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.

Physicians that more frequently use health IT are also more likely to believe in the benefits of health IT: Accenture measured 12 functions of EMRs and HIEs and found that those who more fully interact with these features perceive the fruits of the systems. 87% of doctors who use at least 9 of the 12 applications see positive impacts in using health IT; only 64% of doctors who use 4 or fewer functions believe in the positive benefits of health IT.

Health Populi’s Hot Points: American doctors are more skeptical about the use of health information technology than their colleagues in Asia, Europe and North America. US doctors are also live subjects in the experiment that is the adoption of health care information technology as part of the HITECH Act, working hard to demonstrate meaningful use to earn financial incentives in Stage 1 this year.

Meaningful use, in fact, deals with those kinds of functions that Accenture measured, finding that the more functions a doctor uses, the more likely he/she will appreciate the fruits of health IT in terms of patient outcomes, productive workflows, reducing medical errors, and reducing the risk of litigation.

US doctors are playing catch-up with their global colleagues. This is yet another benefit of the HITECH Act that doesn’t get enough attention.

Originally posted on Health Populi on January 10th.

“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.

WatchMe 911 also contains a simple “call 9-1-1″ button, a check-in button (that reminds me of a combination of  FourSquare and Twitter), and allows select groups of people to join a “neighborhood watch” type network to support friends who might need help. There is a campus version of WatchMe 911, called OnWatch that is modified for college students, allowing them to connect with campus police, for example.

Although the WatchMe 911 app only launched in September of this year, its sister program (OnWatch) has already won the Apps Against Abuse Technology Challenge, sponsored by the Office of the Vice President, the White House Office of Science and Technology, and the Department of Health and Human Services.

Jill told me that WatchMe 911 is available for free download on iTunes now, with in-app purchase fees ranging from $5.99/month to $99.99/year. Call 911 feature is always free. Users are offered a 30-day FREE trial of the entire app.

Although my one concern about these apps is the potential for false alarms (I can imagine how annoying it could be for forgetful joggers to send out unintentional, automated alerts to friends), I believe that version 2.0 of WatchMe 911 could provide revolutionary real-time aggregated data to law enforcement. Nation-wide and local crime hot-spots could be identified easily from users who opt-in to share their alerts, allowing police to allocate resources more effectively – deterring violent crimes before they even occur.

I hope this app gets the traction it deserves, because the potential for benefit is incredibly large. And for all the other women and grandmas out there who are looking for an alternative to “fight or flight” this may well be your ticket.

Originally published on Better Health on December 9th.

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.

For doctors, mHealth adoption is rooted in being productive - another kind of profit maximization based on doing more in less time. For patients, growing co-pays and coinsurance sharing can motivate the patient-as-consumer to opt into self-care through tools like the FitBit and Withings scale that I personally use, or Fooducate for making healthy food buying decisions at the grocery store (which I also regularly use).

So, value becomes an underlying driver of mHealth adoption, where there is transparency of transaction costs in health care, and flexibility for stakeholders to make choices.

What of “values” driving the adoption of mHealth? That’s a softer issue, but no less potent than “value.” We’ve learned through the Great Recession of 2008 (ongoing in much of the U.S. and world economies) that individuals want to engage with organizations and institutions that embody their values. One of the big consumer shifts in the post-recession is DIY – the emergence of the creative economy, where people want to do more for themselves, from home improvement to self-improvement and cooking. People have lost more than a little faith in institutions – business and government – being hard-hit in the stock market seeing retirement funds fall, witnessing home values plummet, losing jobs, or losing faith in public institutions.

For health providers, autonomy and self-determination continue to be a value in practice. So adopting tools that bolster practice productivity and empowerment can delight the health practitioner. Those organizations who enable that garner trust, appreciation and brand loyalty. We’ve seen this, for example, with Epocrates, which continues to enjoy high take-up by physicians for its growing portfolio of mobile applications.

Whatever analyst forecast you read on the mHealth market — and you have your pick of many these days — remember that value + values will drive adoption.

