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Connected Health takes the stage at Partners symposium

Posted on October 28, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The Connected Health Symposium is not one of the larger health conferences, but it is one of the most respected. I met a number of leaders in health IT there who praised it for the conference scope and seriousness, and told me they were glad to see me there covering it.

Many issues in health IT and patient empowerment, however, are best learned not from any conference, but from the tussles and tears of everyday life. Let us hope no reader has undergone the personal experience of having her reports dismissed and of being misdiagnosed, as did several speakers at the conference.

But many of us have spent three hours on the phone with an insurer to approve a single medication shipment, or fought in vain to get the medical records that US law requires providers to give us, or watched our doctor fumble with his new EHR for fifteen minutes while trying to stay engaged with us.

It’s encouraging to see the progress of patient engagement at Massachusetts General Hospital, as reported by Gregg Meyer of Partners Healthcare System (the funder behind the Center for Connected Health that put on the symposium). But can small and rural providers struggling with cash flow join the movement?

These institutions would be comfortable using swyMe, a HIPAA-compliant telemedicine system that allows doctors to interview patients over everyday mobile devices and perhaps avoid a trip to the hospital. swyMe can also transmit audio and video from devices that EMTs can connect up to the phone. (Not many devices with the necessary hardware connectors are on the market, though.)

swyMe was one of the “innovators” highlighted in a conference demo. Jeffrey Urdan, COO of the company that makes it, told me later that he felt “low tech” compared to some of the fancy, expensive devices at the demo. But most of the providers in the US, and elsewhere, are more on swyMe’s level than theirs.

Another hurdle to forming connected teams that serve the patient is interoperability. A sign of the distance we have yet to come can be found in iCancerHealth, a service for cancer patients offered by Medocity. A free app is available to individuals, but the main integrated service is offered through providers or pharma companies doing clinical trials. The service includes such conveniences as medication tracking, treatment plans, a diary, audio and video connections to their physician, and even a way to form communities with other patients.

This is great, but iCancerHealth works with data from only one provider. This can be a limitation even for the few months that cancer patients typically use the service, and could certainly be a problem if the service were expanded to a broader range of illnesses. Similarly, there’s no seamless way to share data with patient communities; it has to be re-entered manually. Enhancing the service to encompass multiple providers would probably require wider adoption of electronic health record standards.

As an example of finding a creative solution to devices that lack interoperability, Mobile Diagnostic Services demonstrated an app that could photograph the display panel of a device, interpret the bars on the display to create digital data, and transmit the values to a health record in the cloud. This is a process well-known to computer programmers from thirty years ago as “screen scraping,” now relevant to the health industry.

One of the strengths of the Connected Health Symposium was the platform it gave to patients and doctors to express their frustrations with the old way of delivering care and the slow pace of change. The testimony could come from entrepreneur Robin Farmanfarmaian, who lost three organs unnecessarily to misdiagnosis, or Sarah Krüg, president of the Society for Participatory Medicine, whose parents died from diseases that might have been caught if the doctors had paid attention to their reported symptoms.

Or the testimony could come from Greg LaGana and Barry Levy, MDs who write and perform in a musical review called Damaged Care that skewers everything about doctors behavior as well as the legal and financial environment in which they have to operate.

Anna MCollister-Slipp, co-founder of Galileo Analytics and a sufferer from type 1 diabetes, regaled us with the dozens of vital sign measurements, treatments, and other details she has to manage on her own manually. She still get lab reports only because her doctor sends them via email (using a private account, so that HIPAA zealots don’t discipline him–the rights and wishes of the patient are supposed to be paramount). Like other conference attendees, though, she reported progress in tools and patient-oriented culture.

Less was heard at the symposium from other sectors of the medical field, but we did hear from Michael of Aetna, Jonathan Bush of athenahealth, and Beverley Bryant of England’s National Health Service. The panel on which Bryant spoke proved to be discouraging. Many of us in the US like to think that other developed nations with their universal health care systems have solved the coordination and interoperability messes that the US is in. But the panelists expressed many familiar frustrations.

I plan to return to the Connected Health Symposium next year, and I’m sure each year will bring a bit of progress toward better communication among staff, better use of patient data, and better integration of tools. The mood at the show was largely positive. But a little probing turned up barriers in the way of the healthcare system we all want.

