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Physician Transparency List

Posted on May 13, 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.

One of the most progressive thinkers in healthcare social media is Ed Bennett. He’s most famous for the Hospital Social Media list that Ed started back in 2009. That list was an eye opener for many hospitals that were debating how and if they should take part in social media. That list is still alive and is owned and managed by The Mayo Clinic Center for Social Media.

Ed Bennett recently announced a new list that looks at healthcare organizations who are publishing patient comments and ratings for their physicians. He currently has 29 healthcare organizations on the list, but I agree that this will likely grow similar to how his hospital social media list grew from 150 hospitals to 1500. If you’re organization is publishing your physician’s ratings and patients comments on your website, you can reach out to Ed and get your organization on the list as well.

Physician Profiles with Physician Ratings and Patient Comments List

I also find it interesting that Ed is listing the “implementation vendors” that do survey and web integration services. Here’s who he has listed so far:

Nice work Ed, putting this together. It’s always interesting how something like a list can move people to change. I have a feeling we’ll have a move towards more physician transparency happening across the industry thanks to Ed’s latest list. Nice work Ed!

Ditching Your EHR Just Isn’t Practical Regardless of Practice Model

Posted on May 12, 2016 I Written By

The following is a guest blog post by Tom Giannulli, MS, MD and CMO at Kareo.
Tom Giannulli - Kareo EHR
A recent piece by Anne Zieger on EMR & EHR opened up the discussion regarding whether or not direct primary care (DPC) physicians can or should ditch their electronic health record (EHR). And, this isn’t the first time the topic has surfaced. Other blogs have suggested that since EHRs are really just a means to gather documentation for insurance claims, DPC doctors don’t need them. Further, they offer other arguments against EHRs—like poor workflow and patient experience—however, the focus was really around insurance.

Yet, this is not a reason in and of itself for why DPC physicians should give up their EHRs. One role of an EHR is to improve documentation and coding to ensure physicians get paid. This is a good thing for DPC physicians, as well as traditional practices. The majority of DPC physicians use more than one payment model within their practice, meaning many also bill insurance for at least some patients.

A study conducted in 2015 showed that only 28% of physicians who used a DPC, concierge or other membership model in their practice had their entire patient panel on that model. The rest used it for some, but not all, patients. In fact, the largest group—37%—had 25% or less of their patients on a membership payment model. That said, insurance billing continues to be a challenge that those practices must navigate. An EHR can help them get paid correctly. It can also help them report for quality initiatives, like Meaningful Use and PQRS, prepare for the newly proposed MACRA ruling, and allow them to bill for chronic care management (CCM) services, while also improving patient experience and outcomes.

Independent practices understand that as we move forward in healthcare, a single payment model won’t do the trick. They need to be nimble and open to many options from fee-for-service to DPC to Virtual ACOs and other value-based reimbursement programs. The agile medical practices will be the ones that thrive in the long term. They are looking both at reimbursement models and industry changes, as well as increasing patient demands, such as increased connectivity, price transparency and improved patient access.

Using the EHR, Regardless of Practice Model

This is why even for those DPC practices that do go all in and don’t bill insurance, an EHR is essential. Many DPC practices offer largely primary care services with a focus on prevention and wellness. The right EHR can enable not only visit documentation but preventive care alerts and quick access to patient education. With a truly mobile EHR, physicians can engage patients face-to-face and share information in real time.

With the addition of integrated patient engagement features, such as telemedicine, self-care instructions and videos, tracking of wearable devices, and secure messaging through a portal, patients and their caregivers can stay in sync with their providers. This is an added level of convenience that DPC practices should support. Moreover, patient engagement components can be a critical part of managing wellness when studies show that most patients forget what their physician said after they leave the office. Keeping patients well means keeping the lines of communication open and a portal can play an important role.

Not only have patients expressed that they are more loyal to a physician who offers a portal (for the reasons stated above), but they have also said they like features like electronic prescribing. In fact, over 75% of patients have said they prefer an EHR to paper charts. Beyond the desire of patients, many states are beginning to mandate not just standard ePrescribing but also electronic prescribing for controlled substances. DPC physicians will not be exempt from rules like these.

