By Robert Barras, vice president of health solutions, CTG Inc.
There’s nothing like a good bandwagon to get everyone excited. Whether it’s the success of your favorite sports team, or a hot new restaurant in town, or a movie that’s breaking box office records, once something gets hot it seems everyone wants a piece of it.
For healthcare IT, one of the loudest and most visible bandwagons in the last few years has been the cloud. The idea of being able to hand off the expense and resource-intensive hassle of purchasing, implementing, and maintaining hardware and software is very attractive to healthcare organizations continuously being challenged to “do more with less.” Yet that expediency is often offset by continuing concerns about security, especially as it relates to protected health information (PHI), speed of access, and other issues.
The reality is the cloud is the right choice for some organizations, or even some specific applications, but it’s not a panacea for HIT. Following are some things to consider as you make the choice of whether to move to the cloud at all, and what makes sense to move to it.
One of the top reasons in favor of moving data and/or applications to the cloud is the ability to scale them on an ad hoc basis – especially as healthcare data continues to grow exponentially. A report from EMC and research firm IDC projects the volume of healthcare data will grow from 153 exabytes in 2013 to 2,314 exabytes by 2020.
Of course, the growth won’t come in a steady stream. At some points, healthcare organizations will need to be able to manage a high volume of data. At others, they may need to boost their computing power temporarily to drive a specific objective.
Rather than trying to manage data or computing needs internally and ending up with over- or under-capacity, the cloud provides a convenient way to scale up or down quickly. It’s also more cost-efficient, as healthcare organizations only pay for what they consume, significantly reducing costs. Finally, expanding capacity through the cloud ensures processing-heavy analytics applications aren’t slowing down the performance of critical clinical applications.
All of that data won’t be coming from a single source, either. As more of healthcare shifts to being value-based, providers of all types and sizes need to populate their population health management (PHM) and other analytics applications with data drawn from a variety of sources inside and outside of the organization.
Most organizations, especially those hyper-concerned with security, will not want all of that outside data flowing into their core systems or internal data centers. The cloud presents an ideal alternative.
It can create a clean separation between the main storage of PHI and all other data by treating PHI as a source that feeds applications housed in the cloud. With the help of a partner, all the incoming data can be cleaned and normalized so it can be used within analytics or other applications, providing better, more complete answers to PHM, patient engagement, trends, and other questions than can be obtained with internal data alone.
As the use of data in this manner grows, it will simplify the exchange between providers – especially as standards such as FHIR proliferate throughout the industry. The result is interoperability almost becomes a byproduct of the use of data in the cloud, avoiding the need for expensive, time-consuming special projects just to send electronic health records from one provider to another.
While telehealth has been around for years, virtual care technology is emerging as a powerful tool that goes beyond the traditional telehealth model. What will it take to reach the tipping point of virtual care adoption?
To become the “next generation” of telehealth, virtual care will need to improve access, availability, application, and acceptance considerations. Virtual care is poised to be embraced by the healthcare ecosystem, helping to optimize satisfaction and outcomes for all.
Timing is everything in critical care situations. Providers need instant access to specialists who can make vital diagnoses and decisions on-demand. Virtual care technology enables specialists to provide an immediate consult via video and ensure that patient questions and emerging conditions are addressed. Remote video-based consults allow a specialist to examine and diagnose the patient in real time, regardless of the specialist’s location. Virtual care will move into the mainstream as more providers (whether at a healthcare facility or home health agency) realize they can obtain timely answers, prevent return trips to the ED, and minimize readmissions. Smaller and rural hospitals will be able to strengthen their role in the community by using virtual care to access offsite, specialized staff. The time-to-treatment will be reduced; providers will not need to waste precious minutes attempting to contact available specialists. And, specialists can provide the needed consult via video, without needing to rush to the patient’s bedside.
Many patients fail to follow up with their provider for post-discharge care. No-shows may result when a patient is unable to leave his/her residence due to a medical condition. Some patients are unable to secure reliable, timely, and/or affordable transportation to a follow-up appointment. Virtual care will improve the standard of care by providing patients with more convenient, comfortable, and cost-effective access to follow-up care. Once out of the hospital or nursing facility, a patient can participate in virtual visits on commodity devices such as tablets and smartphones.
