July 3, 2011 4:16 PM
Posted by: RedaChouffani
, mHealth applications
It’s pretty clear that Microsoft is actively pushing Kinect in the health care space. Even during the absence of the official SDK (software development kit) for business applications, many have managed to use the widely-available, “unofficial” drivers to develop prototype applications that had a bigger “wow” factor.
But at long last, the wait is over. With the official release of the SDK and the push for the development of medical applications for therapy centers, surgical rooms and doctor’s offices, we are likely to see more of Kinect in the health care market, challenging the way we interact and interface with medical tools and applications.
So far, we have seen many real life examples of how Kinect is helping to connect the market, pun intended, with tangible benefits. The prospect of controlling PCs with physical gestures, on top of the existing voice commands, will add considerable value and I envision will most likely be welcomed by many. Let’s take the example of the operating room, where surgeons can navigate through digital images such as CTs, x-rays and other records without the need to touch a keyboard and get desterilized. This saves significant time for many surgeons in the operating theaters.
Another application identified to be one of the most useful concepts would be in the physical therapy. Whether it is a computer directed therapy session, or simply monitoring and measuring the progress patients are making.
Some Universities are even attempting to push the boundaries and have Kinect become an active part of surgeries performed by robots. In this model, they will attempt to utilize the technology to map out the human body and be able to use that as a frame of reference — the robots will literally “see” what it is doing and detect organs and objects with which the robot may come in contact.
It’s clear that in the next year or so, Kinect will most likely be one of the key players at the big HIT conferences such as HIMSS and other CIO conferences. Vendors will showcase how some of their products can be used with this affordable and wireless controller in the health care environment.
July 3, 2011 4:14 PM
Posted by: RedaChouffani
, Medical devices
, mHealth applications
, mHealth devices
, Microsoft Kinect
, Surgical applications
In the health care market, everywhere you go you are bombarded with reminders that you need electronic health care records to be efficient. And not to disagree with that, but the degrees or level of benefits can differ drastically from group to group. Take, for example, the specialists. And to be more exact, the general surgeons. Simply put, the ROI and cost vs. benefit for a pediatrician compared to general surgeon are very different. So what new tools and technologies can we identify as valuable to surgeons?:
1. On-call and surgical scheduling tools: For many surgeons who are on-the-go saving lives, it is critical to know where to report to and the details of the cases they are going to be handling during a certain period. This means that their scheduling staff needs to be able to schedule cases and notify surgeons in real time, per demand, and yet not all scheduling systems are equipped with the functionality that offers this sort of case management ability. However, there are many tools out there available that can fill this gap, which can help maximize the use of the surgeon’s time and ensure a constant flow of communication that helps expand the care continuum.
2. Mobile calendar access: Traditionally we have seen surgeons refer to a printed calendar, stuffed in their coat pockets. Other times we have seen them carrying palm devices that needed to be synchronized at the end of the day to get their calendars up-to-date. But today, with the availability of real time synchronization of their schedules via BlackBerrys, Androids, iPhones, Windows Phones or any other number of mobile devices, surgeons have the ability to review their schedules and case details directly from their smartphones.
3. Interfacing to the hospital system to capture patient demographics and ensure care delivery: Having the ability to capture patient information and view the medical history of a trauma patient, who was admitted directly to the hospital in an emergent situation, presents a real challenge for surgeons. This patient’s information may very well be kept in the hospital’s electronic health record (EHR) system, though in the majority of cases, and especially during the weekend and other peak times in the ED, a surgeon might have to wait until the next business day for their registration and insurance information to be sent or to capture the patient demographics. But with the ability to interface between the HIS (hospital information system) and the surgeon’s office, the information can flow directly, and immediately, giving the ability to add notes directly into the patient’s record, ensuring critical case details are not missed.
4. Mobile encounter: For some surgeons, completing the super bill, or encounter, has become a task that goes home with them after their shifts. And with the extensive paper-based workflow, health care coders are not able to gain access to the information in a timely, efficient manner, thus delaying the billing process even further. But when a surgeon utilizes a smartphone or other mobile health device, given the plethora of new mHealth apps that now exist, they are able to bill and submit the encounter immediately. Charges are not missed and claims are able to go out the door at a much faster rate.
