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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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Phone Systems that keep the Practice and Patient Connected 

Phone Systems that keep the Practice and Patient Connected  | Healthcare and Technology news | Scoop.it

Today’s medical practice office is increasingly concerned with patient satisfaction. Of course, the health and well-being of patients has always been a concern; but as revenue and billing cycles quickly shift to a larger percent of patient responsibility, it’s becoming important to focus on ways to keep the conversation between practice and patient open and customer-centric at all times.

 

Healthcare providers have begun looking to technology solutions to up their patient satisfaction game. One likely solution? Automated phone systems that keep the practice and patient connected. Here’s a look at some of the key pros and cons of using automated phone systems in healthcare.

 

Everyone can relate to being annoyed by automated phone systems that keep directing callers around in circles, never to reach a human voice. That experience doesn’t translate to high patient appreciation. But it’s important to note that a good automated phone system can be far easier to use and more personalized for your practice needs.

 

Pros of Automated Phone Systems

 

Save Money. Automated phone systems have the potential to cover all of the work of your standard receptionist. Calls can be directed to the right party fairly quickly and the practice is still saving on the man hours it takes to answer and direct those calls manually.


Easy Installation and Upkeep. Most phone systems can be installed and up and running in a short amount of time and they can be hosted by the provider, meaning that the office will not need to worry about troubleshooting problems.


Routing Calls. New systems are exceptionally advanced and calls can easily be routed to the right destination, as well as voicemail boxes.


Setting Up Call Options. If the office manager takes a good look at what patients generally call about, they can narrow down specific options so that callers are quickly directed to the right location. For instance, if the largest number of calls come in to schedule appointments, “Scheduling” should be the first item on the automated list.


Cons of Automated Phone Systems

 

Patient Approval. No matter how well designed the phone system is, there will always be patients who are opposed simply because they’ve had bad experiences with automated systems–potentially not even in healthcare, but in another industry altogether. Most patients will get used to a new system, though practices should definitely listen to feedback and adjust to better serve the patients.

 

Voice Recognition Mistakes. Voice recognition is exceptionally useful so that patients can speak their choices and be directed immediately, without punching in any keys. Many people prefer this method, but voice recognition does still have occasional issues in deciphering speech, especially with differing accents.

 

Managers should take some time researching the company and product before deciding on any system. Taking the patients’ needs into consideration can go a long way in making the decision, as well as breeding satisfaction with patients as they become better acquainted with the phone system. Looking to the future of healthcar, technology plays the biggest role in facilitating patient satsifaction.

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StrongBox: Your Medical/Dental Billing Software Solution

StrongBox: Your Medical/Dental Billing Software Solution | Healthcare and Technology news | Scoop.it

In today’s modern world, revenue cycle management and intuitive billing software are essential aspects
of any successful healthcare practice. Together, these tools can help reduce bad debt expense, increase
collections, and reduce overall costs. Here, our team at StrongBox explores how our medical/dental
billing software can be an invaluable asset to your practice. Once our software is in place, our clients
enjoy a number of benefits, all while making more money and working less.


#1: Increase Practice Efficiency
Administrative and billing tasks often take up a shocking amount of time. In fact, according to The
Commonwealth Fund, 20.6 hours are spent every week on health plan-related tasks. [1]  With better
organization, StrongBox can help your practice increase its workflow efficiency. Our proprietary
software integrates seamlessly with your practice management software, not only enabling faster note-
taking, but also helping your entire team stay organized throughout the work day.


#2: Decrease Practice Overhead
Many practice owners assume their billing headaches will go away if they hire more employees. On the
contrary, fewer staff members can actually streamline the process and keep costs down. The best way
to achieve this is to employ a reliable medical/dental billing software. At StrongBox, we design our
software to be user-friendly and intuitive. As a result, your staff spends less time on billing and more
time getting new patients through the door.


#3: Billing Transparency
Part of workflow efficiency is complete billing transparency. You need to know which claims have been
processed and if any have been denied. You also need to keep track of every charge and every
transaction. StrongBox’s medical/dental billing software can help you quickly assess the financial status
of every patient and catch any billing errors in the process.


#4: Increase Your Return on Investment (ROI)
If you’ve been in healthcare for a while, you know how quickly billing costs have risen, and continue to
do so. A positive return on investment is absolutely essential for a successful practice. By keeping
revenue up and keeping costs down, StrongBox medical/dental billing software can help you run your
practice efficiently and reap the rewards for your hard work.


#5: Best Practice Training
When choosing a medical/dental billing software, you want a company that can help train your team
and address any technical issues. At StrongBox, we not only have a team of IT experts, we also partner
with several experts in the dental and medical fields. This gives us a full understanding of your unique
needs as a practice, so we can build a software solution that will enhance your productivity.


Seamless Integration

 

We understand that shopping for new software solutions can seem daunting, especially since you likely
have a number of programs installed already. StrongBox’s billing software seamlessly integrates with
your practice management software of choice, making the transition as simple and as smooth as
possible. Furthermore, StrongBox also offers revenue cycle management as well as a patient payment
portal, making administrative tasks that much easier.

 

Learn More about StrongBox Medical/Dental Billing Software
If you are currently in the market for healthcare billing software, request a free demo from StrongBox.
We can help you assess your needs so we can deliver a fully customized software solution for your
practice. To learn more, contact our Boca Raton, FL office by calling (855) 468-7876.

