The Week’s Most Interesting Healthcare Reading (that you might have missed)

We’re going to start something new on Prognosis this week.  It strikes me that, each week, there is an avalanche of news about not only new policy developments in healthcare but also new innovations in both medical technology and health practices.  It’s impossible for any one person to keep up with it all.

So, each Friday in this space, we’ll spotlight some of the most interesting developments in U.S. healthcare from the week that either bear repeating or may not have captured the widespread attention they deserve.

Among this week’s most eye-catching articles:

•     A new pacemaker has been developed that will allow patients to have MRI scans

•      In Tennessee, physician, hospitals and insurers are working together to improve care and reduce costs.

•     Their work is largely unheralded, but a new study says healthcare group purchasing organizations are generating $36 billion in annual savings

•      A leading insurer, Aetna, is providing grants to a number of universities to better understand the causes of life-endangering obesity in minority populations.

•      Is there an app for that? The Institute of Medicine is challenging college students to use mobile smartphone applications and social networking to address health issues on campus.

•      And speaking of smartphones, the McKesson Corporation announced a plan to sponsor research into how mobile technology can be used to improve patient care for Americans with diabetes.

If you see a story about U.S. healthcare during the week that you feel deserves a broader audience, be sure tocontact us and call it to our attention.

This article was originally posted at http://prognosisblog.com/2011/02/the-week’s-most-interesting-healthcare-reading-that-you-might-have-missed/

Electronic tablets break down educational barriers in R.I. schools

By Linda Borg

Jalixa Ramirez, a seventh grader at the Trinity Academy for the Performing Arts in Providence, uses an iPad to read her essay. The charter school’s 34 students use iPads to write essays, edit videos, practice math skills and e-mail homework.

PROVIDENCE, R.I. — Step into the Trinity Academy for the Performing Arts in South Providence and this is what you see: seventh graders using iPads to write essays, edit videos, practice their multiplication tables and e-mail their homework to teachers.

The iPad and other electronic tablets are quietly revolutionizing the way a handful of Rhode Island schools provide instruction, communicate with students and parents, and evaluate teacher performance.

West Warwick is about to pilot a Windows-based tablet program in two of its elementary schools.

Woonsocket offers dozens of online courses in everything from Mandarin Chinese to bioethics.

Providence is using the iPad to evaluate what teachers are doing in the classroom.

And the Rhode Island Association of School Principals is training educators from 15 public school districts on how to use the iPad in the classroom, in the central office and in special-education settings.

Because Trinity, a first-year middle school charter, only has 34 students and 6 teachers, it can afford to give an iPad to every student. At $500 from the school’s operating budget, the iPad is cheaper than a typical laptop, more portable, and, with its touch screen technology, easy to use.

Delaney Jimenez, a seventh-grade student at Trinity Academy for the Performing Arts in Providence, discusses her idea that she illustrated on her iPad as she is timed by fellow student Preston Powell with his iPad.

At Trinity, the iPad has nearly eliminated the need for paperback novels. The school buys one book for $6 and downloads 34 copies. And there are many books in the public domain, such as the entire works of William Shakespeare, available free of charge. The potential for cost savings is considerable.

“When teachers say, ‘Get out your worksheet,’ I’m like, ‘OK,’ ” says 12-year-old Teri Thompson. “When they say, ‘Get out your iPad,’ I’m like, ‘Yes! The iPad!’ ”

“It’s not boring like when you have pen and paper,” says Jalixa Ramirez, another seventh grader. “Plus, it’s much easier to organize your work. You can save everything to a file.”

Sharon Hussey, the executive director of the Rhode Island Network for Educational Technology, calls the iPad a “transformational device” because of the way it allows students and staff to interact with a host of applications, from math games to streaming video.

“Students today are constantly around technology,” says Jennifer Patten, a seventh-grade history teacher. “That’s how they engage. The iPad heightens that engagement. It gives them access to a wealth of information that goes beyond the textbook and it allows them to be critical of what’s out there.”

Last week, students watched the Egyptian revolution develop in real time by watching live blogs and broadcasts from CNN and other media sources. “Students were able to see history unfold in front of them,” says Elizabeth Richards, the artistic director of Trinity, which is dedicated to the performing arts. “And this was a revolution which arguably began online.”

Trinity uses the iPad to foster a constant dialogue between students and teachers. A child can submit a homework assignment and get almost instant feedback. An essay can be revised several times with teacher input before it is submitted for a grade. If a student forgets his homework assignment, he can e-mail his teacher from home.

“It gives students safe, secure, unprecedented access to us,” Richards says.

Trinity has also created a math portal that allows parents to review their child’s homework assignments via the iPad or a personal computer.

Of course, with greater freedom comes greater responsibility.

That’s why Trinity has developed a detailed policy, signed by student and parent, which explains how the iPad can be used. For example, the use of social networking sites is prohibited. Students may only access the Internet through a specific application that filters out inappropriate material. And the iPad must never be left unattended.

