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A Look at the Recurring Revenue Model for Patient Services

Posted on April 10, 2015 I Written By

The following is a guest blog post by Oleg Ganopolskiy is VP of Operations at Aria Systems.
Ganopolskiy
A few years ago, a global manufacturer of medical equipment developed a new line of CAT scan and MRI machines.

Sales executives soon hit a wall, however, because of the limited number of customers who could pay for these machines, which cost hundreds of thousands of dollars.

Smaller regional hospitals wanted the machines but couldn’t afford them, so what to do?

The manufacturer began leasing the equipment to the regional hospitals on a pay-per-use basis. Pay-per-use, by the way, is one of the many iterations of recurring revenue, a payment model that’s quickly gaining adoption in the marketplace, even down to the level of the small clinic and solo practitioner.

Thus, in going from direct sales to pay-per-use, the manufacturer opened a new market and everyone benefited, including front-line providers of care.

The manufacturer shifted from selling devices to selling a service, and added smaller, regional hospitals to its market for CAT scan and MRI machines.

Regional hospitals preserved their capital and patients received care locally without the additional time and expense of traveling to distant facilities.  Everyone won.

Medical care is at the leading edge of industries embracing innovative delivery of services through the recurring revenue model.  But medical organizations must protect the privacy of both front-line providers and patients with secure, cloud-based technology.

That’s why we recently went through the rigorous HIPAA certification process for our monetization platform, so that our customers migrating to recurring revenue models can continue to protect patient privacy.

That new level of protection couples with our PCI DSS v.3 certification for protecting credit and debit card transactions. As a result, we exceed the administrative, physical, and technical safeguards required to protect patient privacy.

Security becomes increasingly critical as entrepreneurs pursue ideas to build new patient services using mobile healthcare and the Internet of Things (IoT), which links billions of devices to a vast, interconnected network, to unlock recurring revenue.

Monetizing the Internet of Things & New Healthcare Services

Market research firm Gartner predicts that by 2020, 26 bil­lion devices will connect to the IoT, providing a vast array of services worth $300 billion-plus in annual sales. For example, the automatic monitoring of biometric and other devices will soon become pervasive as companies like Apple pioneer new technologies.

Apple’s much-anticipated Apple Watch will include the ability to collect medical research data on a large scale, including data from clinical trials involving thousands of patients. This capability is expected to revolutionize how trials are conducted. Apple said its new ResearchKit for application developers, to be launched as the Apple Watch goes on sale April 24, is a game changer.

Research organizations such as Cornell University, Dana-Farber Cancer Research Institute and Stanford Medical Center are planning to target asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease with new programs enabled by the data-collecting devices.

In the near future, doctors and hospitals will be able to do consultations with “health kiosks” via video conference and access patient monitoring devices securely and quickly for vital signs and recent history. These new businesses will often leverage recurring revenue models to cover the costs of providing these services.

Another possible recurring revenue application: providers offering new services to patients based on their medical histories, such as physical therapy. Cloud-based case management systems could generate recurring payments for the providers during the course of treatment. For instance, a provider could recommend physical therapy through medical records, and recommend facilities where the patient could go for therapy. The provider generates revenue by managing subscriptions to the health club facilities.

With the proper security measures in place, the rush to recurring revenue is on in the healthcare sector. Wall Street rewards it, the competition is doing it and customers and patients are beginning to embrace it.

About Oleg Ganopolskiy
Oleg Ganopolskiy is VP of Operations at Aria Systems where he ensures that all systems provide the highest level of security, compliance, performance, capacity and reliability. Oleg joined Aria Systems from Nokia, where he was responsible for operational capacity, planning, analytics, and modeling across the company’s Global Services Platform. Previously, he managed technology operations at AOL, spent eight years in operations at eBay, and has held senior technical roles at Oracle Corporation and Nordic Systems, Inc.

Where Will We See Analytics in Ambulatory Medicine?

Posted on April 9, 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.

As I prepare to head to the mecca of healthcare IT conferences, I’m getting inundated with pitches. Much like last year, analytics is still a really popular topic. It seems like every healthcare IT vendor has some analytics offering. Many abuse the term analytics (which is fine by me) and that term has come to mean analyzing your health data in order to provide value.

