Healthcare Policy

Archive for Healthcare Policy

Pointing Fingers at Healthcare Problems

I’m only halfway through Elizabeth Rosenthal’s “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” which means that I haven’t gotten to the “what you can do about the problem” part. It’s a slow read, not because it’s not compelling but because it’s too compelling, and if like the current President, you were surprised at how complicated healthcare is, this book will do nothing to dissuade you. It’s really really complicated.

So far, I have two main takeaways from the book, that are easily illustrated through my recent experience of breaking and dislocating my finger: a simple, non-life-threatening problem, that unearthed a couple of key dysfunctions and unintended consequences.

My first takeaway is that everyone is complicit, and yet seem to manage to finger point at everyone else. Rosenthal spares no punches in unearthing decisions that are not made with the best interest in of the patient at heart. Providers, healthcare organizations, payers, pharma, and employers all are complicit in the mess that is our current healthcare system.

This past fall, I broke and dislocated my finger. It wasn’t a big deal, but because it happened on a Saturday night, my only option for care was at the ER. Last week I received a letter in the mail from my insurance company, that according to the envelope required my urgent reply. In the letter, the insurance company suggested that perhaps someone other than them may be on the hook for my ER bill. While I understand they wanted to make sure this wasn’t a worker’s compensation claim, the form was basically for me to tell them whose fault my injury was so that they could go after another insurance company to pay. This was a sports injury in a game of Ultimate Frisbee, a game so granola-like that there are no referees: players call fouls on themselves. . No one was at fault, and even if they were, I would never have considered suing. However, the form didn’t give me that option: only gave me the option of saying whether I had settled my claim. I created a new box that said “NA” and checked it.

When I received the letter, I couldn’t help but think back to Rosenthal’s book, and also consider the amount of effort and cost that was going into finding someone else to blame and pay. Just imagine what this effort and cost would have been if there were legal action….

The second takeaway is that the original intention of a decision always has much farther reaching implications than anyone who agreed on what seemed like a reasonable decision though. Again with the finger, I was asked a number of times if I wanted a prescription for OxyContin. I did not. As has been well publicized we have an opioid addiction problem in North America. While my finger hurt, aside from morphine during inpatient for an appendectomy, I hadn’t had opioids, and really didn’t think that it was necessary, which I explained to the physician. It wasn’t. Tylenol worked fine—however, it seemed that it was very important that I be the one to make this call, not the physician.

One of the unintended consequences of patient satisfaction scores may be the over prescription of pain medication, as many of the questions on the HCAHPS are about whether the patient’s pain was well managed. In Rosenthal’s book, I was also surprised to learn that a finger fracture where an opioid is prescribed has a different billing code than if it is not prescribed, and that with the fracture plus opioid billing code, hospitals get paid more. Now, if you are wondering how this may be the case, if you think about it, a fracture that requires an opioid must be more severe than one that doesn’t and therefore the billing code reflects the severity. This is exactly where the unintended consequences of billing codes can result in exactly the wrong behavior for patient care and safety.

It’s quite possible that the physicians on duty were not aware of either of these two drivers for prescribing, especially the billing code one. They may have just been told “this is our standard of care” and were following guidelines.

If a simple finger fracture and dislocation can shine a light on two key problems in our healthcare system, just imagine what else is out there. Actually, you don’t have to, just get a copy of Elizabeth’s book yourself, and let’s compare notes when I get to the part about what the fix is. It’s going to take all of us.

Posted in: Health Regulations, Healthcare costs, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare transformation, Opioids

Leave a Comment (0) →

Disruptive Innovation, Sparks of Light, or the Evolution of Care: Recap of Mayo Transform Conference

In what has been a roller-coaster year for healthcare legislation, it’s the annual touchstone of the Mayo Clinic Transform Conference provided a welcome opportunity to reflect on where we are. This conference, sponsored by the Mayo Clinic Center for Innovation attracts powerhouse speakers like Andy Slavitt and Clayton Christensen, and yet manages to fly under the radar. This year’s theme was about closing the gap between people and health, so the social determinants of health were a key topic, as was whether disruption alone would solve the problem.

Dr Robert Pearl

This was my third year attending, and second year speaking at the conference, and I’ve noticed a trend: the conference starts by articulating the problem, and building up solutions and creative ways to reshape the problems over the course of the two days. This year the conference was deftly moderated by Elizabeth Rosenthal, MD,Editor-In-Chief of Kaiser Health News and author of “An American Sickness.” Rosenthal, an MD herself, and former NYTimes journalist, peppered her moderation with real-world examples of both waste and inefficiencies and effective programs based on her investigative journalism.

I’ve been wanting to write a blog post for a while that riffs on the theme of “You Are Here” trying to outline where we are in the digital evolution in healthcare, but it’s clear that we don’t know where we are, digital or otherwise: too much is currently in flux. There are points of light with effective programs, and things that seem very broken. The panel I was on, was titled “Disruptive Innovation” and I’m afraid we let the audience down, as while we are doing some very interesting things with health systems, we are not turning every model on its head. We work with providers and patients to help patients outside the clinic. Truly disruptive innovation would work completely outside the system, which leads to the question, can health systems disrupt themselves or will it come from entirely new entrants like say Google, Apple, or Amazon?

Dr. David Feinberg of Geisinger reads from debate opponent Dr. Robert Pearl’s book

Clayton Christensen, the closing keynote speaker, likens hospitals to mainframe computers, and basically says they will be overtaken by smaller more nimble organizations, much like the PC and now smartphone revolution. Organizations like Iora Health who holistically and preventatively manage a Medicare Advantage population are the epitome of these new entrants, and we’ve seen some hospitals struggle this year, but will they go away entirely? The answer to this question may lie in the excellent debate session “Is The US Healthcare System Terminally Broken” hosted by Intelligence Squared and moderated by author and ABC News Correspondent John Donovan.