Healthcare organizations typically pilot the use of virtual care in one department, with one use-case or for a specific patient population, before rolling out the technology across a facility, health system, and/or health plan’s member base. Organizations may hesitate to expand virtual care across departments if they anticipate the implementation may be disruptive to their current processes. However, virtual care technology is designed to complement (and even automate) current workflows. Providers jump on the virtual care bandwagon when they realize that the application factors in a patient’s choice of communication devices (e.g., tablet, smartphone, and computer) and language. Because the technology features the ability to include interpreters in a video call and also provide messaging in the patient’s primary/preferred language, more healthcare organizations will accelerate the deployment of virtual care as they can now engage all patients in their care and across any level of connectivity.
Mobile technology is amazing. With the available technologies, anyone can see a doctor using smartphones. The impact of app developers and mobile app developers is increasing in healthcare. They make this possible by developing and releasing telemedicine and telehealth apps. These apps make the provision and accessing of health more convenient. They make healthcare more preventive, inexpensive and better. These mobile apps for healthcare are unique. They are creating a viable marketplace for healthcare services. These apps reduce time to access medical consultation and treatment.
These mobile apps are revolutionizing healthcare on a daily basis. They allow patients to seek health on virtual platforms. They assist doctors and patients in solving health issues. These apps help healthcare providers to gather and manage information. They serve reference materials for care providers. They assist in monitoring and managing of patients. These apps are available across the U.S. and overseas to travelling U.S. residents. It is a must for mobile apps offering diagnosis and treatment become HIPAA-compliant. Telehealth information is available in the National Conference of State Legislatures. It contains information for each State within the U.S.
There are thousands of these apps available. Top app development companies work on daily basis to meet demands. This is an area where virtual reality app development is increasing without bounds. Highlight of some of the telemedicine and telehealth apps is available on this post.
PingMD is a mobile app that provides a platform for doctors and patients to chat. It is available for Apple and Android smartphone users. This app enables doctors to discuss medical issues with their patients and colleagues. It eliminates the issue of leaking private messages to the public. The discussion between patients and doctors is transferrable to the patients’ medical record. Doctors can bill their patients for e-visitations and e-consultations. With this app, consulting a doctor becomes easy and fast.
HelloMD is an app where doctors set their consultation fees. This app helps to find specialists for appointment booking. It is not an app that provides access to immediate healthcare. This app will help find specialists like neurologists and radiologists. This app is for patients with very special health conditions. Appointments are set up within 24 hours once a specialist in located. Thereafter, consultation between the specialist and patient takes place through video call. The app aims to connect patients with the right doctor. It helps patients seek second opinion on health conditions. Face to face consultation can happen where necessary. Doctors fix their fee and patients pay through credit card. This is before fixing an appointment. This app is web-based and accessible via mobile devices.
Epocrates is an app available for download to users of Android and Apple mobile devices. This app is a powerful app that allows doctors to access the health evidence of patients. It allows doctors access specific guidelines from national specialty societies about patients. It is an app with loads of source information on medications and prescriptions. It is an app for finding doctors to consult. This app provides information on harmful interactions between drugs. It can help identify pills using imprint code and some physical properties. It helps in calculating BMI and GFR. This app provides a platform for accessing medical news and information on researches. This app has two versions, the free and the fee for subscription version. The free version is Epocrates RX and the other is Epocrates Essentials. The Epocrates Essentials costs about $159.99 at the time of writing.
LiveHealth Online is an available to Android and Apple mobile device users. This app allows patients to consult doctors through video calls. These doctors write prescriptions for their patient at the end of consultation. Note that this is possible in only few states. Patients make payment using their insurance plan. Consultation fee is $49/consultation for patients with no insurance coverage. Patients pay the consultation fee if their policy does not cover online visits.
