ON Healthcare

The Value of a Health Information Exchange

Written on Feb 10, 2011 by Diane Beattie 0 Comments

In Nov 2010 InformationWeek, published a Strategy Report in the development of over 200 Health Information Exchanges(HEI) in the US. A HEI ensure that all those providing care to a patient have the most up to date and comprehensive information possible in a secure manner. The expected results being: faster decision making for the patient, fewer duplicate tests and the improvement in patient safety particularly as it applies medication errors. Initial push back from physicians is fading as they begin to see the value and convenience of the technology.

In Canada the forward thinking of our Governments, put Canada Health Infoway in place close to 10yrs ago, with the goal that patient information could be shared with providers, as required, first locally or regionally and ultimately pan-Canadian.

The two countries may use different terms, but the goals are the same. Improve the delivery of care by securely sharing required patient with care providers and/or physicians.

Based on surveys down by HIMSS Analytics, the chart below shows that we in Canada are behind the US, but making progress.

Contrary to what many would believe the best progress in Canada is happening in the Maritimes. New Brunswick is leading the country. Why? This province is smaller both in geography and population which allows them to collaborate and work together differently than some of the larger provinces.

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How to Make the Most of HIMSS: A 5 Step Conference Plan

Written on Feb 08, 2011 by Diane Beattie 1 Comment

Whether a first time attendee or a seasoned conference goer, having a conference plan is a MUST, especially for a show as big and potentially overwhelming as HIMSS 2011.

IT folks are used to planning a project, but sometimes when we are out of our normal day to day environment we forget the basics that have helped make us successful.

I use the five most common questions to help plan my four day adventure: who, what, why, how and when.

1^st – Why Attend?

What are your goals for attending? First time attendees don’t need onerous goals but make them realistic. Examples might be: learn about 1 new vendor or product a day that will help my organization or make 2 contacts each day that I can follow-up with over the next year

2^nd – What Information will help move our Hospital forward in 2011 or 2013?

Know in advance what you think will help your organization. You will always have a pleasant surprise, but that is a bonus.

3^rd – Who will you learn from? Make sure you look through the full agenda before you go to identify who you think will have information or insights that will help both you and your organization. It could be a speaker or a vendor or a person you meet. Identify 2 or 3 speakers and 2 or 3 vendors. You may not ever purchase anything from the vendors you meet, but you will come away with ideas.

4^th – How? – agree that when you go back to your office you will share your learnings with your peers. To do this I suggest you

a) Document each session or booth on the exhibit floor you go to… take notes the old fashion way, dictate as you leave the session or take pictures on you smart phone

b) Summarize your notes each night… the amount of information is overwhelming at times so be sure to finalize your thoughts daily. Whether it is daily notes or a PowerPoint presentation, get the information ready to share with your peers… it only takes a few minutes

c) Make a list of ideas or people to follow-up with.

5th When? use your time efficiently and effectively. Commit to following a plan of attack for 2/3 of the day and leave 1/3 flexible each day. Plan out which major vendors you want to talk with and make an appointment to visit their booth. Plan when you want to visit them, before or after a given educational session.

For example Day 1

a) Attend the Key note address

b) Go to the 1^st session in the social media series

c) Go to 1st session in the mobility series

d) Visit vendor X’s booth to learn about a,b and/or c

It is a great learning environment. Enjoy it!

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PWC Forecasts Healthcare IT Trends for 2011

Written on Feb 06, 2011 by Diane Beattie 0 Comments

PWC in the US recently put out their “Top health industry issues of 2011” report. Although our systems are very different, Canadians will be impacted.

The rush is on!

Expected increased spending in the US on Health IT from 2011 to 2015 is $36 Billion, with at least $20B of that coming from the Gov’t incentive program. The USA has put in place a carrot and a stick approach. This is different than the approach used by Canada Health Infoway, in which organizations are only reimbursed once they can demonstrate they have effectively implemented. The USA health care organizations will receive incentives through 2015 to implement interoperable EHRs and show “meaningful” use. Following the incentives comes the stick or penalty for non-compliance. Over 66% of the CIOs surveyed in US Healthcare see a need to increase their staffing levels, primarily to ensure that Gov’t incentives available through 2015 are secured and used effectively, before penalties for non- compliance kick in.

What will this mean to Canada, a small market (less population than the state of California)

a) less vendor attention and more limited access to US resources, as the large US based software companies focus on the lucrative situation at home.

b) our staff maybe attracted to the US for higher wages and more challenging assignments. There are obviously differing views as to whether Canadians would go south, but with significantly lower projected spending in the next few years especially in Ontario due to high Gov’t deficits, and onerous procurement rules skilled professionals may well leave, just as doctors and nurses did in the 1990’s.

