Thursday, July 24, 2014

Mobile Health Annual Update

It has been 16 months since I wrote here about the proliferation of mobile health applications.  More so than  desktop health IT, these developments place HIT in the hands of consumers and patients, allowing for instant gratfication for questions they may have in real time.

Mobile health IT falls into one of three categories,  information access, monitoring, and guidance.

It is an appropriate time to review my last post on mobile health.

During the past year several large internet presences, Google and Microsoft have taken an active interest, other than the Personal Health Record (PHR).  Market demand for PHR was sadly lacking, given that potential patients balked at entering their own health data. (much like providers). Time was a major deterrent  for data entry.  However the PHR  may be reincarnatedted as a subset or import from the  provider electronic record. (EHR)  In many ways this will improve accuracy, credibility and content.  Perhaps the  web portal may be a more eloquent means for editing and/or extracting personal health items from the professional EHR.

Google and developer Pathfinder have targetted the mobile health IT space.


 The Android Store

Microsoft store. a potential market place for Windows mobile has far fewer offerings. Sadly the Microsoft Store does not even have a category for Mobile Health Apps for the Windows Phone, or Surface Tablet (Microsoft's offering for tablet PCs) Again Open source is more attractive to developers.

Developer challenges with awards and stipends also are stimulating development by venture capitalists for the marketplace.

Android Developers
Surface and Windows Phone Developers

Late Breaking News:  Medicare and Telehealth

Wednesday, July 23, 2014

mHealth App Developer ? Contact the FDA first for Guidelines

Serious mobile health app developers would do well to contact the Food and Drug Administration regarding proposed regulations for mobile health applications.

Health care providers, patients and others are concerned about the safety and reliability of some applications. HPAA regulations forbid identifying data to ensure privacy and confidentiality for many HIT applicatioins.  As applications increase in number the offerings are often duplicated and complex.  There are a bewildering number of health apps currently on the market. 

The FDA is currently in the early phases of studying this area and is proposing "rule making"  This is a precursor to the process and a period of open comments for those interested in approval processes.

Many  developers such as Apple, Google, Microsoft are investing in health technology experts to guide health app development.

                                     Apple has added Divya Nag, 

With experience in managing product launches, gaining FDA approval, and partnering up with existing healthcare industry behemoths, Nag could be the key to Apple being able to launch devices such as the iWatch and Healthbook software that could track the likes of blood sugar, pulse, sleep patterns, and blood pressure. Apple has previously met with the FDA on multiple occasions to discuss upcoming “Mobile Medical Applications.” 

Nag’s experience in medical product testing could also be valuable to the testing process for Apple’s future medical products. Apple job listings indicate that the Cupertino-company has been seeking engineers experienced in designing and executing tests of health-oriented products. 

Saturday, July 19, 2014

International AIDS Conference Impacted by Malaysian Airline Tragedy

IAC: Tragedy, Low Attendance Won't Stop Meeting

Published: Jul 18, 2014   By Michael Smith, North American Correspondent, MedPage Today

The 2014 International The The AIDS Conference will go on as planned despite the deaths of dozens of delegates aboard the airliner said to ave been shot down over eastern Ukraine.
Conference organizers were stunned by reports that dozens of delegates were aboard a Malaysia Airlines jet from Amsterdam that exploded over disputed territory in eastern Ukraine, reportedly after being struck by a surface-to-air missile.
The International AIDS Society, the meeting sponsor, said in a statement late Thursday (U.S. time) that if the reports are accurate, "this is a truly sad day." News reports said that former society president Joep Lange, MD, was among those on the doomed airliner. Professor Lange’s colleagues said that he was one of those who had 'changed the course of humanity'.
"If that is the case, then the HIV/AIDS movement has truly lost a giant," the society statement said. A later statement confirmed that the meeting would not be canceled.
The airline tragedy recalled the 1998 crash that took the life of prominent AIDS researcher Jonathan Mann.
He was aboard Swissair 111, which plunged into Canadian waters off Peggy's Cove, Nova Scotia on Sept. 2, 1998 – scarcely 6 weeks after another International AIDS Society meeting in Geneva, Switzerland.
The AIDS conference commemorates Mann every 2 years in its opening ceremony, when a prominent researcher or activist gives a special lecture named for him. This year, the Jonathan Mann memorial lecture, to be delivered by Michael Kirby, a retired Australian judge, is on HIV and the law.
A minutes silence and a candlelight vigil has been held in Melbourne in honour of the world's leading experts in the battle against HIV who were killed while travelling on Malaysia Airlines flight MH17 en route to an AIDS conference in the city.
The tragic loss of researchers who died should be used to push the life-saving agenda of the meeting, the UN AIDS chief  Mr Michel Sidibe urged as he spoke outside Melbourne Arts Centre Hamer Hall on Friday night.

