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Exploding #telemedicine market splitting into new businesses

Technology gurus have known for many years that telemedicine was possible, at least in theory. But a couple of decades ago, when thinkers first began to pilot-test virtual consults, the technology for delivering private video was extremely pricey. Most video communications took place in the corporate C-suite across a $100,000+ videoconferencing set-up.
Now, however, the worm has finally turned. Broadband Internet connections are available to virtually every consumer, at least if the unwired are willing to sit in a Starbucks or McDonald’s, and all but the poorest Americans can afford some form of smartphone or tablet which supports video.
Perhaps more importantly, intermediaries like DoctoronDemand, American Well and HealthTap have created custom platforms allowing doctors to collect cash on the barrelhead for small slices of their time. Meanwhile, Medicare and some private insurers  have begun paying doctors at market rates. In fact, United Healthcare has just announced that it will begin paying doctors the same rates for telemedicine consults as it does for face-to-face visits.

New telemedicine segments emerge
Despite all of the press hoopla, telemedicine is best described as emerging business rather than a mature one. In fact, it’s just beginning to spin off new business niches which address different needs within the healthcare industry. These include:
  • Franchising:  At least one company, GoTelecare, is offering franchise territories to entrepreneurs who want to run their own telemedicine business independently. This model doesn’t require the entrepreneur to  be affiliated with any particular health system or medical practice.
  • Development tools: A growing number of companies are focused entirely on developing telemedicine platforms which can be integrated into physician, hospital and payer systems. These platforms offer providers and payers pre-developed tools which they can use to offer virtual clinic services themselves.
  • Hosted platforms: Not surprisingly, a market is developing for hosted telemedicine technology which can be used with little development effort and white-labeled as its own. The time is coming fast when patients will expect hospitals and large physician practices to offer such services as a matter of rote.
Given the staggering cost of developing a substantial consumer enrollee base — something companies like AmWell must face — and that a large number of vendors continue to fight for these customers, entries into this consumer space should calm down soon. But vendors that develop telemedicine tools and hosted software have plenty of room to grow — so expect to hear more from them.

P.S.:  We’d be just tickled if you would take three minutes and  answer our short survey on  health IT content at https://www.surveymonkey.com/r/68RZB8Y 

Our recommendations:

  • If you’re a provider you need to figure out where you fit in the telemedicine world. Keep an eye out for platforms like PointNurse, which actually offers a bonus equity stake, in addition to standard pay to providers who are highly engaged.
  • If you’re running a small practice, you have the option of going through one of the national telemedicine brands — notably HealthTap, whose Concierge track is designed be an adjunct to doctors’ private medical practice. But bear in mind that hosted telemedicine platforms, the smarter ones boasting portal features, will also offer worthwhile opportunities as time goes by.
  • Hospital IT leaders should begin planning what their technical approach to telemedicine should be, with careful consideration, of course, of how their institution should handle new bandwidth demands. Regardless, they should assume that any practice the health system or hospital owns will offer a virtual clinic with 12 to 24 months from today.

Has Apple’s HealthKit already won the #wearables data game?

When devices like the Fitbit first came out, they were curiosities at best. While a few athletic individuals picked them up, they certainly weren’t a mass market phenomenon.

But by this point, it’s more or less a given that hospitals, health systems and medical practices need to reckon with patient-generated data. In what seems like the blink of an eye — though it took a few years to happen — the data generated by wearable health devices and apps has become a target for healthcare organizations.

As of January, Credit Suisse estimated that the wearables market sat at $3 billion to $4 billion, and that there were about 50,000 healthcare apps available. Numbers like these have put great pressure on doctors (who complained, early on, that a flood of new patient-generated data would do them little good) to integrate this data stream into their daily practice.

Apple in the lead

So which technology vendor is going to make integration of app and wearables data possible? While it’s too soon to call the race, it’s looking like Apple’s HealthKit will be the tool of choice.

Pilots of HealthKit technology are popping up everywhere, while several health organizations — including Ochsner, Duke and Cedars-Sinai — are hooking up HealthKit to the Epic EMR on one end and a host of digital health devices on the other.

