From despair to hope? New study charts future of patient-generated data in care delivery

click to enlargeA frustration of everyone in healthcare and technology is the unfulfilled promise of Big Data. A study conducted by a team for NEJM Catalyst (New England Journal of Medicine) of 682 health care executives, clinical leaders, and clinicians indicates that at present, very few (<20 percent) believe that their healthcare organizations extremely or very effectively use data for direct patient care; 40 percent believe it is not very effective or not at all effective.

The hope comes in a trend over the next five years (NJEM chart at left above, click to enlarge). Presently, the most useful sources of data are clinical (95 percent), cost (56 percent), and claims (56 percent). In five years, they project that the top four will be clinical (82 percent) and cost (58 percent) joined by patient-generated and genomic data (both at 40 percent). How that patient-generated data will be compiled to be useful is not described, but the hope is that “With patient-generated data and genomic data, we will be able to create true “n of 1” medicine with options specific to each patient’s needs, giving a boost to priorities such as care coordination and improved clinical decision support.”

A possible roadblock is the lack of interoperability of EHRs. Less than 10 years ago, the EHR was touted as The Solution to patient records and a repository of Everything. 51 percent indicate that interoperability is weak. One-third believe that ease of use and training for EHRs are also week.

Other findings indicated strong support for greater patient access to personal medical records (93 percent), fee/price information for comparison shopping (80 percent), and outcomes information listed by hospital (73 percent)–but not by doctor (55 percent).

The full report is available for download at the NEJM Catalyst link here. Also Mobihealthnews.

VA Digital Health Platform proof-of-concept unveiled; new VA head nominated

Back in April 2016, the Department of Veterans Affairs (VA) in Congressional hearings hinted at an end of year preview of a ‘state-of-the-art’ digital health platform which would integrate veteran health information from multiple sources. That debut was revealed this week in analytics vendor Apervita‘s announcement that they are participating in a proof-of-concept of the VA Digital Health Platform (DHP). According to their release, in the first three weeks, they and the DHP partners demonstrated that they could organize and extract insights from veteran data originating from VA, military, and commercial electronic health records, plus e-prescribing, apps, devices, and wearables. The end outcome is to provide a unified view or dashboard that integrates data, implements a care plan, tracks clinical encounters, optimizes medications, responds to patient needs, and more. The prime contractor in DHP is Georgia Tech, which brought on board Apervita, Salesforce (workflow user engagement), and MuleSoft (API). Next steps are not disclosed. Mobihealthnews, Health Data Management

One of the sparkplugs behind the DHP and also interoperability of DOD’s and VA’s badly outdated VISTA EHR is current VA Undersecretary for Health David Shulkin, MD. Today, at an eventful press conference, President-Elect Donald J. Trump nominated him for the VA secretary position. Dr Shulkin was previously CEO of Beth Israel Medical Center in NYC and president of the Atlantic Health System ACO. He will also be, upon Senate approval, the first non-veteran head of the VA. What is apparent is that P-E Trump has not moved one iota from the promise he made during the campaign to move fast on modernizing, improving quality and speeding up veterans health services–and for that he needs an insider.  Health Data Management

Friday’s cyberattack is a shot-over-bow for healthcare (updated)

click to enlargeFriday’s multiple distributed denial-of-service (DDoS) attacks on Dyn, the domain name system provider for hundreds of major websites, also hit close to home. Both Athenahealth and Allscripts went down briefly during the attack period. Athenahealth reported that only their patient-facing website was affected, not their EHRs, according to Modern Healthcare. However, a security expert from CynergisTek, CEO Mac McMillan, said that Athenahealth EHRs were affected, albeit only a few–all small hospitals.

A researcher/spokesman from Dyn had hours before the attack presented a talk on DDoS attacks at a meeting of the North American Network Operators Group (NANOG)

The culprit is a bit of malware called Mirai that targets IoT–Internet of Things–devices. It also took down the (Brian)KrebsOnSecurity.com blog which had been working with Dyn on information around DDoS attacks and some of those promoting ‘cures’. According to Krebs, the malware first looks through millions of poorly secured internet-connected devices (those innocent looking DVRs, smart home devices and even security devices that look out on your front door) and servers, then pounces via using botnets to convert a huge number of them to send tsunamis of traffic to the target to crash it. According to the Krebs website, it’s also entwined with extortion–read, ransomware demands. (Click ‘read more’ for additional analysis on the attack)

