT) industry.

 

Growing agreement upon a standard way to store and exchange electronic healthcare information is what made Apple’s foray into health records possible in the first place. Fast Healthcare Interoperability Resources (FHIR) emerged four years ago as an interoperability standard for electronic exchange of healthcare information. It is a standard framework for the sharing, integration, and retrieval of clinical health data and other electronic health information. Enough agreement upon such a standard for health information exchange has promoted modularity.

 

How modularity fast-tracks innovation

A system is modular when all its components fit together in a standardized way, whether physically, mechanically, chemically or in this case digitally. This standardization enables people to design one component without having to know how everything else in the system works. An everyday example of this is the USB port. It is a standard cable connection interface upon which any number of products can connect—whether it be a keyboard, a charger, external memory, or any other device that can meet the specification. This differs from interdependent systems, in which the design of parts are customized, nuanced, and how they work together is not widely known. Thus, a designer has to know how the whole system works to be able to design any part of it.

 

In the case of the FHIR standard, the manner in which digital healthcare information is exchanged is modularized—the rules of the road are established and easy to follow. Adoption of this bit of digital standardization, by an influential group of healthcare providers, is what allowed the third-party giant, Apple, entry into the modular electronic health records game. Even though their experience in healthcare is limited, the standard lays out the rules well enough for them (and other third parties) to participate in the HIT market.

 

We’ve learned in the past that the creation of and agreement upon standards can expand industries by creating a new ecosystem in which third-party players can add value. In fact, the preeminent example of this type of ecosystem creation is Apple itself, and their AppStore.

 

Along with their AppStore, Apple created a set of standards that specified how third-parties (from companies to individual hobbyists) can more easily create applications that make use of the information on their phone and the Internet. These apps were made available to Apple’s network of users and developers were paid according to the amount of revenue the app generated by Apple (based on usage). Over the span of 10 years, Apple has paid AppStore developers $86.5 billion (paying out $26.5 billion in 2017). The rapid expansion of the market for creating substitutable apps in return gave everyday users the ability to harness information in any number of more convenient, simple, and potentially meaningful new ways.

 

What does this relatively recent and still unfolding story mean for HIT? It means that as opposed to merely viewing your health record, standardization may also allow for the creation of new tools that actually make use of your health record in new, meaningful ways. For example, developers may create an app that helps patients understand their risk of a cardiac event base pulling specific data points from the health record. In short, applications can be created by third party creators for use by the patient that make their healthcare data more accessible, easier to understand, and more actionable.

 

In this way, not only does modularity stand to make healthcare data more accessible to providers, researchers, and public health organizations (current consumers of health data), but to a new market—the patient. Standardization mediated by the adoption of FHIR opens up the market for innovators outside of the traditional health IT industry. These new players can then compete to reach everyday people (just as app creators did on Apple’s AppStore platform), with useful tools that empower them in their struggle for health.

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Major Challenges remain for Health IT Interoperability 

Major Challenges remain for Health IT Interoperability  | Healthcare and Technology news | Scoop.it

The road to the seamless sharing of patient data across the digital health care spectrum is not measured in miles or meters, but in the continued collaborative efforts of the public and private sectors to build and regulate networks for the free flow of information.

 

But for all of its efforts, the Office of the National Coordinator for Health IT concedes that path to interoperability remains winding. That’s why it hosted two panel discussions Tuesday for National Health IT Week to talk about the challenges and successes of the adoption and sharing of electronic health records.

 

“We certainly still have a long way to go with health IT, whether it be usability or interoperability, but we wanted to talk a bit about where we’ve come so far,” said Principal Deputy National Coordinator for Health IT Genevieve Morris.

 

The panels focused on both the interoperability of the digital devices storing EHRs and their usability in an effort to map out where the health sector is and where it still has to go.

Among the takeaways were:

 

It’s not a tech problem — it’s leadership 

Ed Cantwell, president and CEO of the Center for Medical Interoperability—a nonprofit research lab advancing data sharing in medical technology—said that while innovation is being spurred through the health care sector, the gap in information sharing is coming from a lack of collaboration.

 

“I have a hypothesis that you could put 20 executives in a room representing comprehensive interoperability, there would be vendors, hospital CEOs and physicians, but it’s not a technology problem,” he said. “It’s a lack of coordinated leadership. I think the call to action is let’s put those people in a room. Every other industry has done it, they’ve come together and put their differences aside.”

 

Cantwell also said during the panel that while ONC does have the leverage to guide the policy direction of health IT, the private sector will have to lead the move toward greater interoperability.

