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LAM Conference – A patient’s perspective

Dr. George Pappas, LAM Regional Clinic Director

Last weekend, my husband and I attended the Regional TSC and LAM Conference at Swedish Medical Center in Seattle, WA. This conference covered current research developments, treatment options, and patient education. I attended because I wanted my husband to learn more about Lymphangioleiomyomatosis (LAM), because I am a patient. The LAM Foundation defines LAM as “a rare lung disease that usually strikes women during the prime of their lives… this disease is characterized by an abnormal growth of smooth muscle cells, especially in the lungs, lymphatic system, and kidneys.” LAM occurs almost exclusively in women, and it is usually misdiagnosed for years, often as asthma, emphysema, and/or bronchitis. LAM is considered a progressive disease, which can lead to lung transplantation 10 years post diagnosis or for some, like me, it progresses slower. Treatment with a mTOR inhibitor, Rapamune, may improve lung function, which was all the buzz at this conference, but unfortunately there is no cure.

This conference was coordinated by the patient advocacy networks, The LAM Foundation and TS Alliance, and was designed to provide patients with the opportunity to interact with the LAM scientific community, physicians, and patients. I have to be honest, I was surprised to see a packed room because there are only 3-5 LAM patients per million women in the world. I later learned that newly diagnosed patients traveled from as far as Alaska with their loved ones for the same reasons as I: to learn more about clinical drug trials, to ask questions, and meet other ‘Lammies’. This mutual interest was palpable during the presentation by Dr. Ray Yeung, a surgeon and renowned LAM expert. Hands were flying up with questions. Dr. Yeung spoke about the pros and cons of clinical trials, and the pathogenesis of Angiomyolipomas (AML) and LAM. Dr. Yueng had a great amount of positive energy for what he has learned about LAM through his research and it was awesome to hear from a scientist about the importance of patients getting involved in clinical trials.

After the session with Dr. Yeung, we had lunch and I got to talk to a very lovely woman that worked as a Patient Relations Advocate for Lundbeck, a pharmaceutical company that sponsored the conference. Her role was to bring the face of the company to the patient advocacy foundations and their patients, and in return be the voice of patients in order to always keep us in the forefront of the company’s mission. I was particularly impressed with this, especially coming from the pharmaceutical industry, which tends to get a bad rap as being money centric. I continue to be awestruck with her grace, attitude, and lovely disposition, and how she didn’t once talk about her company, but wanted to know more about ME, not my disease. I really hope that our talk (and the fact that I thanked her repetitively) and the other conversations she had with patients that gathered around us, made her journey worth it.

On the drive home, she really got me thinking about how important her role is, and how the information she gathered will be priceless to both Lundbeck and to the LAM community; what she learned cannot be found in any search engine or book. I believe there is a huge disconnect between patients and some of the key players in making us… well, not patients anymore. The folks that advocate for us are so important because not only do they form an overarching understanding of disease, research treatments, help us keep symptoms under control, argue with the insurance companies, help us manage setbacks, etc., they also help us realize there is meaning to getting up in the morning and living life knowing we are not alone. It’s like having a big mama bear always looking out for you, so you can focus on you and not your disease.

Upcoming events…
The International Rare Diseases Research Conference & LAMposium, Cincinnati, OH, Sept 22-25, 2016
LAM Regional Conference, Cleveland Clinic, November 5, 2016.

Posted in: chronic disease, Clinical Research, Managing Chronic Disease, Patient Advocacy, patient engagement, Rare disease, Research, Seattle

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MACRA: A Rule Worth Learning

Introduction to MACRA

Those of us who that work closely with clinicians or simply work in healthcare have no doubt heard of the total revamping of Medicare (Part B) clinician payments from a fee-for-service to a value-based system; this sort of change hasn’t occurred in over a generation. If that isn’t incredible enough for you, how about the fact that this 892 page document was passed by Congress with a bi-partisan ‘supermajority’; that alone speaks volumes on the importance of this change. The culprit of my angst and information overload is called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that will go into effect 1/1/17. This rule is so complicated with so many layers, it does not even have a Wikipedia page (nobody as been so bold); so keeping that in mind this blog post is my attempt to sum up my own understanding of this proposed rule.

Courtesy of CMS.gov

Two pathways to payment. MACRA is built upon two value based pathways that eligible clinicians (physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) must chose from: Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (Advanced APM). Which path a clinician takes depends on their patient threshold and if they are new to the Medicare. It also depends if the clinician is part of an Accountable Care Organization that is established as an APM entity. The advantage of one over the other is a 5 percent annual payment increase from CMS over 6 years if a physician decides to be grouped with their ACO APM entity. The risk is if clinicians do not meet metrics chosen and set by their ACO they will not be rewarded with their shared savings. The good news is Physicians can elect to switch between the two payment models from on year to another. This flexibility is the foundation to the MACRA proposed rule. Additional choices given to eligible clinicians are: they can report on measures that are important to them and decide if they want to report as an individual or in a group.

Courtesy of HIMMS MACRA information Webinar

Fundamental basics to the MIPS. The MIPS replaces the Physician Quality Reporting System (PQRS), Value-Based Modifier (VBM) and Meaningful Use (MU) programs with the categories: Quality, Resource Use, Clinical Practice Improvement Activities and Advancing Care Information. Quality metrics are mainly derived from PQRS, Advancing Care Information is a simplified version of MU, and Resource Use is similar to VBM. The biggest change, as far as I can tell, is clinicians can choose six quality reporting measures that are important to them. Each year HHS will publish a list of quality measures to be used in the forthcoming MIPS performance period (which is 365 days) for clinicians to choose from. Out of these measures, one must be an outcome measure of high priority measure, one must be cross-cutting (hit on several quality measures), and clinicians can choose to report a specialty measure set. Clinicians composed quality score is measured against clinicians similar to themselves; this is another significant change. If you recall previously the sustainable growth rate (SGR) “set an arbitrary aggregate spending target” not based upon individual performance or clinician peers.

