Digital Health May No Longer be a Slow Sell

Though there have been notable exceptions, digital health has often proved a slow sell to the medical establishment. The failures of Google Health and HealthVault to gain traction, for example, underscore the challenges of breaking into the workflow of doctors.

Yet over the past month, three technology giants have, in the form of a series of launches, given an endorsement that digital health will be one of the next important technological trends. From Google has come an API infrastructure called Google Fit. From Samsung,  the data platform SAMI, and from Apple the developer tool HealtlhKit

Healthkit for Sporty Types

Hype or Hip ?

What’s changed to prompt these companies to jump into the digital health all at once? I would argue that the wearables revolution that is currently underway demonstrates that the technology industry has realized that consumers, not the medical establishment, will drive adoption — and that this is fast-tracking the pace of change.

That doesn’t demote the role of the health care establishment in the question of whether this trend proves lasting. Even purpose-build musculoskeletal registries have had difficulty winning the trust of physicians, and it remains to be seen whether the data collected by the current community of health apps and tracking devices is of sufficient quality to create individual-level, real-time health and wellness predictions. To determine this, large-scale validations of insights will be necessary.

It is becoming apparent to all in the industry that data is perhaps the most precious commodity available to digital health and wearable tech firms, and data becomes more valuable when it encompasses multiple perspectives on the same individual. With the explosion of the Internet of Things, users now record their daily activities in several ways, but often in separate locations. Until now there wasn’t any value in sharing these reams of data — not much could be done with them. But with an increased focus on analysis and the provision of insights, this is changing.

Concurrently, with bigger companies offering analytical tools and platforms, a “plumbing system” for the data is becoming a reality. This will provide more exposure to smaller, true data democracy driven startups that are attempting to create a culture of reciprocal data sharing necessary to increase the complexities of  analysis done on wearables data. Indeed, my prediction is that a large number of secondary analysis companies will emerge from the entry of the tech giants and add value to existing devices that have thus far demonstrated poor long-term engagement numbers.

Overall, the latest announcements give me hope that the emergence of wearable tech will become a positive influence on population health and solve some tough problems faced by the medical establishment. The entire world is being faced by a crisis of chronic, non-communicable diseases. Wearables provide one behaviorally-focused tool that may slow or reverse the disease trends and crack the code of wellness for a large segment of society.

Jesse Slade Shantz is an orthopedic surgeon who blogs at The Doctor Blog.

Digital Health Space Services

Our mission statement is written on the header of all our posts.

"DIGITAL HEALTH SPACE.......The distance between providers represents the space that Digital Health Space is attempting to close using virtual applications, websites, social media, email, web portals, custom developer open source and telehealth"

The list of available software offerings are not limited to electronic health records or specifically 'designed' for medical practice. Some are simple adaptations used in other industries or from consumer sources.

How beneficial would it be to be able to automatically reach out to a patient when they are overdue for a specific type of visit?  If you are planning to attest for MU2 you will need to report on having sent these types of reminders to a minimum of 10% of your patients (MU Measure-12).  Even if you don't plan to attest for MU2 this is still something that allows your practice to be more proactive in providing patient care.  Examples:

- Diabetic overdue for an A1C

- Child at X months of age overdue for X vaccine series, or Well-Child visit

- Female overdue for Well-Woman visit, Mammogram or re-PAP...

Software developer's Mission Statement

We are passionate about the idea of assisting healthcare organizations with patient outreach by automating communication that is necessary to create a more compliant, and ultimately healthier, patient population.

As reimbursement models continue to shift towards Accountable Care and outcomes-based medicine, there is a growing need for improved patient compliance.  We all see that reality.  The question is, how will your organization manage all of those details affordably?   There is an answer.

Today, patient engagement technology is being applied to all categories of patient communication. Whether the message is related to health maintenance, appointment, or collections Relatient allows the individual care provider to decide how, when, and at what interval those health reminders are delivered.

There are 3 types of patients:  the Compliant, the Distracted, and the Careless.  The Relatient team is focused on finding ways to move more patients into the Compliant category, and to benefit their lives while making the Provider more successful as well.

We care about you, your patients, and your staff.  Give us an opportunity to partner with you, and we will spend each day reaching for a better healthcare system, together.

