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Practice Fusion Founder Launches Wearables Startup

Posted on May 31, 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.

Free EMR vendor Practice Fusion has always been something of a newsmaker. Since its launch in 2005, the company has drawn both praise and controversy for its revenue-generation approach, which has included the analysis and sale of de-identified patient data and advertising to physicians.

But it’d be hard to question Practice Fusion’s success, particularly given that it found its legs during a hyper-competitive period of EMR vendor growth capped by the Meaningful Use incentive program. Over the company’s lifespan, it has grown to serve over 110 million patients, and reportedly supported more than 70 million patient visits over 2015. It also attracted over $150 million in venture and private equity funding. Will it provide a great return for investors, time will tell, but they’ve definitely left their mark on the EHR industry.

At the helm of Practice Fusion until last year was CEO and Founder Ryan Howard. Howard – whom I’ve interviewed now and again over the years — certainly doesn’t lack for confidence or creative thinking. So I was intrigued to learn that Howard has stuck his toe into the wearables market. Clearly, Howard has not wasted time since August 2015, when he was booted out as Practice Fusion CEO. And if he believes a wearables startup can make money in this rapidly-maturing niche, I’m inclined to give it a look.

Howard’s new startup, dubbed iBeat, is creating a watch which constantly monitors and analyzes users’ heart activity. The device, which transmits its data to a cloud platform, can alert emergency medical services and, using an onboard GPS, provide the wearer’s location when a user has a heart attack or their heart slows down below a certain level. Unlike competitor AliveCor, whose electrocardiogram device can detect heart rhythm abnormalities such as atrial fibrillation, it has no immediate plans to get FDA approval for its technology.

iBeat expects to sell the device for less than $200, though if users want the emergency alert service they’ll have to pay an as-yet unnamed extra monthly fee. That puts it smack in the middle of the pack with competitors like the Apple Watch. However, the startup’s focus on cardiac events is fairly unusual. Another unusual aspect to the launch is that Howard is targeting the 50- to 70-year-old Baby Boomer market. (Imagine a more-focused version of the LifeAlert “I’ve fallen and I can’t get up” service, which focuses on the 75-plus market, Howard told MobiHealthNews.)

My take on all of this is that there may very well be something here. As I wrote about previously, my own heart rhythm is being monitored by a set of devices created by Medtronic, a set-up which probably cost a few thousand dollars in addition to the surgical costs of implanting the monitoring device. While Medtronic’s technology is doubtless FDA approved, for not-so-serious cases such as my own a $200+ plus smart watch might be just the ticket.

On the other hand, I doubt that uncertified devices such as the iBeat watch will attract much support from providers, as they simply don’t trust the data. So consumers are really going to have to drive sales. And without a massive consumer marketing budget, it will be difficult to gain traction in a niche contested by Apple, Microsoft, Fitbit and many, many other competitors. Not to mention all the competitors in the “I’ve fallen and I can’t get up” category as well.

Regardless of whether iBeat survives, though, I think its strategy is smart. My guess is that more-specialized wearables (think, I don’t know, iSugar for diabetics?) have a bright future.

Patients Favor Tracking, Sharing Health Data

Posted on February 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.

To date, I’d argue, clinicians have been divided as to how useful medical statistics are when they come straight from the patient. In fact, some physicians just don’t see the benefit of amateur readings. (For example, when I brought my own cardiologist three months of dutifully-logged blood pressure and pulse readings, she told me not to bother.)

Research suggests that my experience isn’t unique. One study, released mid-last year by market research firm MedPanel, found that only 15% of physicians were recommending wearables or health apps to patients as tools for growing healthier.

But a new study has found that patients side with health-tracking fans. According to a new study released by the Society for Participatory Medicine, 84% of respondents felt that sharing self-tracking stats such as blood glucose, blood pressure, heart rate and physical activity with their clinician would help them better manage their health. And 77% of respondents said that such stats were equally important to both themselves and their healthcare professional.

And growing numbers of healthcare professionals are getting on board. A separate study released last year by Research Now found that 86% of 500 medical professionals said mHealth apps gave them a clearer understanding of a patient’s medical condition, and 76% percent felt that apps were helping patients manage chronic illnesses.

