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5 ways technology will change the future of healthcare

5 ways technology will change the future of healthcare | Healthcare and Technology news | Scoop.it

Companies preparing to launch their health business ventures under the Trump administration's policies have met a state of flux around insurance and regulations.

But this is nothing new for businesses to grapple with, according to Mike Strazzella, a federal government healthcare attorney at Buchanan, Ingersoll & Rooney, PC. Our healthcare system has been in a state of flux for the past eight years, Strazzella said, with former president Barack Obama's commitment to reshaping the healthcare delivery system with the Affordable Care Act.

Back in the early 2000s, healthcare providers such as hospitals would put together five-year strategic plans. Now, the field changes so rapidly that they can only build one- to three-year plans, Strazzella said.

However, technology advances faster than the government can keep up, Strazzella said. "While the industry will have an appetite for more, entrepreneurs have to be ready for slow public sector progress, which is always a frustration," he said. "I think we're going to see the FDA implement processes and regulations to spark greater competition, whether that's a generic medication or a device."

Strazzella recommends businesses stay in touch with the latest trends within the industry, and build relationships with customers to gain a better understanding of their needs. He also advises business leaders to keep up with the happenings in Washington, DC, as much innovation in healthcare is driven by government regulation.

"We're still in flux," Strazzella said. "As long as people continue to think outside the box, and try and shape the policy debate around the delivery of healthcare, it will without a doubt trickle down to new ideas and concepts to try and help make health more effective."

Here are five predictions from Strazzella on the future of healthcare technology.

1. Advances in data mining and record keeping

 

"I think we're going to find that there will be a much stronger need for data mining and record keeping by a lot of people along all providers that touch the delivery system," Strazzella said. That includes information on a patient's income, Medicaid, and citizenship eligibility. "We're going to see more requirements put on places within the delivery system, and checks and balances of whether somebody should be receiving the type of insurance they're receiving, or if they're better suited for another option," Strazzella said.

2. Tailoring the health plan to the patient

"We're starting to see health plans gear people toward the right type of insurance for that person," Strazzella said. "We're starting to see them looking toward tech companies with that information, and how to parcel it out, and either gear future products that are the right fit for people based on that information, or try to help the patient move toward an existing product."

3. Moving to a fee-for-service system

Strazzella predicts that we will move toward a fee-for-service, value-based outcomes system in US healthcare, based on how successful a provider is at treating a patient. That might mean testing a medication to see if it works in three days instead of six days, for example. "It's going to require more metrics as we move to this, so there is going to be high demand on the IT side of things, and higher levels of competition," Strazzella said.

4. Electronic health records that talk to each other

The Centers for Medicare & Medicaid Services (CMS) is going to transition away from investing in electronic health record infrastructure, Strazzella said. Instead, meaningful use will be more about the interoperability of these systems. "We'll see systems that are user-friendly and will minimize time spent interacting with EHRs versus patients," Strazzella said.

5. Rise of telehealth

"Telehealth is starting to get its deserved recognition for how it can help save on costs to the healthcare system and patients in terms of hard dollars, time, and accessibility," Strazzella said. The field is growing in terms of care for patients in neurology, behavioral health, dermatology, and remote monitoring of chronic conditions. "As those tech advances advance, we can see those services can be removed from face to face encounters, and will progress a lot faster," he said.

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Are State Laws Holding Back Telehealth?

Are State Laws Holding Back Telehealth? | Healthcare and Technology news | Scoop.it

When it comes to telemedicine—a market that stood at $17.8 billion globally in 2014, and is anticipated to grow at a compound annual growth rate of 18.4 percent through 2020, according to recent research—one of the segment’s most critical issues is that there is so much variance in its regulatory policy. While there has been evidence showing the benefits of telemedicine in the healthcare industry, the realization of those benefits may come to an abrupt stop at the state border.


