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Meaningful Health Care Informatics Blog

March 18, 2013  9:23 PM

MHealth regulations: helping the market or patients?

Posted by: RedaChouffani
Apps, FDA, mhealth, telemedicine

On March 1, the subcommittees on communications and technology at the health and oversights hearing discussed both the role technology is playing in healthcare and FDA regulations to ensure the patient safety. These regulations apply to medical devices like tablets and smartphones, and consist of taxation, mainly. The committees discussed how they could potentially harm innovation in the field, and possibly create excessive costs for the consumers who are meant to benefit from these devices.

There will be more discussions beginning March 19, 2013 between members and staff of the subcommittee on communications and technology. They will review current taxation laws and mandates that affect some of the medical devices and mhealth apps, which include those used to treat specific health conditions.

The outcome of these discussions will be extremely important, as it could potentially define how mHealth apps are classified.

It could also speak to potential barriers for software developers, thus slowing down innovation. There are certainly many questions and technical challenges that app developers will face if they are required to continuously get certified or cleared for their apps anytime there is a minor app update, or even an OS update. These would increase maintenance cost and limit both updates and app improvements to only a few a year, which could mean less new functionality and innovation.

While it is certainly important to ensure the safety of patients who rely on and trust their mobile devices to provide accurate feedback and quality of information, it is imperative that a balance be maintained between reducing barriers to market and ensuring consumer care.

March 18, 2013  9:18 PM

Samsung’s mHealth dashboard

Posted by: RedaChouffani
Apps, mhealth, Mobile, phablet, smartphone, tablet

Today’s market place offers a number of smartphones to choose from.  Manufactures compete on design, operating systems, camera quality, battery life, speed and size, among other things.  Yet regardless of it all, each device manufacturer seems to be the first one to offer some unique feature and benefit.

Samsung has continued to gain market share with its Android tablets and mobile devices.  As many of these vendors recognize, smartphones are beginning to play a significant role in helping consumers track and manage their lifestyle and capture health related wellness.  In an effort to put one foot in front of its competitors, Samsung has announced its GALAXY S4, which features new functionality in health tracking capabilities, called “S Health.”

The new Android device will be able to assist its users with tracking workouts, daily caloric intake, weight, blood  glucose levels, blood pressure and sleep patterns.  These, of course, are common functions in several other apps. But Samsung had made a point to clarify that the newly released device will yield stats of the surrounding qualifiers during those activities, such as comfort levels. Much of this data will be displayed on the health board, which saves users the hassle of downloading multiple apps.

As more device manufacturers join the growing mHealth and telemedicine market, there will likely be much more integration between devices, as well as advanced capabilities to help consumers manage their lives.

March 11, 2013  8:55 PM

HHS looking to encourage HIE adoption

Posted by: RedaChouffani
blue button, CMS, ePHI, HIE, ONC, PHI

On March 6, 2013, HHS released a notice and request for information around the need for policy changes to help electronic health information exchange outside of the current incentive programs that require interoperability and exchange.

HHS is seeking to create additional rulings to encourage non-meaningful use providers to promote more sharing of information. Some of the current considerations that HHS is looking to adopt as means to encourage the acceleration of HIE are:

  • Incentive payments
  • Payment adjustment (reductions)

CMS and ONC are aiming to push this ruling to help support the new delivery and payment reform by facilitating and increasing the adoption of electronic HIE. There also items within the request of information that discuss the possibility of incorporating improved access to protected health information (PHI) as part of the measures for Consumer Assessment of Health Providers and Systems (CAHPS) scores.

Another option outlined was the possibility of using the Blue Button initiative to provide easy access to electronic PHI.

“CMS could promote the use of Blue Button. The Blue Button provides easy electronic access to personal health information for consumers. To strengthen its success, ONC released guidelines for data holders and application developers that support the growth of an ecosystem of tools to help consumers manage their health.”