As I think about analytics, I wonder how much of it will apply to the small physician practice. I should do this survey, but I bet if I asked 5 physicians working in small group or solo practices about their analytics strategy they’d all give me blank stares. Small physician practices don’t have an analytics strategy. They’re not looking for new ways to leverage analytics to improve their practice. That’s not how a small practice thinks.

So, does analytics have a place in small ambulatory medicine?

The short answer is that it absolutely does. However, I think that it will be delivered in two forms: packaged or purchased by the borg.

In the packaged approach, analytics will be part of a small practice’s EHR system. Much like a doctor doesn’t have a mobile EHR strategy (it just comes with the EHR), they won’t have an analytics strategy either. They’ll just take the analytics solutions that come with the EHR.

In some ways, the reporting capabilities in an EHR have been doing this forever. However, very few organizations have been able to use these reports effectively. The next trend in EHR analytics will be to push the data to the user when and where they need it as opposed to having to pull a report. Plus, the EHR analytics will start trying to provide some insights into the reports as opposed to just displaying raw data.

One key for ambulatory EHR vendors is that they won’t likely be able to build all the EHR analytics functions that a doctor will want and need. This is why it’s so important that EHR vendors embrace the open API approach to working with outside companies. Many of these third party software companies will provide EHR analytics on top of the EHR software.

In the purchased by the borg scenario, the small practice will get purchased by the borg (You know…the major hospital system in the area). This is happening all over the place. In fact, many small practices cite the reason for selling out to the local hospital is that they don’t think they’ll be able to keep up with the technology requirements. One of those major requirements will be around analytics. We’ll see how far it goes, but I think many small practices are scared they won’t be able to keep up.

Ok, there’s one other scenario as well. The local hospital system or possibly even a local ACO will purchase a package of analytics software (ie. purchased by the bog) and then you’ll tap into them in order to get the benefits of a healthcare analytics solution. We see this already starting to happen. I’ve heard mixed results from around the country. No doctor really likes this situation since it ties them so deeply with the local hospital, but they usually can’t think of a better option.

That’s my take on how analytics will make its way to ambulatory practices. Of course, most large hospital systems also own a large number of ambulatory practices as well. So, some of the analytics will trickle down to ambulatory in those systems as well. I just wonder how much value ambulatory doctors will get from the hospital analytics vendors that are chosen. I can already hear the ambulatory doctors complaining about the analytics reports that don’t work for them because they’re so hospital focused.

Where are you seeing analytics in the ambulatory setting?

From Around the #HIMSS15 Twittersphere

Posted on April 8, 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.

Yep, I have HIMSS on the mind. What can I do? I’ll be there for a week with more meetings and events than I care to count. It’s going to be fun. I thought it would be fun to highlight some tweets (like I do regularly) and add a little bit of my own snark (another regular occurrence).


A little self serving (I know), but these hidden gems really are worth it and people don’t even know that they happen. Now you’ve been told.


Would you rather hang out with Bennett at the parties or with Chuck at the workflow tech companies? That’s a tough one. Although, you have to credit Chuck on being true to form. Plus, I hear he’s going to be displaying his robot, 3D Printing, drone, etc at the ClinicSpectrum booth. Should be something different than you’ll find at most booths.


I thought security would be really big at HIMSS as well, but I haven’t seen that to be the case. Or at least I thought it would be much bigger. Sure, the topic will be covered in most sessions and discussions, but I thought we’d see a wave of new HIPAA related vendors at HIMSS, but that doesn’t seem to be the case. Maybe I just haven’t heard from them.


People don’t go to HIMSS? (I told you I’d bring some snark). I think our HIMSS15 Twitter Tricks and Tips will help people out that aren’t attending.


Too far! Hey…they asked. I’m not complaining though. I enjoy walking. I think I lost 5 pounds at HIMSS last year. I chalk it up to all the walking, but also no time to actually eat. One of the best ways to avoid eating is to stay busy. HIMSS keeps me busy. (Look at that health knowledge I’m throwing your way).


Social vendor? How do you measure that? Who throws the best party? Who is the most friendly? Who tweets the most? Who has the best tweets?

