Getting the bad news out of the way first, the seemingly-eternal researchers have thrown their grappling iron into the ancient store of data from the now-only-historically-relevant Whole System Demonstrator data pool and dragged out yet another unexploded bomb that they have then endeavoured to detonate, in the form of a short research article.
Thankfully the explosive has deteriorated with age so (more…)
The acquisition of the assets of Partners HealthCare spinoff Healthrageous by insurance and health service giant Humana is reverberating in the field in the US, particularly those in the buzziest digital health sectors. Some may look away, but a hard look provides some object lessons at the sheer unpredictability of the field for those who are innovating and attempting to shape consumer behavior and health. (Not behavioral health)
Updated/Revised for breaking news and analysis, 12-14 October (US). Much new information noted in dark blue. (Grab your tea or coffee…this is a long one as this story rolls on.)
The mainstream reports continue to build that both the Federal HealthCare.gov site, which provides health exchange enrollment for 36 states, and many of the state-run health insurance exchanges (14 plus District of Columbia) are a nightmare of programming glitches and simply don’t work. It is not the demand–which has been high but not unanticipatedly so with an initial 8 million hits–but more disturbingly, the programming appears to be is unsound. “Computer experts” quoted by CBS This Morning are making statements like “It wasn’t designed well, it wasn’t implemented well, and it looks like nobody tested it,” going on to say ” It’s not even ready for beta testing for my book. I would be ashamed and embarrassed if my organization delivered something like that.” A more technical dissection of the site’s multiple system architecture problems is provided by Reuters here, with the best quote “The site basically DDOS’d itself,” he said. (DDOS–distributed denial of service, a hacking technique but here, the website overwhelmed itself!)
Counting the cost
A rough calculation of the cost has been made on a tech website, Digital Trends. Andrew Couts (who is pro-Obamacare) ran some public numbers on the IT cost of setting up the Federal part of the exchanges and add in associated 2012-13 costs, and arrives at $500 million—not including the $2 billion to build out and operate the exchanges in 2014 (General Accounting Office). Larger numbers north of $600 million have been bandied about, but this Editor will go for now with Mr. Couts’ perhaps low estimate which has been supported by more mainstream reporting. (more…)
Subsumed under the ‘government shutdown’ (affecting in reality a distinct minority of Federal government employees) is the significant concern that the state-based online exchanges now selling individual insurance, effective 1 Jan 2014, much trumpeted under the Affordable Care Act and baked into it two years ago, already present significant vulnerabilities in securing the vital data of millions: Social Security number, date of birth, addresses, tax and earnings information. These state-based exchanges are also dependent on information from a Federal data ‘Hub’ which “acts as a conduit for exchanges to access the data from where they are originally stored.” (HHS Office of Inspector General report August 2013, page 2) If improperly secured, this opens up other Federal agencies to further upstream identity theft mayhem.
Already information is in the hands of thousands of call center staff and so-called ‘navigators’ who may or may not have gone through security verifications. Insurance customer information has already leaked outside of exchanges (see below). (more…)
Not only do company founders have to deal with patent trolls, but find their way through patent thickets. Patent thickets are overlapping patent rights through which developers must find a safe, defensible space for their technology. This article introduces this concept to our readers and outlines a strategy to deal with it–in early days, and not sticking one’s head in the sand as this Editor has encountered. What may surprise you in reading this excellent article is that the author, Dolly J. Krishnaswamy, is not an experienced litigator, but a law student at NYU while working as a Project Manager/Law Clerk, Goldstein Patent Law. She blends law, science, tech and journalism with her prior experience as a journalist for Science magazine, technology work in New York City and in the study of genetics while at Emory University. Enjoy the article.
Many of you are privy to the problem of excessive patents. You have all seen the articles about yet another cellphone company infringing on yet another patent, but what you’re left with are questions of what all this activity means and how to use that information to act in your best interest– whether you are the CEO of a company or the general counsel for one. At the 2013 ABA Annual Meeting held in San Francisco, legal experts tackled this problem, discussing the trends in patent litigation and some potential strategies for companies preparing to introduce products into heavily-patented market segments.
Generally speaking the use of patents can vary with some people using them for insurance and others using them strategically. From a business standpoint, how a company uses a patent depends on the industry that company is in. For example, in the medical technologies space, all the companies will have patents on their core technologies and be highly cognizant of the patents they have to deal with. With the record number of high patent filings, the continued state of high damages, and the fact that even smaller companies are beginning to see patent infringement lawsuits, it’s clear that patent strategy is a complex matter– further complicated by the presence of patent thickets. (more…)
Earthquakes are hard to predict because, depending on the local geology and where you are in relation to the future epicentre, they vary in speed, intensity and effect. However, there are four generally recognised stages:
O2 and Bosch realising that systems which do not use smartphone-based technology are now dead in the water and therefore exiting from the UK telecare market was not the quake; they are just signs of stage two slippage. We will see more strains and cracks appear (more…)
According to a solicitation posted by the Department of Health and Human Services (HHS-Ed.) on Sept. 4, the CMS (Centers for Medicare and Medicaid Services) is commissioning the National Academy of Sciences (NAS) to study how best to add social and behavioral factors to electronic health record reporting. Washington Free Beacon
So a non-profit online publication, which one would site on the conservative or libertarian side (part of the Center for American Freedom), breaks a huge story, way ahead of the mainstream media, which has major implications for privacy, data security, public health, how goes your doctor or hospital visit and the level of care you receive. Is this EHR TMI (too much information)? The Federal inclusion is being linked to Stage 3 of the Meaningful Use program and reimbursement under Medicare, Medicaid and the Children’s Hospital Insurance Program (CHIP). The NAS already is working on this with the Institute of Medicine to draft suggestions for collecting this behavioral data and identifying “core social and behavioral domains to be included in all EHRs.”