Introduction to Advance APM. There is a reason why I explained in more detail the MIPS path- because I understand it better; as with many things in my life I relate it to food. MIPS takes the wholesome ingredients from MU, PQRS and VBM programs and makes it a much better appeasing entrée. Whereas the Advanced APM program doesn’t focuses so much on the recipe but on the consumer. From what I understand so far, you have to be an eligible clinician determined by CMS, and work in an organization that participates already as an APM through an agreement with CMS. Also, so far, CMS has only identified six APMs that qualify as Advanced APMs. These include Comprehensive End Stage Renal Disease care, Comprehensive Primary Care Plus, Medicare Shared Savings Program (Track 2 and 3), Next Generation ACO Model, and Oncology Care Model. The three criterion’s in order to become an Advance APM clinicians are: 50% of physicians must use Certified EHR technology; payments are based on quality measures; financial risk and nominal amount standards. I hope to dive deeper into Advanced APMs in a later blog post. For now please check out the HIMSS information deck here.

MACRA professional I am not… is anyone? Whereas I love to always learn, MACRA was difficult for me to grasp, HOWEVER I spent about 2 years in Graduate school studying Meaningful Use, so that says a lot. I am sad to say that a lot of what I learned about MU no longer applicable, but good riddance! The beginning of this year the Acting Administrator of CMS said “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” I hope we you are right Mr. Slavitt.

Posted in: Healthcare Legislation, Healthcare Policy, Healthcare transformation, Outcomes

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Risk Taking Doesn’t Have to Be Scary

Taking risk is an important part of being human, in order for us to succeed or get what we want out of life, we have to take a path towards uncertainty. Minimizing risk or simply feeling more prepared, can be obtained through resourcefulness and can help us gain a level of confidence in order to take the next step. In the recent article written by our CEO Anne Weiler, she describes the pillars to her own decision making and how she has applied them to starting a healthcare technology company. Anne uses a simple analogy for risk evaluation; rock-climbing. How can this analogy help you with your next big decision?

Please read Anne’s article here and post any comments below. Are you evaluating taking a risk right now? We would love to hear your thoughts!

Posted in: Healthcare Technology

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Patient Engagement in Surgical Outcomes Research Webinar

Hosted by Surgical Outcomes Club
Featuring speaker Danielle Lavalle, PharmD, PhD
03.17.16

I attended this webinar yesterday to learn about patient engagement in research development because of a simple reason: here at Wellpepper patient engagement is very important to us and I love research. I think of research as a tree, a question starts in the trunk and branches out to all these different observations while the leaves take in nutrients so the tree can thrive. Patients are a lot like leaves; they provide nutrients for the research to grow and in some cases without them there would simply be no tree. As with the example of the Comparative Effectiveness Research Translation Network, CERTAIN, they have found ways for patients to provide that vital ‘nutrient’ directly via a Patient Advisory Network. The Patient Advisory Network is made up of caregivers and patients that partner with researchers to provide their perspective in order to improve current research. This is a wonderful collaborative way for a patient to have a voice for many and as Dr. Lavalle said “…patients bring in an insider’s perspective that clinicians and researchers may not think about.”

The role that patients have through the Patient Advisory Network is indispensable; they provide an insiders perspective, articulate the most pressing questions and concerns, and help researchers think through what information should be relayed and how. For example, using language that is understandable by patients themselves, not just clinicians! Patients can partner with CERTAIN through advisory group membership, as a research partner, as a research and materials reviewer, or as a patient representative. One way CERTAIN reaches patients is via their blog; take a look and see if you can help!

-From Dr. Lavalle’s slides/webinar

In this webinar, Dr. Lavalle talks about the development over the last year of the CERTAIN project, Comparison of Outcomes of Drugs and Appendectomy (CODA) Trial for Appendicitis. The study poses the question: is there a new way we should be approaching the treatment of acute appendicitis – Appendectomy or ‘Antibiotics First’ strategy? “No studies to date have compared the impact of these two treatments for appendicitis on the overall patient experience or included standard PROs in addition to clinical outcomes.” With this factor ascertained, the importance of incorporating the patients voice in the very beginning was important to CODA. Therefore, CODA posed the following question to the CERTAIN Patient Advisory Network: If you landed in the ER with Appendicitis would you would you randomize between appendectomy or antibiotics? The attached graphic sums up the results of such findings. Dr. Lavalle was surprised that so many people would randomize, me too actually!

Patient engagement provides a dynamic aspect to research, that comes to all of us as no surprise, but CERTAIN has done a wonderful job of creating a great community that brings together both patients and research experts that in return makes research outcomes that much more beneficial. I am very curious what the patient centered outcomes will be for the treatment of appendicitis with either surgery or antibiotics. I guess we will all find out when the CODA project concludes in 2020.

Thank you for the wonderful talk Dr. Lavalle!

Next Surgical Outcomes Club Didactic Session: Thursday April 21, 2016 at 2 pm (ET)

Posted in: patient engagement, Patient Satisfaction, Research, Seattle

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mHealth and big data will bring meaning and value to patient-reported outcomes

Anne Weiler
Wellpepper, Inc., Seattle, WA, USA
Correspondence to: Anne Weiler. CEO, Wellpepper, Inc., Seattle, WA, USA.
Email: anne@wellpepper.com
Abstract: The intersection of widespread mobile adoption, cloud computing and healthcare will enable patient-reported outcomes to be used to personalize care, draw insights and shorten the cycle from research to clinical implementation. Today, patient-reported outcomes are largely collected as part of a regulatory shift to value-based or bundled care. When patients are able to record their experiences in real-time and combine them with passive data collection from sensors and mobile devices, this information can inform better care for each patient and contribute to the growing body of health data that can be used to draw insights for all patients. This paper explores the current limitations of patient reported outcomes and how mobile health and big data analysis unlocks their potential as a valuable tool to deliver care.