I think he probably means which vendor best uses social media. My guess will be CDW healthcare in that regard. The people behind their social accounts (StudioNorth for those keeping track at home) are always up to something. They better not let me down now that I predicted it ;-)


I’m lucky to call Shahid my partner, so I take every chance I can get to hear him speak or hear discussions he lead. The topic of getting clinical value and ROI out of data is going to be such an important one for healthcare going forward.


This has to make your heart hurt a little. Looks like Richard is from Bogota, Colombia. I hope someone can help him out. Being out $2k would stink.

I fly out Saturday and I’m there until Friday. I look forward to seeing so many of you at the event. I’ll be doing my full write up of places I’ll be and things to see at HIMSS 2015 over on EMR and HIPAA tomorrow.

Where the Jobs Are – 2015 Update: Demand for EHR/HIT Certifications

Posted on April 7, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

One year ago, I looked at the demand for EHR related certifications. I found, as the old line goes, that many are called but few are chosen. Of 30 or so certificate programs, only about a quarter had substantial demand. In fact, 1 had no demand.

Study Update

Finding Certification Programs. To bring the study up to date, I looked for new certificates or ones I’d overlooked. I found one, CEHRS, Certified Electronic Health Record Specialist Certification from the National Healthcareer Association.

Searching for Jobs. As with last year’s study, I then used Healthcare Scene’s Healthcare IT Central to search for jobs posted in the last 30 days that require an EHR or HIT certification.

Certifications Reviewed

Table I lists the 12 certifications, which had at least one job opening. Last year, I found at least 16 certifications with at least one opening. That is, this year as shown in Table II, I found no mentions for 15 certificates.

Table I
Certifications In Demand
1 CCA 7 CHTS
2 CCS 8 CICP
3 CCS-P 9 CompTIA
4 CHDA 10 CPHIMS
5 CHPS 11 RHIA
6 CHSP 12 RHIT

 

Table II, lists the 12 certifications that had no openings in the last 30 days.

Table II
Certifications Without Demand
1 CAHIMS 9 CPCIP
2 CEHRS 10 CPORA
3 CEOP 11 CPHP
4 CHTP 12 CPORA
5 CEMP 13 HWCP
6 CHTSP 14 CPEHR
7 CIPCP 15 CPHIT
8 CMUP    

 

Review Caveats

What Counts. Each certification listed in a job counts as one opening. For example, if a job listed ComTIA, CPHIMS and CPEHR, I counted it as three jobs, one for each certification.

General certifications only. For practical reasons, this review only covers general certifications that have a one word abbreviation. Where the abbreviation isn’t unique, I’ve filtered out non certificate uses.

No EDUs. I excluded certificates from colleges, universities, etc., whether traditional or on line. There are scads of these, but I’m not aware of any that are in general demand. That’s not a judgment on their value, just their demand.

Vendor Certifications I excluded product specific certifications, for example, NexGen Certified Professional.

Dynamics. The openings for these certifications are a snapshot. The job market and the openings that Healthcare IT Central lists constantly change. What is true now, could change in a moment. However, I believe it gives you a good idea of relative demand.

Certification Demand

In the past 30 days, I found 322 openings that listed a certification. See Chart I. As with last year, AHIMA’s were most in demand. Two of its certificate programs, RHIA and RHIT account for 60 percent of certificate demand.

Chart I Certification Openings

RHIA’s designed to show a range of managerial skills, rather than in depth technical ability. If you consider certifications proof of technical acumen, then the strong RHIA demand is a bit counter intuitive. Where the RHIA has a broad scope, the close second, RHIT, is more narrowly focused on EHRs.

In third place, but still with a substantial demand is CCS, which focuses on a specific ability. Compared to last year, CCS has fewer openings. This is due to a change in my methodology not demand. Last year, I counted any CCS opening. This year, I only count those with a clear HIT relationship.

Certification Location Demand

After looking at certification demand, I looked at it by state. To do this, I merged the different certification job openings into a single list. That is, I added those for RHIA, RHIT, etc., and then eliminated duplicates.

After creating a consolidated list, I sorted and subtotaled by state. I then sorted the state totals. This gave me the data for Chart II. It shows the top ten states for openings, including/ two ties.

Chart II State Demand

State Rankings. As you might expect, states with the largest populations have the most jobs. California leads, which is what you’d expect.

