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The New World of Health Monitoring

Posted on December 23, 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 thought that this image was really interesting in the context of another post about the medical smart phone. Ironically, I think the image below actually only depicts a small part of the health monitoring that’s coming. I’m sure that scares the heck out of many people and excites many people. It’s a hard balance. Personally, I’m on the excited side of things. Chew on this graphic as you open your various health tracking devices this Christmas.
New Extreme Health Monitoring

Ten-year Vision from ONC for Health IT Brings in Data Gradually

Posted on August 25, 2014 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.

This is the summer of reformulation for national U.S. health efforts. In June, the Office of the National Coordinator (ONC) released its 10-year vision for achieving interoperability. The S&I Framework, a cooperative body set up by ONC, recently announced work on the vision’s goals and set up a comment forum. A phone call by the Health IT Standards Committeem (HITSC) on August 20, 2014 also took up the vision statement.

It’s no news to readers of this blog that interoperability is central to delivering better health care, both for individual patients who move from one facility to another and for institutions trying to accumulate the data that can reduce costs and improve treatment. But the state of data exchange among providers, as reported at these meetings, is pretty abysmal. Despite notable advances such as Blue Button and the Direct Project, only a minority of transitions are accompanied by electronic documents.

One can’t entirely blame the technology, because many providers report having data exchange available but using it on only a fraction of their patients. But an intensive study of representative documents generated by EHRs show that they make an uphill climb into a struggle for Everest. A Congressional request for ideas to improve health care has turned up similar complaints about inadequate databases and data exchange.

This is also a critical turning point for government efforts at health reform. The money appropriated by Congress for Meaningful Use is time-limited, and it’s hard to tell how the ONC and CMS can keep up their reform efforts without that considerable bribe to providers. (On the HITSC call, Beth Israel CIO John Halamka advised the callers to think about moving beyond Meaningful Use.) The ONC also has a new National Coordinator, who has announced a major reorganization and “streamlining” of its offices.

Read more..

Consumers Are Ready For Wearable Tech

Posted on January 15, 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.

Though they’re pretty, interesting and fun, I’ve never taken wearable devices that seriously as a force that could have impact on healthcare delivery in the here and now.  Well, it seems that I was wrong.  While it’s not certain that the health system can afford these devices — they don’t exactly come in at an easy consumer price point — it seems consumers are ready to use them if given the chance.

According to a new study by Accenture, more than half of consumers “are interested in buying wearable technologies such as fitness monitors for tracking physical activity in managing their personal health,” according to a report in Health IT Outcomes.

According to Accenture, consumers were primarily interested in devices like smart watches and wearable smart glasses such as Google Glass, even though these devices are not yet available commercially.  Consumers were also very interested in phablets, an emerging device category combining smart phone and tablet PC functions.

I can’t help think that this is a very positive trend.  For one thing, consumer wearables can be an important gateway to remote patient monitoring, something that’s less likely with devices that are used and put aside, like wired glucose monitors, pulse oximeters and blood pressure cuffs.

What’s more, wearables can fit into a healthcare ecosystem in which devices talk to one another and other wireless systems (such as their desktop, laptop or smart phone), whereas the other smart devices I’ve mentioned have less flexibility in that arena.

So, who pays for the wearables?  At least at first, it will probably make more sense for providers to invest in these devices and use them to conduct tests of remote patient monitoring and its impact on care.

But as consumers pick up the wearables themselves, providers might want to focus on building a network which seamlessly integrate these devices, as it seems almost a given that consumers will buy them when they’re available and affordable.  It will take years to get that right, so now it’s probably time to start. Get prepared for the Internet of everything!

Is Remote Monitoring Data A Blessing, Or A Distraction?

Posted on August 1, 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, Venture Beat reported on some growing remote monitoring efforts in which a handful of Massachusetts hospitals are working to pull the data into their EMR. The hospitals are hoping to get their arms around a growing body of data which increasingly lives not only in wireless medical devices (such as glucometers and pulse oximeters) but also smartphones, smart wristbands, FitBit devices and other health-tracking technology.

