With consumer use of wearables, smart pill bottles, health apps and other forms of personalized health technology rapidly increasing, concerns around data privacy, proper interpretation of health information and data stewardship are also on the rise. In response, the Vitality Institute, along with Microsoft Corporation, the University of California, San Diego, and other stakeholders, are developing a set of industry guidelines to address the legal, social and ethical concerns associated with the development and use of the technology and the data it generates. The guidelines build on existing best practices to create a standardized approach. A draft of the guidelines is being released online today, opening a three month public comment period before the guidelines are finalized.
“I urge anyone with an interest in the future of health technology to review the guidelines and comment. This includes consumers who use wearables, smartwatches and health apps, along with leaders of the companies that develop, market and distribute these products,” said Derek Yach, executive director of the Vitality Institute and senior vice president of the Vitality Group. “Personalized health technology has great potential to benefit the health of countless individuals and it is critical that we proactively address these legal, social and ethical challenges so that potential benefit is not hindered.”
The draft responsibility guidelines make six recommendations that call on personalized health technology to:
Protect the privacy of a user’s health data
Clearly define who owns a user’s health data
Make it easy for users to accurately interpret their data
Integrate validated scientific evidence into product design
Incorporate evidence-based approaches to health behavior improvement
Alan Portela, CEO of AirStrip, has more than 25 years of experience in bringing medical technology solutions to market. Portela originally joined AirStrip as a senior advisor and member of the board of directors prior to his appointment as CEO in 2011. Prior to joining AirStrip, he was CEO and principal of Hybrid Clinical Transformation, LLC, where he developed EHR adoption strategies for the U.S. Military Health System and much of the Veterans Health Administration. He also served as president and chief strategist at CliniComp, Intl., and in senior executive roles in several innovative healthcare technology and service organizations.
AirStrip provides a vendor and data source-agnostic, enterprise-wide mobile interoperability platform that advances care collaboration and serves as a catalyst for health system innovation. Here he discusses mHealth trends; why and how it needs to change; interoperability; security and protecting against breach;and the biggest issues facing healthcare in the next year.
Can you tell us about yourself and your background prior to starting AirStrip? Why healthcare?
Prior to joining AirStrip, I was the president at CliniComp and responsible for the implementation of high acuity EHR systems at the U.S Military Health System, Veterans Health Administration (VA) and a number of prestigious healthcare organizations in the private sector. In my more than 25 years of experience in the healthcare industry, I have held several senior executive roles with innovative healthcare technology vendors and helped pioneer an mHealth company more than a decade ago that came out of UCLA Medical Center Department of Neurosurgery (Global Care Quest). Leading the industry via disruptive and continuous innovation has become a true passion. Each day I see how technology improves patient care, and I enjoy being an active part of that transformation.
What do you think the mHealth industry needs to change to better support doctors and patients today?
Mobile technology and clinical decision support tools will undoubtedly be the biggest contributors to the needed clinical transformation revolution, providing physicians with a means to deliver proactive quality care to millions of patients throughout the continuum of care. However, for clinical transformation to occur, the industry needs to establish – and enforce – interoperable standards so that data and technology can move seamlessly across systems and provide clinically relevant patient information at the moment of care regardless of where the caregivers and the patients are. Interoperability will remove the data silos that currently impede access to information, and allow for clinical decision support that lets clinicians provide the best care, improving overall patient outcomes and well-being. The fact that legacy vendors are not sharing data means that innovation is being stifled. Unfortunately, both the federal government and a handful of legacy vendors seem to be driving us deeper into the crisis by carrying the flag of interoperability, but only limiting requirements to minimal clinical data sets, which do not contribute to the move from volume to value-based reimbursement.
HIMSS released the results of the 2015 HIMSS Mobile Technology Survey at the annual HIMSS conference. This year’s study, of more than 200 healthcare provider employees, found that nearly 90 percent of respondents are utilizing mobile devices within their organizations to engage patients in their healthcare. The report also showed that respondents believe that mHealth technologies are beginning to drive cost savings and improve the quality of care delivered.
The adoption of mobile technologies has been rapid in recent years with 90 percent of American adults owning a mobile device. The healthcare industry continues to keep up, as these technologies are critical to the industry’s shift to patient-centered and value-based care. Respondents of this year’s survey reported leveraging a variety of mobile tools including: app-enabled patient portals (73 percent), telehealth services (62 percent) and text communications (57 percent). Of these technologies, 36 percent of respondents believe the use of app-enabled patient portals is the most effective tool in patient engagement to date.