There’s no other option but the EHR

It’s true that you can piece together just the technology features you want for your practice by combining several systems. However, the blog post referenced above seemed to suggest you could use an alternate system to an EHR. If you pick and choose features here and there, wouldn’t that mean more work entering data into a bunch of disparate systems? Or, logging into several different platforms translating to added time and less secure environments. One for ePrescribing, one for scheduling and reminders, one for the patient portal and maybe another one for patient collections?

There are cloud-based EHRs today that can offer most, if not all, of this in a single platform. One platform means one patient database, one login, and one easy-to-access system for all employees. And for DPC practices with small staff, no duplicate data entry or tedious jumping from system to system. In addition, a single end-to-end system that can support all the needs of a practice also means the practice can be positioned for flexibility. For example, if a DPC practice decides to accept insurance again or try another payment model, you’ll have the solutions you need without making significant changes to your workflow.

EHRs may not be perfect, but they are improving in their ability to meet increasing consumer demands and changing government regulation. Moving forward, more progressive EHR platforms will continue to offer add-on partners or native capabilities to solve consumer-centric needs. As the types of practice models change and evolve, the need for a core EHR should remain a constant, while additional features will vary. Thus, the flexibility and configurability of the EHR platform is critical to enabling long term success.

Full Disclosure: Kareo is an advertiser on this site.

Health Data Virtual Reality Demo

Posted on May 11, 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.

Ever since I saw the latest demo of virtual reality at CES, I’ve become a big fan. I think there’s so much potential opportunity to take a look at things from a different angle. I think we’ve barely begun to rethink what it means for us. I’m not sure we’ll have one in every household the way we do our cell phones, but then again Google Cardboard is pretty cheap and inexpensive to share.

Mass appeal or not, we’re going to see useful implementations of virtual reality in healthcare. Of that I’m sure. With that in mind, I’m always interested by companies that are experimenting with the technology in healthcare. In this case, here’s a short demo from Mana Health.

I have a feeling we’re going to look back at this basic implementation even a few years from now and laugh at its simplicity. Although, that was the case with every tech revolution. Have you ever looked back at Windows 3.1 or various websites on the Waybackmachine when the internet first began?

Obviously this demo illustrates that we’re still in the very early days of virtual reality. Although, it’s fun to get the mind to start thinking about a new interface.

ZibdyHealth Adapts to Sub-Optimal Data Exchange Standards for a Personal Health Record

Posted on May 10, 2016 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.

Reformers in the health care field, quite properly, emphasize new payment models and culture changes to drive improvements in outcomes. But we can’t ignore the barriers that current technology puts in the way of well-meaning reformers. This article discusses one of the many companies offering a patient health record (PHR) and the ways they’ve adapted to a very flawed model for data storage and exchange.

I had the honor to be contacted by Dr. Hirdey Bhathal, CEO/Founder of ZibdyHealth. Like many companies angling to develop a market for PHRs, ZibdyHealth offers a wide range of services to patients. Unlike, say, Google Health (of blessed memory) or Microsoft HealthVault, ZibdyHealth doesn’t just aspire to store your data, but to offer additional services that make it intensely valuable to you. Charts and visualizations. for instance, will let you see your progress with laboratory and device data over time. They call this a “Smart HIE.” I’ll look a bit at what they offer, and then at the broken model for data exchange that they had to overcome in the health care industry.

The ZibdyHealth application

Setting up an account with ZibdyHealth is as easy as joining Facebook. Once you’re there, you can create health information manually. The company is working with fitness device makers to allow automatic uploads of device data, which can then be saved as a standard Continuity of Care Document (CCD) and offered to doctors.

You can also upload information from your physician via their health care portal–with a degree of ease or difficulty depending on your provider–and share it with other clinicians or family members (Figure 1). You have fine-grained control over which medications, diagnoses, and other information to share, a form of control called segmentation in health care.

