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Answers to Healthcare Leaders’ Cloud Questions
iHT² Releases Answers to Healthcare Leaders’ Cloud Questions Research Report
The purposes of this paper are twofold:
1) to explain the main reasons why most healthcare organizations are not yet migrating their clinical data to the cloud; and
2) to describe how cloud vendors are addressing providers’ concerns. In addition, the paper discusses the key benefits of partnering with a cloud services provider, and explores different types of cloud structures that may suit different providers for all or part of their data storage and software maintenance needs.
Any questions or comments please contact the Institute for Health Technology Transformation (iHT2) directly at (561) 748-6281 or firstname.lastname@example.org
Institute for Health Technology Transformation (iHT2)
iHT2 Research projects are a beginning point for greater stakeholder collaboration to achieve a learning health care system to improve patient outcomes and accelerate research through the effective application of technology. Click Here to Learn More
Apple tightens health data privacy rules ahead of HealthKit launch
Apple HealthKit vs. Google Fit
Infographic: Apple HealthKit vs. Google Fit1
Please the attached image
Apple lanza ResearchKit para la investigación clínica
Apple lanza ResearchKit para la investigación clínica
por Carlos Mateos
Apple ha anunciado una nueva plataforma de código abierto para la investigación médica llamada ResearchKit, que estará disponible el lunes próximo, y que se integrará con la ya conocida HealthKit, para el intercambio de datos de salud. La compañía de la manzana ya ha comenzado a trabajar con media docena de aplicaciones de investigación de enfermedades específicas: Parkinson, diabetes, enfermedad cardiovascular, asma, y cáncer de mama.
La aplicación del Parkinson, mPower, ha sido creada por la Universidad de Rochester y Sage Bionetworks. La aplicación permite inscribirse en ensayos clínicos y es capaz de detectar los síntomas en los pacientes de Parkinson sólo al decir “ahhhh” en el teléfono. También incluye una función para golpear con el dedo que también puede detectar síntomas. Por último, la aplicación puede analizar la marcha del usuario y el equilibrio haciendo que camine 20 pasos y luego dar la vuelta y dar 20 pasos hacia atrás.
La aplicación para la diabetes se llama GlucoSuccess (glucoéxito) y ha sido creada por el Hospital General de Massachusetts. MyHeart Counts (mi corazón cuenta) es la aplicación de cardiología, creada por las universidades de Stanford y de Oxford lo utilizaron para crear una aplicación de investigación de la enfermedad cardíaca. Share the Journey (comparte el viaje), es el sugerente título de la aplicación para supervivientes del cáncer de mama desarrollada por el Dana Farber Cancer Institute, la UCLA School of Public Health, Penn Medicine, y Sage Bionetworks. Asthma Health (salud asma) es la aplicación para el asma desarrollada por el Hospital Monte Sinaí y el Weill Cornell Medical College. El vicepresidente de Operaciones de Apple, Jeff Williams, también mencionó que el Monte Sinaí fueron equipando algunos de los ciudadanos de Nueva York con inhaladores y espirómetros conectados a su aplicación para asignar mejor sus síntomas. También están analizando varias zonas de la ciudad en busca de patógenos y síntomas relacionados geolocalizados.
Williams dijo que “es importante que todo el mundo tenga acceso” a ResearchKit, por lo que Apple está ofreciendo código abierto. Eso significa que los usuarios de Android y los que utilizan otros teléfonos inteligentes también podrían utilizar esta plataforma en el futuro.
El CEO de Apple, Tim Cook también hizo algunos anuncios sobre HealthKit y el smartwatch de Apple, que se lanzará el 24 de abril. Anunció que ahora hay más de 900 aplicaciones que comparten o extraer datos de intercambio de datos HealthKit. También dijo que el reloj de Apple podría ofrecer cerca de 18 horas de duración de la batería.
Sin duda, se trata de un gran potencial para la investigación clínica a gran escala pero también abre la puerta al autodiagnóstico,. Los profesionales sanitarios deben adaptarse a este empoderamiento de los pacientes o de sus familiares a través de las aplicaciones y poder recomendar la aplicación más adecuada.
