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E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT, Second Stanza

Posted on July 7, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As some of you may recall, I recently wrote a positive review of Kaiser Permanente’s use of consumer-facing health IT. (Kaiser Permanente is both my health insurer and provider.) Their offerings have a number of strengths including:

  • Interfaces: The kp.org site is decent, and the KP app highly usable
  • Access to care: Booking medical appointments is easy, as is cancelling them
  • Responsiveness: Physicians are quick to replay to email via the Kaiser portal
  • Connectedness: Thanks to being on a shared Epic platform, every provider knows my history (at least for the time I’ve spent within the KP system, which is pretty useful)

At the time, I also noted that I had a few minor concerns about the portal features and whatnot, but I was still a fan of KP’s setup.

By and large, my perceptions of Kaiser’s consumer health IT strengths haven’t changed. However, after a couple of months in the system, I’ve gotten a good look at its weaknesses as well. And I thought you might be interested in the problems Kaiser faces in connecting consumers, particularly given its use of best practices in many cases.

All told, these weaknesses suggest that over more than ten years after its Epic rollout, KP leaders still haven’t put their entire consumer health IT strategy in place. Here are a couple of my concerns.

Specialist appointments aren’t integrated

The biggest gripe I have with Kaiser’s interactive tools is that while I can schedule PCP appointments myself, I haven’t been able to set specialist appointments without speaking to a real live person. (My primary care doctor seems to be able to access specialist schedules and set appointments with them on my behalf.)

This may work for someone with no significant health problems, but creates a significant burden for me. After all, as someone with multiple chronic illnesses, I schedule a lot of specialist consults. You don’t realize how much time it takes to set each appointment with a clerical person until you’ve done it for five times in a week.  Try it sometime.

You might assume that this is a rationing measure, as organizations like KP are pretty strict about limiting access to specialist care. The truth is, that doesn’t seem to be the case. At least when it comes to my primary care physician (a big shout out to my PCP, Dr. Jason Singh) it doesn’t seem to be unduly hard to get access to specialists when needed.

No, I have concluded that the reason I can’t schedule specialist appointments online is that KP still hasn’t gotten their act together on this front. My guess is that the specialist systems live in some kind of silo, one that KP hasn’t managed to break down yet.

Mobile and web tools clash

As noted above, I’m largely satisfied with both KP’s consumer portal and its mobile app. True, the website sprawls a bit when it comes to presenting static content — such as physician bios — but the portal itself works fine. The mobile app, meanwhile, is great to use, as it presents my choices clearly and uses screen real estate effectively.

That being said, it annoys the heck out of me that there are minor but seemingly pointless, differences between how the portal and the mobile app function. It would be one thing the app was a shrunken down version of the website, offering a parallel but more limited version of available functions, but that isn’t how it works.

Instead, the services accessible through the portal and via the mobile app vary in small but irritating ways. For example, when emailing providers, you must choose a prewritten subject line from a drop-down menu. And I don’t know why, but the list of subjects available on the web portal version varies significantly from the list of subjects you can access via the mobile app.

There may be a rational reason for this. And mine may sound like a petty objection. But when you’re trying to address something as important as your healthcare, you want to know what’s going on with every detail.

I’d identify other ways in which the app and website portal vary, but I don’t have any other examples I can recall. And that’s the whole point. You don’t remember how the site and/or portal function until you stumble into another incompatibility. You roll your eyes and move on, but you see them again and waste one more spark of energy being annoyed.

It’s all about tradeoffs

So, you might ask if there’s any broad lesson to be taken from this. Honestly, probably not. I don’t like that KP’s tools pose these problems, but they don’t strike me as unusual.

And do my criticisms have any meaning for other healthcare organizations? Nothing more than a reminder that patients will take note of even small problems in your health IT execution, particularly when it comes to tools they rely upon to get things done.

In the end, of course, it’s all about trade-offs, as with any other industry. I don’t know whether KP chose to prioritize a potentially dangerous problem in provider-facing technologies over consumer quibbles, or just don’t know what’s going on. Perhaps they know and have added the fix to a long list of pending projects, or perhaps they don’t have their act together.

