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EHR and mHealth Successes and Fails: Around Healthcare Scene

Posted on March 31, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Patients are somewhat taught to fear sharing medical data. While privacy is important, especially when it comes to health, being more willing to share medical data can yield great results. The key is knowing who to share information with, and who to avoid. 

EHR vendors can be tricky when it comes to keeping clients around. Sometimes, they don’t really have a choice because the EHR holds client information “hostage” when the client says they are switching EHRs. However, this is a sneaky tactic, and there are many other ways to keep an EHR client longer — most importantly, providing a great product.

While many aspects of HIT have come to a halt, mHealth continues to flourish. There are many things that other parts of HIT can learn from mHealth’s success. First, mHealth doesn’t focus on every patient at once. Next, it is an unregulated industry. And finally, the projects are marketed directly to consumers and paid for by them as well. 

Are you a hospital leader and curious about what technologies you should be watching out for? Well, the ECRI Institute has compiled a list of technologies they feel executives should be looking at this next year. This list includes Electronic Health Records, mHealth, imaging and surgery, and more. 

When an EHR fails to work correctly, how do physicians deal with it? Researchers have observed clinical workflows to answer just that question. The observations concluded that while there was no correct answer, many use paper to record information. Hopefully, this study will show EHRs where their gaps are, and help them to correct them.

There are so many consumer medical devices out there. What makes one stand out from the best? And which one has the best form factor? Wrist bands or chest straps…hand held or pocket stored? Chime in over at Smart Phone Healthcare.

100% Interoperability, Quantified Self Data, and Data Liquidity – #HITsm Chat Highlights

Posted on March 30, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic 1: Do you think the healthcare system WANTS 100% interoperability & data liquidity? Why/why not?

 

Topic 2: As consumer, what are YOUR fears about your health data being shared across providers/payers/government?

 

Topic 3: What do you think payers will do with #quantifiedself data if integrated into EHR? Actuarial/underwriting?

 

Topic 4: Could there be a correlation between your fear of data liquidity and your health?

 

Topic 5: What could assuage your fears? Education? Legislation? Regulation? Healthcare system withdrawal?

March Madness and the EHR Vendor Shakeout

Posted on March 29, 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’m not sure how many of my readers love March Madness as much as I do. I just love the emotion and the all day experience of March Madness. Unfortunately there haven’t been quite as many last minute buzzer beaters for the win as there have been in years past, but I still love the emotions of the games. These young kids have worked almost their entire life for this moment. I love to see the raw emotions from both teams.

As I think about March Madness, I couldn’t help but think about the EHR Madness we’re experiencing right now. We don’t have 68 teams in the EHR tournament. Instead, there are more like 300+ EHR vendors. In fact, in just the last week or two I’ve had two EHR vendors I’d never heard of contact me. Yes, we’ve seen some EHR software put out to pasture, but we still have a long ways to go before the EHR market really shakes itself out.

The nice thing for EHR vendors is that unlike the NCAA tournament which only has one winner, the EHR world is likely going to have many many successful companies. First, because many EHR vendors will likely get acquired by larger EHR vendors. Second, because it’s fair to say that the EHR world is going to be a heterogeneous environment. There won’t be one EHR to rule them all (although some EHR vendors still think they might get there).

Which type of vendors am I putting my money on in the EHR battle?

While many EHR vendors might win some short term battles, I think the big EHR winners are going to be those who end up battling through the mess of regulation while still having a laser focus on the impact to doctors. The most expensive employee in every healthcare institution is the doctors. EHR software that takes these high paid doctors away from seeing patients is going to have a real challenge long term.

I’ve written about the EHR Backlash a number of times before. I think productivity is going to be at the core of the EHR backlash. I’m hopeful that EHR vendors are taking this idea to heart, but I also still see a very long road in front of us to reach EHR nirvana.

I’ve been digging into the idea of a Smart EMR lately. At the core of the idea is how to make a doctor more efficient at what they do while increasing the quality of care provided. That certainly stands in stark contrast to many of the other EHR initiatives we see out there today.