5. Mobile-rounding lists: During rounds, a surgeon can most definitely benefit from having immediate, mobile access to a patient list, where they are able to accurately and timely chart conditions and capture data during checkups.
6. Dictation: For some surgeons, using voice commands and voice recognition software can significantly reduce, or even eliminate, their transcription costs, as well as give the ability to document case details electronically, and with relative ease.
7. Electronic prescribing of controlled substances: For the many surgeons who have already met their minimum ten prescriptions before the upcoming June 30th, 2011 deadline, they will attest that it can prove to be a much more challenging task than originally thought. Yet when it comes to prescribing controlled substances, you’d be hard pressed to find a surgeon who doesn’t have this on the daily to-do list. The ability to utilize e-prescribing for controlled substances will not only ensure compliance at the federal level, but will also help with medication management, in addition to ensuring patient safety. (Dr. First is piloting, with pain management groups, the use of e-prescribing for controlled substances).
8. Access to medical records and patient history: With many physicians utilizing electronic health records in their offices and on their mobile devices already, and given the huge increase in adoption in the hospital setting given the push for meaningful use, many surgeons now find it invaluable to access electronically patients’ charts, via a web browser, directly in the hospital system, or even on their tablets and other mobile device.
9. CRM tools to help manage referring physicians: Surgery groups tend to receive most of their patients from referrals. And while they do not offer any incentives or rewards for these referrals, they are still in need of tracking where they are coming from. This not only makes maintaining those working relationships easier, but it also helps to ensure that they are continually working on their networks, collaborating and discussing the latest IT innovations, increasing the level of care they can offer their patients by maintaining their awareness of the new tools in the market.
10. Microsoft Kinect: Though it may be more of an early prediction than a proven fact, as I discussed in many of my earlier posts, Microsoft’s Kinect has shown that it has tremendous potential in the market. For the lucky surgeons who are already taking full advantage of the wireless controller technology, it is clear that this is the start of wireless innovations coming to an operating room near you in the not-so-distant future.
June 26, 2011 8:50 PM
Posted by: RedaChouffani
, cloud computing
, mobile health
As the cloud becomes the new avenue toward achieving efficient yet secure data storage, we are continuing to see an increase in the adoption of VDI (virtual desktop infrastructure), as well as PCoIP (PC over IP).Organizations have justified the investment in this technology, and have seen prolific results. Some of the gains have been in disaster recovery and high availability, as well as server consolidation and reduced power consumption, which of course has generated some measurable operational cost savings for organizations. But as we turn and look at the incredible growth and fast adoption rate of mobile devices in all industries, including health care, one must wonder if smartphones will ever get to a point where they, too, will benefit from the virtualization concept. Well, I am a firm believer that it will, and here are some of the top 10 reasons why smartphones will one day simply be thin clients running a hosted or cloud based mobile OS.
1. Increased security: According to micro-trax.com, it is estimated that over 25% of Americans lose or damage their cell phone each year. And with the increasing use of mobile devices by physicians and care providers, having electronic records fall in the wrong hands can be one of the CIO’s worst nightmares. But what if the device is rendered useless the minute it is reported lost or stolen? Well, this is what a virtual mobile platform would help us realize, and in the process will help ensure compliance with HIPAA and other regulatory mandates.
2. Simplified management for large organizations: For many enterprise’s IT departments, deploying specific applications comes with its own challenges, despite the wide availability of some the mobile application deployment utilities. But we cannot ignore the simplicity and usefulness of having powerful tools that assist with the management of VDI through cloning and mass deployment. Having virtualized phones and management product suites will simplify the management and security of mobile devices throughout the organization.
3. Cross platform or hardware independent: For many of us, when we upgrade, replace or change mobile providers, we have to spend a lot of time migrating our data and configuring our new favorite mobile device or toy. But as we embrace a cloud-based mobile phone, setting up new phones would be a thing of the past. It will simply become a matter of identifying ourselves, and voila!
4. No data service, no problem: One downside of cloud computing is the heavy dependency on the connectivity portion, and hosted or cloud based phones would be in the same boat. If we consider how business applications are being used today and their dependency on connectivity, then we can easily accept that we are not really changing much here, since most of today’s applications rely on network connectivity.