“It’s like my baby,” Ramirez says. “I don’t let anyone take it from me.”

“So far,” Richards says, “we have had zero problems with broken iPads, zero problems with stolen iPads and zero problems with serious violations. The kids are rising to that level of responsibility. That’s what we as a school are about.”

Trinity also understands that the new technology is also about having fun. For Christmas, the school bought several game applications, including the wildly popular Angry Birds, for students.

And Trinity is constantly discovering unexpected ways in which technology enriches learning. Richards says that a student e-mailed her about a friend who was in a potentially unsafe situation at home. The school was able to address it immediately.

“The iPad doesn’t make or break what goes on in the classroom,” she says. “You still need dedicated teachers and a quality curriculum. But it’s a huge asset to increase the diversity of content in the classroom. And it puts at students’ fingertips some of the technology that is changing the way the world works.”

Although technology is expensive on any large scale, there is little doubt that school districts large and small are beginning to embrace it.

According to a recent study by Education Week, a national teachers’ magazine, 46 percent of public school districts offer distance learning over the Internet or through video conferencing and 53 percent use online curricula.

But there continues to be a gap between what teachers want and what they get. Although more than 80 percent of teachers surveyed said they would like to use technology in the classroom, 47 percent said that funding for such technology is inadequate.

In the meantime, some districts are harnessing the technology they already have.

In Woonsocket, high school students use videoconferencing to bring authors into the classroom, communicate with other schools, and share data. One day, students piled into the library to watch a surgery performed in real time.

But it is the district’s distance-learning program that has generated the most buzz.

Located in the Woonsocket Area Career & Technical Center, the E-Learning Academy offers 200 electives and 13 advanced-placement courses that students can take on school computers without sitting in class.

What began six years ago as a credit-recovery program has since morphed into a virtual high school that enrolls more than 500 students.

It has saved more than a few students from certain failure, says coordinator Michael Ferry. Last year, a sophomore walked into Ferry’s office and said, “I quit.” After talking with the young man, Ferry realized the student’s biggest problem was getting to school on time.

“Can you make it here for 10 a.m.?” Ferry said. The student said yes.

The student showed up every day and took two courses at a time. He went to summer school.

He kept asking, “Am I a junior yet?” and Ferry kept saying, “Keep taking courses.”

Last spring, he asked the same question. This time, Ferry said, “I’ve got some bad news. You’re not a junior. You’re a senior.”

The young man graduated in June.

“I call them my angels,” Ferry says. “There are 500 stories like this one.”

Not every student is cut out for the traditional high school. Distance learning is perfect for the young mother, the student who is struggling with English or the student who has to work to support his or her family. It also works for the teenager who is “school-phobic,” who can’t deal with 2,000 students and all of the attendant drama.

“Technology offers flexibility in scheduling and the ability to work anytime,” Ferry said. “We would never be able to service these kids face-to-face.”

Working with a company called Nova Net, the high school took the company’s online courses and aligned them with its own curricula. Ferry said that the students taking the online courses receive the same content as those taking the face-to-face classes. The beauty is they can work at their own pace.

Students use this program to make up credits, and Ferry says that 56 students graduated last year thanks to the opportunity. Students can also access the curricula from home.

In Providence, iPads provide a fresh take on the classic “learning walk.” In the past, principals have observed teachers and then scribbled their observations on a long worksheet. The iPad not only makes it much easier to complete the evaluations, it aggregates the data and helps schools identify strengths and weaknesses in each subject.

The observations are not a “gotcha” exercise, however. Rather, they are an attempt to collect feedback from individual classroom visits, collate the data, and spot trends. Are students engaged? Are teachers mixing up different styles of instruction? Does the student know what is being taught and why? Ultimately, the information will be used to give teachers feedback on how to refine instruction.

“It’s important that we look at what we’re doing,” says Lenora Goodwin, an AP environmental-science teacher at Central High School. “I have good days and bad days, but I know that in the end I’m moving my kids along.”

lborg@projo.com

This article was originally posted at http://www.projo.com/news/content/new_school_technology_02-21-11_MCMH38V_v32.1940e6d.html

 

 

 

Interview with HIMSS CEO Steve Lieber: Mobile is the future

Health IT is very much in a transition phase right now. The “meaningful use” incentive program for electronic health records is underway, though in its early phases. National health IT coordinator Dr. David Blumenthal is departing government service in April, even as federal officials work to develop regulations for Stage 2 and Stage 3 of meaningful use.

And right at the nexus of all the change is mobile healthcare, according to H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society (HIMSS).

“The laptop is almost becoming a bit outdated as we move to smartphones and tablets,” Lieber said last week in a wide-ranging interview ahead of the organization’s annual conference, now underway in Orlando, Fla. Mobile is the next evolution in information technology, and we’re right on the cusp of the mobile era.

“It’s where we’re headed. It’s the future,” Lieber said. “The ability to deliver care from somewhere else [while] the patient is in still a different place, that very much is where we are headed.”