Samsung, Google and Microsoft are also pitching technology that can perform similar functions, but they haven’t won over nearly as many testers or buyers as Apple.


P.S.:  We’d be just tickled if you would take three minutes and  answer our short survey on  health IT content at https://www.surveymonkey.com/r/68RZB8Y 


Our recommendations:

  • Before you go with the trend, look at what Microsoft and Qualcomm have to offer. Take a particularly close look at Qualcomm Life, the technology giant’s digital health division, whose 2net platform for digital health data integration seems to offer more than HealthKit at first glance.
  • Bear in mind that Apple has partnered with Epic Systems on HealthKit, which gave it an immediate marketing boost but says little about the scalability and robustness of the platform. If you’re an enterprise level provider you should definitely take the measure of Microsoft Health, a cloud-based family of solutions which include PHR Microsoft HealthVault, which conduct analytics on patient-generated data.
  • We’d argue that telemedicine demand is at least six months ahead of demand for health results based on wearables. If you have to advance your new-service efforts in just one area, go there first.

The patient as CEO of their care

PatientsHealthcare think-tanks like to talk about patient engagement and patient empowerment, and for good reason.

For one thing, patients are sometimes the only people who are in a position to notice that a drug wasn’t dosed correctly or a test wasn’t the right one.  If a hospital or doctor misses a med allergy, the patient could be the only one who stands between him or her and a potentially fatal encounter. And longer term, engaged patients find solutions that get them well.

Such patients aren’t always a joy to work with, perhaps. But the reality is, even if a patient seems to complain a lot or asks “too many” questions, they’re doing the right thing. Ideally, patients consider themselves to be responsible for the outcome of their care, at least when they’re well enough to speak up. Effectively, they’re the CEO of their own care, taking in inputs from well-qualified professionals but ultimately making their own decisions.

Unfortunately, providers can take an assertive patient who’s fighting to engage in smart self-care and make them feel small. Cranking out sarcastic or patronizing remarks, ignoring or under-responding to a patient’s requests for information or unfairly minimizing their worries can be a gut punch to patients who want to take an appropriate level of control.

But doing so  is quite counterproductive. We DO want  patients engaged and we DO want them asking questions. We want them to be confident enough to live a healthy life regardless of what that requires of them. Want them to maintain that confidence? Encourage it!

P.S.:  We’d be just tickled if you would take three minutes and  answer our short survey on  health IT content at https://www.surveymonkey.com/r/68RZB8Y 

Hospital policies make it tougher to get high-quality inpatient mental health treatment

Like many Americans, I have a family member with a major mental illness who sometimes needs inpatient hospital care. Because I have been a healthcare researcher and journalist for 25 years, I’m particularly well prepared to help him navigate the system and get him the attention he deserves.

But there’s one issue which crops up again and again, and despite decades of trying I haven’t been able to find any kind of remedy. And as far as I can tell, this policy — which is universal in my region — actually encourages the delivery of substandard care.

As many people are aware, there’s far too few inpatient mental health beds in many regions of the country. My sense is that the problem may be a bit less acute where I live, in metro DC, as my relative can generally find inpatient care when he needs it. But which bed in which hospital? That’s another story.

Like any other service, inpatient mental health treatment can vary substantially from one institution to another. And as a member of a family support group for mental health problems, I get lots of feedback on which psych units are well-staffed, clean, efficient, thorough, kind to patients and good with discharge planning. (Of course, I also have my relative’s feedback and my own impressions to refer to as well.)

However, area hospitals with psych units absolutely, categorically refuse to tell patients or their families whether a bed is available. Yes, they will typically tell a psychiatrist with admitting privileges whether they can take additional patients, but for reasons which are not clear to me, a shrinking number of psychiatrists choose to obtain such privileges. In fact, in many years of trying, my relative hasn’t found a single one who does do direct admissions.

So here’s what happens. Our family realizes that he needs help, so one of us takes him to a hospital where he feels comfortable and safe. That hospital puts him through several hours of “medical clearance,” and only then do they let us know that there are no open beds there. Then they try to convince us to take whatever bed is available anywhere they can find.

