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Washington's Plan To End Private Practice Medicine

Washington's Plan To End Private Practice Medicine | Healthcare and Technology news | Scoop.it

In fixing the busted system that Medicare uses to pay American doctors, Congress has settled on a scheme that visits so many complexities on physicians, that it will inevitably stoke the continued demise of private, independent medical practices.

Many in Washington favor this outcome. Regulators at the Centers for Medicare and Medicaid Services have long preferred to deal with large entities and corporations that employ physicians, rather than try and enforce rules on a fragmented system of small, independent doctor offices.

Meanwhile, the “experts” on Capitol Hill, who are working to engineer the perfect solution to the nation’s healthcare system and its challenges around cost and quality, believe that large health systems modeled after Kaiser or the Geisinger Clinic are the optimal structuring. And that these models can be replicated nationwide.

For their part, the already big or near-big healthcare institutions, straining under declining reimbursement, see the leverage that comes with increasing their market share as a way to also improve operating margins and better control costs.

The result is a bipartisan package of “reforms” that visits so many new rules and complexities on doctors that individual physicians simply won’t be able to participate. They’ll face three choices. Refuse to see Medicare fee for service patients. Sell their practices and join a hospital or health system. Or ask their older patients to join Medicare Advantage plans, and see them under that arrangement. (Under Medicare Advantage, doctors won’t be directly responsible for adhering to many of the new payment conditions. The presumption is that these plans already enforce their own conditions to try and coordinate medical care.)

At issue is the framework that Medicare uses to set the rates doctors are paid by Medicare’s fee-for-service program on everything from thoracotomies to throat cultures. Referred to as the “sustainable growth rate” it’s part of a budget gimmick designed to cap what doctors are collectively paid and then let physicians fight amongst themselves over how that fixed pot of money gets allocated.

But the ploy never worked, and the price schedules are never properly adjusted for the rising cost of delivering medical care. Since private insurers adopt the prices, the malfunctioning system ends up having an outsized influence on medical care.

As I write in today’s Wall Street Journal Editorial Page, the major bipartisan, bicameral “reform” bill, set to advance in the next Congress, largely adopts many of the so-called doctor “payment reforms” already implanted in Obamacare. These changes are all variations on an old theme: capitation. The idea is to shift risk to providers with the goal of making doctors more discriminating about the cost and benefits of the treatments they prescribe. Rather than have the government ration care, or patients (through consumer directed health plans); the idea here is to have the providers do that reconciliation. The problem is that the new payment provisions come with their own alphabet soup of rules, reporting requirements, administrative procedures, and new bureaucratic infrastructures. Small doctor offices or medical groups simply won’t be able to participate, and will see their income under Medicare Fee for Service purposely reduced as a consequence. This is no accident. The architects of these provisions don’t believe that small medical practices are efficient, equipped to take risk, or comply with reporting requirements.

It isn’t any one single provision that will spell the demise of independent doctors. It’s the meshwork taken in its entirety, and the complexity if visits on providers.

Independent doctors practicing in smaller settings won’t be able to keep up with the requirements for overhead, reporting, and tracking. And the law makes it hard (illegal) for doctors to collaborate in loose associations to help them pool resources and buy these services. The end result is that collectively, the policies intentionally favor the consolidation of previously independent doctors into larger institutions.In the market, this is turning out to mean selling doctor practices to a local hospital.

When it comes to paying for doctors’ services, Washington has been setting prices for so long that it’s hard to envision another approach. But instead of dictating administered prices, it’s possible for Washington to measure them based on market surveys. One idea would simple be to survey prices paid by private Medicare plans, and use these as a barometer for setting rates in the fee for service program.

There’s a chicken and egg problem here. Medicare Advantage plans derive their own prices off the Medicare fee-for-service schedule. But if Washington were to turn the tables, and pay off a survey rather than its own rate setting, the market would quickly settle into a competitive equilibrium, with Medicare Advantage rates rising and falling to reflect supply, demand, and quality as plans compete to contract with the more popular medical practices. There would be new winners and losers. That is part of the problem. Many providers prefer the devil they know to the untried.

But right now, as the consolidation of once independent, privately practicing doctors accelerates it will also extinguish any semblance of local healthcare competition.

Obamacare is already leading to this desired outcome.

