Telemedicine initiatives may have a promising future within the American healthcare system, and could alleviate the shortage of general practitioners, increase reliable access to basic and preventative care, and reduce overall costs. Despite potential positive outcomes of telemedicine platforms, patients remain dubious about this remote option and the quality of diagnosis made during virtual appointments.
According to a nationwide study conducted by TechnologyAdvice Research, nearly 65 percent of respondents said they would be somewhat or very unlikely to choose a virtual appointment, while only 35.4 percent stated the opposite. Approximately 75 percent of people reported they either would not trust a diagnosis made via telemedicine, or would trust this method less than an in-doctor visit.
Cameron Graham
“This is perhaps the largest issue that telemedicine vendors and healthcare providers will need to overcome,” said Cameron Graham, managing editor at TechnologyAdvice and the study’s author. “If patients don’t trust the diagnoses made during telemedicine calls, they may ignore the advice given, fail to take preventative steps, or seek additional in-person appointments, which defeats the point of telemedicine.”
Telemedicine is a newer technology in the medical industry, with greater lack of familiarity, but data from the study shows that younger patients may be less skeptical. Only about 17 percent of 18- to 24-year old respondents, and 24 percent of 25- to 44-year olds, said they wouldn’t trust a virtual diagnosis. Also, 65 percent of respondents said they would be somewhat or much more likely to use a virtual appointment system if they had first seen the doctor in-person.
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
HIMSS is now accepting nominations for awards and scholarships that recognize significant professional contributions to the field of health IT, from outstanding leadership in industry service, service to HIMSS, chapter activity, and publications. Online nominations for both awards and scholarships will be accepted through Friday, August 28 at 5 p.m. CT.
Awards: Award recipients are volunteers and leaders in the field who have contributed to the improvement of healthcare through the use of information and management systems. In 2015, 12 awards will be given in the following categories:
“I joined HIMSS in 1988 for professional growth and networking. HIMSS allows me to further health IT adoption for providers in Nebraska,” said Kevin Conway, Nebraska chapter, 2014 HIMSS Chapter Leader of the Year Award Recipient.
Scholarships:The HIMSS Foundation and HIMSS chapters annually awards scholarships to HIMSS student members who have achieved academic excellence and have potential as future leaders in the healthcare information and management systems industry. The 2015 scholarships include:
Sherpaa connects employees directly with doctors and insurance guides online to reduce healthcare costs. Founded in 2012, Sherpaa has redefined the healthcare experience for companies and employees across the country. Sherpaa powers its medical practice in the cloud with dedicated board-certified physicians and insurance navigators. It saves time and money by solving 70 percent of issues without routing them through the traditional healthcare system – fewer interactions with the healthcare system means greater efficiency for the individual and savings for the employer, Sherpaa currently “takes care” of more than 120 companies including Tumblr, Etsy and GLG.
Dr. Jay Parkinson
Sherpaa was co-founded by Dr. Jay Parkinson MD, MPH, trained in pediatrics and preventive medicine at St. Vincent’s and Johns Hopkins. He’s given talks for TED and The Clinton Global Initiative. He’s been referred to as “The Doctor of the Future.”
Marketing/promotion strategy
We are a B2B company selling into the HR and C-suite. Our founders are a doctor and an experienced HR expert leading up a proven sales team. We know firsthand what companies need, how they make decisions, and how to sell into them. As one of the few employer-driven healthcare services actually founded by a physician, our thought leadership in the space enables us to speak at conferences, produce interesting content, and truly have a respected voice in what the future of healthcare looks like.
Market opportunity
Our sweet spot is companies with 100 to 1,000 employees. Every single company of this size is struggling with out of control healthcare expenses without the in house resources to do anything about these skyrocketing costs. They’re being sold wellness plans that don’t work to control costs and traditional telemedicine services that can’t control costs when only 3 percent of a company uses them. They need a better solution that people will actually use. Without meaningful usage, costs can’t be contained. Unfortunately we’re lumped into the telemedicine space and people confuse us as being in competition with TelaDoc, American Well, Doctor on Demand, and MDLive. Sure, they sell into the same HR departments, but offer a service that nobody uses, and therefore can’t move the needle on healthcare costs. Presently, there is no other service in America available to companies that operates like Sherpaa, gets 70 percent of a company to use our services, and delivers the kind of results that we do.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the second installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues. Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
Michael Fimin
Michael Fimin, CEO and co-founder, Netwrix
The largest concern of any healthcare organization is protecting patient personal data. Every year healthcare entities of all sizes become victims of data leaks, fresh examples are both Anthem and Premera Blue Cross, and lose thousands of dollars mainly because of employee misbehave or human error. Being not an easy one to prevent, human factor sets IT pros a number of challenges to cope with:
1. Insider threat. Unfortunately, privilege abuse is a primary root cause for many data breaches. No matter if an employee is breaking bad or his credentials were stolen, sensitive data is put at risk. The only way to prevent insider threats is to have visibility into the IT infrastructure and be able to track any changes made to both security configurations and data. Monitor user activity and establish rigorous control over accounts with extended privileges. Regularly review all access rights to ensure that permissions are granted adequately to employees’ business needs.