“I think this is the time where the private market needs to step up,” he said. “Whether it’s for-profit or nonprofit or public or military or [the Department of Veterans Affairs], if we are to start the slurry of digital and set a goal to be on parallel with every other data liquid industry, then I think we need to stop this fantasy of think that ONC can, from the sidelines, impact a $3 trillion market.”

 

There’s no one-size-fits-all

John Kansky, president and CEO of the Indiana Health Information Exchange, said that part of the challenge of interoperability is that it has to serve a diverse range of needs across a wide network, from physicians to hospitals to insurance providers.

 

“I don’t think moving health care data around the country is any less complicated than moving people and stuff around the country,” he said. “Interoperability isn’t one thing. Every organization has complex interoperability needs.”

 

Kansky said that both government and the market have distinct roles in guiding and adapting interoperability and have to collaborate to ensure that they can make it more efficient.

 

Hard-to-build software to meet every need

Andrey Ostrovsky, chief medical officer at the Centers for Medicare & Medicaid Services and the Children’s Health Insurance Program, said it’s very difficult to design a product centered on its ease of use while also delivering functionality that serves the layers of users in health care.

 

“It’s very hard to build software well,” Ostrovsky, the former CEO of predictive insights platform Care at Hand, said. “It’s even harder to build software well when you have multiple end users. When we talk about the federal government’s role in somehow influencing how software gets developed or evolves, we not only have the design constraints of what does the patient need but also what does the physician need, what does the practicing admin need, what does the potential payer need in terms of reporting, and then we’ve got what does the federal government need?”

To try to bridge those gaps, at least when it comes to physician adoption, ONC Chief Medical Information Officer Andrew Gettinger said the office is working with MedStar to develop a usability package to help smooth the rocky process physicians face in implementing an EHR system.

 

“Putting in an EHR is very different than buying an automobile,” he said. “If you are buying an automobile, you have a couple different choices for color and drive off the lot pretty quickly. When you do an EHR, there are hundreds and perhaps thousands of small decisions that the implementation team makes along the way.”

Gettinger said ONC expects the usability package to be out by March 2018, which will hopefully provide doctors with a streamlined process for EHR adoption.

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Advancing healthcare through technology

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

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

 

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

 

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

 

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

 

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

 

Together, we all make a difference!

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Digital health startups need a “moat”

Digital health startups need a “moat” | Healthcare and Technology news | Scoop.it

At a recent healthcare conference I attended in Silicon Valley, I met an entrepreneur who introduced himself briefly thus: “I’m the CEO of [his company]. We’ve raised $50 million in VC money.” That was it. No introduction to his product, no mention of how many employees, what clients they serve, or anything else about his business.

 

I wondered if this is the new digital health startup landscape, where raising millions of venture capital or VC money is the goal, not necessarily a means to a goal.  

 

Let the facts speak for themselves. Digital health funding exploded in the first half of 2018, at $6.8 billionuntil the end of Q3, according to Rock Health, one of several firms that tracks these numbers. More investors, bigger average ticket sizes, more companies funded; there is no better time to be a digital health entrepreneur. Money seems to be there for the asking. Big money, early on. Series A looks like the old Series B. (The last time I saw anything like this was when people were buying second and third homes a decade ago with easy credit.)

 

What do the latest digital health funding numbers tell us?

Let us parse the latest numbers a bit. The most significant funding category in the report has been “on-demand healthcare services,” which includes any form of telemedicine and at-home healthcare services. This makes sense. Healthcare is shifting away from the clinic and hospital environments to home-based and virtual healthcare. Indeed, this shift is the whole premise of digital health transformation at this time (never mind that the reimbursement model for virtual care delivery is yet to evolve). Other dominant funding categories included consumer health information, fitness and wellness, and disease monitoring. All these categories of healthcare services are primarily delivered through mobile apps or with the help of remote sensors and devices from which data is harvested to personalize the service.

 

The slew of digital health startups, continuing to raise eye-popping amounts of venture capital money, flies in the face of what the naysayers have predicted for the past couple of years – that most of these startups are “zombies” headed for certain death in the next 18 to 24 months. Evidently, that has not happened. Is there something we’re missing?

 

The Rock Health mid-year funding report provides a couple of clues to solve the mystery. Firstly, the number of exits, especially in the form of IPOs, has significantly trailed behind the fund-raising. While more companies are progressing to later funding rounds and getting there faster than before, there does not seem to be a definite end in sight. Maybe the dam is about to break, and we will be flooded with IPOs next year, but it certainly does not look like it now. Secondly, the exits that are happening are those where one digital health company is acquiring another. This could also explain why the conference I attended felt as if it was a group of digital health startups pitching to other digital health startups. Hardly anyone in attendance seemed to be from the VC or healthcare enterprise community unless they were there in the role of speaker or panelist.

