As HIMSS14 approaches, we are rolling out a pre-show guest blog series from health IT industry experts on trends you can expect to hear about at the event. Below is a guest contribution from Alan Portela, chief executive officer at AirStrip.


The demand for patient-centric tools to mobilize EMR and medical device data in a single viewer is obvious. Many major providers have either begun to go mobile or have a plan ready to do so, but it’s important to implement practical elements in the strategy to make it successful.


The best way to go mobile is to support all form factors. In parallel with mHealth implementation, providers should bring the look and feel (i.e. touchscreens) of mobile technologies to physicians’ desktops and laptops. After all, that’s what they are still primarily using when they are not on the go.


Compatibility with any mobile device is critical for a mobile strategy, especially given the bring-your-own-device (BYOD) demand we’re seeing from physicians. But what a lot of technology vendors are forgetting is that the same experience needs to occur on desktops and laptops. As physicians become accustomed to mobile capabilities that seamlessly aggregate clinically-relevant systems into one single view, they need to have the same interaction on their desktops. They shouldn’t have to face frustrations when logging in on their computers or learn to navigate different applications across desktops and devices.


Achieving the full value of mobility requires that physicians have one unique, seamless view of data no matter where they are – which means making sure they have an extended version of that same view on their computer screens.


In the not-too-distant-future, physicians will be viewing data from any source in a single format, just like they would on their mobile device. They’ll be using a touchscreen desktop at home, in the office, by the bedside or on large, sharable screens as they discuss cases with the care coordination team. One dashboard will show medical device data in near real-time and fully-integrated EMR data with video conference capabilities – and all the other values offered by mobility will be present.


The availability of mobile capabilities on the desktop is going to drive sales of mobile applications, but more importantly, it’s going to enhance mobile utilization. The more applications become seamless, the more physicians will get used to utilizing those applications. By increasing adoption of mobility, physicians will provide higher quality, more efficient care and be able to meet the increasing industry demands put on them by the expanding care continuum.


What questions do you have?

Healthcare workers are increasingly empowered with apps, devices, social media, wearables and the Internet of Things. Concurrent with this trend is the widespread adoption of BYOD (Bring Your Own Device) in healthcare, enabling healthcare workers to use personal devices to complete work tasks. These tools enable great improvements in patient care, but also bring new privacy and security risks.


Research shows that when usability is lacking, security too cumbersome, or the IT department too slow or overly restrictive in healthcare organizations, healthcare workers can and do use workarounds, or procedures out of compliance with policy, to complete their work. Examples of workarounds include using personal devices with apps or websites, personal email, USB sticks, texting and so forth. This may be exacerbated where healthcare workers are increasingly under time and cost reduction pressure.


Some of this risk can be mitigated with safeguards such as MDM (Mobile Device Management) and DLP (Data Loss Prevention). In a sense, these tools are mitigating “black and white” risks where user actions are clearly out of compliance with privacy and security policy, and can detect and prevent incidents such as breaches. However, with many user actions compliance is harder to determine. An example is where a healthcare worker is using a personal BYOD smartphone to post an image to social media. On one hand this could be an image of a patient and represent a clear non-compliance. On the other hand, it may just be a non-sensitive, personal picture the user took last weekend that they are sharing with friends. Another example is an SMS text between healthcare workers that could be a patient update introducing risk, or could be benign and just setting up a lunch date. Many other examples exist of actions users can take that may or may not be in compliance with policy.


In a sense, this is a “grey region” of the healthcare enterprise privacy and security risk spectrum, where compliance really depends on the context, and is difficult to establish technically. Note that in this type of risk the healthcare worker is typically not malicious, and actions that inadvertently add risk are intended to improve patient care. Given technical difficulty in establishing (non)compliance, administrative controls such as policy, training and audit and compliance are often used to mitigate this type of risk.


Unfortunately, training is very often the Achilles' heel in this approach, very limited in effectiveness and typically taking the form of “once a year scroll to the bottom and click accept” that is more of a regulatory compliance checkbox activity than something that empowers healthcare workers with the right knowledge and skills to make better choices that both achieve their goals as well as minimize risk.


Further empowerment of healthcare workers with new apps, devices, wearables and Internet of Things promises great new benefits to patient care, while also exacerbating this growing inadvertent “grey region” of risk. To enable healthcare to embrace new technologies while minimizing privacy and security risk we must find better ways of providing healthcare workers timely training and choices that enable them to navigate hidden potholes of risk associated with new technologies.