Figure 1. Zibdy discharge summary displayed on mobile device

Figure 1. Summary of visit in Zibdy

Dr. Bhathal would like his application to serve whole families and teams, not just individuals. Whether you are caring for your infant or your aging grandmother, they want their platform to meet your needs. In fact, they are planning to deploy their application in some developing nations as an electronic medical record for rural settings, where one healthcare provider will be able to manage the health data for an entire village.

Currently, ZibdyHealth allows speciality clinics to share information with the patient’s regular doctor, helps identify interactions between drugs provided by different doctors, and allows parents to share their children’s health information with schools. This consolidation and quick sharing of medical information will work well with minute clinics or virtual MD visits.

ZibdyHealth is HIPAA-compliant, and support highly secure 256-bit AES encryption for data exchange. Like health care providers, they may share data with partners for operational purposes, but they promise never to sell your data–unlike many popular patient networks. Although they sometimes aggregate anonymized data, they do so to offer you better services, not to sell it on the market or to sell you other services themselves.

In some ways, ZibdyHealth is like a health information exchange (HIE), and as we shall see, they face some of the same problems. But current HIEs connect only health care providers, and are generally limited to large health care systems with ample resources. PHR applications such as ZibdyHealth aim to connect physicians and patients with others, such as family members, therapists, nursing homes, assisted care facilities, and independent living facilities. In addition, most HIEs only work within small states or regions, whereas ZibdyHealth is global. They plan to follow a business model where they provide the application for free to individuals, without advertisements, but charge enterprises who choose the application in order to reach and serve their patients.

Tackling the data dilemma

We’d see a lot more services like ZibdyHealth (and they’d be more popular with patients, providers, and payers) if data exchange worked like it does in the travel industry or other savvy market sectors. Interoperability will enable the “HIE of one” I introduced in an earlier article. In the meantime, ZibdyHealth has carried out a Herculean effort to do the best they can in today’s health exchange setting.

What do they use to get data from patient portals and clinicians’ EHRs? In a phrase, every recourse possible.

  • Many organizations now offer portals that allow patients to download their records in CCD format. ZibdyHealth works with a number of prominent institutions to make uploading easy (Figure 2). Or course, the solution is always a contingent one, because the provider still owns your data. After your next visit, you have to download it again. ZibdyHealth is working on automating this updating process so that providers can feed this information to the patient routinely and, by uploading the discharge CCD as part of a patient’s discharge process, ensure an easy and accurate transition of care.

  • Figure 2. List of electronic records uploaded to Zibdy through their CCD output

    Figure 2. List of uploaded CCDs

  • If providers aren’t on ZibdyHealth’s list of partners, but still offer a CCD, you can download it yourself using whatever mechanism your provider offers, then upload it to ZibdyHealth. ZibdyHealth has invested an enormous amount to parse the various fields of different EHRs and figure out where information is, because the CCD is a very imperfect standard and EHRs differ greatly. I tried the download/upload technique with my own primary care provider and found that ZibdyHealth handled it gracefully.

  • ZibdyHealth also supports Blue Button, the widely adopted XML format that originated at the VA as a text file.

I see ZibdyHealth as one of the early explorers who have to hew a path through the forest to reach their goal. As more individuals come to appreciate the benefits of such services, roads will be paved. Each patient who demands that their doctor make it easy to connect with an application like ZibdyHealth will bring closer the day when we won’t have to contort ourselves to share data.

Pharma’s EHR Opportunity – We Need to Be Involved

Posted on May 9, 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.

I recently came across a great article talking about marketers need to decode the EHR for Pharma. It’s been really interesting to see the evolution on pharma’s relationship with EHR software. No doubt they’ve all always seen a tremendous opportunity, but they’ve all treaded lightly because of the possible undue influence on a provider.