Still, lest it is lost in the discussion, remember I’m the customer, and I really don’t care about your IT problems. I just want to have tools that work every time and simplify my life.

So this is my official challenges to Kaiser leadership. For Pete’s sake, KP, would you please help me cut down on the specialist phone calls? Perhaps you could create a centralized specialist appointment call center, or use carrier pigeons, or let me suss out their schedules using my vast psychic powers — hey, they’re all options. Or maybe, just maybe, you can let me schedule the appointments online. Your call.

Retail Clinics Are Not the Enemy, Inconvenience Is!

Posted on June 16, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Check out this incredible insight that Gabriel Perna shared on Twitter:

What a great insight and something that most of the entrenched healthcare people don’t understand. Retail clinics are not the enemy, inconvenience is.

In many ways, it reminds me of the approach that taxi cabs took to Uber and Lyft. Taxis described them as evil as opposed to understanding why consumers wanted to use Uber and Lyft instead of a taxi cab. If the taxi cab industry would have understood the conveniences that Uber and Lyft provided customers, they could have replicated it and made Uber and Lyft disappear (or at least they could have battled them more effective than they’ve done to date).

Gabriel Perna further describes the issues of retail clinics and AMA’s approach to retail clinics in his article and this excerpt:

There are many reasons for this phenomenon [growth of retail clinics], but more than anything though, retail clinics are convenient and many physician offices are not. Because of this, the AMA shouldn’t be trying to treat the retail clinics as some kind of foreign invader, but rather use their rise to prominence as a way to guide physician practices forward. For instance, getting in to see a doctor shouldn’t be a three-week endeavor, especially when the patient is sick and needs attention immediately. However, that’s what has happened. Personally, I’ve been told “the doctor doesn’t have anything open for at least a month” more times than I can count.

It’s simple supply and demand. If you or your child needs to see someone immediately because of an illness and your doctor’s office can’t take in you for a week, and there happens to be a retail clinic down the street, guess where you’re going? Any hesitations you may have over your care being fragmented, the limited ability of your retail clinic physician, or anything else will go out the window pretty quickly.

I agree completely with the idea that convenience is key. However, what Gabriel doesn’t point out is that the fact that doctors have a 3 week waiting list for patients is why they don’t care about offering convenience to their patients. They have enough patients and so they don’t see why they should change.

You can imagine the taxi cab industry was in a similar position. They had plenty of people using their taxi service. They didn’t see how this new entrant could cause them trouble because they were unsafe and whatever other reasons they rationalized why the new entrant wouldn’t be accepted by the masses. Are we seeing the same thing with retail clinics vs traditional healthcare? I think so. Will it eventually catch up to them? I think so.

What’s even more interesting in healthcare is that retail clinics are just one thing that’s attacking the status quo. Telemedicine is as well. Home health apps and sensors are. AI is. etc etc etc. All of these have the potential to really disrupt the way we consume healthcare.

The question remains: Will traditional healthcare system be disrupted or will they embrace these changes and make them new tools in how they offer care? It took the taxi cab industry years to adapt and build an app that worked like Uber and Lyft. However, it was too late for them. I don’t think it’s too late for healthcare, but it’s getting close.

The EMR Vendor’s Dilemma

Posted on June 6, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Yesterday, I had a great conversation with an executive at one of the leading EMR vendors. During our conversation, she stressed that her company was focused on the future – not on shoring up its existing infrastructure, but rather, rebuilding its code into something “transformational.”

In describing her company’s next steps, she touched on many familiar bases, including population health, patient registries and mobile- first deployment to support clinicians. She told me that after several years of development, she felt her company was truly ready to take on operational challenges like delivering value-based care and conducting disease surveillance.

All that being said – with all due respect to the gracious exec with whom I spoke – I wouldn’t want to be a vendor trying to be transformed at the moment. As I see it, vendors who want to keep up with current EMR trends are stuck between a rock and a hard place.