To account for population, I take job rank from population rank. For example, Washington State is 13th in population. It’s eight in job openings. So, subtracting job rank eight from population rank 13 is five. That is, Washington State’s job share is five ranks above its population ranking. Chart III shows the result where states stand when you account for population.

Chart III Rank Adjusted for Population

Most notable is Colorado. Colorado is 22nd in population, but fifth in certification demand. That is job openings for it are 17 ranks higher than population would account for.

Others ranking higher than their population are: Missouri, Arizona, Tennessee, Wisconsin, etc. Conversely, those states, which have openings below their rank, include New York, Pennsylvania and Florida.

Missouri’s case is interesting. Almost all its openings are from one company: Altegra. Its openings are almost all for one position type: medical record field reviewer. At first, I thought this was a case of over posting, but it doesn’t appear to be. They’re recruiting for several different locations.

Certification Demand Trends

When I stated this update, I expected there would be more jobs due to economic growth, but that hasn’t happened. There’ve been shifts among states, but overall the demand is pretty much the same. RHIA and RHIT demand last year and this year are practically identical while demand for others has dropped. I don’t have any numbers for overall openings then and now, but I suspect that they’ve grown while certification demand has either gone down or been flat. However, as I’ve said that’s just a guess.

Certifications are a response to the demand for persons with demonstrated skills. The question is whether one will reward your time, cost and effort with something that is marketable. Demand alone can’t make that choice for you. For example, working on a certificate that has little or no demand might seem pointless. However, its requirements may be a good way for you to acquire demonstrate your skills, especially if your experience is iffy.

Personal satisfaction also can’t be discounted as a factor. You might be interested in an area with low demand, but when coupled with your other skills might make you marketable in an area you desire.

If you do decide to pursue one of these certificates, I think these numbers can help you know where to look and what to look for.

Where Medical Devices Fall Short: Can More Testing Help? (Part 2 of 2)

Posted on April 6, 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.

As we saw in the previous article, networks of medical devices suffer from many problems intrinsic to the use of wireless technology. But testimony at the joint workshop held by the FCC and FDA on March 31 revealed that problems with the devices themselves run deep. One speaker reported uncovering departures from the standards for transmitting information, which led to incompatibilities and failures. Another speaker found repeated violations of security standards. As a trivial example, many still use the insecure and long-deprecated WEP authentication instead of WPA.

Most devices incorporate generic radio transmitters from third parties, just as refrigerators use replaceable compressors and lawnmowers depend on engines from just a few manufacturers. When markets become commoditized in this way, one would expect reliability. Whatever problems radio transmitters may have, though, are compounded by the software layered on top. Each device needs unique software that can affect the transmissions.

The WiFi Alliance is a consortium of manufacturers that tests devices for reliability and interoperability. But because it doesn’t contain users or government representatives, some panelists thought it was too lenient toward manufacturers. The test plan itself is a trade secret (although it was described at a high level in the workshop by Mick Conley). Several speakers testified that devices could be certified by the Alliance and still perhaps fail to connect.

To my mind, testing is a weak response to design problems. It happens after the fact, and can punish a poor engineering process but not fix it. You can test-drive a car and note that the steering is a bit sluggish, but can you identify the software or the part that is causing the problem? And can you explain it to the salesman, presumably to be conveyed back to the engineers?

Cars tend to be reliable first because of widespread competition that extends internationally, and partly because lawsuits keep the managers of the automobile companies alert to engineering problems. It would be a shame to need lawsuits to correct technical problems with medical devices, but refusing to buy them might do the trick. Test beds do provide warnings that can aid purchase decisions.

Unfortunately, the forum produced no real progress on the leading question of the day, whether a national test bed would be a good idea. It was recognized generally that test beds have to reflect the particular conditions at different institutions, and that multiple test beds would be needed to cover a useful range of settings. Without further clarification of what a test bed would look like, or who would build it, a couple panelists called for the creation of national test beds. More usefully, in my opinion, one speaker suggested a public repository of tests, which are currently the proprietary sects of vendors or academic researchers.