What strategies are is your organization using to tackle this challenge?


David Houlding, MSc, CISSP, CIPP is a senior privacy researcher with Intel Labs and a frequent blog contributor.


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As mobile device and app makers focus their attention on improving user experience and workflow issues, healthcare organizations continue to strive for the best mix of technology suitable for the enterprise.


Having spent the past few years deploying apps to smartphones and managing end user demand for the more feature and information rich tablets, health IT professionals are finding there’s a process for choosing the best tablet for their increasingly mobile workforces.


At Louisville, Ky.-based All Children Pediatrics, for example, CIO J. Barron Breathitt tells me his top-two criteria for laptops and tablets are reliability and durability.


The physicians practice group is using Fujitsu T730s and T731s, which typically are outfitted with the fastest i7 processors available to extend the lifespan of the units. Breathitt also has them configured with solid state drives to boost performance and durability.


Since the doctors at All Children Pediatrics require the ability to ink on the screen for signing and noting issues on charts, IT’s approach to selecting mobile devices centers largely around user acceptance and meeting interdepartmental goals--two metrics that fall in line with recent industry guidance.


Recently, J. Gold Associates released a white paper entitled, Picking the Right Enterprise Tablet: Things to Consider. Among the practical steps healthcare organizations can take to match tablet choice with end user and corporate requirements, the research recommends adopting the following seven-step approach:


• Create a strategic vision. In other words, think proactively, not reactively.

• Look beyond the device. Better to focus on the solution.

• Define requirements. Start by determining your specific goals.

• Build an app portfolio.

• User acceptance is critical.

• Support users while planning for obsolesence.

• Determining technology/infrastructure requirements.


If you haven’t read it yet, I recommend checking it out here.


Tablets offer many advantages to mobile workforces, and the technology’s role in healthcare is clearly established and growing. Formulating a sound tablet strategy, based on analysis, is the best way to support the deployment and utilization of tablets across the healthcare enterprise.


Doing so will enable the technology to achieve its full potential while helping your organization cut costs, satisfy end users, and deliver a higher quality of care.


What questions do you have about tablets in health IT?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent. See his other Intel Healthcare blog posts here.


Nurses are vital to the implementation and adoption of healthcare technology. In the above video conversation, Intel expert Joan Hankin, MSN, RN, sits down with Elizabeth "Betty" T. Jordan, DNSc, RNC, FAAN and Associate Professor University of South Florida College of Nursing, to discuss healthcare technology, how IT impacts patient care, and how generational attitudes shape health IT adoption.


Give a listen and hear what these two nurses have to say about healthcare IT. What questions to you have?

Dr. Andrew Watson is a leader in applying telemedicine and other health information technology to the improvement of patient care. A fourth-generation surgeon who specializes in colorectal and inflammatory bowel disease, he plays a key role in integrating health information technologies, such as telemedicine, mobile applications and voice recognition, into clinical practice across the University of Pittsburgh Medical Center (UPMC).


Dr. Watson is also medical director of the Center for Connected Medicine (CCM). Founded by UPMC and other leading technology and healthcare partners, the CCM promotes a new model of health care that seamlessly integrates information technologies to put patients at the center of care. We recently caught up with Dr. Watson to ask him about the impact of healthcare technology, and specifically about the benefits of mobility for both clinicians and patients.


What does mobility mean to you?


Watson: When I started in medicine, mobility was dragging around a patient or an intern or a resident. But now we’re seeing several forces that have cropped up. Number one is that the providers are more mobile. We were mobile beforehand because we had pagers. Then with electronic health records we had be near a desktop or a wall-based computer. But we’re seeing the providers, nurses and doctors being released into the open air again with mobility. More importantly, the consumer electronics market is making our patients mobile and empowered and this is the force behind mobility. From my perspective, we’re seeing the uncoupling of healthcare from the urban environment and taking it back to the patients where it started and it’s very exciting.


Does mobility improve patient care?


Watson: The effect of mobility on the patients is tremendous. This is a very powerful positive driving force because 95 percent of the time our patients are at home or work and we can now offer healthcare at home or work, which we have not been able to do. So the value to patients is so hard to quantify. I’ll also tell you I don’t how far we can go with this. I would say that 40-50 even 60 percent of my office visits can be done at home.



