Tag Archives: healthcare information technology

Cerner/Siemens merger is big news!!


Well, I was surprised on this one but I’m probably not the one “in the know” on deals such as this – but Cerner & Siemens $1.3 billion merger occurred last week. And I know that everyone from employees to users of the separate companies’ products to the whole HIT world are waiting to see what happens next. The article interviews John Glaser of Siemens and surprised me by noting that the merger has been a bit on the brains of the executives for quite some time – since 2010. Could this bring the two companies together and put them back in a powerhouse position? Guess we’ll have to wait and see. But honestly, with IT products, unless they have been working on programming since 2010, they don’t move that quickly.

Any thoughts from the audience?

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FDA and mHealth: Upcoming FDASIA report implications


In watching what is going on with the FDA and mHealth, I’ve become a bit more nervous on the topics that are lying “in between the lines” of what the FDA is working with the ONC and FCC to determine where government fits in to the oversight and regulation of the apps. Most of the articles I read keep mentioning the apps that are medically oriented – which there are thousands – and then they slide in the software just once in a while. It’s the software that I am concerned with.

In an article from mobihealth news  March 3rd, Bradley Merrill Thompson talks about current events with the Food and Drug Administration Safety and Innovation Act (FDASIA) and the PROTECT Act. Congress gave specific direction to convene a working group which included the FDA (Food & Drug Administration) , ONC (Office of the National Coordinator for health information technology), and FCC (Federal Communications Commission) to make recommendations for the regulation or lack of regulation for HIT. The report from the group is due at the end of this month and frankly, based on my research, we don’t have a really good idea of what they are going to come out with. I talked about some of the questions that Congress recently sent to the FDA in a letter in this blog.

In the article from Mr. Thompson, he gives us a quick review of the Power Point that the FDA presented (Here and then click on the FDASIA Recommendations) and picks out some very good items that the FDA report needs to answer. He refers to slide 35 and notes that the FDA should be very concise about what software is regulated and what is not. This is one of those points that I cringe at. When you say software to me I am thinking electronic medical records but the overarching “software” really can refer to mobile apps or software that is privately produced by either individuals, organizations, or companies to assist with connecting the patient to medical/disease information, patient information collection or even interaction with clinical providers, among many others. It also specifically calls to software that is directly related to or interacts with a medical device. This is truly the first door that the FDA could reasonably step thru to have more oversight and regulation of medical software – specifically electronic medical records.

The second slide he refers to, 36, speaks to defining requirements. These requirements are from development to deployment and then the post deployment updates for the apps. We, in the industry of healthcare IT, need to know the requirements before we start building these apps. Otherwise, the development is severely impacted financially. You can imagine that you spend, for example, 100 hours creating the app and for each of the hours you paid the developer $60. Then you find out after you’ve finished the app and are ready to deploy it to the public that you don’t meet the FDA requirements. That is a lot of money for any business to absorb. Additionally, if you have already deployed the app and are doing updates then you have the same concerns. And next Mr. Thompson notes that slide 37 truly drives home the fact that these regulations need to be entrepreneur friendly. Again, the regulations and requirements for the software need to be known or communicated as well as reasonable.

Generally, the FDA, ONC and FCC should be looking at which software or apps directly touch the patient and medical devices, create clear, concise and communicated regulations so that the entrepreneurs, established companies and organizations can adhere to the regulations at the very beginning. They should also consider for those apps or software already established what the reasonable regulations and timeline for any changes required should be. The industry is very far along and has complex software that could be adversely affected and the economic impact could be significant.

 

Any thoughts on the upcoming report and it’s potential impact on mHealth?

 


mHealth and the FDA – where is the path leading?


Mention FDA in the healthcare world, especially around us software geeks, and everyone gets quiet and cringes.  I’ve been in healthcare for over 25 years and 15 of those included pharmacy work. So I am very familiar with the FDA. And let me tell you, they have some strong points and some weak points. (And this is my opinion only.)

I am passionate about mHealth and what it can do for the patient and the public. And right now we are at the cusp of an explosion with this. Mobile apps, including Apple’s health app, Healthbook, is getting a lot of attention lately. But this attention, in general, has gotten the attention of the FDA and even Congress.

Now, I’m not a person to tell you which app to use, as I have personally experienced the search to find that app that does what I want it to do, preferably for free, and doesn’t charge me to use more of the good stuff/functions. Taking a look at the Healthbook app courtesy of 9to5mac I like what I see because it is not just a fitness, food, exercise tracker but gives some real tools to help those with chronic conditions. But don’t let me get off track here….

