The Limits (and Realities) of Automation in Healthcare

Guest post by Edgar T. Wilson, writer, consultant and analyst.

Edgar T. Wilson
Edgar T. Wilson

Is there an unspoken fear among caregivers that the subtext of all this digital disruption is a devaluation of the human element?

In countless industries, workers and analysts alike watch the slow march of technology and innovation and see as inevitable the takeover of human tasks by robots, AI, or other smart systems. We watched as the threat of outsourcing transformed into a reality of automation in industrial sectors, saw drones take on countless new roles in the military and in commerce, and now we hear about how driverless cars, self-checkout kiosks, and even robotic cashiers in restaurants are all waiting in the wings to dive in and displace even more formerly human occupations.

And looking at how EHRs — by virtue of their cumbersome workflows alone, not to mention all the documentation and growing emphasis on analytics and records-sharing–are taking flack for burnout and frustration in hospitals across the country, it hardly seems a reach to suggest that maybe America’s caregivers are feeling not just burdened by technology, but threatened.

Digital records are already changing what doctors and nurses do, how they work, and what is expected of them — it must surely be only a matter of time before their roles start getting handed over to the robots and supercomputers … right?


Change, Not Replacement

While some jobs or roles may face elimination through automation, the more common effect is transformation. In healthcare, that may mean that for many their title is the same — perhaps even the education and certification standards that go along with it–but their actual functions and roles in context will be different.

We see this already with respect to EHRs. The early, primitive documentation workflows and reporting obligations have drawn ire from clinicians who see their autonomy under attack by digital bureaucracy. But this is naturally destined for correction; medicine has advanced through trial and error for centuries, and the 21st century is no different.

The transition and disruption doesn’t manifest exclusively as growing pains. Consider the role of medical laboratory scientists and technologists: the Obama administration is pushing for a cure for cancer based on the advancement of personalized medicine; patient-centered care is becoming a priority among all caregivers as well as a quality metric in health centers across the country; genomic testing is seeing growing demand on the consumer side, as well as applications in a growing array of clinical settings.

All of these trends point to the medical lab as a newly central component of the modern care center, treatment plan, and information hub. The demands all these new technologies and applications put on laboratory professionals requires them to do more learning, adapting, and leading than ever before, especially to integrate the latest and greatest devices and tests available.

Simply put, machines are still fallible, and require assistance in providing critical context, to supplement their ability to accurately read, diagnose, and self-regulate to ensure accuracy and consistency, not to mention proper application in the clinical setting.

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Health IT Startup: TapCloud

TapcloudTapCloud creates a real-time stream of data that enables care teams to quickly grasp whether a patient is getting better or worse, assess the effectiveness of treatments and medications and identify the onset of emerging complications. TapCloud is currently being used in settings from single practitioner to national hospital systems.


Elevator pitch

TapCloud allows patient’s and provider’s to communicate in ways never before possible to improve the doctor/patient relationship, focus clinicians on patients that need the most attention and insure that the patients that require services receive them in a timely manner to maximize health benefits to the patient (including quality of life, not just physical issues) and minimize the expenditure of health resources.

Product/service description

TapCloud is a solution for gathering key patient information in between clinical visits. There are two parts to the TapCloud solution: a patient facing instructional and information collecting APP and a web-based clinician dashboard. Typical use is for patients to follow/consume their provider-based care plan/educational info and enter their well-being, pain levels, symptoms, side effects, medication compliance and vitals into the APP (unique design allows patients to complete this in less than 1 minute per day). This information is then presented in a comprehensive dashboard that allows clinicians to rapidly interpret key insights into a patients overall well-being. Based on this patient reported information, clinical protocols will dictate if any specific patient needs to be seen, have a home health visit or meds adjusted, etc.