2. Security of devices. In 2014 healthcare organizations suffered from physical theft or loss of electronic devices more than any other industry, said the Verizon 2014 DBIR. Without proper identity and authentication management personal data stored on these devices can be easily accessed by adversaries, leading to financial and reputational losses. If your employees’ laptop or tablets end up in the wrong hands, encryption, two-factor authentication and ability to manage the device remotely will protect your data, or at least will make hacker’s job much harder.
3. Employees’ negligence. Deliberate or accidental mistakes pose more danger to data integrity than you might think. A simple email with confidential data sent to the wrong address may lead to a huge data leak. Make sure that your employees are familiar with the company’s security policy and are aware of what they should do to maintain security each person in the company should clearly understand that integrity of information assets is their personal responsibility.
Barry Chaiken
Dr. Barry Chaiken, chief medical information officer, Infor Healthcare providers organizations invested billions of dollars purchasing and implementing electronic medical records with this investment driven by the economic incentives provided by the HITECH Act. Now that these systems are installed an up and running, organizations struggle to obtain real value from these investments. These systems were implemented with speed in mind rather than clinical transformation that improved quality and reduced costs. Now, organizations must embrace clinical transformation and change management to redo workflows and processes to effectively impact care. Organizations cannot justify their investment in EMRs unless they rework their EMR implementations to obtain true value from their deployment.”
Guest post by Ryan Howard, CEO and founder, Practice Fusion.
Ryan Howard
How many doctors have you seen in your lifetime? Don’t know or remember? You’re not alone – the average American patient will see nearly 19 different doctors during their lifetime. Nineteen different offices. Nineteen different medical charts. Nineteen different phone numbers. Nineteen different calls to track down your records. Now, can you even remember your last five doctors?
The future: Imagine this, you visit your doctor – or any doctor for that matter – and they quickly pull up your medical history. Vaccinations when you were a child? Check. Currently on a hypertensive medication? Check. Pre-disposed to a medical condition? Yep, that’s in there, too. No more arriving 20 minutes early to the doctors’ office to fill out the industry-average seven pages of paper forms. Your records – past and present – are already being reviewed by your trusted provider.
Beyond the sheer convenience, the accuracy and completeness of having your entire medical history available at the fingertips of your provider can impact your well-being and scope of care. Can you accurately remember all procedures you’ve had? And when? Or all the medications you’ve ever taken? With dates? Imagine if you were a senior. Not just daunting, but nearly impossible. Instead of going over just snippets of what you actually remember, your doctor is empowered to holistically review your entire medical history with the potential to make more informed decisions about your health.
Seem like a pipedream? If you were to ask a mere decade ago, most would have agreed. As recently as 2007, 88 percent of physicians were still charting on paper. And those physicians on an EHR system – who were paying a premium – were almost exclusively using a localized, server based platform with no connectivity. For cost perspective, according to HealthIT.gov, the average upfront cost of implementing an EHR is $33,000 per provider plus an on-going fee of $4,000 yearly, a cost-prohibitive amount for most private practices.
Fast forward to 2009 and the passage of the HITECH Act which provided billions of dollars of incentives for providers to implement an electronic health record. In addition to the incentives, new vendors appeared on the market who provided electronic health record platforms completely free-of-charge, allowing providers to reinvest the incentives in their practice as additional staff, new equipment, etc.
Guest post by Dr. Andrey Ostrovsky, co-founder and CEO, Care at Hand.
Andrey Ostrovsky, MD
Seven-hundred-and-seventy billion dollars in Medicare and Medicaid spending and more than one fifth of the federal budget is going to be spent very differently in 2018 compared to today. In particular, Health and Human Services (HHS) secretary Sylvia Burwell declared that at least 50 percent of Medicare payments will be tied to value-based models, such as bundled payment or accountable care organizations, by the end of 2018. The majority of Medicaid dollars have already shifted from fee-for-service (FFS) to managed care. Providers, payers and even patients are increasingly being held accountable for health outcomes and cost of care. So how come there is no accountability for the health IT industry?
