News roundup: of logos and HIMSS roundups, Rock Health’s Digital Health Consumer Adoption survey, and the millennial/Gen Z walkaway from primary care

HIMSS19 was last week. Onsite reports to this Editor declared it ‘overwhelming’, ‘the place to be’, ‘more of the same’, and ‘stale’. With a range of comments like these, everyone’s HIMSS is different, but HIMSS is well, a place that for most of us in digital health, have to be (or their companies have to be). It is still a major commitment, and if you are small, a place where you might be better off with no display and simply networking your way through. 

HIMSS must be conscious of a certain dowdiness, because HIMSS is ‘reforming’ with a preview of a new logo and graphics here that changes out their Big ’80s curvy lettering and muted colors to hard edges in typefaces and equally hard blues.

Mobihealthnews (a HIMSS company) delves into blockchain (Boehringer Ingelheim and IBM Canada) and Uber Health’s continuing foray into non-emergency medical transport. Dimensional Insight’s blog takes some of the sessions from the data governance and healthcare business intelligence perspective, including the opioid crisis, AI to detect cancer (the link between falling hemoglobin rates and a cancer diagnosis), and pediatric disease registries. And there is the always incisive HISTalk with last Monday Morning’s Update, their 2/14/19 roundup, and Dr Jayne’s Curbside Consult on John Halamka’s world travels, including nascent care coordination in China and interoperability in Australia.

Rock Health’s survey of consumer attitudes towards digital health adoption leads with these insights:

  • Wearable use is shifting away from fitness toward managing health conditions
    • There was a 10% increase in use of wearables to manage health, corresponding to a 10% decline in physical activity tracking
  • Telemedicine adoption is climbing, with urban consumers more than twice as likely to use live video telemedicine than rural consumers
    • Paradoxical but true, in terms of adoption of at least one form, it was 67 percent for rural residents and 80 percent for urban residents.
  • Highly trusted entities like physicians and health plans lost credibility in 2018—consumers were less willing to share data with them than they were in 2017. There’s an increasing distrust of ‘big tech’ and confidence in their ability to keep private data private–a wise takeaway given the Cambridge Analytica and Facebook scandals.

More acceptance of healthcare tools, less intermediation–and not trusting that data is secure spells trouble down the road unless these issues are addressed. Rock Health surveyed 4,000 respondents of US adults age 18 and over.

They’re not trad, dad. Accenture’s survey (released at HIMSS) also tracks the rejection of intermediation and gatekeepers when it comes to millennials and Gen Z in choosing non-traditional modes of healthcare, such as retail clinics, virtual and digital services. They are two to three times more likely than boomers to dislike in-person care; over half use mobile apps to manage health and use virtual nurses to monitor health and vital signs. Over 40 percent prefer providers with strong digital capabilities. Also Mobihealthnews 

16 or 27 million 2016 breaches, 1 in 4 Americans? Data, IoT insecurity runs wild (US/UK)

What’s better than a chilly early spring dive into the North Sea of Health Data Insecurity?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/03/Accenture-Health-2017-Consumer-Survey.jpg” thumb_width=”150″ /]Accenture’s report released in February calculated that 26 percent of Americans had experienced a health care-related data breach. 50 percent of those were victims of medical identity theft and had to pay out an average of $2,500 in additional cost. One-third (36 percent) believed the breach took place in hospitals, followed by urgent care and pharmacies (both 22 percent). How did they find out? Credit card and insurer statements were usual, with only one-third being notified by their provider. Interestingly, a scant 12 percent of data breach victims reported the breach to the organization holding their data. (You’d think they’d be screaming?) The samples were taken between November 2016 and January 2017. Accenture has similar surveys for UK, Australia, Singapore, Brazil, Norway, and Saudi Arabia. Release  PDF of the US Digital Trust Report

So what’s 16 million breaches between friends? Or 4 million? Or 27 million?