What’s the future for mobility?


Watson: For the providers, mobility is very powerful because when we leave the hospital we turn into a different person. In the era of pagers or handwritten charts, when we left the hospital, we were only available to be contacted, not make decisions. Maybe you could find me on a pager or a rotary phone at home. Now we have uncoupled, cloud-based providers who can walk around with a device and make very fast coordinated decisions that will very quickly turn into team based decisions in the cloud. We’re just beginning to see it. The future of our quality healthcare success is mobility.


What’s your view of the healthcare landscape today?


Watson: Healthcare as an industry is currently fragmented across the United States. What this is about is enabling patients to move to different levels of care, different care team members and simultaneously access multiple care team members with intelligence. That’s what it is. You can solve one transitional care piece, the discharge, but that’s actually a very small part of it. UPMC is an integrated delivery finance system. We have a health plan and we have providers and hospitals. We have both. So we’re integrated and the heart of making our patients better in western Pennsylvania is taking better care of them.


How has technology impacted your practice and clinician workflows?


Watson: There’s been a tremendous focus on technology in the past five years or so. The providers now understand it’s a necessary part of our lives in the workplace. More importantly, it’s part of our lives outside of work. For both clinicians and patients. I honestly think that the consumer electronics market has thrown healthcare a giant life buoy as we’ve floundered to some degree in the storm of healthcare. The consumer electronics market is teaching us and our patients how to use a piece of glass you can touch and talk to. They’re developing apps, they’re giving us data, they’re teaching all of us about big data. So the cultural change is not an industry specific process, it’s a societal evolution and the timing could not have been better. It’s no longer an IT shop; it’s life as we know it.

Below is the fifth in a series of guest posts from Nirav R. Shah, MD, MPH, the commissioner of health for the state of New York. Look for more of his blogs in the Intel Health & Life Sciences Community in the coming months.


You’re heading to the couch for a post-dinner nap when you get a text message asking if you’ve taken a walk today. You bypass the couch, lace up your sneakers and hit the nearby park for a 15-minute walk. 


For someone at risk for diabetes, that simple walk could be a lifesaver – and the key to preventing diabetes. A little exercise after a meal is often all it takes to usher glucose out of the bloodstream and into your cells, where it’s used up for energy. And the text reminder to take that walk? That could be just one of many new high-tech ways to prevent diabetes, perhaps even “prescribed” for you by your doctor and paid for by your health insurance.


The text app was the winning concept at New York State’s first-ever Health Data Code-a-thon, a 24-hour coding event staged by the New York State Department of Health at the EMPAC Theater on the Rensselaer Polytechnic Institute campus on Troy, N.Y. in December. The event was funded by a grant from the New York State Health Foundation, with additional support provided by Socrata.


Participants were invited to use health data to create applications that can help stem the state’s two biggest health challenges: diabetes and obesity. The code-a-thon was part of a larger event called NY Innovates, which brought together health and technology stakeholders for collaborations and conversations about software development tools and techniques.


The easy-to-use texting app, which was called Vera, won its creators -- Raymond Jacobson, Olufemi King and Ethan Bond -- the top prize of $6,000. Vera asks you to enter your age, height and weight, and then lets you know if you’re at risk for diabetes. If you are, you’ll receive text reminders to make smart food choices, exercise regularly and manage your blood glucose.


Second prize went to ActiveSideKicks, a mobile app that allows users to join groups anonymously or with friends and family, to track exercise and health stats with the support of group members. Third place was awarded to DOEFANI (Diabetes and Obesity Education using Franchise and Nutrition Information), a web app that helps users find restaurants in their area while providing nutritional information about the foods there and restaurant health inspection data.


The Code-a-thon is only the beginning. All three teams will have the chance to participate in the New York State Health Innovation Challenge in 2014. With any luck, these tools will be brought to market.


But for now, we’ve had the chance to see what can happen when tech savvy coders get their hands on health data. The possibilities are in a word, endless.


What questions do you have about health apps?

In the currently raging debates about healthcare, there’s little attention to population aging and the cost of care — two critical trends that I call the $4.6 trillion question.


By 2020, there will be 55 million Americans over age 65, reflecting a global population aging trend that could be as important to our future as global climate change.  Also by 2020, according to federal government projections, the nation’s healthcare costs will be $4.6 trillion, close to doubling in a decade.