Apple Watch & Digital Health
The Apple Watch & Digital Health: 3 Must-Ask Questions
The tech world is still digesting Apple’s big announcement. Some believe Apple’s watch is the Second Coming. Others are disappointed that it does not look cooler. Left-handed people are up in arms that the device is not designed to be worn on the right hand.
My opinion: plenty of people will buy the Apple Watch and it will dramatically improve over time. Apple’s great at getting people to desire its devices (remember what they said about the iPad?) and does a good job of tweaking its designs.
Design Critiques Aside, Are We Focusing Enough on the Bigger Picture Beyond the Device?
But, I’ve always maintained that focusing on form factor, pre-loaded
applications and other surface features of Apple’s devices obscures the larger strategic reality. Apple is playing the long game and working to develop a device-software-data ecosystem that will keep its products relevant and necessary over the long-term. As others have noted, Apple’s foray into health illustrates how it is playing the long game quite clearly. (I’ll talk more about this in a bit.)
One need only look to the entertainment industry and the evolution of the iPhone software ecosystem to understand what Apple is trying to achieve. In music, Apple developed (for a time) a digital ecosystem that was second-to-none. In order to experience hassle-free music downloads, access the latest music on-demand and more you needed to have an iPod (and later the iPhone). Apple’s products went from nice-to-have to essential.
One of the reasons the iPhone did so well was Apple’s decision to open up the app development process to third parties. Inventive innovators developed applications that filled in the gaps in terms of functionality that many complained about when the iPhone and iPad were first introduced. Want a certain feature? There’s an app for that.
What Are the Key Health-Related Questions We Need to Answer About the Apple Watch?
Now, let’s look at what Apple is doing in health. Earlier today, I sent a somewhat breathless message to people on my email list announcing the Apple Watch. I received a number of responses to my message.
Some people wondered whether Apple would be able to solve the consumer engagement issue associated with many wearable devices. Earlier this year, Endeavour Partners put together a now-famous white paper that outlined how most people stop using wearable devices, trackers and other tools after an initial honeymoon period. So, the engagement issue is a big one.
But one of Apple’s strengths is its demonstrated ability to develop partnerships and tap into a vast and talented developer ecosystem that makes its devices more useful and relevant without the company having to invest in a large amount of R&D. In time, people will develop digital health applications that do a great job of harnessing the strengths of the Apple Watch while minimizing its drawbacks (and making it more sticky).
Other people contacted me to take aim at the digital divide — especially the fact that the Apple Watch is expensive. Well, only time will tell whether Apple will shift its pricing strategy. But, it’s done a good job of working with carriers and incentivising them to subsidize the iPhone, which has helped it reach people across economic segments. In addition, Apple is partnering with a range of health insurance firms, hospitals and others. I have to imagine that part of the reason for this activity is to encourage these powerful players to subsidize the cost of the Apple Watch and other tools — especially if they (or the software running on them) can be proven to help improve health outcomes and boost consumer engagement with their health.
The Elephant in the Room: Will Health Consumers Use a Wearable Like the Apple Watch?
The most pressing issue, however, is the adoption question. This goes beyond economics. If consumers decide the device is not very useful or adds anything to their lifestyle that will merit its long-term use, the Apple Watch is doomed. Companies like Pebble have succeeded in creating a long-term user base. Samsung and Google have already introduced watches that have gained limited traction. The jury is still out as to whether the Apple Watch will go much beyond power users.
From a digital health perspective, there’s evidence that some groups of consumers, including people with heart disease are not very interested in connected health devices, as this essay by Mark Bard of the Digital Insights Group suggests. But, it’s worth repeating that the issue of adoption may come down to a simple question: are these devices useful? Frankly, many current wearables are less then useful and require a lot of work and mental energy to optimize. (This is changing, however as this report [available via subscription] suggests.)
Yet, there is certainly a strong willingness among the most digitally active health consumers to use wearables, as our research suggests. These are ePatients or people who regularly use digital tools (i.e., Web, social media) for health.
