Tag Archives: innovation

Expanding the Scope of EHRs II

Morgenthaler Ventures, a premier venture capital firm, announced August 25, 2011, the 11 finalists of their nationwide contest to find the most promising health IT startups looking for seed and Series-A funding. The contest was organized by Morgenthaler Ventures with co-organizers Silicon Valley Bank, Health 2.0 and Practice Fusion.

There are 22 finalists, 21 of which probably (or potentially) could link to a patient’s EHR. My speculation for each product is indicated in italics. Speculation, not knowledge about specific products, based in part on my two recent posts: Expanding the Scope of EMRs and Devices, Applications and EHRs

These products provide more evidence that EHRs must be designed to interface with “data devices” and apps that go way beyond the scope of most traditional EHRs systems.

Seed-Stage Finalists:

Careticker is the world’s first platform that helps patients plan in advance for a hospital or outpatient procedure. (Miami, FL) probable link to EHR for information

EyeNetra is the most affordable mobile eye diagnostic ever developed, allowing anyone to take their own eye test, get a prescription for glasses, and connect to eye-care providers all on a mobile phone. (Cambridge, MA) add results to EHR for complete record

Skimble powers the mobile wellness movement with a cross-platform ecosystem of fun and dynamic coaching applications. Its latest title, Workout Trainer, ranks Top 10 in the free Healthcare & Fitness category on iPhone/iPad.  (San Francisco, CA) possible data capture for EHR

SurgiChart is a mobile, cloud-based, social-clinical network for surgeons to exchange relevant perioperative, case-centric information. (Nashville, TN) could include data from or links to EHR

Telethrive provides patients an instant connection to doctors for a medical consultation using any telephone or computer with complete audio and video conferencing.  (Los Angeles, CA) possible links to EHR for data and recording results

Viewics provides hospitals with cloud-based analytics and business intelligence solutions which enable them to drive enhanced operational, financial and clinical outcomes.  (San Francisco, CA) probable links to EHR for data

Series-A Finalists:

 AbilTo develops and delivers online mental health programs to managed care members and enterprise workforces that help reduce payor costs while improving overall health outcomes. (New York, NY) probable links to EHR for de-identified data

Axial Exchange moves healthcare organizations towards pay-for-performance, enabling providers to coordinate care and measure clinical quality across disparate settings. (Raleigh, NC) EHR as source of data about treatment and results

Empower Interactive‘s online services deliver proven psychotherapy methodologies via an e-learning platform to greatly improve the economics and accessibility of mental and behavioral health solutions. (San Francisco, CA) potential links to EHR for treatment planning and results

Jiff is the first HIPAA-compliant iPad platform for patient education in the medical industry –used by doctors, nurses, patients and more. (San Francisco, CA) could be driven by data in patient’s EHR

YourNurseIsOn.com employs bi-directional text, phone and email communications to help hospitals and agencies put “the right healthcare providers, in the right places, right now.” (New Haven, CT) no apparent link to an EHR, interesting that this was at the end of the list.

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$250 million for the social Web including healthcare

Pioneering venture capitalist John Doerr, lionized in Silicon Valley for leading investments in Netscape, Amazon and Google, helped build the consumer Internet. Now he’s making a huge bet on the next round of the Web. … Kleiner Perkins Caufield & Byers has established a $250-million fund called the “sFund” to back social entrepreneurs who connect people online no matter where they are. …

He described the fund as a “quarter-billion-dollar party,” but its intention is serious: not to create the next Facebook but to give advice and cash to the entrepreneurs building out the social Web. Some of the areas ripe for investment are healthcare, education, mobile computing and tablets. “The third great wave of the Internet is mobile and social together,” Doerr said. “It’s going to be tectonic.”  http://goo.gl/rsDO

Patientslikeme.com may be one example. Almost certainly, these new ventures will involve the collection and distribution of medical information from more people and about more topics. Our picture of both the maintenance of health and the treatment of sickness and injury will be impacted. Our ideas about the scope and role of electronic medical records will change as will the sources and applications of the data.

