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Forrester’s Take On Computing Trends For Next Year

Recently, Forrester Research’s J.P. Gownder released a list of six broad tech trends he feels will dominate 2014. While they’re not healthcare-specific, I thought our readers would appreciate them, as they are relevant to the work that we do.

Mobility:  Gownder is arguing that this year coming will see a “sustained mobile mind shift.” He argues that customers and employees are beginning to expect that the data they touch will be available to them in context on any device at the exact what would’ve need. He argues that customers will actively shun businesses that lack mobile applications.

Fragmentation:  While vendors would like to see us, as consumers, stick to one vendor and operating system, Gownder argues that just the opposite will happen in 2014, with people trading off between multiple devices and thriving across operating systems. This movement, driven by the seeming infinity of new mobile devices, makes things more difficult for health IT administrators, to be certain.

Wearables:  While the wearables devices your editor has seen strike her mostly as toys, Gownder is far more enthusiastic. He argues that next year will see commercial availability of a range of once theoretical wearables — and that enterprise wearables have a particularly rich future ahead of them.

Intelligent assistants:  For me, services like Siri and Samsung’s S-Voice are entertaining, but hardly add anything to the mix when it comes to what your phone tablet or PC can do. Gownder, however, believes that intelligent assistance will rise to prominence in 2014 as they become more sophisticated, interesting and useful.

Gestural computing: Expect to see new applications and scenarios for gestural computing this year, Gownder predicts, driven by phenomena like the presence of XBox Kinect in tens of millions of homes, the emergence of Leap Motion and the emergence of a new device known as Myo from Thalmic Labs. In this case he isolates healthcare specifically as a strong use case, in which professionals manipulate and navigate medical imaging using gestures.

Stores recognize you: Here’s one I can see direct healthcare applications for; next year, Gownder predicts, will be the year in which you walk into a store and the store “recognizes you” and tailors your experience accordingly. I can see this being relevant in virtually any public-facing healthcare setting, including the ED, medical clinics and perhaps even EMT settings. Sounds very much like John’s description of a “biometrically controlled healthcare system.

So which of these trends do you think will be the most important next year? How are you adopting them, if at all, in your healthcare organization?

December 31, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Is Remote Monitoring Data A Blessing, Or A Distraction?

This week, Venture Beat reported on some growing remote monitoring efforts in which a handful of Massachusetts hospitals are working to pull the data into their EMR. The hospitals are hoping to get their arms around a growing body of data which increasingly lives not only in wireless medical devices (such as glucometers and pulse oximeters) but also smartphones, smart wristbands, FitBit devices and other health-tracking technology.

One of the players involved in the new effort is Partners HealthCare, whose Center for Connected Health is focused on collecting and making use of such data. Its latest initiative sweeps patient data collected at home — such as blood pressure, weight and blood glucose — into the Partners EMR, making it accessible as part of routine clinical workflow. (The data collected by patients is transmitted wirelessly and automatically subsumed into the EMR.)  Patients can also review the data through a patient portal known as Patient Gateway.

According to Partners, this process is designed to change care delivery by allowing doctors to keep a close watch on patients when they’re not in the hospital or doctor’s office.

This is all well and good, especially for monitoring the chronically ill, whose condition may fluctuate dangerously and require timely intervention. But the question is, is this new flood of data going to be manageable for doctors?  Can a physician managing thousands of patients really give appropriate attention to every data point a FitBit or smartphone produces?  Certainly not.

Perhaps that’s why Kaiser Permanente recently told a conference that it was going to be rather picky as to what data flows into its EMR. According to Lead Innovation Designer Christine Folck:

“Don’t come to us telling us you can upload [data] into our electronic medical record. We don’t necessarily want it there. We have too much information in our electronic medical record. Kaiser Permanente was one of the first to go nationwide with our electronic medical record, we are fully integrated, but the problem is now everybody wants to upload into it. Our physicians don’t want it all there. They really don’t need to know how much exercise each of their patients is getting on a daily basis; they just don’t have time to process all of that.”

