Prescription and non-prescription opioid abuse have risen to epidemic proportions. Statistics from the CDC are staggering. Deaths from opioid overdoses have quadrupled since 1999 with over 165,000 fatalities. Every day in the US, 44 people die of prescription opioid overdose and over 7,000 are treated in ER's across the country. Over 2-million people in the US are currently addicted to prescription opioids.
One of the challenges facing primary care providers is how and when to safely prescribe opioids for chronic non-cancer pain. In early 2016, the CDC released their opioid prescribing guideline which immediately generated a great deal of controversy in the press.
The guideline is comprehensive and a must read for anyone who prescribes opioids but was hardly a point-of-care tool. Some of the best opioid conversion apps are Opioid Calculator, Safe Opioids, and pH-Medical Opioid Converter, which included links to the CDC guideline. Now the CDC has released an app summarizing their 2016 opioid guideline. CDC Opioid Prescribing Guideline 2016 also contains a morphine equivalency calculator, glossary and an entire section on how to perform motivational interviewing with pain patients. This is one of the many free CDC apps available for physicians and health professionals to use.
Evidence based medicine
The information in the medical app comes from the 2016 CDC guideline. The CDC app includes brief summaries of each key recommendation from CDC opioid guideline as well as links to complete sections of the guideline and many helpful tools/summaries. The medical app is well referenced and includes a helpful morphine equivalency calculator, glossary and section on motivational interviewing for safe opioid prescribing.
Who would benefit from the CDC Opioid Prescribing Guidelines App?
Nurses, students, residents, mid-levels, primary care providers, emergency medicine, pain medicine specialists, or any provider who treats patients on opioids.
Outstanding interface that divides up the guideline into key recommendations with additional information built into each section as well as extensive online information, references, and an easy to use morphine equivalency calculator.
Medical App includes numerous links to full sections of the CDC guideline, helpful PDFs, and references. All these require an internet connection however. The included morphine calculator is built-in.
Real World Applicability
CDC Opioid Prescribing Guideline 2016 now puts the entire guideline in the palm of your hand to assist primary care providers and many other specialties in safe opioid prescribing. With succinct recommendations, information on motivational interviewing and a morphine equivalency calculator built in, the latest CDC app is a must have for anyone who prescribes opioids.
Download for Android
Download for iPhone and iPad
Eight developments in healthcare technology to know about for 2017:
1. Security and compliance. While we do not know how the new presidency will affect federal healthcare regulations, one can safely assume that security and compliance will remain an area of focus. This past March, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) launched its second phase of HIPAA audits of covered entities and their business associates. In October, OCR released new guidance on HIPAA and cloud computing. These and other recent developments indicate security and compliance are under close scrutiny. Practices should take compliance seriously.
They should also take the threat of cybercrime seriously. Cybercriminals are increasingly targeting healthcare providers because of the black market value of medical records and use of outdated security measures. Symantec's "2016 Internet Security Threat Report" noted that the largest number of data breaches in 2015 took place within health services, comprising 39 percent of all breaches last year. Ransomware — when cybercriminals use encryption to hold companies’ and individuals’ data hostage — increased 35 percent percent in 2015. There is no reason to believe cybercriminals will stop targeting providers.
2. Informatics. Informatics has been a buzzword for quite some time. What are its benefits informatics? While it's a few years old, the University of Illinois at Chicago spells this out in a detailed infographic. Key takeaways include dramatic reductions in malpractice claims after introducing EHRs, faster lab results when using EHRs, potential for significant cost savings, and improved quality of care.
Along with informatics, analytics remains in the spotlight thanks to its potential to deliver significant improvements in all aspects of a practice's operations by converting big data into actionable insights. Practices can expect to see more informatics and analytics solutions hit the market in 2017. It will be important to conduct due diligence before investing in an informatics and/or analytics solution.
