Intermountain Healthcare, MModal test mobile speech-enabled CPOE app

By: Neil Versel | Feb 26, 2013        

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Intermountain Healthcare LiVE app

Another iOS app from Intermountain Healthcare: LiVE, a wellness app for teenagers.

Healthcare speech recognition technology vendor MModal is teaming up with Utah’s Intermountain Healthcare to prototype and develop what MModal is calling the first mobile app for speech-enabled computerized physician order entry (CPOE).

“We don’t know anyone who’s ever done this before,” MModal CMIO Dr. Jon Handler tells MobiHealthNews.

Franklin, Tenn.-based MModal and Intermountain, of Salt Lake City, announced their partnership Friday. They will demonstrate a prototype Apple iOS app at next week’s Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans.

With the app, clinicians can speak orders into an iPhone. Voice orders get sent to an MModal server in the cloud, where a natural-language processing engine that MModal calls “speech understanding” recognizes spoken words and translates the information into text, according to Handler.

The server sends information back to the clinician’s phone in a structured format, where the user can proofread and edit the order. After the clinician verifies the data and hits “send,” the MModal server formats the order in a way Intermountain’s CPOE system can understand.

The app also works with iPads, since voice commands are transmitted via the app, not as phone calls. “It really only does require an Internet connection,” Handler says. By the same token, the system currently does not work with standard landline or cellular phones or non-Apple smartphones.

Initially, Intermountain will use the system only for medication orders, but clinicians there will be testing the app for such tasks as laboratory, imaging and observation orders, according to Handler. “Part of our development at Intermountain Healthcare will be testing to see what kinds of workflows work” with this technology, he explained.

“The ability for a physician to dictate common prescription orders and have them seamlessly integrated into our electronic medical record system can create better productivity and improve patient safety,” Intermountain CIO Marc Probst says in a press release. Probst was not immediately available for further comment.

“We looked at the scenarios where there’s a clinician out and about,” Handler continues. Speech-enabled CPOE would come in handy in some but not all situations. “Either they forgot to do something or they just received some new information.”

Since this app is intended to be a convenience for specialists on call and others who might not be immediately available in person at Intermountain hospitals, do not expect physicians there to place major orders such as chemotherapy regimens by voice. “This is not the place where you would do a complex or risky order,” Handler says. It might be appropriate for treating more common ailments like minor rashes or pain, he says.

Simple is the rule since the quality of mobile voice recordings can vary so much. “There’s not an infinite amount of things you can do with this,” Handler says. “It’s a lot hard when you have to understand a lot of things.” However, he reports that the experience so far has been “shockingly excellent” and notes that there is the “human check” before orders get sent.

Intermountain is a development site for GE Healthcare and has an extensive health IT infrastructure in place, so it was imperative for MModal, formerly known as MedQuist, to create an app that worked with the existing electronic health record and CPOE system, Handler says. The user interface is less complex than that of an EHR, the MModal CMIO says, and both partners are working to make sure the app is “extensible to other customers.” That means it needs to work with more than just GE Centricity EHRs, he adds.

MModal is looking at a general release of the yet-unnamed app sometime this fall, but that will depend on how the prototype performs with practicing clinicians. “We want to make sure we give this thing a good test in the real world,” Handler says.

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Needed: Standardized outcome measures for patient-generated data

By: Jonah Comstock | Feb 25, 2013        

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patientslikemeIn order to conduct meaningful clinical trials, it’s important to have solid metrics for tracking disease trajectories and patient experiences. Developing these patient outcome measures is the goal of PatientsLikeMe’s new open-participation research platform, funded by a $1.9 million grant from the Robert Wood Johnson Foundation’s Pioneer Portfolio.

PatientsLikeMe President and co-founder Ben Heywood said that having good patient outcome measures, and seeing them as widely used as possible, is a huge boon for disease research.

“We’re not measuring pain in 45 different ways unless we need to,” he said. “One of the goals we have is a unified medical framework to think about that disease more broadly.”

In other words, the more studies use the same scale, the easier it is to compare their outcomes. At the same time, Heywood believes some diseases don’t have a good existing measurement system for patient-generated data. He said PatientsLikeMe discovered this early on in developing its online patient community, in which patients share data with each other about their diseases. He cited an example from their multiple sclerosis community.

