Interoperability

Archive for Interoperability

Dispatches from the Canadian E-Health Conference: The same but different

Bear statue in VancouverThe annual Canadian E-Health Conference was held in Vancouver, BC last week. I had the opportunity to speak about the work we’re doing at Wellpepper in applying machine learning to patient-generated data, and in particular the insights we’ve found from analyzing patient messages, and then applying a machine-learned classifier to alert clinicians when a patient message might indicate an adverse event. Our goal with the application of machine-learning to patient generated data is to help to scale care. Clinicians don’t need to be alerted every time a patient sends a message; however, we don’t want them to miss out if something is really important. If you’d like to learn more about our approach, get in touch.

My session was part of a broader session focused on ‘newer’ technologies like machine-learning and blockchain, and some of the other presenters and topics definitely highlighted key differences between the US and Canadian systems.

Aside from the obvious difference of Canada having universal healthcare, there were subtle differences at this conference as well. While the same words were used, for the most part: interoperability, usability, big data, and of course blockchain and AI, the applications were different and often the approach.

Interoperability: Universal doesn’t mean one

Each province has their own system, and they are not able to share data across provinces. Unlike the UK which has a universal patient identifier, your health records in Canada are specific to the province you live in. As well, apparently data location for health records is sometimes not just required to be in Canada, but in the actual province where you reside and receive care. As for interoperability, last we heard, British Columbia was doing a broad roll out of Cerner while large systems in Alberta were heading towards EPIC, so Canada may see the same interoperability challenges we see here if people move between provinces.

Privacy: The government is okay, the US is not

What’s interesting is as a US company, is that whenever we talk to health systems in Canada they bring up this requirement, but as soon as you mention that the PIPEDA requirements enable patients and consumers to give an okay for out of Canada data location they agree that it’s possible. Regardless, everyone would rather see the data in Canada.

What was possibly the most striking example of a difference in privacy was from one of my co-presenters in the future technologies session, who presented on a study of homeless people’s acceptance of iris scanning for identification. 190 out of 200 people asked were willing to have their irises scanned as a means of identification. This identification would help them access social services, and healthcare in particular. The presenter, Cheryl Forchuk from the Lawson Health Research Institute said that the people who participated didn’t like to carry wallets as it was a theft target, that they associated fingerprinting with the criminal justice system, and that facial identification was often inaccurate due to changes that diet and other street conditions can make. When I tweeted the 95% acceptance rate stat there were a few incredulous responses, but at the same time, when you understand some of the justifications, it makes sense. Plus, in general Canadians have a favorable view of the government. The presenter did note that a few people thought the iris scan would also be a free eye exam, so there may have been some confusion about the purpose. Regardless, I’m not sure this type of identification would play out the same way in the US.

Reimbursement: It happens, just don’t talk about it

The word you didn’t hear very much was reimbursement or when you did, from a US speaker the audience looked a bit uncomfortable. The funny thing is though, that physicians have billing codes in Canada as well. It’s just that they are less concerned about maximizing billing versus being paid for the treatment provided and sometimes even dissuading people from over-using the system. Budgets were discussed though, and the sad truth that money is not always smartly applied in the system, and in a budget-based system, saving money may decrease someone’s future budget.

Blockchain: It’s not about currency

Probably the biggest difference with respect to Blockchain was the application, and that it was being touted by an academic researcher not a vendor. Edward Brown, PhD from Memorial University suggested that Blockchain (but not ethereum based as it’s too expensive) would be a good way to determine consent to a patient’s record. In many US conferences this is also a topic, but the most common application is on sharing payer coverage information. Not surprisingly this example didn’t come up at all. If you consider that even though it is a distributed ledger, a wide scale rollout of Blockchain capabilities for either identification or access might be more likely to come from a system with a single payer. (That said, remember that Canada does not have a single payer, each province has its own system, even if there is federal funding for healthcare.)