A 2014 survey of American docs that sampled 20,000 U.S. physicians found that 35% of doctors described themselves as independent, down from 49% in 2012 and 62% in 2008. These trends are becoming self-fulfilling by shaping expectations of newly minted docs. A new survey of 1,400 medical students conducted by Epocrates found that 73% plan to seek employment with a hospital or large health group when they graduate. Only 10% of students hope to work in a private practice.

Proponents of a market-based alternative to Obamacare will find that there’s not enough local rivalry between providers on which to eventually fashion a competitive structure to replace the Affordable Care Act.

All medical care is local. Once a single, large healthcare system or hospital controls all of the providers in an area, relying on market competition between separately contracting health plans won’t be possible. We will be dependent on administered pricing and increased regulation. For some in Washington, this is a fine outcome.

Many of our most pernicious problems in medicine don’t exist in spite of Medicare, but precisely because of the disorganized way that the Centers for Medicare and Medicaid Services buys doctors labor for seniors and other beneficiaries, and the outsized influence that the program exerts on the practice of medicine. If Congress passes this current bill, it might as well breath honesty into the law and repeal longstanding language saying that Medicare doesn’t regulate medical practice.

In a nutshell, the new legislation nixes the existing formula for capping the rate of growth in Medicare spending on doctors in favor of a new calculation. It ends the SGR, which was an attempt to tie Medicare’s budget to the inflation rate. In its place, the new plan limits total spending on physician services to .5% annual updates.

To give doctors a chance to earn more money, the legislation creates a new Merit-Based Incentive Payment System (MIPS). This plan basically consolidates three existing incentive programs, the bulk of which were already solidified under provisions established in the Affordable Care Act.

MIPS confer on doctors a score of 0-100 based on their adherence to different programs that purports to measure quality and outcomes based on information the doctors report. Those above certain numerical thresholds will get a raise. Those below it will get cut. To estimate their bottom line, doctors will have to track there performance against benchmarks they derive off of data that Medicare provides.

Mostly, the scores are tied to steps that doctors have to take in their medical practice that are believed to improve care. In other words, it measures inputs, not outcomes. The reporting requirements will be subject to audits, and civil penalties for mistakes. It doesn’t seem to matter that none of the programs that MIPS cements have reliably demonstrated that they actually improve outcomes, or lower costs.

The fee increases that the law enables (even baking in the bonus pools) are expected from the outset to fall far short of the real rise in medical practice costs. Physicians’ real income under Medicare will decline. It is another reason why the new scheme strongly favors the delivery of Medicare services through large, often hospital based systems. These bigger systems have more opportunity to enroll in the alphabet soup of legislative programs and inducements that will help goose reimbursement.

Over a short period of time, it’s likely that remaining office-based physicians will stop taking Medicare, or cap their Medicare patients at a small number. In fact the law explicitly exempts doctors that don’t treat a lot of Medicare patients from some of the penalties that are levied on doctors who don’t take part in MIPS. There’s little chance that smaller, independent medical groups (in particular, medical specialists) will be able to meet the multitude of provisions that this new law outlines, even with the help of some exemptions and special subsidies that the law provides.

Some doctors will just absorb the cuts to their rates (up to 9 percent a year). Others doctors will opt out entirely. The provision of services for the elderly will shift to the hospital outpatient setting. The law’s most significant payment bonuses are already reserved for doctors that practice as employees of hospitals and other integrated medical systems (which are referred to as Alternative Payment Models under the new law). In this way, the law furthers provisions in ObamaCare that favor the consolidation of medical practice around large hospitals and health systems and the movement of doctors from independent practices to salaried arrangements.

The law may also favor Medicare Advantage. These plans may have an easier time contracting with the doctors who cannot comply with the requirements, but still want to see some Medicare patients. Medicare patients, in turn, may favor Medicare Advantage if these plans are able to let them continue using outpatient practices.

But in the end, what the bipartisan plan really favors is Obamacare. It’s ironic that the only major healthcare reform measure likely to pass in 2015 is a bill that cements some of the most significant features of the Affordable Care Act. Republicans say they oppose Obamacare. They need to seize the opportunity to roll back some of its pernicious features. Or at least preserve enough of a medical marketplace to reserve for the future, a chance to come up with a better alternative.



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5 Big Questions About Health Insurance

5 Big Questions About Health Insurance | Healthcare and Technology news | Scoop.it

In theory, most of the U.S. health care delivery system and most of the health care finance system could work about the same way in 2018 as they’ve worked in 2017.