The article did make an interesting comparison between how pharma approaches EHR and how they approached social media in the past:

Their pervasiveness has raised eyebrows throughout pharma. What’s happening with EHR “reminds me of the early days of being in the digital center of excellence [DCOE],” Flaiz recalled. “Social was exploding. It belonged to corporate comms, brands, PR — there wasn’t anyone who didn’t think they owned it.”

The same thing is happening now with EHR, but with a different cast of characters: trade, pricing, medical affairs, R&D, marketing, and the DCOE — all want a piece, she said.

I also love that the article frankly states that agencies will focus on placing banners and messaging and that marketers will need to focus on a much deeper approach to marketing pharma in an EHR. In fact they outline the other EHR Opportunities for pharma that pharma marketing professionals should consider: clinical decision support, integration with the hub and patient-assistance programs, patient engagement and education, and scraping it for other information of value.

I’m sure that many readers of this don’t like this discussion at all. No doubt many feel like pharma shouldn’t have any relationship with an EHR vendor. That’s naive since pharma already has relationships with many EHR vendors. It’s a mistake for us to put a blind eye to this topic.

Yes, we need to proactive in talking about how EHR vendors should work with pharma and how they should not work with pharma. If we’re not involved in the conversation, we’ll miss out on the opportunity to shape the discussion.

Plus, not all pharma interaction with EHRs is bad. It can be a really good thing as long as what’s being done is transparent. Plus, the reality is that pharma is going to have an influence on doctors. Why not have that work done in an EHR where you can know what influence pharma is having on the doctor? Pharma and EHR vendors will work together. The question is how much we’re going to know about their involvement.

Making Health Data Patient-Friendly

Posted on May 6, 2016 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.

Most of the efforts designed to make healthcare processes more transparent hope to make patients better shoppers. The assumption is that better-informed patients make better decisions, and that ultimately, if enough patients have the right data they’ll take steps which improve outcomes and lower the cost of care. And while the evidence for this assumption is sparse, the information may increase patient engagement in their care — and hopefully, their overall health.

That’s all well and good, but I believe too little attention has been paid to another dimension of transparency. To wit, I’d argue that it’s more than time to present patients with clinical data on a real- or near-real-time basis. Yes, shopping for the right doctor is good, but isn’t it even more important for patients to see what results he or she actually gets in their particular medical case?

Patients rarely get a well-developed look at their clinical data. Patient portals may offer access to test and imaging results from today through 10 years ago — my health system does — but offer no tools to put this data in context. If a patient wants to take a good look at their health history, and particularly, how test results correlate with their behavior, they’ll have to map the data out themselves. And that’s never going to work for your average patient.

Of course, there are obstacles to making this happen:

  • Physicians aren’t thrilled with the idea of giving patients broad healthcare data access. In fact, more than one doctor I’ve seen wouldn’t let me see test results until he or she had “approved” them.
  • Even if you set out to create some kind of clinical data dashboard, doing so isn’t trivial, at least if you want to see patients actually use it. Significant user testing would be a must to make this approach a success.
  • To my knowledge, no EMR vendor currently supports a patient dashboard or any other tools to help patients navigate their own data. So to create such an offering, providers would need to wait until their vendor produces such a tool or undertake a custom development project.

To some extent, the healthcare IT industry is already headed in this direction. For example, I’ve encountered mobile apps that attempt to provide some context for the data which they collect. But virtually all healthcare apps focus on just a few key indicators, such as, say calorie intake, exercise or medication compliance. For a patient to get a broad look at their health via app, they would have to bring together several sets of data, which simply isn’t practical.

Instead, why not give patients a broad look at their health status as seen through the rich data contained in an EMR? The final result could include not only data points, but also annotations from doctors as to the significance of trends and access to educational materials in context. That way, the patient could observe, say, the link between blood pressure levels, exercise, weight and med compliance, read comments from both their cardiologist and PCP on what has been working, and jump to research and education on cardiovascular health.

Ultimately, I’d argue, the chief obstacle to creating such an offering isn’t technical. Rather, it’s a cultural issue. Understandably, clinicians are concerned about the disruption such approaches might pose to their routine, as well as their ability to manage cases.

