Year: 2014

Would You Take a Bullet For Your Clinical Data?

Sep 16, 2014• 2

BONNIE CASSIDY

Millions of important pieces of health information are entered into systems of record daily. Without an information governance play book, we are asking our patients to take a trust fall with their health. How confident are you that this is the single source of truth and care is being accurately reflected?

Data has become the vital component against which all things are measured— from determining short-term efficacy to developing long-range strategies. As a result, a new role is emerging in many industries, the Data Quality Officer (DQO), who is entrusted with ensuring data health, analyzing trends, and deriving actionable insights from the information. While this role may be new to Fortune 500 companies, its core competencies have existed in healthcare for years, championed by health information management (HIM) professionals.

In healthcare, data has always been the lifeblood of better patient care — and accurate documentation is an essential first step to ensuring integrity. Data integrity not only helps improve patient care, it has downstream effects on regulatory compliance, case mix index (CMI), quality reports and your organization’s bottom line, as well. But it won’t stand up today’s pressures and levels of scrutiny unless it all starts with an information governance strategy.

Create a playbook

A lot has been written about health IT and the vast amounts of patient data that is being entered into systems every day. How do we organize it, track it, analyze it, and leverage it to improve patient outcomes? Before we can execute against any of these initiatives, we first have to know that the information is accurate and uniform. Creating a playbook that includes protocols and processes, such as, who is allowed to enter clinical information into a record, what information is included and how it is presented, and a process for amending possible discrepancies is vital. Outlining these procedures and policies will help maintain dataintegrity.

Unnecessary “Preventive” Mastectomies are Surging in Young, White Women With Insurance

Sep 16, 2014• 1

By LAURA NEWMAN

I remember the first time that I heard about an unexpected rise in unnecessary mastectomies in young white women, who were privately insured. About five years ago, I was at the largest cancer meeting of the year, the annual meeting of the American Society of Clinical Oncology. Speakers raised the issue; they’d speculate why; and within minutes, the speaker and the entire audience looked crestfallen and helpless.

For many, it was a devastating turnaround. The women’s health movement and progressive forces in medicine had vigorously fought for breast-conserving surgery because the best science long ago proved that total mastectomies were overkill. Not only has breast-conserving surgery been tested rigorously against total mastectomies, but the results have consistently shown, that for women with early breast cancer, there is no survival advantage to having more aggressive surgery. Compelling proof that breast-conserving surgery AKA lumpectomy and radiation should be the standard of care for early breast cancers goes back until about 1990. Simply put, for women with early breast cancers, if both breasts are removed, they will not reduce their chance of getting cancer again, nor will they improve their survival any more than if they had had a minimally invasive lumpectomy followed by radiation. Additionally, unnecessary hysterectomies were also questioned and they are far less common today.

The Must-See Digital Health Startups of 2014

Sep 16, 2014• 9

HEALTH 2.0

Ten new digital health companies will demo their products for the first time in the Launch! session during the Health 2.0 8th Annual Fall Conference being held in Santa Clara, CA on September 21-24. Launch! is a contest held at 12:00 p.m PDT on Wednesday, September 24th, where the technology is demoed in three and a half minutes. At the end, the audience votes for their favorites. Previous Launch! winners have included Castlight Health, Basis, and OM*Signal. This year’s finalists:

Symptify helps the user navigate a series of questions to narrow down the cause of their symptoms while also helping them find a nearby medical facility.

Open Source Health MyAVA, uses Open Source health IT for a collaborative patient – physician educational and informational sharing platform for women. Advocating everything from female health, fertility, to healthy aging.

Intake.Me is a communication and patient engagement product that allows patients to check-in for their doctor’s visit from anywhere and attach medical records stored in their own virtual private health cloud.

Livongo Health introduces the brand new InTouch, which is a diabetes monitor, advisory and coaching service, community, and communications tool—all rolled into one. The concept is so exciting that it’s got Glen Tullman out of his post Allscripts “retirement” and back into the startup game.

DaVinci.io builds apps with a mission – introducing a PHR that consolidates existing health records onto the user’s mobile device.Continue reading…

Those New Neighbors

Sep 16, 2014• 3

By DANIEL GARRETT

Look at who is entering the New Health Economy: Amazon, with digital health applications; Intel, with a home health gateway; Google, with a fit platform, not to mention the news out of Cupertino last week.

Why? According to the 2013 PwC Global Innovation Survey, nearly half of drug and device companies are focusing on traditional product innovation rather than on breaking their efficacy and safety mold. And the stakes are high: As patients become value-seeking consumers, they want quick and easy technology connections to their health source.

It appears that the biggest barrier to transforming traditional healthcare business is culture. Most (89%) of the drug and device CEOs surveyed by PwC view technological advances as the global trend to follow. Yet three-quarters of these executives cite an inability to grasp new information technologies.

