Electronic Health Records: Why Teach New Tricks When The Old Tricks Work Better?

Guest post by David Cooper, CEO and co-founder, Medical Mime.

As most of us involved in the healthcare industry already know, the Affordable Care Act calls for providers to adopt secure, confidential, electronic health information systems. Why? Because most experts agree that by using these electronic health records, we can collectively reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve healthcare outcomes. But reality has had a funny way of challenging those expectations.

Yes, financial incentives have motivated doctors to get on the bandwagon, and many – if not most – office-based physicians have adopted some form of electronic health records. A study published in the journal Health Affairs reported that 78 percent of doctors working in office-based environments had implemented an electronic health record.

However, only about 48 percent of doctors had an EHR system with advanced functionality, according to the same source. Only 39 percent reported they had used their system to share medical data with other providers, and a stark 14 percent reported sharing data with providers outside their own practice. In short, the adoption of EHRs has not resulted in the promised integration of patient data that we hoped for. In fact, the use of electronic medical records – so far – may actually be having a negative impact on the quality of care doctors deliver.

According to a Northwestern University study published in the spring of 2014 in the International Journal of Medical Information, doctors who use electronic health records in their exam rooms spend one-third of their time looking at their computer screens. By comparison, physicians who rely on paper charting spend about 9 percent of their time looking at a patient’s records during an encounter. The study also asserts that because physicians spend so much time looking at their EHRs, they miss out on nonverbal communication cues from patients, thus affecting the quality of the care they’re delivering.

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Quick and Painless: Electronic Medical Billing

Guest post by Kristen Gramigna, chief marketing officer, BluePay.

Kristen Gramigna
Kristen Gramigna

Replacing a hard copy-based billing system with one that is electronic can help your healthcare organization realize the operational efficiencies, cost reduction and expedited accounts receivable rates that are critical to financial stability in healthcare. Here’s a look at the benefits of electronic medical billing, and why making a switch may not be as complicated or costly to your organization as it may seem.

Patient perception is critical to your organization’s survival. Though health care spending is projected to increase by an annual average of 4.4 percent from 2013 to 2017 in America, more insured Americans and an aging population mean that competition for patients is fierce. Patients have a choice when it comes to where they invest their health care dollars. Their brand perception of a health care organization is no less important than their perception of any branded service or packaged good.

In a recent Accenture survey, healthcare CEOs echoed their acknowledgement of this new industry reality: Nearly half of those surveyed ranked patient satisfaction as a top business priority for their organization in the next three years. Though employing reputable medical professionals, offering quality facilities and communicating a memorable brand message are important, the many interactions a patient has with the health care organization (including scheduling, medical care providers and billing departments) all shape their perception, which ultimately impacts the organization’s reputation.

Electronic billing is one simple way to enhance the odds that patients have the positive experience that leads to retention and referral to friends and family. In one study by TransUnion Healthcare, the impact that medical billing has on patient perception in both front-office and back-office functions was made clear. In that study, 85 percent of respondents who had a negative billing experience with a medical provider rated their overall experience with the organization as negative. Conversely, 80 percent who reported a high level of satisfaction with a healthcare provider and/or organization also had a positive billing experience.

Billing inefficiency carries a billion-dollar price tag. If your organization has failed to adopt an electronic billing system because of concerns with the costs and potential risks in implementation, the more important question may be whether it can afford not to leverage electronic billing. In a New York Times op-ed piece, healthcare policy expert Ezekiel J. Emanuel estimated that administration costs in the healthcare industry at large amount to about $360 billion per year; half of those costs are attributed to billing waste, including paper-based record keeping, processing and redundancy associated with paper forms. In one Black Book case study called “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors” conducted among healthcare financial leaders, respondents indicated that the cost of moving to an electronic billing system was quickly offset by its benefits. According to the study findings, 81 percent of respondents were able to realize “basic and intermediate efficiencies” that resulted in a measurable return on investment within six months of implementation; 94 percent said they realized ROI benefits after one year.

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Health IT Startup: 2nd.MD

2nd.MD provides direct access to the world’s best doctors for personalized second opinions via video or phone within about three days.

Elevator pitch

When it comes to your health, don’t second guess, do 2nd.MD.

