Patient-generated data is the future of care, VA official says

By: Neil Versel | Jul 18, 2013        

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Humetrix iBlueButton app won the ONC's Blue Button Mashup Challenge.

Humetrix iBlueButton app won the ONC’s Blue Button Mashup Challenge.

Patient engagement is on the minds of a lot of people in healthcare, spurred not only by a requirement in Stage 2 Meaningful Use regulations, but by imperatives to improve the quality of care and boost patient satisfaction. Some providers beginning to open their minds, but technical and cultural challenges stand in the way, according to a high-level panel at last week’s Healthcare Unbound conference in Denver, Colorado.

“The future is PGD – patient-generated data,” said Dr. Susan Woods, director of patient experience for connected health at the Veterans Health Administration. “The voice of the patients and the caregivers has never been louder.”

Clinicians who resist growing demand to cede some of their authority and to accept health data from patients would be wise not to ignore changing expectations, for the sake of better care, Woods suggested. “Transparency breeds trust. Trust between patients and clinicians breeds outcomes,” she said.

The approximately 200 people who came to Denver for the 10th annual Healthcare Unbound already are well-versed in new technologies and emerging paradigms. Still, Lygeia Ricciardi, director of the Office of Consumer eHealth in the federal Office of the National Coordinator for Health IT, was pleasantly surprised by the thoughts of one physician in attendance.

After Dr. Kenneth Joslyn, a healthcare quality consultant from Plymouth, Minnesota, said he was more concerned with the “extraneous” nature of clinician-entered data in electronic health records than with information supplied by patients, Ricciardi smiled. “That’s so refreshing,” she said.

Leslie Kelly Hall, senior vice president of policy at consumer-focused health content developer Healthwise, said that it is essential to have structure to health data – not just plain text – to help physicians “separate wheat from chaff.” She believes taxonomies are less than ideal right now and must improve, but that should not preclude doctors from wanting to know as much as possible about their patients’ health. “Initially it will be messy, but isn’t it better to know?”

Stage 2 of Meaningful Use, the federal incentive program for providers to adopt electronic health records, requires hospitals and physician offices to offer at least 50 percent of their patients’ electronic access to their own medical records. At least 5 percent of patients actually have to view or download their records, either through portals, personal health records or an interface such as Blue Button, making patient engagement a necessary part of Meaningful Use compliance.

Blue Button, a program with roots in the VA, initially output unstructured text, but an offshoot called Blue Button Plus adds structure and formatting, acting as kind of an application programming interface for software developers. Ricciardi has previously suggested that Blue Button Plus could be part of Stage 3 Meaningful Use regulations, which will not take effect before 2016, or possibly later.

The format is important, but so is how clinicians and patient alike apply data to actual care. Health insurers have long encouraged the development of care plans, and Medicare, through Meaningful Use, is starting to require such plans for some patients. But Erin Mackay, associate director for health IT programs at the National Partnership for Women and Families, a left-leaning advocacy group that promotes wider access to healthcare services, said that the definition of a care plan needs to change, and freer flow of data can be the impetus.

“Our concept of a care plan as fixed in time is outdated and ineffective,” Mackay said. “What consumers really want is [a platform and dialog for] ongoing, bidirectional care.”

Woods said that quality of the data matters as well. “Blue Button is a concept. The most important thing is what’s behind the door. If it’s just your allergy list, it ain’t good enough,” the VA representative said.

But data sharing at least is a good start. “Sharing physician notes is a quality improvement,” Woods said, noting that two-way data exchange between provider and patient really is in its infancy. She compared the current state of affairs to the early days of television, when everything was in black-and-white. “I’m optimistic my kids will get color TV.”


ONC launches initiative for EHR data sharing

By: Jonah Comstock | Jul 17, 2013        

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douglas-fridsm-200x300The Office of the National Coordinator for Health Information Technology (ONC) launched its data access framework initiative this week, an effort to increase interoperability among electronic health records (EHRs) from different vendors. Creating a data standard for all EHRs will empower patients who are switching from one provider to another, help smaller practices analyze and learn from their EHR data, and encourage innovation, according to Dr. Doug Fridsma, the Chief Science Officer and Director of the Office of Science and Technology at the ONC.

