Tag: America

Health Informatics insights: remote health monitoring


I just got better from a month long ordeal with an infection, which required daily visits to a care provider to assess the state and provide care. Though, the care was exemplary by Ontario CCAC, there are areas of improvement needed in care coordination among providers and remote health monitoring to increase efficiencies.

Remote health monitoring, means different things to different people.  The following report from California Health Foundation offers the current state of the market with a clear definition on the terms and the state of the market.

The Connected Patient: Charting the signs of remote health monitoring


Image Source: California Health Foundation – The connected patient: charting the vital signs of remote health monitoring.

Key insights: little has changed in the last four years with mixed results from pilot projects

Why little has changed when the economic benefits offer several millions and billions of dollars in savings and efficiencies ?   The author of the report points to the structural issues of the US health care system, which tends to be fragmented and focused on episodic care.  I believe that this is not just a US problem and is a common issue between the publicly funded Canadian healthcare& and friends south of the 49th parallel.  By far the biggest barrier to more pervasive adoption of DM has been the continued fragmentation of operations and information technology across health systems.

That is a well known problem with the providers paid on a fee for service basis.   In the US there are recent developments with the introduction of HITECT act and Accountable Care Organizations towards an outcomes based system.  In Canada, from my view the change appears even slower and the outcomes based model is being discussed at the provincial level, who are essentially payors of the service.

Though there are several drivers for remote health monitoring including communication technology advancements, mobile data standards, the chronic care tsunami we are facing as a society,  there are some significant challenges in adoption at the physician office,  consumer engagement and payment models for this service.

In spite of the challenges there are significant economic benefits and prospects to remote health monitoring both in US and Canada.

& Rethinking Our Approach to Disease Management: Technology and Information Flow Considerations

State of Health Information Exchanges: New Report


eHealth Initiative released a new report on the state of Health Information Exchange in the US and here are my findings and view of the survey.

Key Findings:

  • 234 active health information exchange initiatives (HIEs) in America
  • More than half the HIEs are not dependent on federal funding
  • Revenue source from transactions and subscriptions fees to data users and providers, which points towards sustainability of HIEs in  the long run rather than depending federal funding.  The model is similar to Canadian Diagnostic Imaging Repositories in some provinces, where the central organization (non-profit entity) has a sustainable revenue model continuing operations.
  • Data exchange between the various providers is on the rise from medications to lab results, inpatient discharge summaries, radiology results, inpatient diagnoses and procedures looks promising for the EHR.
  • Benefits and ROI of a HIE: Various measures of benefits and ROI are presented from reduced time spent to locate clinical results and records, decreased dollars on duplicate diagnostic procedures and decreased cost of care for chronic disease patients to name a few.
  • More Patient Engagement: There is no questions that patients want to get engaged and the survey underscores that point once again. HIEs are the avenue to break patient health information islands.

Thanks to the folks at eHealth Initiative for the survey,  I understand that this is a high level survey, a more detailed one will be very useful to shed light on the %of data exchanged between stakeholders for each type of data and the governance and architecture model followed for ensuring sustainability and scalability of the service.

Please click on this link to access the full survey and the associated webinar.

Saravana Rajan

HIMSS Webinars on Meaningful Use


HIMSS provides six part webinar on Meaningful Use and implications.

1. Overview of Meaningful use final rule

http://www.himss.org/content/files/MU_Overview_Slides.pdf?src=winews20100728

2. Implications of Meaningful Use on Hospitals:

http://www.himss.org/content/files/Implications_of_MeaningfulUse_in_Hospitals_072810.pdf?src=winews20100728

Key highlights from #2 above,

  • CCHIT not grand‐fathered as an ATCB, previously certified products must be re-certified – work on the vendor side and I cant gauge the impact
  • Key Applications Needed to Meet Stage 1 Meaningful Use Requirements
    •  Core HIS System with Clinical Data Repository
    •  Clinical Documentation
    •  Clinical Decision Support
    •  Computerized Physician Order Entry
    •  Medication Management
    •  ED System or module

Source: HIMSS

Meaningful Use – Stage 1 final rule


Healthcare IT is quite brimming with lots of activities with the healthcare stimulus package in the US through ARRA and HITECT act and deadline looming (effective from October 2010) for healthcare providers(hospitals, group practitioners, imaging centers) and eligible professionals (physicians) to get their slice of the pie.