“E” HR

Physician use of portalFor many of the session the “E” in e-health stood for EHR, which while also true in the US, the rollout of wide scale EHRs is still not as advanced. Cerner and EPIC in particular have only just started to make inroads in Canada, where the a telecommunications company is actually the largest EHR vendor. In one session I attended, the presenter had done analysis of physician usage of a portal that provided access to patient labs and records, but they had not rolled out, what he was calling a “transactional” EHR system. Physicians mostly accessed patient history and labs, and felt that if the portal had prescribing information it would be perfect. Interesting to see this level of access and usage, but the claim that they didn’t have an EHR. What was also interesting about this study is that it was conducted by a physician within a health system rather than an academic researcher. It seemed like there was more appetite and funding for this type of work within systems themselves.

Other Voices: Patients!

Patients on the mainstageDuring the interlude between the presentations and judging for the well-attended Hacking Health finals, and on the main stage, presenters interviewed two advocate patients. While they said this was the first time they’d done it, both patients had been at the conference for years. So while the mainstage was new, patient presence was not, and patient advocate and blogger Annette McKinnon pushed attendees to go further when seeking out engaged patients. Noting that retirees are more likely to have the time to participate in events she asked that they make sure to seek out opinions for more than 60 year old white women.

There was also an entire track dedicated to First Nations Healthcare. Think of the First Nations Health authority as a VA for the indigenous people of Canada, which incorporates cultural differences and traditional practices of the First Nations people. The track started and concluded with an Elder song and prayer.

Manels

Speaking of diversity, I didn’t witness any manels.

Best Quote

 

Posted in: big data, Clinical Research, Health Regulations, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient-generated data

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HIMSS 2018: We’re having a party in your house!

From the opening keynote of HIMSS 2018, you could tell things were going to be different. Unlike last year, where actors touted the marvels of flash drives and backup storage, this year kicked off with singers from The Voice. Not sure how to interpret their music choices, though, I’m sure Leonard Cohen never envisioned his anthem Hallelujah pumping up 45,000 healthcare IT experts.

Keynote speaker Eric Schmidt executive chairman of Alphabet, admonished the crowd to get to the cloud, any cloud, even Google Cloud’s competitors. He also described a scenario with an assistant named Liz, listening in on a doctor/patient visit and transcribing notes. Ironically, this exact scenario was announced by Microsoft the week before. I’ve witnessed shifts to digital and cloud before in other industries, and it does take a village, so Eric calling on the power of the technology and being rather vendor agnostic is a good sign. That said, there were a few things in his talk that might have ruffled his audience. First, where were the partners? In the utopia of voice and cloud for healthcare that Schmidt described the only partner referenced was Augmedix, poster child for Google Glass, and absolutely no healthcare system examples. Which makes sense, as when asked by HIMSS president emeritus, Steven Lieber for his parting words to the crowd, Schmidt said:

“You’re late to the party.”

Which is an interesting comment at as he was a guest keynote speaker at a healthcare IT event and representing big tech, so you could interpret this to mean:

“You’re late to the party (that we’re throwing in your house).”

As the keynote emptied in a mass stream to the tradeshow floor, I eavesdropped on a number of conversations, and many people weren’t too happy about the message: “they (aka tech) don’t understand how complicated our lives are.” It’s an interesting conundrum, because Google et al have solved some pretty complicated problems making sense of what we’re all looking for online, a problem of completely unstructured data, and yet, as recent Facebook incidents show, there can be a lack of respect for people’s data and privacy that is crucial for any type of healthcare deployment in big tech.

The tradeshow floor itself showed a lot of new entrants, including booths from Lyft and Uber, who previously had only partnered with companies like Circulation for medical transportation, and a much larger Google Cloud and Amazon Web Services presence than the previous year. Microsoft and IBM have been at the healthcare party for a long time, and have settled in.

Big tech is indeed at the party. Who else is at the party? Purveyors of security and in particular block-chain crypto were definitely there. We saw APIs hanging around the punch bowl, this time invited by the new Blue Button 2.0 initiative, unlike previous years as the date of big tech.

Who wasn’t at the party? Patients. On the one hand, we’ve found that the digital patient experience and patient engagement is now mainstream, and our research partner Tamara Deangelis from Boston University Center for Neurorehabilitation was awesome talking about patient/provider messaging at the patient engagement summit. At the broader HIMSS conference, it seemed only vendors were representing patients. Most of the patient invitations must have gotten lost in the mail.