PWC mixes into the discussion Health Care IT trends were 2 very interesting Healtrh Care Trends:

Limited Consumer Demand

Similar to Canada, consumers are not demanding that they have Electronic records and/or have access to their own personal health record. PWC doesn’t feel that Health Care reform and thus lower costs will occur until consumers are engaged and willing to be accountable for managing and improving their own health. Canada is not different in this respect. But ‘Meaningful Use” requires hospitals and physicians to provide patients with an electronic copy of their health record on request. The theory of build and they will come may work, but significant consumer education is required to take advantage of this huge investment.

Generic Drugs

One may wonder why the introduction of more generic drugs is seen as a huge plus when taking about Health Care IT. Between 2010 and 2014, 50% of the drugs in the USA currently protected by patents will become available in their generic format. The US Health care sees this as a huge savings. In 2011 alone $26Billion of annual drugs costs goes off patent. If savings are 50%, the costs reduction is $13 Billion. So do we care? Yes, I think we do. Funding of Health Care is an issue for most provinces as they struggle with large deficits. Have the Ministries of Health factored in these expected decreased costs, or can this be a potential source of funds to help implement electronic records in Canada.

Bottom line:

We have a solid foundation with investment from Canada Health Infoway, the Provinces and the providers. We must find ways to continue investing in the Electronic Health Record.

Resources:
Find the PWC report online HERE!

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Cloud and SaaS Among IDC’s Top 2011 Healthcare Industry Predictions

Written on Feb 06, 2011 by Kevin Magee 0 Comments

January is prediction season and IDC has released it’s own top ten list of tends that will shape and define the Healthcare landscape in 2011.

Here’s their list:

Health reform providers will explore new care and reimbursement models.
EMRs will shift from purchase to adoption phase for hospitals in 2011.
EMR-as-a-service options will take off among ambulatory providers.
CPOE will get real-world experience.
Clinical decision support will be integrated into care.
Meaningful use and healthcare reform technology purchasing will continue.
Clinical mobility will drive meaningful use.
Business and clinical intelligence will become actionable.
Client virtualization will become the rule for point-of-care applications.
Healthcare storage will transform to support electronic records and images.

Not surprisingly, technology takes a number of the key spots with Electronic Health Records, CPOE, Mobility and Virtualization making the list however the inclusion of Cloud and SaaS may surprise some. While most other industries have been quick to adopt Cloud and SaaS Healthcare has been hesitant to make this leap. IDC is predicting that 2011 will see EMR and overall storage move in this direction and I quite agree.

Companies like Cerner have been providing a substantial number of EMR hosted services for a number of years now and the model has not only proven to be cost effective, but also extremely efficient for adoption and deployment of enhanced clinical systems. Moving administrative applications, data and communications to the cloud should be a natural fit for the healthcare industry which is in need of not only cost savings but also greater efficiencies and access to innovative technologies.

Offloading the management of technology through traditional outsourcing allows organizations to focus more resources and dollars on innovation and improved quality of care often providing better and more auditable security as well. Cloud and SaaS take the model to the next level with clinical and non clinical applications deployed and managed as a utility service. I expect we’ll begin to see more and more offerings move into this space or be created to meet demands in this space over 2011 and it’s nice to see that IDC agrees.

Resources:
Find the complete IDC article online HERE!

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Electronic Health Records and Hospital Quality: Reading beyond the WSJ headlines

Written on Feb 04, 2011 by Diane Beattie 0 Comments

In a late December Wall Street Journal article if you only read the headline, you would get the impression that the value of an Electronic Health Record is quite limited, that the investment in technology in Health Care is not a good use of resources and that this conclusion is supported by noted researchers. BUT if you take the time to read the full article and the report it was based on, you might come away with a very different perspective.

The researchers themselves in the full article, indicate that there are 6 major limitations to their study. The key points being:

1) The USA should ‘temper expectations for the pace and magnitude of the effects” of the governments incentive programs.

2) Work needs to be done on how to measure the return on investment and quality

So we should not discredit the article, but should go beyond the headline to understand what the real issues are.

Observations from someone who has worked at implementing Hospital Electronic Patient Records:

1) There are 3 key components to implementing these large systems: Technology, Process Change and Culture Change. The technology is the easy part. In the 1^st 3 or 4 stages of the ENRAM model, we are providing the clinicians with tools and they are generally receptive (example PACS). These stages can be lead or directed by IT.

But as you move into Clinical Documentation, CPOE and Clinical Decision Support the baton must be handed to the clinicians to lead. This is their work that will change. Paper processes need to be redesigned to take advantage of what computers can do. Automating the paper process for the sake of automating is general a recipe for disaster.