“The thought was that if we could open up the EHR and provide basic connectivity, what we’ve heard from the innovation community is that would really drive the innovation community to get engaged because they’re not having to build 15 different interfaces into the EHR,” Fridsma told MobiHealthNews. “They can build one [interface] and have a whole host of EHR systems they might be able to build value added services for, based on the data that’s contained within them.”

In addition, being able to easily extract information from EHRs will help accountable care organizations to measure the effectiveness of care when determining reimbursement. Data standardization would eliminate redundancies, where patients some times have to get tests done multiple times because the results aren’t transferred from one system to another. Earlier this year, the West Health Institute projected that interoperability — among both EHRs and medical devices — could save the US healthcare system $30 billion a year.

The initiative includes members from Allscripts, Surescripts, the CDC, GE Healthcare, the Mayo Clinic, McKesson, Partners Healthcare, and others.

“This is our call to action across the industry to get people to engage in telling us what would be helpful standards or specifications or common ways of doing things that the industry can agree on both in terms of larger EHR vendors, smaller vendors and the innovation community,” Fridsma said. “What would it be helpful for them have access to?”

Fridsma said the ONC will use multiple levers to get EHR vendors on board with whatever standards the initiative comes up with, including incorporating them into future certification requirements for meaningful use.

“There are incentives for the vendors, realizing if they have a product that’s not certified it’s going to be hard for them to sell that in the marketplace,” Fridsma said. “That’s one of the levers we have, but we work closely with the vendor community to make sure we’re asking them to do things that in the end are going to be beneficial to patients and to the healthcare systems.”

Fridsma said that Meaningful Use certification, and the government subsidies that come with meeting it, have already proved a successful tool in driving EHR adoption.

“In 2009, when the program was started we had about 17 percent adoption of EHRs in this country,” he said. “This year we passed 50 percent, we expect that growth will continue for the next couple of years, probably getting us to 80, 85 percent in the next two years or so. It’s hard to create an innovation and interoperability ecosystem if everyone’s working on paper. So getting things from paper to electronic was really the first step in the process.”

He said the new initiative is following the lead of ONC’s Blue Button initiative, which standardized EHR data to make it more available to patients via mobile devices.

“Once we began to standardize Blue Button for patients, we really saw the innovation community be incredibly responsive and have all sorts of new valuable services that took off as a result of that,” he said. “We’ve always sort of said, and I think [White House Chief Technology Officer] Todd Park can echo this as well, data is the fuel for innovation. If you don’t have the data it’s really hard to create applications that people can use in healthcare and in health IT.”

Remote patient monitoring to save $36B by 2018

By: Jonah Comstock | Jul 17, 2013        

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Remote patient monitoring will save the world’s healthcare systems up to $36 billion by 2018, according to a new projection by Juniper Research. The firm says North America will account for a little over three quarters of the savings, with Western Europe making up the next biggest chunk.

Juniper 2018 projectionJuniper predicts that a shift toward accountable care, especially in the United States, will lead to wider adoption of remote cardiac monitoring and remote monitoring for chronic diseases. The $36 billion figure is their most optimistic projection. On the other hand, a recent survey by Spyglass Consulting found that more than half of accountable care organizations were still unsure about the savings inherent in remote patient monitoring.

“With accountable care the delivery of healthcare funding is linked more directly to the health of the patient or individual, rather than being based upon the cost of treatment,” the firm writes in a whitepaper. “Even though remote patient monitoring, particularly for chronic diseases, is still at a very early stage in the development cycle, it fits well with new healthcare practices and the goal of keeping patients out of hospital.”

The report goes on to say that smartphones and connected devices will grow more rapidly than dedicated, non-smartphone-connected mobile health devices. It also suggests that the most powerful way to advance mobile health will be to prove these cost-savings to healthcare funders.

Juniper also looked at the mobile fitness market, finding “robust growth driven by a motivated user-base and coherent product offering from several players,” according to a press release.

GBI Research predicted recently that the market for remote patient monitoring in just the US would hit $296.5 million in 2019. Prior to that, research firm Kalorama put the US market for advanced wireless monitoring systems at $20.9 billion by just 2016. Juniper predicted last year that by 2016, 3 million patients would be monitored remotely over cellular networks.

