Ekso is an exoskeleton bionic suit or a "wearable robot" designed to enable individuals with lower extremity paralysis to stand up and walk over ground with a weight bearing, four point reciprocal gait. Walking is achieved by the user’s forward lateral weight shift to initiate a step. Battery-powered motors drive the legs and replace neuromuscular function.
Ekso Bionics http://eksobionics.com/
House and Senate lawmakers announce a $17 billion plan aimed at addressing appointment wait times. The bill would provide $10 billion for veterans to seek medical treatment from non-VA providers, with another $5 billion going toward hiring additional medical to help the VA keep up with appointment demands.
A new Kaiser Permanente report claims the health system’s portal and mobile app saw 131 million visitors during 2013. Kaiser ties their web presence to impressive gains in medication adherence rates and chronic disease management.
The ACA is generating increased patient volumes, and thus having a positive impact on quarterly earnings for publicly traded hospitals, according to Modern Healthcare.
Geisinger Health System CEO Glenn Steele, MD, will retire next year after 12 years leading the organization.
I believe that there is inadequate strategic planning taking place in pathology and by pathologists. It's true that many of the individual pathology societies support some strategic planning activities but there are few published reports articles addressing the challenges facing our specialty. Here's what I consider the four of the most important challenges facing the field consideration from a strategic perspective: (1) cancer oncology; (2) digital pathology; (3) the future of the LIS; (4) increased lab complexity with reduced lab budgets.
By way of contrast, radiologists has been addressing strategic planning in their field head-on for many years. For example, the International Society of Strategic Studies in Radiology (ISSSR) held its ninth biennial meeting in August 2011. Here is the citation for the published proceedings of that meeting: Eur Radiol (2012) 22:2283-2294. This article is a revealing compendium about what the future holds for radiology. A number of topics are addressed in the proceedings including molecular imaging, diagnostic algorithms, information technology in radiology, integrated diagnostics, and health information exchanges. Here's a passage from the article describing population imaging:
Population imaging employs computational radiology techniques such as unstructured and structured data mining, image segmentation, and statistical modeling to map and summarise imaging features from large image databases and thus extract meaningful imaging biomarkers. The biomarkers may be anatomic structures, disease manifestations, tumour characteristics, or haemodynamic abnormalities. The summation of one or more imaging features, or biomarkers, from a global data set can be considered a phenotypic “population image” representing a particular disease or health state. In clinical care or clinical trials, population images may be used as a reference to classify individuals or patient groups into diagnostic categories. Radiologists can play a key leadership role in providing the needed intuition to productively integrate the computational information from population images with personal medical information....These imaging biomarkers may facilitate prediction of future disease onset, the development and implementation of preventive measures, and even the development of pre-clinical diagnostics....Furthermore, because of the statistical power provided by large sample sizes, population studies using global databases could potentially replace individual prospective studies as a means of validating new biomarkers, saving both time and money.
Here's a more succinct definition of population imaging (Population Imaging):
The ultimate aim of the European Population Imaging Infrastructure is to help the development and implementation of strategies to prevent or effectively treat disease. It supports imaging in large, prospective epidemiological studies on the population level. Image specific markers of pre-symptomatic diseases can be used to investigate causes of pathological alterations and for the early identification of people at risk.
I certainly applaud the strategic planning efforts of our colleagues in radiology and this focus on population imaging effort has tremendous merit. However, the apparent absence of clinical and anatomic pathology data in this project is a significant problem.
I had a chance to catch up with an old friend this weekend. He’s an OB/GYN, and as an employed physician, he’s had EHR in both the hospital and ambulatory settings for years.
Their efforts have resulted in massive amounts of data that can be mined to improve patient care. Surgeons can easily access their own outcomes data and compare morbidity and mortality data when incorporating new techniques (such as robotic surgery) into their practices.
There’s a dark side to that big data, however, and it’s starting to rear its head.
Although most laypeople are aware that babies are going to arrive when they’re going to arrive, administrators at his hospital may have missed that part of health class. They’re creating reports looking at delivery times and labor lengths under the guise of optimizing patient care. The seedy undercurrent of their research, however, is a desire to reduce staffing costs. Although they haven’t overtly said it, he suspects they’re on the verge of asking physicians to start acting in the hospital’s best interest rather than the patient’s.
I delivered babies at the beginning of my career. When you’re caring for a mother in labor, it can be hours of waiting punctuated by moments of terror. Although delivering a child is a natural human process, in the US, we’ve medicalized it for a variety of reasons. As a result, over the past quarter century, we’ve seen an increase in the percentage of babies delivered surgically (it sounds a little scarier when you say it that way, rather than “by C-section”) and there have been concerted efforts to try to reduce this trend.
It’s not just a problem in the United States. The World Health Organization has set a goal of 15 percent C-sections as realistic number for the procedure. In the US, it’s at about 28 percent, in Britain it’s 25 percent, and in Brazil, nearly 80 percent of women delivering in private hospitals have C-sections. Some blame cultural factors for the rise in the procedure. The ability to deliver “on schedule” is certainly a plus for some women as well as for their physicians. Others blame our medical payment system, because reimbursement is higher for a surgical delivery.
It’s not just C-sections, though. We’ve seen a rise in labor inductions, where drugs are used to start labor, often before the due date. Although there are definitely medical reasons when this might be indicated, it had become so prevalent (one in every five women) that ACOG, the OB/GYN professional organization, issued revised guidelines to try to ensure appropriate use of medical interventions.
Why would someone want to electively deliver a baby (through induction or C-section) anyway? Some blame the risk of litigation in the case of a poor outcome. Others blame physicians who want to deliver babies at their convenience. In my practice, I had a fair number of women request induction because they live far from their families and wanted to schedule the delivery to ensure relatives could travel to assist with the baby or help with young children at home.
In countries that spend a lot of money on post-partum home visits or in-home assistants, this may be less of an issue, because women may feel more supported at home after a delivery. Data is shared between community-based caregivers and coordinating physicians so that care can be delivered outside of the hospital. That kind of care has a cost, though, and isn’t an option for many US women, hence the request for inductions.
When thinking about cost controls, however, the idea of asking physicians to intervene in the labor and delivery process to try to better match facility staffing capacity is just too much to accept. Using data in this way sets us on a very slippery slope. What’s a little extra Pitocin? We can convince ourselves that it would be better for the baby to be delivered sooner than later, and if it happens so we can deliver before shift change, so much the better. Looks like the extra drugs may be creating some fetal distress, better prep the OR.
I haven’t delivered a baby in years, but I can’t imagine the stress of having my labor and delivery management decisions questioned by someone who has motives other than reducing maternal and neonatal morbidity and mortality.
Pregnant women are some of the most empowered patients I see in practice. They have more time to research various options and choose the best for themselves and their families, unlike patients facing cancer, injuries, and other unexpected issues. They share the knowledge of how to fight back against the medical establishment (as proven by anyone who has had a patient arrive with a 20-page Birth Plan) and are increasingly demanding of alternatives to the hospital birth experience. Many women in my area are using Doulas and Labor Coaches to have a dedicated patient advocate with them if they do deliver in hospitals. Some can cite the labor and delivery data and the risks of interventions better than a med student prepping for boards.
If the hospital is serious about this, I hope the physicians and nursing staff stand their ground. Better yet, I hope the patient community gets wind of it and reacts strongly.
As for my friend, he’s trying to work from the inside to convince hospital leaders that this is the wrong way to use big data. I hope he’s successful, but I also know he’s fearful for his job as an employed physician.
Have any other examples of misuse of Big Data? Email me.
Email Dr. Jayne.
Linda Reed is VP of integrative and behavioral medicine and CIO of Atlantic Health System of Morristown, NJ.
Tell me about yourself and your job.
I’m the vice president of integrative and behavioral medicine and chief information officer. I’ve been at Atlantic Health 10 years. For the first six, I was vice president and CIO.
