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HIMSS WA Innovation Summit

I had the opportunity to attend the Washington HIMSS Innovation Summit, where leaders from Virginia Mason, Providence, Overlake, Seattle Children’s, UW Medicine, Vera Whole Health and Confluence spoke about innovation in their organizations. A lot of great themes and takeaways. These are the ones that stood out most to me.

Technology Adoption

Several panelists mentioned they have problems with their health systems adopting new technologies. Executives tend to bring in new technologies, get pilots kicked off, but struggle in the system-wide adoption. A lot of times new technologies are implemented and expected to work immediately. The reality is that no matter what Health Systems are implementing, they need to invest resources. Physicians and end users need to be engaged early on to really take ownership of the new technology. A well-defined change management process is also key to ensuring a successful adoption. Lastly, even though organizations are piloting the new technology, call it Phase 1 vs Pilot. Pilots imply a short-term project with and end date. Phase 1 makes the technology more real and gets people thinking about what Phase 2 and 3 look like.

Return on Investment

One of the panelists challenged any technology vendor to show him a technology that has ROI. He said his organization does over $200M in uncompensated care per year so he must evaluate new technologies against cost of patient care, which is a valid point. This brought up an interesting discussion about what health systems consider to be a ROI. Not all technologies will give Health Systems dollar-for-dollar return. Some technologies will. ROI can be a blend of hard and soft cost, so it’s important to spend time thoroughly defining a business case and make sure that success metrics align with the overall mission of the Health System.

Patients

I was surprised at how much of the discussion was focused around clinician-facing vs patient-facing technologies. I agree better tools and algorithms for clinicians will directly influence the quality of care that patients receive. Virginia Mason panelists did a great job bringing everything back to the patients. Patients should be the center and they should have access to all their data, regardless of where it comes from, in one place. They should have one seamless app and experience for all their healthcare needs. We at Wellpepper could not agree more!

Key Takeaways

When evaluating and implementing new technologies:

  • Define a realistic business case and what financial and non-financial ROI looks like
  • Ensure alignment to Health System’s mission and goals
  • Don’t assume that new technologies can just be plugged in and solve all problems
  • Allocate resources and engage providers and end users from the beginning
  • Treat it as a multi-year, phased journey; call it Phase 1 instead of a Pilot
  • Have a solid change management process
  • Keep patients’ experience and needs at the top of mind

Posted in: Adherence, Behavior Change, Healthcare costs, Healthcare Disruption, Healthcare Technology, Healthcare transformation, HIMSS, patient engagement, Patient Satisfaction, patient-generated data, Return on Investment, Uncategorized, Using Wellpepper

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Reading for Healthcare Disrupters: In Shock, by Rana Awdish, MD

May 13-15, I’m heading to the Patient Experience Conference at Cleveland Clinic where Dr. Jonathan Bean, our research partner from Harvard Medical School will be presenting the results of a study using Wellpepper to deliver an interactive care plan for people between 65 and 85 who are at risk of adverse events. We’re excited about the positive clinical outcomes he saw, but more importantly, about the ability for technology to deliver empathy in patient care.

in shock book coverThe ultimate in empathy is to “walk a mile in someone’s shoes.” While this is often not physically possible, if you can emotionally understand someone else’s view this is the beginning of empathy. Research shows that reading fiction increases empathy, but I can imagine that non-fiction like Dr Rana Awdish’s compelling and gripping “In Shock” would do the same. Dr Awdish chronicles her near-death experience and subsequent recovery at the hospital where she practices. By becoming a patient with the mind of a doctor, she is able to deeply experience and understand both sides of a situation: the doctor who sees a case, and the patient who is so much more than a collection of symptoms. As a patient she experiences incorrect diagnoses, not being believed or listened to, arrogance, and condescension. As a physician, she struggles with her training to not get involved emotionally involved with patients and to shrug off traumatic events with her newfound understanding that experiencing pain is the only way to really empathize and connect with each other, and the only thing that will enable physicians to truly deliver care.

The book can be read as case study of experiences from both sides of the equation as Dr. Awdish struggles to make sense of her experiences, and learn how well-meaning instructions can result in the wrong outcome. For example, Dr Awdish reflects on her medical school and residency training and how it was designed to search for diagnosis not for meaning.

“We weren’t trained to listen. We were trained to ask questions that steered people to a destination”

When she’s taken to emergency and immediately steered to OB despite her protestations that the problem is not the pregnancy it’s something else, she directly experiences the impact of this training.

When Awdish is admitted to the hospital for bed rest during later pregnancy, her room becomes a defacto support group for medical professionals who need somewhere to properly process and sometimes grieve patient outcomes. This community defies their training which was to shrug off the emotions, and it’s during this period that Awdish comes to her hypothesis that switching communication may have the most powerful impact of all.

