The elderly account for two million unplanned admissions (68% of total admissions) per annum in the UK and the number is growing.  In some areas of the country each 65+ year old spends 4 days per annum as an unplanned admission in a hospital bed.  Care of the elderly, in this regard, costs the NHS £8.3bn per annum. This is a small amount in comparison with the social care costs and the wider personal and economic costs which encompass items like loss of economic productivity due to carer commitments.


Most of the cost arises from issues only emerging when patients present in an acute care setting. The issues associated with overcrowded geriatric wards, lack of capacity in social care beds, problems reintroducing patients back into their own home settings, higher than optimal length of stay and exacerbation of co-morbidities are all well known. Many times patients present with falls and subsequent breaks - this is what the structured record in the Electronic Medical Record (EMR) sees


Managing avoidable admissions

Almost always this is not the cause of the presentation and therefore the admissions are avoidable. The information that allows clinicians, service designers and payers to address this issue does not lie, fully, in the structured EMR data – it lies in Case Notes. Santana Big Data Analytics is a company geared to unlocking the value of these notes and our project with North East London NHS Foundation Trust (NELFT) is an example of our transformative technology in action.


NELFT provides integrated community and mental health services for a diverse population of almost 1.5 million people living in the London Boroughs of Waltham Forest, Redbridge, Barking & Dagenham and Havering. Additionally, the Trust also manages community health services in south-west Essex. NELFT has an annual budget of more than £325 million in 2013/2014. employs around 5,500 staff and is a recognised research leader and innovator, partnering with diverse academic and private-sector leaders to explore new approaches to improving the quality of its services.


High Quality, Succinct Case Notes are Key to Success

As a Community Provider, part of NELFT’s role is to provide services that prevent admissions and allow people to live longer healthier lives by consuming services away from hospitals. Services include those that are designed to be preventative, rehabilitatory and quality of life preserving. Clinicians in NELFT recognize that high quality, succinct case notes are key to the way they operate their services.


Savings are made and benefits are gained, by changing clinical and operational practice. Although there are large volumes of data to be processed using Big Data tools and techniques, this is really a small data problem: what information can be delivered in a consumable format to clinicians to inform care?


Trigger Alerts, Identify Unmet Needs and Prioritize Care

Clinical requirements for information are often expressed in terms of need for integrated care records that go beyond the coded EMR / commissioned care pathway data set and present data in a more timely way to integrated and yet virtual teams. They need to focus quickly on what is important without having the time to “train importance” into their data.


In NELFT there are a number of EMR systems, which contain data that needs to be seen in the context of Social Care data from the local Council and other care providers, including the independent sector and primary care. NELFT have an award winning business intelligence platform which is well used by many staff, however it relies on structured and often coded (thus latent) EMR data. Clinicians like the idea of a single source of clinical and operational truth in a web-based, mobile / private cloud environment, but need it to do more.  They need it to produce alerts, identify unmet need, prioritize care and most importantly have a complete overview of all the organisation knows about the patient.

Extracting Structured Information from Unstructured Text

Enter Santana BDA. Santana Big Data Analytics brings together proven expertise in the fields of business and clinical intelligence, data analytics, big data and natural language processing (NLP). They worked in conjunction with the NELFT Performance Team to address the above issues using NLP, a technique for automatically extracting structured information from unstructured text. It provides a way of generating large amounts of coded clinical data without additional data entry requirements. The potential uses of this data are enormous - case summaries, monitoring performance, critiquing clinical decisions, screening risk, etc. Natural Language Processing also provides a way of readily combining information from different electronic records systems.


Intel Implementation of Cloudera Technology Stack

Intel have been instrumental in this project. Having worked previously with the team that founded Santana BDA in Leeds, Intel were well positioned to provide a wide range of inputs. This ranged from user experience design, big data processing and technology optimization support alongside clinical input to assist the Santana BDA team with hardware provision. Having understood the collective needs of the team of NELFT and Santana BDA staff, Intel worked to implement the Cloudera technology stack which is driving the project.


Ultimately this resulted in the design of an NLP appliance where the technology is optimized for the fast processing of Case Notes and the derivation of clinical meaning through the design and implementation of sets of data classifiers. The classifiers are created using machine learning and recognized, high quality clinical research.


The Santana Big Data Analytics engine is architected to run in a secure cloud or server cluster running on premise or externally. The initial implementation of Santana NLP engine used SQL Server technology to process the data. This worked well at NELFT for processing batches of 100,000 patient records. To create a solution that can process larger volumes of historical data, the Santana team are working with Cloudera to utilise the power of Apache Hadoop.


They have implemented the NLP engine as a scalable appliance running on Cloudera Distribution for Apache Hadoop (CDH) Enterprise. Both implementations run on scalable infrastructure powered by Intel® Xeon® processors.


A Flexible, Affordable and Scalable Platform for Analyzing Unstructured Data

Apache Hadoop is an open-source software framework that allows massive data sets to be distributed and processed across clusters of computers. Hadoop offers a flexible, affordable, and scalable platform for analyzing unstructured data, as well as for other analytics scenarios where the velocity, volume, and variety of data make them impractical for traditional databases. Cloudera CDH provides enterprise capabilities for Apache Hadoop processing along with system management capabilities that make it well-suited to deployment in healthcare and other enterprise environments.