Founders’ story

When Clint Phillips’ — our CEO — daughter, Gabi, suffered from a stroke, the family faced immense hurdles to get answers to their health-related questions. The uncertainty of choosing the right doctor, the many months of waiting for an appointment and the time spent traveling to see specialist after specialist were constant struggles. 2nd.MD was founded to save other families from the confusion and barriers faced by the Phillips’ family. Leading doctors joined forces, as well as innovative investors, to develop 2nd.MD into a driven cause that continues to create more dedicated and passionate care.

Marketing/promotion strategy

Clinton Phillips
Clint Phillips

2nd.MD partners with businesses and employers to provide our expert second opinion services to their employees. We communicate monthly through a variety of channels to stay top of mind with employees, reminding them to use our service when they need us.

Market opportunity

Our target audience consists of the 5 percent of employees that make up 50 percent of healthcare costs for companies. These employees are facing a new diagnosis, possible surgery or change in medication, and are not aware of their options. 2nd.MD allows employees the opportunity to speak with the top specialist for their condition, which provides the most up-to-date treatment options for each individual case. Additional statistics can be provided.

Second opinions result in changed diagnoses in 15 percent to 20 percent of cases and modified treatment recommendations in 60 percent to 70 percent of cases, according to the Institute of Medicine.

Who are your competitors?

Because of the service 2nd.MD provides, we have no direct competitors. Companies, such as Best Doctors and Cleveland Clinic, do offer a similar service; however, they can take six weeks and do not provide direct access to a physician. As a result, the utilization and appeal of 2nd.MD is highly valued.

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Workflow Management Systems in Healthcare: Complex Interventions

Guest post by Jeff Robbins is president and CEO of LiveData, Inc.

Jeffrey Robbins
Jeffrey Robbins

It is no secret that many of today’s best hospitals are still enmeshed in implementing and fine-tuning new, enterprise-wide electronic health record (EHR) systems. With purchase prices in the tens or even hundreds of millions of dollars, the EHR is a focal point of bringing technology to bear on the various challenges of delivering consistent, high quality care to an increasing number of patients.

Yet many hospital administrators and caregivers are finding that the level of effort (and expenditure) isn’t moving the needle as much as was expected. It turns out that this isn’t because of any specific failing on the part of the EHR vendors. Rather, it is because of a missing layer in today’s EHR technology stack.

This missing layer, workflow management systems, is software designed to coordinate specific action, create consistency, and deliver visibility by automatically connecting caregivers with relevant tasks and information. The EHR, by necessity, is focused on creating a heads-down log of all encounters. Workflow technology adds the missing heads-up displays, alerts and analytics that help drive use of the EHR during patient encounters.

One of the more complex interventions in healthcare is surgery. The choreography involving patients, caregivers, equipment, supplies and operating rooms at a busy hospital is demanding, and the added manual data-entry burden of new EHR implementations paradoxically adds to the risk of variability.

Perioperative workflow

Workflow technology can mean many things. At the planning level, one common device is using whiteboards and Post-It notes to create a basic map of tasks. This data gathering approach is an excellent team activity, and allows many stakeholders to collaborate and share knowledge about interdependencies.

The challenge posed by the complexity can be summarized as, “Where do we go from here?!” It is tempting to picture using a computer-based workflow diagramming tool to capture and enact this diagram. While the “state diagram” is a useful technology tool, the complexity of even this small detail should help highlight why the myriad states, conditions, and rules that could be brought to bear to deliver workflow technology benefits to complex interventions is, in a word, complex.

Where do we go from here?

Workflow technology, delivered via a workflow management system, is intended to implement the workflow processes built on the activities and preferences of stakeholders. By making aspects of these human processes “executable,” via executable process models, healthcare workflow technology can provide a form of power-assist to caregivers.

But, as we have seen, creating a computerized process model of a complex process will, of necessity, have to mirror some of that complexity, or risk oversimplification and the potential for harm to patients. This model is executed or consulted, in conjunction with caregivers, when they deliver care. These executable process models are at the heart of what distinguishes healthcare workflow technology from today’s EHR. Healthcare workflow technology drives workflow to achieve the consistency and quality required by our society’s burgeoning healthcare spend.

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The Things We Do To Undermine Our Own Data Security

Guest post by Mac McMillan, CEO, CynergisTek.