Patients surveyed by the SPM, meanwhile, seemed downright enthusiastic about health trackers and mobile health:

* 76% of adults surveyed would use a clinically-accurate and easy-to-use personal monitoring device
* 57% of respondents would like to both use such a device and share the data generated with a professional
* 81% would be more likely to use a consumer health monitoring device if their healthcare professional recommended such a device

Realistically, medical pros aren’t likely to make robust use of patient-generated data unless that data can be integrated into a patient’s chart quickly and efficiently. Some brave clinicians may actually attempt to skim and mentally integrate data from a health app or wearable, but few have the time, others doubt the data’s accuracy and yet another subgroup simply finds the process too awkward to endure.

The bottom line, ultimately, seems to be that patient-generated data won’t find much favor until hospitals and medical practices roll out technologies like Apple’s HealthKit, which pull the data directly into an EMR and present it in a clinician-friendly manner. And some medical pros won’t even be satisfied with a good presentation; they’ll only take the data seriously if it was served up by an FDA-approved device.

Still, I personally love the idea of participatory medicine, and am happy to learn that health trackers and apps might help us get closer to this approach. As I see it, there’s no downside to having the patient and the clinician understand each other better.

Consumers Take Risk Trading Health Data For Health Insurance Discounts

Posted on August 28, 2015 I Written By

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

When Progressive Insurance began giving car owners the option of having their driving tracked in exchange for potential auto insurance discounts, nobody seemed to raise a fuss. After all, the program was voluntary, and nobody wants to pay more than they have to for coverage.

Do the same principles apply to healthcare? We may find out. According to a study by digital health research firm Parks Associates, at least some users are willing to make the same tradeoff. HIT Consultant reports that nearly half (42%) of digital pedometer users would be willing to share their personal data in exchange for a health insurance discount.

Consumer willingness to trade data for discounts varied by device, but didn’t fall to zero. For example, 35% of smart watch owners would trade their health data for health insurance discounts, while 26% of those with sleep-quality monitors would do so.

While the HIT Consultant story doesn’t dig into the profile of users who were prepared to sell their personal health data today — which is how I’d describe a data-for-discount scheme — I’d submit that they are, in short, pretty sharp.

Why do I say this? Because as things stand, at least, health insurers would get less than they were paying for unless the discount was paltry. (As the linked blog item notes, upstart health insurer Oscar Insurance already gives away free Misfit wearables. To date, though, it’s not clear from the write-up whether Oscar can quantify what benefit it gets from the giveaway.)

As wearables and health apps mature, however, consumers may end up compromising themselves if they give up personal health data freely. After all, if health insurance begins to look like car insurance, health plans could push up premiums every time they make a health “mistake” (such as overeating at a birthday dinner or staying up all night watching old movies). Moreoever, as such data gets absorbed into EMRs, then cross-linked with claims, health plans’ ability to punish you with actuarial tables could skyrocket.

In fact, if consumers permit health plans to keep too close a watch on them, it could give the health plans the ability to effectively engage in post-contract medical underwriting. This is an unwelcome prospect which could lead to court battles given the ACA’s ban on such activities.

Also, once health plans have the personal data, it’s not clear what they would do with it. I am not a lawyer, but it seems to me that health plans would have significant legal latitude in using freely given data, and might even be seen to sell that data in the aggregate to pharmas. Or they might pass it to their parent company’s life or auto divisions, which could potentially use the data to make coverage decisions.

Ultimately, I’d argue that unless the laws are changed to protect consumers who do so, selling personal health data to get lower insurance premiums is a very risky decision. The short-term benefit is unlikely to be enough to offset very real long-term consequences. Once you’ve compromised your privacy, you seldom get it back.

Wearables Data May Prevent Health Plan Denials

Posted on August 27, 2015 I Written By

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

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

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

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

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

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

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

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

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

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

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

A Rub On Tatoo for Diabetics

Posted on January 27, 2015 I Written By

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

I’ve been covering a lot of wearables and sensors over on Smart Phone Healthcare through the years. It’s been great to see the evolution and I still think we’re just at the very beginning of what is going to be possible with these health sensors. However, the leaks in the damn are starting to appear and soon we’ll have a tidal wave of amazing health data from these health sensors.

Don’t believe me? Check out this story on Gizmodo about a Rub On Tattoo that measures a person’s blood glucose levels. For those too busy to click over, here’s an excerpt:

Pricking your finger for a blood glucose test will never, ever be fun. Thankfully, scientists have been hard at work on a bloodless and needleless alternative: a rub-on temporary tattoo that, as weird as it sounds, gently sucks glucose through the surface of the skin.