Which Comes First in Accountable Care: Data or Patients?

Posted on September 30, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The headlines are stark and accusatory. “ACOs’ health IT capabilities remain rudimentary.” “ACOs held back by poor interoperability.” But a recent 19-page survey released by the eHealth Initiative tells two stories about Accountable Care Organizations–and I find the story about interoperability less compelling than another one that focuses on patient empowerment.
Read more..

What Happens When You Forget Your Laptop?

Posted on September 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many people have long talked about the day when desktops and laptops will no longer exist. When you think about it, there is really nothing that couldn’t be done on your cell phone that can be done on a desktop or laptop.

Sure there are some applications that haven’t yet been made available on a cell phone (I mean natively. Of course a remote desktop environment can run anything) yet. However, every application could be made available on a cell phone if desired. The cell phone is powerful enough. Especially when attached to a powerful server. Yes, I know that many of the mobile apps aren’t as great as their desktop counterparts, but they could and will be.

If we could just use our cell phone for these applications, why don’t we? It admins would happily get rid of desktops and laptops in order to have a much smaller device footprint that they have to manage. It would take some time to make the switch, but it would happen.

The biggest reason I think we have yet to go all in with cell phones as our primary device is the value of peripherals. I think we seriously underestimate the value of a decent keyboard and extra screen real estate.

I’m amazed at how well you can type on a cell phone keyboard, but it still pales in comparison to a quality keyboard. Voice recognition might help in some situations, but it can’t be used everywhere a keyboard can be used. I don’t see us ever beating a physical keyboard at least until it starts typing our thoughts.

Screen real estate is an even bigger issue. As much as you shrink the internals of a cell phone you’re still bound by the size of the screen. Just look at Apple’s choice to release an iPhone with a larger screen. We love as much screen space as we can get. If you’ve never had the delight of using dual monitors on your desktop, you have no idea the efficiencies you’re missing out on. I can do everything on my laptop that I can do on my desktop, but dual monitors makes doing so much more effecient. I even bought a second monitor I could plug into the USB on my laptop. It’s that valuable.

I think the clear solution to this problem is to be able to easily connect your cell phone to external “monitors” and other peripherals like keyboards. Soon these connections will all be available wirelessly. I put “monitors” in quotes since I think we’ll have electronic viewing areas on everything from windows to tables and everything in between. That’s an exciting future to consider (we’ll leave the security issues for another post).

Unfortunately, we’re not there yet, but I think it’s where we’re headed. Eventually we’ll sit down at our desk where our cell phone will wirelessly connect to the monitors and peripherals on your desk. Until then we do this awkward dance between cell phone, laptop and desktop.

In fact, I just boarded a flight with my laptop charging at home instead of being in my laptop bag. Now I get to see first hand the difference between my laptop and cell phone on a work trip. If only the seat back was a monitor and the tray table a keyboard I could connect to my cell phone. Then, I’d been in business and wouldn’t even need my laptop. One day!

Afterthought: This is definitely a first world problems” post. Also, excuse any typoes, because I wrote this post in air on my cell phone keyboard. Certainly the lack of keyboard and monitor didn’t stop me from doing this post, but I could have probably done it twice as fast. Although, it’s a bit ironic that this post wouldn’t exist if the tech was already available. If you’ll be at the Insite Build conference in Fargo, ND, we’ll see you there. Just don’t be surprised if I ask to borrow your laptop.

Apple’s Security Issues and Their Move into Healthcare

Posted on September 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m on the record as being skeptical of Apple’s entrance into healthcare with Apple Health and HealthKit. I just don’t think they’ll dive deep enough into the intricacies of healthcare to really make a difference. They underestimate the complexity.

With that disclosure, I found a number of recent tweets about Apple and healthcare quite interesting. We’ll start first with this tweet that ties the recent nude celebrity photos that were made public after someone hacked the celebrities’ iCloud account together with Apple’s HealthKit release.