 

So, the first thing we learn from the latest funding report is that digital health startups are not scaling fast enough to merit IPOs or big exits. This is the rock they are pushing up against. I have discussed this in a previous column here.

The “kill zones” for digital health innovation

In my book, The Big Unlock, I classified the technology vendor landscape as Custodians (electronic health record or EHR firms), Enablers (big tech platform companies like Google and Microsoft), Innovators (startups) and Arbitrageurs (consulting firms). There is a degree of inter-dependency among all these categories of vendors when it comes to transforming healthcare through technology. However, there are significant asymmetries in the interdependencies.

 

As an example, innovative startups cannot go on their own if they are looking to sell their solutions to large enterprises. For the most part, digital health startups are focusing on “last mile” solutions. These solutions must sit on another platform such as a Google or Microsoft Health Cloud, or more likely an EHR, such as a Cerner or Epic. While many of these new digital health solutions are innovative and user-friendly, there are many reasons they do not reach scale quickly. In this piece, I discuss the several “kill zones,” or situations a startup can find itself in and become vulnerable to external forces.

 

A common kill zone is the pilot phase deployment for a digital health solution in a large healthcare enterprise. “Death by pilot,” “pilotitis” and “pilot purgatory” are some of the colorful terms used to describe this painful situation. The gaps in handoffs between innovation groups and operations in the health system is another. Innovation groups by and large are set up as separate, stand-alone units which, while facilitating innovation, often fail in the process of transiting the solution to a broader adoption through the enterprise IT function. The no man’s land between the Chief Innovation Officer and a CIO is a potential kill zone for startups.

 

Even if digital health startups successfully cross the Rubicon into CIO-land, they face the ultimate kill zone: a dominant EHR vendor who has a similar solution on their product roadmap. Many health systems will choose to go with the EHR vendor’s solution by default even if the choice is to go with an inferior solution.

 

“Kill zones,” where innovators can be put out of business simply by being in the wrong place at the wrong time, are common threats to startups across the spectrum. Digital health startups need a “moat” – an unsurpassable advantage from a superior product or service to keep the big tech firms at bay. The investors pouring money into these startups are presumably betting on some of the startups achieving just that. For the vast majority of digital health startups that do not have it, they can only hope to continue to raise money and stay afloat till they become cash flow positive or score a successful exit. The other options are not pretty.  

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4 most important healthcare trends in 2018 

4 most important healthcare trends in 2018  | Healthcare and Technology news | Scoop.it

To say that it has been a tumultuous year for the healthcare industry is an understatement. Federal policy changes and recent transactions involving large insurers, health systems and retailers will affect providers, payers and patients alike.

 

While there are many new and emerging trends we need to pay close attention to in 2018, here are what I think are the four most significant issues that will command our attention in the year ahead.

 

1. Inconsistent healthcare policy will continue to dominate the headlines

 The federal debacle with so-called healthcare reform this year has been a case study in confusion, inefficiency and lack of focus. Every week seemed to bring a new twist in the direction of healthcare policy, especially in regards to the ACA, with almost no consistency to the legislative thought process. In many ways, the whole focus of ACA repeal and replace efforts was misguided — you can't take something apart without some ideas for a replacement. The federal government's lack of direction on healthcare policy has created chaos among all industry players.

 

Given the healthcare provisions in the proposed tax bill and potential future action with the ACA, there are serious implications for states across the country. The confusion surrounding Medicaid and other joint federal-state partnerships has discombobulated state budgets, and it is patients who will ultimately face the harshest consequences if states are forced to slash funding for healthcare.

 

For the foreseeable future, we're going to continue to see inconsistency in government policies and funding. This is especially dangerous for hospitals in underserved communities that rely almost exclusively on Medicaid and Medicare funding. Unless they are supported in some way, many of these providers will sink deeper into debt.

 

2. In order to keep pace with newly formed organizations and partnerships, hospitals and health systems need to innovate

 

The CVS-Aetna deal did not come as a surprise to industry leaders who have been keeping their ears to the ground and have paid attention to recent trends. But nevertheless, this merger is a major shake-up that cannot be ignored. Google, Amazon and IBM Watson are all looking to stake out a piece of the healthcare field, and deals such as  Optum's purchase of DaVita Medical Group underscore the ever-evolving nature of the ways people access and pay for care and services. Providers should not view this movement as a threat that must be stopped. Instead, we should spur innovation on our end. We can't sit still. That's why, in Northwell Health's case, we have been forging new partnerships and pursuing ventures that will enable the organization to compete more effectively in this rapidly changing environment. 

