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Behold The Arrival of The Chief Mobile Healthcare Officer

Posted on June 9, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Managing fleets of mobile devices is an increasingly important part of a healthcare IT executive’s job. Not only must IT execs figure out how to provide basic OS and application support – and whether to permit staffers and clinicians to do the job with their own devices – they need to decide when and if they’re ready to begin integrating these devices into their overall lines of service. And to date, there’s still no standard model using mobile devices to further hospital or medical practice goals, so a lot of creativity and guesswork is involved.

But over time, it seems likely that health systems and medical practices will go from tacking mobile services onto their infrastructure to leading their infrastructure with mobile services. Mobile devices won’t just be a bonus – an extra way for clinicians to access EMR data or consumers to check lab results on a portal – but the true edge of the network. Mobile applications will be as much a front door to key applications as laptop and desktop computers are today.

This will require a new breed of healthcare IT executive to emerge: the mobile healthcare IT leader. It’s not that today’s IT leaders aren’t capable of supervising large mobile device deployments and integration projects that will emerge as mHealth matures. But it does seem likely that even the smartest institutional HIT leader won’t be able to keep up with the pace of change underway in the mHealth market today.

After all, new approaches to deploying mHealth are emerging almost daily, from advances in wearables to apps offering increasingly sophisticated ways of tracking patient health to new approaches to care coordination among patients, caregivers and friends. And given how fast the frontier of mHealth is evolving, it’s likely that healthcare organizations will want to develop their own hybrid approaches that suit their unique needs.

This new “chief mobile healthcare officer” position should begin to appear even as you read this article. Just as chief medical information officers began to be appointed as healthcare began to turn on digital information, CMHOs will be put in place to make sense of, and plan a coherent future for, the daily use of mobile technology in delivering care. The CMHO probably won’t be a telephony expert per se  (though health systems may scoop up leaders from the health divisions of say, Qualcomm or Samsung) but they’ll bring a broad understanding of the uses of and potential for mobile healthcare. And the work they do could transform the entire institution they serve.

Hospitals Should Give Smartphones To Sick Patients

Posted on June 1, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As I see it, hospitals have developed a new and rapidly emerging problem when it comes to managing mobile health services. Not only do they face major obstacles in controlling staff use of tablets and smartphones, they’re right in the center of the growing use of these devices for health by consumer. It’s BYOD writ even larger.

Admittedly, most of the consumers who use mobile devices don’t rely that heavily on them to guard and guide their health. The healthiest of consumers may make a lot of use of wearable fitness bands, and a growing subset of consumers may occasionally leverage their phone’s video capabilities to do telemedicine consults, but few consumers base their medical lives around a mobile device.

The chronically-ill patients that do, however, are very important to the future of not only hospitals — which need to keep needless care and readmits to a minimum if they want to meet ACO goals — but also the insurance companies who finance the care.

After all, the more we dig into mHealth, the more it appears that mobile services and software can impact the cost of care for chronic conditions. Even experiments using text messages, the lightest-weight mobile technology available, have been successful at, for example, helping young women lose weight, change their diets, and slash their risk of cardiac problems. Just imagine the impact more-sophisticated technologies offering medication management, care coordination, blood glucose and pulse ox tracking could have on patients needing support.

But there’s a catch here. A long as mHealth services are delivered via the patient’s own device, the odds of successfully rolling out apps or connected health monitoring services are minimal. I’d argue that such mHealth services will only have a major impact on sick patients if the technology and apps are bolted to the hospital or clinic’s IT infrastructure.  And the operating system used by patients, be it Android or iOS, should be the same one the hospital supports among its employees, or maintaining apps, OS upgrades and patches and even firmware upgrades will be a nightmare to maintain.

Given the security and maintenance issues involved in fostering a connection between provider and patient, I’d argue that providers who are serious about advanced mHealth services absolutely must give targeted chronically-ill patients a locked-down, remote controlled smartphone or tablet (probably a smartphone for mobility) and lock out their networks from those trying to use connected apps on a rogue device.

Will this be expensive?  Sure, but it depends on how you look at costs.  For one thing, don’t you think the IT staff costs of managing access by various random devices on your network — or heaven forbid, addressing security holes they may open in your EMR — far exceed even the $700-odd retail price for such devices?