In fact, the American Telemedicine Association (ATA) recently analyzed how all 50 U.S. states grade out on telemedicine policy, finding a supportive landscape for physician practice standards and licensure in slightly less than half of them. The widespread differences in state law that prevent the seamless use of telemedicine across state borders include diverse state medical practice rules, restrictions on the interstate practice of medicine, the complex state insurance landscape, state privacy laws, and conflicting rules and guidance across state agencies.


“Telehealth has the ability to breakdown geographic barriers to care, but the lack of uniformity in state law makes it very challenging to operate in a multi-state environment,” says Dale Van Demark, partner in the health law group at the Chicago-based McDermott Will & Emery, a full service law firm with an active healthcare practice representing provider organizations that are interacting with telemedicine companies, and the companies themselves. Van Demark recently spoke with HCI Associate Editor Rajiv Leventhal about these telehealth variances, possible ways to break regulatory barriers, and what the future holds. Below are excerpts from that interview.


How big of a barrier is it to the telehealth industry that states have varying laws?


Healthcare is a highly regulated industry; any business has to think about the regulatory environment, as they have to act in within the confines of the legal and regulatory structure. Insurance companies are regulated by each state and they have to comply with the state law. Telemedicine companies are no different. In addition to that, states are not consistent from a policy perspective in how they view telemedicine. While there has been a general and rapid acceptance of this form of care in many states over the years, it’s not a universal truth. Some states have taken a much more restrictive approach, be it via a legislative body or board of medicine. There is more acceptance generally, but plenty of states are not marching down that path in the same way. As a national business in some instances, there are vastly different requirements via telemedicine, and in some instances, these variances are impractical.


What are some examples of the variances you’re seeing?


When you talk about the delivery of care in any situation, you’re thinking about in a basic sense, someone needing a license to practice medicine. One issue is the practice of medicine itself—What does it mean and require? In Texas, you’re seeing a rulemaking body taking a conservative approach to telemedicine. They have accepted that certain kinds of care can be delivered by telemedicine, but they believe it’s important for a patient to first see a doctor physically prior to any services being delivered via telemedicine. That falls into the category of “What is a telemedicine encounter and what’s required?” In Texas, an initial first visit is required.


Separately, each state has its own licensing rules. A New York license doesn’t permit me to practice in Colorado.  If I wanted to start a telemedicine company in South Carolina and treat patients across the country somewhere, you have to ask that if I am a doctor in South Carolina and I’M seeking video conferencing with a patient in Arizona, am I appropriately licensed to do that? As a general matter, states take the view that if you’re going to do that, you need a license in that state to engage in the state where the patient is. The multi-state licensure issue is another big one. Some states are more open to accepting “foreign” doctors and will be more liberal in the recognition of an out-of-state license. You can get a telemedicine license specifically in some cases too. There are different ways, but it’s another variation.


Other variances are with reimbursement and privacy. On the reimbursement side, some telemedicine services are reimbursed by Medicare or Medicaid. That is fairly restrictive, especially on the Medicare side where a number of circumstances have to be met. The structure of Medicare telemedicine reimbursement has been geared towards communities with a lack of healthcare resources. That element is often necessary, though it has been expanding slowly. Individual states have mandated that insurance companies to reimburse for telemedicine services, but again, it’s not uniform.

There is also a whole array of state privacy laws that come into play when dealing with healthcare that need to be addressed for any sort of healthcare company. This is another layer of complexity, as laws could be stricter than the Health Insurance Portability and Accountability Act (HIPAA).


With so many variances, are there ways to eventually get around these barriers and make things more uniform?


It’s a great question. We tend to think of the government as a single entity when it isn’t. What we’re talking about here are 50 jurisdictions—each state has different privacy laws, ways to govern medicine, and approaches to reimbursement. The feds have their own approach, and within governments you have different perspectives. A state legislature may pass a law saying you have to reimburse for telemedicine, but that state medical board could do what they did in Texas. If you have that dynamic, you have essentially two different parts of the government heading in two different directions. And that’s overlaid with privacy, which may be more restrictive than HIPAA.


