By Jane Sarasohn-Kahn. To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow.

However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.

As the subtitle of the report recognizes, there is an age chasm at the age of 50: physicians under 50 years of age more likely believe in the benefits of health IT; fewer older doctors do, on a global basis. Accenture points out that younger doctors are comfortable using computers during patient interactions in the exam room, compared with older physicians who prefer face-to-face conversations without what they may perceive as a disruptive interruption of looking at a keyboard or computer screen. (more…)

By Val Jones. There aren’t too many grandmothers developing mobile health apps these days, but I met a charming one (Jill Campbell) at the mHealth Summityesterday. Jill is a 60 year-old woman from Texas who has been actively concerned for the safety of herself and her daughter over the years.

“My daughter took a self-defense class,” Jill explained, “And she was taught the ‘fight or flight’ response to escape harm. I’m 60 years old. I’m not good at fighting and not very fast at fleeing. So what’s my third option?” Jill created the WatchMe 911 app to provide the solution.

“I first started thinking about a personal alarm system before smart phones even existed. I saw that there were car alarms and house alarms, and wondered why there weren’t personal alarms. At the time I imagined that the personal alarm would go through an answering service system, but since smart phones were created, it can all be tied together in an app format.”

Jill demonstrated the WatchMe 911 app to me during our interview. It contains features such as a panic button that can be armed in advance. Two taps on the smart phone screen and a circle of friends and 9-1-1 are contacted immediately with your GPS location and an alert message. The panic button is a favorite for women who are concerned for their safety when walking late at night or in dimly lit parking lots or alleys.

The “Monitor Me” feature allows the user to schedule messages to friends in advance of a potentially dangerous situation. The message will be sent at a specific time unless disarmed by the user. This is helpful in situations where, for example, a user is out for a run without their phone and might become injured or threatened. They can set the alarm to send out a call for help to friends, with a pre-programmed description of the trail that they’re on. This feature is also popular during blind dates when users would like their friends to check in with them at a certain time. (more…)

By Jane Sarasohn-Kahn. This week’s mHealth Summitin Washington, DC, features scores of presentations, posters, and corporate announcements demonstrating the typical chaos of emerging technology markets: the Big Question at this stage on S-curves for new tech is always, “what’s the timing of the pace of change,” or for you mathematically-inclined readers, “what’s the slope of the mHealth adoption curve?”

Before we address that question, let’s be transparent about the fact that there are several definitions of just what ‘mHealth’ is: purists may conceive it as covering only those health tools and applications that ‘go’ mobile–that is, that are deployed via mobile phones and devices like tablet computers. Then there’s the other end of the spectrum (pardon the tech-pun) embodied by the West Wireless Health Institute‘s concept of infrastructure-independent health care. My friend and long-time colleague Matthew Holt, co-founder of the Health 2.0 Conference, addresses this idea with his paradigm of “un-platforms.”

Wherever your own idea about “mhealth” sits on this continuum, it’s crucial to recognize that mHealth does not equal only mobile phone apps. There is a lot of hype around health apps for smartphones, but the traction is already with text messaging on simple phones in developing countries, doctors accessing prescription drug information on their beloved iPhones, and a growing number of people quantifying themselves through wearable devices that provide health-promoting nudges throughout the day.

What’s driving the adoption behind these programs? First, it’s about the value that the program offers the health system, health provider, and individual health consumer. Cash-strapped developing countries have leapfrogged over developed nations’ health systems– where health capital is sunk into hospital beds, legacy IT systems, and incentives that aren’t well-aligned with providers to deliver health care at the most appropriate, efficient site. In the developed world, providers deliver care based on how to maximize reimbursement — often in higher-cost-than-necessary settings — but paid-for by both public and private payers. In poorer countries, necessity is indeed the mother of invention — read “adoption” — of mobile health. (more…)

By Pam Cipriano. We use our smart phones to manage most of our social life–calendars, communications, coupons, you name it.  So why not health care?  Perhaps you are already taking advantage of some amazing mobile health applications, or wireless monitoring devices that not only take measurements but can also report them to your health care provider or personal health record.  A renowned expert on disruptive innovations, Clayton Christensen (The Innovator’s Dilemma and The Innovator’s Prescription) who has diabetes, revealed in an interview with Health Affairs several years ago*, his methods for using his glucose meter and algorithms, mail order testing, and email communication, allow him to stay on top of his care and progress, rarely needing to go to provider’s office for care.  Even though he may be an outlier, more and more people, young and old, are able to benefit from the advances in mobile technologies.  Being accustomed to mobility, consumers are empowered by technology that liberates them from the bureaucracy of inconvenient schedules, poor parking options, laborious waiting, and mysterious fee schedules. 

