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Telemedicine Cartoon

Posted on January 29, 2016 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.

Thanks to @WTBunting for this week’s Fun Friday cartoon.

Healthcare Telemedicine Humor

Telemedicine and remote monitoring does raise a lot of interesting questions and situations. However, I’m starting to see a lot more people tackle those challenges. I look forward to that future.

My Optimism for Healthcare IT in 2016

Posted on January 1, 2016 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.

In yesterday’s post about physician EHR dissatisfaction in 2015 that there are many reasons to be optimistic about where healthcare is heading. I really am optimistic about healthcare IT in 2016. Here’s a look at some of the reasons I’m optimistic about 2016 improving healthcare and improving life for doctors.

Medical Knowledge Sharing – Platforms like Figure 1 are changing how medical knowledge is learned and shared. It’s impossible for any 1 person to keep up with the body of medical knowledge that’s available. That’s why crowdsourced platforms like Figure 1 are so exciting. Add in the AI developments like Watson and there’s a lot of cause for excitement about how patients will benefit from doctors getting the right information they need to provide the best care. I’m also excited by efforts to share best practices and clinical decision support findings between institutions. I’m hopeful that 2016 will mark a banner year for this type of sharing between medical professionals.

Meaningful Use Shackles are Broken – We’ll see if the government shuts down the meaningful use program or if doctors will essentially shut down the meaningful use program by not participating. Either way, I predict that 2016 will put meaningful use in our rear view mirror. The shackles of meaningful use will be broken and we’ll be able to start focusing EHR on things that matter to doctors and patients: improved care, improved productivity, and lower costs.

Data Sharing Starts Providing Value – Value based reimbursement and associated trends are pushing data sharing and I believe healthcare organizations are finally on board. No, 2016 won’t bring one central repository of all your healthcare data that any health care provider can access anytime. No, 2016 won’t bring ubiquitous sharing of all your healthcare data in exact the right place it’s needed at the right time. Those will both take more time. However, we’re going to see targeted sharing that makes patients lives better and lowers costs.

Patient Activism – The waves of sensors and high deductible plans is changing patients from passive viewers of their healthcare into active patients. Many won’t have a choice but to be involved in their healthcare since they can’t afford to not be involved. This will require some doctors some angst, but will ultimately be embraced and appreciated by most. This change in patient behavior is going to inspire a whole new breed of technology that enables patients and changes our view of healthcare.

New Care Models – A wide variety of new models have started in healthcare. Direct primary care and concierge medicine are two that have gotten a lot of attention. However, I’m not sure those will scale across all of healthcare. However, combine those with trends in telemedicine (which I believe is inevitable) and platforms like HealthTap which open up health care services in new, creative ways.

Healthcare Communication – It still shocks me how poorly health care has implemented the communication that’s available every where else in society today. I realize that privacy concerns has been used as the excuse for why healthcare is further behind, but that’s a poor excuse. I’m not trying to discount the need for applying appropriate privacy and security principles in these applications. I am suggesting that it’s possible to implement the latest communication technologies in healthcare in a HIPAA private and secure manner. There’s so much opportunity for health care to benefit from better communication that’s facilitated by technology that it’s impossible for this not to improve in 2016.

Those are a few of the things which have me optimistic for healthcare in 2016. I’d love to hear your thoughts in the comments. What will 2016 bring us?

Time For A Health Tracking Car?

Posted on December 30, 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.

Several years ago, I attended a conference on advanced health technologies in DC. One of the speakers was Dr. Jay Sanders, president and CEO of The Global Telemedicine Group. And he had some intriguing things to say — especially given that no one had heard of a healthcare app yet and connected health was barely a vision.

One of Dr. Sanders’ recommendations was that automobile seat belts should integrate sensors that tracked your heart rhythm. After all, he noted, many of us spend hours a day behind the wheel, often under stressful conditions — so why not see how your heart is doing along the way? After all, some dangerous arrhythmias don’t show up at the moment you’re getting a checkup.

Flash forward to late 2015, and it seems Dr. Sanders’ ideas are finally being taken seriously. In fact, Ford Motor Co. and the Henry Ford Health System are co-sponsoring a contest offering $10,000 in prize money to employees creating smartphone apps linking healthcare with vehicles. While this doesn’t (necessarily) call for sensors to be embedded in seat belts, who knows what employees will propose?