About five and a half years ago, I got integrative medicine, which is massage, yoga, supplements, functional medicine, and acupuncture. Then about three years ago, I got behavioral health. One of my doctor friends here says, “Who did you annoy that you were able to get such a wide variety of things?” It’s funny because I tell the CFO here that I’m like the empress of everything that is expensive that makes no money. It’s interesting. My day is right brain, left brain.
I’m a nurse by background. I’ve been a CIO for almost 20 years. I just love what I do every day. I’m an activity junkie and this job really suits that.
How much of your IT effort is focused on plumbing type work like Meaningful Use and ICD-10?
I’d say it’s probably 60 or 65 percent.
We try really hard to do some other interesting things. We’ve put a lot of effort into mobile health. We’ve got a mobile health strategic plan. We just published a mobile health app. Taking a look at some interesting new and different kind of things to do with mobile health. We’re trying to spend a lot of time there doing a little more with telemedicine. There’s all this new, cool stuff you want to do, but you’re really anchored back in the ICD-10, Meaningful Use world.
We’re doing a lot of acquisition. We’ve added two hospitals in the last three and a half years and we’ve got one more coming at the end of December. They’re all different. One hospital was on a really old platform, not the one that we’re on, so we kind of ripped and replaced. The second one that we got had put some money into the platform that they’re on, so we decided to leave that one alone because they had attested. The third one that we’re getting is a little bit of both. They’ve got two different systems on the front and back end, so we’re still looking to see exactly how that one’s going to transition in. We just went live on Tuesday with a brand new ambulatory system for our physicians. It never stops.
Which ambulatory system did you go live on?
Are you still primarily a McKesson shop?
Yes, we’re still McKesson.
They’ve sent some mixed signals about their healthcare IT direction. How do you see that playing out?
Their direction is Paragon. The hospital I said that had a pretty good platform that we left in place is Meditech.
We belong to a consortium called AllSpire. That is us, Lehigh Valley, Lancaster General, Hackensack Medical Center. Of the seven members, four are already on full Epic.
We know the direction McKesson is going with Horizon. We’re going to have to make a decision in the next couple of years as to where we’re going to go. We know we’re not going to stay on Horizon.
My job is to try and give the organization options. When you take a look at what’s going on in healthcare and you start looking at the trajectory of hospital buy-ins, can you really justify a huge expense?
Nobody goes ambulatory Epic unless they’re going inpatient as well. Isn’t that predetermined?
I don’t know. I’m not really sure. Before we did this, I talked to a number of consulting companies. How much cross do you have between the people that come into your ambulatory and are in the hospital? How much back and forth do you really need? Could that be done by a summary of care, CCD, and CCDA? I’m not sure — that might be.
We’ve got a direction we could take, where we have like-for-like licenses because of all the investment we’ve made over lots of years. We’ve got an option for an integrated platform that already exists in one of environments — it might be something we want to do. We’ve got a third option that we’ve already got the ambulatory component in, and then if we wanted to work with our partners in our coalition, we could do that. What I’ve tried to do is try to give Atlantic Health multiple options to choose from.
What do you think the driver will be as to which way they go?
I think it will be looking at where we are from a volume perspective, where we want to be on the risk side, how much we want to manage what we have.
We’ve got two accountable care organizations. If we do a good job in that realm, aren’t we going to be driving patients out of our own hospitals? If we do that, we want a really, really robust ambulatory system along with population health management, analytics, and care management tools. How big does the hospital system really now have to be?
Have you looked at any of those technologies for ACOs, population health management, and analytics?
No. We stepped in gingerly. We took our time. We tried to use what we had in place.
We started off with RelayHealth. We’ve been a big user of RelayHealth for many years. RelayHealth provides the platform for our regional health information exchange. We’ve got 30 hospitals on that here. We started off with that, and then we moved into some business intelligence. We have MedVentive for population and risk management. McKesson does a lot of work in the payer space for disease management, so we’re working with them right now on putting in their care coordination tool.
We spent a little time understanding what it is we needed to do, then tried to put a few technologies in to be able to do that. We’ve got the business intelligence. We’ve got to work on the care coordination tool — that’s next. We’ve got Relay to do some of the health information exchange.
We use Imprivata Cortext, a secure texting tool. We’ve built specific directories for the ACO physicians so that they can now use that as a secure referral tool for each other.
I’ve been a customer of Imprivata in multiple organizations. They’re an easy company to do business with. I’ve used their OneSign. Our doctors love the tap-and-go because they all have their little card and their one workstation. They don’t even log off, they just tap. It closes the screen and they tap it again wherever they go — it brings up their session wherever they are. They just love that. We started using their secure texting about a year ago.
They’re using Imprivata Cortext it as their communications clearinghouse so they don’t have to play phone tag? They just send the text message and walk away?
That’s right. Our ACO put together a per-member, per-month incentive for physicians up front so the physicians don’t have to wait until savings at the end of the year. There’s a number of different sections there. There’s one for the use of technology. If they use RelayHealth, if they use Imprivata Cortext, if they automate their offices, they get a certain amount of money. For some process measures, they get it. For some outcomes, they get it. There’s a couple of other things. Their whole per-member per-month incentive is based on certain activities that they do.
I assume you need to analyze your data across the Epic on outpatient and McKesson and Meditech on inpatient. What are using for a data warehouse?
We use Horizon Performance Manager. The pop stuff all comes out of MedVentive. MedVentive has data from the EMRs, from the HIE, and whatever they might need from the hospital.
Are you looking at any technologies that can help support the clinician-patient relationship and patient engagement?
Our app is a patient-facing app. We’re constantly working on we help physicians and patients communicate.
A number of years ago, we put in RelayHealth, which had secure messaging with physicians. I had one doctor say to me, “ I will never, ever, ever, ever trade an email with a patient.” Then about a year ago, she came back and she said, “That’s not so bad.” She was telling another doctor, too, “I talk to my patients on email all the time.” It’s really interesting to see the dynamics. I think we’re probably going to be looking at doing something very similar on the mobile front.
Tell me about the mobile app.
It’s called Be Well. We have one for each one of our hospitals, because our physicians are more specific to our geographic area. It’s got a physician directory, ED wait times, and a whole bunch of different health trackers, including a way to download your Fitbit information.
Did you develop that yourself or have it developed?
We worked with a company called Axial Exchange. Everybody today will tell you that it doesn’t make any sense to go out and do that kind of work yourself when there’s just so many other companies that you can work with.
There’s a health encyclopedia in there, but it’s the same kind of health encyclopedia we use on our website. For us, now we’re migrating from the web to mobile. That’s where we’re going there.
As a nurse, do you think nurses are underserved as far as technology that helps them do their clinical role rather than just documenting so that somebody else can send a bill or have the doctor read their notes?
That’s an interesting question. We put in Vocera a lot of years ago now. One of nurses’ biggest issues was the phone tag that they were playing with doctors. They don’t all carry around organizationally-provided smartphones. From an access to information, it could be more helpful if they did.
Do you discourage them from using their own?
We don’t. We do discourage them from SMS texting on their own. It is one of the reasons why we went out and got Cortext. Just telling people not to use SMS text and not giving them something to use makes no sense. It’s like spitting in the wind.
The interesting thing about nurses is that we’ve got those computers on wheels. They’re on those things all the time. To take them off takes them out of their work flow. The Cortext component has a PC-based user interface, not just mobile. You can be on the COWs or you can be on the mobile.
Right now for nursing, I think it’s moving in that direction. I just don’t think that it’s quite as mobile-enabled as some of the physician tools right now.
What are the organization’s biggest strategic issues that need IT help?
Care coordination is huge. We’re kind of schizophrenic because we still are fee-for-service and we still are doing procedures and patient care in the hospitals, but we also have these ACOs. While we still need to be able to get people in and have great turnaround time, decrease the length of stay, get more turns in as much as we can, on the other side, we’re still working on how do we keep people out of the hospital and in the ACO and keep and have that gap and address all the gaps in care and the transitions of care?
It’s like two different initiatives that we’re working on. We still have to keep the whole patient engagement and satisfaction thing going on the other side.