Origin story

Tom Riley
Tom Riley

Our CEO, Tom Riley, is a former health insurance executive who spent the past 25 years living at the intersection of healthcare and technology. A few years ago, after his mom was diagnosed with ovarian cancer, his experience with the healthcare system became much more personal as he became a primary caregiver for her. During that time he attended office visits with his mom on a regular basis, and discovered that there is an inherent gap in communications between the way doctors organize/accept information from patients, and the way patients organize and deliver information to their doctors and other clinical staff.

Over and over again, he found himself serving as a translator between his mom and her doctors. He would help his mom by creating easy to understand checklists of things she was supposed to be doing each day, activity, medications, etc. And he would help the doctors by keeping track of his mom’s symptoms and watching for developing complications and then making sure that the information was shared during her appointments. It frequently made a significant impact on the diagnosis of issues, and the assessment of treatment effectiveness. It also helped his mom regain a measure of “quality of life” by making sure that even non-critical complications like chronic constipation were identified and addressed.

After his mom passed away, he decided to devote his time to taking what he had learned first-hand and developing a solution to improve patient-doctor communications in acute-care settings like post-surgical recovery and chemotherapy and since has morphed into a chronic disease management solution as well. TapCloud runs on smart-phones and tablets and includes personalized services for the patient, helping them organize and customize generic discharge/care plan instructions into a personalized daily plan for them to follow. At the same time, the technology uses a sophisticated, but incredibly easy to use, interface to probe for indications of developing complications and/or medication side-effects. It allows clinicians to effectively monitor patient progress remotely and focus their attention on the right patients. It also ensures that doctors are aware of all of the issues affecting a patient, not just the life-threatening ones that have their patients end up in the ED or admitted to the hospital without them even realizing their patients were experiencing any issues.

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How Healthcare Technology is Saving Lives

Guest post by Devin Jollimore, training coordinator, Mission Safety Services.

We live in an age where the use of technology dominates our lives and these technological developments have had an amazingly positive impact on the healthcare industry. Healthcare technology has heavily influenced the improvement in our health and the increased life expectancy we are seeing today.

In particular, the progress we have made in cancer research and the greater survival rates have been heavily influenced by developments in technology. It’s amazing that healthcare technology played a role in saving 1.2 million lives between 1991 and 2009 thanks to progress in cancer treatments and detection.

Malaria is thought to have killed more people than all wars put together and technology is helping reduce this startling statistic. Something as simple as a bed net with insecticide has reduced malaria in children under 5 by 20 percent.

Also, stem cell research has limitless possibilities to save lives. We are still progressing with this development, but diseases, such as heart disease and Alzheimer’s, may be hugely reduced through stem cell research and we are already making good progress.

Let’s not forget the importance of the Internet and how it has increased healthcare efficiency. Healthcare facilities are reaching patients through social media and doctors have access to thousands of medical books at the touch of a button.

This infographic from Mission Safety Services outlines the progress we have made, the work that is being done, and possible future developments in technology that have potential to make real change.

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Health IT Thought Leader Highlight: Jim Lacy, CFO, ZirMed

Jim Lacy Biography Pictures
Jim Lacy

In the following conversation, Jim Lacy, CFO and general counsel of ZirMed, discusses the company’s mission, goals and growth; his passion for healthcare and serving those who work in it; ZirMed’s transition from a clearinghouse to a revenue cycle management, population health and predictive analytics firm; why privacy has become the biggest issue very few are seriously talking about; and the changing face of healthcare as a whole.

Tell me more about ZirMed, the brand, its solutions, and your mission for it.

Our core mission is to help healthcare providers, hospitals and health systems get paid. It sounds simple, but efficiently and effectively getting providers paid for their services and supporting their mission in an ever-evolving technological, regulatory, and clinical environment is incredibly complex.

ZirMed is uniquely positioned to deliver a comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions. That means that at every point in the revenue cycle, we have solutions that support healthcare providers in collecting monies from payers and patients, and do it as quickly, efficiently, and cost-effectively as possible. Our solutions address the challenges of the current fee-for-service and consumer-driven payment systems, and also support fee-for-value reimbursement, broadly defined as population health management.