 

Medicare and group health plans look as if they’ll continue on something like the same path.

 

Even the 2018 individual major medical market could go through some bumps and then settle down into looking like a creakier version of the 2017 market.

 

At press time, however, the future of the U.S. health care delivery and finance systems was up in the air.

 

Most of the Affordable Care Act was still in place. The Trump administration was administering the ACA system, including HealthCare.gov, about as well as possible, in some ways, but appeared to be working to block it in other ways.

 

The administration appeared to be close to working out a settlement with health insurers on billions of dollars in ACA cost-sharing reduction subsidy payments, but, whatever happens to the subsidy payments, the administration has made the point that it could change health insurance system administration procedures quickly, without much apparent concern for how the changes might affect health insurers.

 

Many nonprofit health insurers seem to be hunkering down and trying to stand up to the administration: they have elected chief executives from two of the most enthusiastic insurance company players in the ACA system to lead both America’s Health Insurance Plans and the Blue Cross and Blue Shield Association.

 

But some of the biggest, publicly traded health insurers seem to be coping by doing when they can to retreat from the individual major medical insurance market, and avoid talking too much about their role in the fully insured employer-sponsored health plan market.

UnitedHealth Group Inc., for example, is calling itself a health care company.

 

Aetna Inc. is trying to become a division of a drug store chain.

 

If the individual major medical market stays as unpredictable in 2018 as it’s been in 2017, and some of that upheaval spills over into other health insurance sectors, what then?

 

Trying to make anything as firm as a “prediction” for the health insurance system seems foolhardy, but here are some questions that might shape our coverage of health insurance in the coming year.

1. Will more companies could try to disguise more major medical insurance products as something else?

 

One symptom of a regulatory-driven market breakdown is participants’ efforts to escape from the official market, into black market or gray market alternatives.

 

Many insurers, agents and consumers have already been trying to sidestep the challenges plaguing the individual major medical market by focusing more on partial individual major medical substitutes, such as short-term health insurance or hospital indemnity insurance.

 

Up till now, fear of patients’ facing serious gaps in coverage, and lawsuits, have held down many agents’ sales of major medical substitutes.

 

The more the individual major medical market deteriorates, the less squeamish market players may be about trying to work around it. 

 

2. Will everyone get religion?

 

The Affordable Care Act includes a provision officially allowing the sale of a kind of arrangement that could, in theory, provide something like true individual major medical insurance: health care cost-sharing ministry memberships.

 

Ministries in effect when the ACA came along can continue to sell memberships without facing ACA mandates, or any other federal regulations or oversights whatsoever.

 

Rapid expansion of health care cost-sharing ministries could be another symptom of individual major medical market breakdown.

 

3. Will hospitals collapse?

 

Health insurers see hospitals as the biggest components in large sophisticated health care systems that tend to have much higher profit margins than health insurers.

 

S&P Global Ratings are predicting, in a look at top industry trends for 2018, that the big hospitals S&P rates should do reasonably well in 2018.

 

“We expect hospitals to see very low single-digit organic growth (consisting of near-zero volume growth and low-single-digit blended reimbursement rate increases), while companies providing outsourced services to hospitals and outpatient providers should grow slightly faster,” the S&P analysts write. “We expect industry participants to see modestly higher bad debt expense in 2018 (reflecting slightly lower insurance coverage levels and the increasing prevalence of high-deductible health plans, given difficulty in collecting amounts owed by consumers).”

 

But many small hospitals, especially those that treat many uninsured patients, and many patients who have Medicaid coverage, operate on thin margins.

 

If the individual major medical market goes through severe problems, or the Congress or the administration somehow impose sharp reductions in Medicare or Medicaid reimbursement rates, that could push some hospitals over the edge.

 

A wave of hospital failures could affect patients with group health coverage or Medicare coverage as well as those with individual major medical coverage and Medicaid.

 

4. Will doctors go fishing?

Consumers in many communities already see that psychologists have, in effect, dropped out of the market for insurance-paid behavioral health services.

 

Mental health care providers in those communities often refuse to provide care for the rates health plans are willing to pay them.

 

The S&P analysts say they expect to payers to continue to focus on containing costs.

 

If health plans try to cut costs too much, it’s possible that large numbers of medical doctors could follow mental health care providers out of the health plan provider network door. 