On the one hand, such vendors need to support providers’ evolving health IT needs, which are changing rapidly as new models of care delivery are emerging. Not only do they need to provide the powerhouse infrastructure necessary to handle and route massive floods of data, they also need to help their customers reach and engage consumers in new ways.

To do so, however, they need to shoot at moving targets, or they won’t meet provider demand. Providers may not be sure what shape certain processes will take, but they still expect EMR vendors to keep up with their needs nonetheless. And that can certainly be tricky these days.

For example, while everybody is talking about population health management, as far as I know we still haven’t adopted a widely-accepted model for adopting it. Sure, people are arriving at many of the same conclusions about pop health, but their approach to rolling it out varies widely.  And that makes things very tough for vendors to create pop health technology.

And what about patient engagement solutions? At present, the tools providers use to engage patients with their care are all over the map, from portals to mobile apps to back-end systems using predictive analytics. Synchronizing and storing the data generated by these solutions is challenging enough. Figuring out what configuration of options actually produces results is even harder, and nobody, including the savviest EMR vendors, can be sure what the consensus model will be in the future.

Look, I’m aware that virtually all software vendors face this problem. It’s difficult as heck to decide when to lead the industry you serve and when to let the industry lead you. Straddling these two approaches successfully is what separates the men from the boys — or the girls from the women — and dictates who the winners and losers are in any technology market.

But arguably, health IT vendors face a particularly difficult challenge when it comes to keeping up with the times. There’s certainly few industries are in a greater state of flux, and that’s not likely to change anytime soon.

It will take some very fancy footwork to dance gracefully with providers. Within a few years, we’ll look back and know vendors adapted just enough.

Dogged By Privacy Concerns, Consumers Wonder If Using HIT Is Worthwhile

Posted on May 17, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I just came across a survey suggesting that while we in the health IT world see a world of possibilities in emerging technologies, consumers aren’t so sure. The researchers found that consumers question the value of many tech platforms popular with health execs, apparently because they don’t trust providers to keep their personal health data secure.

The study, which was conducted between September and December 2016, was done by technology research firm Black Book. To conduct the survey, Black Book reached out to 12,090 adult consumers across the United States.

The topline conclusion from the study was that 57 percent of consumers who had been exposed to HIT through physicians, hospitals or ancillary providers doubted its benefits. Their concerns extended not only to EHRs, but also to many commonly-deployed solutions such as patient portals and mobile apps. The survey also concluded that 70 percent of Americans distrusted HIT, up sharply from just 10 percent in 2014.

Black Book researchers tied consumers’ skepticism to their very substantial  privacy concerns. Survey data indicated that 87 percent of respondents weren’t willing to divulge all of their personal health data, even if it improved their care.

Some categories of health information were especially sensitive for consumers. Ninety-nine percent were worried about providers sharing their mental health data with anyone but payers, 90 percent didn’t want their prescription data shared and 81 percent didn’t want information on their chronic conditions shared.

And their data security worries go beyond clinical data. A full 93 percent responding said they were concerned about the security of their personal financial information, particularly as banking and credit card data are increasingly shared among providers.

As a result, at least some consumers said they weren’t disclosing all of their health information. Also, 69 percent of patients admitted that they were holding back information from their current primary care physicians because they doubted the PCPs knew enough about technology to protect patient data effectively.

One of the reason patients are so protective of their data is because many don’t understand health IT, the survey suggested. For example, Black Book found that 92 percent of nurse leaders in hospital under 200 beds said they had no time during the discharge process to improve patient tech literacy. (In contrast, only 55 percent of nurse leaders working in large hospitals had this complaint, one of the few bright spots in Black Book’s data.)

When it comes to tech training, medical practices aren’t much help either. A whopping 96 percent of patients said that physicians and staff didn’t do a good job of explaining how to use the patient portal. About 40 percent of patients tried to use their medical practice’s portal, but 83 percent said they had trouble using it when they were at home.

All that being said, consumers seemed to feel much differently about data they generate on their own. In fact, 91 percent of consumers with wearables reported that they’d like to see their physician practice’s medical record system store any health data they request. In fact, 91 percent of patients who feel that their apps and devices were important to improving their health were disappointed when providers wouldn’t store their personal data.

Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 25, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

AI-driven chatbots are becoming increasingly popular for a number of reasons, including improving technology and a need to automate some routine processes. (I’d also argue that these models are emerging because millennials and Gen Z-ers have spent their lives immersed in online-based social environments, and are far less likely to be afraid of or uncomfortable with such things.)

Given the maturation of the technology, I’m not surprised to see a number of AI-driven chatbots for healthcare emerging.  Some of these merely capture symptoms, such as the diabetes, CHF and mental health monitoring options by Sense.ly.

But other AI-based chatbots attempt to go much further. One emerging company, X2ai, is rolling out a psychology-oriented chatbot offering mental health counseling, Another, UK-based startup Babylon Health, offers a text-only mobile apps which provides medical evaluations and screenings. The app is being pilot-tested with the National Health Service, where early reports say that it’s diagnosing and triaging patients successfully.

One area I haven’t seen explored, though, is using a chatbot to help doctors handle routine communications with patients. Such an app could not only triage patients, as with the NHS example, but also respond to routine email messages.

Scheduling and administration

The reality is that while doctors and nurses are used to screening patients via telephone, they’re afraid of being swamped by tons of electronic patient messages. Many feel that if they agree to respond to patient email messages via a patient portal, they’ll spend too much time doing so. With most already time-starved, it’s not surprising that they’re worried about this.

But a combination of AI and healthcare chatbot technology could reduce their time required to engage patients. In fact, the right solution could address a few medical practice workflow issues at one time.

First, it could triage and route patient concerns to doctors and advanced practice nurses, something that’s done now by unqualified clerks or extremely busy nurses. For example, the patient would be able to tell the chatbot why they wanted to schedule a visit, with the chatbot teasing out some nuances in their situation. Then, the chatbot could kick the information over to the patient’s provider, who could, with a few clicks, forward a request to schedule either an urgent or standard consult.

Perhaps just as important, the AI technology could sit atop messages sent between provider and patient. If the patient message asked a routine question – such as when their test results would be ready – the system could bounce back a templated message stating, for instance, that test results typically take five business days to post on the patient portal. It could also send templated responses to requests for medical records, questions about doctor availability or types of insurance accepted and so on.

Diagnosis and triage

Meanwhile, if the AI concludes that the patient has a health concern to address, it could send back a link to the chatbot, which would ask pertinent questions and send the responses to the treating clinician. At that point, if things look questionable, the doctor might choose to intervene with their own email message or phone call.

Of course, providers will probably be worried about relying on a chatbot for patient triage, especially the legal consequences if the bot misses something important. But over time, if health chatbot pilots like the UK example offer good results, they may eventually be ready to give this approach a shot.

Also, patients may be uncertain about working with a chatbot at first. But if physicians stress that they’re not trying put them off, but rather, to save time so they can take their time when patients need them, I think they’ll be satisfied.

I admit that under ideal circumstances, clinicians would have more time to communicate with patients directly. But the truth is, they simply don’t, and pressuring them to take phone calls or respond to every online message from patients won’t work.

Besides, as providers work to prepare for value-based care, they’ll need not only physician extenders, but physician extender-extenders like chatbots to engage patients and keep track of their needs. So let’s give them a shot.

The Disconnect Between Where Wearables Are Needed and Where Wearables are Used

Posted on April 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

No one can argue that we haven’t seen an explosion of wearable devices in the healthcare space. In most cases, they’ve been a consumer purchase, but there are a few cases of them being used clinically. While we’ve seen a huge uptick in wearable use, there seems to be a massive disconnect between those who use them and those who need to use them.

This was highlighted to me recently when I heard someone say that at the recent Boston Marathon they predicted that almost every athlete running the Boston Marathon had some sort of tracking device on them to track their running. Runners love to track everything from steps to heart rate to speed and everything in between. I wish the Boston Marathon did a survey to know what devices the runners used. That would be a fascinating view into which wearables are most popular, but I digress.

When I heard this person make this observation, I quickly thought “That’s not who we need using wearables if we want to lower the cost of healthcare.”