In the most recent case, they pressured us to send him to Hospital X, an underfunded, poorly-rated facility which I’d dearly love to see decertified and closed. Since his episode seemed to be tailing off, we decided to take him home and bring him to another good facility the next day, which we did, successfully. But given the coercive nature of the original facility’s approach, it took all of the strength we could muster to do so.

I am certainly aware that with the limited availability of psych beds, every hospital will turn patients away at times. But if the hospitals let patients and/or family members know whether there was even a chance of admission, patients could make informed choices. They could also choose between their preferred hospitals, rather than being sidetracked into those that did not deserve their patronage.

My guess is that such hospitals, whose psych units are often unprofitable, are colluding to make sure that the more effective, humane and resource-rich psych units don’t get all of the traffic. After all, if patients don’t know which units can serve them, it’s easier for facilities to ricochet them across the region and give some of the inpatient days to whichever player is next in line.

But even if there’s no conspiracy involved, the policy of keeping patients out of the loop is unconscionable nonetheless. If patients end up wherever they’re sent, hospitals have no incentive to offer improved services. And that just about defines “anticompetitive.”  I dearly hope someone calls these hospitals to account someday.

In the mean time, I dare any hospital administrator to defend these hospitals’ actions. I’m listening…

Healthcare quality data doesn’t help patients

Today, my 70-something mother called me to tell me about an interesting new site.  The site, which was featured by her local news channel, apparently offers some kind of scoreboard rating surgeons on how often they experience complications.

Being a healthcare weenie, I immediately shot the idea down. “Mom, that sounds like a good idea on the surface,” I said, “but there could be big problems with that data.”

For example, I explained, what if a surgeon had complications or deaths in five out of the ten times she operated? Sounds like she’s a dangerous hack, doesn’t it? Well, maybe not. “What if that surgeon only saw the sickest patients, and the five that did well would be dead or dying without her skills?” I asked her. “Wouldn’t you rather see her than someone who can only handle easy cases?”

She thought about it, and agreed I had a point. But being a disrespectful kid, I persisted in schooling her a bit more. “If I had to search for a surgeon, I’d love data on how many times that surgeon had performed the surgery I needed during the past year,” I told her, “especially if I needed a complex procedure like a heart or lung transplant.”  By that point, I think she’d already absorbed as much as she could, and it’s little wonder. This is complex stuff.

Unfortunately, my mother isn’t the only one who’s being inundated with allegedly helpful provider ratings info. With countless patients going around with huge deductibles — the conservative economists’ dream! — healthcare prices should be falling and care problem improving dramatically. The thing is, they’re actually having little or no impact on pricing (something my friend Andy Oramoutlines brilliantly in a recent article), and even less, arguably, on the quality of care. Even my mother, who has plenty of intelligence and common sense, has no real way to know whether a particular measure makes sense. (Not everyone’s secret ambition is to write for Health Affairs.)

As healthcare industry readers know, disputing the value of consumer-facing quality data is hardly a new argument. The battle continues to rage on whether any form of clinician or hospital ratings really captures usable data, or accurately reflect the acuity of the patient mix seen by providers.

The thing is, the issue is becoming more urgent, as employers force staff onto high-deductible plans and many exchange policies sport them as well. Also, the mainstream media is beginning to pick up on the (inaccurate) notion that all consumers need is the right data to make smart healthcare choices for themselves and their families.

Here’s where I stand. While I’m not a clinician or academic healthcare researcher, I’ve been studying and writing about the healthcare industry for 25 years, as well as managing chronic conditions for both myself and family. In other words, I’m about as qualified as any average Jane to leverage healthcare ratings. But even knowing what I know, I highly doubt that I’m equipped to choose a provider based on quality data. In fact, I’d argue that nobody is. Do even physicians know how best to judge their peers? I’d submit that they’d be guessing like everyone else.

The bottom line? Bad provider performance data is worse than none at all. Until some magic day when we figure out how to accurately, clearly and safely profile clinicians and facilities, asking them to rely on performance data can actually put them at risk. Do we want to do that?

Why Hospitals Are My Favorite Part of The Healthcare World

Since I began researching and reporting on the healthcare industry, some 25 years ago, hospitals have always been my favorite sector to explore. Whenever I say this, both my professional colleagues and personal friends look at me oddly. So I’ll explain.