Lieber did acknowledge that some people are already there. “It’s certainly current for many. It’s the future for all,” he said.

In many ways, HIMSS conference is a new venue for mobile technology. While Sprint CEO Dan Hesse keynoted at HIMSS10 in Atlanta and more than 200 of the 900-plus vendors at HIMSS11 claim to offer mobile applications, mobile is struggling to find the spotlight in this massive event.

As we reported last week, a good portion of the mobile-related content at HIMSS is taking place outside of the regular conference.  Sunday featured a pre-conference RFID symposium, and mobile is central to HIT X.0: Beyond the Edge, a series of sessions on emerging healthcare technologies—including mobile, wireless and social media—that HIMSS really is running as a separate conference with an additional registration fee.

“The objective here is to bring into the HIMSS conference those things that you typically didn’t find prominently,” Lieber said of the X.0 programming. They’ve been there, but might have been hard to find. “You almost had to go looking for them,” he added.

“We want to be bringing into the conference what’s coming or what’s here but hasn’t necessarily been embraced on a widespread basis, as other technologies might,” Lieber explained. “It attracts a very different kind of audience.”

How much so? Of the approximately 900 people who signed up for HIT X.0, more than half had never attended HIMSS before, according to Lieber, likely because they didn’t see enough value in the main conference  to make it worth their while.

“We were successful in reaching out to a different audience, focusing on a different subject and structuring it in such a way that the audience recognizes that this is not typical for HIMSS,” Lieber said.

Lieber did caution against falling victim to unreasonable expectations some may have set for mobile health. “We see it all the time, in terms of hype cycles and booms,” he said.

“People need to be careful as they’re looking at applications and they’re looking at hardware, making sure that it’s designed for the environment,” Lieber cautioned. “The iPad wasn’t really designed for a linoleum floor,” for example. Nor was it designed for hospital-grade sanitizers.

“There’s a lot that happens in the early days [of a technology]—people coming into the field who come from a different sector and think they can just transplant their product or learning to healthcare, and it doesn’t work quite that way,” Lieber added.

One area prone to hype is remote and home monitoring, but Lieber is optimistic about its future. “Home care, that’s an area that still is in its infancy—if it’s even barely in infancy—that’s going to be another transition that we’ll see over the coming years.”

Of course, lack of reimbursement has held back wider adoption of wireless monitoring technologies. HIMSS is not actively lobbying insurers to pay for telehealth services, but the organization historically has been slow in getting into financial and reimbursement issues. “It’s related to what we do, but we’re much closer to the technology, the hardware and software issues,” according to Lieber.

But the time is coming. “What we are starting to see is a recognition by the payers that it’s in their best interest to find the ways to provide the right kind of reimbursement and incentives that help move care to the lower-cost—and oftentimes more-effective—setting,” Lieber said.

Insurers must make sure that they aren’t just paying for a service on top of regular care, though, Lieber said. “They’ve got to figure out how [to] bring that reimbursement scheme in that provides the right incentives that shifts it from a higher per-unit cost to a lower per-unit cost.”

This article was originally posted at http://mobihealthnews.com/10268/interview-with-himss-ceo-steve-lieber-mobile-is-the-future/

Mobile solutions, new tech to play key roles at HIMSS Read more: Mobile solutions, new tech to play key roles at HIMSS

Along with interoperability, mobile solutions and new digital technologies will be among the biggest foci of the upcoming HIMSS conference (Feb. 20-24) in Orlando, Fla. We’ll be hosting an executive breakfast on Tuesday, Feb. 22 at the Wyndham Orlando Resort on mHealth’s ever evolving role in achieving Meaningful Use. And the health IT fair will showcase new mobile products from RIM, Sprint Nextel, and Siemens, which is teaming up with Enterasys.

NaviNet, which specializes in online communications between physician practices and health plans, will unveil its first set of mobile products since acquiring Prematics last fall. Prematics, which started with e-prescribing software subsidized by health plans, now offers clinical messaging and care management platforms, as well. NaviNet has integrated these patient information capabilities with its own revenue cycle management solution and connections with health insurers.

Health plans will also be represented at HIMSS through recent acquisitions of health information exchange (HIE) vendors. Axolotl, which was purchased by United subsidiary Ingenix, and Medicity, now part of Aetna, both will have a presence. Ingenix also will be touting its acquisitions of Picis, A-Life Medical and Executive Healthcare Records.

Also of interest on the exhibition floor will be the emergence of the “digital pen” technology, which promises to make it easier for physicians to document visits in electronic health records. Shareable Ink, already being used in many emergency departments, is about to announce a deal with a major ambulatory EHR vendor. Anoto, another digital pen firm, describes outpatient EHR vendor NextGen as its partner.