Top Tech Innovators Poised to Make Big Impact on Healthcare

Posted on March 28, 2013 I Written By

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

I had the pleasure of attending my second Georgia Technology Summit earlier this month, an annual event presented by the Technology Association of Georgia (TAG) that brings together the state’s up and coming companies, offers established businesses great networking opportunities, and presents everyone with great insight from some really A-level keynoters. (My husband, a fan of philosophy, was extremely jealous that I got to attend an event featuring Ray Kurzweil.)

As with last year’s event, healthcare IT dominated many of the presentations and exhibitor presentations. During the summit, TAG offers the top 10 in its list of Top 40 Innovative Technology Companies a chance to present, and so I thought I’d highlight those in the top 10 poised to make a big impact on healthcare.

Buzzy4shots.com
As you can tell from the image above, Buzzy4shots had a fun booth that demonstrated the kid-friendliness of their product. They also had the most kid-friendly giveaway – bright yellow kazoos, which I quickly snatched up. According to their website, their product purports to provide natural injection pain relief via “gate control,” which “works by confusing the body’s own nerves and distracting attention away from the poke, thereby dulling or eliminating sharp pain from shots, itching or burning from medications.”

While I don’t think this product is going to gain quite the level of buzz that more consumer-friendly mobile health apps have attained, I think it’s got a great business model. There will always be a need for injections, and people will likely always have a fear of needles, so I predict Buzzy4shots.com will do well if they can market themselves to the right business partners.

Catavolt
It wasn’t until I saw their stage presentation that I realized Catavolt is making a play in the healthcare vertical. According to its website, the company’s flagship product, Catavolt Extender, is a “software service that connects to your existing enterprise systems, giving you secure access to all enterprise data anywhere at any time, through tablets, smartphones and desktops. Using an online control panel you can create, customize and manage mobile and web applications without any programming.”

A Catavolt rep talked me through some of the work the company is doing with the Defense Health Information Management System EHR (AHLTA) via its partnership with SAIC. You can read more on that here.

SoloHealth
This company seems to be Atlanta’s HIT darling at the moment. Bart Foster and his team are doing a great job of strategically marketing the company, and developing partnerships that position SoloHealth for even bigger impact. You may already know that the company “provides a free healthcare access point for consumers via its nationwide network of SoloHealth Stations that offer screenings for vision, blood pressure, weight and body mass index; a symptom checker; and an overall health assessment free of charge.

As more folks become accustomed to the idea that they will ultimately need to drive their own healthcare, consumer-friendly technologies like these kiosks will start popping up more and more. Foster announced on the GTS stage that its kiosks are already in 2,500 retail locations across the U.S., with another 1,500 likely by 2014.

AirWatch
If you’re a CIO worried about BYOD, then you’ve likely had a conversation with or at least heard of AirWatch and its mobile device management solutions for healthcare. Their booth at HIMSS was hard to miss and always busy, reflecting the fact that their solutions – no matter what industry you’re in – are here to stay with good reason.

I’d be remiss if I didn’t mention the other healthcare-related innovators within TAG’s Top 40:

Allscripts Drops Lawsuit Over $303 Million Deal

Posted on March 27, 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.

Allscripts has agreed to drop a lawsuit against the New York City Health & Hospitals Corp. over a $303 million contract, Bloomberg reports.  In a display of what may be wishful thinking, Allscripts said it “looks forward to having the opportunity to work with HHC on other matters in the future,” according to Bloomberg.

Allscripts had sued the Health & Hospitals Corp., which runs the city’s public hospitals, when it awarded an EMR contract to Epic Systems. The contract involved tying together 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients.

Allscripts had argued that it was a more logical choice because among other things, it offered a less costly choice. Execs had estimated that over 15 years, when ancillary costs are included, it would cost $1.4 billion to implement Epic, while its own EMR rollout could be completed for less than half that number.