For those who don’t follow Apple, they have a big announcement planned for September 9, 2014. Rumors have the new sizes of the iPhone 6 could be announced and the new iWatch (or whatever they finally call it) will be announced alongside the iPhone 6. We’ll see if the announcement also brings more details on Apple Health and HealthKit which has been short on concrete details.

Even if Apple Health and HealthKit aren’t involved in the announcement, every smartwatch I’ve seen has had some health element to it. Plus, we shouldn’t be surprised if the iPhone 6 incorporates health and wellness elements as well. Samsung has already embedded health sensors in the S5. I imagine iPhone will follow suit.

With Apple doing more and more in healthcare, it does bring up some new security and privacy issues for them. In fact, this next tweet highlights one healthcare reaction by Apple that is likely connected with the iCloud security issues mentioned above.

This reminds me of a recent business associate policy I saw from a backup software vendor. They were willing to sign a business associate agreement with a healthcare organization, but only if it was their most expensive product and only if it was used to backup your data to your own cloud or devices. Basically, they just wanted to provide the software and not have to be responsible for the storage and security of the data. Apple is taking a similar approach by not allowing private health data to be stored in iCloud. Makes you wonder if Apple will sign a business associate agreement.

We’ll continue to keep an eye on Apple’s entrance into healthcare. They have a lot to learn about healthcare if they want their work in healthcare to be a success. Security and privacy is just one of those areas.

Fitting the Failure Glorified IT World Into the Failure Free Healthcare World

Posted on September 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most readers know, I’m a tech person by background (and literally @techguy on Twitter). It’s fair to say that I come from a tech perspective when it comes to dealing with most things in life. However, I think I’m a very reasonable tech person that understands the best solution to a problem and applies it appropriately. I’ve always loved people as much as I’ve loved tech.

I feel lucky that I’m usually able to bridge the divide between the two different worlds quite well. In fact, my favorite compliment I get is when people who’ve read my blog forever meet me in person and learn that I’m not a doctor. I’m definitely not a doctor, but I’ve always tried to write from a physician perspective. However, what is very clear to me is that the IT perspective on the world and the Healthcare perspective on the world are very different. In fact, it’s very much a clash of cultures.

The best example I’ve seen of this is in how each of these worlds (IT and Healthcare) approach failure. In the technology world, there is a culture that glorifies failure. The idea that you tried something and failed means that you’re that much closer to a solution. The tech world doesn’t see it as failure at all. The so called “failure” is just a way to rule out one of the available options. This is even true for tech startup companies. Having a failed tech startup company is almost a badge of honor that will help you get more funding for your next company.

On the other side of the world is the healthcare world which has a culture defined by their efforts to make sure that they never fail. While that’s not achievable, that’s their goal in everything they do. Look at the medical device industry regulation as a simple example of this. Look at how doctors take care of patients. As a patient, I want my doctor to try every way possible to make sure they don’t fail. The cost of failure in healthcare can mean someone loses their life. This is not something to take lightly and I’m glad that most in healthcare don’t take it lightly.

Thus we have this amazing clash of cultures. One that glorifies failure as part of the learning process and another that has deeply embedded that failure is unacceptable. You see this in every large healthcare organization. You see it even more when a young tech startup company tries to enter healthcare. It’s why so many of these young startup health companies fail to gain any traction in hospitals and healthcare.

What’s the solution? There is no easy solution. Changing culture is never a simple or quick process. However, both sides can learn from each other. The key is that we need to move away from an all or nothing approach to failure and move to a much more nuanced view of failure. Healthcare leaders need to realize that not all failure is bad, even in healthcare. Yes, there are some times when failure can never, ever be acceptable. However, there are plenty of other times where failure will not only not do any major damage, but will be an important step towards learning and growing. On the other side of the coin, tech people need to realize when something they’re doing in healthcare can not fail and realize there are plenty of situations where this is a requirement in healthcare.

Much like privacy, it’s not that avoiding failure isn’t important in healthcare. It’s extremely important, but we need to have a more nuanced and sophisticated view of when it’s important. This is not an easy balance, but not doing so will cause us to miss out on so many needed opportunities. The good part is that a great leader will have the tech people pulling for more failure and the medical people pulling for more reliability and security. We just need to bring the two together.