To learn more:
– explore the conference agenda and exhibitor list at the HIMSS website
– read about the Navinet-Prematics solution

This article was originally posted at http://www.fiercehealthit.com/story/mobile-solutions-new-tech-play-key-roles-himss/2011-02-14

Education Budget Makes Tough Choices to Allow for New Investments in Early Learning, Reform and Innovation, Teachers and Leaders, and College Completion

Deep cuts and efficiencies in several key education programs will help fund new education investments to keep American students competitive in the global economy under the proposed 2012 Obama administration education budget. The President released the budget at a Baltimore public school on Monday, February 14.

“We are cutting where we can to invest where we must,” said Education Secretary Arne Duncan, who joined President Obama for the announcement. “These are challenging times, but we can’t delay investments that will secure our future. We must educate our way to a better economy by investing responsibly, advancing reform and demanding results.”

Areas for new investment run the spectrum from early learning to college completion, and include funding for formula and competitive K-12 programs, including a new district-level Race to the Top program with a rural set-aside and another round of Investing in Innovation grants. The budget also includes new and expanded programs that support teacher and principal effectiveness.

Not including Pell Grants, the administration’s 2012 budget request for the Department of Education is $48.8 billion, an increase of $2 billion or 4.3% over the 2011 budget, which was not approved by Congress and is being funded through continuing resolutions.

The Department expects demand for Pell grants to reach 9.6 million students next year, up from 6 million in 2008. The President’s budget protects recent increases in the maximum grant to $5,550 while ensuring that all eligible students continue to be served.

In order to sustain the program in a responsible way, the Administration proposes saving billions by eliminating subsidies for graduate students with loans and eliminating a provision that enables some students to receive two Pell grants in a single year.

“These are very tough choices but with rising demand, we have to stretch our dollars as far as possible and do more with less,” Duncan said.

In addition to eliminating 13 programs that will save $147 million next year, the Administration will cut $265 million in career and technical education (CTE) grants. States will still receive $1 billion in CTE grants next year as well as $3.1 billion for Vocational Rehabilitation State Grants and $635 million for Adult Education grants.

“Career education is vitally important to America’s future but we need to strengthen and reform our programs before expanding them,” Duncan said.

Other highlights of the budget include:

• $350 million for a new Early Learning Challenge Fund to boost quality or early learning programs.
• $900 million for a district-level Race to the Top program with a rural set-aside.
• $300 million for a new round of i3 (Investing in Innovation) grants.
• $500 million more for Title I (for low-income students) and IDEA (for students with disabilities) formula programs.
• $150 million for the Promise Neighborhoods program, which integrates educational and social services in targeted communities.
• $100 million more for after school programs (21st Century Community Learning Centers) for a total of $1.27B.
• $54 million more ($600 million total) to turn around low-performing schools
• $4.3 billion for teacher and principal preparation programs. This includes formula grants to states, alternative certification programs, STEM teacher prep programs, funds to support a well-rounded education, minority teacher recruiting programs and scholarships for high-achieving students to work in high-need schools.
• $175 million in competitive grants to boost college completion.
• $90 million for a new education research and development program and $60 million more for research and evaluation programs at IES.

“These targeted funding increases reflect the administration’s competitiveness agenda and our continuing commitment to protect students most at risk while supporting reform at the state and local level,” Duncan said.

In addition to setting aside some new RTT funding for rural districts so they get a fair share of the dollars, Duncan said that the competition would, “Recognize districts leading the way in terms of increasing productivity and raising student achievement.”

Additional information on the U.S. Department of Education’s FY 2012 budget proposal is available at http://www2.ed.gov/about/overview/budget/budget12/index.html.

This article was originally posted at http://www.ed.gov/news/press-releases/education-budget-makes-tough-choices-allow-new-investments-early-learning-reform

Utah Poised to Lead in Online Learning

Utah is on the verge of having the best K-12 online learning policy in the country.  SB65 makes provision for multiple statewide providers and student choice to the course level.

While high schools around the country are cutting expensive courses, students in Utah high schools this fall may have access to every AP course, any foreign language, and high level STEM courses rich with computer simulations.  Assuming bill passage, students that are struggling will have several personalized options that will allow them to catch up.

SB65 encourages providers to support completion by withholding 40% of the funding until student successful finish a course. The bill expands options and creates the opportunity for students to graduate in three years.  More options, better outcomes, reduced costs—it’s a good deal for Utah students, schools, and taxpayers.

The bill reflects the recommendations of Digital Learning Now, a December report from an expert panel co-chaired by former governors Jeb Bush and Bob Wise.

Super-advocate Robyn Bagely of Parents for Choice in Education and Open High School organized a capital breakfast for legislators this morning.  Michael Horn of the Innosight Institute shared findings from his book Disrupting Class, co-authored with local hero Clayton Christensen.  Michael thinks online learning is an important disruption to ineffective historical education practices because it is affordable, scalable, flexible, and a mode natural for students.