A special tribute to the former president of the International AIDS Society (IAS) and ‘giant’ of HIV research, Joep Lange, was also given by Mr Sidibe.

The 20th International AIDS Conference was nearly cancelled after it emerged many of the 298 who died when Flight MH17 crashed in Ukraine were delegates with their family members.

Organisers of AIDS2014 still don't know exactly how many of the 12,000 researchers coming to Melbourne for the five-day conference were on board MH17.


Sunday, July 13, 2014

What do Patients Expect in Health Information Technology ?

There are thousands of applications available for eHealth. There are several categories

  • Standard readily available consumer driven platforms and software, such as Google and all of it's related services, such as Gmail, Docs, Calendar,Impress (a presentation app) and a social media platform known as Google pllus. Google plus offers a video conferencing app which has connectivity to many other google plug ins. (Hangouts, and Hangouts on Air_)
  • Microsoft offers either a client server suite of Microsoft Office or a cloud based Office called Windows Office 365. This is offered on a paid subscription  basis. Their  email is named Outlook. Office 365 includes a calendar, word processor, spreadsheet, powerpoint presentation,and other apps as well.

  • Apple amd Android have  significant library of health apps, mobile health apps utilizng individual operating systems, iOS for Apple and Android for Google smartphones, and tablets, as well as Chrome for Chromebooks.  Apple's applications are available on iTunes. Android apps are available on the Android store, Chromebook Store, or Google play.  The available health apps mirror each other on both OS systems, however there are some differences. Practically speaking users select an OS when they purchase their devices.  The marketplace for Apple and Google have evened out in the past two years.     

Predicting the future in certain areas of HIT can be dangerous for manufacturers, vendors and providers. Health IT is still in it's infancy as far as usabiity and functionality. As we progress in the use of HIT the curve of innovation is not slowing down .

Most U.S. Residents Prefer Doctors Who Email With Their Patients

However providers are reticent to use this approach due to vulnerability of email systems that are not seccure.  Inevitably this will change.

A majority of U.S. residents say they prefer physicians who offer email communication with their patients, according to a survey by Catalyst Healthcare Research, MobiHealthNews reports.

Study Details

For the study, researchers surveyed 433 U.S. residents over the age of 21 to gauge how they prefer to receive information from their health care providers. Respondents were split into four categories:
  • Generation Y, or those ages 21 to 33;
  • Generation X, or those ages 34 to 48;
  • Baby Boomers, or those ages 49 to 67; and
  • The Silent Generation, or those ages 68 and older.

Study Findings

According to the survey, 93% of respondents said they prefer to see a physician who offers email communication with his or her patients. Of those respondents, one-quarter said they still would choose a doctor who offers email consultations, even if there is a $25 charge for such communication.
In addition, the survey found that:
  • 84% of respondents in the Baby Boomer group used the Internet to obtain medical or drug information;
  • 62% of respondents in the Generation Y group searched for physician information online; and
  • 41% of respondents in the Generation Y group looked for medical procedure costs online.
The survey also showed:
  • 44% of respondents were interested in paying medical bills online, including 55% of both the Generation Y and Generation X groups; and
  • 46% of respondents in the Generation X group were interested in viewing lab results online.
However, the survey found that 27% of all respondents said they preferred to schedule physician appointments online, compared with 67% who preferred to do so over the phone.
The survey also asked respondents about their preferred forms of physician communication outside of office hours. The survey found:
  • 14% of respondents were interested in a video chat program, such as Skype;
  • 57% were interested in dialing a number that offers a call-back feature; and
  • 30% desired a 24-hour phone number (Pai, MobiHealthNews, 6/3).

Wednesday, July 9, 2014

Progress on the Frontiers of Health and Medicine

The frontiers of medicine are not only in the development and transformation of delivering health care, but is also a physical impediment to delivering a level of quality health care.Rural health care presents unique challenges for delivery of care. There are fewer providers, facilities, and less economic support.