“When we started our MS community, we looked at the way the disease is measured broadly. The general consensus among the research and scientific community was that those measures were inadequate, outdated, and not very good,” he said. “So we built a rating scale, that we then deployed on the PatientsLikeMe platform. Over time we had thousands and thousands of patients measuring their symptoms. We did a lot of work, making sure it was validated internally, and then we validated it clinically outside the system. And it became a much better scale.”

Now, with the new open access system, any researcher who wants to develop a scale can have access to the PatientsLikeMe disease community in order to test it out, as well as to a number of development tools built into the platform. In return, PatientsLikeMe asks researchers to share the scales they develop, making them available for users of the site and people conducting offline clinical trials. If someone uses the scale and adapts it or improves upon it, they’re asked to report those changes back to the PatientsLikeMe database as well.

Heywood hopes the platform will trigger a shift in how patient outcome measures are developed and used. He said currently even when good scales are developed, the system doesn’t always work well.

“One of the big problems with outcome measures today is once they get validated, they never get improved upon. The reality is our understanding of disease, and patients needs, evolve over time, and our cultural understanding of questions evolves over time,” he said. “This system is going to greatly lower the barrier in improving those steps.”

In general, PatientsLikeMe has a philosophy of open access to research. Paul Wicks, the director of research and development at PatientsLikeMe, who announced the new platform in his TED talk today, wrote a blog post on the subject last year. The company has published 25 peer-reviewed studies, many of which they’ve paid the publishers to open up to the public.

“It’s about allowing the people who were engaged in the research, ultimately the patients, to have access to it. We really think data should be open and available, so people can validate and understand the raw data and anyone can learn from the work of everyone else,” said Heywood. “Morally, if patients are engaged in doing this research, they should have access to the results. It’s similar in an open platform, having everyone see it and have access to it and understand it will evolve the science much more rapidly.”

At present, the grant allows PatientsLikeMe to offer the platform free of charge. However, PatientsLikeMe, a for-profit company, might charge for access in the future.

Here comes the third wave of healthcare consumerism

By: Jonah Comstock | Feb 25, 2013        

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Triple Tree Associate Joe Long

Triple Tree Associate Joe Long

Minnesota investment banking firm Triple Tree has released a report about the rise of consumerism in the healthcare industry. The company says the industry is becoming less like a traditional healthcare system and more like a retail environment, with B2B2C, or business-to-business-to-consumer, business models becoming the dominant format.

“Viewed through the lens of many healthcare product and pharmaceutical companies as well as select services providers (e.g., Weight Watchers) that have been addressing the health needs of consumers through business-to-consumer (B2C) and direct-to-consumer (DTC) models for considerably longer, consumerism is already here,” the report reads. “For payers and providers however – and for the technology and service companies they rely on – consumerism is new, and the change is having a significant impact on the industry.”

Joe Long, an associate at Triple Tree, said many analyses of the consumerization of health care focus on the fact that consumers are taking on more of the cost of healthcare. He suggested that’s an outdated framing of the conversation.

“A lot of people have looked at the consumer in healthcare and thought of it more along the lines of the cost shift that’s occurred,” he told MobiHealthNews. “But the cost shift has already happened. The issue now is consumer engagement in healthcare: Initiatives made by payers and providers to interact with the consumer and help them better navigate the system.”

The report describes the shift toward a retail healthcare model as happening in three waves. The first of the three waves of this change was the rise of consumer-driven health plans, or CDHs. These efforts were driven by employers and had the advantage of making health management for patients easier, the report says. But because the patient interface wasn’t matched with improved cost transparency, it was difficult to truly engage or empower patients. Too many CDH plans used B2B models, which were targeted to large groups and categories of consumers, rather than designed to help individuals. Keep reading>>

Older heart patients like remote monitoring, prefer in-person visits

By: Neil Versel | Feb 22, 2013        

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Medtronic AdaptaDespite high levels of satisfaction with wireless monitoring technology, older patients with implanted cardiac devices still greatly prefer in-person physician visits to remote consultations, according to a newly published study from Portugal. But the authors caution not to draw too many general conclusions from their findings, because their sample size was small and the research did not take into account the cost savings to patients from avoiding future hospital admissions.

The report, published in the journal Telemedicine and e-Health, found that 53 percent of patients with pacemakers, defibrillators and other implanted, wireless devices that regulate or measure heart rhythm said they would rather have in-office follow-up with their doctors, while just 27 percent stated a preference for remote monitoring. The other 20 percent were “indifferent” to the two options, according to the study.

