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August-21-2014

9:28
Global Center for Health Innovation Cleveland

Global Center for Health Innovation in Cleveland

Global Center for Health Innovation in Cleveland

The Global Center for Health Innovation opened for business last October in Cleveland, Ohio, but will officially open to the general public this October. The futuristic glass structure, designed by LMN Architects of Seattle, comprises four floors and 235,000 square feet of space. The Global Center is adjacent to Cleveland’s new underground Convention Center, also designed by LMN. Jointly, they hope to attract more healthcare-themed conferences and exhibits to Cleveland.

A Technology Showcase for All

John Paganini HIMSS

John Paganini of the HIMSS Innovation Center

HIMSS Innovation Center

HIMSS is one of the anchor tenants at the Global Center occupying the entire fourth floor. The HIMSS Innovation Center features a Technology Showcase, Simulation Center, and conference rooms. HIMSS now has a year-round exhibition space to complement its Annual Conference & Exhibition, which is the industry’s leading conference for healthcare professionals.

“This is a very interesting place, not for healthcare professionals only, but also for the general public,” according to John Paganini, Senior Manager of Interoperability Initiatives at the HIMSS Innovation Center. The aim is to drive interaction between health IT companies, healthcare professionals, and consumers.

I saw this mix in action while visiting the HIMSS Innovation Center and watching Apple conduct an educational event on replacing computers with iPads. The event attracted Apple’s new partner IBM, MobileIron Enterprise Mobility Management, app developers like HIPAAchat, physicians like Dr. Mark Aeder of the Case Western Reserve School of Medicine, and members from the social media team of the Cleveland Cavaliers.

To find a cultural “fit” for a place requires a creative process of active dialogue between our clients, colleagues and stakeholders. We have found our projects increase in richness and meaning when the design process actively engages a broad diversity of participants. – LMN Architects

“The entire building was designed to be interactive and self-guided,” says Paganini, “Touch screen monitors allow you to see all the different vendors who have interesting healthcare IT products and services out on the Technology Showcase floor. ”

GE Healthcare at HIMSS Innovation Center

Collaborative Testing for Interoperability

HIMSS is still building onto what is already an impressive list of collaborators who are interested in collaborative testing and how interoperable systems can improve quality of care for patients and communities. Paganini revealed that the HIT industry’s largest interoperability testing event, the IHE NA Connectathon, will be held at the Global Center for Health Innovation in January, 2015. More than 550 systems engineers gather annually at the Connectathon to run thousands of real-time tests and verify their systems.

use case vendors

Also on the schedule of events is the Cleveland Clinic Medical Innovations Summit taking place October 27 through 29, 2014, that will feature an Innovation Basecamp and the Top Ten Medical Innovations for 2015.

Four Floors, Four Themes

Intelligent flooring from Forbo Flooring Systems talks to caregivers and patients. For example, the flooring can alert a nurse she did not wash her hands as required.

Intelligent flooring from Forbo Flooring Systems talks to caregivers and patients. For example, the flooring can alert a nurse she did not wash her hands upon entering the room.

In addition to HIMSS’ innovation and interoperability on the fourth floor, each floor at the Global Center for Health Innovation has a theme. The first level ,”Health and Home”, offers a peek into the future with a 2,000 square foot State-of-the-Art Home. It features a living room, kitchen, bedroom, and bathroom, each designed to show how people with disabilities or health challenges can thrive through innovative healthcare technologies.

Four Northeast Ohio hospital systems are part of the Welcome Center on the first floor including the Cleveland Clinic, University Hospitals, MetroHealth System, and St. Vincent’s Sisters of Charity.

“Clinical Spaces” on the third floor is dedicated to the clinical experience, and the second floor, themed “People, Patients and Caregivers”, is dedicated to patient care including GE Healthcare, Cardinal Health, MetroHealth, Cleveland Clinic, STERIS, and BioEnterprise–Team NEO.

Biomedical Innovation and Startups

BioEnterprise–Team NEO markets Northeast Ohio’s biomedical community to the world. Over a billion dollars has been invested in 200 startup companies in the area with 41 exits since 2002. Cleveland Clinic, University Hospitals, Summa Health System, and Case Western Reserve University collectively conduct over $700 million in annual research.

Alego Health

Making Healthcare Cool

Hopefully, in the future, people will say, ‘I’ve got to go to Cleveland to see the Rock and Roll Hall of Fame, and the Global Center for Health Innovation.’ – John Paganini

All photos by Angela @healthiscool.