You take a look and wonder if the state is supportive of telemedicine or not. The answer could be a little bit of everything. You need to keep in mind that we’re talking about multiple governments and multiple branches that have an impact on the delivery of healthcare via telemedicine. So a governmental fix to all of this is a little unrealistic and optimistic. Having said that, there has been a clear movement across governments to accept and embrace the delivery of healthcare via telemedicine. But it is a lack of coordination that creates the problem.


The only multi-jurisdictional effort that I have seen that could impact the nation broadly is the proposed Federation of State Medical Boards Compact Act, which provides a way for states to more readily accept a physician practicing within its boarders who does not have a license in that state, but does in another state. It’s a form of reciprocity, like your driver’s license. If states adopt the Compact, and a number have or are considering, then the licensure issue could be addressed. But that’s just one issue, and it doesn’t address the others such as privacy and reimbursement. But it’s the one effort I can point to where you would see a barrier to multi-state telemedicine licensures being lifted.


How does the physician community feel about all this?


The physician community is very diverse, so you can’t really make a broad statement. The advent of telemedicine, like the advent of urgent care centers that are out there, present a potential economic threat to other types of practices of medicine that we think of more traditional. There is an economic impact there, so you can see there being a reaction to this, and you are seeing that in places.  


There is also a reaction to telemedicine in terms of what a physician should be able to do in a telemedicine encounter as opposed to a face-to-face clinical encounter. If you’re there with a patient and able to perform a full clinical examination, a physician has more information than if he or she is speaking with the patient over the phone. No one would argue with that. Technology can overcome some of those limitations, but there are so many different versions. It’s a legitimate issue that the physician community is still wrestling with. What is it that a telemedicine encounter should be able to do? What are the best practices?


Moving forward, how will this play out— in the favor of telemedicine or against it?


I think it will be generally embraced, and the reason I say that is assuming efficacy of telemedicine programs, that they do no harm and benefit the patient, there is the the promise of telemedicine being cheaper and expanding access to care—both things we want to have in our healthcare system. Will we see it die away or be embraced? I would say embraced, not in every version, but definitely in general. In the history of humanity, we haven’t had many instances in which we made technological advances and not used them.

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Telehealth Program at Banner Health Reduced Costs, Hospitalizations

Telehealth Program at Banner Health Reduced Costs, Hospitalizations | Healthcare and Technology news | Scoop.it

The Phoenix, Az.-based Banner Health has announced successful results from its at-home telehealth pilot program for patients with multiple chronic conditions.


The Intensive Ambulatory Care (IAC) pilot program, done in partnership with the Netherlands-based Royal Philips, focuses on the most complex and highest cost patients —the top five percent of patients who account for 50 percent of healthcare spending. The program first launched in 2013 and aims to improve patient outcomes care team efficiency and prevent IAC patients from entering the acute care environment where costs are significantly higher.


As part of the pilot, Philips and Banner assessed the results of 135 patients to determine the effectiveness of the IAC program in meeting its clinical and financial goals. An analysis of the results of each patient's first six months demonstrated that the program:

  • Reduced costs of care by 27 percent. This cost savings was driven primarily by a reduction in hospitalization rates and days in the hospital as well as a reduction in professional service and outpatient costs.
  • Reduced acute and long term care costs by 32 percent. This cost reduction was primarily due to a significant decrease in hospitalizations.
  • Reduced hospitalizations by 45 percent. Prior to enrollment in the IAC program there were 11.5 hospitalizations per 100 patients per month; after enrollment the acute and long-term hospitalization rate dropped to 6.3 hospitalizations per 100 patients per month.
  • What’s more, the acute short term hospital stays decreased from 7.7 hospitalizations per 100 patients per month to 4.9; long term care home health or other facility stays decreased from 3.9 hospitalizations per 100 patients per month to 1.4; and the average number of days in the hospital per 100 patients per month also trended down from approximately 90 to 66.   


