The Impact of mHealth on Five Important Health Conditions

mobile health conditions
Soelberg

Guest post by Stein Soelberg, director of marketing, KORE Telematics

As a provider of machine-to-machine (M2M) wireless networking services specifically designed for connecting mHealth solutions, KORE is approached every day with new use-case scenarios where telemedicine can provide life-saving or quality-of-life improving solutions for patients.

Currently, there are many health conditions that are being positively affected by the growth of mHealth applications; however, the top five health conditions for telemedicine treatment are active heart monitoring, blood pressure, diabetes, prescription compliance and sleep apnea.

1. Active heart monitoring. For at-risk patients, wireless heart monitoring devices have already proven to reduce hospitalization through early detection of heart failure. In addition, these devices are able to limit the time that physicians spend looking at data that is not pertinent, since they only send notifications with information that is outside an acceptable range.

2. Blood pressure. Wireless sensor nodes have become cost-effective, compact and energy efficient, which allows for continuous cycle reporting and electronic dispatch in urgent situations. It is important, however, to distinguish in this category between “critical monitoring” and “convenience monitoring.” The former are able to account for stress, eating habits and other external triggers more completely and pinpoint life-or-death issues. The latter are iPhone Apps for the health conscious consumer.

3. Diabetes. Wireless glucose monitoring devices can send alerts to patients and doctors alike when values move outside an acceptable range. These devices can also monitor for dietary intake to help impact a patient’s lifestyle choices.

4. Prescription compliance. On the surface this is an easy one. Patient health risks — and the risk of hospital admission — get greatly reduced by patients taking their medications as directed. But there is also a need to ensure that people take entire drug courses and eliminate the potential for re-prescribing. Literally billions of dollars each year reach their expiration date in patient’s medicine cabinets. Additional intangible benefits include fewer provider phone calls, and even shorter wait times in provider offices, by eliminating visits from improper prescription utilization.

5. Sleep Apnea. The thing that is really interesting about telemedicine devices for sleep apnea is that they can handle both investigatory and direct treatment. The two-way nature of the device can report on sleep patterns, body position and breathing to refine research and treatment course for any given patient. There is a direct cost saving here as well, since the devices directly eliminate the need for expensive Polysomnography exams and limit the need for overnight hospital stays, on an ongoing basis.

These mHealth applications are helping to promote more efficient use of medical equipment and resources, ensuring that devices and medication are being used as prescribed, improving patient outcomes by providing real-time data, improving patient quality of life, decreasing treatment costs and minimizing travel to and from offices and hospitals to allow for ease in care. Overall, the rise of mHealth/telemedicine will drastically and positively affect the lives of patients with a wide variety of health conditions.

Stein leads a team whose responsibility is to own the branding, advertising, customer engagement, loyalty, partnership and public relations initiatives designed to propel KORE into the 21st century. With more than 15 years of technology marketing experience in the business to business software, Internet services and telecommunications industries, Stein brings a proven track record of launching successful MVNOs and building those brands into leaders.

Why Don’t Vendors Partner to Build Interoperable Systems Before Mandates Force them To?

In a recent conversation with Steve Ferguson, vice president of Hello Health, he described how the company is identifying new revenue sources for practices while working to engage patients. Even though the company’s business model is one that sets it apart and helps it rival other free EHRs, like Practice Fusion, I left the conversation with him wondering why more venodrs weren’t trying the same thing as Hello Health: trying something no one in the market is trying to see, if by change, a little innovation helps pump some life into the HIT market.

Along the same lines, myself and thousands of others in HIT have wondered why systems are not interoperable and, for the most part, operate in silos that are unable to communicate with competing systems.

Certainly, there’s a case to be made for vendors protecting their footprints, and for growing them. In doing so, they like to keep their secrets close; it’s the a business environment after all and despite the number of conversations taking place by their PR folks, improving patient health outcomes comes in only second (or third) to making money.

However, let’s move closer to my point. Given the recent rumors that Cerner and McKesson are working on a joint agreement to enable cross-vendor, national health information exchange, I’m wondering: Why don’t other vendors partner now and begin to build interoperable systems.

According to the rumors, the deal, if completed, could shift the entire interoperable landscape for hospitals, physicians and patients. It would position Cerner, which has more EHR users, and McKesson, which has a strong HIE product in RelayHealth with a loyal user base, to take on Epic Systems, a leading EHR vendor.

An announcement is expected at HIMSS13.

Here’s why this is important news: Interoperability mandates are coming. Like most things, it’s really just a matter of time. Systems will be forced to communicate with other, competing systems. They should already. It’s actually a bit shocking that given the levels of reporting required of care givers, the push for access to information through initiatives like Blue Button and patient’s access to information through mobile technology that there’s not more openness in the market.