Link to full article can be found here

Posted in: Adherence, Healthcare Technology, M-health, Telemedicine

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EvergreenHealth Selects Wellpepper as Mobile Patient Engagement Solution for Total Joint Replacement

SEATTLEJan. 20, 2016 /PRNewswire/ — Wellpepper, Inc., a clinically validated platform for patient engagement, today announced that EvergreenHealth, an integrated health care system that serves nearly 850,000 residents in northern King and southern Snohomishcounties in Washington State, has selected Wellpepper as the mobile engagement solution for all total joint replacement and musculoskeletal care plans. The project was made possible at EvergreenHealth with a generous donation from The Schultz Family Foundation, a private not-for-profit foundation founded by Howard Schultz, CEO of Starbucks Corporation, and his wife Sheri.

Patients with musculoskeletal issues that require surgery or rehabilitation will use Wellpepper on their mobile devices to track their outcomes and adhere to their care plans. This information will enable patients, physicians, and other healthcare providers to track progress and patient-reported outcomes in real-time to improve care. Wellpepper enables health systems to implement their own care instructions on its task-based platform and makes it easy for patients to understand and adhere to their care instructions.

“Across our organization, we strive to be a trusted source for innovative care solutions for our patients and families, and our partnership with Wellpepper helps us deliver on that commitment,” said EvergreenHealth CEO Bob Malte. “Since we began using Wellpepper in 2014, we’ve seen how the solution enhances the interaction between patients and providers and ultimately leads to optimal recovery and the best possible outcomes for our patients.”

The Wellpepper remote care management solution is designed to be easy-to-use and highly engaging for patients while being flexible and easily customizable for use in clinical practice. It is clinically-proven to improve patient adherence and outcomes with over 70 percent patient engagement.

Health systems are increasingly looking for solutions to enhance patient care while reducing costs, and this is particularly true in total joint and musculoskeletal scenarios. The new Comprehensive Care Model for Total Joint replacement announced by the Centers for Medicare and Medicaid aims to reduce the cost and quality variability of procedures.

“We are seeing a lot of interest in using the Wellpepper platform in orthopedic and total joint replacement scenarios,” said Anne Weiler, co-founder and CEO of Wellpepper. “Interest and adoption are largely being driven by our ability to customize the care plans based on the health system’s own protocols, personalize the plans for each patient and collect the standardized outcomes required as part of the new Center for Medicare and Medicaid requirements.”

The Wellpepper platform doesn’t dictate care plans; instead it provides a set of task-based building blocks that health systems and providers can customize to reflect their own methodologies and practices. The patient interface is simple and straightforward, so patients get only the tasks and questions they need on a given day.

For more information about Wellpepper or to find out how the Wellpepper patient engagement solution can support value-based payment models, please visit wellpepper.wpengine.com or email info@wellpepper.com.

About EvergreenHealth
EvergreenHealth is an integrated health care system that serves nearly 850,000 residents in King and Snohomish counties and offers a breadth of services and programs that is among the most comprehensive in the region. More than 950 physicians provide clinical excellence in over 80 specialties, including heart and vascular care, oncology, surgical care, orthopedics, neurosciences, women’s and children’s services, pulmonary care and home care and hospice services. Formed as a public hospital district in 1972, EvergreenHealth includes a 318-bed acute care medical center in Kirkland, a network of 10 primary care practices, two urgent care centers, over two dozen specialty care practices and 24/7 emergency care at its Kirkland campus, Monroe campus and at a freestanding center in Redmond. In 2015, the system expanded to include EvergreenHealth Monroe – an accredited, full-service 72-bed public hospital district, established in 1960 in Monroe, Washington. EvergreenHealth has clinical and strategic partnerships with several health care entities, including Virginia Mason, Seattle Cancer Care Alliance and dozens of independent practices that are part of the clinically integrated EvergreenHealth Partners network. In addition to clinical care, EvergreenHealth offers extensive community health outreach and education programs, anchored by the 24/7 EvergreenHealth Nurse Navigator & Healthline. For more information, visit www.evergreenhealth.com.

About The Schultz Family Foundation
The Schultz Family Foundation, established in 1996 by Howard and Sheri Schultz, creates pathways of opportunity for populations facing barriers to success. The Foundation invests in innovative solutions and partnerships that unlock people’s potential, and strengthen our businesses, our communities, and our nation. For more information about the Foundation and its work: schultzfamilyfoundation.org.

About Wellpepper
Wellpepper is a healthcare technology company that provides a clinically validated platform for digital treatment plans delivered via mobile devices. The Wellpepper patient engagement solution improves patient adherence and outcomes with its patent-pending adaptive notification system and just-in-time, task-based instructions and by fostering communication between healthcare providers and patients. Wellpepper is used by major health systems that are moving to an accountable care organization model and need to track and improve patient outcomes while lowering costs. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Media Contact:
Jennifer Allen Newton
Bluehouse Consulting Group, Inc.
503-805-7540
jennifer (at) bluehousecg (dot) com

SOURCE Wellpepper

RELATED LINKS
http://wellpepper.wpengine.com


Posted in: Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Physical Therapy, Prehabilitation, Press Release, Rehabilitation Business

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2016: The Year of Telehealth

Judging by the freezing rain hitting my window pane and the darkness that comes at 430 pm, it is evident we are coming to the year’s end here in Seattle. As always the approach of a new year brings a great number of predictions and I don’t mean the kind that are derived just out of hope, but out of reality. A quick Internet search produces many real 2016 telehealth predictions; some are witty, honest and steadfast, others more conservative. However one common thread not to ignore is the ever increasing benefits of telehealth and the great strives by the US Congress to regulate and support such. For instance there are 17 telehealth bills pending in the Senate and 21 in the House; from excise tax on medical devices to the “VETS Act to improve the ability of health care professionals to treat veterans via telehealth…” The 114th Congress ends in January 2017 so the progressive reality of telehealth to have a presence in your healthcare entity is undeniable and if such already exists it will be more palatable.

Another common thread in my searches is the statement: 2016 will be the Year of Telehealth. It is easy to believe this statement without any gullibility especially after experiencing first hand the steadfast innovation of telehealth over the last few months of 2015. Coupled with the readmission penalties, competitive advantage, telehealth parity laws, quality reporting outcomes incentives, and transformation of rural care it is no surprise that this statement is used liberally. Furthermore every year it is becoming increasingly more difficult to find skeptics of telehealth, the list of benefits are always increasing and scrutiny of our healthcare system forces many to find solutions. Telehealth is on that strong progression towards not just being an added bonus to way we provide care to our patients, but in some cases the only way we provide care.