August-20-2014

6:00
Image: CC BY 2.0 Robert Scoble

Image: CC BY 2.0 Robert Scoble

The first time I saw someone wearing Google Glass was at HIMSS14 in Orlando. My initial reaction: that guy looks like a geek. Not that I have anything against the geek look but I couldn’t imagine myself ever wearing Glass goggles while walking about in public. I’ve progressed a bit and no longer giggle when I see someone wearing a pair, yet I wasn’t impressed by the Glass-wearing guy (definitely a Glasshole) that I recently noticed driving in a car next to me.

On the other hand, plenty of folks in the health IT world were quite impressed with Dr. Rafael Grossmann, the first physician to record a surgery wearing Google Glass. Since that landmark event about a year ago, a small number of companies have popped up offering healthcare solutions that leverage Google Glass. It’s perhaps too early to tell which ones will still be around next year but here’s a short list (in alpha-order) of some that are making in-roads:

APX Labs – APX has built a robust, horizontal data-integration platform optimized for smart glasses. They promote their solution for a variety of industries in addition to healthcare, but the clinical applications focus on telemedicine, first responders, nurse and clinical EMR interfaces, vitals monitoring, administrative visibility, and medical education. From what I can tell, they either don’t have any healthcare customers yet, or, they are still opting to fly well under the radar.

Augmedix – Augmedix claims to be the world’s first Google Glass start-up and their application focuses on improving the clinical documentation process. In January the company conducted a pilot with the California-based Dignity Health, who provided three family physicians with Google Glass and Augmedix’s physician documentation app. After four months the doctors reported a drop in the amount of time spent documenting from 33 percent of their day to nine percent and an increase in time spent directly engaging with patients from 35 to 70 percent of their day. Compared to some other vendors, the Augmedix application appears to be more narrowly focused.

ContextSurgery – The Context-aware software is geared to the operating room and includes a Surgical Dashboard that pushes relevant patient information to Glass-wearing providers. The HIPAA-compliant application also supports video-sharing. I assume that the company is still in the development stage as they are looking for additional betas to test their product.

CrowdOptic – ProTransport-1 recently announced it will deploy the CrowdOptic Google Glass broadcasting solution in its ambulances and mobile medical machines to broadcast real-time video of patients in transport.  UC San Francisco is also testing CrowdOptic software to enhance physician training through the use of live video streaming from Glass devices.

Pristine – Pristine offers the EyeSight product as a HIPAA-compliant, first-person audio/video streaming solution optimized for Google Glass. Currently their platform is in use at several facilities, including UC Irvine Medical School and Houston Methodist Hospital (to allow physicians to broadcast procedures to students or for continuing education purposes) and Rhode Island Hospital (for remote dermatology consults). The Chicago-based MedEx Ambulance service also recently acquired Pristine’s technology to allow Glass-wearing paramedics to transmit live video and audio from an ambulance to an ER doctor.

Remedy – Remedy has launched a pilot study with three Harvard hospitals in which Glass-wearing PAs will connect with doctors (usually at night), allowing the supervising physicians to “see” the patients. Remedy is targeting its application for use by residents, medical students, general practitioners, nurses, and PAs to extend the reach of specialists.

Wearable Intelligence – Physicians at Beth Israel Deaconess Medical Center are using devices from WI as a means of gaining hands free access to patient charts. The company also promotes a procedural checklist application and telehealth and video recording options for healthcare. In addition to the high-profile BIDMC, the multi-national oil services firm Schlumberger also uses WI’s Glass applications.

I’m impressed by the number of big-name health systems that are giving Google Glass a test drive. It’s also interesting to note the diversity of applications, from telehealth, education, remote consults, and EMR access. By the time HIMSS15 rolls around next April I am sure we’ll have a clearer idea of which vendors have figured out the formula for success.

And regardless how hot the market gets, I doubt I’ll be Glass-adorn any time soon.

August-14-2014

11:39

FB post

A girlfriend of mine recently posted the above note on Facebook. Not surprisingly, several women (and a couple of progressive men) expressed similar discontent with the procedure; a couple of commenters said they were sure that a man invented the technology, while another pointed out that more women would likely be compliant with screenings if the process was not so unpleasant.

While I can’t say I love getting a mammogram, there are definitely other aspects of my well-woman check-up that I dislike more.  Lest your mind wander too far from HIT, let me clarify a few of the other annoyances:

  • Filling out multiple forms. My primary care physician and my gynecologist both have Epic. Why can’t they share my information with one another so I don’t have to fill out all this redundant paperwork?
  • No option for online scheduling or checking lab results. As I mentioned in a previous post, I am a fan of patient portals – when they work well. In fairness to my doctor, his group just recently went live on Epic and they have not yet launched their portal.
  • Looking at the backside of my doctor as he reviews my online chart and enters his note. (To be clear, I don’t mind looking at the backside of men as a general rule.)

