3 EHR Gaps That Hinder Systematic Chronic Disease Management

3 EHR Gaps That Hinder Systematic Chronic Disease Management

The following is a guest blog post by Andrei Khomushka.

An EHR typically contains multiple highlights of patients’ health, including observations, lab results, diagnoses and treatment plans. However, this data might be insufficient for systematic chronic care management, and there are 3 key reasons for that.

1. Interrupted care setting

Most EHRs are built around the idea that patients control their conditions to the extent that they can arrange timely appointments with their doctors should disturbing symptoms arise. However, the no-shows rate is still high (up to 55%, according to Family Medicine, 2013), and chronic patients often tend to overlook and mistreat symptoms. Leading to occasional appointments in acute situations. This breaks patient data and thus care delivery. So, EHRs can’t show the real picture of a disease progression.

Only continuous care and health tracking can help prevent, or at least detect early complications and exacerbations. As EHRs simply don’t have the tracking functionality, providers need additional solutions bound to their EHRs. For example, mobile patient apps connect individuals and caregivers, allowing the former to sync medical devices and continuously share their health data with doctors, thus ensuring remote monitoring of health status. Then, this information is automatically analyzed and aligned with the EHR so it’s always up-to-date.

2. Lack of patient engagement

As individuals can’t access EHRs directly, they don’t provide any patient engagement elements. Patients can only interact with the EHR data (to some extent) by visiting the patient portal. Here is your chance to engage them. With the standard functionality, such as appointment scheduling, e-billing, lab results checking, portals allow setting goals, sharing achievements across social media, exploring interactive learning materials and more.

However, systematic chronic care is more effective when a technology is proactive and connected to a patient’s daily life (patient portals can’t beat mobile patient apps here). This way, when multiple personal encouragements, guidelines and notifications are already in your pocket, it’s easier to control a chronic condition.

3. Patient-generated data missing

Most EHRs can’t collect and store patient-generated information such as physical activity, nutrition, daily subjective and objective. To benefit from daily updates of patients’ health statuses, we suggest implementing a separate solution integrated with the EHR. This will automatically process and analyze data to identify condition changes that require a physician’s attention. Then, the solution will notify both the patient and the health specialist about the disturbing patterns and suggest scheduling an appointment or test.

Afterword: Reducing the gaps

Overcoming these limitations is essential for a systematic care of chronic patients in the comfort of their homes. However, a thorough rebuild of an EHR is not realistic. Instead of investing substantial time and budget in making the EHR something it is not supposed to be, we recommend creating a holistic solution based on a chronic disease management system (CDMS), which will be connected to the mobile patient application and the EHR. You can find more about CDMS and its benefits in our recent chronic disease management entry.

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Telemedicine A Growing Priority For Hospitals

Telemedicine programs are not new to hospitals. In fact, tele-stroke and tele-ICU programs have gained significant ground over the past several years, and other subspecialties, such as tele-psychiatry, seem likely to grow in popularity.

In coming years, telemedicine will go from being a one-off strategy to an integral part of hospital care delivery, if a new survey is any indication. Government and private insurers are gradually agreeing to pay for telemedicine services, knocking down the biggest obstacle to rolling out such programs. And while integrating telemedicine services with EMRs poses major challenges, hospital leaders seem determined to address them.

Virtually all of the hospitals responding to the survey, which was conducted by telemedicine vendor ReachHealth, told researchers that they were busy planning and preparing for telemedicine programs. Twenty-two percent of survey respondents, which also included some medical practices, said that rolling out telemedicine programs was one of their top priorities, and another 44% said that it was a high priority. Health systems averaged 5.51 telemedicine service lines, up almost 20% from last year.

I was interested to note that 96% of respondents were planning to roll out telemedicine because they felt it would improve patient outcomes. I’m not aware that there’s any substantial body of evidence demonstrating that telemedicine can have this effect, but clearly this is a widespread belief.

Also, it was a bit surprising to read that “improving financial returns” was a very low priority for providers when developing telemedicine programs. On the other hand, as researchers point out, hospitals and practices to see improved patient satisfaction as a driver of ROI. Apparently, execs responding to this survey are convinced that telemedicine to have a substantial effect on satisfaction and outcomes, though to date, only 55% said telemedicine was improving outcomes and 44% felt it was boosting patient satisfaction.