Here we have another warning for healthcare, if ransomware wasn’t enough. According to MH, “even for those hospitals with so-called “legacy” EHRs that run on the hospital’s own computers, an average of about 30 percent of their information technology infrastructure is hosted (more…)

VA’s moves spell the end of the homegrown EHR

The Veterans Health Administration (VHA) is formally reaching out to the private sector to explore switching from its current, pioneering EHR system, VistA (also referred to as CPRS, Computerized Patient Record System) to a commercial system. Their ‘feeler’ is an August 5 and 8 notice in FedBizOpps.gov titled 99–TAC-16-37877 * RFI – VHA supporting COTS EHR REQUEST FOR INFORMATION (RFI), Solicitation Number: VA11816N1486. This requests information on business support for transitioning to a commercial-off-the-shelf system (COTS–don’t governments love acronyms?–Ed.) and closes 26 August, which is not a lot of time even for an RFI.

VHA has been under extreme pressure from Congress to modernize its EHR, lately in July hearings before the Senate Appropriations Committee. EHR replacement is also in line with the Congressionally-mandated, now concluded Commission on Care’s recently published recommendations on a total, top-down reorganization of VHA, including a sweeping reorg of their HIT management. The VHA strategy appears to be that while they are walking down the road to replace VistA and have already spent to assess where they are with KLAS and other EHR consultancies (spending $160,000+ on surveys), they are essentially ‘kicking the can down the road’ to the next administration (POLITICO’s Morning eHealth, 14 July).

Current state is to continue to upgrade VistA through late 2018, though the closely related Department of Defense’s Military Health System is in the long process of cutting its homegrown AHLTA over to Cerner-Leidos as MHS Genesis, awarded last August, with a first trial in the Pacific Northwest later this year (HealthcareITNews, Ed. emphasis). Of course, it will take the VHA years to roll it out; there are close to 9 million veterans enrolled in the closed system that is the VHA.  FCW, Morning eHealth 10 August

Love EHRs or hate them, the sheer size of the VHA and its growing concession that VistA won’t do in caring for American veterans makes it clear that the future of EHRs is in private systems from major developers–a field which is winnowing out to The Few (take that, GE).  (more…)

Paper beats the EHR rock, docs in British Columbia conclude

“Moving to an electronic system should enhance the care we provide, rather than jeopardize it.” “We do not want a catastrophic event to occur in order to have our concerns heard.” “We do not feel that it is ethical to put patients at risk using a system that makes it difficult to ‘do the right thing’ and much easier to make a significant error.”

Nine weeks into the launch of a C$174 million Cerner EHR in March, emergency room and intensive care unit doctors Nanaimo Regional General Hospital in British Columbia, Canada reverted to paper orders and instructions out of concern for patient safety. Internists and others wanted to do the same. They formed a 250-member Medical Staff Association, which had enough concerns to go on the record with a report that included the above. One example: the lack of confidence in the electronic ordering system module for diagnostic tests, drugs and patient instructions was enough for sixty-one Association members to vote unanimously on a  “no confidence” motion in the system and a return to paper orders. The report also detailed “a multitude of physician-reported major safety issues from every department that deals with acute patient care.”

The B.C. provincial health authority, which in Canada’s system can overrule doctors and parent companies (Island Health), won’t remove the offending module, but is concerned enough to order additional resources and ongoing refinements, based on physician concerns and recommendations from a recent internal investigation. Island Health’s board also asked the health authority to: address fatigue in clinical staff and medical professionals; adjust resources to alleviate workload burden; Improve trust in the electronic health record and associated clinical care processes; work collaboratively with clinicians and medical staff to evaluate improvements in the electronic health record for quality and safe patient care. Times Colonist (BC)

Rock Health: 1st Q funding deals up nearly 50%, approaches $1bn (US)

click to enlargeFunding’s up, but the digital darlings have changed. The stock market and tech sector may have been uncertain kicking off 2016, but digital health wasn’t. Rock Health’s first report for 2016 exudes optimism. Compared to the same quarter in 2015, funding increased nearly 50 percent to $981.3 million, the highest amount since 2011. But the devil may be in the details:

  • Five deals accounted for 56 percent of the volume (in descending order: Flatiron Health (clinical intel for cancer care), Jawbone, HealthLine (consumer health info), Health Catalyst (data warehousing) and Higi, an odd little kiosk + consumer engagement program nationally placed in Rite Aid stores–odd enough to gain $40 million in its first venture round
  • Seed and Series A raises were still well over half–54 percent, over the 50 percent in 2015
  • Later stage deals (Series D and above) shrank to 13 percent in 2016 from 35 percent
  • Top categories also demonstrated the fickleness of funding favorites. Only two categories in the top six were carry-overs from 2015: wearables (driven by Jawbone) and consumer engagement. New favorites: analytics/big data, population health management, consumer health information and EHR/clinical workflow.
  • There were no venture-backed IPOs in the quarter, and public company performance was down (9 percent y/y)

The new picture favors what to do with the data–finding trends and putting them to use both consumer and clinical sides. And exits were popular as well: 187 was the Rock Health count, with fitness wear Asics‘ acquisition of the Runkeeper fitness wearable and provider One Medical acquiring the Rise app. Will the trend continue in 2nd quarter? Stay tuned….Rock Health Q1 Update

A gallimaufry of short digital health items to start the day with

The WHO has produced an excellent report on the state of eHealth in the European region, including a review of telehealth readiness. Ericsson have produced a very interesting report confirming what I guess anyone will have realised if they’ve traveled by public transport or have children: young people downloading video content are driving a surge in data usage: there’s much detail here though. Both are well worth the read.

Mentioning Ericsson reminds that the Telegraph recently produced a summary of the 20 best-selling mobile phones of all time – takes you back, with the substantial number once produced by Nokia.

The Royal Society of Medicine has it’s fifth annual medical app conference on April 7th – numbers booked have already well exceeded last year’s sellout so they are expecting to fill this year’s much larger conference venue. The focus this year is on the many legislative, regulatory and voluntary measures being introduced that will impact medical apps – there’s still room for old favourites though, such as Richard Brady’s always-topical (more…)

‘VC tourism’ in Health Tech Land is over (updated)

The ‘silly money’ is packing its bags and taking the next flight from the Coast. An exceedingly tart take out of Fast Company confirms what your Editors have noticed in Rock Health and other year-end reports. Funding for digital health may have surpassed $4.2 billion in 2015, but it barely eked over 2014’s total of $2.3 billion despite rising geometrically since 2011 [TTA 16 Dec 15, revised by Rock Health since then]. Since then, we’ve had the Trouble Every Day of ‘unicorns’ (overreaching) Theranos and (ludicrously) Zenefits [TTA 17 Feb]; EHR Practice Fusion stalled out and cutting 25 percent of its staff, hoping to be acquired by athenahealth–or anyone (Healthcare Dive); shaky Fitbit shares [TTA 20 Feb]. Perhaps the high point was last year’s ‘Corvette Summer’ with yet another big round to a company yet to fulfill its promise, ZocDoc [TTA 15 Aug 15]. Even Castlight Health with decent revenue (still at a loss) has been dubbed an ‘absolute horror show’ when it comes to its share prices, if you were foolish enough to buy it at or near its IPO.

Fortunately a large dose of sanity may prevail among VCs with a sobering realization–no different than five or ten years ago–that investment has to be strategic and far longer than the usual 18 month-and-out time frame. Too many companies have systems which work the same niche–you don’t need 50 companies doing these things: data analytics for care management, patient engagement platforms, med reminders or diabetes management. [We’ve already noted the ‘sameness’ in companies getting funded in 2015, almost as if investors were seeking reassurance in similarity, a sure sign of a coming fail–TTA 30 Dec 15.]

Developers must fill a need–uniquely. And have a superb business plan, squeeze the nickels till they squeak and forget about the party culture. Investors: Dumb Money For Digital Health Will Vanish As Quickly As It Came In

 

A Hollywood ending? Medical center’s $17,000 ransom to recover systems from hack attack

click to enlarge‘Hollywood’ Hulk Hogan is getting a workout! (UPDATED)

Hollywood Presbyterian Medical Center paid $17,000 (40 bitcoins) last night to hackers to regain control of its IT systems after last week’s ‘ransomware’ attack forced them offline. According to CEO Allen Stefanek, “The quickest and most efficient way to restore our systems and administrative functions was to pay the ransom and obtain the decryption key.” HealthcareITNews has the details and the full CEO letter/press release, including that no patient or employee information appears to have been compromised.