Kit Check gets $10.4M to help hospitals track drugs

By: Jonah Comstock | Jul 16, 2013        

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A KitCheck scanning station.

A Kit Check scanning station.

Washington, DC-based Rock Health startup Kit Check has raised $10.4 million in a round of funding led by New Leaf Venture Partners. Sands Capital Ventures, Easton Capital Investment Group and LionBird also participated in the round.

Although Kit Check has been in hospitals since April 2012, this is the company’s first funding round of any kind.

“We took the Rock Health seed money and other than that we’ve been bootstrapping it. It was tough, but we thought it was worth it for us,” CEO Kevin MacDonald told MobiHealthNews. “But what we’ve realized is there’s a pretty big demand for this. And there’s a pretty big capital purchase associated with that. We need to have the sales team, the delivery team, and the product team in place to meet the demand.”

Kit Check makes a cloud-based software, which uses radio frequency identification, or RFID, tagging to increase the efficiency of replenishing the hospital’s pharmacy kits. Pharmacy kits are placed around hospitals to give doctors and nurses quick access to critical care medications. The startup claims their technology can reduce the time it takes to replenish these kits by 90 percent.

The company describes the process like this in a press release: “At the pharmacy, technicians check each remaining item to determine which have been used and which are expired or nearing expiration. After the kit is replenished, a registered pharmacist then checks every item to verify that the technician correctly restocked the kit. Following the pharmacist check, the kit is resealed and returned to the clinical care area in the hospital. Kit Check automates the pharmacy technician process and indicates in five seconds exactly which items require restocking or removal due to expiration. The Kit Check verification of replenishment accuracy also eliminates the need for a pharmacist to double-check the technician’s work.”

In February, the VA announced a massive project to use the same kind of RFID tagging to track medical and surgical equipment in its facilities, working with startup Intelligent InSites.

Washington DC-based Kit Check actually relocated to the San Francisco Bay Area for the duration of its time at Rock Health, then moved the company back to DC, MacDonald said.

“Rock Health by far had the best partner base and the best traction in terms of who they were attracting,” he said. “We felt that even though they were West Coast it was the only one that was really worthwhile.”

Kit Check’s system is currently being used in seven facilities, with nine more scheduled for implementation next month. MacDonald said he couldn’t share the facilities, but said there were “several big names” including one in the Boston area. He said hospitals have responded enthusiastically, even requesting that Kit Check adapt its technologies to help track other things within the hospital.

“It’s been unbelievable. People really can’t believe they’ve done it manually for so long,” he said. “This is something that every hospital does manually and I know I would pull my hair out if I had to do it. It’s a night and day difference.”

Canada subsidizes iPads for speech therapy

By: Aditi Pai | Jul 16, 2013        

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TalkRocketLast week, Toronto, Ontario-based MyVoice announced a discounted iPad or iPod Touch program for people who purchase the company’s TalkRocket Go communication app, subsidized by the Ontario Ministry of Health’s Assistive Devices Program, according to the company.

TalkRocket Go, normally $99 in the iTunes App Store, uses voice synthesis technology to provide verbal communication for people with conditions such as Autism, Cerebral Palsy, Aphasia, Parkinson’s disease. The app is designed with big buttons and high-contrast text for people of all ages to use easily. A user’s personalized text can be added, and other phrases can be deleted from the app to create the vocabulary that best expresses his or her personality.

In order to access the discount, families need to visit one of the 26 Assistive Devices Program clinics in Ontario to take an assessment. If after the assessment, the clinic recommends using TalkRocket Go as the right communication aid, a professional can help complete paperwork to purchase the app and device at a 75 percent discount.

In 2009, MobiHealthNews covered a similar topic in response to Roger Ebert’s letter to the Editor of the New York Times in which Ebert discussed Medicare’s decision to only cover dedicated text-to-speech devices, even though those are more expensive than multi-functional devices like the iPhone, which also offer text-to-speech applications.

In the post, MobiHealthNews’ Brian Dolan said: “At a time when everyone is debating how best to reduce costs and improve efficiencies in the U.S. healthcare system, it’s easy to sympathize with Ebert’s frustration. Why spend thousands of dollars more per patient when another device may work just as well for some patients who need text-to-speech technology?”