One of the players involved in the new effort is Partners HealthCare, whose Center for Connected Health is focused on collecting and making use of such data. Its latest initiative sweeps patient data collected at home — such as blood pressure, weight and blood glucose — into the Partners EMR, making it accessible as part of routine clinical workflow. (The data collected by patients is transmitted wirelessly and automatically subsumed into the EMR.)  Patients can also review the data through a patient portal known as Patient Gateway.

According to Partners, this process is designed to change care delivery by allowing doctors to keep a close watch on patients when they’re not in the hospital or doctor’s office.

This is all well and good, especially for monitoring the chronically ill, whose condition may fluctuate dangerously and require timely intervention. But the question is, is this new flood of data going to be manageable for doctors?  Can a physician managing thousands of patients really give appropriate attention to every data point a FitBit or smartphone produces?  Certainly not.

Perhaps that’s why Kaiser Permanente recently told a conference that it was going to be rather picky as to what data flows into its EMR. According to Lead Innovation Designer Christine Folck:

“Don’t come to us telling us you can upload [data] into our electronic medical record. We don’t necessarily want it there. We have too much information in our electronic medical record. Kaiser Permanente was one of the first to go nationwide with our electronic medical record, we are fully integrated, but the problem is now everybody wants to upload into it. Our physicians don’t want it all there. They really don’t need to know how much exercise each of their patients is getting on a daily basis; they just don’t have time to process all of that.”

So, while there’s clearly benefit to tracking chronic conditions via remote monitoring, it seems clear that there will be some pushback from doctors, who can’t possibly absorb all of the data the healthier “quantified self” types are producing.  It looks to me like we’re going to have to narrow down what categories of data are actually helpful in an EMR and which aren’t.

How to Track Your Health – Jump on the Self-Logging Bandwagon

Posted on February 6, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Last week, I wrote about Margalit Gur-Arie’s idea for a national health data repository. Commenters, including Gur-Arie, had some great comments. And one of the things that came out of that post was that if there is ever a community run national database, I would happily log my health data into it, and maybe do it for my parents and kids as well. But I don’t really have a great track record of health-logging. I’m not a Quantified Self afficionado, I don’t even check my weight on a regular enough basis. Having my husband photograph me and gauging my weight by the relative puffiness of my cheeks is what constitutes a weight check in my universe. So what are the odds of me going through piles of paper records and typing it all up for a UHR? Slim to none, but a girl can still dream.

Wired published an article late last month on How to Use Tech to Track Your Health, just for people like me. Don’t worry, assures the article, self-logging ain’t that hard, it’s probably so easy even a cavewoman can do it.

Now, just because the article is on Wired doesn’t mean it comes with awesome pedigree and stellar writing. People, it’s 2012, not 1992. If I hear about one more app that sends you text reminders about getting your annuals done, I’m going to barf. Ditto for those tired ovulation trackers. I don’t know who I blame more. the tech companies that come up with these novel solutions after every iPhone developer and their mother has already created a dozen apps and websites around the idea, or the Wired writer who thought it was newsworthy enough to include in her round-up of the most happening ideas. Either way, I don’t care. I don’t want to know about any more reminder and calendar apps, not unless this magical app connects me directly to someone like Simon Cowell or Idris Elba (ok, I have a thing or two for Brit accents). See, there’s a business idea for you – have celebrities become our health coaches and cheerleaders. Some of us might be ready to pay for the privilege.

There are the usual sleep-pattern analyzer apps and personal sleep coaches that help you get a good night’s worth.

Kvetching aside, not everything in the Wired article sounded like it was floated circa the 1900s. I quite liked reading about the BodyMedia biometric patch that apparently works like one of those ciggie patches, and logs your sleep, heart rate etc for upto a week. It is intended to be used a week prior to your appointments, presumably so you can bombard your doctor with the aforesaid minutiae. I also liked the Moodscope idea – you can go to the Moodscope website and play a game, and your reponses to the game are used to gauge your mood. I can imagine how useful that could be to people who might be prone to depression or who want to chart what external stresses produce what reactions in them.

I haven’t used any of the apps or gadgets mentioned in the article, so I’m just reacting at a very surface level to the idea behind the product/service. And your mileage may, of course, vary.

Check it out here.

Costs of Healthcare, Benefits of Healthcare IT and Health Tracking at #chs11

Posted on October 21, 2011 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.

Seems like people really liked my tweets from yesterday at the Connected Health Symposium. So, I thought I’d do it again today. Here’s some of the interesting tweets I saw and wrote during the Connected Health Symposium.