It is clear, without a doubt, that providers have increased their adoption of electronic medical records. The next logical push should be sharing and collaborating on care. And while States are looking to roll out their HIEs, CMS and ONC are looking for ways to engage and encourage the adoption of HIEs through incentive programs and payment adjustments that have previously shown positive signs in influencing and increasing adoption.

March 11, 2013  8:54 PM

What mobility means for desktops in HIT

Posted by: RedaChouffani
mHealth apps, mobile devices, mobility, tablets, VDI

More and more mobile users are using their devices to access enterprise content and cloud hosted data related to their organization. This has enabled the workforce to access information from anywhere, at anytime. But there are still some limitations to mobile devices, preventing them from being able to completely overtake and replace the traditional desktop market.

Desktops and laptops provide clinical and administrative staff the horsepower and platform to run line-of-business applications that enable them to capture, retrieve and visualize information. Mobile devices aren’t able to perform such functions. Mobile devices are limited by lack of compatibility, or scarcity of some of these applications in the mobile platform arena. While we continue to come back to our laptops and PCs, the availability of virtual desktops and on demand cloud-based apps is continuing to shrink our dependency on traditional workstations. These mobile platforms allow users to run many of their critical business applications on cloud-based desktops that are completely accessible from any internet-enabled device.

Virtual desktops, available on tablets and mobile phones, offer a wide variety of functionality that enables IT departments to efficiently manage and deploy desktops and applications to mobile devices, tablets and any platform over the Internet. Vendors such as Citrix, VMware, and Microsoft offer products that enable users to virtualize their desktops.

There are some vendors that are taking unique approaches to ensure end users have choices.

VMware Horizon Mobile is a suite of providers that allows employees to add a virtual identity to their phone and deploy entirely customized mobile profiles based on employees groups. This enables effective application deployment, system security and better control over the apps that are rolled out on personal devices.

Ubuntu, which is known for having a successful version of Linux for desktops and servers, has announced that it is planning on launching a mobile version of its operating system in 2013 or 2014. The mobile operating system is based on their desktop environment and offers many of the capabilities. This means that future end users could run one operating system from any device.

March 4, 2013  10:39 PM

Mobile cart showcased at HIMSS13

Posted by: RedaChouffani
himss13, mhealth, tablets, Uncategorized

Mobile carts continue to be a common solution for nurses to increase efficiency when caring for patients.  Over time, these mobile stations have provided nurses easy and quick access to PCs or laptops that help verify and dispense medication, enter notes, and review results for ordered tests.

While there are several models and manufacturers of these carts, some of the leading vendors offer models that resolve various nurses’ needs. One showcased today at HIMSS13 is Rubbermaid’s CareLink cart model.

These units will be used in surgery centers, emergency departments and the ICU, as well as for patient registration.  Some of its highlighted functions include:

  • Integrated into the cart communication tools: For nurses, having access to communication tools is very critical to be able to communicate with their colleagues without leaving their cart.
  • Centralized Asset Management tools: In order to help manage the fleet of the carts and maintain them a new centralized portal and dashboard has been supplied to help IT departments in hospitals manage these carts.
  • Data capture capabilities: The CareLink has a full color touch screen that provider’s applications that make it capable to be used as a data capture point.

Rubbermaid in this released cart has focused on maintaining the availability to load a PC/thin client or laptop, but also offered a built-in small touch screen tablet that provides additional functionality. While there have been many attempts to substitute PCs or laptops in the cart with much smaller computing devices such as tablets, there is still some resistance as many of the tablets do not fully support all the applications that nurses need.

March 4, 2013  10:30 PM

McKesson announcement: HIE alliance

Posted by: RedaChouffani
AllScripts, AthenaHealth, Cerner, EHR, Greenway, HIE, John Hammergren, jonathan bush, McKesson, RelayHealth

Today at  HIMSS 2013, an announcement made by John Hammergren, Chairman & CEO of McKesson, showed the willingness of some of the biggest players in EHRs to work toward increasing data fluidity and exchange among software vendors.

