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Accessing Near Real Time Patient Data In & Out of the Hospital with Alan Portela

Posted on April 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare Scene recently sad down with Alan Portela, CEO of AirStrip to talk about the shifting world of real time access to healthcare data in and out of the hospital. We cover a lot of ground including AirStrip’s experience being on stage at the announcement of the Apple Watch, the challenge of EHR data interoperability, and the amazing work that AirStrip is doing to make near real time health data available on devices across healthcare. Enjoy the recorded video interview with Alan Portela below:

In the “after party” discussion, we continue the discussion and are joined by Jimmie Legan, MD and Charles Webster, MD.

mHealth Apps May Create Next-Gen Interoperability Problems

Posted on November 20, 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.

According to a recent study by IMS Health, there were 165,000 mHealth apps available on the Google Play and iTunes app stores as of September. Of course, not all of these apps are equally popular — in fact, 40% had been downloaded less than 5,000 times — but that still leaves almost 100,000 apps attracting at least some consumer attention.

On the whole, I’m excited by these statistics. While there’s way too many health apps to consider at present, the spike in apps is a necessary part of the mobile healthcare market’s evolution. Over the next few years, clear leaders will emerge to address key mHealth functions, such as chronic care and medication management, diet and lifestyle support and health data tracking. Apps offering limited interactivity will fall off the map, those connected to biosensors will rise, IMS Health predicts.

That being said, I am concerned about how data is being managed within these apps. With providers already facing huge interoperability issues, the last thing the industry needs is the emergence of a new set of data silos. But unless something happens to guide mHealth app developers, that may be just what happens.

To be fair, health IT leaders aren’t exactly sitting around waiting for commercial app developers to share their data. While products like HealthKit exist to integrate such data, and some institutions are giving it a try, my sense is that mHealth data management isn’t a top priority for healthcare leaders just yet.

No, the talk I’ve overheard in the hallways is more geared to supporting internally-developed apps. For example, seeing to it that a diabetes management app integrates not only a patient’s self-reported blood sugar levels, but also related labs and recommended self-care appointments is enough of a challenge on its own. What’s more, with few doctors actually “prescribing” outside apps as part of their clinical routine, providers have little reason to worry about what commercial app developers do with their data.

But eventually, as top commercial health apps become more robust, the picture will change. Healthcare organizations will have compelling reasons to integrate data from outside apps, particularly if doctors begin viewing them as useful. But if providers and outside app developers aren’t adhering to shared data standards, that may not be possible.

Now, I’m not here to suggest that commercial mHealth developers are ignoring the problem of interoperability with providers. (Besides, with 165,000 apps on the market, I couldn’t say so with any authority, anyway.) I am arguing, however, that it’s already well past time for health IT leaders to begin scoping out the mobile health marketplace, and figuring out what can be done to help with data interoperability. Some sit-downs with top app developers would definitely make sense.

What I do know — as do those reading this blog — is that creating a fresh set of health data silos would be destructive. Creating and managing useful mobile health apps, as well as the data they generate, is likely to be important to next-generation health IT leaders. And avoiding the creation of a fresh set of silos may still be possible. It’s time to tackle this issue before it’s too late.

mHealth and Hospitals

Posted on December 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’ve been doing quite a bit of thinking around the topic of mobile health thanks to all the #mHealth14 tweets I’ve been seeing on Twitter. One of the major takeaways I’ve seen from this year’s mHealth Summit and previous mHealth Summits was the prediction that one day mobile health and connected health and all the other variations will one day just be health.

I think it is true that mobile and connected health will eventually just be standard healthcare. However, it’s not today. In fact, I think that’s why most hospitals haven’t hopped on board mobile health yet. They are waiting for mobile health to be a standard of health. This tweet seems to capture some of this feeling.

Most of the hospitals I know see mobile health as a tool as opposed to a solution. Is it because we’re early in the market? Maybe, but I think there’s a lot more to this discussion.

When I think about hospitals and mHealth, I think there are three ways that they are adopting these mobile health technologies: existing vendors, rogue apps, and research dollars.

Existing Vendors
This is the most common use of mobile health in hospitals. However, most hospital CIOs and other hospital IT professionals wouldn’t even think of it as mobile health. They already think of it as health.