5. Will health savings accounts shine?

 

President Donald Trump promoted health savings accounts (HSAs) while he was on the campaign trail.

 

Most Republicans in Congress, and Trump’s nominees at the U.S. Department of Health and Human Services and other federal agencies, like HSAs.

 

The tax bill would leave the HSA intact.

 

If the Trump administration and Congress start to move past major budget reconciliation bill battles, efforts to promote and expand the HSA program could heat up.

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Healthcare Technology trends to watch out 

Healthcare Technology trends to watch out  | Healthcare and Technology news | Scoop.it

The healthcare industry is on the cusp of a digital revolution. People are empowered with health information, thanks to technological innovations in digital health. It’s vitally important that healthcare professionals continue to stay up to date on advances in technology that will improve not only their internal systems but also patient treatment and care.

 

In this article, we’ll focus on top healthcare technology trends for 2018 in three main areas, namely Patient Engagement, Hospital Workflow, and Treatment.

 

Patient Engagement


2018 will witness more developments in the arena of patient-centric care. Mobile health is gaining prominence, pointing us to the fact that individuals are taking a more active role in their own health. Wearables and fitness trackers are gaining mass adoption by people of varying demographics. About 50% of healthcare consumers are expected to be active digital health tech adopters in 2018. Now, more than ever, patients will begin to have a say in their choice of treatment and expect transparency of information exchange from healthcare providers.

 

Telemedicine is another model of healthcare that is gaining traction in this hyper connected world. Get ready to see a rise in demand by consumers for health advice and information in the coming months. Adoption of telemedicine will connect patients and doctors like never before. The digital health empowered individual will pose a challenge to traditional healthcare services that are slow in adapting to the digital transformation happening around. The quality of service from healthcare providers will be measured by the ease of access to information by patients.

 

Hospital Workflow


Technology continues to advance as people become more and more accustomed and able to access information in seconds rather than hours or even days. Because of this, slow-paced administrative processes in hospitals are becoming increasingly frustrating to patients. This includes things as simple as difficulties of scheduling an appointment, to accessing medical reports, or even trouble in exchanging information between providers.

 

Hospitals are expected to make use of digital platforms and cloud computing services as part of their patient engagement measures. The motto of 2018 will be data access, anywhere, anytime.

 

Mobile health, telemedicine, and Electronic Health Records (EHR) will produce a plethora of data that healthcare providers can utilize to improve patient care. One of the challenges that many providers will face is the issue of storing and securely transmitting sensitive patient health information (PHI). Many organizations still depend on legacy fax equipment to securely transmit documents despite the criticism of relying on this ancient technology. Thankfully, 2018 will be the year hospitals decide to choose alternative technologies like online faxing that is secure, cost-effective, and environmentally friendly.

 

Other exciting news awaiting us as we talk about secure transmission of data is the blockchain. Utilization of the blockchain will disrupt the way data has been handled until now. IDC Health Insights predicts that 20% of healthcare organizations will actively develop systems utilizing the blockchain to keep data secure and enable easy exchange of information between trusted partners.

 

Treatment


Robots are coming - Not Terminators, but life savers.

 

Experts suggest that practitioners will make use of Artificial Intelligence (AI) for better diagnosis, surgeries, assistants, and more. Virtual Reality and Augmented Reality will become common tools at the hands of doctors for educating patients. AI bots will slice and dice data to help doctors make more accurate clinical decisions. The combined force of blockchain and AI will open a new realm in healthcare which will ultimately help provide better patient care. Use of AI will increase the efficiency and productivity of doctors as well. For those who fear a robotic conquer of the world, be assured that AI in healthcare is not going to replace doctors, but empower them.

 

These technological developments will help to fuel a positive change in the healthcare industry in 2018. It’s impossible to predict the pace of these implementations in hospitals, as these require not only capital and training but also an open-minded and forward thinking CIO that’s willing to adopt new and innovative technologies. The pertinent question is, are you ready to embrace the change?

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Top 5 Technology Trends for Healthcare

Top 5 Technology Trends for Healthcare | Healthcare and Technology news | Scoop.it

It's been a challenging year for the healthcare industry - new payment models and regulatory changes combined with big data and tech innovations have forced healthcare providers to rapidly adapt their practices at all levels of healthcare management and delivery. With big changes on the horizon and uncertainty everywhere, one thing providers can count on is that technology will continue to play a bigger and bigger role in health care services and delivery in the coming year.