Today, you can receive text messages, voice mail, or email reminders for just about anything from medications, to testing, to health tips, or appointments.  Information and help where you want it, when you want it, and how you want it are transforming the relationship between you and your providers.  Teens get help with diet and smoking cessation as well as disease management.  Elders and their care givers get live follow up and real time transmission of important vital signs through remote patient monitoring that can alert providers to developing problems at home.  Ambient assisted living systems that track movement at home, and personal emergency response systems help elders stay at home but alert others when a condition changes over time or in an emergency.

Mobile personal monitoring is getting a boost from other companies who recognize people want to be on the go, and are not held back by the need to monitor or address health needs in traditional ways.  In the next several years, Ford Motor company plans to provide “First Assist” emergency health care instruction through its OnStar system. They will provide allergy alerts based on day-to-day location indices of allergens, and glucose level monitoring alerts via dashboard applications.  Future plans also include voice requests for health information and updates, seat sensors to detect electrical heart rhythms/problems, and stress reduction responses.  Leveraging existing technologies such as GPS, telecommunications, and internet access is catapulting us into an age of ubiquitous computing where our environment is instantaneously and unobtrusively enabled by computer assisted functions. (more…)

By Robin Strongin. A recent report from Rock Health (Disruptive Woman Halle Tecco is their Founder and Managing Director) provides an overview of current and emerging medical sensors. These include sensors made by fitbit, BodyMedia, Basis, and AliveCor.

The report says that by 2014 – there will be 400 million consumer sensor oriented devices, comprising a $4 billion market! Disruptive Women in Health Care hopes to contribute to developements in this area through its Health in Place Initiative.

To view the Rock Health report click here.

The breast and colon cancer app are designed to provide newly diagnosed breast and colon cancer patients with personalized information about their diagnosis and are based on the My Breast Cancer Coach and My Colon Cancer Coach online tools. Basically, patients answer just a few simple questions and then get an individualized treatment guide that addresses their specific tumor type and diagnosis –leading to a more empowered patient and a informed dialogue between patients and their healthcare providers. You can check out or download the free app for iPhone here: http://goo.gl/ql1Wd or here for the Android: http://goo.gl/CMLrM.

The Ovarian Cancer Symptom Diary App will help you learn about the risks, signs and symptoms of ovarian cancer. This first-of-its-kind application allows a woman to track symptoms that could indicate ovarian cancer, and alerts her if she should make an appointment with her doctor for further testing. To download app click here.

Today’s post is by guest blogger, Shannah Koss

Dear Colleagues,

Health Information Technology and the substantial HITECH investment are a critical part of putting the U.S. health care industry and the U.S. consumer population on the 21^st century path to improved health and health care. The investment however is almost exclusively focused on enabling the provider infrastructure. We need a mirrored infrastructure that will help patients and caregivers navigate, access and understand the growing health information universe and what it means to them.

The newly announced “Putting the IT in TransITions” initiative is a critical opportunity to help consumers better access and use their own healthcare information, but only if it is put in context and made truly consumer friendly. This means not just plain language but with tools, translation and interpretation resources that make it actionable.

The two-page project summary “Patients and Caregivers the 1^st Step Not the Last Mile” describes an initiative that would explore how to enable a parallel consumer-facing infrastructure that complements and readily connects to the provider-facing infrastructure. Although ultimately there will be one shared infrastructure the timing and challenges of the emerging provider connectivity runs the risk of leaving consumers as the last mile.

We are stepping up to the IT in TransITions two-week challenge with a deadline of October 28, 2011 by seeking broad support for the project and its goals. We have many committed partners and we need your help in emphasizing to HHS and the industry leadership the critical importance of the consumer component to their efforts.

If you can lend your name and/or your organization’s name to this letter of support please email kossoncare@starpower.net by Thursday October 27th.

Your information, exactly as you provide it, will appear after the following statement: We the undersigned agree that successful care transitions need increased consumer IT support and focus consistent with the goals of the Patient and Caregiver Gateway project.

By Jane Sarasohn-Kahn. “56 million U.S. Consumers Access Medical Information from Electronic Health Records,” asserted Manhattan Research’s press release of October 12, 2011. This statistic, fresh out of the firm’s 2011 Cybercitizen Health survey, is among several stunning numbers that demonstrate a growing trend: U.S. health citizens’ embrace of their personal health information in digital formats, via electronic channels.

To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together, they guided me through the topline on digital health information use among U.S. adults in 2011.