 

Shannon Brownlee, senior VP of the Lown Institute and visiting scientist at the Harvard T.H. Chan School of Public Health, and Robert Pearl, MD, and former CEO of the Permanente Medical group were arguing that the system is broken, vs Ezekiel Emmanuel, MD, Senior Fellow Center for American Progress, and David Feinberg, MD, CEO of Geisinger.

While prior to the debate the audience favored the idea that the system is irreparably broken, by the end, they had come around to the idea that it’s not, which would point to the ability for healthcare to disrupt itself. The debate

Is Healthcare Terminally Broken

The final audience vote

was ridiculously fun, partially from the enthusiasm of the debaters, and because the topic was so dear to all attendees. You can listen to the podcast yourself. However, the posing of the question set up an almost impossible challenge for Pearl and Brownlee: they had to argue the patient is terminal, but without any possible solution. No one in the room wanted to hear that, and so when Emmanuel and Feinberg were able to point to innovative programs like the Geisinger Money Back Warranty or Fresh Food Pharmacy that just needed to find scale, the audience latched onto the hope that we can fix things, and we all have to believe in these points of light, to face each new day of challenges.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare Technology, Healthcare transformation

Leave a Comment (0) →

Who Defines Value?

Pharma companies have recently jumped on the value bandwagon with proposals for value-based drug pricing based on outcomes and effectiveness. They have started to enter contracts with payers for specific drugs based on the impact the drug has on the condition the drug is treating.

This is a step in the right direction, and much better than pricing based on maximizing shareholder value, but value is in the eye of the beholder, and the patient is a key stakeholder. Shared decision making does a good job defining what’s important to a patient. The goal of shared decision making is to choose courses of care that offer the best outcome to the patient, and can consider some of the following:

  • Is this procedure my only option? What are alternative types of treatment?
  • What are the possible outcomes and side effects of each option, including the option of doing nothing?
  • What is the estimated cost of the procedure and any related follow-up care or medication?

Source: Center for American Progress

Simply, value can be defined by the following.

The challenge of the equation is in the definitions of acceptable outcomes and costs. Here are a few things that people might consider when evaluating a drug or a course of care.

  • Inconvenience or effort: How much does this disrupt their life? Does it prevent the person from doing other things?
  • Cost: How much does it cost? This could be in monetary terms, time, side effects, or quality of life.
  • Outcome: What is the expected outcome and how closely does it align with the outcome that’s important to me?

You can see that based on these factors, that healthcare can be a market of one. My idea of value and acceptable outcomes could be very different from yours. And, unfortunately, the patient is not a consumer in a free and transparent market. That said, it is possible to make consumer-like decisions in healthcare.

Let’s look at the value decision I tried to make this past weekend. I fractured and dislocated a finger while playing Ultimate Frisbee. I was pretty sure the finger was dislocated, which shouldn’t be a big deal, so tried to go to urgent care where I expected value based on time, outcome, and cost. Well guess what? Urgent care is not open on a Saturday night. I had a feeling that emergency care would not meet my value criteria of effort, since I expected a long wait, and I got it. On the cost, I did know that the provider I went to was in-network so that wasn’t a big issue, but I still don’t know the total cost if I’d had to pay out of pocket.

Waiting in ED

Waiting

Outcome was great, and the level of care was great. What was not great is that it took 4 hours to get x-rays, pop my finger back in, and splint it. If I had been choosing as a consumer, I’d never have chosen this. With higher deductibles and co-pays, people are making decisions as consumers which is why hospitals advertise wait times, and some are looking at how to completely overhaul the ER, both of which would get us closer to value.

Let’s look at an example on value-based drug pricing. Back when I had the Cadillac of US healthcare plans when I was working at Microsoft, I was prescribed a topical psoriasis drug. The expected outcome was no psoriasis lesions. The cost was $800 for a 60g tube. Since I didn’t have to pay anything out of pocket, I got the prescription. Did it work? Yes. Was it worth it to me? No. I had other creams that cost much less, and worked almost as well. I didn’t end up getting it again—I wouldn’t have paid $800 for it myself, so why should my employer? If cost is not part of the equation, people are making decisions with only partial information, and can’t possibly judge value. Co-pays and transparency can help guide people to consumer-like behavior in healthcare, even in an imperfect market.

What’s the upside? The upside is that we’re having these discussions, and that we can see a shift to value and consumer focus, even without legislation, which is really how it needs to happen. The other thing to remember is that people want to deliver excellent and quality care. Everyone I met during my finger ordeal, from the admitting staff to the x-ray tech, to the resident who was excited to see a dislocation he’d never seen before was excellent, and that defines quality in my mind. Maybe we have less far to go than we thought.

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Outcomes

Leave a Comment (0) →

Trends That Survive Healthcare Reform

While many aspects of the Affordable Care Act drove significant new opportunities, innovation and change in healthcare, this recent article from Harvard Business Review points out that there are trends that are not dependent on the system. In particular they identify three trends that are not dependent on the act in its current form:

  1. Aging population
  2. Technology adoption
  3. Discoveries in life sciences

However, we think there are at least three more that will mean that the momentum in technology innovation and a patient-centered approach will continue.

  1. Consumer focus: High deductibles are driving two types of behavior. Patients are acting more like consumers and are shopping with their healthcare dollars. Healthcare organizations are trying to attract patients and better understand their experiences and pathways through the organization. The expectation of good and real-time service is high.
  2. People are getting less healthy: While we would like to see this change on its own, through diet and exercise, the fact is that people are not eating well or active enough, and the rates of diabetes and pre-diabetes are increasing. By 2030, it’s estimated that over 470M people world-wide will have pre-diabetes.
    Leading causes of death

    Leading Causes of Death from http://www.independent.co.uk/news/health/the-things-most-likely-to-kill-you-in-one-infographic-a7747386.html

  3. Value stays top of mind: Our healthcare costs cannot keep rising indefinitely, and experiments in value-based payments have shown to work. Payer/provider organizations are looking to deliver better outcomes at lower costs, and patient self-management and self activation can help with that.

