Connected Health

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Taren Grom, Editor

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Connected Health According to Accenture, the future of healthcare is an ecosystem that is based on connecting all parts of a healthcare delivery system, seamlessly, through interoperable health information processes and technologies so that critical health information is available when and where it is needed. This special issue aims to provide a framework around the challenges and opportunities available through a connected health ecosystem. Experts will provide their insights on the connected health market, the impact on patients, clinical trials, and regulations. There is also a section — the Innovators’ Corner — that details new connected health technologies and products. The future of healthcare, according to many experts, will be a connected, or integrated, model that encompasses a number of different technologies, including apps, EMR, telehealth, mHealth, wearable devices, etc. Initially, these sectors were quite distinct; today, however, the lines are starting to blur as technologies intertwine to make connections more successful. Connected health, according to the definition put forth by Accenture, is an approach to healthcare delivery that leverages the systematic application of healthcare information technology to facilitate the accessing and sharing of information, as well as to allow subsequent analysis of health data across healthcare systems. But connected health goes beyond the management of patients’ clinical data to encourage communication and collaboration among all of the various stakeholders involved in a patient’s health. David Collins, senior director, healthcare information systems, mHIMSS, says connected health defines the new look at the health system and where it’s going, from the volume base to the value base. “The idea of connected health is a culmination of the concepts of care coordination and coordinated care; it’s better information at the point of care and the ability to drive toward efficiencies, reduce costs, and improve quality outcomes,” he says. “Because patients are getting more involved in their own health, other pieces of the connected health equation include information at the point of care, communication engagement between the patient and the provider, population health management, especially important for ACOs, and an aging population.” Connected health is achieved with a range of information and collaboration technologies. Electronic health records and other clinical applications, data repositories, and analytic tools, connected biomedical devices and telehealth collaboration technologies all enable connected health. Most importantly, those solutions must rest on a foundation of technology and data standards and security that ensures the confidentiality of personal health information. By structuring and exchanging healthcare information to center care delivery around the patient or a defined population, Accenture analysts believe connected health facilitates improve care coordination, disease management, and the use of clinical practice guidance to help reduce errors and improve care. In so doing, connected health is a key enabler of integrated healthcare delivery. Dr. Milton Chen, CEO of VSee — Telemedicine Video Platform, says telehealth/telemedicine/telecare will become a regular part of healthcare delivery — from consult-a-doctor kiosks in corner drugstores to tele-NICU units in hospitals to virtual video doctor visits on personal devices. “Telehealth is the direction we are headed,” he says. “This past year has already seen significant growth in the telemedicine and telehealth market due to reforms to telemedicine reimbursement, anticipated effects of the Affordable Care Act, increased use of personal devices, and a more consumer-oriented mentality toward healthcare. More doctors, hospitals, and health systems are all looking for ways to incorporate telehealth into their practices whether it’s creating an online telehealth portal, deploying telehealth apps, or using mobile telemedicine units in remote clinics. Telehealth is becoming the way to make health services more accessible to patients worldwide and to improve the efficiency of healthcare delivery.” Neal Benedict, CEO, healthcare, Verdande Technology, a provider of real-time case-based reasoning (CBR) technology, says technology upgrades and changes are necessary to usher in more efficiency for the healthcare industry, including hospitals need to step up their administrative business operations; business intelligence best practices, such as predictive analytics, CBR, and complex systems analysis; demonstrative compliance through the adoption of process and technologies that will show regulators that hospitals are on the path toward and taking action to improved patient outcomes; the promotion of prevention — keeping people out of hospitals; and anticipating the future physician shortage as a result of the Affordable Care Act. The Patient — Front and Center At the heart of the connected health ecosystem is the patient. The various technologies in play currently and in the pipeline are being designed to make sure the patient care and outcomes are improved. This