Here’s the kind of thinking that makes me wish I was going to TEDMED 13 (John Lynn will be there if any other readers are attending.). At this years’ show, a team of current and future medical professionals plan to do a complete “smartphone physical” for attendees, using a bunch of devices that appear to be compatible with an iPhone. Not only is the data immediately readable as the testing goes on, it’s EMR-ready, too, both pretty neat features.
Check out just how thorough the physical is going to be (courtesy of the TEDMED blog):
Participant Shiv Gagliani, a Johns Hopkins medical student, tells TEDMED that the smartphone physical can improve doctor-patient relationships, as the real-time, audible and visual results help connect patients to the tests and increase their understanding of their bodies. Not only that, the patients can help gather the data themselves, increasing their engagement with their care.
And of course, the devices that make the smartphone checkup possible are also very portable, making it possible for doctors to take them wherever they go, be it down the street or across the globe. What’s more, less-trained global health workers will be able to use these devices to gather baseline readings and via telemedical links, get instructions on how to treat patients. This device connectivity is part of what John suggested was needed for successful Telehealth.
To learn more about this project, visit http://www.smartphonephysical.org/. I’d definitely take a look; it seems to me that this type of mobile health technology is here to stay.
Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.
Most of the ideas are pretty self explanatory, but check out the full post for his explanation of each item. I agree with each item, but I think there are a number of other things that are needed for successful telehealth as well.
Multiple Application Support – While we’d love to have the entire Telehealth experience on one application, it’s unlikely to ever happen. While doing a Telehealth visit, the doctor is going to need access to a number of other applications such as their EHR. This is where the dual monitor Telehealth setup is so beneficial. They can have the Telehealth visit up on one screen while they browse their EHR or other health application on the other screen.
Telehealth Reimbursement – I recently asked an insurance company executive about Telehealth and if they’re really start reimbursing for it. He said they were happy to reimburse a Telehealth visit, as long as they had a way to know that there was indeed a visit that justified payment. You can see where they’re afraid of Telehealth reimbursement fraud. His solution to that was reimbursing Telehealth systems that were their trusted partners. With this in mind, you want to make sure whatever Telehealth solution you use is trusted by the payers so that you get paid.
Device Connectivity – One of the challenges of Telehealth is the ability to get device information from a patient. There’s a new wave of Telehealth technologies that are incorporating medical devices into the Telehealth experience. Integrating Telehealth and devices really takes Telehealth to the next level and since the cost of devices is dropping dramatically we’re going to see more and more integrations. Just be careful because many Telehealth platforms won’t have the forethought to do this type of device integration.
I’m sure there are other keys to Telehealth success. I’d love to hear your additional ideas in the comments. Where are you seeing it implemented? What’s been most successful?
I believe the Telehealth market is set to grow like it’s never grown before. The technology and infastructure are in place for it to become a reality. Things like shared savings will drive adoption of Telehealth as a way to lower costs. The article linked above says that Telehealth is projected to be a $27.3 billion industry in 2016. I’m personally looking forward to the shift to Telehealth.
John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.
In this space, we talk a lot in the abstract about how physicians feel about EMR usability. Today, though, I wanted to share with you some great observations from a KevinMD.com piece by an angry anesthesiologist who lays out her own usability wishlist for EMRs and health IT generally.
In the piece, Dr. Shirie Leng fumes over the sheer work it takes for her to negotiate the systems she uses at her hospital. She notes that over the course of doing eight cases during a day, she’ll a) sign something electronically 32 times, b) type her user name and password into three different systems a total of 24 times and c) generate about 50 pages of paper given that the the computer record must be printed out twice.
To Dr. Leng, there’s ten steps institutions can take to eliminate much of the hassle and waste:
1. Eliminate user names and passwords: She suggests using biometric sign-in technology.
2. Eliminate the paper: Why print data that’s already entered into the system, she asks?
3. Make data systems compatible and 4. Make everyone statewide use the same system: Dr. Leng says it’s crazy that we don’t have interoperability within hospitals or between different institutions.
5. Don’t make her turn the page: “All the important information about a patient should be on the first page you open when you look at a patient,” she says. “I shouldn’t have to click six different tabs.”
6. Don’t make her repeat herself: If she does several cases the same way, with the same documentation each case, don’t make her re-enter it every single time.
7. Invest in voice-recognition software: During patient interviews, Dr. Leng notes, she wants to look at patients and talk, not hunt and peck at the keyboard or worse, spend hours later typing in data or clicking checkboxes.
8. Go completely wireless: Not an EMR point, but a good one nonetheless: why make doctors untangle cords and monitoring wires?
9. Hire a typist if you need one: Don’t turn nurses into data entry clerks, she argues. Right now they have massive amounts of data entry piled onto their plate.
10. Triple back-up the system: Paper doesn’t crash but computers do, she notes.
So there you have it, a list of EMR and health IT concerns straight from a practicing physician. I think all her points deserve attention.
Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.
I think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.
The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.
So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.
Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..
So the significant question is Where are the patients held accountable in all these free health care reforms?
This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.
While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?
The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?
I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?
John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.