But if we are to make patients healthier, putting the right tools in their hands is absolutely necessary. And hey, after paying so much for EMRs, why not get more value for your money?

P.S. After writing this I discovered a description of a “digital health advisor” which parallels much of what I’m proposing. It’s worth a read!

Halamka Ponders The Need to Leave Medicine If We Continue Our Current Trajectory

Posted on May 5, 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.

The famous Dr. John Halamka, Hospital CIO, Doctor, Former member of the HIT Policy committee, blogger at Life as a Healthcare CIO, recently read the 962 page MACRA NPRM and he wrote up a detailed look at the IT elements of MACRA. The post is worth a read if you’re interested in MACRA. Especially if you don’t want to spend the 20 hours reading it that he spent.

MACRA aside, he ends his post with this bombshell of a comment:

As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.

A doctor in the comments shared a similar view to Dr. Halamka:

Wow, I feel exactly the same as you do. As a front line ortho provider in a small group. I think now I get the message. CMS and ONC wants us out of private practice, either retire, or join as a salaried doc or hospital employee. That is the only justification for this 1000 page nightmare.

We’ve written a lot about physician burnout and many doctors distaste of all this government regulation, but having someone like John Halamka comment like this is quite telling. What’s scary for me is that I don’t see much light at the end of the MACRA tunnel from a physician perspective. Do you?

Too Many Healthcare Apps

Posted on May 4, 2016 I Written By

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

As we all know, if we want something, there’s probably an app for that. From head to toe, from bank to restaurant to club, in most places in the world, there’s probably an app to meet your needs.

Apple is rightly lauded for its contribution in this area. While it didn’t invent the smart phone as such — early devices mashing together PDAs and connected computing preceded the march of i-Everything by some time — but obviously, it popularized this technology and made it usable to virtually everyone, and for that it deserves the kudos it has gotten.

But as we work to build mobile healthcare models, I’d argue, the notion of there being an app for each need is falling flat. Healthcare organizations are creating, and clinicians prescribing, targeted apps for every healthcare niche, but consumers aren’t showing a lot of interest in them.

Healthcare consumers have shown interest in a subsection of health app categories. According to a study completed last year, almost two-thirds of Americans would use a mobile app to manage health issues. The study, the Makovsky/Kelton “Pulse of Online Health” survey, found that their top interests included tracking diet/nutrition (47%), medication reminders (46%), tracking symptoms (45%) and tracking physical activity (44%).

But other research suggests that consumers aren’t that enthused about other categories of healthcare apps. For example, a recent study by HealthMine concluded that while 59% of the 500 respondents it surveyed had chronic conditions, only 7% used digital disease management tools.

I’ve made the following argument before, but I think it’s worth making again. From what I’ve observed, in talking to both providers and patients, the notion of developing a multitude of apps covering specialized needs is a failed strategy, reflecting the interests of the healthcare industry far more than patients. And as a result, patients are staying away in droves.

From what I’ve observed, it appears that healthcare organizations are developing specialized apps because a) that strategy mirrors the way they are organized internally or b) they’re trying to achieve specific outcomes (such as a given average blood sugar level among diabetics). So they build apps that reflect how they collect and manage data points within their business.

The problem is, consumers don’t care what a facility or clinician’s goals are, unless those goals overlap with their own. They certainly don’t want to open a new app every time they take on a new health concern. And that sucks the benefit right out of app-creation efforts by healthcare providers. After all, aren’t people with multiple conditions the expensive patients we’d most like to target?

What’s more, apps designed to capture data aren’t terribly motivating. Clinicians may live or die on the numbers, but unless those numbers come with a realistic path to action, they will soon be ignored, and the app discarded. Consider the humble bathroom scale. For most people, that one data point isn’t particularly helpful, as it says nothing about where to go from there. So people generally give up when they’re neither motivated nor taught by the apps they download.

To be successful with mobile healthcare, providers and clinicians will need to back the development of apps which guide and sustain users, rather than turn them into data entry clerks.  It’s not clear what should replace the current generation, but we need to turn to a more patient-centric model. Otherwise, all our efforts will be wasted.