To inspire potential entrants, the Connected Health Challenge sponsors have suggested a few ideas for possible designs, including in-vehicle monitoring and warnings and records access from the road. Other suggestions included appointment check-ins and technology allowing health data to be transmitted to providers. The contest kicks off on January 20th.

In some ways, this isn’t a huge surprise. After all, connected vehicles are already a very hot sector in the automotive business. According to research firm Parks Associates, there will be 41 million active Internet connections in U.S. vehicles by the end of this year.

At present, according to Parks, the connect car applications consumers are most interested in include mapping/navigation, information about vehicle performance, Bluetooth technology and remote control of vehicles using mobile phones. But that could change quickly if someone finds a way to interest the well-off users of wearables in car-based health tracking. (A possible direction for Fitbit, perhaps?)

Ordinarily, I’d have some doubts about Henry Ford Health System employees’ ability to grasp this market. But as I’ve reported elsewhere on Healthcare Scene, Henry Ford takes employee innovation very seriously.

For example, last year HFHS awarded a total of $10,000 in prizes to employees who submitted the best ideas for clinical applications of wearable technology. Not only that, the health system offers employees a 50% share of future revenues generated by their product ideas which reach the marketplace.

Now, it’s probably worth bearing in mind that the wearables industry is far more mature than the market for connected health apps in automobiles. (In fact, as far as I can tell, it’s still effectively zero.) Employees who participate in the challenge will be swinging at a far less-defined target, with less chance of seeing their ideas be adopted by the automotive industry.

Still, it’s interesting to see Ford Motor Co. and HFHS team up on this effort. I think something intriguing will come of it.

Significant Articles in the Health IT Community in 2015

Posted on December 15, 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.

Have you kept current with changes in device connectivity, Meaningful Use, analytics in healthcare, and other health IT topics during 2015? Here are some of the articles I find significant that came out over the past year.

The year kicked off with an ominous poll about Stage 2 Meaningful Use, with implications that came to a head later with the release of Stage 3 requirements. Out of 1800 physicians polled around the beginning of the year, more than half were throwing in the towel–they were not even going to try to qualify for Stage 2 payments. Negotiations over Stage 3 of Meaningful Use were intense and fierce. A January 2015 letter from medical associations to ONC asked for more certainty around testing and certification, and mentioned the need for better data exchange (which the health field likes to call interoperability) in the C-CDA, the most popular document exchange format.

A number of expert panels asked ONC to cut back on some requirements, including public health measures and patient view-download-transmit. One major industry group asked for a delay of Stage 3 till 2019, essentially tolerating a lack of communication among EHRs. The final rules, absurdly described as a simplification, backed down on nothing from patient data access to quality measure reporting. Beth Israel CIO John Halamka–who has shuttled back and forth between his Massachusetts home and Washington, DC to advise ONC on how to achieve health IT reform–took aim at Meaningful Use and several other federal initiatives.

Another harbinger of emerging issues in health IT came in January with a speech about privacy risks in connected devices by the head of the Federal Trade Commission (not an organization we hear from often in the health IT space). The FTC is concerned about the security of recent trends in what industry analysts like to call the Internet of Things, and medical devices rank high in these risks. The speech was a lead-up to a major report issued by the FTC on protecting devices in the Internet of Things. Articles in WIRED and Bloomberg described serious security flaws. In August, John Halamka wrote own warning about medical devices, which have not yet started taking security really seriously. Smart watches are just as vulnerable as other devices.

Because so much medical innovation is happening in fast-moving software, and low-budget developers are hankering for quick and cheap ways to release their applications, in February, the FDA started to chip away at its bureaucratic gamut by releasing guidelines releasing developers from FDA regulation medical apps without impacts on treatment and apps used just to transfer data or do similarly non-transformative operations. They also released a rule for unique IDs on medical devices, a long-overdue measure that helps hospitals and researchers integrate devices into monitoring systems. Without clear and unambiguous IDs, one cannot trace which safety problems are associated with which devices. Other forms of automation may also now become possible. In September, the FDA announced a public advisory committee on devices.

Another FDA decision with a potential long-range impact was allowing 23andMe to market its genetic testing to consumers.