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Adoption of Telehealth Can Generate Cost Savings for Hospitals 

Adoption of Telehealth Can Generate Cost Savings for Hospitals  | Healthcare and Technology news | Scoop.it

The adoption of telehealth technologies in rural areas can result in significant cost savings for hospitals and their communities due to transportation cost savings, lost wages savings, hospital cost savings and increased revenues for local labs and pharmacies, according to a white paper by the NTCA-The Rural Broadband Association.

 

In the white paper, titled “Anticipating Economic Returns on Rural Telehealth,” Rick Schadelbauer, manager, economic research and analysis at the organization, outlines the case to be made for increasing adoption of telehealth in rural areas, and throughout the country, by keeping patients using local health care services rather than traveling to bigger, nearby cities for health care services. Schadelbauer noted that within the United States, there is a distinct health disparity between rural and non-rural Americans, primarily as a result of demographics and limited access to health care.

 

Telehealth and telemedicine, or the remote delivery of health care services and clinical information using telecommunications technology, holds potential to improve the quality, cost and availability of health care in rural areas. However, telemedicine is not viable without access to robust, reliable broadband service, Schadelbauer wrote. “Rural areas currently lag in broadband deployment, but continue to make impressive gains due in large part to the efforts of small telecommunications providers. Wireless applications require wireline infrastructure in order to be viable options,” he wrote.

 

The white paper examines the rural health care challenges, telehealth adoption and the potential benefit of telehealth technologies, both non-quantifiable and quantifiable. And the white paper drills down into challenges for rural health, such as reimbursement, cost, patient privacy and licensing.

 

According to the paper, the non-quantifiable benefits of telehealth are numerous: improved access to specialists, speedier treatment, the comfort of remaining close to home, eliminating the need for long-distance transportation, the ability for health care providers to sharpen their skills, and improved patient outcomes.

 

The white paper also quantifies several categories of quantifiable benefits of telehealth: transportation cost savings (median cost savings: $5,718 per medical facility, annually); lost wages savings ($3,431 per medical facility, annually); hospital cost savings ($20,841 per medical facility, annually); and increased revenues for local labs ($145,109 per medical facility, annually) and pharmacies ($8,558 per medical facility, annually.)

 

More specifically, hospitals in rural communities could potentially save more than $81,000 a year on employing doctors, and the white paper presented as one example a hospital that reduced its use of a full-time radiologist from five days a week to one. And, at the same time, hospitals could potentially generate revenue from lab work and pharmacy services that would remain local as a result of telemedicine, according to the white paper. For example, the authors estimated that tens of thousands of dollars could generated by local MRIs, CTs and other lab and pharmacy billings.

 

“The decision to implement telemedicine is unique to each medical facility, and should take into account not only costs but also non-quantifiable benefits and quantifiable benefits accruing to parties other than the medical facility, such as the patient and local labs and pharmacies located in the communities where telemedicine takes place,” the authors wrote.

 

As potentially significant as the potential benefits to telehealth—both non-quantifiable and quantifiable—may be, , Schadelbauer wrote that “it is critically important to remember that rural telehealth’s role in addressing the significant health problems inherent to rural areas will depends upon the availability of an underlying, future-proof, fiber-based broadband infrastructure. Further investment in, and expansion of, broadband infrastructure is a critical need not only for rural Americans but also our country as a whole.” Further, he noted, “Absent access to such an infrastructure, the benefits of telemedicine will remain merely theoretical.”

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5 Ways Telemedicine Is Helping Hospitals & Their Communities 

5 Ways Telemedicine Is Helping Hospitals & Their Communities  | Healthcare and Technology news | Scoop.it

Change has been hard on rural hospitals and their communities. Since 2010, more than 48 rural hospitals have closed and much more are on the brink of the same fate. Patients are seeking higher levels of specialized care from urban hospitals while rural communities are struggling to find top-notch providers willing to reside in remote areas. Lack of resources, provider shortages, and all-time low patient censuses are causing more and more hospitals to consider closing their doors.

But according to a Becker’s Hospital Review article, many believe that virtual health could be the answer to much of the woes rural hospitals are experiencing.

 

1- Patients are looking for more specialized services
When patients within rural communities contract long-term illnesses that require more extensive testing and monitoring, they’re often forced to spend additional time and resources on traveling to larger hospitals and health systems that are more equipped to provide the care they need. This could include regular check-up appointments with specialty physicians or more in-depth tests that require equipment their rural hospital doesn’t have access to. This can cause a snowball effect by taking away the same patient for general care needs that they can certainly receive from their community hospital.

 

Rural hospitals have quite a number of options when it comes to providing telemedicine to their patients and all are helpful in their own ways to combat the potential churn of a patient.

 

Remote specialist consultations can allow a rural hospital to connect with the nearest urban hospital and their physicians for specialized services while still retaining the patient and making their care more convenient and low-cost.

 

Outsourced diagnostic analysis allows patients to receive diagnostic tests followed by top-notch care depending on the outcome. Patients no longer need to travel for hours just to have an x-ray or specialty lab work performed.

 

Remote consultations allow doctors to perform routine check-in appointments with patients from home. Not only do they get to skip the long drive to their nearest urban hospital, they can even avoid the short commute to their rural hospital while still seeing their same physician.