One CIO I talked to suggested that there was a different feeling at HIMSS this year and that this is the year we’ll look back and see that things really changed for healthcare IT. We’ve seen an acceleration of the shift to the cloud for new patient-facing applications, and a rapid realization of a need for an overall patient digital strategy. All heartening, especially since it will take everyone at the party to accomplish this transformation, debutantes and charming hosts alike.

Until next year’s party, cheers!

(Footnote: The actual Google Cloud party had a long line immediately, so some people heeded Schmidt’s words about not being late for the fantastic view of the Bellagio fountains, poke bowls, and open bar. The party was predominantly male, which hopefully isn’t part of the vision. Of course, it was at the same time as the Women in Healthcare IT event, which I heard was awesome. Perhaps a poor party choice on my part.)

Posted in: Healthcare Technology, Healthcare transformation, HIMSS, Interoperability

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4 Reasons Why the Future of Health IT is Serverless (AWS re:Invent 2017 wrap-up)

The big theme at AWS re:Invent 2017 was serverless computing. Whether deploying microservices in containers using ECS, Kubernetes, or Fargate, or building systems using Lambda that connect to serverless relational databases like Serverless Aurora or DynamoDB, Amazon is rapidly moving to remove “undifferentiated heavy lifting” common to building and deploying software applications.

Healthcare has historically been slow to move to the cloud. Some of this stemmed from spotty HIPAA eligibility, and from a desire of health systems not to be the first to break new ground. Today, however, many of the barriers have been cleared away: serverless technologies like Lambda and ECS are already on Amazon’s HIPAA-eligible services list with many more likely to come in the future.

There are many benefits to serverless architectures, including faster time to market, lower operating costs, and lower complexity. Here are 4 compelling reasons why serverless systems are uniquely positioned to thrive in healthcare:

Improved Security

The HIPAA security rule contains a number of requirements for server security. You’d be hard pressed to find a list of security recommendations that doesn’t start with patching your servers. Indeed, over the last year unpatched servers have led to several major security incidents and breaches. There are many (poor) reasons why people don’t patch. Failure to patch machines promptly is a significant risk vector.

With serverless systems, this risk vector goes away.

https://www.csoonline.com/article/3075830/data-protection/zero-days-arent-the-problem-patches-are.html

In actuality, the risk is not entirely removed; instead you’re selling it to Amazon. Underneath serverless technologies, there are still servers running operating systems. However, the bet that you’re making is that Amazon has this down to a science across their millions of servers in a way that other IT departments can’t match.

 

Governance and Compliance

HIPAA mandates a set of administrative controls that govern things like access control and auditability. This is another area that is already baked deeply into serverless architectures.

AWS contains a strong policy-driven identity and access framework in AWS IAM. This is a core component of serverless architectures to control access at every step in the architecture. Applying the ‘least privilege’ principle with IAM roles naturally limits the “blast radius” if a service does become compromised. And because policies are all held in one place, it’s easier to see and control which accounts have access to what.

Auditability and robust logging go hand-in-hand, and if serverless architectures do anything, they generate a ton of log data. Each service, from AWS Gateway routing request to VPC delivering network traffic, to Lambda services handling requests, to S3 getting and setting bulk data is heavily logged, with most logs aggregating into either S3 or CloudWatch Logs. Several of the re:Invent sessions this year explored novel ways to report on this data using tools like ElasticSearch (note: the AWS-managed ElasticSearch Service is not yet on the HIPAA eligible list), and even automatically detect anomalous usage patterns using Kinesis Analytics.

Finally, AWS Artifact organizes all of the compliance documentation for Amazon’s part of the shared-responsibility model, including things like your AWS Business Associate Addendum (BAA), and access to SOC2 audits.

All of this stuff is just baked in, and there’s hardly any work needed to make use of it.

 

Availability and Scalability

While the security and encryption parts of HIPAA get most of the attention, it also contains provisions for ensuring availability, business continuity, and emergency mode operations.

Capacity and availability is something that used to be hard to plan in the days of individual server instances. A well-designed serverless architecture, by contrast, encourages robust-by-design implementations that can scale based on actual usage. Deploying across multiple data centers (AZs) is the default. Deploying across multiple regions is easy. This once again removes a common source of error and failure and gives solution builders tools to build “internet scale” systems that deliver three, four, or more 9’s of availability.

