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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50% Of Consumers Expect IoT & Wearables To Provide Full HealthIT Monitoring

50% Of Consumers Expect IoT & Wearables To Provide Full HealthIT Monitoring | eHealth - Social Business in Health |
Consumers want technology to monitor every aspect of their life and Wearable Tech, IoT and all emerging technologies are working together towards such goal. The question remains: Will this help or hurt providers’ efforts?
rob halkes's insight:

Technology itself creates expectations. Handling these and making them true is a challenge. Lots of healthcare providers are relucatant to their impact. eHealth thinking and realization can go in manageable steps creating your proper roadmap. See here

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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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ACOs held back by poor interoperability | Healthcare IT News

ACOs held back by poor interoperability | Healthcare IT News | eHealth - Social Business in Health |
Most accountable care organizations have health information technology in place to improve quality and lower costs, but many say difficulties with data exchange are keeping them from reaching their potential.

Of the 62 ACOs polled by Premier healthcare alliance this past summer, 88 percent report "significant obstacles" in integrating data from disparate sources. Also, 83 percent say they have a hard time fitting analytics tools into their workflow. As ACOs grow, gathering data from more and different care settings, these challenges become more accute, according to Premier.

Cost and ROI are also cited as key roadblocks to more effective implementation of health IT, according to 90 percent of respondents.

Even when ACOs have successfully merged health IT systems, "they aren't able to effectively leverage data and analytics to derive value out of their investments given the pervasive issues with data quality, liquidity and access, as well as issues with integrating data from disparate sources," said Keith J. Figlioli, Premier's senior vice president of healthcare informatics, in a press statement announcing the findings.

The numbers reported in the survey suggest interoperability is a "pervasive problem among ACOs, and it could stymie the long-term vision for ACO cost and quality improvement if not addressed," Figlioli added.

The good news is that ACOs are reporting heartening improvements in clinical quality (66 percent), preventive screenings and vaccinations (63 percent), chronic disease management (59 percent) and health outcomes (55 percent). But those percentages could be even higher.

"While accountable care organizations are providing quality care for many patients, even more could be accomplished if interoperability issues were addressed," said Jennifer Covich Bordenick, chief executive officer, eHealth Initiative. "However, the cost of interoperability can be prohibitive for many organizations."

In a Sept. 24 call discussing the report's findings, Bryan Bowles, Premier's vice president for population health solution management, noted that this new era of shifting risk from payers to providers requires a lot of these organizations, necessitating that they manage health at both an indvidual and population level, and make smart use of clinical, claims, financial and administrative data.

See more here in the original blog

rob halkes's insight:

A great example showing that there's more to ehealth than just technology. Apart from this, taking ehealth initiatives, means a good think through of all aspects of the health care process. But we are getting there. Let people with experience help!

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House Bill Introduced to Promote Telehealth Through ACOs « Center for Telehealth and e-Health Law

House Bill Introduced to Promote Telehealth Through ACOs « Center for Telehealth and e-Health Law | eHealth - Social Business in Health |

Representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced bipartisan legislation in the U.S. House of Representatives  to build upon the progress of Accountable Care Organizations (ACOs) in shifting the reimbursement of healthcare providers away from the traditional “fee for service” model to a focus on improving the health outcomes of patients.

The ACO Improvement Act (H.R. 5558) will improve the ACO model by providing additional incentives focused on health outcomes, increasing collaboration between patients and doctors, and providing ACOs with additional tools, according to a news release issued from their offices.

According to an article in Med City News, the legislation would allow ACOs to utilize remote patient monitoring tools and maintain and share technology that delivers images with more remote providers.   Many current restrictions that apply to originating care sites would be waived for telemedicine provided through ACOs, according to the bill.

“As a nurse of over forty years, I know firsthand the challenges facing health care professionals as they seek to provide their patients with the best care possible,” said Congressman Black. “It is unfortunate that the current fee for service payment system does little to encourage and incentivize providers and patients to use the most appropriate and effective health care options.  By incentivizing providers to focus on improving health care outcomes instead of increasing the quantity of services provided, this legislation will help improve care coordination, increase efficiency, and mostly importantly, ensure the patient receives the best care possible.”