patient focus will become more critical as the number of elderly patients, who have chronic conditions, continues to grow. For example, according to a report from the National Alliance for Caregiving in association with AARP, more than 65 million people — 29% of the U.S. population — provide care for a chronically ill, disabled, or aged family member. “Resources like the tablet-friendly Head and Neck Cancer Guide provide information for caregivers as well as people affected with a head or neck cancer,” says Joe Doyle, director of digital strategy, HCB Health. The user experience team at HCB health created an approach that uses various devices and activities to reach adults, teens and kids — everyone affected when a loved one has cancer. “When we look at the top 10 mobile searches for health terms on Google, we find a laundry list of society’s unmentionables — STDs, depression, smoking, etc.,” Mr. Doyle says. “An opportunity exists for any pharma or health testing company to offer responsive websites with rich features like clinic finders, photo matching, and education.” The Journey Accenture’s global research shows that there is no single way to achieve the high performance information sharing at the center of connected health. The journey to connected health begins from a starting point that is usually unique to an individual country or health system. Structure, finance, size, and cultural issues, including public and professional attitudes to privacy, all play a part in shaping the journey. However, despite these differences, it is clear from its case studies that the journey to connected health can be regarded as comprising three key stages of organizational and systems development, each requiring greater healthcare IT functionality. Increasing functionality, in turn, brings greater levels of value to clinicians, organizations and patients. The dynamics of connected health, according to Accenture, create a virtuous cycle of integration that will shape the future of both connected health and healthcare. The beginnings of major change are already underway, including: integrated systems that blend electronic medical records with methods of communication, remote care and process management to build seamless systems and workflows; redirection of healthcare interventions away from expensive hospital settings through the use of telemedicine, remote care, and mobile health; engagement of citizens in their health and wellness through a variety of connected health tools, including the creation and use of personal health records; genomics, which will offer the possibility of personalizing treatment and wellness plans, present clinicians with a powerful range of analytical and diagnostic tools, and enable managers to coordinate care, target resources and improve public health outcomes. These changes and others will drive greater integration of healthcare, which can ensure that the most appropriate and efficacious care is provided where and when it is needed and offer the potential of better health outcomes and greater control of costs. How quickly the necessary changes to drive true connected health will occur is a guesstimate at best at this point, but Bill Pence, executive VP and chief technology officer of WebMD, says, whether it’s five, 10, or 15 years, given the changes in healthcare, whether healthcare reform or the continuing trend toward consumers having more of an ownership stake in managing their own health, there will be a dramatic change. “All the incentives are lined up,” he says. “Every other industry has gone through a digital transformation, a digital disruption. There are good reasons why healthcare has not moved as fast and some of them are because of the need to have stronger protections in a regulated environment.” Mr. Pence predicts that there will be interesting new players and some players that are less relevant. “I do believe, again, whether it’s five or 10 years, things are going to be very different,” he says. “I cannot imagine us living in a non-digital healthcare analog world. It is just so inefficient for so many different reasons. All of the forces are now lined up to help make change happen. There will be a point when the connected health ecosystem becomes a reality. The space is going to be very dynamic. From the WebMD perspective, we see connected health as a big opportunity. We recognize that we come from a heritage of content and information, but we look at that as the first step on the journey. We certainly think we’re in great shape to participate.” Technology Driving New Care Models Technology — apps, mHealth, analytics, wearable devices, etc. — is the connector in connected health. And the use of mobile technologies and other Internet and online-based products will continue to increase. According to the Consumer Electronics Association’s Connected Health and Wellness Market report, the evolution of U.S. healthcare will result in a more than 142% increase over the next five years in personal health and wellness product sales and software and service revenue. “The current sea change in healthcare is resulting in far more consumer-centric products and services,” says CEA President and CEO Gary Shapiro. “Design innovations, advancing technology, and the widespread