So none of the questions about test beds received answers at the workshop, and no practical recommendations emerged. One would expect that gathering the leading experts in medical devices for seven and a half hours would allow them to come up with actionable next steps or at least a framework for proceeding, but much of the workshop was given over to rhetoric about the importance of medical devices, the need for them to interoperate, and other standard rallying cries of health care reform. I sometimes felt that I was in hearing a pitch for impressionable financial backers. And of course, there was always time taken up by vendors, providers, and regulators trying to point the finger at someone else for the problems.

Device and networking expert David Höglund has written up how the workshop fell short. I would like someone to add up all the doctors, all the senior engineers, all the leading policy makers in the room, calculate how much they are paid per minute, and add up the money wasted every time a speaker extols patient engagement, interoperability, or some other thesis that is already well known to everybody in the room. (Or perhaps they aren’t well-known–another challenge to the medical field.)

Personally, I would write off most of the day as a drain on the US economy. But I have tried to synthesize the points we need to look at going forward, so that I hope you feel the time you devoted to reading the article was well-spent.

Where Medical Devices Fall Short: Can More Testing Help? (Part 1 of 2)

Posted on April 3, 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.

Clinically, medical devices do amazing things–they monitor vital signs (which, as the term indicates, can have life-or-death implications), deliver care, and measure health in the form of fitness devices. But technologically, medical devices fall way short–particularly in areas of interference, interoperability, and security.

The weaknesses of devices, their networks, and the settings where they reside came up over and over again in a joint workshop held by the FCC and FDA on March 31. I had a chance to hear most of it via live broadcast, a modern miracle of networking in itself.

Officially, the topic of the gathering was test beds for medical devices. Test beds are physical centers set up to mimic real-life environments in which devices are used, hosting large numbers of devices from different manufacturers running the popular software and protocols that they would employ out in the field. The workshop may have been an outgrowth of a 2012 report from an FCC mHealth Task Force which recommended “FCC should encourage and lend its expertise for the creation and implementation of wireless test beds.” (Goal 4.4, page 13) I thought the workshop had little new to offer on test beds, however, as the panelists concentrated on gaps between clinical needs and the current crop of devices and networks.

Medical settings are notoriously difficult places to employ technology. One panelist even referred to them as “hostile environments,” which I think is going a bit far. After all, other industries employ devices outdoors where temperatures drop below zero or rise precariously, or underwater, or even on battlefields (which actually are also medical settings).

I don’t dispute that medical networks present their own particular challenges. Hospitals crowd many devices into small spaces (one picture displayed at the workshop showed 15 wireless devices in a hospital room). Some last for decades, churning away while networks, environments, and requirements change around them. Walls and equipment may contain lead, blocking signals. Meanwhile, patient safety requires correct operation, resilience, and iron-clad security. Meanwhile, patients and their families expect access to a WiFi networks just like they get in the cafe down the street.

And yet Shawn Jackman, Director of Strategic Planning at Kaiser Permanente IT, said that problems are usually not in the infrastructure but in the devices. Let’s look at the main issue, interference (on which the panelists spent much more time than interoperability or security) and then at the ideas emerging from the workshop.

All the devices we associate with everyday network use (the IEEE 802.11 devices called WiFi) are all squeezed into two bands of the radio spectrum at 2.4 Gigahertz and 5 Gigahertz. When the inventors of WiFi told the world’s regulators that they had a new technology requiring a bandwidth in which to operate, freeing up existing bandwidth was hard to do, and the inventors were mere engineers, not powerful institutions such as the military or television broadcasters. So they resigned themselves to the use of the 2.4 and 5 Gigahertz bands, which were known as “junk spectrum” because all sorts of other equipment were allowed to emit radio-frequency noise in those bands.

Thus, because the bands are relatively narrow and are crowded with all sorts of radio emissions, interference is hard to avoid. But you don’t want to enter a patient’s room and find her comatose while a key monitor was unable to send out its signal.

Ironically, at the request of health IT companies, the FCC set aside two sets of spectrum for medical use, the Medical Device Radiocommunications Service (MedRadio) established in 1999 and the Wireless Medical Telemetry Service (WMTS) established in 2002. But these are almost completely ignored.