Reducing the Complexities of Existing Infrastructure

The close collaboration among NELFT, Santana, and Intel, coupled with Santana’s methods and tools, meant that the appliance could be installed quickly in the NELFT infrastructure. Within a few weeks the team had gathered the data and the Santana engine on the Cloudera and Intel appliance churned through records in seconds that would have previously taken months of labour to read and analyse manually.


The use of modern Big Data technologies, if architected well, can reduce many of the complexities with existing infrastructures and with the use of NLP can provide information to a clinical or operational organisation with a forward looking approach and can augment Business Intelligence (BI) systems that apply a rearward looking dashboard system currently in use today.


Today’s world is mobile by default. Everyone is connected. Everyone expects to have information at their fingertips. Everyone expects to have understanding and meaning immediately available to them. That’s why I think the term “mHealth” is redundant.


If we are going to define a term, then that implies that there is something on the other side of that term. What’s the opposite of mHealth? Is it stationary health? Or siloed health?


Five years ago, when smartphones and mobile devices were first coming on the scene, mHealth was an appropriate description. We were still defining what it meant to be truly connected. We underappreciate how radical the transformation has been in a very short period of time. In about seven years, these mobile devices have completely changed our expectations. They have changed the way my children interact with technology.


Mobile, to me, is not a product. It’s not a category. Mobile is an experience that could be better defined by terms like available, accessible, convenient, engaging, informative and even entertaining. When I think of mobile, I immediately think that I can get my needs met. When it comes to healthcare, mobile technology is a means to provide patient care. In my book, that’s just called healthcare.


So, it’s time to rebrand the term “mHealth.” My vote is for “connected health” because everything is connected right now. We saw this at the most recent HIMSS Conference, where connected devices are connecting caregivers in different settings. That’s what connected care is all about.


What do you think? Is mHealth redundant today?

Dr. William Hahn is a professor of medicine at Harvard Medical School and chief of the Division of Molecular and Cellular Oncology at the Dana-Farber Cancer Institute. We recently sat down with him to discuss bio data, genomic sequencing, and where he sees advances in technology impacting clinical practice.


Intel: How has bio data research changed in the last five years? How do you envision it progressing in the next five years?


Hahn: The medical industry has been slow to think about data. When you consider the rest of the world, you see that people take their access to data for granted. In the last five years, there’s been a realization that medicine is going to change fundamentally in both the amount of data we’re going to create for each patient and how we’re going to handle that data and protect it. In five years, I can imagine that we’re going to have a tremendous amount of data and information on each patient. We need to think deeply about how to protect this data in a way that allows access to the patient’s healthcare team, but prevents any security breaches. 



Intel: How are you seeing technology lead progress in your practice and your research?


Hahn: Healthcare technology is changing at an incredibly rapid rate. Just as in the home, everything from the toaster to the car has a computer chip. So does everything today in the hospital. As healthcare professionals, our ability to monitor, access, and track information has dramatically changed. In my clinic, the speed of information is very important. Right now, it’s significantly more expensive to access information in a quicker fashion. For example, we have created a panel for sequencing leukemia samples that can be done in three days rather than three weeks, but at a much higher rate.


Intel: Is there any disadvantage to data access?


Hahn: Patients increasingly have general information about diseases as well as specific information about their own health at their fingertips, which is very good. While transparency is an important component, it’s also created a situation where people are more confused than ever because the information is complex and occasionally wrong. There are scenarios where we simply don’t have an answer and it’s more difficult for patients to realize that their physician is going to make decisions based on the best available information in the absence of good data.


Intel: What should clinicians be discussing with their patients?


Hahn: First, we need everyone to have their genomes sequenced. Genome sequencing is important because it’s the blueprint that makes you who you are, makes you the same as some in your family, and different from your neighbors and coworkers. Without being able to specify your genome sequence, we’ll never be able to understand all of these questions about what makes you who you are and also what makes you different than other people. It will certainly give insight to questions that relate to your health and any relevant diseases. My hope is that what’s right for the patient will win the day.


Intel: Intel launched an initiative in 2015 called All in One Day, where the goal is to diagnose a cancer, sequence the genome, and provide a care plan to a patient in 24 hours. What are your thoughts on this? 


Hahn: The diagnosis of cancer for a patient and their family is often one that elicits anxiety, fear, and anger. One of the things we can do as physicians is to reassure patients and their families that we are going to take care of the problem. The All in One Day initiative would provide information about the molecular basis of a patient’s cancer within a very short period of time and help physicians to have a clear and specific path for treatment. The ability to give reassurance that this is not an unknown, there is a path forward, and that your physician and care team are informed is going to be tremendously helpful for patients.

As expected, HIMSS 2016 in Las Vegas was a constant buzz of activity. From the opening keynotes to the exhibit floor to Peyton Manning giving his final speech before announcing his retirement, HIMSS brought the world of healthcare technology together for discussions around moving implementation forward with the ultimate goal of improving patient care.


Our ears were open when attendees came by the Intel booth wanting to talk about some of the trends we are seeing, such as how the patient, and their user generated data, plays into healthcare going forward, precision medicine and personalized treatment plans, and the devices (mobile and wearables) that will drive the volume of data coming our way. booth2.jpg


During the event, we had the opportunity to speak with a number of CMIOs and physicians about their views of healthcare technology. The one thing they all mentioned in common was the rise in patient engagement and how consumers will be owning their own health in the coming months and years. This was perhaps the most shared trend we observed at HIMSS and something that chief information officers are preparing for as they consider the next generation of their health IT infrastructure. This movement will drive more technology adoption on both sides (consumer and clinician) so the need for interoperability and security, in my view, is at an all-time high.