Many of these firms invested heavily in social media in 2012 and 2013, but then retreated, possibly awaiting further guidance from the FDA on what is acceptable conduct for “socializing” with consumers.

In fact, the FDA released draft guidance this spring outlining rules for interactive promotional media, including blogs, social networking sites, online patient forums, and podcasts. Some companies, such as Qu Biologics, already use social media to enhance trial recruitment. Companies can scan social media for information about adverse events related to their products. A recent study showed that social media had three times more adverse-event reports for 23 commonly used prescription medications than the FDA did during the same time period.

Any cultural transformation should begin at home. Although drug and device companies say they value social media as an important accelerator of innovation, the evidence is scant on how these firms use technology to promote internal communications that can better connect employees across traditional silos—from R&D to commercial business units.

Interview with Adam Pellegrini Walgreens, VP of Digital Health

Sep 16, 2014

In less than one week, the Health 2.0 8th Annual Fall Conference will feature over 200 LIVE demos, 150 speakers, on over 60 panels and sessions focused on innovative solutions within health care technology. Indu Subaiya, CEO & Co-Founder of Health 2.0 interviewed Adam Pellegrini, VP of Digital Health of Walgreens ahead of his appearance at the 8th Annual Health 2.0 Fall Conference. Adam will be participating in the Monday main stage panel “Consumer Tech and Wearables: Powering Healthy Lifestyles.” In this interview, Adam gives insight into Walgreens innovative API creating the seamless user experience.

Indu Subaiya: So you are leading up a number of very exciting initiatives at Walgreens in terms of digital health. Let’s begin by talking a bit about the API program and the developer ecosystem that you’ve built.

Adam Pellegrini: Absolutely. So Walgreens has been offering a very robust API program for quite some time – this idea that our stores in the online space should be really an omni-channel user experience. If you think about our stores, our stores actually have a lot of partners that actually have products in the stores.

So really, our API program is really about partners. It’s about bringing and facilitating the digital ecosystem together via API. So for us in the Health API space, it’s about how do we help all of these different apps leverage the ingredient technologies that Walgreens has created to create a seamless friction as user experience.

IS: You mentioned that the Health API has drawn a lot of members within the Health 2.0 community. Can you tell us a little bit about some partners there and how this is then connected to your Balance Rewards program?

AP: GenieMD is actually one of our partner apps that leverage our Refill by Scan, our personal health app that goes on both Androids and iPhones. And some of that could be really convenient and add a value to their app by embedding the API that we have for refilling prescriptions, the Refill by Scan.

Anesthesiologist’s Review of the Facts in the Joan Rivers Case

Sep 15, 2014• 83

By KAREN SIBERT, MD

Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered.

News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused by a polyp or tumor on the vocal cords, or by acid reflux irritating the throat, among other possible causes.

So Ms. Rivers underwent an endoscopy by Dr. Lawrence B. Cohen, a prominent gastroenterologist, to evaluate her esophagus and stomach for signs of acid reflux. At the same time, a specialist in diseases of the ear, nose, and throat (ENT) reportedly examined her vocal cords (also known as vocal folds).

We don’t know exactly how much or what type of sedation Ms. Rivers’ may have received, though several news sources have reported that she was given propofol, the sedative associated with the death of Michael Jackson. No physician who specializes in anesthesiology has been identified on the team taking care of Ms. Rivers, and we don’t know who was in charge of giving her propofol.

It seems clear that at some point during Ms. Rivers’ endoscopy and vocal cord examination, there was a critical lack of oxygen in her bloodstream.

Was laryngospasm the cause?

Giving sedation for upper endoscopy is tricky, as any anesthesia practitioner will tell you. A large black endoscope takes up space in the mouth and may obstruct breathing. Any sedative will tend to blunt the patient’s normal drive to breathe. But most patients breathe well enough during the procedure, and go home with no complaints other than a mild sore throat.

News reports have speculated that the root cause of Ms. Rivers’ rapid deterioration during the procedure could have been laryngospasm. This term means literally that the larynx, or voice box, goes into spasm, and the vocal cords snap completely shut. No air can enter, and of course the oxygen in the bloodstream is rapidly used up.

The most common situation that leads to laryngospasm is irritation of the vocal cords. Everyone knows that when a drop of liquid or a crumb of food goes down the wrong way, it’s highly irritating and provokes a fit of coughing. When the vocal cords are stimulated or even lightly touched, their natural protective response is to close up.

Every anesthesiologist is taught how to manage laryngospasm, because it can be a life-threatening emergency leading to brain damage or death if the patient is deprived of oxygen for too long. Sometimes the vocal cords relax and open up on their own, but often they don’t.

mHealth – Beyond “There’s an app for that”

Sep 14, 2014• 3

By NIRAV DESAI

“There’s an app for that” popularizes the fact that over 1 million apps for smartphones and tablets have been developed to address anything, from small to complex, that people may want to do. In the world of mobile health, or mHealth, we’re prone to agree.

