Saturday, January 14, 2017

Health Care's Most Wired

In this day and age do you know how your hospital compares to others in your region.  How wired are you?

Patients and providers are much more aware of these capabilities, and they are one more metric availalbe to grade rank.  HealthGrades, and many other sites list Meaningful Use as one of their criteria.

Health IT is now firmly  embedded as one of the key factors in quality measures. It shares equal importance with mortality rates, infection rates, readmission rates, patient satisfaction scores and others.

Measure your 'Most Wired'  rating, take the survey. The survey opens on January 15, 2017

2016 Wired Survey Results

Most Wired Award

The Most Wired Survey and Benchmarking Study recognizes hospitals and health systems for excellence in IT, based on the organization’s achievements within an analytic structure. Hospitals are stratified based on progress in adoption, implementation and use of information technology in four areas:
  • Infrastructure
  • Business and Administrative Management
  • Clinical Quality and Safety (Hospital Inpatient/Outpatient)
  • Clinical Integration (Ambulatory/Physician/Community)
Participating organizations will be identified as FoundationalCoreAdvancedExpert or Leader in each of the four focus areas. The number of organizations recognized as Most Wired is based on the number of hospitals that achieve "Core Level (2)" development across all four focus areas. Most Wired Advanced recognizes organizations that achieve "Advanced Level (3)" in all four focus areas.
  • January 15, 2017: 2017 Most Wired Survey opens
  • March 15, 2017: 2017 Most Wired Survey closes
  • May 2017: Winners announced
  • July 2017: Health Forum Leadership Summit, Awards presented

Small and Rural

A hospital is considered small and rural based on bed-size (100 beds or less) or location outside a Metropolitan Statistical Area (MSA), as designated by the U.S. Office of Management and Budget (OMB). Organizations whose responses reflect development in the four survey focus areas not already recognized on the primary Most Wired list are Most Wired—Small and Rural.

Most Improved

Organizations whose responses reflect the most improvement from the last to current survemey period not already recognized on the primary Most Wired list are Most Improved.

Innovator Award

Up to three winners and three finalists will be selected for the Most Wired Innovator Award. Organizations may complete a separate application detailing innovative IT solution(s) already implemented at their hospital or system. A panel of hospital and information technology leaders will evaluate IT projects based upon achievement of business objective, creativity and uniqueness of concept, scope of solution and impact on the organization. These organizations may or may not be included in any of the other award types. Learn More about the Innovator Award.

Survey Follow-up and Verification

Based upon your organization's answers to survey questions, we may need to follow up to verify your answers or to gather additional information. Each year, approximately 10 percent of participants are verified.
Additionally, you may be contacted to be interviewed for an upcoming article in H&HNmagazine.

Friday, January 13, 2017

A New Generation of eHealth Systems Powered by 5G

Just when we have become comfortable with 'there's an app for that' and downloading an icon to  your android smartphone or iPhone there cometh a new 'boy on the block'.

By 2020 4G will become obsolete to be replaced by 5G.  Health 3.0 will evolve into Health 4.0. What are the advantages and disadvantages of such a change?

Not only is 5G faster, it is a totally new technology that requires re-engineering what happens on your smartphone.

Standardized 5G systems will be market ready around 2020. What is clear is that 5G will be more than a simple evolution of the current network. Indeed, it will be a catalyst for new products and services by integrating networking, computing and storage resources into a unified infrastructure, becoming the nervous system of cognitive objects and cyber-physical systems. This white paper has as its scope the requirements of providing effective healthcare using 5G technology.

What factors are driving this change ?

Health 4.0 is a vision of care delivery that is distributed and patient-centered, and there is already evidence of a shift towards virtualization and individualization of care. With 5G as its foundation, the transition to person-led care can be completed. Healthcare models are rapidly changing due to demographic and socio-economic changes from a hospital based, specialist focused approach to a distributed patient centric care model. The point of care is shifting from hospitals towards GP surgeries, day-clinics, care homes, patient homes and the Internet.

 It is generally assumed that commercial standardized 5G mobile communication systems will emerge around 2020.

"A New Generation of e-Health SystemsPowered by 5G" white paper posted by the European Commission, "Digital Single Market" defines the new standards and what they will accomplish in 2020.  That is a mere 4 years away.....a millenium in internet and smart device lives.

The WWRF World Wireless Research Forum presents an overall view of wireless technology.