A grand introduction

During the first few years of my career, I did the grand hospital tour of my part of Florida. I visited with about 50 senior executives in South Florida hospitals, or more or less every institution within a 100-mile radius. At the time, most were independently owned and operated, though now-Florida Governor Rick Scott was just beginning the hospital acquisitions which would form the core of Columbia Hospital Corp. I was getting pure, unadulterated Hospital Management 101.

For a wet-behind-the-ears junior reporter in her early 20s, it was very flattering to speak on more or less equal terms with CEOs who were bosses of hundreds or even thousands of people and commanded multi-million dollar budgets.

But what really got me excited about meeting them was seeing the CEOs “pull back the curtain” and explain — to some degree at least — how the astonishing number of moving parts actually functioned. It was like watching a technical genius pull the cover off a supercomputer and tell me exactly what those flashing lights, wires and chips could do.

The more I learned about hospitals, the more I was awed by the astonishing ballet bringing personalities, training, technologies, infrastructure and finance coming together into patient-by-patient care. And I was determined to master core hospital industry knowledge well enough to tell stories right, analyze trends properly and collect the right data.

Why hospitals are magical

Since those days early in my career, I’ve become convinced that hospitals are among the most magical institutions in the entire healthcare spectrum. While I’m sure hospital leaders can’t take time to dwell on this, it’s just astonishing that they manage to help as many patients as they do. The number of gears that have to mesh to say, get a moderately sick ED patient diagnosed, treated and admitted is beyond what virtually any other industry must engage.

Now, don’t get me wrong, I’m completely aware that bad hospitals with poorly meshing gears, indifferent staff or broken processes kill people every day. Some get closed down by CMS. (Here’s a particularly egregious example of a deadly facility, Los Angeles’ Martin Luther King Jr./Drew hospital, closed in 2007 after failing patients on just about every level.) And it’s no surprise to me that hospital staffers and clinicians make medication errors and surgical never events happen. But what continues to surprise is how rare they are statistically.

Maybe I’m romanticizing their mission too much — they are businesses of course, some of which with, for example, charity care policies that appall me — but I see well-run hospitals as the key to transforming the health of the nation. I’m not trying to minimize the critical work that community doctors, home health organizations, nursing facilities and other critical health organizations do, but I am suggesting that we rethink their relationship to hospitals.

Build from the center out

To me, the best way to harness hospitals’ amazing strengths is to centralize them as controllers of care, integrated far more intimately with their partners in other sectors. Obviously, this has been going on at a rapid clip with physician practices, but I’d like to see more community health planning work from the center out.

I’m certainly not suggesting that most care should take place in the hospital physically — you’ll never meet a bigger fan of mHealth/connected health/remote monitoring than me — but that hospitals are the only ones with the administrative and data management capacity to manage the health of a population. (We certainly don’t want commercial payers controlling everything, which is pretty much what we’ve got today.)

Ultimately, though, I have to admit to a sentimental attachment to hospitals, which opened their doors to me and led me into the endlessly fascinating world of healthcare.

And when I walk through the doors of a well-built, welcoming, well-staffed hospital replete with everything it takes to meet my health needs, I feel absolutely safe. And that’s how it should be, no?

Pharmas need to make strategic digital health plays


Pharmaceutical companies are some of the best-positioned players in healthcare, with a captive audience for their key products and muscular global relationships. And on the surface, it seems unlikely that they’ll lose their powerful grip on drug distribution and pricing anytime soon.

But in reality, I’d argue, the #digitalhealth revolution is putting their future at risk. Despite the size of the companies involved, digital health is poised to play havoc with pharma business models, just as with every other major healthcare industry sector.

The truth is, no one relies more than pharmas on a network of intermediaries to keep profits high. And digital health technologies are poised to be powerful disintermediators.

