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Doctors, Not Patients, May Be Holding Back mHealth Adoption

Posted on June 24, 2015 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.

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.

The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.

It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.

While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)

But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.

Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).

When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.

Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

“You can’t list your iPhone as your primary-care physician.”

Posted on June 2, 2015 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.

iPhone as Primary Care Physician
“You can’t list your iPhone as your primary-care physician.”

This cartoon and more importantly the phrase below it has been going around a bunch on social media lately. I’m sure it makes the majority of doctors roll their eyes and get a little bit angry. Their immediate response is likely “Are you trying to say that my 15 years of school can be replaced by a smart phone?”

I think this question misses the point of the humor. Remember that it’s a cartoon and so it’s meant to be exaggerated. Let me clear the air though. I don’t think any smart phone or even technology is going to completely replace the human element of healthcare. I’m even someone that believes that love and affection can be shared using technology (I’ve seen it and experienced it), but technology can’t replace the human interaction completely. I’ve yet to see a gall bladder removed using a smart phone.

Yes, we’ll need doctors. However, that doesn’t hide the point of the cartoon, which is to highlight the ever increasing influence that our mobile phone will have over our healthcare. You can hide your head in the sand and act like it’s not happening if you want, but that doesn’t change the reality of how the smart phone is going to change healthcare as we know it. In many ways, it already is.

Wearables Trendsetters Don’t Offer Much Value

Posted on June 1, 2015 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.

Today I was looking over my Twitter feed and this tweet popped up:

The referenced article appeared on the corporate site of Qmed, a supplier to the medical device industry. I found this interesting, as it’s pretty obvious that wearables and other mHealth toys will evolve into medical-grade devices over time.

But the choices the article made for hottest wearable firms, while worth a look, demonstrate pretty clearly that few wearables makers can point to any real, meaningful healthcare benefit they offer. (That’s obviously not Qmed’s fault — none of this is aimed at the editor who pulled this piece together — but it’s still a significant point.)

Some of the wearables listed are half-hearted medical device plays, others are fashionable eye candy for upscale geeks, and still others are tadpoles evolving from some other industry into a healthcare mode. Here’s some examples from the list, and why I’m skeptical that they deserve a high five:

* The list includes Apple courtesy of  its Apple Watch.  Right now nobody seems to know quite how the Apple Watch, or any smartwatch for that matter, serves anyone except gadget geeks with extra cash. How, exactly, will having a smartwatch improve your health or life, other than giving you bragging rights over non-owners?

* There’s Fitbit, which is undeniably the wearables success story to beat all others. But just because something is cool doesn’t mean it’s accomplishing anything meaningful. At least where healthcare is concerned, I fail to see how its cursory monitoring add-ons (such as automatic sleep monitoring and heart rate tracking) move the healthcare puck down the ice.

* The list also includes Misfit, whose $850K success on Indiegogo has vaulted it into the ranks of hipster coolness. Admittedly, its Shine is a lovely piece of wearables jewelry, and the Flash is cool, but again, should healthcare leaders really care?

* I admit to a certain interest in Caeden, a Rock Health wearables firm which apparently started out making headphones. The Qmed article reports that the company, which got $1.6M in funding this year, is creating a screenless leather wristband which does health monitoring. But I’m critical of the “screenless” aspect of this product; after all, isn’t one of the main goals of monitoring to engage patients in the process?

I could go on, but you probably get the point I’m trying to make. While the devices listed above might have their place in the consumer health device food chain, it’s not clear how they can actually make patients do better or feel better.

I do have to offer kudos to one company on the list, however. Chrono Therapeutics has an intriguing product to offer which could actually save lungs and lives. The company, which took in $32M in financing last year, has created a slick-looking wearable device that delivers doses of nicotine when a smoker’s cravings hit, and tracks the doses administrated. Now that could be a game change for consumers trying to beat nicotine addiction. (Heck, maybe it could help with other types of addiction too.)

I only hope other wearables manufacturers pick a spot, as Chrono Therapeutics has, and figure out how to do more than be cool, look good or sell to trendies.

A “Collaborative Consult” Could Greatly Improve EMR Value

Posted on May 19, 2015 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.