The Department of Health and Human Services has taken on exceedingly ambitious goals during 2015. In addition to the daunting Stage 3 of Meaningful Use, they announced a substantial increase in the use of fee-for-value, although they would still leave half of providers on the old system of doling out individual payments for individual procedures. In December, National Coordinator Karen DeSalvo announced that Health Information Exchanges (which limit themselves only to a small geographic area, or sometimes one state) would be able to exchange data throughout the country within one year. Observers immediately pointed out that the state of interoperability is not ready for this transition (and they could well have added the need for better analytics as well). HHS’s five-year plan includes the use of patient-generated and non-clinical data.

The poor state of interoperability was highlighted in an article about fees charged by EHR vendors just for setting up a connection and for each data transfer.

In the perennial search for why doctors are not exchanging patient information, attention has turned to rumors of deliberate information blocking. It’s a difficult accusation to pin down. Is information blocked by health care providers or by vendors? Does charging a fee, refusing to support a particular form of information exchange, or using a unique data format constitute information blocking? On the positive side, unnecessary imaging procedures can be reduced through information exchange.

Accountable Care Organizations are also having trouble, both because they are information-poor and because the CMS version of fee-for-value is too timid, along with other financial blows and perhaps an inability to retain patients. An August article analyzed the positives and negatives in a CMS announcement. On a large scale, fee-for-value may work. But a key component of improvement in chronic conditions is behavioral health which EHRs are also unsuited for.

Pricing and consumer choice have become a major battleground in the current health insurance business. The steep rise in health insurance deductibles and copays has been justified (somewhat retroactively) by claiming that patients should have more responsibility to control health care costs. But the reality of health care shopping points in the other direction. A report card on state price transparency laws found the situation “bleak.” Another article shows that efforts to list prices are hampered by interoperability and other problems. One personal account of a billing disaster shows the state of price transparency today, and may be dangerous to read because it could trigger traumatic memories of your own interactions with health providers and insurers. Narrow and confusing insurance networks as well as fragmented delivery of services hamper doctor shopping. You may go to a doctor who your insurance plan assures you is in their network, only to be charged outrageous out-of-network costs. Tools are often out of date overly simplistic.

In regard to the quality ratings that are supposed to allow intelligent choices to patients, A study found that four hospital rating sites have very different ratings for the same hospitals. The criteria used to rate them is inconsistent. Quality measures provided by government databases are marred by incorrect data. The American Medical Association, always disturbed by public ratings of doctors for obvious reasons, recently complained of incorrect numbers from the Centers for Medicare & Medicaid Services. In July, the ProPublica site offered a search service called the Surgeon Scorecard. One article summarized the many positive and negative reactions. The New England Journal of Medicine has called ratings of surgeons unreliable.

2015 was the year of the intensely watched Department of Defense upgrade to its health care system. One long article offered an in-depth examination of DoD options and their implications for the evolution of health care. Another article promoted the advantages of open-source VistA, an argument that was not persuasive enough for the DoD. Still, openness was one of the criteria sought by the DoD.

The remote delivery of information, monitoring, and treatment (which goes by the quaint term “telemedicine”) has been the subject of much discussion. Those concerned with this development can follow the links in a summary article to see the various positions of major industry players. One advocate of patient empowerment interviewed doctors to find that, contrary to common fears, they can offer email access to patients without becoming overwhelmed. In fact, they think it leads to better outcomes. (However, it still isn’t reimbursed.)

Laws permitting reimbursement for telemedicine continued to spread among the states. But a major battle shaped up around a ruling in Texas that doctors have a pre-existing face-to-face meeting with any patient whom they want to treat remotely. The spread of telemedicine depends also on reform of state licensing laws to permit practices across state lines.

Much wailing and tears welled up over the required transition from ICD-9 to ICD-10. The AMA, with some good arguments, suggested just waiting for ICD-11. But the transition cost much less than anticipated, making ICD-10 much less of a hot button, although it may be harmful to diagnosis.

Formal studies of EHR strengths and weaknesses are rare, so I’ll mention this survey finding that EHRs aid with public health but are ungainly for the sophisticated uses required for long-term, accountable patient care. Meanwhile, half of hospitals surveyed are unhappy with their EHRs’ usability and functionality and doctors are increasingly frustrated with EHRs. Nurses complained about technologies’s time demands and the eternal lack of interoperability. A HIMSS survey turned up somewhat more postive feelings.

EHRs are also expensive enough to hurt hospital balance sheets and force them to forgo other important expenditures.