“This way of questioning, this recommendation built on empathy and a patient-centered narrative has the potential to heal everyone involved.”

Awdish is full of hope that the medical community can change. She’s a frequent lecturer and has won awards for building empathy and communication programs. The book also includes a study guide, and is being included in medical school curriculum.

You can hear Dr Awdish read from her book in this clip, or follow her on twitter @RanaAwdish

If you’re looking for more great reads check out these recommendations from our blog. Or, if podcasts are more your style, we’ve got those too.

Posted in: Behavior Change, Healthcare Disruption, Healthcare Research, physician burnout, Uncategorized

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Boston University Study Demonstrates that mHealth-Supported Exercise Program Benefits People with Parkinson Disease

Boston University Study Demonstrates that mHealth-Supported Exercise Program Benefits People with Parkinson Disease

Boston, MA – February 7, 2019 – The randomized controlled pilot study used the Wellpepper patient engagement platform to examine the comparative effectiveness of mobile-health-supported exercise compared with exercise alone for people with Parkinson disease.

Key Points:

  • The comparative-effectiveness study, which took place over a 12-month period, was published in the February 2019 issue (Volume 99, Issue 2) of the journal Physical Therapy.
  • It is among the first randomized controlled studies to clinically validate the use of digital health tools in supporting improved patient outcomes.
  • The study positively demonstrated the impact of a digital intervention on people with Parkinson disease who were evaluated as sedentary during study enrollment. People with Parkinson disease who were less active when they entered the study, and who used the Wellpepper application during the 12-month period, showed a statistically and clinically significant improvement in their overall mobility scores compared to similar individuals in the control group without the digital intervention.
  • The study was led by Terry D. Ellis, PT, PhD, Department of Physical Therapy and Athletic Training and Sargent College of Health and Rehabilitation Sciences at Boston University with a research team from Boston University, the University of New England and Brigham and Women’s Hospital at Harvard Medical School (see full list of authors below).
  • Ellis is continuing research in this area at two sites with an NIH-funded clinical trial to further determine the effectiveness of a “connected behavioral approach” against a control group in increasing real-world walking activity in persons with Parkinson disease. The study is onboarding the first subjects this month (February 2019).

“Behavioral change strategies provided through mHealth applications such as those delivered by Ellis and colleagues provide a promising theoretically based and practical approach for helping people with PD (and possibly other chronic disabling conditions) to successfully engage in sustained exercise behavior over the long term,” said Alan M. Jette, PT, PhD, FAPTA and editor in chief of Physical Therapy in an editorial. “As the rehabilitation field shifts from traditional approaches to digital platforms in delivering behavior change interventions, an mHealth application like the one examined in the Ellis et al study holds promise in increasing the reach and scalability of physical therapist services in the digital age.”

This VIDEO demonstrates how the technology was used.

Background:

Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to significantly reduced functional capacity and overall quality of life. Previous studies have demonstrated the benefits of exercise and physical activity in reducing disability and enhancing quality of life in people with PD.

This study was designed to explore the effectiveness, safety and acceptability of a mobile-health-mediated exercise program in promoting sustained physical activity in people with PD. Essentially, the Wellpepper mobile patient engagement application became a tool for motivating and monitoring behavior change.

There were 51 participants in the study, all of whom had mild-to-moderately severe Parkinson disease. They were divided randomly into two groups – mHealth and active control – and each group was further subdivided into those who were more active when they came into the study and those who were more sedentary.

Over the course of one year, the mHealth group’s outcomes were compared with those of an active control group, looking at daily steps, moderate-intensity minutes and other measures of activity and mobility. Evaluations were made at the beginning and again at the end of 12 months and exercises were provided by physical therapists with expertise in PD.

  • mHealth: The mHealth group participated in a technology-mediated exercise program that included walking with a pedometer and engagement in exercises. The Wellpepper mobile patient engagement application was used to provide the take-home exercise instructions (along with videos of each person doing their own exercises in proper form), ongoing text-based communication and support (e.g. changing exercises over time to accommodate progress or health changes) and tracking of physical activity and adherence. Ttracking was visible to participants to monitor their own progress and to researchers.
  • Control: The active control group walked with a pedometer, received paper-based exercise instructions and tracked their activity in a paper calendar.

Outcomes:

At the end of one year, both groups had increased their daily steps, moderate-intensity minutes and 6-Minute Walk Test, however the Parkinson Disease Questionnaire 39 mobility scores among the subgroup who were less active prior to the study demonstrated a statistically and clinically meaningful improvement.

An abstract of the study is available HERE and the full study can be made available to media upon request. Editorial overview of the study is also available.