While patient engagement is not the only solution, we believe activated people and patients are an under-utilized source of positive health outcomes. Regardless in of changes in the healthcare act, that will remain true.

Patient engagement has been a mantra for those seeking to reform health care, as it’s widely accepted that patients who are engaged in their own health care have better outcomes. Frank Baitman & Kenneth Karpay

 

Posted in: Healthcare Policy, Healthcare transformation, Outcomes, patient engagement, Uncategorized

Leave a Comment (0) →

T2 Telehealth aka ATA 2017 aka ATA 23: Part 2, How Did We Get Here and Where Are We Going?

This was my second trip to Orange County Convention Center this year, so it was hard not to compare and contrast the annual American Telemedicine conference to HIMSS, the biggest health IT conference. As well, it was my third time at the ATA conference, back after skipping in 2016, and the gap made it easier to reflect on previous years as well.

The ATA annual is almost 10 times smaller than HIMSS, which makes it a lot less exhausting and easier to focus. There’s not a feeling that for every second you’re talking to someone you’re missing out on talking to someone else equally as interesting and valuable. (There is no shortage of interesting people, just a more manageable group.) The size also makes it a bit easier to talk to people as they’re not rushing off to walk a few miles across the convention center to the next session.

The first year I attended, 2014, the tradeshow floor was full of integrated hardware and software solutions, and Rubbermaid was even a vendor selling telemedicine carts. It was almost as though the iPad hadn’t been invented.  It was the year that Mercy Virtual launched their services as a provider of telestroke and telemonitoring for other health systems. A provider as a vendor caused a bit of a stir on the tradeshow floor.

By the next year, the integrated hardware and software vendors were dwindling, but talks were largely still given by academics and were focused on pilot projects that while showed success, talks often ended with a plea for thoughts on how to scale the program.

ATA evolved out of an academic conference and that’s still quite prevalent in the presenters who are often from academic medical centers, and reporting on studies rather than implementation. Data was important in all sessions, but measurement of value was inconsistent. In addition to academic medical centers, most leaders in telehealth seemed to be faith-based not-for-profits, like Mercy and Dignity, and as well as rural organizations where the value was clear.

That said, a welcome addition to this year’s content was two new tracks on Transformation and Value. I spoke in the Value track at ATA, along with Reflexion Health and Hartford Healthcare about the value of telerehab in total joint replacement, and we were able to share data points from real patient implementations, in addition to clinical studies. (If you’re interested, in the Wellpepper segment, get in touch.)

Although, harkening back to the day 1 keynote, the definition of value depended on the business model of the telemedicine platform being implemented. There’s no question that telestroke and neurology programs, and telebehavior programs deliver value especially in rural areas without direct access. At Wellpepper, we’ve seen definite results in post-acute care, both in recovery speed and readmissions.

In other sessions the value was not as clear and no one was able to fully refute the study that when offered the choice, patients used telemedicine in addition to in-person visits, thus driving up costs. In fact, the director of telemedicine for a prominent healthcare organization confirmed that patients were using televisits for surgical prep when they could have just read the instructions given to them. (Or interacted with a digital care plan like Wellpepper.)

As with every technology conference the voice of the patient was absent, with the exception of head of Mercy Virtual Randall Moore, MD who started all his presentations by introducing us to patient Naomi who was able to live out her life at home, attend bingo, and enjoy herself due to the benefits of the wrap-around telemedicine program that Mercy put In place. Oh, and it cost a lot less than the path of hospital admissions she’d been on previously. Sounds like triple aim, and what we all need to aspire to.

So, based on the keynotes, the sessions, and the show floor, I’d characterize this year’s conference as a world in flux, like what’s going on elsewhere. There was a sense of relief that the ACA had not been repealed. HIMSS took place before the proposed repeal and replace plan died, and there was a lot more fear and uncertainty. Vendors and providers alike are looking to strengthen the value chain. Unlike HIMSS, there was a lot less hype. Machine learning and AI were barely mentioned except in keynotes possibly because telemedicine is still largely a world of real-time visits, and extracting meaning from video is a lot harder than from records. We see promise, people want to do the right thing, but it’s not clear which direction will help us ride out the storm.

 

Still trying to figure out what this has to do with Telemedicine. Look better on realtime visits?

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Healthcare Technology, M-health, Prehabilitation, Rehabilitation Business, Telemedicine

Leave a Comment (0) →

T2 Telehealth aka ATA 2017 aka ATA 23: Part 1, The Eye of the Hurricane

While there is a focus on transformation, value, and outcomes going on, if the keynotes are any indication it may be a rough road ahead for telemedicine.

“It’s the 23rd year for the American Telemedicine Association conference, why are we still talking about how to get paid?”, admonished Pamela Peele, PhD economist and Chief Analytics Officer of UPMC during the opening keynote of the annual conference of the American Telemedicine Association.

Pamela Peele at ATA2017

Pamela Peele at ATA2017

“Especially since, as this audience knows, telemedicine is the best thing since sliced bread?

Why indeed? Well, it’s complicated. The problem is that each person in the value chain, the payer, the physician, the healthcare organization, the patient, and the patient’s closest adult daughter (aka primary caregiver), only see the value of one slice of that loaf of bread, and we collectively as purveyors of telemedicine have to sell the entire loaf. There’s no clear solution to this problem. However, with unsustainable costs of healthcare, and increasing consumerization we have got to figure it out. The taxpayer is bearing the brunt of the costs right now, and Peele characterized the shift of baby boomers to skilled nursing facilities as a hurricane we are unprepared for. One way out is to keep people at home, and for that we need Medicare to fund a cross-state multi-facility study to determine efficacy, value, and best practices. Fragmentation of trials is keeping us from wide scale adoption.