 

Direct-to-consumer telemedicine allows rural hospitals to expand their services to new patients. Patients who don’t typically take the time to see a doctor can now have virtual consultations for urgent care needs without making an appointment, driving to an urgent care, or spending time waiting in the emergency department.

Telemedicine consultations of any kind save time for both the patient and the doctor, leaving room in the physician’s schedule for more appointments with other patients who do require in-person care. Patients in rural areas benefit by removing the barrier of transportation, long drive times and the costs associated with both.

 

2- Rural hospitals are experiencing provider shortages
There is expected to be an overall shortage of 46,000 to 90,000 physicians by the year 2025 and rural hospitals will feel it. Rural communities are having a hard time attracting physicians who are willing to live in remote areas. Rural communities have about 68 primary care doctors per 100,000 people compared with 84 in urban areas.

 

Rural hospitals who are experiencing provider shortages can utilize telemedicine platforms that come completely staffed with physicians who are fully trained in providing virtual care, and at a much less expensive rate. Telemedicine platforms who come staffed with 24/7 physician coverage are the perfect solution for small rural hospitals whose emergency departments get overwhelmed with patients not experiencing a true emergency. Patients can access a doctor from home and leave the resident physicians available for truly urgent conditions. Most physicians who staff a telemedicine platform are not primary care physicians, so there is no risk of losing patients to outside providers. In most cases, the physicians can help refer patients back to the hospital for other medical needs.

 

For hospitals who need an extra benefit to attract physicians from urban areas, according to Dr. Wilbur Hitt in an NEJM career resources article, “telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town,” he said. “With telemedicine, it’s like having one foot in the city but being able to live and practice out in a rural area. It’s also reassuring to know that you’re on the right track with the treatment plan and are staying current.” In addition, it gives rural physicians the opportunity to specialize in something high-tech and innovative that will surely be the way of the future.

 

3- A high percentage of a rural hospital’s patients receive Medicare
Medicare and the subject of reimbursement often hinder the way a rural hospital can deploy telemedicine to their patients, especially in North Carolina where telemedicine parity doesn’t exist.

 

Currently, patients in rural areas who are covered by Medicare Part B can be reimbursed for telemedicine services, like office visits and consultations, as long as they are located at one of these places during the telemedicine consultation:

  • A doctor’s office
  • A hospital
  • A critical access hospital
  • A rural health clinic
  • A federally qualified health center
  • A hospital-based or critical access hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center


An additional advantage of telemedicine for any patient, including those on Medicare, is that the cost of a visit is much less expensive compared to an urgent care facility or an emergency department visit which often tend to be the first choice for unscheduled care. With most virtual consultations costing less than $50 per visit, patients are able to save on both routine and urgent medical care costs. The savings also applies where insurance isn’t concerned. Non-existant commutes save on the cost of transportation and allow those without means of reliable transit to see a doctor from the comfort of their home.

 

4- Helping rural hospitals reduce readmissions
Telemedicine is already a proven tool for helping rural hospitals lessen the penalties they receive from value-based reimbursement policies. Rural hospitals who are using telemedicine in addition to implementing care coordination and patient experience improvement strategies are receiving fewer penalties than their urban counterparts.

 

While rural hospitals are already excelling, there is always room for improvement. According to RevCycle Intelligence, rural hospitals still have ways to go under the Hospital Readmissions Reduction Program. 79% of participating rural hospitals faced value-based penalties in 2015 under the program. This year, hospitals will see a 3% maximum rate of penalty and CMS estimates that will total $528 million dollars in penalties across the US.

 

A big factor in reducing readmissions is providing better preventive care, this is where telemedicine excels. Remote monitoring allows patients to check in more frequently with their physicians or nurses and also increases the chance that they’ll seek advice when experiencing an unscheduled medical care need before it advances to a more serious condition. By catching a sudden change in status, a patient can be seen by a primary care physician rather than being readmitted to the hospital, thus impacting a hospital’s penalties.

 

For some patients managing at-home care can be the challenge, especially when dealing with lengthy discharge instructions. When patients aren’t following their discharge instructions correctly, disease symptoms can flare, causing a trip back to the hospital. With remote monitoring via a HIPAA secure video connection, physicians and nurses have the ability to check in on a patient to see if they’re following their discharge instructions correctly and can also administer help remotely for patients who need a little extra hand-holding, this is especially useful for those who do not have at-home care or someone to assist with the fine details.

 

Prescriptions can also cause problems. Elderly patients may have trouble remembering to fill a prescription, especially when it involves scheduling an additional doctor appointment. By communicating via telemedicine, prescriptions can be refilled during a regular, virtual consultation and can be ready for pick-up at their preferred pharmacy in just a few short hours.

 

5- Increase patient census & reach the remote and underserved
As mentioned under section #1, direct-to-consumer telemedicine increases a hospital’s reach by attracting patients who otherwise wouldn’t seek care from a rural hospital’s network. Those who live and work in the corners of rural areas have the longest drive time and those who are underserved and do not have reliable transportation usually go without medical care. Even established patients will find value in seeing a doctor from home, greatly increasing their satisfaction of care received.