Health Populi’s Hot Points: While there’s a go-go mood about mHealth adoption, a few significant barriers remain to be addressed: building out broadband to people who especially need it and don’t have it, aligning payment for health care so that providers will adopt the right tools for value-based and connected health; and patient engagement with their own health.

While a cadre of pioneering doctors, providers and patients have begun to engage with mobile health tools and apps, 2012 could be the year when we may begin to stop using the “m” and see mobile as just another infrastructure option for delivering health to engaged, activated patients.

Originally posted on Health Populi on December 6th.

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.

Electronic medication reminder boxes and vials already offer services to remind people what to take, and when to take it with flashing lights and compartments that release.  Failure to respond on schedule triggers follow up to the consumer and family members. Simple transmission of daily weight and other vital signs is easily performed through a variety of economical products including one scale that will post your weight on Twitter.  Edible computer chips are being tested to report proper drug ingestion. 

Thousands of cell phone applications provide tools to receive and send health information as data points, documents, and static as well as moving images.  With 24/7 expectations, we now have 24/7 access to information and data interactivity.  Technology is delivering on the promise to help improve care.  It is always on, and fits in our pockets. 

*Mark D. Smith. Disruptive Innovation: Can Health Care Learn From Other Industries? A Conversation With Clayton M. Christensen.  Health Affairs, 26, no.3 (2007):w288-w295. (published online March 13, 2007; 10.1377/hlthaff.26.3.w288)

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 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.

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.

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.

Monique Levy pointed out that EHR information users are “more acutely aware of the pain points they have in the health system: they are more likely to identify certain problems and barriers in managing care. They are a more self-aware group about what’s working, what’s not working, and what they need” out of the health system.

What’s beyond the 56 million (24%) U.S. adults who Manhattan Research calls “users” of EHR information? Another 41 million who are interested in doing so but haven’t yet.

This leaves millions more people in America who don’t appear interested in accessing their health information via a doctor’s EHR. Cybercitizen Health identified the least-engaged group within this cohort: 15% of people who have seen a doctor in the past twelve months whose doctors provided access to medical information on an EHR, but neither accessed their EHR data nor are interested in doing so.

Thus, the consumer side is only one-half of this equation: physicians, of course, play yang to the patient’s yin. In Taking the Pulse, Manhattan Research’s annual physician poll, the company found that doctors’ adoption of tablets (especially the iPad) continues to quickly grow. Their use will turbocharge physician adoption of mobile EHR capabilities, and physicians’ ability to share data, up-close-and-personal, and in seamless ways without disrupting workflow in the exam room which can happen when sitting behind a computer monitor.

For Cybercitizen Health, Manhattan Research surveyed 8,745 U.S. adults age 18 and over via online and phone in the third quarter of 2011.

Health Populi’s Hot Points: In The Two-Way Street of Patient Engagement in Health IT, I wrote in California HealthCare Foundation‘s iHealthBeat on September 27, 2001, “In the two-way street that is patient engagement, it is health care providers  who will play a key role in getting the mass-middle of people more involved in  their health data. That may be a lot to ask of health care providers given their  already-cramped workflow, but doctors and hospitals will be motivated by at  least two market drivers: payment and consumer pressure.”

Manhattan Research found that people who have begun to embrace their PHI via EHR tend to have physicians who bring them into the process in the exam room: physician engagement with meaningful use is drawing patients into conversations about their personal health information and, therefore, their health.

Further fanning the flame of physician involvement is Meredith Ressi’s observation that, “once you get an iPhone or Droid in physicians’ hands, it changes their behavior.” She noted that access to the web is the first changed behavior: doctors are doing medical information searches via smartphones wherever they are — and with iPhones, the use of simple-to-access apps further bolsters their mobile health behavior.

Originally posted on Health Populi on October 14th.

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.

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.

The second chart presents the major barriers to mHealth implementation cited by WHO member states. The most significant barrier to adopting mHealth is competing priorities within health systems. Without a strong evidence-base, WHO concludes, nations with limited health resources must allocate them based on expected return on investment — for example, buying vaccines versus investing in a mobile health project.

