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New Mexico Hospital Battles Addiction with Health Information Technology Apps

By David Dallago, former chairman, McKinley County Commission.

David Dallago
David Dallago

McKinley County, New Mexico, is the namesake of the assassinated 25 U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks.  Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”

For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.

McKinley County Is One of Poorest in U.S.

There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.

The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.

Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians were board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.

RMCHCS Hospital Fights Addiction with Behavioral Health Apps

Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received a $400,000 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grant out of which NCI was born.

The leader of that effort in the ’80s and ’90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations that have captured the attention of the healthcare industry.

Turing the Tables on Addiction

When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.

The center is operated by Ophelia Reeder, a long-time healthcare advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the behavioral special projects director.  He opened “Bill’s Place,” an outdoor facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group that he founded and serves as president.  The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s case work, provide behavioral health services and are certified in peer support.

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Lessons from HIMSS 2018: The Need for Cloud, “Killer Apps” and Connectivity, But Are They Already Here?

By Donald Voltz, MD, Aultman Hospital, department of anesthesiology, medical director of the main operating room, assistant professor of anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.

Dr. Donald Voltz
Dr. Donald Voltz

In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud.  He also advocated transforming the massive amount of data held in EHRs into information and knowledge.

Schmidt is correct in his assessments.  There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.

One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.

The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.

On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.

Chronic Care Continuum App     

Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.

“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”

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The 13th Factor in Building HIPAA-Compliant “12-Factor Apps”

Guest post by Lucas Vogel, principal consultant, Endpoint Systems.

Lucas Vogel
Lucas Vogel

Imagine being a software developer at a company where your job description involves building HIPAA-compliant apps and services. As you onboard with your new company, you receive some formal basic training and learn about the privacy, security and breach notification rules, and after some additional training on various topics about your job, you enter your department and get acquainted with your work environment. This is the point where you find out what you’re really getting yourself into.

There is a direct correlation between the maturity level of applications developed in your organization and the quality of your work life. For example, if you walk into a developer role for a healthcare provider, you’re likely walking into a large and well-established IT group with many old and new technology platforms deployed, where you’ll take your place with a department that’s existed for several years and does fairly predictable work on prebuilt systems. But let’s say you’re working at the more cutting edge of healthcare technology, at a startup straddling innovation with compliance. In that case, understanding HIPAA compliance can feel incredibly daunting, especially as you may essentially be learning as you go with little guidance.

The good news is that it’s never been a better time to work on HIPAA-compliant healthcare apps. Advances in identity and access management (IAM) and consent frameworks make it easier for apps to authenticate, authorize and audit users, logging who is performing what within your application; advances in machine learning make it easier to parse these log streams, detecting threats and anomalies to application use, among other countless benefits. Further advances in application architecture, cloud and API technologies, database and container platforms (not to mention containerized database platforms), and development methodologies over the past decade have dramatically changed the way companies build applications and deploy platforms, culminating in what is known as the “twelve-factor application.”

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7 Healthcare Apps Every Medical Professional Needs

Guest post by Cassie Phillips, an online security blogger, who writes about the best Internet privacy apps.

Cassie Phillips
Cassie Phillips

App technology is revolutionizing the world. The sudden rise to popularity of the smartphone and tablet has put more power in our hands and more information at our fingertips than ever before. This has opened up a world of opportunities in many different fields, and medicine is no exception to that rule.

For health professionals, the vast quantity of ever-changing knowledge required to do the job properly has always been one of the most trying elements of the work. Now, there are many apps available that allow quick and easy access to a wealth of information at the push of a button. Here are just seven of the many offered.

Medscape

Designed and brought to you by the creators of WebMD, this app has been hailed as one of the best for reference and diagnosis assistance. Available for free download for both Android and iOS, it is an incredible tool with many features including drug identification and information, in depth patient care tutorials, disease and condition referencing and up-to-date medical education courses. This app is a vital medical resource for medical students and professionals alike and has a huge part to play in the electronic modernization of healthcare.

3D4 Medical

This clever piece of software allows you to explore anatomy like never before. With intricate on-screen models of all parts and elements of human anatomy, this is a valuable tool that gives healthcare professionals a chance to take a look inside the body. It’s completely anatomically accurate and uses impressive 3D technology.

Alongside this, it has features to customize body parts and add labels, which makes it a perfect assistant for keeping track of cases. It also offers tutorials and introductory anatomy lessons, which are great for medical students or anyone wanting to refresh their knowledge.

ReferralMD

When working in healthcare, it’s not just the patients that you have to worry about. All treatments come at a cost and as much as many of us would like that not to be the case, it’s a fact that isn’t going to change anytime soon. Trying to balance treatment costs can be a nightmare but ReferralMD is a great app that cuts your budget dramatically through one simple idea—optimizing referral communication. By moving all referrals to this app, a vast amount of money is saved through paper and fax machine expenses. It also ensures immediate processing of the request, which avoids handling costs.