Electronic health records also took a hit from ONC’s Sentinel Events program. To err, it seems, is not only human but now computer-aided. A Sentinel Event Alert indicated that more errors in health IT products should be reported, claiming that many go unreported because patient harm was avoided. The FDA started checking self-reported problems on PatientsLikeMe for adverse drug events.

The ONC reported gains in patient ability to view, download, and transmit their health information online, but found patient portals still limited. Although one article praised patient portals by Epic, Allscripts, and NextGen, an overview of studies found that patient portals are disappointing, partly because elderly patients have trouble with them. A literature review highlighted where patient portals fall short. In contrast, giving patients full access to doctors’ notes increases compliance and reduces errors. HHS’s Office of Civil Rights released rules underlining patients’ rights to access their data.

While we’re wallowing in downers, review a study questioning the value of patient-centered medical homes.

Reuters published a warning about employee wellness programs, which are nowhere near as fair or accurate as they claim to be. They are turning into just another expression of unequal power between employer and employee, with tendencies to punish sick people.

An interesting article questioned the industry narrative about the medical device tax in the Affordable Care Act, saying that the industry is expanding robustly in the face of the tax. However, this tax is still a hot political issue.

Does anyone remember that Republican congressmen published an alternative health care reform plan to replace the ACA? An analysis finds both good and bad points in its approach to mandates, malpractice, and insurance coverage.

Early reports on use of Apple’s open ResearchKit suggested problems with selection bias and diversity.

An in-depth look at the use of devices to enhance mental activity examined where they might be useful or harmful.

A major genetic data mining effort by pharma companies and Britain’s National Health Service was announced. The FDA announced a site called precisionFDA for sharing resources related to genetic testing. A recent site invites people to upload health and fitness data to support research.

As data becomes more liquid and is collected by more entities, patient privacy suffers. An analysis of web sites turned up shocking practices in , even at supposedly reputable sites like WebMD. Lax security in health care networks was addressed in a Forbes article.

Of minor interest to health IT workers, but eagerly awaited by doctors, was Congress’s “doc fix” to Medicare’s sustainable growth rate formula. The bill did contain additional clauses that were called significant by a number of observers, including former National Coordinator Farzad Mostashari no less, for opening up new initiatives in interoperability, telehealth, patient monitoring, and especially fee-for-value.

Connected health took a step forward when CMS issued reimbursement guidelines for patient monitoring in the community.

A wonky but important dispute concerned whether self-insured employers should be required to report public health measures, because public health by definition needs to draw information from as wide a population as possible.

Data breaches always make lurid news, sometimes under surprising circumstances, and not always caused by health care providers. The 2015 security news was dominated by a massive breach at the Anthem health insurer.

Along with great fanfare in Scientific American for “precision medicine,” another Scientific American article covered its privacy risks.

A blog posting promoted early and intensive interactions with end users during app design.

A study found that HIT implementations hamper clinicians, but could not identify the reasons.

Natural language processing was praised for its potential for simplifying data entry, and to discover useful side effects and treatment issues.

CVS’s refusal to stock tobacco products was called “a major sea-change for public health” and part of a general trend of pharmacies toward whole care of the patient.

A long interview with FHIR leader Grahame Grieve described the progress of the project, and its the need for clinicians to take data exchange seriously. A quiet milestone was reached in October with a a production version from Cerner.

Given the frequent invocation of Uber (even more than the Cheesecake Factory) as a model for health IT innovation, it’s worth seeing the reasons that model is inapplicable.

A number of hot new sensors and devices were announced, including a tiny sensor from Intel, a device from Google to measure blood sugar and another for multiple vital signs, enhancements to Microsoft products, a temperature monitor for babies, a headset for detecting epilepsy, cheap cameras from New Zealand and MIT for doing retinal scans, a smart phone app for recognizing respiratory illnesses, a smart-phone connected device for detecting brain injuries and one for detecting cancer, a sleep-tracking ring, bed sensors, ultrasound-guided needle placement, a device for detecting pneumonia, and a pill that can track heartbeats.

The medical field isn’t making extensive use yet of data collection and analysis–or uses analytics for financial gain rather than patient care–the potential is demonstrated by many isolated success stories, including one from Johns Hopkins study using 25 patient measures to study sepsis and another from an Ontario hospital. In an intriguing peek at our possible future, IBM Watson has started to integrate patient data with its base of clinical research studies.

Frustrated enough with 2015? To end on an upbeat note, envision a future made bright by predictive analytics.