3. mHealth. Mobile health (mHealth) is showing no signs of slowing down. A Pricewater Cooper Health Research Institute (PwC) survey revealed some insightful statistics about the use of mobile devices, including the following:
It will not be surprising if all of these figures increase in 2016. Practices will want to examine how they can use mHealth to boost patient engagement and satisfaction to improve care delivery and help achieve a competitive edge over slower adopting providers.
4. Telemedicine. How do you grow patient volume without increasing foot traffic to your practice? Telemedicine. It's already on the radar of many providers, with the PwC survey indicating that 58 percent of clinicians would rather provide a portion of care virtually. Insurance companies are getting on board with covering telemedicine, and an increasing number of states have laws concerning its coverage. As previously stated, a growing number of consumers are willing to consider video visits with a physicians. It's up to practices to meet these consumers in the middle.
5. Remote monitoring. Already, there are technologies used by patients that capture vital signs, blood pressure, heart rate and more that then transmit the data to healthcare facilities. Practices can expect the number and types of these devices to grow in 2017, and patients to become more accepting of them, especially as an alternative to physically visiting a practice.
6. Interoperability. For the past few years, there has been an effort on behalf of government agencies to move toward increased interoperability of health IT systems.
Congress' recent passing of the 21st Century Cures Act (Cures) shows the government's intention to make interoperability a high priority in the coming years. As the U.S. House of Representatives Committee on Energy and Commerce noted, "The development of new drugs and devices is meaningless unless they are delivered to the right patients at the right time. Cures will help improve delivery by: ensuring electronic health record systems are interoperable for seamless patient care and help fully realize the benefits of a learning health care system."
7. Integrated systems. A contributor to Apple's success is the tendency for users of Apple products to own multiple Apple products. One reason for this brand loyalty is that Apple products are integrated systems.
It is for this reason that practices can expect a greater push for integrated systems in the market in areas such as access control, video surveillance and audio/visual equipment. When these devices are integrated, implementation, management, upgrades, data retrieval and training is easier.
With a growing emphasis in healthcare on streamlining operations, technology companies are working to meet this objective and secure more of an organization's business at the same time.
8. Cloud technology. No discussion about technology trends of the past several years and likely the next several years would be complete without at least mentioning the cloud. As practices and other healthcare providers implement a greater number of robust systems, the need for convenient, secure data access and retrieval will grow.
Practices should expect technology vendors to encourage greater use of cloud computing. It is important to remember that if a practice shifts any of its data storage to the cloud, use of the service must comply with HIPAA.
With the release of two different final rules, the federal government is trying to make it easier for doctors to use electronic health records and to report data on practice outcomes, leaders at two Health and Human Services agencies said.
The Office of the National Coordinator for Health Information Technology (ONC) held two conference calls with reporters to outline final rules issued for two sets of regulations: the Health IT Certification Program and the health information technology portion of the Medicare Access and CHIP Reauthorization Act (MACRA).
The Health IT Certification Program rule addresses three areas, officials said: it allows the agency to directly review certified health IT products and take action -- including decertification -- if health and safety issues or other problems arise; it establishes a way for the ONC to oversee accredited testing tabs for health IT programs; and it allows for health IT surveillance results to be made public.
"With the vast majority of physicians and hospitals now using health IT, the ONC plays an important role in helping make sure these products operate appropriately in the field," Vindell Washington, MD, who heads ONC, said.
"Because ONC's goal is for any concerns found with certified health IT to be corrected and for certified health IT to function as intended for clinicians, the final rule concentrates on corrective action plans as a means of addressing issues that arise," he continued. "If a direct review reveals a problem, for example, with certified health IT, ONC will work with developers on comprehensive corrective action plans to address the problems that are found."
There are several parts of the new rule that will become obvious to physicians, Washington said. "The first will be more information flow; one of [our] three major components of this [rule] is transparency," he said. "On the certified health IT product list ... a provider would be able to have a good idea -- whether they are using a tool or getting ready to purchase a tool -- whether or not that tool has problems or has a great safety rating. That would be pretty evident early on."
