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=”https://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.
- Veterans Affairs (VA) VistA EHR system transitioning to a new architecture: terminated October 2010 at a cost of $1.9 billion
- VA-Department of Defense (DOD) iEHR integration: as previously written about, it collapsed under its own weight for another $1 billion [TTA 8 March]
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.
- 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.
- 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=”https://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 Jan, 7 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?
- Nascent maturity and realism in business plans–the horizon narrowing
- The continued collapse of practice EHRs into a few trusted providers [Doctor backlash brewing, TTA 22 Feb]
- 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?
- 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?
The data-EHR integration hurdle spanned?
The fifth of the Five Big Questions (FBQs)*–how data is integrated into patient records–may have finally been answered by Partners HealthCare. They have integrated patient remote monitoring data directly into their EHR, viewable by clinicians alongside patient charts–and also portaled to the patient. The integration was designed by Partners’ Center for Connected Health and includes data sent via Alere Connect (formerly MedApps) from various blood pressure, weight and blood glucose devices. CCH is also introducing mobile connectivity through Qualcomm Life’s 2net hub. Partners HealthCare’s EHR interestingly is an in-house system, but they are transitioning their records to Epic. Dr. Joseph Kvedar, director of the CCH, also discusses how the next step is how to make this data easier for clinicians to read and use in Mobihealthnews. It is about time. Also mHIMSS and Partners’ own press release.
* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.
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…)
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