 

It will be especially intriguing to see what market segments CVS and Aetna pursue after the merger is finalized. Undoubtedly, they will offer prescriptions, preventive care and other primary services to supplement CVS' "Minute Clinics," but it remains to be seen what other health services will be provided as part of this new collaboration. Regardless of what new competitors enter the healthcare market, the seriously ill, elderly patients with chronic conditions and those who have suffered traumatic injuries will still be relying on hospitals to take care of them. It's highly unlikely that any of the new players will be providing inpatient care. As we all know, the bulk of healthcare funding is spent on long-term care for people at the end of life. The Amazons and Googles of the world are not targeting that population.

 

Recognizing that traditional healthcare providers do need to adapt to this era of consumerism, among my strategies are to continue expanding our ambulatory network, facilitating innovative partnerships, enhancing efforts in prevention, maximizing our use of artificial or augmented intelligence, and improving our already robust telemedicine program.

 

In the end, I believe competition is good. Market disruptions give all of us headaches, but they are ultimately beneficial because they force us to do better and be more efficient, productive and creative

 

3. Unless we continue to improve the customer experience, customers will go elsewhere for care

 

The more competitive the market becomes, the more work we as providers must do to continually improve the patient experience and develop customer loyalty. This can partly be done through improving communication and curating a more retail-focused experience.

 

This is unbelievably important, as patients now have more access and choice for their healthcare than ever before. This is not limited to the in-person experience, but also how hospitals and health systems communicate with patients to help them get information and make appointments. Online and mobile platforms are already important for engaging customers, and they will only grow more essential in 2018.

 

Online engagement is not only for younger patients. It's a medium that has become increasingly more effective than print or broadcast advertising for reaching older patients. Equally important is creating an experience that connects families with providers. We deliver more than 40,000 babies every year in our health system. Those are 40,000 families with whom we could be creating life-long bonds. Pursuing initiatives to maintain a connection with mothers and families is essential.

 

Over the past five or six years, we've seen major changes in the way innovative organizations in all industries treat their customers. For far too long in our industry, there was a pervasive attitude of, "We're hospitals, or we're physicians, people will always come because we’re here in the community," but those days are over. Consumers don't want to be told when to come or what to do – they want to access care and services on their terms, not ours. We are in the consumer service business, and our patients are educated and knowledgeable. They value easy access, a pleasant experience and quality care, so it's our job to adapt quickly to meet their needs and expectations. 

 

4. Strategies about "healthcare" must now encompass behavioral and mental health

 

As social stigmas surrounding mental health begin to break down and more people feel comfortable confronting behavioral health issues, it is the responsibility of providers to design their systems in a way that addresses the needs of these individuals. This is especially important at a time when opioid abuse has become one of this nation's most-challenging public health crises.

 

The problem goes beyond drug and alcohol abuse. For instance, studies have shown that younger generations' increased use of technology, particularly mobile devices, can lead to increased rates of anxiety, depression or loneliness. We as providers must consider these trends and tailor services accordingly, as more and more patients turn to us seeking care for issues that are destroying lives and breaking up families. All of us need to do a better job developing and training staff to meet this demand, especially when it comes to screening those who are trying to hide their addictions to opioids. It entails not only psychiatrists but nurses, social workers, case managers and other clinicians.

 

Regardless of the issues we face in this ever-evolving industry, we as providers must not resist change. We must continually adapt — those that don't will get left behind.

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Digital Technologies can Address Cancer

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Five Digital Health Imperatives for Patient Safety

Five Digital Health Imperatives for Patient Safety | Healthcare and Technology news | Scoop.it

The most discussed issues in healthcare today are cost savings and access to care.  There is no denying their rightful preeminence in the public discourse.  Something which has received more attention in the past but has been surpassed by the aforementioned topics in both lay and healthcare policy press has been patient safety. Perhaps the best definition of patient safety is that of the World Health Organization. Simply put, it is “…the prevention of errors and adverse effects to patients associated with health care.” Patient safety initiatives have taken many forms. Most are aware of public awareness (ex. healthcare worker hand washing) and regulatory clinical requirements (ex. wrong site/procedure/ person surgeries) publicized in the past. Digital tools now present opportunities for unprecedented improvements in patient safety. I would like to highlight a few.