5. Hosted data and accessible from anywhere, anytime: With virtual phone,s we can truly leverage the capability of having access to our data from tablets, PCs, and smartphones and ensure data protection in the event of device failure.
6. More control over what is being installed and deployed: Whether you are using an Apple or Android based mobile device, chances are that before long you will need a DICOM viewer for all medical imaging you are viewing, an messaging application, an HL7 parser or viewer for lab results, a dictation tool, an electronic medical record viewer, a SOAP note generator, an ePrescribing app and many other products to be able to fully maximize the use of this device. But with all the free apps available, many of us can’t resist the temptation of installing new apps and playing around with our phones, and when the user installs anything and everything they can get their hands on, this can turn into an IT manager’s worst nightmare. But within a virtual phone environment, there will be more control over what the baseline image has pre-installed for business purposes and will also allow the end user to reset their device back to “zero day”.
7. Increased protections against viruses and malware: With the increasing threats from mobile Malware, Lookout Mobile Security warned of a new kind of Android malware that bypassed Google’s protections and downloads itself directly to your mobile phone, and this has many security analysts warning corporate and health care mobile users to tighten their security protocol around mobile devices. And more than ever, having a virtual phone may open the door to possibly lock down the platform and increase the safe guards against malware/antivirus.
8. More choices for service providers: With the different wireless providers available in the marketplace and the different wireless technologies that each supports, it was very difficult for users to easily switch carriers. In a perfect world we would have a device that we can take with us to any US phone carrier. Well, with a virtual mobile phone in the future, this would become a reality for many. This would also be an incredible value for high availability as you can, say, drop your phone in the pool, and then turn around and get a replacement up and running in no time.
9. Early signs of such: With products such as VMware and their desktop virtualization solutions, as well as the recent Google Chrome OS, we’re seeing signs of a cloud based phone.
10. Data bandwidth continues to grow: Most mobile devices have 802.11x in order to connect to a private network, but the wireless carriers are working hard at upgrading their speeds to attract more subscribers.And with the threat of voice communications shifting to VoIP and services, such as Skype and Facetime, its clear that telecommunication groups would require new, innovative ways to keep clients signing up. Faster speeds at an affordable price would mean more clients, and that can also mean more bandwidth for virtualization.
There maybe additional signs and measurable benefits for vendors to develop and enable their mobile platforms to become cloud based. At this stage, simulators or primitive versions of virtual phone platforms are available for developers.But with time, more and more will recognize the value that a virtualized mobile platform will bring, and this will mean that hardware manufacturers will also need to make some adjustments to ensure compatibility.
June 25, 2011 3:36 PM
Posted by: RedaChouffani
, Electronic health records
, Google Health
, Microsoft HealthVault
, personal health records
For most patients, having access to their medical records electronically is definitely a plus, but not something they see as a must. And with the majority of PHRs not as widely used as initially anticipated, Google decided that their Google Health Personal Health Records system was no longer a sustainable product to keep active. On June 25th, 2011
This is of course very disappointing to hear, especially coming from a company such as Google, which continues to invest in innovation and new technologies. The health care market of course benefits from these products, too, since they often help engage consumers to adopt electronic charts and encrease interoperability in the space. And now, one must beg the question: how will (might?) the PHR market change now that the key player like Google has taken itself out of the picture, and Microsoft HealthVault is the big dog left on campus?
I personally believe that PHRs will eventually see wider adoption rates, with some of the key factors why being below:
· Bottom-up approach: For years now we have seen and experienced the value of storing medical records in the cloud via companies like Microsoft and Google. But unfortunately that has not convinced the average patient to upload or ask their physician to send their medical history and sensitive patient data to the cloud. In the next few years, as we continue to see an increase in PHR adoption, I believe the intial growth will come via electronic health records stored at large hospitals and health systems, who will then make them accessible to patients. Since we are seeing a new wave of care coordination from practices owed by the same health systems, data will start flowing from one specialist to another. Of course, this is without even taking the ACO model and new frameworks of care. Web portals such as MyChart from EPIC or Care360 PHR from Quest will be the preferred method for patients to access their charts, and this will push more patients to slowly get exposed to using PHRs on a regular basis. And this is a plus for providers, who would not have to invest in integrating with a big PHR providers since their EHR vendor has that functionality fully integrated already.