 

In a shaky regulatory environment, the healthcare providers that survive and thrive will be the ones that quickly adapt to the needs of the patient by adopting the latest innovations. With healthcare premiums set to rise across the country and growing transparency regarding service costs, patients will be raising their expectations for quality of care in 2018, giving the upper hand to facilities that invest in infrastructure that meets patient engagement requirements and improves business processes.

 

In this article, we've highlighted our picks for the top 5 healthcare technology trends of the year. In our view, these should be major areas of concern for healthcare IT departments. How will your healthcare facility address these trends over the next 12 months?

 

Telemedicine an Expanding Service Area for Healthcare Providers


Telemedicine will play a bigger role in our healthcare systems than ever before. With increasing life expectancy, treatment for the elderly and those who may face issues with mobility or feasibility of transportation is heavily supported by telemedicine solutions that allow physicians and specialists to interact with their patients remotely, using video conferencing technology.

 

Although telemedicine saw significant adoption throughout 2017, growth drivers for the future include a rise in leaner and more expensive health care plans and the growing prevalence of value-based compensation for healthcare providers. Telemedicine helps to minimize external and incidental costs associated with obtaining health care, enhancing patient engagement at a time where growing premiums for health care insurance are threatening access to health care services for at-risk groups.

 

Cloud Computing Grows in Importance for Healthcare Facilities


A study conducted by Black Book, a leading research firm in healthcare information technology, found that 55% of hospital Corporate Information Officers (CIOs) expressed confidence in their cloud application strategies, but that many had not yet invested in cloud storage for disaster recovery.

 

Other studies have estimated that 65% of interactions between patients and healthcare facilities will take place via mobile devices in 2018. 80% of doctors are already using smartphones and medical applications, while 72% use smartphones to access drug data on a regular basis.

 

It's clear that mobile data and communications will play a big role in the modern hospital, and those who invest in cloud infrastructure that adequately supports the volume of interactions that take place in a healthcare setting will benefit from improved performance and patient satisfaction.

 

Big Data Solutions for Population Health Management


New technology continues to unveil new possibilities in the world of medicine, and healthcare facilities are starting to understand how a robust cloud infrastructure and real-time EHR tracking can be used to facilitate population health management. Nearly all hospitals with 200 beds or fewer say they're not adequately capturing all the information needed for actionable population health analytics, according to Black Book.

 

How will hospitals solve this problem? Electronic data warehouses that capture data from thousands of EHR updates per day and use risk modeling to assess population health are the way of the future, and it's likely that they will be adopted on a large scale by the largest hospitals. Still, those with large-scale data monitoring solutions still face difficulties in effectively storing and managing EHR data along with financials, labor, and supply chain information.

 

Improvements Coming for EHR and Interoperability


The EHR mandate has seen widespread adoption throughout our healthcare system, especially in hospitals and larger healthcare facilities, but it's crucial that EHR vendors continue to adapt to new requirements.

 

For example, the new Medicare Access and CHIP Reauthorization Act 2015 (MACRA) may not be supported by all EHR vendors, and many EHRs do not support the level of record keeping that would be required for meaningful application of pay-for-performance reimbursement structures. These structures require features that most EHRs just don't have today, like the ability to track contractual payment agreements or assess the contribution to care.

 

Facing pressure from many sides, interoperability is becoming a concern for facilities that want to upgrade their infrastructure and data analytics, but require support from EHR vendors and other service providers, and regulatory relief while making the required upgrades. The successful healthcare facility of the future will effectively integrate EHR records, big data analytics, population health management, and a robust cloud infrastructure that supports it all, and this will require extensive cooperation and collaboration between healthcare providers, EHR vendors, insurance firms, and other stakeholders.

 

The Internet of Things (IoT) Could Change Everything


Are big innovations in the Internet of Things on the horizon for healthcare facilities? We definitely think so, and it's the facilities that upgrade their computing capabilities that will be set to take advantage as medical device companies roll out an increasing number of products that can plug into the hospital's internal networks for tracking and operation.

 

Wearable devices that allow physicians to receive real-time emergency updates on patient welfare and respond accordingly will impact patient expectations for standards of care in the coming years, and hospitals with monitoring systems that leverage the IoT will find business systems improvements at every turn.