 

Telemedicine providers today are able to provide a white-labeled app, meaning they can design both the desktop and mobile interface where patients receive care to use a specific hospital’s brand standards- allowing a patient to seek care from a known and trusted healthcare provider. But, the branding isn’t the most important part. You should also consider how a patient is recognized when using telemedicine provided by your hospital and how their PHI is delivered back to your EHR. While most telemedicine providers can white-label the app, some cannot connect the patient back to your hospital, this creates a fragmented patient record contributing to disparate care coordination.

 

In addition to being able to tell where a patient is coming from, it also allows the physician providing the virtual care to help the patient determine where they should receive follow-on, in-person care, if necessary. Patients who are linked to one rural hospital can be referred back to that hospital’s network if it makes the most sense.

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8 Signs of a strong security culture

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

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

 

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

 

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

 

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

 

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

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

 

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

 

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

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Continuous Learning in Healthcare and Technology

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

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

 

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

 

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

 

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

 

A few observations and tips from my own experience:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Innovation or disruption?

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Digital transformation and the law of small numbers

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

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

 

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

 

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

 

 

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

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

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

A slowdown in technology investments

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

Renewed debates on the state of data and analytics

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

 

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

 

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

Relax, digital is alive and well

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

 

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

 

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

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3 trends that will drive the future of technology in healthcare 

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

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

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

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

Data, analytics and artificial intelligence (AI)

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

 

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

Changing healthcare markets

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

 

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

The digital health platform of the future

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

 

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

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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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Using telemedicine to treat chronic disease 

Using telemedicine to treat chronic disease  | Healthcare and Technology news | Scoop.it

Flash back to the brink of the Patient Protection and Affordable Care Act. On the cusp of the passage of the ACA, more than 41 million Americans were uninsured or underinsured, driving one of the largest health care overhauls in history. While controlling costs was an important consideration, the main focus of the ACA was expanding coverage. To increase accessibility to affordable health insurance options, the law employs a mixture of mandates, subsidies, tax credits, and penalties to increase coverage of the uninsured, spur health care innovation, and provide for new payment models to reward quality of care and improved health care outcomes.

 

More than five years into the ACA era, the White House touts that the number of people without health insurance continues to decline and has dropped by 15.8 million since 2013. Of the roughly 11 million people who enrolled in state or federal Marketplaces in 2015, about 4.2 million were auto-renewals or renewals, indicating that roughly half of all 2015 enrollees kept their 2014 Marketplace insurance plan.

 

The rurally ignored

 

Despite the widely publicized successes of the ACA, many rural Americans were forgotten by health care reform. Although the ACA proclaimed a renewed focus on rural America, little was accomplished for rural populations outside of Medicaid expansion. A policy brief published by the National Advisory Committee on Rural Health and Human Services stressed the importance of coverage in rural areas, where the population is disproportionately older, more chronically ill, lower in income, and less insured compared to urban areas.

 

Where are the rural communities? "Rural" encompasses all populations, housing, and territories not included in an urban area; essentially, it is defined by what it is not. In 2010, the U.S. Census estimated that 59.5 million people – 19.3 percent of the population – lived in rural areas.

 

Rural residents tend to be poorer, earning a per capita average income of $19,000, which is nearly $7,000 less than what their urban counterparts earn. Although rural Americans account for only 22 percent of the population, rural residents account for 31 percent of the nation's food stamp beneficiaries. Only 64 percent of rural residents are covered by private insurance, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts (45 percent versus 49 percent, respectively). Compounding the issue of obtaining affordable coverage, rural areas rarely have access to the same types of coverage. According to the National Rural Health Association, only about 10 percent of physicians practice in rural America, even though nearly 25 percent of the population lives in rural areas. There are only 401 specialists per 100,000 people, compared to 910 in urban areas.

 

"Rural Americans face a unique combination of factors that create disparities in health care not found in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators, and the sheer isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life."

 

Perpetuated by the inability to find and afford care, rural populations face higher incidences of chronic disease. Obesity, diabetes, heart disease, and alcohol and substance abuse are all chronic conditions that disproportionately affect rural populations.

 

Turns out, chronic disease is costly

 

In the U.S., chronic diseases and the health risk behaviors that cause them account for highest health care costs. In fact, 86 percent of all health care spending in 2010 was for people with one or more chronic medical conditions. The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who are obese were $1,429 higher than those for people of normal weight in 2006. Of the top 10 states with the highest rural populations, half fell on the list of the states with the highest rates of adult obesity and diagnosed diabetes

 

So what is the government doing? Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services recently awarded $2.7 million to improve rural health, however, those grants will support 3-year pilot programs designed to train health professionals and expand health insurance coverage in rural areas, rather than impact rural health directly. Essentially, the 20 recipients of the grants (ranging from $75,000 to $200,000) are community colleges, hospitals, health education centers, individual counties, and other various providers, which are to use the money for formal training programs for health professional students. To put it in perspective, HRSA responded to the outcry by millions of rural Americans by awarding grants equal to the price of 17-year-old Kylie Jenner's first home, after spending hundreds of millions of dollars implementing the ACA and federal and state Marketplaces.

 

Is telemedicine the perfect solution? Maybe

 

Although the ACA does not specifically link telemedicine to rural populations, "telehealth" or "telemedicine," which is using telecommunication and information technologies to provide clinical health care at a distance, is a critical component of transitioning to value-based treatments, and to better serving rural communities and chronic conditions.