Back to my main point with the FDA and Congress. A few days ago mHealth News shared an article by Erik Wicklund telling us of some of what Congress wants to know from the FDA on their (what I call) control of mobile health apps. And of course, Congress sent the FDA a nice little letter.

“It is important for the FDA to be well-equipped with the proper tools to advance public health while taking care that innovation is not stifled through uncertainty or over-regulation,” the letter stated. “While the FDA’s final guidance has provided clarity on the agency’s approach to regulation of mobile medical applications, we believe more transparency is needed to avoid stakeholder confusion over how a wider range of medical software might be appropriately regulated.”

Then they provided 9 questions to the FDA. When reading thru them I caught note of a few that asked how Congress might help with XYZ. That’s awfully nice of them to ask the FDA. And Congress had some really good technical questions for the FDA. They asked about risk levels, software update tracking, how do they know that the if the app has a function not classified by the FDA, and if they have been coordinating with the Office of the National Coordinator and the FCC. But my favorite question was:

“What approach does the FDA use to regulate complex medical software with multiple and separate functions?”

That made my gut churn. So far the medical software companies have been good at keeping themselves out of the FDA reach. But this question tells me that not only does the FDA have them on their minds but now Congress has caught onto this idea of regulation. I’ve worked in healthcare IT for over 10 years now and mainly with the software implementations and it truly alarms me to think of the FDA stepping in, much less Congress (we’re familiar with their record in other areas lately) and the effect and total chaos that they could bring to the industry.

But I’m going to sit back and pay close attention to this development and I’ll keep sharing my opinion with you. Again, some may not agree with my opinion but maybe you/they will take it as food for thought…
In the meantime look for upcoming posts!


Social media and healthcare


I bet you use Facebook…bet you Google for information, too. Do you Tweet? If you read my previous post about Tweeting for your health you might know that Twitter is becoming a sort of marketing and information source for healthcare. I know of many hospitals, healthcare organizations and public health organizations that use Twitter as information outlets to target specific chronic disease populations. For example, my mother, sister and I have essential tremor so I “like” the International Essential Tremor Foundation Facebook page. It provides information regularly on the disease state as well as activities that are going on.

courtesy Power DMS Suite

courtesy Power DMS Suite

 

 

This infographic (picture with information) has some interesting statistics on how healthcare is using social media today. Of interest to me, because I am also very careful with my personal Facebook page versus my public pages, is the percentage of the physicians that DO accept Facebook friend requests from their patients. Unless I was truly a friend of that physician I think that I would want to respect their privacy, and mine, by not being their FB “friend”.

So how do you use social media in your healthcare life? Are you a fan/”liker” of any hospital or health system Facebook pages? Do you follow a chronic disease group on Twitter?


Do you print or view? Information today…


Working in IT (information technology) we are always conscious of printing. We try to avoid it. It is, in our world, similar to being caught using your finger to get some icing off the wedding or birthday cake when no one is looking. (yes, Tisha humor/opinion.)

So how do you get your information? Do you print off directions from MapQuest? or do you send them via text to your smart phone? Or even have that handy navigation system in your car? What about your grocery list? Is it on paper or do you have a handy app on your smart phone or iPad? Do you read paperbacks or use a Kindle/Nook/iPad?

A recent article in HIT Consultant noted the top 20 most insightful infographics of 2012. (infographics = pictures with words and/or information.)

courtesy HealthEd Academy

courtesy HealthEd Academy

 

This particular one seems to give some good statistics on how patients are learning in our age of technology. Healthcare extender I take to mean a healthcare provider. It is interesting that the majority of information given to patients is printed. Yet, when I think about some of the meaningful use requirements, one is to provide patient education upon discharge. So they print the information. Even if they were to give you links to videos or websites they print them on paper. I haven’t seen anyone emailing info rather than printing though that doesn’t mean that it doesn’t happen.

The infographic does point out that the provider (extenders) are getting their information from technology (online) resources. I would say that the majority of those resources are available to the general public, also. Yet there is often so much information available that it is contradictory or confusing for us when we search. There are some information providers that we feel are true and correct resources such as WebMD.

So how do you get information from your healthcare provider? Do you do your own research? If yes, is it before or after you see the provider? or both?


The new “drugs” – smartphone apps or patient engagement? or both?