The second most cited barrier is “knowledge:” in this case, understanding how mHealth can impact public health. Here again, evidence needs to be gathered and disseminated so that potential investors in mobile health applications can identify the right application and success factors for their health citizens – taking into account limited health resources.

Gathering a sound evidence-base is key to mHealth getting its due around the world. Yet the level of evaluation of the projects, both established and piloting, is scant, based on the survey findings.

Public policy, cost-effectiveness, legal issues and operational expenses are also key barriers to adopting mHealth programs. In many countries, the concept of mHealth isn’t part of public policymakers’ mindsets. WHO rightly points out that technology has developed far faster than the public’s understanding of how it can positively impact public health.

One important barrier not mentioned in the survey, but suggested early in the report, is the lack of a standard definition of “mHealth.” WHO defines it as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

The important point here is that mobile health goes beyond the mobile phone: that there is a growing array of various mobile platforms that can be used for mHealth. Infrastructure-independent health services are being deployed in countries, both rich and less-so. Because this survey is based on 2009 data, the needle will have moved in 2010 on mHealth. But this survey does prove that mHealth is a moving market, on the upswing, the world over.

Originally posted on Health Populi on June 15th.

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.

Nielsen reveals fresh findings regarding family finance and media habits. Higher income families watch less TV but spend more TV-time with their kids; wealthier families also use digital video recorders 4x more than lower income households. Higher income families also use the Internet most, especially for conducting research, viewing news, and accessing travel information. While only 11% of Hispanics bank online, 30% do banking transactions on mobile phones.

Time-shifted viewing and 3-screen lifestyles (TV, Internet, mobile screens) are the new normal. Search 1.0 has morphed to social networks 2.0 for travel, health and other topics, Nielsen notes.

Health Populi’s Hot Points:  “The Internet is more than a way to study the world; it is a mechanism for building community,” Nielsen concludes. This phenomenon can profoundly impact health for an individual and for populations. Whether influencing Mobile Moms, asthmatic kids, or seniors managing COPD, the smartphone is that great leveler according to Nielsen’s survey data. Web preferences differ across income and ethnic lines. Thus, the mobile platform may be universal, but messaging and design must account for health-user preferences and cultural norms.

Smartphone penetration is 45% among Hispanics in the U.S., matching that for Asians. The chart illustrates that Hispanics are more likely to text than whites are, and Asian people, much less overall. But Nielsen’s data show that Asian-Americans are much more likely to stream video online than the national average.

Health behaviors can be inspired and sustained by using mobile platforms where people live, work and play. But organizations seeking to influence such behavior need to keep usability, design and consumer preferences in mind in the emerging era of the New Digital, Multi-Cultural Family.

Originally posted on Health Populi on April 27th.

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.

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.

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.

Seven months and 2000+ professional and public comments later, the final rules lay out a three phase graduated approach of requirements for demonstrating meaningful use of certified EHRs.  Since not one stakeholder group is wholly enamored with the rules, they are more than likely equitable and balanced.  Listening to the feedback, the ONC made a number of changes from the proposed to the final rules, taking into account concerns about the speed and scope of implementation of criteria to qualify as a meaningful user.  Groups across the industry gave faint praise as they acknowledged the greater flexibility in the final rules and an easing of some of the requirements.  The phased approach lays out the goal for Stage 1 as capture of data in coded format, Stage 2 exchange of information with emphasis on guiding and supporting care processes and coordination, and Stage 3 improving outcomes by focusing on decision support with improved access to comprehensive patient data.

With quality at stake, the meaningful use incentives tie payments to achieving advances in health care processes and outcomes.  The payments are intended to help accelerate use of HIT. Fortunately there is already broad agreement that populating data into EHRs, using electronic prescribing, reviewing and sharing data across providers and settings, and reporting on quality measures has a positive effect on care.  Dr. Don Berwick, newly appointed Administrator of the Centers for Medicare and Medicaid, emphasized that the new rules define the use of EHRs that is “meaningful to care and to people,” emphasizing the direct improvement in patient safety, transparency, and access to data resulting in better, safer, and more reliable care for everyone.  Certified EHRs help providers know more about their patients, make better informed decisions, and reduce costs of care.  Electronic systems can reduce potential for errors, and enable consumers to work with their providers to coordinate and manage their care.    