Study Authors:

Terry D. Ellis, PT, PhD, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; JamesT. Cavanaugh, PT, PhD, Department of Physical Therapy, University of New England, Portland, Maine; Tamara DeAngelis, PT, DPT, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; Kathryn Hendron, PT, DPT, Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University; Cathi A. Thomas, RN, MS, Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University; Marie Saint-Hilaire, MD, Department of Neurology, Parkinson’s Disease and Movement Disorders Center, Boston University; Karol Pencina, PhD, Research Program in Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and NancyK. Latham, PT, PhD, Research Program in Men’s Health, Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School.

About Boston University Center for Neurorehabilitation

The vision of Boston University Center for Neurorehabilitation is to lead the development of evidence based, innovative, theory-based approaches to the rehabilitation of persons with Parkinson disease and other neurological conditions and to disseminate this information on a global level. Lead by Director and assistant professor Dr. Terry Ellis, PhD, PT, NCS, the center is part of the College of Health and Rehabilitation Sciences, Sargent College, Boston University.

About Wellpepper

Wellpepper is a healthcare technology company with an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. Wellpepper treatment plans can be customized for each health system’s own protocols and best practices and personalized for each patient. Wellpepper’s patented adaptive notification system helps drive over 70 percent patient engagement with treatment plans. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington. Visit http://www.wellpepper.com/ for more information.

Media Contact:

Jennifer Allen Newton
Bluehouse Consulting Group, Inc. for Wellpepper
jennifer@bluehousecg.com
503-805-7540

 

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Electronic Patient Surveys Done Wrong

Recently, a family member spent some time in a hospital following an emergency operation, giving me a chance to experience healthcare from the other side. The surgeon did a great job, the hospital staff was uniformly helpful and competent, and the facilities were great. But there was one small part that didn’t measure up.

During our stay, we were asked to participate in a patient quality survey, something which I was happy to do, both because patient surveys are part of the many of the interactive care plans we build at Wellpepper, and because I have an odd affinity for survey-filling, a condition which I’m assured is not yet classified in the DSM-5. Unfortunately, the quality survey was the lowest quality part of our visit, for a few reasons.

Hygiene

The survey was delivered on an iPad outfitted with a soft case and an asset tracking device. Maybe it was because I’d read too many articles about Hospital Acquired Infections, but I kind of gave this device the side-eye in its squishy soft case. I decided that if I had to go out somehow, filling out a survey would at least let me go out as a hero. I’m sure it was fine, but hard plastic and some obvious evidence of disinfection would have made me feel better. There were vendors selling nice UV charging boxes at HIMSS this year – seems like these should just be everywhere at a hospital, even for patients and their families to use with their own devices.

Security vs Usability

Right after the iPad was delivered, a group of docs stopped by to round. By the time they’d left, the iPad had locked itself and prompted me for a PIN. If I was anyone else, I might have just given up here, but I thought I’d be helpful and try the top few most frequent PINS. I didn’t make much progress (+1 for security), so I had the nurse call in some IT person who unlocked it. This person put the iPad in a kiosk (“Guided Access”) mode. However it also prevented the iPad from sleeping. Now I was in a race against the battery to get the survey completed.

Why Do I Have To Tell You This?

It’s weird how our expectations evolve with the medium of communication. If this was a piece of paper on a clipboard, I’d be more understanding about writing down how long we’d been at the hospital and how long I’d been planning this unplanned emergency operation. But on a tablet? Shouldn’t you be telling me this stuff? Imagine if you could only add friends to Facebook by entering their email addresses, DOB, and full name. Instead, they recommend people, even to the point of recommending someone I happened to say hi to at a coffee shop the other day. On the one hand, I know there’s a terrible data silo problem at health systems, particularly for EHR data. On the other hand, getting the admit date and length of stay isn’t a probabilistic graph traversal recommender problem – it’s a one-liner SQL query.

Electronic surveys could be truly helpful with even basic steps to reduce the survey-filling burden. How many times have you written your name and DOB on a hospital form? But sadly the industry hasn’t been able to crack this nut yet.

Connectivity

On sitting number three, I grabbed the iPad – battery now half drained – and tried to resume the survey. This survey, like many, was web based. Unfortunately, the iPad had lost its WiFi connection, and was now asking whether I wanted to resubmit the form. I gambled on “yes”, which was not the right answer, because now I was told I needed some kind of code to get back into my survey. I don’t know if the information I’d completed already was saved, or lost into the ether. In either case, it was clear that I’d gone as far as I could go, so I set the iPad aside and wondered whether someone would stop by to collect it before its battery ran out.