The Cerner/McKesson news is incredibly refreshing and worth a look. Two major competitors may be realizing that by partnering they’ll be better able to take on each company’s biggest competitor: Epic.

Imagine connected systems exchanging data. The thought alone would be marketable across several sectors of the healthcare landscape and the move worthy of reams of coverage, which would lead to great brand awareness for each and the change to do what all EHR companies aim for: To create thought leaders; to stand out; to set the market on its heels.

If nothing else the partner vendors would stand ahead of the pack when future interoperability mandates are enacted and will be seen as experts in the exchange game. Tongue and cheek aside, the idea really is a good one and with no one currently doing it, it’s a great opportunity for a couple of HIT companies to actually move change forward and create an environment where information can be easily exchanged across practices, across specialties and across  borders.

Then, perhaps, we’ll see a real commitment to improved patient health outcomes rather than them simply trying to improve bottom lines.

Charge Capture Software: MedAptus at MD Anderson Cancer Center

Little

Guest post by Rick Little, vice president of Client Services, MedAptus.

Revenue cycle management. Right now you’re probably thinking this term sounds like some fancy business school jargon, so why should you care about it? Isn’t that an accounting issue? What does it have to do with healthcare IT?

Well, a lot actually. Applying health IT resources to revenue cycle management processes is a must-do now as the Affordable Care Act, Meaningful Use and the looming ICD-10 transition swing into full gear. In fact, now more than ever, technology solutions are needed to drive correct coding and billing compliance for an optimized revenue cycle. Without it, your organization will struggle into 2014 and beyond.

Here’s a quick look at how charge capture and management software helped The University of Texas MD Anderson Cancer Center prepare technologically and financially for all that the ACA, ICD-10 and other initiatives may bring.

More than eight years ago MD Anderson identified electronic charge capture as a technology capable of providing financial, administrative, and compliance improvements.  MD Anderson Cancer Center is part of the University of Texas system and located in the heart of the Texas Medical Center. One of the largest employers in Houston, MD Anderson has more than 18,000 employees including more than 1,400 physicians, and served nearly 110,000 patients in 2011.

Back in 2004, when the organization identified improving its revenue cycle management as an initiative, here are some of the challenges it faced:

Beyond automating and streamlining physician charge capture processes, MD Anderson also required its chosen software solution to integrate with its EHR, link together numerous legacy systems and drive reconciliation improvements across its many clinical areas.

MD Anderson began using charge capture and management technology from Boston-based MedAptus with 50 physicians piloting the company’s mobile Professional Charge Capture (Pro) in early 2005. After initial pilot results that demonstrated improved revenue and decreased charge lag, MD Anderson implemented MedAptus’ use across its entire enterprise. Today, more than 1,300 clinicians utilize Pro for their professional charge capture and management.

Since MD Anderson began using charge capture technology, many improvements have evolved out of their implementation. These include:

EHR Charge Entry

A vital component of the charge capture deployment at MD Anderson is integration with the hospital’s proprietary EHR, Clinic Station. Working together, MD Anderson and MedAptus created an interface directly within the EHR allowing providers to easily complete charging and charting tasks via a single sign-on and with the preservation of patient context between the two systems.  This real-time, simultaneous entry has reduced errors, improved compliance, decreased time-to-billing and driven personal efficiencies.

Inpatient consultation charges

As MD Anderson evaluated areas for improvement within its revenue cycle processes, inpatient consultation charges stood out as an area for review. To improve capture here, a new interface from the consult scheduling system capable of creating consult visits within MedAptus was implemented. As a result, consult charge opportunities can now be consistently capitalized on by providers and MD Anderson is able to reconcile for anything that may have been missed for appropriate follow-up.

Reconciliation tools

In looking for help with charge reconciliation, MD Anderson needed a solution that provided support staff with full transparency of activity. In general, this staff consists of those tasked with reconciliation and those responsible for charge accuracy (typically coders). Regardless of organizational role, using MedAptus, staff are able to view the number of charges expected, submitted and missing at the provider, specialty and location level. They can also view the status of submitted charges as they are worked and approved by the coder group. Coders leverage the almost one million rules embedded within the MedAptus application which include Medicare edits, NCDs and LCDs as well as MedAptus proprietary and custom rules.

Once charges have been submitted for back-office review, the MedAptus configuration at MD Anderson allows charges to be “stamped” with specific data elements that are important to financial reporting across the MD Anderson enterprise. Prior to MedAptus, administrative staff needed to manually designate fields such as billing areas or revenue centers. Charge management automation has led to better staff productivity and increased accuracy of revenue reporting around this task.