The Adaptation Curve

The Adaptation Curve

“We have got to figure it out” was also the theme of best-selling author and New York Times columnist Tom Friedman’s keynote promoting his new book “Thank-You For Being Late.” Friedman claimed to be more right than the rightest Republican and suggested abolishing corporate taxes and at the same time more left than the leftist Bernie Sander’s supporter suggesting we need an adaptable safety net. His major thesis is that we are undergoing 3 climate changes right now: globalization, climate, and technological. To survive and thrive in this new world, we need to adapt and evolve, and take our cues from Mother Nature, not from some sort of top-down regulation. Like Peele on the previous day, Friedman also sees a hurricane coming and suggests that the only way to survive is to find the eye of the storm not by building a wall.

Adapting and evolving will come in handy with the harder times for healthcare investment ahead predicted by the venture investing panel in the day 3 keynote. Tom Rodgers of McKesson Ventures, and Rob Coppedge of the newly formed Echo Health Ventures pulled no punches, as they tossed of tweet worthy statements like “Don’t tell me you’re the SnapChat of healthcare” and “it seems like there are only 3 business models for telemedicine.” The later was Coppedge’s comment on walking the tradeshow floor. (The models are direct to consumer, platform, and as a combined technology and service.) Rodgers had no love for direct to consumer models or anything that targeted millennials who he deemed low and inconsistent users of services. Platform vendors were advised to surround themselves with services: video was seen as a commodity.

So where does that leave us? Value, value, value. The challenge is that the value is different depending on the intervention, the patient, the payer, and the provider. Preventing readmissions, aging at home, decreasing travel costs, all provide benefits to one or more of the key stake holders. Can we figure out how to reimburse based on slices of value? How do we get together to realize that value? And how do we do it before the hurricane hits?

Posted in: Behavior Change, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare transformation, Telemedicine

Leave a Comment (0) →

Telehealth 2.0: Our picks for Orlando

File-2016-3478-2017_ATATradeshow_1920_25I am really looking forward to heading to Orlando for the American Telemedicine Conference, aka Telehealth 2.0. Seattle has been under a rain cloud this entire year, and I want to see the sun. I’m also looking forward to sharing our findings in using asynchronous mobile telehealth for remote rehabilitation with patients recovering from total joint replacement. I’ll be speaking with our colleagues from Hartford Health, Reflexion, and Miami Children’s Hospital on Sunday during the first breakout sessions. Hope to see you there!

In addition to the topics about legislation and regulations, it’s great to see these sessions on value, quality, and new treatment models. Here are some of Wellpepper’s picks for the conference.

Sunday

Monday

Tuesday

Now with all this great content, networking and a talk to prepare, when will I see the sun?

Posted in: Adherence, Behavior Change, Health Regulations, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare Research, Healthcare Technology, patient engagement, Telemedicine

Leave a Comment (0) →

Wellpepper attends Episodes of Care Summit at Cambia Grove

Last week, Wellpepper CEO, Anne Weiler and I attended a half-day Episodes of Care Summit put on by Cambia Grove. It was great to see payers, providers and technologists come together to focus on initiatives that directly impact the patient experience. Here are some of our takeaways:

Horizon BCBS of New Jersey is an episodes of care pioneer

Focus on retroactive bundles before proactive. Episodes of care and bundled payments are often used interchangeably. An episode of care typically refers to a payment made retrospectively while a bundled payment typically refers to a payment made prospectively. Horizon BCBS of New Jersey first launched retrospective pilots in 2010 (total hip and total knee replacements). In this model, savings are shared with the physician or practice once quality benchmarks and patient experience thresholds are met and costs come in below budget. After 7 years of scale and success, Horizon is now launching more immediate, risk-based, prospective initiatives in 2017.

Drive success through quality. Horizon piloted with over 200 quality metrics with member-specific, risk-adjusted financial targets. Metrics are key in driving success. Identify 3-5 standard quality metrics and 2-4 episode-specific metrics.

Community involvement is imperative

It’s great to see continued focus on community involvement in innovation and healthcare. The Bree Collaborative is an excellent example of bringing together community and industry leaders to identify and promote strategies that directly impact patient outcomes, quality and affordability. Wellpepper firmly believes in the work that the Bree Collaborative is doing. In fact, our total joint and lumbar fusion care plans follow Bree recommendations.

The Episodes of Care Summit held breakout sessions that mapped out the ideal episode of care/bundle experience through the lens of people, process and technology. Think of people, process and technology as a three-legged table. Remove one leg and the table falls. If the three legs are not the same size, the table does not function properly. Effort needs to be allocated equally across people, processes and technology to drive behavior change. Reimbursement seemed to take a precedence in every conversation rather than the patient’s needs or the provider’s care. Until this mindset is fixed, it’s hard to focus on what healthcare is really about. Dr. Hugh Stanley, from the Bree Collaborative did an excellent job bringing the focus of the conversation back to the patient.

Memorable quotes from breakout sessions:

  • “Patients need to be at the center of episodes of care.”
  • “We need to capture patient satisfaction in real time.”
  • “I’m blown away I can get more info on a dog bed than a provider.”
  • “We need to rebuild the patient deductible and copay mindset.”
  • “The payer community has a responsibility to share information to publicize data that drives provider readiness.”
  • “Creating episodes vs bundles benefits providers and ultimately patients.”

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, patient engagement, Patient Satisfaction, Uncategorized

Leave a Comment (0) →

Using AWS with HIPAA-Protected Data – A Practical Primer

When we started building the Wellpepper platform four years ago, we thought carefully about how to build for privacy and security best practices as well as HIPAA compliance, since we work with customers in the healthcare industry. We chose to build the system entirely on Amazon Web Services (AWS), and learned a few things in the process about building HIPAA compliant applications on AWS. Hopefully this will be helpful to others considering AWS as the home for their healthcare online service, whether you’re a software company hoping to sell to healthcare systems (as a “Business Associate” in HIPAA terminology) or an internal development team at a health system (a “Covered Entity”).