 

  • Improving health literacy. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health  What does health literacy have to do with patient safety? People who do not know their diagnoses when they leave an office visit or hospital (some estimates are 60%) or do not know the reasons for each medication they are prescribed are much more likely to be non-adherent to medical advice or recommended treatment regimens. In fact, low health literacy is related to higher mortality rates. In a post I wrote here in 2012, I discussed some of the implications of low health literacy. In one study last year examining the extent of use of digital health tools in relation to health literacy, it was found that those subjects with low health literacy used these tools less. Though there is much to be desired regarding the analysis in this study, the authors are to be commended for the number of participants (>5000) and for highlighting how health literacy and digital technology can affect each other.  According to the Department of Health and Human Services, only 12 percent of US adults are health literate. Improving health literacy via digital tools is not only an opportunity it is necessary. The 15 or 20 minute office visit does not afford even the best physician to explain a diagnosis or proposed treatment plan in a digestible way a patient and caregiver deserve. Language barriers compound the health literacy dilemma. There is a well-established legal framework for language access. The cost to providers and inaccessibility outside of the clinic or hospital make mainstream language translation technology insufficient to close gaps in care.  Mobile non-human digital language translation tools will hopefully soon become the preferred alternative.

 

  • The use of AI in workflow. There’s been a lot of buzz about artificial intelligence (AI). The present popular conversations surrounding AI involve speculation whether AI will replace humans in every possible aspect of healthcare. There are even statistics bantered about as to percentage of physicians, nurses, and others who will lose their jobs to AI technology.  That aside, AI can have a significant role in improving patient safety.  Medtronic, Masimo, and others are working with the Patient Safety Movement Foundation by sharing de-identified data from medical devices in designing predictive analytics programs with the ultimate goal of improving patient safety. Many software platforms exist which claim they improve patient safety but evidence is scarce.  In advertizing their software, many companies equate hospital readmissions with a patient safety metric though strictly speaking it isn’t by the definition above unless it is related to a complication of treatment rendered during the prior hospitalization. Predictive analytics and other AI may however be relevant to patient safety by gathering data from the patient’s EHR (and heaven help us one day from data sets of other systems) to predict both minor and major preventable adverse events. AI platforms have the opportunity to make all the data about a patient come to life, integrate and provide a real-time picture of what is happening to the patient and provide alerts which might change treatment. AI is technology which needs to be incorporated into workflows which themselves are designed with maximum patient safety in mind. In this manner, the human aspect in patient safety is still important.

 

  • The use of digital tools for inventory and other tracking. Inventory tracking in both the enterprise and ambulatory clinic is an important patient safety issue.  Equipment servicing schedules, drug, medical device, patient and personnel tracking and other logistical considerations are important in patient safety. RFID and other advanced digital technologies have been developed to help in this regard.

 

  • Improving the electronic medical record (EHR). A 2016 study published in the Journal of Patient Safety demonstrated a 17-30% reduction of in-hospital adverse events in patients with cardiovascular diagnoses, pneumonia or a diagnosis leading to surgery when a fully electronic EHR is used. Specifically the adverse events included hospital-acquired infections, adverse drug events (based on selected medications), and post-procedural events. As this studied playing field has leveled today with the vast majority of institutions utilizing completely electronic records, there exist yet more opportunities for improving patient safety with EHR associated technologies. One hot button issue is that of matching of patients with their own EHR record. The challenge lies in the strong legislative opposition to a unique national patient identifier.  To this end the Office of the National Coordinator has launched a Patient Matching Algorithm Challenge.  Other ways in which the EHR can improve patient safety involve the use of AI (see above). Input from patients in reviewing their records via the patient portal is arguably the first place to start.

 

  • IT security. IT security is a direct and indirect threat to patient safety. This has been demonstrated with cardiac implantable electronic devices and recent global IT hacking which involved hospital systems. A technology called blockchain was developed in 2008 and has found its biggest interest in the financial industry. The use of blockchain in healthcare has been discussed for a number of years.  However there exist significant challenges in the utilization of blockchain for patient records.

 

While popular discussions focus on health insurance coverage, shortcomings of EHRs and the health system in general, we must never lose sight of what should be the focus of care itself, patients.  Healthcare must be accessible, affordable, efficient, of high quality with good outcomes and most of all as safe as possible. Patient safety should always be a metric of good care and new programs and technologies.