If you were unable to attend HIMSS, or didn’t quite make it to all of the booths at the exhibition, here’s a little glimpse of what Intel was focusing on in our space:


Precision Medicine: Illumina* was on hand and demonstrated its Intel-based, FDA cleared MiSeqDx System*, showcasing how the industry is moving toward clinical genomics. This is especially important as the pace of diagnosing and formulating care plans around cancer accelerates.


Healthcare IT and Devices: Attendees toured a patient and provider experience of the future utilizing Intel® Unite™ collaboration software and Intel® RealSense™ Technology. Booz Allen Hamilton* demonstrated its CareMap* solution enabling patients to input and monitor progress toward their rehabilitation and recovery plan, share this progress with their physician, and communicate with their physician.


Another big topic on the show floor was that as the industry evolves, healthcare is no longer confined to the hospital. Patients now have the ability to monitor their progress with remote patient monitoring (RPM) solutions, and physicians can stay connected to patients, wherever they may be. Our booth partners InterSystems* and Care Innovations* were displaying their innovative solutions in this arena.


Consumer Health: Consumers are generating massive amount of data from wearable devices like the Basis Peak* fitness and sleep tracker. Intel technology is enabling the aggregation and analysis of this data to generate insights for better healthcare management with Intel Health Services Gateway and the Trusted Analytics Platform. See how Oregon Health & Science University* leveraged this technology to help cardiologists analyze Big Data in a next-generation clinical study that merges 24x7 lifestyle data with wearable devices, and clinical records.


Finally, the international flavor at HIMSS continues to grow, showing that healthcare is not limited to a specific country. We met with large contingents from Europe, Asia and Latin America who are looking at healthcare technology as a way to improve care and decrease costs. At the end of the day, that is the real value of HIMSS: the opportunity to collaborate and together improve solutions.


Thank you to everyone who stopped by to visit. It was a terrific week and we are already excited for HIMSS 2017.


What did you find most valuable at HIMSS this year? Did you learn something new that surprised you?



* Other names and brands may be claimed as the property of others.

Discussions of genome sequencing often focus on human genomes and precision medicine. But genomic information about the plant and animal worlds is equally crucial. On a fragile planet, our ability to study genomes across the tree of life is critical to preserving biodiversity. Knowledge of plant and animal genomes can also help us manage climate change, feed a growing population, and mitigate the impact of newly emergent diseases. It can lead to breakthroughs in drug discovery, food safety, and more.


Reflecting the importance of plant and animal genomics, the Smithsonian Institution has established a new Institute for Biodiversity Genomics to focus on genomic studies that can help humans understand and preserve the diversity of life on earth.


To run their genomic assemblies and analysis, the institute’s researchers used the Smithsonian Institution’s shared HPC cluster, a massive system with multiple generations of processors and networked storage. But, as is often the case with such systems, there were problems. Genome assemblies often took weeks to complete. Some large assemblies failed to run to completion, causing frustration for scientists and slowing the research pipeline.


With the clock ticking on species extinction, leaders at the Smithsonian Institute for Biodiversity Genomics set out to see what impact Intel’s latest data center technologies could provide for their genomics workloads. They worked with Intel technologists to evaluate the performance of the Intel® Xeon® processor E7-8890 v3 using dedicated Intel® Solid-State Drive (Intel® SSD) Data Center (DC) Family for PCIe P3700 series.


We recently worked with Dr. Rebecca Dikow of the Smithsonian Institute for Biodiversity Genomics to create a white paper describing the results of this collaboration. This paper discusses the open-source technologies used in the institute’s genomics workflows, and describes the dramatic speedups produced by the new technologies. It also shares insights about what these performance improvements will mean for scientists like Dr. Dikow—and ultimately for all of us.


Read the paper and share your observations in the comments. How is your work affected by plant and animal genomics? How could your work benefit from newer processors and dedicated SSDs?


Learn more about big data in healthcare


Read about the Smithsonian Institute for Biodiversity Genomics


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  • @IntelHealth, @portlandketan
  • @smithsonian, @rdikow

Telehealth Will Evolve

Posted by JohnSotosMD Mar 8, 2016

When I think of telehealth, I think of the conventional telephone. In that light, physicians have been doing telehealth for many decades and, during this time, have gradually figured out which clinical problems are amenable to a telephone consultation and which are not. The same thing is going to happen with the new generations of “telephones,” if you will, which have video capability and built-in sensors.


Consulting a physician via a device will never wholly replace the in-person examination, however, after a time, the acceptable use-cases for telehealth consultations will solidify into a conventional standard of practice, just as the profession saw with the telephone.


But there is one important difference between telephone technology and today’s mobile technology: Before smartphones arrived, telephone technology was relatively static – it exchanged voices in an intelligible manner, no more, no less. Today, however, smartphones have become *platforms* permitting the exchange of voice, video, sensor data, and who-knows-what in the future. As a result, physician-patient telecommunication capabilities will continue to evolve, and the profession will constantly have to adapt to a moving target.


As with any new medical technology, reimbursement will be an issue.  Generally, telephone consultations have not been reimbursed.  With telehealth, we’re already seeing a change – a CPT code for telehealth services now exists. Although it is applicable only under narrow circumstances, we should expect evolution here, too, especially to the extent telehealth proves to deliver better outcomes at lower cost.