The cost of healthcare was a major theme throughout the entire conference. I agree completely that as patients start to pay more of their healthcare, they need more information and make better decisions.


I found this really interesting. Twitter (and even this blog) doesn’t quite capture the irony of the statement. Basically, Dr. Tippets from Verizon really highlights how if we did IT right in healthcare we have the potential of saving lives and live longer. Both noble goals.


I think Blumenthal might have actually said Healthcare IT instead of EHR, but there’s a lot of overlap in this. I agree with Blumenthal that the media and even blogs like mine love to write about the negative more than the positive. It makes for a compelling headline. Maybe the people behind the good research studies need to promote themselves more too.


This kind of hit me on multiple levels. First, I found it interesting that 15% are tracking their weight and exercise. Is that too low? It’s probably the highest level of any other healthcare data tracking app. I wonder where the rest of the apps stand. The second thing that hit me was the fact that doctors aren’t using this data. Finding some way to make it easy and useful for doctors to use all this collected information is going to be a challenging, but important next step. I’ll be interested to see how EHR companies work through the process of taking that data and integrating it into their EHR software. It won’t be easy, but I believe patients will love this type of integration. Plus, it would encourage many others to start using these medical devices.

Gamification and Encouraging Healthy Living

Posted on October 17, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

There are those that swear by the Quantified Self movement and those that think its bunkum. Having grown up around a grandfather who kept a meticulous daily diary of his bowel movements and sleep patterns, I can totally relate to the pleasures afforded by such healthful navel gazing. But unless the data can be distilled into meaningful information or can be used to effect behavioral change, it is just interesting data, destined to remain the domain of card-carrying data geeks.

Social health networks might just change all that. Dr. Jan Gurley, writing on SFGate, had a great post a couple of weeks ago on the effects we can expect to see with healthcare gamification. She wrote about Mindbloom, a website in beta with about 15000 users, whose CEO wants us to not “run away from something” but to want to run towards good health. To achieve that, Mindbloom has devised a game around the a tree of life, where the actions you report (positive health related changes based on commitments you made), get transformed into virtual rain for the tree, which in turn helps it grow. You can use your good deeds to purchase seeds and raindrops for your friends, and you can collectively inspire one another . Dr. Gurley calls it the Farmville of Health, but yeah, it is pretty similar to those virtual pets (fish, gerbil) you could raise in the early 2000s. As inspiring as this is supposed to be, I can totally imagine someone gaming the system by reporting that they ate a piece of fruit when they didn’t. I think the Achilles Heel of this idea is its reliance on self-reporting. It also veers Chicken Soup for the Soul-ish and that is not really everyone’s cup of tea.

One of the more interesting pieces of nuggets in Dr. Gurley’s post was about how working towards a collective goal as a group helps one travel farther than one would on one’s own (she cites religion, tai-chi in the park and Alcoholics Anonymous as examples of real life social networks that can affect positive behavioral change). The companies Dr. Gurley cites in her blog support this thesis.

Startup Zamzee keeps kids motivated to move by giving them points for ANY movement they make. The referral rates for Zamzee were as high as 50%, and soon involved original participants’ parents and friends. Livn.it figured that while people fall off the change bandwagon very soon, they would also climb back on if the distance between the ground and the wagon was close enough. A company called Shapeup let people form teams to lose weight, increase exercise or walking. Apparently the game went viral in Rhode Island where 10% of the population participated. Shapeup also creates social health networks for employers. Now, these are programs I would love to know more about.

Electronic Health and the Non-Digerati

Posted on October 3, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Everytime we discuss something innovative and interesting to do with our lives, my friend comes up with yet another app or game we should design and market via the App Stores and live richly and happily forever. And I, true to my vaguely creative pursuits, always state that not every problem has a solution rooted in IT or mobile phones or the next iThingamajig. While this is a strange admission to make on a blog that is titled “EMR Thoughts”, bear with me. For example, there are entire classes of problems that IT cannot solve – such as whether the water in a village well is potable, or ensuring that there is enough food for a growing world populace, our collective Farmville skills notwithstanding.

Today I was reading John Moore’s report of the recent SFO Health2Con, where I felt he addressed a health version of the same discussion my friend and I have. More on that later. First the reviews.