Horn was great, but a panel of sophomores from Open High was the highlight for senators and representatives, and school board member.  They mentioned ten benefits of online learning:

1. I can work ahead if I’m able to
2. I get nearly instant responses from my teachers
3. I get personalized support when I need it
4. My teachers are just as excited about online learning as I am
5. I can do all my math for the week on one day if I want to
6. I know how I’m doing, my grades are right on the screen
7. My parents can see my work and grades
8. My courses are more challenging
9. I can keep up with my work when my family travels
10. I can work around a busy schedule

Utah has a history of innovation in education.  Utah was an early leader in distance learning with Electronic High School but the content is dated and it’s funded through a supplemental appropriation (which is not sustainable or scalable).  Utah also gave birth to Western Governor’s University, a leader in affordable competency-based higher education.   Gov Leavitt was a leader in the development of early college high schools where student can earn an AA degree with their high school diploma.  Open High School is statewide virtual high school making extensive use of open education resources.

Mickey Revenaugh, Connections Academy, and I represented the International Association for K-12 Online Learning (iNACOL) at the breakfast.

Utah is near the bottom of average per pupil funding in the U.S. but near the top in terms of the tax burden per capita as a result of youngest demographic distributions in the country.  School funding isn’t going to get better any time soon.  Many legislators realize that they’ll need to incorporate online learning to expand options, boost achievement, and do it for less.   Sen. Howard Stephenson, the bill sponsor, thinks SB65 fits the bill.

This article was originally posted at http://edreformer.com/2011/02/utah-poised-to-lead-in-online-learning/

 

Top 10 Benefits of Online Learning

Choosing Online Learning

Choosing to go to school for an online education is a personal choice. Weighing the decision involves learning the benefits and the drawbacks of the online learning environment. Here we cover the benefits of online learning to the student in his or her personal and professional life.

Top 10 Benefits to the Student in Online Learning

1. Flexibility- learning online can give flexibility to the non-traditional student, professional student or the rural student, caused by saved travel time. Students will not need to plan for rush hour traffic. Also, harsh travel conditions call for students who go to a traditional class to prepare for extra travel time. Learning online saves valuable time and allows more flexibility in the learner’s life.

2. Diversity- students learn alongside people from all over the country and even world. This diversity causes the student to see different views, broadening their experience. This will teach students to speak better in their professional lives.

3. Technology- Student confidence will grow when he or she has better computer skill. Online students will also bring this knowledge to the work environment.

4. Deadlines- students must meet deadlines for reading, writing, and meeting online at set times. Meeting a deadline will be vital to work place success.

5. Support- students in an online learning environment share the experience and critique one another. Critique is meant to help; hence, students get more peer-guidance than in a traditional course.

6. Professional Growth- professional students will see the value of their education at work and motivated to continue. Transfer of learning from the classroom to work life will improve the student’s understanding of the subject matter and set him or her apart among other professionals.

7. Reading, Writing, Listening and Speaking Skills- Working in an online course will cause a student to read and respond critically and articulate well and intelligibly. This is a great benefit to a future employer. Employees who speak well with other professionals form strong relations and respect in the work place.

8. Prioritizing- Students in online learning create a balance of other daily life activities. They must learn to arrange time as there are deadlines to meet. Coordinating activities and prioritizing tasks are vital skills in the professional environment.

9. Choice- This will give the online learner the freedom to decide when and where learning is right for him or her. The student can decide if he or she is a morning person or night owl. Students have the choice to decide if they like to study in a quiet room or where the family is.

10. Discipline- Students in an online learning environment will learn to take responsibility for their learning. They will learn to follow written directions, think and reply critically, and research online, all of which will improve professional abilities.

From Challenges to Benefits

In researching whether to go for an online education or not, one will become well aware that there are some problems to face when studying in an online environment. More research needs to be conducted so the schools offering online programs can improve the learning experience.

Also, online learning is not for everyone. Some students are incapable of handling the time restraints to meet the deadlines, finishing the independent work in the course, or overcoming the lack of face-to-face instruction and feedback. Yet, these challenges can be the same benefits of online learning if they cause the learner to grow personally and professionally.

This article was originally posted at http://www.brighthub.com/education/online-learning/articles/29375.aspx

Will Health Data on Mobile Devices, iPads, Be Private and Secure?

There have been many recent and public events involving security breaches of electronic medical records and other patient data in hospitals. The unfortunate event in Tucson, Arizona where a Congresswoman was shot, led to the firing of three curious clinical support staff members for improperly accessing EMRs at  the University Medical Center where the Congresswoman was being treated. In Iowa, five total hospital employees were disciplined (three fired) for violating federal law by viewing the medical records of hospitalized University of Iowa Hawkeye football players.

Beyond curiosity, one would think that people want to access medical records information from newsworthy people and events to try and sell the stories to the media who obviously would pay large sums of money to be the first to break the story about something like Michael Jackson’smedical past. But, then I wonder why a Las Vegas man, would go through the trouble of organizing a patient records scheme where he used private hospital files to solicit business and clients for a personal injury attorney. He obviously has some decent planning skills and would be better off in Wall Street, where schemes such as this go largely unnoticed, and can go on for quite some time.