Mac McMillan, CEO CynergisTek
Mac McMillan

There is no doubt about it, healthcare as an industry is absolutely reliant on its systems environment and electronic information to the point that efficiency, safety and productivity are affected any time it suffers any disruption. Yet it seems we are destined to incur disruptions more often than not because of our own actions or in-actions.

This article takes a somewhat tongue in cheek look at some of the naïve or bad behaviors, misconceptions, short-sighted decisions and mistakes we make that contribute to making our own data security situation more difficult.

Misplaced Trust

The list of examples here is virtually endless, from having too much confidence in vendors to underestimating employees to naïve beliefs about the internet, social media and applications. Hundreds of hospitals blindly relied on a vendor to process their billings without once questioning the company’s security practices. They were surprised when their revenue cycle was interrupted when that company suffered a Ransomeware attack. Other healthcare entities have found themselves embroiled in breach investigations when subcontractors they never knew existed lost their data, some overseas.

Expressing surprise may be a realistic response, but it’s hardly an acceptable excuse for lack of due diligence. Few organizations watch the folks who represent the highest risk to their systems and information – those with elevated privileges. Examples abound of administrators who became saboteurs. What is amazing is the almost immediate reaction when these kinds of things happen. How could we not be auditing these folks? It should be pretty simple to answer this question when they are usually the ones responsible for auditing. And then there is the internet and social media. The first myth organizations fall victim to is, “we’re too small to attract anyone’s attention” or “no one is looking at us.”

Most attacks from the internet are indiscriminate automated probing of systems looking for anyone vulnerable. You’re right they are not looking for you specifically, but if you are connected they may find you. Last but not least, the naïve belief that there is actual privacy on social media and applications when they tell you there is. Weekly we hear about another app compromised or information leaked from a site thought to be secure. There is no such thing as foolproof security and apps, even ones named “secret” should be approached with caution.

Underestimating Risk

Organizations make bad decisions all the time based on misplaced or erroneous perceptions of risk, or just plain disregard for the risk. Bad decisions though, regardless of the reason, are still bad decisions. How about underestimating the risk from USB ports?

Organizations routinely underplay the fact that these ports unprotected can be the source of information loss or importation of malware. We encrypt mail, laptops, maybe even provide encrypted USB drives, but fail to manage the ports themselves. In complex environments it’s also easy to be overwhelmed with what seem like routine chores, like documenting all changes. Someone says it’s a routine change, it only affects one system, or the vendor is just applying a regular update… implying that it doesn’t have to go through change control and thus, does not get documented. There is also underestimating the risk when we acquire another entity. This risk comes in two forms. The first is the acquisition without the assessment, or rushing the acquisition so assessment is not possible, and assuming the risk blindly. Continue reading

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Did Electronic Health Records Just Get Good News from POTUS?

Guest post by Stephen Cobb, senior security researcher, ESET.

Stephen Cobb
Stephen Cobb

Whatever you thought of President Obama’s penultimate State of the Union address, you have to admit it set some sort of record for the most words devoted to issues of data privacy and security (198 by my count). Furthermore, those words alluded to a raft of statements and announcements on these topics that were published in the days leading up to the speech. In short, it is clear that this President wants to make some changes with respect to cybersecurity and data privacy. What is not yet clear is how those changes will affect healthcare IT and the management of electronic health records. Will breach notification requirements change? Will penalties for breaches be increased?

The answers are not entirely clear at the moment. For a start, the President is a Democrat, but Republicans control the House and Senate. In other words, it is hard to know which of his proposals will be enacted. That said, it is better to look at them now and ask questions, engaging in the debates they are bound to provoke rather than wait and see what new laws finally emerge. For example, the President proposes to erect a single national 30-day data breach notification law in place of the scores of different state data laws that companies currently have to comply with. How will that affect electronic health records?

The answer may be “very little” and that could be good news for electronic health records and health IT. In its current form, the proposed Personal Data Notification & Protection Act does not disrupt existing federal notification requirements related to health data breaches. The draft legislation does not apply to HIPAA covered entities and business associates, nor the FTC covered vendors of personal health records. Here is a boiled down version of the current language which I have put in quotes to show it comes from the bill: “Nothing in this Act shall apply to business entities to the extent that they act as covered entities and business associates subject to the HITECH act (section 17932 of title 42), including the data breach notification requirements and implementing regulations of that act. Nor will it apply to business entities to the extent that they act as vendors of personal health records and third party service providers subject to the HITECH act.”