The best example of this is with the EHR vendors. Many of them are rolling out mobile interefaces for their EHR. Is that mobile health? Absolutely. However, the hospital didn’t really think about it as mobile health. They thought of it as implementing their EHR software. It just turns out that the mobile health implementation of EHR software made sense in that situation.

We see this happening across a wide variety of hospital apps. You can be sure that this will continue and only accelerate as these enterprise software vendors finally get their mobile health development complete.

Rogue Apps
Every hospital I know has made a lot of effort to manage mobile devices. Search for BYOD and surrounding topics and you’ll find a ton of conversation about this topic. One major part of this discussions is around rogue apps. Even if the hospital doesn’t allow the rogue mHealth app on the hospital devices, that’s not going to stop a doctor from downloading it on their personal smart phone. Sure, some hospitals have policies against some of this stuff, but rogue apps are alive and well in hospitals all over the country.

Rogue apps reminds me of shadow IT. I guess that rogue apps are a form of shadow IT. So, the concept isn’t new. What’s the lesson? Find a way to empower your users to be able to bring in outside apps that can be used in the hospital. Just because you play ignorant doesn’t mean your hospital’s not responsible for them just the same.

Research Dollars
This is where I see most of the mHealth efforts by hospitals. If it’s not coming from a current vendor, then they usually use some sort of research dollars to “experiment” with mobile health. For some reason it feels better for a hospital to hide behind a “research project” or a “pilot implementation.” Some of it has to do with the procurement and approval process. Other times, they’re just afraid to commit to something that’s not fully tested.

I don’t think mHealth being a pilot project or research project is a bad thing. In fact, I think this is the major reason why mobile health and connected health are still separate from health. Until we have enough time to prove out these ideas, the healthcare establishment won’t be ready to accept them. Once they’ve proven themselves, they’ll just become a standard part of healthcare.

Is mobile going to play an important part of the future of healthcare? Absolutely. Will it take some time to prove out the various methodologies in order for the healthcare establishment to adopt these mHealth technologies? Yes. This is how I see the evolution of mHealth in hospitals. What have you seen?

The Various Approaches to Mobility in Healthcare

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m about to head down to the CTIA Super Mobility Week conference. I try to attend a few conferences each year that aren’t directly related to healthcare and health IT in order to get a broader perspective on what’s happening in the rest of the world. I think this will be one such case (although, they do have some mHealth sessions and exhibitors as well).

As I started to think about mobility and where it’s headed, the industry is all about the smart phone and smart mobile devices. I think it’s an incredibly powerful concept and one that will only become more important. However, I think that many people are taking it too far. While I love my smartphone and its capabilities, I still love the productivity that’s possible with a great desktop setup with dual monitors, a mouse and a keyboard. I’m not sure we’ll replicate that in a mobile world and I’m not sure we should.

In fact, it’s one of the trends I hate most about many of the website designs that are coming out lately. They are going all in on mobile and in the process they’re killing the productivity of the desktop experience. It’s a travesty and continues to annoy me with many of the applications I use on a daily basis.

We can apply this same principle to healthcare IT. Often we need to step back and ask ourselves if something really needs to be mobile or not. Plus, if we decide to make something mobile, we need to ensure that those who still use the same application in a non-mobile environment have their workflow optimized as well.

At the end of the day, we need to create a much more sophisticated approach to mobile computing. There are many times when a doctor or nurse really need whatever they’re working on to be mobile. There are extreme benefits to having a point of care device which allows the nurse or doctor to document at the point of care. However, there are just as many times when mobility is actually a hindrance to the required workflow.

What are you doing in your organization to leverage the amazing mobile technologies that are out there while still maintaining the optimized workflow?

mHealth Technology Market Exploding

Posted on June 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.

Driven largely by the growth in remote patient monitoring, the mobile health marketing is expanding rapidly, with the global market expected to reach $10.2 billion USD by 2018, according to Transparency Market Research.

According to TMR, the global mHealth market added up to just $1.3 billion in 2012, but should grow at a compound annual growth rate of 41.5 percent through 2018, with monitoring services contributing heavily to the total.