Researchers also found that providers that dedicate more resources to telemedicine are seeing more success than those that don’t. Specifically, hospitals and clinics that have a 100% dedicated telemedicine program manager in place were doing better with their initiatives.

In fact, two thirds of respondents with a dedicated program manager in place ranked their efforts to be “highly successful,” while only 46% of programs without a dedicated program manager met that description. (The programs were most successful when a VP or director was put in charge of telemedicine efforts, but only slightly more than when a CEO or coordinator was in charge.)

That being said, it seems that the highest barriers to telemedicine success are technical. The respondents complained that the lack of common EMR in hub and spoke hospitals, and the lack of integration between telemedicine and their current EMR, were still standing in their way. Many were also concerned about the lack of native telemedicine capabilities in their EMR.

Despite all of the obstacles to creating a flourishing telemedicine program, hospitals and clinics have continued to make progress. In fact, 36% have had a tele-stroke program in place for more than three years, 23% tele-radiology for three years plus, and 22 percent have had neurology and psychiatry telemedicine programs for three years or more. ReachHealth researchers note that service lines requiring access to specialists are growing more rapidly than other service lines, but contend that this is likely to shift given pending shortages of primary care physicians.

Admittedly, any survey published by telemedicine vendor is likely to be biased. Still, I thought these statistics were worth discussing. Do they track with what you’re seeing out there? And do you think EMR vendors will do more to support telemedicine anytime soon?

Posted in Healthcare Integration, Hospital EHR, Hospital EHR Company, Hospital EHR Consulting, Hospital EHR Vendor, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital EMR Company, Hospital EMR Vendor, Hospital Healthcare IT, Hospital IT Systems, Telemedicine | Tagged , , , , | Comments Off on Telemedicine A Growing Priority For Hospitals

An Acronym Look at MACRA QPP

The proposed rule for the MACRA program has been announced. Here’s an acronym laden summary of what MACRA did (Worth noting that CHIP is the C in MACRA for those keeping track of acronyms at home).

MACRA creates a QPP.

MACRA ends SGR

MACRA creates two paths: MIPS and APMs.

MIPS and APMs timeline from 2015 through 2021.

MIPS combines PQRS, VM (or VBPM if you prefer), and Medicare EHR (MU and Certified EHR) into 1 program.

APMs include ACOs, PCMH, and bundled payments.

MU is now ACI.

If you’re not sure about some of the acronyms above, you can find their longer names here. Good thing they simplified and streamlined the various programs!

We’ll be becoming friends with the acronyms MIPS and APMs. Here’s a good summary PDF of MACRA as well. More details to come.

UPDATE: In a bit or irony, Andy Slavitt posted this acronym free video about MACRA:

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Quality Systems, Inc. Discontinues NextGen Now in Favor of MediTouch Platform

IRVINE, Calif.–(BUSINESS WIRE)– Quality Systems, Inc. (NASDAQ:QSII) announced today its Board of Directors approved management’s recommendations for several strategic initiatives, the Company’s updated cloud strategy, a corporate restructuring and the initiation of financial guidance.

MediTouch® Based Cloud Strategy

Following several months of assessment of both the recently acquired MediTouch platform and the Company’s NextGen Now platform in development, management concluded that the MediTouch platform offers the most efficient path to providing a high-quality, robust, cloud-based solution for ambulatory care. As a result, the Company will cease further investment in NextGen Now and immediately discontinue all efforts to use or repurpose the NextGen Now platform. This assessment was conducted under the technology leadership of David Metcalfe, who joined the Company on February 1, 2016 as chief technology officer.

“The acquisition of the MediTouch platform accelerates our time-to-market with a cloud-based platform that already meets the needs of smaller practices. Our focus now will be to scale this solution to address the needs of enterprise-level organizations and larger practices,” stated Metcalfe.

As a result of this decision, Quality Systems’ fiscal fourth quarter and full-year results will reflect a pre-tax charge of approximately $32 million, relating to the impairment of the Company’s previously capitalized investment in NextGen Now. This charge did not result in, nor is it expected to result in, any additional cash expenditures.

Streamlined Corporate Structure

The Company also announced a restructuring plan, which will eliminate its business units in favor of a streamlined, functional-based organizational structure. This new structure will enable a more efficient, integrated and client-centered delivery of the holistic solutions ambulatory care organizations need.