In addition, "the idea of support for products that are being remediated or have a plan to improve them will also be relatively evident to providers," Washington said. "In particular, what we've heard is there is a gap between what may happen in the testing lab and what may happen in the field. So this ability to do more direct oversight and look at how those products work -- and particularly how they work with the entirety of the physician's IT system -- will be more evident more quickly to providers."
The issuance of the final MACRA rule -- announced on Friday morning -- "is [viewed] as an opportunity to move the focus away from paperwork and reporting toward paying more for what works and giving physicians more freedom and more flexibility to practice better medicine and deliver better care,"Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), said on an afternoon conference call. "We worked ... alongside physicians to design a portal -- a one-stop shop and support center -- to allow physicians to learn about access and even design their involvement in MACRA's quality payment program.
"For physicians to be successful in value-based care requires technology that's easier to use, simpler, more connected, less burdensome, and ... simplifies by delivering exactly what patients and doctors need when they need it, and no more," he said. "Until technology supports the needs of the workflow, [physicians] will view certified EHRs as a burden. ... That's one reason we reduced the requirements for advancing care information from 11 measures to 5 in the final rule, and added more flexibility so physicians could pick the measures that are right for their practice."
Advancing care information must become a supporting category, not the main event, he added. "This really should serve to communicate a clear message to clinicians -- we expect the focus to be on your goals with patients, not your goals with technology. "
The MACRA final rule includes several regulations aimed at making life easier for small practices, Slavitt said. "One of the things we've done is ... people need to actually even report and participate in [the Merit-Based Incentive Payment System, MIPS] to have [at least] $30,000 in annual revenue with Medicare." That way, if a practice has fewer than 10 physicians, "more than half won't need to participate in MIPS at all -- many of them will be in advanced APMs [alternative payment models], will be new to the program, or will just have too low a volume."
"Second, we reduced the time and cost to participate [in MACRA] ... because we know small practices have fewer resources; we've also increased the number of advanced APMs available to small practices, and reduced the amount of risk pretty significantly that a physician would need to take to qualify for an APM."
Slavitt added that he didn't really consider the MACRA rule to be truly "final," despite its name. "This has to be a living, breathing, evolving set of ways we're going to structure the payment system, because we're going to learn a lot over the next couple of years. Our goal is that we have a successful, sustainable Medicare program over the long haul, so I suspect we'll continue to see changes over the next year as we continue to visit clinicians [to see] what their priorities are."
As many know, the iPhone 7 has a new solid-state home button that functions similar to a touchscreen than a button. There is no longer a "press" when you touch the button. Rather, Apple's new Taptic engine delivers a "tap" response when you touch the home button, giving the impression that you "clicked" it. The new solid-state home button does create issues, however. There have been several reports of the button not working with gloves.
There are several medical apps that physicians can use at the bedside with patients, and often times we are using gloves when using these apps with patients. These range from Optokinetic Drum apps to medical apps that help us risk-stratify a chest pain patient or determine whether or not a patient needs to be on daily aspirin therapy. These medical apps are best used at a patient's bedside, since they require direct interaction with a patient.
There is good and bad news to report on using the iPhone 7 with medical gloves. For nonsterile gloves there seem to be no issues. The app was tested while wearing the Flexal Nitrile Powder-free exam gloves and there were no issues with activating the solid-state home button. The bad news - for sterile gloves, the solid-state home button could not be activated. The thickness of the sterile gloves may be why the solid-state home button doesn't activate when tapped. Overall, not big deal. Physicians shouldn't be using an iPhone with sterile gloves anyway, and most point-of-care apps can be used when with a patient without needing a glove in the first place.