As described by Leila Samy, Meghan Gabriel, and   Jennifer King on HealthITBuzz

Leila Samy

                                                                Meghan Gabriel
                                                                                                               Jennifer King

Critical Access Hospitals (CAHs), some with a census of fewer than 10 patients, are the smallest of the small rural hospitals. In some regions, such as frontier areas, a CAH may be the only local health care provider serving an area the width of the state of Rhode Island! CAHs are small, geographically isolated and have limited resources.

CAHs are found in every region of the country, and represent roughly 30 percent of hospitals nationwide. Often serving as the focal point for all health care services in a rural area, CAHs often own and run the local rural health clinics and skilled nursing facilities. They may also be responsible for public health and emergency medical system services. These hospitals extend services to places where they wouldn’t otherwise be available. And those are the reasons why it is important for CAHs to have access to health IT systems and capabilities.
As of 2013, 89 percent of CAHs had an EHR in place; 62 percent of CAHs with an EHR had a fully electronic health record system, and 27 percent had a health record system that was part electronic and part paper.
Most CAHs adopted (as of 2013) or planned to adopt (by the end of 2014) the health IT capabilities evaluated in this study (i.e., telehealth, teleradiology, care coordination and health information exchange with other providers and patients).
As of 2013, CAHs reported the highest rates of adoption for teleradiology (70 percent) and telehealth (59 percent) capabilities. Fewer CAHs reported other capabilities related to electronic exchange of key clinical information with other providers. Even fewer (15 percent) of CAHs reported patient engagement capabilities (i.e., offer patients ability to view, download and transmit their health information
Among the challenges to health IT adoption among CAHs, financing and workforce related challenges were most commonly reported.
CAHs that pooled resources with other hospitals were more likely to have EHR and capabilities related to health information exchange and care coordination, compared to those that did not pool resources or engage in group purchasing.
CAHs with faster Internet upload speeds were more likely to have the capability to provide patients with the option to view, download, and transmit their health information compared to those with slower upload speeds.
The Federal Government is offering funding opportunities and offers Creative Solutions to Expand  Rural Health IT Funding

Benefits of Health IT adoption among CAHs and other small, rural hospitals

Thursday, June 26, 2014

The Doctor's Lounge' The VA Crisis

The impact of Medical Information Technology, "meaningful use" HITECH regulations, and the ongoing VA scandal are on tap, at  America's Web Radio 

The Docs4Patient Care organization is featured on the initial episode of The Doctor's  Lounge, as Hal Scherz M.D. and Michael Koriwchak discuss HITECH and the V.A. Crisis.  Listen in

Dr. Koriwchak heads up the conversation, being the policy expert on Medical Information Technology and primary author of our D4PC white paper, "Policy on Medical Information Technology" - available online

Tune in on Thursdays at 8 AM for 'The Doctor's Lounge" for future topics: 

Digital Health Space will carry these weekly presentations.

Wednesday, June 25, 2014 Online User Experiences

Similar to the roll out of Covered California, the nationwide exchange was even more flawed and unreachable for more than one month.

Short Videos of Users on the Website

The brief videos below highlight some of the challenges faced by the study participants outside California as they used the federal website to enroll in health coverage under the Affordable Care Act.
  • Positive Impressions: Participants had anxiety about applying for health insurance and were surprised and relieved by the ease-of-use and clean look and feel of Watch Video
  • Quitting Points: There were several points at which participants abandoned, or would have abandoned, the online process to seek phone or in-person help. Watch Video
  • Areas of Uncertainty - General Context: Participants were unsure about some ACA concepts such as "deadlines" and "tax credits," and they didn't always find adequate explanations or help. Watch Video
  • Areas of Uncertainty - Site Elements: Some participants had challenges providing income and household information, logging into the system and navigating through certain parts of the site. Watch Video

The Affordable Care Act expands coverage options and provides an opportunity to streamline the enrollment process in public and private coverage. CHCF funded an assessment of to identify actionable ways to improve consumer experience with online enrollment.
The assessment uses a methodology not common in the public sector — direct observation of consumers as they move through the website. This technique captures sources of consumer satisfaction, knowledge, confusion, and frustration. The most compelling findings relate to assisting consumers with plan shopping and selection, providing adequate help throughout the process, and ensuring accuracy in consumers' responses to application questions. The report concludes with researchers' recommendations for improvement.

Compare these findings with those of  Covered  California in our earlier blog post.

The California Health Care Foundation also published a study of for comparison of states using the national website.

Were this a private enterprise it would have stood little chance of success. Supervision and implementation were poor from the bottom to the top of the chain of command. User Experience  download