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Experiences and Perspective from #NatCon16

Posted on March 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.

The past couple days I’ve been enjoying a new experience at the National Council for Behavioral Health’s NatCon Conference. It’s been quite an experience for a techguy like me to dip my toes into the world of behavioral health. Plus, in many ways this takes me back since when I started my journey into the world of healthcare, I was charged with implementing an EMR into a university counseling center. I’m no doubt one of only a few bloggers that’s ever blogged about behavioral health EMR and the challenges of implementing a general medicine focused EMR (most of them anyway) in a counseling center.

As I noted in my previous post, what’s surprising is how many things behavioral health EMR has in common with the rest of the healthcare world. That theme seems to carry through.

However, today I had a couple more insights. First, we think we have it complex when it comes to medical care and sometimes it is very complex. However, the challenges that behavioral health professionals face is much more challenging and often absolutely gut wrenching. Hearing some of the stories just tugs at your heart in an extraordinary way. It definitely takes someone special to work in the behavioral health field. That’s especially true given the many stigmas they have to battle against. It was amazing to hear how many times the stigma of behavioral health was discussed at the conference. It’s unfortunate how much stigma holds us back.

Second, we need better collaboration between behavioral health providers and the rest of the healthcare system. In a private Q&A I saw with Dr. Kevin Pho (better known as @KevinMD), he clearly articulated how there’s only so much he can do to help a patient with behavioral health issues in his 10-15 minute appointment slot. We have to work together to solve these problems or it will never get better.

As I think about the need for collaboration and overcoming stigmas, I can’t help but think of the Twitter Chat session I attended at the conference. I’ve always been amazed by how an open platform like Twitter can bring together so many communities of people around a common cause. These communities can break down barriers and stigmas. It’s not easy, but it’s possible. I see it happening every day on social media. The news media likes to only cover the bad effects of social media, but there is a tremendous amount of good that comes from actively participating in social media as well.

All in all, #NatCon16 was an eye opening experience for a blogger like me. It gave me a reminder of how challenging behavioral health is, but also the tremendous opportunities that are available to do so much good in the world when we tackle these challenging problems and are successful.

Will AI (Artificial Intelligence) Provide Your Own Personal Health Coach?

Posted on November 20, 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://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.

Adhering to the principle that health improvement is based on sustained behavior change, and that behavior change is based on a profound intervention by health care providers in a patient’s daily activities, a certain fantasy has made the rounds of the health care industry. In this article I’ll describe this fantasy and a product by Lark Technologies that starts to realize the fantasy in real life.

First, a bit of comparison. Some 15 years ago I shed a lot of weight (and kept it off) through firm but supportive monitoring by the health care profession. I went to my primary care physician every three months, and visited a nutritionist twice. I also exploited my personal network, conveying my goal to all my friends and lining them up to support eating habits that would lead there.

This model doesn’t scale well. Furthermore, a visit every 90 days is no match for the temptations that scream at me from the billboards and restaurant windows. (Believe me, as a chronic dieter I am very aware of the food industry’s marketing techniques.) So numerous technologists have imagined virtual assistants that follow you around and act like an intrusive Mom, asking you why you’re buying that donut or whether you’ve signed up for the health club yet.

These assistants would have to be subtle and very well tailored to your personal style to be affective. At the recent Connected Health Conference, MC Joseph Kvedar laid out a requirements list for such assistants. They must be:

Automated

To serve billions of people, these systems can’t depend on constant communication with health professionals. Somehow, software must be observer of your habits, come to know you from your demographics and health conditions, and intervene at appropriate moments with messages that have a chance of getting through the armor of your established routines.

Contextual

This fancy word just reflects the kind of empathetic adaptions each of us does all the time to reflect the situation we’re in. Just as we would shout “Stop” to someone about to step in front of a trolley but “Excuse me, did you want this trolley?” to someone absorbed in her cell phone, contextual software understands that you like donuts (but would enjoy a good fruit salad if offered one), that you like to exercise before work instead of at lunch time, and so on. The interventions it makes for each person would be unique.

Motivational

Positives work better than negatives in getting people to go along with suggestions. “Did you know that another round on the track will put you ahead of your walking record for yesterday?” works better than “Hey, you’ve been sitting for two hours–get up!”

Empowering

If a user doesn’t like an app, he always has the option of turning it off. Therefore, a health app must reflect the user’s goals, not the goals of hie doctor, his daughter, or the Centers for Medicare & Medicaid Services. Empowering software will ask you what matters to you–for instance, being able to play with your grandchildren or stay in your third-story apartment–and remind you of these goals as a way to persuade you to stay on track.

Incentivizing

I find this trait a bit redundant, if software is empowering. Dr. Kvedar suggested that people using this kind of personal agent get a discount on their health care premiums. I’m a fan of intrinsic rewards, myself. But the distinction can be hard to make. If an app sends you a message from your wife saying, “So proud that you lost five pounds this week!” is it an intrinsic or extrinsic reward?