Moore says:
– the Health2Con demos sported cleaner interfaces, better UI,
– had more realistic business models (fewer free/Freemium models).

On the not-so-great news side:
– mobile health is cheap and the “it” technology of the moment but Moore doesn’t think anyone’s figured out how to use it,
– demos rarely give enough detail to be instructive,
– And if he cannot deal with any more demos that call for gamification or Facebookization as a way to approach health (I hear him)

Then about midway through the post, he made a comment that made me sit up and take note:

“[Health IT Vendors] want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati [digital literati]

Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system.”

Another post on iHealthbeat clearly examines the motivations behind our health IT thrust.

EMRs/EHRs will make healthcare efficient and reduce costs. Engaged, empowered patients will take charge of their own health and again bring down health costs. These are some assumptions we hold to be true.

The problem with these assumptions that they don’t take into account the non-IT savvy grandmother problem. How do we reach her and others like her? A particularly trenchant comment from commenter Kim Slocum on iHealthBeat says:

We know that half the US population consumes essentially all the nation’s health care resources.

I’m guessing that a large proportion of high car(sic) utilizers are also off-line and currently unreachable via this medium (e.g. dual eligibles and substantial fraction of the Medicare population). If that’s true, a lot of the “Health 2.0” buzz is misguided if it is thought to be a vehicle to bend the cost curve via “consumer engagement.”

Something to think about. John Moore’s post is here, and the iHealthbeat post is here.

Future of EHR and the Human Genome

Posted on August 30, 2011 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.

Dr. West has a really interesting post up over on Happy EMR Doctor about EMR Software and the Human Genome. In the post he talks about a new program to help integrate EHR software with genome data. It’s a 4 year project, but I believe is the start of something groundbreaking.

It’s become quite clear to me over the past year that the EHRs of the future will be far more than patient records as recorded by the doctor. Instead, the EHR of the future will include a whole bunch of outside data that is collected by the patient.

Yesterday, we briefly discussed health-logging and that will be a major source of data that doctors can use to treat patients. However, probably even more powerful could be tying EHR software to a person’s genome data.

Once we understand the genome, we will likely be able to treat patients more effectively. We will be able to diagnose patients with more precision. We will be able to treat future issues before they become issues. Imagine if you could prescribe a drug that was unique to that person’s genome. Pretty cool stuff.

We are a long way from this happening, but I can clearly see that it’s the future of healthcare and the best way to leverage the genomic data is to tie it with the EHR and its clinical decision support system.

Unless someone thinks it might be better to have patients bring in their genome data on paper. Oh wait, last I checked you couldn’t do genomic tracking on paper.

Data Security in the Age of Self-logged Health

Posted on August 29, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Over at EMR and EHR I have a post going about the self-logging trend, in which people log their medical and other observations on a regular basis. I’m fascinated by the trend, but as an IT person, I shudder at the data nightmares this movement will leash if it becomes widespread.

Quantified Self, a major web hub for self-trackers, has posts on monitoring devicest hat can measures the vitals of people up to 10 meters away, and microsensor embedded mindfulness pills that transmit data to your phone when ingested.

So if someone steals my smartphone, does it mean that not only can s/he spam-text all my friends, but s/he can access all my health logs and PHRs that only my HIPAA compliant provider’s office and EMR systems were supposed to get their hands on?

Indeed, a news story in Med City News says that physical theft, not hacking, is the major concern for mobile storage devices. It’s far easier to flick an iPhone lying on somebody’s desk than to devote the brain- or computing power needed to hack into an EHR system from a reputable vendor.

Med City News reports that during the period from 2009-2011, there were 116 cases of data breaches involving at least 500 patient records (breaches that exposed fewer than 500 records were not included). Physical loss of devices accounted for a whopping 60% of security breaches.

As the Med City News piece notes:

HIPPA violations aren’t happening in the cloud. Rather, they’re happening in the doctor’s office, hospital IT closets, cars, subways, and homes.

Think about how much more this problem can be compounded if health logging becomes practise du jour?

Bottomline: Self-tracking may yet revolutionize healthcare, but could we as individuals potentially jeopardize our own data security? Possibly. It might be a fad among tech geeks but it needs some thinking through from an EMR/EHR perspective.