· Health care reform is asking for it: As the changes due to the health care reform start becoming a reality and more physicians adopt certified EHRs under the established ONC criteria, products will be easily able to provide access to electronic records. And with the law requiring a health providers to have that data available to the patient within days, the most effective, efficient step is to make the data available online.
· PHRs reduce operational costs: The reality is that many health care organizations are still using traditional and expensive methods to provide patients with copies their medical records. Whether it is copying the chart, putting it in an envelope and mailing it, or using a third-party service to handle the requests for medical records, the fact is that having access to your records real-time and via the web is simply the most cost effective model. So, as the adoption of certified products increases, so is the ability to have more patients accessing their data electronically.
· An increase in public awareness and Web 2.0 technology: With the announcement from Facebook that they have passed the 750 million membership mark, and are predicting that they will reach the one 1 billion in less than a year, the general public is continuously utilizing the web and social media platforms on a daily basis. And with the success of many health care related sites such as PatiensLikeMe.com, PHR usage will continue to gain momentum and interest from new users in this thriving market.
While I am certain that Google has done extensive research and review prior to making their decision to discontinue operating Google Health, whether it was a decision that was made premature or not remains to be seen. As market forces and things in the industry continue to change, Google may one day come back down the road and provide even a much more attractive platform to facilitate the storage and sharing of patients’ health data. But until then, Microsoft HealthVault is not slowing down, and will continuing to add more functionality to their PHR product. Just this week they have released an SDK that will enable mobile application developers to create apps that can interact with the HealthVault services through the mobile platform Windows Phone 7, and I believe this is just the beginning.
June 19, 2011 3:51 PM
Posted by: RedaChouffani
, healthcare it
, soft skills
As technology folks, we love to resolve niche technical issues and discuss the latest innovations. And we tend to view that the more knowledgeable we are in the specific technology areas, the more valuable we are to an organization. This tends to make our resumes ooze with industry buzzwords, such as virtualization, replication, BI, information exchange, network optimization, and the like. This, of course, is a good thing, though one must keep in mind that to be able to move up in a health care IT environment, there are a few additional, critical skills that must be acquired to ensure your continued success in any organization.
As one might have guessed, these skills, which technology leaders identify as critical in having when reviewing health care technology candidates, are of course the “soft-skills”. The below is a small list of check points which can help ensure you are adding value to your organization in more ways than one:
Have strong communication skills (Oral and written):
Having strong communication skills, both written and oral, when speaking with end users and working with management, is essential. It is also important to establish a standard method by which you communicate the status of projects and current initiatives to management, clients, etc. Ensure you describe the overall status in terms of the business impact, not just the technical details.
Understand your organization and how the system you are supporting helps the business:
My favorite illustration of this is from an IT executive who was managing an overhead service provider describing the impact of their servers being down. It was simply stated that, during server downtime, their team understood that this meant that many physicians in a hospital system or primary care facility may be delayed diagnosing a patient with a serious condition, as they are not able to call upon the radiologists’ electronic records to provide them with a detail report. This executive and his team understood the importance of the work they do, and the direct link to patient care. It is no longer just a matter of “well, the server’s down, but we’ll get it up.” It is now a matter of realizing the severity of the problem and direct business impact downtime — not only in terms of the technology, but more importantly in terms of patient safety and coordinated care.
Expand your health care technology knowledge
If you spend much of your own “downtime” on gaming, then this next point is a little difficult. The reality is that we are continuously in a learning mode. And in health care especially, things are very fluid. In fact, the only thing that is ever a constant is change. Staying up-to-date on regulatory changes specific to your organization type and staying on top of the latest health IT trends is critical. You must also continually strive to broaden your knowledge by learning what CIOs and other IT executives are reading, from business and trade publications to association resources and blogs, and the industry events which they are attending, from live conferences to webinars.
These are just few tips that will make you a well-rounded health care techie and help ensure you are a valuable asset to your company. And in a rough economy, organizations are continuously reorganizating and reevaluating their internal resources. This further reinforces that hard-skills are only part of the recipe — to truly stand out at a level above and beyond your average candidate, it’s the soft stuff that counts.