Health Organizations Failing At Digital Health Innovation

Posted on May 3, 2016 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.

Few healthcare providers are prepared to harvest benefits from digital health innovations, a new study suggests. The study, by innovation consultancy Enspektos LLC, concludes that digital health innovation efforts are fairly immature among healthcare organizations, despite the enormous wave of interest in these technologies.

While this should come as no surprise to those of us working in the industry, it’s a little depressing for those of us — including myself — who passionately believe that digital health tools have the potential to transform the delivery of care. But it also reminds providers to invest more time and effort in digital health efforts, at least if they want to get anything done!

The study, which was sponsored by healthcare IT vendor Validic, chose 150 survey participants working at health organizations (hospitals, pharmaceutical firms, payers) or their partners (technology firms, startups and the like) and asked them to rate digital health innovation in the healthcare industry.

The results of this study suggest that despite their high level of interest, many healthcare organizations don’t have the expertise or resources needed to take full advantage of digital health innovations. This tracks well with my own experience, which suggest that digital health efforts by hospitals and clinics are slapdash at best, rolling out apps and doling out devices without thinking strategically about the results they hope to accomplish. (For more data on digital health app failures see this story.)

According to Enspektos, only 5% of health organizations could demonstrate that they were operating at the highest level of proficiency and expertise in digital health innovation. The majority of health organizations worldwide are experimenting with and piloting digital health tools, researchers concluded.

Apparently, digital health is moving slowly even with relatively mature technologies such as mobile platforms. One might think that mobile deployments wouldn’t baffle IT departments, but apparently, many are behind the curve. In fact, health organizations typically don’t have enough technical expertise or large enough budget to scale their digital health efforts effectively, Enspektos researchers found.

Of course, as a digital health technology vendor, Validic is one of many hoping to be the solution to these problems. (It offers a cloud-based technology connecting patient-recorded data from digital health apps, devices and wearables to healthcare organizations.) I’m not familiar with Validic’s products, but their presence in this market does raise a few interesting issues.

Assuming that its measures of digital health maturity are on target, it would seem that health organizations do need help integrating these technologies. The question is whether a vendor such as Validic can be dropped into the technical matrix of a healthcare organization and bring its digital health program to life.

My guess is that no matter how sophisticated an integration platform they deploy, healthcare organizations still have a tremendous amount of work to do in thinking about what they actually want to accomplish. Most of the digital health products I’ve seen from providers, in particular, seem to be solutions in search of a problem, such as apps that have no bearing on the patient’s actual lifestyle and needs.

On the other hand, given how fluid digital health technology is at this point, perhaps vendors will be creating workflow and development models that healthcare organizations can adapt. It remains to be seen who will drive long-term change. Honestly, I’m betting on the vendors, but I hope more healthcare players step up, as I’d like to see them own this thing.

When Providing a Health Service, the Infrastructure Behind the API is Equally Important

Posted on May 2, 2016 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.

In my ongoing review of application programming interfaces (APIs) as a technical solution for offering rich and flexible services in health care, I recently ran into two companies who showed as much enthusiasm for their internal technologies behind the APIs as for the APIs themselves. APIs are no longer a novelty in health services, as they were just five years ago. As the field gets crowded, maintenance and performance take on more critical roles in offering a successful business–so let’s see how Orion Health and Mana Health back up their very different offerings.

Orion Health

This is a large analytics firm that has staked a a major claim in the White House’s Precision Medicine Initiative. Orion Health’s data platform, Amadeus, addresses population health management as well as “considering how they can better tailor care for each chronically ill individual,” as put by Dave Bennett, executive vice president for Product & Strategy. “We like to say that population health is the who and precision medicine is the how.” Thus, Amadeus can harmonize a huge variety of inputs, such as how many steps a patient takes each day at home, to prevent readmissions.