But that misses the larger issue: The solid-state home button problem is a huge hit to using iOS devices in the medical setting. It makes sterile cases useless in the medical setting. Naturally, Apple will move the solid state button to its iPad - which will be a huge blow to companies that are using the iPad in the medical setting with sterile cases. There are several companies and hospitals that use iPads in the hospital setting to help facilitate patient care. My own hospital uses a medical translating company that uses iPads for video translation. The iPad is in a case that can be sterilized, covering the entire iPad, including the home button.With the solid-state home button, you can't encase an iPad effectively to keep it sterile and still use the device. With iOS 10, you can only access the home screen through the home button (prior iOS versions enabled you to use the lock button to access the home screen). I'm hoping a company is able to figure out a way to make sterile cases that will accommodate the new home screen, but at this time it doesn't exist. Even if it does, it will be a huge hassle for companies and hospitals when the iPad eventually gets the same home button.
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When the FDA released its first guidance on which health apps it intended to regulate, it quickly became clear that the agency intended to focus on a pretty narrow part of the market. In general, the FDA has used a risk-based approach, trying to focus on health apps and devices that could cause harm if they fail to work as advertised. In that original guidance, FDA officials alluded to general wellness and health apps as areas in which they would exercise enforcement discretion (i.e. not apply broad oversight to). In this latest guidance, however, they really define what kinds of health apps and devices fall into that category. And it's a pretty broad - and in some areas seemingly arbitrary - group. Here's how they define this group:
A general wellness product ... has (1) an intended use that relates to maintaining or encouraging a general state of health or a healthy activity, or (2) an intended use that relates the role of healthy lifestyle with helping to reduce the risk or impact of certain chronic diseases or conditions and where it is well understood and accepted that healthy lifestyle choices may play an important role in health outcomes for the disease or condition.
That category includes many health apps that I think most people would agree are probably outside the purview of the FDA - weight-loss apps and activity apps, for example. These health apps are really aimed at promoting general healthy lifestyles. Even though we frequently recommend them to people with a variety of chronic conditions, they aren't necessarily intended to treat, say, diabetes or heart disease.
Other examples included may be more surprising, such as brain training apps or devices to monitor heart rate or even collisions during athletics and exercise. It may be confusing, in particular, given recent action by the Federal Trade Commission (FTC) against brain training company Lumosity or developers of an app that provided "vision training" for athletes. That discrepancy, though, highlights the importance of "intended use" to the FDA. For example, an app that claims to help you lose weight is OK per this guidance, but an app that claims to "treat" obesity is not. On the other hand, the FTC is really looking at "truth in advertising," or whether the health app does what it claims to do. And while that's important and useful, its an approach that's inherently limited to making an example out of a few bad actors in a very large and rapidly growing market.
While the evolving regulatory rules may seem confusing to most clinicians, this new FDA guidance highlights more than ever the need for clinicians to take the lead in rigorously evaluating health apps so that we can make informed recommendations to our patients.
In this video, Ron Harman King, CEO of Vanguard Communications and author of The Totally Wired Doctor: Social Media, the Internet & Marketing Technology for Medical Practices, discusses the essentials for every doctor's website.
A website is the first step in effectively marketing your medical practice. This video shows examples of effective and less effective web designs that will help you build your own site to more effectively serve current and future patients.s
In part 2, later this month, King will discuss the information patients want to see and the most common mistakes made on doctors' websites.
To view the video: tinyurl.com/z6vvcb6
Nearly a third of Americans use complementary health approaches, ranging from dietary supplements to acupuncture. Point of care resources to identify that supplement your patient is taking but you've never heard of can be really useful. Developed by the Integrative Medicine folks at Memorial Sloan Kettering Cancer Center (MSKCC), the About Herbs app includes information on herbs, supplements, and alternative medicine techniques like acupuncture and acupressure. Pictures are included with each entry.
Download for iPhone
For the busy physicians, deciding whether or not to order an imaging test for various medical conditions can be challenging. The American Academy of Family Physicians and the American College of Radiology (ACR) provide different Choosing Wisely recommendations for various conditions. The ACR publishes their Appropriateness Criteria online, but only basic search functions are allowed for non-members and there is no mobile version available.