The problem with mammograms, EMRs, patient portals, and other healthcare technologies is that too often the developers seem to have forgotten the patient experience. Case in point: EMRs. Having all of a patient’s visit record online is a tremendous benefit. Frequently, however, the EMR interferes with the patient exam because the physician seems to be paying more attention to finding the right drop down item than to the actual patient. Especially if I am sick, I want my doctor’s full attention and assurance that he/she is engaged and invested in my care.

I’m not just blaming the software developers.  Some of the blame goes to the government for requiring all the meaningful data that can seem irrelevant to the visit, or items like a multi-page visit “summary” that is too verbose and confusing to be of much benefit to the patient.  I personally love the idea of a visit summary, but it’s painful to read through all the medical jargon and other superfluous data. If I take my daughter to the pediatrician for an ear infection, I’d prefer a one page “summary” that includes a bottom line telling me, 1) give her antibiotics until finished and Ibuprofen for pain, and 2) call the office if symptoms get worse or she is not better in three days.

I am not sure who gets the blame for the whole explanation of benefits mess. I mean, who can glance at one and determine if and how much insurance is paying, if the provider is going to send me an additional bill and for how much, if the carrier is waiting on more detail from the doctor, if the patient needs to follow up with the doctor, etc.? And just when you think you are a semi-expert at reading an Aetna EOB, your employer switches to Humana – which of course has an entirely different EOB format.

Here’s a novel idea: let’s get patients more involved in the whole software design process. Not just those patients who love technology, but also my 79 year-old dad who still uses a phone book to look up phone numbers, or my sweet retired neighbor who loves to do her shopping from mail-order catalogs. I’m not sure how one builds a better mammography machine, but I am sure there are plenty of women out there willing to provide some input.

And yes, we do get to blame – and thank – a man, Dr. Robert L. Egan – for developing the modern-day mammogram

August-12-2014

10:25

I’m not sure if parenting has always been this way, with a three year old I still consider myself a newer parent, but it seems like it has become a competitive sport. I see a lot of one upping from parents who try to prove their parental skill by judging other parents. One of the biggest sources of contention I see among parents is regarding screen time. Many will flat out tell you that letting children use screens – television, computer or handheld – is lazy parenting that makes children dumb, fat, unmotivated, violent, etc.

I have friends who are are very adamant in their opinions about screen time. I know this because they post rants against it on their Facebook pages a few times a week. I find this, shall we say interesting, since they need to use some type of screen or handheld device to get their anti-screen time message out there, but to each their own. The latest piece of support for their opinion I’ve seen circulating is this post from the Huffington Post “10 Reasons Why Handheld Devices Should Be Banned for Children Under the Age of 12.”

Unlike some of my friends, I don’t think kids love of screens is necessarily a result a of “bad parenting” but more a result of screens, or at least the things presented on the screen, being designed to be engaging. They’re colorful, they come with songs and they’re interactive. I mean, you can use a catapult to launch an irate bird and a bunch of bright green pigs. That’s pretty engaging and entertaining. Thanks to an app from PBS Kids, my daughter has learned concepts like matching, counting and problem solving. Of course, I teach her these concepts in other non-screen ways as well, but a little time playing her “games” on my Nook help reinforce the concepts she’s learned in the real world.

The concept of engagement is a hot topic in health care. We hear the terms “patient engagement” and “engaged patients” frequently though there is some disagreement on what the terms actually mean. There was a 2012 article in the Journal of Participatory Medicine called The Many Faces of Patient Engagement that tried to help define the concept. The authors wrote that the task was more challenging than they first realized and patient engagement was defined differently by different groups. They also noticed that the terms involvement, engagement, and participation are often used interchangeably in regards to patient engagement.

To me an engaged patient is someone who is interested in his or her health and health outcomes and is willing to work with their healthcare provider to achieve a set of mutually established goals. Patient engagement is the act of getting a patient involved in being an active participant in his or her own health care.

As a healthcare professional and a patient, I’ve seen both engaged and non-engaged patients. Some patients are very interested in outcomes and will come with research, ideas and a desire to achieve those goals. Other patients don’t seem at all interested and might actually be pessimistic about achieving goals and outcomes.

Take, for example, patients who are ready manage their blood pressure by taking personal responsibility and dedicating themselves to a walking program to help them lose weight. They are very engaged in their care. Then there are the patients who don’t seem at all interested in making lifestyle changes to improve their blood pressure readings and just continue with life as usual. I wouldn’t label this group as engaged.