The Future Of Electronic Forms

So, I’m sorry Unnamed Hospital. I really wanted to help. I was going to be your best customer (remember, I like filling out forms). But it was one hurdle too many, between the logistics, the security-over-usability posture, and making me answer questions you knew the answers to. In the end it was your WiFi network that robbed you of my input.

Of course, it doesn’t have to be this way. I’m pretty sure the health IT community is going to figure this out. With a little user-centric design thinking the electronic experience could actually be helpful for patients. A little more critical thought about security vs. usability could reduce user frustration. And eventually hospital WiFi will be consistently awesome. Perhaps eventually I’ll even be allowed to use my own device. It might be covered with germs, but at least they’re my germs.

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Electronic Health Records and Physician Burnout: Fraught with Frustrations

Electronic Health Records (EHRs) have become a scapegoat for physician burnout. A quick google search of “EHR” and “burnout” will yield nearly 350,000 results. Systematic reviews over the last 10 to 15 years look at much of this data and draw a similar conclusion; higher physician burnout rates are correlated to use of EHRs. They point at increased documentation times, decreased user satisfaction, and “clerical burden” as causes of burnout. Data from other sources suggest we may be laying the blame in the wrong place.

At Stanford Children’s Health, in an effort to improve physician satisfaction with EHR use, they have created extensive and personalized education programs. They obtained data from the EHR to develop an efficiency profile, surveyed physicians on their perspective of their efficiency, and performed observation sessions with physicians so support staff could see how physicians used the EHR. With this information, personalized learning plans were developed. Providers were incentivized to participate and they found physician satisfaction with EHR improved as well as their efficiency and less time spent on medical records outside of the hospital.

This suggest that the problem with the EHR is not of the EHR, but rather the onboarding and training process related to it. Most EHRs can be made to work for you, rather than against you, and improve your efficiency with documentation and patient care.

Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? Annals of Internal Medicine. July 2018.

Drs. Downing and Bates recently published in JAMA that there may be another underlying cause that is driving physician burnout and dissatisfaction which is being blamed on the EHR. In looking at health systems across the United States and abroad on a similar EHR (Epic Systems), they found that physicians abroad reported higher satisfaction with the EHR and that it improved their efficiency. In other countries, they noted, documentation is briefer, containing only essential clinical information rather than bogged down by compliance and reimbursement documentation. On average, within the same EHR, notes in the United States were found to be four times longer than those abroad. Notes in the United States had documentation requirements from a “clinically irrelevant” number of elements in each part of a note so that fee-for-service components are fulfilled.

Their argument suggest that a key cause of physician burnout which is being blamed on EHRs is actually our “outdated regulatory requirements.” With reform of these requirements, documentation would become only the essential clinical data, rather than notes with strict documentation requirements of a “clinically irrelevant number of elements” in the various components of a note.

A third argument that I would challenge us to consider as a more likely cause of physician burnout rather than the EHR is the cultural state of medicine in the United States. Due to increasing numbers of lawsuits over the last 20 years, physicians are spending a lot of time on “CYA” medicine (Cover Your A**), feeling forced to order unnecessary testing for an unlikely diagnosis “just in case” things do not go according to planned. We also get pulled into the trap of what I refer to as “Burger King” medicine, playing off the fast food giant’s slogan of “Have it your way.” Patients are coming to the physician already “knowing” their diagnosis and requesting specific treatments or testing. If the physician disagrees? No problem, the patient will just go find one down the road who will do what they want.

In an era of electronic health records on the rise and an increase in rates of physician burnout in the United States, it looks easy on paper to show a correlation between the two. What if instead the EHR is not to blame, but any number of other things like lack of physician EHR training and support, documentation regulations, or “Burger King” medicine? Is it more likely that the relationship between EHR prevalence and physician burnout is only a correlation and not a causal relationship? My hope is that in the coming years we will recognize the EHR as a tool to improve patient care and outcomes, increase our efficiency, and return to practicing medicine at the bedside.

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The Challenge of Challenges: Determining When To Participate

There’s an explosion of innovation in healthcare and with that comes a plethora of incubators, accelerators, pitches, challenges, prizes, awards, and competitions. Trying to sort through which ones are worth paying attention to can be a full-time job. At Wellpepper we’ve tried to be selective about which ones we enter. A recent post by Sara Holoubeck, CEO and founder of Luminary Labs about the outcomes of challenges got me thinking about the cost/benefit analysis of entering challenges. Both costs and benefits come in hard and soft varieties.

If you want to be scientific, you can assign a score to each of the costs and the benefits, and use it to decide whether to throw your hat in the ring. (For the purposes of this blog post, we’ll use the term “challenge” to refer broadly to all of these opportunities.)

