Telemedicine

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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

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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

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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

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Wellpepper to attend The Beryl Institute Patient Experience Conference in Dallas!

I will be traveling to the great state of Texas for my first Beryl Institute Patient Experience Conference next week. The Beryl Institute is a global community of practice dedicated to improving the patient experience through collaboration and shared knowledge. They define patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.

As a first time attendee, I am thrilled to be part of this community that is inspired to improve the patient experience. It will be a great 3 days of networking, education and sharing of ideas on how we, as a healthcare community, can make a difference in patient care.This shift to patient centered care has been coming for quite some time. Now that value-base reimbursement is starting to take shape, this conference could not be timelier. Since I will be an attendee and not an exhibitor (yea!), I will be able to get in the trenches with leaders of patient experience, quality and transformation from major health systems from across the country.

There are so many sessions that touch upon all aspects of patient experience and engagement, it’s a bit overwhelming. But, here are the sessions that peaked my interest.  Hope to see you there!

April 13, 2016
Opening Keynote: Dr. Ronan Tynan – Recording artist, physician and champion disabled athlete

Breakout Sessions I
Patent is Not a Consumer – Here’s Why
Leveraging Physician Engagement in Patient Experience Improvement Efforts
Evolving to a Patient-Centered Team-Based Culture – Engaging the Healthcare Team

April 14, 2016
Keynote Day: Cynthia Mercer – Senior Vice President & Chief Administrative Officer – Mercy Health

Breakout Sessions II
Removing Complexity from the Post-Acute Patient Experience
The Role of the Built Environment in Improving Patient Experiences and Outcomes

Lunch & Learn
“I’m There to Efficiently Help People”: How Our Busiest Clinicians Balance Productivity and Patient Experience
The Role of the Built Environment in Improving Patient Experiences and Outcomes 

April 15, 2016
Keynote: Montel Williams – Talk Show Host and MS Awareness Champion

Breakout Sessions III
Digital Engagement of Discharged ED Patients is a Must
The Impact of Cultural Diversity on Patient Experience

Breakout Sessions IV
Enhancing Patient Experience and Engagement Through Technological Innovation
The Patient Financial Experience: A Link to Satisfaction, Payment and More.
Closing Keynote: Kelly Corrigan – Author, Philanthropist and Breast Cancer Survivor

Conference program full packet can be found here

If you will be at the conference too, please contact Robin to schedule a meeting.

Posted in: Adherence, Healthcare transformation, patient engagement, Patient Satisfaction, Telemedicine

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Did HIMSS deliver on its Charter? Transforming Health through IT

HIMSS Annual Conference
February 29-March 4, 2016

Another HIMSS has come and gone for me. I will not brag about how many times I have attended this conference, but I will brag about it being the first time with Wellpepper. Overall, the level of activity exceeded our expectations and validated the need for innovative patient engagement technologies like ours.

Being with a new company gave me a whole new perspective on the HIMSS annual event. Reflecting back, years of HIMSS events can blur together and it can seem like the same old same old. This year was different: the healthcare ecosystem is going through a profound change and the providers and payers know this. Health systems are beginning to understand that the model is moving away from a passive engagement with the patient, to a model where the patient is taking more initiative to include their own wants/needs to participate in their care delivery.

With that, comes a whole new set of demands from the patient consumer and that I believe is where HIMSS is trying to make the transformation.  For the second year, HIMSS has partnered with HX360’s Innovation Pavilion to showcase pioneering health IT solutions that are addressing these challenges. As a start-up company, we can often get lost in the maze of vendors at a large conference such as HIMSS (estimates suggest more than 1200 exhibitors). The HX360 Innovation Pavilion provides an opportunity for entrepreneurial health IT companies to shine… and that we did.

Along with this venue, HX360 sponsors an Executive Program that runs concurrent with HIMSS. These educational sessions attract leaders such as Chief Innovation Officers, Nursing Informatics Officers and Vice Presidents of Digital Health who are looking for innovative solutions from companies like Wellpepper. Because of this venue and opportunity, we were able to have meaningful conversations with IT and executives that are looking to get a head of the curve and provide innovative solutions for their patients and systems.

Upon my travels home, I felt optimistic this shift to value-based healthcare will really drive innovation and allow companies like Wellpepper to part of the conversation and solution. The future appears to be bright and full of opportunity.  It is an exciting time for both the healthcare community and the consumer.