For certain musculoskeletal conditions such as neck, ankle and knee pain, the Ottawa Rules have been proposed to aid providers in their medical decision making concerning imaging. The rules were derived and validated over many years of research by Dr Ian Stiel at The Ottawa Hospital.
Dr Stiel and his research team in Ottawa have released a dedicated app for the Ottawa Rules — called The Ottawa Rules. The Ottawa Rules medical app is designed to educate providers about the validated rules, and aims to decrease unnecessary radiographic imaging. Additionally, the medical app is part of a study at Ottawa Hospital, but you can download and use the Ottawa Rules app without being part of the research study.
Download for iPad
The Drugs.com app is a medication reference that brings the popular Drugs.com website to mobile devices. Drugs.com’s goal is to provide comprehensive and up-to-date drug information, in versions for consumers and healthcare providers. This goal is well-met with an impressive list of resources from which the web and app content is derived including Micromedex, the American Society for Health-System Pharmacists, and Mayo Clinic. Users can search a variety of medication topics including drug monographs, an interaction checker, pregnancy and breastfeeding database, pill identifier, and side effect database. Professional information contains much of what is included for the patient while the patient version includes a cost database for popular drugs. Users may choose their version and can toggle from one to the other at any time.
Users may register for a free account through the Drugs.com app that allows them to save a personal drug list, but the app doesn’t require an account for general use. Account information is used to provide targeted ads in the app. Users may opt-out of participation in behavioral advertising, however, general ads will still appear in the app.
The Drugs.com app drug database is extensive and provides FDA labeling in the professional section with more lay-friendly language in the patient version. Users may search for medications via brand or generic names or disease states. The patient version includes a list of the 40 most searched drugs. Because it is package insert information, guideline-specific dosing may not be available as in the case of pediatric dosing of Augmentin suspension for otitis media.
One disadvantage: brand drugs that are no longer available such as Prinzide are included in the database. A couple of unique features in the Drugs.com app help identify those medications with unpronouncable names. Within some monographs, there is a pronunciation button which will speak the drug name. Unfortunately, it’s not available for all medications in the database, particularly those newer -mab and -nib drugs that have more syllables than indications. There is also a phonetic and wildcard search feature that allows users to search based on how a drug sounds and using asterisks in the drug name if only a few letters are known.
Other cool features include a searchable database of drug safety in pregnancy and lactation and a side effect checker. The pregnancy and lactation database provides information on U.S. and other countries’ safety ratings for drugs during pregnancy and whether the medication is safe or should be avoided while breastfeeding. The side effects database is a nice idea but the information provided comes from search term hits with no clarity on actual relevance. For example, a search for diarrhea as a side effect provided Pepto Diarrhea Control medication (loperamide) and oxycontin as potential iatrogenic causes of diarrhea.
A symptom checker powered by Harvard Health Publications is included with the app. Users first designate gender and whether the patient is pediatric. A series of questions is asked based on location and characteristics of the symptoms the patient is experiencing. Answers that could indicate an emergent condition offer a recommendation to see a provider while common conditions like headache may suggest using typical remedies then seeing a provider if the patient experiences no relief.
Drugs.com also includes a pill identifier and interaction checker, similar to those found in other drug information apps. Drug interactions are ranked according to clinical importance.
Drugs.com certainly is poised to compete with Epocrates in the drug information realm. A few unique features like the spoken drug pronunciations, symptom checker and side effects database set it apart, though the side effect checker needs the ability to rank the info provided on relevance. The drug database is robust but only includes package insert info which may not always be consistent with current guidelines or manufacturing information.
As the industry turns its attention to interoperability, the nation's health information exchanges (HIEs) -- some regional in nature, some statewide -- are helping clinicians avoid productivity-sapping phone calls and faxes, and meet some challenging meaningful use requirements.The forces that are making these HIEs essential include streamlining workflow utilizing Integrating the Healthcare Enterprise's EHR-to-EHR integration and Direct secure messaging connectivity built into meaningful use–compliant EHR software, exchanging summaries of care when EHR integration is not yet present, and responding to business pressures such as accountable care.