“If we are going to reduce health care costs and increase quality, the incentives built into the provider payment system need to be changed.  In short, we need to reward value, not volume,” said Rep. Welch.  “Paying health care providers based on improvements in patient health rather than the number of procedures they perform is the way of the future.  Our legislation will advance these payment reforms and is based on the experience of ACOs in Vermont and around the country.”

Rep. Black is a member of the House Ways and Means Committee and Rep. Welch is a member of the House Energy and Commerce Committee.  These two committees are the primary House committees that consider healthcare-related legislation

rob halkes's insight:

Great move towards broader implementation of telehealth and ehealth. Let'shope the House will pass that..

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Researchers at Intermountain Medical Center develop new smartphone technology and app to diagnose and monitor adrenal gland diseases

Researchers at Intermountain Medical Center develop new smartphone technology and app to diagnose and monitor adrenal gland diseases | eHealth - Social Business in Health |
Diseases of the adrenal gland have long been difficult to diagnose. But now, researchers have found an affordable and easy way to diagnose and monitor endocrine diseases of the adrenal gland by using saliva and a smartphone.

Researchers at Intermountain Medical Center in Murray, Utah, have developed new smartphone technology to help screen patients for a number of adrenal gland diseases, including Cushing's syndrome. The new tool also helps to identify adrenal insufficiency, monitor cortisol replacement and assess physiologic changes in adrenal function.

Adrenal diseases are commonly overlooked because measuring cortisol, the so-called "stress hormone" that is released by the adrenal glands as part of the fight-or-flight mechanism, is costly and complicated, especially for those with limited resources, say researchers.

"When cortisol levels are overlooked too many people suffer and die because of excess or insufficient cortisol," said Joel Ehrenkranz, MD, director of diabetes and endocrinology at Intermountain Medical Center, and lead researcher of the project.

To help solve this problem, researchers developed a simple saliva test that uses a smartphone and an attached device that inexpensively feeds the results of a saliva test into the smart phone. An app then quantifies and interprets the results of a salivary cortisol assay and gives results in five minutes at the point of care.

"The cortisol assay is similar in design to a home pregnancy test and urine sample drug tests," says Dr. Ehrenkranz. "It's like having an endocrine specialist in your phone."


The new technology will especially help diabetic patients.

For diabetics, controlling stress levels is key to controlling cortisol levels, which helps prevent and control the disease. Stress increases the levels of cortisol in their body, and elevations in cortisol impair the body's ability to metabolize glucose. This increases blood glucose levels. High cortisol levels also affect the body's ability to fight infections, lose weight and recovery from injury.

"What this means is when blood cortisol levels are too high, insulin will not lower blood sugar," said Dr. Ehrenkranz. "Elevations in cortisol decrease the effectiveness of insulin and other drugs used in the treatment of diabetes. Having the ability to easily and inexpensively measure cortisol levels is important in managing diabetes."

See also

rob halkes's insight:

Great example of Intermountain Health development of Mobile Med Tech - a first step into further development of ehealth eco systems for diabetes and other chronic diseases needing " identify adrenal insufficiency, monitor cortisol replacement and assess physiologic changes in adrenal function"

This development however will take some next steps into adopting the right processes and actions to create functional interaction with patients. I would say: go on! ;-)

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5 recommendations for telehealth success

5 recommendations for telehealth success | eHealth - Social Business in Health |

Recognizing that licensing and regulation has not kept pace with the growth of telemedicine applications, a new report offers five recommendations for the successful adoption of telehealth.