 

Patients could be empowered to test their own vitals, using wearable devices to measure their heart rate and pulse, or even to conduct an ECG whose results can be transmitted automatically to healthcare providers through the hospital's cloud storage system. This could improve healthcare outcomes and positively impact labor costs, but only for those who invest in the infrastructure and interoperability measures to support it.

 

Conclusion


Healthcare is undergoing a period of significant change in many ways. While it's unclear how healthcare insurance and accessibility will look in the coming years, pressures like increasing cost transparency and pay-for-performance will force hospitals to continue finding cost-savings and efficiency through adopting the latest technologies and working with vendors to continue meeting the needs of an aging, and increasingly more demanding, patient population.

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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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mHealth Scores High With Consumers in Boosting Medication Adherence 

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

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

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

 

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

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

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

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

That’s where mHealth comes in.

 

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

 

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

 

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

 

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

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

 

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

 

The survey also shed some interesting light on prescription habits.

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

 

Among other results:

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

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

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

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

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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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Blockchain is a system that makes health information accessible to doctors from anywhere, anytime, and on any electronic medical system. http://sco.lt/5yVeuP
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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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Interactive text messages improve Medicare members prescription refills by 14 percentage points 

Interactive text messages improve Medicare members prescription refills by 14 percentage points  | Healthcare and Technology news | Scoop.it

new large-scale study shows that interactive, tailored text messages can improve medication adherence by 14 percent.

“The program results far exceed our expectations with 44 percent refill rate in the text message group as compared to 30 percent in the non-text group,” Rena Brar Prayaga, the paper’s corresponding author and a behavioral data scientist at mPulse Mobile, said in a statement. “In addition to the difference in refill rates, the 37 percent response rate by this older Medicare population was higher than expected and patient feedback was very positive with 96 percent of the patients indicating that the solution was easy to use.”

 

The study — conducted at Kaiser Permanente Southern California and using technology from mPulse Mobile — included 88,340 Medicare patients (all over age 65) with multiple chronic conditions. Specifically, patients were taking ora diabetes medications, blood pressure medicines, statins, or some combination of the three. The cohorts were not randomized. All patients were given the option to sign up for text messages, but only 12,272 opted in, leaving 76,068. Both groups received traditional adherence aids like automated and non-automated phone calls reminding them to refill prescriptions.

The mPulse Mobile platform instigated an automated dialogue through which patients could get prescriptions refilled, ask questions, or explain why they had not refilled their prescription. Eighteen percent of text message dialogues resulted in refill requests.

 

Researchers also used natural language processing to parse the tone of patient responses to the automated message. About half were neutral, 41 percent were positive or very positive, and just 9 percent were negative or very negative. When asked directly whether the service was easy to use, 95 percent of those who responded said yes and 5 percent said no.

“It is worth noting that patients in the texting group engaged at a much higher rate than predicted,” researchers wrote in the study. “We had estimated that the patient response rate would be between 10 percent and 20 percent. … Our target refill request rate was 5 percent to 7 percent since we were messaging an older patient population. At the same time, we hoped that the ease of use of the refill dialogue might draw in more patients and nudge them toward completing their refill requests. The program results far exceeded our expectations. Throughout the three-month program, the response rate was around 37 percent, and the three-month average refill request rate was 18 percent.”

Based on the success of the program, Kaiser Permanente intends to deploy it at additional locations.

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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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The Latest Trends in Nursing Technology

The Latest Trends in Nursing Technology | Healthcare and Technology news | Scoop.it

If trying to make sense of the stock market is enough to have you ready for a straitjacket. It is much easier to let your 401(k) do its thing and not think about it too often. The same can’t be said for those of us in the healthcare industry even though it feels like things are changing as rapidly as they do on Wall Street. Between the legislative changes, corporate mergers, innovative technologies, and everything else that is happening in our industry, it is enough to make your head spin. Let’s look at trends and technologies that will become more commonplace in 2018 and beyond.

 

Patient Engagement. As with most industry trends, nurses are on the front lines of patient engagement efforts. If you haven’t already been exposed to the concept, patient engagement is the practice of a patient taking more responsibility for their own health and well-being. When providers and patients work together, health outcomes are improved. New technologies are being developed to support patient engagement, and nurses are finding themselves more involved in helping evolve engagement efforts for their patients.

