At HIMSS this year, multiple speakers laid out visions for a future where parents could consult with a pediatrician via a telemedicine encounter during the middle of the night, take their children to receive immunization shots at a retail clinic, and have all of this information aggregated in their primary care provider’s record so that providing an up to date immunization record at the start of the next school year is as simple as logging into the PCP’s patient portal and printing out the immunization record. In short, multiple speakers presented visions of a truly interoperable future where patient information is exchanged seamlessly between providers, healthcare applications on smartphones, and insurers.
While initiatives such as the CommonWell Health Alliance, Epic’s Care Everywhere, and regional health information exchanges attempt to address the interoperability challenge, these fall short of fully supporting the future vision described above. Today’s solutions do not address smartphone applications and still require manual intervention to ensure that suggested record matches truly belong to the same patient before the records are linked. This process is costly but manageable in an environment where a low volume of patient records are matched between large provider organizations. In a future world where patient data is available from a multitude of websites, smartphone applications and traditional healthcare organizations, it would be cost prohibitive to manually review and verify all potential record matches.
Of course, one solution to this dilemma would be to improve patient matching algorithms and no longer require manual review of records before they are linked. However, for this to be possible, a standard set of data attributes would need to be captured by any application that would use or generate patient data. In a 2014 industry report to the Office of the National Coordinator for Health Information Technology, first name, last name, middle name, suffix, date of birth, current address, historical address, current phone number, historical phone number, and gender were identified as data attributes that should be standardized. Many of the suggestions in this report were incorporated into the Shared Nationwide Interoperability Roadmap that the ONC released in January 2015.
Deb Dahl, vice president of patient care and innovation at Banner Health, discusses her experiences managing the telehealth program for the health system. Banner Health is a nonprofit health system based in Phoenix operating more than 20 hospitals and specialized facilities. It is the second largest employer in Arizona, providing emergency care, hospital care, hospice, long-term care, outpatient surgery centers, labs, rehab services, pharmacies, and ambulatory clinics, which include Banner Arizona Medical Clinic and Banner Medical Group.
The health system is a long-time user of telehealth technology, which has had a profound positive impact on providing patient care and is seen as a major benefit to the organization.
Have you used telehealth services in your practice to provide care?
Yes, we have had a long standing relationship with Philips collaborating on telehealth programs, using a “technology, people and process” approach to healthcare. We started with a single facility in 2007, and our telehealth program now reaches more than 400 beds at 18 facilities in Arizona, Colorado, Wyoming and Nebraska with plans to cover our Fairbanks, Alaska, facility and Nevada site some time in 2015. Across these facilities we utilize telehealth in the intensive care unit, acute care, skilled nursing facility, and ambulatory space (patients at home). We use a command center approach, which allows a dedicated team of physicians, nurse practitioners, nurses, pharmacists and social workers. We provide coverage to more than 400 ICU beds in five states, more than 200 medical/surgical patients, neuro and behavioral health ED coverage, 500 complex chronic members at home, as well as simple low acuity on demand home visits.
What’s it like? Is it all it’s cracked up to be?
Yes, we went live with our first 50 ICU beds in 2006. With our program growth, we’ve experienced great results: in 2013 our ICU results were among the top three in the U.S. Using APACHE as the actual to predictive model Banner saved more than 33,000 ICU days, 47,000 hospital days and 1,890 lives in 2013. We are expecting similar results for 2014.
PipelineRx is a telepharmacy company offering remote and SaaS pharmacy services to rural hospitals, as well as larger integrated delivery networks (IDNs). For smaller hospitals, PipelineRx offers 24/7 staffing during nights and weekends, verifying medication orders remotely to promote patient safety. The SaaS technology platform allows larger IDNs to essentially create their own telepharmacy, using one of their own pharmacists to staff additional locations.