Below is a chart illustrating some of our ePatient data.
We asked ePatients to tell us whether they would be willing to use a wearable device with the ability to track and monitor their health status. A slight majority of all ePatients said they would be very willing to use these devices. In addition, I looked at our data by socioeconomic status and found something interesting. Interest was greatest among the most affluent, but remained relatively strong across income groups. For example (as shown above) about 49% making between $31,000 and $40,000 annually were willing to use this type of device.
Related: Rise of the ePatient Movement
Now the question remains: would they be willing to use an Apple Watch? I’m not sure. But, this data does suggest that — for the company that gets wearables right — there is a significant opportunity in health.
The Bottom Line: Only Time Will Tell if the Apple Watch is a Hit, or Flop
Recent news reports make it clear that Apple is doing its best to develop a suite of indispensable products (in health and beyond), partnerships that will help it make its health data useful and relevant to medical professionals and learning the regulatory ropes. But, only time will tell whether the Apple Watch will be successful or a rare (for Apple) flop.
What’s clear is that the wearables arena is continuing to evolve, especially in health. For those willing and able to get it right, the rewards are potentially massive.
Fard Johnmar is a digital health futurist, researcher and co-author of the #1 bestselling book, ePatient 2015: 15 Surprising Trends Changing Health Care. He is also founder of Enspektos, LLC, a globally respected innovation consultancy providing original research, strategy, analytics and more to health executives, organizations and others.
Take your digital health knowledge to the next level by enrolling in a unique and free 5-part email course. You’ll receive little-known, but vital insights, original research and analysis that’s critical to your success. Click here to learn more and enroll.
The Apple Watch & Digital Health: 3 Must-Ask Questions by Fard Johnmar
Digital Health Companies Rush To Integrate With Apple's HealthKit
Zina Moukheiber | Contributor
Notwithstanding HealthKit’s aborted launch due to a software bug, digital health companies have jumped at the opportunity to integrate their products with Apple AAPL -1.56%’s HealthKit, a hub of personal health data that consumers can display in Apple’s new Health app in iOS 8. Many are betting that the tech giant has the clout and reach to make Health an indispensable tool for patients looking to engage with their doctors outside the clinic. “It’s going to be the biggest health release ever,” says Daniel Kivatinos, a founder of electronic health record provider drchrono.
It might take some time for doctors still struggling with electronic health records to widely accept the deluge of data HealthKit brings, but many companies don’t want to be caught flat-footed. Soon after Apple announced HealthKit in June, HealthLoop went to work to integrate its software. The start-up allows doctors to check in with their patients between visits, especially post surgery, to follow their progress. Patients who underwent joint replacement, for example, can now opt to share with their doctors who prescribe HealthLoop, the number of steps they took or their temperature from trackers and blue-tooth enabled devices uploaded through HealthKit. A lack of activity or a spike in fever, can prompt a clinician to intervene. “HealthLoop is able to wrap these streams of biometric data with clinical context,” says Jordan Shlain, founder of HealthLoop and a practicing internist.
The application of biometric data in a defined clinical context, such as hypertension or diabetes, is critical in determining the success of monitoring devices with health care providers, as well as patients who are motivated to engage because of illness. “If data comes in and is not actionable, no one is going to bother,” says Michael Blum, a cardiologist at the University of California, San Francisco, and director of its Center for Digital Health Innovation, which validates tracking devices in a clinical setting.
iHealth Labs, a subsidiary of Chinese medical equipment company Andon Health, which Apple chose as a partner to pilot HealthKit, sells FDA-approved wireless blood pressure and glucose monitors, among other tracking tools. Data from blood pressure cuffs are uploaded onto mobile devices, such as the iPhone and iPad, and are currently used in clinical studies at UCSF, and the VA Medical Center in San Francisco.
iHealth’s chief marketing officer Jim Taschetta says Apple introduced the company to electronic health records vendors Epic Systems and UK-based EMIS Group, as well as Stanford University, and Duke Medicine. To test HealthKit, Duke incorporated readings from iHealth blood pressure monitors into its Epic patient portal. Epic has integrated its MyChart with HealthKit, but it is up to its customers to decide whether they want to enable sharing. Taschetta is encouraged to see a handful of health care leaders adopt HealthKit. “The odds are in our favor to see widespread adoption,” he says.