Here’s some recent events that underscore the need for pharmas to make substantial, strategic digital health plays:

  • Some pharmas are already going there, and it wouldn’t be smart to be outmaneuvered. For example, the news recently broke that Teva Pharmaceuticals has invested tens of millions of dollars in consumer telemedicine startup American Well. According to company CEO Erez Vigodman, the idea behind the investment is to help Teva “expand to solutions beyond medication.” But I’d argue that the quote was disingenuous at best. The pharma company enjoys a 13.6 percent profit margin on its existing drug business, and I doubt it plans to wander too far away from that business, or have any expectation that the Amwell investment will have any major impact on its nearly $22 billion in annual revenue. But investing in telemedicine could help Teva understand how its products will reach digital consumers.
  • Drug channel players see digital health as a way to gain control of consumers — and they may get it.  Take a look at how Walgreens, the largest drugstore chain in the U.S., is engaging with digital health.The chainjust announced that it will offer virtual medical visits in 25 states, working in partnership with telehealth vendor MDLIVE.While Walgreens doesn’t generally put the pieces together in its public statements, it is clearly looking to expand its digital service line substantially, led by Vice President of Digital Health Adam Pellegrini. Pellegrini’s job is to build out next-gen digital health and mHealth platforms for the drug retailer. Over time, I’d submit, when Walgreens has developed a global audience of drug consumers, it will have the muscle to squeeze far more profit out of drug sales distribution chain. Exactly how that will happen, I’m not sure, but controlling the next big direct-to-consumer audience will help.
  • Under new reimbursement schemes, providers will seek to control pricing risk, especially high-end drug prices, and digital healthcare could be their best weapon.  With providers increasingly signing value-based or even capitation contracts — hey, back to the future! — they’re going to need much tighter control of variable costs, and drug expenses are clearly a massive example. One way they’ll do that is by doing a much better job of managing chronic illness, which includes cutting down on the often eye-popping medication costs needed to care for such patients  While it won’t happen overnight, digital health solutions are likely to be the default source of data on chronically-ill patients in the near future. If pharmas want to maintain any control over how providers manage drug therapies for sicker patients, they’ll need to invest in mobile population health technologies themselves, and position themselves as the data vendor of choice.

Ultimately, the best justification is common sense. If pharmas want to understand and play effectively in the new digital health era, they’ll need to have skin in the game.

Why the time has arrived for the Chief Mobile Healthcare Officer

executive on phone

Right now, mobile healthcare is still in its infancy. While cool hipster devices that measure basic vital signs and count steps are everywhere, nobody in healthcare that I’m aware of is leveraging mobile tools for better health on a systematic, day-to-day basis.

But if healthcare organizations want to get ahead of the mobile healthcare phenomenon, it’s more than time for them to put leaders in place who sleep, eat and breathe mobile care delivery.

If healthcare organizations want to get ahead of the mobile healthcare phenomenon, it’s more than time for them to put leaders in place who sleep, eat and breathe mobile care delivery.

I’m talking about putting someone in the C-suite whose job it is to keep up with the astonishing rate of change in mobile health, grab ahold of technologies and software that bring care to the next level, and turn them into an engine for care improvement.

Creating a “chief mobile healthcare officer” slot is as important to the future of healthcare delivery as chief medical information officers are to today’s digital healthcare. In fact, I’d argue that healthcare organizations that don’t do this may lose the battle to transform, disrupt and right-size care over the next five to 10 years.

Why do you need a CMHO?

Why does a healthcare organization need a chief mobile healthcare officer? Consider the following:

  • Technologies like Apple’s HealthKit are quickly turning wearables data into a source of actionable insight for clinicians. However, HealthKit — and competing platforms developed by powerhouse competitors like Qualcomm — are still largely solutions looking for a problem. Who will know enough to decide what specs define the next-generation wearable data strategy?
  • Telemedicine has already become a viable means of delivering care, but it’s far from clear what a hospital or practice’s tele-strategy should be. And figuring this out isn’t just a matter of determining market demand or supporting the right technology. Determining how to play telemedicine, and harmonizing it with the delivery of traditional care, calls for a mature and nuanced view of the entire spectrum of digital health.
  • Moving ahead an organization’s mobile strategy involves working not only with established vendors like Apple, but also making some significant bets on startups whose dazzling ideas aren’t yet backed up by a solid track record.  If no one in your organization has both the skills and experience to make these bets, and the authority to pull the trigger, how will you ever make the transition to mobile care?
  • Managing the transition to a mobile-driven healthcare enterprise require will require more patient-facing development than virtually any IT job in the house — after all, in no other aspect of HIT is the patient controlling and carrying around the device healthcare providers want to access. Empowering a top leader to make these decisions makes it far more likely that this aspect of the mobile healthcare transformation doesn’t get neglected.