CEO Brian Roberts has spent most of his career focused on healthcare services and staffing. Prior to co-founding PipelineRx, he was the president of Canopy Healthcare until it was acquired in late 2008. Canopy Healthcare was the leading allied healthcare staffing firm on the West Coast. Prior to Canopy Healthcare, Roberts was the EVP of business development at CHG Healthcare Services, a $600 million leader in diversified healthcare staffing which supplied physicians, pharmacists, nurses, and allied healthcare professionals to hospitals nationwide.
Here, Roberts discusses his firm and its capabilities, technology developments he’s seeing, telemedicine challenges and trends we’ll see in the coming year.
Tell me more about yourself and what inspired you to found PipelineRx?
I spent the first half of my career as a venture capitalist investing in early stage healthcare services and healthcare IT companies. I spent the second half of my career building companies from the ground up as an entrepreneur. I love the operations and technologies that are critical for building a sustainable business model. After building two successful medical staffing companies, I figured out that we could “staff” hospitals using remote pharmacists that work from home. The labor arbitrage of enabling one pharmacist to work on multiple hospitals drove on average a three to one return for hospitals. This all was enabled by creating a technology that allowed interchange between PipelineRX and hospital pharmacy information systems and EHRs.
We now have an amazing management team bringing more than 100 years of experience in building pharmacy technology companies.
Tell me more about your desire to lead a telepharmacy company? Who uses this service? How is it growing and how has it changed?
Leading PipelineRx is exhilarating each and every day. Overcoming challenges are what makes it interesting and trying to apply cloud based technology to a service that must be completed (pharmacy verification services).
Hospitals of all sizes use the service. From the small side, critical access hospitals with 25 beds use the service for long stretches, say 6 p.m. to – 6 a.m. and 24 hours on the weekends. Our service allows them to save significant costs yet have world class medical coverage of their hospital. We can also fill in if an employee pharmacist calls in sick or if there is a big snow storm and the employee pharmacist can’t make it to work. We also work with larger hospitals and hospital systems that are looking to optimize their staffing levels. While pharmacies traditionally were staffed like a firehouse with ample coverage, PipelineRx allows the hospital to staff to the median levels and then use our staff for peak or overflow. It’s been an amazing journey to see hospital administrators and C-suite’s understand that we assist in moving traditional fixed costs to variable costs through our unique service.
eVisit is the telemedicine software platform for physician’s offices. Its cloud-based SaaS application allows physicians, PAs and NPs to evaluate and treat their existing patient population remotely, via webcam interaction. Unlike competitors, eVisit is the only platform for providers, designed to allow telemedicine reimbursement from third party payers. eVisit can increase patient flow up to 300 percent; and can decrease “no shows” by 80 percent, allowing a practice to recover up to $120,000 a year.
eVisit is telehealth software that enables providers to increase patient flow and revenue, while providing convenience to their patients with online treatment.
Bret Larsen, Co-Founder, CEO. Glen McCracken, MD, Co-founder, president.
We are actively marketing through strategic channel partnerships and product integrations.
The Primary Care Market generates $135B/year in revenue with a CAGR of 2.6 percent. It employs 745,642 (246,090 physicians) over 130,526 medical practices; 90 percent of primary care physicians operate in SMB medical practices, our target segment (IBISWorld). This segment represents a $9.99B/year addressable market (221,481 buyers x $1,200) + ($121.5B x 8 percent billing fee).
How your company differentiates itself from the competition
Competitors offerings include B2B models with value propositions of lowering costs, B2C models offering convenience or enterprise hardware and software (none offer physicians ability to bill a patient’s insurance, the doctor-patient relationship is non-existent and patients are being asked to pay more).
Healthcare practice sign up on a subscription that is charged on a per user, per month fee of $99.
We are currently raising our seed round of investment ($1M) and actively looking to hire talented developers.
Healthcare is one of the last industries to be disrupted by technology. Although unprecedented levels of biomedical knowledge, surgical procedures, and condition management have been amassed, we are not using them to their potential to create the tools to improve healthcare experiences. A balance of privacy and policy regulations with technology is the key to creating a secure yet efficient healthcare system.