Medscape is an app accessible by Android and Apple mobile device users. It offers healthcare professionals the access to millions of medical information. It is a platform where medical profession can access educational tools. For clinicians in the U.S., it is the number one medial platform. It has more than 4 million users. It helps caregivers to look up medications and their dosages. It has a drug interaction check for preventing adverse combination of drugs. Its evidence-based disease and condition reference assists in finding important information on patients. There are medical calculators and image collection platforms on this app. This is a free app but requires that users to set up an account. It is available to users of Kindle Fire.
Microsoft HealthVault is a free health mobile app. It is available to Apple and Window mobile device users. This app is a platform where individuals can keep their medical records. It is safe and up-to-date in storing medical record. It eases sharing of personal medical records to health professionals and family. People with chronic condition use this app to trail their health metrics. It is possible to input manual data. For automatic data input, patients connect the app to health trackers. Accessing this app through the web is possible.
Nearly 100 percent of chief medical information officers (CMIOs) in U.S. hospitals believe medication management improvement initiatives are having a positive impact and that patient safety issues are less likely to occur today as compared to five years ago, according to a new survey from the Association of Medical Directors of Information Systems (AMDIS). The survey of physician leaders, sponsored by DrFirst, also revealed that CMIOs believe there is more work to be done to address gaps that could potentially impact patient safety.
Among the top patient safety gaps identified by CMIOs is the “inability to prevent financial constraints” from impacting patients’ adherence to prescribed medications. In fact, 71 percent of the survey respondents cited concerns with the lack of price transparency—the ability to inform patients how much a prescribed medication will cost, including their insurance co-pay amount. Medication costs are a key concern for patients as well, as evidenced by a Truven Health Analytics-NPR Health Poll which found that 67 percent of patients who failed to fill their prescriptions in the last 90 days reported high costs as their reason.
Addressing high drug prices is also a priority for the Trump administration, which earlier this year introduced the American Patients First blueprint, a comprehensive plan to bring down prescription drug prices and out-of-pocket costs.
The surveyed CMIOS also identified a major gap related to the opioid epidemic. Sixty-five percent of respondents cited the need for an integrated clinician workflow that makes it easy for clinicians to coordinate the entire medication management process, including electronic prescribing of controlled substances like opioids, access to state Prescription Drug Monitoring Programs (PDMPs) to identify patients’ opioid histories, and electronic access to prescriptions from other providers and locations to avoid potentially harmful drug combinations. Similarly, 41 percent shared concerns about providers’ abilities to prevent opioid abuse since they often cannot easily distinguish “drug shoppers” from genuine patients.
Overall, 82 percent of surveyed CMIOs concur that medication management improvement initiatives have had a positive impact on adverse drug events. However, only half of the CMIOs expressed satisfaction with the medication management process, while 12 percent indicated dissatisfaction. According to the survey, the biggest gaps in the entire medication management process are incomplete patient medication histories (80 percent) and misaligned medication reconciliation and care transition cycles that lead to misinformed decisions by care teams (75 percent).
“While the industry has clearly made significant strides to improve medication management processes, CMIOs remain troubled by a number of gaps that compromise patient safety and quality outcomes,” said G. Cameron Deemer, president of DrFirst. “That’s why DrFirst has remained firmly committed to addressing these pain points with innovative new technologies that make a meaningful difference in patient care and the physician experience.”
Remote monitoring. Smart sensors. Better communication and overall patient care. The internet of things has some incredible applications for the health industry — assuming we can overcome the security challenges it brings with it. But where do we start?
The potential of the Internet of Things to revolutionize the world has already been well-documented – as has its potential security shortcomings. I don’t believe it’s hyperbole to call IoT one of the most disruptive digital technologies ever developed, if not the most. But that disruption can easily be a double-edged sword.
Consider the healthcare industry, for example. Hospitals, care providers, and covered entities regularly work with some of the most sensitive data in the world, subject to some of the most stringent protections. They have an inarguable duty of care to keep protected health information (PHI) out of the wrong hands.
Incautious application of IoT technology runs directly counter to that duty of care.
Unless you want your organization to be included in that statistic, you’re going to need to take a step back and re-examine your security practices. The Internet of Things is by its very nature unlike any technology you’ve used in the past. What that means is that it requires a completely different approach.