So, while there’s clearly benefit to tracking chronic conditions via remote monitoring, it seems clear that there will be some pushback from doctors, who can’t possibly absorb all of the data the healthier “quantified self” types are producing.  It looks to me like we’re going to have to narrow down what categories of data are actually helpful in an EMR and which aren’t.

August 1, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Health IT Costs, Health IT Adoption, HIE and CommonWell – Pre #HITsm Thoughts

Last week I took the #HITsm Chat topics and created a blog post about Healthcare Unbound. I enjoyed creating the post so much that I decided to do it again this week. Not to mention I’ll be on the road to Utah during this week’s chat and won’t be able to participate. (Side Note: If you live in Utah and want to do lunch, I’d love to meet and talk EMR or health IT. I’ll be in Hawaii in July if you want to do the same.)

The chat topics make perfect discussion items. Plus, I love that I have more of an opportunity to really dig into the topics in a blog post. You can’t dig in quite as much in 140 characters.

Topic 1: Costs vs benefits. Will high costs always be the #1 barrier cited to #healthIT adoption?
We’ve seen an enormous shift in the cost of healthcare IT since I first started blogging about EMR 8 years ago. Cost use to be a much bigger issue when the cheapest EMR software you could find was about $30,000+ per doctor (in the ambulatory space). Plus, they expected you to pay the entire lump sum payment up front (many did offer financing). These days the cost of EMR software has dropped dramatically and fewer and fewer EHR vendors are using the lump sum payment model. This change means that costs are much more in line with a practice’s revenue.

These days, I’d say that those who use cost as the reason for not adopting health IT are really just using it as an excuse not to do it. There are a few rural providers where cost is more than just an excuse, but those are pretty few and far between. I’m not saying that cost isn’t an important part of any health IT project, but I’ve most often seen cost used as a mask for other reasons people don’t want to implement health IT. The most common reason is actually just a general resistance to change.

Topic 2: Why does ePrescribing have such widespread acceptance while #telehealth adoption is so low?
If providers could be reimbursed for telehealth, adoption would be high.

It is ironic that doctors don’t really get reimbursed for ePrescribing, but they do it at a high level. Although, the doctor does get reimbursed for the visit that generates the need for the prescription. A deeper investigation of why ePrescribing has had good adoption would be interesting. Certainly there are many doctors who miss their sig pad. However, once you have to record the prescription in the EHR, you might as well ePrescribe it.

Plus, there are some obvious reasons why ePrescribing is better. Whether it’s replacing the unreadable prescriptions or the drug to drug and allergy interaction checking that’s built into every ePrescribing platform, the benefits can be understood quickly.

The sad thing is that the benefits of Telehealth can be seen quickly as well, but you can’t get paid to do it.

Topic 3: #HIE as a noun or a verb? Does negative press for HIE org$ hinder health data exchange as a whole?
HIE is currently more of a noun than a verb. Verbs require action and we’re not seeing enough HIE action.

In some ways negative press could discourage healthcare organizations from participating in an HIE organization. However, negative press about HIE’s weaknesses can also put pressure on healthcare organizations to finally step up to the plate and have more HIE action and less HIE talk.

The biggest hindrance to HIE is business model, and good or bad press won’t do much to change that.

Topic 4: Is #CommonWell just a bully in a fairy godmother costume?
I love this question mostly because I sent the tweet that inspired it. Although, a smart health IT PR/marketer was the one who said it to me.

It’s a little too early to tell if the fairy godmother costume that CommonWell has on is real or fake. I think there path is paved with good intentions, but will the almighty dollar get in the way of them realizing these good intentions? I don’t know. I’m hopeful that it will be a success. I’m also glad that at least the conversations are happening. That’s a step forward from where we were before CommonWell.