One of the things we did a few years ago –it’s on paper and we’re just getting ready to take a look at how to automate it — is we had created a patient itinerary report. One of the big things that patients always complain about is that they don’t know what’s going to happen to them during the day. We created a report that pulled it from different parts of our technology — what’s the patient’s name, why are you here, when did you get here, who are the care providers on your case, what medications are you on, what labs did you have ordered for you, what were the results of the labs that you had yesterday, are you going for any other tests? Then there’s a little spot for “questions to ask my doctor.” That really was pretty popular and the patients seemed to like that. We’re probably going to automate that.
One of our next ventures in the mobile space is probably a bedside app that would give you that whole access to “my care team, my itinerary, my meds.” We also have that on our TVs right now, but we’ll look at putting it on an iPad.
Most hospitals would use an interactive patient system approach and put it on the TV, but you’re going to give patients iPads. Has anyone done that?
No. There’s a couple of places that are looking into doing it. There’s also a company out there called PadInMotion. They do some of that and they also give patients access to like Netflix and things like that on the iPad.
The more of this education stuff that you’re going to put in front of patients, a TV on a foot wall is really a tough user interface to give patients unless the thing is like 120 inches. I don’t know how big the screen has to be. Giving them an iPad is probably a good way to do that, but again, we also have to take a look at the patient population. When my dad was in the hospital, he could barely work the remote control on the TV, much less an iPad. It’s just trying to meet the needs of the patients that are there. You have to have multiple user interfaces to help patients through all the technology we throw at them.
Physicians are moving, or moving back, into leadership roles in health systems. What advice would you offer nurses who want to move into leadership roles outside of nursing?
Don’t say no to anything. I have a job today that practically didn’t exist when I first started in my nursing career. Take on any opportunity.
The one thing that sometimes you see with nurses is that they like to have things that are very concrete. It’s interesting because we work on the fly every day. We are the leaders of multitasking. But sometimes I think having a job that doesn’t have a very concrete job description or isn’t very clear on the time or the hours or the responsibilities — I think they shy away. They don’t realize how freeing a job that’s maybe not quite baked can be, because you can bake it yourself.
Nursing is also very isolating because you’re in those nursing units all the time. Sometimes you don’t get a lot of opportunity to meet and speak to board members, meet and speak to senior leadership. You’re just tucked away enough that you’re not exposed. That’s the other thing–say yes to any committee. Get out of the nursing unit and get some exposure.
Do you have any final thoughts?
For anybody who’s in a hospital and just thinks of healthcare as a hospital, where we are going should be frightening to you. We’re not going to be a hospital, especially if we start taking a look at the people who are going to disrupt us the most — retail medicine.
We have to start thinking about ourselves as the providers of retail medicine. We have to think about fast access, customer service, the customer’s always right — those things that you’ve traditionally heard about retail environments. We have to stop thinking about healthcare as a civil servant-type environment where you call and you get an appointment four weeks later. It’s going to change everything we do. We’re going to have to get faster, better, and more consumer friendly very quickly.
The following is a guest blog post by Trevor James.
If you work in the health/dental/medical space, you already know that HIPAA violations are a serious matter. Fines today for not complying with HIPAA laws and regulations are a minimum of $100-$50,000 per violation or record and a maximum of $1.5 million per year for violations of the same provision. Some violations also carry criminal charges with them, resulting in jail time for the violators.
Many dental offices are breaching HIPAA laws without realizing it or have employees doing so without their knowledge.
If you’re a dentist, office manager, or someone who’s been tasked with ensuring HIPAA security within your group, here are the 10 most common ways dental offices are breaching HIPAA regulations so your practice doesn’t make the same mistakes as others.
1. Devices with patient information being stolen
This is a common HIPAA violation for dental offices. It’s important to ensure the devices your dental office uses, like USB flash drives, mobile devices and laptops, are carefully handled and securely stored to prevent them and the patient information on them from being stolen.
2. Losing a device with patient information
Along the same lines as above, it’s also easy (and common) for an employee to lose those kinds of devices. USB flash drives and mobile devices are smaller items, so it’s easy to misplace them. When that happens, it’s easy for sensitive patient information to end up in the wrong hands.
Train your employees on the importance of properly handling these devices and set up some sort of tracking device, like downloading the Find My iPhone app or Where’s My Droid, to help you locate a device if it ends up lost.
3. Improperly disposing of papers and devices with patient information
When it comes time to get rid of papers or devices containing dental records or billing information, be sure you properly dispose of them. Crumpling paper in a ball and throwing it in the trash isn’t the correct way to do things nor is shutting down a device and then tossing it in the garbage. Use a paper shredder and wipe your devices clean of all information before disposing of them.
4. Not restricting access to patient information
Unauthorized access to a patient’s dental information will get you in serious trouble with HIPAA. Patients trust your office with this personal information, so be smart when handling such information so other patients, employees and relatives who aren’t allowed access don’t come across it.
A dental practice breached HIPAA in a case relating to this when they put a red sticker reading “AIDS” on the outside cover of patient folders and those not needing to know said information were able to read it while employees handled the folders. Don’t make simple, costly mistakes like they did.
5. Hacking/IT incidences
Most patient dental information now is stored on computers, laptops, mobile devices, and in the cloud. Today’s technology allows dental practices to more easily communicate, and look up and share patient information or their status on these devices.
The downfall of this technology is the people who are just as smart or smarter than your technology and hack into your devices or systems to get their hands on patient information. Make sure every device has some type of passcode or authentication to get on, install encryptions and enable personal firewalls and security software.
6. Sending sensitive patient information over email
While it’s not a violation to send these kinds of emails, it is a violation if the email is intercepted and/or read by someone without authorized access. Use encryptions and double check that whomever you’re sending the email to is supposed to be receiving the email.
7. Leaving too much patient information over a phone message
A patient may give you the A-Okay to call them, but be sure you don’t leave a message disclosing too much of their information. A friend or family member could check your patient’s message and hear things they shouldn’t, making said patient upset, or equally as bad, you could call the wrong number and say more than you should, which would probably make your patient even more upset with you. Your safest bet when calling a patient and they don’t answer is to leave a message for them to call you back.
8. Not having a “Right to Revoke” clause
When your dental office creates its HIPAA forms, you have to give your patients the right to revoke the permissions they’ve given to disclose their private dental information to certain parties. Not providing this information means your HIPAA forms are invalid and releasing subsequent information to another party puts you in breach of HIPAA.
9. Employees sharing stories about patient cases
People talk. It’s a simple fact. Employees talk with one another and they also talk to patients every workday. Remind them, though, that discussing a patient’s information to an employee lacking authorized access or to other patients is unprofessional and puts your whole practice at risk of being fined by HIPAA.
10. Employees snooping through files
It might seem shocking — or maybe not to some — but employees have been caught snooping through patient and co-worker files before. They do this to find out information for themselves but also because relatives or friends ask them to find things out about a certain person. Snooping is wrong and unprofessional on all levels.
Make sure your employees are clear on this and that they understand how bad the consequences can be for them and your office for doing so.
HIPAA violations in dental offices are all too common. Now that you know the top 10 ways dental offices are breaching HIPAA, you can take every precaution necessary to prevent your practice from violating any HIPAA laws and regulations.
About The Author
Developing and launching a competitive product, and getting initial traction in the market are not inconsiderable milestones. And yet for the entrepreneur and their investors, this is just the beginning. What was record setting last quarter is barely acceptable this quarter, and next quarter had better be back on track.
Developing a solid plan for growth depends on two things: a good understanding of the basic means to drive growth, and a deep understanding of the market. This post seeks to combine both of these in a brief survey of the key factors to drive messaging middleware revenue growth in health care. We’re going to consider three basic growth strategies: organic growth, product line extension, and the roll-up strategy.
For start ups, organic growth can be realized first by targeting a market segment that has broad appeal and large numbers of early and late adopters. Going back to Moore’s market adoption model, it’s relatively easy to identify a market need and generate initial sales to innovators and early adopters. These early buyers want technology and performance, something new the buyer can leverage to gain a competitive advantage of their own.