According to the researchers, the global mHealth market’s explosion is being driven by factors such as growing adoption of smartphones and the rising incidence of chronic diseases.  Also, the incredible growth in the availability of smartphone applications has created new channels for communication between patients and healthcare providers, a connection which further feeds the emergence of new applications.

According to TMR’s analysis, remote monitoring services currently make up the largest share of the global mHealth market, or about 63 percent, followed by diagnostic services and healthcare systems strengthening. And monitoring services will continue to be the fastest growing segment in global mHealth, given this technology’s ability to help ameliorate acute conditions such as coronary artery disease, hypertension, and congestive heart failure, the group notes.

These findings are underscored by related figures from Kalorama Information, which just released a report tagging the telemedicine patient monitoring market as having grown from $4.2 billion in 2007 to over $10 billion in 2012.

While they’re are clearly engaged in some forms of remote monitoring here and there, this approach is still at an early stage for most hospitals, as reimbursement for hospital-based remote monitoring is scant or non-existent in some cases, Kalorama notes.

However, the home healthcare and remote location health monitoring markets are already well-positioned to grow, and are poised to expand using wireless, handheld and ambulatory devices that replace older monitoring equipment, Kalorama researchers say.

Homecare Firm Dispatches 4,000 Android Tablets With Nurses

Posted on February 27, 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.

Could Android gear be sneaking up on Apple? Here’s one case where a national healthcare organization decided to go with the Android technology for a very large and clearly mission-critical purchase.

A national homecare agency has bucked the iPad trend in tablets, picking up 4,000 Android-based units to send with its personnel to patient homes. The company, Philadelphia-based Bayada, issued the Samsung 7-inch Galaxy Tab 7.0 plus to its therapists, medical social workers and other home health professionals.

In issuing the tablets, Bayada hoped to make its homecare professionals more efficient, especially when visiting Medicare home health patients who only get one hour each.

The tablet deployment followed a 20-person pilot in which it found that the typical nurse reduced his or her typing by one-half hour every day if using a tablet during visits instead of paper or a laptop.

Not only do workers use the tablets to document care within patient homes, they also pull up patient data before they head out on their patient visits.  This spares the nurses having to report to a central office to get their appointments before they leave in the morning.

To make clinical data entry simpler, Bayada has loaded the tablets with SwiftKey Healthcare’s keyboard software, an app which is preloaded with medical terms. It uses artificial intelligence to anticipate which words will be typed next and “learns” over time what words healthcare workers use most often.

Since implementing the SwiftKey software, 69 percent of Bayada’s nurses said they preferred using a tablet for taking clinical notes.

Given the large price difference between the iPad/iPad mini and Android tablets — with Android, obviously, at a lower price point — I’d be surprised if other large healthcare organizations didn’t follow in Bayada’s footsteps.

After all, Apple fan though I am, I have to admit that as the suite of apps available for the Android platform matures, there’s less and less reason for institutions to pay the premium Apple demands.  I wonder if we’re seeing the beginning of a major shift in Android investment by healthcare organizations.

What Do Patients Need From EMRs?

Posted on November 14, 2012 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 we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?

Health IT Can Change Delivery Models From The Outside In

Posted on July 2, 2012 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 we all mull over the implications of the recent Supreme Court decision affirming the key pillar of the health reform law, transformation is definitely in the air.  Hey, if nothing else, we’ve got a presidential election on the way, and it’s likely there will be big changes — either yanking back parts of PPACA or expanding it significantly — when the new POTUS steps in.

This is a great time for the health IT world to assert its place in the system and change the way care is delivered. Of course, I don’t have anything like the space to cover this topic in full  but a few ideas that I think have high potential include:

* Hospital At Home:  This Johns Hopkins model delivers care at home to patients who could use hospital-level care but aren’t likely to deteriorate. It can lower costs by almost one-third and reduce complications, researchers say. Let’s step up and bring sophisticated mhealth apps and remote monitoring to power this further.

*Medical Body Area Networks: With the approval of specifically-dedicated spectrum for MBANs, the FCC has kicked off what should be a revolution in health monitoring, both for consumers interested in self-care and for clinicians. Where can we take it this year?  For example, will consumers wear their network, connected to a receiver in their car, and transmit their own data as they come into an ED for care?  The mind boggles.