According to IMS Health, there are over 23,000 healthcare-related apps covering numerous clinical areas (from primary care to surgery), care sites (from home to acute care), users (from patients, to caregivers, to clinicians) and parts of the patient journey (from wellness to complex chronic disease). And, a recent study we conducted found that 70 percent of people use mobile apps on a daily basis to track calorie intake and monitor physical activities.

But the view of the mHealth world as just a proliferation of apps, while exciting and important, is flawed in several ways:

It ignores the fact that while apps may be primary user touch points in a mobile-connected world, they are not the only ones.
It leaves people with the idea that all you have to do to solve a problem is build an app. Often, the solution is much broader.

Healthcare is evolving beyond “there’s an app for that.” Here’s what’s happening…

Countdown to Health 2.0 2014: Exclusive Interview with ONC Chief Medical Officer Jacob Reider

Sep 13, 2014

Matthew Holt interviewed Jacob Reider, Deputy National Coordinator for Health Information Technology and Chief Medical Officer at the ONC, ahead of his appearance at the 8th Annual Health 2.0 Fall Conference. Jacob will be participating in several panels at Health 2.0, beginning with the Monday main stage panel “Smarter Care Delivery: Amplifying the Patient Voice”.

In this interview, Jacob gives an overview of the HITECH program, the question of interoperability, and the broad adoption of technology in health care as an industry.

Matthew Holt: So, let’s touch base on a couple of things. You’ve been in ONC some time now. Let’s talk about how the general HITECH program has gone and is going. If you were to get to rate it, the spread of EMRs and the usefulness of them, their usability, how would you say we’re doing so far?

Jacob Reider: I think we’re doing very well. Some of your readers know I went to college at a place that had no grades. So I’ll give you the narrative score.

The narrative score is that the program has been very successful achieving the goals that were defined at the outset. So the first iteration of the program, stage one, was all about getting organizations to adopt Health Information Technology, and I think all of the metrics that we’ve seen have validated that the program has been quite successful in accelerating the adoption of Health Information Technology, in both hospitals and practices. That doesn’t mean that we’re finished, but the vast majority of these organizations have now adopted Health Information Technology. Are there additional goals that we’d like to be able to meet? Absolutely, we’d like to see interoperability working better. As you mentioned, we would like the products to be more usable, and therefore, safer.

We’d like to see patients even more engaged than they currently are, so they have more access to the information in their records. We’d like to solve a problem that we’re starting to see in the industry, which I started to call hyperportalosis, which is that in any given community, there may be many portals that patients are expected to log in to. So we’re trying to think about how those problems can be solved in the next iteration of the HITECH program.

What Would You Give Up For a Virtual Doctor Visit?

Sep 13, 2014• 1

By Girish Navani

With the fast adoption of smart phones, tablets and wearable devices, the way people communicate, travel, eat and entertain have all been simplified. Why not streamline the way we experience healthcare as well? A study released in May 2014 from MDLive discovered that 82% of young adults 18-34 would prefer consulting with their doctor via a mobile device than show up for an appointment. Twenty seven percent of patients confirmed they’d be willing to give up shopping for a month, skip their next vacation, even refrain from showers for a week—if it meant they would be able to access their doctor via a smart phone! These results, along with the multiple surveys and studies conducted in the past year, confirm that a new way to conduct healthcare services is in high demand.

The solution to changing up the healthcare system sits at the center of three key advancements: patient engagement, population health and electronic health records (EHRs). At eClinicalWorks, we consider these components of healthcare to be like a three-legged stool where two cannot stand without the other. We recognized this need as an opportunity within the healthcare IT space and created healow in order to provide our customers and their patients with a platform to schedule doctors’ appointments and get immediate access to medical records via an online interface or mobile app. healow empowers doctors and patients by packaging personal health records (PHRs), healthcare tools and appointment scheduling together, making the data readily accessible to patients and their doctors from the palm of their hand.

CVS Health: Breathing a Little Easier and Holding Our Breath

Sep 11, 2014• 2

William G. Shadel

Well, it’s official: CVS has stopped selling cigarettes and other tobacco products.

The sales ban will cost the multi-billion dollar pharmacy chain about $2 billion a year in profits. But the hope is that the move will provide a more consistent health promotion message to consumers (it has changed its corporate name to CVS Health) and lead to new business (for example, through visits to its in-store health clinics).

But will this move have any effect on smoking in the population? It’s difficult to say at this point.

The impact of the ban on overall tobacco sales nationwide will probably be negligible. Only a very small percentage of consumers buy their tobacco at pharmacies and there are plenty of retail options available beyond the local pharmacy.

CVS is also banning the sale of electronic or e-cigarettes. Advocates from this industry are predictably agitated: “It’s smoking that causes all the health problems, not the smokeless alternatives.” Others argue that e-cigarettes and other smokeless alternatives are effective aids for those wishing to quit-smoking.