I would never claim to be an elite expert in the field of healthcare innovation and policy, so I do not want to go into what I think will happen in 2016, but one cannot help feel the buzz in our Wellpepper office in Fremont, Seattle, WA. Our group serves has an example of what is going on in the mhealth field; we have grown in leaps and bounds just over the last 6 months in order to keep up with the demands of the industry. I cannot believe how incredibly lucky I am to be part of such great innovative team of professionals that have one goal of many in mind that brings my sentiment home, to make healthcare better for all of us.

Happy New Year!

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health, Seattle, Telemedicine

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Help Wellpepper! My headache is agonizing

I remember when I was a kid walking into my grandmothers bedroom while she was in bed tending to, what I know now was, a headache. It was the middle of a busy summer day, but yet the room was dark, cool and completely silent, well except for me gasping; she wore these thick black eye masks that always scared me. Now as an adult I frequent this same scenario, except I have more than just aspirin to help me cope with my migraines, and very soon a useful device, my smartphone.

If you suffer from migraines, the thought of getting in the car, driving to the doctor, sitting in a busy clinic and being away from your cool dark room, is daunting. Honestly I don’t go to the doctor until sometimes days after, and by then I tend to block out that terrible afternoon I spent in bed. As a patient being able to record the effects in real time and communicate remotely with a helathcare professional is so much better than considering that trip. The new Wellpepper app will enable migraine sufferers to connect with their neurologist in real time, noting the severity of their headache, side effects, triggers and any medication taken. I cannot express how awesome it would be to roll out of bed for a minute, answer a few simple questions on my smartphone and go back to bed. This would save me money, a trip to the doctor after the fact (because let’s face it I am not driving to the ER in that state) and yet another session with my doctor that entails just getting out the prescription pad.

I have used great apps like Migraine eDiary and My Migraine Triggers, but they always left something to be desired, that connection to a human being that can help. Doctors are nurturers and when you are in as much pain as some of these headaches can be it is so reassuring to know that your doctor is on the other side of the Wellpepper app doing whatever they can to help. I know apps will never replace our clinicans, that much is evident, but if apps can be used as a tool to help us function better especially in times of distress, I couldn’t be happier.

Posted in: Healthcare Technology, M-health, Patient Satisfaction, Telemedicine

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Press Release: Sentara Healthcare Chooses Wellpepper

Sentara Healthcare Chooses Wellpepper for Mobile Patient Engagement in Headache Care

SEATTLE, Nov. 19, 2015 /PRNewswire/ — Wellpepper, Inc. today announced that Norfolk, Va.-based Sentara Healthcare is partnering with Wellpepper to provide a mobile patient engagement solution for headache care. Wellpepper is a clinically validated patient engagement platform. Sentara is an integrated not-for-profit system of 12 hospitals and more than 100 sites of care, including a robust neurosciences program. Sentara patients who suffer from migraines and other severe headaches are able to use the Wellpepper mobile application to report their headache experiences in real time, including pain, triggers and use of over-the-counter or prescription medication. Sentara Neurologists are able to use the information collected to diagnose, treat and monitor the ongoing progress of headache patients with the goal of better outcomes, fewer office visits and lower healthcare costs.

“We believe Wellpepper can help us provide timely care for headache patients,” said Alexander Grunsfeld, MD, medical director for Sentara Neurosciences. “Sentara encourages patients to be partners with us in their care and the Wellpepper solution offers a new opportunity to achieve that goal.”

Currently, when patients are referred to a neurologist, they are asked to complete surveys and try to remember what triggered their headaches. Follow-up surveys are typically given every 3-6 months. The result is often multiple office visits and patient care is delayed until the root causes for headaches are eventually discovered.

Data collected through the Wellpepper application is presented to healthcare providers via a clinical dashboard. Neurologists can easily communicate with headache patients to alter treatment plans without the patient having to unnecessarily visit the office. Wellpepper also provides a way for patients to log pain levels using the visual analog pain scale and to record medication use and how much.

“Too often, data collection from patients is disconnected from their care plan,” said Anne Weiler, co-founder and CEO of Wellpepper. “Being able to use patients’ own smartphones and tablets to provide care plans and show results using Wellpepper is not only a way to help drive patient engagement, it is a way for healthcare providers to gather strong, real-time data and patient-reported outcomes in a way that after-the-fact surveys cannot.”

Approximately 18 percent of women and 6 percent of men between the ages of 12 and 80 suffer from migraines in the U.S. According to a study published in the Journal of General Internal Medicine, migraine cases require, on average, 2.3 more physician office visits than non-migraine controls (9.1 vs 6.8, respectively) and were significantly more likely to have been seen in an emergency department (20.7% vs 17.6%) or admitted to a hospital (4.5% vs 2.8%).

For more information about Wellpepper or to find out how the Wellpepper patient engagement solution can support value-based payment models, please visit wellpepper.wpengine.com or email info@wellpepper.com.

For information on the Sentara Neurosciences program, visit www.sentara.com/neuro

About Sentara Healthcare
Sentara Healthcare, based in Norfolk, VA, celebrates a 127 year history of innovation, compassion and community benefit.  Sentara is a not-for-profit family of 12 hospitals in Virginia and North Carolina, the Optima Health Plan, a full array of integrated services and a team 30,000 strong on a mission to improve health every day.  This mandate is pursued through a disciplined strategy to achieve Top 10% performance in key clinical measures through shared best practices, transformation of primary care and strategic growth that adds tangible value to the communities we serve. www.sentara.com

About Wellpepper
Wellpepper is a healthcare technology company that provides a clinically validated platform for digital treatment plans delivered via mobile devices. The Wellpepper patient engagement solution improves patient adherence and outcomes with its patent-pending adaptive notification system and just-in-time, task-based instructions and by fostering communication between healthcare providers and patients. Wellpepper is used by major health systems that are moving to an accountable care organization model and need to track and improve patient outcomes while lowering costs. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Posted in: Healthcare Technology, M-health, Press Release, Seattle, Telemedicine

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Certified Health IT provision proposed by CMS

Finding that you have to be hospitalized again has got to be frustrating enough, but learning that it could have been avoided has to spark a cocktail of emotions for all involved. It’s not rocket science that avoiding readmission is dependent on strong discharge planning practices; i.e. seamless transfer of vital information and strong communication between a hospital and post-acute care facility. Furthermore it’s hard to sidestep statistics; the cost of readmission for Medicare patients is over $26 billion a year and approximately 2.6 million seniors are readmitted within 30 days. What? As a tax payer and a friend of many Medicare patients, I am troubled… that is a lot of individuals and money!