And in the unlikely event that there is an outage, backup and restore is also easy. Relational (Aurora) databases automatically perform backups, and backup/restore support for the DynamoDB document database was announced at re:Invent.

 

Increased Interoperability

Healthcare data has often been locked into data silos inside EMRs and other proprietary systems-of-record. Additionally, the quantity of data has meant that health systems need to undertake massive data consolidation and data warehousing projects to begin to recognize the value stored in this data.

At the same time, in recent years, there has been an explosion in patient-generated data. Vast quantities of activity tracking data, medication adherence records, blood glucose measurements, and patient reported outcome data (to name a few examples) sits collected but underused and uncorrelated.

In modern serverless architectures, patient data from inside and outside the four walls of the clinic can be easily collected and stored in large-scale data lakes like S3 where it can be easily aggregated, cleaned, transformed, queried, and reported on. HIPAA regulations are easily fulfilled, with HIPAA-compliant encryption at no additional cost just a button-click away (or sometimes a few buttons if you want to manage your own encryption keys). Control over who can access and use this data are returned to governance groups and clinicians based on business requirements and policy rather than obscure formats, closed databases, and network firewalls.

 

Wrap Up

At Wellpepper, we help healthcare providers deploy interactive care plans to their patients, so we take our data security and compliance responsibilities seriously. We were an early adopter of the AWS cloud back when EC2 and S3 were the only services available under the HIPAA umbrella, but things have changed! Following AWS’ announcement earlier this year that Lambda is now HIPAA-elegible, we’ve been looking more seriously at serverless system design, and we like what we see.

This is the future that anyone building solutions in healthcare IT should be excited about.

 

Relevant Content from AWS re:Invent 2017

Adopting Microservices in Healthcare: Building a Compliant DevOps Pipeline on Amazon ECS

What’s new in AWS Serverless 

Simplifying Healthcare Data Management on AWS 

Building a Secure and Healthcare-Compliant Platform for Adopting a Cloud-First Strategy using AWS 

American Heart Association: Finding Cures to Heart Disease Through the Power of Technology 

 

 

Posted in: Adherence, Data Protection, Healthcare Technology, Interoperability

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In Defense of Patient-Generated Data

There’s a lot of activity going on with large technology companies and others trying to get access to EMR data to mine it for insights. They’re using machine learning and artificial intelligence to crawl notes and diagnosis to try to find patterns that may predict disease. At the same time, equal amounts of energy are being spent figuring out how to get data from the myriad of medical and consumer devices into the EMR, considered the system of record.

There are a few flaws in this plan:

  • A significant amount of data in the EMR is copied and pasted. While it may be true that physicians and especially specialists see the same problems repeatedly, it’s also true that lack of specificity and even mistakes are introduced by this practice.
  • As well, the same ICD-10 codes are reused. Doctors admit to reusing codes that they know will be reimbursed. While they are not mis-diagnosing patients, this is another area where there is a lack of specificity. Search for “frequently used ICD-10 codes”, you’ll find a myriad of cheat sheets listing the most common codes for primary care and specialties.
  • Historically clinical research, on which recommendations and standard ranges are created, has been lacking in ethnic and sometimes gender diversity, which means that a patient whose tests are within standard range may have a different experience because that patient is different than the archetype on which the standard is based.
  • Data without context is meaningless, which is physicians initially balked about having device data in the EMR. Understanding how much a healthy person is active is interesting but you don’t need FitBit data for that, there are other indicators like BMI and resting heart rate. Understanding how much someone recovering from knee surgery is interesting, but only if you understand other things about that person’s situation and care.

There’s a pretty simple and often overlooked solution to this problem: get data and information directly from the patient. This data, of a patient’s own experience, will often answer the questions of why a patient is or isn’t getting better. It’s one thing to look at data points and see whether a patient is in or out of accepted ranges. It’s another to consider how the patient feels and what he or she is doing that may improve or exacerbate a condition. In ignoring the patient experience, decisions are being made with only some of the data. In Kleiner-Perkin’s State of the Internet Report, Mary Meeker estimates that the EMR collects a mere 26 data points per year on each patient. That’s not enough to make decisions about a single patient, let alone expect that AI will auto-magically find insights.