“We are realigning the organization to remove silos and be better positioned to serve our clients, as they pursue population health and value-based reimbursement initiatives. It will also reduce our cost structure and make the organization more nimble,” explained Rusty Frantz, president and chief executive officer.

This organizational realignment is expected to result in approximately $4 million of restructuring-related charges, consisting principally of severance and other one-time termination benefits. The restructuring costs are expected to be primarily incurred and funded in the first and second quarters of fiscal year 2017. In connection with such charges, the Company estimates that it will reduce its headcount by approximately 150 employees, approximately six percent of its U.S.-based workforce. The Company expects $14 million to $16 million of personnel-related savings in fiscal year 2017, excluding the restructuring charge.

Fiscal Year 2017 Guidance and Preliminary & Unaudited Fiscal Year 2016 Results

Effective in fiscal year 2017, the Company will begin providing annual guidance for certain financial metrics. For fiscal year 2017, the Company anticipates revenues of $508 million to $522 million and non-GAAP diluted earnings per share of $0.78 to $0.86. This fiscal year 2017 guidance reflects the anticipated full year contribution from the acquisition of HealthFusion as well as the impact of the corporate restructuring. The Company expects to update this guidance, as appropriate, in its fourth quarter 2016 earnings announcement, scheduled for May 19, 2016.

To provide context for the fiscal year 2017 guidance, the Company also reported that, based upon preliminary financial data, it expects total revenue of $491 million to $493 million for fiscal year 2016 and $126 million to $128 million for its fourth quarter ended March 31, 2016, which are modestly below analysts’ consensus. The Company also expects to report non-GAAP diluted earnings per share of $0.70 to $0.72 for fiscal year 2016 and $0.17 to $0.19 for the fourth quarter, in line or slightly above analysts’ consensus. The Company expects GAAP earnings per share of $0.08 to $0.10 for fiscal year 2016 and a GAAP loss per share of ($0.28) to ($0.26) for the fourth quarter, largely due to the aforementioned impairment charge.

These preliminary, unaudited results are subject to the completion of the Company’s customary accounting and auditing procedures. Final adjustments and other developments may arise between the date of this press release and the dates on which the Company announces its 2016 fourth quarter and audited year-end results and files its Annual Report on Form 10-K with the Securities and Exchange Commission, that may cause actual results to materially differ

About Quality Systems, Inc.

Irvine, Calif.-based Quality Systems, Inc. (QSI) and its subsidiary, NextGen Healthcare Information Systems, develop and provide a range of software and services for medical and dental group practices, including practice management and electronic health record applications, patient portal, interoperability and connectivity products, and population health management and analytics offerings. Services include managed cloud services, revenue cycle management, claims clearinghouse, data interchange and value-add consulting. The Company’s solution portfolio is readily integrated and collectively positioned to drive low total cost of ownership for its client partners, as well as enable the transition to value-based healthcare. Visit www.qsii.com and www.nextgen.com for additional information.

Posted in EHR, EHR Vendors, Electronic Health Record, Electronic Medical Record, EMR, EMR Consolidation, Healthcare, Healthcare IT | Tagged , , , | Comments Off on Quality Systems, Inc. Discontinues NextGen Now in Favor of MediTouch Platform

CMS Announces Details for MACRA, MIPS, APM – The Future of Meaningful Use

Seven years ago, Congress passed a law to spur the country to digitize the health care experience for Americans and connect doctors’ practices and hospitals, thereby modernizing patient care through the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.” Before this shift began, many providers did not have the capital to invest in health information technology and patient information was siloed in paper records. Since then, we have made incredible progress, with nearly all hospitals and three-quarters of doctors using EHRs. Through the use of health information technology, we are seeing some of the benefits from early applications like safe and accurate prescriptions sent electronically to pharmacies and lab results available from home. But, as many doctors and patients will tell you (and have told us), we remain a long way from fully realizing the potential of these important tools to improve care and health.

That is why, as we mentioned earlier this year, we have conducted a review of the Meaningful Use Program for Medicare physicians as part of our implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), with the aim of reconsidering the program so we could move closer to achieving the full potential health IT offers.