  • That is the number (well, 15.9 million and change) of healthcare/medical records breached in 2016 in 376 breaches reported by the Identity Theft Resource Center (ITRC), a Federally/privately supported non-profit. Healthcare, no surprise, is far in the lead with 34 percent and 44 percent respectively. The 272 pages of the 2016 End of Year Report will take more than a casual read, but much of its data is outside of healthcare.
  • For a cross-reference, we look to the non-profit Privacy Rights Clearinghouse which for many years has been a go-to resource for researchers. PRC’s 2016 numbers are lower, substantially so in the number of records: 301 breaches and 4 million records.
  • HIMSS and Healthcare IT News insist that ransomware is under-reported, (more…)

Cerner’s takeoff delayed on DOD’s new EHR, MHS Genesis

The new $4.3 billion US Department of Defense EHR, jointly developed by Cerner and Leidos, has taken another delay from the aggressive rollout schedule set in April.  The original test start date was 6 December at the Fairchild Air Force Base hospital in Spokane, Washington (state) and the Oak Harbor Naval Hospital on Washington’s Whidbey Island. Back in early September, it was reported that it would be delayed by at least a few months for technical reasons (Federal News Radio and Healthcare IT News). The rara avis in the latter is a mention of major dental supplier Henry Schein–along with Accenture, they were part of the award, but very much a junior partner in providing the dental EHR. (Leidos release)

The latest update on the start of MHS Genesis is February 2017 for Fairchild AFB and June for Oak Harbor. Healthcare IT News

Why hackers feel the $$ love for healthcare: Brookings study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”150″ /]It’s the information, silly! A recent study by the Center for Technology Innovation at the Brookings Institution tells us what we already know: healthcare organizations hold high-value information electronically, and because they haven’t invested equally in cybersecurity, it’s all vulnerable. When those nifty EHRs hold names, dates of birth, addresses, Social Security numbers and health histories, they are eminently salable. What’s new here is that the vulnerability increases due to factors not based on security, but on legal and data exchange requirements:

  • Data sharing and accessing
  • Length of storage to comply with regulations
  • The size of the records–the more information they hold, the more vulnerable

Lay on top of this ransomware.

The worst threat is not the hacker in a Bulgarian basement, but what is termed ‘state actors’ who want health information for a variety of reasons. They may be compiling a big database:”…a dossier of individuals that they could use for social engineering for future attacks”–such as sending phishing emails to government employees with specific, accurate information that when opened, infect their computers with malware for another purpose. Some solutions presented are using an outside cloud storage provider; using blockchain, which requires both public and private encryption keys; intrusion-detection systems (IDS) and security information and event management (SIEM) software. CSO, Brookings report (28 pages)

Hyperbole, pets & apps: a brief romp around the digital health scene

In technology, over-use of the term “groundbreaking” is common. However it takes some nerve to use the term to describe “Home Assist”, a push-button pendant-based telecare service now being sold by Boots (provided by Tunstall). Whilst TTA can only applaud the arrival of another high street offering, we would counsel a more realistic service description for a telecare service already offered by many.

Research via Boots’ own website reveals that in addition to the advertised push-button pendant, a falls detector is available as well. This site gives price details too, which look quite competitive at the basic level with non-subsidised local authority telecare schemes, though of course without the linkages to local services, including response services in the event eg of a fall, that some of these schemes also offer. Downloading the in store leaflet gives yet further information, for example that the pricier ‘advanced’ package includes a smoke detector (surely for older people almost as important as a basic pendant, and ideally one/floor of your house?) and bogus call detector, as well as falls detector etc.