If the law were to be passed with that language intact, it would leave in place what many of us still think of as the HIPAA 60-day notification deadline, as well as the FTC 30/60-day PHR regime. And when you’re trying to comply with a regulatory regime, a lack of change can be good. Another way of looking at the breach notification issue is that the healthcare sector, while often maligned for leaking data, is actually a pioneer in notification. The HIPAA privacy and security requirements were in play even before California passed the first of the state breach notification laws, which now exist in some form in more than 40 states (creating the patchwork regulatory nightmare that the President’s unified federal law seeks to dissolve).

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Physician Engagement: Make It Convenient, Credible and Fun to Impact Outcomes

Guest post by Maureen Ladouceur, vice president, Health Systems Products, Marketing and Services, Quantia, Inc.

Maureen Ladouceur

According to a recent Physicians Foundation survey, 82 percent of physicians believe they have “little influence on the direction of healthcare.” At the same time, data suggests that physicians are the ones driving 80 percent of our increasingly unsustainable national healthcare spend.

There’s been plenty of speculation on the reasons physicians are feeling so disenfranchised – including their frustration with having to do things that don’t appear, to them, to have anything to do with good medicine. Things like onerous documentation, EHR training and quality report cards are just a few examples. Further, physicians are being asked to learn about marketing, customer service, leadership, management and cost effectiveness that have more to do with taking care of the system than taking care of patients.

In most cases it boils down to this: there’s too little time, too many distractions and too much change to the clinical and administrative guidelines that go along with being a practicing physician.

So how can health systems overcome these very real obstacles and engage their physicians in ways that keep them current and aligned? For starters, any physician engagement strategy has to be digital if it’s going to scale. And to be sustainable, it’s got to be convenient, credible and enjoyable—while giving physicians a voice (and thus, gaining their buy-in) on topics that will impact the future of their practice, their organization and the overall healthcare system.

Health systems looking to engage their physicians in ways that foster ongoing learning and inspire change can leverage a few proven best practices:

Make it convenient

With an estimated half of current medical knowledge becoming obsolete every five years, even the most experienced physician can’t keep up with all the changes in healthcare. Yet many bristle at the idea of spending time away from the office at symposiums, or submitting to onerous exams on content that may or may not be relevant to their practice.

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The Inexorable March toward Accountable Care: CMS Adds 89 New MSSP ACOs

Guest post by Ken Perez, vice president of healthcare policy, Omnicell.

Ken Perez
Ken Perez

During much of 2014, there seemed to be a rising tide of negativism about the Centers for Medicare & Medicaid Services’ accountable care organization (ACO) programs. After losing nine of its participating organizations after its first year of operation, the Pioneer ACO model suffered some more high-profile departures in 2014.

In August, Sharp HealthCare, a five-hospital system in San Diego, Calif., exited the program, and the following month, three other ACOs—Franciscan Alliance in central Indiana, Genesys PHO in Flint, Mich., and Renaissance Health Network in Pennsylvania—also dropped out. Since the Pioneer program’s inception in January 2012, the total number of Pioneers has dropped by 41 percent, from 32 participants to 19.

The bad news wasn’t confined to the Pioneer program. An October 2014 survey by the National Association of ACOs (NAACOS) indicated that two-thirds of Medicare Shared Savings Program (MSSP) participants are “highly” or “somewhat” unlikely to remain in the ACO program as it currently stands. Clearly, the Medicare ACO ship certainly seemed to be sinking.

In an attempt to right the ship, on Dec. 1, 2014, CMS released a long-awaited 429-page proposed rule to modify the MSSP, seeking to retain as many of the current MSSP ACOs as possible and attract new participants to the program. The words “encourage” or “encouraging” appear almost 100 times in the document—with an eye, ultimately, toward greater ACO participation in risk-based models. However, in spite of CMS’s intention, NAACOS and the American Hospital Association’s initial responses to the proposed rule were generally critical. CMS is accepting public comments until Feb. 6, 2015, after which it will compose the final rule, a process which should take, if history is a guide, three to six months.

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The Push to Telehealth Is On

Scott Zimmerman
Scott Zimmerman

Guest post by Scott Zimmerman, president, TeleVox.

