The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health
These demands for greater value in the use of increasingly precious resources are producing effects across all sectors of healthcare-related products and services. For example, value-based delivery system reimbursement continues to advance and is increasingly supported by more robust measures of quality and cost-effectiveness.
Transparent reporting of performance is reaching critical mass, although not without controversy in some physician communities. Encouragingly, the "Choosing Wisely" campaign led by several medical societies, and supported by influential patient advocacy organizations, does signal recognition by clinicians that evidence-proven wasteful practices require serious attention.
Value-based reimbursement is also becoming aligned with value-based health benefits and value-based technology assessment. Taken together, these three initiatives are gaining a critical mass effect.
Value Based Care: for whom ?
Where is the value assigned, the provider who works tirelessly to see all his patients, finish his paperwork, save for retirement, support a family, pay health insurance premiums?
So, don't insurance companies gain with value based care, expecially if they assign the value based upon increased, or at least stable profits.
For patients it is the matter of do you know what you are buying, and how much does it cost?
Why it is crucial for people who struggle with IT not to give up now. The reason is that a lot of developments coming out in the coming months and years will make the use of digital technologies very simple.
The image above is a great example demonstrating how we could use workplace desktops in the future:
Michael Kitchell: Accountable Care Organization results
By Dr. Michael Kitchell
One of the major healthcare reforms coming out of the Affordable Care Act is the promotion of the three-part aim of: 1) better experience and outcomes of care, 2) better health of the population, and 3) lower per capita costs in healthcare.
These three goals have been the guiding force for many changes in how healthcare is delivered.
One delivery system reform involves a group of physicians who are willing to be held accountable for their quality of care and their patients’ outcomes while keeping costs below a certain level.
Not all physicians are willing to be held accountable for both quality and cost, so these delivery reforms have been based on those physicians who voluntarily agree to be part of an organization that is held responsible for the value of their care.
The concept of an organization delivering higher value care has been one of the major points of emphasis in reforming health care since Dr. Donald Berwick served as the administrator of the Center for Medicare and Medicaid.
Berwick wrote the rules for Accountable Care Organizations in 2011.
The number of Medicare Accountable Care Organizations has been growing steadily since the first year of activity in 2012, and we are now hearing about the results of the second year (2013) of Medicare Accountable Care Organization performance.
Accountable Care Organizations consist of a group of primary care physicians who are often associated with hospitals and other specialty physicians.
Accountable Care Organizations are measured by their performance on quality indicators and spending for patients that are attributed to the primary care providers who are responsible for guiding most of their care.
The hospitals and doctors in an Accountable Care Organization are paid by fee for service (the traditional way) in most cases, plus a bonus if they perform well.
Patients may not even know they are in an Accountable Care Organization because the doctor or hospital is doing the service and billing just as it always has been done.
The Accountable Care Organization’s success in achieving a bonus for their better care and lower cost though depends upon exceeding certain quality standards before receiving any payment for lowering costs. The Accountable Care Organization will not receive any bonus payment unless they are high performers in 32 quality measurements.
The payment for Accountable Care Organizations is therefore based on the services they give, and the bonus or payback depends on whether the organization keeps the costs below their historical (last year’s) spending.
The Accountable Care Organizations’ strategy is to keep costs down by prevention or earlier detection of disease (such as heart disease) and managing chronic diseases (such as diabetes), keeping patients healthier and out of the hospital, which can be very expensive.
Accountable Care Organizations cannot skimp on care because they must meet higher quality standards as well as higher patient satisfaction results.
Of the 243 groups that were Medicare Accountable Care Organizations last year, 64 of them performed well enough to receive shared savings bonuses, the amount of which is half of the savings compared to their spending the year before. Those 64 Accountable Care Organizations earned a combined total of $445 million, and even with paying those bonuses, Medicare saved a total of $372 million after accounting for all the 243 Accountable Care Organizations, some of which did not have success. Only four Accountable Care Organizations had to pay back some of the money they received in 2013 because they went over the expected spending.
Though these numbers are small compared to the $500 billion Medicare spends per year, the success of these Accountable Care Organizations in bending the cost curve down instead of going up every year is encouraging.
There are now more than 360 Medicare Accountable Care Organizations. As Accountable Care Organizations improve their disease prevention and management of chronic disease there will be more savings, and patients will benefit by their physicians’ focus on keeping them healthier rather than on increasing the number of services they bill.
The concept of Accountable Care Organizations and promotion of higher value in healthcare has been so successful that many private insurers are offering Accountable Care Organization contracts for physician groups.
In Iowa, 14 large physician/hospital groups are now contracting with Wellmark for ACO payments for value.. ..
The ACO value based payment model is voluntary, and despite it's promises some have little faith in it's ability to reign in costs. ACO may have effect, if and when it is competitive in price in the marketplace for health care.