So, did HIMSS hit their mark? In part, yes. HIMSS is making great strides to keep up with the changing landscape of healthcare. No longer is it just about the EMR, servers, networks and storage in the IT back room. It’s about patient facing solutions that provide ownership and accountability for the patient while securing that brand loyalty for the provider.

The transformation of healthcare is now. Healthcare does not take to change lightly. But, companies like Wellpepper will continue to pave the way to innovation and the industry will take notice.

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

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

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

Link to full article can be found here

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

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APTA Combined Sections Meeting Wrap Up

Walking the floor at APTA CSM 2016 Anaheim, CA

Last week, I attended the American Physical Therapy Association Combined Sections Meeting (APTA CSM) in Anaheim, CA. The show was well attended by about 18,000 Physical Therapists and professionals in related roles. The packed house meant lots of energy, a few full sessions, and long lines for coffee at the two overwhelmed Starbucks kiosks in the nearby hotels. Wellpepper started out in physical rehabilitation, so it was great to be back in the company of many talented ‘movement system experts’ and associates working together to gain knowledge in order to achieve best practices for healthcare systems, patients and/or caregivers.

I attended a number of sessions, mostly focused on the shift to value-based payment, and outcome measurement. The healthcare value equation has penetrated deep in this community. I saw the same basic slide in at least 3 talks:

* This formula has been widely discussed by Michael Porter and others.

I attended two presentations on outcome measurements by Beth Israel Deaconess Medical Center (BIDMC) and Johns Hopkins. Both organizations spoke about the task of adopting outcome measurements in an acute settingand their thoughtful deliberate steps to take research-based measurement techniques and apply them into clinical practice;BIDMC’s applied the Knowledge Translation framework, and Hopkins’ applied the Translating Knowledge Into Practice (TRIP) initiative. There were many similarities that both organizations encapsulated in their task of adopting outcome measurements; both organizations had to fight against “don’t give me more documentation work” attitudes, worked cross-functionally with PTs, nurses, physicians and administrators to gain support for their plans. And both adopted process measurements to observe the rollout of outcome measurement tools and practices. Furthermore both had some crossover in the specific measurement tools they used (e.g. AM-PAC / 6 clicks).Another common thread I believe important to note was the development of practical tips and tricks for how to make it easy to capture data into their EMRs that weren’t always designed to capture this kind of data (real nuts-and-bolts stuff like how to copy and paste boilerplate text).

Finally, armed with data on patient functional outcomes, Johns Hopkins shared some of the work they were doing on risk-stratifying patients to help control costs. In a world where Post-Acute Care costs represent one of the largest and most variable cost centers for many procedures, this is critical. The quantity and richness of this data is something I hadn’t seen presented at this conference before. Here is real objective data on how real patients progress through their care journeys that can be used to at the individual level to have an informed conversation with the patient and provides fantastic optics into the most important work product of the healthcare system: making people better.

I was struck that both presentations concluded that measuring outcomes was less of a technical feat than an organizational one. It is, as Michael Friedman a presenter from Johns Hopkins articulated, “About culture change more than anything.”

Throughout the conference, there were also mentions of Patient-Reported Outcomes (Oswestry, HOOS, KOOS were frequently mentioned – thankfully ones that Wellpepper supports!) My sense was that these are still not as widely deployed and not as consistently measured to have made their way into any of the mainstream presentations. As Wellpepper and other companies keep pushing to measure (and improve!) the patient journey with patient reported outcomes, I expect this will change in the coming years.

The one disappointment I had from the conference was that the excellent session on the Patient Experience was not better attended. Jerry Durham (a minor celebrity in the PT world!) introduced a panel of 2 patients to present on their experiences and lamented that often the Triple-Aim objectives are reduced to a Double Aim, ignoring the patient experience. So we had the excellent chance to learn and hear real patients talk. Both patients were both doing great thanks to their Physical Therapists, but both talked about the significant failings they’d seen in their medical practitioners (of all stripes). In a string of wrenching, quotable sound bites, one said “I couldn’t have gotten this bad without the help of PT”. It’s a shame that despite the healthcare rhetoric about putting patients first that more attendees didn’t put this into practice and take the opportunity to learn from some honest patient-driven conversation.