Over the last several months, we have made an unprecedented commitment to listening to and learning from physicians and patients about their experience with health information technology – both the positive and negative. We spoke with over 6,000 stakeholders across the country, including clinicians and patients, in a variety of local communities. Today, based on that feedback, we are proposing to incorporate the program in to the Merit-based Payment System (MIPS) in a way that makes it more patient-centricpractice-driven and focused on connectivity. This new program within MIPS is named Advancing Care Information.

What We’ve Learned

In our extensive sessions and workshops with stakeholders, a near-universal vision of health information technology surfaced: Physicians, patients, and other clinicians collaborating on patient care by sharing and building on relevant information.

Three central priorities to address moving forward:

  1. Improved interoperability and the ability of physicians and patients to easily move and receive information from other physician’s systems;
  2. Increased flexibility in the Meaningful Use program; and
  3. User-friendly technology designed around how a physician works and interacts with patients.

This feedback created a blueprint for how we go forward to replace the Meaningful Use program for Medicare physicians with a more flexible, outcome-oriented and less burdensome proposal.

How We’re Moving Forward

Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology. Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduces burden, and improves patient outcomes because it would:

  • Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice
  • Simplify the process for achievement and provide multiple paths for success
  • Align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria
  • Emphasize interoperability, information exchange, and security measures and require patients to access to their health information through of APIs
  • Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting
  • Reduce reporting to a single public health immunization registry
  • Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures
  • Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

A full list of the operational differences included in this new proposal is available here, along with more details on how it would work.

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

Under the new law, Advancing Care Information would affect only Medicare payments to physician offices, not Medicare hospitals or Medicaid programs. We are already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well.

This proposal, if finalized, would replace the current Meaningful Use program and reporting would begin January 1, 2017, along with the other components of the Quality Payment Program. Over the next 60 days, the proposal will be available for public comment. It is summarized here http://www.hhs.gov/about/news/2016/04/27/administration-takes-first-step-implement-legislation-modernizing-how-medicare-pays-physicians.html  and the full text is available here https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf . We will continually revise and improve the program as we gather feedback from patients and physicians providing and receiving care under the Advancing Care Information category – and the Quality Payment Program as a whole. We look forward to hearing from you and working together to continue making progress in the coming months and years.

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Health IT Software Must Be Meaningful and Pleasurable

One of the most dynamic healthcare CIO’s is Shafiq Rab, MD, MPH, Vice President and CIO at Hackensack UMC. Healthcare Scene was lucky enough to talk with him at the DataMotion Health booth during HIMSS 2016. Dr. Rab talked with us about Hackensack UMC’s approach to healthcare IT innovation. He offered some great insights into how to approach any healthcare IT project, about Hackensack University Medical Center’s “selfie” app, and their efforts to use Direct and FHIR to empower the patient.

I love that Dr. Rab leads off the discussion with the idea that healthcare IT software that they implement must be meaningful and pleasurable. Far too many health IT software miss these important goals. They aren’t very meaningful and they’re definitely not pleasurable.

Dr. Rab’s focus on the patient is also worth highlighting. Health IT would be in a much better place if there was a great focus on the patient along with making health IT software meaningful and pleasurable. Thanks Dr. Rab and DataMotion Health for doing this interview with us.

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No Doubt Digital Health Has Gone Mainstream

The big digital health news yesterday was that Nokia was acquiring Withings. There’s no better sign of the massive market opportunity that is the digital health space. It also seems to show a huge pivot in the business model of Nokia. Long a phone manufacturer, they’re now using their massive war chest and understanding of the mobile industry to enter into the digital health space in a big way with this acquisition.

From the Withings perspective, I’ll be interested to see what Nokia can do as far as distribution of the Withings product lines. Withings has had a strong presence in the digital health space for a while, but there’s definitely a land grab happening between all the various players in the industry. We’ll see if having Nokia around can accelerate their acquisition of market share.

I’ll be interested to see where Nokia takes this as well. Is this the first of many digital health acquisitions? Withings has a great digital health product line, but we’re seeing an explosion of health sensors that could compliment their product line. Nokia has much deeper pockets than Withings, but are they willing to acquire companies to build up their war chest of health sensors? It will be fun to watch it play out.

