eHealth - Social Business in Health
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eHealth - Social Business in Health
ehealth, integrating care, health monitoring, on line communication, interaction and (mobile) technology to care for health better
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What Banner Health and Philips learned from an outpatient telehealth program

What Banner Health and Philips learned from an outpatient telehealth program | eHealth - Social Business in Health |

Population health strategies have the benefit of advanced remote monitoring and telemedicine capabilities than in decades past, but to create a truly successful telehealth program you have to keep an open mind.

That is the message that Banner Health, an integrated, nonprofit health system based in Phoenix, Arizona, has taken to heart from its ongoing ambulatory care program for patients with chronic and complex diseases which is powered by Philip’s telemedicine platform. [...]

The program – named Intensive Ambulatory Care or Banner iCare — launched June 1, 2014, and the goal was to provide better care and reduce costs for the most complex patients – those with two or more chronic conditions — who happen to account for the highest cost in terms of healthcare dollars spent on their care.

Many population health programs focus on one chronic disease or another, but Dr. Hargobind Khurana, senior medical director of health management at Banner Health, said Banner’s approach was different.

“The idea was to say that there are complex, chronic patients who don’t have one chronic disease but have multiple chronic diseases and they have a hard time managing these diseases …these patients keep coming to the ED. They are in and out of the hospital,” he said in a recent interview. “Our goal was to be more broad than just one or two chronic diseases, so we focused on this aspect and said let’s find the high-utilizers who end up [repeatedly] in the hospital, in the ED.” [...]

But the population health strategy isn’t just high-tech. It is high-touch too.

“There’s a large team central team that’s dedicated for this work – health coaches that go to the patient’s home, there’s a social worker, there’s a pharmacist there are tele-nurses and there’s a physician who kind of helps coordinate their care,” Khurana explained.[...]

When the program launched, not enough patients who Banner felt could benefit were choosing to participate. The reason was simple: they didn’t want to switch their primary care providers as the program protocol required.

“We went in with this program thinking that what we would do is we would identify these patients and we’ll become their entire care team, so basically we would go to these patients and say, ‘We will become your primary care physician and we would also be the care team that would help with the telehealth platform,'” Khurana said. “Part of the lesson learned there was that patients were hesitant in the idea of leaving their PCP and entering a new entity.”

So Banner iCare pivoted. “So we changed that model about a year into it and told them, ‘You don’t have to leave your PCP. We will be an add-on to your care team. So you will have your PCP and you will work with them but we will be supporting your care as an addition to your PCP,’ ” he recalled. “That really helped the patients feel more comfortable joining my team, andI think that was a good learning.”

Changing the model based on feedback shows that in year two Banner Health was willing to take on the additional complication of keeping PCP’s apprised of any intervention they did to help the PCP’s patients. All without overwhelming the primary care doctor with raw data that was being transmitted through Philips’ telehealth platform.

Currently, about 500 patients are being cared for using the Banner iCare program and to date more than 1,000 have utilized the program. Khurana said people drop off when they move, change health plans, or die, adding that very few people leave the program because they didn’t like it.

Banner has seen some savings too.

The Banner iCare program has reduced the total cost of care per beneficiary by 27% per year. It has also reduced hospitalizations by 45%.

The program is ongoing, and Khurana believes that while they have hit upon an effective program, all the answers aren’t available yet.

For Philips, which codeveloped the program with Banner, there have been some important lessons too.

“We learned and showed that telehealth technologies can have a big impact on the care for patients dealing with multiple chronic conditions,” said Jeroen Tas, CEO of Philips Connected Care and Informatics, in an email. “We also learned that the process of integrating telehealth and other connected health solutions is a delicate one. It will only be successful if existing care pathways are redesigned. Change management and education are needed too as telehealth enables a more integrated and multidisciplinary care team approach than the traditional doctor-patient interaction.”

That traditional assumptions must be questioned was something that Banner Health also learned through the iCare program. And those assumptions center around who is a high-cost patient.[..]