The regulation sets out a road map with requirements for hospitals and clinicians in years 2011 and 2012.  Moving away from an all or none achievement of the original objectives, there are now two groups of objectives—a core set of measures (14 for hospitals and 15 for eligible providers) and a menu of ten options from which an additional 5 are selected for implementation over two years.  Core elements include basic essential components of an EHR such as vital signs, demographics, active medications, allergies, problem lists, and clinical summaries. Reporting of quality data, assuring privacy and security of data, and electronic prescribing are also expected.  The extent of implementation for each measure varies such as percent of orders, or transactions to show how one uses the EHR. Menu options range from drug-formulary checks, to recording of advanced directives, to sending preventive care reminders to patients.  A summary overview of meaningful use objectives is provided by David Blumenthal, MD, MPP, ONC, and Marilyn Tavenner, RN, MHA, principal deputy administrator of CMS, in the New England Journal of Medicine. 

Up to $27 billion over ten years will be made available to eligible providers and hospitals in a multiyear inventive program to help overcome logistical, technical, and financial barriers. Some say this funding is too modest.  It is difficult to shift from legacy paper systems to electronic ones.  Workflow patterns and personal habits must change, and there is the real expense of acquiring a system, training staff, and retooling care processes.  The American people deserve this upgrade from low tech paper to high tech systems that help even the smartest provider avoid life threatening errors.   Clinicians may qualify for payments up to $44,000 through Medicare and $63,750 from Medicaid over a four to six year period.  In all, these resources will help fuel the development, adoption, and use of a nationwide system of EHRs.

Using certified EHRs in a meaningful way will lead to improved health care quality, efficiency, and safety.  We can expect to see ongoing refinement and new rules in anticipation of Stage 2 and 3 requirements.  Hitting the milestones of meaningful use will move the HIT agenda from aggressive and ambitious goals, to reality.

Additional information is available:

1) Complete document on the final rules as published in the Federal Register: http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

2) CMS meaningful use: http://www.cms.gov/EHRIncentivePrograms/

3) Programs HHS/ONC:   “Being a Meaningful User” http://healthit.hhs.gov/portal/server.pt?open=512&objID=2998&parentname=CommunityPage&parentid=18&mode=2&in_hi_userid=10741&cached=true

4) Healthcare IT News: “summary overview of meaningful use objectives-core set”: http://www.healthcareitnews.com/news/meaningful-use-objectives-eligible-professionals-hospitals

5) HIMSS meaningful use info: http://www.himss.org/economicstimulus/

6) HITECH Act funded programs: http://healthit.hhs.gov/portal/server.pt open=512&objID=1487&parentname=CommunityPage&parentid=3&mode=2&in_hi_userid=10741&cached=true

The FCC voted unanimously to have the federal government pay a greater share of broadband Internet costs for rural health care providers, and the commission also expressed its intent to subsidize the construction of broadband networks.

Why is this important?  Over the past 25 years, according to the Center for Health Transformation, over 500 rural hospitals have shuttered their facilities.  And, while 25 percent of the U.S. population lives in rural areas, only about one in ten doctors base their practices in sparsely populated areas, creating a serious physician shortage.  For many, it’s an economic hardship to drive a few hundred miles to see a specialist.  Broadband access can bridge those distances and help physicians and rural patients share vital information.

The FCC has a $400 million annual spending cap for rural health care telecommunications programs, but it wasn’t spending all of that money.  So, now it will pay 50 percent of monthly broadband charges for eligible health providers, instead of 25 percent.

It’s not a lot of dollars in the grand scheme of federal outlays, but if it can help bring quality health care closer to those living in America’s wide open spaces, it’s one of our nation’s better investments.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

www.youtube.com/watch?v=btHOhNbwTvI