The study “Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores‘” published in the February 2013 issue of Health Affairs examined the relationship between “patient activation levels” (which could also be called patient engagement) and care costs. In a companion piece to the study the authors wrote that “patients who were more knowledgeable, skilled and confident about managing their day-to-day health and health care (also known as “patient activation,” measured by the Patient Activation Measure) had health care costs that were 8 percent lower in the base year and 21 percent lower in the next year compared to patients who lacked this type of confidence and skill.”

Basically, engaged patients had better outcomes and cost less to care for. So how do we get patients who are not engaged to become more participatory and invested in their care? In my next post, two weeks from now, I’ll discuss the concept of Interactive Patient Care and how it can affect engagement and outcomes.

August-7-2014

12:24

The telehealth market is expected to experience a tenfold growth spike by 2018, burgeoning to $4.5 billion. We saw some significant signs of this growth recently, as reported by Forbes contributor Neil Versel. For those of us in healthcare, this projection is no surprise. Telehealth devices and services are a huge boost to organizations shifting from a fee-for-service model to value-based care. They also help enable healthcare providers to expand their geographic reach by delivering, caring for and monitoring patients who might not otherwise make the trek to see them.

Considering Americans make 1.2 billion visits to physician offices, hospital outpatient facilities and emergency departments every year, you’d think busy consumers would eagerly embrace telehealth and the convenient access to care it provides. Add the ubiquity of mobile devices (58 percent of American adults have a smartphone  and 42 percent own a tablet), it seems consumers would be hopping on the telehealth train at a rapid rate.

But they’re not – at least not yet.

iTriage provides simplified healthcare information, connection and convenience to people, in part via a mobile application that’s been downloaded more than 12 million times. With such a large community of health-engaged consumers, we have the opportunity to gain some pretty interesting insights into healthcare trends. With the projected growth in telehealth, we wanted to get some insights from our loyal users on the market, and here’s some of what we found:

#HITsm (1)

  • 85 percent of the 2,681 respondents told us they’ve never heard of or used telehealth services
  • 51 percent of respondents stated when it comes to a telehealth doctor’s visit, they have no preference if they have seen the provider in person before or not
  • Only a quarter said telehealth services are an important factor when choosing a doctor
  • Similarly, only 27 percent said it’s important for their insurance plan to offer telehealth services

Do these results indicate that consumers are ready for telehealth? Not exactly.

Many factors may have led to these findings, but looking at the data a little more closely, we found that people who use video chat services like Skype, FaceTime and Google Hangouts to communicate in other areas of their lives are more inclined to use video chat for health appointments versus face-to-face visits. These people also showed a higher awareness of telehealth, as well as preference for text messaging and emailing with their healthcare providers, than people who didn’t.

Additionally, 62 percent of women – the typical household chief medical officer – said they’d most prefer telehealth services for urgent care situations like ear infections and sore throats. This makes sense, since telehealth gives them a more convenient and less costly option in a stressful time of need. And about half of all respondents said they’d like to be notified if iTriage began offering telehealth services.

These findings indicate that telehealth will follow the same adoption curve we all have witnessed in the banking industry: People already familiar with convenient and efficient technologies elsewhere in their lives were the first to embrace mobile banking apps, e-payments and paperless check deposits. As more people learned of their benefits, the masses followed – in fact, mobile banking users are expected to represent 32 percent of the global banking population by 2019. Banking consumerism also sped adoption among financial institutions, and now, almost every bank offers apps for at least one smartphone operating system.

Similarly, the number of patients using telehealth is projected to reach 7 million in 2018. I’ve used telehealth services as both a clinician and a patient and it’s virtually impossible to imagine we won’t reach, or even surpass, the 7 million figure given where the delivery system is headed. The maturity of value-based models of care will overcome challenges around reimbursement and payment.

And like we saw in banking, healthcare consumerism will help drive adoption of telehealth among healthcare providers. Consumers will seek out lower-cost options for high-quality care, especially as insurance plans transition to high-deductible plans requiring patients to pay higher out-of-pocket costs. Seventy-six percent of our survey respondents said they would pay $10 or less for connecting with their provider using telehealth. Health systems thinking about total cost of care will be well positioned to engage these people in a cheaper and more convenient telehealth services. With about 350,000 telehealth users today, we advocates have our work cut out for us, but it will happen.

What are your thoughts about what telehealth could do for our industry? Post your comments below and reach me on Twitter @kriddleberger.

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