So naturally my next question is: What is the government doing about it?! CMS published a proposed rule in the federal register last week that includes the implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) and a revision of the discharge planning requirements (IT interoperability orientated). There are 21 discharge planning data requirements; these patient centered data elements are what a certified health IT system should provide to a PAC facility in order to enable seamless transition of care. I especially like the bullet: ‘patient’s goals and preferences’; I think this is very important for many reasons… one being that after a few patient interactions, clinicians will get a good feel of what is important to the patient through discussion. It takes time to build this knowledgebase because it requires that all important human ‘touch’.

Such patient and provider experiences are now being taken advantage of, therefore the idea of patient involvement during discharge planning provides better outcomes (therefore lower readmission) is not new, but the idea of assisting patients when selecting Post-Acute Care (PAC) providers by sharing data on quality and resource use measures, is relatively. The proposed provision also puts a time frame on when to start discharge planning; discharge planning must begin within 24 hours of admission/registration and discharge plan must be completed “before the patient is discharged home or transferred to another facility”. I have faith in our system and that this quoted remark is not new, but perhaps the first time formally written by the IMPACT committee!

I think it is also important to point out here the Community-based Care Transitions Program (CCTP) that was implemented by the Affordable Care Act in February 2012 allocating $300 million in funding to reduce readmissions. An annual report of the CCTP program success can be found here. The report concludes “Only one site had a significant reduction in readmission…” but goes on to say that not all sites entered the program at the same time, therefore this information isn’t reliable. With that said, I cannot help but wonder if the certified Health IT system would have been required already to contain the 21 data elements during electronic transmission during discharge planning (for several years mind you) these 46 Community Based organizations (CBO) would of had lower readmission rates. In 2017 when the CCTP initiative is over, I hope we learn of it’s effectiveness and it helps millions of Americans.

Posted in: Healthcare Policy, Healthcare Technology, Interoperability

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Press Release: Wellpepper Venture+ Forum Winner

CirrusMD And Wellpepper Named Venture+ Forum Pitch Competition Winners At 7th Annual mHealth Summit

WASHINGTON, Nov. 11, 2015 /PRNewswire/ — CirrusMD Inc., and Wellpepper were named the winners of the 2015 Venture+ Forum Pitch competition for startups at the mHealth Summit. They were among four companies selected to deliver live pitch presentations during the ‘final four’ competition Tuesday evening. The finalists were selected from a field of eleven digital health startups who presented during the first round of live competition held on Sunday at the Summit.

The 2015 Presenting Companies were chosen based on criteria for demonstrated impact and quantifiable results for improving health care delivery and outcomes.  The Venture+ Forum provides a recognized platform for health entrepreneurs, fostering commercialization of innovative health technology solutions to advance healthcare delivery.

“The Venture+ Forum has become an anticipated event for health technology startups, with tangible results for pitch competition winners,” said Richard Scarfo, Director, mHealth Summit, and Vice President, Personal Connected Health Alliance (PCHA). “Venture+ Forum is designed to support the startup community, investors and entrepreneurs, and advance innovation in health technology. Congratulations to CirrusMD, Wellpepper and each of the finalists.”

CirrusMD develops “closed loop” virtual care solutions for value-based healthcare, with a unique telemedicine methodology that ensures continuity of patient care and enables full data integration over multiple communications channels – text messaging, phone and video chat.

Wellpepper is a clinically-validated mobile patient engagement platform, and is used in orthopedics, rehabilitation, trauma and burns, pain management and neurology at hospitals and clinics. It enables healthcare professionals to create and prescribe custom treatment plans based on their own best practices and protocols, and personalize them for each patient.

The first Venture+ Forum event of 2016 will be held at the HIMSS Annual Conference taking place February 29-March 4 in Las Vegas, as part of its mission to promote innovation in health technology. PCHA will also host the 2nd annual HX360 event at HIMSS16, inviting health system executive leaders, innovation teams, entrepreneurs, investors and technologists to explore technology-based solutions to challenges in healthcare delivery and operations, as well as new business models, novel partnerships and approaches to sustaining innovation.

About the mHealth Summit
The mHealth Summit is the global convener of the expanding mobile health ecosystem, exploring the disruptions, challenges and opportunities of the integration of mobile and wireless technologies into the healthcare system, and in consumer and patient engagement, for the delivery of better health outcomes. The 7th Annual mHealth Summit will take place November 8-11, 2015, in Washington, D.C. Focusing on four fundamental platforms – technology, business, research and policy – the mHealth Summit is presented by HIMSS, in partnership with Continua, the Foundation for the NIH and the mHealth Working Group. mHealth Summit is part of the Personal Connected Health Alliance (PCHA), an international non-profit organization established by Continua, mHealth Summit and HIMSS to represent the consumer voice in personal connected health. Visit the mHealth Summit for more information; and follow at @mhealthsummit.

 

Posted in: Healthcare Technology, M-health, Press Release

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Disruptive Innovation to Improve Mental Health Care

Health Innovators Collaborative, University of WA Bioengineering
Dr. Jurgen Unützer, Chair of UW Psychiatry and Behavioral Sciences

The Health Innovators Collaborative seminar that I attend last week by Dr. Unutzer gave me an emotional whirlwind, which is ironic because the subject was mental health. That afternoon I innocently put my boots on and galloped down to the university in my VW Beetle and waited for the seminar to begin by eating an apple in the front row. I had no idea what was in store for me in the next 60 minutes or so. I would have cowardly slumped down into my chair if this was a talk taking place outside of Washington… because I am so ashamed about how we brush our mental illness folks under the rug. My jaw almost dropped in shock; we are ranked 48 out of 51 to have the correct resources available for our mentally ill with only 20 psychiatrists in Rural Washington. Dr. Unutzer argued that we spend more money on preventing auto accidents and homicide, when the rate of suicide is much higher- there is a suicide every 15 minutes in our country and 2-3 a day in Washington.

