Welsh Government to develop new eHealth and Care Strategy

The Government of Wales has announced that it is to develop a new eHealth and care strategy in [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Welsh-Goverment.jpg” thumb_width=”150″ /]conjunction with health boards, NHS trusts and local authorities in Wales. The strategy will focus on using technology such as video conferencing, remote monitoring and better use of health records.

In a written statement issued last week while the Welsh Assembly is on its break, the minister for health and social services states that consultation will take place with health and social care professionals and users and the strategy will be in place by the end of the year.

“This will help us achieve our aim of ensuring there are more services, care and support available for patients in their homes or in their local communities” says the statement from Mark Drakeford.

“Technology has a key role to play. This could include the use of video conferencing to allow patients and health professionals to talk to each other; to aid diagnosis and decision making and remote monitoring for people with particular health conditions. Technology can also help improve access to services by bringing them closer to people’s homes, for example by providing mobile services in rural areas.

“With an increasing ageing population it is essential we enable people to live independently for as long as possible. Without this, the health and well-being of individuals will be adversely affected.

“We will expect our information to be accessible to professionals where and when it is needed whether in health or in social care. We already have the Individual Health Record, with appropriate security and governance in place. Any potential wider access to people’s data would only be with their consent.”

The full statement is available on the Welsh Government website here.

Box.com’s odd swerve into healthcare cloud storage and PHRs

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /] Both The Gimlet Eye (filing from a remote island) and Editor Donna have been pleased users of the Box.com file storage site for storing all sorts of files in the ‘cloud’ (a/k/a Somewhere Out There On A Whole Bunch Of Internet Servers), sharing and collaboration. It’s simple to use, it works and, for our needs, actually free. However founders Aaron Levie and Dylan Smith, who look barely old enough to shave (but smartly have A Touch of Grey in their management team), have their eyes set on far bigger prizes than our mediocre needs. Now they have added ‘special advisers’ Aneesh Chopra, first US CTO, and Glen Tullman, former CEO of Allscripts. Mr. Tullman certainly does add major luster (and connections) and Mr. Chopra, despite the Eye’s consideration of him as hyperbolic and politically, not technically, qualified for his previous positions in the Government and the state of Virginia, adds the inevitable political ones. Having them on the roster also adds heft to their imminently rumored IPO (TechCrunch; update, filed 24 March) and ultimately acing out other file sharers Dropbox in the enterprise area. Expectations are high; Box has $414 million in funding from a roster of investors (including Telefónica and Australia’s Telstra) through a Series F (CrunchBase) with a valuation of $2 billion (TechCrunch) and undoubtedly they’d like some of it back. Soon. (The completely overheated Castlight Health IPO only whets the appetite.)

Healthcare one key to a rich IPO. Box’s healthcare moves point in the enterprise direction. (more…)

Reflections on the NHS Innovation Expo (UK)

Editor Charles visited the Expo in Manchester on Tuesday 4th March – here are his personal reflections.

I decided to devote the one day I had to visit the NHS Innovation Expo to visiting stands to try to spread the word about DHACA that was launched last week.

The first thing I noticed about the event was that it seemed less crowded than previous ones. When passing them, I never saw the main auditoria full either, very much in contrast to earlier Expos.

The other principal observation was that (more…)

Mobile in healthcare: HIMSS Analytics infographic

You can read the full 3rd Annual HIMSS Analytics Mobile Survey of 170 health IT and clinical staff or treat yourself to the highlights in this infographic. It summarizes key findings such as 59 percent have a mobile technology plan and 29 percent are developing a mobile technology plan; 62 percent indicated that they offer patients access to at least one of the mobile tools identified in the research, including patient portals, telehealth services and remote monitoring devices; only 22 percent indicated that three-quarters of the data captured by mobile devices was integrated into the organization’s EMR. Developed by HIT Consultant.