Pennsylvania: Making the transition
The Keystone Health Information Exchange connects 20 hospitals, 239 physician practices, and 30 home health locations primarily located in 31 counties in central, northern, and northeastern Pennsylvania, as well as 69 long-term care facilities spread throughout the state."We first went live in 2007 with a pretty rudimentary system of just connecting a few provider portals that were being offered by different healthcare systems and making it available through a single platform," says Jim Younkin, director of KeyHIE. Younkin is also IT director for external customer relations at Geisinger, a system that operates and participates in KeyHIE and itself serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.In 2009, with funding from the U.S. HHS Office of the National Coordinator or Health Information Technology's Beacon Communities program, KeyHIE enabled a registry and information repository based on Cross Enterprise Document Sharing (XDS), a health IT standard developed by the nonprofit organization IHE, for storing and retrieving documents for providers who belonged to KeyHIE.
In fall 2013, use of KeyHIE leapt when it activated a notification service. "Any time a patient presented at a hospital or emergency department participating in KeyHIE, either as an inpatient or at an ED, we would send those alerts," Younkin says. At the same time, KeyHIE successfully connected EHR software that had the ability to consume records via IHE's XDS protocol and present these records to clinicians as part of their regular workflow -- a marked improvement from traditional HIEs, which require separate log-in via a physician portal to access information. In May 2015, 559 users of the HIE accessed information via the portal, with 461 using XDS-powered access within the EHRs themselves.Those users include one of Geisinger's area competitors, Susquehanna Health, a four-hospital integrated health system, Younkin says. From within Susquehanna's Cerner Soarian EHR, clinicians can click on a link that will connect them to KeyHIE and bring back a list of documents associated with that patient. "My understanding is that that is just at a document-level consumption at this point, but we have similar functionality with customers using Allscripts; Epic does consuming, and there's a regional EHR called Medent, and we have set up with that as well," Younkin says.
KeyHIE is just in the process of finishing a multiyear migration of its HIE technology platform from an earlier technology offering by Caradigm to Orion Health HIE technology, he says.One challenge for KeyHIE has been the varying degrees to which participating organizations obtain consent from patients to release their records to other members of the HIE. For instance, Geisinger asks registering patients to sign an authorization allowing Geisinger to share their information with other members of the care team. But those patients would have to sign the same authorizations at other organizations where they registered."The challenge is that some organizations were good at asking patients to sign this, and some were very lax, and as a result, the organizations that were good at getting them signed were the ones who were frustrated, because when they went to access data from organizations that were lax at getting them signed, they found many times the data wasn't available," Younkin says.
Another KeyHIE feature helps participating healthcare organization bridge an oft-criticized gap in care coordination by connecting data from long-term care facilities and nursing homes to inpatient and ambulatory EHRs.Those facilities often lack EHRs of their own, which prompted KeyHIE to offer them its Transform service, a low-cost software tool that allows nursing homes and home health agencies -- with or without an electronic health record -- to contribute patient assessment information to any HIE."Transform allows us to take patient assessment data from a nursing home or a home health agency that normally would be sent to CMS or their billing process," Younkin says. "We've used the HL7 standards, as well as IHE profiles, to generate a Continuity of Care Document from the nursing home and home health settings." CCDs facilitate transitions of care that are required for providers participating in the meaningful use EHR incentive program.Four hospitals and four group practices in KeyHIE saved money by using the organization's patient portal to fulfill meaningful use stage 2 requirements to have a patient portal, despite efforts by the EHR vendors of those organizations to sell them separate patient portals, Younkin says.