According to Shahid Shah, a medical device and software development expert, technologies that are dedicated to narrow markets such as health are crippled from the outset. They can’t benefit from the economies of scale enjoyed by mass market technologies, so they tend to be expensive, poorly designed, and locked in to their vendors. Just witness the market for electronic health records. So the medical profession found devices designed for the medical bands unsatisfactory and turned to devices that used the WiFi spectrum.

In 2010, by the way, the FCC relaxed its rules and permitted new devices to enter the little-used spectrum at the edges of television channels, known as white spaces, but commercial exploitation of the new spectrum is still in its infancy.

Furthermore, the FCC has freed up the enormous bandwidth used for decades to broadcast TV networks, by kicking off the stubborn users (known with respect as the “last grandmas”) who didn’t want to pay more for cable. An enormous stretch of deliciously long-range spectrum is theoretically available for public use–but the FCC won’t release it that way. Instead, they will sell it to other large corporations.

Networks are unreliable across the field. How often do you notice the wireless Internet go down at a conference? (It happened to me at a conference I attended the next day after the FCC/FDA workshop. At one conference, somebody even stole the hubs!) Further problems include network equipment of different ages that use slightly different protocols, which prove particularly troublesome when devices have to change location. (Think of wheeling a patient down the hall.) And you can’t just make sure everything is working the first time a device is deployed. Changes in the environment and surrounding equipment can lead to a communications failure that never turned up before, or that turned up and you thought you had fixed.

Medical device and wireless expert David Höglund claims that WLAN can work in a healthcare environment for medical devices. He lays out three overarching tasks that administrators must do for success:

  • They have to understand how each application works and its communications patterns: real-time delivery of small packets, batch delivery of large volumes of data, etc.

  • They have to provide the coverage required for each device or application. Is it used in the hallways, the patient rooms, the labs? How about the elevators on which patients are transported?

  • They need to obey the application’s quality service requirements. For instance, how long is a failure tolerable? For a device monitoring a patient’s heart in the ICU, a five-second interruption may be too long.

Medical devices and hospital networks need to be more robust and more secure than the average WiFi network. This calls for redundant equipment, separate networks for different purposes, and lots of testing. Hence the need for test beds, which many hospitals and conglomerates set up for themselves. Should the FCC create a national test bed? We’ll look at that in the next installment of this article.

#HIMSS15 Mix Tape

Posted on April 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The always inspiring Colin Hung has put together what he’s calling the #HIMSS15 mix tape. He basically reached out to various people on healthcare social media (including myself) asking them which songs we’d add and why. The results were quite entertaining. Here were my three submissions:

Cry – Faith Hill. Suggested by @techguy (John Lynn) “I think there are plenty of reasons to cry at HIMSS”

Just Give Me A Reason – Pink Suggested by @ehrandhit “About doctors love of healthcare”

Ice Ice Baby – Vanilla Ice. Suggested by @ehrandhit See this fantastic blog for the reason why.

I really liked Brad’s creativity (no surprise he’s talking ICD-10):

The Final Countdown – Europe. Suggested by @Brad_Justus “For hopefully the last countdown to ICD-10!”

Who doesn’t like the shoutout to the #HITChicks:

Every Little Thing She Does is Magic – The Police. Suggested by @CyndyNayer “I’m thinking this is the background for #HITChicks wherever we are!”

I can imagine Wen and her team having a dance party to this song (would make me want to be on her team):

Everything is Awesome – Tegan and Sara ft The Lonely Island. Suggested by @HealthcareWen“Because it’s an awesome team song”

So many other good ones, so go and read them all.  However, Mel Smith Jones offers a solid description of HIMSS:

I’m Gonna Be (500 Miles) – The Proclaimers. Suggested by @MelSmithJones “It’s always too long of a wait until I get to see everyone. Then we put ourselves into blissful misery with all of that endless walking. Then I can’t wait until next year as soon as it is over :)”

Word on the street is that Colin is working to play the mixtape during the New Media Meetup at HIMSS15 that we host each year. Of course, a big thanks to Stericycle and their product Patient Prompt (Where Colin works) for sponsoring the New Media Meetup.

The Evolving Security and Privacy Discussion

Posted on April 1, 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.