Given all of the areas along the revenue cycle that charge capture and management technology can impact … still wondering why enhancing revenue cycle management processes is an IT challenge?

Rick Little is responsible for the implementation of software products and ongoing customer support services at MedAptus, including the implementation of MedAptus’ software solution at The University of Texas MD Anderson Cancer Center. 

Even with Digital Health Tools Available to Track Health Conditions, Most Still Would Rather Use Paper and Pen

According to a recent Pew Research report, adults prefer to track health data “in their heads” over tracking it digitally. Currently, only 20 percent of Americans track their health digitally using a variety of tools available to them, Pew reports.

The report was compiled through a national phone survey conducted by the Pew Research Center’s Internet & American Life Project. The results of the survey found that 69 percent of U.S. adults keep track of at least one health indicator, such as weight, diet, exercise routine or other symptom. Of those, half of the respondents track “in their heads” while one-third keep notes on paper and one in five use technology to keep tabs on their health status.

When the respondents were asked to think about the health indicator they pay the most attention to either for themselves or someone else, 49 percent of trackers in the general population say they do so “in their heads” with men being more likely to keep track in their heads than women.

According to Pew, the report results are “surprising given the growing availability of digital health tools available to the consumer to monitor and track their health. It also validates the challenges many digital health developers face when creating digital health tracking tools.”

Another 34 percent of trackers in the general population say they track the data on paper, like in a notebook or journal as women are more likely than men to track health data using pencil and paper (40% vs. 28%) as are older adults (41% of those ages 65 and older, compared with 28% of those 18-29 years old).

One in five trackers in the general population (21%) says they use some form of technology to track their health data, which matches the previous 2010 findings. Other key findings specific to the technology adoption of tracking include:

The results of the report came from a nationwide survey of 3,014 adults living in the United States. Telephone interviews were conducted by landline (1,808) and cell phone (1,206, including 624 without a landline phone).

Interesting that this is the case especially given all of the recent attention a variety of health tracking tools and patient portals are getting. Most likely, this falls into the category of one of two things: 1). the condition is so minor that it only needs to be tracked in someone’s head or 2.)  as younger patients “enter the market” we’ll see a considerable uptick in the number of people using technology to track their conditions.

Or, maybe patients will never care about such things and firms like Pew will continue to produce reports telling us the results of their surveys.

What say you? Will we see an uptick in the use of technology to track health data or not? Why?

Taking Health into Our Own Hands: Mobile Technology, Apps and the Coming Healthcare Revolution

Oscar

Guest post by Robert Oscar, R.Ph., founder of RxEOB.

Mobile technology has changed the way we live in dramatic fashion. Now it’s changing the way we access healthcare and medical information. In fact, the popularity of health-related smartphone apps as on-the-go tools has skyrocketed. Our smartphones and other mobile devices have made health and wellness choices simple and convenient.

More people than ever before are finding physicians, managing weight, controlling allergies, looking up symptoms, making doctor appointments and even checking into the hospital through their smartphones. For the house-bound and people living in rural areas, this technology can actually save lives by greatly improving connectivity and access to care, and streamlining self-management of such chronic diseases as diabetes, asthma and high blood pressure.

Health apps can also make medical-financial tasks easier, such as integrating financial data from high-deductible health plans or comparing prices between pharmacies. Furthermore, health apps can help streamline the flow of information between health plans, physicians and patients — making communication easier, quicker and more informative.

At work, employees can take greater control of their own health and work more closely with in-network healthcare providers. This is especially true for those who are looking to save money and reduce their out-of-pocket healthcare expenses.

Today, health-related apps are used mostly for accessing information, with some mobile devices making one-on-one interaction possible. As more hospitals and doctors begin to use apps, they will be able to reach more people with greater efficiency. Along these same lines, apps designed for physicians will become better at connecting to patients’ clinical records so that information can be easily shared — where and when it is need.

The impact of the mobile app revolution is expected to grow. In fact, a recent study found that nearly 17 million consumers were accessing health information on mobile devices in 2011, according to American Medical News, representing a 125 percent increase from 2010. These statistics have experts predicting that healthcare and medical app downloads will reach 44 million this year, and 142 million by 2016.

Consider the example of a large shipping company that participated in a pilot project involving a new mobile health app. Early reports showed that 42 percent of employees who used the app saved money on their prescription drug costs, according to Employee Benefit News. These employees had easy access to prescription drug plan information via their desktop and smartphones. End result, a whopping 71 percent of the participants said they’d recommend the service, and the company savings ranged between $174 and $366 per user per year.