You can’t use retrospective costs or utilization data and assume that it would be the same in the future because it doesn’t account for the regression to the mean,” Khurana said, adding that just because some patients “had a bad year doesn’t mean that they are going to keep having bad years, year after year after year.”

In other words, the entire thinking about who is going to be an expensive patient in the future requiring coordinated care needs to be overhauled.

“We have to be smarter in building and developing more intelligent algorithms to identify patients who would be future high utilizers,” he said. “That will be the next focus of population health – to have better predictive analytics.”


rob halkes's insight:

Banner Health learned old assumptions must be put aside to develop a patient-centered telehealth program by harnessing home monitoring devices, tablets for video consults, all integrated and powered on Philips Healthcare's software.

Experience teaches that telemedicine and ehealth is an all encompassing effort: patient trust, medtech, mobile applications, but also the healthcare providers team must be adequately designed in order to gain trust AND to be effective. Design and development for implementation is as crucial as working tech and multidisciplinary coordination.
See here: for introduction to ehealth and for the ehealth thoughtlab

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Platform Economy – Accenture Digital Health Tech Vision 2016

Platform Economy – Accenture Digital Health Tech Vision 2016 | eHealth - Social Business in Health |

Ecosystems are the new bedrock of digital healthcare.

Platforms are enabling smart cities, connected machines, robust customer analytics and more. In healthcare, they provide the underlying technology that can make healthcare experiences more connected. Some companies have taken the plunge into platforms, while others are just beginning to use digital technologies and cloud foundations as a first step into the platform world.

Platform potential

The power of platforms should not be underestimated. More than ever before, they can link the entire healthcare ecosystem—from patients to providers to health plans. Imagine a future when healthcare consumers will go to one central place to book an appointment, check their electronic medical record or pay an out-of-pocket expense. Providers will track a patient’s activity from hospital to home. Upon discharge, data from a patient’s blood pressure monitor, coupled with analytics, could indicate a pending complication and give providers ample time to take corrective action.

Health plans will use platforms to connect with consumers in more meaningful ways. For example, some are using engagement platforms, such as Rally Health and Welltok, to collect data from wearables and give rewards or premium discounts for progress.

Platform privileges

Platforms can help reduce out-of-pocket costs by supporting healthier lifestyles among consumers. Furthermore, they make previously difficult to access services more mainstream. Take for instance leading health plans that are making wellness programs available to the masses because platforms make it easy and cost-effective to scale such offerings and integrate into existing experiences.

rob halkes's insight:

From disrupted care to #ehealth #integratedcare #iot and #platforms: see the strategic roadmap for health as imagined by Accenture: a scenario to think about!  #pharma are you "in" ?

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Your eHealth Initiative - Three Strategic Steps

Your eHealth Initiative - Three Strategic Steps | eHealth - Social Business in Health |
Implementing an eHealth initiative is the first step in moving your healthcare organization to the forefront of eHealth technology. For instance, how would your organization make use of this revolutionary eHealth initiative innovation? How would you react if patients began asking to connect their eHealth applications to your information system?  eHealth initiatives require an analysis of your entire workflow from operations to systems and technology, from clinical and financial performance to implementation.

eHealth initiative general outcomes expected include benefits to providers and to patients, rapidly expanding technological tools, and even more use of internet based activities.

Working with The Fox Group’s eHealth experts through our three strategic eHealth Thought Lab meetings allows you to get customized knowledge on the processes and strategic changes that must be made in order to maximize the eHealth initiative potential within your organization. Each eHealth Thought Lab meeting will be tailored to your situation, and can jump-start your organization’s eHealth initiatives.  By the end of this series of three strategic meetings, you will have an appreciation of the potential for your organization to embark on a meaningful eHealth initiative. [..]

I.  The Current eHealth Initiative: a short, to the point workshop introducing the main elements of the eHealth initiative, a working definition, the effectiveness and implications of eHealth in the future.  You select the proper internal stakeholder audience of your organization.