The State of Healthcare
A staggering portion of healthcare costs are wasted. According to the Institute of Medicine (IOM), $765 billion or 30 percent of the 2009 total U.S. healthcare spending was wasted. Key areas that were tracked include unnecessary services, services inefficiently delivered, prices that are too high, excess administrative costs, missed prevention opportunities and medical fraud.
Overused services, defensive medicine and higher-cost services total $210 billion in excess cost;
Medical errors, care fragmentation and preventable complications total $130 billion in excess cost;
Duplicative costs to administer insurance and insurances’ administrative inefficiencies drive $190 billion in excess cost;
Product prices beyond competitive levels total $105 billion in excess cost;
Missed prevention opportunities like primary, secondary and tertiary prevention total $55 billion in excess cost;
Fraudulent claims total $75 billion in excess cost.
Additionally, there will not be enough physicians in the next few years to meet the growing demand. The Association of American Medical Colleges (AAMC) projects a shortage of 62,000 physicians by 2015. This shortage is expected to increase to 91,000 by 2020. This physician deficit is due to an aging Boomer Baby population, the insuring millions of new patients through the Affordable Card Act, and the retiring of a large number of doctors in the coming decade.
Technology can curb inefficient health management, increase knowledge sharing, and improve access to a shrinking physician pool. However, proper precautions must be taken to safeguard patient information privacy while empowering healthcare providers to provide more efficient care.
Healthcare technology is largely regulated by the Health Insurance Portability and Accountability Act (HIPAA). It was created in 1996 to protect the privacy of electronic patient data, known as protected health information (PHI) and to restrict access to PHI. Predating the iPhone by 10 years, the HIPAA rules were strengthened in 2013 to increase rigor on de-identifying PHI, to broaden HIPAA’s reach to include all entities that touch PHI directly and indirectly, and to notify affected parties if a PHI breach has occurred.
As we head into Christmas, and 2015, millions of Americans have hopes for a bright holiday willed with hope, health and happiness. And while America’s consumer engine is in full force, presents are getting bought, wrapped and covered with ribbons and bows, it’s hard to image that there’s little that can’t be bought and given in the spirit of good cheer for the betterment of man and for the greater good. But, as in all areas of life there are a few things that won’t fit nicely in the stocking or under the tree.
If only everything we wanted and needed could be placed in our stocking to be unwrapped on Christmas morn, but there’s just too much on the list. The list would be long for those in healthcare – interoperability, improvement of policies, better communication with care providers, and even more, qualified employees to join healthcare-related ventures.
If only some of these Christmas wishes could be packaged and stuffed in the stocking. Here are a few ideas from several healthcare folks who wish they could make the world’s dreams come true.
Common language between all healthcare electronic health records (EHR) systems, such that they can communicate with each other and patient notes may be accessed between all providers. We have gone digital, but none of the systems communicate with one another. This does not make any sense. Patients should be able to elect to have their records “shared” between systems when they visit other physicians, and more so to have their accounts sync’d between systems so that all physicians are up to date with all tests, procedures and visits. For now, the only thing EMRs have provided for is more legible notes that are inundated with information required by national standards regulations. Healthcare is far beyond the rest of the IT world. Indeed, it functions in the pre-internet era – we have electronic systems, but they do not communicate in any meaningful way. Healthcare IT is still functioning as if we are in the 1990s.
Bill Marvin, president, chief executive officer and co-founder, InstaMed
Health IT Christmas wish: Interoperability. By integrating technology and processes across heterogeneous environments, providers automate administrative processes and simplify compliance requirements, resulting in lower operational costs.
I would love to see a fully functional telemedicine capability in every hospital and office across the country. What I mean by fully functional is that reimbursement hurdles have been cleared, apps are standard, we have a maturity and adoption model in place all so that patients are receiving the best care from the right clinician in the most optimal manner possible.