“mHealth continues to evolve as a tool to drive healthcare efficiencies. The proposed Meaningful Use Stage 3 rule realizes this with the concept of APIs and patient generated health data, and this year’s survey showed that the wide spread availability of mobile technology has had a positive impact on the coordination of patient care,” said David Collins, senior director of HIMSS mHealth Community.
According to a new report from InMedica, a subsidiary of IMS Research, American healthcare providers are turning to telehealth in large numbers to help cut costs and projects patients using telehealth services to grow by nearly a factor of six by 2017. While 51 percent of HIMSS Mobile Technology Survey respondents indicated budget tolls as a key barrier to further implementation of mobile technologies, 54 percent indicated they had achieved cost savings when asked if the deployment of mobile technology had a positive effect in this capacity. Specifically, areas of impact included preventative support care (24 percent), telehealth interventions (23 percent) and resource utilization (21 percent).
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.
Guest post by Daniel Piekarz, Vice President of Business Development, Life Sciences, DataArt.
mHealth is a broad category of healthcare technology including medical, health and wellness applications and devices. The mHealth market is exploding because of the vast interest in the space and a relatively low cost of entry. We are seeing the marketplace grow at a very rapid pace with likely more than 100,000 apps available on the market today.
Why is there so much excitement around the mHealth market? The platform that mHealth runs on has expanded around the entire globe with nearly 7 billion mobile phone subscriptions worldwide. This is equal to more than 95 percent of the world’s population as estimated by The International Telecommunication Union. This 7 billion includes 1.75 billion smartphone users globally, according to eMarketer. The world is more connected today than ever before and this has laid the foundation for the mHealth market to begin its climb into the mainstream.
But is the market ready?
In many ways the excitement in the market reminds me of the excitement that swarmed during the early 90s regarding the Internet. Every company was entering the space, trying all sorts of new business models and many companies were simply copying others trying to get in on the action. Unfortunately, as we saw with the Internet bubble, high levels of excitement around technology without a clear focus on the problem we are trying to solve can cause very expensive mistakes.
While government and patients are pushing for change in healthcare, a survey by PriceWaterhouseCoopers reveals doctors are less optimistic and more resistant to the disruption mHealth holds for their traditional roles. Only 27 percent encourage patients to use mHealth applications to become more active in managing their health; 13 percent actively discourage mHealth and 42 percent of doctors worry that mHealth will make patients too independent, and it seems to be the younger doctors who are the most worried, with 24 percent of them discouraging mHealth use.
The results of the PwC survey reflect what I have seen when discussing mHealth with doctors. The fear that patients will try to diagnose themselves, the fear of a relatively unregulated market and the lack of evidence-based information, a general fear of change. Yet the same survey states that 60 percent of doctors and payers feel that the wide adoption of mHealth is inevitable in the next few years.
Over the past few years, we have seen the healthcare industry shift toward cloud-based services to improve workflow, patient care and access to information. In fact, a 2014 HIMSS Analytics Survey estimates 80 percent of healthcare providers use the cloud to share and store information today. A cloud network allows physicians, referring providers and specialists at many different sites to simultaneously and securely access patient information in real-time on any Internet-connected device to provide urgent care to patients. This technology is changing how information is exchanged to meet the needs of both physicians and patients. Specifically, using cloud-based services for medical image and report sharing can be a game changer when it comes to advancements in quality of care.
Patient care before the cloud
The best way to explain the benefits of cloud-based image and report sharing is to look at life without the cloud. For providers not using this technology, medical images are stored on a physical CD, and the patient is responsible for carrying it from facility to facility – or, even worse, providers rely on couriers and the postal service to ship discs (which takes days and delays patient care). Most physicians will attest that 20 percent of these CDs are lost, forgotten or corrupt. When this is the case, not only is all the information stored on the CD lost, but time and money is wasted having to repeat the imaging procedure.
Josh Pavlovec, PACS administrator at Children’s of Alabama describes the challenges physicians faced to read CDs before the facility moved to a cloud-based image exchange. “In the middle of the night, if a trauma surgeon needed someone to look at a CD that couldn’t be opened properly, that surgeon or a resident, would physically run the patient’s CD down the street, knock on doors and find a radiology resident to view that study; and then run back to their OR and start treating the patient.”
Another challenge arises when a complete profile is not made available to the entire patient care team. For example, if a patient is sent by a primary care physician to a larger hospital for an exam, and the hospital sends the patient to an outside specialist – that specialist will likely not get the patient’s full medical history, and will certainly not receive that information prior to the patient’s arrival. Children’s emergency physician, Dr. Melissa Peters explains, “Having the reading that’s associated with the transferred images is something that’s very helpful to us. When we have a child that’s transferred, our pediatric radiologists interpret the films, and they need the reading from the other facility in order to create a comprehensive report.”