Ultimately, health-related apps and the wealth of information they provide help patients become more engaged in their health so that they can make better choices, cuts costs and, eventually, help ease the strain on the US healthcare system.

Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market. Before founding RxEOB more than a decade ago, Oscar worked in the medical information systems industry, designing, developing and implementing several different claims analysis tools. Licensed in Virginia and certified in pharmacy-based immunization, Oscar is a graduate of Ohio Northern University.

Do We Have a Healthcare IT Public Relations Problem?

I may be preaching to the choir, or, perhaps, I’m speaking to myself. Here I am, a member of the both the health IT community and a member of the PR community. One of my tasks is to help educate and inform those within and those on the outside of the healthcare community about the benefits of technology that’s designed and created for the betterment of physicians, caregivers and patients.

Being in my somewhat unique position, where I publish a site dedicated to healthcare technology and my role as a PR professional, I get to see things from both sides of the fence, in many cases several times in a given day.

I do a lot of pitching to media sources, sending stories and ideas that have been developed by my clients to best educate the community about a plethora of subjects to the media. I live by a credo established by myself to approach the media only with topics I feel are specific, educated and advance the overall conversation about a certain subject. Never do I blindly pitch ideas simply for the sake of landing coverage in obscure outlets.

Perhaps Electronic Health Reporter is an obscure outlet. I’d like to think not. Nevertheless, I get pitched by fellow PR practitioners a lot. More than you might think; several times a day. As regular readers of this site know, I tend to focus on healthcare information technology and it peripheral topics. But, that’s more than I receive from my colleagues for story ideas.

Some of the topics in my inbox are enlightening and some are entertaining; some of completely off topic and some should never have been sent. So, why is this important; why take the time to dedicate to a post about the subject?

Perhaps I’m a purist. Maybe I have a sense of self importance, but I tend to think that the conversations taking place with the media, things that are being positioned for the press by leaders in the HIT community, just might not be what the market – those serving patients and others in the practice of healthcare – really need, want or like.

At its very base, this is the sort of thing that makes me wonder just how much “innovation” there is because those in the position of creating a product for the purpose of selling it to make money are convincing those that are counting on them for the newest products to advance their mission in the field according to innovation and need.

I’m often called a cynic. It’s true. I’m suspicious of a lot of things. It’s something that I developed during my days as a reporter when, like now (as a site publisher and blogger), I get pitched a lot of stories that were not worthy of my time.

I’ve got to admit, I’m surprised by this disconnect. It’s somewhat eye opening to me that the vendors serving the healthcare community seem so far from synched up with those actually providing the care.

If I’m wrong, I hope you’ll let me know. If I’m right, I promise not to be part of the problem.

Patient Portals Play into the Long-term Success of Health Organizations Seeking Patient Engagement

KLAS EnterprisesAccording to a recent report issued by KLAS Research, “Patient Portals 2012: The Path of Least Resistance,” published by HIT Trends health systems and practices are turning to patient portals more than ever before. Meaningful use is an obvious reason, but convenience and “the ease of integration that comes from having an established relationship with an EHR vendor are the primary factors providers use to choose a patient portal.”

In light of the expanding need of patient portals, the KLAS study focused on solutions that providers use, and what role the portals play in the long-term strategies each organization for patient engagement. The report included respondents from a mix of health systems, hospitals, and clinics.

“Providers are feeling increased pressure to engage with their patients at deeper levels than ever before. About one-half of interviewed providers already had a portal in place, primarily from their current EHR vendor. Providers needing to connect a number of disparate EHRs were the only group more likely to opt for a best-of-breed solution.”

“The existing EHR vendor relationship appears to be more important than any other factor when choosing a patient portal,” said report author Mark Allphin. “While functionality and ease of use are important to providers, they take a backseat compared to providers’ desire to manage fewer vendors and interfaces.”

Although many providers are choosing to stay with incumbent EHR-based patient portals, KLAS did report significant interest and engagement with third-party vendors.

Access to the patient clinical record is the most implemented function. Other functions in place or planned include: appointment scheduling, provider messaging, bill pay, online registration and patient education.

Of those interviewed for the report, 57 percent of providers surveyed report a patient portal in place.

According to Michael Lake, publisher of the monthly healthcare IT newsletter, HIT Trends sums up the report this way: “Providers are putting patient portals in place to meet meaningful use requirements for access and messaging. Some are looking at kiosks and mobile solutions, too. In single EHR organizations, using portals from their current vendor makes tactical sense. Niche solutions may fare better when providers look at long-term strategies and required functionalities.”