adoption of mobile devices mean consumer-centric care is now possible in ways we never imagined. Continued innovation promises to increase personalization, reduce costs, and provide novel new solutions to our healthcare challenges.” More than 40 million personal health and wellness products were expected to sell in 2013, a figure that will rise to more than 70 million by 2018. Product sales and software and service revenues will see the largest growth, generating more than $3.3 billion in revenue in 2013 and more than $8 billion by 2018. According to the 2013 HIMSS Analytics Mobile Technology Survey, clinicians are most likely to use mobile technology to look up patient information or reference information like clinical guidelines. Respondents were also most likely to indicate that their organization leveraged mobile technology for pharmacy management. Respondents were also asked to identify the purposes for which clinicians at their organizations use mobile technology; 69% responded that they were most likely to use mobile technology to view patient information such as a lab result or digital image. Approximately two-thirds, 65%, also indicated that they used mobile technology to look up non-PHI information, such as clinical guidelines. Respondents were less likely to report that clinicians use mobile technology to facilitate remote patient monitoring. This was identified by 20% of respondents. For more information from the 2013 HIMSS report, please see our digital edition. David Collins n mHIMSS “The idea of connected health is a culmination of the concepts of care coordination and ­coordinated care; it’s better information at the point of care and the ability to drive toward ­efficiencies, reduce costs, and improve quality outcomes.” The Functionalities of Connected Health Connected clinical practice » Hospitals/physician offices use electronic tools to reduce the administrative burden of healthcare ­delivery (e.g. e-scheduling or e-billing) » Physicians capture patient data electronically » Physicians receive electronic alerts/reminders while seeing patients (e.g. prompts regarding ­contraindications or preventative care) » Physicians use clinical decision support systems (CDSS) to help make correct diagnostic treatment decisions at the point of care Connected to clinical practitioners in other organizations » Physicians communicate electronically with clinicians in other organizations (e.g. via secure email) » Physicians are notified electronically of patients’ interactions with other health organizations (e.g. ­admission to hospital) » Physicians send or receive referrals electronically to/from health professionals in other organizations (e.g. for specialist appointments) » Physicians electronically access clinical data about a patient who has been seen by a different health organization (e.g. hospital, laboratory) » Physicians send prescriptions electronically to pharmacies (e-prescribing) » Physicians send order ­requests electronically (e.g. for tests) » Physicians receive clinical results electronically that populate patients’ electronic medical records Connected to patients » Patients can book/change/cancel appointments with their physicians online » Patients can communicate with their physicians electronically via secure email or video conferencing » Patients can electronically access their own medical information (e.g. lab results, medications, ­imaging results, etc) » Patients can monitor and record their own health indicators and share information with their ­physicians or with other approved clinicians Connected to analytics » Healthcare organizations capture and analyze care data and use this to identify needs for ­improvement in clinical care protocols and clinical outcomes across the organization » Public health agencies use system-wide clinical data for population health reporting, allowing them to carry out analysis to monitor trends and manage disease in the population Source: Accenture — Connected Health Study 2013 HIMSS Analytics Mobile Technology Survey Key Survey Results Legal & Policy » Mobile Technology Policy: More than half of respondents (59%) reported their organization has a mobile technology plan in place. Another 29% reported their organization is presently developing a mobile technology plan. ­Securing data is a key component of ­organizational policy. Privacy and Security » Means for Securing Data on Mobile Devices: Most respondents offer a variety of methods for securing data on mobile devices at their ­organizations. Passwords are the most ­widespread security device in place. New Care Models » Pharmacy Management: For the second ­consecutive year, respondents reported that they would be most likely to leverage mobile technology for pharmacy management, ­including medication reminders or medication reconciliation. Technology » Development of Apps: Respondents reported that apps within their organization were most likely to be developed by a third party or by HIT vendors. Half of respondents reported that they would expand their use of apps in the ­future. » Impact of Mobile Technology on Patient Care: Slightly more than one-third of ­respondents indicated that mobile technology will substantially or dramatically impact patient care in the future. This is a decrease