A Review of the midyear progress of mHealth

A Review of the midyear progress of mHealth focuses on several mHealth IPOs,  specifically Fitbit and Teladoc.

They serve two separate niches, fitbit in the area of mhealth wearables, and Teladoc as a provider-patient centered application allowing remote video patient encounters with physicians.

Several transformative shifts are occuring between mHealth and EHR integration. In some cases mHealth is driving EHR integration.

Our blog today offers a quick centralized source for progress in mHealth application development.

Will mHealth's rise signal the end of the EMR?

One of the hot trends is the integration of patient-facing data into the electronic medical record. 

EPIC , is developing it's own mhealth application in concert with Apple's Healthkit. Epic has begun to offer details about what the platform will look like when the kinks are finally ironed out. 

From Epic's new app store to Validic's partnerships with Cerner and athenahealth (to name just a few), EMR platforms are evolving to accept health and wellness data from devices to better define a patient's profile outside the medical encounter.  "It's not just physician documentation any more," says Girish Navani of eClinicalWorks. "The patient is part of that equation … but there have to be filters."  Consumers, she says, "are more involved in their healthcare, which puts the onus on (clinicians) to work with them, but we haven't seen much good data come out of the FitBits and other consumer-facing devices" that would make a doctor sit up and take notice.

 EHRs and wearables - their time has come?]

The convergence of two industry titans, Apple and Epic portends another swift sea-change fueled by adequate capitalization of IPOs and equity funding. Does this mean the EMR is becoming obsolete? Or is it evolving into an EHR?

Much of the conversation between a doctor and a patient focuses on what the patient is doing outside of the doctor's office – in other words, the doctor is looking for data that today's health and fitness wearables are collecting. This means that all that information in the margins is now being pulled into the record.

Providers say they don't want all that extra information coming into the medical record, but they can't deny the value of health and wellness data in developing a care management plan for their patients. They're worried about validity – is data entered by the patient reliable enough to be included in clinical decision support?

At this point, the answer is no, and mHealth vendors and EMR providers understand this. As Navani points out, the data has to be curated first – collected, sifted and organized into something that a provider can trust and ultimately use. Some EMR companies tackle this issue by shunting consumer-entered data into a PHR or similar silo; the consumer then grants permission to the provider to parse over that data and determine what can be pulled out and ultimately entered into the medical record.

f that's the case, then this truly is a health record, not a medical record.

The proliferation of consumer-facing apps and devices has also given rise to a dichotomy in how mHealth data is collected. On one side stand platforms like Apple's HealthKit and ResearchKit, which gather consumer data for use by healthcare providers. On the other side are platforms like Qualcomm Life's 2net hub, which takes data from reliable devices – not the consumer – and goes to great lengths to ensure that such data is "medical grade."

Can both data streams share space in the same record? That depends on how EMRs and EHRs are defined.

Can We Rely on Mobile Health Apps?

Exclusive: Aetna to shut down CarePass by the end of the year

Troubling news from Carepass, After MobiHealthNews spotted and reported on the departure of two Aetna executives on the CarePass team, Aetna has confirmed exclusively to MobiHealthNews that it will be phasing out the platform, and that the previously announced employer pilots will not be going forward.

Carepass has been available in the Chrome Store and on iTunes, however Aetna will cease to support the platform.

“At this time, we have decided to make no further investments in the CarePass platform,” an Aetna spokesperson told MobiHealthNews in an email. “Current CarePass users will continue to have access to the CarePass platform for the time being, but we plan on closing the CarePass web and mobile experiences by the end of this year. In addition, we will not be conducting pilot programs with Aetna plan sponsors that were previously reported.”

In additional comments, the company emphasized the exploratory nature of the platform and stressed that valuable lessons had been learned.

The company found no shortage of willing partners to feed data into the app. Over the two years of its existence, CarePass interfaced with MapMyFitness, LoseIt, RunKeeper, Fooducate, Jawbone, Fitbit, fatsecret, Withings, breathresearch (makers of MyBreath), Zipongo, BodyMedia, Active, Goodchime!, MoxieFit, Passage, FitSync, FitBug, BettrLife, Thryve, SparkPeople, HealthSpark, NetPulse, Earndit, FoodEssentials, Personal.com, Healthline, GoodRx, GymPact, Pilljogger, mHealthCoach, Care4Today, and meQuilibrium.