These early buyers tend to be large institutions with a corporate culture of innovation and the internal resources to support such endeavors. Accounts like the Cleveland Clinic, Mayo Clinic, Partners Healthcare, come immediately to mind. Kaiser Permamente would also fall into this group, except they are held back by their need to have solutions that can scale to considerable extremes, a requirement that is not applied to these other health care provider titans. There is even a cadre of smaller nimble early buyers: Overlake Hospital, Bellevue, Washington, and El Camino in Mountain View spring to mind. Spend enough time in this industry and the early buyers tend to make themselves known. The problem is that this population of early buyers is quite limited; early buyers will only take a company so far.
Once most of these early buyers in a market segment have bought, the market adoption chasm arises because the next group of buyers to adopt – the much larger early majority – don’t want technology and performance, they want complete, proven, easy to adopt solutions. This shift gives rise to the conventional wisdom that, “hospitals want solutions to problems, not tools they can use to solve their own problems.” For vendors, the importance of this is self evident when considering how to maintain or even increase their growth rate over time. For providers, it’s important to recognize from which side of the chasm your organization is operating and proceeding accordingly.
To cross the chasm, vendors must add to the original innovative technology the required features and services to create a whole product solution that is laser focused on a recognizable problem. Figuring out exactly what it is that’s required to transform an innovation worthy of inspiring early buyers into the safe and reliable solution required by the early majority is a challenge. Recognizing the gaps and knowing how best to fill them is not easy, although there are processes that can be used to identify those requirements and confirm that they’re met.
Moore calls the process of creating and going to market with the whole product solution being in the bowling alley. The bowling alley let’s you shift your growth from the early market, which may be nearing penetration, to the much larger early majority portion of the market. Crossing the chasm is an essential objective for new companies. In a crowded market like messaging middleware, numerous companies will be struggling with crossing the chasm.
Achieving strong organic growth is an excellent indicator that, beyond a solid whole product solution, sales and market are also top notch. Sales and marketing are especially important because health care is not a field of dreams market, where “if you build it, they will come.” Brand awareness, demand generation and market education are key marketing tasks. Sales requires effective sales tools and proofs in support of a sales strategy or process that leads first time buyers to the right decision in an efficient and reliable manner.
A main characteristic of the messaging middleware market is the variety of different problems that can be solved by the same basic technology. These different problems are reflected as market segments. Each of the different market segments listed in the previous blog post can potentially support a start up, or represents a potential product line extension. Moore frames these other market segments as additional bowling alleys that leverage the same foundation of product and services that make up the original whole product solution. Some product line extensions may require changes to the whole product solution to gain early majority market adoption.
Much like selecting the initial target market for a start up, the key is to identify new bowling alleys with sufficient market demand (of course, competition is also a factor). Synergy with preexisting whole product solutions is also desired. It’s also helpful if the new bowling alleys under consideration target the same markets (e.g., physician practices or hospitals) so that existing sales and marketing resources can be easily leveraged to take advantage of cross-sell and up-sell opportunities that emerge. If different bowling alleys target different markets – say, physician practices for one and hospitals for another – each target market will require major investments in marketing and sales; potential synergy from a targeting a common market are lost.
Sometimes a product line extension includes product changes that add substantive new features to the platform. For example, a secure messaging solution that is designed to support a single enterprise might add the capability to support users across multiple enterprises, or the addition of a scheduling module to support a more complete secure messaging solution for on-call physicians.
A roll-up strategy entails a series of acquisitions used to construct a bigger company made up of complementary products or solutions. A relevant example of this strategy can be found in Amcom Software. After their merger with Xtend Communications, Amcom came to dominate the hospital operator console market (due to their HL7 integration capability) and related telephony applications. Subsequent acquisitions extended Amcom’s reach with various communications solutions for health care, government and other vertical markets.
Amcom Software was acquired by USA Mobility in 2011 for $176,800,000. The combined company is now called Spok (pronounced spoke with a long “o”). Starting with the merger with Xtend, the Amcom Software strategy was to build a company through acquisitions and then sell the company. With a 2010 revenue of $60 million, things appear to have worked out well for Amcom’s investors.
Because of the nature of this market, a roll-up strategy can be challenging. Unlike the product line extension strategy, where a company’s existing technology is reconfigured or enhanced to target new market segments, the roll-up strategy entails the acquisition of other companies. How those acquired products, employees and customers are optimized is the challenge.
Mergers and acquisitions occur frequently in the health care industry. The goals of these transactions include:
The first two bullets are obviously related, however the degree and ways they’re related depends on the specific companies and their business models. A company that goes to market selling mostly capital goods (hardware and licensed software) is quite different from a company selling their solution as a cloud based service.
As discussed in a previous post, most messaging middleware solutions are built using a similar architecture that is often made up of software engines. These engines can be licensed from commercial vendors or from open source projects. The resulting solutions can be built relatively quickly and for modest sums. Consequently, the value in purchasing a messaging middleware vendor for their technology may be limited.
Creating interfaces between multiple messaging middleware acquisitions can be problematic. To date, messaging middleware systems have been designed to operate alone; manufacturers do not intend for their messaging middleware system to be one of a constellation of messaging solutions serving the same user base. Some manufacturers have added to existing designs by implementing APIs and other integration points to facilitate the incorporation of other messaging middleware apps – often to fill feature gaps demanded by prospective buyers. Implementing multiple messaging middleware solutions via acquisitions raises questions about message routing, escalation and the existence of more than one rules engine impacting message flow. A system of systems made up of messaging middleware solutions gets very complicated very quickly, increasing configuration and verification and validation test complexity.
An acquiring company with older software technology may see value in the acquired software platform, or in the intellectual property and expertise behind the development of that software. Further, the acquired company may have software capabilities that are extensions to messaging middleware solutions – such as the staff scheduling for on-call physician messaging example used earlier.
The acquisition of mVisum by Vocera is worth a closer look. It should be noted that Vocera does not appear to be executing a classic roll-up strategy but the rationale that may have driven this acquisition is of interest. mVisum was a start up with an attractive messaging middleware product. Unlike many other messaging middleware solutions, mVisum was FDA cleared for alarm notification, conveyed snippets of medical device waveforms with medical device alarms (important for screening non-actionable false/positive alarms), and also included remote medical device surveillance features. The company subsequently ran into some patent infringement issues with AirStrip Technologies. mVisum was acquired by Vocera for $3.5 million less than a year later.
There is considerable overlap between Vocera and mVisum solutions. Potential areas of value for Vocera include mVisum’s FDA clearance for alarm notification, one of the strongest messaging middleware market segments. mVisum also filed a number of patent applications that may be of value to Vocera. Vocera was founded in 2000, so there may be some value in mVisum’s software architecture – if not the actual software, then the requirements and design may be leveraged in future versions of Vocera’s software.
To summarize the roll-up strategy applied to messaging middleware, there is likely not a lot of value in acquiring other messaging middleware companies when compared to the product line extension strategy. The main reason is because most software architectures will be similar. There are exceptions to this, some of which are alluded to in the Vocera/mVisum discussion above. Because the messaging middleware market is relatively undeveloped – we’re far short of a penetrated market – there’s little opportunity to buy cash flow or market share through acquisitions. Nor is the market so developed that human resources are a likely justification for acquisition.
The roll-up strategy does make more sense when one looks beyond messaging middleware. Just as Amcom Software took a broader view of vertical market messaging and communications solutions that included messaging middleware as a portion of the whole, one could frame a roll-up strategy from a similar, higher level. For example, a roll-up targeting health care could encompass point of care solutions, rolling-up messaging middleware with nurse call, medical device data systems (MDDS), data aggregation and patient flow with enabling technologies like real time location systems (RTLS) and unified communications (enterprise phone systems). The resulting entity could define a new enterprise software category: point of care workflow automation.
Another practical application of the roll-up strategy is the secure messaging market targeting physicians. There is little apparent differentiation between solutions and vendors with good adoption in a particular geographic market will be difficult to dislodge. Here a classic roll-up, where the acquiring company offers broader economies of scale superior to those of regional players has a lot of potential. Such a strategy would be complex to implement, due to the technical product integration issues noted above. Provided they could dedicate sufficient cash flow, this could be an attractive strategy for Spok, although any company with access to several tens of millions could pull this off.