HIMSS put out the great tweet above. The image itself is worthy of a laugh. Although, only a partial laugh since in healthcare many people don’t understand that a password doesn’t mean it’s encrypted. Plus, that’s just emblematic of how elementary healthcare’s implementation of security is in most healthcare organizations.

Yes, there are the outlier organizations and there are even the outlier security and privacy individuals within a large organization. However, on the whole healthcare is not secure. The hard thing is that it’s not because of bad intentions. Almost everyone I’ve met in healthcare really want to ensure the privacy and security of health information. However, there’s a general lack of understanding of what’s needed.

With that said, I have seen a greater focus on privacy and security in healthcare than I’ve ever seen before. HIMSS featuring so many sessions is just one indicator of that increased interest in the topic. It’s hard to ignore when every other day some major corporation inside and outside of healthcare is getting breached.

One of the biggest security holes in healthcare is business associates. Most don’t have a real understanding of how to be HIPAA compliant and that’s a massive risk for the healthcare organization and the business associate. That’s why I’m excited that people who get it like Mike Semel are offering HIPAA Compliance training for business associates. Doing HIPAA compliance right is not cheap, but it’s cheaper than getting caught in a breach.

Personally, I’ve seen a whole wave of HIPAA compliance products and services coming out. In fact, I’m looking at creating a feature on EMR and HIPAA which lists all of the various companies involved in the space. I’m sure I’ll hear a lot of discussion around this topic at HIMSS.

Insurance and Pricing as Gateways to Changing the Health Experience

Posted on March 31, 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.

“So why are you partnering with insurers and employers?” I asked the staff at Maxwell Health, who had just been regaling me with an expansive vision of consumer-centered health and transparency. Co-Founder and Chief Product Officer Vinay Gidwaney laid out a view that’s in line with everything reformers ask for: a long-range view of health care that guides people to proper health at home and not just in the clinic, giving the consumers choices along with the information to let them make good ones, etc. The kind of health system Maxwell Health aims at will be totally different from what we have now–and the current actors will have to change or vanish as it comes into being.

Maxwell Health on phones

Maxwell Health running on phones

But of course I knew why Maxwell Health is dealing with insurers and employers. In our health care system, you must join the guild to hang your street sign. Before you can get access to the consumer, you need access to the professional organizations with whom the health consumer interacts. Individuals may download one or two of the many thousands of available health and fitness apps, but few people stick with them–or with the fitness devices that carve their behavior into eternal records in the cloud.

Although doctors complain that they can’t change people’s behavior, people are more likely to adopt technology if it is recommended by their doctor, their insurer, or even the government. Furthermore, payment models have to reward the right things, or people will continue to engage in risky behaviors and costs will continue to expand.

So Maxwell Health has found a business model on the insurance side of health care’s multi-faceted polygon. Through this they hope to reach the consumer and create change.

Another company I met at the Health 2.0 Boston hackathon, a week after talking to Maxwell Health, is making a related play in order to prosper in the health care market. PokitDok offers health care appointments on both a pay-per-visit basis and using health insurance. To this end, they have relationships with both health care providers and insurers. They can be used by any individual consumer, whereas Maxwell Health deals with people through their employers. A PokitDok API allows developers to create apps that have access to prices, providers, insurers, referrals, etc.

PokitDok screen

Getting started with PokitDok

Let’s start with Maxwell Health. Their salient feature is “bundles” of health care options offered as benefits packages by employers, organized around a core of the insurance plans their staff can choose from. Maxwell Health can direct an employee to an appealing insurance package–for instance, one for people near retirement, another for a young couple about to have a baby. Benefits administrators create personas (hypothetical types of employee) around demographics such as age, income, and family status, then create bundles to offer to employees around these differences. Anyone who has tried to seriously compare his insurance options knows what a headache it is to figure them out. Medicare Advantage is a daunting market, and while no employer has such a large number of choices, they have enough to make the decision a nail-biter. I had trouble just choosing my tax-free flexible spending amounts each year, until the law changed this year and let employees roll unspent money forward. Maxwell Health hopes to turn benefit choices into an experience as appealing, well-integrated, easy as a good online retail shop.

While choosing an insurance plan, employees are prompted also to sign up for services that may help them with their health needs: fitness devices, coaching services, emergency day care, meal delivery services, etc. Bundles also contain services that benefits coordinators think would interest employees with a given persona.