These results come despite the fact that 11 of the 15 patients queried said the Medtronic CareLink remote monitoring system used in the study was “easy” to set up and operate and two more called it “very easy” to use. The majority of the patients, ranging from 48 to 83 years old, with a mean age of 63, said the transmission equipment did not require a lot of time to send data from their heart monitors, while every one of those studied were “satisfied” or “very satisfied” with the system.

The findings also contrast with those from an earlier study from Italy, reported in the Journal of Telemedicine and Telecare in 2008, in which 73 percent of patients said they would choose remote monitoring over office visits. “The fact that the patients who preferred the in-office method selected the direct physician observation or the direct contact with health professionals as the chief element in that preference leads us to think that those are possibly the main reasons,” the research team, from Centro Hospitalar do Porto in Portugal, write in the new study.

“In our analysis it was not possible to associate the preference for the in-office visit with the occurrence of clinical events or costs, so that the challenge remains to study additional reasons for that preference,” they continue.

One thing that may be a key factor in patient preference is waiting time. Among those who said in-office visits were better than remote monitoring, the mean waiting time upon arrival was 17.5 minutes, compared to 45 minutes for the rest of the study panel.

“Furthermore, it was possible to determine that the point that better distinguishes the two groups is to consider that the preference for an in-office visit disappears when the mean waiting time is greater than or equal to 37.5 min (corresponding to real data of waiting times greater than 45 min). This means that if the waiting time indicates that the patient does not prefer the remote appointment, then the patient really does not prefer that modality. In clinical terms this value could be of some importance, namely as the maximum waiting time for in-office visits,” the Portuguese researchers say.

They also remain optimistic about the potential for wireless home monitoring to save lives and reduce hospitalizations. Keep reading>>

Average Rock Health startup now worth $5.2M

By: Jonah Comstock | Feb 21, 2013        

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due date plus

Wildflower Health's Due Date Plus app.

Rock Health held the demo day for its fourth class this week, highlighting some impressive accomplishments from its newest batch of 14 portfolio companies. Last year, MobiHealthNews reported that this class would start with an increased $100,000 investment from Rock Health, shortly after the incubator signed on Kleiner Perkins Caufield Byers. This is also the first class to benefit from new Rock Health advisor Kaiser Permanente.

Rock Health companies have the third highest average valuation of any incubator according to Angel List, at $5.2 million (behind StartX and Y-Combinator). Rock says the incubator’s portfolio companies have raised $43 million to date, not including investments from Rock itself, averaging about $900,000 per startup. The current class accounts for $13.9 million of that total.

Rock noted in its press release that its current class is targeting a wide variety of customers: consumers, employers, and hospitals.

Consumer companies include Beam Technologies, makers of the Beam Brush, the FDA-cleared smart toothbrush that made a splash at CES, and Wello, a startup offering affordable one-on-one training sessions over two-way video chat. Wello raised $1 million in December, with Rock-partner Kleiner Perkins leading the round. The company launched group workouts this week, allowing friends around the world to work out together with a Wello trainer.

Several more of the companies focus on creating innovative health apps. Mango Health, which recently received $3.1 million in seed funding, has released its iOS app, which seeks to improve medication adherence through gamification. The app includes a rewards system where users can earn points for taking their pills and exchange them for real-world gift cards. SuperBetter, an online application, also uses gamification principles to help people reach health goals like working through depression or trying to lose weight.

Other apps target specific challenges for the consumer. LabDoor is an iOS app that can scan supplements and over-the-counter medications and return grades based on safety and efficacy — determined through investigation up to and including independent lab work. Moxe Health, through products like triage.me, aims to help the underinsured find the best care they can afford, and reduce unnecessary emergency room visits. Wildflower Health creates apps to help women stay healthy throughout pregnancy. It’s first app, Due Date Plus, helps women keep track of doctor visits and track symptoms.

A number of the companies in the fourth class are building tools for providers rather than patients. CliniCast is aiming to ease the transition from fee-for-service to fee-for-value healthcare by selling providers predictive analytics that help minimize costs and maximize outcomes. Eligible is developing a REST API with the goal of standardizing and simplifying health eligibility requests (which founder Katelyn Gleason describes as a “mind-bogglingly broken” space in healthcare). Eligible raised $1.5 million and counts practice management system Kareo.com as one of its largest customers. KitCheck reduces the time, money, and potential for error in assembling medication kits. Rock Health reports they already have six-digit revenues from multiple hospital customers.