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

Hospital CIOs Cutting Back on Non-Essential Projects

Posted on July 10, 2014 I Written By

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. Contact her at @annezieger on Twitter.

Generally speaking, cutting back on IT projects and spending is a tricky thing. In some cases spending can be postponed, but other times, slicing a budget can have serious consequences.

One area  where cutting budgets can cause major problems is in preparing to roll out EMRs, especially cuts to training, which can lead to problems with rollouts, resentment, medical mistakes, system downtime due to mistakes and more.  Also, skimping on training can lead to a domino effect which results in the exit of CEOs and other senior leaders, which has happened several times (that we know of) over the past couple of years.

That being said, sometimes budgetary constraints force CIOs to make cuts anyway, reports FierceHealthIT Increasingly projects other than EMRs are falling in priority.

A recent survey of hospital technology leaders representing 650 hospitals nationwide published by HIMSS underscores this trend. Respondents told HIMSS said that despite increases in IT budgets, they still struggled to complete IT projects due to financial limitations. In fact, 25 percent said that financial survival was their top priority.

What that comes down to, it seems, is that promising initiatives fall by the roadside if they don’t contribute to EMR success.  For example, providers are stepping back from HIE participation because they feel they can’t afford to be involved, according to a HIMSS Analytics survey published last fall.

Instead, hospitals are taking steps to enhance and build on their EMR investment. For example, as FierceHealthIT notes, Partners HealthCare recently chose to pull together all of its EMR efforts under a single vendor.  In the past, Partners had used a combo of homegrown systems and vendor products, but IT leaders there  felt that this arrangement was too expensive to continue, according to Becker’s Hospital Review.

This laser focus on EMRs may be necessary at present, as the EMR is arguably the most mission-critical software hospitals have in place at the  moment. The question, as I see it, is whether this will cripple hospitals in the future. Eventually, I’d argue, mobile health will become a priority for hospitals and medical practices, as will some form of  HIE participation, just to name the first two technologies that come to mind. In three to five years, if they don’t fund initiatives in these areas, hospitals may look  up and find that they’re hopelessly behind .

Health Datapalooza 2014 Recap

Posted on June 9, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

The Health Datapalooza conference is ripe with opportunities to inspire and be inspired.  At any given session or lunch, the developer of an emerging app is seated at your left, and the winner of some other developer challenge a few years ago is on your right.  The vibe is a bit frenetic, in a good way.

At this conference, data geeks get right down to the business of discussing controversial and innovative healthcare data issues.  Nothing is watered down.  Even the Director of NIH Francis Collins, whom everyone wanted to hear play his guitar and sing, charged right in with data-rich graphs and statistics.  Jeremy Hunt of the UK offered sobering yet transparent error figures, encouraging the use of data to learn from and improve upon our safety practices at the point of care.  Keynotes from Jonathan Bush and Todd Park alleviated any need for caffeine, even though there was plenty on hand.  Countless application developers told truly compelling stories of their solutions.  Kathleen Sebelius challenged us to reconsider “the way we’ve always done it”.

What’s not to love?

I had hoped we would dive deeper into interoperability issues such as consistent data transport and payload standards.  Or, how a sensitive dependence on initial conditions such as protocol specifications, as in chaos theory, can lead to unexpected behaviors in pairwise HISP (Direct Exchange service provider) interoperability, seemingly at random.  Our data needs to be free to move about the care continuum, in order to be the most useful to us.  Gamification was suggested as a way to help patients adhere to medications.  Perhaps it could also encourage Healthcare IT companies to better adhere to specifications?

Silo was another buzzword that was used a lot last week.  That is to say, it’s a buzzword you don’t want to be associated with.  It was reassuring that we’ve set expectations properly around interoperability.  Fortunately, silos are going the way of the beeper and the booth babe.

There were some well-received promises of intense BlueButton promotion in the fall by Dr. Oz and several others.  I was also really encouraged to see the BlueButton Toolkit site preview on Sunday.  Look for more information about this when it goes live, and be sure to send Adam Dole your suggestions.  Great work, Adam!

Maybe next year at Health Datapalooza, we’ll talk about structuring the data collected by wearable devices, since we certainly heard this year about how integral to wellness quantified self is expected to be.  Quantified self and interoperability might even be considered as separate award categories in the Code-A-Palooza contest next year.  This could lead to more diversity and creativity in developers’ solutions, while helping to spur patient engagement and data transfer.