Eighty-two percent of health plans responding to a recent survey consider payment reform a ‘major priority.’ Nearly 60 percent forecast that more than half of their business will be supported by value-based payment models in the next five years. And, of those, 60 percent are at least mid-way through implementation, according to a study published May 9 by Availity, a health information network.
The Health Plan Readiness to Operationalize New Payment Models study delves into the progress of the country’s commercial health plans, as they migrate from fee-for-service to value-based models of compensating physicians, according to a news release by Availity. The study highlights the consensus among plans that information sharing with physicians must be automated – primarily in real-time – for these models to achieve success.
The transition from fee for service to a value-based payment model will be complex.
Managing value-based payment models alongside existing fee-for-service arrangements, and across numerous health plans, is creating issues that range from accurate revenue forecasting to workflow integration challenges. According to one physician practice respondent, “The administrative complexity of administering these plans is likely to be costly. The unpredictability of the revenue stream is likely going to make administering some of these plans not worth the cost.”
From volume to value: how health execs see the future of health care From Volume to Value
Mission Impossible is what some think about the Affordable Care Act, and it's consequences. Admittedly, unless you are an expert the law is baffling, and even more so it's implementation.
Meet Jim, the chief medical officer at a well-respected integrated delivery system. His meeting with the board resulted in one key directive... a Mission Possible!
Kryptiq and Case Manager present an interesting portrayal of the impossible mission.
Formerly physicians would receive negative reviews or 'bad press' in a local newspaper as a result of a malpractice case, deserved or not. The negative information is difficult to counter even if disputed. False reports were subject to libel complaints. Individual bad feelings or complaints about a physician would be disregarded in the noise of other news.
About 40 to 50 online sites -- such as Healthgrades, RateMDs.com and Vitals -- allow patients to rate or write reviews of their physicians.
The visual appearance of a web page often has more authority than the printed content, when a user is searching for physicians and their ratings: For Example:
Physician Satisfaction Score
Dr Good ******
Dr Soso ***
Dr. Who -------
Dr. Uhoh *
Dr. Missing
Dr. Maybe **
Let's hope it is not something like this:
Early on these services were very questionable, but some have improved. Some are even 'respectable' and now have a mechanism for building their ratings, and sources. An algorithm for **** power appears to have developed.
Once upon a time physicians were unaware of these 'consumer oriented websites". Some did not even know they existed, however they are now or should be uppermost in any practice administrator or physicians mind set. Even one negative review, or the absence of any reviews or a missing listing on a search engine such as Google, Yahooor Yelp can be disastrous and result in a patient's bypassing your services. It is mandatory that administrators and/or physicians routinely monitor these websites, and have a consistent proactive approach to building reputation. It is not expensive but does require a professional plan. It can be done internally, however there are marketing services that can incorporate into your overall marketing plans.
Any administrator can easily search any of those search engines to find ratings, or where your practice shows up on Google....page 1 or page 1000. Few patient and consumer searches go beyond page 2, and page 1 is best.
Unfortunately the internet and social media are growing and changing on an almost daily basis. New social media sites appear, and grow rapidly, even in their content. What at one moment appears to be a simple social media site morphs into Google pages, Google local, Facebook pages and rating capabilities. The source of virtually all of the ratings is from users and not accredited or credible.
Patients and/or consumers go first to Googlewhen looking for services, even if it is a friend referral, and yes even if it is your 'plan provider book', online or printed. No longer do patients call the medical society, which is usually way behind on information about their physician membership.
The opposite is also true. Physicians look up medical information as well as information about their patients on Google. Find out more specifics and dowloand: White papers:pdf file if you cannot open the pdf file download word file
His reputation precedes him, he has had some failures but also manages to turn lemons into lemonade, one foot in the Venture Capital arena, the other in a 'gestalt' of health innovation and organizational abilities. Forbes Magazine featured him as the icon of "The Manhattan Project". They titled the article,
His biography, and resume demonstrate an outstanding presence, and personal charm, daring to go 'where no man has gone before'. His accomplishments are diverse, especially manipulating his financial treasure to march forward on his mission of disrupting medicine with innovative ideas, merging new tools together. Many have and are trying to accomplish this same goal. Perhaps he has become more visible due to his extroversion and lack of fear from the establishment, since he is independent of grant funds private or public. He is a quiet speaker and refrains from bold and embellished ideas.
United States physicians have had the advantages of Google Glass for the past year. Glass just recently was released for use in the U.K.
Kathi Browne of BrowneKnows, a well known social media moderator on Health Care Talk had the opportunity to discuss the promise of Google Glass for users and developers in the U.K. In this Google Hangout several medical developers discuss their use and plans for Google Glass.