With some exceptions, those who run the Boston Marathon are in incredible shape. They exercise a lot (maybe too much in some cases) and most of them eat quite healthy. These are the outliers and my guess is that they’re not the people that are costing our healthcare system so much money. That seems like a fair assumption to me.

Yes, the people we need using these wearables are those people sitting on the couch back at home. We need the unhealthy people tracking their health, not healthy people. While not always the case, unhealthy people don’t really want to track their health. What’s more demotivating to your healthy goals than being in a FitBit group with a marthon runner that always destroys you?

This is a challenging psychological problem that I haven’t seen any wearable company address. I guess there’s too much money to be made with healthy people that want to track themselves that they don’t need to dive into the psychological impact of wearables on unhealthy people. However, that’s exactly what we’re going to need to do as wearables become more clinically relevant and can help us better understand a patient’s health.

A Tool For Evaluating E-Health Applications

Posted on April 11, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In recent years, developers have released a staggering number of mobile health applications, with nearly 150,000 available as of 2015. And the demand for such apps is rising, with the mHealth services market projected to reach $26 billion globally this year, according to analyst firm Research 2 Guidance.

Unfortunately, given the sheer volume of apps available, it’s tricky to separate the good from the bad. We haven’t even agreed on common standards by which to evaluate such apps, and neither regulatory agencies nor professional associations have taken a firm position on the subject.

For example, while we have seen groups like the American Medical Association endorse the use of mobile health applications, their acceptance came with several caveats. While the organization conceded that such apps might be OK, it noted that such approval applies only if the industry develops an evidence base demonstrating that the apps are accurate, effective, safe and secure. And other than broad practice guidelines, the trade group didn’t get into the details of how its members could evaluate app quality.

However, at least one researcher has made an attempt at developing standards which identify the best e-Health software apps and computer programs. Assistant professor Amit Baumel, PhD, of the Feinstein Institute for Medical Research, has recently led a team that created a tool to evaluate the quality and therapeutic potential of such applications.

To do his research, a write-up of which was published in the Journal of Medical Internet Research, Baumel developed an app-rating tool named Enlight. Rather than using automated analytics, Enlight was designed as a manual scale to be filled out by trained raters.

To create the foundation for Enlight, researchers reviewed existing literature to decide which criteria were relevant to determine app quality. The team identified a total of 476 criteria from 99 sources to build the tool. Later, the researchers tested Enlight on 42 mobile apps and 42 web-based programs targeting modifiable behaviors related to medical illness or mental health.

Once tested, researchers rolled out the tool. Enlight asked participants to score 11 different aspects of app quality, including usability, visual design, therapeutic persuasiveness and privacy. When they evaluated the responses, they found that Enlighten raters reached substantially similar results when rating a given app. They also found that all of the eHealth apps rated “fair” or above received the same range of scores for user engagement and content – which suggests that consumer app users have more consistent expectations than we might have expected.

That being said, Baumel’s team noted that even if raters like the content and found the design to be engaging, that didn’t necessarily mean that the app would change people’s behaviors. The researchers concluded that patients need not only a persuasive app design, but also qualities that support a therapeutic alliance.

In the future, the research team plans to research which aspects of app quality do a better job at predicting user behaviors. They’re also testing the feasibility of rolling out an Enlight-based recommendation system for clinicians and end users. If they do succeed, they’ll be addressing a real need. We can’t continue to integrate patient-generated app data until we can sort great apps from useless, inaccurate products.

E-Patient Update: Doctors Need To Lead Tech Charge

Posted on April 7, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Doctors, like any other group of people, vary in how comfortable they are with technology. Despite the fact that their job is more technology-focused than ever before, many clinicians use tech tools because they must.

As a result, they aren’t great role models when it comes to encouraging patients to engage with portals, try mobile apps or even pay their healthcare bills online. I too am frustrated when doctors can’t answer basic tech questions, despite my high comfort level with technology. I like to think that we’re on the same page, and I feel sort of alienated when my doctors don’t seem to care about the digital health advantage.