But Alan Aviles, HHC’s CEO, argued that his team had given plenty of consideration to Epic’s rivals, spending four years on its nine-vendor shortlist. Moreover, he didn’t buy Allscripts’ savings estimates, according to a New York Times piece. Aviles noted that Allscripts’ estimate had assumed that application support for its product would cost nothing for 15 years, while HHC estimated the cost at $357 million.

Well, I don’t know what good all of this legal fencing did Allscripts. The vendor is already under closer scrutiny than its peers, given its management troubles and continued rumors that it will be acquired. I’d argue that the last thing it needs is to dissipate executive energies on a lawsuit that makes it look unreasonable or even desperate. But at least its leaders had the sense to drop the suit and move on.

Now it can turn its energies to the MyWay suit filed against it by a group of Florida physicians. The suit claims that the MyWay EMR, which was taken off the market last year, was defective, and that the offer of a free upgrade to its professional suite imposed additional costs.

Tech We Take for Granted in Healthcare

Posted on March 26, 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.

Every once in a while I like to take a step back and think about all the tech that we take for granted. Yes, it’s easy to get stuck in the discussions of what’s missing from our tech life or ways in which tech could be implemented better in healthcare. However, there’s a whole series of technologies that we use all the time and barely give it a second thought.

Certainly there are some rural areas of the country where their internet connection isn’t very good, but for a large portion of healthcare a nice internet connection is just a feature. Most clinics don’t give their internet connection a second though. It just works. They go online and do what they need to do. Sure, you might have an outage here or there (and those are brutal), but most of the time the internet just works.

Related to this is Wifi. Unless you’re in a clinic where the wifi implementation isn’t very good (and there are still plenty of those), you roam around with your laptop, tablet or other wireless device and it just works. It’s amazing to watch my kids, because they really don’t have any idea on how it works. They just open up the iPad and watch movies as they wish. They literally have no idea what’s required to make that possible. Yep, they take it for granted because the tech has become so good.

We’re now starting to see the next level of ubiquitous internet with 4G speeds being nearly as good as Wifi for many applications. Soon we’ll be taking for granted that we can get good internet speeds almost everywhere we go. The same is true for cell phone connection. The only time I can remember looking at my phone to see how many bars I had was when I was deep in the heart of a National Park. Yes, there are a few places in the wilderness where phone coverage is not likely to hit. However, for 99% of most people’s activities the phone just works.

Another great example is email. I totally take for granted that email just works. If I send an email I assume it’s going to be delivered. Sure, there are times when your email service provider goes down and we have to deal with spam folders, but I don’t really give much thought to whether my email is going to work or not. I just do it all day every day and it just works.

Instant Messenger is another application I use that just works. I know some healthcare institutions that use it, but so far not for PHI. It’s amazing technology that I can see whenever someone is online and send them a message. They can reply almost instantly. The beauty is that most people have become really mature with the use of this technology. It’s a use as needed thing. I don’t greet every person that comes online, but it’s there if I need to get a hold of someone quickly.

Often related to IM is video chats. Unfortunately this hasn’t taken hold very much in healthcare and it’s unfortunate. Video is built into most IM platforms: Skype, Gchat, MSN Messenger (or whatever it’s called now). With video cameras built into so many laptops or desktop cameras available for as cheap as $30, doing a video chat with someone is almost trivial. Add in things like FaceTime on the iPad and the idea of doing a video chat with anyone anytime you want is almost here.

I’m sure there are a hundred other technologies that I could list. The reason I find this so fascinating is that I think we’re going to have the same thing happen with EMR. In the next 5 years, EMR is just going to be another technology that we use without really even thinking about it. We’re not there yet, but it will happen.

I look forward to the day when we start to take EHR for granted.

ACO Tire Change Analogy

Posted on March 25, 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 was at an ACO conference a while back and one of the speakers compared the idea of ACOs to a tire change. Although, he suggested in an ACO world, you’d get your tire changed and then a mile down the road the tire goes flat and the tire company will say they couldn’t predict that to happen.