New Jersey: Pockets of success
Four regional HIEs divide the state of New Jersey, says Linda Reed, RN, vice president of behavioral and integrative medicine and CIO at Atlantic Health System a Morristown, N.J.–based system with multiple hospitals and more than 1,599 licensed beds, which is a founding member of Jersey Health Connect, one of the four HIEs. Providers in the state hope to bring all four together but face funding and technological challenges.Now integrating 30 hospitals, Jersey Health Connect uses RelayHealth technology and, at the end of 2014, says it saw a sharp increase in providers contributing health summaries via the HIE, rising from around 100 in November to nearly 900 in December.One reason Jersey Health Connect has grown rapidly is that the HIE was set up so patients had to explicitly opt out of the HIE; if they didn't, their records would be available throughout the HIE, Reed says. "It looked like our governor at one point was going to go after opt-in, but we all rallied, got our government people involved, and he did just let it ride as an opt-out. Otherwise, we would have just had to close up shop."
Jersey Health Connect's success so far has been driven by the hospitals because they collectively realized it was the right thing to do for patients, Reed says."New Jersey is a small state," she says. "We've got a hospital on every corner. As a patient, you could be at an Atlantic Health facility today, you could be at a St. Barnabas facility tomorrow, and you could get Robert Wood Johnson the next day."The CIOs of the respective hospitals realized that the best patient care comes from sharing results, Reed says. "We then convinced some of our colleagues in our facilities that it was the right thing to do, and I think some of them still are concerned that maybe it's not; but when the accountable care organizations started coming around, they now needed to know what's going on down the street: 'Because now I'm the accountable party for this care, and I didn't know that they were in the Robert Wood Johnson ED two weeks ago,' " he offers as an example.Also, 14 participating hospitals were able to use Jersey Health Connect in 2014 as a means to meet the meaningful use stage 2 requirement for patients to view, download, and transmit records.
Now, New Jersey as a state is facing the challenge of integrating three other regional HIEs into a shared infrastructure to handle, among other things, the typical HIE challenge of patient IT matching, but across a state of nearly 9 million people.The New Jersey Institute of Technology, which itself runs a small HIE based in Newark, hopes to model a new overall statewide health information network after Michigan Health Information Network Shared Services, an HIE hub that oversees and coordinates information from seven regional HIEs in Michigan, Reed says. "It's not unlike the conversation about interoperability in electronic medical records," she says, "except that you have a bigger issue with the patient matching, especially because of the multiple medical records."The elephant in the room, Reed says, is that vendors now power many HIEs, just as they power EHRs. "They are still going after proprietary stuff, and we see similar things moving into HIE technology," Reed says.
Some vendor-introduced differences are as mundane as whether a vendor takes one identifier in a data field instead of two. Reconciling these differences makes the job of an HIE that much more difficult, Reed says. Even in supposedly well-defined data standards, "There was enough wiggle room for them to interpret some of these things differently."Another challenge all HIEs face is to go beyond the usual utilization metrics they publish, to much more difficult-to-capture metrics of how the HIE has affected patient outcomes, Reed says.And finally, the new statewide initiative faces funding challenges. New Jersey is applying for a federal grant but will need more resources. "That's been one of my concerns," Reed says. "We don't want to put any more financial requirements on our members."
New Mexico: Reboot marks rebuilding phase
The New Mexico Health Information Exchange grew out of the state's HIE Cooperative Agreement Program originally funded by ONC in 2010. Operated today by nonprofit firm LCF Research, the HIE faced a major setback in 2012 when a vendor discontinued the product powering the HIE, although the HIE was able to get by until it transitioned to a new technology vendor.Through a combination of continuing to run that older technology while migrating to new Orion technology, New Mexico's HIE has avoided the fate of some other states, whose HIEs completely shut down."We've been fortunate here that the state Medicaid program, Centennial Care, has been a great supporter of this, and they help through their managed care organizations to participate in this," says Thomas East, CEO and CIO of LCF Research. "They're using the HIE for care management for the Medicaid population, so we've been able to spread the costs out to not just healthcare organizations and providers but also payers."