Applying Automation to Healthcare
6 Big Benefits of Applying Automation to Healthcare
James Dias, Founder & CEO at Wellbe shares six big benefits that can be realized by applying automation to healthcare for overall cost reduction and efficiency.
Three out of four hospital and health systems CEOs cite overall cost reduction and efficiency as one of their top two financial priorities, HealthLeaders recently reported. With the healthcare industry continually looking to cut costs and waste and improve efficiency and throughput, automation of manual tasks can be an important part of a strategy for performance improvement.
Automation is defined as the use of control systems and information technologies to reduce the need for human work in the production of goods and services. The introduction of the assembly line at Ford Motor Company in 1913 is often cited as one of the first forms of automation. With this innovation Ford achieved a dramatic reduction in the time to produce a car from 12 hours down to 1.5 hours!
Now automation surrounds us every day in our lives, including automated teller machines (ATMs), Redbox DVD rentals, self-checkout at the grocery store, cellphone-controlled thermostats, auto park assist in vehicles, and many more routine activities managed by technology. Despite its use for years in banking, retail and other industries, healthcare has lagged behind in its use of automation. The recent pressure from healthcare reform and increased competition is driving a heightened interest to reduce costs and eliminate waste in healthcare delivery. And that has brought the adoption of automation to the spotlight.
An aging population along with more people in the healthcare system will require more care, and staffing levels in healthcare will not be able to keep up. In the July/August 2009 issue of Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. The looming shortage of RNs demands efficiency and the elimination of redundant work and manual tasks.
John Dragovits, chief financial officer of Dallas-based Parkland Health & Hospital System, toldHealthLeaders in 2012: “If you look at an average hospital’s financial statement, 50%-60% of their expenses are salaries and benefits. By definition healthcare is an inflationary model, but it’s exacerbated by the fact that everyone wants to hire more people rather than think about how they can live with fewer people… The challenge in this industry has always been getting people excited and intrigued and rewarded for looking at things innovatively and using technology to do things quicker and cheaper.”
Once the industry transitions to population health, automation goes from a “nice to have” to a “must have.” There are not enough care providers to continuously monitor and check in with large patient populations for this new model of care. A report by the Institute for Health Technology Transformation says, “Automation makes population health management feasible, scalable and sustainable.”
Automation is often linked to a negative connotation in association with the loss of jobs in manufacturing industries. When automation and robotics were first introduced into the pharmacy, some feared it would be the end of pharmacists, with robots taking the place of human workers. However, ultimately it let them get rid of medication counting tasks that required little cognitive value, and instead let them focus on more clinically-relevant work for productive and rewarding work time.
Critics also point out that automation can’t replace doctors and nurses. And they are correct. However, automation can be blended in to their workflows to make a wide swath of care delivery processes much more efficient and to improve productivity. Patient engagement, for example, can get a big boost from automated check-ins and reminders.
Here are 6 big benefits that can be realized by applying automation to healthcare:
1. Labor Savings
2. Improved Quality and Consistency
3. Reduced Waste
4. Increased Predictability of Outcomes
5. Higher Throughput
6. Data-Driven Insights
When looking for good areas to apply automation in your healthcare environment, a standardized, repeatable process is the first thing to look for. Within hospital walls, a common procedure that is performed on a large population of patients on a routine basis, like joint replacements, is a prime area to apply automation tools. Ask yourself this question: Which program would you rather have?
Between programs A and B, automation is what makes the difference. So the next time you’re ready to tackle a new process and realize you need to hire 3 more FTEs to support it, first do a gut check and see if there’s a better way to do it through automation.
James Dias is the Founder & CEO at Wellbe where he leads innovations program to empower people and providers with new tools to improve health. He is also the co-inventor of the Patient Guidance System.