 

For rural populations, telemedicine has the potential to increase accessibility to providers and specialists who can remotely monitor and treat chronic disease, without the hassle or costs associated with traveling. In many states, telemedicine services are covered by insurance to the same extent as in-person services. It helps eliminate distance barriers to medical services that would often not be consistently available in distant rural communities.

 

Although it seems like a catch-all, it is important to note that telemedicine is not a replacement for an annual, in-person physical; it is used most effectively to manage chronic condition and preventive health care costs. Even the best physicians in the world cannot take the blood pressure of a patient or press on the abdomen of a sick patient remotely. While certainly this represents a drawback, it also presents an opportunity. The rules governing the practice of medicine do not need to be the same rules that govern the practice of telemedicine. By linking patients with doctors either via telephone or video chat, barriers of distance can be eliminated, which proves crucial for rural areas.

 

Telemedicine snapshot: Mississippi

 

To address the prevalence of chronic conditions, Mississippi became the 16th state to pass advanced telemedicine provisions. In 2014, the American Telemedicine Association (ATA) graded existing state telemedicine programs based on reimbursement and physician practice standards, rating Mississippi with the highest possible composite score. Evidence of a collaborative landscape accommodating telemedicine, Mississippi requires telemedicine services to be a 'real-time' consultation, which does not include the use of audio-only telephone, email, or fax. Additionally, the Mississippi legislature also required that telemedicine services are covered to the same extent as in-person services, although a health plan may limit the number of telemedicine providers to a local network.

 

With the highest prevalence of adult obesity and diabetes in the country, Mississippi prioritized remote patient monitoring services to coordinate primary, acute, behavioral, and long-term social service needs for high-need, high-cost patients. For telemedicine services to be reimbursed, patients must be eligible for remote patient monitoring and specific patient criteria must be met. For example, qualifying patients for remote patient monitoring must be recommended by their physician, be diagnosed in the last 18 months with a chronic condition like diabetes or heart disease, and have a history of costly services because of that condition.

 

Initial barriers to telemedicine implementation

 

Although Mississippi has faced relatively little resistance incorporating these laws, many states still need to consider a number of issues or barriers when developing telemedicine programs and policy.

 

1. Requiring coverage for telemedicine under private insurance, state employee health plans, and public assistance


Reimbursement continues to be a barrier to telemedicine adoption in some states. Medicare, which typically sets reimbursement standards, reimburses for telehealth services with relatively stringent requirements. Medicare pays for telemedicine services only when patients live in Health Professional Shortage Areas (HPSAs) and those who engage in "face-to-face" interactive video consultation services and some store-and-forward applications (e.g., teleradiology, remote electrocardiogram applications). As stated in a report by the American Hospital Association, "Without adequate reimbursement and revenue streams, providers may face obstacles in investing in these technologies."

 

Plan administrators and providers need to work together to discuss telemedicine benefits and determine coverage options and reimbursement policies, similar to the Mississippi State Legislature passing a bill requiring private insurance to pay for telemedicine services at the same rate as it does for in-person care. States considering telemedicine will have to wrestle with similar decisions about what to cover (e.g., video consultations, asynchronous store-and-forward platforms, patient monitoring) and review technology guidelines that determine reimbursement eligibility to ensure maximum reimbursement. To put it simply, if providers are not getting paid, they cannot provide.

 

2. Patient consent and education

 

Consent is a vital component of health care and is more complicated with a telemedicine platform. States must consider requirements for how to approach and obtain patient consent. The risk of consent-based claims for providers is a concern, and malpractice laws are currently geared toward face-to-face interactions; if consent-based claims become rampant, the willingness of providers to administer health care via telemedicine will likely decrease. Nebraska, for example, requires written informed consent, while California and Arizona law permit verbal consent to satisfy the statutory informed consent requirement. Since telehealth is a new and emerging field, patient education is critical to patients' health and providers' ability to practice.

 

Ideally, patients need to understand details about the expected risks and benefits of telemedicine, available alternatives, and how telemedicine fits into their personal wellness plan.

 

3. Geographical restrictions on telemedicine services


Although many states are ironing out provisions for health professional licensure requirements, including implementing special telemedicine licenses, border state and consultation exceptions, and interstate reciprocity and endorsements, little research has been done regarding restrictions on limitations for patient location while receiving telehealth services. For instance, can a patient on vacation in another state or country meet with his or her physician for an appointment? If the physician prescribes medication, can the patient fill his or her prescription outside of state lines?

 

Consideration needs to be placed on not just where the provider is operating from but also where the patient is located at the time of treatment and how treatment is administered.

 

4. Establishing the provider-patient relationship


Trust is an essential factor in a provider-patient relationship. It has been historically built during face-to-face interactions. States need to consider whether an in-person examination component is necessary or telemedicine can be used instead of an initial in-person patient evaluation.

 

The face of health care is changing, but prioritizing relationships is at the core of what creates value and better outcomes in health care. When implementing telemedicine programs, it is essential to consider the health of the patient first and design an interaction model that will create the most effective patient-provider relationship.

 

Overwhelmed? Here's what we know, and where we're going. We know that there are a significant number of rural Americans in the U.S. who have a difficult time accessing and affording health care. We know that many of these Americans are the ones who really need it, given their higher incidence of chronic disease. We know that chronic disease costs a lot and that most rural Americans cannot afford to treat it conventionally. We know that on its face, telemedicine may be one solution to solving the problem of rural health care.