Dolan also pointed out a 2001 quote in which Director of the Assistive Technology Law Center Lewis Golinker said the difficulty in making changes, like Medicare’s decision to even reimburse for text-to-speech devices, had a lot to do with the small number of people who need text-to-speech devices being “invisible to Medicare”.

As an example of the reimbursement process in the United States, Princeton, New Jersey-based Lingraphica makes apps and dedicated devices for the treatment of aphasia, but users can only get reimbursement from Medicare, of up to 80 percent, for the dedicated devices. Similar to TalkRocket, a speech-pathologist must evaluate the potential user’s condition and prescribe the app best suited for his or her condition. According to Lingraphica, many private health insurers can also reimburse a patient for the Lingraphica products.

Mobile health literature builds as researchers explore alternatives to RCTs

By: Neil Versel | Jul 16, 2013        

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Dr. Robert Kaplan

The research community appears to be relishing the challenge of producing enough scientific evidence to prove or disprove the efficacy of mobile health technologies while also remaining open to new methods of evaluation that can keep pace with rapid innovation.

“The literature has really mushroomed in the last couple of years,” Robert M. Kaplan, director of the Office of Behavioral and Social Sciences Research at the National Institutes of Health, told MobiHealthNews.

“There is a growing evidence base,” agreed Wendy J. Nilsen, a health scientist administrator in the same NIH office.

That was not the case when NIH convened a workshop in August 2011 to discuss the state of mobile health research.

“[W]hether mHealth leads to better overall health outcomes and reduced disease burden is still unknown,” says a report from that workshop, published last week in the American Journal of Preventive Medicine. “In a healthcare system already burdened with suboptimal outcomes and excessive costs, premature adoption of untested mHealth technologies may detract from, rather than contribute to, what is needed for true overall health improvement,” the report cautions.

In addition to changing the way healthcare is delivered, mobile technologies are changing the way medical research is conducted. “Because many measures collected by mHealth can be obtained remotely in real time without the subject having to participate in traditional measurement visits, data analysis can be conducted more quickly, sometimes in real time,” according to the paper, which has 19 named contributors, including Nilsen.

“This can enable studies to be concluded earlier than planned when evidence of outcomes is obtained. Near real-time data analysis also can be used to control various versions of adaptive experimental approaches and designs. Additionally, the streaming data of mHealth can be used for real-time predictive modeling.”

These characteristics, along with the fact that innovations in mobile technology are occurring so much faster than the medical establishment is used to, has led some to question whether the long-accepted gold standard of research, the randomized controlled trial, is even appropriate for mobile apps. (One of the 19 contributors, Bonnie Spring, director of the Center for Behavior and Health at Northwestern University, defended RCTs in the name of patient safety at the 2012 mHealth Summit, but did allow that traditional trials might be too slow for mobile health.)

The NIH officials say there is room for other approaches. “We have heard a lot in mobile about just ditching randomized controlled trials,” Nilson tells MobiHealthNews. “Randomized trials are right in the right situation … but I think researchers are ready to embrace new methods that reduce burden,” she adds.

“The real issue is bias,” according to Kaplan. “RCTs reduce bias. We definitely want to preserve the protection against bias,” Kaplan says.

However, the ability to collect data outside of traditional laboratory settings might be shifting the bias. The lab, according to Kaplan, is “not representative” of how technologies work and patients behave in the real world. “This is just a revolution in the collection of data in ways that we couldn’t get data before,” he says.

“In the past, we collected very little data,” Nilsen says. “This is joyful.”

The continuous collection of data for evaluation deserves to be tested as an alternative to the RCT, Nilsen says, as does the role mobile technologies can play in recruiting subjects for traditional trials. “Some of the things that are slow are not really the randomized trial’s fault,” she says.

“By increasing scalability, reducing burden, and spreading access to people beyond the reach of traditional health research, new populations may consider participating who would have never done so before. By broadening the participant pool for research studies, research can be not only more efficient but also more generalizable,” the journal article states.

There does need to be a balance between measuring results in real life – data that may be skewed by external factors – and taking readings in the “perfect” conditions of the lab, according to Nilsen. “The computing community is looking at algorithms to reduce noise,” Nilsen says.