All told, I think it’s pretty clear that hospitals and practices that want to make a credible mobile play going forward — something they’d be foolish to neglect — they’ll need to put a very senior pro in charge of making it happen. Can anyone make a strong case to the contrary? Have at it, folks.


Anne Zieger is CEO of Zieger Healthcare Communications, an independent research and content development firm based in northern Virginia. She can be reached at anne@ziegerhealthcare.com or @ziegerhealth on Twitter.

Five easy pieces: A simple overview of #digitalhealth

digital health

Not long ago, digital health tools like telemedicine and remote patient monitoring were almost the stuff of science fiction. Were they technically possible? Sure. But the technologies needed to make them happen were bulky, expensive and hard for patients to use.

Today, we’re at the opposite end of the spectrum. Digital health technologies are growing to be much cheaper and simpler, so much so that we’re almost smothered in innovations leveraging cheap, ubiquitous wireless and broadband Internet connections. And this is bad for business. After all, it’s hard to tell how new ventures in the space will fare when it’s not clear what targets they’re addressing.

Despite the exponential growth of digital health market, and a seeming increase in complexity, digital health ultimately breaks down into a handful of categories which are fairly easy to follow:

  • Telemedicine: This sector of the market includes not only video-based medical consults by providers with patients, but also phone and text consults. Telemedicine is increasingly being seen as “real” medicine by health plans, some of which are actually paying for it. These days, it’s delivered by proprietary Web and smartphone services provided by vendors like HealthTap or DoctoronDemand, though doctors could theoretically use Skype or Google Hangouts.
  • Specialist telemedicine: There’s also a separate arm of telemedicine — such as the teleICU or telestroke consults — in which remote specialists may care for multiple at-risk patients at one. This type of service is particularly helpful to rural hospitals, for whom it may be nearly impossible to summon, say, a stroke expert on demand.
  • Remote monitoring: This once consisted largely of expensive add-ons to devices such as blood glucose meters and wireless scales. The add-ons beamed the data wirelessly to PCs, which shunted the data to doctors for use in improving care. In recent times, remote monitoring has become affordable and flexible, thanks to the explosion of relatively cheap wearable health tracking devices.
  • Connected health: This is a broad term which covers virtually all forms of digital patient-doctor connection. However, it’s beginning to look like self-described connected health ventures are focused on building a digital health “ecosystem” linking up providers, patients, caregivers and families.
  • Remote testing:  Several emerging companies are championing this concept, in which patients gain the means to perform sophisticated testing at home. For example, they might be given an all-purpose health monitor or sonogram wand which can be used with a smartphone. They can then bring the data to a face to face visit or beam it to a doctor during a telemedicine consult.

There are some digital health categories which are still too new to even deserve a “sector” label yet, such as virtual reality-based medicine. But the categories above offer a current look at the swiftly-diversifying world of digital health.

Our recommendations:

  • If you’re going to invest in these technologies as a venture capitalist, sink your money in remote testing. The companies that make it possible for everyone from third-world doctors to suburban housewives to monitor their care are going to change the world.
  • If you’re a provider trying to figure out which digital health technologies are important to your future, look into ways of scaling remote monitoring and telemedicine. Both have near-boundless promise for improving the care of chronically-ill patients and making medicine more accessible to all.
  • Hospitals, care coordination tools are still at an early stage, so there may be no single place to buy them. But if you are investing in innovation, build them! Tools tying together consumer technology and community support with medical know-how stand the chance of reducing readmissions and lowering expenses.

Industry evolution makes the death of the #HIE model inevitable

HIE imageBack in their heyday, health information exchanges (also known as Regional Health Information Organizations) looked like they might have legs. The clinical rationale for HIEs made sense  — after all, who would argue with the idea that data sharing improved care? — and grants to support them were springing up out of the woodwork. True, some HIEs capsized even in the early days, usually because they ran out of grant money or provider funding — but the idea still seemed sound to many healthcare industry leaders.