The announcement detailed a new organization called CommonWell Health Alliance that is a non-profit alliance of  health IT expertise from six vendors: AthenaHealth, Cerner, AllScripts, Greenway, RelayHealth and McKesson. Hints of an HIE deal between Cerner and McCesson were leaked weeks ago.

HIMSS 2013 hosted a round table that featured four of the top executives from members of the Alliance in an open discussion about the challenges the health care industry faces, as well as the motivation that encouraged the collaboration.

Collectively, these vendors represent 41% of the total market place of EHR systems in the US. However, not all of the large software vendors were present during the meeting. Don Fluckinger from our very own SearchHealthIT received a response to his question about EPIC and their lack of involvement in the panel, stating that many of the others were invited to the alliance.

This industry-led approach will focus on resolving the following issues:

  • Match patients. Provide a way for HIT suppliers to match patients with their health care records as they transition through care facilities in a seamless, industry-wide data environment.
  • Manage consent. Foster a HIPAA-compliant and patient-controlled means to simplify management of data sharing consents and authorizations.
  • Link records across care locations. Help providers link records to deliver a history of recent patient care encounters, and, with appropriate authorization, patient data across multiple providers and episodes of care.

As we continue to see vendors recognizing the importance of data exchange and addressing the challenges physicians face when attempting to connect systems, this initiative will significantly help to ensure that patients’ information can easily be exchanged.

“At the end of the day, healthcare is going to become personal,” Jonathan Bush said during the Q&A.

February 25, 2013  9:59 PM

Enhanced security from Dell’s Latitude 10

Posted by: RedaChouffani
DELL, EHR certification, Latitude 10, mhealth, tablets

Dell has launched the Latitude 10, a tablet PC with new capabilities.  The device’s benefits lie chiefly in security, performance and battery life.

For security officers, the tablet has safe guards that allows for better data protection or access capabilities, both of which may be stored in the device itself.

For financial institutes, government entities, and healthcare organizations, biometric capabilities and smart card reader seem to set this tablet apart from its competitors. While there are other methods available to secure tablets, these Dell features will help its users, especially health care providers, meet some of the requirements associated with two-authentication form factors. This is important, since meaningful use (EHR certification) and e-prescribing of controlled substances require it as part of the authentication process.

Another important aspect to note is the tablet’s ability to offer changeable battery. For many healthcare providers, having to plug in a tablet to charge can be disruptive and inconvenient. Accordingly, the ability to switch out batteries can mean longer use periods and more overall acceptance in the enterprise environment. The tablet also comes with the capability for mobile broadband (HSPA+).

The enhanced security functionality is available in one of Dell’s four offerings.  The tablet will likely peak the interest of many health care IT executives, especially those interested in the biometric, smart-card and removable battery features.

February 25, 2013  9:57 PM

Innovation and mHealth initiatives: Still pushing

Posted by: RedaChouffani
FDA, mhealth, remote monitoring, Sanita, telehealth, tricorder, X Prize Foundation

Without a doubt, mHealth and telehealth (remote monitoring) will continue to play a significant role in facilitating the care and collaboration of patients today and in the future.  There are several initiatives and projects that speed up the process of getting products and devices to market.

Historically,  medical device manufacturers recognize that in order to gain market access for mHealth initiatives quickly, the FDA must be on board.

Sanita recently received approval from the FDA to offer a mobile and web platform that helps patients manage and monitor their health data in a HIPAA compliant medium, a product called “Wellaho.” As described on its website, Wellaho is “an online treatment management system tailored for you and your condition. Learn about your condition, monitor your progress, and enlist your friends, family, caregivers and others into your support community.”

This acceptance by the FDA encourages software developers to continue to innovate and introduce new mHealth products.

Another initiative that will likely encourage aggressive innovation is the X Prize Foundation, a friendly competition with a goal of encouraging the development of the next generation of medical devices that will help diagnose patients using a small device, or Tricorder.  The first place winner who creates a Tricorder able to assist/detect up to 10 health conditions accurately will receive up 10 million dollars.