Patient Engagement software providing these services and much more.  In fact, our software vendor often provides MORE functionality at a fraction of the price charged by other Patient Engagement vendors.  How do we do it?

• FLAT RATE PRICING...instead of the old per-contact model.  The more you use it the better the results!

• NO LONG-TERM CONTRACT...use it as long as you want and stop at any time with no penalty

• NO DAILY REPORT BUILD & EXPORT...we will interface to your PM/EHR systems 

• NO COSTLY SERVERS...we utilize Amazon Web Services to send everything via the Internet

• Appointment Reminders via phone, text or email...UNLIMITED

• Collections Reminders via phone, text or email...UNLIMITED

• Health Maintenance Reminders via phone, text or email...UNLIMITED

• Patient Surveys via email...UNLIMITED

This software provides the follow options:

• Appointment Reminders via phone, text or email...UNLIMITED
• Collections Reminders via phone, text or email...UNLIMITED
• Health Maintenance Reminders via phone, text or email...UNLIMITED
• Patient Surveys via email...UNLIMITED
• 
  

Programs

With custom options to match your organization's unique needs - Relatient has the right combination of services to be your partner in automated reminders!

• 

  Timely and effective appointment reminders
 
• 

  Unlimited, custom health event reminders
 
• 

  Reduce your A/R and generate capital efficiently
 
• 

  Any message, delivered to any audience, affordably
• 

  Better your practice through Surveying your Patients

If you would like to hear more about how we can help enhance patient care while at the same time reduce your no-show rate AND reduce your AR, please contact me.  @glevin1 or leave a comment here.

email: digitalhealthspace@gmail.com

When Analytics Fall Short

"The joys of unintended consequences never end. The Patient Protection and Affordable Care Act required hospitals to get paid based on how much they improved their patients' health rather than on how many tests and procedures were completed. The intent was to improve patient care.

But some data brokers saw dollar signs in those changes and have started mining patients' payment card data, public records and loyalty programs and using that to create risk profiles, which they are then selling to hospitals and insurance companies. For asthma, they look at pollen counts associated with the current residence as well as cigarette purchases, plus pharmacy records indicating whether prescriptions are being refilled regularly and on time, suggesting compliance, according to a Business Week report.

Data analytics is generally a wonderful thing, but I'm not seeing how this program could really deliver much of a benefit to anyone involved, other than the data brokers who sell it."

So says Evan Schuman

Follow him on Twitter @eschuman.

Although there are absolutely privacy issues raised, there are some initial limits. However, it's unclear how long those limits will remain in place. For example, the individual information is analyzed and massaged by the data broker, who turns it into a series of risk numbers, but the hospital isn't told the purchase/public record facts that went into those crunched numbers. In other words, the hospital won't be told that a gym membership lapsed or that 20 pizzas are being ordered a week, but will solely see that weight gain risk increased.

The biggest problem with such data collection is simply that the analysis could be highly inaccurate, mostly because a purchase made is not necessarily for the patient to personally use.

"It's important to remember that credit card and customer loyalty program data are not soundly indicative nor solely attributable to an individual's behavior. For one thing, individuals may be purchasing items for family members or even an elderly or disabled neighbor," said Pam Baker, a  business data analyst who has a new book out on the topic: Data Divination: Big Data Strategies.

Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare, one of the health groups that is purchasing this kind of data, is quoted in the BusinessWeek piece, arguing that "information on consumer spending can provide a more complete picture than the glimpse doctors get during an office visit or through lab results." That's certainly true, but even if the data were accurate -- which is far from a given -- how much good is likely to come from it?

5 ways hospitals can use data analytics

George Zachariah, a consultant at Dynamics Research Corporation in Andover, Mass., explains the top five ways hospital systems can better use health analytics in order to get the most out of the information.

1. Use analytics to help cut down on administrative costs.

2. Use analytics for clinical decision support.

3. Cut down on fraud and abuse.

4. Use analytics for better care coordination.

5. Use analytics for improved patient wellness.

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.

Heavy Weight in the Mobile Health Zone

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

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.

Apple adds rising star with background in FDA approvals & product testing to medical team

Source: Mark Gurman, 9to5Mac

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. 

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.

Chris Beyrer, President-Elect of International AIDS Conference

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.

More:

Huffington Post

Buzzfeed

NY Times

The Australian

The Guardian

Los Angeles Times

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).

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

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