With 100+ competitors, the messaging middleware market is remarkably crowded. Over time, many of these firms will fade away as they fail to gain initial market traction, cross the chasm or get acquired. There will certainly be mergers and acquisitions. There will be some who plan and execute well, and grow their companies to tens and hundreds of millions in annual revenue. Some degree of luck with be a factor. But regardless of the strategy or outcome, the imperative shared by them all will be the drive for growth.
You can find a post Messaging Middleware Defined here and the post on Messaging Middleware Market Segmentation & Adoption here. In the coming week a post on HIPAA will be published. Be sure to check back!
— Wen Dombrowski MD (@HealthcareWen) July 22, 2014
I agree with Wen that the EMR and claims data needs to be cleaned up. I think it gives the wrong message to say it’s not meaningful though. Once it’s cleaned up, it has a lot of value.
— Jobs in Washington (@W4_Jobs_in_DC) July 28, 2014
How many of you have applied for a job because you saw it posted on Twitter? I’m really interested in this since I do a lot of health IT job posts on Twitter. We see quite a bit of traffic from Twitter to our healthcare IT job board, but I haven’t added a good way to track who signs up and applies for jobs. That’s next.
— Practice Fusion (@PracticeFusion) July 27, 2014
I love how academic Practice Fusion tries to make the discussion. I thought I made the discussion of EMR vs EHR much simpler.
The Senate Appropriations Committee cuts ONC’s requested $75 million budget for 2015 down to $61 million and adds a stipulation that ONC should decertify and publicly report any EHR vendors that “proactively block sharing of information.”
In South Africa, a $133 million Siemens implementation is put on hold over allegations that the local Siemens reseller engaged in bid-rigging to close the deal.
Self Regional Hospital (SC) announces a data breach affecting at least 500 patients stemming from a Memorial Day office break in that led to the loss of an unencrypted laptop.
In a local article, 71-bed Nevada Regional Medical Center CFO Greg Shaw blames its Cerner billing system for the hospital’s $5.6 million YTD net loss, claiming that the system incorrectly classified insurance payers and aging accounts.
A draft report from the Senate Appropriations Committee, responding to HHS’s FY2015 budget request, proposes to give ONC $61 million of the $75 million it requested. It adds that ONC should publicly report and then decertify EHRs that “proactively block the sharing of information.” It also wants the Health IT Policy Committee to create a report describing the challenges to interoperability and whether certification helps or hinders it. Reading down the long list of funded projects, it’s depressing to see how much taxpayer money is being dumped into government programs that claim to help one issue or another. All that aside, the interesting dynamic here is that ONC, like every government agency unwilling to reduce its budget or authority, keeps trying to expand its mission while Congress seems to think it is overstepping its authority and questions its effectiveness. I suppose $75 million is a rounding error in the federal budget, but as a taxpayer, I might question ONC’s value, along with what I’m getting for my $25 billion in HITECH handouts to providers who mostly regret having given up control in return for strings-attached government money.
From EarsToTheGround: “Re: Siemens. Well-placed sources say they’ve been told that their consultant and contractor positions are being terminated by the end of September as they phase out several EHR vendors. I don’t know if this is related to the possibility of a Cerner buyout.”
From All Hat, No Cattle: “Re: pic from the Redwood Mednet conference in Santa Rosa, CA. I see the audience is a lot of older hippie types and open source geeks like Wes Rischel, Will Ross, John Mattison, David McCallie, etc. discussing HIEs with John Halamka.” There’s nothing like that "bald spot meets gray ponytail" look when it comes to self-identifying as an IT geek or that vaguely creepy “stuck in the 1970s” sound guy at the local music bar who doesn’t have the talent or nerve to be on stage but toils in the worshipful shadows of decades-younger musicians who do.
From Laredo Dave: “Re: Weird Al. Almost every buzzword you have ever heard, all in one video.” I’ve always detested Weird Al and his heavy-handed, sophomoric parodies of current events, but this one might make me a convert since even the music is good (very CSNY-like). It even includes one of my least-favorite, unnecessary pseudo-words: “administrate.”
From Lupe: “Re: Childhood Cancer Awareness Month. It’s in September. I don’t have a million dollars to give for research, but I am the very lucky mother of a 16-year-old diagnosed a year ago. My goal, short of a cure, is to make the gold ribbon representing these horrific diseases as recognizable as a pink one for breast cancer.”
From PP: “Re: Android tablet. Which inexpensive one did you buy that you liked quite a bit?” I got an Asus MeMO Pad HD 7 in December 2013 for $119 when it was on sale at Office Depot, frustrated that a newer version of my first-generation iPad was more expensive than a laptop. I still use the Asus tablet regularly and have no regrets. Android-powered tablets are just as good or better than the ones Apple sells for multiple their price, which may be why iPad sales are nosediving. I’m a casual user (checking email, looking up stuff on the Web, watching Netflix, and reading Kindle books around the house, all over WiFi instead of cellular), so I don’t need a $499 iPad Air or even a $229 Google Nexus 7. The just-released latest model of the MeMO Pad is $134 on Amazon.
Athenahealth provided a response to the question from Watertown Boy about the effect of the company’s updated Meaningful Use calculations on those practices that have already attested. I posted their comment under the original question.
Half of my poll respondents own stock or other equity of a healthcare IT company. I’m in the other half that doesn’t. New poll to your right: do EHR vendors have too much influence on related government policy?
Welcome to new HIStalk Gold Sponsor DocuSign. Its solutions allow business to sign, send, and manage documents in the cloud, making them available and legally enforceable. Healthcare organizations such as Blue Cross Blue Shield, Cedars-Sinai, HCA, and New York-Presbyterian use DocuSign to streamline document-based processes. The result is HIPAA compliance, faster patient inboarding, shortened turnaround time for Medicare billing, and faster handling of paperwork involving credentialing, supplier contracting, and HR. I interviewed the company’s founder, Tom Gonser, a few months ago. I have received documents that required DocuSign signatures and it was infinitely easier than printing, signing, scanning, and emailing. Try it yourself with the company’s 14-day free trial. Thanks to DocuSign for supporting HIStalk.
I’ve mentioned before the really cool (and free for personal use) remote control software I use: TeamViewer, from Tampa, FL. You can remote in to someone’s computer to fix something, remote into your own desktop from your phone, transfer files, and even hold online meetings or training sessions for up to 25 people. It is unbelievably simple, reliable, and satisfying to use. Just this week I’ve used it to remote into a colleague’s PC to diagnose a Windows problem and to remote into my home desktop from my phone.
Listening: a new hard-rocking single, “Cool Kid,” from The Eeries, an unsigned Philadelphia band. Also: Young the Giant, great California indie rock. Here’s one more, this one with a healthcare IT angle: VEX (above), a locally popular early 1980s college punk band (Georgia College & State University) featuring a young Larry Stofko, now EVP of the Innovation Institute of St. Joseph Health System of Irvine, CA. VEX’s music is now on CollegeBand, which tracks down long-defunct cult college bands, digitizes their music, and sells it along with merchandise and music rights for movies and TV. That’s my kind of business.
Last Week’s Most Interesting News
August 12 (Tuesday) 1:00 p.m. ET. City of Hope Improves the Cancer Patient Experience With Salesforce.com. Sponsored by Salesforce.com. Presenters: Fred Stevens, director of call center operations, City of Hope National Medical Center; Todd Pierce, EVP of operations and mobility, Salesforce.com. Learn how City of Hope improved patient satisfaction and intake inquiries in 16 areas, gave 75 call center representatives the information they needed to deliver a personalized and seamless interaction, improved first-call resolution, and reduced average call transaction time by 42 percent (90 seconds) for over 1 million inbound calls per year. A live demo of Salesforce1 will follow.