June 19, 2011 3:49 PM
Posted by: RedaChouffani
, Medical Home
On June 6, CMS announced that it will provide over 42 million dollars in grants through HRSA to support an initiative with up to 500 federally qualified health centers. This assistance will give funds under a Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) patient-centered medical home demonstration, which will implement the medical home model for Medicare patients. This will also encourage coordination of care, which CMS is actively encouraging eligible providers to move towards.
Community health centers have also benefited from previous grants for technology and EHR implementation and utilization, with some even combining dental and medical services. In addition, we have seen a number of EHR vendors provide specific modules and interfaces specifically designed to facilitate EDS and other reporting requirements imposed on the FQHCs. Now, with the new grants available, they will be able to utilize their application for coordination of care and to help care for patients with chronic disease and the high risk population.
The current outlined requirements for this new initiative are:
· FQHCs must have provided primary care medical services to at least 200 eligible Medicare beneficiaries in the most recent 12-month period (“look-back” period).
· All participating FQHCs must be listed in the Provider Enrollment Chain and Ownership System (PECOS) file and be able to receive electronic funds transfer (EFT).
· FQHCs that currently do not receive claims payment through EFT must submit the necessary form to receive EFT or they will not be eligible to participate in the demonstration.
· FQHCs must submit claims for payment to National Government Services or to Noridian Administrative Services, the jurisdiction 3 Medicare Administrative Contractor (MAC).
CMS has provided the applicants with a web site to gain access to details on the programs www.fqhcmedicalhome.com Applications will be accepted until Friday August 12th, 2011.
CMS is clearly trying to demonstrate the ACO model under the FHQCs, as they are currently caring for a significant amount of patients (uninsured as well as Medicaid and Medicare). And with this push toward care coordination will come the further integration of information technology, which will continue to move the industry closer toward achieving meaningful electornic data exchange and health IT adoption.
June 12, 2011 9:04 AM
Posted by: RedaChouffani
, mobile health
The recent changes to health care reform and the increased regulations imposed on insurance companies are forcing payers to rethink their strategies to both maintain members, and profits. In order to keep costs down, payers have had to play an increasing role in helping their subscribers live healthy lifestyles.
To help members lead active lives and make healthier choices — and ultimately help drive down the cost of care — different payers have taken different approaches. While some have created wellness campaigns and may offer a cash back rebate for fintess club membership, others send out newsletters about healthy living and are optimizing their reach through social networks and online messaging.
UnitedHealth Group is one organization that took a mobile approach to this. On Mar. 21, UnitedHealth Group announced the release of the “OptumizeMe” mobile application for Android and iPhone, with existing support of Windows Phone 7. This application is designed to encourage healthy living through social networking, namely helping friends connect and compete for better health outcomes.
The group is also taking advantage of social media by integrating popular sites such as Facebook to encourage the spread of healthy behavior. This is a great example of how mhealth apps can provide value to a business and consumers.
We are most likely going to see more apps being rolled out to patients from their insurance carrier that can assist with:
Provide access to Personal Health Record (PHR) data
Wellness programs and meal suggestions
Access to EOB (Explanation of Benefits)
Healthy living tips
Rewards on healthy living such as coupons to certain restaurants
Provide news about new treatments and generic drugs
Medical educational information on patient’s condition
These mobile applications, without a doubt, can provide tremendous value to the consumer. And while some patients may still be concerned about their privacy, in regards to data being available to payers, the benefits and potential for cusomized care, such as a meal plan for diabetic patients on the go, could far outweigh the risks.
June 12, 2011 9:03 AM
Posted by: RedaChouffani
, Employer health and human capital
, healthcare reform
, Insurance companies
In June 2011, Mckinsey &Company released a report that discusses the potential outcome of the US health care reform bill that passed this year post 2014. The report discusses the potential shift away from employer-provided health insurance at a much higher rate than initially anticipated by the Congressional Budget Office (CBO).
While the part of the law mandates that all individuals — regardless of their medical status — get insured, this law won’t take effect until 2014. The report suggests that most employers will need to pick between either dropping coverage completely for their employees, who would potentially seek government subsidies, or else maintain their current model.