 

Precision Medicine. Another newer concept that will ultimately involve nurses providing direct care to patients, Precision Medicine, refers to the advancement of medical research that targets how certain diseases impact people differently based on their genetic makeup. It may include different treatments for certain types of cancers based on the genetics of the tumor. Precision medicine is an acknowledgment that healthcare is never one-size-fits-all and treatments are being adapted to the individual rather than the disease.

 

Centralized Command Centers. Inspired by NASA, many hospitals are implementing command centers that serve as a “mission control” for all of the services and functions related to patient care. Today’s nurses are finding themselves able to interact with the second set of eyes and also have help in managing daily bottlenecks. These command centers are also being utilized for central monitoring of patients to overcome alarm fatigue from the 90% of hospital alarms that aren’t actionable. The centers utilize complex algorithms and analytics to assist nurses in making real-time decisions to improve quality of care and reduce costs.

 

Smarter Smartphones? All of us are already using our smartphones for just about everything we track, post, and read lately, so nurses using them for their work is not surprising. One example of ways that nurses are able to use their smartphone is called Steth IO, which turns your phone into a modernized stethoscope. A special case is attached to your iPhone (not yet available for Android) and channels the sounds of a patient’s heart and breathing into the microphone. The Steth IO app then digitizes the heartbeat into a graph on the phone screen to record and enable easier detection of abnormal heart sounds.

 

Overcoming Language Barriers. As our nation’s population becomes more diverse, nurses are finding themselves in more frequent situations where patients speak a language other than English. This often leads to another nurse who speaks the language being brought in to translate. By September of this year, a hand-held, two-way voice translator, The Pocketalk, will be available to translate up to 63 languages in real time. Working via Wi-Fi, mobile data, or a personal hotspot, the translator transfers speech to text on the screen and relays responses verbally. Nurses will also be able to save up to 20 exchanges to assist with post-visit notes and charting.

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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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A Path to Putting Patients at the Center 

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

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

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

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

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

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

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

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

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

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

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Empowering Patients through Decentralized Information Governance 

Empowering Patients through Decentralized Information Governance  | Healthcare and Technology news | Scoop.it

Health care will be transformed if we empower patients and physicians through access to information. Don Rucker is right to focus attention on APIs to enable the transformation. A year and a half into the new administration and the massively bipartisan 21st Century Cures Act, the Department of Health and Human Services (HHS) is having to navigate between the shoals of highly unpopular Meaningful Use regulations and the apparent need for regulation to undo the damage of market consolidation that they caused. From my perspective, it looks like HHS is doing a good job.

Prediction is a dangerous game but it’s necessary for investments that depend on health information technology. Nowadays, pretty much everything in healthcare depends on information technology, particularly if we need effective quality measures to enable transition to value-based healthcare.

Based on Verma’s most recent remarks, it’s safe to predict that HHS will use the power of the $900 Billion purse as a way of avoiding regulation as it tries to break down the oligopoly of the consolidated “integrated delivery networks” and their even more consolidated EHR vendors. What’s more interesting is to anticipate how Rucker’s recent remarks about Persistent Access will be translated into decision support information for patients and physicians that will actually drive the practice innovation Verma is talking about.

 

Today, the information available to physicians and patients at the point of care is centrally governed by hospitals and by EHR vendors. A service seeking to present a piece of information such as therapeutic alternatives, quality ratings, out-of-pocket expenses, and research or clinical trials opportunities, must run a gauntlet of censorship by both the hospital and the EHR vendor. A thoughtful paper on how preemptive genomic testing has significant impact on subsequent treatment decisions shows the evolving connection between medical science and information governance.

The barriers to providing independent decision support when it matters most, during the physician-patient encounter, are immense. Let’s list some of them.

An independent information service

  • Must be “certified” by the hospital even if a particular physician wants to get it
  • Must be “certified” by the EHR vendor before it’s even accessible to the hospital certifiers
  • Involves up-front certification costs that are incompatible with open source or other non-profit information sources
  • Can’t access the complete patient’s record in the EHR
  • Requires the physician to sign-in to a separate system with a separate password
  • Is not covered by insurance, or, if covered, is subject to pre-certification delays that the physician won’t put up with
  • Is unaffordable because each EHR and each hospital presents a different integration challengecan’t get investors because the EHR vendors will demand unspecified rent on access to the physician-patie t relationship or, in many cases, actually demand access to the intellectual property itself.