The recommendations, made by the Information Technology and Innovation Foundation, a District of Columbia-based think tank, include:

  • Adoption of a standard definition for telehealth: While a recently published study found there to be seven different federal definitions of telehealth, the report's authors stress that H.R. 3750, the Telehealth Modernization Act of 2013, can remedy that "by defining telehealth to include healthcare delivered by real-time video, secure chat, secure email or telephone. ...
  • Establishment of a single, national license for telehealth providers  ...
  • Creation of technology- and location-neutral insurance policies ...
  • Collaboration by state prescription drug monitoring programs ...
  • Funding of research to boost quality and lower costs of telehealth programs

A framework for evaluating telehealth programs must consider socioeconomic aspects--not just the technological--argue researchers in an article published online recently in Telemedicine and e-Health. Costs, benefits, barriers and outcomes, including clinical outcomes, are among the integral socioeconomic factors at play in telehealth implementations, they say.

Meanwhile, the American Telemedicine Association has suggested some changes to the Federation of State Medical Board's (FSMB) proposed regulation of telemedicine. Among the suggestions: Don't make remote consults more cumbersome than in-person treatment and clear the way for docs to practice across state lines.

To read more:
- read the report(.pdf)

rob halkes's insight:

Great blog and great report: concluding about the necessary steps to enable the development and implementation if ehealth over multistakeholders, health care providers and industry.

Not all have been copied here. so do read the report and the blog..!

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Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Definition of Health 2.0 and Medicine 2.0: A Systematic Review | eHealth - Social Business in Health |
Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Background: During the last decade, the Internet has become increasingly popular and is now an important part of our daily life. When new “Web 2.0” technologies are used in health care, the terms “Health 2.0" or "Medicine 2.0” may be used.
Objective: The objective was to identify unique definitions of Health 2.0/Medicine 2.0 and recurrent topics within the definitions.
Methods: A systematic literature review of electronic databases (PubMed, Scopus, CINAHL) and gray literature on the Internet using the search engines Google, Bing, and Yahoo was performed to find unique definitions of Health 2.0/Medicine 2.0. We assessed all literature, extracted unique definitions, and selected recurrent topics by using the constant comparison method.
Results: We found a total of 1937 articles, 533 in scientific databases and 1404 in the gray literature. We selected 46 unique definitions for further analysis and identified 7 main topics.
Conclusions: Health 2.0/Medicine 2.0 are still developing areas. Many articles concerning this subject were found, primarily on the Internet. However, there is still no general consensus regarding the definition of Health 2.0/Medicine 2.0. We hope that this study will contribute to building the concept of Health 2.0/Medicine 2.0 and facilitate discussion and further research.

(J Med Internet Res 2010;12(2):e18)

During the last decade, the Internet has become increasingly popular and now forms an important part of our daily life [1]. In the Netherlands, the Internet is even more popular than traditional media like television, radio, and newspapers [2]. Furthermore, the impact of the Internet and other technological developments on health care is expected to increase [3,4]. Patients are using search engines like Google and Bing to find health related information. In Google, five percent of all searches are health related [5]. Patients can express their feelings on weblogs and online forums [3], and patients and professionals can use the Internet to improve communication and the sharing of information on websites such as Curetogether [6] and the Dutch website, Artsennet [7] for medical professionals. The use of Internet or Web technology in health care is called eHealth [1,8].

In 2004 the term “Web 2.0” was introduced. O’Reilly defined Web 2.0 as “a set of economic, social, and technology trends that collectively form the basis for the next generation of the Internet, a more mature, distinctive medium characterized by user participation, openness, and network effects” [9]. Although there are different definitions, most have several aspects in common. Hansen defined Web 2.0 as “a term which refers to improved communication and collaboration between people via social networking” [10]. According to both definitions, the main difference between Web 1.0 (the first generation of the Internet) and Web 2.0 is interaction [11]. Web 1.0 was mostly unidirectional, whereas Web 2.0 allows the user to add information or content to the Web, thus creating interaction. This is why the amount of “user-generated content” has increased enormously [12]. Practical examples of user-generated content are online communities where users can participate and share content. Examples are YouTube, Flickr, Facebook, and microblogging such as Twitter. Twitter, for example, improves communication and the sharing of information among health care professionals [13]....

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