From my perspective, and probably yours, serious portal conversations have taken place for about the last three years, and with the mandates of meaningful use, it was only a matter of time before they started to proliferate the market.

Even as practices look to engage their patients more, portals will likely be the first tool considered to do so. As the report suggests, the biggest question here may be whether to add a portal from your current vendor or to find a third-party solution.

Are you going through a portal implementation? What’s your strategy going to be?

Health IT in 2013: A Renewed Focus on Efficiency and Effectiveness

Castro

Guest post by Daniel Castro, senior analyst with the Information Technology and Innovation Foundation.

Although we are only a month into it, 2013 is already shaping up to be an important year for health information technology (IT).

Two recent developments have increased pressure on the health care community to deliver results from government investments in health IT systems.  First, concerns about the federal budget are causing policymakers to take a close look at programs with a large budget. As of July 2012, the U.S. Centers for Medicare and Medicaid Services (CMS) reports that the government has spent almost $6.6 billion in incentive payments for electronic health record (EHR) systems, and the amount of money spent on health IT will only continue to grow.

Second, policymakers are taking an extra critical look at any program that appears to be under performing. Whether fair or not, health IT will likely fit this profile as well because of recent concerns that have been raised about the effectiveness of some of these investments. In particular, earlier this month, the RAND Corporation released a report backtracking on its earlier assertion that health IT could save the United States more than $81 billion annually. This claim in the original RAND study played an important role in helping to quantify the potential impact of health IT for policymakers.

The authors of the latest RAND report have raised doubts about the accuracy of that prediction. More importantly, however, they have pointed to a number of factors that have contributed to the lower-than-expected performance of health IT in the United States. In particular, they argue that current performance is the result of slow adoption of health IT systems, the selection by health care providers of EHR systems that are not interoperable or easy to use, and the failure of health IT providers to adapt their processes to the technology.

Many of these problems were somewhat expected. For example, it is not too surprising that healthcare providers adopted systems that are not user friendly since those purchasing the systems are a relatively unsophisticated customer-base. We’ve seen the same type of problems in other areas of government. In the early-2000s, the Help America Vote Act gave out millions of dollars to state and local election officials to purchase new voting systems. Although there was (and is) a strong need to procure more sophisticated voting systems, many of these officials made poor decisions on what types of systems to purchase. We’ve seen the same type of problem in health care.

It is also not too surprising that healthcare providers are experiencing interoperability concerns since the federated, bottom-up approach to building health information exchanges does not properly incentivize data sharing or consumer access to data. The Department of Health and Human Services (HHS) has included some top-down mandates on meaningful use around these issues, but that is no replacement for consumer-driven competition. Still, while the United States may be taking the long route to data portability, at least projects like the VA’s “Blue Button” initiative to give consumers access to data are generally moving us in the right direction.

That is why, even with these minor setbacks, we should still have a positive outlook on the potential of health IT. True the RAND report is a bit discouraging, but it’s also come at an ideal time when healthcare practitioners and policymakers still have time to refine their efforts to implement the HITECH Act. After all, implementation is far from over and there is still time to have a course correction.

For example, HHS was tasked with defining three stages of meaningful use for EHR systems where each stage reflects an increase in complexity and utility. We have passed stage 1, where the criteria focused on capturing important data and reporting clinical quality measures, and we have moved into stage 2, which focuses on exchanging and transferring health information in different settings. The third stage, which focuses on improved outcomes, is not set to occur until 2016, so there is still time to get this right.

And the key to maximizing benefits is to encourage healthcare organizations to meet high performance metrics through the adoption of advanced technologies. A few years ago I co-authored a report on maximizing the benefits of IT. I wrote “Policymakers should recognize that IT is a means and not an end—it’s unreasonable to expect that simply using IT to perpetuate existing analog processes will lead to better solutions. Existing problems shouldn’t just be digitized; IT should be used to find new solutions to old problems.” These same words hold true today in healthcare where providers do not always understand that innovation takes a combination of people, process and technology.

This is why we need to be thinking long-term about how to maximize the benefits of health IT, not only in delivering more effective and efficient care, but also in rethinking how we use IT to innovate in healthcare. There are countless possibilities where IT can lead to radically new solutions in healthcare, from using IT to monitor health in the home to using health data for new types of medical research. But the reality is that we won’t get there unless we constantly evaluate where we are falling short and implement policies to address these problems so we can successfully move forward.

Daniel Castro is a senior analyst with the Information Technology and Innovation Foundation.

Another Year Ahead of Compliance Activities Dominating the Healthcare Landscape