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How blockchain can address the two biggest challenges in healthcare IT

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

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

 

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

Taking a look at the healthcare blockchain pioneers

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

 

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

 

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

What it will take for blockchain initiatives to succeed

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

 

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

 

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

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

 

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

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No dilemma for innovators in healthcare

No dilemma for innovators in healthcare | Healthcare and Technology news | Scoop.it

The big trends in healthcare today are rising consumerism, a shift to value-based care, emerging data sources, and the use of advanced technologies for improving care delivery and reducing costs. There is unprecedented innovation opportunity in the digital transformation of healthcare.

 

At a recent industry event, I moderated a panel discussion on innovations in health care with a group of technology innovators and healthcare veterans. We all agreed that technology-led innovation was accelerating rapidly, but the innovation landscape had a set of unique challenges as well. In this post, I share some of the key thoughts from the discussion.

The market landscape for healthcare innovation

In the past few years, we have seen several significant changes in the market for technology-led innovation in health care. Here are some important trends.

 

  • A shift towards the virtualization of health care. Many routine health care services are now available on your smartphone – a perfect example would be urgent care visits or routine consultations. According to one report, there are over 300,000 health apps in the Apple and Android stores. However, only a small number have reached critical mass, indicating that consumer preferences for virtual care are changing slowly.
  • Huge amounts of venture capital pouring into digital health: $11.5 billion in 2017, according to one report. The first quarter of 2018 has seen continued investments in digital health, serving as a validation of the promise of digital health innovation and the opportunities in the digital transformation in health care. At the same time, many of these startups are struggling, exits are not keeping pace with expectations, and a few that have raised very large amounts of money, such as Outcome Health, have gotten into trouble for trying to find short-cuts to growth and profitability.
  • Innovations from big technology firms are also struggling to gain traction. Recent troubles at IBM’s Watson Health business which has reportedly laid off significant numbers of employees in the face of market and organizational challenges indicate a deeper problem for the business model itself.
  • New data sources such as genomics, wearables and social determinants are driving a whole new way of managing patient populations. Unstructured data, such as clinical notes, is now the new goldmine that people are digging into, with the help of emerging technologies such as AI. Other emerging technologies, like blockchain, are still in early stages but with great potential. However, data interoperability, especially with the big electronic health record (HER) systems like Epic and Cerner, remains a challenge.
  • We are in the early stages of breakthroughs such as gene-editing with CRISPR (powered by massive data analytics capabilities) that are likely to transform healthcare, along with an explosion in smart sensors and wearables. Other technologies, such as augmented reality (AR) and virtual reality (VR) are in very early stages but show enormous potential in transforming the way healthcare is delivered in the future.

Health care’s innovation focus and the players

A recent survey by Modern Healthcare indicates that health care consumerism is the no. 1 area for innovations, followed by clinical practice, or care delivery, and payment reform or alternate payment models. Most respondents in the survey felt that innovation was accelerating.

 

Data from Rock Health, a venture capital (VC) firm, lines up with the survey responses. While disease diagnosis and treatment remain significant focus areas, consumer empowerment is emerging as a strong funding category, confirming the rise of consumerism in health care. As healthcare shifts progressively away to virtual care delivery models, interest in telemedicine, remote monitoring, and alternate care delivery models continue to drive innovation.

 

It’s not just VC firms that are funding and driving technology-led innovation in health care. We are seeing health systems getting into the innovation game themselves by setting up funds.

 

Examples include Partners Healthcare, UPMC, Intermountain and Mayo Clinic, to name a few. While these funds are relatively small, the opportunity for promising startups with innovative solutions to accelerate the path to product validation and market acceptance improves with the support of the sponsoring health system.

 

We are also seeing some non-traditional partnerships emerging. The big announcement earlier this year by Amazon and Berkshire Hathaway, and the more recent announcement by a consortium of healthcare companies to invest in blockchain technology are examples.

 

Despite health care's reputation as a slow follower of technology, the innovation ecosystem is buzzing. In my book, the Big Unlock, I refer to four categories of technology solution providers: The Custodians such as the EHR vendors, who have the data and the workflow; the Enablers, which are big companies like Google, Microsoft, and Salesforce who have invested in health cloud infrastructures that can be rented for building digital health experiences; the Arbitrageurs, which include global consulting and technology services firms who rely on information and labor arbitrage for developing and delivering technology solutions; and finally the Innovators, which include the hundreds of startups and VC-funded companies who are developing entirely new ways to deliver health care. Every one of these categories is innovating in their own way.

 

At the heart of the innovation ecosystem is a final category of innovators, namely the healthcare enterprises. Leading health systems are innovating with health care delivery models and pricing/contracting models and are using technology to enable their digital transformation.