This is the next installment of EHR Benefits. Some clinics claim that the space saving that comes with having an EHR is definitely a benefit. It’s usually more of a benefit for smaller practices, but can also benefit larger ones. One way is that the elimination of a document room could make room for another office.
This is a guest post by Carl Bergman from EHR Selector. The post dicusses the results of the Healthcare Design Challenge put on by by the VA and the ONC. First place went to Nightingale and second place StudioTACK. There were also a few other rewards given out. Bergman also talks about several problems with this challenge.
A new study published in Medical Decision Making found that patients aren’t as thrilled about computer-assisted decision making. The study revealed some interesting findings, like patients don’t trust physicians who use CDS. For those that use this, the study may be a bit unnerving, but it’s interesting nonetheless.
This post contains the views of Joe Condurso, president of CEO of health IT vendor PatientSafe, on building usable health IT. He offers several recommendations. They include responding to context, being mobile, and starting from a mobile design.
Although BlackBerry used to be the device of choice among physicians, it has been crowded out with the introduction of newer devices. However, BlackBerry is trying to get back in the game with the release of some new devices which they believe offer something unique. Will doctors switch back, or is BlackBerry grasping at straws?
A new iPhone app has been released to help parents keep track of their infants growth. BeCuddle has a variety of features, including the ability to track medication, record milestones, and just help a parent make sure their child’s health is right on track.
Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.
T1: The main driver I see if pervasiveness… #socialmedia will need to become more convenient & accessible to the masses. #HITsm — Erica V. Olenski (@TheGr8Chalupa) February 1, 2013
T1: The drivers will be two-fold: Patient engagement and Clinician engagement. It may be chicken/egg, but need to begin actively. #HITsm — Jon Mertz (@jonmertz) February 1, 2013
T1: A start to increasing participation is going to be MD offices establishing a presence online. Then, drive your patients there. #HITsm
Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.
EMR Templates can be helpful, but also makes life harder as well. A recent study found that 82 percent of progress notes by residents had 20 percent or more copied and pasted material. This function is tempting for physicians who need to cut time somewhere, but its something that needs to be watched out for and prevented.
In an effort to eliminate confusion that often comes during an inpatient stay, Boston Children’s Hospital has developed an iPad app. The app, called MyPassport, helps patients understand more about what is going on during their stay. It displays photos of doctors and nurses, others involved in care, as well as lab results that have been condensed to patient-friendly terms.
This is the next part of the EHR benefits series. Many doctors were thrilled to give up their transcription for an EHR in hopes of saving costs. However, some are feeling that their EHR may not be the best solution after all. Because of this, some are wanting to implement transcription services again. So, for some, eliminating transcription may not have saved as much money as some had hoped.
Physicians aren’t often given access to the psychiatric records of patients they are treating. However, a study by Johns Hopkins found that perhaps they should be. The study showed that a signficant percentage of patients whose physicians had access to both physical and mental health data had a smaller readmission rate than those whose mental health records weren’t available.
The CDC is getting into mHealth with the recent release of their mobile app. The app has many different features, such as health articles, quizzes, and a news room with information outbreaks or other pertinent information. The app is free and definitely one that should be downloaded if you enjoy hearing about health news.
After the failure of Google Health, Google is making an attempt to get into the activity tracking world. “Google Now” basically turns the phone into a personal tracking device, including for fitness. It isn’t as accurate as some of the more sophisticated tracking devices out there, but it is a lot easier to use because it is embedded into the phone. It may make it easier for people to
Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.
Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.
Today I stopped by the convention center and got an early look at the incredible setup that’s going on to make the CES show happen. By all accounts, I expect this to be as big and crazy as any CES show I’ve attended. Plus, I got an early look at the Health Spot kiosk which is stationed in the lobby between the central and north halls of CES. I’m glad I went today, because I’m sure that kiosk is going to be crazy the next 3 days.
With that said, I’d suggest that anyone in healthcare take the chance to stop by the HealthSpot kiosk. HealthSpot is taking on an enormous challenge. They’ve created a kiosk that provides a whole suite of medical tools and an online connection to a remote doctor. It’s a fascinating mix of medical technology to try and make the patient visit a much smoother experience for the patient.
One use case that I found really fascinating is having a HealthSpot kiosk located in a hospital ED. In many cases one hospital ED might have a long line of patients waiting to be seen while their other hospital ED or quick care center across town might be sitting empty. Instead of making the patient wait or get sent across town to be seen, the patients can use the HealthSpot kiosk to be seen by an available doctor in the other hospital’s ED across town. It’s a fascinating use of technology to try and utilize the available medical resources across a health system.
There are a number of other use cases with one of the biggest being in retail pharmacies. Many have already started going to their local pharmacy for shots. It’s not hard to see retail pharmacies supporting some sort of office visit as well. If the price is right and the access to the doctor is more streamlined than your regular office visit, then this could become a common option. Plus, you can imagine that the price will be good since it’s a way for the retail pharmacy to get you as a customer. Once your HealthSpot visit is done, the pharmacy will have your prescription waiting for you before you leave. At least that’s what HealthSpot envisions happening.