Over the past several years, EMRs have taken some steps forward. At least in some cases, analytics have improved, vendors have begun offering cloud or on-premise install versions of their products and user interfaces have even improved.

But one problem with EMRs that seems to be nearly unfixable is the need for providers to stare at an EMR screen, leaving patients to fidget uncomfortably while they wait for a bit of face-to-face contact and discussion. Sure, you’ll see scribes in hospital emergency departments, allowing ED docs to speak to patients without interruption, but in the outpatient settings where patients spend most of their time, the EMR screen is king.

Such a focus on the EMR display isn’t unreasonable, given the importance of the data being entered, but as critics have noted countless times, it does make it more likely that the provider will miss subtle clues as to the patient’s condition, and possibly end up offering lower-quality care than they would have if they had an old-fashioned computerless encounter.

I have long thought, however, that there’s a solution to this problem which would be helpful to both the physician and the patient, one which would literally make sure that patients and doctors are on the same page. I’m speaking of a new group of settings for EMRs designed specifically to let patients collaborate with physicians.

Such an EMR setting, as I envision it, would begin with a section depicting a dummy patient of the appropriate gender.The patient would touch the areas of the body which were causing them problems, while the doctor typed up a narrative version of the problem presentation. The two (patient and doctor) would then zoom in together to more specific descriptions of what the patient’s trouble might be, and the doctor would educate the patient as to what kind of treatment these different conditions might require.

At that point, depending on what condition(s) the doctor chose as requiring further study, lists of potential tests would come up. If a patient wanted to learn what these tests were intended to accomplish, they’d have the liberty to drill down and learn, say, what a CBC measures and why.  The patient would also see, where possible, the data (such as high cholesterol levels) which caused the doctor to seek further insight.

If the patient had a known illness being managed by the physician, such as heart disease, a tour through a 3-D visual model of the heart would also be part of the collaboration, allowing the doctor to educate the patient effectively as to what they were jointly trying to accomplish (such as halting heart muscle thickening).

The final step in this patient-doctor process would come with the system presenting a list of current medications taken by the patient, and if appropriate, new medications that might address any new or recurring symptoms the patient was experiencing.

The final result would come in the form of a PDF, e-mailed to the patient or printed out for their use, offering an overview of their shared journey. The doctor might have to spend a few minutes adding details to their notes after the patient left, but for the most part, the collaborative consult would have met everyone’s needs.

Now you tell me:  Why aren’t we doing this now?  Wouldn’t it make much more sense, and take much more advantage of the powerful desktops, tablets and smartphones we have, than having a provider stare at a screen for most of their visit with a patient?

Customizable EMRs Are Long Overdue

Posted on May 5, 2015 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.

EMRs can be customized to some extent today, but not that much. Providers can create interfaces between their EMR and other platforms, such as PACS or laboratory information systems, but you can’t really take the guts of the thing apart. The reality is that the EMR vendor’s configuration shapes how providers do business, not the other way around.

This has been the state of affairs for so long that you don’t hear too much complaining about it, but health IT execs should really be raising a ruckus. While some hospitals might prefer to have all of their EMR’s major functions locked down before it gets integrated with other systems, others would surely prefer to build out their own EMR from widgetized components on a generic platform.

Actually, a friend recently introduced me to a company which is taking just this approach. Ocean Informatics, which has built an eHealth base on the openEHR platform, offers end users the chance to build not only an EMR application, but also use clinical modules including infection control, care support, decision support and advanced care management, and a mobile platform. It also offers compatible knowledge-based management modules, including clinical modeling tools and a clinical modeling manager.

It’s telling that the New South Wales, Australia-based open source vendor sells directly to governments, including Brazil, Norway and Slovenia. True, U.S. government is obviously responsible for VistA, the VA’s universally beloved open source EMR, but the Department of Defense is currently in the process of picking between Epic and Cerner to implement its $11B EMR update. Even VistA’s backers have thrown it under the bus, in other words.

Given the long-established propensity of commercial vendors to sell a hard-welded product, it seems unlikely that they’re going to switch to a modular design anytime soon.  Epic and Cerner largely sell completely-built cars with a few expensive options. Open source offers a chassis, doors, wheels, a custom interior you can style with alligator skin if you’d like, and plenty of free options, at a price you more or less choose. But it would apparently be too sensible to expect EMR vendors to provide the flexible, affordable option.