The thin, flexible device created by nanoengineers at UCSD is based on the much bulkier GlucoWatch, a now-discontinued wristband that worked through the same glucose-sucking principal. But the electric current GlucoWatch used to attract glucose to the surface of the skin was too high, and wearers were not keen on the discomfort. This temporary tattoo gets around the problem by using a gentler but still effective current.

Unfortunately, we’re still a few years out from this becoming a market ready product, but it’s another illustration of the kind of research and ingenuity that’s being put into the health sensors marketplace. I’m personally concerned about my risk for diabetes, and so I’m extremely excited about new developments around diabetes. However, this is just one of many more developments that are going to change the world of healthcare as we know it.

What do you think of this new wave of sensors? How will the medical establishment integrate all this new data? What other changes are happening which we should keep an eye on? I don’t think most doctors, practices, hospitals, EMR companies, etc are ready for what’s happening.

Fitbit Data Being Used In Personal Injury Case

Posted on December 8, 2014 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.

Lately, there’s been a lot of debate over whether data from wearable health bands is useful to clinicians or only benefits the consumer user. On the one hand, there are those that say that a patient’s medical care could be improved if doctors had data on their activity levels, heart rate, respirations and other standard metrics. Others, meanwhile, suggest that unless it can be integrated into an EMR and made usable, such data is just a distraction from other more important health indicators.

What hasn’t come up in these debates, but might far more frequently in the future,  is the idea that health band data can be used in personal injury cases to show the effects of an accident on a plaintiff. According to Forbes, a law firm in Calgary is working on what may be the first personal injury case to leverage smart band data, in this case activity data from a Fitbit.

The plaintiff, a young woman, was injured in an accident four years ago. While Fitbit hadn’t entered the market yet, her lawyers at McLeod Law believe they can establish the fact that she led an active lifestyle prior to her accident. They’ve now started processing data from her Fitbit to show that her activity levels have fallen under the baseline for someone of her age and profession.

It’s worth noting that rather than using Fitbit data directly, they’re processing it using analytics platform Vivametrica, which uses public research to compare people’s activity data with that of the general population. (Its core business is to analyze data from wearable sensor devices for the assessment of health and wellness.) The plaintiff will share her Fitbit data with Vivametrica for several months to present a rich picture of her activities.

Using even analyzed, processed data generated by a smart band is “unique,” according to her attorneys. “Till now we’ve always had to rely on clinical interpretation,” says Simon Muller of McLeod Law. “Now we’re looking at longer periods of time to the course of the day, and we have hard data.”

But even if the woman wins her case, there could be a downside to this trend. As Forbes notes, insurers will want wearable device data as much as plaintiffs will, and while they can’t force claimants to wear health bands, they can request a court order demanding the data from whoever holds the data. Dr. Rick Hu, co-founder and CEO of Vivametrica, tells Forbes that his company wouldn’t release such data, but doesn’t explain how he will be able to refuse to honor a court-ordered disclosure.

In fact, wearable devices could become a “black box” for the human body, according to Matthew Pearn, an associate lawyer with Canadian claims processing firm Foster & Company. In a piece for an insurance magazine, Pearn points out that it’s not clear, at least in his country, what privacy rights the wearers of health bands maintain over the data they generate once they file a personal injury suit.

Meanwhile, it’s still not clear how HIPAA protections apply to such data in the US. When FierceHealthIT recently spoke with Deven McGraw, a partner in the healthcare practice of Manatt, Phelps & Phillips, she pointed out that HIPAA only regulates data “in the hands of, with the control of, or within the purview of a medical provider, a health plan or other covered entity under the law.”  In other words, once the wearable data makes it into the doctor’s record, HIPAA protections are in force, but until then they are not.

All told, it’s pretty sobering to consider that millions of consumers are generating wearables data without knowing how vulnerable it is.

Forrester’s Take On Computing Trends For Next Year

Posted on December 31, 2013 I Written By

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

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

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

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

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

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

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

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

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

Patient Accountability and Responsibility

Posted on February 22, 2013 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 think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.

The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.

So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.

Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..

So the significant question is Where are the patients held accountable in all these free health care reforms?

This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.

While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?

The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?

I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?