We have to be careful with telehealth reimbursement, however, because it could absolutely reformulate clinical care. No one doubts that a long-term personal relationship with a primary care physician is a good thing. It would be very easy for poorly constructed telehealth reimbursement policies to destroy the last vestiges of such relationships in today’s medical system. My personal opinion is that we should not reimburse physicians for telehealth consultations unless there has previously been an in-person consultation.  This is sensible because, just like the days when conventional telephones ruled the communications landscape, physicians will need to assess whether a particular patient can use telehealth technology successfully and give reliable information. Among the sick and infirm, using modern interactive telehealth technology will be much more problematic than using simple telephone technology.


There is another aspect to technology adaptation. For the younger generation of physicians just starting their careers, an important lesson is: do not accept today’s status quo as the ultimate good. Medicine is a very old profession that has always made great demands on technology, evolving workflows and information-handling procedures over thousands of years.  Workflows based on papyrus technology became incredibly well optimized, but were largely destroyed by the imposition of electronic technology that did not enable a similar degree of optimization. The profession is adapting to new technologies, but we’re far from optimized now.


So, if you are coming into the medical profession, do not be satisfied with the systems that are put in front of you. If you think of a way such systems can be improved, say something to the people who can make changes, or, better yet, help the profession by working yourself to make the changes happen.

Connected care is a rapidly growing and important new trend in healthcare delivery. This broad term encompasses a variety of care models – from the use of smart devices to collect data, to mobile solutions that provide point-of-care access to data, and even integration between care providers across the continuum of care.


Augmenting traditional care delivery pathways with connected care programs is not without challenges. As this model continues to grow, so does the amount of data generated, and the number of devices used to collect and transmit that data. This presents new challenges to scaling existing IT infrastructure and securing patient data – millions of smart devices create millions of new attack vectors for hackers and cyber criminals. Along with these challenges, sifting through large composite data feeds to find meaningful insights becomes more complex and requires increasingly sophisticated analytic capabilities which organizations may not have readily available. Intel is addressing many of these challenges with innovative new technologies and industry-wide programs to enable new wearable sensor platforms, empower big data analytics, and secure patient data.


Intel continues to develop the wearable device ecosystem through investment and innovation. Over the past several years, Intel has completed significant market transactions with the acquisitions of Basis and Recon Instruments as well as making venture investments in 18 wearables companies through Intel Capital. Smart devices like Basis are currently being used by health systems and payers to better manage population health as early examples of how these devices can improve healthcare. Perhaps Intel’s greatest contributions to the wearable device space, and connected care, will be the Intel Curie™ System on a Chip (SoC) platform. Already this technology has been used in a variety of exciting applications from powering analytics for extreme athletes in the X-Games, to bio-sensing clothing, and smart safety devices for children. It will be exciting to see how future innovators are able to apply this technology to develop new solutions and disruptive business models within the health ecosystem.


While new wearable devices are an important precursor for connected care, much of the value that will be derived from these new models comes from the analytics performed on data generated by these devices. The Intel Trusted Analytics Platform (TAP) is a comprehensive analytics platform developed for just this task. It integrates leading edge technologies for the ingestion, storage, and analysis of large data sets. The TAP platform has been open sourced and has already been successfully used by Penn Medicine to improve early detection of patients with critical conditions.


Finally, organizations looking to implement connected care programs must understand that these new data streams are potential targets for cyber criminals. To help health and life science organizations understand their risk of a data breach, Intel has developed a Healthcare Breach Assessment Program. The cornerstone of this program is a three-stage breach maturity model that encompasses forty key elements considered either baseline, enhanced, or advanced. This model helps health and life science organizations identify possible vulnerabilities and appropriate remediation activities. The program also includes peer and industry comparisons to help organizations on a quarterly basis, a useful tool for IT leadership when considering where to make future investments in security capabilities. Requiring only a 1-2 hour initial phone assessment, the program maps to best in class products and services today across a spectrum of solution providers and provides ongoing quarterly reporting.


What questions about connected care do you have?

This week at HIMSS16 in Las Vegas, the Intel Health & Life Science team displays many new and exciting ways to make health more personal through technology. In the booth, we will share the You 24x7 Cardiovascular Wellness Study – a Big Data approach to clinical research.


What’s unique about the You 24x7 Cardiovascular Wellness Study is researchers are using a big data analytics platform to bring together a wide range of data – from daily life plus clinical data – to get a more complete picture of the participants’ wellness. Hundreds of volunteers wore an activity tracker 24x7 for six-months and contributed their EHR, clinical lab reports and remote patient monitoring data, including weight and blood pressure, for a team of cardiologists and sleep experts to analyze at Oregon Health & Science University (OHSU).


Find out more: OHSU Wearables Big Data Analytics Paper


Study Details:

A Basis Peak watch provided minute-by-minute data on activities, sleep stages, pulse, calorie burn, perspiration and skin temperature. Participants told the investigators that having their own dashboard to view their information — on the watch itself, on a smart phone app, as well as in a web browser — helped them understand their lifestyle choices, quantifying their sleep quality and exercise levels, for example.


Some of the participants also had weight scales and blood pressure monitors in their home. Every time they take a reading, the data streams wirelessly to an Intel-powered remote patient monitoring gateway, and the gateway uses the 3G network to send the information securely to a cloud environment.


The Basis Peak watch, scale, blood pressure cuff, clinical data and EHR all contributed to a robust data set and this is definitely Big Data — a half-billion data points over the course of the trial.


Exploring expanded data sets:

A team of cardiologists, sleep experts and biostatisticians at the OHSU Knight Cardiovascular Institute are now drilling into all that 24x7 data using the Trusted Analytics Platform to explore associations between daily life and clinical findings.