Acquisitions, Funding, Business, and Stock
From the Cerner earnings call:
I missed this earlier announcement: Google launches Calico, a health and wellness company that has already hired four prominent physicians and named as its CEO the board chair of Apple (who is also board chair at drug maker Genentech.) It seems that Google is dipping toes all over the healthcare waters right after Google co-founder Sergey Brin complained that it’s a waste of his time because it’s too regulated. Maybe he was just being cranky over the FDA’s pressure on his wife’s consumer genetics business 23andMe, which still hasn’t complied with FDA’s requirement that as a medical device, it has to submit validated proof of its accuracy to earn the agency’s marketing approval.
Surgical Information Systems names Jim Linder (Norwest Equity Partners) as acting CEO and executive chairman, replacing Ed Daihl.
Healthgrades joins athenahealth’s More Disruption Please program, giving athenahealth’s practice customers the ability to post appointment availability online for patient self-scheduling. In the spirit of disruption, I would urge Healthgrades to stop sticking the superfluous “Dr.” in front of every provider’s name – we understand that MD is a doctorate without needing its conferees redundantly identified as “Dr. John Smith, MD.” Every time I see that, I think of chiropractors and podiatrists, whose DC and DPM credentials don’t provide adequate ego stroking since many people don’t know what they mean. “Dr.” in front of a name should be used only in social situations where you might otherwise use Mr. or other titles – it should never be used on a website, business card, sign, online article, or obituary unless you want to emphasize your smug pomposity.
Qlik announces availability of a free desktop version of its data visualization and discovery tool.
In South Africa, the government freezes the Siemens-related EHR and radiology system contracts of Gauteng Department of Health, worth $133 million, following allegations of bid-rigging. The winning bidder of the 2007 tender, Siemens reseller-controlled Baoki Consortium, provided a health department executive with free housing. Prosecutors added that the bid was issued even though the health department didn’t have the money, infrastructure, or trained users to operate the proposed systems for 37 hospitals and 300 clinics. The systems were never implemented. The contracts were terminated in 2009 when new a Member of the Executive Council was elected. Siemens has been named innumerable times over many decades as being involved, directly or otherwise, in bribery-related contract awards, although it was a subcontractor in this transaction and wasn’t accused of doing anything wrong.
Self Regional Hospital (SC) goes public with the news that a laptop stolen in a Memorial Day weekend break-in contained information on at least 500 patients. The laptop was not encrypted. Police arrested two suspects, who said they panicked and threw the laptop into a lake. Perhaps the hospital’s apparently lack of technology sophistication in failing to encrypt PHI-containing devices extends to its website, which automatically starts playing the cheesiest, blandest royalty-free music imaginable as soon as its home page displays, with no option to shut the racket off.
Bonny from Aventura did some self-study on the CMS “Two Midnights” rule and decide to memorialize her newfound knowledge as a cartoon.
One of the major goals of Big Pharma is to enlarge its customer base, which is to say, sell more product. One way to accomplish this is through the medicalization of "conditions" that previously have not been viewed as diseases. One example of such a condition is obesity. This medicalization process has also been referred to as "disease mongering" (see: Disease Mongering (i.e., Medicalization) by Pharmaceutical Companies; Medical Device Mongering, a Variant of Disease Mongering). The reason that Big Pharma spends huge amount of money each year on direct-to-consumer (DTC) advertisements on TV is to circumvent physicians by creating demand for prescription drugs among consumers (see: Effectiveness of "Direct-to-Consumer" Drug Advertisements). Although consumers can't write prescriptions, they can certainly request a particular drug from their physician.
Given all of this, it should not be surprising that the pharmaceutical industry is teaming up with Silicon Valley companies to develop wearable IT devices to monitor health. The details of a recent Google/Novartis deal were discussed in a recent article in the Financial Times (see: Big pharma teams up with big data). Below is an excerpt from it:
Big pharma and Silicon Valley have been circling one another for some time, looking for ways in which they might harness the power of data technology to medical ends. Now a fusion of West Coast entrepreneurship and lab-coated medical expertise has spawned its first big publicly announced transaction. Google has struck a deal with Novartis to develop a “smart” contact lens designed to help diabetics track their blood sugar levels. The lens works by analysing the level of glucose in a wearer’s tear fluid and communicating the data to a mobile device. It replaces the need for diabetics to test their own blood sugar several times a day....But this is only one of the reasons to applaud the marriage of pharma and big data, and the emergence of such “wearable” medical devices. The increasing incidence of chronic diseases and an ageing population has created the need for real-time health monitoring. At a time of stretched healthcare budgets, having a device that tracks the state of the wearer’s health can help to give physicians better early intelligence of problems, reducing the need for costly interventions and long hospital stays later on. Monitoring is, moreover, only part of the story. Wearable technology may also have a role to play in treating conditions. For instance, Novartis is also looking at using Google’s technology to produce an “autofocusing lens”....Another area of investigation is into so-called “electroceuticals”. These are implants that use electronic impulses to affect and modify the functions of the body.
I have no problem with wearable devices for monitoring health status. I think that this is both inevitable and useful for increasing health awareness among the general population if not to improve health. I am also enthusiastic about the notion of having healthcare consumers take more ownership of their own health status. Early autodiagnosis and ongoing health monitoring is certainly one way to reduce the cost of healthcare by avoiding the expense of nagging chronic diseases. Why then would I be concerned about pharmaceutical companies getting involved in the development of such devices? My greatest fear is that the companies will "fudge" these devices such that the diagnosis of various diseases and the need for treatment will be overstated. This will be an extension of the medicalization discussed in the first paragraph. One example of such chicanery was a rigged depression survey that Eli Lilly posted on the web. The company manufactures the anti-depressant Cymbalta. Regardless of how one answered the survey, the conclusion was that the subject may be depressed (see: Rigged Depression Survey on the Web Steers Readers to Lilly's Cymbalta).
I’ll admit that I’m a sucker for infographics. I usually post the various EHR infographics I find on EMR Thoughts, but this one seemed more appropriate to post on EMR and HIPAA. You can find all of the various EHR and Health IT infographics I’ve posted on this Healthcare IT Infographic pinterest board as well.
Thanks to Coalfire for putting together this HIPAA Security Risk Analysis Myths infographic.
Update: David Harlow offered this interesting note that might be helpful to some “The infographic suggests that only covered entities need to undergo a security risk assessment. In the EHR context that makes sense, since them with EHRs are CEs, but of course Business Associates need to do this too.”
Ever since Watson made its debut on Jeopardy, I haven’t been able to not check out what Watson was doing next. No doubt what Watson did on Jeopardy was impressive. However, it’s one thing to do what it did on Watson. It’s another thing to commercialize the Watson into something useful.
I’d long been hearing that Watson was going to be great for healthcare IT and that healthcare would really benefit from the technology. However, everything I saw felt very conceptual as opposed to practical and implemented. So, I was really interested in talking with Modernizing Medicine about their EHR integration with Watson.
You can find my interview with Daniel Cane and Dr. Michael Sherling, Founders of Modernizing Medicine, talking about Watson and some of the other cool ways they’re trying to help doctors make use of the data in an EHR in the video below. Plus, we even talk ICD-10 and MU 2 delay as well.
Note: Modernizing Medicine is a Healthcare Scene advertiser.
This is a new tamper proof drug which means if it is crushed it looses it affect, but of course people can still swallow the pills. Purdue will have to conducted follow up studies on rates of abuse, addiction and death as that’s a standard anymore for any Opioid drugs. BD
Washington • The Food and Drug Administration has approved a new combination pain pill from the maker of OxyContin that is designed to discourage abuse by painkiller addicts.
Purdue Pharma’s new drug Targiniq ER is an extended release tablet that combines oxycodone — the active ingredient in OxyContin — with the drug naloxone. FDA regulators approved the drug for daily, round-the-clock pain that does not respond to other medications.
Stamford, Connecticut-based Purdue has often been cited by public health advocates as a key contributor to the overprescribing of opioids. In 2007, Purdue Pharma and three of its executives paid $634 million and pleaded guilty to charges of misleading the public about the safety and addictiveness of OxyContin.