Charles A. Settles, product analyst, TechnologyAdvice
There are a myriad of things I’d like to find in my figurative “stocking” come Christmas morning, but perhaps the one I’d like to see the most is more widespread patient, provider and payer use of health wearable devices or fitness trackers, i.e. Fitbit, FuelBand, Jawbone, etc. The spread of these devices is something we are keeping a close eye on here at TechnologyAdvice; we recently surveyed nearly 1,000 adults about their use of fitness trackers and uncovered several key insights. Perhaps the most actionable of those insights was that nearly 60 percent of adults would use a fitness tracking device if it would help reduce their monthly health insurance premiums. Of course, there are potential benefits to payers and providers as well — in the push to switch the healthcare reimbursements from a fee-for-service to a outcomes-based model, these devices could provide invaluable information to physicians that would aid in health maintenance, preventative care, and overall population health modeling. As these devices evolve and are able to track more and more biometrics, they could enable less expensive and higher quality telemedicine.
MedWand Solutions develops and distributes the MedWand solution, a patent-pending telemedicine device that easily connects to a PC or mobile device, like a cell phone or tablet. MedWand contains a set of fundamental, easy-to-use vital sign measurement and examination devices integrated into a single wand about the size of a large electric toothbrush. It includes a pulse oximeter, an otoscope camera for ear examinations with attachments to also allow views of the eyes, throat, or nose, an in-ear thermometer, a digital stethoscope and provision to support optional third party Bluetooth wireless devices, such as glucose meter or blood pressure monitor. In addition enabling remote examinations, MedWand can assemble all measurements and required information into a secure electronic health record, enabling a clinical-quality, interactive, at-home telemedicine experience for both patients and their doctors.
With all the advancements we have experienced in technology, routine telemedicine still doesn’t allow examination capabilities for all patients. With MedWand, no matter where the location, patients can experience remote examinations like never before.
MedWand is the first handheld telemedicine device that allows doctors to examine patients and gather important medical vitals, remotely, via secure Internet channels on tablets and personal computers. In the rapidly growing industry of telemedicine, the majority of remote consultations are limited to audio and video without the possibility of direct physician examination. Now, with a MedWand, doctors can listen to a patient’s heart, lungs, and abdomen; look at skin and into ears, nose, and throat with an embedded high-definition video camera; obtain basic vital signs, including blood oxygenation; and even obtain a thre-lead EKG – all remotely, with a single unit that can be cradled into the palm of a hand. In addition, MedWand provides continuous medical vitals monitoring services with alerts when patients may be headed in the wrong direction.
The MedWand telemedicine device was conceived by former Pebble Beach house doctor Samir Qamar, a family physician and founder of MedLion Direct Primary Care, one of the nation’s leading direct primary care companies. It was after being dissatisfied with current limitations of telemedicine that Dr. Qamar came up with the idea to build a compact telemedicine device capable of remote patient exams. After an extensive search, Dr. Qamar approached engineer Robert Rose, founder of Cypher Scientific engineering, formerly of Red Digital Cinema, who agreed to join the project. Together, on a mission to advance telemedicine, Dr. Qamar and Mr. Rose created the MedWand.
MedWand appeals to the entire telemedicine industry. Having already been approached by branches of the U.S. military and many large telemedicine companies worldwide, MedWand will soon be helping hospitals, accountable care organizations, and companies control healthcare costs by allowing real-time examinations to telemedicine services. A major computer manufacturer has offered to be a launch partner for MedWand, and MedWand is ripe for international distribution. Eventually, the MedWand will be distributed directly to patients and their families worldwide.
Guest post by Brandee Norris, assistant professor healthcare administration and management school of business and technology, Trevecca Nazarene University.