It’s a new, big data approach to discovery, taking advantage of wearable devices, home monitoring devices and gateways, and a Big Data analytics platform. It allows scientists to shed light into blind spots like sleep quality to test associations and patterns in data never before available. We think information about the actual daily lives of patients is an untapped resource for a wide range of healthcare stakeholders, including patients themselves.

Although the 2016 HIMSS Annual Conference and Exhibition next week is coming to Las Vegas just a month or so after the Consumer Electronics Show, no one would ever mistake the two.


While HIMSS16 is likely to break its own attendance record of 43,129 set last year in Chicago, CES is in a class of its own, with more than 170,000 attendees.


CES is all about the gadgets (some gadgets, of course, being 88-inch 4K televisions or electronic cars) that technology-obsessed consumers swoon over, while the HIMSS annual conference will continue to emphasize infrastructure, policy and education for healthcare IT professionals – it’s bread-and-butter for the past quarter century. Picture1.jpg


That being said, HIMSS16 reflects the organization’s growing embrace of the roles consumerism and gadgetry are now playing in the health IT ecosystem. Sessions like “Empowering Clinicians with Smartphone Technology” and “The Internet of Healthcare Things” recognize that it’s not all about the EHR anymore. And the lunch and learn session “Holograms, Wearables and Future Technology: How Trends in Technology are Changing the Face of Patient Care” gets my vote for the most promising session at the show based on its title. I mean, holograms!


Writing over at Healthcare IT News, Penn Medicine chief information officer Mike Restuccia listed “wearables” as one of his top three things to seek out at the show. He says, “Penn Medicine successfully completed a pilot study to monitor the blood pressure of 20 postpartum women over a high risk period of time. Key components of the pilot study were a wireless Bluetooth blood pressure cuff, smartphonoe and the integration with our Epic electronic medical record. Ill be on the lookout to see what other healthcare and vendor organizations are doing in the space of wearables and remote monitoring.”


Interoperability on FHIR


I’ll also be interested to see how much attention the new HL7 Fast Healthcare Interoperability Resources (FHIR) standards framework generates. Last year, FHIR generated a lot of buzz on the strength of a couple of demonstrations and breakfast talk. This year, there are a half-dozen sessions devoted to the emerging framework, such as ‘Innovation on FHIR: Clinical Application Development using the Evolving Standard."


I did some interviews on FHIR for an upcoming research piece and I can see why developers, especially those from Silicon Valley’s start-ups, are excited. FHIR leverages standard web-based API technologies to improve interoperability — moving healthcare away from a “document” exchange model to a more granular object-level exchange.


If and when FHIR achieves maturity and broad acceptance, it will open up the often insular and complex world of health IT vendors to thousands of developers of new, interoperable apps and consumer devices.


(What I really need now is a session where an expert convinces me why we should pronounce the FHIR acronym like “fire.” I don’t get it.)


Criminal Intent


Finally, the conference continues the organization’s emphasis on security. A key topic at past shows, there are 28 individual sessions dedicated to privacy and security at HIMSS16 and a “Cybersecurity Command Center” on the Exhibit floor.


One thing that I find really fascinating is the shift in language around security topics at HIMSS. In the early days, privacy and security sessions seemed to emphasize more neutral terms like “breaches” and “noncompliance.” But look at the description for Stephen Cobb’s session on managing health IT security risks: “Criminal activity in cyber-space, commonly referred to as cybercrime, can expose personally identifiable information (PII) to unauthorized access and abuse. Some criminals derive substantial income from black market sales of PII. Data thieves have discovered that the electronic patient records held by American healthcare providers and insurers can be a rich source of PII…”


“Cybercrime…” “Black market sales…” “Data thieves…” That’s kind of scary, right? But I don’t think Cobb, who has been researching and writing on these topics for 20 years, is an alarmist. Instead, his terms convey the true severity of the problem.


I think the former language of “breaches” minimized — and attempted to defang — the criminality of hacks and attacks. It was as if hospital executives didn’t want to use stronger imagery and create doubt in their patients’ minds. Or to put it another way, the neutral terms suggested that perhaps providers feared the damage to their organizations’ reputation rather than the actual harm inflicted by the attacks on their patients.


But I digress… Having covered the industry for more than a dozen years now, I sense a greater urgency and relevancy in the topics at the HIMSS Annual Conference. They address both the promises and the problems that health IT faces. Kudos to the organizers and it will be no surprise if the show does, as predicted, break its attendance record yet again.

'All in One Day by 2020' - it's a phrase I hear often here at Intel, and this vision of a single 24 hour period in which a cancer patient’s tumor DNA can be sequenced, to ultimately come up with a better, personalized treatment plan, is a major driving force behind what we do. Doctors and researchers should be enabled to find all the information they need from all the structured and unstructured healthcare data, that will improve patient outcomes, and we want to help them do that quickly.


With that in mind, it's fantastic to bring you news of how Intel and Dell have joined forces to deliver a blueprint architecture for SAP Foundation for Health and SAP Medical Research Insights. SAP Foundation for Health serves as a platform for a number of new applications targeted at personalized medicine and allows the analysis of large amounts of data from disparate sources; and in in real-time using SAP HANA.


The new reference architecture will enable customers across the globe to deploy this solution quickly and with full confidence in its capabilities. Speed is a critical factor in personalized medicine, and with the SAP HANA infrastructure, optimized for Intel® Xeon® Processor E7, it is possible to deliver fast-paced analysis of the mission critical structured and unstructured data.