ZirMed’s solutions are logically oriented to address the revenue cycle needs of providers ranging from small physician practices and durable medical equipment providers to the largest hospitals and health systems. At the front end, we offer Patient Access solutions focused on registration and check-in to streamline pre-registration, estimate patient responsibility, accurately verify eligibility, and more.

Core to our mission of getting hospitals and health systems paid for services provided is our Charge Integrity solution. We use big-data and predictive analytics to identify and capture charges, resolve process inefficiencies, improve coding compliance, and ensure the complete integrity of all inpatient and outpatient billing.

Our claims and A/R management solutions include robust edits and rules aggregating claims across an entire system, and provide highly efficient claims and receivables workflows, reduce preventable denials, and deliver insights into financial performance for critical decision support.

With the ability to process vast amounts of data and provider metrics across an organization, our cost and utilization solutions benchmark provider performance, stratify risk, and support fee-for-value reimbursement programs.

Population health management has come to hold very different meanings across different organizations. Our population risk management solutions combine clinical and financial information, enabling insights into patient populations while identifying risk, analyzing discharges for readmission risks, and managing referrals across an integrated system.

And, of course, healthcare is always about the patients. We offer a comprehensive suite of Patient Engagement solutions including consumer-friendly billing and payment options and a patient portal offering online payment, statement management, and two-way messaging between the patient and provider.

What about you? What keeps your passion for this mission, and organization, alive? Tell me more about what excites you about your work and why you love what you do?

I love what I do, and couldn’t design a better job for myself than this one: I get to be a CFO, counsel and influence product design, all within the course of a normal day.

My roles are seemingly very different and one person holding them is rather non-traditional; however, there is logic to the fit. ZirMed develops financially focused software solutions in a highly regulated healthcare environment. We deal with billions of transactions and hundreds of billions of dollars annually with an extreme focus on privacy, security and compliancy. My background from the provider side of healthcare prior to joining ZirMed directly influences the types of solutions we build and how we deploy them to positively impact provider organizations.

Ric Sinclair, our VP of product, and his team excel at designing and delivering great software that’s beautiful, powerful, and easy to use. Their role is to take all this complexity and make it as simple and easy as possible for users and managers in client organizations. My role is to weave my experiences into the design of our products and support the role of the client in everything we build.

So I’m doing what I love and working with incredibly smart, talented people every day. That makes it easy to stay passionate and excited about my work and about ZirMed.

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The Quantified Self: A Vain Hope, or an Impending Reality?

Dr David Whitehouse
Dr. David Whitehouse

Guest post by Dr. David Whitehouse, chief medical officer, UST Global.

Technology innovation is changing many fields dramatically but unevenly, and that is especially the case with the medical field. When I get into my car each morning and look at the dashboard, I know more about the health of my car than myself.

When it comes to health, we live our lives directed by our beliefs about health and symptoms. Beliefs drive us to strategically invest in aspects of our physical selves, from diet to exercise, to immunizations. What causes us to go to the doctors, for the most part, are symptoms: aches, rashes, pain, and general losses of function. Once we see a doctor, specifics about our health are further defined by numbers (temperature, blood pressure, cholesterol).

For the most part, I am aware of my symptoms, but not my numbers. Some with a chronic illness like diabetes use numbers to help pinpoint the ups and downs of their health. The majority of us do not keep track, because internally, automatic sensors measure and assay everything – glucose levels to direct the secretion of insulin, and blood pressure changes to alter our heart rate.

Homeostasis takes place unconsciously, as conscious knowledge of all these internal processes would be information overload. Certain manifestations like fainting, blushing, and dizziness, remain on the macro level to warn us that the system was in trouble.