Meanwhile in a far off land (Los Angeles to be precise) Active4Pets are busy recruiting to accelerate the US rollout of their “innovative” telehealth communication platform for pets. The (admittedly far-fetched) thought of pets regularly reporting vital signs electronically conjures up all sorts of bad, (though unavoidable) puns such as: (more…)

Primary care ‘virtual health’ could save $10 billion annually: Accenture study

A newly-released Accenture study on US primary care estimates that savings of about $10 billion per year in US primary care could be achieved through use of ‘virtual health’, defined as “digital tools such as biometric devices, analytic diagnostic engine and a virtual medical assistant” that would allow much of the work of a typical office visit to be done prior to or separately from the visit, and follow up/check in tools such as video visits/telemedicine which would further offset costs. The cost savings were calculated by Accenture Insight Driven Health as a total of time-per-visit savings of five minutes–when aggregated, $7 billion, $300 million in telemedicine visits, telehealth self-management in diabetes alone $2 billion, health system savings $63 million. This could potentially solve the shortage of US PCPs now projected at 31,000 in the next ten years. Nary a mention of patient care savings, chronic care management or telecare for proactive behavioral home monitoring, however. Accenture release (BusinessWire), Accenture page and paper.

Accenture projects that 50 percent of digital health startups fail after two years

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/08/Accenture-zombie_webready.jpg” thumb_width=”175″ /]Based on historical funding data and analyzing 900 healthcare IT start-ups, Accenture predicts that within two years of life, 50 percent will fail. These ‘zombie startups’, in Accenture’s charming term, burned through $4 bn in funding between 2008 and 2013. An additional $2.5 bn will go to fund digital health in 2015-16.

Does this mean that for the angels to the VCs, a visit to Las Vegas may be more fun? What remains can be mined for gold. There’s a wealth of IP–1,700 patents between the 900 startups analyzed–and experienced people who can be “aqui-hired”. Their solutions, despite failure, can be sound. Kaveh Safavi, managing director of Accenture’s global health care business, said, “Many digital startups that are dying or in danger of failure have developed solutions that can help traditional and non-traditional health care companies achieve their goals.” Mobihealthnews, iHealthBeat, FierceHealthIT. Accenture announcement.

Cerner win at Defense a crossroads for interoperability (US)

Modern Healthcare’s analysis of the Cerner/Leidos/Accenture win of the Department of Defense (DoD) EHR contract focuses on its effect on interoperability. In their view, it’s positive in three points for active military, retirees and their dependents.

* EHR interoperability with the civilian sector is needed because 60-70 percent of the 9.6 million Military Health System beneficiaries—active duty military personnel, retirees and their families—is delivered by providers in the US private sector through Tricare, the military health insurance program.

* A major criticism by Congress and veterans’ groups of both DoD and VA is the lack of interoperability between these systems as well as civilian. Many military members change their status several times during service, and can cycle within a few years as active, Reserve, National Guard and inactive reserve. Records famously get lost, sometimes disastrously.

* It’s a boost to state health information exchanges (HIE) in states with large military bases and also for the CommonWell Health Alliance, an industry group which is establishing EHR interoperability standards.

Less optimistic are some industry observers who see the DoD contract as sidelining resources demanded by Cerner’s civilian hospital clients, and whether realistically they can develop a system to exchange data with every EHR, including dental, and e-prescribing system in the US (and probably foreign as well). Modern Healthcare

US Department of Defense picks Cerner/Leidos/Accenture for $4.3 bn EHR

Breaking News Updated  The winner of the massive, potentially ten year contract for the Defense Healthcare Management System Modernization program is defense computer contractor Leidos, which brought in Cerner and Accenture Federal Systems.The DOD announcement mentions only lead contractor Leidos, interestingly under the US Navy Space and Naval Warfare Systems Command, San Diego, California. The announcement was released just after 5pm EDT today.

This combination beat the Epic/IBM and the Allscripts/Computer Sciences/HP bids. According to the DOD announcement, “This contract has a two-year initial ordering period, with two 3-year option periods, and a potential two-year award term, which, if awarded, would bring the total ordering period to 10 years. Work will be performed at locations throughout the United States and overseas. If all options are exercised, work is expected to be completed by September 2025. Fiscal 2015 Defense Health Program Research, Development, Test and Evaluation funds in the amount of $35,000,000 will be obligated at the time of award.” Modern Healthcare attended the embargoed press conference this morning and adds in its article that only one-third is fixed cost, with the remainder as ‘cost plus’, which could conceivably run the contract to the $4.33 bn ceiling over the 10 years. The system will be used in 55 military hospitals and 600 clinics, with an initial operational test as early as 2016 (Washington Post) and full rollout by 2023.  Interoperability with private EHR systems was a key requirement (Healthcare IT News).Over the 18 year life cycle, the contract value could be up to $9 bn, according to the WaPo.