One of the ways we must respond to these trends is to use technologies that enable a model I call “care anywhere.” Thanks to a range of personal health technologies available now—mobile health (mHealth) capabilities for smart phones and tablets, telehealth technologies for remote patient monitoring and virtual visits, intelligent software assistants for prompting and coaching, and social technologies for connecting patients, families, and providers in powerful new ways—we have the opportunity to move away from costly, institution-centric care delivery for the majority of needs.


The core necessity is this: care must occur at home as the default model, not in a hospital or a clinic. We need this to curb escalating costs, increase access and improve patient experience and outcomes.


Policy makers are paying attention. Last month, committees in both the House and Senate passed Medicare reform through Sustained Growth Rate (SGR) bills with bipartisan support, encouraging greater interoperability and data exchange for electronic health records (EHRs). And a discussion of telehealth measures led to an agreement between the Congressional Budget Office director and Senate to work together on how to estimate savings, an issue that has plagued telehealth and mHealth for years.


But even with all of the excitement, reforms and investment activity around mHealth, the promise of care anywhere – made possible by mobile technologies, data analytics and real-time connectivity – is far from being realized.


I think about the importance of care anywhere from three perspectives:


As a patient who tried to force in-home, mobile and virtual care models for myself while undergoing cancer and chronic kidney disease treatment for 24 years, my fight was not just against cancer but against a flawed healthcare system.


As a social scientist who has studied the cultures of healthcare innovation, I have seen the many challenges we must overcome to redefine the roles of patient, caregiver and provider.


And as a business executive responsible for health innovation opportunities globally, I have learned a lot from other parts of the world that are deploying social, political and technical infrastructure for care anywhere.


A new Intel study found that more and more people are feeling empowered through new technology tools to become fuller participants in their own care. More than half of the respondents globally believe the traditional hospital will become obsolete in the future.


Today, technology is reducing unnecessary emergency room trips using real-time video collaboration between patients, EMTs and doctors and reducing doctor office visits with innovations such as in-home blood pressure, ultrasound and eye tests that instantly send information from your smartphone to your doctor.


In Indianapolis, where cardiac patients were treated using remote care technology, St. Vincent’s Hospital saw a 75 percent decrease in hospital readmissions, proving that care anywhere can take costs out of the system and better support patient recovery.


In the future, doctors will be able to track patients’ health instantaneously through ingestible tracking devices in their bodies. More than 70 percent of respondents in our research are even receptive to using tools like toilet sensors, prescription bottle sensors and swallowed monitors.


But no amount of technology innovation investment alone can help us mainstream mHealth. We need a shared roadmap and strategy to create a movement around these care models. Remote care will never gain momentum without laws that allow doctors to be reimbursed for effective patient care no matter how it is delivered.


Medicare reform through the SGR includes telehealth as a method for physicians to transition to alternate payment models. Reform should provide incentives to use advanced technology innovation, when appropriate. As Congress makes needed changes in payment, let’s take this opportunity to make bold changes in the way people access care. By expanding telehealth reimbursement for all chronically ill patients in their homes, not only will patients benefit, but the United States will see a reduction in Medicare costs.


The Wyden-Isakson-Paulsen-Welch Better Care, Lower Cost Act of 2014, introduced last week, offers a targeted approach for providers to focus on chronic care management by offering preventive services through new technologies such as telehealth.  This bipartisan, bicameral legislation would encourage providers to coordinate care and reward them for achieving healthy outcomes rather than for the number of services they provide. It’s about time we change the formula for smart care and payment in the United States.


Our nation is aging and traditional healthcare costs are unsustainable. Technology advancement has outpaced our laws. Patients have told us that they are ready to embrace care anywhere. It is time for policy makers to help patients, their families and a broader range of health workers innovate answers to the $4.6 trillion dollar question.

Mobile point-of-care has dramatically changed clinicians’ workflows. An additional benefit may be the impact on patients. Mobile technology has empowered patients and brought a renewed sense of involvement in their own care.


How clinicians and patients interact using mobile technology is in its infancy, according to one prominent physician. Andrew Watson, a chief medical information officer and the medical director for the Center of Connected Medicine at the University of Pittsburgh Medical Center, says a cultural shift is underway and that by using mobile technology patients can have access to care wherever they may be. Watch his video interview above to learn more.