I wonder if Nokia’s ties to Microsoft will be a help or a hindrance to Withings. Certainly they’re going to have to hook into the iOS and Android platforms. They already are, but will this acquisition make those integrations harder? Will they miss out on opportunities with these 2 major phone types because of the new connection to Nokia?

I’m always interested which large companies are starting to enter the digital health space. We’ve seen a ton of work from large brands like Adidas, Nike and Under Armour for example. iFit has been working really hard on the space and they come out of NordickTrack. Fossil acquired Misfit. I’m sure there are bunch more I missed, but such an extraordinary diversity of companies working in the space.

Who else do you think will enter the space? Any companies you think that will become the leaders?

Posted in Digital Health, Health Care, Health Sensors, Healthcare IT, mHealth, Mobile Health Care, Windows Phone | Tagged , , , , , | Comments Off on No Doubt Digital Health Has Gone Mainstream

Nokia and Withings: Connecting People to Better Health

By Ramzi Haidamus, President Nokia Technologies

Today is a day to celebrate! Over the years, many of you have shared with us your love for Nokia. We’ve heard so many great stories about the coolest Nokia device you ever owned — something that helped define your life, make it better, more fun, and more connected to the people and things that matter to you most. Your continued enthusiasm is just one of the reasons we’re thrilled to announce some very big news today.

We’re now starting a new chapter as a company, this one focused on connecting you to better health through technology. We aim to help you lead a happier, healthier life through the kind of beautifully designed products that you expect from Nokia.

To help us do this as fast as possible, we will be welcoming Withings into the Nokia family. A leader in digital health products and apps designed to improve everyday well-being and long term health, Withings will combine perfectly with Nokia’s heritage of mobility and connectivity.

Withings products already help people manage every aspect of their health and lead a more balanced life. Their products allow you to measure how your lifestyle is affecting your wellness — how well you’re sleeping, how many calories you’re burning, how many steps you’re taking — and go beyond the numbers to give you information that matters. They help you understand how your body responds to activity and changes — the impact your activity is having on your body temperature, your weight, your blood pressure and your heart. And they do it with such a beautiful design that you love to wear them anywhere — at work, at home, or even at the opera.

Please stay tuned for more news about this new chapter for Nokia. We’re thrilled to be welcoming the Withings team to Nokia Technologies and help spread the word about all the awesome products they’re building. Together, we’ll take digital health products beyond counting and tracking to help people everywhere connect to healthier and happier lives.

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Nokia plans to acquire Withings to accelerate entry into Digital Health

Espoo, Finland – Nokia has announced plans to acquire Withings, a pioneer and leader in the connected health revolution with a family of award-winning digital health products and services to help people all over the world lead healthier, happier and more productive lives. Withings would be part of our Nokia Technologies business.

“We have said consistently that digital health was an area of strategic interest to Nokia, and we are now taking concrete action to tap the opportunity in this large and important market,” said Rajeev Suri, president & CEO of Nokia. “With this acquisition, Nokia is strengthening its position in the Internet of Things in a way that leverages the power of our trusted brand, fits with our company purpose of expanding the human possibilities of the connected world, and puts us at the heart of a very large addressable market where we can make a meaningful difference in peoples’ lives.”

World Health Organization figures show cardiovascular disease as today’s number one cause of death, with more than a billion adults around the world living with uncontrolled hypertension. Diabetes now affects more than one in twelve adults worldwide, a four-fold increase since 1980. Healthcare is expected to be one of the largest vertical markets in the Internet of Things, with analysts forecasting that mobile health, with a CAGR of 37%, will be the fastest growing health care segment from 2015-2020.

“Withings shares our vision for the future of digital health and their products are smart, well designed and already helping people live healthier lives,” said Ramzi Haidamus, president of Nokia Technologies. “Combining their award-winning products and talented people with the world-class expertise and innovation of Nokia Technologies uniquely positions us to lead the next wave of innovation in digital health.”

The combination of innovative products from Withings and the Digital Health business will also ensure the ongoing renewal of Nokia Technologies’ world class IPR portfolio.

Withings was founded by Chairman Eric Carreel and CEO Cedric Hutchings in 2009 and is headquartered in France, with approximately 200 employees across its locations in Paris, Cambridge, US and Hong Kong. Withings’ portfolio of regulated and unregulated products includes activity trackers, weighing scales, thermometers, blood pressure monitors, home and baby monitors and more, and is built on a sophisticated digital health platform, providing insights to empower people to make smarter decisions about the health and wellbeing of themselves and their families. Withings’ own products are complemented by an ecosystem of more than a hundred compatible apps.