It’s Not Rocket Science

As you probably already know, the Health Insurance Portability and Accountability Act (HIPAA) is made up of several parts. Usually when IT people talk about “HIPAA compliance”, they are talking about the Title II Security Rule which governs privacy and security practices for electronic protected health information (ePHI).

Many of the requirements in the HIPAA Security Rule are simply best practices for security and data privacy that have been written into law. Things like encrypting traffic travelling over a network. Anyone building good, secure software, should be following these principles anyway. You need to be informed of the requirements, and you need to make sure you establish ongoing practices for maintaining security and privacy, but it’s not rocket science. In fact, your health system (or healthcare customers) may actually have more stringent or additional data security requirements to what is required by HIPAA.

Our experience is that HIPAA isn’t a major departure from what we would have built anyway.

Stay Up To Date

HIPAA was established in 1996, with the final Security Rule being published in 2003. In some cases, the guidance has not kept up with current threats and practices in 2017. If you are developing healthcare software, you should be applying industry best practices in combination with the HIPAA requirements. Your ultimate goal needs to be protecting patient data, not just regulatory compliance. Invest in training yourself and your team and staying current. Some resources we found helpful:

Take Responsibility

Compliance usually isn’t at the top of an engineering team’s list of fun things, so it’s tempting to look for solutions that can abstract away the responsibility. There are a few online healthcare platform-as-a-service hosters that make claims in this direction. Be wary of these. No service can remove your responsibility for compliance.

We decided that using AWS infrastructure services was the best level of abstraction. This let us build new services, host data, and install 3rd party applications in our VPC with high confidence that we were living up to our promises to protect patient data.

In addition to thinking about your software solution, compliance also covers your business practices and policies for things like training, background checks, and corporate device security – securing your people. These are often overlooked areas that are really important, since security researchers complain that people are the weakest link in the security chain. As with your software design, the application of commonsense practices and good documentation will go a long way.

There is no single group that certifies systems as HIPAA compliant. However, HHS can audit you at any time, whether you’re a covered entity or a business associate. You should do your own internal assessments against the HIPAA Security Rule both when you are building new capabilities, and on an annual basis. Augment this with external third party reviews. You’ll want to be able to show summarized reports of both your internal process and a stamp of approval from an external auditor.

HHS produces a tool called the SRA tool which you might find useful in performing security rule assessments: https://www.healthit.gov/providers-professionals/security-risk-assessment-tool. We used this for a couple years, but now just use an Excel Spreadsheet to evaluate ourselves. Bonus: this is probably what your auditor will want to see.

This Risk Toolkit from the HIPAA Collaborative of Wisconsin is a good starting point, and looks very similar to the spreadsheet we use: http://hipaacow.org/resources/hipaa-cow-documents/risk-toolkit/ (look at the Risk Assessment Template).

Share the Responsibility

AWS certifies a subset of their services for HIPAA compliance. This includes restrictions on how these services are used, and requires that you enter into a Business Associate Agreement (BAA) with AWS. This agreement establishes the legal relationship needed to handle ePHI, and ensures that you’ll be notified in the unlikely event that there is a data breach.

When you sign a BAA, you enter into a shared responsibility model with AWS to protect ePHI. AWS largely covers physical security for their facilities and networks. You can view their SOC audit results on request. You own the security for your applications and anything else from the OS on up. For example, if you use Elastic Compute Cloud (EC2) instances, it’s your responsibility to keep those instances patched.

AWS occasionally adds new services to their HIPAA-certified services, so you’ll want to check occasionally to see if there are new services you might be able to take advantage of.

Draw a Bright Line Around Your ePHI

At any time, you should be able to quickly say exactly which parts of your system (which servers, which network segments, which databases, which services) have or store ePHI. These systems are inside your bright line defense perimeter, are subject to HIPAA regulations including breach notifications. That means if you lose data on one of these systems, you need to notify your patients (or if you are a Business Associate, notify the Covered Entity so that they can notify the patients).

EC2, Simple Storage System (S3), Elastic Load Balancing (ELB), when used in accordance with guidelines can be HIPAA compliant. Make sure you read the guidelines – there are usually certain restrictions on usage in order to be covered. Many of AWS’ platform-as-a-service offerings are currently not offered under the AWS HIPAA umbrella (for example Kinesis and Lambda). You can still use these services, just not with ePHI.

Many modern systems designs make use of 3rd party framworks and SaaS offerings for things like analytics, monitoring, customer support, etc. When you are holding and conveying ePHI, you will need to be careful about which dependencies you take. For example, in one of our recent product updates we were considering using an external web & mobile analytics platform to better understand our traffic patterns. We walked through our use cases and decided that while none of them required us to send any ePHI to the analytics platform, the risk of accidentally sending some piece of protected data was too high. So we came up with a different plan that allowed us to keep PHI within our safe boundary and under our direct control. Many of your decisions will be grey-area tradeoffs like this.

Secure at Rest and Over the Wire

This is often the first question we see on any healthcare IT security review. How do you protect data at rest and over the wire? Use strong SSL certs with robust SSL termination implementations like ELB. If you terminate your own SSL connections, they need to be well patched due to evolving threats like Heartbleed, POODLE, etc. You may choose to do further application-level encryption in addition to SSL, but SSL should usually be sufficient to satisfy the over-the-wire encryption requirements.

For at-rest storage, there are many options (symmetric/asymmetric) that will depend on what you are trying to do. As a baseline, AWS makes it incredibly easy to encrypt data with AES-256 both in S3 or in the Elastic Block Store (EBS) drives attached to your EC2 instances. There’s almost no reason not to use this, even if you are using additional encryption in other layers of your architecture. AES-256 is usually the “right answer” for IT reviews. Don’t use smaller keys, don’t use outdated algorithms, and especially never try to roll your own encryption.