IMPACT- Collaborative Care Model

After giving us such somber news he talked at great lengths about ‘working smarter’ in order to close the gap of inadequate mental health professionals. One of the largest treatment trials for depression, Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) was spearheaded by Dr. Unutzer and his colleagues. They designed IMPACT to function in two ways; “The patient’s primary care physician works with a mental health care manager (can be a mental health nurse, social worker etc.) to develop and implement a treatment and the mental health care manager and primary care provider consult with psychiatrist to change treatment plans if patients do not improve.” The IMPACT study was started over 15 years ago when the use of EMRs and video conferencing were just starting to become ‘mainstream’. Therefore in a way this study was the forerunner in utilizing a multi-based ‘high tech’ mental health patient care platform; population registry/database (tracking tool of patients PHI, treatments, etc.) psychiatric consultation (video), treatment protocols and outcome measures (I feel I am writing about Wellpepper!). The video consultation takes place between the patient and a remote psychiatrist typically after treatments protocols are administered in the primary cares office with little or no patient improvement. This is imperative especially in Washington where half of the counties don’t have a single psychiatrist or psychologist.

There is a great JAMA article written on the outcomes of the IMPACT program (I am proud to say I did my homework on the positive slides presented and not the slippery slides) that really nails out the particulars in the normal scientific journal fashion. As always I shot to the bottom of such article for the ‘results and conclusions’ because I knew this one was going to be great, I had a sneak peak last Wednesday. After a year 45% of the 1801 patients studied had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants! Furthermore this study reduced healthcare costs; $6.50 saved for every $1 invested, with the most being saved in inpatient medical and pharmacy costs. In conclusion having a system that provides population based care, that is patient centered, has target treatment solutions, and is evidence based leads to more efficient modes of getting a patient in and out the door with positive results.

I exhaled what a clever man you are Dr. Unutzer to present your slides in such an order, from negative/scary to positive/uplifting, it’s almost like you are a psychiatrist and now how the mind works, oh wait you are!! Thank you for a wonderful talk, it was superb and always nice to learn something new!

Next seminar is “Bad Language, Worse Outcomes” with Jeremy Stone, MD MBA on November 3.

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, Outcomes, Seattle, Telemedicine

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Falls Prevention Awareness Day September 23rd

Last year my 80 year old grandmother fell walking back from my cousins wedding reception, luckily she grabbed onto my sister and broke her fall. Nevertheless as we studied the sidewalk for several minutes only to discover its perfectly flat surface and our tremendous worry… my dear grandmother could think of nothing other than her embarrassment. We later learned from my grandfather that she has fallen several times over the last few months; she shook it off with laughing commentary in the background saying he was exaggerating. Whereas I appreciate her humor, it is no laughing matter. 2.5 million elderly adults are treated in the ER for fall injuries, with one out of five falls result in broken bones. With those statistics I continue to worry about the next time she falls and my sister isn’t there.

Pick up your cars, grandma is coming over!

With that said, today being Falls Prevention Awareness day I cannot help but think of everyone in my life that is prone to falling… which I am sure you are now pondering yourself. So we should all take a minute (or longer depending on how caught up you are on house chores!) and look around our environment for fall hazards and think about prevention. I have a two year old son that contributes a lot to fall hazards with his hotwheels toys strewn all over the house, which makes my house a high risk zone no doubt! I have to ask what’s on my grandmothers floor?! We need to encourage our elderly loved ones to remove fall risk factors in their homes too; broken steps, faulty handrails, uneven pavement, clutter, throw rugs, poor lighting… grandchildren toys! However most of all we need to make sure they are still getting out of the house and do NOT let the fear of falling limit their mobility. Lower mobility is a major fall risk factor due to deteriorating body strength, which in return also influences balance. It is argued strengthening your balance is the single most important factor in avoiding falls. Senior centers across the country teach classes to elderly adults called “Matter of Balance” (I have taught a few in the past!), they are a great way to teach folks about balance strengthening through exercise and awareness of ‘fall-ty’ habits.

Working for Wellpepper and learning more each day about how it is helping patients, I cannot help but think about how mHealth technology could also help with fall prevention. There are several balance strengthening exercises that we do in our ‘Matter of Balance’ classes at the senior center that could be very easily translated onto the mHealth platform. Honestly now that I think about it the whole class could be taught this way, and might even have better results since a lot of elderly adults express interest in the class, but don’t show up because they are too embarrassed about admitting to of fallen, just like my poor grandmother.

Such thoughts of mine have been expressed officially (to say the least!) by Harvard researchers, because today it was announced on Falls Prevention Awareness Day no less, in a press release, that they are utilizing Wellpepper as an patient engagement solution to lower the costs of care and to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. I cannot wait to see how this study plays out, because it could mean a whole world of good for our lovely elderly family members. I cannot help but visualize how cute my grandmother would be practicing her muscle strengthening exercises on an iPad and the great peace of mind my family would have.

Congratulations team Wellpepper for your involvement in making this Falls Prevention Awareness Day a big notch in your ongoing achievement index!