It’s an interesting comparison to consider. I know many doctors are concerned with ACOs for situations like the one described. This is particularly true because they only have so much control over the health of a patient. Using the car analogy, they don’t know if the person is going to go off roading with their car (risky behavior), run over a nail (get in an accident), or slash the tire themselves (smoking or other unhealthy behavior). Yet, in an ACO world, the doctor is held accountable for all of these things.

I don’t pretend to be the foremost authority on ACOs. I’m still learning (and so is everyone at this point). However, there are some real challenges associated with reimbursing based on improving the health of a patient so they don’t return to the office.

Certainly technology can play a major role in making this happen. In fact, without technology this is a really hard thing to do. Mobile devices can help patients be more accountable for the choices they make. They can help a doctor influence healthy behavior in ways that weren’t possible before.

Big data can help a healthcare organization know which patient populations need the most attention to be able to increase the overall health of a population. Plus, this is only going to get more powerful as patients start tracking their health data more and more and healthcare can address those who have the most need before they even know they need it.

I like the direction that we’re headed in healthcare where we try and reimburse for the right things, but it’s going to be a really long, hard road. In fact, as I look into the future of ACOs I don’t really see a road at all. Instead, I see the ACO movement as trailblazing its way to an unknown future.

Google EMR, Healthcare Innovation, and EMR Social Media

Posted on March 24, 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.

We have a wide range of tweets today, but so many of them offer interesting insights and discussion points. I think you’ll agree.


I think the reply to the original tweet is a great response. I honestly can’t imagine Google getting back into the healthcare game through an EMR. They might do something with discovery of health information. They might do something cool with their image recognition technology and healthcare, but they’re not going to build an EMR. EMR is enterprise software, and Google won’t be going there.


I’m a huge supporter of API’s and the innovation they can create. I just don’t see many healthcare IT vendors ready to open up their systems like that. This is possibly because there’s too much money to be made by selling their product as is. Thanks EHR Incentive money.


It’s pretty provocative to consider, but the simple answer is yes it will. Although, it might be the HIE more than the EMR. I guess we’ll see how that plays out. However, I think control of when and where your information is shared will be a feature. Of course, most people won’t ever use that feature. They’ll just leave the default settings.

Are Cloud-Based Health Record Banks Better Than HIEs?

Posted on March 22, 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.

This week a group of researchers published an opinion in the Journal of the American Medical Association suggesting that cloud-based record banks are a better way to share patient health data than HIEs. I think their view is interesting and sensible, and so here’s a short recap.

The authors argue that cloud-based health record banks are a more logical way to share such data than HIEs, reports MedCityNews. After all, as they note, interoperability challenges make it “inefficient” to share patient data, as every organization has to be able to communicate with every other organization where a patient has been treated.

But cloud-based health record banks wouldn’t pose the same challenges, they note.  These record banks would be more scalable and easier for end institutions to use, according to the authors.  Though local providers could keep copies of a patient’s health record, the electronic health record would be stored in a cloud-based bank in the patient’s community, they say.  When patients moved, their records would travel to a different community health data bank.

This approach isn’t just a theoretical discussion. It’s backed by a group called the Health Record Banking Alliance, which was founded by one of the article’s authors, Dr. William Yasnoff, MD, PhD, FACMI, former senior advisor for the National Health Information Infrastructure. The group has developed white papers outlining a proposed architecture and a business model for community health record banking.

My take on all of this is that the cloud-based community health record bank is a very worthwhile idea. After all, in theory it can greatly reduce the amount of infrastructure build out and interoperability issues providers face in connecting to HIEs.

That being said, the HIE concept is firmly planted in the industry’s mind, and despite all of the issues involved in building out HIE networks, I don’t see providers changing gears to embrace a completely new model. What about you?