 

A continued focus on this population of Americans and a renewed sense of urgency will allow for thoughtful state legislation and progressive development. Using Mississippi as a model of telemedicine implementation that is more thorough than many of its counterparts, other states can review their successes and challenges, with specific focus on the issues identified in this piece. For instance, considering where a patient must be located to receive care from providers, as well where they are legally able to fill a prescription from that provider are critical considerations for every state developing and amending telemedicine laws. There are a number of stakeholders involved in the telemedicine field. To ensure comprehensive, thoughtful laws and reforms, state legislature should reach out to local health care providers, nonprofit research centers, state insurance and Medicare/Medicaid departments, private insurance companies, state legislators, and patients to evaluate needs and requirements, and implement suitable legislation.

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CMS is making telehealth a cornerstone in its first Rural Health Strategy.

CMS is making telehealth a cornerstone in its first Rural Health Strategy. | Healthcare and Technology news | Scoop.it

CMS has unveiled its first-ever Rural Health Strategy in an effort to improve access to healthcare for the estimated 60 million Americans living in rural areas. The plan includes an emphasis on modernizing and advancing telehealth and telemedicine.

 

The Centers for Medicare & Medicaid Services unveiled the first-ever program this past week, releasing a five-point, eight-page initiative to improve access to care for the estimated 60 million Americans living in rural and underserved communities.

 

“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” CMS Administrator Seema Verma said in a press release. “The Rural Health Strategy supports CMS’s goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”

 

One part of the strategy focuses on using connected care technologies to bring healthcare to those residents.

 

“Telehealth has been identified as a promising solution to meet some of the needs of rural and underserved areas that lack sufficient health care services, including specialty care, and has been shown to improve access to needed care, increase the quality of care, and reduce costs by reducing readmissions and unnecessary emergency department visits,” the plan states. “To promote the use of telehealth, CMS will seek to reduce some of the barriers to telehealth use that stakeholders identified in the listening sessions, such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.”

 

In its strategy, CMS says it will look to modernize and expand telehealth and telemedicine programs, particularly through the Next Generation Accountable Care Organization Model, Frontier Community Health Integration Project Demonstration and Bundled Payments for Care Initiative advanced model.

 

CMS has long come under criticism for its guidelines on reimbursing healthcare providers for telehealth delivered in rural areas, including restrictions on what services can be reimbursed under Medicare, where those services can be delivered, and even how rural areas are defined.

 

The agency has been the focus of several lobbying efforts to improve telehealth and telemedicine reimbursement, as well as several bills introduced in Congress. But few of those bills have become law, and healthcare providers still see Medicare reimbursement as one of the biggest barriers to pushing sustainable virtual care into rural America.

 

Last year, The Healthcare Information and Management Systems Society (HIMSS), American Medical Association (AMA), American Medical Informatics Association (AMIA), Center for Connected Health Policy (CCHP) and Personal Connected Health Alliance (PCHA) all called on CMS to go beyond current proposals to amend the Medicare 2018 physician fee schedule and open the doors to more connected care services.

 

“HIMSS encourages CMS to embrace a reimbursement system that recognizes the unique characteristics of connected health that enhances the care experience for the patient, providers and caregivers,” former HIMSS President and CEO H. Stephen Lieber and Denise W. Hines, chair of the HIMSS North America Board of Directors and CEO of the eHealth Services Group, wrote.

 

In that letter, HIMSS called on CMS to support:

 

Collaborative decision-making involving diverse care-teams. “Decisions are no longer just between a doctor and patient,” the organization wrote. “Connected technologies allow for the incorporation of a patient’s family and trusted advisors, as well as other allied health professionals, in the decision-making process.”
Expanded care locations and always-on monitoring. “When patients are always connected, care (the interpretation of data and decision support) can occur at any time and in any place,” HIMSS said.


A reliance on technology, connectivity and devices. “Connected health involves communication systems using a variety of components; these may be managed by the provider, the patient, or other parties in the care team,” HIMSS said.
And “empowerment tools and trackers that enable patients to become active members of the care continuum outside of the hospital setting and promote long-term engagement which, in turn, leads to a healthier population.”


Recognizing the challenges faced by healthcare providers in sustaining and scaling telehealth, the National Quality Forum (NQF) issued its own report last year, in which it proposed to set a national framework for measuring and supporting success in telehealth and telemedicine.

 

“Telehealth is a vital resource, especially for people in rural areas seeking help from specialists, such as mental health providers,” Marcia Ward, PhD, director of the Rural Telehealth Research Center at the University of Iowa and co-chair of NQF’s Telehealth Committee, said in a release accompanying the 81-page report. “Telehealth is healthcare. It is critically important that we measure the quality of telehealth and identify areas for improvement just as we do for in-person care.”

 

CMS’ Rural Health Strategy, developed by the CMS Rural Health Council, formed in 2016, and culled from input gained at 14 public hearings, features five objectives:

 

  • Apply a rural lens to CMS programs and policies;
  • Improve access to care through provider engagement and support;
  • Advance telehealth and telemedicine;
  • Empower patients in rural communities to make decisions about their healthcare; and
  • Leverage partnerships to achieve the goals of the strategy.
    The effort was met with words of support from several organizations.