Over time, however, many HIEs have collapsed, still unable to make their business model work. While few health execs argued that HIE data sharing was a good thing, capable of eliminating duplicative tests and supporting coordinated care, health leaders simply didn’t want to pay for them. They also weren’t thrilled about sharing data with their competitors, particular when they competed in dense urban areas with hospitals on every block.

But as bad as those attitudes have been for the future of HIEs, current trends are far worse, all but guaranteeing that the HIE model will go out with a whimper.  Interoperable EHRs should take their place.

New data sharing models

While the market for HIE organizations is bleak, the market is guaranteed to snap up the right tools for data flow between risk-sharing ACO partners. And it would be no surprise if the HIT vendors capturing an early share  of the market were those who are already known for data connectivity.

According to a Black Book Research study which surveyed operators of public and private exchanges, top HIE vendors include Cerner  (for its HIE to EHR capabilities), Orion Health (for government payer and commercial insurer-centric HIEs) and Aetna Medicity (for core private enterprise HIE solutions.)

As providers pick up value-based contracts from payers, and desperately need decent data sharing to coordinate care, I can only  imagine that  they’ll turn to familiar names  to help them make that transition.  Data connectivity based on regions will die out, but vendor solutions that support ACOs and population health analytics will soar.

The HIE was a good idea, but it’s never been given a real chance to fly, and now its moment has passed.  The HIE is dead; Long live the Clinical Data Network.

Our recommendations:

  • While most of the energy around HIE building has focused on enterprise-level technology, it’s time to make things workable for the patient.  Conduct campaigns to engage consumers in data sharing, standardize the patient identification process so patients don’t develop workarounds that drop data out of the system.Begin planning  an architecture which makes not only EMR data, but also data from mobile devices, wearables and remote computers available to your partners. After all, it’s inevitable that you’ll need to get your arms around this information for internal purposes anyway.
  • If you want your clinicians to use new data streams from post-HIE networks, you’ll have to explain what’s going on. Prepare to educate them proactively, and often, how new dashboards and analytic capabilities can help them meet both ACO requirements and their patient care goals.

How #digitalhealth is changing doctor-patient relationships

hip doctorsA few days ago, I was skimming my Twitter feed when I saw a post from a major academic medical center. The post, which showed off a group of the center’s specialists, featured five forty-something men and women, grouped in a “C” and dressed so casually that they looked like they were taking their dogs for a walk. (Sort of a “Friends” look, if you ignored the thinning hair and scattered wrinkles.)

Even five  years ago, you would never have seen a hospital present their specialists to the public in such an informal manner. No, the men would have been wearing dress shirts and ties, and the women business-like dresses and carefully conservative jewelry, capped, of course, by white lab coats. What’s more, they would have been posed with some sitting and some standing, all staring at the camera rather than paying any attention to each other, a display of powerful experts rather than people.

What a difference a few years of digital health evolution can make.

Today, with mHealth tools and social media putting patients into direct, sometimes intimate contact with their doctor or NP, providers are being nudged into the direction of exposing more of their actual selves rather than hiding behind that white coat.

While they still need to be careful what they say on medical topics, many providers are developing a more casual professional style, a development which is nearly inevitable as they spend increasing amounts of time in the same social sandboxes as patients.

Also, given the way apps, digital health tools like telemedicine and social media work, providers stand a chance of encountering their patients digitally 24 hours a day, rather than living in a completely separate world. This, too, lowers the barriers between doctors and patients, turning doctors into trusted advisers rather than stern scientists whose word is never to be challenged.

This trend is likely to expand in the future as patients are given some of  doctors’ minor superpowers, such as doing their own lab tests or conducting their own ultrasound with a smartphone-connected reader. True, patients have gradually been demanding more power in their medical relationships for quite some time, but with technology leveling the boundaries, the pace of change should accelerate.

Admittedly, both the patient and the doctor will probably go through some difficult moments as they shift dance steps. But if both sides are willing to keep dancing, change will come.

P.S.:  We’d be just tickled if you would take three minutes and  answer our short survey on  health IT content at https://www.surveymonkey.com/r/68RZB8Y 

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