The Economic Lessons of mHealth

Posted on I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

I wrote this article for mHIMSS which was posted yesterday.  The original post is available here:

 

The recent HIMSS 2013 meeting witnessed the emergence of mHealth as a significant component of health information technology (HIT).  The meeting offered 35 educational sessions on mHealth. One of the meeting’s keynote speakers, Dr. Eric Topol, predicted a revolution in health care based on smartphones.  Connecting a smartphone to a currently available bio-sensor allows anyone to monitor and share with a physician his vital signs, heart rhythm, sleep patterns or blood sugar, and soon other physiologic data as well.  Eventually these systems will include software that will enable laypersons to interpret data and determine when physician involvement may be appropriate.  The way each of us will learn to interpret our own body’s data will become a natural extension of the way we now interpret our own “internal body cues” and symptoms.

Meanwhile, progress within the more established parts of HIT has ground to a standstill. At the HIMSS meeting results of a provider survey conducted by the American College of Physicians and AmericanEHR Partners were presented.  Among over 4000 surveys the percentage of clinicians that were “very dissatisfied” with their EMRs has increased by 10% from 2010 to 2012. 39% of EHR users would not recommend their EHR to a colleague (up from 24%).  Satisfaction with EMRs has clearly deteriorated since the 2008 pre-Meaningful-Use study published in NEJM that showed 93% of physicians were satisfied with their EMR.  In the physician blogosphere the leading EMR story last week was about a physician class-action lawsuit against an EMR vendor who allegedly sold defective software and then abandoned the product.  Outside of mHealth there is not a lot to cheer about in HIT right now.

Why is mHealth growing so fast while the rest of HIT is stalling? There are many reasons but three important reasons bear discussion.

First, most mHealth projects don’t take on every patient at once.  An mHealth project designed, for example, to monitor congestive heart failure patients at home addresses only that population of patients and providers associated with a single diagnosis. A project with such a narrow, focused scope has a greater chance of success than a typical EMR project which must cover every patient and every physician regardless of diagnosis.

The other two reasons illustrate an important economic lesson. At the moment mHealth is a relatively unregulated industry. Any startup company can acquire a bio-sensor and/or write a mobile app for a smartphone and be off and running.  There are no Meaningful-Use-type regulations that require all mHealth apps to operate a certain way or meet a minimum set of requirements.  Barriers to entry are relatively low.

Third, many mHealth projects are marketed directly to consumers and are paid for directly by consumers.  The just-released Samsung Galaxy S4 smartphone has a suite of built-in mHealth apps and available biosensors to monitor sleep, calories burned, heart rate and (Samsung implies) blood glucose.  Consumers will purchase this phone like any other – with their own money.  There are no third party payers involved.  That means no insurance approval, no complex coding and billing, no politics ….so far less overhead and far more flexibility and speed.  All you have to do is build a quality, useful product.

mHealth currently operates in a free market where products can be designed any way their creators choose. Their target customers choose what products to buy – or not to buy at all – and how much to pay.  Many of these products will fail, but the ones that succeed may indeed revolutionize healthcare as Dr. Topol predicts.

EMR vendors, burdened by Meaningful Use requirements, have little bandwidth left to address customers’ real needs.  As Meaningful Use requirements and EMR certification raise the barrier to entry into the market, the market is increasingly dominated by the largest vendors at the expense of the smaller ones.  As competition is suppressed product quality and customer service both suffer. Given the AmericanEHR survey results it is no surprise that EMR vendors are now marketing to current EMR users who are unhappy with their present system. There are certainly plenty of those.

Unfortunately the freedom mHealth enjoys may soon come to an end.  The FDA’s upcoming release of its final regulations of mobile medical applications is expected soon.  These rules will likely impose an approval process similar to those already in place for drugs and conventional medical devices.  One source estimates the cost of this approval process for a single mHealth product will be as high as $24 million.  While that estimate seems high, there is no doubt that the cost of compliance will have a detrimental effect on the mHealth marketplace.  Costs will go up dramatically, smaller companies will be forced out, and true innovation will slow as mHealth companies expend most of their resources on compliance.  Those products that survive to reach FDA approval will no doubt seek third party payor reimbursement.  With that will come loss of price transparency, driving up costs even further.  The mHealth market will become as bloated and ineffective as the rest of the health care system.

Will the mHealth revolution survive?  Time will tell.