 

“(The) AHA is pleased CMS put forward thoughtful recommendations to address the unique challenges of providing care to patients in rural communities,” Joanna Hiatt Kim, the American Hospital Association’s vice president of payment and policy, said in a release. “We look forward to working with CMS and Congress to take meaningful action to stabilize access in rural communities, such as creating new alternative payment models, expanding coverage of telemedicine and access to broadband and reducing regulatory burden.”

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Virtual Healthcare Gets Real, As Telehealth Turns to AI

Virtual Healthcare Gets Real, As Telehealth Turns to AI | Healthcare and Technology news | Scoop.it

One day you wake up with a pain in your side that persists. You want to be seen by a medical professional, but you don't want to go through the hassle of making an appointment and schlepping to your doctor. Most large healthcare organizations now allow you to make an appointment with a physician and get observed from the comfort and privacy of your own home — via video conferencing software on your smartphone, tablet or PC.

 

Such "telehealth" capabilities, as they're known, have been around for several years, but they're gaining traction as the sector swivels from fee-for-service to outcomes-based care. Intermountain Healthcare, a healthcare system that operates 23 hospitals and 170 clinics in Utah and Idaho, earlier this year took the concept of telehealth to another level by launching a virtual hospital.

 

The digital service, Intermountain Connect Care Pro, provides people anything from basic care to advanced services such as stroke evaluation, mental health counseling and critical care for newborns, says CIO Marc Probst.

 

Virtual care on the rise
Connect Care Pro marks the acceleration of a trend. Seventy-four percent of healthcare customers have already received or are interested in some form of virtual care, according to Forrester Research. The researcher also says that 55 percent of healthcare organizations are making a new investment or increasing investment in virtual care technologies, which they view as crucial to patient acquisition and retention.

 

"Patients seek personalized and convenient care," Forrester analyst Arielle Trzcinski wrote in a recent blog post. "They will not tolerate an aggravating, time-consuming experience when options that fit their needs are just a click away."

 

For Connect Care Pro, Intermountain Healthcare wove together 35 telehealth programs and allocated more than 500 caregivers. Probst says the virtual hospital saves patients and doctors the time and trouble of meeting in person for routine ailments, such as a headache or a pulled muscle. "They do 100 percent of their work virtually," Probst says of the physicians working for the virtual hospital. Probst estimates that as much as 75 percent of healthcare appointments can be performed virtually.

 

That presents great opportunities for Intermountain, which can now more efficiently treat patients who require emergency medical attention, Probst says. Probst helped implement the software and systems for the virtual hospital, including integrating them with the provider's Cerner electronic medical record (EMR) system.

 

The virtual hospital is one of the cornerstones of Intermountain's multi-year digital transformation, supporting more than 2,300 physicians and clinicians. It builds off of a decade-old telehealth initiative that Probst helped expand to more than 12 non-Intermountain healthcare facilities in Utah, Wyoming in Idaho.

 

However, he acknowledges that the technology doesn't work for all scenarios. "I don't want my prostate exam over my computer," says Probst, when asked for an example of a necessary in-person treatment. Indeed, while telehealth will never completely supplant on-site caregivers, Intermountain believes it can ease the burden on existing staff, particularly with the population of Baby Boomers set to exceed children in the U.S. by 2030, according to the U.S. Census Bureau.

 

A virtual assistant for your healthcare needs
For Intermountain, virtual care is just one piece of a larger emerging healthcare puzzle that Probst says will also include virtual assistants driven by artificial intelligence (AI) — think Iron Man's "Jarvis" for healthcare. Take the virtual hospital or telehealth scenarios, for example.

 

If someone has a medical issue they want attended to, they can cue up Amazon.com's Alexa or Google Assistant from their home-based smart appliance and describe the condition. The virtual assistant could walk the patient through questions about the location and severity of the pain, while in the background accessing the patient's EMR (with the patient's prior permission, of course). Ideally, the assistant could then "get close to a diagnosis" and recommend the person see a doctor either in-person or via virtual care, Probst says. The assistant can then make that appointment.

 

Probst says these capabilities, which he expects could one day be integrated into Connect Care Pro, will likely happen within his career. "It's very much using AI and tapping into the EMR for digital triage," Probst says. He says the AI will also, with a patient's permission, assist with ordering prescriptions, such as an antibiotic to a CVS or Walgreens.

 

Eventually, AI could be extended to the exam room, assisting a doctor while he or she is examining a patient. Most doctors today spend an inordinate amount of time entering notes into a patient’s EMR on a computer.

 

Probst envisions a future where computer vision and voice recognition technologies can “listen” and “understand” what a doctor is telling a patient during an exam and accurately enter the data into the EMR.

 

"It may seem a little farfetched, but a lot of what we can do for healthcare can be completely digitized with little to no human interaction once we've proven out the AI,” Probst says.

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How telemedicine is transforming treatment in rural communities? 

How telemedicine is transforming treatment in rural communities?  | Healthcare and Technology news | Scoop.it

There's no denying it: rural hospitals are in trouble.

 

More than 48 rural hospitals have closed since 2010, according to the National Rural Health Association, and another 283 are in danger of closing.