What's your take on the direction of mobile health IT?

Below is a guest blog from Terri Kennedy, Director of Product Management at Allscripts.


In his keynote address at the Allscripts Client Experience (see video below), Dr. Rasu Shrestha from University of Pittsburgh Medical Center said, “He who tames the data wins.”


As healthcare organizations manage evolving delivery and payment models, an analytics strategy is top of mind for many. Big Data is the next frontier for analytics and offers them access to rich data they can use for population health, research and consumer marketing and satisfaction.


Quickly emerging Big Data technologies augment traditional business intelligence technologies by efficiently and affordably acquiring and storing enormous amounts of data. Providers can query and re-query information without retooling the data model every time. This capability is particularly important with the mountains of data we have access to today.


3 opportunities to get value from Big Data


With so much data coming from so many different places, how can healthcare providers tame Big Data? There are different opportunities, depending on the type of information:


1. Join the conversations happening on the Internet – Patients are posting status updates in Facebook, Twitter and other social media that give valuable information about their own health. They’re also talking about their experience with their hospitals and clinics.


Monitor these status updates to find out if patients are unhappy with wait times, how they were treated by staff, or overall condition of facilities. Chances are good that patients are “hash-tagging” your organization. Do you know what they are saying?


2. Mine clinical documentation for critical nuggets of information – Even with the heavy adoption of electronic health record (EHR) technology, a significant amount of clinical documentation is still unstructured. Clinical notes and reports hold valuable information that providers can use to better measure quality, support research and feed predictive models.


Use Big Data technology to manage volumes of unstructured documentation in various formats. If you apply text mining techniques, you can drive near real-time clinical decision support. You can also use predictive algorithms to help understand what might indicate an adverse event before it occurs.


3. Harness and analyze device data – Medical devices and smartphone applications are capturing a wealth of healthcare data that could easily become overwhelming. But think about the possibilities of capturing this data and applying analytics improve clinical interventions.


What if monitoring streaming device data in the hospital such as heart rate and respirations could feed predictive models for detecting sepsis? Or caregivers could monitor populations of diabetics using smartphone apps to report weight, glucose levels and blood pressure so that care teams can easily identify patients that may be trending out of control?


Health care is not lacking for data. But we must tame it to recognize its true value. Big Data technology and our partnership with Intel can help transform enormous amounts of data into insight that can ultimately result in better quality of care and more rapid interventions.


What do you think about health IT Big Data?


Below is a guest blog submission from Ashley Rodrigue, Healthcare Ambassador at Lenovo.


Without a doubt, technology has transformed how healthcare providers deliver care. Providers are increasingly using technology in the management and treatment of their patients, and this surge is a result of federal guidelines that were passed requiring hospitals to demonstrate “meaningful use” of electronic health records. And if certain criteria are met, providers are eligible to earn incentive payments.


We talk a lot about what technology is doing for providers, but what can it do for patients?  There’s growing appeal for technology to target end users, or patients, in addition to providers. In fact, providers and organizations are investing in technology that not only meets IT requirements, but patient requirements, as well.


Hospitals are starting to explore how technology, can improve the inpatient experience. Imagine you’re a patient. You walk through the doors of your hospital and when you check in, you’re handed a tablet – and it’s yours to use until you check out. A recent Wall Street Journal article discusses the variety of ways tablets are being used by inpatients. From the comfort of their beds, they can use their tablet to contact their doctor with questions, notify nurses if they need meds, access hospital paperwork that needs sign off, and turn the lights on and off in their room.


Tablets that are equipped with mobile point of sale (mPOS) solutions can even be used by patients to make secure electronic payments. With an easy swipe, they can order meals from the hospital cafeteria, a movie if they’re bored, access Facebook and Skype with family and friends.


By the time patients check out of the hospital, they leave having been more connected and engaged with their doctors, nurses and the management of their health. And it doesn’t have to stop there. Other healthcare environments – like ambulatory care and long term care facilities – can leverage tablets.


Patients can use a tablet to check into their appointment at an ambulatory care facility. If it’s a routine visit, they can check in, log in how they’re feeling, sign into their patient portal to review their medical history, access their co-pay information and sign off on relevant documents. And how about using a tablet to occupy your time as you’re sitting in the waiting room, waiting for your name to be called? Imagine having the opportunity to read your email, play a game, or check Facebook or Twitter to pass the time.