I began to think about the possible issues stemming from physicians rapidly adopting mHealth applications on tools such as iPads, Android devices, Blackberries, and others. I posed the question on a Center for Democracy and Technology forum about Health 2.0 and HIPAA, as I thought about physicians moving around a medical facility with a device in hand containing lots of private patient medical information.

Barry Chaiken, MD, former chair of HIMSS and chief medical officer for Imprivata, shared 5 Key Considerations for Hospitals to Ensure Mobile Device Security in Becker’s Hospital Review.

Here they are:

1. Keep data in a cloud: Perhaps none of the data can be saved on the actual devices, because of their portability.
2. Get creative with passwords: More sophisticated authentication is evolving, so its necessary to have a unique password.
3. Limit how devices are utilized: Hospitals and medical centers should configure access so that the hospitals control what is seen and accessed through a cloud.
4. The ultimate goal should be zero breaches: Hospitals are at risk for losing not only patients, but also lots of money in remedying security breaches.
5. Keep up with trends in technology: Hospitals should stay updated on the latest trends in technology and security applications.

Outlining preventative steps such as Dr. Chaiken’s will help reduce the risk of security breaches as the mHealth market continues to grow, and physicians adopt mobile devices as a convenient way to help deliver efficient and accurate patient care.

This article was originally posted at http://www.medicalrecords.com/2011/02/04/blog/will-health-data-on-mobile-devices-ipads-be-private-and-secure.html

Physician Executives Should Not Ignore How Smartphones Will Transform Healthcare

Physician executives who ignore smartphones and their healthcare applications will miss the most important disruptive technology trend in the next five years. Physician executives who understand how smartphones will transform the industry for providers, payers, patients, and employers will thrive in their careers.

Rajeev Kapoor, a former executive at Verizon, describes the smartphone-enabled transformation: “The paradigm of healthcare has changed. You used to bring the patient to the doctor. Now you take the doctor, hospital, and entire healthcare ecosystem to the patient.” (http://ow.ly/3GIir) Susannah Fox of the Pew Research Center’s Internet and American Life Project offers a specific example when she talks about the celiac disease patient who uses her smartphone to evaluate food products in the grocery store.

“You cannot call your gastroenterologist every time you buy a new product.” (http://e-patients.net/index.php?s=fox) David Jacobson of Wellpoint notes that “The technology of telehealth is well ahead of the socialization of the telehealth idea and we are at a tipping point for utilization to begin taking off.” (http://ow.ly/3GIir)

The Global mHealth Developer Survey found that today 78% of respondents said that smartphones offer “the best business opportunities for mobile healthcare” in 2011; by 2015, 82% said smartphones would dominate the industry. Cell phones, tablets, and PDAs trailed smartphones in popularity according to the survey. (http://ow.ly/1aVf9V)

Smartphones run on a specific operating system and can download applications (apps) that run on the operating system. The most popular operating systems in the United States are iPhone, BlackBerry, Windows Mobile, Palm, Web, Symbian, and Android. (http://ow.ly/3GIwf) We are just beginning to discover how to harness the smartphone’s computing power, cameras, audio, video, motion sensors, and GPS functions to better manage health and wellness. (http://ow.ly/3gVzg)

In contrast to the rather slow adoption rate for both health information technology and personal health records, smartphone use is skyrocketing. In October 2006 15% of Americans owned a smartphone; by December 2009 that number was 42%. Surprisingly, one report noted that the smartphone market was “unfazed by the recession.” (http://ow.ly/3GIwf) In late January 2011 Apple reported that someone downloaded the 10 billionth app for the iPhone. (http://ow.ly/3IlLY) That lucky smartphone user received a $10,000 gift card to the iTunes store.

Why are smartphones so popular? The ability to carry around a handheld computer that is user-friendly and that allows users to do things anywhere at any time is attractive. One research whitepaper coined the term “care anywhere” for smartphone-enabled health care. (http://ow.ly/3GIir) But it has to be more than just that when people routinely say they “love their iPhone.”

MIT’s Sherry Turkle in her book Evocative Objects: Things We Think With writes “We think with the objects we love, and we love the objects we think with.” She also emphasizes how important it is that we carry this “second self” with us at all times. Mark Rolston, chief creative officer of Frog Design, observes that people grieve when they lose a personal electronic device. “You are leaving your brain behind,” he says (http://ow.ly/3jjCG).

Joseph Kvedar, MD, director of the Center for Connected Health at Partners HealthCare in Boston, states that humans find it easy and natural to anthropomorphize pet rocks and tomagotchis, and that we are truly forming trusting relationships with our smartphones. (http://e-patients.net/index.php?s=fox) In her new book, Alone Together: Why We Expect More from Technology and Less from Each Other, Turkle explores the positive and negative consequences of this love affair with smartphones and other forms of technology.