All told, this was a good conference, notable for the increasing use of patient data to measure and improve. If the attendance for CSM 2017 in San Antonio is anything like this one, let’s hope for more coffee and more chairs!

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

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2016: The Year of Telehealth

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

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

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

Happy New Year!

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

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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

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Help Wellpepper! My headache is agonizing

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

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

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

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

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Press Release: Sentara Healthcare Chooses Wellpepper

Sentara Healthcare Chooses Wellpepper for Mobile Patient Engagement in Headache Care

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

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

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

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

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

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

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

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

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

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

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

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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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This Month [August] in Telemedicine

This Month [August] in Telemedicine

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

Gary Capistrant
Chief Policy Officer,
American Telemedicine Association

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

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

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

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

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

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

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

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

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This month [July] in Telemedicine

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

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

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

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

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

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

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

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

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

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

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

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MobiHealth News: Digital Health 2015 Midyear Review

Digital Health 2015 Midyear Review

Speakers:

Brian Dolan
Editor-in-Chief MobiHealthNews
brian.dolan@mobihealthnews.com

Ryan Beckland
CEO Validic
ryan@validic.com

Fitbit wearable- price tag $250.

This trend webinar presented by MobiHealthNews was packed full of information, information that many of us have already heard about individually from bigger news reporting agencies, but Brian did an excellent job in a 20 minute recap of the latest market trends. Since as we all know whenever you hear about a market (even your local farmers market!), the mention of money is never far behind, the HIT market is not any different except by the number of zeros, the very many! A whopping quarter million dollar funding increase from last year; $741 million to 1 Billion. If that wasn’t a big enough highlight, get a load of this, FitBit a wearable camera company, debuted its initial public offering (IPO) on the NYSE, raised 732 Million, making it the biggest EVER consumer electronics IPO in history. That is a very BIG deal indeed! With all this money rolling around in the form of connected health devices, therefore all the personal health data in return being generated, the Federal Trade Commission is nervous that HIPPA is not enough. It will be interesting to see what additional training employees, caregivers, etc. will have to do to appease FTC and well patients like myself!

Ryan Beckland, CEO and co-founder of Validic, a “…cloud-based technology platform that connects patient-recorded data from digital health applications, devices and wearables to key healthcare companies”. Validic works with the largest healthcare systems in the world, reaching 160 million individuals in 47 countries. Validic is continuously evolving their services to the accelerated demand and innovation of HIT, and has profited by the ‘recent’ wave of patient generated health information. The focus of Ryan’s presentation was on the behaviorism’s of patients and providers and how they have been changing due to the HIT market trends. Increase options for care has helped patients be more in charge of their care more than ever before, stating that in the not so distant future devices are going to replace the role doctors have in diagnosis and initial doctor appointment. Ryan very clearly laid out the benefits of telehealth, it doesn’t take a rocket scientist to see that telehealth empowers patients, prevents hospital readmissions, reaches patients in rural locations etc. and it can address doctor shortages.

Another noteworthy point that Ryan made is that by 2020 it is expected that the Pharma market will be entirely reshaped by digital health; dubbed Pharma 2020: The vision. Three major trends driving shift is patients expect technology to provide convenient and regular access to their providers, regulatory environment of data access and speed of competition requires more technology enabled solutions. Pharma is pressured to increase patient adherence to drug therapy (currently at 50% adherence!) and seeing how telehealth has been successful in other factors (lower readmissions, etc.) it’s time Pharma takes the reins on their patients’ health as well. I am extremely interested to see what new technologies this market develops/adapts since this is a very wealthy sector in the realm of healthcare.

You watch and listen to the webinar here, where you can also access the slides presented.

 

 

 

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

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This month [May] in Telemedicine

American Telemedicine Association: This month [May] in Telemedicine
June 2, 2015

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

John commenting on the heat in Washington, D.C.

John commenting on the heat in Washington, D.C.

The annual ATA conference in LA last month had the largest attendance rate that ATA has seen in 20 years. It featured over 500 presentations; the video recordings of every presentation is available for purchase. Our own Wellpepper CEO, Anne Weiler, went to the conference and you can read her blog here. Also in May there were some big changes at ATA; a new president, new officers and members of the board of directors were elected. Their backgrounds are all impressive, thank goodness because we need them!