Connected Health Conference Tops Itself–But How Broad is Adoption? Part 1 of 3

Posted on November 5, 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.

Along the teeming circuit of health care conferences that Boston enjoys year-round, a special place is occupied by the Connected Health Conference sponsored by Massachusetts giant Partners HealthCare. For 12 years this conference, shepherded by the spirited Joseph Kvedar, has shown Boston and the rest of the world what can be accomplished by the integration of data, technology, and clinical empathy.

But people I talked to at the conference were asking: where’s change visible in the health care field? Why aren’t we seeing these great things adopted throughout the country to support value-based care? The much-vaunted Accountable Care Organization model is failing to thrive, interoperability continues to elude medical sites, and consequently, health care costs are “eating” American’s incomes.

The way forward may have been shown by the two final keynotes of the conference, delivered by executives at Massachusetts General Hospital (one of the central institutions in Partners HealthCare and a destination for patients around the world).

Chief Clinical Officer Gregg Meyer referred to “punctuated evolution” to suggest that the health care field is at an “inflection point” where change is starting to happen fast. What makes this change hard is that two major initiatives separate most health care institutions from the fee-for-value world we want. One initiative focuses on organizational change and payment regimes, whereas the other involves wrenching changes to technology that track, record, and analyze what doctors and patients are doing.

I believe the reason many ACOs and other fee-for-value systems are failing (or at least not showing cost improvements) is that they took on the organizational change before they were ready with the technological parts. According to Meyer, Massachusetts General Hospital took on the technological change first, years before a payment system was offered that reimburses them for it.

Many speakers at the conference pointed to recent payment changes, such as Medicare Advantage, that promote fee-for-value. Programs along those lines in Massachusetts have shown modest headway against costs.

Even so, MGH has made only some early steps in health IT. Some doctors allow virtual visits, but it’s not done strategically and most providers don’t understand that such visits could reduce their workloads in the long run. Chief Health Information Officer O’Neil Britton said that the Epic EHR they installed still can’t accept streaming data. But he vaunted MGH’s growing use of genomics, wearables, video information delivery, and telehealth. The use of video was praised frequently at the conference for bringing information to people when they need it and reducing office visits that are costly and inconvenient for everyone.

The next section of this article will contrast techno-optimists with techno-skeptics and mention some advances reported at the conference.

Wearables Data May Prevent Health Plan Denials

Posted on August 27, 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.

This story begins, as many do, with a real-world experience. Our health plan just refused to pay for a sleep study for my husband, who suffers from severe sleep apnea, despite his being quite symptomatic. We’re following up with the Virginia Department of Insurance and fully expect to win the day, though we remain baffled as to how they could make such a decision. While beginning the complaint process, a thought occurred to me.

What if wearables were able to detect wakefulness and sleepiness, and my husband was being tracked 24 hours a day?  If so, assuming he was wearing one, wouldn’t it be harder for a health plan to deny him the test he needed? After all, it wouldn’t be the word of one doctor versus the word of another, it would be a raft of data plus his sleep doctor’s opinion going up against the health plan’s physician reviewer.

Now, I realize this is a big leap in several ways.

For one thing, today doctors are very skeptical about the value generated by patient-controlled smartphone apps and wearables. According to a recent survey by market research firm MedPanel, in fact, only 15% of doctors surveyed see wearables of health apps as tools patients can use to get better. Until more physicians get on board, it seems unlikely that device makers will take this market seriously and nudge it into full clinical respectability.

Also, data generated by apps and wearables is seldom organized in a form that can be accessed easily by clinicians, much less uploaded to EMRs or shared with health insurers. Tools like Apple HealthKit, which can move such data into EMRs, should address this issue over time, but at present a lack of wearable/app data interoperability is a major stumbling block to leveraging that data.

And then there’s the tech issues. In the world I’m envisioning, wearables and health apps would merge with remote monitoring technologies, with the data they generate becoming as important to doctors as it is to patients. But neither smartphone apps nor wearables are equipped for this task as things stand.

And finally, even if you have what passes for proof, sometimes health plans don’t care how right you are. (That, of course, is a story for another day!)

Ultimately, though, new data generates new ways of doing business. I believe that when doctors fully adapt to using wearable and app data in clinical practice, it will change the dynamics of their relationship with health plans. While sleep tracking may not be available in the near future, other types of sophisticated sensor-based monitoring are just about to emerge, and their impact could be explosive.