The customer can also load apps from Maxwell Health that help them find services. For instance, they have a contract with Doctor on Demand, a popular telemedicine site. (This one-time telemedicine service is a convenience, not a replacement for developing a relationship with a provider who has a broad knowledge of the consumer and family.) Another service lets employees can take a picture of a confusing medical bill and contact an expert to explain and even change the bill.

On the back end, Maxwell Health provides typical web-based services to benefits administrators, making it easier for them to carry out their routine tasks such as determining participation in plans by employees and tracking the use of services. As PR and marketing associate Meg Murphy says, benefits administrators “can throw away their fax machine.”

The company’s solution requires a lot of work at each employer, but the insurance broker is well positioned to work with each employer to represent the benefits correctly, suggest new benefits, and serve up the benefits through the Web and mobile devices. In addition to its close work with insurers, Maxwell Health also lets fitness devices stream data to a Maxwell Health mobile app. This app has three overall parts: a virtual insurance ID card for every insurance plan in which the employee is enrolled, a wellness program with connections to fitness devices and rewards, and a healthcare concierge who handle requests like the confusing bill already mentioned.

Now for PokitDok. The simplest part of their offering is an app helping consumers find doctors for individual fee-for-service procedures. A consumer can search for the medical procedure he needs and book an appointment through the service. PokitDok determines fees through a rather labor-intensive process (calling the doctors) as well as by checking actual prices paid in the past. The web site guides the user by showing a range of possible insurance costs (low, median, and high).

Once the user chooses a provider and books a procedure, PokitDok charges the posted fee and collects the money online. Hence, the welter of health care costs is managed by simply making each provider advertise his fee (already quite a break from the standard health market in the US.) PokitDok therefore includes a degree of transparency for its providers that Clear Health Costs provides through crowdsourcing for a wide range of popular tests and procedures.

But PokitDok also allows patients to pay through insurance. This is a much steeper challenge. Insurance reimbursements vary from doctor to doctor, plan to plan, and employer to employer. Nor do most of the actors in this masquerade want to reveal their prices and the yawning ranges they span. So PokitDok, once again, checks prices paid in the past to estimate the low, median, and high cost for insurance coverage. The user can also specify one or more insurers when searching for a procedure.

It’s interesting that John Riney, coder and technical evangelist at PokitDok, described their essential goal in terms very similar to those used by Maxwell Health representatives: let’s turn the search for health care into a consumer experience as simple and satisfying as good retail shopping.

Right now, the main actors in the health care space maintain silos. The new players like Maxwell Health and PokitDok feel the way most of us in the health movement feel: they would prefer an open ecosystem where the parts work together and anybody can sign up to play. Piggybacking on a complex payment system set up decades ago may be the necessary focal point on which new companies can press the lever of change.

Getting Paid for Telemedicine

Posted on March 30, 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.


In case you’re like me and missed the slow rolling out of reimbursement for telemedicine, it looks like it’s slowly becoming a reality. 22 state mandated reimbursement of telemedicine is a really big deal. Makes you wonder if a federal law will be far away.

The biggest complaint I’ve heard over and over from doctors about telemedicine is that they don’t get paid to do it. Sure, every once in a while some will say that they’re not sure how well they can treat a patient over video (which is true in a number of cases), but the majority of the physicians I talk to would have no issue using telemedicine if they could just get paid for doing the work.

In fact, I think it’s some pretty genius marketing of Chiron Health (who created the tweet above) for mentioning in their Twitter profile that they’re a telemedicine provider and they want doctors to get paid for it. That’s a message the resonates with many doctors.

In fact, I think Chiron Health’s website hits the key areas where I’ve seen telemedicine taking off: Follow-Up, Chronic Patients and Behavioral Health. This image from their website describes well where I see Telemedicine working well:
Telemedicine Options

I’ll admit that I didn’t know anything about Chiron Health until today (Looks like they’re hiring which is a good sign for a company). However, I’m impressed by the way they’re approaching the telemedicine market. I’d love to learn more about the ways they help doctors get paid for telemedicine. Although, I’m certain that list is about to grow in a really amazing way. I have no doubt that telemedicine will be an important part of the future of healthcare.