The health information technology (HIT) industry is on the verge of a dramatic dawning. As more healthcare organizations transition to paperless systems and to meaningful use of a certified electronic health record (EHR), the need to ensure the safety and integrity of healthcare data and to eliminate the risk of health IT breaches increases. In the past five years, the Department of Health and Human Services reported more than 800 breaches of healthcare patient data, breaches that affected more than 30 million patients. Breaches in electronic healthcare data cause serious negative outcomes for patients, stakeholders, and organizations—both public and private—and result in millions of dollars in fines and losses.
As the use of HIT systems increases within the healthcare industry, hospitals and providers of private practices are seeking effective methods to enhance data storage and streamline access to patient information without jeopardizing the privacy of the data. A possible solution to this problem is the transference of protected health information from a local system’s network to a cloud-based electronic medical records (EMR) service. Cloud computing may be categorized as private or public. Based on HIPAA regulations, professionals in the healthcare industry continue to dispute the legitimacy of public cloud computing and compliance with specific requirements of the HIPAA.
Contrary to provisions mandated by HIPAA, cloud-based platforms could accommodate the growing needs of healthcare organizations and provide flexibility to adapt to frequent changes, while providing significant cost savings. The primary objectives of using any variation of a cloud-based program are efficient leveraging of healthcare information, enhancement of patient experience, versatility for providers, and improved clinical outcomes. Cloud-based programs permit 24-hour patient access to electronic records.
Consumers in the 21st century prefer convenient methods to access healthcare services and manage personal information. Consequently, healthcare organizations have adopted patient-centered models to deliver health care and increase provider-patient communication. In addition, cloud-based platforms can facilitate the use of mobile devices, such as smartphones and iPads, allowing patients and providers to access health software applications. The number of healthcare consumers using smartphones to access health information soared from more than 60 million to more than70 million in the last two years. Anderson projects an estimated 20 percent annual increase of software application sales during the next five years.
Healthcare providers have suggested that significant benefits could occur for patients using mobile software applications to monitor their health status. Currently, numerous types of health software applications exist that are free or obtainable at a reasonable fee. Last year, healthcare providers used health software applications for obtaining diagnostic test results, sending alerts for patients to self- medicate, track and monitor levels of chronic pain, and store vital signs and emergency contact information. Consumers should be aware that a compatible operating system and adequate storage space are required to download health software applications to a mobile device.
Dr. Mary Jo Gorman established Advanced ICU in 2005 as a solution to the growing ICU crisis across the country — ICU care accounts for a large portion (40 percent) of hospital costs. With only 1.5 ICU physicians per hospital, there is already a shortage in care; which will continue to magnify as Baby Boomers age (those 65+ use the ICU 3 times more than those under 65).
Advanced ICU aims to deliver a solution to this critical issue by working alongside hospital staff to provide 24/7, remote patient monitoring in ICUs across the U.S. The company manages more tele-ICU programs than any other organization in the country, and combines physician-led teams with telemedicine technology to improve the operational, clinical and financial performance of ICUs. For example, after an average of one year of services, Advanced ICU clients see a 40 percent decrease in mortality, and patients spend 25 percent less time in the ICU.
You started out as a medical doctor in the field. What drove you to leave your practice and start your own business? How has your perspective changed since launching the company?
As I practiced in the hospital ? both as an intensivist in the ICU and as a hospitalist — I saw firsthand the importance of having a well-staffed and well-run ICU. In addition, I have been responsible for recruiting physicians and experienced the recruiting challenges that ICUs face. I was aware of some of the technology solutions that were being developed and saw how we could combine our knowledgeable medical team with technology to bring our special expertise to hospitals in need. Now, as I look back, I realize that through the Advanced ICU Care team, I have been able to help more people than I ever could have in private practice. Every week at our staff meetings we highlight a clinical success story, and every month when I look at our clinical outcomes, I know that my training is having a positive impact and helping improve ICU patient care. Since Advanced ICU Care was founded, we have cared for nearly 100,000 patients.
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.