Modernity has shifted the need for conscious measurement of our internal processes. The diseases that are killing us – obesity, metabolic disease, type 2 diabetes, hypertension, and heart disease – are ones for which our control systems are poorly evolved. These types of diseases do their damage silently and over long periods of time. Unable to correct imbalances well, these problems tax us physiologically but send us no symptomatic warning until it is too late and the damage is well on its way.

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Modifications to Meaningful Use for 2015 through 2017: Realigning the EHR Incentive Programs

The following is an announcement from CMS about potential modifications to the meaningful use program, announced Apr. 10, 2015:

On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

The proposed rule is just one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: improving the way providers are paid, improving the way care is delivered, and improving the way information is shared to support transparency for consumers, health care providers, and researchers and to strengthen decision-making.

The proposed rule is a critical step forward in helping to support the long-term goals of delivery system reform; especially those goals of a nationwide interoperable learning health system and patient-centered care. CMS is also simplifying the structure and reducing the reporting requirements for providers participating in the program by removing measures which have become duplicative, redundant, and reached wide-spread adoption (i.e., are “topped out”).  This will allow providers to refocus on the advanced use objectives and measures.  These advanced measures are at the core of health IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.

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Health IT Thought Leader Highlight: Dr. Sol Lizerbram, HealthFusion

Dr. Sol Lizerbram

Dr. Sol Lizerbram has been co-founder and chairman of the board of HealthFusion since its inception in 1998. HealthFusion develops web-based, cloud computing software for physicians, hospitals and medical billing services. HealthFusion’s fully integrated solution includes MediTouch EHR and MediTouch PM. Dr. Lizerbram was a co-founder of a national physician practice management company, and served as chairman of its board of Directors from 1986 through July 1998. Dr. Lizerbram has been in the healthcare industry for more than 35 years, received a degree in pharmacy in 1970 from Long Island University, School of Pharmacy, and was licensed as a registered pharmacist in the states of New York and Pennsylvania. He obtained a medical degree from the Philadelphia College of Osteopathic Medicine in 1977.

He is board certified in family practice and is licensed as an osteopathic physician and surgeon in the states of Pennsylvania and California. Dr. Lizerbram was recognized by NASDAQ/Ernst & Young as the 1996 Entrepreneur of the Year in the healthcare industry. He was a trustee of the US Olympic Committee and is active as a committee member in the Jewish National Fund. Dr. Lizerbram was appointed by the California Insurance Commissioner to the Governing Committee of the Workers’ Compensation Insurance Rating Bureau, and appointed by the California Governor as a Commissioner to the Health Policy and Data Advisory Commission.

Here, he discusses HealthFusion, the technology he helps develop and how it’s being used by physicians, the future of health IT, interoperability and the rise of consumerism and the cloud, the survival of EHR companies.

Tell me more about yourself and your background. Why healthcare?

I was a pharmacist prior to attending medical school in Philadelphia. After completion of my medical training I moved to San Diego, where I practiced as a board certified family physician. After several years in practice, I was appointed as the medical director of Prudential PruCare in San Diego. Soon after, I began to see the need for software that would assist doctors in improving the health of our population.

In 1998 I helped to found HealthFusion with Dr. Seth Flam, our CEO and a fellow family physician, to make the practice of medicine simpler for physicians and their staff by finding novel methods of utilizing the Internet.

Our job is to create the software tools used by physicians to further the health of their patients. We are honored that each day thousands of providers use our healthcare software to help make someone’s life a little better.

I come from a family with a strong healthcare orientation; my brother and six cousins are all physicians. As a result, I had an interest in helping people with their healthcare needs and found it very interesting.

What do you see as the sector’s biggest issues and, technologically, how can we solve them?

One of the biggest issues in healthcare right now is interoperability, the ability to seamlessly exchange patient data between physicians, hospitals, diagnostics centers, etc. This communication has been a challenge in healthcare because it needs to be accomplished between disparate systems, but it’s vital to garnering full value from digital healthcare information for patients, and for improving population health.