The absence of readily available images and reports creates silos of patient information within healthcare leading to costly delays and repeat testing and, limiting the quality and efficiency of care provided by teams.
Guest post by Paul McRae, director of business development, healthcare, AirWatch by VMware.
The evolution of mHealth has caused a dramatic increase in the use of mobile devices across the healthcare landscape. Mobile innovations are now positioned to vastly improve both the quality and quantity of the lives of human beings. New technologies and applications are helping organizations lower costs and provide higher quality service to patients. Mobile deployments in the healthcare industry enable clinicians and healthcare IT professionals to access medical records, diagnose illness, integrate with existing providers, enhance patient engagement and improve EHR interoperability.
As EHRs and the growth of deployed mobile devices and apps become increasingly popular, the need for mobility management and security is paramount. To embrace mobility, healthcare organizations must provide secure, easily accessible apps for staff and IT departments must manage devices while remaining HIPAA compliant and protecting patient records.
Enter containerization, an emerging class of management tools that carve out a separate, encrypted zone on the user’s smartphone within which corporate apps and data can reside. Policy controls apply only to what’s in the container, rather than to the entire device. Mobile containerization offers a way for hospitals to securely deliver apps and data to clinicians without interfering with the users’ ability to access their personal content.
Currently, the end user is divided into two separate personas – the personal and the corporate. Duality provides two different levels of security for very different forms of information present on a device. For example, the corporate security measures might require compliance with federal or HIPAA regulations, a form of monitoring that would be seen as invasive to employee privacy.
Mobile platforms are beginning to integrate containerization into their frameworks, which allows for more secure and tighter amalgamations of data with their corresponding operating systems. OEM’s are placing containers for work use with the underlying OS for greater efficiency, better feature support and improved user transparency. This embedded form of containerization allows IT to maintain consistent security policies to mitigate threats on every mobile device, from smartphones and tablets to laptops, peripheral devices and emerging machine to machine (M2M) technologies.
Containerization allows healthcare organizations to remain compliant with the stringent security requirements they must meet, while providing employees a consistent user experience across multiple platforms. However, each mobile operating system presents its own security challenges, such as Web-based malware or the ability to download apps outside of designated app stores. Securing corporate information that has been accessed on personal devices from applications and content repositories remains a major challenge, especially to ensure data loss prevention (DLP) if the device is stolen or the employee leaves the organization.
Tapan Mehta, global healthcare lead, Cisco, brings more than 15 years of healthcare information technology, marketing and business development leadership as Cisco’s global healthcare lead. Mehta is responsible for managing the development and marketing efforts for healthcare solutions including clinical workflow improvement, telemedicine, patient safety, regulatory requirements and EHR integration.
Here he discusses the demand for telehealth, the changing role of hospital health IT, wearable technology and patient monitoring and what Cisco is doing to serve its healthcare clients.
Tell me about Cisco and how it serves healthcare.
At Cisco, we see the healthcare industry as ripe for technology disruption. After doing things the same way for years, we think technology can be the catalyst that brings positive changes to how care is delivered. Drawing from our experience as the worldwide networking leader, Cisco is well positioned to help improve the future of healthcare through networked technologies that transform how people connect, access and share information, and collaborate. New healthcare technologies, like those offered by Cisco, benefit everyone – from patients to providers, payers to life sciences organizations.
What is your role, specifically, and what is the most challenging aspect of it?
I have a global marketing role where my team is tasked to develop healthcare specific solutions, go-to-market strategy and field enablement, as well as serve as the “voice of the customer” by bringing the outside-in view to Cisco and its various business groups. Healthcare is at a very critical inflection point in the industry whereby there are several key underlying currents in areas such as mHealth, telehealth, data analytics, wearables, etc. While there are several interesting opportunities to pursue, what makes it difficult is to prioritize them as each segment has substantial market opportunity and growth prospects.
What inspires you and does this translate to your leadership style?
Healthcare is very personal. It touches everyone in the society in some shape or form. I have been in the healthcare space for the past 15 years and I am extremely fortunate that I am in an industry that is going to go through a transformational change over the next decade. Historically, healthcare has fundamentally lagged behind most industries when it comes to technology adoption, but I perceive that changing over the next several years. Healthcare “consumerism,” combined with government mandates around the globe, is going to force the industry to adopt technology if it truly wants to improve quality of patient care and workflows throughout the continuum of care. I am really excited to be part of this healthcare eco-system, whereby I can make a difference in how our customers do their business and more importantly how quality of patient care can be vastly improved.