Whether it is a device for glucose-monitoring, performing ECG, chronic disease management, or capturing vitals data periodically using a smart phone, it’s clear that in the last few years there has been a strong drive toward creating devices or platforms to help patients with the management of their condition, access of their medical information and quick diagnosis — without the trip to physician’s office.

February 18, 2013  10:23 PM

New CONNECT HIE platform driven by federal collaboration

Posted by: RedaChouffani

There is a new version of the open source platform for secure exchange of health information, CONNECT V4. HHS, DOD, SSA and the VA collaborated on the platform with the intent to provide both federal and other entities a secure data exchange platform.

Since both the CONNECT Project and the Direct Project have continued to change since their release, this announcement means even more updates have been made to benefit users.

As listed on the HHSwebsite, some features of new platform are:

  • Receive higher message volumes – CONNECT 4.0 can support secure health information flows of 1600+ messages per minute.
  • Exchange large files (for the first time) of  up to 1 GB.
  • Run CONNECT on additional application servers such as Glassfish, IBM WebSphere, and Oracle WebLogic to meet unique IT environment needs.
  • Get more comprehensive event and metric data with improved logging capabilities. Since CONNECT is often used as a gateway in concert with other systems like electronic health records, improved logging allows adopters to integrate CONNECT into whole-system monitoring.
  • Determine the state of a transaction across messages to better track and analyze the operations of CONNECT and trading partner gateways.
  • Minimize deployment load by supporting a lightweight gateway, which allows for a smaller server footprint and use of system resources.

During the HIMSS event in New Orleans this year, the ONC and FHA will hold several sessions to highlight programs like CONNECT, direct project, State HIEs, NHIN, SHARP program, S&I Framework and Beacon Communities. These will provide a chance for technology enthusiasts, clinicians and both the private and public sector to understand initiatives linked to the interoperable health information exchange at the HIMSS.

February 18, 2013  10:22 PM

Natural language processing: Changing health care

Posted by: RedaChouffani
EHR, information extraction, NLP, text analysis, text parsing

An area of computer science long studied by university graduates and professors is becoming one of the leading informational technologies: natural language processing.

Many markets already implement NLP. Apple uses it in accordance with Siri. Nuance uses a health care specific model offered alongside clinical language understanding. Certain search engines use it to translate user queries into structured responses.

Thinking long term, NLP would provide nearly endless possibilities  in the way we interact with computer systems. By leveraging the increase we have seen in both computing powers and storage capability, it could have a great impact on at least two major areas of healthcare.

Text parsing and information extraction:

The use of NLP in regard to text parsing is focused on the extraction of information from unstructured or semi-structured documents like text, dictations or scanned and indexed health records.  This information is then used either for reporting or collection and indexing for future use.  These text parsing tools help clinicians extract meaningful, actionable information from data stored in unstructured formats, whether those are EHRs or other health information sources.

Natural language to command or sort queries:

NLP interacts with users through voice, which may seem to be an idea torn from a sci-fi flick. But consider examples such as IBM’s Watson, or some of the pilot projects previously made around natural language interfaces to databases. We can ask simple questions and a computer system can translate them into actual commands or queries that can in turn be used to look up specific information.

In a clinical setting, we are seeing basic integration capabilities in several voice recognition products that not only allow for voice commands, but also discrete data capture through voice. And as the field continues to advance, these systems will mature and enable us to interact with information directly by using our voice and commands.  This will allow clinicians to not only completely avoid typing to capture information, but also to simply ask for information about their patients and have that data displayed on a screen. Theoretically, they might never need a keyboard.

NLP is right alongside big data  initiatives, IVR systems, search engines, sentiment analysis and several other areas that continue to see a significant growth in invention and adoption. That being said, there are still only a handful of examples within healthcare that showcase how NLP is changing the way we interact with information.

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