We’ve seen the value of patient engagement in our own research and data collected, for example in identifying side effects that are predictors of post-surgical readmission. If you’re interested, in these insights, we publish them through our newsletter.  In interviewing patients and providers, we’ve heard so many examples where physicians were puzzled between the patient’s experience in-clinic or in-patient versus at home. One pulmonary specialist we met told us he had a COPD patient who was not responding to medication. The obvious solution was to change the medication. The not-so-obvious solution was to ask the patient to demonstrate how he was using his inhaler. He was spraying it in the air and walking through the mist, which was how a discharge nurse had shown him how to use the inhaler.

By providing patients with useable and personalized instructions and then tracking the patient experience in following instructions and managing their health, you can close the loop. Combining this information with device data and physician observations and diagnosis, will provide the insight that we can use to scale and personalize care.

Posted in: Adherence, big data, Clinical Research, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient engagement, patient-generated data

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Consumerization Is Not A Bad Word

When you say consumerization, especially with respect to healthcare, people often jump to conclusions about valuing service over substance. There’s a lot of confusion over the meaning of consumerization, whether it’s possible in healthcare, and whether it’s happening. I recently had the privilege of speaking at the Washington State Health Exchange’s Annual Board Retreat on this topic. (Perhaps you saw it, the event was live-streamed to the public. 😉 ). The Health Exchange is pondering questions of how to attract new users, how to better serve their needs, and how to make the experience more useful and engaging. And, this my friends is consumerism, or at least one facet of it: user focus, better service, understanding needs. Doesn’t sound bad at all, does it? In fact, it sounds like something any good service or organization should be doing for its customers.

Consumer-centered pain scale. Baymax from Disney's Big Hero Six

Consumer-centered pain scale. Baymax from Disney’s Big Hero Six

And there’s that word, customers. That’s the debate. Are patients really customers? Not really, often they don’t have a choice, either because of their insurance coverage or from the necessity of an emergency where decisions are often made for patients. However, patients, and everyone else for that matter (except people in North Korea), are consumers, and they judge healthcare experiences both service delivery and technology as consumers. Think of it like this, your patients will judge your experiences through the lens of any other service they’ve interacted with. Fair or not, they will do that. Why do they do this? It’s human nature to remember positive experiences and try to seek them out. Although there’s another reason: high-deductibles are also driving people to examine where they are spending their healthcare dollars, and they evaluate based on outcomes, convenience, and the overall experience.

Since healthcare technology is my area of expertise, let’s stick to that rather than critiquing hospital parking, food, or beds. (Although these are often things that impact HCAHPS scores.) Consumerization when applied to health IT means that patients have an expectation that any technology you ask them to engage with, and especially technology you ask them to install on their own devices, will be as usable as any other app they’ve installed.

Consumerization also impacts internal health IT. Doctors were the first wave, when they pushed using their own devices to text with other providers within the hospital setting. (In IT this is often referred to as “bring your own device.”) The pager became obsolete and replaced with our own always on, always connected mobile devices. (Sadly, the fax machine, like a cockroach, keeps hanging in there.)

Patients are also bringing their own devices, and using them in waiting rooms and hospital beds. We’ve had patients reporting their own symptoms using Wellpepper interactive care plans from their hospital beds. This presents an opportunity to engage, and at a low cost: they are supplying the hardware. The final wave of consumerism will happen when clinicians and other hospital staff also demand convenient, usable, and well-designed tools for clinical care.

Consumerization is late to arrive in healthcare IT. Other industries have already reached tail end of this wave, and have already realized that technology needs to be easy to use, accessible, interoperable, and designed with the end-user foremost. However, consumerization is coming, both from internal staff demands and patients. Technology, healthcare IT, and the people that build and support it are facing scrutiny, being held to higher standards, and becoming part of the strategic decision-making healthcare organizations. This is a great thing, as it will result in better clinician and patient experiences overall, because at its core consumerism is about expecting value, and ease and getting it, and who doesn’t want that?

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Patient Satisfaction

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EvergreenHealth: Evolving Care Outside The Clinic for Better Outcomes

In 2016 we formally announced our collaboration with EvergreenHealth to deliver interactive care plans for Total Joint Replacement.

“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.”