This needs to change. Given the extent to which technology permeates care delivery, physicians must become better at explaining how basic tech tools work, why they’re used and how they benefit patients.

Below, I’ve listed three tools which I consider to be critical to current medical practices, based on both my patient experiences and my ongoing research on health IT tools. To me, knowing something about each of them is unavoidable if doctors want to keep up with trends and improve patient care.

The top three tools I see as central to serving patients effectively are:

  • Patient portals: This is arguably the most important technical option doctors can share with patients. To get the most value out of portals, every doctor – especially in primary care – should be able to explain to patients why accessing their data can improve their health and lives.
  • Connected health: For a while, connected health/remote monitoring solutions were a high-end, expensive way to track patient health. But today, these options are everywhere and accessible virtually anyone. (My husband bought a connected glucose monitor for $10 a few weeks ago!) If nothing else, clinicians should be able to explain to patients how such devices can help tame chronic diseases and prevent hospitalizations.
  • Mobile apps: While few apps, if any, are universally trusted by doctors, there’s still plenty of them which can help patients log, measure and monitor important data, such as medication compliance or blood pressure levels. While they don’t need to understand how mobile apps work, they should know something of why patients can benefit from using them.

Of course, this list is brief, but it’s a decent place to start. After all, I’m not suggesting that physicians need to get a master’s in health IT to serve patients adequately; I’m just recommending that they study up and prepare to guide their patients in using helpful tools.

Ultimately, it’s not as important that clinicians use or even have a deep understanding of digital health tools, health bands, smartwatches, sensor-laden clothing or virtual reality. They don’t have to understand cybersecurity or know how to reboot a server. They just have to know how to help patients navigate the healthcare world as it is.

By this point, in fact, I’d argue that it’s irresponsible to avoid learning about technologies that can help patients manage their health. Bear in mind that even if they don’t act like it, even confident, experienced patients like me truly admire our doctors and take what they say seriously. So if I am enthusiastic about using tech tools to manage my health, but my doctor’s eyes glaze over when I talk about them, even I feel a bit discouraged. So why not learn enough to encourage me on my journey?

Epic Launches FHIR-Based App Platform

Posted on March 2, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like Epic is getting on the FHIR train. According to an article in Modern Healthcare, Epic is launching a new program – serving physician practices and hospitals – to help them build customized apps. The program, App Orchard, will also support independent mobile app developers who target providers and patients.

The launch follows on the heels of a similar move by Cerner, which set up its own sandbox for developers interested in linking to its EMR using FHIR. The Cerner Open Developer Experience (code_), which launched in early 2016, is working with firms creating SMART on FHIR apps.

App Orchard, for its part, lets developers use a FHIR-based API to access an Epic development sandbox. This will allow the developers to address issues in connecting their apps to the Epic EMR. Previously, Epic wouldn’t let mobile app developers connect to its EMR until a customer requested permission on their behalf.

In addition to providing the API, App Orchard will also serve as an online marketplace along the lines of Google Play or the Apple app store. However, end users won’t be able to download the app for their own use — only software developers and vendors will be able to do that. The idea is that these developers will create the apps on contract to customers.

Meanwhile, according to the magazine, Epic will screen and pick an initial group of developers to the program. Brett Gann, who leads the Epic-based team developing App Orchard, told Modern Healthcare that factors which will distinguish one developer from the other include app safety, security, privacy, reliability, system integrity, data integrity and scalability.

As part of their participation, developers will get documentation listing these criteria and what they mean to Epic. The Epic team will expect the developers to commit to following these guidelines and explain how they’ll do so, Gann said.

While Epic hasn’t made any predictions about what types of apps developers will pursue, recent research offers a clue. According to new research by SMART and KLAS, providers are especially interested in apps that help with patient engagement, EMR data viewing, diagnostics, clinical decision support and documentation tasks.

One thing to watch is how Epic decides to handle licensing, ownership, and charges for participation in their Orchard Program. If they have a true open API, then this will be a good move for the industry. If instead they choose to take ownership of everything that’s created, put restrictive licenses on developers, and/or charge huge sums to participate, then it’s unlikely to see much true innovation that’s possible with an open API. We’ll see how that plays out.