“The results of our at-home telehealth pilot with Philips have been dramatic and are indicative of the exponential success such a program could have by engaging patients in their own care and building a strong support system around them" said Dr. Hargobind Khurana, senior medical director of health management Banner. "As we continue to expand this program we anticipate seeing further proof that telehealth programs can address readmissions rates reduce costs and improve the health and quality of life for patients with multiple chronic diseases."


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Health checks by smartphone raise privacy fears

Health checks by smartphone raise privacy fears | Healthcare and Technology news | Scoop.it

Authorities and tech developers must stop sensitive health data entered into applications on mobile phones ending up in the wrong hands, experts warn.

As wireless telecom companies gathered in Barcelona this week at the Mobile World Congress, the sector's biggest trade fair, specialists in "e-health" said healthcare is fast shifting into the connected sphere.

"It's an inexorable tide that is causing worries because people are introducing their data into the system themselves, without necessarily reading all the terms and conditions," said Vincent Genet of consultancy Alcimed.

"In a few years, new technology will be able to monitor numerous essential physiological indicators by telephone and to send alerts to patients and the specialists who look after them."

More and more patients are using smartphone apps to monitor signs such as their blood sugar and pressure.

The European Commission estimates the market for mobile health services could exceed 17.5 billion euros (19 billion euros) from 2017.

The Chinese health ministry's deputy head of "digital health", Yan Jie Gao, said at the congress on Wednesday that the ministry planned to spend tens of billions of euros (dollars) by 2025 to equip 90,000 hospitals with the means for patients to contact them online securely.

Patients are entering health indicators and even using online health services for long-distance consultations with doctors whom they do not know.

"There is a steady increase in remote consultations with medical practitioners," particularly in the United States, said Kevin Curran, a computer scientist and senior member of the Institute of Electrical and Electronics Engineers.

"Your doctor can be someone who's based in Mumbai. We have to be very careful about our data, because they're the ones who probably will end up storing your data and keeping a record of it."

- Cloud-based healthcare -

Other users are entering personal health data into applications on their smartphones.

This kind of "e-health" could save governments money and improve life expectancy, but authorities and companies are looking to strengthen security measures to protect patients' data before such services become even more widespread.

"I think tech companies are becoming more concerned with privacy and encryption now," said Curran.

"The problem quite often is that a lot of this data is stored not on the phone or the app but in the cloud," in virtual storage space provided by web companies, he added.

"We are at the mercy of who the app providers are and how well they secure the information, and they are at the mercy sometimes of the cloud providers."

Others fear that insurance companies will get hold of customers' health information and could make them pay more for coverage according to their illnesses.

Various sources alleged to AFP that health insurance companies have been buying data from supermarkets about what food customers were buying, drawn from the sales records of their loyalty cards, following media reports to that effect.

The kind of "e-health" indicator most sought after by patients is fitness-related rather than information on illnesses, however, said Vincent Bonneau of the research group Idate.

A study by Citrix Mobile, a specialist in wireless security, showed that more than three quarters of people using e-health applications were doing so for fitness reasons rather than for diagnosing illnesses.


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New Legislation Helps Remove Telemedicine Barriers

New Legislation Helps Remove Telemedicine Barriers | Healthcare and Technology news | Scoop.it

There is no doubt that the practice of medicine has changed in many ways over the years.  Local physician practices that used to serve those within their community, now own or work for medical entities offering services across state lines and physicians practice in multiple states, both via telemedicine and in person. 

Legislation in this country has largely not kept up with the times, but it is expected that we will soon see many legal changes to catch up with the increasingly national practice of medicine. 

One of the major hurdles that has delayed the growth of telemedicine and the expansion of healthcare providers is the control of every state over licensure of physicians within their own borders.  This means that physicians must be licensed in every state in which they desire to practice medicine. 

Although there are some general exceptions among certain states that allow reciprocity (and many states allow for second opinions and special consultations), most states consider a physician to be practicing medicine without a license if he provides services to an in-state patient without a license (whether via telemedicine or in the state where the patient is located).    