Now that Google Glass has been made available to the UK, we are seeing many new Glass explorers stepping forward in +Giannis Anastasiadis is interested in developing healthcare Glassware. If you have an idea you wish someone would develop for Glass, share it. For those of you who wish to become Glass Explorers,
While Google Glass is not yet HIPAA compliant there are developer plans to make it so. Currently Glass users must receive permission from patients if it is used for them. The potential for use of Glass in Healthcare is enormous, more than I want to cover in this post, and will be listed elsewhere (as of September 30, 2014.
The current iteration of google glass has some limitations for medical use. It currently has not been cleared as a 'biomedical device', requiring specific adminstrative consent for use in a health facility, for reasons of legal liability. It is a small and powerful computer, generating much heat and was designed for very short bursts of information rather that a continuous use video recorder.
If you are a physician, surgeon or a google glass developer, we would like to hear from you, for either a post or a Google Hangout Conference.
Social media in medicine continues to be controversial. Those who are recent graduates and/or less than 35-40 years of age seem to have integrated social media within the context of HIPAA restrictions. Most physicians do not use social media unless they restrict personal identification of patients. None offer treatment recommendations over an insecure connection, and their social media and web sites have a visible warning about information provided by their web site is for informational purposes only and not treatment.
A recent study found that social networking websites like Facebook can be an important tool for both patients and providers but that such sites need to be further refined to fully realize their potential in health care.
In an iHealthBeat audio report by Rachel Dornhelm, experts discussed the future of social media and health care. The report includes comments from:
Timothy Hale, a research scientist at Partners HealthCare's Center for Connected Health;
Ben Heywood, co-founder and president of PatientsLikeMe;
Christina Thielst, a health administration contractor focusing on social media; and
Robert Wah, chief medical officer of Computer Sciences Corporation (Dornhelm, iHealthBeat, 8/20).
Our continuing research done by appears to corroborate earlier studies about decreased efficiency and decreased patient volume with the implementation of electronic health records.
For the research letter, researchers from the National Library of Medicine's Lister Hill National Center for Biomedical Communications analyzed the results of a survey conducted in December 2012 by American College of Physicians (Leonard, U.S. News & World Report, 9/8).
The survey consisted of 19 questions and received responses from 411 internal medicine attending physicians and trainees who worked in an ambulatory practice and used an EHR system (McDonald et al., JAMA Internal Medicine, 9/8).
Findings
A difference was noted between practicing clinicians and trainees (residents).
The research letter, which was presented Monday at the National Library of Medicine, found that the mean loss of time for physicians was 48 minutes per day, compared with a mean loss of 18 minutes per day for trainees (U.S. News & World Report, 9/8).
Specifically, the research letter found that after EHR implementation:
89.8% of respondents said at least one data management function was slower;
63.9% of respondents said the time spent taking notes increased;
33.9% of respondents said the time spent finding and reviewing patient data took longer; and
32.2% of respondents said they spent more time reading other clinicians' notes (JAMA Internal Medicine, 9/8).
The authors wrote, "We can only speculate as to whether better computer skills, shorter (half-day) clinic assignments with proportionately less exposure to EMR time costs, or other factors account for the trainees’ smaller per-day time loss"
Author: Our experience is that trainees are often using a particular EMR for the first time, which does not require an 'unlearning experience" and that trainees (who are younger were brought up with computers during high school, elementary school, and college), in addition to their immersion in social media. Some or all of these traits explain the difference in the findings.
Mobile app development continues to accelerate at an ever increasing rate. It becomes difficult to segregate the bad from the mediocre and good ones. Here are a few new hopefuls. Our Next several posts will summarize many hopeful startups as 2014 progresses as predicted.
San Francisco-based accelerator Launchpad Digital Health funded its first five companies this week.
Through the accelerator, the companies receive between $200,000 and $500,000, office space in San Francisco, and advising with legal, accounting, and risk management issues. Launchpad focuses on companies that are working on wellness, remote monitoring, electronic health records, data analytics, and independent living support.
AddApp aims to provide users with context about their daily life. The app integrates data from other apps and devices that the user owns and puts the data into context. Some examples of insights that AddApp provides includes pointing out what gives the user a good night of sleep, showing users which days they are most active, and how they can run farther.
Lyfechanneldevelops programs for patients who have chronic diseases. The programs are designed to help patients who were recently diagnosed with a chronic disease and need additional help as they begin their care regimen like changing eating habits or getting used to a medication regimen. The program focuses on diabetes, pre-diabetes, COPD, smoking cessation, and heart health. According to an SEC filing, Lyfechannel raised $200,000.
Medablehelps healthcare professionals, like physicians and payors, make apps that connect physicians and patients, store medical information safely, and follow the appropriate regulations. Providers can also use the app they make to communicate with each other. The company has built an API so that developers can build the program on Medable’s cloud platform.
QueueDr helps doctors add more appointments to their schedule if they have free time. A doctor’s office will use the platform to send texts to patients telling them about an open appointment slot so that that patients can get in to see the doctor earlier.