The 56 million US adults who access data via electronic health records (EHRs) was a surprise to me, and to this trio, as well — so much so that they revisited the study methodology and samples to ensure that this was not a statistical anomaly. It’s not. But as with all numbers, it’s insightful to know what lies beneath the raw stat.

The big number to consider here is 24% of U.S. adults who are accessing their personal health information (PHI) from their physicians’ EHRs. In this case, the 56 million tend to be younger, better educated (more with college education), higher internet adoption, and more likely to own smartphones and tablet computers. They are also more likely to observe a physician doing digital activities during the consult – such as seeing the doctor entering information into the EHR.

What’s common among those consumers interacting with their EHR-borne health information is that they are more frequent online health information seekers than people who are non-users of their EHR data: three times more likely. (more…)

By Robin Strongin.  Three years ago, in September 2008, Disruptive Women in Health Care launched with an exciting program at the National Press Club (take a look at our media page to see what we had to say at the time.)

I know, I know it’s October…but hey, we are disruptive so celebrating on the exact day seems so well, ordinary.  And the past three years have been anything but ordinary.  We all had something to say about the new health reform debate and ultimate passage.  We still have much to say about the new law, as well as a multitude of other topics.

One area that I have been thinking a lot about is the exploding area of mhealth (mobile health), remote monitoring, and telehealth.  Technology alone is not the answer of course.  But technology, coupled with innovative care delivery models (think health reform), and patients, caregivers and clinicians more comfortable with smartphones, apps, data sharing and online connectivity have all contributed to a new framework of health and wellness.  Aging in Place, staying connected, eICUs, PHRs and EHRs.  Exciting stuff.

But, like most solutions in health care, success must look beyond the health sector.  Here’s what I mean by that: staying healthy can’t just take place in a health setting or even in your home.  Maintaining your health and wellness or managing your chronic disease or disability requires a connection where ever you are — in other words, Health In Place.  Young people with epilepsy and diabetes still attend school, go on vacation and use public transportation.  Elderly individuals aging in place still travel to visit gradnchildren. And, adults maintaining exercise and nutrition regimens who travel for work need to stay connected to maintain wellness.  The Health In Place concept takes this broad view and will be bringing together thought leaders from not only the health field, but the telecom, travel, automobile and real estate sectors as well. 

The organizers of the 2011 mHealth Summit were so taken with this idea that they invited Disruptive Women to launch the Health In Place or HIP initiative with a reception on December 6th–we couldn’t be more thrilled or more flattered. So SAVE THE DATE:

Health In Place (HIP)™ — Disruptive Women in Health Care is Launching a New Initiative

Tuesday, December 6, 2011, 5:00–7:00 PM
Location: Pose Ultra Lounge & Nightclub–at the Gaylord Hotel in National Harbor (Washington DC)

Overview: The concept of Health In Place™ is built around the idea that our homes are more than just homes, our offices are more than just workplaces, our schools are more than just places of learning, and even our cars are more than just modes of transportation. Thanks to wireless communications and emerging technologies, each of these venues has become potential health and wellness centers or HIP. No matter where we are or what we’re doing, we can be protecting and enhancing our well-being. For this facet of 21st century health care to achieve its full potential — for more Americans to have the tools to link to their caregivers, to protect against and manage illness, while monitoring their well-being — a number of public policy issues are involved, cutting across multiple disciplines from health care regulations and benefit structures to tax policy to technology incentives. That’s why Amplify Public Affairs and the Disruptive Women in Health Care® blog (along with our media partenr, The Hill) have formed the Health In Place™ Initiative — to bring together policymakers and change agents from multiple industries.

 Please join us as we unveil this new initiative.

 Speakers:

• Robin Strongin, President & CEO, Amplify Public Affairs & Creator, Disruptive Women in Health Care — Moderator
• John Marttila, President, Marttila Strategies (a national polling expert)
• John C. (Jack) Lewin, MD, Chief Executive Officer, American College of Cardiology
• Pamela Cipriano, PhD, RN, NEA-BC, FAAN, Professor, University of Virginia School of Nursing, Editor-in-Chief, American Nurse Today, 2010-11 Institute of Medicine Nurse Scholar-In-Residence (and a Disruptive Woman blogger)
• Halle Tecco, Founder & Managing Director of Rock Health (and a Disruptive Woman blogger)

Stay tuned for more information.  And by all means, please come out on December 6th and celebrate with us.