That being said, as health systems are increasingly forced to be all things to all people — managers of population health, risk-bearing ACOs, trackers of mobile health data, providers of virtual medicine and more — they’ll be forced to throw their weight behind a more flexible architecture. Buying an EMR “out of the box” simply won’t make sense.

When commercial vendors finally concede to the inevitable and turn out modular eHealth data tools, providers will finally be in a position to handle their new roles efficiently. It’s about time Epic and Cerner vendors got it done!

Integrating Devices, Patients, and Doctors: HealthTap Releases an App for the Apple Watch

Posted on April 16, 2015 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.

Doesn’t HealthTap want the same thing as all the other web sites and apps crowding into the health space? Immediate and intimate connections between doctors and patients. Accurate information at your fingertips, tailored to your particular condition. Software that supports your goals where automation makes sense and gets out of the way at other times.

HealthTap pursues this common vision in its own fashion. This week, its announcement of an app for Apple Watch pulls together the foundations HealthTap has been building and cleverly uses the visceral experience that the device on your wrist offers to meet more of the goals of modern, integrated health care.
Read more..

Healthcare Enterprise Mobility Framework

Posted on March 19, 2015 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.

I recently saw the following healthcare enterprise mobility framework shared with me on Twitter by Clinic Spectrum.

Healthcare Enterprise Mobility Framework

While the image gives some interesting stats and the breadth of what an organization needs to do to really adopt mobile in their organization, I was struck by something else. In the bottom left it shows which organizations are “actively adopting mobility.” It’s quite the list of industries. However, I think you could put just about any industry there, no? Am I wrong? Is there an industry that’s not actively adopting mobile? It’s got to be a pretty niche industry (can you call it an industry if it’s so niche?) if it’s not adopting mobile.

Those in healthcare might also laugh about healthcare being listed as an industry that’s actively adopting mobility. There is a lot of mobile use in certain areas of healthcare, but in a lot of areas it’s still very immature.

Most important, this graphic is a reminder about the importance of mobility. Which reminds me, I need to finish working on the mobile optimized version of this website. We’ll be rolling that out soon.

Full Disclosure: ClinicSpectrum is a sponsor on EMR and HIPAA.

Parkinson’s Disease and Health Data: A Personal Story

Posted on March 5, 2015 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.

For 20 years, I’ve been writing about clinical data management, analytics and what has now come to be known as Big Data. Like everyone else who follows this sector, I’ve been exposed to many examples of brilliant thinking about leveraging health data, and of late, a growing number of examples where data analytics has improved care and saved lives.

I’ve also reported on dozens of notable case studies in which combing EMRs for telltale signs of disease has resulted in finding dangerous or even life-threatening conditions, including heart disease, diabetes and to a more limited degree cancer. What’s even more remarkable is that we’re likely to see the list of conditions detectable by data analytics expand greatly, particularly if we make smart use of the growing flood of mobile health data.

The problem is, we’re still extremely far from achieving universal health data interoperability, and no amount of inspiring speeches by HIT thought leaders or Congressional bellyachers will achieve this goal on their own. We need a shift comparable to cultural transformation that fueled the astonishing progress of our space efforts. (Maybe someone should claim that the Russians are ahead of us in the interoperability race — we can’t let them Russkys achieve national health data interoperability before we do, durn it!)

And none of this will help me get the last few years of my life back.

You see, while the diagnosis hasn’t been all-out finalized, it appears that I have a case of early-onset Parkinson’s Disease. I won’t bore any clinicians with a detailed description of the illness, but suffice it to say that it’s neurological in origin, potentially disabling and at present, uncurable and unstoppable.  I can probably still live a good life, particularly if I respond well to standard drugs, but all told, this thing is a major buzz kill.

I’ve had signs and symptoms that fit the diagnosis for at least a couple of years, and I dutifully reported them to the caregivers I saw. That included several encounters with doctors associated with the large, high-quality health system which serves the region where I live.  The health system providers entered the symptoms into their jet-fueled Epic EMR, but it seems that despite that, they never put two and two together.  (And as is still the norm, the data gathered at PCP visits has been in no way connected to the data living in the hospital Epic system.)