In a recent post I mentioned a quote from Sherry Reynolds:

 “If  # OpenNotes was a new drug that increased patient engagement by 85%,  every doctor in the country would be prescribing it.”

Now I see an article from American Medical News talking about smartphone apps being the new drug. That really caught my attention – mostly because I am trying to use that concept in my graduate class theory paper. But back to the point…We all have kids that can’t put down the phone – the smartphone because they are texting, Facetiming, gaming, or who knows what else. I’m one of those adults that is almost as bad as my child. I am always checking Facebook, checking my WordPress for comments or likes, looking up the closest cupcake bakery, or texting one of my children or Hubby because I’ve forgotten what I was supposed to have been doing while I was doing all of that. Am I addicted to my smartphone? Nahhhh Could I go a day without it completely? Hmmmm, not so sure…..I’ve gotten close while on two cruises. But when you get to shore you can usually see who’s doing what on Facebook that you might have missed. Or even those wonderful work emails that you are truly afraid that someone messed that project up while you were gone. OOYY!!

So you can see where I am going with the familiarity of those people in the US younger than the age of say 55 – no, don’t go all ballistic on me if you are over 55! My dad only knows how to answer and call on his flip phone and my mom is becoming an iPhone guru so people are different! We rely on those smartphones. Sometimes we rely on them to the point of psychically wrong proportions -but that’s another article.

This is the key point I like about this article:

Discussions are taking place in exam rooms across the country about how a $1 app could be a viable alternative to prescribing a medication and help patients monitor their health. Some even have referred to the act of physicians recommending mobile health as “prescribing an app.”

In the traditional sense of prescribing, the phrase is not accurate, said David Collins, senior director of mHIMSS, a subsidiary of the Health Information and Management Systems Society focused on mobile health initiatives. “But in the digital wave of medicine, when it comes to mobile health, I’d say it does make sense. Patients are used to going to their doctor’s office, getting their problem solved and leaving with a prescription in their hands.”

A few things to think about with this theory, from my point of view.

1) are the patients in that group of users that will know how to get the app, download/install it and then use it? If yes, this can be quick – a business card with the name of the app and whether it is available on the Apple platform or the Android.

2)If they can get to the point of using it then do they know how to get the good stuff out of the app? With calorie counter apps it seems to be easier – you program the number of calories per day, track what you eat, see how you do. With apps that are more complicated and linked – usually via bluetooth – then there is a bit more complexity to the use of the app and the information that you get from it. Then how do you share that information at your next visit? Or even before your next visit?

3) The physician – or designated office person – would need to become a person who helped patients go thru this cycle of us. They are going to have questions when they get home. They are going to have questions when they have a weeks’ worth of data in the app and can’t see what they think they should. They will need help. Can a physician office or clinic charge for that service? (my devil’s advocate at work there.)

Overall, this is a great idea. It is moving on the right path to a nation that has been embracing a healthier lifestyle over the last 15 years. Truly, we have. There are still issues with obesity and such but there is a major trend in our population to develop and maintain healthy lifestyles.

These are some great statistics:

PATIENT MOBILE HEALTH BELIEFS

59% say mobile health has given them solutions that have replaced some doctor visits.

52% say mobile health will lower health care costs within three years.

49% think it will change the way they manage their overall health.

48% say it will improve health care quality within three years.

48% think it will change the way they manage chronic conditions.

48% say it will change the way they manage medication.

46% believe it will make their health care more convenient within three years.

PHYSICIAN MOBILE HEALTH BELIEFS

42% say mobile health will make patients too independent.

27% will encourage patients to use mobile health apps.

13% will discourage patients from using mobile health apps.

Source: “Emerging mHealth: Paths for growth,” PwC, June (pwc.com/en_GX/gx/healthcare/mhealth/assets/pwc-emerging-mhealth-full.pdf)

 

Do you think you would use an app that your physician recommended ? How much “help” would you expect to need to use it? How much interaction would you expect with the physician/office if you were to use it – more or less?

 


Is our health care connected? Or is it connected under certain conditions?


Reading an article from newly named Kaiser Permanente CEO Bernard Tyson-article was written before he attained the position 4 days ago – where Mr. Tyson talks about how connected the patients at KP are with their health records. Having worked as a consultant at KP before (and remember that little page about disclaimers up there to the right….) I think that Mr. Tyson is on the right path.