You must have some way of monitoring, managing, and locking down any endpoints that might have even a passing connection to patient data. You need to implement new processes and procedures regarding how devices are used and interconnected within your organization. Finally, you need to be aware of PHI no matter where it is and who’s using it — and if someone is accessing it who shouldn’t be, you need the capacity to lock down their access and protect that data.
For an industry where even standard IT can prove challenging, that’s a pretty intensive list. It’s a small wonder, then, that many healthcare organizations choose to work with managed services providers rather than deal with things internally. And if, after a security assessment, you find that your own IT staff lack the expertise, that might be the best bet for you as well (at least until your staff can receive proper training).
Of course, selecting an IoT services provider comes with its own laundry list of challenges. You’ll need to school yourself in the tactics and language the bad eggs use to try to lure in new clients, and you’ll need to ensure that any providers you work with are fully HIPAA-compliant. There are a few signs you should look out for in that regard:
Ivenix, Inc., a medical technology company with a vision to eliminate infusion-related patient harm, was founded in 2012 to develop innovative solutions that transform infusion delivery. Designed from the ground up to streamline medication delivery and bring legacy technology into the digital age, the Ivenix Infusion System includes a large-volume infusion pump supported by a robust infusion management system designed to set new standards in usability, medication precision and interoperability.
Today’s IV smart pumps rely on technology developed more than a decade ago and continue to put patients at risk. At Ivenix, we believe it’s more important than ever to empower clinicians with the most effective infusion equipment, training and processes to ensure they do no harm. No hospital wants to wonder: “Are we doing enough? Are we making every effort to prevent infusion mistakes?” We are all patients. And Ivenix is dedicated to the belief that infusion technology should put patients first with enhanced outcomes and a better patient experience, while dramatically improving clinical workflow and efficiency. It’s what inspires us, motivates us, and brings us together for the shared purpose of delivering groundbreaking infusion innovation to healthcare.
Ivenix is generating awareness through a number of channels, and has partnered with industry associations, such as HIMSS, IHE and AAMI, which has an Infusion Safety Therapy Coalition, to address current market issues in infusion safety, interoperability and innovation. Ivenix is also testing its infusion pump system with a number of integration partners, including leading EMR, alarms management and clinical communication vendors to provide interoperability solutions.
Ivenix is addressing the $9 billion global infusion pump market, with first targeted efforts on the U.S. large volume pump market, a $2..6 billion market segment that represents the majority of infusion pumps used in the U.S. hospital and ancillary clinic market.
Who are your competitors?
Braun, BD, ICU Medical, Baxter
How your company differentiates itself from the competition and what differentiates Ivenix?
Ivenix has developed an infusion platform to address an industry fraught with medication errors. Infusion-related errors account for more than 50 percent of the 1.5 million adverse drug events reported annually to the U.S. Food and Drug Administration (FDA). Between 2015 and 2017, more than 23,000 pump malfunctions, including subsequent injuries, were reported to the FDA. With today’s pumps, infusion errors are attributed to error-prone programming tasks, usability issues and clinical use, inaccurate flow, hardware failures and outdated designs with limited information. Currently, less than 1 percent of IV pumps are fully integrated with electronic medical records. Ivenix is rethinking infusion delivery to set new standards in safety, simplicity, and interoperability, Ivenix designed its infusion system on three fundamental dimensions:
Patient-centered design: Intuitive design enables faster bedside setup and lowers risk of programming errors, benefiting patients because clinicians spend less time troubleshooting pumps or resolving nuisance alarms.
Integrated data-driven insights: Advanced IT platform integrates with the EMR and other hospital information systems, securely manages data and connects clinicians with patient-specific knowledge to be better informed – and therefore make better decisions – at the bedside.
Adaptive fluid delivery: Advanced pump technology reduces clinical variability of medication delivery to help improve patient outcomes.
Healthcare delivery is being transformed as we speak, from technological breakthroughs and regulatory change to changing patient demographics and consumer expectations. As the healthcare landscape evolves, forward-looking healthcare providers are seeing their real estate in a new light. It’s time for healthcare providers to consider new approaches to real estate and facilities as a way to improve efficiency and patient outcomes.