Beam Technologies' Beam Brush

Beam Technologies' Beam Brush

Wellframe is building a system to hopefully reduce readmissions by giving patients an app with day-to-day instructions for managing a condition or enhancing recovery from a surgery or procedure. OpenPlacement also deals with continuing care, helping match seniors with housing and assisted living options. The company already has 500 facilities listing open beds on its platform.

Finally, a couple of Rock Health companies are working with employers. Benefitter, formerly called BenefitsMe, is a tool for navigating the upcoming health insurance changes due to the Afforcable Care Act. The company promises to help employers determine what the most cost-effective coverage option is for both company and employees. The company raised $2.7 million from angel investors. Zipongo, a company which aims to motivate healthy eating with personalized meal plans and digital coupons, is currently positioning itself as a consumer product. But according to Rock, the company has established relationships with a number of payers, and has secured “a multi-million dollar deal with a national retailer” after raising $2 million in seed funding.

3 mobile health trends at HIMSS 2013

By: Brian Dolan | Feb 21, 2013        

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Brian Dolan, Editor, MobiHealthNewsLater today I’ll be presenting alongside Rich Roth, the Vice President of Strategic Innovation at Dignity Health, which changed its name from Catholic Healthcare West last year. Dignity provides care to patients at 40 hospitals and care centers across California, Nevada, and Arizona. It has also been one of the more pioneering healthcare systems when it comes to mobile health adoption. Rich and I will also be joined by Dr. Matt Patterson, the Chief Transformation Officer of AirStrip Technologies — the mobile health company that received the very first FDA clearance for a smartphone app and more recently acquired mobile EHR technology from Palomar Health that enables physicians to easily access data stored in various EHR systems.

During today’s webinar — it’s free to attend, be sure to sign up here and join us live at 2PM ET — we’ll be sharing our best guesses as to how the mobile health conversation at HIMSS next month will take shape. Here’s a quick preview of my top three trends and questions for HIMSS 2013:

How will healthcare providers approach the patient engagement requirement for Meaningful Use?

Recent months have brought about a noticeable uptick in the phrase “patient engagement”. Meaningful Use Stage 2 requirements, which published in their final form in late August 2012, included different thresholds from the Stage 2 proposal released in February — timed with HIMSS 2012. To demonstrate patient engagement providers have to show that at least 5 percent of their patients had used some form of secure messaging with their care team. The proposed rule in February required 10 percent adoption. While secure messaging and simple access to health records seem like the most basic of steps toward patient engagement, the requirement is one of adoption not just availability. I expect patient engagement to be a dominant theme — or very likely the dominant theme — at HIMSS in March.

Of course, providers can enable access and secure messaging through various technologies and channels, but in recent years mobile has risen up as the consumer engagement channel of choice. Many providers are considering a mobile-centric approach to patient engagement. The MU Stage 2 requirements will accelerate these rollouts and once they begin to take effect in 2014, we will begin to see many more patient-facing mobile health offerings from provider groups.

How will providers deal with an increasing amount of patient generated data?

For technologists this year is shaping up to be the year of the wearable device. Google and Apple are claiming face and wrist real estate, respectively, and a sizeable crop of health and fitness device makers has been growing impressively for the past two years. The proliferation of sensors and wireless-connected personal medical devices is an important related parallel trend. And a contingent of patients are also tracking all sorts of biometrics and observations of daily living via mobile health apps — no additional sensing equipment required.

These tools exist today. Stage 3 of Meaningful Use, which would not go into effect until at least 2016, might require providers to incorporate health data created by at least a small percentage of their patients. One request for comment that the ONC put out last year suggested that providers help 10 percent of their patients contribute this information, which may include patient-created health goals, exercise data, or other pre-visit information. The comments also sought suggestions for incorporating home medical device data into EHRs.

2016 is a few years away, but I believe this discussion will move quickly, even if implementation only follows the potential MU timeline.

Beyond Apple: Can other device makers win back healthcare providers?

This is a fairly simple question: Will other tablet makers and smartphone companies begin to make a dent in Apple’s dominance among healthcare providers? BlackBerry is making it a go of it in general — what kind of a push will they make for healthcare? Microsoft is pitching its new line of tablets at healthcare providers, too. HP seems to be doing the same. There’s also been a steady but small niche market for medical-focused tablet makers. I’m curious about their prospects.

For more on mobile health at HIMSS 2013 join us this afternoon at 2PM ET / 11AM PT: Register Today! And be sure to bring your own predictions and questions for the Q&A at the top of the hour!