There’s also significant opportunity for tablets to be “leased” to long term care patients. It is estimated that the population of adults 65 years and older will expand to 72 million by 2030.1 As part of a home care preventative maintenance plan, or a long term care facility inpatient plan, a tablet equipped with what patients need, like apps, can make a significant difference to their health. For instance, just think how a grandparent can benefit from understanding how to video chat with their families that live far away or can’t visit all the time.


What do you think of this growing trend, and how tablets can improve the patient experience?


1 U.S. News & World Report. How Baby Boomers Will Change the Economy.

It used to be so simple.


A patient arrived at the office, the clinicians analyzed their problem, performed a service, and sent a bill. Next.


Even though I am wildly overstating the simplicity of fee for service (the method described above), at a very basic level it is pretty straightforward. The complexities primarily originate from the fact that we have over 1,000 health insurance companies each with slight variations (a single payer system would be a lot easier).


Even though fee for service (FFS) hardly seems simple, the future may be significantly more complex. We all know the reason: under the current system, which is dominated by FFS, the nation is approaching spending 20 percent of GDP on healthcare, an unsustainable level for individuals, companies and the country (on personal note, my premiums have doubled in the last five years—ouch.)


The one thread throughout all payment reforms schemes is an increased burden on providers and their organizations to deliver higher quality and lower cost care. This will require a significant transition in delivery models—the way medical work is done. More on that later. 


Here are some of the new payment modes on the near horizon.


Bundled Payments: instead of receiving a fee for each specific service, a bundled payment defines a flat fee that will be paid for a particular episode of care. Let’s say a patient is diagnosed with congestive heart failure or needs a new knee, under bundled payments a fee would be calculated for the diagnosis and then divvied out to the various providers that care for the patient. To prevent underutilization of services, quality measures are attached to payment. To prevent over-utilization, the fee is fixed and may specifically define what is allowed for a patient with a particular episode—anything above that will not be paid. It encourages coordination because all providers are on the hook for achieving desired outcomes. Although the details of this approach are daunting for any organization that has not fully integrated hospital, primary care, and specialty services, it does get the incentives right. If providers are getting a fixed fee and are judged on outcomes, the incentive is for efficient, high quality care. The devil is in the details which will mean some pretty sophisticated IT to operationalize it.


Modified Capitation: under a capitated plan providers receive a flat monthly fee for every member that is assigned to them. Version 1.0 of capitation got a black eye because of the overzealousness of some plans in restricting care as a means of controlling costs. In the new iteration of capitation, quality performance measures have been added so that plans and providers are incentivized to keep care standards high as well as keeping costs low. Patients are risk-adjusted (with an associated modification of fees), so that providers are not punished for having an unhealthy panel. I love the basic simplicity of capitation (like all of these systems, the under the hood details are brutal) and it can be lucrative for practices that perfect the model. Since providers are taking risk, they have strong incentives to keep people healthy. It does favor integrated delivery systems or medical homes that are actively coordinating care across settings. The challenges: collecting and managing to quality metrics and dealing with difficult, non-compliant, chronically ill patients. 


Hybrid Models: Some schemes will blend fee for service plus either rewards, penalties or supplemental fees to drive the right behavior. Example: providers that transition to a patient centered medical home (PCHM) may be eligible for monthly per member care coordination fee. This is a great idea since a huge hunk of medical costs are driven by individuals with chronic illnesses bouncing through the health care system. A fundamental principle of medical homes is help the chronically ill navigate this maze more effectively and with better outcomes. Physicians on FFS that are part of larger group or ACO (accountable care organization) may be able to participate in gain sharing in which bonuses are provided based on the ability of the group to achieve annual cost savings while meeting specified quality metrics.


Whatever ends up sticking, provider organizations will have to adopt their operations to fit the payment model. ACOs and the Patient Centered Medical Home (for primary care) are the two most prominent examples of modified delivery systems built to fit the new payment models.


Where are we now in payment reform? Still very early in the transition. Advocacy group Catalyst for Payment Reform recently reported that only about 11 percent of medical payments are outcome or value based. Report is here.


Since we are now in period of experimentation with new payment models, it is premature to predict what methodology will prevail; over the next five years there will be detailed analyses of pilot projects using these systems to see what works and what doesn’t. One thing is certain: the existing system will not stay the same.