Good guidance in this area is easy to find:

Logging and Auditing

A key HIPAA requirement is being able to track who accessed and changed patient records and verify the validity of a record. Even if you don’t make this available through a user interface, you need to log these actions and be able to produce a report in the case of an audit or a breach. Keeping these logs in encrypted storage in S3 is a good way to do this. You’ll want to restrict who has access to read/write these audit logs as well.

In addition to automatic audit trails generated by your application-level software systems, remember to carefully keep track of business-process events like granting someone access to a system or revoking access. AWS CloudTrail can help track system changes made to AWS resources like servers, S3 buckets, etc.

Authentication

All healthcare applications will need a way to identify their users and what permissions those users have. HIPAA is not specific about authentication systems beyond being “reasonable and appropriate” (164.308(a)(5)(ii)(D)), but does require that you have good policies in place for this. Here you should follow well-established security best practices.

For starters, you should try not to build your own authentication system. In purpose-built systems, you may be able to integrate into an existing authentication system using oAuth, or SAML (or maybe something more exotic if you’re plugging into some legacy healthcare application). In patient-facing applications, you may be able to integrate with a patient portal for credentials – this is something that will probably show up on your requirements list at some point anyway. If neither of these apply, you may be able to use another identity provider like AWS’ Identity and Access Management (IAM) system to manage user credentials. We briefly tried using consumer-facing oAuth using Facebook, but quickly found that consumers are (rightly) worried about privacy and chose not to use this method.

If you find that you need to build an authentication system, be sure to follow current best practices on things like how to store passwords securely, as well as other tricky areas like password resets.

Since Wellpepper is often deployed standalone before being integrated into other back-end systems, we offer a built-in username + password authentication system. One silver lining to building this ourselves is the ability to build meaningful password complexity rules, especially for patients. Some of the traditional healthcare systems have truly draconian rules that are not only user un-friendly, but actively user-hostile. Thankfully, the best practices in this area are changing. Even the draft NIST password recommendations, updated in August 2016, trade some of the human-unfriendly parts of passwords (multiple character classes) for more easily memorable, but still secure ones (length). Also, consider the difference between health-system password requirements for clinicians with access to thousands of records and those for patients who only access a single record.

Once your users are authenticated, they will need to be authorized to access some set of resources. As with authentication, if you can delegate this responsibility to another established system, this is probably the best approach. If you are adding unique resources with unique access control rules, you will need to make sure that your authorization mechanisms are secure and auditable.

Conclusion

Creating a HIPAA-compliant service doesn’t have to be a big scary problem, but you do want to make sure you have your ducks in a row. If you’re reading this blog post (and hopefully others!), you’re off to a good start. Here are some additional resources that we found handy:

Posted in: Data Protection, Health Regulations, Healthcare Policy, Healthcare Technology, Uncategorized

Leave a Comment (0) →

What’s True Now?

 

Health systems and payers alike are scrambling to figure out what the incoming administration means by repealing Obamacare. The payers admitted to having no contingency plans if Trump won. Trump doesn’t have a clear model, and the Republican party has a number of proposals. Some involve changing the names of programs or offering them in a different way. Some involve scrapping large sections of the affordable care act.

Rather than second-guessing what’s to come, at Wellpepper, we are focusing on what’s true now and what will remain true going forward.

We believe these things will continue to hold true:

  • Innovation will continue. If anything we hope that new innovation in healthcare, and technology innovation in particular is driven by market forces rather than legislation which created winners out of what was not always the best technology.
  • Consumer-focus is good. 20M newly insured individuals and high-deductibles helped create a market for new care organizations like local urgent care and patient-focused primary care. This consumer evolution will continue as patients demand that their healthcare dollars deliver good service.
  • Value and outcome focused approaches will be rewarded. Whether it’s traditional payers or self-insured employers, the light has been shone on areas to improve care AND reduce costs. Healthcare organizations have seen investments in outcomes pay off as well.

It’s time for a new patient experience that is real-time, connected, and based on the individual. We need to take advantage of the ability of technology to scale, analyze, and deliver personal experiences to leapfrog the current technology implementations in healthcare and deliver better outcomes and greater value in healthcare.

Posted in: Health Regulations, Healthcare Legislation, Healthcare Policy, Outcomes

Leave a Comment (0) →

Is Connected Health Entering The Mainstream?

I’m just back from Parks Associates 3rd Annual Connected Health Summit. The summit, which began with a focus on consumer health and devices, is broadening to include the consumer experience in all digital health. Most attendees were from technology, payer, and device industries rather than healthcare organizations, and I was struck that a lot of the discussion of about the data from devices, predictive analytics, and natural language processing was beyond what we’re seeing in implementation in healthcare industries today.

Evolution of Digital Health

Evolution of Digital Health

Possibly because Parks Associates focuses on consumer data, and also that the conference has been consumer-device focused in the past, attendees and presenters included telecommunications companies, and even home security companies. This was my first time at the conference but from the data presented by Parks it seems as though digital health, and consumer focused health has become accepted as inevitable and mainstream. A few examples include ADT, the home security company talking about in-home sensing to enable seniors to stay in their homes longer, and Wal-mart talking about meeting healthcare consumers where they are. All of this is a far cry from traditional healthcare delivery. There was also a belief that digital health and the digital health consumer touches everyone from seniors, to the example that for many homeless people their most prized possession is their mobile phone.

Top takeaways:

  • There is no silver bullet for mobile health, digital health, or sensors.
    • Personalization is going to be key as the drivers for engaging in health are different for each person
  • There is no digital health consumer. Segmentation is very challenging in this market. Parks Associates Research identified 4 consumer groups, and 14 segments within those groups.

Digital Health Segments

  • Technology is currently out-pacing implementation possibly due to a slower transition to value-based care than the speed of consumer technology adoption.
  • People are sometimes consumers and sometimes patients, and this is not mutually exclusive.