This might be a good time to get ahead of this issue. If you’re forced to play catch up later, it could cost a lot more.

Infographic: How Mobile Health Use Is Changing

Posted on May 26, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Mobile health apps and hardware offer intriguing possibilities, though it’s hard for providers to tell what models and methods of use are going to stand out.  Clearly, mHealth is going to change the way care is delivered, and how patients take part in that care, but how?

Here’s a tidbit from McKesson that might offer some useful insight. The infographic, which draws on data from The Economist Intelligence Unit, predicts that mHealth is moving from providing consumer information to driving patients’ involvement in their own care.

One of the more interesting details in this chart is the prediction that within five years, the percentage of people using mHealth apps to share information will fall from an already-low 17% to 14%.

I was also intrigued by the notion that the number of people using mHealth to gain social support will rise from 17% now, rise to 26% then fall to 13%.  Does this suggest that consumers will shift communications styles back to more face-to-face channels of support?  That they’ll rely on some technology or model that hasn’t been invented yet?
It’s something to consider.

 

photo-changing-trends-in-mobile-health-technology

 

Cedars-Sinai Medical Center Rolls Out Apple HealthKit

Posted on April 29, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Racking up yet another win in a string of deals with prominent health systems and hospitals, Apple has won Cedars-Sinai Medical Center over to running its HealthKit platform. According to Bloomberg, the agreement which connects 80,000 patients to HealthKit is the largest integration project done with HealthKit to date.

Apple caught a lead in the patient health data game early on, snagging high-profile Ochsner Health System as its first customer in October of last year. And HealthKit has continued to see success. A Reuters story reported in February that 14 of 23 top U.S. hospitals contacted by the news organization had rolled out a pilot program testing the platform. In other words, while it has formidable competition, Apple seems to have already become the platform of choice for experimenting with patient generated data.

It has to have helped that HealthKit was already set to connect with a wide range of consumer health tracking apps. Within months of its summer 2014 launch, Apple could boast a family of more than 60 apps that connected to the platform, including Withings app HealthMate, Weight Watchers Mobile, a Panera Bread app allowing users to plan meals at the store, a  Mayo Clinic app, Epic’s MyChart portal app and more.

But Apple’s competitors in the consumer health space aren’t going to give up without a fight. With the wearables market reaching 21% of consumers, fellow behemoths like Samsung, Google and Microsoft will continue to challenge Apple for the patient-generated data crown.

Microsoft, for example, has launched a collection of wearables devices — including a fitness-tracking wristband, mobile health app and cloud-based health data platform called Microsoft Health. In Microsoft’s architecture, users store health and fitness data generated by wearables, which is, in turn collected by the Health app. And remember Microsoft’s HealthVault PHR?  It finds new life here, as another place for patients to store the data they personally generate.

Google also announced its a fitness and health tracking platform last summer, dubbed Google Fit. Google Fit is an open platform offering the platform SDK freely to developers. At launch, its partners included Nike+, Adidas, Motorola, Runkeeper and HTC.

Samsung, for its part, has positioned itself in more of a support role to the wearables revolution. Last May it introduced the Samsung Simband, a reference architecture for wearables. It also released open health data cloud platform SAMI (Samsung Architecture for Multimodal Interactions), which takes data from multiple sources and drills down on the data to analyze the health status of individual users.

But despite the massive firepower behind Apple’s competitors, Apple seems to have slipped ahead and taken the marketing high ground. Expect to see lots of hospitals announce that HealthKit is their patient-generated data platform of choice over the next few years. It seems like Apple is doing the right thing at the right time.

Is Apple HealthKit Headed For Hospital Dominance?

Posted on February 12, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Even for a company with the cash and reach of Apple, crashing the healthcare party is quite an undertaking.  Not only does healthcare come with unique technical challenges, it’s quite the conservative business, in many cases clinging to old technologies and approaches longer than other data-driven industries.

Of late, however, Apple’s HealthKit has attracted the attention of some high-profile healthcare institutions, such as New Orleans-based Ochsner Medical Center and Stanford Healthcare. All told, a total of fourteen major U.S. hospitals are running trials of HealthKit. What’s more, more than 600 developers are integrating HealthKit tech into their own health and fitness apps.