True, there’s no guarantee that health insurers will change their ways. But my guess is that if doctors have more data to back up their requests, health plans won’t be able to tune it out completely, even if their tactics issuing denials aren’t transformed. Moreover, as wearables and apps get FDA approval, they’ll have an even harder time ignoring the data they generate.

With any luck, a greater use of up-to-the-minute patient monitoring data will benefit every stakeholder in the healthcare system, including insurers. After all, not to be cliched about it, but knowledge is power. I choose to believe that if wearables and apps data are put into play, that power will be put to good use.

Accenture: “Zombie” Digital Health Startups Won’t Die In Vain

Posted on August 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.

I don’t know about you, but I’ve been screaming for a while about how VCs are blowing their money on questionable digital health ventures. To my mind, their investment patterns suggest that the smart money really isn’t that smart. I admit that sorting out what works in digital health/mHealth/connected health is very challenging, but it’s far from impossible if you immerse yourself in the industry. And given how much difference carefully-thought out digital health tools can make, it’s exasperating to watch failing digital health startups burn through money.

That being said, maybe all of those dollars won’t be wasted. According to no less an eminence grise than Accenture, failing digital health ventures will feed the stronger ones and make their success more likely. A new report from Accenture predicts that these “zombie” startups — half of which will die within two years, it says — will provide talent and technology to their surviving rivals. (OK, I agree, the zombie image is a bit unsettling, isn’t it?)

To bring us their horror movie metaphor, Accenture analyzed the status of 900 healthcare IT startups, concluding that 51% were likely to collapse within 20 months.  The study looked at ventures cutting across social, mobile, analytics, cloud and sensors technologies, which include wearables, telehealth and remote monitoring.

While most researchers try to predict who the winners will be in a given market, Accenture had a few words to say about the zombie also-rans. And what they found was that the zombies have taken in enough cash to have done some useful things, collecting nearly $4 billion in funding between 2008 and 2013.

The investments are part of an ongoing funding trend. In fact, digital health dollars are likely to pour in over the next two years as well, with healthcare IT startups poised to take in $2.5 billion more over the next two years, Accenture estimates. Funding should focus on four segments, including engagement (25%), treatment (25%), diagnosis (21%) and infrastructure (29%), the study found.

So what use are the dying companies that will soon litter the digital health landscape? According to Accenture, more-successful firms can reap big benefits by acquiring the failing startups. For example, healthcare players can do “acqui-hiring” deals with struggling digital health startups to pick up a deep bench of qualified tech staffers. They can pick up unique technologies (the 900 firms analyzed, collectively, had 1,700 patents). And acquiring firms can harvest the startups’ technology to improve their products and services lineups.

Not only that — and this is Anne, not Accenture talking — acquiring healthcare firms get a wonderful infusion of entrepreneurial energy, regardless of whether the acquired firm was booking big bucks or not. And I speak from long experience. I’ve known the leaders of countless tech startups, and there’s very little difference between those who make a gazillion dollars and those whose ventures die. Generally speaking, anyone who makes a tech startup work for even a year or two is incredibly insightful, creative, and extremely dedicated, and they bring a kind of excitement to any company that hires them.

So, backed by the corporate wisdom of Accenture, I’ve come to praise zombies, not to bury them. While they may give their corporate lives, their visions won’t be wasted. With any luck, the next generation of digital health companies will appreciate the zombies’ hard work and initiative, even if they’re no longer with us.

Could On Demand Medical Services Be Good for Doctors?

Posted on August 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’ve been seeing a lot of discussion lately about the peer sharing economy and how it applies to healthcare. Some people like to call it the Uber of healthcare, but that phrase has been applied so many ways that it’s hard to know what people mean by it anymore. For example, is it Uber bringing your doctor to your home/work or is it an Uber like system of requesting healthcare? There are many more iterations.

I’ll to consider doing a whole series of posts on the Peer Sharing Economy and how it applies to healthcare. There’s a lot to chew on. However, most recently I’ve been chewing on the idea of on demand medical services. In most cases this is basically the Skype or Facetime telemedicine visit on a mobile device. These models are starting to develop and it won’t be long until all of us can easily hop on our mobile device and be in touch with a doctor directly through our phone. In some cases it will be a telemedicine visit. In other cases it might be the doctor coming to visit you. I’m sure we’ll have a wide variety of modalities that are available to patients.