Obviously there will be more to follow including the usual opining, but in this resolution and spin, a bad precedent has been set in this Editor’s view. Labeling it a ‘low-tech’ attack shines a Klieg light (this is Hollywood after all) on the vulnerability of this hospital’s system. They now have the decryption key to the malware, but what other bad code and general mischief is buried in their systems to crop up later?  Another question: was the inflated bitcoin number floated to make the paid ransom seem ‘affordable’? Is this a Hollywood ending where all is happy, or is this an episode in the continuing soap opera of ‘Hospital as Cash Machine’?

Our original article follows: (more…)

Hospitals should ‘wash their hands’ of older medical devices, OS: expert

Our Readers are likely well aware that older medical devices may present a Hacker’s Holiday, but putting a very fine point on it was Kevin Fu, associate professor of electrical engineering and computer science at University of Michigan, speaking at a Healthcare IT News healthcare cybersecurity forum this week in Boston. Mr Fu pointed out that many hospitals are actively using old devices and old PC systems; one local hospital had 600 supposedly unpatched Windows XP (!) boxes deployed. Older medical devices were not designed with security in mind, which he likens to basic sanitation:

“If you’re using this old software, these old operating systems, you’re vulnerable to all that malware – that garden-variety malware – that has been out in the wild for more than 10 years.” and “This is not rocket science; this is basic hygiene. This is forgetting to wash your hands before going into the operating room. Here we have medical devices where, if malware gets through the perimeter, there is very little defense.”

The press has been concentrating on the big breaches and external hacking (they do make good copy–Ed.), and we’ve expended a lot of air on things like the EHR Wars, but the real threats are more mundane, as Ponemon and others in the field have warned for years. Software updates and infected USB flash drives can spread malware. A vendor can be a regular Typhoid Mary unintentionally corrupting systems and devices down the line.  (more…)

Turn down the noise! Is it possible in a hospital?

click to enlargeTry texting and more. One of the more unfairly overlooked mHealth tools is text or SMS. While simple, the back end and integration can be complex, especially when integrated within healthcare IT systems.

In the US, one of the key metrics that hospitals are rated on in their HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) is quietness of the hospital environment. Hospital noise is more than annoying–it is at a level that blocks healing and deprives patients of needed sleep (see study). There are door slams, people walking and talking, TVs and incessant boops and beeps from equipment. This annual survey told Inspira Health Network, a three-location hospital system in southern New Jersey, that they had a noise pollution problem.

One noise IHN hospital management could control was overhead pages–over 150 daily at their Vineland hospital. In a Quiet Hospital initiative, they replaced the overhead page system largely with a secure texting system developed by Newark, NJ-based Practice Uniteimplemented by their reseller, Futura Mobility and consultant Pursuit Healthcare Advisors. Texts now go from nurses to physician smartphones, reducing overhead pages to perhaps two emergency ones daily. Scores for quietness satisfaction have improved drastically: at the Elmer hospital from 60 to nearly 100 percent, Woodbury from 45 to 56 percent, and Vineland from 55 to 62 percent.

Where the interesting integration–and workload reduction–happens is that those nurses can also make a stat consult request to a physician via Inspira’s EHR which is then sent to the physician’s phone. It also leaves an audit trail so that completion can be tracked. Lab results also can be sent to the EHR or phone, depending on physician preference, and patient round lists to residents’ phones. According to Healthcare IT News, these features have been adopted by affiliated medical practices; it has improved response times, patient consults and EHR updates, plus reduced patient stays. Health Data Management, HIT Consultant (Photo Cambridge Sound Management from their article on sound masking in hospitals.)

A diagnosis of why digital health startups die–an old (and new) story

click to enlargeFor years now, your Editors have championed integration of data and system interoperability–search on these terms and you’ll find a wealth of articles and views. This Editor also included how data is integrated in patient records as the Fifth Big Question (FBQ) in 2012 [TTA 8 Aug 13]. Many digital health companies, not just startups, have failed at the data integration (and security) tasks, whether with EHRs, hubs, billing and practice management systems or with other devices. (Let us not forget that the initial impetus for Continua back in 2007, the US state/regional HIXs and for HL7 now, was to have common data and interchange standards.)