VA, DoD aren’t collaborating on EHR: GAO

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

AliveCor links with Practice Fusion

Breathlessly noted in today’s mHealth blogosphere is AliveCor’s partnership announcement with EHR giant Practice Fusion to integrate their patient-generated ECG information. According to the release, the 100,000 physician base of Practice Fusion will have the option to import AliveCor ECG data into patient records. This is a major breakthrough for AliveCor, which just gained FDA over-the-counter clearance for its snap-on case [TTA 11 Feb]. The AliveECG app also enables physicians to obtain an expert review of the ECG data, annotate and electronically transfer this data into the EHR within seconds. Is this the confirmation that AliveCor is the ‘product of the year’ as the Forbes article puts it? Or just an indicator where mHealth with clinical quality could be going?  (Let’s see if other EHRs like Athenahealth join the trend.) Release

An essential link to mHealth devices and apps?

Guest columnist Lois Drapin thinks so. She shares her insights on Validic, an emerging company in data integration for payers, providers, preventive wellness companies and pharma;how it evolved from its original concept in consumer health engagement, along with a few pointers its founders have for fellow entrepreneurs.

One of the keystone aspects of “ecosystems” is interoperability and this also applies to the data pipeline that flows from health apps and devices to the appropriate segment of the healthcare delivery system, and eventually, to the users—patients, consumers and/or medical professionals such as physicians and nurses or other clinicians. By now, we all know that the capture and analytics for both “big” and “small” health data are business imperatives for healthcare in the US. With data of this nature, we can embrace our understanding of behavioral change at the individual and population levels. The anticipated outcomes of behavioral change may power operational and cost efficiencies in the healthcare industry.

But data will no longer come from just inside the healthcare delivery system. In addition to the changing technology enablement within the health system, as we all know, data will flow from many things—in fact, The Internet of Things (IoT). This means that data that relates to our lifestyle, wellness and health will pour from the many types of wearable devices not now connected to the heath delivery system. In addition to our computers, tablets, phablets and smartphones, are the many sensors paired with tech innovations such as the wearables— from wristbands, smartwatches, clothing (from shoes to headbands), glasses, contacts, and pendants — to things such as refrigerators, clocks, mattresses, scales, coffee pots, cars, and even, toilets…all of which are predicted to become an important market in the coming years.

Validic, based in Durham, NC, has put itself smack in the middle of that market (more…)

US, UK agreement on HIT

Edited from the HHS releaseUS Health & Human Services (HHS) Secretary Kathleen Sebelius and UK Secretary of State for Health Jeremy Hunt on Thursday 23 January signed a bi-lateral agreement for the use and sharing of health IT information and tools. The agreement strengthens efforts to cultivate and increase the use of health IT tools and information designed to help improve the quality and efficiency of the delivery of health care in both countries.  The two Secretaries signed the agreement at the Annual Meeting of the HHS Office of the National Coordinator (ONC) for Health Information Technology. It concentrates on four key areas identified at the joint June 2013 summit:

  • Sharing Quality Indicators
  • Liberating Data and Putting It to Work
  • Adopting Digital Health Record Systems
  • Priming the Health IT Market

Collaboration efforts will be showcased at the Health Innovation Expo conference at Manchester Central 3-4 March (two weeks before HC2014) and the Health Datapalooza on 1-3 June in Washington, DC. A possible good sign for telehealth as there’s a great deal of mention of ‘preventive interventions’, ‘accessing and sharing data’ and the ‘health IT marketplace’.

Full memorandum of understanding text here. Also iHealthBeat.