Costs

  • Time: How many hours will your team need to put into this challenge? How much of your team needs to be involved?
  • Focus: Does the focus on this challenge distract your team from core customer or revenue priorities?
  • Financial: Is there an entry fee to participate? What other costs, like travel, may you need to incur to deliver on the challenge?
  • Strategy: Is this challenge aligned with your
  • IP: Do you have to give up intellectual property rights as part of this challenge? Do you have to give away any confidential information that you are not yet ready to share publically?

Benefits

  • Financial: Is there prize money? Does it cover your expected costs? Could you actually profit from entering? If winner receives funding who decides the terms? Is this an organization that would be beneficial to have on your cap table?
  • Focus: Does this challenge provide the team with a forcing function to deliver innovation in an area that is aligned with your overall strategy?
  • Innovation: Does this challenge take your team in stretch direction or enable you to demonstrate a direction on your roadmap that you may otherwise not immediately approach due to market issues?
  • Publicity: Where will the winner be announced? Is there a PR strategy for the entire process or just the winner? Does it help your organization to be aligned with the content or sponsors of this challenge?
  • Introductions: Who will this challenge help you meet that can further your business goals?

It’s up to you to consider the cost/benefit analysis. Both may not have to be high, but when they are the opportunity can be high if you have the ability to put in the effort. You may also consider your chances of winning if it’s defined as a competition, and whether there is any drawback to losing, or if just participating provides enough benefit.

Here are a few examples from our own history that may help illustrate the tradeoffs.

Low cost/medium benefit

We entered a local pitch event for a national organization. The effort to pitch was minimal: we had case studies and examples that fit the thesis directly. The event was nearby and there was no cost to enter. The pitch was short. We won this pitch and got some local awareness and leads. However, when we were offered to go to the national conference and pitch for an even shorter period in a showcase heHIMSS Venture+ Winnersld simultaneously with other conference activities and with no actual competition, we declined as the cost/benefit was not there.

Medium cost/medium benefit

Each year HIMSS has a venture competition at the annual conference. We won this event in 2015, and received PR as well as in-kind benefits at HIMSS conferences including booth space. The effort to prepare was medium: any startup should be prepared for an onstage venture pitch, and the audience was exactly right. As a follow on from this event we’ve been involved in panels showcasing our progress.

High cost/migh benefit

Both the Mayo Clinic ThinkBIG challenge, and the Alexa Diabetes Challenge had a relatively high effort and opportunity cost to participate and high rewards, but both were aligned with directions our company had already embarked on, and both resulted in deeper connections for us with the sponsoring organizations, positive press, validation of our company and solution, and financial support.

In the case of the Mayo Clinic ThinkBIG challenge, we received investment on our convertible note for winning, and the challenge afforded us introductions to important clinical and IT contacts at Mayo Clinic. We were also able to showcase our solution to other potential customers live at the annual Transform event.

Our team put in a tremendous effort on our winning entry for the Alexa Diabetes Challenge but the pay-off was worth it in a number of ways. Certainly the prize money and publicity was welcome, but more importantly, we have created new IP and also come to a whole new understanding of how people can move through their daily lives with technology to support them in managing chronic conditions.

Both of these challenges have afforded us ongoing opportunities for engagement and awareness as a result our participation, and our positive outcomes.

One thing to note, none of these challenges I mention had an entry fee. Sometimes nominal entry fees are used to deter casual entries, but for the most part if a challenge is seeking to fund itself by charging the startups to participate, it’s the wrong model.

While you don’t have to be this explicit when making your decisions about entering a challenge, consideration of the costs and opportunity cost of either participating or not, can help you sort through the ever increasing number of grand challenges.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Uncategorized, Voice

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HIMSS 2018…See you there!

HIMSS17 in Orlando was a great conference for Wellpepper. We’re looking forward to HIMSS18 in Las Vegas even more!

We have a long list of sessions to attend and booths to visit, but below are some places you’re guaranteed to find us:

Monday, March 5th

  • Hear from Tami Deangelis on how our research partners at Boston University engaged patients outside the clinic and improved outcomes using Wellpepper care plans. She is speaking at the “Remote Patient Messaging for Adherence and Engagement” session from 4:05pm-4:25pm at the Patient Engagement & Experience Summit

Tuesday, March 6th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CTO, Mike Van Snellenberg will be demonstrating our voice-powered scale and foot scanner, and integrated diabetes care plan at the Industry Showcase at BHI & BSN 2018 https://bhi-bsn.embs.org/2018/industry-showcase/

Wednesday, March 7th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-6pm
  • CEO, Anne Weiler, will be sharing the Wellpepper Vision and Mission at HIMSS VentureConnect http://www.himssconference.org/education/specialty-programs/venture-connect
  • CEO, Anne Weiler, will be joining other industry leaders to continue the conversation with CMS toward inclusion of patient engagement and outcomes tracking in the MIPS Improvement Activity for provider reimbursement

Thursday, March 8th

  • Hall G, Innovation Zone: Booth 9900-78 from 9am-4:30pm

We can’t wait to connect with friends, partners, colleagues and industry leaders to continue the journey towards an amazing patient experience. Hope to see you there!