Into the great wide open

Despite all the activity and the fierce competition, there is good news for innovators; the market is wide open, and there is no single dominant entity in the digital health innovation landscape. Each of the categories of technology providers I refer to have their unique strengths and many would like to become that one dominant solution provider of choice.

 

While it does not seem likely that we will see a dominant digital health innovator in the near term, the window of opportunity for innovators is narrowing. As the high value “white spaces” get filled up and the risks of failure increase, VCs are committing larger and larger amounts of funding to more mature companies in the hope of a successful exit. New entrants in the innovation landscape will either need to find new white spaces or build “better mousetraps” to challenge well-capitalized incumbents on their turf. At the same time, as the pace of exits picks up, VC firms will look for new investment opportunities for their liquidation gains. For now, it’s best for digital health innovators to operate with an abundance mindset. It’s an “all you can eat” world out there. 

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Could Apple Store-like digital health retail stores be popular? 

Could Apple Store-like digital health retail stores be popular?  | Healthcare and Technology news | Scoop.it

Here’s why I think the time is right. Rumour has it that CVS, Walgreens, Kroger, and many other pharmacies carrying digital health and wearables product draw in-store customers. If that’s the case, could we drive more sales of telemedicine, remote monitoring, chronic care apps, and other digital health products by creating specialty stores in which we had trained sales people that knew how to combine products, services, and solutions from a variety of companies and educate consumers, caregivers, and patients about their use? What if some smart pharmacies, smart health insurers, and smart health systems got together and put together healthcare management retail stores in malls, similar to an Apple Store or a Microsoft Store?

 

In a fee for services (volume-driven) world, selling healthcare products and services to individual institutions is certainly time-consuming but reasonably straightforward. In an outcomes-driven (fees for value) world driven by shared risks and shared rewards, selling healthcare solutions across multiple disciplines, multiple stakeholders, and multiple institutions is much harder and even more time-consuming. That’s because there’s no easy buyer to identify. Population health is all the rage but our current 3+ trillion dollar healthcare industry was never devised nor incentivized to work together as a team for a long-term patient or population benefits (it’s reimbursed mainly for episodic care).

 

Our country’s healthcare industry is more about sick care and episodic transactions rather than longitudinal care. But, since we are moving to population and outcomes-driven care where the patient is more responsible for their own care management and payment, it would seem patient education and digital health tools are more important than ever. So, perhaps we need to get together and innovate around how we’re going to present next-generation solutions from across multiple innovators and showcase them to patients and their caregivers.

 

Using the Apple Store as a model, let’s imagine a Digital Health Store where we can have computers, wearables, tablets, phones, medical devices, remote monitoring, care quality, and other cool devices sitting in one place where shoppers can see how things work together and salespeople are trained to talk about chronic care. Even Amazon, who basically killed the large bookstore retail model, is giving retail bookstores a shot.

 

If the Digital Health retail store idea is reasonable, we could even think about allowing people to shop for insurance — on existing insurance exchanges — through a guided expert in store. There are tons of way of monetizing these stores.

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Health IoT creates huge opportunities for public health and software companies 

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

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

 

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

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

 

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

 

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

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

 

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

 

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

 

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

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

 

There are two challenges, and they are slowly receding.

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

 

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

 

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

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6 Healthcare Trends to Watch in 2018

6 Healthcare Trends to Watch in 2018 | Healthcare and Technology news | Scoop.it

It’s 2018, and the world looks much different than it did a year ago. Go back even further and the differences are even starker. No place is that more evident than in healthcare. As the largest industry in the world, healthcare has weathered the most significant political waves of the last fifteen years. As the costs of healthcare increased unchecked, politicians took notice.

In our pseudo free-market health system, where a considerable portion of costs are covered with public funds, and where the largest public payor initiates changes that are then emulated by commercial payors and, likewise, where government entities heavily regulate healthcare’s techniques and technologies, politicians have intervened to force changes. With healthcare being a major topic of the last several elections and a top priority for President Obama during one of his two terms (as it was for President Clinton, though his primary initiatives in healthcare didn’t pass), it’s no surprise that the current administration also would like to impart change. President Trump is now working to alter some of what the Obama administration put into place. This move creates more uncertainty and requires change. I think everyone agrees on a defined set of goals for the industry, known as the triple aim (better outcomes, lower costs, improved experience), but the path to achieving those goals is wildly variable depending on your political position.