Following are four ways hospitals and health systems can stay ahead of the curve.
Leverage the M&A boom to improve facilities performance and value. While 2017 seemed to be the year of hospital M&A, JLL analysis points to an even higher volume of M&A in 2018. Cost containment is often a key motivator for initiating M&As. In the aftermath of consolidation, many health systems are now sitting on large portfolios of underutilized real estate that represent a major source of value and capital investment. A data-driven analysis can help identify opportunities to drive more value from each facility and put each to its highest and best use.
Unlock operational efficiencies with a centralized approach. As health systems expand their real estate portfolios with diverse outpatient facilities, centralized facility management and maintenance may be the most efficient way to manage their growing footprints. Partnering with a third-party facility management service provider is a common path to centralization, although it is critical to partner with a firm that understands the nuances of the healthcare environment.
Centralized control of facilities data and analytics provides a complete picture of how different facilities are performing, so the facilities team can make accurate capital plans based on data rather than informed guestimates. Also, today’s facility management technology supports preventive maintenance and can even generate automated alerts if a building system is malfunctioning or approaching a complete breakdown. In addition to improving efficiency, a facilities management partnership can help reduce compliance risks and improve patient and staff satisfaction.
Embrace new definitions of what it means to be a health system—and how that plays out on the map. Though hospitals remain a critical focus, traditional networks may soon be rendered obsolete as industry leaders find that new opportunity lies outside the hospital campus. From medical office buildings to healthcare-anchored retail centers, tailored care settings can improve the patient experience and increase patient loyalty—and boost the hospital balance sheet.
However, managing a complex network of medical facilities requires a thoughtful strategy informed by location analysis. Thinking differently can reap big rewards, but it’s important for executives to carefully weigh the risks and benefits of paying a little more to be closer to where patients already spend time.
With every sector of the economy feeling the effects of ever-increasing healthcare costs and no relief in sight, it’s no wonder household names outside of traditional healthcare are stepping in and attempting to improve what could only be characterized as a problematic system.
Industry outsiders take an interest in “solving” healthcare
This year began with three modern-day titans of industry declaring they are ready to disrupt healthcare. Jeff Bezos of Amazon, Warren E. Buffett of Berkshire Hathaway, and Jamie Dimon of JP Morgan Chase announced they were forming an independent healthcare company for their employees. By June they named a CEO for this venture: Dr. Atul Gawande. A Harvard surgeon, author, and executive director for Ariadne Labs, Dr. Gawande has built his career on examining how medicine is practiced in the US.
Industry outsiders see data as a key leverage point
What is noticeably apparent with this surge in “healthcare outsiders” is that none of these big players are attempting to remake all of healthcare. To remake a system as vast and complex as the US healthcare system is more than any one company or consortium can reasonably hope to do.
However, they all do seem to be focused on data as the key point of leverage for disrupting and remaking a segment of healthcare. Gathering and processing data into diagnostic, predictive, or operational information is seen as the leverage point for ultimately making healthcare more efficient and effective.
Some of these industry outsiders are focusing their efforts directly on finding and exploiting opportunities for cost savings. Here are some examples.
Optimizing the pharmacy purchasing experience
Making the patient purchasing experience for pharmaceuticals, medical devices, and medical supplies seamless and reliable has drawn the attention of Amazon.
For the patient ordering and refilling prescriptions, the process could be automated and culminate in same-day delivery to the patient’s door. To some extent, patients will be able to comparison shop for non-prescription items and bundle purchases. For the seller inventories and distribution can be centralized and possibly some operational savings can be realized.
Finding a more efficient way of selling and delivering medical supplies will increase convenience for patients. But patients rarely pay the full cost of their prescriptions, so the cost drivers present in optimizing retail sales aren’t present at the pharmacy.
By Poornima Venkatesan, senior consultant, Virtusa.