* Prescribe An App: This is an area which is juuust getting a foothold in American medicine — though as the linked article notes, the Department of Health in England has created a list of 500 apps for primary care docs to prescribe to patients. The practice can only grow here as evidence helps us sift out the best apps.

*Patient Portals:  Yeah, so what, they’re required under Meaningful Use anyway. So why am I listing them here? Because a nice interspersing of the above technologies with a robust,  user-friendly portal has nearly unlimited potential for medical collaboration:  video visits, telemedicine, mobile visits and check-ins and so on. Although, John also wrote about some of the challenges of patient portals recently on EMR and EHR.

Of course, I’ve said nothing about EMRs themselves, which obviously lie at the center of this Web.  But for a reason. I’m taking the position that in most cases, given the incredible mhealth explosion, care delivery change is going to push in from outside the hospital rather from within. Am I wrong there?

Billing App For Doctors Should Catch Hospitals’ Eye

Posted on April 2, 2012 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’m going to do something I seldom do — talk about a specific app and what it represents in terms of trends.  The product, SwiftPayMD, is interesting not only because it seems to be solving an important problem, but also because it may be one of the early entrants in a new category of mobile software.

The product,  which runs on the iPhone/iPad, is made by a startup called Iconic Data. Iconic describes SwiftPayMD as a “mobile revenue cycle management app” which lets doctors submit diagnosis and billing codes directly to their office while still at their local hospital.

Hmmm. A mobile revenue cycle management app. What, you mean a product that acknowledges that doctors on the move need not only to access, review and enter clinical data, but also to keep the money coming in?  It’s astounding!  It’s revolutionary!  It’s…a no-brainer.

While I admit I didn’t find any major studies on the subject, it does look as if the app developers and (slow moving) firms on the revenue cycle management side are starting to get it that if you’re going to document, read data and diagnose on the road, you might as well bill for your time too.

A Google search on the words “mobile revenue cycle management” doesn’t turn up a lot that’s on  point, though it does seem that there’s a few small providers in this space, including one focused on anesthesiology.  But my guess is that this will change dramatically within the next six months. The idea just makes sense.

In summary, I guess I’m saying that we’re looking at something really important here. While I haven’t tested SwiftPayMD — and thus, can’t begin to predict whether it will be a major player — the idea is almost certain to catch fire.

Now, I’m tossing the ball to you, hospitals. Is this an opportunity for you?  Should hospital IT departments supply branded apps which allow doctors to collect money faster (and perhaps their own institutions as well)?  Seems like a good idea to me.

Consumer Health IT Tools Could Allow Self-Prescribing

Posted on March 23, 2012 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.

Should patients be allowed to use online questionnaires, patient kiosks or other self-assessment technologies to determine the need for and obtain medications which now require prescriptions?  The FDA is taking up just that question this week in hearings at its DC headquarters.

The FDA is looking at ending prescription requirements for drugs used for several chronic conditions, including diabetes, asthma, high blood pressure, migraines and high cholesterol. It seems that the FDA has been paying close attention to the tech world, including movements like mobile tracking of health and the general trend toward self-assessment and consumer data collection.

According to iHealthBeat, the FDA thinks it might be a good idea to let consumers figure out whether they need certain medications by answering questions posed on a Website (a practice which, it should be noted, has been common on what are now rogue pharmaceutical sites) or perhaps respond to questions at a patient kiosk. I imagine that if enacted, such rules would apply to smartphones and tablets too.

A pharmacist from UC-San Diego quoted in the story argues that while some members of the public will be able to manage the information needed and make good decisions, others won’t. This is definitely a legitimate concern.

As I see it, though, our job in the health IT industry is to study models like these and see what failsafes we can put into to make self-prescribing as bulletproof as taking money out of an ATM machine.

It’s going to take sophisticated logic to get the right questions out there, smart machines to make inadvertent answers almost impossible, and crystal clear UIs to keep consumers oriented, but I think this has to happen.  After all, consumers are adopting health IT more and more each day. The barn door is open and the horse is running around, so let’s saddle it and leverage that energy!