Sense.lyhas developed a “virtual nurse” that provides follow-up care to patients, focusing mostly on those that have chronic diseases. The company offers patients an avatar that analyzes the patient’s condition and provides insights into what steps patients should improve their health. Earlier this month, MobiHealthNews reported that Sense.ly is set to come out of beta later this year.
Electronic health record implementation can result in reduced patient volume but can increase revenue over the long term, according to a study published in theJournal of the American Medical Informatics Association, Becker's Hospital Review's "Hospital CIO" reports (Gregg, "Hospital CIO," Becker's Hospital Review, 9/3).
For the study, researchers from Drexel University compared patient volume and reimbursement at 30 ambulatory practices in the two years after EHR implementation with the practices' pre-implementation baseline (Pedulli, Clinical Innovation & Technology, 9/4).
Study Findings
The study found that practices' reimbursements increased "significantly," even as their number of patient visits declined (Durben Hirsch, FierceEMR, 9/2). Specifically, practices on average submitted claims for 94 additional ancillary procedures per quarter after implementing an EHR system, while patient volume decreased on average by about 108 patients per quarter ("Hospital CIO," Becker's Hospital Review, 9/3).
The researchers wrote they did not find any indication of "upcoding or increased reimbursement rates to explain the increased revenues" (Clinical Innovation & Technology, 9/4).
They noted that their finding of increased revenues "is reassuring and offers a basis for further EHR investment," while their finding of decreased patient volume indicated that EHR systems were increasing practices' efficiency.
They recommended that any practices continuing to see declines in patient volume two years after implementing EHR systems should add analytics functionality to their EHR system to "focus on seeing the right patients" (FierceEMR, 9/2).
A team of investigators discovered the breach on Aug. 25 during a routine security scan. I suppose HHS and federal IT infrastructure have their own "Malwarebytes" to detect and clean their systems, regularly. I know that good IT practices require this type of routine maintenance.
Perhaps the hackers broke in to see if they could improve health.gov for the Dept. of HHS. I am sure many were willing to help there. Probably any videogamer could improve the web site. It's been a whole year for things to improve, and the next enrollment period begins in about one month.
According to an HHS official, the attack appears to be the first successful breach of the website, through which millions of U.S. residents have purchased health insurance coverage since fall 2013.
Details of the Hack
Investigators found no evidence that enrollees' personal data were taken in the attack. Rather, the hacker accessed a server used to test code for the website (Wall Street Journal, 9/4).
Common malware was uploaded to the test server and designed to incapacitate other websites, a method often referred to as a "denial of service" attack. Government officials say the malware was not intended to steal consumers' data (Viebeck/Hattem, The Hill, 9/4).
"Our review indicates that the server did not contain consumer personal information; data [were] not transmitted outside the agency, and the website was not specifically targeted," HHS said, adding, "We have taken measures to further strengthen security" (O'Donnell, USA Today, 9/4).
I feel relieved
It's about like someone breaking into your house and leaving a 'stink bomb' rather than taking your large screen T.V.
Reaction
Rep. Darrell Issa (R-Calif.) -- chair of the House Oversight and Government Reform Committee -- in a statement said the revelations were "unsurprising" amid previous concerns about the website's security. He added that the administration repeatedly had "dismissed concerns about the security of HealthCare.gov, even as it obstructed congressional oversight on the issue." Issa also called on CMS Administrator Marilyn Tavenner to testify alongside GAO officials before the committee on Sept. 18 (Hattem, The Hill, 9/4).
Meanwhile, Rep. Diane Black (R-Tenn.) called on the Senate to join the House in passing theHealth Exchange Security and Transparency Act (HR 3811), which would require the federal government to notify individuals if their personal information has been breached (Black release, 9/4). (A one paragraph-regulations) I thought that was already covered by HIPAA.
Let us hope that things will get better (don't hold your breath)
Todd Park, the former CTO in the Obama administration has been replaced by Megan Smith, following his resignation several months ago. Todd, during the rapid growth of HIT including Health Information Exchanges, and in conjunction with the Office of the National Coordinator of HIT (ONCHIT) was responsible for the successful role out of Health Information Exchanges, and later with the challenge of implementing Health.gov . Megan Smith Named CTO of the United States!
Today +Megan Smith (formerly VP at Google[x]) joins President +Barack Obama as the Chief Technology Officer of the United States of America. Megan co-founded Women Techmakers in 2012 with +Stephanie Liu, and seeing the potential for building on the movement to empower women in technology, Megan and I created my current role as Google's Women in Technology Advocate. Megan has been an advisor to Women Techmakers despite her busy schedule advocating for women and children globally, and I'm honored to have worked side-by-side with her to enact change. I'm proud of my friend and mentor, and look forward to seeing the impact she'll make in her new role.