In today’s value-based care environment, patient engagement is a vital key to success in clinical outcomes. This is especially true for chronic diseases such as arthritis, where continuous care is necessary because of the disease’s physical, emotional and economic impact on patients. Although the advent of specialty drugs in the past decade has made disease control possible, clinicians still face challenges in patient care because patients’ preferences about therapy aren’t often considered.
Understanding patient goals and expectations
While a clinician’s goal is to achieve remission, a patient’s goal could be clinical or nonclinical and varies depending on their individual characteristics and demographics.
Patients from low-income countries such as Morocco expect access to primary care (never mind rheumatologists), support services and education about the disease. The high expenses related to rheumatoid arthritis (RA) in such countries result in poor treatment compliance, school absenteeism in children and deterioration in quality of life. Comparatively, even with excellent health insurance systems in the United States, one in six adults with RA reduce their medication use because of high out-of-pocket costs. Most patients expect cost-effective care. In wealthier countries like the United Kingdom, patients expect increased social connectedness and family support.
Elderly patients expect reduced pain, fatigue and side effects, whereas young adults expect independence and normalcy from their treatments. Women, who are most affected by RA, might expect a lesser impact on family life and childrearing.
If such multidimensional expectations are not met, patients tend to discontinue their treatment. As new biologics and non-biological complex drugs (NBCDs) are developed, patient adherence is essential in determining both therapeutic and potential adverse effects. Studies reveal that frustration towards the method of drug administration (like self-injection) also impacts adherence. In the U.S alone, the total cost of non-adherence is estimated between $100 billion and $289 billion annually.
Therefore, it is important for the patient and the physician to trust each other and have open discussions about treatment strategies and expectations to ensure better alignment and cooperation.
Measuring patient engagement
The first step towards patient engagement is awareness of their current engagement levels. The patient activation measure (PAM) tool is helpful here. PAM measures the attitude and knowledge of patients about the disease and treatments. Studies have proven that highly activated patients have better outcomes via increased medication adherence, resulting in lower healthcare costs through fewer ED visits, hospital admissions and re-admissions. By continuously monitoring activation levels, providers can measure sustained changes in patient behavior and personalize their care programs.
We can also measure engagement levels by taking advantage of data. Data derived from direct [electronic health records (EHR), claims] and indirect sources (wearables) provide a holistic view of an individual patient. Simple analytics applied to population data can predict patient behavior. For example, analytics can help providers know which patients are likely to miss their appointments, which patients will fill their prescriptions on time, and so on. Detailed patient-based data could also lead to better and more accurate diagnoses and treatments.
The 21st century has seen a massive change in the way people live their lives. It is now the digital era, and almost everything is online or made available in electronic form. There are now jobs online. Elections are now run in many countries so that people can submit votes electronically. Hotel bookings and other travel accommodations can be done online. Even bank transactions are done over the web.
One of the most consequential manual-to-digital revolutions is the US government’s drive to create electronic health records (EHRs) from the mountains of filed information for patients. The main aim is to make medical information available to all concerned parties whenever needed. The long term goal is making healthcare significantly more effective.
This policy direction delivered a jolt to the medical IT industry, inspiring hospitals all over the US to start looking for digitalization partners. It has also pushed clinics and hospitals to standardize their functions, especially those that relate to drug formulas.
Because of the scale and promise of these standardization efforts, health and pharmaceutical leaders and administrators are wondering how to best respond and take advantage of the EHR frenzy. Here are some of the ways that pharma companies can plan for the future…
Intensify efforts to get empirical support for product effectiveness.
The digitization of almost everything has bestowed on people the power of more effective insight. The mountains of data that is being digitized can be searched for trends, such as the effectiveness of one prescription over another. Informative resources that allow anyone to immediately refer to them for help in making crucial decisions regarding health are now on the horizon.
To make their products appealing to doctors and patients, pharmaceutical companies can focus on getting empirical support for their claims. They can conduct many forms of scientific analysis on the use and effectiveness of their drugs.
However, be careful not to interpret with the results just so they project only a positive image. Bear in mind that the main purpose of testing is to understand the actual mechanisms at play and eventually get ideas on how to improve. Tests should never be aimed at getting marketing support points, though those are going to be very welcome bonuses if that is what the study uncovers.