6 Big Benefits of Applying Automation to Healthcare by Jasmine Pennic
Are EHRs Life Savers?
Are EHRs Life Savers? Maybe So, According to Preliminary Research
by Rajiv Leventhal
Can the adoption and implementation of electronic health records (EHRs) be tied to hospital performance and lowered mortality rates? While we might be a bit of time away from being able to make that precise claim, new research does suggest a measurable beneficial relationship.
The findings were revealed by HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society (HIMSS), and Healthgrades, an online resource for comprehensive information about physicians and hospitals. The value of EHRs has long been discussed, but until now evaluations have lacked comprehensive clinical data, according to HIMSS officials.
Using HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) and mortality rate measures collected by Healthgrades across 19 unique procedure and condition based clinical cohorts, the analysis found that hospitals with advanced EHR capabilities (as reflected in high EMRAM scores) demonstrated significantly improved actual mortality rates, most notably for heart attack, respiratory failure, and small intestine surgery.
Most cohorts experienced improvement in predicted mortality rates when compared to hospitals with lower EMRAM scores. The predicted mortality rate is an indicator of the level of documentation and capture of patient risk factors that are correlated to increased risk of mortality. In total, 4,583 facility records were selected from the HIMSS Analytics database, representing the total number of facilities with complete data from 2010 through 2012.
Collecting the Data
One such facility that participated in the study was the Charlottesville-based University of Virginia Health System, which includes a 604-bed hospital, Level I trauma center, cancer and heart centers, and primary and specialty clinics throughout central Virginia. According to UVA Health System’s CIO, Richard Skinner, who is also a board member for HIMSS Analytics, while the EMRAM model has enabled healthcare systems to see where they rank as far as EHR maturity, any kind of data that describes the impact of implementing an EHR on clinical performance has been missing until now. “The reason for this study was to describe potential benefits from the EHR, and preliminary results say there are benefits,” Skinner says.
For years, HIMSS Analytics has collected a very detailed data set from each hospital in the U.S. with the exception of some very small ones; the model has very specific criteria for which capabilities a facility needs to have for each stage (0-7) on the scale. “Every year, [HIMSS] will call someone from each hospital and ask them to renew that data set. They ask questions such as, ‘Do you have an electronic medical administration record and do you do CPOE (computerized physician order entry)’, for example. With all of that data in hand, HIMSS can then say Hospital A is at Stage 4,” says Skinner. Then, Healthgrades takes Centers for Medicare & Medicaid Services (CMS) data and looks at people who have died in a specific facility, and CMS’ grading of if those people in the aggregate were expected to have died given their diagnoses and so forth, Skinner says.
According to Skinner, to date, the study has shown that those facilities that are higher on the EMRAM (in Stages 6-7) have a better ratio of actual mortality to expected mortality than do hospitals that are lower down on the scale. But Skinner does say that a deeper dive of the data is coming, and that the analysis is very preliminary. “We don’t know why that is yet, but to date that’s what the data has showed us. And you might ask about other factors—‘Are the ones higher on the EMRAM better funded, bigger, and in urban areas?’ There are a host of factors that can come into play. But again, the preliminary data shows a correlation between mortality rate and implementation of EHRs,” says Skinner.
As of today, the study hasn’t gotten down to institutional level to see what happened at a given organization, Skinner says. “And it might not, because the power of the study is the size of the sample’ and it’s the size that enables being able to discover the correlation,” he says.”If you did it at one hospital, there would be so many other variables that statistically, you couldn’t make that association.”
At UVA Health System, Skinner says he has looked at the organization’s clinical performance indicators over time and whether they are improving or not. “For some of those indicators, it’s clear there is at least an association with having better data and having that data in front of clinical decision makers. For others, it’s hard to tell, he says. “Things like urinary tract infection (UTI rates) are getting markedly better, but is that all because of EHRs? No, but you can credit the EHR with at least being able to expose the data and communicate it effectively.”