Much of the commentary around big data analytics in healthcare seems to focus on what might be possible, at some time in the future. The joint efforts of Intel, Dell and SAP in building this software-hardware blueprint shows that it is possible to deliver real value to researchers and clinicians today, in an easy and uniform manner. Delivering value to researchers and clinicians means that jointly we will deliver maximum benefit to patients, and impact the quality of life.


To learn more about how Intel and Dell are working together in the field of health and life sciences I highly recommend watching this Translational Genomics Research Institute (TGen) video, which highlights how high performance computing is helping doctors and researchers better understand data to treat and prevent diseases.


We want to continue this conversation with you at HIMSS16 (Feb 29 – Mar 4, Las Vegas) where we will be happy to discuss Intel, Dell and SAP’s work in personalized medicine in more detail; all three companies have booths on site. To meet with Intel, contact me below to arrange a suitable day and time to meet. I look forward to seeing you.




When we look back on 2016, my hope is that the year will be a milestone in the progress toward patients owning their health. Over the years, technology has allowed consumers to own their banking, travel arrangements and cable television subscriptions. Now, it’s healthcare’s turn. Healthcare technology such as wearable devices and electronic health records (EHRs) is, for the first time, putting the patient in the driver’s seat to take control of their physical care.


Own Your Health will be a rallying cry in 2016 that works on several levels:

At the patient level, Own Your Health means understanding one’s physical well-being and taking steps to improve it. This can be done with information – doctor visit summaries, medications, medical imaging, diagnosis codes, clinical notes and laboratory results — that is available today through a wide range of wearable devices, smartphones, and sensors. These technologies enable a deeper level of participation in one’s health, and a much richer set of data so that patients understand that what they do affects their bodies.


At a broader level, owning your health contributes to insights and discoveries in populations of people. In 2016, Intel will be reporting on a clinical trial in which people volunteered to let research scientists analyze their deidentified biometric data from the Basis Peak fitness tracker combined with data captured in clinics, laboratories and in homes. I mention this example because it reflects a clear industry trend toward using consumer-grade wearables in population health, wellness monitoring and drug discovery efforts. Intel’s work with the Michael J. Fox Foundation using wearables to measure tremor events in Parkinson’s patients is another great example, enabling analysis of how various types of patients respond to specific doses of medication.


For the fast-growing consumer healthcare marketplace, Own Your Health will be a call-to-action. Intel is working with a wide variety of partners to develop this ecosystem and break new ground with devices and biosensing, data interoperability and integration, affordable and scalable storage, and predictive analytics, all delivered with an acceptable level of security and trust. Our goal is to make consumer health analytics easier on Intel® architecture.

Overall, Own Your Health is about gaining value from biometric information that has been untapped for too long. And it is based on the power of individuals to learn about and improve their health, and contribute to the well-being of others at the same time.

Where do you see consumer health technology heading this year?

Observations from 2015 Travel

In 2015, I had the opportunity to visit more than 10 countries, including Japan, Mexico, the United Kingdom, Brazil, Germany, and China. After meeting with numerous healthcare leaders and government officials, a recurring theme emerged regardless of location: how can countries and healthcare systems best care for aging populations? How can coordination among providers be improved to better provide care to the elderly, and in particular serve the needs of patients who have multiple complex chronic conditions? And how can better outcomes be achieved for such patients especially with ever tightening healthcare budgets?


Increasing investment and interest in Telemedicine and Remote Monitoring as a solution to these pressing healthcare challenges

A universal sentiment I observed is enthusiasm toward telemedicine and remote monitoring technologies as a potential solution for addressing these challenges. Government and healthcare leaders in the countries I visited are hopeful that these tools will enable patients, caregivers, and providers to work together in a more effective manner to better manage chronic disease, and in turn improve health outcomes at lower costs. Forecasts suggest the international market for telemedicine will grow from $14 billion in 2015 to $34 billion in 2020.


Telemedicine and Remote Patient Monitoring: Why now?

Telemedicine and remote monitoring are not new concepts. They have long been touted as having potential to transform healthcare for the better, and peer reviewed literature increasingly supports this view (e.g., increased patient satisfaction, improved health outcomes). For a number of reasons, though, the implementation and use of telehealth has yet to fully reach its potential. Policies are often vague or confusing, and reimbursement is still lacking for many telemedicine services. This was generally the case in every country I visited, and in the United States. However, there is reason to believe this market will soon expand rapidly. Several forces, including consumer demand, advancements in technology and data security, growth in private companies entering this field, and changes in regulatory and reimbursement policies that support the use of telemedicine, are converging in such a way that will increasingly bring these services into routine care.


Variations across countries: Use cases, policies, and opportunities for growth

Here, and in a series of blogs to follow, I will highlight how the countries I visited this past year are using telemedicine and remote monitoring tools, the country-specific regulatory and reimbursement policies that affect the use of telehealth, and how Intel Health & Life Sciences is working with partners in these countries to promote the use of this technology.


Observations from Japan

During two trips to Japan this past year, discussions about telehealth technology were of top priority. Japan is in an ideal position to use telemedicine and remote monitoring for two reasons: 1) it has the technological infrastructure and sophistication to support and rapidly implement it, and 2) more than 20% of Japan’s population is over the age of 65, and this percentage is expected to rapidly increase. In providing home care for this population, telemedicine and remote monitoring capabilities will be increasingly important.