At the conference I had the privilege of meeting with Julia Hu, cofounder and CEO of Lark Technologies, who showed off their personal weight loss coach, Lark Chat (available for download for Apple and Android). It was amazing how closely this software–available since this past April–matched the simulation that Dr. Kvedar showed off in his opening talk.

Lark Chat uses Siri software to accept voice input or a text message, which is then submitted to artificial intelligence software to respond appropriately to the user. When I told it what I (pretended I) had for lunch, the software readily understood french fries and salad, and made a comment on each. It did not understand what to do with breaded, fried fish, which ought to have triggered a warning. But it has been trained to understand a number of different foods enjoyed by different ethnic groups. Users can also opt into sharing the data collected by Lark so that it can run analytics and improve its interventions.

The interface is enjoyable and popular. According to Hu, “Over the last four months, the Lark coach and its users have text messaged each other 350,000,000 times. Based on a typical chronic disease case manager’s load, that’s equivalent to 25,402 full time nurses and coaches.” This adds up to the longest user engagement record of any interactive apps in the weight loss space.

The industry has been taking notice. Business Insider recently named Lark one of the 10 most innovative apps in the world, and Apple once featured it as the “Best New App” in their App Store. Forrester Research named Lark the “Most Innovative Digital Health Product of the Year” in 2015 and published an exclusive report on it.

People are getting accustomed to apps such as Foursquare and interfaces such as Siri that in previous ages might have been seen as annoyingly intrusive. As our relationships to devices and software evolved, we may find apps such as Lark Chat the perfect support for behavior change. And we may all become better people as a result. If only Mom could have created an app for me.

Connected Health Conference Tops Itself–But How Broad is Adoption? Part 2 of 3

Posted on November 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://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.

The previous section of this article introduced this year’s highly successful conference, along with some reports from its lead sponsor, Partners HealthCare in Massachusetts. This section looks at some controversies.

A shiny techno-optimist view was offered by two leaders of the computer industry. Venture capitalist Vinod Khosla, co-founder of Sun Microsystems, is famous for suggesting that 80% of what doctors now do could be replaced by technology. Joichi Ito, Directory of MIT’s Media Lab, reinforced this claim by pointing out how much productivity scientists gained by replacing manual number-crunching with digital calculators. “The less subjective decision-making we have,” Khosla said, “the better health care quality will be.”

With diagnosis and prescribing thus handed over to smart machines (some descendant of IBM’s Watson, in my imagination), doctors can focus on building relationships with patients. It’s easy to parody the role of empathy in health care, but realistically, empathy is the one thing that we’ve found to make a difference in chronic care. One hospital in New Orleans achieved a 45% reduction in readmissions through interventions that reduce social isolation and other barriers such as transportation problems.

Furthermore, technology will not act alone: it will allow the delivery of care to move down the cost stack from specialists to general practitioners and from doctors to nurse practitioners.

However, a couple decades of research stand between us and the empathic, tech-supported future. Khosla expects a 20-year evolution, starting with systems that just recommend questions to rule out rare conditions, and devices to monitor patients. More specific interventions will come with the growth of data. Another speaker pointed out that recommendation systems are currently good enough to recommend movies we might like, but not to recommend what medication we should take.

A lot of data crunching in the health care space goes to predictions that have dubious validity and may even be obnoxious, such as guessing what your health patterns will be on the basis of your credit rating or the kind of car you drive. Thomas Goetz, former editor of WIRED Magazine and now an investor in medical research, stressed the importance of treating patients as partners if we want them to participate in big data research efforts. The subjects of experiments will demand full transparency about what we’re looking for.

The obverse of the coin was persuasively delivered by Ezekiel Emanuel from the University of Pennsylvania, the self-declared token techno-skeptic at the conference. He laid out a few narrow areas where we can expect technology to improve outcomes (or at least reduce costs) over the forseeable future: medication adherence (although he also wise-cracked that most people would do better on half their current medications) and preventing a useless trip to the hospital during the final weeks of life. Everything else we try to do relies on a long chain of technological and workflow changes that will be hard to put into place.

But mainly conference speakers firmly believe that technology is already making a difference, and are building businesses around them. Technologist Rosalind Picard found a possible indicator of epilectic seizures that had been missed by clinical research. Muse makes a headband that trains you to relax by showing your brain waves. And the social aspect of health is being avidly addressed, whether through simple phone calls to isolated elderly people (The Silver Line in Britain) or helping people with mental health problems communicate online anonymously (Big White Wall).

The anonymous communities of Big White Wall, of course, update practices that go back to the earliest days when ordinary people got onto the Internet in the 1980s. And the practice seems to work: CEO Jen Hyatt says that 73% of members share an issue there for the first time in their lives, and 95% of members report feeling better.

The final section of this article will generalize what I discovered at the conference.