Countless examples of knowledge gleaned from large datasets, that could be used to make better medical decisions, were cited.  But this information hasn’t yet been integrated into day to day clinical workflow in a way that’s helpful to individual patients.  There’s no single source of individualized, analytics-enabled tools for patients to guide medical decision-making today.  But there will be!

Digital Therapeutics

Posted on May 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here’s a new term for you to consider: digital therapeutics. I guess I could add it to the list I polled about earlier: Digital Health, Connected Health, Wireless Health, Mobile Health, and Telehealth. By the way, the poll results are showing a mix basket when it comes to using these terms. Digital Health leads the way with mobile health following pretty closely behind and connected health with quite a few votes.

I don’t think adding digital therapeutics to the ring helps to clear up the confusion of terms, but I think it can open us open to a new way of thinking when it comes to how we use digital in healthcare. I’ve long loved the idea of prescribing an app and digital therapeutics is along those same lines. Can we prescribe a digital therapy that will help improve a patient?

Since we’re throwing out new terms that stretch our thinking, how about the ideas of digital chemistry and digital biology. I like these because they suggest a rigor in their study and understanding like you might see in chemistry and biology. I think it’s fair to say that the very best healthcare IT companies are going to be digging into the digital chemistry and digital biology world.

Once you start digging into these areas though, you better be ready for the FDA regulation that comes with therapeutics. I’ve written quite a bit about EHR and FDA regulation and this is why I don’t think EHR vendors will be digging into this type of digital therapeutics. Instead, I think the EHR will stick to being the database of healthcare.

In a recent video interview I did with Alan Portela, he made a really good point about the transition to really smart mobile health technologies that start to suggest treatment (some might call that a shift to digital therapeutics). The problem with many mobile health technologies that have avoided FDA clearance is that they won’t be able to do digital therapeutics. It will take a company that’s FDA cleared and understands that process to put these type of digital “treatments” into place.

I’m excited about the potential for digital therapeutics (or whatever word you prefer). This will change the way we look at healthcare and that will be a very good thing.

Will Telemedicine Really Lower Costs?

Posted on May 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was talking with the mobile health lead at one of the large telcom providers recently and we had a good discussion about telemedicine and its possible impact for good or bad on healthcare. She asked a really good question, “Will telemedicine lower the cost of healthcare or just add new touch points?

The translation to that question is whether telemedicine will replace other healthcare costs or if it will just create new healthcare costs that never existed before. I should say that her feeling was that telemedicine would end up lowering costs, but the question is well worth asking. In fact, even if the answer is that telemedicine will lower healthcare costs, there are many on the payer side of the equation that aren’t as confident.

The reality is that a telemedicine visit likely could raise costs. The idea of having to uproot yourself, go to the doctors office, wait in the waiting room, wait in the exam room, etc is a really big deterrent that stops many of us from going to the doctors. The idea that I could click on a link and see a doctor from the comfort of my own home with no wait times (or at least I’m waiting at home where I can get other things done) will definitely cause us to see the doctor more often.

This means that the real question isn’t whether telemedicine will increase the number of visits to the doctor (and more visits equals more costs). Let’s assume that we do see the doctor more often in a telemedicine enabled world. This then begs the question of whether these extra visits will reduce the long term costs of healthcare.

Using our assumptions above, it suggests that we’ll visit the doctor earlier under telemedicine than we would today. Could these early visits catch a disease earlier? Could these early visits avoid a hospitalization or other expensive healthcare cost? Could early treatment of an issue prevent someone from having a visit (or dozens of visits) later? Looking at it from a different angle, can telemedicine make a doctor more efficient?

This impact won’t likely happen immediately, but is the long term hope of what telemedicine can become and how it could lower healthcare costs. I personally lean towards telemedicine being able to realize these goals. Although, we won’t know until we figure out the way to reimburse a doctor for a telemedicine visit. Not to mention overcoming the physician licensing issues with telemedicine. Each of those will happen though and then we’ll really know if telemedicine lowers the costs of healthcare or not.