With linking the data to outside Nosey Parkers agencies such as public health entities, the possibilities for identified data becoming insecure or compromised increase dramatically. Will it be accessed (abused) by other entities involved in ACA such as the IRS, state Medicaid databases and Social Security? How much of this data will accidentially leak out in non-deidentified files? Will breaches of millions of non-encrypted records become the norm? Another important and oft-overlooked factor is the additional workload on already overworked hospital and clinical staff, who presently struggle to get comprehensive vital data correctly into multiple fields and screens on present EHRs–a major pain point among many speakers and participants at this past week’s iHT2 Health IT Summit. Finally, there’s the patient. He or she will be pressed to answer, due to penalties baked into the ARRA/HITECH MU3 incentives, the most personal questions about their life and behavior particularly if the diagnosis is one of what euphemistically was called a ‘social disease’. Having spoken this week to those in public health both at iHT2 and at Health 2.0 NYC, this Editor can see it as a deterrent to getting the care they need–or choosing evasion rather than truth with their doctor because there are no more confidences. Even the California Healthcare Foundation, hardly on the right wing, sounds an alarm in iHealthBeat.
Times are tough for those who believe that technology can help improve the efficiency and effectiveness of healthcare delivery to improve patient outcomes. As pointed out by Richard Vize in the Guardian recently, telehealth has become the weapon of choice in the battle between GPs and the NHS, with publications such as Pulse and, most recently the HSJ, continuing to remind readers of the historic, and wholly-unrepresentative-of-telehealth cost effectiveness comparisons for the Whole System Demonstrator (WSD).
At the same time, the national Telehealth Forum’s survey of potential users indicated (more…)
Internet.org — Every one of us. Everywhere. Connected.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]Much has been made of the Internet.org alliance (release). The mission is to bring internet access to the two-thirds of the world who supposedly have none. It is led, very clearly, by Mark Zuckerberg, founder and CEO of Facebook. Judging from both the website and the release, partners Ericsson, MediaTek, Nokia (handset sale to Microsoft, see below), Opera (browser), Qualcomm and Samsung, no minor players, clearly take a secondary role. The reason given is that internet access is growing at only 9 percent/year. Immediately the D3H tea-leaf readers were all over one seemingly offhand remark made by Mr. Zuckerberg to CNN (Eye emphasis):“Here, we use Facebook to share news and catch up with our friends but there they are going to use it to decide what kind of government they want, get access to healthcare for the first time ever, connect with family hundreds of miles away they haven’t seen for decades. Getting access to the internet is a really big deal. I think we are going to be able to do it”
Really? The Gimlet Eye thought that mobile phone connectivity and simple apps on inexpensive phones were already spreading healthcare, banking and simple communications to people all over the world. Gosh, was the Eye blind on this?
Looking inside the Gift Horse’s Mouth, and examining cui bono, what may be really behind this seemingly altruistic effort could be…only business. (more…)
That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.
and
Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.
Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices (more…)
Apparently echoing the comments about health technology awareness made in our post last week about O2 (who are, by the way, to be congratulated for their parent company’s announcement today that they are preferred bidders for two of the three smart meter regions), the HSJ has reported the results of a YouGov poll that nine out of ten adults in the UK have never heard of telehealth. Of those over 55, the age above which use of telehealth is more likely, 92% hadn’t heard of it. (Note that the HSJ article is behind a paywall, however via a Google search on “National Telehealth Forum”, the commissioner of the survey, you can currently go past it). The National Telehealth Forum press release is . EHI also covers the story, .
So is this a matter of serious concern? (more…)
The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al). It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.
This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.
However reading on, perhaps a key passage, in the conclusion, is (more…)
Overall there was a huge sense of sadness that came through from many comments – many had seen the move into retail sales a confirmation that telecare had finally arrived as a mainstream technology in the UK, so a withdrawal so soon afterwards caused much grief. It was touching to see the concern for the staff too, who have worked so hard to get this venture airborne.
Although there were few comments specifically about the retail telecare kit, none were complimentary; it was seen as being single purpose, limited and hard to use. The ability to replicate the hardware functionality on a standard smartphone, (more…)
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?
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.
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.
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…)
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