Orion Health has a cloud service, a capacity for handling huge data sets such as genomes, and a selection of tools for handling such varied sources as clinical, claims, pharmacy, genetic, and consumer device or other patient-generated data. Environmental and social data are currently being added. It has more than 90 million patient records in its systems worldwide.

Patient matching links up data sets from different providers. All this data is ingested, normalized, and made accessible through APIs to authorized parties. Customers can write their own applications, visualizations, and SQL queries. Amadeus is used by the Centers for Disease Control, and many hospitals join the chorus to submit data to the CDC.

So far, Orion Health resembles some other big initiatives that major companies in the health care space are offering. I covered services from Philips in a recent article, and another site talks about GE. Bennett says that Orion Health really distinguishes itself through the computing infrastructure that drives the analytics and data access.

Many companies use conventional relational database as their canonical data store. Relational databases are 1980s-era technology, unmatched in their robustness and sophistication in querying (through the SQL language), but becoming a bottleneck for the data sizes that health analytics deals with.

Over the past decade, every industry that needs to handle enormous, streaming sets of data has turned to a variety of data stores known collectively as NoSQL. Ironically, these are often conceptually simpler than SQL databases and have roots going much farther back in computing history (such as key/value stores). But these data stores let organizations run a critical subset of queries in real time over huge data sets. In addition, analytics are carried out by newer MapReduce algorithms and in-memory services such as Spark. As an added impetus for development, these new technologies are usually free and open source software.

Amadeus itself stores data in Cassandra, one of the most mature NoSQL data stores, and uses Spark for processing. According to Bennett, “Spark enables Amadeus to future proof healthcare organizations for long term innovation. Bringing data and analytics together in the cloud allows our customers to generate deeper insights efficiently and with increased relevancy, due to the rapidity of the analytics engine and the streaming of current data in Amadeus. All this can be done at a lower cost than traditional healthcare analytics that move the data from various data warehouses that are still siloed.” Elastic Search is also used. In short, the third-party tools used within Orion Health are ordinary and commonly found. It is simply modern in the same way as computing facilities in other industries–così fan tutte.

Mana Health

This company integrates device data into EHRs and other data stores. It achieved fame when it was chosen for the New York State patient portal. According to Raj Amin, co-founder and Executive Chairman, the company won over the judges with the convenient and slick tile concept in their user interface. Each tile could be clicked to reveal a deeper level of detail in the data. The company tries to serve clinicians, patients, and data analysts alike. Clients include HIEs, health systems, medical device manufacturers, insurers, and app developers.

Like Orion Health, Mana Health is very conscious of staying on the leading edge of technology. They are mobile-friendly and architect their solutions using microservices, a popular form of modular development that attempts to maximize flexibility in coding and deploying new services. On a lark, they developed a VR engine compatible with the Oculus Rift to showcase what can creatively be built on their API. Although this Rift project has no current uses, the development effort helps them stay flexible so that they can adapt to whatever new technologies come down the pike.

Because Mana Health developed their API some eighteen months ago, they pre-dated some newer approaches and standards. They plan to offer compatibility with emerging standards such as FHIR that see industry adoption. The company recently was announced as a partner in the Commonwell Alliance, a project formed by a wide selection of major EHR vendors to pursue interoperability.

To support machine learning, Mana Health stores data in an open source database called Neo4j. This is a very unusual technology called a graph database, whose history and purposes I described two years ago.

Graphs are familiar to anyone who has seen airline maps showing the flights between cities. Graphs are also common for showing social connections, such as your friends-of-friends on Facebook. In health care, as well, graphs are very useful tools. They show relationships, but in a very different way from relational databases. Graphs are better than relational databases at tracing connections between people or other entities. For instance, a team led by health IT expert Fred Trotter used Neo4J to store and query the data in DocGraph, linking primary care physicians to the specialists to which they refer patients.

In their unique ways, Mana Health and Orion Health follow trends in the computing industry and judiciously choose tools that offer new forms of access to data, while being proven in the field. Although commenters in health IT emphasize the importance of good user interfaces, infrastructure matters too.