Category Archives: Technology

Technology including development, systems, testing, implementation, etc.

Apps & Comments

One of the virtues of the Internet is its ability to expand and respond to changing needs, interests and capabilities. A particularly good example occurs at the junction between electronic medical records (EMRs) and smart phones.

Several of my blogs have addressed the opportunities for patients to capture data and add it to their EMR and the challenges of making that information useful in the process of planning and managing the maintenance of good health and, as needed, treatment. Part of the challenge is to know what apps are available. “There’s an app for that” is now part of our language. But which one is the best one for your particular need?

There is a Wiki that will help: PHARMapps. It is structured by apps that deal with branded products and services and those that are unbranded, those for healthcare professionals and for patients, and by device operating systems. There are also classifications by topic. At this point there is no quick way to do a search by your choice of key word. Each app has an area for user comments–over time that may become the most valuable part of the Wiki.

Related:

FDA to Review Medical Smartphone Apps … the FDA is proposing a set of guidelines, outlining the types of apps that it plans to oversee. This won’t be all apps in the “Health” category, but will include those that, in the FDA’s words, “could present a risk to patients if the apps don’t work as intended.” 7/20/2011

iMeidicalApps Mobile medical apps review and comments by medical professionals

Digital Pharma: Big pharma’s iPhone apps: most recent update July 7, 2010

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Cloud Based EMRs: Better Post-FDA-Approval Research

A recently closed longitudinal study of a medication to boost “good” HDL cholesterol concluded: “… that the HDL-boosting drug niacin failed to cut the risk for heart attacks and strokes.” The study was designed to track patients for 4 to 6 years but was terminated 18 months early based on the results to that point. The cost: $52.7 million or $15,500 per person for the 3,400 study participants. Fully networked, cloud based, electronic medical records (EMR) appear to offer a better solution.

The topic of this post is research about medications that have received FDA approval and are being prescribed for general use. The subject of a research study could be a new medication being tracked for purposes of risk management among patients who were not fully represented in the limited sample used to obtain FDA approval. It could also be an established medication where adverse events are suggesting that more needs to be learned or where there is reason to believe it is not significantly effective to justify continued sale. In this case, it was a matter of both effectiveness and risk.

The key to a better solution is the evolution of fully networked, cloud based EHRs that create a database that is large enough to provide meaningful statistics about specific occurrences. As an example, Practice Fusion now hosts electronic records created by 90,000 medical providers in a single database that has more than 12 million patient records and is growing. The data is being collected as part of physicians’ normal practice—the electronic version of historically hand written notes.

There are operational advantages:

• Data collection is conducted to serve the day-to-day needs of the physician and their staff so they have established procedures and a vested interest in quality.
• The use of the data is totally independent of its collection so there is no bias in the data collection process or the data; neither the doctor nor the patients are even aware of how the data may be used: a totally blind process.
• Separation of data collection and use remove any presumption of undue influence by the sponsor of the study.
• Data is uploaded by physicians daily so it can be made available in near real-time for use at checkpoints in the study.
• If an area of particular interest is discovered, e.g., women over 60 who are more than 20 pounds overweight, additional participants with those characteristics can be identified and added to provide a larger, more reliable sample of that group.
• The study can provide information about risks and effectiveness, increased levels of HDL, and continued use, i.e., prescription renewal.
• In many cases, patient history related to their disease including prior medications is available and information will be available about patients who stop taking the medication or change to a different medication.
• The same database can be used to create a control group of patients that are not taking the medication and have essentially the same medical conditions and demographics as those who are; if a member of the control group begins taking the medication they can be moved to the study group and replaced in the control group—there is no need to deny patients the opportunity to take the medication just to protect the integrity of the data.

The largest benefit is that there is no marginal cost for data collection. The data is already being collected. There are, of course, charges for extraction of the specific data required for the study, for HIPAA compliant de-identification of the data, and for the use of the data. The study costs cited in the introduction, $15,500 per participant, include costs in addition to data collection, but data collection is a major part of that cost and could be dramatically reduced through the use of fully networked, cloud based, electronic health records.

Better data for the reasons noted above at lower cost translate to better healthcare at lower cost.

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Medical Records Are Just One Form of Healthcare Information.

In just a few years medicine has taken major steps to move from paper records in individual doctor’s offices to electronic medical records that can be shared with patients and their other physicians. The primary point of coordination of care among a patient’s physicians is moving from the patient—I saw Dr. Adams last month and he told me…—to the patient and her team of physicians who share the same records. The good news is each physician now has more information; the bad news is they have no additional time to analyze it. That is the tip of the iceberg.

At the same time, the marketplace has seen the value of health related information and is rapidly creating new ways to collect that information. Sources as diverse at private individuals working on smart phone apps to corporate giants like Ford Motor, Intel and General Electric are creating new ways to capture more and more health related information. Most of this will be routine but some of the haystacks will have needles of data critical to a healthy future for some patients or even life savings requirements.

Physicians can choose what medical information to collect depending on each patient’s specific circumstances; they can decide what is relevant and influence the volume of physician generated medical information. Patients will make the decisions about the information to be collected from many of the marketplace solutions: Here are my vital signs taken during my bicycle ride last week when the temperature was 89 to 95 degrees and I climbed 1321 feet and averaged 13.2 miles per hour. Here is the data from my Ford car last month and the statistics Intel/GE captured with regard to when I took my medication and how I answered the phone. How good is the data? Are there any needles of critical data?

We are rapidly moving from inadequate amounts of data to overwhelming amounts.

