The Boston Marathon tragedy and health tech implications

The terrorist bombings at the end of Monday’s Boston Marathon has already stimulated some analysis on what tech did–and could have done–to save lives. MedCityNews’ article analyzes the handling of the casualties–well done in the coordination of multiple hospital ERs (EDs) in caring for over 100 moderately to severely wounded, but showing the present inability in Massachusetts for the state health information exchange (HIE) Mass HIway to exchange patient EHRs under emergency circumstances. “With HIEs that have this capability, emergency department personnel can search for a patient’s record immediately upon his arrival or even as he’s being transported to the hospital. In hospitals connected to the Indiana Health Information Exchange (IHIE), for example, the system searches for a patient’s record automatically when he’s registered to the ED.” mHIMSS focuses on emergency response, triage, mobile data collection–and Boston’s Center for Connected Health on how health tech could assist in victims’ recoveries and mental support. But in the short term, the Greatist health and fitness website offers links to ways to help, including blood and financial donations, showing support, finding people and keeping up with news. Also there’s the official email for the FBI on where to send photos of the Boylston Street/finish line area.

But what of the long-term–the recovery from both the physical and mental wounds, and managing long term care issues? Four entrants in the MassChallenge accelerator 2013 startup class  to be announced in early May have medical therapies directly applicable to the survivors:  Advanced Amputee Solutions (shock absorption for the lower limb, Benevolent Technology for Health (adjustable fit for prosthetics), Keradermlab (alternative to skin grafts for burn healing) and Lucirix (connectivity platform for all health providers. MedCityNews

Telehealth tiptoeing into skilled nursing facilities (US)

Shattering a few stereotypes on older adults and technology use is this profile of Las Colinas of Westover Rehabilitation, a short and long-term-care (LTC) residence near San Antonio, Texas Technology. Their short and long-term residents–largely in their 70s and 80s–use CogniFit brain training games, videos and Skype-ing on a Kindle Fire and Apple TV for brain stimulation, games, socialization and connectedness with families.The facility is also up to date with the specialized long-term-care EHR PointClickCare. Perhaps not typical in LTC now, but a pointer to where the near future should be. Senior care goes high-tech (San Antonio Express-News)

DOD, VA stuck behind the Magic 8 Ball: report (US)

Institute of Medicine, ‘Daily Show’ rap DOD, VA for unlinked EHRs

When the US Department of Defense (DOD) and Veterans Affairs (VA) announced back on 27 February that they would not achieve their major goal since 2009 of a single EHR system by 2017, with initial test next year, for this Editor it was just another billion-dollar ‘fail’ day out of DC. FDA dithers since July 2011 on final guidance on mHealth approval–yawn. Centers for Medicare and Medicare Services (CMS) cutting back rural telemedicine consults–business as usual. Individual health insurance premiums going up 30 percent next year? We knew that was coming! So no surprise here when the Institute for Medicine of the National Academy of Sciences issued a report highly critical of both agencies regarding the needs of 2.2 million Iraq and Afghanistan veterans, with one key criticism the lack of EHR interoperability. According to iHealthBeat:

The IOM report found that:
• 49% of returning veterans have experienced post-traumatic stress;
• 48% have dealt with the “strains on family life;”
• 44% have experienced readjustment difficulties; and
• 32% have felt “an occasional loss of interest in daily activities.”
According to IOM, the federal government’s response to troops returning to the U.S. “has been slow and has not matched the magnitude of this population’s requirements as many cope with a complex set of health, economic and other challenges.”

Neil Versel in his Meaningful HIT News article published yesterday highlighted the EHR single-system fail through, rather incredibly, a Jon Stewart Daily Show video segment called ‘Red, White and Screwed’. (Today, in American life, you know an issue has gone mainstream when it makes a ‘news/comedy’ show such as this or the Colbert Report.) This Editor is no fan for multiple reasons, but to his credit Mr. Stewart has been a strong advocate on behalf of veterans and showcases the failure of veterans’ support regularly on a segment called ‘The Red Tape Diaries’ without sparing a certain Administration from criticism.  Aside from over 900,000 veterans waiting an average of 273 days for their disability claims to be processed, the icing on the cake is how the EHR ‘fail’ was announced. At 3:20 in the video, a Government Accountability Office (GAO) official drily depicts both DOD and VA as perpetrators of project mismanagement and poor oversight. And this is despite a 40 percent increase in budget from the Republican-controlled House, which confounded Mr. Stewart. The criticism goes on from there. Magic 8 Ball says ‘messed up, try again.’  DoD-VA integration failure is no laughing matter, even to Stewart  Hat tip to reader Ellen Fink-Samnick, MSW of ‘Ellen’s Ethical Lens’ for featuring this article on her LinkedIn group. 

Related, ironic note: the DOD’s and VA’s EHRs are respectively called AHLTA and VistA, a nostalgic touch for those of us who used the first real search engine, AltaVista, circa 1996.

Practice Fusion EHR buys a ‘nudger’

Practice Fusion, a leading US EHR which is free to practices, bought predictive modeler 100Plus. Besides sharing a founder (Ryan Howard) and a focus on healthcare data, 100Plus uses individual data to ‘nudge’ (there’s that word again) people into healthier behaviors. The interest of Practice Fusion of course, is that it is awash in patient data–but HIPAA privacy regulations limit direct, identified use. 100Plus plans to stay safe by focusing on medication adherence and tools that doctors and patients can use together to encourage engagement. Forbes

Microsoft Surface dives into mHealth, telehealth tablet market

“Not only Lync but Skype as well are becoming fairly predominant platforms for what I call ‘commodity’ telemedicine and telehealth services,” Dr. Bill Crounse, Microsoft’s senior director for worldwide health, told Pulse IT Magazine during a promotional visit to Australia. “We are seeing amazing progress at an institutional level, with people understanding and mapping out where are their patients coming from and how far are they travelling. How can we leverage this technology to better serve that population [of] patients who are being asked to travel three hours across town for a snippet of information or reassurance, when in fact this technology can be applied.”

It’s a good point, but as EHR Intelligence goes on to point out: ‘In contrast to the iPad mini, which fits neatly into lab coat pockets and has the advantage of millions of apps in the mature Apple ecosystem, the Surface Pro is a bulkier product, weighing in at two pounds and saddled with an $899 price tag. In the era of bring your own device (BYOD) healthcare, Microsoft faces an uphill battle when it comes to attracting individual physicians looking to pick up a supplementary device for their office work.’ EHR Intelligence item: Microsoft Surface dives into mHealth, telehealth tablet market.

Revealed: Hospital EHRs lobbied for stimulus funding (US)

Man Bites Dog! The New York Times just discovered that not only did large EHR companies lobby for the health records mandatories that were part of the 2009 Federal ‘stimulus’ bill–along with ‘Meaningful Use’ subsidies–but also they also won big in hospital sales. This article focuses on Cerner, Allscripts (which bought Eclipsys) and Epic, and the 60% + gain these companies have made in sales since. It touches on the sticking point of non-interoperability, but not at all on the chaos at the practice level where the Big Three (nor the unmentioned GE Centricity) largely do not play. Here is where 600-odd companies, many of them offshored IT outfits, also around 2005 started to peddle various EHRs which were first software, now cloud-based. It took off after 2009 as well, to primary care doctors worried about Federal regulations–or missing out on years of subsidies and MU payouts. (more…)