Although, that’s really only the beginning of what HealthSpot hopes to achieve. HealthSpot isn’t selling these devices to other organizations. Instead, they still own the HealthSpot kiosks and plan to have a network of HealthSpot kiosks across the nation that are available to patients. In fact, they showed me a mobile app they’re developing that will allow someone to book an appointment with a doctor at a HealthSpot kiosk right from their mobile phone. In many ways it reminded me of how I reserve a RedBox movie from my mobile phone. I choose the movie and then find the nearest RedBox that has that movie. Replace movie with doctor visit and RedBox with HealthSpot and you get the basic idea.
Yes, they do have protocols in the mobile app and the kiosk that are defined by the providers to ensure that the HealthSpot kiosk visits are ones that can be treated through the kiosk interface. For example, I couldn’t book a HealthSpot kiosk visit for chest pain.
It seemed to me that HealthSpot still needed to work on the workflow for office visits that didn’t fit into a HealthSpot kiosk visit. They didn’t have the chest pain option. If I’m really experiencing chest pain, I’m likely to just choose another option if chest pain is not available and just wait until the visit to tell the doctor my real reason for the visit. This seems like an accident waiting to happen. Instead, I think HealthSpot should offer chest pain as an option. Then, if a patient selects it, they get a message to call 911 immediately (or some similar clinical protocol). I expect these types of issues will be worked out as HealthSpot refines the clinical workflows with their beta customers.
One part of HealthSpot that’s hard to describe in a blog post is how the patient kiosk handles the medical devices. First, a medical attendant (similar to an MA or front desk staff I’d assume) is their to assist a patient through the visit as needed. The kiosk has doors that fall open to present various medical devices such as a: Blood Pressure Cuff, Dermascope, Otoscope, Pulse Oximeter, Stethoscope, and Thermometer. Each of the devices is made available to the patient as needed by the doctor who is doing the visit remotely via video for the visit.
This video will also help to demonstrate how the HealthSpot kiosk works:
I’m sure that many are wondering about the cleaning and sanitizing that is provided for the kiosk. After the visit, the medical attendant is provided a check list of items that need to be cleaned, replaced and sanitized. Plus, the kiosk has a UV light that can clean and sanitize the kiosk similar to what is used in surgeries to clean instruments.
Like I said, it’s an experience that’s hard to explain in words. So, stop by the HealthSpot kiosk at CES to see what I mean. I also believe they’ll be at HIMSS in March where you can see it as well.
I’d of course be remiss if I didn’t talk about its connection with EHR software. They don’t plan on having HealthSpot be the full EHR. Instead they plan to integrate HealthSpot data with outside EHR software. Considering how casually they talked about integrating the HealthSpot data into an EHR, I’m pretty sure they haven’t started down that road. Maybe they have some in house expertise that has dealt with the challenge of this before, but I think they’re in for a big surprise as they try to get their HealthSpot data into EHR software. It should be academic, but it certainly is not.
Obviously, there is a lot that goes into the HealthSpot kiosk experience and I’ve only covered a few pieces of it. Like I said, they’ve chosen to take on an enormous challenge. I’ll just point out one other challenge: reimbursement for the visit. I was assured that HealthSpot has talked with all the payers and the payers are looking at the HealthSpot patient visit experience much more like an office visit than a telemedicine visit. We’ll see how that works over time and how the new e-visit laws effect this, but I expect that any changes to e-visit laws will benefit someone like HealthSpot.
John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.
T1: #Mhealth apps have the power to provide patients w/ discharge info & other care directive so they aren’t readmitted in the new yr #hitsm — Vocera, Inc. (@VoceraCom) January 4, 2013
T1: Sharing! No better way to be accountable than making your friends aware. Even more if you make your enemies aware. #HITsm — Jarrod Sandel (@JarrodSandel) January 4, 2013
T1: Apps provide real-time monitoring (GPS), social interaction (SolMe) – motivate us to exercise, eat healthy. #HITSM — Gautam Jaggi (@GautamJaggi) January 4, 2013
A1: Beauty of using apps is that they are always with us. Put it front & center on your home screen and you’ll see it constantly #HITsm — TigerText (@TigerTextApp) January 4, 2013
Topic Two: What health app do you use today, and how has it helped you become more engaged in your health?
T2: I use MyFitnessPal during the work week, but typically forget during the weekends. #HITsm — Chad Johnson (@OchoTex) January 4, 2013
A2: Love the App: Map My Run & Map My Ride – they let me know my route, pace, distance… updates/encouragement during my workouts #HITsm — Melissa Cole(@MelissaColeHTR) January 4, 2013
T2 Closest I have to health app is Daily Mile (to track running). PCP patient portal kinda stinks and I gave up on it. #hitsm — Brian Eastwood (@Brian_Eastwood) January 4, 2013
Responses to T2 makes me wonder what truly defines a health app? Do you consider access to health info on the web an app?#HITsm — Chad Johnson (@OchoTex) January 4, 2013
Topic Three: Speaking of engaged, if you could tell the ONC to do one thing in 2013, what would it be, and what result would it produce?
T3. Change their name and educate consumers as to what is now housed under them. #HITsm
Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.