At three years of age, we are not only Disruptive, we are also HIP.

mHealth Summit to Highlight Groundbreaking Research Abstracts and Innovative Presentations

TOPIC AREAS:

• RESEARCH: Ground-breaking health research using mobile technologies in clinical medicine and public health outcomes.
• TECHNOLOGY: Categories that examine the technologies being deployed today while also exploring new technologies currently under development. 
• BUSINESS: Focus on moving the debate forward by addressing the business models that impact mHealth with a focus on lessons learned, best practices, and the emergence of commercially viable models to scale mHealth globally.
• POLICY: Showcase of healthcare, technology and investment communities seeking regulatory clarity on wireless medical technologies to accelerate this promising engine of health care innovation

The submission deadline is this Friday, July 8th. Click here to submit an abstract or presentation. For more information on the 2011 mHealth Summit click here.

Amplify Public Affairs is proud to be a media partner for the 2011 mHealth Summit – please consider participating in this event.

By Jane Sarasohn-Kahn. Over 85% of the world’s population is covered by wireless phone signals. The global proliferation of wireless phones provides a technology platform to move health services to people — broadly referred to as ”mobile health” or “mhealth.” mHealth: New Horizons for health through mobile technologies, the World Health Organization’s (WHO’s) second report on mobile health, summarizes a survey of mobile health developments around the world, published in June 2011 based on survey data from 2009 collected in 114 nations.

WHO learned that mHealth is most easily deployed into health applications where voice communication via traditional phone networks has been used. Thus, in important applications like surveillance and decision support, mHealth is less likely to be established because these functions require more advanced capabilities and technology infrastructure.

The survey evaluated mHealth services in 14 categories, as shown in the chart. These include health call centres, emergency toll-free phone services, emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support.

The most prevalent of these services are toll-free emergency applications, mobile health call centres and emergency services, and mobile telemedicine, all available in over 50% of WHO member states. In addition, mHealth-based appointment reminders are available in a plurality of nations.

The most popularly piloted mHealth programs include patient monitoring, treatment compliance, mobile telemedicine, and patient records.

Health Populi’s Hot Points:  Most of the mHealth deployments around the world tend to be small-scale pilots that deal with single issues. The largest scale mHealth programs are usually supported via public/private partnerships. (more…)

By Jane Sarasohn-Kahn. “Ward and June Cleaver have left the building,” observe analysts at Nielsen. “The white, two-parent, ‘Leave it to Beaver’ family unit of the 1950s has evolved into a multi-layered, multi-cultural construct dominated by older, childless households,” starts a report from The Nielsen Company, The New Digital American Family.

Whatever ethnic flavor this Digital Family may represent, there’s one equalizer across all of them: the smartphone, which is owned by households across cultures and income levels.

First, the socio-demographics paint a picture of increasingly multi-cultural households. Recent immigrants to the U.S. accounted for 90% of population growth from 2000-2010, over-indexing for Hispanic and Asian communities. Hispanics are the fastest-growing segment of the multi-cultural nation, now numbering 50 million people in the U.S. Marriage seems to be going out of fashion, with only 52% of adults being married in 2008 compared with 72% in 1960. In the next decade, households with young children will grow more slowly than in the past; the greatest growth will be among multi-cultural, lower/middle income families. Nielsen forecasts that most families with kids in the U.S. will be multi-cultural before the end of this decade. (more…)

By Casey Quinlan. In my daily business life, I have lots of conversations about healthcare IT (HIT), electronic medical records (EMR), personal health records (PHR), and the rest of the alphabet soup of acronyms used in health care’s march into the 21^st century. Each of those conversations always winds up leading to the same question, “what’s the ROI?” Meaning what’s the expected financial benefit to the provider deploying the technology.

This is most definitely a valid question – any enterprise looking at a technology product or service needs to have a solid understanding of what the business results of that technology can be, and what the cost of those results will be. Also, the likelihood of those results actually showing up is important: what’s the track record of the system or service on offer?

Here’s where the ROI question falls short of the mark in the current health care landscape: results become all about revenue. This is a particularly sticky question in health care, given that, outside of large health systems like Kaiser Permanente or the Veterans Administration, health care IT has been more about managing information and data flow within a closed system than about sharing information with patients, other providers, or payers.

The Patient Protection and Affordable Care Act (PPACA, or as it’s known in arguments across the US, “health care reform”) is the best attempt yet to get everybody in health care – from major hospitals to urgent care centers, from Park Avenue ob/gyns to free clinics – into the EMR pool. The carrots driving adoption are meaningful use incentive payments. The sticks are lower reimbursement schedules for failing to adopt EMR or to achieve that meaningful use.

Looking for strictly financial ROI in this landscape is almost impossible – there isn’t enough data yet to make any accurate statements about what the return, in dollars, might be. Vendors make promises, but anyone who’s been involved in a large-scale IT implementation knows that projects take a big commitment in time and treasure, and can often stretch far beyond the original scope of the project.