Process Re-design and Culture Change are not areas where clinicians/physicians have expertise, experience and in some cases interest. It is not what they were trained to do. But to be successful going forward they need to be the champions.

2) HIMSS has published in a number of articles that they have not seen significant ROI (quality or dollars) until Hospitals move to stage 5 on the ENRAM scale. The first 4 stages are about building the infrastructure.

3) Understanding and articulating benefits is an area that needs significant work. The return in many cases does not come back to the organization that is investing, but to the system as a whole. Small organizations, at least in Ontario, have been criticized for making the investments.

4) The small remote hospitals may see the most benefit as their patients often must be transported to larger centres for care or physicians come on a rotating bases to provide care.

In today’s world where time is of the essence and short fast communication is valued, take the time to read past the headline… the message is often much different than the few words used to capture our attention.

Resources:
Find the original online at the WSJ Health Blog HERE!
Find the full study at the American Journal of Managed Care HERE!

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FDA Regulation of Mobile Health Report Released

Written on Jun 24, 2010 by Kevin Magee 0 Comments

The question that comes up in almost any deep and detailed discussion related to the emerging mHealth market is: how does or will medical device regulation apply? Sometimes it surprises people, especially outside of the industry, that this is even a consideration. Is a Doctor’s Blackberry really a “medical device”? The answer is a resounding: maybe.

The FDA in the United States is the primary focus of most of the relevant information and speculation and to date there has been very little consolidation of facts available to healthcare executives and the vendor market to review.

To fill this gap MobiHealthNews one of, if not the leading online site covering the mHealth market has published a free report entitled “FDA Regulation of Mobile Health” which covers a great deal of this ground. The report is written by Bradley Merrill Thompson who leads the Medical Device Regulatory Practice, the Clinical Trials Practice and the Connected Health Practice for law firm of Epstein Becker Green, P.C. and who clearly knows a thing or two about the subject.

What is a “Medical Device” then?

The report begins with a few definitions that provide context for further discussions as well as a little overall clarity. The definition used for a “medical device” is the FDA’s own, coming from Section 201(h) of the Federal Food, Drug, and Cosmetic Act:

… an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, which is … [either] intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals … [or] intended to affect the structure or any function of the body of man or other animals.

Components and Accessories

The two other distinctions the report points out are that of a “component” and an “accessory”. Both are regulated but to different extents and as a vendor, understanding this distinction is the key to minimizing or managing the level of compliance required.

Interestingly, the difference is defined not so much by the actual equipment or technology, but rather by who is purchasing it. End users buy “accessories” while manufactures buy “components” even though for all intents in purposes the actual device may be identical this distinction governs the regulatory compliance that will need to be met.

Summary

For those with an interest in the topic the report is extremely accessible even though it covers very technical and legal subject matter. For vendors or manufactures developing products in the mHealth market, the report is a must read if nothing else to ensure that your understanding of regulatory compliance is in line with the FDAs.

Resources:
Download of read the report online at here,
And find more mHealth news and reports at MobiHealthNews

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Developing Nations Lead the Way in mHealth

Written on Jun 21, 2010 by Kevin Magee 1 Comment

Mobile eHealth Solutions for Developing Countries In many markets disruptive innovation and technologies that were once the domain of developed countries with extensive University and private research networks have been overtaken and surpassed by developments in emerging markets.

If “necessity” is the mother of all invention, then there is no greater necessity than access to quality healthcare in developing nations and it is this fact that is driving innovation at a pace that developed countries just cannot compete with.

Mobile Health solutions are not only a necessity due to long distances, lack of infrastructure and high clinician to patient ratios, but they also make the most sense in nations where the mobile phone is the key communications device for individuals, business and sometimes entire communities.

This focus on mHealth, lack of hang-ups with existing infrastructure and communications legislation and will to bridge the gap in quality care with developed nations has been the catalyst for incredible growth. So much so that it’s now worthwhile and even advisable to be looking to developing nations for simple, efficient and effect solutions to global health problems.

If this is an area of interest or you are simply looking for a great primer resource for the mHealth market than have a look at the Mobile Health Solutions for Developing Countries 2010 published by the International Telecommunication Union (a United Nations Agency).

The report is 122 information packed pages and does a great job of capturing the requirements of an emerging mHealth market, outlines the technical aspects of the infrastructure requirements and provides excellent real world examples from a diverse group of emerging and developed nations including Algeria, India, Russia, Uganda and Nepal.

Resources:
Find the complete report online and available for download here,
Visit the International Telecommunication Union site here.