From Fee For Service To Value-Based Payments

I had the pleasure of participating on a panel on moving to value-based care with Dr. Alexander Grunsfeld, Chief of Neurology from our customer Sentara Healthcare, and Angie Kalousek  from Blue Cross/Blue Shield of California. Too often value gets lumped into the idea of bundles versus fee for service, instead of considering the triple aim of healthcare and delivering the best patient experience and outcomes cost effectively. Fee for service remains the stumbling block to value-based care and organizations have to straddle two worlds when considering implementing two programs. Those who can effectively cross the chasm from fee-for-service to value-based care will be the ones who succeed in the long run, and especially those who consider options before they are legislated to do so.

Crossing the chasm from fee for service to value-based payments

Crossing the chasm from fee for service to value-based payments

Our headache management project with Sentara started from the need of one neurologist to manage his caseload. He had too many patients and not enough data, and needed a way to identify patients that needed the most help and also to enable patients to self-manage their headaches. Interestingly, though although the problem that he was trying to solve was focused on access, in a fee-for-service world, initial appointments are compensated at a higher rate that follow on appointments, so decreasing the need for follow on appointments could actually increase revenue. In an exact opposite scenario, this project has caught the attention of those in Sentara’s health plan, Optima, and they are looking to use this patient self-management to decrease ER costs by enabling patients to better self-manage.

Audience poll on in-home care

Audience poll on in-home care

Posted in: Adherence, Behavior Change, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient engagement

Leave a Comment (0) →

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

Leave a Comment (1) →

Our Picks for APTA CSM 2016

APTA CSM 2016Wellpepper CTO Mike Van Snellenberg will be at APTA CSM in Anaheim this year, and here are a few of the sessions you might see him at. If you want to be sure to see him, book a meeting.

As usual we’re following sessions about healthcare transformation, patient experience and patient centered care, patient reported outcomes, and interventions that include technology. With the conservative care and physical therapy being an important part of new bundles like CMS’s Comprehensive Care for Total Joint Replacement, these are hot topics as well.

Here are a few session picks from Wellpepper.

Patient-Centered Care

Exercise and Diabetes: Tools for Integrating Patient-Directed Practice

The Customer Experience in Health Care: The Game Changer, Part 1

Words Mean Things: How Language Impacts Clinical Results

Acute Care Productivity Measurement, “What about the Patient?” The Time has Come to Shift to a Value Based Measurement System

Technology

Wearable Technology Meets Physical Therapy

Virtual Reality and Serious Game-Based Rehabilitation for Injured Service Members

Tracking Outcomes

Changing Behavior Through Physical Therapy: Improving Patient Outcomes

Functional Reconciliation: Implementing Outcomes Across the Continuum

Using Outcomes Data to Improve Provider, Patient and Payer Engagement and Demonstrate the Value of Your Services

Healthcare Transformation and New Models of Care

Exceptional Care and Profitability in Light of Health Care Reform for Patients with Chronic Musculoskeletal Pain

The Complicated Hip: A New Debate

Emerging Issues in Medicare and Health Care Reform, Part 2

Bundled Payment Implementation for Primary Total Joint Patients

Managing Patient-Centered Care in a Changing Reimbursement World

Health System PT’s Leading the Transition to Value-Based Health Care

Posted in: Adherence, Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Policy, Healthcare Research, Physical Therapy, Prehabilitation, Rehabilitation Business

Leave a Comment (0) →

Hot topics of 2015 from the Wellpepper Blog: It’s All About Value

As we get ready for big changes in 2016, especially in the world of value-based payments, let’s take a quick look at our most popular blog posts of 2015. Not surprisingly, they are related to changes coming with bundles and value-based payments, and the role of patient-reported outcomes and patient engagement.

In no particular order, here are our most popular blog posts from 2015.

From Wellpepper CTO, Mike Van Snellenberg.

http://wellpepper.wpengine.com/decreasing-the-patient-survey-burden-for-total-joint-pros

From Wellpepper, VP of Business Development, Robin Schroeder-Janonis

http://wellpepper.wpengine.com/does-healthcare-need-a-call-to-minga

And from Wellpepper CEO, Anne Weiler

http://wellpepper.wpengine.com/value-based-bundles-for-total-joint-the-glass-is-more-than-half-full

And from Wellpepper Business Analyst, Liz Zampino

http://wellpepper.wpengine.com/2016-the-year-of-telehealth

 

Posted in: Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare transformation, Outcomes

Leave a Comment (0) →

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

Leave a Comment (0) →

Does Healthcare Need a “Call to Minga”?

ihi-logoIn the most recent months, I have experienced a lot of “firsts” since I have joined Wellpepper. Although still in healthcare, I have ventured into the patient engagement space which has opened up a whole to new world. This technology is evolving in the marketplace with the charter of quality, value and engagement, specifically around the patient. This is one of the reasons why I joined Wellpepper…..we are about improving the patient experience.

Attending the Institute for Healthcare Improvement National Forum in Orlando (IHI) last week was another “first”. This conference was focused around how we change and improve healthcare for the patient. There was a real sense of community at this conference among the attendees. Everyone was focused on the patient and how to better serve and improve outcomes.

Unlike other conferences I have attended, I was able to participate in several sessions. Even though we exhibited at this forum, attending the sessions provided me with a different perspective on what healthcare professionals are really concerned about and how they are looking to learn from others on how to “fix” it. Again, another “first”.

The atmosphere at the conference was very upbeat and optimistic but there is a transition happening at the helm of IHI. Maureen Bisognano, President and CEO for the last 12 years, she will be retiring after 27 years at IHI. She gave the opening keynote which was very inspirational and echoed the commitment of IHI to improve the quality in healthcare for the better of the patient. Her theme was all about collaboration among the healthcare teams to give care with the patient and not just to the patient. Quality should be everyone’s job and that is why they developed the Breakthrough Collaborative at IHI. This brings together patients, families and health systems to improve the care.