The general findings of the 1300 employers surveyed during early 2011 suggests the following:
Over 30% of employers will discontinue offering ESI in their company. For those groups with less than 50 employees, they will not be subject to the penalty; however, when you look at the rising premiums, other employers recognize that the penalty is significantly lower than the potential, looming costs with which they will be faced.
The report also states that some of the surveyed employees would be ok with an employer dropping ESI, though about 60% of them would expect an increase in compensation.
The bottom line is that all companies, small and large, must assess the post-2014 ROI of their benefits packages. While organizations need to ensure that retaining employees and attracting talent is a top priority, they will also need to identify the best way to stay profitable and reward those employees while recognizing that there is a significant shift ahead in how ESI is provided in the future.
June 5, 2011 9:44 PM
Posted by: RedaChouffani
, electronic forms
, electronic health data
For much of the healthcare market, whether you’re part of a hospital system or medical practice or not, you are constantly faced with paper-based documents. And for those who’ve made the leap and gone digital, there are still challenges to be faced in the effort to liberate the industry from paper altogether.
For organizations that have selected an electronic method to capture patient information and clinical data, there are several options from which to choose:
Web-based forms: These forms are browsers based (such as html forms) and offer the flexibility of being available and accessible without the need to pre-install anything. They also can be viewed using almost all current platforms and provide the ability to store all data captured from the users as discrete. However, the organization would still rely on web developers to make changes to these forms.
Thick forms: These are the forms that run within specific applications. They are similar to the forms that are available in most EHR packages that are used to capture clinical data as well as registration data. Unfortunately, these forms often are fixed and not easily changeable. They are also only available in the package of which they are a part. We can classify some of the forms available through mobile devices, such as the iPad and Android tablets, under this category as well. MHealth tablets have already seen several apps in their repositories that enable end users and/or patients to enter the data directly into the devices. These forms are, in most cases, written specifically for that platform (iOS or Android).
PDF forms: PDF forms have been one of the most commonly used forms in the industry. These forms can be generated from MS Word documents, or simply by using many of the available off the shelve form builders. They also offer the flexibility to store the data in XML and/or directly to a database. They provide the ability to perform front-end data validation and can run on almost any platform.
Digital Pen: These not so ordinary ballpoint pens can capture handwriting and drawings from special digital paper forms. The information is captured in the device and then uploaded to a central server, where it is then processed and automatically converted into text. While this concept simplifies the capture of data, unfortunately there is still the dependency on the accuracy of the handwriting recognition software and quality of the symbols, which may cause some concerns if the information is not readable.
OCR-based forms: Optical Character Recognition, or OCO, has been around for a while and utilized in many markets, from banking, to the justice system having the ability to scan through a document and recognize the handwriting. An organization can use any form, which provide tremendous flexibility, but unfortunately you are still dealing with a paper document that requires scanning and then disposal as part of the workflow.
The reality is that we are simply finding hospitals using a combination of the above solutions to resolve their data capture challenges. The market had some promising technologies out there, and at one point, xforms showed some promising results, but lacked wide adoption. I was very disappointed to see that xforms did not gain popularity, as it made a lot of sense from a conceptual design standpoint. Similar to XML (XML is a widely adopted method to exchange data across systems in a standardize format), xforms relied on a standard “xml” like method to describe the fields, data types. That meant that many applications had the ability to easily display the forms included mobile devices, as part of an application or simply viewed via browser.
But luckily the dream of having standardized coding for form building has been reborn again through HTML5. Not only can HMTL5 be viewed from any browser or device, but it also means that the forms can easily be modified using web based tools and some of the advanced web authoring applications.
I am most definitely not asserting that HTML5 is the only way to go. There have been many more successful technologies available that enabled efficient data capture across applications and platforms. But we simply need to have some standardization and interoperability in these forms.
Healthcare will always require some data input from patients, family members, clinicians and other staff members. Different devices will be made available for this purpose from tablets, kiosks, mobile devices and desktops. And to ensure ease of use and improved workflow, the technology has to be there to support the overall mission, and so far it’s still too early to tell which technologies will be best suited for the age of electronic data exchange.