The race to replace DOD’s AHLTA accelerated with the final failure to launch a plan to create a joint DOD-VA EHR in March 2013 [TTA 27 July 13], though hopes revived in Congress occasionally during the past two years [TTA 31 Mar].

It is also widely interpreted as a blow to Epic, which has been defensive of late about its willingness to play in the HIT Interoperability sandbox with other EHRs; certainly it cannot make Big Blue, which would undoubtedly have found some way to sell Watson into this, happy.

POLITICO’s Morning eHealth had many tart observations today, mostly pertaining to the belief of some observers that Cerner will be strapped in meeting this Federal commitment and would find it increasingly difficult to innovate in the private sector.

Example–From Micky Tripathi, CEO of the Massachusetts eHealth Collaborative: “My biggest worry isn’t that Cerner won’t deliver, it’s that DOD will suck the lifeblood out of the company by running its management ragged with endless overhead and dulling the innovative edge of its development teams. There is a tremendous amount of innovation going on in health IT right now. We need a well-performing Cerner in the private sector to keep pushing the innovation frontier. It’s not a coincidence that defense contractors don’t compete well in the private sector, and companies who do both shield their commercial business from their defense business to protect the former from the latter.”

HIMSS Monday highlights

HIMSS is the largest US healthcare conference in the world, and Neil Versel, who has just joined the staff of MedCityNews, reported that registrations in this year’s event in Chicago were in excess of 40,000. He has a 37 minute interview with HIMSS Executive Vice President Carla Smith where they touch on CMS, Meaningful Use, EHR interoperability, data security, patient engagement and the empowered patient such as E-Patient Dave deBronkart (who will also be at The King’s Fund Digital Health conference in June). HIMSS is also showcasing on the show floor mobile health, interoperability, cybersecurity, disaster preparedness, intelligent health and the connected patient….Another sign that the Wild West days of digital health are over is the increasing oversight of the Federal Trade Commission (FTC) on non-HIPAA regulated health data collected by fitness and wellness devices. This is in addition to health apps making unsupported claims (see today’s and previous articles on melanoma detection apps) and the PaymentsMD patient billing software that was collecting a little extra patient data. This is both extra- and in addition to FDA. Mobihealthnews….. The Venture+Forum on Sunday discussed doctor burnout particularly in acute care and to ease this, focusing on the Holy Grail of proactive rather than reactive care and results rather than ‘shiny new objects’ (what this Editor has called Whiz-Bang Tech) “Doctors want clinical decision execution. Don’t give me any more tools.” Healthcare IT News….A survey by Accenture released today on doctors and EHR usage headlines good news–79 percent US doctors feel more proficient in their EHR usage than in their 2012 survey. The bad news is that other numbers are plummeting: fewer believe that EMR has improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012), reduced medical errors (64 vs. 72 percent) and improved health outcomes for patients (46 vs. 58 percent). Familiarity breeds contempt? Buried way down in the release is that US physicians offering telehealth monitoring to patients has tripled since the last survey, from just 8 percent in 2012 to 24 percent now. Accenture surveyed over 2,600 physicians in six countries….HIMSS goes to Thursday, so more to come!

66% of ‘tech-savvy seniors’ dissatisfied with current health tech

Yes, those same people who–gee whiz–designed computers, did their own programs in MS-DOS and went from Palm Pilots to BlackBerries to iPhones, are already over or hitting 65 (3.9 million in US in 2015)–and they aren’t happy with what’s being served up to them in healthcare tech. The Accenture study across 10 countries and over 10,000 adults points out the demand–67 percent–and the dissatisfaction–66 percent. They want independent self-care tools, wearables to monitor themselves, online communities like PatientsLikeMe, patient navigators and health record tools. Moreover, the more comfortable they are with and value technology, the more likely they are already using technology for tracking weight and cholesterol levels. Couple this with the ‘Drawn and Quartered’ Parks Associates research [TTA 11 Aug 14] and moving past the mHealth hype earlier this week, the study points out a strong market for apps, online tools and other digital health–but designed not for a peer group of most designers, nor to be ‘cool’. Helloooo designers! Wake up! Laurie Orlov does point out on AgeInPlaceTech that there’s not much new here, but that we shouldn’t move on. Accenture release, Modern Healthcare, Fred Pennic in HIT Consultant, Stephanie Baum in MedCityNews