So there’s no real element of surprise here by John Sung Kim’s pleading in TechCrunch re ‘integrating into legacy systems’ and the troubles his own startup DoctorBase encountered in what he tactfully puts ‘political and technical hurdles’ encountered. But then the velvet gloves come off about EHRs and their less-than-scrupulous idea of ‘partnerships’. (more…)

Integrating inexpensive lab testing, imaging to EHR–and vice versa

In the Dr Eric Topol patient-driven world, personal lab testing would be walk in, keep retail hours and not even need a doctor’s order. That is the model for Theranos, a well-funded low cost blood testing company operating 43 centers in California, Arizona (no doctor order needed) and one Pennsylvania Walgreens. Their latest alliance is with EHR physician practice giant Practice Fusion, which claims about 112,000 doctors actively using its cloud-based, ad supported platform, claims to be the fastest growing US EHR with at present 100 million patient records. The Theranos reporting app, which also connects patients with doctors who can help interpret the results (MD Connect) integrates with other EHRs (though not listed) and now the results will also show in their Practice Fusion patient record. Practice Fusion is also integrating imaging center RadNet‘s results.

Since the late 2000s, Practice Fusion has historically been the game changer in cost (one of the first in the cloud) and in catering to smaller practices. They are good at managing their hype, but as Neil Versel points out, there’s been a CEO ‘change-lobsters-and-dance’, there are questions about revenue and their awaited IPO seems far away, especially given the recent market upset. Hospital EHRs Cerner, Epic and NextGen now all have lower-cost practice versions that integrate with hospital versions. An American College of Physicians (ACP) 2014 survey identified that Practice Fusion is third (and tied with others) among most used practice EHRs behind Epic and eClinical Works, though strongest in solo practices. On the polar opposite of Mr Versel’s skeptical article is this breathless Forbes piece which confuses partnerships with acquisitions. Perhaps self-made billionaire Theranos CEO Elizabeth Holmes may decide to buy Practice Fusion!

Unicorns to Series A–health tech funding gained in (perhaps) the nick of time

click to enlargeMoney, money everywhere–unicorns get the headlines, but the companies are still (largely) small

Up until early August, this Editor would have assumed that our Readers would look at this funding roundup as a bracing windup to a largely positive eight months and a veritable Corvette Summer for healthcare technology funding. We may have to give back the keys a little sooner than we imagined. Will the dropping market affect digital health as 2008-9 did–‘out of gas’ for years? Or will it barely affect our motoring onward? Despite the Dow Jones average hitting an 18 month low today, we hope it’s closer to the latter than the former. though the new and big entrant to digital health investing is the country most affected, China.

Our roundup of the August Action includes ZocDoc, Fitbit, Alphabet, PillPack, Owlet and more, along with a few comments:

**ZocDoc, a NYC-based online medical care appointment service that matches patients with doctors by location and schedule, had the most sensational round with last week’s Series D funding of $130 million, giving it a valuation of $1.8 bn. It took over a year after the filing (June 2014) and was led by two foreign funds (London-based Atomico and Edinburgh-based Baillie Gifford) with additional funding from Founders Fund, which previously participated in raises of $95 million.

Though it claims 60 percent coverage in the US  and ‘millions of users’ (numbers which have been quoted for some years), ZocDoc won’t disclose profitability nor volume–metrics that would be part of any IPO.

Direction? Points given for deciphering this windy statement (quoted from Mobihealthnews): (more…)

Telemedicine: critical massing or déjà vu, dear Humans, too?

A veritable blitz of telemedicine advocacy articles have appeared in the past week in leading healthcare and business publications. All of them promote telemedicine as a mix of consumer friendly (rapid care from anywhere at relatively low cost), a solution to the paucity of primary and specialty care in rural America, and contributing to quality affordable care. They both point out the increasing acceptability of the online consult (75 percent of consumers favor in a recent Cisco survey) and by doctors (60 percent). The writers are former Senator, Majority Leader and practicing surgeon Dr Bill Frist, and Dr Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via. Health Affairs (Frist) and Wall Street Journal (Boxer).

Of course, do you need a human doctor at the other end, or will Humans do? The University of Southern California has tested Ellie, a virtual human,who’s been successful at getting patients to report honestly to her–more honestly than to real people.  (more…)

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