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ResearchKit: A Valuable tool for Researchers, but with Limitations

Guest post by Kalisha Narine, technical architect, Medullan.

Kalisha Narine
Kalisha Narine

In March 2015, Apple announced the next big thing for the scientific community: ResearchKit. According to Apple, the new application would help researchers gather more data, more frequently, and more accurately than ever before, all by utilizing the more than 94 million iPhones in use in the U.S. today as a strategized recruitment channel.

In a nutshell, ResearchKit makes it easier for researchers to create iOS apps for their own research, focusing on three key things: consent, surveys, and active tasks. ResearchKit provides communication and instruction for the study, in addition to pre-built templates for surveys that can be used to collect Patient Reported Outcomes. Plus, ResearchKit can collect sensor data (objective patient activated outcomes) on fitness, voice, steps, and more, all working seamlessly within Apple’s HealthKit API, too, which many users have on their devices already. This allows researchers to access relevant health and fitness data (passive patient outcomes).

ResearchKit-powered apps like MyHeart Counts, Share the Journey, Asthma Health, GlucoSuccess and mPower have shown us that people want to do their part in advancing medical research by sharing their data with researchers committed to making life-changing discoveries that benefit us all.

Five months after its launch, I’d say, in no exaggerated terms, that ResearchKit has proven to be game-changing for researchers, leapfrogging patient reported outcome studies into a “mobile first” world. However, the current framework certainly doesn’t cover the full gamut of what is needed to build a patient-centered, engaging, scaleable digital outcomes solution. If you’re planning piloting a solution around ResearchKit, here’s what you need to know:

ResearchKit offers up important benefits for medical researchers, especially when it comes to recruitment capability and the speed at which researchers can acquire insightful data to speed medical progress.

The MyHeart Counts app has been arguably the most successful example of ResearchKit use to date — it’s a great example of the recruitment capabilities provided by ResearchKit. In just 24 hours, the researchers from MyHeart Counts were able to enroll more than 10,000 patients in the study. Then they clocked an unprecedented 41,000 consented participants in less than six months (even before entering UK and Hong Kong markets). As most researchers know, recruitment can be one of the biggest challenges in building a study. But with ResearchKit, scientists are able to grow their number of participants into the thousands very quickly; it would have taken the MyHeart Counts researchers a year and 50 medical centers around the country to get to 10,000 participants.

Additionally, ResearchKit also increases the speed at which researchers are able to find the insights they’re looking for. This is mostly because people use their mobile devices constantly (most Americans clock more than two hours per day), which means that the accumulation of mass amounts of subjective (surveys), objective (sensors/active tasks) and passive (background) data happens quickly. The Asthma Health app is a great example of this, as it combines data from a phone’s GPS with information about a city’s air quality and a patient’s outcomes data, all to help patients adhere to their treatment plans and avoid asthma triggers — study participants told researchers that the app was also helping them better understand and manage their condition. The app is also assisting providers in making personalized asthma-care recommendations.

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Mobile Health Technologies Changing Healthcare

Mobile health technologies have been on the rise for quite some time, with the number of health and fitness apps doubling over the last two years, these tools are becoming a part of our daily lives. Health apps can do everything from monitoring sleep patterns to diagnosing diseases, while other evolving technologies are paving the way for a seamless patient care experience via online patient records. An expansive infographic by the Adelphi Healthcare Informatics Master’s Degree program that follows details these important technologies.

In the beginnings of 2014, almost 50 million Americans were using health and fitness apps to monitor their behaviors. Among their most important reasons for doing so are keeping track of personal goals, staying on top of health issues, and gaining motivation. The ability to track and improve eating and exercise habits has only scratched the surface; as more and more people hop on board, the technologies will continue to get better and better.

Beyond the health and wellness applications of mobile health technologies are the value of mobile diagnoses. There are mobile technologies for diagnosing issues with the eyes, for diagnosing malaria and thyroid conditions and screening for oral lesions. These and other technologies have a wide range of applications and will only become more useful as remote areas and countries gain more access to them.

Reviewing test results online, scheduling appointments and requesting medication refills are just some of the capabilities that come along with the evolution of online patient records. Being able to interact with records and doctors in real time from miles away has the potential to revolutionize the way that the healthcare industry functions. Not only does this improve communication, but it also saves time and removes barriers that can crop up along a patient’s medical journey.

The possibilities for keeping track of health and wellness, improving the ability to make diagnoses around the world, and accessing patient records from anywhere are what make mobile health technologies exciting.

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