For example, if a patient is in Illinois and obtains a diagnosis and prescribed treatment from a physician licensed only in California, then absent an applicable exception, that physician has practiced medicine in Illinois without a license.  The same would be true if the physician came to Illinois to see the patient in person.

In the fall of 2014, the Federation of State Medical Boards finally came out with the Interstate Medical Licensure Compact, which is intended to streamline the process of physicians obtaining licenses outside their own state.  With this legislation, more states will join in the effort to allow physicians to engage in medicine freely across borders.   

Under the proposed legislation, a physician would generally follow these steps to gain licensure in multiple states:

1. The physician files an application with the state in which she is are primarily located.  This is known as the “Principle Board.”  This does not have to be, but would generally be the board in the physician’s state of residence. 

2. The Principle Board would then decide whether to recommend that the physician be issued an expedited license with another state.  This recommendation would be made to the “Interstate Commission.”  This is the body that has been charged with administering the Compact. 

3. Once a physician is recommended to the Interstate Commission, that physician would then complete a registration process and pay the applicable fees to practice in each state for which he is applying.  The normal license fees would still apply for every state in which the application is being made. 

4. Each of the “State Member Boards” will share information related to any complaints and actions concerning a physician’s professional performance in another state.  Although states already share in this manner, information will likely be shared more quickly under the compact.  Similarly, future actions taken against a physician in one state will cause similar action to be taken by the other states, most likely in a more expedited manner. 

5. Physicians will still need to comply with the medical practice requirements of every state in which they obtain a license.  In no way does the Compact alter a state’s jurisdiction over medicine in any state. 

The compact makes a lot of sense for licensees who know how cumbersome the process is to apply for multiple licenses.  Through the compact, a single set of verified documents will be shared with multiple states, rather than repeating the same process multiple times.  This saves time and money and opens up new market for physicians (and companies) who were deterred by the licensure process. The compact will hopefully also speed up the growth of telemedicine and mhealth throughout the country.

While there are many details still to be worked out about how the compact will work, it does seem to be a step in the right direction in keeping up with the current state of medicine.


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Mentoring, Telemedicine Offer Paths to Better Rural Health Care Access -- AAFP News

Mentoring, Telemedicine Offer Paths to Better Rural Health Care Access -- AAFP News | Healthcare and Technology news | Scoop.it

One doesn't have to look too hard to find long-standing obstacles to providing rural health care: too few primary care physicians in sparsely resourced areas and limited support for specialty care referrals. And even as new technologies are enabling greater access for patients and enhanced training to improve care coordination, old education and payment standards persist..

Long-distance Mentoring

In 2003 in New Mexico, gastroenterologist Sanjeev Arora, M.D., was treating patients with hepatitis C virus infection -- many of whom faced an eight-month waiting period to see him. Moreover, some had to drive as much as 250 miles each way for their appointments. Patients were dying of liver cancer and other ailments because they could not obtain timely care.

"I knew if we had treated them earlier, we could have cured them," he said.

Ultimately, Arora realized that the best way to manage patients with complex chronic conditions was not simply for the subspecialty physician to see patients around the clock. Rather, an entire network of health care professionals could be trained to provide needed care. The idea of spreading that knowledge gave birth to Project ECHO (Extension for Community Healthcare Outcomes), where Arora serves as executive director.

ECHO is a mentoring network that seeks to teach primary care physicians and other health care professionals how to care for specific chronic conditions. To make this "telementoring" system work, subspecialty physicians provide guided instruction to primary care physicians, nurse practitioners and physician assistants.

"We know that chronic disease management is a team sport," Arora said. "You become a mentor as opposed to a doer."

Such interactive training sessions are a necessity in a changing medical environment, according to Arora, who said he thinks the traditional graduate medical education (GME) curriculum is no longer effective.

"The system of GME where we educate residents and fellows and just send them out there isn't going to work in a knowledge-based workforce," Arora said. "Academic medicine needs to take responsibility for training the entire health care workforce for their entire career."

Arora said funding for such career training efforts should be considered an infrastructure investment similar to the U.S. National Library of Medicine, a publicly funded institution.