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Healthcare To Pair Well With Bluetooth 4.0

Written on Jun 20, 2010 by Kevin Magee 1 Comment

Blue Tooth 4.0 Often when we think of mobile Health we focus on mobile as in cellular devices however there is a great deal innovation taking place in other areas of this market that will have impact beyond the iPhone. Bluetooth is one of these technologies that is a rather silent but potentially huge game changer.

When most people think of Bluetooth, they think of headsets for their mobiles however this technology can be adapted for a number of uses in Healthcare. Basically take any two devices in relatively close proximity that do, could or should exchange information and Bluetooth can provide the solution.

A brief walk through any ward in any hospital around the world would be all that is required to complete a business case for evaluation or adoption. Take note of all of the hardwired devices and imagine the benefit of removing the tangle of integrated wires from the environment; then consider the medical and other equipment that could transmit patient data directly to a nursing station, a handheld or even an EHR without all the hassles, expense and power requirements of WiFi. It’s probably a good size list.

There have been limits to the Bluetooth technology that have made it’s integration into Healthcare technology somewhat limited to date, namely battery life. The average mobile headset can last a day or maybe two on standby but drains very quickly when in active use. A four hour charge just won’t work for for a nurse on a 12 hour shift so overcoming this hurdle seems to be the key to the technologies future success.

Enter Bluetook 4. iMedicalApps has a great article on the future of this technology which outlines why Bluetooth 4 is going to be a game changer for healthcare and one of the key components is a set of standards that will see battery charges last for weeks or possibly months.

Resources:
Check out the iMedicalApps article online here,
Or for more technical details try the Bluetooth Directory here.

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New England Journal of Medicine iPhone App

Written on Jun 17, 2010 by Kevin Magee 0 Comments

New England Journal of Medicine iPhone App

The New England Journal of Medicine has launched an iPhone app and judging by the reviews it’s been very well received thus far.

As Dr. Bryan Vartabedian points out on his blog 33 Charts, “the way to a doctor’s heart is through his smartphone” (perhaps doubly so for cardiologists?) and the application’s developers have certainly understood and embraced this.

Not only is this an excellent markeitng move by the Journal, it may also be a good thing for patients too. Access to Journals by clinicians increased dramatically when they were originally ported to the web, however “webified” versions certainly do not leverage technology beyond “distribution” in most cases. Not so with this next generation of medical journals.

The integration of multimedia, pod casts and other communication and collaboration channels behind a fire-walled website limited thier accessibility and therefore effectiveness, however now Doctors can browse the Journal anywhere, download audio material to be listened to via the iPod portion of the iPhone and collaborate via social media immediatly with thier Colleagues.

This means, more clinicians keeping up-to-date, more collaboration and greater distribution of information, data and ideas.

With the advent of the iPad and other mobile technologies, it will be interesting to see how medical journals, now faced with the same challenges as other traditional media adapt, survive or become irrelevant over the coming years. Clearly, the NEJM has set the bar high for all others going forward.

Resources:

Download the app directly here,
Read a great review on 33 Charts.

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Apple Files iPhone Heart Rate Patent

Written on Jun 16, 2010 by Kevin Magee 0 Comments

Apple Heart Rate Patent
Apple has filed a patent that could be the first step in a larger plan to merge mobile and consumer health devices into the iPhone platform.

It makes great business sense for Apple. Many people exercise with their iPhone whether it be jogging, walking, cycling or at the gym. With the device already attached to the person, why not extend it’s capabilities to monitor heart rates and provide other physical data that can improve workouts? Create new interactive games? Sync music to the level of activity? The opportunities are endless.

For patients living with heart conditions, the presence of a heart monitor in the form of a cellphone seems a non-invasive to an individuals lifestyle and could also involve a great deal of added services and protection. If a patient were to suffer a heart attack, could the iPhone not immediately alert a physician or even call 911?

Integrating health monitoring capability into the market leading consumer mobile health device is a shrewd move on Apple’s part and it will be interesting to see if they actually leverage such technologies in the future.

Resources:
Go straight to the patent filing here,
Read additional summaries on Medgadget and Engadget.

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ON Healthcare

The Value of a Health Information Exchange

How to Make the Most of HIMSS: A 5 Step Conference Plan

PWC Forecasts Healthcare IT Trends for 2011

Electronic Health Records and Hospital Quality: Reading beyond the WSJ headlines

FDA Regulation of Mobile Health Report Released

Developing Nations Lead the Way in mHealth

Healthcare To Pair Well With Bluetooth 4.0

New England Journal of Medicine iPhone App

Apple Files iPhone Heart Rate Patent

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