I’m glad to say that we are already accomplishing this with HealthFusion’s MediTouch; as an example, we provide data exchange successfully between Miami Children’s Hospital systems and MediTouch in the community doctors’ offices.

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Amazing Charts: Healthcare Predictions for 2015

Amazing Charts, a provider of electronic health records and practice management solutions, issued its healthcare predictions for 2015. Some interesting predictions here I thought you might find worthwhile. Concierge medicine, which I’ve said for some time is going to have a lasting impact, especially in the era of the Affordable Care Act, made the list.

Patient engagement, and consumerism of healthcare– somewhat of a slam dunk — appears here, too. I believe we’ve get some clarification on what that movement means this year. Amazing Charts agrees.

Also, wearables (oh, wearables, will you become more than a fad?) makes this list, and telehealth is here, too; I think we’ve finally reached the saturation point of telemedicine. This year should show strong results that I hope will validate its role at the point of care. We’ll finally get to see if payers get the message.

Here’s the full list of healthcare predictions for 2015 from Amazing Charts:

Membership Medicine Comes on Strong: The patient membership approach to medicine will grow in all forms, including value-based Direct Primary Care (DPC), high-end concierge medicine and primary care services contracted directly by employers. Market-driven medicine, fueled by changes occurring in healthcare today, such as inexpensive health plans with very high deductibles, will continue to encourage consumers to explore more cost-effective alternatives for primary care.

Patients Help Define the Experience: The patient, in partnership with the provider, will help define the care experience going forward. This trend will be powered by technologies that enhance face-to-face interaction in the exam room. One example is the projection of an EHR onto a large display screen to facilitate information sharing between provider and patient. This in turn will help reduce errors and misdiagnosis, as well as motivate patients to take a renewed interest in their own healthcare and treatment options.

EHRs Get Personalized: The EHR market will further mature and become customizable for individual patient needs and treatment plans. Intuitive data analytics will play a critical role here, helping clinicians measure, assess and manage their specific patient populations to better define specific gaps in clinical care and introduce the latest evidenced-based treatment procedures or diagnostic techniques.

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The Power of Predictive Analytics in Healthcare, Told through a Netflix Lens

Dan Ward is VP of revenue integrity at MethodCare, now part of ZirMed.

To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.

Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.

As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.

Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?

As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.

In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.

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What I Learned at PointClickCare Summit 2014

Mike Wessinger

I recently had the opportunity to attend PointClickCare’s annual user summit held in Orlando. Though the senior care market is not one I’ve spent a great deal of time covering, senior and long-term care are deeply interesting to me. There are several reasons for this interest: Seniors are becoming the largest population segment in the US and that has serious ramifications ranging from politics to economics, and because I’m interested in alternative care models. And, in some way, senior care effects all of us.

There are a number of differences between senior care and ambulatory or in patient, but the technology needs are still overwhelming and great. Senior care facilities across the US face tight budgets, extremely high levels of employee turnover and technology challenges, but the care they provide is still important, as is how the information they collect on behalf of their patients is similar to other sectors.

According to Mike Wessinger, CEO and co-founder, “PointClickCare’s goal is to enrich the lives of care providers through technology that will help them better care for their residents in ways that are effective and efficient.”

Dave Wessinger

PointClickCare’s primary reason for being is to deliver electronic health record and practice management solutions, but the company has an eye on mobile delivery, where both Mike and brother David Wessingner, CTO and co-founder, feel the future of health IT lies.

Mobile is king for its ability to deliver health data quickly and where needed, as well as to alleviate stress and confusion of overwhelmed healthcare employees.

Hospitals, too, are overwhelmed. Data flowing in from various systems often goes unnoticed or unpackaged, a particular troubling problem for the senior population. When there’s a patient transferring in from a senior home to a hospital for emergency care, a health record of some kind may accompany them. A fully loaded paper chart may only be shuffled through and details lost.

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