If you caught Maria Bartiromo’s interview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:

“Telehealth is going to be a booming industry.”

Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.

Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”

The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.

One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.

It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.

Progress Is Underway

Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.

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Achieving Effective and Targeted Customer Communications: It’s All About Managing the Three “C’s”

Guest post by Doug Cox, chief strategy officer, Elixir Technologies.

Doug Cox
Doug Cox

The good news is that there is plenty of great content being generated throughout most health organizations to create engaging, effective member and patient customer communications, which we will call “customer communications” to include any recipient. The bad news is that the content is often locked away in siloed systems and workflows, making it very difficult for marketing, customer experience and mobile strategy teams to leverage information in a streamlined, cost-effective way. The result? Marketing promotions and graphics are only available for use in brochures, purchase history data is only accessible for billing, and so on. Content is trapped in the specific system it served originally, limiting its value to the organization.

These challenges can be overcome by implementing the newest concept in healthcare document creation: content lifecycle management (CLM). The goal of CLM is to enable business teams to create and manage correspondence themselves using portals configured for specific document types, such as healthcare plan summaries, coverage change notifications and benefits statements. Implementing a CLM approach can unlock valuable data, avoid dependence on the availability of IT resources, reduce costs, and speed time to market.

Employing a CLM approach requires achieving three important “C’s”: centralization, collaboration and control. Each of these areas plays a critical role in attaining effective communications that speak directly to the customer’s individual needs and desires.

Here’s a look at each of the three C’s:


An important step to improving customer communications is centralizing access to content and templates so that they are readily available to business users. Making it possible to reuse content in multiple health plans and versions, for instance, rather than having substantial amounts of duplicate content that is not shared, will improve efficiency and reduce the amount of effort and time needed to update or change data across versions. Changing a plan benefit for example, can be accomplished in one step for hundreds of document versions, rather than having to replace the information in each individual file.


Participation from people outside the primary workflow is often required but can cause bottlenecks. A good collaboration tool sits atop the entire enterprise, integrating people automatically into the workflow on an ‘as needed’ basis. A browser-based system provides the greatest flexibility because it can be accessed by anyone regardless of location.

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Securing Healthcare Against Advanced Persistent Threats

Garret Grajek
Garret Grajek

Guest post by Garret Grajek, chief security officer, dincloud.

A March 2014 study by the Ponemon Institute titled, “Ponemon Report on Patient Privacy & Data Security,” stated that cybercriminal attacks on healthcare organizations have doubled in the past three years. If you follow IT news at all, you know that healthcare organizations are also under attack, with some of the latest of these attacks being what experts classify as APTs (Advanced Persistent Threats). APT attacks distinguish themselves by being persistent attacks orchestrated by an organized (and usually well-funded) institution, either government or criminal, with a specific target and purpose for the attack.

APTs distinguish themselves from past “script kiddies” and accidental hackers who execute “crimes of opportunity” (e.g. they find a site that they can do an SQL injection and see what data they can download). Advanced persistent threats however follow the opposite workflow – they select a target and then use any and all mechanisms to obtain access to the data they desire.

You’re in healthcare – but should you care?

Healthcare IT systems are a target rich environment for advanced persistent threats attacks. What’s the reward? PHI (Personal Health Information) and PII (Personal Identification Information).  PHI/PII for hackers is the gift that keeps on giving! With someone’s identity information, hackers can create multiple accounts – financial and other – for the purposes of fraud.  This was seen in mid-August when Community Health Systems announced that it had fell victim to an APT attack earlier that year from an APT group based in China. Chinese hackers stole medical records for 4.5 million patients, according to a regulatory filing from the healthcare provider. And how can we forget the security breach at HealthCare.gov, the government’s health insurance marketplace.

Healthcare has the same type of information, and more. User identities, associated e-mail addresses, phone numbers, street addresses, and often insurance, credit, and other key PII information (like employer’s and spouse information), are held by health care providers. Attackers know this, and for these reasons, health care entities have become an easy target for advanced persistent threats attacks.

Defending Against APTs

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Technology Steps Up in Home Healthcare: Using Innovation to Help Fraud Prevention

John Olajide

Guest post by John Olajide, president and CEO, Axxess.