Every patient loves this idea. Every insurance company is trying to figure out the right financial model to make this work. Most doctors are scared at what this means for their business. Certainly there are reasons for them to be concerned, but I believe that this new on demand medical service could be very good for doctors.

In our current system practices do amazing scheduling acrobatics to ensure that the doctor is seeing a full schedule of patients every day. They do this mostly because of all the patient no shows that occur. This makes life stressful for everyone involved. Imagine if instead of double booking appointments which leads to all sorts of issues, a doctor replaced no show appointments with an on demand visit with a patient waiting to be seen on a telemedicine platform. Basically the doctor could fill their “free time” with on demand appointments instead of double booking appointments which then causes them to get behind when both appointments do show up.

I can already hear doctors complaining about them being “mercenaries” and shouldn’t they be allowed free time to grab a coffee. I’d argue that in the current system they are mercenaries that are trying to fill their schedule as full as possible. The current double booking scheduling approach that so many take means that some days the doctor has a full schedule of appointments and some days they have more than a full schedule of appointments. If doctors chose to back fill no-shows with on demand appointments, then their schedule would be more free than it is today. Plus, if they didn’t want to back fill a no show, they could always make that choice too. That’s not an option in the double book approach they use today.

In fact, if there was an on demand platform where doctors could go and see patients anytime they wanted to see patients, it would open up a lot more flexibility for doctors much like Uber has done for drivers. Some doctors may want to work early in the morning while others want to work late at night. Some doctors might want to take off part of the day to see their kid’s school performance, but they can work later to make up for the time they took off (if they want of course).

Think about retired doctors. I’m reminded of my pharmacist friend who was still working at the age of 83. I asked him why he was still working at such an advanced age. He told me, “John, if I stop, I die.” I imagine that many retired doctors would love to still see some patients if they could do it in a less demanding environment that worked with their new retirement schedule. If there was an on demand platform where retired doctors could sign in and see patients at their whim, this would be possible. No doubt this is just one of many examples.

Currently there isn’t an on demand platform that doctors could sign into and see a patient who’s waiting to be seen. No doubt there are many legal, financial and logistical challenges associated with creating a platform of this nature. Not the least of which is that doctors are only licensed to practice in specific states. This is a problem which needs to be solved for a lot of reasons, but I think it will. In fact, I think that legal issues, reimbursement changes, and other logistical challenges will all be solved and one day we’ll have this type of on demand platform for healthcare. Patients will benefit from such a platform, but I believe it will open up a lot more options for doctors as well.

EMRs Should Include Telemedicine Capabilities

Posted on May 22, 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.

The volume of telemedicine visits is growing at a staggering pace, and they seem to have nowhere to go but up. In fact, a study released by Deloitte last August predicted that there would be 75 million virtual visits in 2014 and that there was room for 300 million visits a year going forward.

These telemedicine visits are generating a flood of medical data, some in familiar text formats and some in voice and video form. But since the entire encounter takes place outside of any EMR environment, huge volumes of such data are being left on the table.

Given the growing importance of telemedicine, the time has come for telemedicine providers to begin integrating virtual visit results into EMRs.  This might involve adopting specialized EMRs designed to capture video and voice, or EMR vendors might go with the times and develop ways of categorizing and integrating the full spectrum of telemedical contacts.

And as virtual visit data becomes increasingly important, providers and health plans will begin to demand that they get copies of telemedical encounter data.  It may not be clear yet how a provider or payer can effectively leverage video or voice content, which they’ve never had to do before, but if enough care is taking place in virtual environments they’ll have to figure out how to do so.

Ultimately, both enterprise and ambulatory EMRs will include technology allowing providers to search video, voice and text records from virtual consults.  These newest-gen EMRs may include software which can identify critical words spoken during a telemedical visit, such as “pain,” or “chest” which could be correlated with specific conditions.

It may be years before data gathered during virtual visits will stand on equal footing with traditional text-based EMR data and digital laboratory results.  As things stand today, telemedicine consults are used as a cheaper form of urgent care, and like an urgent care visit, the results are not usually considered a critical part of the patient’s long-term history.

But the more time patients spend getting their treatment from digital doctors on a screen, the more important the mass of medical data generated becomes. Now is the time to develop data structures and tools allowing clinicians and facilities to mine virtual visit data.  We’re entering a new era of medicine, one in which patients get better even when they can’t make it to a doctor’s office, so it’s critical that we develop the tools to learn from such encounters.

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!