Meanwhile, in other Epic news, Becker’s Hospital Review notes that the vendor is planning to develop two additional versions of its EMR. Adam Whitlatch, a lead developer there, told the site that the new versions will include a mid-range EMR with fewer modules (dubbed “utility”), and a slimmer version with fewer modules and advanced features, to be called “Sonnet.”

Whitlatch said the new versions will target physician practices and smaller hospitals, which might prefer a lower-cost EMR that can be implemented more quickly than the standard Epic product. It’s also worth noting that the two new EMR versions will be interoperable with the traditional Epic EMR (known as “all-terrain”).

All told, these are intriguing developments which could have an impact on the EMR industry as a whole.

On the one hand, not only is Epic supporting the movement towards interchangeable apps based on FHIR, it appears that the vendor has decided to give in to the inevitable and started to open up its platform (something it hasn’t done willingly in the past).  Over time, this could affect providers’ overall Epic development plans if Epic executes it well and enables innovation on Orchard and doesn’t restrict it.

Also, the new versions of the Epic could make it available to a much wider audience, particularly if the stripped-down versions are significantly cheaper than its signature EMR. In fact, an affordable Epic EMR could trigger a big shakeup in the ambulatory EMR market.

Let’s see if more large EMR vendors decide to offer an open API. If access to EMR APIs became common, it would represent a major shift in the whole health IT ecosystem.

The Healthcare AI Future, From Google’s DeepMind

Posted on February 22, 2017 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While much of its promise is still emerging, it’s hard to argue that AI has arrived in the health IT world. As I’ve written in a previous article, AI can already be used to mine EMR data in a sophisticated way, at least if you understand its limitations. It also seems poised to help providers predict the incidence and progress of diseases like congestive heart failure. And of course, there are scores of companies working on other AI-based healthcare projects. It’s all heady stuff.

Given AI’s potential, I was excited – though not surprised – to see that world-spanning Google has a dog in this fight. Google, which acquired British AI firm DeepMind Technologies a few years ago, is working on its own AI-based healthcare solutions. And while there’s no assurance that DeepMind knows things that its competitors don’t, its status as part of the world’s biggest data collector certainly comes with some advantages.

According to the New Scientist, DeepMind has begun working with the Royal Free London NHS Foundation Trust, which oversees three hospitals. DeepMind has announced a five-year agreement with the trust, in which it will give it access to patient data. The Google-owned tech firm is using that data to develop and roll out its healthcare app, which is called Streams.

Streams is designed to help providers kick out alerts about a patient’s condition to the cellphone used by the doctor or nurse working with them, in the form of a news notification. At the outset, Streams will be used to find patients at risk of kidney problems, but over the term of the five-year agreement, the developers are likely to add other functions to the app, such as patient care coordination and detection of blood poisoning.

Streams will deliver its news to iPhones via push notifications, reminders or alerts. At present, given its focus on acute kidney injury, it will focus on processing information from key metrics like blood tests, patient observations and histories, then shoot a notice about any anomalies it finds to a clinician.

This is all part of an ongoing success story for DeepMind, which made quite a splash in 2016. For example, last year its AlphaGo program actually beat the world champion at Go, a 2,500-year-old strategy game invented in China which is still played today. DeepMind also achieved what it terms “the world’s most life-like speech synthesis” by creating raw waveforms. And that’s just a couple of examples of its prowess.

Oh, and did I mention – in an achievement that puts it in the “super-smart kid you love to hate” category – that DeepMind has seen three papers appear in prestigious journal Nature in less than two years? It’s nothing you wouldn’t expect from the brilliant minds at Google, which can afford the world’s biggest talents. But it’s still a bit intimidating.

In any event, if you haven’t heard of the company yet (and I admit I hadn’t) I’m confident you will soon. While the DeepMind team isn’t the only group of geniuses working on AI in healthcare, it can’t help but benefit immensely from being part of Google, which has not only unimaginable data sources but world-beating computing power at hand. If it can be done, they’re going to do it.