The home health delivery model has become more prevalent in recent years as a cost-effective, patient-preferred alternative to traditional hospital and skilled nursing settings. Approximately 12 million U.S. individuals receive care from more than 33,000 agencies for acute illness, long-term health conditions, permanent disability, or terminal illness — according to a survey by the National Association for Home Care & Hospice (NAHCH).

Demand for home health services is seeing an increase as more baby boomers turn 65 daily and choose to receive their health care services at home. Recent surveys of older adults are showing a preference to receive healthcare in the dignity and comfort of their homes. As an example, surveys by the American Association of Retired Persons (AARP) consistently show that over 80 percent of older adults want to remain in their homes and communities throughout their lives. Several surveys show the same trend in the wider patient populations; and technology innovations are making it possible to deliver quality healthcare services to patients at home.

While the increased awareness in and recent growth of the home healthcare sector is promising for home health agencies, critical to their success is the adoption and integration of the right cloud-based technology to increase operational efficiency, ensure compliance with stringent regulatory requirements and improve patient outcomes.

Technology can also assist in preventing home healthcare fraud. While fraud can occur in all sectors of healthcare, home health is unique in that the caregiver visits the patient in the home. A common example of fraud in home health is when a caregiver submits documentation for visits that were not made and the home health organization, in turn, submits claims to insurance providers for such services without obtaining proof that such service was actually rendered. Home health agencies would be wise to protect themselves from the possibility of this type of fraudulent activity by a disreputable employee.

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Health IT Startup: Twine Health

It’s called healthcare for a reason. Technology is a powerful tool, but people are the solution. The Twine Health Collaborative Care Platform allows for the co-creation and tracking of personalized care plans that serve as common ground for continuous collaboration between patients, coaches and their clinicians. Patients get support from their care team, on their terms whenever, wherever they are: so they reach their health goals faster and focus on living.

Healthcare has lost its way. In recent years the “care” has fallen by the wayside — victim of flawed automation efforts, perverse payment models and the constant pressure to reduce costs. Technology is a powerful tool. However, if not used properly it’s impersonal and the human connections, which are critically important to caregiving, get lost. People are the solution to better healthcare.

People are the most underutilized resource in health. Twine Health changes the game by empowering them to take an active role in their care, learning along the way, and overtime building self-efficacy. Twine Health surfaces patients who need help at just the right time, allowing them to remain effective even as panel sizes grow. Coaches provide the ongoing support and expertise that is key to successful behavioral change. This also allows clinicians the time and focus to practice at the top of their license, interacting directly with patients when challenging medical conditions arise.

Elevator Pitch

The Twine Collaborative Care Platform is a new class of digital health technology that helps patients build self-efficacy via continuous support from coaches and their clinicians. Spun out of research performed at the MIT Media Lab, and proven cost effective via clinical trials and commercial pilots, Twine delivers results that cannot be ignored – 90 percent of patients reach their health goals (e.g., blood pressure < 140/90) within 3 months at 1/3 the cost of the standard of care.

Founder’s Story

John O Moore MD, PhD
John O Moore MD, PhD

John Moore, MD, PhD, is the co-founder and CEO of Twine Health. Moore’s passion for a better healthcare system started during his medical training where he was frustrated to learn that the best diagnostic and treatment capabilities did not result in healthier and engaged people. To be successful, Moore realized patients had to be in control of their own care, but also recognized the clear need for expert support. Moore came up with the idea for Twine Health during six years at the MIT Media Lab where he studied the healthcare delivery model and created a revolutionary approach to care: technology-supported apprenticeship. Bringing together advances in health psychology, learning science and human-computer interaction, Twine is designed to become the primary tool for teamwork between patients and clinicians. Before attending medical school, Moore received a BS in Biomedical engineering, and was a Fulbright Scholar.

Marketing/Promotion Strategy

Patients, coaches and clinicians are looking for a better way to provide and receive care – a way to make health care healthier. Twine Health provides clinicians, and the health organizations (HCOs) they work for, an effective and scalable chronic care platform that improves outcomes, reduces costs and increases patient and clinician satisfaction. The results speak for themselves:

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Population Health and High-Value Care Coordination

Guest post by Mark Hefner, CEO, Infina Connect Healthcare Systems.

Mark Hefner
Mark Hefner

Various forms of payment reform are in play throughout US healthcare today, and with good reason as we search for the right combination of incentives, alignment and engagement that produce systemically better health outcomes at lower overall cost.