The ROI on EMR won’t be visible until EMR systems have been in wide use for at least two years within a provider organization. It will take another two years to see how the creation of state, regional and national health information exchanges (HIEs) return results in time or money.

A better question for HIT in its current state is, “what will it cost to do nothing?” I don’t just mean not getting the meaningful use stimulus payments – I mean the cost to health care providers who don’t adopt EMRs, or who don’t join up with state and regional HIEs as they come online.

The push to repeal PPACA that started when the balance of power in Congress shifted after the 2010 election risks making health care worse, not better, if repeal leads us back to Square 1. Health care – all parts of the process: providers, patients, and payers – has a stake in creating a better system. From Square 1, looking for the ROI on technology that can create that better system is only half the question.

What will it cost to do nothing? The answer to that question shows the way forward.

By Halle Tecco. It was beautiful in San Francisco last week, the perfect weather to welcome 1,000 health geeks to the fourth Health 2.0 conference.

Two themes seemed to anchor the demos and conversations at the conference: data and consumer empowerment.  

On day 1, Aneesh Chopra, CTO of the United States and Todd Park, CTO of US Health & Human Services set the tone with their enthusiasm for data.gov and what this means for healthcare.  They also announced the ‘Blue Button’, a program being piloted by the Department of Veterans Affairs to give veterans the ability to download their claims or medical information.

Private sector innovation was demonstrated by companies like FirstLife Research.  FirstLife is mapping and analyzing user-generated medical data that’s already on the web.  Then they use semantic algorithms and medical ontologies to convert these reports to actionable insights about medications.  Similarly, PatientsLikeMe combs through data on 19 conditions through their army of 45,000 patients that regularly track their health.  

With consumer technology comes the ability for patients to be more informed and connected.  There was lots of buzz for Castlight, a new site that provides employees with individual-level views of their health care benefits and costs. Such granular detail enables employees to become informed consumers and better shop for health care services.

Wellness apps were abundant, and a team of students from Stanford won the Move Your App! Developer Challenge, sponsored by Catch and HopeLabs.  They created an app, called Happy Feet, that encourages physical activity through a game-like activity tracker.  Another team built an augmented-reality mobile app that displays Health Rankings information based on a GPS reading, for home-shoppers or just the curious.

It was great to see a combination of large players like Google Health and Microsoft HealthVault, alongside garage hackers and health geeks.  Everyone agreed– technology is quickly making its mark on healthcare.

By Jane Sarasohn-Kahn. Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system.

Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act and estimates that 80% of existing hospital IT applications will be affected by the regulation. Hospitals will be spending about $120 billion to meet the adoption and meaningful use provisions of the Act. This equates to $80,000 to $100,000 per hospital bed. ARRA incentive payments will cover roughly 20% of this cash outlay, meaning that $60-80K won’t to covered.

But McKinsey says, “Hold on!” There are ways to recoup the spending gap between HITECH incentives and cash-out-of-the-hospitals-budget. McKinsey’s research calculates that optimizing labor, reducing adverse drug events and duplicate tests, and adopting revenue cycle management can help the average hospital save $25,000 to $44,000 per bed each year. That gets to the $40 billion in annual savings when multiplied across all hospital beds in the U.S.

In operational terms, the savings accrue through:

• Managing inpatient beds more efficiently using equipment-scheduling software
• Optimizing the use of clinical equipment
• Determining optimal staffing
• Reducing administrative waste
• Reducing adverse drug reactions through computerized-physician-order-entry (CPOE) which cost $8,000 to $15,000 per bed each year (up to $3 million for a 200 bed hospital)
• Managing the revenue cycle by billing unbilled services, equivalent to 0.4% of hospital services, or $4,000 per bed.

Jane’s Hot Points: The McKinsey team rightly points to three critical success factors for maximzing health IT investments that the most wired, effective hospital-adopters have learned: get critical buy-in among clinicians and hospital execs early in the HIT adoption process; ‘radically’ simplify health IT architecture; and, elegantly plan and execute.

It’s the implementation phase in health IT adoption that so often gets short-shrift. McKinsey notes that Canada’s hospital system devoted 30% of its entire budget to change management. That’s a big number, but it’s also where rubber meets road: a capital outlay of $N million is the easy part of HIT adoption. The follow-on implementation resources, both in terms of sheer dollar volume and labor/staffing, along with disruption of clinical workflow, is the hard part. But getting to meaningful use will require no small amount of implementation effort in the form of evangelism, education and training, and ongoing assistance and support.

Originally posted on The Health Care Blog on August 18th.