Prior solutions are the source of almost all significant problems. There is a problem on the horizon and now is the time to explore ways to manage the growing amount of data being generated and shared within the medical community and the marketplace. The people who are harnessing computers to capture medical data may be the logical ones to develop ways to capture, assess, integrate and analyze the growing amounts of data or the solution may be out in the marketplace. Stay tuned.

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EMRs: Increasing Complexity and Capabilities

Stadiums Utilize EHRs For Injured Fans

Electronic health records are coming to a sports arena near you. A hospital in New Jersey is providing emergency medical services at a stadium that hosts the local major league soccer team. If a person is hurt, they can go to the first aid station, where a team of doctors will treat them. When a person is transported to a hospital, doctors are able to treat them more quickly because they already have the patient’s medical record from the stadium and are notified of any medications that were already administered.”

Next step, an interface to transmit those records to the patient’s doctor if they do not need to be transported. The strategic objective, capture information that may be useful for medical purposes wherever and whenever it is generated and make it available wherever it is needed in essentially real-time.

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Health Insurance: reform, stimulus & codes

I have been focusing on electronic medical records from the point of view of physicians and hospitals. The impact on insurance companies may be even greater. An article in McKinsey Quarterly: The new IT landscape for health insurers, August 2010 ends with the conclusion: “… CIOs will need to transform more than 90 percent of a typical payer’s IT architecture and help other executives make the corresponding changes in their business processes.”

The article provides a comprehensive analysis supported by two exhibits that define and illustrate the issues. Excerpts:

Periodically, a dramatic change in an industry enables CIOs to step up and play a decisive role in corporate affairs. We see such a seismic shift in the US health insurance industry, which faces the most sweeping changes in its half-century history. The ranks of the health care payers comprise more than 350 companies, with combined revenues of $500 billion and combined IT spending of $13 billion annually. Three principal regulatory currents are producing the impending change:

Health care reform: The legislation anticipates 30 million new individuals will join insurance rolls, while an additional 100 million will be shifting policies. The law will usher in a fundamental change to the industry’s business model. Today: 90 percent of all private policies are paid for by employers that negotiate prices and terms of coverage. The recent legislation mandates new insurance exchanges, subsidies, and tax credits that will lead millions of consumers to contract directly with the health insurance payers.

US stimulus funding: In 2009, the US Congress passed the American Recovery and Reinvestment Act (ARRA), which contains special provisions for health care IT. These reforms will first affect providers, as over the next decade health care will become rooted in readily available, comprehensive medical records and IT-based clinical decisions. …  payers’ will need to build substantial new systems that can readily interface with health information exchanges and analyze electronic health records.

ICD-10: The modern data format documenting diagnosis and procedure codes—ICD-10—was released by the UN World Health Organization in 1994. But it is overdue in the United States, where it will replace ICD-9 and expand the available number of medical codes by a factor of eight [in some cases by a factor of 144.] This change will enable a much more detailed description of diagnoses and treatments. While ICD-10 promises to improve the accuracy of medical management and claims, its adoption will force payers to undertake an effort likely to exceed that of the Y2K campaign. Yet while the costs of adopting ICD-10 are significant, the potential regulatory penalties for failing to adopt will make it a necessity.

There are concerns being expressed in the medical community about the availability of resources to provide the infrastructure required for electronic medical records. Add the demands for resources required by insurance companies and the outlook is even more grim, unless of course, you are one of those needed resources.

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EMRs: Increasing Complexity and Capabilities II

EMRs, Intel, GE and telehealth for seniors

Intel has been studying technical and societal solutions for problems related to care for the aging for more than ten years. On August 2, 2010, Intel and GE announced the formation of a joint venture that will focus on telehealth and independent living to tackle the increasing global burden of chronic disease and age-related conditions. Said simply, using technology at places other than medical facilities to improve senior health.

Some of these technologies, particularly the diagnostics, will be heavily data oriented. As an example, monitoring and tracking the ways a person uses the telephone to detect changes that are predictors of Alzheimer’s and Parkinson’s 5 to 10 years before clinical symptoms appear. The analysis is based on subtle changes over a period of time. For an engaging explanation link to a TED MED presentation at http://goo.gl/vALK

More and more data over an extended period of time. Almost certainly, additional providers serving the same or related areas. The providers will deal with the data collection and analysis and then what happens? It needs to be linked to other medical data, both historic and current, analyzed, and made available to the person being monitored so they can be responsible for their own health to the fullest extent possible, to their doctors – seniors almost always have multiple doctors – and the person’s caregivers, and concerned family members. Different forms and presentations of results based on the same data for different uses and users. Complexity and capabilities way beyond the scope of the systems being installed today.

Intel and GE are preparing to do this now. It will be a few years before the impact becomes a major issue but now is the time to design our EMR systems and networks to deal with the increasing need as the population ages and as the technology to assist them advances.

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Six Tech-Enabled Business Trends to Watch

The August 2010 issue of the McKinsey Quarterly is titled: “Ten tech-enabled business trends to watch.” http://goo.gl/cpqN  Six of the trends are related to EMRs and EHRs. I took advantage of an invitation to be a guest blogger to write about these six trends. The post concludes:

EMRs/EHRs started by addressing a limited opportunity: moving from paper to electronic files and to then sharing the data. The Internet is full of examples that started small and evolved in ways undreamed of. That will happen to EMRs/EHRs and, like all other changes on the Internet, it will happen with increasing speed. The six items above provide an “outside the box” look at some of what is on the horizon.

The post is at: http://goo.gl/bYy0

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