As an example, providers are paying much more attention to the small percentage of patients with the highest costs, including patients with chronic conditions. As a result, they are identifying these patients, establishing care plans and engaging care coordinators and patients to improve outcomes. Less attention, however, is being focused on the powerful capability to better connect, communicate and coordinate care among the multiple providers that care for a patient. This caliber of care coordination has the potential to improve outcomes across the entire patient population and is rooted in results that suggest a coordinated network of providers, each capable of high quality and cost effective care, with appropriate information about the patient available to them, can deliver improved outcomes across large patient populations.

Patient populations may be systemically managed under various forms of accountable care, commercial shared savings, Medicare Advantage and full risk – or managed by episodes of care, bundled payments, etc. The shift from fee-for-service to “fee-for-value” incentivizes preventive care, best practice care, and high-value delivery of care and it puts a premium on the ability to coordinate care.

Therein lies a very significant challenge: The collective group of providers that interact with a large patient population are invariably part of different organizations, with different technology platforms or no platform at all and are dependent upon fax machines, phones, and paper to exchange documents and communicate. The provider groups also possess differing incentives: the “at-risk” provider attempts to influence improved health and financial outcomes while other providers may still be receiving fee-for-service payments.

Reconciling these challenges and harnessing the power of care coordination is now possible via referral coordination. One of the most powerful mechanisms for coordinating care are the hundreds of thousands of patient referrals made every day between various providers, with Primary Care Providers (PCP) being the largest initiator of consulting and diagnostic referrals on behalf of their patients. Providers need to communicate with each other when they are treating the same patient, and these patient transitions between providers represent a significant opportunity to realize high value care.

The referral itself is equivalent to a PCP or patient making a decision on which provider to “hire” to provide the needed care. This referral decision and the coordination of the referral are critical to the delivery of better health at lower cost, but improving the overall referral process requires key elements to be implemented consistently:

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Challenges to Emerging Health Technologies

Steven Chau
Steven Chau

Guest post by Steven Chau, CTO and co-founder, Doctor Quickly.

Healthcare is one of the last industries to be disrupted by technology. Although unprecedented levels of biomedical knowledge, surgical procedures, and condition management have been amassed, we are not using them to their potential to create the tools to improve healthcare experiences. A balance of privacy and policy regulations with technology is the key to creating a secure yet efficient healthcare system.

The State of Healthcare

A staggering portion of healthcare costs are wasted. According to the Institute of Medicine (IOM), $765 billion or 30 percent of the 2009 total U.S. healthcare spending was wasted. Key areas that were tracked include unnecessary services, services inefficiently delivered, prices that are too high, excess administrative costs, missed prevention opportunities and medical fraud.

Key findings:

  • Overused services, defensive medicine and higher-cost services total $210 billion in excess cost;
  • Medical errors, care fragmentation and preventable complications total $130 billion in excess cost;
  • Duplicative costs to administer insurance and insurances’ administrative inefficiencies drive $190 billion in excess cost;
  • Product prices beyond competitive levels total $105 billion in excess cost;
  • Missed prevention opportunities like primary, secondary and tertiary prevention total $55 billion in excess cost;
  • Fraudulent claims total $75 billion in excess cost.

Additionally, there will not be enough physicians in the next few years to meet the growing demand. The Association of American Medical Colleges (AAMC) projects a shortage of 62,000 physicians by 2015. This shortage is expected to increase to 91,000 by 2020. This physician deficit is due to an aging Boomer Baby population, the insuring millions of new patients through the Affordable Card Act, and the retiring of a large number of doctors in the coming decade.

Technology can curb inefficient health management, increase knowledge sharing, and improve access to a shrinking physician pool.  However, proper precautions must be taken to safeguard patient information privacy while empowering healthcare providers to provide more efficient care.


Healthcare technology is largely regulated by the Health Insurance Portability and Accountability Act (HIPAA). It was created in 1996 to protect the privacy of electronic patient data, known as protected health information (PHI) and to restrict access to PHI. Predating the iPhone by 10 years, the HIPAA rules were strengthened in 2013 to increase rigor on de-identifying PHI, to broaden HIPAA’s reach to include all entities that touch PHI directly and indirectly, and to notify affected parties if a PHI breach has occurred.

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