We saw a piece of action today from  US Centers for Medical and Medicaid Services with their release of final rule for Stage 1 Meaningful Use requirements and a coordinated release of final rule of Standards/Implementation Spec and Criteria for certification for EHR and  from US Dept of HHS.

Here are some updates on final ruling of “Meaningful Use”,

  1. US dept of HHS and ONC have released their final rule for meaningful use.  Check this link and this.
  2. Dr. John Halamka’s impression on the final Meaningful Use rules.  overall he is impressed with the final rulings and the scope.
  3. New England Journal of medicine’s summary of the final rule – Here is the table of rule from NEJM
  4. Healthcare IT vendors welcome the final rule – of course – industry is going to get even busier with the set targets for the years 2010 and 2010

    Summary overview of Meaningful Use Objectives

My brief and quick analysis:

1. Coordinated release of Meaningful Use and Standards requirements final rule

While the meaningful use represents the functional requirements ( the WHAT piece)  that has to be met by the providers, the coordinated release of HHS final rule on standards, implementation specification and certification criteria ( the HOW piece) is a commendable job by the people at CMS and HHS.

For example there are requirements in final meaningful use on submitting immunization and laboratory data to public health agencies and providing patients with timely access to their electronic health data

HHS final rule on standards requires using existing penetrated (both from providers, vendors and available resources in the market perspective) standards like HL7 version 2.3.1, 2.5, HL7 CDA to accomplish exchange of information between providers and public health agencies and transferring data to patients.

This enables the providers, vendors to use existing standards to reach compliance on various functional requirements in meaningful use from a technical perspective.

I will follow up with frequent updates as I consume the bulk documents on meaningful use and HHS standards requirements and the nuances of implementation requirements.

Exciting times ahead in the Healthcare IT industry indeed and also I am starting to lead a delivery work on an eReferral project in the province of Ontario to enable physicians to refer patients to their specialist electronically rather than current way of phone calls, faxes and hodgepodge of activities.

Cheers!

Saravana Rajan

healthcare…once upon a time!


“Once upon a time, going to your doctor was simple. You knew his first name, or perhaps just called him “Doc.” He lived just down the street and made house calls. And if you were sick, you would see him that day, because, well, you were sick” … that’s how the story starts for Hello Health! (founded by an American and Canadian in NY)

Hello Health attempts to make healthcare simple and accessible to patients and promises  to taking medicine to its basics.  With Hello Health, you can interact with your doc in your favourite means of technology.  If you have query and you would like to just e-mail, you just e-mail and its Free!  You make your appointments online and access your records as well.

At the primary care level, as the first point of contact for the patients, accessibility and responsive care is crucial for patients and especially for patients with chronic diseases like diabetes, cancer, heart disease and COPD.

So is Hello Health disruptive ? Absolutely in private healthcare market like US, its bringing the medicine back to basics and attacks the complex payer/physician centric model.  In market economics, as the value propositions of the consumers change, new players emerge to provide the missing value and this is often called as invisible hand and works in most cases. It remains to be seen whether it will work in healthcare.

Can a service like Hello Health, work in a single payer system like Canada ? Of course, it can, provided it meets the regulatory requirements of the government and the docs adopt the government certified EMR

Hello Health!
Hello Health!

(Electronic Medical Record), of course with lots of incentives.

Accessing a primary case physician is  relatively easy (caveat: if you have a family physician) in the Canadian Healthcare system and every one is aware of the improvement needed in terms of technology adoption.

In US, the question remains whether the proposed mandatory legislation by Obama administration can hinder a service like this. Boston Globe has a good coverage on this. http://bit.ly/WE67p

Also this type of pay for use service only serves the basic healthcare needs and Can it fix the completely ailing US healthcare system, where complex care consumes most of the resources in the system ?

It remains to be seen and the quest for solving the healthcare puzzle continues.

EMR (eletronic medical record): does it exist in Ontario ?


Electronic Medical Record as defined by HIMSS Analytics is an application environment composed of the

  • clinical data repository
  • clinical decision support
  • controlled medical vocabulary
  • computerized order entry
  • provider order entry
  • pharmacy and
  • clinical documentation applications

This environment supports the patient s electronic medical record across inpatient and outpatient environments, and
is used by healthcare practitioners to document, monitor, and manage health care delivery within
a care delivery organization (CDO) like a hospital / clinic / doctor’s office and imaging centers.

The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

If you still have confusion between EHR and EMR, please refer to this document published by HIMSS Analytics which explains the difference and does a good job.

So where is Ontario in terms of EMR implementation compared to the United States. slide_0026_full