The news is noteworthy because CarePass, which Aetna launched last year and allowed consumers to track certain health apps from one online hub, was a unique mobile approach in the insurance industry that garnered widespread support and collaboration from mobile companies, including MapMyFitness, FitBit and Care4Today.

Aetna's CarePass also received consumer support, at least initially. "Overall, for the CarePass integrated apps, the downloads are more than 100 million. We started around the most popular spaces in mHealth--fitness and nutrition really dominate. So those are where you get the most downloads," Martha Wofford toldFierceHealthPayer in an interview before she departed Aetna as head of the CarePass program. Recent surveys have shown a very high dropout rate for users after an initial spurt of interest.

Aetna cancelled another mobile project — InvolveCare — earlier this year, although the company had invested considerably fewer resources in that product than in CarePass. Although Aetna had begun to downplay CarePass in recent months, for most of its existence it was the face of Aetna’s consumer health outreach and its mobile health endeavors.  This was despite expertise from Pivotal Labs after initial difficulty developing the platform.

The comments from Aetna follow a pattern of what has become a 'boiler-plate' statement by insurers and anyone connected with HIT. 

“One of the primary ways that Aetna is improving health care is through the increased use of innovative technology,” the spokesperson wrote. “We are consistently creating technology-based solutions that make it easier for consumers to navigate the health care system and get the most out of their health benefits. While we are continually developing these solutions, we also need to evaluate our investments to ensure that we are providing the most value to our members.”  “Aetna is committed to being a consumer-focused company that helps build a more connected and effective health care system,” 

Aetna CEO Mark Bertolini had high hopes for the product, saying it would reduce healthcare costs and “make our economy healthier”.

Aetna is a major insurer with deep pockets. Software is not inexpensive to develop and early failures will lead to increasing costs.  Despite measures to create uniform interoperable electronic health records for providers, the same cannot be said about consumer oriented products.

When all is said and done, many enthusiastic and dedicated developers will find the going difficult.  Time will tell, and those mHealth apps with the most demand on the consumer side, or provider dependent mobile apps which are necessary for practice operations will suceed. 

Providers will insist on mobile health portals for communication and accessing data on the run.

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

• 
  

Health IT in Asia at Health 2.0 India

Read more about it at Health Train Express including these topics of interest

• Designing an improved patient experience for a Billion people

• Trending – Startups, Funding and Accelerating Health 2.0

• Health 2.0 in the village

• Quantified self, wearable sensors and trackers

• Mobile health in real life

• Rise of big data and better decisions

• Pharma and better outcomes

• C-Level executives unplugged

• Unmentionables amplified – Sex, Sport & Rock n’ Roll

Visit Health Train Express to learn more........

CES 2014 What's in IT for Digital Health ?

Many generic IT software and hardware have been adapted for health care by DIYers who are already physicians.  This year's CES will emphasize the expansion and new offerings for mobile health in health care, including new software for all  operating systems, and the new technology in smart devices.

Attending a CES show in Las Vegas offers much for physicians now. The offerings have expanded exponentially for both iOS, Windows, and Chrome/Android on a variety of hardware applicatons. Each OS serves different segments, depending on EMR, and legacy hardware.

CES offers a unique show, a one place visual carnival in a large exposition. The event is located in Las Vegas, where a global entertainment industry and gambling exist, side-by-side.

DHS will be focusing on the electronics at CES 2014 both health oriented and in the consumer space that could be applied to health care.

C-Net  also will offer full coverage specials on exhibitor booth and their offerings, for those who are couch potatos or unable to travel.

  .
For Las Vegas Information and general information about CES, Housing, Transportation, Reservations, and Information about Shows, Entertainment, and much more: CES hosts a Website.

For those who need the "intimate" social reality experience attend in person.  Make certain you have taken your flu shot .

Where to get urgent health care.  Turntable Health is a Primary Clinic in downtown Las Vegas whose medical director is Zubin Damania (stage name- ZdoggMD)  a physician well known in social media circles and  trained at UC San Francisco.

While you are in Las Vegas  he may even be producing one of his unique and outrageous "ZdoggMD" episodes   (not to be missed)

The area that Turntable Health is located is in  an area that is underutilized and developed by Zappos, the well known online retailer. It is the innovative ultra-modern Los Vegas Medical Clinic where Patient-Centered Care is given, and is a worthwhile tourist destination to see where all the CES and HIT is used.

And Remember..."what happens in Vegas stays in Vegas.

This has been an unpaid public announcement.  See it, or pay the price.