Telehealth’s exceeding advantages in both entrepreneurial and patient health naturally have lead to several new organizations popping up every year (or every month it seems) that use clinical consultations over the internet/phone. And where there is money to be made and quite literally lives at stake, legality is involved. The Texas medical board ruling prohibiting use of telehealth without previous relationship with patient, or a healthcare professional being present with patient when telehealth is being utilized (Huh, how is that telehealth?) lead to Teladoc filing a lawsuit against TX. Consequentially last Friday the Federal court ‘temporarily’ stopped TX medical board ruling. With that said ATA provides accreditation for online consultation sites to make sure sites are open/transparent, adherence to all relevant laws and regulations and promotes patient safety; however Teladoc isn’t accredited by ATA.

For those of us waiting for a particular practice guideline from ATA, there are now 10-12 Telehealth practice guidelines available on the ATA website and six active workgroups are under development; Teleburns, teledermatology, child mental health, general pediatrics, remote health and data management and telestroke. Please contact ATA if you would like to be involved in a workgroup, it is practicing professionals like you that make these guidelines viable.

If your state has a Telemedicine Parity Law, kudos, but 23 still do not. To be positive, we are getting there, a new milestone was achieved in the laws; Minnesota, Nevada and Indiana this week alone have added their own parity laws. Also in state news ATA added the highly awaited and much needed resource, the ATA State Telemedicine toolkit titled “Working with Medical Boards: Ensuring Comparable Standards for the Practice of Medicine via Telemedicine”. Again this is a call for involvement!

Congress or digress? The three letter difference is slight! But hey three new bills were introduced to Congress since the last webcast that will be interesting to watch; Telehealth Enhancement Act 2015, Amendment to Social Security Act to expand access to telehealth stroke services under Medicaid, and the VETS Act of 2015. The VETS Act of 2015 would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. I cannot help but speculate the motives of introducing this bill; are they using the VA as a pilot for licensure compacts for ‘civilian’ physicians, etc.? Let’s hope so and more importantly I hope it goes well and only reaps benefits.

The announcement of a new Distance Learning and Telemedicine Grant from the USDA was mentioned and I wanted to make note of it in case any of our readers qualify. Please check it out here.

The next ‘This month in Telemedicine’ will be announced shortly on the ATA website and as always is free to watch.

Posted in: Healthcare Policy, Healthcare Research, Healthcare Technology, Telemedicine

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Session Picks for 2015 American Telemedicine Meeting

We can’t promise to get to all these sessions and blog about them for you, but here are a few that caught our attention at the American Telemedicine Association Annual meeting coming up in Los Angeles next week.

Monday May 4th

Establishing a Program to Reduce Readmissions and Costs in the Ambulatory Setting: A California Success Story

Telehealth is proven to decrease costs without sacrificing quality for many scenarios.

Learning Opportunities from Large Scale Telemedicine Initiatives

An interesting mix of private and public sector initiatives across disciplines including pediatrics and psychiatry.

Improving Commitment, Quality, and Outcomes

We love outcomes, and this session also feature’s Seattle’s own Carena.

It’s a Small World After All: Approaches in Neonatal ICU Care

Cute title, serious results with examples across pediatric care.

A New Model for Remote Diabetes Care Best Practices

One of the biggest issues facing our healthcare system so new models welcome!

Expanding Telehealth to Improve Hospital-wide Readmission Rates

Readmissions and care transitions, so important.

Mainstream Medicine Moves into Direct to Consumer Health

Mercy, a Catholic Health System from St. Louis, is a quiet leader in telehealth. Find out why they dedicated an entire new building to for their telehealth practice. Plus a case study from Cleveland Clinic. Whew, that’s a lot of great content.

Tuesday May 5th

Utilizing Interactive Voice Response (IVR) and Telemonitoring to Reduce Hospital Admissions and Readmissions for Heart Failure Patients

Heart failure is a patient group where readmissions can be prevented with better communications, which telemedicine and remote monitoring can provide.

A Large Provider Focuses on Consumers: The Experience at Kaiser Permanente

With large deductibles, patients are increasingly making decisions as consumers.

Implementing Successful Clinical Specialty Programs: Burns, Infectious Diseases, and Genetics

Telemedicine helps scale specialists, especially from centers of excellence and to rural areas.

Using Community Health Models to Enhance Patient Performance and Outcomes

Another great benefit of telemedicine is to empower community health workers through remote support from specialists.

Posted in: Behavior Change, Health Regulations, Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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