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Outcomes, patient engagement, Uncategorized

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Trends That Survive Healthcare Reform

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

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

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

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

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

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

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

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

 

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

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Falls Challenge

How might we enable older adults to live their best possible life by preventing falls? We have entered a challenge with AARP and IDEO to bring our proven falls solutions to the masses. Along side our partners at Harvard and Boston University, we believe that using mobile technology to enhance and scale a proven falls prevention program will lead to better life by increasing access to care and decreasing costs.

The challenge started with over 220 submissions and recently weeded down to the top 40. We’re thrilled to have made the first cut. Our method is proven and we invite you to participate in the next round to refine our idea and help achieve greater impact.

Click here to check out our entry!

 

 

Posted in: Aging, Clinical Research, Healthcare Technology, Outcomes, Physical Therapy, Research, Uncategorized

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Wellpepper attends Episodes of Care Summit at Cambia Grove

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

Horizon BCBS of New Jersey is an episodes of care pioneer

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

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

Community involvement is imperative

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

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

Memorable quotes from breakout sessions:

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

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

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Using AWS with HIPAA-Protected Data – A Practical Primer

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

It’s Not Rocket Science

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

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

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

Stay Up To Date

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

Take Responsibility

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

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

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

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

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

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

Share the Responsibility

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

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

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

Draw a Bright Line Around Your ePHI

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

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

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

Secure at Rest and Over the Wire

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

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

Good guidance in this area is easy to find:

Logging and Auditing

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

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

Authentication

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

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

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

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

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

Conclusion

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

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

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Wellpepper Receives Seattle Business Magazine’s 2017 Leaders in Healthcare Gold Award for Achievement in Digital Health

We are honored to have been named the Gold Award winner for outstanding achievement in digital health from Seattle Business Magazine’s 2017 Leaders in Health Care!

Thank you to our amazing team and partners!

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Press Release, Seattle, Uncategorized

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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Cardiac rehab is effective, but patient-centered care needs to actually be patient-centered

With CMS’s new Cardiac Bundle, cardiac care (especially post-acute care), is the next service line to go under the microscope. As with total joint, variations in outcomes and costs are often seen in post-acute care so looking at how that care is delivered is key. For any bundle to be successful, engaging patients and ensuring their participation in follow up is a driver of success.

I have to admit, I haven’t read the bundle specs yet, just the news on the bundle. According to Becker’s Hospital Review’s “10 things to know about CMS’ new mandatory cardiac bundle”, the bundle includes provisions to test cardiac rehabilitation services, with 36 sessions available over 36 weeks. However, according to this article from NPR, although cardiac rehabilitation is proven to be effective, most people don’t participate. If you read through the comments on the NPR article (ignoring the trolls of course), you’ll start to see the reasons: cardiac rehabilitation care is built around the needs of the people providing the rehabilitation, not the patients.

From our experiences delivering post-acute care plans, as well as talking to payers and providers we’ve learned a few reasons why patients don’t follow up with their outpatient care:

  • Distance: In cardiac cases, patients are taken to the closest hospital, but this may not be the closest to their home or work. In other post-acute scenarios, they may have gone to a center of excellence that is also at distance.
  • Time commitment: These programs often require multiple days of treatment a week. Not everyone has the flexibility to take off work.
  • Timing: Programs are usually offered during 9 to 5, to accommodate the needs of the providers. Patients might prefer evening or weekend programs. We talked to one provider that focuses on lower income patients. People in hourly wage jobs don’t get to choose when they take breaks and their breaks are usually 15 minutes, and maybe 30 minutes for lunch. It’s next to impossible for them to attend in-person sessions.
Francis Ying/Kaiser Health News

Francis Ying/Kaiser Health News

The NPR article keyed in on these within the one example of Kathryn Shiflett (a healthcare worker herself!) whose distance and work hours (4:30 AM – 3:00 PM) pose a significant barrier: “She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.”

While the bundles are definitely driving the right behavior in focusing on patient outcomes rather than procedures, they need to go further to promote patient-centered care. In this case, that should be testing new models like mobile health or community-based rehab programs that are adaptable to the unique needs of different patient groups.