The 5G Huddle: Opening Presentation of Houlin Zhao - Secretary General of ITU

However, no medical doctors or patient organizations, who are the end users of e-Health and medical applications, are members of any 5G research projects. Their voices are indirectly represented by government officers, the term citizen is used. Also medical and e-Health together claim the second most frequent vertical applications, while the top vertical application is vehicle.

The key point is that once again medicine and health technology are lagging in vertical integration of a future technology that promises to increase usability and  reliability of IOT, remote monitoring, and mHealth. These new technologies ie, 5G are well along in development for other industries, particularly automotive and autonomous vehicle controls.

Health Care IT appears to be bogged down by counterproductive regulations from Washington, D.C. in regard to scraping data for MIPS and MACRA.  Energy to develop 5G for health has been diverted into government's self-interest to regulate health care and decrease cost.

Health 4.0 – virtualization of care Industrial and emerging economies are undergoing groundbreaking demographic and socio-economic changes. The 19th and 20th century healthcare systems with hospitals and specialists at their core surrounded by General Practitioners are changing in a rapid and progressive manner. More and more people receive treatment in day clinics, day surgery units, doctors’ surgeries, at home – or over the Internet. The delivery of care in the future will be distributed and patient centered rather than hospital based and practitioner focused. So far this trend has only been visible by studying statistics on hospital beds, treatment costs, doctor numbers, demographics and case mixes3.    Health 4.0 will support the collection of data in the real world and their transformation and aggregation into more complex services (virtual world). This will allow for delivery of care close to the patient’s domain (hospital to home) (Virtualization and decentralization). The delivery of (virtualized) care will be in real time and based on (next to) real time data collection.

Simply put Health 4.0, with 5G as its foundation, will see well-being, social care, and healthcare services transition from supplier-led to person-led. There are several important concepts in this seemingly simple statement – the inclusion of well-being in the care spectrum, the transition of leadership of services, and use of the term ‘person’ not ‘patient’. 5G provides a technical foundation for much opportunity in health domain. In parallel to the formal health and social care services, 5G enables the consumer market to play a role. Consumer devices have proliferated in the marketplace. These devices cover the range of data-generating apps through fit bit-like devices that automatically collect and share data, through what would otherwise be considered devices solely in the purview of the medical community like pulse oxymeters, which measures oxygen saturation in a person’s blood non-invasively. This availability and proliferation of consumer devices is pushing healthcare from treatment triggered by symptoms and medical incidents to more self-diagnosis and care, and health. With a wealth of devices and hence knowledge, the average person is able to make different choices to proactively impact health and well-being and thus healthcare truly now includes well-being. As care includes well-being more and more, the term patient will no longer apply. A patient by definition is someone seeking healthcare; someone that already has health symptoms or experienced an incident. With consumer devices and virtualized ‘care’, the patient becomes less relevant and the person more relevant. This will also trigger discussions around new business models, which are able to integrate well-being, health and social care approaches. This might lead to individualized healthcare accounts, which may enhance people’s ability to design their individual care profile that might be funded from different sources. It is easy enough to visualize people using IoT technology and consumer devices for their well-being to monitor and manage exercise, sleep, heart rate and so on. Consumer-oriented medical devices will extend this, allowing people to more easily manage their chronic conditions in ways that only their health care providers could formerly. Proper management of chronic disease leads to better patient outcomes.

Based upon previous lag in adoption of new HIT providers may reject these new technologies as it first appears to decrease provider involvement in patient care.  The reality is that it will relieve allied health personell from monitoring patients, with data going directly to the electronic health record for analysis by the provider.

The key take-aways can be summarized as follows:  Healthcare models are rapidly changing due to demographic and socioeconomic changes from a hospital based, specialist focused approach to a distributed patient centric care model  The point of care is shifting from hospitals towards GP surgeries, day-clinics, care homes, patients’ own homes and the Internet  The empowerment of patients and their formal and informal carers has become a prime target of health care strategy development in Europe and elsewhere  Emerging new network technologies, including 5G, will form the backbone of future healthcare, enabling the Internet of Things, Smart Pharmaceuticals and Individualized Medicine  Cloud computing, Big Data and enhanced security will enable virtualization and individualization of care and allow the application of Industry 4.0 design principles in health care (Health 4.0). 

Merger May Revitalize California’s Flagging Effort To Pool Medical Records

California Healthline Reports on merger
by Chad Terhune

This announcement strikes close to my heart. In early 2005 then President George W. Bush II appointed David Brailer M.D. from California to be the first Chairman of the Office of the National Coordinator for Health Information Technology. His experience as the head of the now defunct Santa Barbara HIE was invaluable as he catalyzed the growth of what was then called RHIOs, or Regional Health Information Exchanges.