What’s particularly interesting is that some of these healthcare organizations are integrating Apple’s new patient-facing, iOS HealthKit app with Epic EMRs and the HealthKit enterprise platform.  If this works out, it could vault Apple into a much more lucrative position in the industry, as bringing together health app, platform and EMR accomplishes one of the major steps in leveraging mobile health.

According to MobiHealthNews, the new app allows patients to check out test results, manage prescriptions, set appointments, hold video visits with Stanford doctors, review medical bills — and perhaps most significantly, upload their vital signs remotely and have the data added to their Epic chart. This is a big step forward for hospitals, but even more so for doctors, many of whom have warned that they have no time to manage a separate stream of mobile patient data as part of patient care.

For Apple leaders, the next step will be to roll out the upcoming Apple Watch and integrate it into its expanding Internet of Apple Healthcare Things. CEO Tim Cook is pitching the Apple Watch as a key component in promoting consumer health. While the iPhone gathers data, the smart watch will proactively remind consumers to move. “If I sit for too long, it will actually tap me on the wrist to remind me to get up and move, because a lot of doctors think sitting is the new cancer,” Cook told an audience at an investor conference recently.

All that being said, it’s not as though Apple is marching through healthcare corridor’s unopposed. For example, Samsung is very focused on becoming the mobile healthcare  technology provider of choice. For example, in November, Samsung announced relationships with 24 health IT partners, including Aetna, the Cleveland Clinic and Cigna.

At its second annual developer conference last December, Samsung introduced an array of software tools designed to support the buildout of a digital health ecosystem, including the Samsung Digital Health SDK and Gear S SDK, which lets app makers create software compatible with Samsung’s smart watches. Also, Samsung is already on the second generation of its Simband reference design for wearable device design, as well as the cloud-based Samsung Architecture for Multimodal Interactions, which collects sensor data.

And Microsoft, of course, is not going to sit and watch idly as a multibillion-dollar market goes to competitors. For example, late last year the tech giant launched a fitness tracking wristband and mobile health app. It’s also kicked off a HealthKit-like platform, imaginatively dubbed Microsoft Health, which among other things, allows fitness band users to store data and transfer it to the Microsoft Health app. Microsoft isn’t winning the PR war as of yet — Apple still has a gift for doing that — but have no doubt that it’s lurking in the swamps like an alligator, ready to close its powerful jaws on the next right opportunity to expand its healthcare presence.

Bottom line, Apple has captured some big-name pilot testers for its HealthKit platform and related products, but the game is just beginning. Having users in place is a good start, but Apple is miles away from being able to declare itself the leader in the emerging hospital mobile health market.

UPMC Kicks Off Mobility Program

Posted on July 1, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re going to look at how physicians use health IT in hospitals, it doesn’t hurt to go to doctors at the University of Pittsburgh Medical Center, a $10 billion collosus with a history of HIT innovation. UPMC spans 21 hospitals and employs more than 3,500 physicians, and it’s smack in the middle of a mobile rollout.

Recently, Intel Health & Life Sciences blogger Ben Wilson reached to three UPMC doctors responsible for substantial health IT work, including Dr. Rasu Shrestha, Vice President of Medical Information for all of UPMC, Dr. Oscar Marroquin, a cardiologist responsible for clinical analytics and new care model initiatives, and Dr. Shivdev Rao, an academic cardiologist.

We don’t have space to recap all of the stuff Wilson captured in his interview, but here’s a few ideas worth taking away from the doctors’ responses:

Healthcare organizations are “data rich and information poor”: UPMC, for its part, has 5.4 petabytes of data on hand, and that store of data is doubling every 18 months. According to Dr. Shrestha, hospitals must find ways to find patterns and condense data in a useful, intelligent, actionable manner, such as figuring out whether there are specific times you must alert clinicians, and determine whether there are specific sensors tracking to specific types of metrics that are important from a HIM perspective.

Mobility has had a positive impact on patient care:  These doctors are enthusiastic about the benefits of mobility.  Dr. Marroquin notes that not only do mobile devices put patient care information at his finger tips and allow for intelligent solutions, it also allows him to share information with patients, making it easier to explain why he’s doing a give test or treatment.

BYOD can work if sensitive information is protected:  UPMC has been supporting varied mobile devices that physicians bring into its facilities, but has struggled with security and access. Dr. Shrestha notes that he and his colleagues have been very careful to evaluate all of the devices and different operating systems, making sure data doesn’t reside on a mobile device without some form of security.