We need to understand what matters to the patient and not what we think matters. In the session, “Thriving in a Value-Based Environment”, Anna Roth, CEO of Contra Costa Health Services, emphasized what matters to patient might not be their health problem but their ability to buy food, pay rent, and job security. So value for that patient goes beyond addressing their health issue but rather access to other life sustaining needs. Furthermore, when you engage with your patients be prepared to act. Lisa Schilling from Kaiser added during this session – “find the problems that really matters and then find an elegant solution”.  This can lead to innovation both from a technology perspective and re-design of care plans for that patient community. As an example, physicians are now prescribing community parks as part of their treatment plans to help address obesity and get their patients moving.

This theme echoed with the other keynote speakers such as Earvin “Magic” Johnson. He was on course with his message of bringing together a sense of community to improve healthcare access and services in the urban cities. He stressed people can make a difference if we just listen to what matters to the community. He has engaged with many charities to address the food deserts that plague our urban cities.  Providing better options to fruits and vegetables will result in healthier communities.

However, the keynote from Craig Kielburger really hit home for me. Craig is the co-founder of Free the Children, an international charity; Me to We, an innovative social enterprise; We Day, a signature youth empowerment event. His journey to where he is today started when he was 12 years old. He was touched by a tragic event with a young Pakistani boy by where he felt compelled to make a difference in children’s lives. Today, he is building schools and empowering our young to make a difference.

So what has this got to do with a “Call to Minga” and healthcare? Craig experienced a “Call to Minga” for the first time more than a decade ago when he and his brother Marc (co-founder of Free the Children) went to Ecuador to build a school with volunteers. Given unforeseen obstacles such as transportation for building materials was difficult and the time to transport was longer than anticipated, his team was falling short of completing the school….in fact, they didn’t even get a chance to start it.  They were two days from traveling back to North American when he and his brother had to explain to the Chief of the village that they would not be able to complete their task. At that moment, the Chief went outside her hut and called “Minga”. The next day, people from surrounding villages ascended upon this village and began to work on building the school and completed it. The “Minga” was a call to action. It is a community coming together to work for the benefit of all.

This is what was happening at IHI, a call to action. We must come together as a healthcare community and work to improve healthcare for patients and overall, our country. Our community consist of caregivers, educators, innovators and the patient. With all the resources available to us, we can have a “Minga” moment. Here at Wellpepper, our “Minga” moment is now. Health systems are hearing the call to action to engage their patient in a fashion that supports their live style along with the technology they use every day.  Our technology allows patients to personalize their care plans that will drive ownership and improve outcomes because we are able to provide them with what matters. This is a “first” for the patient!

Since this is probably my last blog post of 2015, I invite you to consider your call to Minga at your organization for 2016. There is so much we can do together!

Posted in: Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Policy, Meaningful Use, Outcomes, Patient Satisfaction

Leave a Comment (1) →

Digital Health and the Influence on Healthcare: Wearables, Telehealth, & Treatment

Things are looking up in the world of digital health at least this was the view from “Digital Health and the Influence on Healthcare: Wearables, Telehealth, & Treatment.” The WBBA held their last event of the season with a panel on digital health, hosted by Russell Benaroya, CEO of Everymove, and featuring Dr. John Scott, Director of Telemedicine at UW Medicine, Davide Vigano CEO and co-founder of Sensoria, Mike Blume, independent healthcare consultant, and myself. I’d characterize the overall event as being optimistic and realistic, both from the panel and the attendees.

Digital health event

It was a dark and stormy night

No one said that the road to digital health was easy or fast, but the consensus that things like moving to the cloud, and the acceptance and adoption of patient-driven digital care is reaching a turning point.

Both Sensoria and Wellpepper’s business models are made possible by the cloud. For Sensoria this was the ability to process millions of datapoints coming from their wearable technology. For Wellpepper, this is our ability to rapidly implement solutions working with department heads facing a particular challenge in patient engagement and outcome tracking and improvement. Dr. Scott remarked on the dramatic drop in the cost of telemedicine solutions over the years he’s been an advocate and solutions due to both Moore’s Law and cloud computing over his tenure running telemedicine at UW.

Sensoria's Quantified Socks

Sensoria’s Quantified Socks

As well, although Dr. Scott highlighted how telemedicine was limited by arcane reimbursement models that did not allow for patients to receive telemedicine consults in their homes, he and other panelists discussed that they were not waiting for billing codes to do the right things in using technology to deliver better care. As usual, the Affordable Care Act was seen as a big driver as patient-centered and digital care.

Possibly because there were two ex-Microsoftees on the panel (Davide and me) a cloud-based platform approach was touted as the best way to both collect, analyze, and sort the data that came in directly from patients. In the case of Sensoria and Davide, this was to look for trends and patterns coming from sensor-integrated clothing, and in the case of Wellpepper it was to collect patient outcomes in the context of care and compare these across patients, procedures, and healthcare organizations.

This view led to a discussion about the proliferation of data, and everyone agreed that digital health has the ability to overwhelm health systems with data that they are currently not prepared for. EMRs are not set up to include sensor or patient-reported data, and as Dr. Scott pointed out, physicians are not looking for every data point on a patient, only the anomalies, like glucose out of range.

One audience member asked about whether healthcare organizations had an overall data strategy, and whether digital health data should be collected as part of that. It’s an interesting idea to consider but it seems like it’s still a long way off in healthcare. Does your organization or CIO have an overall data strategy? It seems that quality measures and the need for patient reported outcomes are introducing new requirements for data, but this is at the departmental or initiative level. Grappling with questions like this will be important as connected devices, digital, health, and patient reported outcomes enter the mainstream.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Outcomes, Telemedicine

Leave a Comment (0) →
Page 1 of 2 12
Google+