Is this a great story or what? Listen to the video and read below about his past, pretty grizzly so he’s off his rocker to begin with. He earned his money the old fashioned way, he inherited it. He was recognized as a regular patron at the store. BD
Police say multimillionaire Robert Durst unzipped his pants in a Houston CVS, exposed himself and then urinated on a cash register and candy before walking away from the store just after noon Sunday, Houston NBC affiliate KPRC reported.
He had left the scene by the time police arrived, but on surveillance video he did not appear to have been agitated or argumentative before the incident, police said.
Durst had been arrested in 2001, jumped bond, was found in Pennsylvania trying to steal a sandwich and a Band-Aid from a grocery store and eventually faced trial in the murder. He claimed he had shot Morris Black in self-defense during a struggle over a gun, according to the Houston Chronicle.
Flagstaff is located in northern Arizona and now the center will be closing. There has been a lot of speculation if Walgreens will stay headquartered in the US or move to the UK or Switzerland.
Last year Walgreens had 75.2 billion in revenue and 2.8 billion in profits. Remember too these folks bring in about 1 - 2 billion in revenue from selling data which would be part of of the 75 billion in revenue. In addition Senator Dick Durbin wrote a letter to the chairman of Walgreens stating they were turning their backs on the US should they decide to move. Well they have to finance their stock buy backs and reductions and cut backs are part of that as they are pretty leveraged these days if they stay in the US. The company is also suing CVS and Rite Aid over IP software patents.
In addition to save money last year all employees were moved to a private health insurance exchange for their benefits that is run by an investor relations firm. Sounds like things are headed to be a little toxic around Walgreens. BD
The community is now scrambling to do what it can to keep as many of those workers in town.
"This is the biggest one we've ever had in Flagstaff," said Coconino County Career Center Director Carol Curtis.
The distribution center in Flagstaff was once thought to be an employer that would be around for good. The city even named the road it's on Walgreens Street.
Curtis says the news made the Coconino County Career Center's rapid-response team spring into action.
We have another new one added today in the form of Wal-Mart Senior VP Leslie Dach to be Burwell’s senior counselor to help manage the health insurance exchanges. As I have said before I think HHS and CMS has nowhere else to turn with the lack of building their own models over the years. A former CMS employee told me that for years when they go stuck they just called in United to provide and create a model for them so I think this study is really true from Plos One, the fear of math gives people real physical pain:) Of course we know this doesn’t apply to Wall Street either but it could alive and well at HHS and CMS these days:)
Of course we know that we don’t have any real experts anymore either so half dozen of one and six of another, it’s modeling for inequality using segmentation anyway with the “Scoring of America’ that denies access. As I said below we are all busy as consumers being chased by corporate profit algorithms all the time with our data by all means and in time the glut will come out as it is beginning to show that all the models are not accurate and many are flawed or just cheat as what happened with the AMA and Ingenix, while the current Andy Slavitt who’s the #2 person in control now at CMS was CEO over that subsidiary. If you read the article, Andy Slavitt has officially been forgiven for anything he’s done or will do maybe. So far the focus has been on the QSSI incident, but how about the AMA suit, he was CEO then of Ingenix…
This is the guidance we can look forward to I guess as I don’t know about you but I do get suspicious about leopards changing their spots, a few do but you can base your own opinion here. There’s still a bunch of unsettled Ingenix (Optum) lawsuits out there unsettled.
Of course we all might remember Steve Larsen who left CMS to work for Optum as well a couple years ago who was responsible for a big part of the ACA law.
I said back in 2009 that these two would run over by insurers duping them and well, what do you think:) I just visualize and said what I felt in 2009 and sad but it’s what happened and we have issue at the SEC going right now too.
The mess we have right now is all credited to the insurers and their companies that’s how they make money with complexities just like Wall Street and the government sucked it all in and I’m far from the first on the web to state this fact. So we can add a new “sprinkle” of Wal-Mart here, who by the way has a pretty big technology lab up in the Silicon Valley too in case you were not aware. I like good data and it makes us smarter and we do need it but there’s so much room for one heck of a lot of Algo Duping which works well on the folks living in “The Grays” who can’t tell the difference between virtual and real world values and that’s a real problem in the US..all you have to do is recall the Facebook study a few weeks ago, and there you are:)
So it’s going to be pretty miserable indeed as the White House themselves has been caught with being duped with some junk science numbers so HHS and CMS unless something changes will as I see it keep sucking in what ever models they are presented with, and I did a post on some of that too, “quantitated justifications” for things that are not true and one by one all over today we’re seeing numbers and models fail. For an easy reference look at all the money spent with Lewin (another United subsidiary) that gave us a steady diet of of studies with “how much much money would be saved with this or with that”. You can go research and find them on the web too that claims billions and sometimes even trillions would be saved, while banks of data bases were built that scrape and sell our data for billions all the time to which we have absolutely no say or the ability to even see who they are. World Privacy Forum called that out perfectly “What going on with the secret scoring of US consumers”…we all watching. Sadly that’s what a lot of these models for better care are built around when it comes out in the wash, not better care, just more algorithms and more scoring to deny access. BD
“Leslie’s experience, which spans the business, government and civil society sectors, will further enhance our ability to deliver impact for the American people,” Burwell said. “We want to not only retain, but also recruit, talented individuals to our mission of ensuring every American has access to the building blocks of a healthy, productive life.”
I briefly mentioned Dr. Oz in my recent post about NY Med (and the healthcare social media firing). It’s clear to anyone watching the show that Dr. Oz is there for the celebrity factor and not for the actual medical work. He’s always “partnered” with another cardiologist who provides the actual patient care. Of course, I don’t really care too much that he’s on it or not. If it gives them a boost in ratings, good. I like the show.
However, I don’t know a single doctor that likes Dr. Oz and I know many of them who hate Dr. Oz. With this in mind, I found this interview with a medical student whose trying to “take down” Dr. Oz quite interesting. Here’s a short take on what this med student is doing:
Last year, Mazer brought a policy before the Medical Society of the State of New York—where Dr. Oz is licensed—requesting that they consider regulating the advice of famous physicians in the media. His idea: Treat health advice on TV in the same vein as expert testimony, which already has established guidelines for truthfulness.
Although, this quote is really powerful as well, “DR. OZ HAS SOMETHING LIKE 4-MILLION VIEWERS A DAY. THE AVERAGE PHYSICIAN DOESN’T SEE A MILLION PATIENTS IN THEIR LIFETIME.”
This is absolutely one of the problems with social media and other medium like television. The person with the biggest voice doesn’t always have the best information. In fact, sometimes the wrong information is the best way to grow an audience. What’s popular is not always what’s right.
Mazer in his interview highlights the biggest problem with some of the things that Dr. Oz says. The movement in healthcare has largely been towards evidence based medicine. I think that movement will only grow stronger as we can prove the effectiveness of care even better. However, many of the things on Dr. Oz’s show go contrary to evidence based medicine. This leaves the patient-doctor relationship at a cross roads when a patient chooses to follow something they’ve seen on TV versus the advice of the doctor (even if the doctor is on the side of evidence).
Dr. Oz aside, the same principle applies to other information patients might find on the internet. Many doctors would like to just brush this aside and say that patients should “trust” them since there’s bad information on the internet or there’s a bigger picture. That might work in the short term, but won’t last long term.
Long term doctors are going to have to take a collaborative approach with patients. As patients we just have to be careful that we don’t take it too far. Collaboration means that the patient needs to be collaborative as well.
The other way for doctors to battle the misinformation out there is to provide quality sources of trusted information. One way this will happen is on the physician website. Instead of being a glorified yellow page ad, the physician website is going to have to do more to engage and educate patients. That’s part of the opportunity and vision for Physia. It’s an exciting time to be in healthcare…if you like change.
In various conversations on how to improve patient care, the importance of health literacy is often raised. Health literacy is needed as it relates to effective patient engagement and healthy habits. Information and knowledge create greater awareness of how to live healthier and interact with doctors in a more meaningful way.
Another element of health literacy needs to include health IT literacy. With about 78% of care providers now using electronic health records (EHR) and wearable technology gaining momentum, healthcare is moving into the digital age. Patients will not need go deep into the technology, but a base understanding will be required.