On the self-promotion front, Wilson asks the doctors about a pilot  project (an Intel and Microsoft effort dubbed Convergence) in which clinicians use Surface tablets powered by Windows 8. Given that this is an Intel blog, you won’t be surprised to read that Dr. Shrestha is quite happy with the Surface tablet, particularly the form factor which allows doctors to flip the screen over and actually show patients trends.

Regardless, it’s interesting to hear from doctors who are gradually changing how they practice due to mobile tech. Clearly, UPMC has solved neither its big data problems nor phone/tablet security issues completely, but it seems that its management is deeply engaged in addressing these issues.

Meanwhile, it will be interesting to see how far Convergence gets. Right now, Convergence just involves giving heart doctors at UPMC’s Presbyterian Hospital a couple dozen Microsoft Surface Pro 3 tablets, but HIT leaders plan to eventually roll out 2,000 of the tablets.

Hospitals Using Tablets to Improve EMR Access

Posted on February 18, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Some high profile hospitals are turning to tablets as a way to give physicians better access to EMRs when they’re walking the halls.  Using tablets is seen as a way of working around desktops’ limitations in making better use of EMRs’ capabilities, according to MedPageToday.

For example, back in 2010, the University of Chicago School of Medicine issued tablets to all hundred 15 internal medicine residents. After a year, three quarters of residents reported tablets help them finish tasks more quickly and spend more time on direct patient care.

In another example, the Cleveland Clinic is pilot testing the use of tablets with a few sectors of its workforce, such as its rapid response teams. Using tablets, clinicians can look up patient data on the way to the patient was crashing and be better prepared when they arrive.

In yet another instance, the University Of Pittsburgh Medical Center is testing the use of Windows tablets with cardiologists. The medical center has developed special software allowing physicians to jump between different mobile apps without having to reenter patient information to do their work.

These are just examples of how hospitals can turn mobile devices into effective extensions of the EMR, said David Collins, senior director of mHIMSS, the mobile wing of HIMSS. “If you can spend $300 on a tablet and issue these to providers so that they’re more mobile, it’s really a minimal cost for the payoff,” Collins told MedPageToday. Although, John Lynn makes a pretty good counter argument for why IT admins prefer the more expensive Windows 8 tablets over iPads or Android tablets.

These are just a few early examples of how hospitals can use tablets to make access to patient data simpler. Over the next year or two expect to see far more examples of tablet use in hospitals, as it’s become increasingly clear that they can help enhance the use of clinical data, on the spot when clinicians need it.

Deploying WiFi For Clinicians, Hospital Guests A Complex Problem

Posted on December 3, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

These days, offering WiFi for both hospital visitors and clinicians is pretty much de rigeur. The problem is, clinicians need different things from their Wi-Fi connection than consumers do. And as a recent story in Healthcare IT News notes, that can make it difficult to keep up with everyone’s demands.

According to Ali Youssef, senior clinical mobile solutions architect at Detroit-based Henry Ford Health System, maintaining a wireless network that suits everyone’s needs is “moving target.”

Youssef was responsible for planning and implementing the HFHS wireless network, which included expanding coverage from 4 million to 8 million square feet. What’s more, the network rollout had to take into account the needs of the HFHS enterprise EMR system, according to the HIN piece.

For Youssef, one of the most difficult problems health IT managers face in this situation is provisioning bandwidth appropriately to all the different types of devices that will share the bandwidth.

Not surprisingly, Youssef believes that one of the most important ways to see that everyone has enough bandwidth is regular contact with the system’s clinicians.

In some situations, clinicians may need far more bandwidth then the IT department had anticipated, for example, where clinician is launching a new project fueled by grant money, notes the Healthcare IT News piece. (We’re also increasingly see a growing list of wireless medical devices, such as wireless glucometers, edge into mainstream clinical care.)

To cope with these rapidly changing demands, Youssef recommends planning for a high level of wireless system redundancy and conducting site surveys.

And in what may be a more difficult challenge, he recommends that network architects keep continuous tabs on what types of devices are going to be used, and testing them see how they behave on their health system’s network.