Fortunately, picking up on the earlier signs of Parkinson’s — if that is indeed my condition — wouldn’t have done anything to slow the progression of the illness. (If I had a malignant cancer, of course, this would be a different story.)  But heaven knows I would have had the clarity I needed to make good self-care choices.

For example, I could have seen physical therapists to help with growing muscle weakness, occupational therapists to help me adjust my work style, joined patient groups to gather support and volunteered for clinical trials. (I live in the DC metro, not too far from NIH, so that may well have been an option.) And most importantly, as I see it, I wouldn’t have had to live with the vague but growing dread that something was Just Not Right for years.

Because I’m not a clinician, I’ll never know how likely it is that I could have been diagnosed earlier if all my caregivers had all of my health data.  But I’m confident that interoperability and the accumulation of population data will help with earlier diagnosis and treatment of many unpleasant, disabling or even fatal conditions.

So when you go about the business  of improving data analytics tools and interoperability, mining population health databases for trends and leveraging mHealth to improve chronic disease management, I invite you to think of me — not a tragic figure by any means, but someone who’s counting on you to keep connecting the dots.  Never doubt that the human value of what you do is extraordinary, but never forget that real people are waiting in the wings for you to supply insights that can give them their life back.

Millennials Reshaping Digital Health

Posted on February 26, 2015 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.

I thought that the infographic below was really interesting and a nice balance to Paul’s previous post Mobile Health and Me…I Think Not! The infographic is based on the report, “Healthcare Without Borders: How Millennials are Reshaping Health and Wellness”, which looked to study Millenial healthcare values. There’s clearly a large divide between generations when it comes to how they approach healthcare. It will be interesting how this divide impacts healthcare going forward.

how-millennials-are-reshaping-digital-health

Mobile Health and Me…I think not!!

Posted on February 20, 2015 I Written By

All that I read tells me, or at least tries to, that the future of healthcare is embedded in mobile healthcare. Through the magnificence of technology, I can see how my health is, test results were and when done, shop for a doctor to fix me if I’m broken. I have the opportunity to find the least expensive option for a cure or, when and if I have the time and after a self-diagnosis I can research my options on the care I need to fix whatever is broken. AND, I can do it all from my iPhone. Are you kidding??? You guys believe that there really are Super Heroes flying around out there, right??

I know that I am not a kid anymore. I know that even though my local hospital is rated as one of the best in the country, it and the doctors in it are a long, long way from the health technology I read so much about. Do we really want them to “compete” for our business?

Forsaking the fact that I live out in the pucker brush, if I get sick, I don’t want to find out about it because I researched the results of some tests, did a self diagnosis and went shopping for a cure. I want MY doctor to tell me what the problem is, if there is one and what can be done to fix it. If I agree with MY doctor, I want him to come up with a cure and whom I might need to be referred to to make it happen. I know that that is not technologically advanced, but it works.

That is one of my problems with all this and I guess I qualify for the title of Dinosaur. I can accept that, but I am also a parent. I take that responsibility very seriously.

One of my son’s is at the tail end of baby boomers and the other at the leading edge of Millennials. Both are very technology savvy. I think that the healthcare expectations I read about are nuts and even if it means being labeled a Dinosaur, I have to caution them about mHealth.

I watched my youngest son ignore the fact that the cold he was suffering from was very severe and getting worse. He finally went to one of those minute clinics and found out that he really had the flu and a touch of pneumonia to go with it. They suggested that he go to where I was trying to get him to go to. A real doctor. Had he done it originally he wouldn’t have lost three weeks because he was too sick to do much.

Then there is my very tech savvy baby boomer son. He understands HIT and mobile health better than most. Two times in the last three years he needed medical care. The first time he went to the minute clinic and they gave him Ibuprofen. It cured the hurt. The second time, he was doing an EHR implementation at a major university hospital. He spoke to one of the doctors he was working with, explained his issues, and was referred to the emergency room. They diagnosed him, treated him and sent him home because he was still contagious. He had also done a self diagnosis, on his smart phone. while sitting in an airport. His diagnosis was faulty.

Having gone through 3-4 life threatening illnesses in my life, the future methods of healthcare scares the heck out of me. It’s the future of medicine, I’m told. Iron Man, Bat Man, where are you when we need you?