EHR interoperability redux for VA, Department of Defense (US)

Back in late February, the US Department of Defense and Veterans Affairs announced that they would not achieve their goal of a single EHR by 2017, and would stick with their creaky AHLTA and VistA systems for the foreseeable future [TTA 3 April]–along with the general lack of interoperability–eyes rolled at the $1 billion down the drain, but seemingly not much else budged. (And this does not include the $4 billion spent on failed updates and fixes in both systems–TTA’s ‘Pondering the Squandering’, 27 July) To this Editor’s utter shock, the 2014 National Defense Authorization Act (NDAA), agreed to by the House and Senate this week, mandates a plan for either interoperability or a single system by 31 January–about 6 weeks from now–and to adopt it by 2016. Moreover, both systems must be interoperable with private providers based on national standards by 1 October 2014. A close reading of the NextGov article indicates that the bill adds levels of complexity and perhaps unworkability. Getthereitis, anyone?–or does this sound like Healthcare.gov, redux? FierceMobileHealthcare

And it takes a grad student to find a major info security flaw in VistA.  (more…)

Box-ing up interoperability and file sharing

File storage and sharing platform Box.com announced thirteen additional partners for its healthcare platform, joining the group of ten announced in the spring. If you use Box.com for document storage and sharing (this Editor uses it for portfolio and collaborative space), their foray into healthcare may come as a surprise. What the partners are on board for is to facilitate storage/sharing in four major areas: clinical documentation, care coordination, interoperability and access to care. The latest on board include NYC-based Medikly (pharma digital marketing to physicians), Grand Rounds (second opinion/referral) and CareCloud EHR. Box releases 2 October, 25 April.

Doctor disciplined for using Skype for telemedicine consults

A family practice physician in eastern Oklahoma was disciplined by the state medical board for using Skype on initial mental health consults. Skype is not approved by the board for telemedicine; other factors were that the patients were not physically seen at any point and that they were prescribed controlled substances (including narcotics). Three of the patients died while under care but the deaths were not attributable to Dr. Trow. It is easy to score the doctor for what could be seen as bad practice in telemedicine, but a mitigating factor is his practice in a remote area of the state and the distance of the patients. Joseph Kvedar, MD of the Center for Connected Health/Partners HealthCare reviews the situation (more…)

Systems sharing data, still behaving badly

A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):

direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.

Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually.  HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)

(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.

With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?  

Pondering the squandering of taxpayer money on IT projects (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has been in Observation Mode this week. But this handful of Dust-In-Eye necessitates a Benny Goodman-style Ray on another US governmental ‘fail’. When it comes to IT, the government admits…

Agencies Have Spent Billions on Failed and Poorly Performing Investments

Exhibit #1: FierceHealthIT summarizes five big ones out of a 51-page Government Accountability Office (GAO) report focusing on the inefficiency of agency IT initiatives–just in healthcare.

  1. Veterans Affairs (VA) VistA EHR system transitioning to a new architecture: terminated October 2010 at a cost of $1.9 billion
  2. VA-Department of Defense (DOD) iEHR integration: as previously written about, it collapsed under its own weight for another $1 billion [TTA 8 March]
  3. DoD-VA’s Federal Health Care Center (FHCC). Opened in 2010 as a joint facility under a single authority line, but somehow none of the IT capabilities were up and running when the doors opened. ‘Jake, it’s ChiTown.’ Only $122 million.

  4. DoD’s own EHR, AHLTA (no VistA–that’s VA’s) still doesn’t work right; speed, usability and availability all problematic. A mere $2 billion over 13 years.
  5. VA’s outpatient system is 25 years old. Modernization failed after $127 million over 9 years before the plug was pulled in September 2009

You’ll need Iron Eyes to slog through the detail, but it is a remarkable and damning document. PDF (link)

but…there’s more. Excruciating, hair-hurting, and would be amusing if not so painfully, and expensively, inept. Malware Removal Gone Wild at Commerce(more…)

The doctor’s dilemma: I hate my EHR, but is it worth the ‘rip and replace’? (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/07/doctor_pulling_hair.jpg” thumb_width=”150″ /]Will this doctor be able to replace his hair? Confirming EHR misery for doctors, this article in Healthcare Technology Online gives more details on the Black Book Rankings’ 2013 State of the Ambulatory EHR Market report that we presented back in February when early findings were released. Out of their 17,000 users from solo practitioners to 100+ doctor practices, 31 percent of respondents were dissatisfied enough with their EHR to consider making a change with 18% seeking to change systems within the next year. Poor usability led the reasons why. But there’s 84 percent plus queasiness about vendor viability, reasonable when there are 600+ vendors and a number have already gone out of business leaving their practices stranded. The basics aren’t enough–must-haves are support for mobile devices (80 percent), data sharing and integration (83 percent)  and patient portal (58 percent). And it has to be Web-based/SaaS  based (70 percent). One detail: confirmation of the anecdotal ‘we jumped too fast to get the Meaningful Use money’.  #EHRbacklash, indeed. 