Policy Roadblocks

Japan is hardly an outlier in having policies that hinder the implementation, use, and reimbursement of telemedicine. The American Chamber of Commerce in Japan (ACCJ) and the European Business Council in Japan (EBC) have recommended amending the Medical Practitioners Act to clarify who is allowed to implement and practice telemedicine. Additionally, while some services are reimbursable (e.g., tele-radiology and tele-pathology), many other services such as disease management and patient education are not. Thus, while the technology exists to make this care a reality, policies have not always kept pace to allow it to happen.


Use cases in Japan

Policy and reimbursement challenges notwithstanding, Japan has made impressive progress in how it effectively uses this technology for patient care. For example, KOHOEN is a social welfare organization in Japan. One of its primary missions is to improve and provide community-level care, and to promote team-based care among doctors, nurses, pharmacists, and care managers. It equips care teams and patients with remote care tools, which in turn help older individuals live at home and maintain independence. One tool KOHOEN uses is a tablet solution (an Intel atom processer powered android-based ASUS fonepad) for a 24-hour visiting nurse and attendant service. The care team members use these tablets and a cloud-based information sharing system to share information with one another. The flexibility and security of this tool allows for real-time data input and transmission, which enables physicians to provide medical advice while the nurse is at the home of a patient.


Sharing best practices and learnings across countries

As countries around the world continue to integrate these types of technologies into their care delivery systems, sharing best practices will be important and valuable as other countries invest in similar tools. Policies, too, must continue to evolve to keep pace with these technological advancements for the benefits to be fully realized. Intel will continue to work with policy makers abroad and in the U.S. to encourage such progress.


With all of the media hype around breaches, and pressure from your stakeholders to avoid being the  next headline, it is easy to focus too much on one or another type of breach, perhaps the one that caused the latest headline. This risks missing many other common types of breaches, and being blindsided by a breach you did not anticipate, and therefore are unprepared for. In this blog, I look at six of the most common types of data security breaches in health and life sciences organizations. iStock_000054104746_Large.jpg


1. Cybercrime Hacking: In this type of breach, an external hacker accesses your organizations network and obtains unauthorized access to sensitive patient information. A common example of this type of breach starts with the hacker spear-phishing a worker in your organization, resulting in that worker clicking on a malicious link, and leading to drive-by download of malware. The malware then proliferates inside your intranet and key-logs the database administrator database credentials, at which point it turns into a bot that logs into your database containing sensitive patient data and exfiltrates this data "low and slow" to evade detection.


2. Loss or Theft of Mobile Device or Media: In this type of breach, a worker either loses or has stolen a mobile device or media containing sensitive patient data, resulting in potential unauthorized access to that data and a breach.


3. Insider Accidents or Workarounds: In this type of breach, a worker performs a well-intentioned action that results in unauthorized access to sensitive patient information. A common example of this type of breach involves a worker emailing unsecured sensitive patient information, resulting in potential unauthorized access to this information, and a breach. This type of breach can involve the use of either corporate or BYOD devices by workers.


4. Business Associates: In this type of breach, a third party organization contracted by your organization experiences a breach event involving unauthorized access to sensitive patient information. In this case the patient information impacted originates from your organization and was previously shared for the purpose of the third party organization fulfilling its contractual obligations. In the United States these entities are known as Business Associates, while in Europe they are typically referred to as Data Processors.


5. Malicious Insiders or Fraud: In this type of breach, a worker performs a malicious action that results in unauthorized access to sensitive patient information. This could be a disgruntled worker, or done for the purpose of committing fraud. A common example of this type of this breach involves medical claims fraud where a worker files dishonest healthcare claims in order to turn a profit, or sells sensitive patient information on the black market. Prescription fraud and financial fraud are other examples of this type of breach.


6. Insider Snooping: Insider snooping involves a worker accessing the records of patients of your organization without any legitimate need to do so, for example where a patient is not under the direct care of the worker.


Only by understanding all the types of breaches your organization is at risk of and how to defend against these can you achieve effective security and adequately mitigate your risk of breaches.


What other kinds of breaches are you considering to protect your health and life sciences organization from breaches?

By Douglas L. Wood, MD, Mayo Clinic


Wearables and the data they generate are often thought of as great solutions for health and healthcare. While the benefits of these new devices and the information they provide are many, there are some challenges that we had not anticipated with so much data flowing to physicians.


At Mayo Clinic, we have started performing experiments with patients who wear these devices. What we’ve learned is that the precise data that is generated is helpful; however, the behavioral changes we are able to recommend to patients based on the data is where true value will be recognized. The patients know we are partnering with them and that’s powerful.


Many patients who come to our facility expect us to talk with them in detail about what they are seeing in their own data. If we don’t, it undermines our credibility in the visit, in their eyes. One of our patients likened this situation to being stopped by a police officer for speeding. If you knew you were speeding and the officer talked to you about something else, you would think that was odd. That’s the current state with wearables and healthcare.


We have come to the conclusion that information, or data, is cheap. What’s priceless is the context and relevance of that data. For us, the value of data is being able to take the information and distill it into contextual frameworks that have meaning for physicians and nurses and for patients who are trying to find ways to live better.


Interestingly, when we’ve studied people with diabetes and other chronic conditions, we’ve learned that the clinical data is not that important. What is important is that these patients do not want to be considered a diabetic or labeled as some kind of condition. They want to be a person. Herein lies a challenge with big data: it makes it very easy for clinicians to apply labels to people, and that’s not going to help anyone. We have to think about this data differently.