Demographics will also drive increased use of smartphones in health care. The first of the 78 million baby boomers will turn 65 in 2011 and as the sandwich generation who are concerned about the welfare of their children and their parents, they know the importance of health and wellness. Boomers also lead all generations in technology spending, and they will use smartphone technology to foster ongoing independence for themselves and to care for their relatives who live across the country. John Sherry, Director of User Experience Design for Intel, observes, “A number of economic, generational, and societal factors combine to make boomers likely early users of remote health monitoring and management products.” (http://ow.ly/3GIPJ)

Smartphones will transform healthcare by offering solutions in four classes of activities: communication, transactions, knowledge, and integration of information. (http://ow.ly/3GIir)

Communication

Communication between all players in the healthcare space will be changed by the use of smartphones. The most obvious arena to examine is the patient/doctor relationship. People who access scientifically sound advice through their smartphones wherever they find themselves can become more independent, empowered, self-managing patients as the above celiac example shows. Smartphones also make patients more likely to participate in online conversations with other patients on social media websites like PatientsLikeMe and DiabetesMine. Patients want to communicate with their physicians via email, but physicians have been slow to accommodate this desire. Although many consumers have not been able to use smartphones for communication with their provider, 85% of those that have connected with their doctor by means other than face-to-face were satisfied with their discussion. (http://ow.ly/3GIir)

Physicians worry about patient compliance, and 88% would like their patients to be able to monitor their weight, blood sugars, and vital signs on their own. 66% of physicians said they would like to use email for administrative communications like appointment reminders, but only 23% of consumers preferred communication by email for such simple communications. (http://ow.ly/3GIir) Forty percent of physicians said 30 percent of office visits could be avoided with the use of remote monitoring, email or text messaging with patients. (http://ow.ly/3GIPJ) A Mayo Clinic two-year study found that e-visits could replace in-office visits in 40 percent of 2,531 cases. (http://ow.ly/3GIir)

The Good Shepherd Health System developed their own iPhone app to help physicians access medical records, track vital signs, order medication, and coordinate care with other team members. Physicians from Duke, Harvard, and the John Theurer Cancer Center have worked with Zibbel, a health solutions technology company, to create a smartphone enabled virtual network for mobile cardiology and oncology consults between experts. (http://ow.ly/3GIir)

Smartphone technology can also change and improve communication between consumers and their pharmaceutical companies, health plans, employer, and health system. Michael Mathias, Aetna’s chief technology officer comments, “The days of mass communication are over. We can now deliver customized communications through mobile apps, online, telephonically, or through mail based on our understanding of how each member wants to be communicated with.” (http://ow.ly/3GIir)

Kaiser and Mayo are both developing smartphone apps to help patients managing chronic conditions and healthy consumers who want to stay fit. Scott Eising of Mayo Clinic says, “We’re a very content-oriented organization. In our research into the mobile health consumer, we found that people are looking for very action-oriented information.” Mayo Clinic has launched Mayo Clinic Meditation and Symptom Checker iPhone apps so that we can “take care of patients here and ‘there,’ whether at home or at work.” (http://ow.ly/3GIwf)

Qualcomm is creating “the clinic without walls” to take care of its 12,000 employees in the San Diego area. Using the Myca Health platform, Qualcomm’s health staff can consult remotely with mobile employees via smartphones. “People are so connected to phones, they’re an extension of themselves. You can’t have your doctor with you all the time but the phone can keep you on the right path toward health and wellness,” states Dr. Marion Zabinski. (http://ow.ly/3GIwf)

Merck Serono has developed a smart electronic injection device with two-way Bluetooth communication functions that track all injections made by the patient. When an injection is missed, nurses contact the patient to remind them to adhere to the treatment plan. (http://ow.ly/3GIir)

Transactions

The ability of consumers to use smartphones to book a flight or make a hotel reservation has revolutionized the travel industry, and many predict health care will soon follow suit.

The first area in healthcare that has utilized smartphones for transactions is e-prescribing. The most common prescription orders that a doctor uses can be automatically populated on their smartphone. Donald Burt, MD, chief medical officer of PatientKeeper, says their 25,000 physician users spend 20 percent of their time on their smartphone. Trusted nurses can post prescription order request on smartphones, and the physician can modify or approve the order no matter where they are located physically. A PricewaterhouseCoopers 2010 survey found that over 80 percent of both specialists and primary care doctors were interested in e-prescribing using their smartphones. (http://ow.ly/3GIir)

Aetna has made transaction functions such as physician finder and claims check available on smartphones. CVS Caremark has iPhone apps for prescription drug information and patient management of drug refills as well as for retail location finder functions. (http://ow.ly/3GIir)

Knowledge

Allowing physicians to have access to the latest evidence-based medicine knowledge at the point of care may be the most exciting and important application of smartphone technology. In a national survey, one third of physicians responded they make decisions based on incomplete information in nearly 70 percent of the patients they see. (http://ow.ly/3GIir) Lay people are also utilizing this technology to become wiser consumers of health care.