 

The malaise effecting rural healthcare comes from several vectors. Reduced populations, higher percentage of uninsured and elderly patients, equipment underuse, and the absence of high-margin specialty services makes for a bleak economic outlook. A shortage of doctors willing to work in remote areas creates quality of care and a staffing issues. Then, there is the challenge of getting patients into rural hospitals in a timely manner because travel distances sometimes are too great.

 

Many believe that telemedicine and mHealth offer a way out for struggling rural hospitals, however.

 

A 2012 report by the Institute of Medicine for the National Academies, entitled The Role of Telehealth in an Evolving Health Care Environment, found that telehealth drives volume, increases quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Through telemedicine, rural hospitals can serve rural patients at better costs and help cut down on the time it takes rural patients to receive care, particularly specialty care.

 

"When rural patients know their hospital is using telemedicine, they have higher regard for that hospital and are less likely to bypass it for treatment at an urban facility," noted James Marcin, director of the UC Davis Children's Hospital Pediatric Telemedicine Program, a pioneer in remote medicine.

 

The ways that rural hospitals can take advantage of telemedicine and mHealth technology advancements are many, and include remote consultations, in-home monitoring, outsourced diagnostic analysis, and remote specialist consultations.

 

Instead of waiting days or weeks for a healthcare professional to travel to a remote area, or traveling into a hospital and waiting for an appointment, telemedicine enables remote physician consultations that are faster, cheaper and more efficient than traditional healthcare appointments. For consultations on simple health concerns, or follow up on existing conditions, remote consultations can dramatically improve the patient experience while helping rural hospital economics at the same time.

 

The Georgia Partnership for Telehealth, for instance, assesses and treats students so that they do not need to travel to a clinic for healthcare, and currently has replaced more than 350 locations where a traditional doctor's visit was formerly required.

 

A second way that rural hospitals are leveraging telemedicine is through in-home monitoring. One example is decreased hospitalization rates for seniors enrolled in the FirstHealth Home Care Chronic Disease model in North Carolina. Patients previously diagnosed with heart failure, diabetes, or COPD and who experienced frequent hospitalizations are monitored by telehealth at home between periodic visits from nursing staff. Response and intervention times have improved substantially, according to the program.

 

Another benefit to struggling rural hospitals is outsourced diagnostic analysis and access to remote specialists. It is difficult for many rural communities to staff their own diagnosticians, but mobile imaging centers and lab specimen kiosks that can take X-rays and perform collections can work in conjunction with remote analysis labs in larger urban areas to bridge the gap.

 

One study that looked at 24 hospitals in four rural states in the Midwest including Kansas, Oklahoma, Arkansas, and Texas found that telemedicine brought an annual economic impact of at least $20,000 per year, with an impact of up to $1,300,000. The majority of these savings came from increased lab and pharmacy revenues due to additional work performed locally.

 

In addition to outsourced diagnostics, telemedicine also enables consultation with remote specialists at larger, urban hospitals instead of the need for having these specialists on staff. This can be particularly good for attracting doctors to rural hospital settings.

 

"Telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town," noted Dr. Wilbur Hitt in a report, Telemedicine: Changing the Landscape of Rural Physician Practice. "With telemedicine, it's like having one foot in the city but being able to live and practice out in a rural area. It's also reassuring to know that you're on the right track with the treatment plan and are staying current."

 

Still, roughly 66 percent of rural hospitals had no telehealth services or were only in the process of implementing a telehealth application when the RUPRI Center for Rural Health Analysis reviewed 4,727 hospitals in the 2013 HIMSS Analytics database. Part of the reason comes from broadband access challenges.

 

Rural communities not only suffer from a population shortage and a lack of resources, they also typically have trouble with the necessary broadband infrastructure for telemedicine. The benefit of remote consultation by video conference for rural patients is clear, for instance, but these remote consultations amount to nothing if there isn't the broadband infrastructure to support it.

 

"The ability for physicians to connect with those in areas that don't have much of a wireless connection is the biggest problem when trying to treat these patients," noted Tony Zhao the CEO of Agora.io, a video SDK company that provides easy video conferencing with quality-of-service guarantees so telemedicine and e-learning initiatives work even in rural settings.

 

"With weak connections, video streams for telehealth are blurry, choppy or just won't work," he added. "Implementing technology that doesn't rely on the general internet but which relies on an infrastructure that strengthens signals in the most remote areas is crucial."

 

Another barrier for rural hospitals is the challenges that surround reimbursements. Medicare reimbursement is a major challenge for telemedicine, with states each having their own standards by which their Medicaid programs will reimburse for telemedicine expenses.

 

There is no single standard telemedicine reimbursement system for private payers, either. Some insurance companies value telemedicine and will reimburse for a wide variety of services while others do not.

 

These and other challenges put a drag on rural telemedicine at the same time as the need for it grows. Rural hospitals have a path toward recovery in the form of telemedicine, but obstacles still remain.

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Advancing healthcare through technology

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

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

 

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

 

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

 

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

 

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

 

Together, we all make a difference!

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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Digital health startups need a “moat”

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

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

 

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

 

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

 

What do the latest digital health funding numbers tell us?

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

 

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

 

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

 

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

The “kill zones” for digital health innovation

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

 

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

 

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

 

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

 

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

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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.

Technical Dr. Inc.'s insight:
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inquiry@technicaldr.com or 877-910-0004
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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!

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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