Skinner says that the reason why such evaluations have lacked comprehensive clinical data is two-fold. First of all, the EHR is a relatively new phenomenon, as most organizations have only implemented a comprehensive EHR in the last few years, and getting it to operate effectively takes some time, he says. The second factor is that the contributing factors to an improvement in clinical performance are, even in the simplest cases, “numerous and interrelated.” So analytically, Skinner says, “It’s difficult to figure out what the most causative variable happen s to be in improvement in expected mortality, or whatever it is that you’re trying to measure. I think the message to the industry is that for hospitals with EHRs, there exists great potential to get further benefits from these tools as we mature in figuring out how to use them,” he says.
Skinner adds that he feels confident in saying there is a “statistical” correlation between advanced EHR capabilities and improved mortality rates. “But again, what part of that correlation is causative awaits further analysis of the data and is not in the preliminary report. All we can say at this point is that there is a correlation. Now, intuitively, it stands to reason that further analysis will filter out those other variables to get to the real contribution to having an EHR.”
What’s more, Skinner does say that the results so far are exactly in line with what he expected. “Of course I am a biased CIO who has a stake in this business,” he says. “But organizations that have spent billions in the aggregate to implement EHRs obviously have the same expectations. While meaningful dollars play a role in that, the entire industry has the expectation that having better information better organized in front of clinical decision makers will lead better results. This study indicates that we’re starting to see that.”
Skinner says he feels that it’s important for the industry to demonstrate this not only because of the magnitude of the investment that’s already been made, but also because there is a huge amount of work left to make truly optimal use of these tools to improve performance. “That’s the hill we are climbing as an industry,” he says.
Clearly a proponent of EHRs, Skinner says that those who criticize the technology for not providing clinicians enough value might not be accurately measuring what the “value” really is. “It may be that a specific clinician hasn’t found much value to him or her, but that doesn’t mean his or her use of the EHR hasn’t proved value to the patient, to the institution as a whole, or to other parts of the institution,” he says.
Skinner notes that the case is easier to make at the organizational level than it is than it is at the individual physician level. “Providers do have a point in that they are being asked to do more and put their hands on a tool they never had to worry about. So there’s no question they have acquired added burdens. But the real question is, ‘Has the institution and its patients gotten sufficient benefit to justify that extra burden?’”
Are providers failing to connect with consumers?
Are providers failing to connect with consumers?
by John Sharp
While patient engagement is both incentivized by Meaningful Use and touted as a solution for Accountable Care Organizations, both look to patient portals as the primary tool for patient engagement. However, patient portals vary in the features they offer, their usability and mobility. Some portals have been criticized for simply replicating features that the physicians view in the EHR. This would include lab results, prescriptions and future appointments. Without any context, these features may lack utility for most patients. For instance, is it clear that a lab result is abnormal, and if so, what does it mean – urgent action, repeat the test, see a specialist?
Second, usability may be lacking. For instance, the patient portal may require a complex process for signing up. Or once logged in, the interface is confusing to use. For instance, I am looking for my list of prescriptions and a way to request a refill. Is there a clear link to a list of current medications, or does it list all medications I have been prescribed in the past? Is the list alphabetical or by prescription date or sortable? Does the list tell me what condition or symptom the prescription was written for?
Third, consumers expect mobility in their healthcare. Mobile apps are so pervasive, for a patient portal not to be mobile-enabled seems outdated. Along with a portal becoming a mobile app are assumptions about usability and security. What if the busy parent wants to schedule a vaccination for her child while at a soccer game? Why should this function not be available on a smartphone? Securing the data viewed on a mobile device is also assumed by consumers despite many well-publicized data breaches. Then there are those that do not have smartphones but may use texting on a regular basis. Is this an option for communicating with a provider?
Kyra Bobinet, MD, has some helpful approaches on how providers can make consumer engagement a priority: http://ow.ly/S68T4. She and other patient engagement experts will share their approaches at the HIMSS Media Patient Engagement Summit on Oct. 12-13 in San Diego. Join in on the conversation and learning at the second Patient Engagement Summit: http://ow.ly/S699W.
How do you think patient engagement technologies can be better designed and utilized to improve health?