I was enthused and asked if I could come to Washington, D.C. to assist in the then visionary ideas of central repositories and linkages between providers and hospitals.  Dr Brailer asked me to remain in Southern California and  lead my own efforts.

His leadership and expertise guided me in my efforts to promote and implement the Inland Empire Health Information Exchange.  At this stage of early development many proponents were volunteers. There arose several advisory bodies, whose names changed, but whose personel remained the same dedicated group.

The challenges were and continue to be many. I list some of them here.

1. Building a sustainable business model from day one.  Avoiding state and/or federal grants
2. Lack of a demonstrable ROI for  hospitals and providers.
3. Funding the considerable hardware/software platform with interoperable functionality.
4. Initially the total lack of interoperability of EHRs.
5. Lack of real world platforms.  Picking one from many poor applications was a challenge in itself.
6. Hospitals and Providers looked at their own data as proprietary information and would not share.
7. Legal precedents were lacking, and created a need for responsibility, and privacy guidelines.
8. Ensuring HIEs would be compliant with HIPAA

During the past 12 years many things have occured.

1.  ONCHIT's interoperability standards
2   The requirement for EHR vendors to attest to their EHR's interoperability.  Unfortunately this fell on the already overburdened shoulders of providers and hospitals.
3.  Congressional funding via the  HITECH Act which included incentive payments to providers, and funds to develop a skilled worker set for  HIT.
4.  Public enthusiasm and knowledge of the potential for accessing their medical history from other locations than their principal place of health care.


Not all HIEs are equal
Few patients leave their region to obtain health care
Individual providers have no interest in interoperability outside their own group practice. They do not want to pay for HIE.
The further development of EHRs with  messaging capability, and patient portals now allows patients to download and print their own summaries.
The demonstrable threats to cybersecurity.   Although there have been no reports of intrustion into a HIE there have been many major breaches of large health systems and insurance companies. The saving grace for HIE is that it is not a real repository and only a system of links to dispersed data files.

Although it is stated there is a statewide depository holding all the medical records of millions of patients, this is a half truth.  There are really no depositories, rather a collection of data files dispersed in many locations that the Health Information Exchange can access via linkages.

With this in mind,

Claudia Williams, will lead The nonprofit California Integrated Data Exchange, 

Welcome to Obama administration veteran Claudia Williams, who will take the helm as chief executive on Feb. 1.  California is a big state, it's needs are regional and it's medical marketplace is diverse. There are several health systems that are so large and encompassing they have no need for an outside HIE since most of their patients never leave their care.  Kaiser Permanente is perhaps the model for that statement.

And welcome to best wishes and good luck.

Saturday, January 7, 2017

Teladoc Sets Industry Record, Surpassing 2 Million Telehealth Visit Milestone

Business Wire reports a 100% growth rate for Teladoc from 2015 to 2016. Teladoc makes some interesting claims in terms of cost savings.

Teladoc makes some interesting claims;

"Teladoc’s accelerating utilization fuels the company’s track record of driving meaningful savings for clients and the overall healthcare industry. Based on a recently completed, comprehensive study performed by Veracity Analytics, this two million visits milestone translates into more than $900 million that it is estimated Teladoc has saved its clients, and the American healthcare system, since its inception."  Without knowing the details for comparison it is difficult to accept their numbers.

The continued growth of utilization and associated savings will be significant to the healthcare market as telemedicine continues to take off. This new and enhanced study is based on analyses of multiple external, independent case control, episode of care studies to predict ER cost avoidance in a highly accurate and dependable way. They compare the cost of an emergency department visit to that of a telehealth consultation.  Emergency department charges are dis-proportionally high when compared to a routine office visit.

Their claim of saving $ 900 million dollars may be exaggerated. 
Teladoc, Inc. is the nation’s leading provider of telehealth services and a pioneering force in bringing the virtual care visit into the mainstream of today’s health care ecosystem. Serving some 7,000 clients — including health plans, health systems, employers and other organizations — more than 17 million members can use phone, mobile devices and secure online video to connect within minutes to Teladoc’s network of more than 3,100 board-certified, state-licensed physicians and behavioral health specialists, 24/7.
Teladoc offers the industry’s most comprehensive and complete telehealth solution including primary care, behavioral health care, dermatology, tobacco cessation and more.

Regardless of their self-agrandizement readers must recognize the potential and acceptance by patients of this clinical encounter.  Legislation will catch up with reality.  Telehealth is a disruptive technology.