Youssef didn’t offer any detailed advice on how to accommodate hospital visitors in this story, but clearly, they will pose a significant challenge to any hospital network architect as well.

Particularly as apps become part of patients’ health system experience, network architects will need to bear consumer experience of the network in mind as well. It will be interesting to see, over the next few years, whether consumer wireless health use demands a fresh approach to network architecture generally.

Hospital Residents Question Value of iPad For Clinical Rounding

Posted on November 13, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Though the iPad has a sexy reputation — the Apple mystique is alive and well — it may not not necessarily the best tool to use for clinical rounding or education, according to a new study published in the Journal of Mobile Technology in Medicine. That being said, there’s a lot of issues with the study, as you’ll see below.

First, the study design. During the 2011-2012 academic year, researchers gave iPads to 102 medical and surgical residents at Riverside Methodist Hospital in Ohio. The tablets were 16 GB iPad2 models with wireless Internet capabilities, reports iHealthBeat. The iPads had Wi-Fi but no cellular network connectivity, which left many residents complaining about hit-or-miss connectivity.

At the end of the academic year, researchers surveyed the residents to learn how iPad use had worked for them. What they found out was that while the residents largely liked the iPads, they didn’t find them useful for clinical rounding. On the other hand, though the study doesn’t address this directly, they had reason to be uncomfortable.

Of the 102 residents, only 14.7 percent used the iPad on rounds, and a scant 7.8 percent said the tablet helped them document care more efficiently. But it should be noted that the iPads were running only VMware View, not an iPad-native care system, forcing the residents to cope with an interface designed for seated users on keyboards.

Meanwhile, almost 58 percent of respondents said that the iPad was useful for sourcing articles outside of the hospital and 52 percent said the iPad was valuable for research.

The medical residents also valued the iPad for making recommendations to a colleague (58.3 percent), facilitating patient care (45.8 percent), as an educational tool (41.7 percent) and to view results and use as a guide for evidence-based practice (38.9 percent). (Surgical residents were much less impressed, with, for example, only 6.7 percent agreeing that the tablet was a valuable educational tool.)

Despite its flaws, the study does make one important point — that it’s well past time for EMR vendors to create iPad-usable interfaces, rather than forcing residents to use some awkwardly hacked version of their desktop/laptop product. If this study is any indication, large numbers of residents like the iPad a great deal, but they’re not going to use it for documentation unless they have a good user experience.  Vendors, your move.

P.S. By the way, if you want to read about a case in which iPads are being used in daily rounds, check out this piece from drChrono that was highlighted on the Apple iPad website.

Patient’s Take On Making Hospital IT Patient-Friendly

Posted on September 4, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I was talking with my mother about her experiences with hospitals and IT. My mother, you should know, is so computer averse that she won’t send or receive e-mails — she leaves that to Dad.  But despite her fear of home computing, she’s got some interesting opinions about how hospitals should use health IT to involve patients in the care process:

* If possible, she suggests, hospitals should assess a patient’s “electronic IQ” to see how comfortable they are with using technology. I liked this because it could apply not only to in-hospital info sharing but also the patient’s ability to participate in remote monitoring or other mHealth modalities.

*Give patients access to a schedule (via an app on a tablet, perhaps) which tells them when various tests, procedures and clinician visits are likely to happen. This not only calms the patient, it helps keep the family in synch with the patient’s routine, she notes.

* Display results of key tests — or if clinicians are concerned that patients won’t understand them, at least register when the results have been received, so  patients know their care process is progressing. She’d be happy with a note that said: “Dr. X will be in to discuss the results of your CT scan shortly.”

* Allow the patient and their family/caregivers to make notes within the system of what they want to discuss with clinicians.  Otherwise, as she rightly points out, they’re likely to forget what they wanted to say when the nurse or doctor swoops into the room with their own agenda.

Actually, my mother’s vision is already largely in place in at least one facility. As I reported last year, the Mayo Clinic has already begun a program using content- and app-loaded iPads to move the patient through their inpatient stay. Not only does the Mayo implementation do everything on my mother’s wish list, it also allows patients to report on pain levels and exchange messages with doctors.

Let’s hope more hospitals find a way to use IT to make the care process more transparent for patients. While it calls for a not-inconsiderable investment in time and resources, it seems like an excellent way to keep patients engaged in their care.