from the two-thirds that reported this to be the case in 2012. ROI/Payment » Return on Investment: Almost half of ­respondents formally measure ROI related to their investment in mobile technology. » Total Cost of Ownership: One-third of ­respondents evaluate the total cost of ownership as it relates to their mobile strategy. Standards and Interoperability » Integration of Mobile Devices and Electronic Medical Records: Nearly one-quarter of ­respondents (22%) indicated that at least three-quarters of the data captured by mobile devices was integrated into the organization’s EMR. » Mechanisms for Accessing Data from Clinical System via Mobile Device: The majority of ­respondents reported that their organization ­offers clinicians the ability to access their key clinical system via a mobile device. Clinicians are most likely to do this via Internet access using a VPN. » Alerts from Remote Monitoring Devices: More than half of respondents indicated that alerts/notifications that are from remote ­monitoring devices are via an alert in their EMR/clinical system. Barriers and Benefits » Benefits of Using Mobile Technology: ­Respondents were most likely to identify ­improved access to patient information and the ability to view data from a remote location as key benefits to the use of mobile technology at their organizations. » Barriers to Mobile Technology Use: Lack of funding is widely identified by survey ­respondents as a barrier to the use of mobile technology at their organization. For the first time in 2011, HIMSS explored the use of mobile technology to improve access to the information needed on a day-to-day basis in a healthcare setting. The study was designed to collect information on an array of items related to mobile device usage. This year, to more closely align with the HIMSS strategic initiatives in the area of mobile technology, the questions were modified to closely align with the mHIMSS Roadmap, originally released at the 2012 mHealth Summit and updated in 2013 . Over the past several years, the United States government has taken a more active role in the adoption of technology in the healthcare industry, including the use of mobile technology. In 2010, the Federal Communications Commission (FCC) announced the country’s first National Broadband Plan, which identified ways in which expanded access to broadband technology has the potential to foster innovation and enable a better healthcare system. That same year, the FCC and the FDA entered into a partnership to advance investment in wirelessly enabled telehealth devices. In June 2012, the FCC assembled a group of the nation’s leading wireless healthcare technology experts to assess the opportunities and challenges facing the adoption of wireless health technologies and offer recommendations for the government to move forward to promote adoption of mobile technology. The federal government’s interest and efforts in mHealth, particularly changes to HIPAA and Meaningful Use are, impacting the way in which healthcare organizations are implementing mHealth solutions. This is clearly evident in the findings from the 3rd Annual HIMSS Analytics Mobile Technology Survey, particularly as it relates provision of solutions to patients and consumers. To illustrate, slightly more than one-third (35%) of the 170 respondents participating in the study indicated that their organization offered apps for patient/consumer use. This finding is up from 13% a year ago. Respondents also reported that their organization offers other mobile tools for patient/consumer use, including access to patient portals, telehealth services and remote monitoring devices to patients. The HIMSS Analytics Mobile Technology Survey covers a wide array of topics impacting the use of mobile technologies in healthcare organizations. Key findings from the study revealed that nearly all of the survey respondents supply mobile technology to clinicians, most often laptops and workstations on wheels. However, use of tablet computers is expected to increase in the future. The majority of respondents, 83%, reported that physicians use mobile technology to provide patient care. Clinicians are most likely to use mobile technology to either look up patient information or looking up non-PHI health information. Mobile Technology Environment The wide use of mobile devices by clinicians in healthcare organizations supports the high priority organizations have for the deployment of mobile devices. Using a scale of one to seven, where one is “not at all a priority” and seven is a “high priority,” respondents were asked to identify to what extent deployment of mobile devices is a priority at their organization. The average score identified was 5.25. Indeed, three-quarters of the respondents considered this to be a higher priority in their organization (response options 5, 6, and 7 collapsed together), with 44% of respondents identified this to be a top priority at their organization. This question was not asked in the 2012 study. Respondents were asked the percent of patient care at their organization that is facilitated by the use of mobile technology. This question was broken out across a variety of types of clinician groups. Respondents were most likely (83%) to indicate that physicians at their