Healthcare IT professionals’ greatest concern around mobile health technologies is the potential of a breach of patient data, according to a recent survey of HIMSS14 attendees conducted by Axway, a market leader in governing the flow of data.
Conducted at the HIMSS annual conference in Orlando, the poll found that 45 percent of individuals surveyed believe the greatest barrier to mobile health adoption is the risk of a data breach, followed by meeting regulatory and compliance requirements for the privacy and security of patient data.
Other key findings include:
44 percent of those surveyed believe the integration of disparate health IT systems is the most challenging IT issue facing healthcare organizations;
53 percent believe that improved access to healthcare information is the most important benefit driving mobile health adoption;
38 percent believe that the widespread adoption of mobile health services is one to three years away, and nearly 90 percent believe it will occur within five years.
The results demonstrate the rising trend of mobile health services and reflect growing concerns of healthcare professionals on the risks associated with new services.
“Mobile health is not only helping improve clinical outcomes and lower medical costs, it is also becoming a way to differentiate services and win over new customers as they are given more choices for insurance and providers,” said Rob Meyer, vice president of solutions, vertical marketing and management, Axway. “The risk of data breaches, HIPAA compliance, and reliability have been some of the biggest issues for the hundreds of payers and providers we’ve worked with. But they do not have to be a barrier. Together we have repeatedly been able to put in place the technology and processes needed to avoid breaches and ensure compliance in major mobile health initiatives.
The Axway poll was conducted at HIMSS14 Annual Conference & Exhibition in Orlando, Florida and includes responses from 39 healthcare IT and business professionals. Axway healthcare solutions enable organizations to securely integrate and exchange private healthcare, administrative and financial information across disparate platforms. For more information, visit: http://www.axway.com/industries-customers/industry/healthcare
Axway (NYSE Euronext:AXW.PA), a market leader in governing the flow of data, is a global software company with more than 11,000 public- and private-sector customers in 100 countries. For more than a decade, Axway has empowered leading organizations around the world with proven solutions that help manage business-critical interactions through the exchange of data flowing across the enterprise, among B2B communities, cloud and mobile devices. Our award-winning solutions span business-to-business integration, managed file transfer, API and identity management, and email security– offered on premise and in the Cloud with professional and managed services.Axway is registered in France with headquarters in the United States and offices in 19 countries. www.axway.com
Sending text messages has become a common method of communication among teenagers, adults, and more recently, medical professionals. Physicians are discovering that texting provides a quick and efficient way to communicate with colleagues, patients, and office or hospital staff. A recent survey by QuantiaMD of 38,000 physicians found that approximately “83 percent of physicians own at least one mobile device and about one in four doctors are ‘super mobile’ users who leverage both smartphones and tablet computers in their medical practices.”
As patients and healthcare providers increasingly use mobile devices to communicate with each other, concerns are raised about the security of electronic protected health information (e-PHI). The Health Insurance Portability and Accountability Act (HIPAA) Security Rule allows healthcare providers to communicate electronically with patients, but it also outlines standards to protect individuals’ e-PHI with appropriate safeguards to protect confidentiality, integrity and security of e-PHI. The following identifies security issues raised by texting of PHI between healthcare providers or provider and patient and how unsecure texting may violate the HIPAA Security Rule and create liability for healthcare providers.
As a general rule, texting of PHI by healthcare providers is strongly discouraged. Texting, or traditional short message service (SMS) messaging, is non-secure and non-compliant with HIPAA because data stored on personal mobile devices is not encrypted and is usually stored within the computer memory or on a smartphone SIM card or memory chip. The lack of encryption and the easily accessible storage methods allow any e-PHI communication on a mobile device to be retrieved and shared by anyone with access to the mobile device. This means that messages containing PHI can be read by anyone, forwarded, remain unencrypted on phone company servers, and stay forever on the sender and receiver’s phones.
Another reason why physician-patient texting is discouraged is that standard texting/SMS limits the message to 160 characters. This limited text field may cause critical information or options to be eliminated. According to a recent policy statement from the American College of Physicians and the Federation of State Medical Boards, physicians should understand text messaging is “not analogous to e-mail because of its abbreviated format and the greater possibility of missed messages.” Physicians are urged not to use text messaging even with established patients “except with extreme caution and with patient consent.”