EvergreenHealth is an integrated health care system that serves nearly 1 million residents in King and Snohomish counties in Washington State, and offers a breadth of services and programs that is among the most comprehensive in the region. More than 1,300 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. With expansion into more rural areas, and a catchment area that serves Seattle’s ‘eastside’ home to Microsoft and other major technology companies, delivering virtual care is both an imperative for an an expectation of EvergreenHealth patients.

Since our initial announcement, we’ve seen thousands of patients complete care plans and outcome surveys, and expanded within the musculoskeletal service line to include preventive care, spine surgery, and general rehabilitation.

User Experience

EvergreenHealth has a white labeled version of the Wellpepper patient application called MyEvergreen and available in Android and Apple App Stores. Clinicians use the Wellpepper clinic portal, and receive alerts to their email inbox if patients report any issues or unexpected outcomes.

EvergreenHealth has deployed care plans based on their own clinical best practices. 

Outcomes

  • Thousands of patients have used Wellpepper interactive care plans at EvergreenHealth
  • Interactive care plan users show higher scores on standardized outcome reports than those tracking outcomes without an interactive care plan
  • EvergreenHealth patients show a higher engagement level than Wellpepper’s overall 70% engagement

I would not want to have another knee surgery without the app. I was 81 and it wasn’t hard for me at all!

Total Knee Replacement Patient at EvergreenHealth

Technology

This deployment used a white labeled Android and iOS application for patients, and a clinic portal for clinicians. Patient invitation is synched with the Cerner medical records software using an ADT feed. Clinicians are notified of patients requiring additional help with an email alert. Wellpepper’s entire HIPAA secure platform was leveraged for this implementation, and EvergreenHealth deployed custom care plans based on their own best practices. They continue to add innovative features as they are added to the Wellpepper platform.

Posted in: Exercise Physiology, Healthcare costs, Healthcare Technology, HIPAA, Interoperability, M-health, Outcomes, patient engagement, Prehabilitation, Seattle

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HIMSS 2017 Recap: What’s Hot and What’s Hype

Wellpepper had a great HIMSS 2017 Conference with a very busy booth in the Innovation Zone, a panel on the current state of innovation, and a talk on Delivering Empathy Through Telehealth. Here are a few of our thoughts on the conference compiled from our team.Empathetic Care Through Telehealth

Cognitive and AI: Hype

Starting with Ginni Romety’s keynote, Cognitive and AI were definitely the buzzwords of the conference. Everyone is excited about the promise but it seems like the current status is not ready for takeoff. First, there’s a lot of work to get data out of the EMR, and second, no one seems quite sure what the killer use case is going to be. Immediately before HIMSS, MD Anderson announced that after a $62M investment they weren’t seeing value in IBM Watson and were pulling out of the program. That did not stop them from co-presenting with Mayo Clinic and Watson at the conference. The main use case seemed to be shortening the time to identify cancer patients for clinical trials from 30 minutes to 8 minutes. Another example, which just highlights the sorry state of clincial technology, was to use Watson on top of Epic to help staff figure out how to use features. During the session, Mayo CIO Christopher Ross referred to Watson as a toddler. While all of this was disappointing, it’s heartening that for once healthcare is on trend with the rest of the tech world, and possibly pointing to an accelerated evolution of health IT.

IMG_0611Patient Engagement: Hot

In 2016, patient engagement was also hot, but this year, we’d also say it was real. Buyers visited our booth with checklists of capabilities they wanted to see. Pilots were completed last year, and now they are making platform decisions for patient engagement. We’ve noticed this ourselves in the past 6 months, we’ve seen the patient engagement purchase decision elevated to the C-suite, and the decision being made based on capabilities that will address the needs of all patients and all service lines.

Interoperability: Hot

Compared to the previous year, we saw a lot more talk about interoperability, whether that was EMRs building out APIs and developer programs, the CommonWell Alliance, or talk about how block-chain could be used to both secure and transfer healthcare data. Understanding that data needs to flow with the patient, and also that a heck of a lot of data is being created outside the EMR (in patient engagement solutions for example), is driving a greater commitment to interoperability in the industry.

Healthcare Investment: Hot

The Sharks said so, so it must be hot. The HIMSS Venture+ Investment forum this year had a much more diverse set of pitches than previously, including a social venture. and was won by DiaCardio, a woman-led company from Israel automating evaluation of heart ultrasound.