 

Unfortunately, these required changes have placed the industry in turmoil. In an effort to modernize its technology, EHRs have been forced between providers and patients to ensure better, more consistent data collection. Ideally, this move should reduce medical errors and redundant tests, however, the government missed a massive opportunity here when it spent north of $40B on incentives to increase digitization of medical records — EHR software that wasn’t built to reduce medical errors, unnecessary tests or even improve clinician communication or data sharing across providers that would ensure continuity of care. At the same time, government financial incentives prompted a change to healthcare services to ensure quality. Yet, most of these quality initiatives didn’t go far enough and consequently increased data reporting burdens for clinicians. Meanwhile, payments for the majority of healthcare services have been reduced, squeezing provider margins and changing the rules for how providers are paid.

 

Healthcare hasn’t improved for consumers. During appointments, providers struggle to connect because they have screens, not patients, in front of them. Insurance coverage has gotten worse; choices have been reduced and the complexity of bills and payor communications to consumers more complex. How much worse have things become? I have an MD, MBA, and MS. I run a healthcare company with ~50 employees and have been writing and speaking on healthcare and healthcare technology for ten years. My wife and many of my friends are practicing physicians; some are my physicians. Yet, I woefully struggle to understand my medical bills, choices in providers, and generally how to navigate our broken system.

 

Where does that leave healthcare going into 2018? I’d argue that healthcare, if anything, is worse today than it was a year ago. The government, individuals, and private sector will certainly continue pushing for more changes in 2018. Given that, I predict we’ll see a few major healthcare trends as we move through the new year.

Subscription / direct pay / cash-based practices

Consumers, with minimal choice in healthcare, find it difficult to speak with their wallets or their feet. Similarly, providers have even fewer options. It’s no wonder that subscription medicine and cash-based medical practices are growing in popularity for both providers and patients (more on that below). These care models align incentives and are transparent. Geared towards those who have the ability to pay extra for better services, today, the majority of these care models bank on the pocketbooks of the middle to upper class. However, emerging data sets show the success of this model is also possible for underserved populations, as well. Learn more about what I think will happen with cash-pay practices in 2018.

Post-EHR healthcare

The gravy train of meaningful use (MU) is over. The effect of MU was a significant, artificial, driver of adoption for a few EHRs. Today, digital health records are the standard. As we move through 2018, keep an eye on EHRs and how they justify their ROI once massive capital expenditures are written down. Likewise, you’ll want to consider how clinicians adjust to this brave new world. Read more about my 2018 predictions for the post-EHR world.

Clinicians as developers

The EHR wave of health IT left out clinicians. EHR and IT vendors drove those early technology decisions. Now, with software eating the world, clinicians are acting like software developers and corporate innovators in helping to design and, in some cases, build new technology and technology-enabled services for their colleagues and their patients. Read more of my thoughts on clinicians as developers.

The real cloud

HIMSS 2018, the largest health technology conference on the planet, will for the first time see the behemoth booths of EHR vendors challenged by the equally massive booths of public cloud service providers like Amazon, Microsoft, and Google. This is the canary in the coal mine moment for healthcare, not just for the adoption of the real cloud over simple virtualization, but also in the fragmentation of infrastructure and services managed by third parties for healthcare delivery organizations. Learn more about the real cloud in healthcare.

Beyond digital health hype

Digital health has been hyped for a long time as a savior for healthcare. Unfortunately, healthcare is not that simple and no savior exists to untangle us from our current mess of a system. Technology, for technology’s sake, is not going to fix healthcare. While we’ve witnessed incredible enthusiasm around new technologies disrupting healthcare, we’re also now seeing some public failures, like the recent acquisition/fire sale of Practice Fusion, or the Castlight Health initial public offering hype and valuation assumptions compared to the market reality of today. Similar to EHRs, digital health now must prove it’s worth if it’s going to have sticking power. Find out more about getting beyond the digital hype.

Blockchain to the rescue

Speaking of hype, blockchain has made its way into healthcare. Smart contracts, immutability, and a clear audit trail — hallmarks of blockchain technology — hold much promise for healthcare data and exchange. The problem is that technology, especially when it comes to data sharing and interoperability in healthcare is not the dominant roadblock. Layering in new technology, like blockchain, leaves the fundamental organizational and political problems unsolved.

 

I’ll focus on each of these trends in subsequent posts, distilling all of these healthcare trends down into one larger narrative: post-EHR healthcare is finally ready and incented to start making the necessary changes that will align with the triple aim. Massive organizations will vie for their place in this new healthcare world; some will win and others won’t. The winners will be the providers AND the patients.

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ScientificAnimations's comment, May 22, 8:46 AM
Blockchain is a system that makes health information accessible to doctors from anywhere, anytime, and on any electronic medical system. http://sco.lt/5yVeuP