What do you see coming down the road for healthcare payment reform?


Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel

I have been going to the mHealth Summit for the past four years. As much as the mHealth industry is progressive and dynamic, it is also in some ways very slow to develop as many of the discussions and keynotes from this year were not altogether different from those of four years ago.


However, I do see progress and I’m optimistic about the positive impact mHealth will eventually have. Here are three developments that I find encouraging:


1.) Doctor Prescription of Apps. According to PC Magazine(1), doctors are now starting to prescribe mobile apps. Some of the top prescribed apps mentioned included:


• Allergist- four-day pollen forecast

• Cardiologist- Smoking cessation support

• Dentist- tooth brushing education

• Dermatologist- mole tracking

• Obgyn- Pregnancy education and social support

• Pediatrician- activity tracking

• Nutritionist- glucose trending


I can envision additional Apps that enable consumers to take a more proactive approach to their health (e.g., quality of sleep tracking and education).  Are there other Apps that you would consider using if your doctor prescribed it?


2.) Patient Engagement. In the U.S., several of the Meaningful Use capabilities that are being incentivized from the HHS HITECH Act promote mHealth for patient engagement. These include:


• Patient ability to view online, download electronic copies of their health information and clinical summaries

• Patient reminders for preventive/ follow-up care

• Patient-specific education resources

• Electronic messaging to communicate between patients and care providers

• Access to self-management tools


Mobile devices will make it easier to use these capabilities and should result in better informed, engaged consumers. If these capabilities were available now from your Provider, would you take advantage of them?


3.) Proven Results. There have been many trials and implementations with positive outcome indicators as follows:


• 30 percent reduction in medication errors (2)

• 50 percent reduction in wait time (ER, admission, transport) (3)

• 85 percent faster to transact admission, discharge, and transfer changes (4)


Driving costs down will continue to be a high priority for care centers and proven ROI savings from mHealth implementations are important to increase adoption.


The mHealth initiative is moving forward and will inevitably impact our lives and change the way we approach our health.  While the market is not transforming as fast as some anticipated, there is no denying that we are making progress.  I’m encouraged by the developments discussed above and am looking forward to what is to come in the future.


What are your thoughts on mHealth advancement?




2) Wireless at El Camino Hospital, California

3) St. Luke’s Episcopal Hospital, Houston, Texas

4) RFID at St. Vincent’s Hospital, Alabama

As the healthcare industry transitions from fee-for-service to fee-for-value, and to team-based care models that require a high degree of care coordination (such as PCMH), a more holistic, 360 degree view of the patient is needed. Over time, this patient view will be built not only from traditional data types such as claims data and healthcare data (e.g. from the EHR), but also non-traditional data types such as patient or member sentiment data from social networks. So what new approaches are needed to respond to this changing data landscape?


Organizations need to be able to apply analytics to Big Data; data from varied repositories that exist structured, semi-structured and unstructured form.  Solutions that enable this need to be high performance, horizontally scalable, and balanced across compute, network and storage domains (e.g. to mitigate impact of I/O bottlenecks). High-performance analytics software, with capabilities such as natural language processing, machine learning, and rich visualization also enable these Big Data solutions. 


Innovative Payers and Providers are pursing these solutions to improve the user experience for their patients and members, better market produces and improve outreach to encourage healthy lifestyles. Take a look at this paper to learn what Blue Cross Blue Shield of North Carolina and Carolinas HealthCare System are doing in these areas.


The paper also describes 5 steps for getting started with Big Data:


1. Work with business units to articulate opportunities

2. Get up to speed on technology

3. Develop use cases

4. Identify gaps between current and future state capabilities

5. Develop a test environment


Payment reform and care models that foster a patient-centric approach have the potential to transform healthcare.  Analytics solutions that break down traditional data silos to develop a complete view of the patient, enable effective outreach programs, and promote collaboration across the continuum of care will be the technical foundation of this transformation.


Are any of you deploying Big Data or advanced analytics solutions in your organizations? Please feel free to share your observations and experiences below.  You can follow me on Twitter @CGoughPDX.

For the past four years, I’ve watched thousands of health and technology influencers, developers, policy makers, business leaders, and others pack themselves into the mHealth Summit for a glimpse at the latest in mobile and wireless health technology. And why not? It’s a good time, and the policy changes, apps launches, and new comers to the field are always worth noting.