Topic 5: Open forum: What #HealthIT topic had your attention this week?
There are so many topics that I discuss each week, but I think I’m most excited by the project announced this week to create a Common Notice of Privacy Practices. I hope their crowdfunding is successful and they get a lot of great healthcare organizations on board with what they’re doing. I also found the Vitera Healthcare acquisition of Success EHS quite interesting. EMR is slowly but surely consolidating.

June 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Partners Integrates Mobile Data With EMR

In a move that could realize much of the promise of wireless remote monitoring, Partners HealthCare system has made it possible for providers to view remotely-collected patient health data in its EMR.  The program was launched by Partners division The Center for Connected Health, which focuses on delivering new forms of patient care outside of standard medical settings.

For years, Partners has been running programs which collect patient data through a combination of remote-monitoring technology, sensors and Web-based tools. Their focus has included management of chronic diseases such as diabetes and high blood pressure, medication adherence and improved pregnancy outcomes and cardiac care outcomes. The Center’s remote monitoring database now stores over 1.2 million  patient vital signs.

Now, Partners has linked The Center’s proprietary remote monitoring database to its EMR, a step which moves the system in the direction of offering continuous chronic disease management. If a patient is participating in a remote monitoring program, Partners physicians can can now see a patient’s day-to-day vital signs, blood glucose levels, weight and other key health indicators directly within their records in the EMR.

The ultimate notion, according to the press release at least, is to  ”put the patient at the center of their care while maintaining a close watch on their condition when they are not in the hospital or doctor’s office.”

While Partners didn’t say how many patients are involved in The Center’s programs, it’s doubtless a small fraction of overall Partners patient population. So despite the general coolness of what they’re trying to do, this is still more on the order of an experiment than a population health management program via remote monitoring.

Still, what Partners is doing is a large step in the right direction, and will doubtless realize some of the long anticipated benefits of remote monitoring for patients who are involved. Good show, folks.

June 25, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Telemedicine Not Connecting With EMRs

As smartphones and tablets become a standard part of healthcare as we know it, telemedicine is gaining a new foothold in medicine too.  In some cases, we’re talking off the cuff transactions in which, say, a patient e-mails a photo to a doctor who can then diagnose and prescribe.  But telemedicine is also taking root on an institutional level, with health systems rolling out projects across the country.

The problem is, however, that these telemedicine projects simply don’t integrate with EMRs, according to an article in SearchHealthIT.  The piece’s writer, Don Fluckinger, recently attended American Telemedicine Association’s 2013 Annual International Meeting & Trade Show, where complaints were rife that EMRs and telemedicine don’t interoperate.

I really liked this summary of the situation one executive shared with Fluckinger:

For now, the executive (who asked not to be named) said, telemedicine providers need to keep away from the “blast radius” of EHR vendor conflicts, lest their budgets get consumed by building interfaces to the various non-interoperable EHR systems.

Not only are health systems struggling to integrate telemedicine data with EMRs, telemedicine providers are in a bit of a difficult spot too, Fluckinger notes. As an example, he tells the tale of Seattle-based Carena Inc., a provider of primary care services to patients via phone and video, which provides after-hours support to physicians at Franciscan Health System in Tacoma, Wash.

Carena itself has an EMR which has the ability to share searchable PDF documents for use in patient EMRs, but Franciscan’s seven hospitals are bringing up an Epic implementation which can’t support this trick.  Top execs at Franciscan want to connect Carena’s data to Epic, but that won’t happen right away.  So Franciscan may end up setting up Carena’s after-hours service within Franciscan’s Epic installation to work around the interoperability problem.

This is just one sample of the interoperability obstacles healthcare organizations are encountering when they set out to create a telemedicine service. As telemedicine explodes with the use of portable devices, I can only imagine that this will impose one more pressure on vendors to conquer compatibility problems. (But sadly, I doubt it will force any real changes in the near future.)

June 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

EMR Ready: The Smartphone Physical

Here’s the kind of thinking that makes me wish I was going to TEDMED 13 (John Lynn will be there if any other readers are attending.).  At this years’ show, a team of current and future medical professionals plan to do a complete “smartphone physical” for attendees, using a bunch of devices that appear to be compatible with an iPhone. Not only is the data immediately readable as the testing goes on, it’s EMR-ready, too, both pretty neat features.