  • This workshop is a quick tour around basic issues, examples of effective applications, and rationales for undertaking an eHealth initiative.
  • Benefits include (1) development of a common frame of reference within your internal stakeholder audience; (2) correction of mis-perceptions and biases; (3) clarify expectations as to the impact of an eHealth initiative; (4)  follow up; and (5) motivation to get things going.

II.  eHealth Discussion and Analysis: a workshop reviewing your current eHealth applications, including electronic health record systems, mobile health, internet-based, social media interaction tools, telemedicine, and similar components.  It will also address your organizational enthusiasm and/or challenges to creating a strategic planning process addressing the future in eHealth technologies as they unfold.  Discussion between your representatives and experts from The Fox Group will run deep into several aspects of the eHealth initiative phenomenon.

  • Using tailored examples fitting your organization, moderators of The Fox Group will demonstrate how eHealth technologies pertinent to providers, patients and your organization can result in a successful eHealth initiative for your organization.
  • Implications for your organization to be addressed include (1) consequences of the use of eHealth technologies to operations, organization, and Information Technology resources; (2) costs of care and administration;  and (3) satisfaction of patients and other stakeholders.

III. eHealth Strategic Planning: a strategic workshop, where you discuss currently existing concepts, modules, and devices available to you and your patients.  The final step is to identify the strategic  actionable steps to implement your eHealth initiative, bridging the gap between what is available and what needs to be developed.

  • Within the workshop, you and your selected stakeholders will reflect on the organization’s actual situation, both from a medical, organizational (structures, processes, staff, IT), and financial and patient perspective.  Wishes, challenges, and criteria for a successful eHealth initiative development path are explored. Initial ideas about a specific eHealth initiative can be discussed and placed in a framework of pros and cons.
  • Financial considerations will be addressed as well.  This strategic plan outline will be tailored to capture the ROI, patient and provider benefits and ultimate outcome expectations of your eHealth initiative. Government, payor, and regulatory issues are addressed as well.
  • Expectations and outcome: The output is a structured roadmap defining the path to development and implementation of your eHealth initiative, fully tailored to your specific situation. [..]
rob halkes's insight:

This is my and the Fox group's take on approaching ehealth. Yes it is promotional, but firmly based on experience and expertise. I thought one could do with the three step approach: update on what, discussing the impact for you and setting up a clear and effective plan to accomodate and develop your practice in health

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Dutch eHealth-monitor 2014 - -

Dutch eHealth-monitor 2014 - - | eHealth - Social Business in Health |

The Dutch ehealth monitor of the Netherlands has been released recently. There is no English translation yet, nor a summary, but a English infographic is presented at this post on the website. Here you can see that ehealth is steadily but I guess, firmly growing in NL.

More healthcare users say their GP allows them to make online appointments: from 7% in 2013 to 13% in 2014; or request repeart prescriptions: from 21% to 30%.

More GP's, 93% to 98% (!) and medical specialists, 66% to 75% use mainly or exclusively electronic records!

However no major shifts are found in the use of eHealth compared to 2013.

There will be greater coordination in the area of eHealth. The Ministry of Health Welfare and Sport sets concrete objectives, and parties 'in the field' seek each other out for joint activities!

Four things stood out in the study:

  1. eHealth in the workplace is still not always 'plug and play'
  2. Process innovation is difficult
  3. Healthcare users and healthcare providers do not always see sufficient added value
  4. Healthcare users are often unaware of possibilities already available

For a real, large scale use of eHealth a good balance is needed between the investment in money and effort and the experience added value in terms of imprived care, convenience and financial benefits.

See here for Nictiz  and here for Nivel the sources and down;oads of inforgroaphic (in English too) and the report (Dutch).

rob halkes's insight:

I would say that experience demonstrates that ehealth initiatives may be initiated by small efforts to digital services from physicians to patients, like repeat prescriptions. These are relatively easy first steps.
However, when it comes to more complicated developments in digital health involving interaction, exchange of data and information, and communication between professionals and patients, that is a more heavy change to conquer. It needs more motivation, organization and perseverance on the site of the professionals besides the readiness of technology. More support to implementation seems to be necessary.

I reckoned that on the basis of my own experience from early on.

See some information to this here.

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