Epocrates is perhaps the best example of a mobile reference resource that physicians turn to in real time for information about the patients they are seeing right now. Epocrates’ drug reference app is the most popular free medical download for iPhones, and one study documented that 60 percent of Epocrates users avoided three or more medical errors a month. More than 125,000 doctors use Epocrates on iPhone and iPod touch devices. (http://ow.ly/3GIwf)

UpToDate is another evidence-based, peer-reviewed information resource available via smartphones. Over 400,000 providers use UpToDate for their synthesis of the medical literature, the latest studies, and treatment recommendations. (http://www.uptodate.com/home/index.html)

Skyscape has put together the largest library of medical resources that is available for smartphones, and the Medical Encyclopedia from the University of Maryland was one of the top ten free apps in the iTunes Store in December 2009. FDA Recalls is a free app for iPhones that keeps clinicians on top of which products have recalled by the manufacturer. (http://ow.ly/3GIwf)

Diagnostic tools for clinicians are too numerous to catalog. Examples include Diagnosaurs for general diagnosis, ARUP Consult for laboratory, OsiriX for digital imaging, Instant ECG for ECG interpretation, Vigilance for Emergency room situations, AirStrip OB for obstetrics, and American Well for remote physician consultations. (http://ow.ly/3GIwf)

Consumers are also using smartphones apps to keep abreast of medical knowledge. The Evincii app matches symptoms to over the counter medications, and the Mayo Clinic Symptom Checker iPhone app became available in early 2010. (http://ow.ly/3GIwf) Consumer interest has been highest in fitness and weight control apps (Tap & Track, iTreadmill, Walk It! And Pedometer-Widget), Diabetes Management (Glucose Buddy, Handylogs Sugar), High Blood Pressure Management (HeartWise, My Blood Pressure and Heart Rate), sleep hygiene (Sleep Cycle Alarm Clock, Smart Alarm Clock), Stress Reduction (Stress Free with Deepak Chopra, Rage Eraser), and First Aid (Pocket First Aid & CPR). (http://ow.ly/3gVzg)

Integration of Information from Diverse Sources

Perhaps the biggest challenge for both consumer and physician is how to integrate all of this information that is available via smartphones. It truly is like drinking from a fire hose, and the amount of information can be overwhelming.

Health systems have been focused on implementation of the electronic medical records, and the Patient Protection and Affordable Care Act has provided billions of dollars to support rapid adoption. Unfortunately both the hospital systems and the Office of National Coordinator have largely ignored the importance of integrating mobile health into other health information technology efforts. For example, two thirds of physicians in a national survey said they were using smartphones in their practice that are not connected to either their office or hospital HIT systems. Thirty percent of physicians said their health systems or medical group would not provide support for smartphones. (http://ow.ly/3GIir)

Many physicians and hospital administrators, tired of wearing multiple devices on their belts, have wanted their IT Departments to consolidate all messaging functions to smartphones. Most hospitals already have invested in pagers, cell phones, Vocera badges, SpectraLink Wi-Fi phones, and two-way radios, and what works for maintenance staff may not work for ICU nurses. A research white paper reporting on the experience of smartphone early adopter hospitals recommends supporting a variety of devices at the present time, but it also warns against being too slow to adopt smartphones. It also points out that work processes have been designed around the currently employed technologies and replacement by smartphones will necessitate work process redesign which may result in cost-savings. (http://ow.ly/3HalT)

Smartphones in health care will not live up to their full potential if integration is not successful. No matter how many readmissions for congestive heart failure remote weight monitoring at home could avoid, such programs will fail if the information does not appear in the office or hospital medical record.

Joseph Kevdar, MD, director of the Center for Connected Health at Partners HealthCare, stated that while “sensor technology may be rapidly becoming commoditized, integration with EMR and data aggregation systems is not something we have done well. We need to get better at gathering information, adding logistical software to get to the intersection of all the data and population health management.” (http://ow.ly/3GIir)

There are technological advances that are promising, according to Kvedar. Emotional sensors predict the patient’s mood by analyzing their voice (Cogito) or by facial recognition (Affectiva). Bodytrace’s wireless weight scale, Telecare’s wireless glucometer, and Vitality’s GlowCaps device all can find mobile networks when the sensor is triggered and so transmission of clinical data does not require the patient to do anything. (http://ow.ly/3K2FR)

Conclusion

Smartphone technology is already transforming the healthcare industry, but many physician and hospital leaders have not thought through the implications of their widespread adoption by both consumers and physicians. By understanding the implications of smartphones for communication, transactions, knowledge, and integration, leaders can begin to map successful strategies and tactics during a time of delivery system and payment reform. As John Mattison, MD, of Kaiser Permanente states, “The new wellness delivery channel for ubiquitous care will be the smartphone, and it will happen sooner than you think.” (http://ow.ly/3GIwf

This article was originally posted at http://www.thehealthcareblog.com/the_health_care_blog/2011/01/physician-executives-should-not-ignore-how-smartphones-will-transform-healthcare.html