The CES has already started, and there is already much appearing on YouTube, and all the standard social media platforms, if you cannot attend.

Watch for Digital Health Space on Google +

Networked Intelligence in Health and Medicine fueled by Social Media

Attribution given to Bryan Vartabedian, MD

How does a hospital or provider move into the digital space ? And what part of the space should you participate ?

Are you a part of it, and do you want to be a part of it? Is this a necessity, or just a fad ?

Do you have an overall marketing plan, or separate department for marketing?

You will need to assess your reasons for HIT and social media.  Electronic Health Records, Health Information Exchanges, mHealth, social media, all serve different needs, some elective and some necessary.

An important component is time and money, neither of which are an infinite resource. Given the current massive health reform that is being legislated practice resources must be aligned with regulatory mandates.

Reality plays a big role.  Many social media users do it for pure enjoyment as a break from conventional routines of their day.  Some do it for making new contacts, social or medical, based on current interests.  Others look for new vistas, hobbies, and activities one would never entertain,unless in the process of social media it happens spontaneously.  Some social media hobbyists transition into a vocation in marketing, education, or entertainment.

Your regional  social media politically correct standards may play a role in your decision making. Social media is just that…….voluntary.  Let’s compare social events such as medical staff meetings, part business, part pleasure, and a source of much information and communication.  If you think about your daily activities, meetings, learning experiences, creative thinking can create reasons for using social media.

You may want to expand your visibility either locally, regionally, nationally, or internationally.

There are choices:

1. Do it yourself.  This requires significant time and effort as well as a learning curve to

do it efficiently. There are many who are willing and able to teach you, some for free, and

others who charge a fee.  One example is the Social Media Residency offered by Lee

Aase and the Mayo Clinic.

2.Hire someone or a professional digital marketer to do it for you. Since you are in

the business of medicine, highly skilled and have a relatively high ability to generate

income. Why bother yourself with these tasks.

There are innumerable online companies offering software products to encompass

a marketing plan.

3. Like Real Estate the main concern is ‘location, location, location. So too is social

media.  Your choices and perhaps limitations will depend on where you practice ?

Factors such as the form of your medical practice, solo,group, specialty, or academic

will more than influence your options. Listen to this story from “33 Charts”, a well known

blog.

DECEMBER 14, 2013Albert Flexner, M.D. (courtesy, National Library of Medicine)

Last year was part of a small group charged with building a social media toolkit for medical schools.  An early conference call participant made it clear that if the project didn’t meet certain criteria for academic advancement, he’d be unable to participate.  It was the last time we heard from him.  Unfortunate but predictable.

There is a movement to qualify and/or quantify social media publishing by clinicians and scientists. In an article published on iMedicalApps, one pharmacist had this to say about this prospect,

“The movement to start evaluating blogging and tweets on par with academic publications”

by Timothy Aungst, PharmD

What counts is what brings value

New forms of knowledge creation and how they fit into a dated system of promotion is a growing preoccupation for many physicians.  And the question of what should ‘count’ toward academic advancement is one that’s received attention lately.  Some have approached advancement committees to have their blogs recognized as evidence of scholarship.  I haven’t decided whether these attempts are noble or laughable.

What counts is what brings value.  And what brings value in medicine are cameos in peer-reviewed publications.  This makes sense.  Because in the era of analog medicine, this was the only means by which physicians communicated ideas and findings.  Appearance in this 17th century tool of idea transmission has defined leadership through most of medical history.

Embedded habits are slowly eroded, as better solutions appear.

The age of networked intelligence will spawn a new kind of leader

But things have changed and doctors have new ways to share ideas and change minds.  Now every doctor, independent of institutional affiliation, tenure, pedigree or lineage is empowered with the capacity to grow, share and develop ideas.

And so the age of networked intelligence will spawn a new type of leader.  Expect to see regular doctors emerge as influential not based on lists of publications but on the strength and novelty of their ideas.  Leadership will be determined in part by the capacity to leverage new tools to build, communicate and influence.

But don’t expect them to be promoted.  For now.

Think much, publish little

Despite how we connect and communicate, peer-reviewed research will remain an important element in the advancement of medicine.  But it represents only one way to lead.  For those early in their career, there are some things you can do.

Perhaps we should think more before we publish our blogs, tweet or build facebook and/or google pages.  (or at least make our posts less often, and shorter.

Thanks to Dr. Vartabedian for his insights.