Posted in: Adherence, Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare transformation, Occupational Therapy, patient engagement, Patient Satisfaction, Rehabilitation Business, Uncategorized

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Different System, Same Challenges: Long-Term Care Perspective From Canada

Kristin Helps, our Director of Client Operations, and I had the opportunity to speak about delivering Empathetic Care for Seniors Through Technology at the annual BC Caregiver’s Association Conference in Whistler, BC. The BCCPA is the representative body for long-term care, skilled nursing, homecare and retirement facilities in the province of British Columbia in Canada. These types of facilities are mostly privately run, by both for-profit, and charity organizations, as opposed to acute care which is run by provincial and regional authorities. While this was a BC organization and conference, delegates came from across the country, and ranged from individual home care works, to facility owners, to university professors and researchers.

For the most part we heard similar challenges to those encountered in the health system in the US:

  • Communication between care settings
  • The struggle to deliver patient-centered care
  • Decreasing reimbursement for homecare
  • Enabling staff to operate at the top of their license

At the same time, people expressed a desire to age in place, and the health system wanted to be able to support this. While 80% of Canadians cited wanting to die at home, only 40% actually do.

One of the big differences we noted at this conference was that speakers and participants were calling on the Federal government to step in and fix many of the problems in a way that we don’t often see in the US. Another difference was that participants were looking globally for solutions to challenges, particularly in dementia care.

Looking Globally for Dementia Care

This was our first time at this conference and veterans told us that the previous year was quite focused on analytics, while this year the focus was on dementia care. While not primarily our area of expertise at Wellpepper, we heard about a number of innovative initiatives to improve care, including a novel approach by the government of Japan. Japan decided to characterize dementia as a social problem rather than a medical problem and trained bank tellers and grocery store clerks to recognize the signs of dementia. It was thought that these people were most likely to see problems, for example if someone was unable to understand how to pay bills or buy groceries. Considering that many with early onset dementia are quite successful at hiding changes from their loved ones, this idea is quite interesting. It also puts the responsibility for care back into society rather than relying on medical facilities that often distance the rest of us from the challenges of aging.

Basketball courts at Aegis Living Seattle

Basketball courts at Aegis Living Seattle

The Butterfly Household Model of Care, which was initiated in the UK, but has been implemented in Alberta with some success, is another novel idea. People with dementia often don’t know what day it is or what they had for lunch, but they do have vivid internal experiences, often remembering happier times of their lives. Butterfly Households are designed to stimulate people with dementia with bright colors, and also to stimulate memories with areas designed to invoke feelings of the past, for example an ice cream shop or an area with old photographs. The idea in a Butterfly home is to meet patients where they are, and caregivers report much joy in delivering care and significantly fewer of the violent behaviors often associated with dementia.

While not a designated Butterfly Home, you can see some of these techniques in action at Aegis Living in Capitol Hill, Seattle. Here are a couple of pictures from when I visited last fall. In an outdoor area they have a car and a garden shed designed to stimulate conversation and fond memories, and an old-gym styled basketball court, where you can shoot hoops sitting down.

Invoking memories at Aegis Living Seattle

Invoking memories at Aegis Living Seattle

To find out more about the topics in this post:

Bank Tellers Act Serve as Caregivers in Aging Japan

BC Caregivers Association

Butterfly Household Model of Care

Aegis Living Capitol Hill Seattle

If you’re interested in learning more about our talk on delivering empathy through technology, contact us.

Posted in: Aging, Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Managing Chronic Disease, Seattle, Uncategorized

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Wellpepper goes to Vegas for HIMSS16!

Screen Shot 2016-02-24 at 4.03.54 PM

 

Sunny and 70’s all week,Vegas here we come! We will try to bring some sun back with us.Vegas Weather HIMSS Blog

We will be in booth #5 @ the HX360. Let us know if you’ll be attending HIMSS16 by sending us a tweet @wellpepper.

Contact us, to set up a meeting with Anne Weiler CEO or Robin VP of Business Development 

The annual HIMSS conference is almost here! A few tips.  Wear comfortable shoes and your Fitbit, you will be walking miles. With over 43K in attendance at HIMSS15, the lines for coffee and food were long.  Bring a few snacks and get your morning coffee before you get to the conference!

So many interesting and inspiring education sessions, so little time! Between walking and navigating the crowds, it can take up to 10-15 minutes to get where you are going so take some time to plan out your education sessions. Get to the sessions early if you want a seat, many sessions end up being standing room only. 

Stop by to see Wellpepper CEO Anne Weiler on this panel which is part of the HX360 Innovation Leaders Program

Date: Monday, February 29, 2016: [Time: 2:30 PM – 3:15 PM]

Session Title: Flexible Care to Fit the Second Half of Life: from Independent Aging to Acute & Long Term Care

Session Description:  How can technology support flexible, high quality, cost-efficient care delivery that meets patients’ needs in the second half of life? Where are the most egregious gaps in care for older patients? These are the questions that will be explored by our panel, covering topics ranging from aging independently to rehabilitation, home care support, family caregiving and honoring end-of-life wishes.