organization use mobile technology to facilitate at least some patient care. Nearly three-quarters of respondents (71%) of respondents also indicated that nurses used mobile technology to facilitate at least some patient care. However, in terms of the volume of patient care facilitated by mobile technology, respondents note that home health workers were most likely to provide at least 75% of care via mobile technology. And 18% of respondents indicated that the home health workers at their organization facilitate at least 75 patient care via mobile device. In comparison, 13% reported this was the case for nurses and 12% noted this was the case for physicians. Respondents were also asked to identify their organization’s stance on supporting mobile devices. One-third of respondents (31%) indicated that they supported only devices provided by their organization and another 21% reported supporting only personal devices used for business purposes. Nearly one-quarter (22%) reported that they supported devices of both types. Last year, nearly half of respondents indicated they supported both type of devices. While 34% of respondents were favorable toward their organization’s level of maturity, only 16% of respondents indicated that they were a highly mature organization. New Care Models Clinicians are most likely to use mobile technology to look up patient information or reference information like clinical guidelines. Respondents were also most likely to indicate that their organization leveraged mobile technology for pharmacy management. Respondents were also asked to identify the purposes for which clinicians at their organizations use mobile technology. Because this question last year referred specifically to the use of apps, no year-over-year comparison will be provided. Respondents were most likely (69%) to indicate that they used mobile technology to view patient information such as a lab result or digital image. Approximately two-thirds (65%) also indicated that they used mobile technology to look up non-PHI information, such as clinical guidelines. Respondents were less likely to report that clinicians use mobile technology to facilitate remote patient monitoring. This was identified by 20% of respondents. Additionally, respondents were asked to identify the extent to which organizations leveraged technology to impact patient care. Using a scale of one to seven, where one is no benefit and seven is high degree of benefit, respondents were most likely to indicate that mobile technology was leveraged for pharmacy management, which includes tasks such as medication reminders and medication reconciliation. This item received an average score of 3.73. This item also received the highest average score in 2012, at 4.10. The lowest average score was recorded for pharma research validation, which includes items such as clinical trials recruitment or execution of clinical trials. This item received an average score of 2.63. This also received the lowest score in 2012, at 2.50 Patients/Consumers Respondents were also asked about their use of apps for patients/consumers. One-third of respondents (35%) indicated that their organization supplies at least one app for patient/consumer use. he remaining respondents either reported that they do not provide this (59%) or do not know (7%). Among those who do provide apps for patient use, slightly more than half (56%) provide a single type of app. Additionally, respondents were asked to identify which of several tools their organization uses to engage patients and consumers in their healthcare today. Two-thirds of respondents (62%) indicated that they used at least one of the tools identified in this research. Among these respondents, the tool most likely to be provided to patients and consumers were app-enabled patient portals (56%). More than half of respondents reported that their organization offers this to patients and/or consumers. At least half of respondents (52%) also noted that they offer telehealth services. With regard to tools that will be offered in the future, approximately two-thirds (67%) will add to or expand upon the tools that are presently offered to engage patients and/or consumers. Respondents were most likely to report that they would expand or add to their use of app-enabled patient portals. Nearly three-quarters of respondents (71%) with plans reported future plans in this area. Offering telehealth services was identified by 46% of respondents. Impact of Mobile Technology on Patient Care Finally, respondents were asked to identify the extent to which mobile technology has changed the way in which patient care was provided at their organization. Nearly half of respondents (45%) indicated that mobile technology has had only a minimal impact on the way in which healthcare is provided at their organization. In contrast, one-third (34%) identified a substantial impact and 4% note a dramatic impact; 10% do not believe that mobile technology has changed the way that healthcare was delivered at their organization. For a copy of the full 3rd Annual HIMSS Analytics Mobile Technology Survey, contact: Joyce Lofstrom, Senior Manager, Corporate Communications, HIMSS, at 312-915-9237 or jlofstrom@himss.org.

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