The Affordable Care Act: Prognosis Unclear

Make no mistake, the potential repeal of the ACA is looming heavy even in health IT. Health systems Boehner, HIMSSare concerned about impact on Medicare and Medicaid revenue. While bundles and value-based care have been quite positively received, the current uncertainty is putting a hold on capital expenditures. (Did we mention that Saas can be accounted for as operating expense?) Possibly the most entertaining speculation on the ACA came from former house speaker John Boehner and former governor Ed Rendell. Rendell suggested that we repeal Obamacare and replace it with the Affordable Care Act. Boehner mused that repealing without a plan would place all the blame and problems with the current system firmly on the sitting government, and recommended that it not be repealed.

The Takeway?

We’re still optimistic. IT is increasingly having a seat at the table within healthcare. Although not all EMR implementations have been seen as a success for clinicians, we are seeing a shift to an expectation of better software for both patients and providers, for data to move smoothly, and the promise of insights and better care when that data can be analyzed and acted on. We’re already looking forward to HIMSS 2018 Las Vegas.

Posted in: big data, Clinical Research, Interoperability, patient engagement

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HIMSS17 Sessions of Interest

We are thrilled to attend a number of sessions at HIMSS17 with topics pertaining to Wellpepper’s Vision and Goals!

Patient Engagement

Sessions that impact our ability to deliver an engaging patient experience that helps people manage their care to improve outcomes and lower cost:

Insight from Data

Sessions that impact our ability to derive insight from data to improve outcomes and lower cost:

Clinical Experience

Sessions that impact our ability to deliver more efficient experience for existing workflows and are non-disruptive for new workflows:

 

Posted in: big data, Healthcare Technology, Interoperability, M-health, patient engagement

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Population Health and Patient Engagement: A Reckoning Is Coming

Population health and patient engagement should be best friends. To draw conclusions for population health, you need a lot of data, and patient engagement that is, patients interacting digitally with treatment plans and healthcare providers, generates a ton of data. Population health tries to analyze the general to get to the specific and identify patients at risk. Patient engagement starts with the specific patient, and with enough data recorded by those patients, can find general trends.

With patient engagement, the information is real-time. With population health it is backwards-looking. Population health has the richness of the medical teams notes and diagnosis but it is missing the patient perspective. Patient-generated data will have diagnosis if it’s part of a treatment plan prescribed by a physician, but it won’t have the full notes. A blurring of the boundaries between population health and patient engagement presents a way forward to greater insights about both individuals and groups, and can make population health actionable at the individual patient level by providing personalized instructions (with or without care managers).

However, to get to this desired end-state, we need to clear some obstacles, first of which is the idea that patient engagement generates too much data for physicians.

Yes, an individual physician does not want to see or review each data point that a true patient engagement solution generates. However, this information can be extremely interesting to the patient, especially when looking for trends to help self-manage a chronic condition so it is worth enabling patients to collect it. For example, looking at whether certain foods trigger arthritis, or whether certain activities trigger headaches. However, to draw conclusions like this, you must record a lot of data points and in real-time, and this makes physicians nervous. They have enough to do, and not enough time to do it in, so this data cannot add to that workload.

As well, patient-generated data is messy, which can be intimidating, especially in an industry that is looking for deviations from norms. The challenge with patient-generated data is that it can uncover that the long-tail is actually longer than previously thought, that there are sub-groups within previously thought to be homogeneous groups of patients with a similar condition. In the long run, this will result in medical breakthroughs and personalized medicine. In the short run this can be difficult to deal with in the current systems.

the long-tail is actually longer than previously thought

Does that mean that we shouldn’t collect patient-generated data? Not at all. Helping patients track their experiences is a great first step to self-management. Knowing whether they are following a treatment plan, and what their experiences are with that treatment plan can help healthcare systems determine the impact of their instructions outside the clinic.

Although physicians don’t want all this data, healthcare organizations both providers and payers, should want it. Other industries would kill for this type of data. Data scientists and population health managers at health systems should be clamoring for this valuable patient-generated data.