The task ahead for HHS is formidable. Regulation that drives patient empowerment at the point of care (when the physician is about to sign that order that drives $3.5 Trillion of healthcare costs) is inconceivable under the US healthcare system and out of reach for even the nationalized health systems in other rich countries. The proprietary EHR vendor business model means EHRs must control the “app store” as the driver of future growth. Separately, the Accountable Care Organization business model for hospitals drives them to control their physicians and restrict access to “out-of-network” providers regardless of what’s best for a particular patient.

But there is hope, particularly if CMS, ONC, and maybe even the VA orchestrate their actions. The hope lies in the upcoming definition of “information blocking” as mandated by 21stC Cures.

HHS can and should define information blocking in terms of independent decision support at the point of care.

Access to independent decision support at the point of care is an outcome rather than a process. It’s easy to tell if it’s blocked without resort to heavy-handed regulation of the API technology. No new legislation is required because HIPAA, HITECH, and 21stC Cures already enable patient-directed information sharing via API at no significant cost. Patient-directed APIs are also directly accessible to the physician, subject to patient consent.

Technically, what’s required is that *every* API of an EHR be supported as a patient-directed API. That’s not much to ask since the EHR vendors are already building the APIs to use in the app stores they need to stay competitive. What’s also required is what Rucker calls Persistent Access which is what FHIR calls Refresh Tokens and is already widely implemented in the Apple Health APIs. Finally, what’s needed is the ability for a patient to direct information anywhere we choose, without censorship or delay, via the API. (Note that patient-directed exchange is different from patient access rights that require information to flow through personal health records. PHRs have largely failed in the marketplace.) Under HIPAA, patients have this right to patient-directed use for in-person requests to send patient records using paper forms, but this right to uncensored patient-directed exchange needs to be made accessible via the patient portal and linked to the FHIR API. The technical term for this is Dynamic Client Registration and it’s a unimplemented security capability of the FHIR API.

Patient-directed APIs can impact the physician-patient encounter in real time when one or both parties have a smartphone, although ideally the independent decision support will also be available in the EHR as long as the physician and the patient approve.

I’m calling this prescription for empowering patients Decentralized Information Governance. It’s completely consistent with both Verma’s and Rucker’s vision. Because it’s also consistent with current law, it can be implemented by Medicare, Medicaid, VA, and All of US immediately by joining the Health Relationship Trust (HEART) workgroup and implementing our profiles in the VA BlueButton 2.0 and CMS MyHealthEData projects.

The key is for all of us to reject calls for centralized governance of information services by government, academic hospitals, or global corporations (Facebook, Google, etc…) that have all proved resistant to regulation in the digital age. We must also reject the idea that new information governance bureaucracies like DirectTrust, or CARIN Alliance, or some government-controlled Recognized Coordinating Entity can be invented to ensure that our incredibly valuable health information drives open medical science. Decentralized information governance explicitly gives each patient the power to choose which patient interest groups, community organizations, or congregations one trusts to control access to his or her health records for both clinical and research uses.

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Adults use Online Health Resources instead of Primary Healthcare 

Adults use Online Health Resources instead of Primary Healthcare  | Healthcare and Technology news | Scoop.it

A recent survey of 2,201 US adults, conducted by University of Phoenix® College of Health Professions, found that almost 59 percent of the population is choosing to use online health information sites, such as WebMD, instead of primary care. The survey also found that though online health resources are being preferred by people, other health technologies are not getting adopted at the same rate.

 

Doris Savron, Executive Dean for the College of Health Professions, noted that “The healthcare industry is shifting to a patient-centered model that harnesses technology to both open communication channels and create a platform for patient engagement. Given this shift, it is crucial that patients not only have access to these technologies but also view them as important resources for improving their health and overall care experience.”

 

Merely a quarter of US residents who have access to technology utilize resources such as appointment booking, accessing health records and e-prescription filing.

 

In traditional care settings, Americans expect a certain level of quality from their healthcare professionals team. As per this survey, most of the respondents value the presence of interpersonal skills amongst their care teams, which includes listening, verbal communication and bedside care.

 

Savron further added, “The data shows that technology is just one piece of the puzzle when it comes to patient care. Although new technologies are resources that we should lean on to help improve communication, interpersonal skills are the foundation for ensuring patient trust and better care. Communication and empathy are vital skills for health professionals seeking to improve adherence and drive positive outcomes for patients.”

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