Posted in: Aging, Behavior Change, Healthcare Research, M-health

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This Month [August] in Telemedicine

This Month [August] in Telemedicine

Moderated by:
Jonathan Linkous
Chief Executive Officer,
American Telemedicine Association

Gary Capistrant
Chief Policy Officer,
American Telemedicine Association

This month in Telemedicine webcast was interesting because more than once was the ATA sentiment geared towards realizing the big picture of telemedicine: To help patients. Unless you are lucky enough to work directly with patients that utilized telemedicine on a daily basis, I think sometimes, including myself, we get caught up in the bureaucracy/methodological side of things. Sometimes it takes talking with patient or clinician in order to make me grasp how HIT is improving lives, my life too! So I appreciate the reminder John! At the end of the webcast he asked if you have a personal story of how telemedicine helped you or a loved one ATA needs to hear it, please email John Linkous -jlinkous@americantelemed.org

The main highlight of the first 20 minutes of this webcast focused on the positive trend of telemedicine utilization. Not surprising the younger crowd just beginning their careers in medicine strongly support the use of telemedicine; Medscape conducted a survey and found out that 70% residents had no problem consulting via telemedicine. And maybe because I am of the ‘younger’ crowd (bahaha) I think this is ingenious: the Colorado medicine board is doing away with the rule that patients need to see doctors face to face before utilizing telemedicine; ok so how many times have you gone all the way to the doctor’s office only to get a referral or need blood work done before they can give you a diagnosis/treatment?! Genius! Other interesting facts: 20% of American adults use some technology to track health care (counting steps, migraine triggers & heart rate, etc.) and 57% of households with children access one health portal per a month. Finally big employers are seeing the benefit of telemedicine to cut back on insurance costs; 75% of large employers will be using telehealth as a benefit next year.

Licensure compacts. Ok guys really? Every “This month in telemedicine” webcast talks about this. What is the hold up?! It is so frustrating to me that if I get ill on vacation in Hawaii (ok dreaming, who gets sick in Hawaii?) I cannot get a consult from my doctor over the phone or the internet. This is silly people and it was clear to me that John thinks so as well. He underscored the importance that ATA supports the federation’s compacts in principal, but has some concerns… it is estimated that it will cost 300 million for the 21% of physicians that have more than one state license. Oh money, yea ok that’s the same old hold up every time. Next time they talk about state licensure compacts I am just going to put a dollar sign in my post… you’ll understand.

Circa 1934. Broadcast to Webcast; Radio Technology to Wireless Telegraphy… and now just ‘wireless’. http://www.cio.noaa.gov/rfm/index.html

Frustration was also heard in John’s voice about the FCC Telecommunications Act of 1996. The last Telecommunications act was in 1934, 62 years it took to write a revision, and it looks like it will take another 62 years at the rate they are going! ATA continues to be disappointed in the Act; the FCC estimated there would be a 400 million a year in spending on broadband linking rural healthcare, last year they approved for 200 million. They have only deployed 100 million; only spending a quarter on what the program was supposed to spend- “they need to step up.” Why John? They have 62 years to spend that!

A big note: telemedicine care for post discharge (knee and hip replacements) isn’t expanded out to Physical and Occupational Therapy for Medicare patients. CMS has waived two of Medicare restrictions: allow any Medicare beneficiary to provide services regardless of where they reside but somehow does not include health innovation- “we will be commenting to CMS” and so they did in a letter dated 9/8 strongly urging CMS “…to allow for PT and OT to provide rehabilitation by telehealth means, otherwise covered by Medicare…”

The ATA Fall Forum is next week (9/16-18) in Washington D.C. (and yes I put in D.C. being from Washington state!) with the highest registration rate ever and the exhibits have sold out. They actually have a ATA meeting mobile app for those of us that cannot make it. With a conference that has “Tele” in the name, I see this as the most logical and sensible way to attend.

Posted in: Healthcare Technology, Healthcare transformation, Occupational Therapy, Physical Therapy, Rehabilitation Business, Telemedicine

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HIMSS Federal & Stage Public Policy Update

Speaker:  Jeffrey R. Coughlin, MPP
Senior Director, Federal & State Affairs
HIMSS North America

This luncheon appropriately took place in the relatively new and beautiful Alder Commons Auditorium on the University of Washington Campus. Jeff briefed me (I cannot speak for others in the room) on Meaningful Use current events (what CMS expected upon inception and the reality of now) and the new incentives to push interoperability. I graduated from UW with a degree in Clinical Informatics in 2011 when CMS was just rolling out EHR incentive program, now 4 years later it is an interesting perspective, the positivity outlook I once saw is fading. In 2011 CMS estimated by 2019 that 100% hospitals and 70% professionals would be utilizing EHRs. As of June 2015 537k eligible professionals and 48 hospitals registered for Medicaid/Medicare incentives; a whopping 31 billion incentives were paid out. With all that money paid, it raised question of what was actually bought with those dollars with only 48 hospitals registered. I am sure Congress and the House will try very hard to find this out exactly!

I know that the carrot and stick approach to EHR incentive payments are producing results in regards to getting eligible professionals and hospitals to get on board with Meaningful Use (MU), I am more drawn to the value of care improvement I can see myself in the works; interoperability. Jeff talked about this subject as well with more interest and I sat up in my chair. After the slides he presented on numbers/facts interlaced with disappointment that CMS is no doubt feeling over MU and EP/Hospitals are actually frustrated by, the subject matter of interoperability I was very happy to see. The Office of the National Coordinator for Health IT (ONC) defines interoperability “… as the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user.” I believe that EHRs are worthless without the ability to follow patients throughout their lives; we are no longer born, live and die in the same town, even less so go to the same doctor, hospital or clinic our entire lives. Therefore it is more important than ever for the 2015 Interoperability Standards Advisory to “…coordinate the identification, assessment, and determination of the best available interoperability standards and implementation specifications for industry use toward specific health care purposes.” Please check out this wonderful graphic that very nicely lays things out.

Jeff’s closing remarks were centered around how important it is for us to advocate the role Health Information Technology has on creating a healthcare system based upon patient centered care and with National Health IT week coming up October 5-9 what better time to knock on your senators door. Also the HIMSS policy summit is October 7-8 and you can sign up for early bird registration until Sept. 10th.

Posted in: Health Regulations, Healthcare Policy, Healthcare Technology, Interoperability, Meaningful Use

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This month [July] in Telemedicine

American Telemedicine Association: This month [July] in Telemedicine
July 28th, 2015

Presenters:
Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Jonathan Linkous, CEO, American Telemedicine Association

The theme of this Month in Telemedicine webcast was progress; progression from telemedicine not being just an alternative to doctor office visits, but more as a replacement to them. The large amount of funds now being circulated through the market is worthy of making note of in your memory storage box. Here are a few.