Check out just how thorough the physical is going to be (courtesy of the TEDMED blog):

• Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

•Heart electrophysiology using the AliveCor Heart Monitor.

•Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patient’s lungs and heart.

• Carotid artery visualization using a Mobisante probe.

Participant Shiv Gagliani, a Johns Hopkins medical student, tells TEDMED that the smartphone physical can improve doctor-patient relationships, as the real-time, audible and visual results help connect patients to the tests and increase their understanding of their bodies.  Not only that, the patients can help gather the data themselves, increasing their engagement with their care.

And of course, the devices that make the smartphone checkup possible are also very portable, making it possible for doctors to take them wherever they go, be it down the street or across the globe.  What’s more, less-trained global health workers will be able to use these devices to gather baseline readings and via telemedical links, get instructions on how to treat patients. This device connectivity is part of what John suggested was needed for successful Telehealth.

To learn more about this project, visit http://www.smartphonephysical.org/. I’d definitely take a look; it seems to me that this type of mobile health technology is here to stay.

April 9, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Keys to Successful Telehealth

Rob Sobie wrote a nice post on the Point of Care Corner blog about the 4 Keys to a Successful Telemedicine Launch. These are the 4 keys he offers:

  • Reliability
  • Ease of Use
  • Mobility
  • Flexibility

Most of the ideas are pretty self explanatory, but check out the full post for his explanation of each item. I agree with each item, but I think there are a number of other things that are needed for successful telehealth as well.

Multiple Application Support – While we’d love to have the entire Telehealth experience on one application, it’s unlikely to ever happen. While doing a Telehealth visit, the doctor is going to need access to a number of other applications such as their EHR. This is where the dual monitor Telehealth setup is so beneficial. They can have the Telehealth visit up on one screen while they browse their EHR or other health application on the other screen.

Telehealth Reimbursement – I recently asked an insurance company executive about Telehealth and if they’re really start reimbursing for it. He said they were happy to reimburse a Telehealth visit, as long as they had a way to know that there was indeed a visit that justified payment. You can see where they’re afraid of Telehealth reimbursement fraud. His solution to that was reimbursing Telehealth systems that were their trusted partners. With this in mind, you want to make sure whatever Telehealth solution you use is trusted by the payers so that you get paid.

Device Connectivity – One of the challenges of Telehealth is the ability to get device information from a patient. There’s a new wave of Telehealth technologies that are incorporating medical devices into the Telehealth experience. Integrating Telehealth and devices really takes Telehealth to the next level and since the cost of devices is dropping dramatically we’re going to see more and more integrations. Just be careful because many Telehealth platforms won’t have the forethought to do this type of device integration.

I’m sure there are other keys to Telehealth success. I’d love to hear your additional ideas in the comments. Where are you seeing it implemented? What’s been most successful?

I believe the Telehealth market is set to grow like it’s never grown before. The technology and infastructure are in place for it to become a reality. Things like shared savings will drive adoption of Telehealth as a way to lower costs. The article linked above says that Telehealth is projected to be a $27.3 billion industry in 2016. I’m personally looking forward to the shift to Telehealth.

April 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Frontline Female Veterans Likely to Benefit from New VA Telemedicine Project

As anyone in healthcare will tell you, the U.S. government has an interesting sense of timing. A day after the Pentagon announces it plans to end its ban on women in frontline combat, the VA announces that it has awarded grants to VA facilities that are launching women’s health projects, including establishing telehealth services for female veterans living in rural areas. Coincidence, or well-timed marketing/public relations strategy?

According to the VA’s press release announcing the grants, “Women serve in every branch of the military, representing 15 percent of today’s active duty military and nearly 18 percent of National Guard and Reserve forces. By 2020, VA estimates women Veterans will constitute 10 percent of the Veteran population.”