Cerner acquires Siemens HIT business

The big news in HIT circles today was Cerner’s purchase of Siemens’ health IT business for $1.3 billion. Forbes has the most detailed analysis by far, which appears prepared in advance based on the 22 July rumor published by HISTalk at that time. HISTalk’s and their readers’ comments on the announcement conference call today are moderately scathing and worth reading if of interest to you. The takeaway for this Editor is that it was a defensive move for Cerner versus Epic Systems, Athenahealth and Allscripts; they bought out a competitor, bought market share with the acquisition (although how much of it would have fallen to them anyway is a question), gained more of an international foothold plus an inside track to customers eager to move to newer technology. For Siemens, it appears  (more…)

NHS futures: Personalised and Preventative Care presentation

Courtesy of Accenture, we now have (perhaps exclusively?) Aimie Chapple’s full presentation delivered at the NHS Futures Summit in November. The link is contained at the end of Editor Charles’ article on ‘NHS futures – more encouraging signs of change‘ which puts it into context and is definitely worth your reading time. Hat tip to Mark Radvanyi of Accenture for providing Personalised and Preventative Care: Technology Trends and Disruptors that will Shape the Healthcare Transformation.

NHS futures – more encouraging signs of change (UK)

Monitor has now released the output from the NHS Futures summit held on 21 November 2013, hosted by NHS England, Monitor and the NHS Trust Development Authority. The summit was designed to spark debate about how the landscape of health and care providers could evolve over the next decade to better meet the challenges outlined in the Call to Action. Over 100 senior health leaders took part including commissioners, providers (including GPs), health policy experts, and patient and charity representatives.

The summary Call to Action document makes encouraging reading for those who believe technology can help the NHS to improve patient outcomes at lower cost.  Contrary to the consultation exercise held by NHS England last August when we pointed out that remote consultation was not even mentioned, this features prominently in the Monitor summary (see especially Appendix 3, on pages 19-21), together with many other uses of technology such as smart homes, encouraging self-care, telemedicine, single patient record, interoperability, etc.

There are also some great videos – in particular (more…)

Telehealth saves $55 million in the Basque Country

Faced with an aging population (18 percent over 65) and a failing Spanish economy, the Basque Country Health System is testing telehealth systems to keep its older population healthier and out of the hospital (23 percent are readmitted to hospital). The Accenture-developed TEKI is based on a Microsoft Kinect and connects to a heart rate monitor, pulse oximeter and a spirometer, using the Kinect to evaluate their mobility and provide prescribed exercise therapy as part of rehabilitation. TEKI is part of an Accenture-developed ‘Multi-channel Health Service Center’ that provides a variety of counseling and education services to the local older adult population. The Kinect is also used as a telemedicine platform to communicate with the patients in the study. Results achieved by the program:$55 million saving in Year 1 through eliminating 52,000 hospital visits, a 7 percent cost reduction per patient. CNBC/Philips feature, MedCityNews, video of Osakidetza Hospital staff using TEKI with respiratory patients, Accenture paper.

Philips, Accenture examining Google Glass

Philips and Accenture announced their test of a proof of concept which seamlessly transfers Philips’ IntelliVue patient monitoring data into a Google Glass display. The test is on how a surgeon could simultaneously view vital signs data while performing surgery and not having to turn away. In addition, the surgeon could consult with doctors in other locations in real time. Ready of course is a glossy YouTube video simulation (02:57). For the trend-spotters, (more…)