Finally, we’ve begun to see a tremendous opportunity for physicians and nurses to use wearable computing, especially if we could link to cognitive computing to help us do our daily work and make that work more meaningful and less cluttered with some of the regulatory requirements that we have now. If clinicians had access to this type of technology, we could free ourselves from some of the very restrictive documentation and other process measures that are based on rules that were written 20 years ago, when the records were still largely paper.


Think about it: Having electronic records that are populated with real data and video would mean we would not need to rely on recreating a 20-year-old paper record. It’s time we break out of this old way of thinking and devise a new way of delivering care, namely letting actions stand on their own with the capacities of modern technology to record and advance them.


What do you think is the most valuable aspect of wearable technology?




Douglas L. Wood, MD, is the medical director at the Center for Innovation at Mayo Clinic and a practicing cardiologist.

January launched 2016 with as much velocity as any year that I recall but as I look out to how healthcare will shift this year (and probably next), what jumps to mind is an overall comfort that almost every aspect of healthcare is undergoing rapid change (or some say evolution). This is the new normal and I see it in communities all across our country.


I also must admit that our personal thoughts and ideas are largely shaped by our circle of peers and influencers so I personally work hard to keep a foot in multiple healthcare markets to understand how the majority of our communities are shifting. Here are a few consistent themes I see emerging over the next 12-18 months:


Provider expansion of services and strategies

By this I mean, whether in the city of Atlanta, Boston or San Francisco, or the rural communities of South Carolina, Texas or Massachusetts, I see and work with health systems and physician practices that are expanding services, partnerships and expanding “consumer” access. The motivations behind these expansions are diverse, but everyone is experiencing a shift in how healthcare is being consumed, where it’s being consumed and when it’s being consumed. I am also seeing a stronger focus on efficiency, but not enough yet, in my opinion. All organizations need to strategically and wisely better align their processes and operations with their revenue drivers for today as well as their revenue drivers for tomorrow.


Focus on the patient and better respecting that the patient is a “consumer”

Physician practices, clinics and health systems of all sizes are working to make conducting business with their organization easier. In that I mean align or re-align processes, services and innovation to ensure that patients can easily access scheduling, appointments and certainly, payments. While this sounds like an “of course!” statement, most, even leading health systems, don’t properly align these aspects of their organization and operation, thus leaving millions of dollars on the table. For example, ensure your organization offers simple ways to schedule an appointment. Ensure that you are researching - or better yet deploying - “community-based” strategies that offer care where the patient/consumer wants to consume care. Sometimes the best place may be inside the four walls of your organization, but sometimes it may not be. A few proven strategies here include new care settings that are convenient for your community and even a virtual care or telehealth strategy. These can offer new revenue streams and allow practices, clinics and health systems of all sizes to deploy strategies that will allow them to evolve alongside a healthcare system that is embracing value-based medicine, bundled payments and alternative payment models.


Other consumer-focused strategies that I see growing quickly are patient navigation and wayfinding to simply and profitably enhance the patient experience (and as we know from research flooding the market, consumers are paying premiums for “experience,” and as our economy shifts, everyone needs to keep an eye on this because you can offer a terrific experience and actually save money by better embracing innovation.


The other area that I see exploding for practices, clinics and health systems is around “compassionate collections” and a strong, focused strategy on the patient revenue cycle. Many innovations are hitting this from different angles, but as patients continue to pay for more of their healthcare “tab,” efficiently and effectively managing this process is key to protecting and increasing your organization’s bottom line.


Use of innovation to navigate the future of healthcare

I see innovation being deployed at every level of service, process and technology. To start, many organizations are focusing on better managing their overall “revenue cycle”. This is best deployed through a technology-enabled service whereas a specific market expertise leverages software automation, “rules” intelligence and robust clinical, financial and administrative reporting. Not only is this important today to optimize an organization’s overall financial health, but it is going to become vital to everyone’s success and preservation as healthcare quickly shifts to new payment and care delivery models, outcomes and quality-based payments and razor thin margins on traditional payment models. This experience and expertise will be worth its weight in gold…


Interoperability is still a large focus for many. Certainly more in the urban areas than rural, but I do see the rural communities picking up interoperability steam to drive care coordination, protect or enlarge their patient base as well as to participate in new payment and care delivery models. We’ve been talking about standards and interoperability for a long time now but the conversation has shifted in many communities to actionable intelligence on how interoperability is fueling coordinated and higher quality care.


We’ll see much faster progress with “connected care” that is driving innovative care and increasing care access in every community. Advancements across the board with telehealth and virtual care as laws mature and payment & reimbursement structures are solidified.


I also see pop health & quality reporting finally begin to receive the respect that it deserves. With many progressive organizations today, it is driving their financial and strategic bottom line. Those organizations are well-positioned to successfully navigate the future of healthcare no matter what, since managing structured data, clinical quality measures (CQMs) and robust reporting will be essential to all sustainable payment structures in the very near future.


I would be remiss not to mention the importance of data security for 2016 and beyond. While it may not feel as exciting and opportunistic as implementing cool innovations popping around consumerism, mobility and population health, having a strong data and platform security strategy and implementation will be essential to protect your information, integrity, brand and bottom line…


As I wrap up these thoughts, I realize that even after 20 years in healthcare and health IT, I just love this industry and all of the opportunity it serves each of us to help create the smartest and most sustainable healthcare system in the world.

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