But this year, as we head into the 5th Annual mHealth Summit, I’m looking beyond the 300 exhibitors and 450 speakers—I’m following the money to the most promising new mHealth tech.


What choice do I have? Last quarter, as reported by CB Insights, venture capital investors deployed some $1.2 billion to U.S. mobile-related companies, making Q3 2013 the wildest VC financing quarter in history for the Mobile & Telecom sector.


Health IT overall drew $2 billion in funding this year, according to a Healthcare IT News report, but if you look at VC deal volume in mobile, the Health & Wellness sub-industry barely registered in Q3. So, yes, investment dollars are flowing to mHealth, but my take is that, despite the boom, we’re just getting started. That’s likely to be good news for mHealth entrepreneurs as they continue to bring their own innovations to market, and the money works its way deeper into the health niche.


Although VC funding is hardly the end-all-be-all for tech entrepreneurs—and somewhat less relevant to healthcare CIOs—financing trends obviously play an important role in the growth and evolution of mHealth. To the extent that new mobile and wireless devices (and apps) will need to be added, integrated, and supported by health IT professionals, these funding trends could prove very relevant to CIOs indeed.


That’s why one of the presentations I’m most interested in this year is the Venture+ Forum.


Keynoted by Qualcomm Life Fund’s director Jack Young—an electrical engineer and former EVP with the world’s fourth largest mobile phone manufacturer (ZTE)—this session should be eye-opening.


Young, who has questioned the sustainability of current funding trends, believes digital health is at a crossroads. Among other things, he’s planning to talk about the viability of today's boom in mHealth funding, and where investment dollars might trend over the coming years.


Personally, I welcome input from Young and others on this topic, as the industry prepares for the next wave of mHealth technologies that promise to span everything from mobile-clinical integration platforms, to personal genomics, to clinical research technologies.


The Venture+ Forum also will review presentations from 11 mHealth startups, which is always fun and inspiring. So, whether you have a mobile solution on the market, in the works—or you’re just wondering how the next wave of mHealth offerings will impact workflows—there should be some actionable information coming out of the Venture+ Forum. Hope to see you there!


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

The 2013 mHealth Summit is coming up next week and will feature a tremendous lineup of sessions and exhibitors all focused on mobile health IT. Below is a guest blog from Ken Jarvis, Director, Health & Life Sciences Industries, Americas Region at HP.


In the lead up to the fifth annual mHealth Summit next week, HP is working with Intel to highlight how clinician mobility is transforming patient care and access to data capturing. As the vision of mobility in healthcare becomes reality, we are seeing a transformational shift in the way health is managed and care is delivered. Mobile health technology gives healthcare providers the power to offer care at the right time and place.


The use of mobile devices has the potential to save time, enhance accuracy and improve bedside attention. Tablet PCs, notebook PCs, mobile workstations and mobile thin clients give hospitals the option to choose the product, or combination of products, that best suit their needs. Companies like HP aren’t just offering options in devices, but rather an opportunity for change, which can help providers create better experiences for patients during their medical stay.


For example, physicians use tablet PCs like the HP ElitePad 900 to be more efficient and accurate in their day-to-day activities. With remote access to medical records, the physician is able to have productive face-to-face interactions with patients by providing them with personalized healthcare information in real-time. The physician can also use the tablet to capture patient information digitally in the moment so detailed information can be created and retained faster and more efficiently. For practices that want to streamline processes, windows-based tablet PCs are a smart choice as they can run the same programs available on their existing desktop PCs.


Next week, we’ll be on the mHealth show floor at Intel’s booth #1311. HP’s mobile portfolio will be on display including the HP ElitePad 900, HP EliteBook Revolve and HP EliteBook Folio. For more on what you can do to improve your mobile strategy, HP’s Ken Jarvis will be speaking in his session on the general stage on Monday December 9 at 2:45 p.m. about Creating a Secure, Effective and Popular BYOD Policy.


Learning objectives in this session will include:

• Enablers and inhibitors to an effective BYOD policy

• Current and future landscape of BYOD

• Tips from practitioner experiences on how to develop an IT strategy and foundation for an expected surge in clinicians’ adoption of BYOD


What questions do you have? If you will be at the event stop by the Intel booth #1311 and say hello.

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