There is no 30-day readmission penalty for EHR vendors. There is no medical-loss ratio applied to population health management platforms. There is no shared savings for predictive analytics apps supporting bundles. The lack of accountability in the health IT industry is hampering the promising shift in the rest of the healthcare system from volume to value.
Technology has the potential to speed up adoption of payment-for-performance and achievement of the Triple Aim including improving outcomes, decreasing cost and improving patient experience. However, a recent analysis by the Institute for Healthcare Improvement (IHI) found major gaps in the current digital health ecosystem with only 2 percent of technologies achieving all three aims and only 23 percent of technologies having any peer-reviewed research evidence for their claims.
While regulation can slow tech innovation and the FDA should be commended for loosening its regulatory grip over apps, financial incentives and constraints should be put in place to spread the risk – and reward – that the entire healthcare system is facing to the HIT industry as well.
Before the federal government realizes that health IT has slipped under the radar of accountability, our industry has a chance to shape it’s own future by incorporating risk-bearing into our business models. More important than the viability of technology vendors is the implication of accountability on the lives of vulnerable consumers and sustainability of providers serving those consumers.
The following guiding principles can ensure that vendors are held accountable of supporting high-quality, patient-centric delivery models and achievement of the Triple Aim:
Guest post by Ali Din, senior vice president, dinCloud.
Ali Din
With support having ended for Windows Server 2003, many organizations are left asking how to proceed with the soon-to-be obsolete server operating system. For organizations held to regulatory compliance standards, this question holds additional complexity. One of the industries undoubtedly scratching its proverbial head this week as support ends is healthcare.
Over the past few years, HIPAA, the Health Insurance Portability and Accountability Act of 1996, and HITECH, The Health Information Technology for Economic and Clinical Health Act, have largely determined the trajectory of IT and operations in healthcare. Perhaps most notably, HIPAA has helped govern patient security as healthcare institutions were incentivized to migrate health records to an electronic format through meaningful use. As EHRs, cloud and mobility solutions abounded, HIPAA guidelines dictated privacy and security standards for the industry. Today, many healthcare organizations are faced with a similar transition. Like all organizations, healthcare institutions have the option to migrate their servers to a supported operating system, which typically includes a corresponding hardware upgrade. Alternatively, they can migrate these workloads to the cloud. However, as reported by the Wall Street Journal, “analysts say that the technology [Windows Server 2003] is more prevalent in healthcare, utilities and government,” demonstrating that inaction seems to be more prevalent in the healthcare sector than one would think.
Those who have not yet migrated from Windows Server 2003 will be exposed to significant security risk and may compromise HIPAA compliance, as it is unlikely the operating system will remain a HIPAA supported platform.
The implications of not migrating extend beyond just the affected server. One unpatched vulnerability can compromise an organization’s entire infrastructure.
End of support means that Microsoft will no longer issue patches and security updates for Windows Serer 2003, and the resulting security risk is so severe, US-CERT, a branch of the Department of Homeland Security, issued a security alert warning of the “impact” of end of support. The alert states, “organizations that are governed by regulatory obligations may find they are no longer able to satisfy compliance requirements while running Windows Server 2003.”
Like the security risk, cost for extended support will also compound for healthcare organizations. Microsoft is charging $600 per server for the service, which will quickly add up.
With the risk and cost associated with not migrating, why are so many healthcare organizations approaching the deadline with no foreseeable migration plan? Like many goings-on in the industry, it’s complicated.
One factor is that some mission critical applications may not transition to a supported platform. That leaves IT administrators choosing between migration and applications that, in some cases, may be in daily use by their workforce.
And, finally, if it ain’t broke (yet), don’t fix it. Like many industries, healthcare organizations are often seeing heightened demand placed on smaller teams, which doesn’t leave ample time for proactivity. In these scenarios, migration planning may not have been prioritized with budget or resource allocation.
However, with end of support approaching in just a few days, regardless of the reason why these organizations didn’t migrate, they will soon be faced with the consequences.
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 
HIMSS is now accepting nominations for awards and scholarships that recognize significant professional contributions to the field of health IT, from outstanding leadership in industry service, service to HIMSS, chapter activity, and publications. Online nominations for both awards and scholarships will be accepted through Friday, August 28 at 5 p.m. CT.