Last week SHL telemedicine, an Israel based company, was bought by Shanghai Jiuchuan Investment (Group) Co., Ltd. for $116.34 Million. This event signifies the seriousness of China’s increasing interest in Telemedicine. Also in Asia it was reported that there was a 40% reduction of patients being transferred to Vietnam city hospitals for treatment from satellite provincial hospitals due to telemedicine. Chúng ta nên nhìn vào thị trường Việt Nam Wellpepper?

Station developed by HealthSpot… if you are in Ohio you might see one in your neighborhood Rite Aid.

Also in July Rite Aid launched a pilot project utilizing HealthSpot walk-in stations in throughout the state of Ohio. “HealthSpot stations offer customers convenient access to high-quality, medical care from board certified medical providers using high-definition videoconferencing and interactive medical devices”. Because I am a curious creature, I had to look up where the stations are. Doing a quick search in my sister’s zip code in Florida, I found one in a casino! I will not start with the jokes, but let your imagination ride!

Another Telemedicine company to keep an eye on is Teladoc. On the first of July stocks went from $19 a share to nearly $30 a share. They had predicted the stock would be between $15-17 a share! If that came as a little bit of a shock, this announcement really grabbed me… $570 million investment dollars is now breaking the ground harder in telemedicine (and related entities) than HIT. Specifically mhealth companies raised 214 million, personal health raised 209 million and telehealth raised 152 million, making it 570 million dollars raised in 2nd quarter alone of this year.

Another interesting ‘progression’ tidbit is what John mentioned; the ATA accreditation has 330 registrations in hand, mainly consisting of Healthcare orgs, instead of companies that provided standalone independent telemedicine services. The increase is believed due to the huge gap in services that healthcare orgs provide patients; telemedicine services are frankly quicker to utilize vs. the old way of: calling your docs office, making an appointment that is 2 months away, etc. etc. How often is your smartphone, tablet or computer right next to you a day? It’s okay to admit the truth; we know you sleep next to it! With that said, obviously healthcare orgs are losing patients (literally in their sleep!), so there is a huge spike in healthcare orgs wanting to create their own telehealth services. I ask why? Use an already created wonderful app like Wellpepper! J

To access this videocast recording:
http://services.choruscall.com/links/ata150728

Next Month in Telemedicine [August] webcast will be mentioned here.

Posted in: Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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“How to Hack Healthcare” hosted by HIMSS

“How to Hack Healthcare” presentation by Alluvien Information Security experts:

Aaron Hayden, MBA
Software Development / Ethnics & Compliance

Alex Haslach, GSEC, CEH
System Administration / IT Control Analyst

June 25, 2015

This webcast hosted by HIMSS covered ‘recent’ healthcare entities that have been hacked (Anthem, Premera, CHS, etc.), how the hackers got into their systems and what safeguards (cover risk) could have been put into place to avoid these intrusions. Later in the webcast Alex covered HIPPA requirements; Administrative, Physical, Technical (Access, Audit, Intergrity and Transmission). Thoughtful and useful advice was given to the audience on the best actions for healthcare, etc. to take to avoid hacks.

*Image source: Fox Small Business Center

As mentioned in the slides, over the last decade healthcare providers account for 26.8% of data breaches (about 1200), however not every sector has mandatory reporting, healthcare is overrepresented. Both Anthem (2010) and Premera (2014) were hacked via spear phishing. A fake website was created with very similar web address; an employee went to this website and gave away their credentials. Aaron goes into detail of why hackers preform these ‘mega breaches’, citing the main reason is because there is a huge black market for data, and the suspicion is that hackers assemble a database about individuals and can use this protected information to target same group of people in the future by using better ‘crafted’ phishing emails; federal employees are usually main target. Another hypothesis is that this is illicit market research, used to generate new and better uses of healthcare products. This is the ‘positive’ spin on things, I applaud your efforts Aaron, but I am VERY doubtful! Aaron also talked about the Community Health Systems (CHS) hack of more than 200 healthcare facilities somewhere between April and June 2014. This was a far more sophisticated attack utilizing malformed requests (hackers asked for encrypted sessions with the webserver) and a OpenSSL Heartbleed vulnerability reportedly resulted in a VPN session hijack.

So are governmental mandates enough to help prevent such attacks? If an organization is compliant with HIPPA, it “…does not mean it is secure in any way”. One huge downfall that was a common theme with Premera, Anthem and other attacks, was the length of time hackers had access to data before it was even noticed by anyone due to the lack of monitoring and the strong compliance beyond just HIPPA. Protection systems like Intrusion Detective System (IDS), Intrusion Prevention System (IPS) and Security information and event management (SIEM) System need to be in place. A useful source mentioned was a non-profit cooperative research and education organization called SANS that has a comprehensive list of top 20 Critical Security Controls that mitigate and prevent security breach; organizations that have implemented these security controls have an 85% less likely chance of a breach.

The slides that go into HIPPA are in the link below for your reading pleasure! I don’t want this to become a blog about the subject (easily done due to the vastness), but please read their slides because they do a wonderful job of summing it up. Instead I want my next point to be about my question asked. I wrote in asking Aaron and Alex their opinion on utilizing Amazon Web Services (what Wellpepper uses), to store PHI data etc. and what they believed the pros and cons to be. Aarons opinion was the bigger the company the better… they have solid safeguards to protect PHI data and can easily present their policies to clients, but as a customer if you have a security request that is in conflict with their efficiently organized architecture, they are not going accommodate. Alex agreed adding that it is a matter risk of transference; will Amazon do a better job of protecting our data by taking the risk for us? Yes, because Amazon maintains class one data centers all around the world that have very good security controls, they have resources to invest in the highest level of protection available with an entire team to do so. With that coming from Alluvien security professionals, it is nice to be reassured that PHI data that Wellpepper utilizes is well protected.

The webcast is available here after a short ‘registration’ process. The on demand webcast expires at the end of July.

Posted in: Data Protection

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