Partnerships Between Behavioral Health & Telemedicine Drive Real Value and Impact Outcomes

Posted on April 24, 2015 I Written By

The following is a guest blog post by Dr. Bill Bithoney, Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation.
Bill Bithoney
The behavioral health and medical care delivery systems have long been separate, but the tides are changing. We’re starting to see more of a push to integrate the two, and it’s a trend expected to continue. Increased efforts to grow behavioral health service capacity through better integration with clinical care have health systems turning toward telemedicine. The benefits of this partnership are almost considered a “no brainer” when you take a look at the numbers and the opportunity for growth:

  • $6 billion: Where the telemedicine market will grow by 2020, according to the American Medical Association.
  • 7 million: The number of individuals with co-occurring substance abuse disorders and mental health issues, according to SAMHSA’s most recent National Survey on Drug Use and Health.
  • 38 percent: The number of adults with diagnosable mental health problems who actually receive needed treatment, according to the Department of Health and Human Services.

Still, providers and payors often find themselves asking, “How can I ensure this partnership will drive real value for the organization and impact outcomes?”

Telemedicine provides caregivers the ability to be in multiple locations at once – and provides patients access to care at times and places more convenient to them. As noted above, only 38 percent of adults with diagnosable mental health problems actually receive treatment. This means that more than 60 percent of individuals who know they need help aren’t able to receive it due to commonly cited challenges of not knowing where to go, inconvenience and lack of transportation. Further, psychiatrists, particularly those certified in addiction treatment, are in high demand nationwide. Indiana, which is experimenting with behavioral health telemedicine, has 462 in a state that should have 600.

And telemedicine has been proven effective in behavioral health treatment in numerous studies. Smartphones and apps are actually preferred by patients over prescriptions for medication. Through practices such as screening, brief intervention and referral to treatment (SBIRT)—included in Medicare telehealth services since 2013­­—problematic use issues, abuse and dependence on alcohol and illicit drugs can be proactively identified, reduced and prevented before ballooning into something greater. Moreover, the reduction in facility costs and increased access to patients makes telehealth, and telepsychiatry specifically, a cost-effective alternative to in-person treatments, while delivering much needed care.

Virtual visits and virtual early intervention through SBIRT impact not only the consumer’s health by extending the potential reach of substance abuse and mental health providers, but also the finances of the individual’s employer and insurer since the risks of costly and unanticipated urgent care and emergency department visits are greatly reduced. Additionally, insurers view this aggregation of data as a way to proactively monitor patients’ health, which can help prevent the risk of costly hospital admissions and readmissions.

The era of a partnership between behavioral health and telemedicine is upon us. Developing new avenues to deliver care that support behavior change, while engaging individuals in their own health, can not only be a more cost-effective strategy than simply providing more (or different) health care services, but can also be a smarter strategy to ensure better quality of care.

Dr. Bill Bithoney is a Managing Director and Chief Physician Executive with The BDO Center for Healthcare Excellence & Innovation. He can be reached at bbithoney@bdo.com

 

Behavioral Health EMRs: A Small Sampling

Posted on February 8, 2011 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.

In theory, any medical practice-friendly EMR could be adapted for use in a behavioral health setting.  (That’s my theory, at least.)  But as with other specialties, there’s a growing list of vendors who are offering EMRs focused on behavioral health.

Since we’re not finding any comprehensive sources of such vendors out there, we thought we’d share a  very small sampling of those we could find and see if you have any feedback. Yes, there’s probably of hundreds of vendors who claim to support psych, but we hope these few help to start a discussion.

If our quick look is any indication, there’s no single model or feature set that’s won over the psych marketplace.  Here’s hoping it matures soon;  right now my guess is that these would be a nightmare to integrate into a shared HIE.

Are any of you using an EMR specific to behavioral health? How is it working out? Have we left any important vendors out (including non-specialized platforms which seem to work well in psych settings)?

We look forward to your feedback!

-Anne

* Acrendo (http://www.acrendo.com/psychiatry-emr)  Tablet PC-based EMR.   Features include mental health templates, appointment setting, Dragon-based dictation and e-prescribing.

* ICANotes (http://www.icanotes.com/) Web-based EMR focused on psychiatry/psychology practice. Supports sub-specialities, including child/adolescent, substance abuse, eating disorders and geropsychiatry.

* OmniMD Psychiatric EMR (http://www.omnimd.com/html/SpecialtyPsychiatry.html) Includes mental health intake and depression/anxiety exam.

* Psychnotes EMR (http://www.psychnotesemr.com/)  Available as hosted or installed solution. Company specializes in psychiatric products. Supports speech and handwriting recognition.

* Psytech Solutions (http://www.psytechsolutions.com)  Offers Epitomax, a hosted EMR whose features include scheduling and billing.

*  Sigmund Software (http://www.sigmundsoftware.com)  Described as “an enterprise management software application for human service agencies.” Features include target behavior tracking.

*  Valant Psychiatric EMR (http://info.valantmed.com/) Hosted EMR also featuring billing and e-prescribing.

* Qualifacts (http://www.qualifacts.com/)