Here are some of our  education session picks.

Connected Health

March 1, 2016 — 08:45AM – 09:45AM : Trends & Resources in Connected Health: Harnessing the power of mobile for research 

Clinical and Business Intelligence                                                                

March 1, 2016 — 10:00AM – 11:00AM: Actionable Analytics: From Predictive Modeling to Workflows

March 3, 2016 — 02:30PM – 03:00PM: Getting to Big Data Insights in Healthcare

Consumer and Patient Engagement

March 2, 2016 — 10:00AM – 11:00AM: Patient Engagement – The Next Chapter

March 4, 2016 — 12:00PM – 01:00PM: Patient Engagement Beyond Patient Portal-Strategic Approach

Care Coordination and Population Health

March 1, 2016 — 10:00AM – 11:00AM: Too Many Patient Portals – What Can You Do About It?

March 1, 2016 — 01:00PM – 02:00PM: Coordinated Health: The Experience You Should Expect

March 1, 2016 — 03:15PM – 03:45PM: mHealth solution for remote patient engagement

March 1, 2016 — 04:45PM – 05:15PM: Rethinking patient engagement and provider workflow

Clinical Informatics and Clinician Engagement

March 1, 2016 — 04:00PM – 05:00PM: Enhancing Patient Outcomes with Big Data: Two Case Studies

March 2, 2016 — 10:00AM – 11:00AM: Taking Plans of Care from Clinician to Patient-Centric

March 2, 2016 — 01:00PM – 02:00PM: Seven Essentials in Clinical Information Technology Adoption

 

Posted in: Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Outcomes, Patient Satisfaction, Uncategorized

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The Tide of Change is Coming…….

I have been in healthcare my entire career and have seen lots of change in some form or fashion for this industry. But, as many will attest to, BIG change is fast approaching when it comes to reimbursement. That was very evident at a recent conference I attended – The American Association of Hip and Knee Surgeons – AAHKS. Change in reimbursement was the common theme and the ones shouting it from the roof tops were the industry expects, the surgeons in the trenches, and us – the vendors. Although many are getting ready for this tidal wave, there are still the ones, very few, that are digging their heels in hoping to ride out the wave. I think they’ll likely crash head first.

In January 2016, bundled payments will be here for total joints via the Comprehensive Care for Total Joints mandates from CMS.  The sessions I attended at AAHKS made it loud and clear: surgeons need to be prepared for this change. What they need to be prepared for could be anywhere from working collaboratively with their hospitals partners to really understanding the data for process improvement, results and patient engagement. All of these efforts are needed to drive value for their practices, partners and ultimately the patient. No longer are the days where practices, departments or hospitals can stand alone in this journey.

Dr. Thomas Vail from UCSF suggested in order to attract patients that still have a choice, physician practices and health systems must work together to drive value and make that the centerpiece to improve outcomes. Furthermore, instilling competition among the care teams will instinctively drive better behavior and thus, have shown to improve patient satisfaction stats in those departments.

Every department at UCSF will be effected by change in reimbursement. They use the data to drive a strategy of quality, safety, efficiency and financial performance to help mitigate the risk fact that goes along with this change in reimbursement. The data will show trends to drive change verses just looking at individual metrics. Their focus is on the goals that focus on the measurements.

During a panel discussion on Patient Reported Outcomes – This is Your Reality, it was all about engaging the patient. Dr. Kevin J. Bozic from Dell Medical School at UT Austin, PROs are the “holy grail” for measuring quality. Physicians should understand patient outcomes are based on the patient’s expectations and the cost it takes to get to that outcome.

Orthopedic society groups such as AAHKS, AAOS and AJRR are taking it upon themselves to bring the PROs up to today’s reality by working together to modify the surveys to make them more patient friendly – thus getting the patient more engaged. (These recommendations are awaiting CMS approval.) Also, there is a big push to ensure there is a “risk adjustment” factor taken into consideration in order to make it a level playing field given the diversity of total joint surgery and the different levels of complexity. However, regardless of any update or approval by CMS, the panel agreed that obtaining RPOs will be the cost of doing business. Last, which I believe supports the need for patient engagement technologies, Dr. Bozic closed with……“It (PRO) will be a nice to have to a need to have”.

The Tide of Change provides a tremendous opportunity to all of us who look to make a difference in the way technology can improve the delivery of healthcare but most importantly, provide the patient with a better experience.

Posted in: Uncategorized

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