No mention was made in the release, of course, of the 237,000 jobs that will be available to women in the armed forces now that the combat ban has been lifted. I wonder if that 10-percent figure might jump a little once 2016 rolls around and arguments amongst government agencies regarding combat roles that should remain closed to women are laid to rest.

Telehealth grants were awarded to 10 facilities, and, according to the VA, will be used to provide services including tele-mental health, tele-gynecology, tele-pharmacy and telephone maternity care coordination.

While I applaud Secretary of Veterans Affairs Eric K. Shinseki’s statement that “[t]hese new projects will improve access and quality of critical health care services for women,” I’m not quite sure where I stand on the underlying issue – why aren’t female veterans already given 100 percent access to care at VA facilities, and why does the government seem to be planning for an increased need for healthcare services? But that speaks to a bigger problem that is probably best addressed elsewhere.

January 30, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

New Telemedicine Stats Bode Well for EMRs

With the recent projection that telemedicine will reach 1.8 million patients worldwide by 2017, I think it’s fitting to continue the discussion I started last week pertaining to the current ROI of EMRs. While current utilization based on scrambling to meet Meaningful Use for federal incentives may not be all it’s cracked up to be, I do believe EMRs will ultimately provide a fiscally sensible return on investment, especially if telemedicine technology becomes part of any given vendor’s standard EMR package/offering.

I decided to bounce the idea off Sande Olson, a Twitter friend (@sandeolson) and Senior Healthcare Consultant at Olson & Associates. Being a healthcare professional that has worked in telemedicine long enough to witness its evolution, Olson seemed a fitting expert to speak with on the subject of EMRs, telemedicine and the bottom line.

How have you seen the telemedicine landscape change over the last few years?
Olson: Until recently, telemedicine has been a niche industry. Early users recognized the potential value of telemedicine, but successful business models (showing a viable ROI) didn’t exist, and technology was costly. The challenge was reimbursement; who was going to pay for it?  Without reimbursement or a viable business model, telemedicine could not go viral.

The telemedicine landscape began to change with advancements in information and communication technology on the heels of The Affordable Care Act. The push for healthcare reform provided financial incentives to “nudge” healthcare providers towards EMRs. Reform mandates and the availability of government funding created new opportunities around technology. Telemedicine, a valuable if fledgling technology, became a buzzword around technology and healthcare reform.

Industries saw business opportunity as solution providers for an “industry poised to undergo radical change.” Entrepreneurs, inventors, investors and healthcare visionaries followed new and sometimes disruptive ideas. Care delivery tools moved from PCs to tablets, along with mobile apps.

The confluence of all these influencers is creating a potential tipping point for telemedicine; it only needs wider reimbursement and licensure portability. Our aging population and forecasted physician shortage will help continue to thrust telemedicine into the forefront of change. Telemedicine is already being used successfully; reimbursement is still a challenge. But, healthcare innovation is just getting started. We have challenging times ahead, but this is also the most exciting time to be in healthcare ever!

Do you think there’s been a trickle down effect from the Affordable Care Act in terms of increasing interest in and adoption of telemedicine?
There has been a trickle-down effect on telemedicine. The Affordable Care Act has increased interest in exploring the possibilities of telemedicine outside of previous niche markets. As I noted, it is the confluence of influencers around healthcare reform that continues to push the tipping point for telemedicine.

Do you think EMRs will prove their worth in the coming years by better facilitating more novel methods of healthcare delivery, like telemedicine, or integrating with consumer-friendly mobile health apps?
Will EMRs prove their worth? Well, data silos do not support healthcare’s philosophy of providing a continuum of care from cradle to grave. And, you cannot provide care without a medical record; you can’t measure outcomes. So, interoperability– across all silos– is critical to successful healthcare reform. EMRs today may fall a bit short, but they will create efficiencies and improve patient outcomes. They will get simpler to use. EMRs will assist in improving reimbursement and revenue cycles. And, future EMRs will push and pull data from HIEs, PHRs and mobile health apps; we are just not there yet.

January 24, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.