Although this is not a complete list, we need to begin somewhere. Highlighted below are some basic health IT elements to raise the literacy levels of patients.
Affordable Care Act: This law generates intense feelings and debate. The Medicaid.gov site defines the Affordable Care Act in this way:
“…provides Americans with better health security by putting in place comprehensive health insurance reforms that will:
Hold insurance companies accountable,
Lower health care costs,
Guarantee more choice, and
Enhance the quality of care for all Americans.”
Essentially, the Affordable Care Act expands Medicaid coverage to low-income individuals and works toward adding improvements to our healthcare system. Read more about your healthcare rights here.
HITECH / Meaningful Use: In health IT circles, most will know what Meaningful Use is and where it came from. Move outside this circle and most will just think the drive to electronic health record adoption is a part of the Affordable Care Act (Obamacare). Meaningful Use was born out of the American Recovery and Reinvestment Act of 2009 (aka Stimulus bill) in which the Health Information Technology for Economic and Clinical Health (HITECH) was buried. Meaningful Use is a part of HITECH and, together, they seek:
“…to improve American health care delivery and patient care through an unprecedented investment in health information technology. The provisions of the HITECH Act are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EHRs.”
Simply stated, HITECH/Meaningful Use is an incentive program to move patient records from paper to an electronic format, which will then enable secure, efficient exchange of patient data, and provide patients easier access to their records.
EHR – Electronic Health Record: According to the HealthIT.gov website:
“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.”
An important element to an EHR is it contains all relevant patient information from different clinicians involved in a patient’s care.
PHR – Personal Health Record: According to American Health Information Management Association (AHIMA),
“The PHR is a tool that you can use to collect, track and share past and current information about your health or the health of someone in your care. Sometimes this information can save you the money and inconvenience of repeating routine medical tests. Even when routine procedures do need to be repeated, your PHR can give medical care providers more insight into your personal health story.”
Patients own and manage their health data – you own it, you maintain it. Having the ability to electronically receive relevant data from care providers in a usable, efficient way is very helpful.
HIPAA – Health Insurance Portability and Accountability Act: Finding a concise definition for HIPAA is challenging. On HHS.gov, the following explanation is good:
“Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals’ protected health information, whether electronic, written, or oral. The Security Rule is a Federal law that requires security for health information in electronic form.”
Even better, watch this quick video:
Your rights include saying who can see your data from clinical visits, and providers are responsible for securing your data collected during these visits.
PHI – Protected Health Information: Since protected health information was used in the HIPAA definition, we should address it. The National Institutes of Health highlights PHI as “individually identifiable health information that is transmitted or maintained in any form or medium (electronic, oral, or paper) by a covered entity or its business associates, excluding certain educational and employment records.”
Essentially, PHI is your health data.
Quantified Self: There is much more health data available because there are more tracking devices to use. Quantified Self, or wearable tech, are interchangeable terms and what it means you are proactively tracking (quantifying) your health metrics. Watches, mobile phones, apps, and other devices make the recording of your daily health information easy.
By tracking your health status, the objective is to understand your healthy habits and their impact as well as keep chronic conditions monitored and stable.
With better and timelier data, your health patterns are recognized and can be adjusted more effectively, as needed. Think diet, exercise, blood sugar, heart rate, and much more… recorded, tracked, and shared as you define.
Interoperability: Inevitably in health IT conversations, the lack or challenge of sharing patient data between providers, applications, and devices will arise. Healthcare has many data standards (e.g., HL7, X12) and different communication protocols (e.g., TCP/IP, Direct Project, Web Services).
For data to flow, each application vendor needs to open up their application or device to send and receive data. After this, the data differences need to be understood and then mapped. Integration solutions exist to orchestrate this patient data flow, but the considerations are many: application perimeters, privacy and security requirements, data specifications, workflow necessities, and more.
Interoperability is achievable and, as a patient, requesting your data in an electronic, secure way will help facilitate this requirement.
When health IT literacy works, it looks like a more fully engaged patient. The flow of health IT literacy may look like the illustration below. Pieces of the healthcare puzzle begin to fit together and patients have a broader perspective of how it all fits together, along with their important role within the healthy flow.
Healthcare has many components and, ultimately, the most essential elements are delivering high quality care in a timely and efficient manner. In the middle of this is you – the patient. Understanding what is healthy is core to health literacy. Understanding how your data is collected, stored, used, and exchanged is central to health IT literacy. We need to raise our health standards for both healthcare and health IT literacy, and this will take a community and your active participation.
What other key elements are required to raise health IT literacy? Add your thoughts and let’s expand this list to what is important for patients to grasp and use.
A recent article addressed both the diagnostic challenge and the changing presentation of diabetes mellitus. It included a description of the development of a new microchip for the inexpensive analysis of the autoantibodies that are pathognomonic of type-1 disease (see: Type 1 diabetes can be diagnosed with new microchip). Below is an excerpt from it:
An inexpensive, portable, microchip-based test for diagnosing type-1 diabetes could improve patient care worldwide and help researchers better understand the disease, according to the device’s inventors at the Stanford University School of Medicine....The handheld microchips distinguish between the two main forms of diabetes mellitus, which are both characterized by high blood-sugar levels but have different causes and treatments. Until now, making the distinction has required a slow, expensive test available only in sophisticated health-care settings....Better testing is needed because recent changes in who gets each form of the disease have made it risky to categorize patients based on their age, ethnicity or weight, as was common in the past, and also because of growing evidence that early, aggressive treatment of type-1 diabetes improves patients’ long-term prognoses. Decades ago, type-1 diabetes was diagnosed almost exclusively in children, and type-2 diabetes almost always in middle-aged, overweight adults....Now, because of the childhood obesity epidemic, about a quarter of newly diagnosed children have type-2 diabetes. And, for unclear reasons, a growing number of newly diagnosed adults have type-1. Type-1 diabetes is an autoimmune disease caused by an inappropriate immune-system attack on healthy tissue....The disease begins when a person’s own antibodies attack the insulin-producing cells in the pancreas. The auto-antibodies are present in people with type-1 but not those with type-2, which is how tests distinguish between them....The old, slow test detected the auto-antibodies using radioactive materials, took several days, could only be performed by highly-trained lab staff and cost several hundred dollars per patient. In contrast, the microchip uses no radioactivity, produces results in minutes, and requires minimal training to use. Each chip, expected to cost about $20 to produce, can be used for upward of 15 tests.
It used to be the case that type-1 diabetes with an autoimmune etiology was diagnosed in childhood and type-2 disease was diagnosed in older adults. This latter disease was often referred to as adult-onset diabetes. The age of the patient thus took the physician most of the way to the diagnosis. Now and due to the epidemic of childhood obesity, children are developing type-2 disease and some adults, for unknown reasons, are developing autoimmune disease. Type-1 and type-2 diabetes can be differentiated using an analysis for pancreatic islet cell autoantibodies but the test is slow and expensive (see: Autoantibodies in Diabetes). Researchers at Stanford are now developing a micro-chip based test for autoantibodies that is reportedly both fast and inexpensive.
Here are some additional comments about the microchip-based test and the diagnosis of diabetes from a Stanford web site (see: Researchers invent nanotech microchip to diagnose type-1 diabetes):
The microchip relies on a fluorescence-based method for detecting the antibodies. The team’s innovation is that the glass plates forming the base of each microchip are coated with an array of nanoparticle-sized islands of gold, which intensify the fluorescent signal, enabling reliable antibody detection....In addition to new diabetics, people who are at risk of developing type-1 diabetes, such patients’ close relatives, also may benefit from the test because it will allow doctors to quickly and cheaply track their auto-antibody levels before they show symptoms. Because it is so inexpensive, the test may also allow the first broad screening for diabetes auto-antibodies in the population at large. “The auto-antibodies truly are a crystal ball,” [the inventor of the chip] said. “Even if you don’t have diabetes yet, if you have one auto-antibody linked to diabetes in your blood, you are at significant risk; with multiple auto-antibodies, it’s more than 90 percent risk.”