Funding: the concentration continues

The funding concentration trend apparent in RockHealth’s latest survey [TTA 9 July] is not contradicted by latest bits of news:

  • PracticeFusion, a free physician, web-based and ad supported EMR, is rumored to be raising $60 million from what Venture Beat last week termed “a New York-based investment firm, not one of the usual (local) Silicon Valley suspects.” Now we can suppose that sources would be silent unless the deal was signed, sealed and delivered. The leaks can also be strategic ones. (PracticeFusion has also introduced PatientFusion, a PHR with added functions of booking appointments and leaving doctor feedback–which puts it squarely in ZocDoc’s increasingly challenged, but extremely well-funded territory. (We advise them to put aside a few dollars for the inevitable MMRGlobal challenge as well.) Having raised $34 million less than one year ago, the funding is clearly going to updating ‘Meaningful Use’ requirements, the patient portal and to be determined growth.
  • Chicago-based Caremerge just raised $2.1 million for its mobile apps for coordination of long term care (LTC) between providers, doctors and families. (MedCityNews)  It claims to be the first-ever integrated mobile and web solutions provider for this market. It does answer a crying, not-terribly-glamourous need in senior care, and it’s also interesting that two of the key investors are from Poland and Switzerland. But Caremerge has deep roots in GE-land: one of its founders came from GE Healthcare IT Solutions and it’s currently part of the StartUp Health/GE Healthymagination program–which accepts only companies further along in their development for their $250 million fund, and takes a generous slice of equity for advisory services rendered. [TTA 10 Jan7 March, 4 April]
  • Health tech accelerator Blueprint Health announced its latest class–and they are increasingly not in the earlier pattern of true startups in need of guidance to appeal to angels and VCs. Five of the ten companies already have customers, versus two in the previous class. Is this mission creep? According to an article in Gigaom, their co-founder has said that they are not deliberately looking for more ‘mature’ companies, but are nonetheless accepting them. Of course, early stage companies that have already gotten into the market have a greater chance of success and look better on the record of any accelerator program. Another trend is B2B rules. Only one of the picks is consumer focused (health coaching) and another is engaged in employee wellness rewards adopted by companies.

Are these pointers to the future, at least in the US?

  1. Nascent maturity and realism in business plans–the horizon narrowing
  2. The continued collapse of practice EHRs into a few trusted providers [Doctor backlash brewing, TTA 22 Feb]
  3. With less funding to go around, and with few companies moving from A to B to C rounds, will future investment and development go to those who have already gained traction in customers and previous investment–and somehow got to that stage with the help of angels and crowdfunding?
  4. Is it the end of the Quantified Self consumer device buzz? These investments, and the past quarter’s, are largely in the surer, more VC-acceptable water of B2B tech.

Samsung speeding hospital EHR/workflows (US)

Much has been made of iPad/iPhone dominance in the US hospital/clinician setting, but Samsung is interestingly going after blockages–not heart ones, but workflow and data integration systems. This brief Technorati article on their pilot with Olympic Medical Center (OMC) in Washington state notes how Samsung is working with them and others on digitization (such as cloud services and touch screen monitors) which help to speed physician dictation and chart completion, as well as soon speeding secure interoperable access to patient records. The article unfortunately is short on Samsung-specific details. Now if hospitals and practices work with Samsung on this, can the hardware (tablets, phones, monitors) be far behind?