Perinatal Care Via Telemedicine

In rural states such as Arkansas, some residents must drive for hours to meet with a physician. Forty-four percent of the state's population resides in rural areas, and the number of obstetricians, in particular, is inadequate to meet population needs. Curtis Lowery Jr., M.D., medical director of the University of Arkansas for Medical Sciences ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) program, outlined how telemedicine has helped to close the gap in regions without enough physicians to provide care for women with high-risk pregnancies.

"It's very difficult to get physicians to go to the (Mississippi) Delta," said Lowery, who is also chair of the university's department of obstetrics and gynecology. "They feel alone, like they are on an island with no support. So we use technology to support them."

When the ANGELS program started in 2003, there were only three maternal/fetal specialists in a state that saw 45,000 deliveries each year. Initially, a few telemedicine hubs were set up around the state with local government support. Thanks to an infusion of $102 million in federal funding, however, the program soon expanded to cover the entire state.

Instead of expecting rural patients to meet physicians in urban areas, telemedicine enables physicians to connect with those patients by teleconference. A 24-hour call center is available for patients and physicians to coordinate care. And telemedicine efforts that originally focused on management of high-risk pregnancies have expanded to include care protocols for patients with stroke or sickle cell anemia, as well as those in need of surgical consultations.

Much as the influx of patients newly insured under the Patient Protection and Affordable Care Act has initially added to overall health care system expenditures, wider adoption of telemedicine will also likely lead to increased costs in the short term as more patients are seen via this method. But, Lowery predicted, the system will ultimately save costs on travel and the long-term care that becomes necessary when appropriate preventive and management services are unavailable.

Still, for telemedicine to achieve its full potential, Lowery said changes that permit payment for telemedicine consultations are needed.

"The biggest problem with the adoption of telemedicine is the payment," he said. "We need to change the way we pay and need to be able to pay for new systems. In my career, I've done thousands of telephone consultations, but I've never been paid for one."

Effecting this change is particularly difficult, Arora chimed in, when one considers the fact that elderly patients -- those in their 80s and 90s -- consume 10 times more health care than an individual in his 60s. And it's certainly conceivable that these older people would be using telemedicine services frequently.

"The payers are terrified," Lowery said. "When a lot more care is given, a lot more money is spent in fee-for-service. That's where we are in telemedicine."



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

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

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

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

Teladoc

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


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


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

Doctors on Demand

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


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


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


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

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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news | Scoop.it

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.


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Medicine and Health Care Will be Personalized Thanks to Technology

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

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

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

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


How will this impact the cost and quality of care?


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


Who will resist this change the most?


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

What role will the Affordable Care Act play?


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


What should policymakers do?


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

What risks should patients be worried about with new technology?

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


What can consumers expect ahead?


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


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

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

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

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

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

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

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

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

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

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

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


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

interesting....

Shamma khan's comment, April 14, 8:43 AM
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Telemedicine market could grow by $5 billion in next five years

Telemedicine market could grow by $5 billion in next five years | Healthcare and Technology news | Scoop.it

By the year 2020, the patient monitoring market in the U.S. is expected to grow by about $5 billion--mostly because of the expansion of telemedicine use, according to a reportby iData Research.

The report also looks at the impact vital sign monitors, fetal and neonatal monitors, cardiac output monitoring devices and blood pressure monitors will have on the market, among others. In addition, the telehealth market in the U.S. is projected to grow in double digits in the next five years, according to an announcement on the report, with telehealth for disease conditions management set to make up more than half of that market. 

Public and private organizations will also help telemedicine grow as they budget more funds for the technology in the ensuing years, according to the announcement.  

Another industry report also says major growth in telemedicine is on its way, predicting the market will double in the next four years, FierceHealthIT previously reported. The market will see growth at 18.88 percent CAGR, from 2014 to 2019, according to ReportsnReports.com.

Other factors moving telemedicine forward are changes in reimbursement and healthcare policies, which will increase physician confidence in spending money on the technology. according to the iData report.


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