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EMRs: Increasing Complexity and Capabilities III

Change-over-time rather than point-in-time

There is an evolving body of services that gather health related data beyond the scope of traditional healthcare and then deliver the data and analysis to your personal health record. They provide a form of diagnosis based on measurement-of-change-over-time rather than the point-in-time-assessment made at your doctor’s office or a hospital in response to an incident. The enabling technology records information about what you are doing or how your body is reacting as it as it happens and then transmits the data to a central computer for analysis.

The data and the analysis are then sent to you and your doctor. Not necessarily better information but additional information for preventative medicine or to supplement the assessment of a medical incident.

The Internet has a history of beginning simple and then adding new capabilities. It is not clear whether need leads to the creation of these new capabilities or the new capabilities awaken unfelt needs. Either way the scope of the information that is available continues to grow and systems become more robust. That kind of future evolution must be built in to each step forward if progress is to continue. Two recent examples:

US Preventive Medicine is offering a preventive “program and it sounds pretty cool: you pay $229 for the first year, complete an online health risk questionnaire, and then go to a local lab to have a panel of blood tests. The company sends your lab results to a PHR, you and your doctor get a custom prevention plan, you gain access to online dashboards and action programs, and a nurse advocate is available to help with health maintenance. Since it’s not tied to insurance or employment, nobody sees the information without your approval.”
DirectLife, a subsidiary of Phillips, provides a, “program designed to help you become more active by setting goals based on your current activity levels. The monitor tracks your movements and, when plugged into the computer, transmits your data to the website where you can track your progress.”

I would be surprised if there are not similar services already available on your iPhone or Android based phone that will expand the amount of data available for diagnosis.

I’ve written on this topic before. The first dealt with the Johns Hopkins University depression mood tracking SMS technology. The second dealt with Intel’s ten year old program studying technical and societal solutions for problems related to care for the aging. On August 2, 2010, Intel and GE announced the formation of a joint venture that will focus on telehealth and independent living which suggests further expansion of these and related programs.

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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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EMRs: Increasing Complexity and Capabilities

EMRs and the Internet: evolutionary processes

The Internet is a place where a good idea are expanded and enhanced to make them more and more useful to more and more people. Early email often included links to “cool” sites and then we got Web crawlers that gave us access to more site and then there was Google. Email with lists of recipients grew into social networks that are still expanding.

Tomorrows medical records will be electronic, have formats that include today’s standard codes plus further refinements that make the sharing of existing and new information available for uses we have not even dreamed of.

A recent example: “Many in the medical community believe that those who treat depression would be able to dramatically reduce suicide or medication related problems if the doctors had access to daily mood diary data. Pilot data from John’s Hopkins has confirmed that. … We will use the Johns Hopkins University depression mood tracking SMS technology [the technology of Twitter] and adapt it to connect to the Practice Fusion EHR instead of the current physician standalone system [which will make it available to additional doctors and bring all relevant data to a single patient record.]” http://goo.gl/3R6v

Simply using today’s paper based formats and codes for the creation of medical records does not provide for “daily mood diary data” from cell phones and other SMS devices and the integration of the additional data with traditional medical data.

The history of the Internet argues that whatever is built today must allow for future flexibility for new uses and new technologies. Simply providing faster ways to replicate the faxing of standard code-based-forms will not provide access to the benefits that can be achieved.

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Electronic Tower of Babel II

“Friday, July 30, 2010: When the Veterans Affairs and Defense departments began testing health information sharing for their joint virtual lifetime electronic record (VLER) project, they could not initially exchange patient data successfully using the very standards specified by the Office of the National Coordinator for health record formatting. …

“Dr. Doug Fridsma, acting director of ONC’s standards and interoperability office, used the experience of VA and DOD as an example of the trickiness of getting standards right so healthcare providers can exchange health information properly. C32 is among the requirements of ONC’s recent final rule on standards and certification of electronic health records (EHRs).” Government Health IT http://govhealthit.com/newsitem.aspx?nid=74346

Two agencies of the Federal Government encounter the electronic Tower of Babel. Can 200+ vendors who are focused on individual healthcare providers with little or no financial incentive to deal with the networking of data beyond insurance do it better?

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