“Since we started Withings, our passion has been in empowering people to track their lifestyle and improve their health and wellbeing,” said Cédric Hutchings, CEO of Withings. “We’re excited to join Nokia to help bring our vision of connected health to more people around the world.”

The Nokia brand continues to be recognized, valued and trusted by consumers, built on a heritage of beautifully designed, innovative and reliable technology in the service of people around the world to help real human needs.

The planned transaction values Withings at EUR 170 million and would be settled in cash and is expected to close in early Q3, 2016 subject to regulatory approvals and customary closing conditions.

Sources:

World Health Organisation: Diabetes fact sheet; Cardiovascular diseases fact sheet; Global Health Observatory data.

P&S Market Research, “Global Digital Health Market Size, Share, Development, Growth and Demand Forecast to 2020.” November 2015

About Nokia Technologies
Nokia Technologies is Nokia’s advanced technology and licensing business. Formed in 2014, TECH builds upon our solid foundation of industry-leading licensing and technology R&D capabilities. By focusing on Digital Health, Digital Media, Brand Licensing, and Patent Licensing, TECH is expanding the human possibilities of the ever-evolving world of technology. In 2015, Nokia Technologies launched OZO, the world’s first virtual reality (VR) camera designed for professionals.

About Nokia
Nokia is a global leader in the technologies that connect people and things. Powered by the innovation of Bell Labs and Nokia Technologies, the company is at the forefront of creating and licensing the technologies that are increasingly at the heart of our connected lives.

With state-of-the-art software, hardware and services for any type of network, Nokia is uniquely positioned to help communication service providers, governments, and large enterprises deliver on the promise of 5G, the Cloud and the Internet of Things. http://nokia.com

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It’s Time For A New HIE Model

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?

Posted in HIE, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT, Hospital IT Systems, Medical Devices, Mobile Technology | Tagged , , , , , | Comments Off on It’s Time For A New HIE Model

The “Feature List” Disconnect from Healthcare Problems

One of the big takeaways coming out of the Healthcare IT Marketing and PR Conference is that most health IT companies are still spouting out the features they offer and very few actually talk about the problems they solve. This is a huge mistake for a health IT company, but it’s also a big reason why most hospital executives don’t want to hear from you.

As a healthcare executive you’re inundated with marketing and sales pitches and after a while they all start to look the same. Plus, many (some might say most) of those pitches require the hospital executive to try and translate a long list of features into the problems that executive is trying to solve. It’s no wonder that most hospital executives barely look at these pitches and often aren’t aware of the opportunities for innovation that exist for the problems they’re trying to solve.

Think about how many healthcare IT companies could list the following set of features in their sales and marketing:

  • Data Analytics
  • FHIR Enabled
  • HIPAA Compliant
  • EHR Integration
  • Machine Learning
  • Mobile Optimized
  • Real Time Processing
  • etc

I could keep going on, but you get the point. I’m reminded of something Shahid Shah said at our session at HIMSS. No one in healthcare has an interoperability problem. His point isn’t that interoperability isn’t important or valuable. His point was that no one is trying to solve interoperability. They have other problems they are trying to solve and data sharing (ie. interoperability) might be the solution. However, when they think about their problems and challenges interoperability is not on that list.

Hospital systems definitely have plenty of problems they’re trying to solve. Here’s just a few examples to give you a flavor of problems hospital executives are working to solve:

  • Improving HCAPHS Scores
  • Reducing Hospital Readmissions
  • Improving Provider Efficiency
  • Ensuring Accurate Patient Identification
  • Lowering Sepsis Numbers
  • etc

This list never ends. These are problems that hospital executives are working to solve and understanding which problems are vexing a hospital executive is key to getting them interested in the solutions. I think this small change would make it so hospital executives dread the wave of marketing and sales pitches a little less. The reality is that most of these executives are looking for great solutions. It’s just often hard for them to know what problems your company can really solve.

Of course, the next challenge is showing proof of your ability to solve the problem. However, at least that gets a hospital executive one step closer to finding solutions to their problems and challenges.

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