Patient-generated data is usually collected in real-time so it may be more representative of the actual current population. The benefit of real-time collection is that further exploration of the actual patient experience is possible and can be used to prevent issues from escalating. With backwards looking data whatever was going to happen has happened, so you can only use it to impact new groups of patients not current groups.Patient-Generated Data

Finally, patient-generated data is less likely to be siloed, like clinical data often is, because the patient experience is broad and often messy and crosses clinical department thresholds (or more simply, patients are usually treated for more than one issue at a time.) Being relatively new to market, patient-engagement systems are built on modern and interoperable technology which also makes accessing data for analysis easier.

So where will we end up? To our team at Wellpepper, it seems inevitable that influencing and understanding patient experience outside the clinic. If you are making decisions for an individual patient with only a few clinical touch points, this is a very thin slice, often with a specific clinician’s specialty lenses on the actual situation. While healthcare systems are currently dipping their toes in the water on collecting and analyzing this data, if they don’t embrace the whole patient, patients will vote with their feet and pocket books towards organizations that are data and technology driven.

Posted in: Adherence, big data, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient engagement, population health

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Intelligent Disruption in Healthcare

Two recent webinars tracking recent trends and outlooks on the future of digital health presented interesting perspectives on how the healthcare industry is evolving, but also trigger some concerns about such advancement. The first webinar, Digital Health Tech Vision 2016, hosted by Accenture Consulting, featured Kaveh Safavi, M.D, J.D. (Senior Global Managing Director of Accenture Health) and Jane Sarasohn-Kahn (Health Economist, Industry Advisor and blogger at Health Populi) addressing their prediction of the top five digital health trends in the coming year:

  • Intelligent Automation – the merger of humans and artificial intelligence in a health setting (citing an intriguing example of a company integrating AI into a therapy setting).
  • Liquid Workforce – technology enabling the application of healthcare across geographies.
  • Platform Economy – an economy based on multiple technologies to platform architectures that allow them to work together.
  • Digital Trust – the importance of ensuring patient information isn’t shared improperly by those who have legal access to it.
  • Predictable Disruption – industry leaders agree that the nature of healthcare services will change faster in the next ten years than the last thirty

The second webinar was the MobiHealth News Digital Health 2016 Midyear Review, featuring Brian Dolan (Editor-in-Chief of MobiHealthNews) and Ryan Beckland (CEO and Co-Founder of Validic), who spoke about the past year in digital health, including key acquisitions, policy news, and the importance of patient generated health data in the future.

Both webinars addressed the fact that there is significant consumer demand for digital health innovation. Patients want a more seamless and efficient experience that gives them a better “life-health balance” and does so inexpensively. From the physician point of view, MobiHealthNews pointed out that doctors have about seven minutes on average to spend in person with a patient, most of which is spent doing data entry on a computer, so physicians are looking for solutions that enable them to be more “present during care” and not miss out on any important clinical information. As for healthcare systems, the Accenture webinar touched on the “Predictable Disruption” trend, noting a recent poll showing 86% of healthcare executives feeling pressured to “disrupt” their business model or face disruption from the outside (e.g. companies like Wal-Mart, Apple, Google, and financial service firms are entering the healthcare space).

This high demand for digital health solutions is certainly good news for any companies operating in the space, especially in light of regulations pushing the industry more towards value based care. But is it good news for patients?

With such multipronged pressure facing hospital systems, a concern might be that in trying to keep up with the industry, they too quickly install digital health solutions that aren’t adequately designed for interoperability with other technologies and EMRs and in doing so, could make the patient experience worse. The American Medical Association CEO recently commented on the influx of “ineffective” and “mixed quality” digital health products, going as far as comparing them to modern-day snake oil, and Dr. Sachin Jain, the CEO of CareMore, said that most remote monitoring solutions are not currently working because they aren’t adequately integrated into a system of care, and are just “bolted on” to a current system.

In such a fragmented market, it will be important for healthcare systems to take the time to make decisions based on how well these solutions can integrate with the current systems and EMRs (which aren’t patient-facing, but need to integrate with these new technologies for a seamless patient experience), work with other digital products within the system (achieving the platform economy mentioned by Accenture), and enhance the patient and physician experience and interaction. Perhaps then the industry can claim a new trend: intelligent disruption.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, Patient Satisfaction

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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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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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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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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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