Technology is changing this paradigm and creating what we at Kaiser Permanente call connected care. This means that all the patient’s providers have access to the same health care records and information is available around the clock. Patients can access their full medical records electronically anytime, viewing all medications, lab results, office visits, and more. They even have direct access to their physicians through e-mail. Patients can connect to health information 24/7 and manage their health care when it’s convenient to them instead of having to wait for an appointment. And it is safer and more secure.

The unfortunate part is that I am not a KP member. I do not live in a KP serviced area. I do not have the connection that Mr. Tyson talks about. And somehow that is wrong – for me. Why don’t I have that same information? I don’t have  health insurance right now. So does that mean I don’t get access to my records? Is it dependent on me having insurance or having a doctor that I use – and then must I use them regularly? Where are the rules for when and what records I get to see? And how long do I have to see them? Can I look back 5 years?

I applaud KP for the work they have put into making this happen. I personally know of the blood, sweat and tears that went into where they have gotten so far. So what is holding the rest of us back? Were we waiting on an election? Shame on us? While we were waiting on that election there were insurance companies buying up hospitals and health systems. Now they have my information even if I don’t.

More to come….just thought I’d ruffle the feathers a little…shake it up some… maybe get your attention…..

🙂

 


Is there an app for that?


My guess is that if you were to ask this question of your peers – which I kinda have over on my Facebook page of the same name – that the answer would be yes. There are apps out there that I never dreamed about. And there are a LOT that are targeted to health – your health, your clinician getting information for your health, your exercise, your disease monitoring…. I could go on.

Recently, I broke the mold of myself and got an Apple laptop product. I was excited to get the iPad back in March and loved it for my trips – music, movies, games – then found out all the other significant stuff it could do. So I decided to give Apple a try against my trusty monster – my Dell. So now I have access to an even greater and different set of apps than I do with my Android based smart phone, my iPad, my Apple laptop and my Dell laptop. A gal could get confused here…

Alas, to my point -when I put mhealth into the PlayStore on my Android phone I got apps that I would never have expected. One that really took me by surprise was EPI mHealth Lite – an application used with EPI Mini to connect the smartphone to the device to read the ECG. WOW!

My Mobile Med Box came up for a fee in which it describes itself as “your secure personal health record”. Hmmm, wonder how that works. One of the comments on the reviews stated that the fire department recommended it to the person for people who call them a lot because it can give them info when you can’t. Again, hmmmm…I have a lot of questions on that security setup….

AT&T mHealth is on my list of interest. When you go to the play store on the Android it has the “warning” that “you must have an invitation to participate from your employer or health management company.” Well, that counts me out. I don’t have health insurance. Ping! That is a consideration with all these apps – what are the prerequisites?

I was excited to get WebMD on my iPad so that I could figure out what was wrong with me. Or my neighbors and friends. Seriously – how many times have you had a person tell you that this was aching, they had a rash somewhere, their chest pains were low in their ribs, or that the doctor gave them a medicine for that newly diagnosed condition but they forgot what else they were supposed to do other than take the medicine? Now, I’m likin’ some WebMD on my iPad!

For those clinicians out there listening in you can get Epocrates on your Android or Apple products, too. I kinda like that. Except for the part where I have to pay the pricing ($$) you need to pay for more than just RX (prescription) information.

A pretty neat one that I would never have thought of is Recalls.gov. It is available on Android and other versions are on the Apple products.

And what about those fitness and exercise apps? I found My Fitness Pal – really a lot like Weight Watchers that I did online about a year and a half ago but I thought it was less user-friendly. I had to guess at my calories and I’m always going to go for the help myself think that I’m losing weight side of things.

 

So what apps on your smartphones, tablets, or laptops do you use that relate to health/wellness?? I’m truly curious! I know there are a lot out there and one or two might just be of interest to me, also. Come on! Share!


OpenNotes link


Take 5 minutes of your day today to read about and familiarize yourself with this initiative. It is well worth it. Then come back and tell me what you think. I’ve been blogging on this topic for a few days now and found this site and initiative very informative and inspiring, actually.

OpenNotes 

Shared/copyright OpenNotes


More patient engagement – if it were a drug….


I’m just stumbling onto all kinds of articles on the OpenNotes topic. Remember those articles with the AHRQ topic of patient access to their medical/clinician notes? Here is another post that I like from Forbes by Dave Chase! It compares patient engagement to a new drug with this great quote from Sherry Reynolds:

“If  # OpenNotes was a new drug that increased patient engagement by 85%,  every doctor in the country would be prescribing it.”

And here is the great graphic from Robert Woods Johnson Foundation


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