The NMHIC HIE contains 1.2 million uniquely identified persons out of a total state population of just over 2 million. "We make sure the New Mexico Centennial Care Medicaid population is all represented in the master patient index," East says.In its current rebuilding phase, NMHIC has been able to gain commitments of participation from a statewide diagnostic imaging organization, and the New Mexico Primary Care Association is funding participation for 15 federally qualified health centers, East says. "There's a number of different organizations in the state, and records don't always easily flow when patients move from care setting to care setting, so folks are anxious to get access to records that haven't made their way very effectively the traditional ways via paper or fax," he says.A challenge NMHIC and other HIEs face is the lack of comprehensive patient records among participating healthcare practices. "We'd ideally like to see folks move closer to a meaningful use 2 transition of care record," East says.
One New Mexico medical practice that finds value in NMHIC is ABQ Health Partners, a 220-physician, multispecialty group based in Albuquerque. ABQ Health Partners was acquired by DaVita Healthcare Partners in 2012."The exchange is our only way of getting information easily across systems," says Robert White, MD, MPH, medical director of informatics and quality at ABQ Health Partners.White recalls seeing a patient "a couple years ago where I was able to see documents that drastically changed what I did with the patient. Compared to asking the patient or calling somebody else and having something faxed, it's far, far better."While White and his fellow physicians have been able to exchange summaries of care over NMHIC, moving documents via direct messaging has been difficult. "In the HIE, it's sort of designed to give me the document as well as discrete test results and discrete vital signs," he says. "It's the note about the exam the patient had that I want to see that tells me what to avoid or what needs to be done in follow-up."As the HIE matures, much of its power will simply live inside EHR software, White says.
"We're going to continue to work with our HIE to embed it in our EHR so clinicians are not having to think about two different systems," he says.But White also echoes the importance of the New Mexico approach versus HIEs powered exclusively by EHR software itself."The payers and the state are really critical, because the HIE doesn't have an automatic business case," White says. "In fact, a lot of people, including some imaging centers and hospitals, don't want to see it succeed, because sequestering data makes their lives easier and more financially productive."
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complaint and also clinical diagnosis. You are given the advantages and
disadvantages of various testing modalities.
The app is created by a team of Professors from the Radiology
Department at State University of New York at Buffalo.
Not available for the Android platform
iPhone download here
The webPOISONCONTROL Poison App was made by a group of Poison control
centers in various states collaborating together under the guidance of
the National Capital Poison Center in Washington, DC.
Poison Control Centers are tremendously useful not only for patients,
but for physicians as well. They provide a critical resource from
ingestions that range from the serious — TCA poisonings, to the benign —
“baby powder in a pediatric child’s eyes”.
The poison control centers behind the app state they created it
because more people are starting to look up possible adverse ingestions
online and on their devices, and they wanted to create a reputable
platform for this. They have an online version that is similar to the
app they released.
The webPOISONCONTROL Poison App enables you to enter basic patient
information, and then go through a variety of algorithms to determine if
the ingestion is something that requires further medical attention. The
app and the online version of their algorithm are limited, often
prompting you to call your local poison control center before you are
finished with inputting all of your information — but it’s a great first
step. Price: Free
Android download here
This free Anticoagulation Toolkit helps healthcare providers determine whether or not to
anti-coagulate patients and also helps you determine dosing guidelines
for anticoagulation based on a patient’s INR levels.
Per the Anticoagulation Toolkit team:
This toolkit was produced by the Michigan Anticoagulation
Quality Improvement Initiative (MAQI2), a consortium of anticoagulation
clinics and experts from across the state of Michigan. Funding for
MAQI2 is provided by Blue Cross Blue Shield and Blue Care Network of
Michigan through the Collaborative Quality Improvement (CQI) program.
The goal of this toolkit is to provide practitioners with an up-to-date,
reliable, and easy to use source of information for anticoagulation. Price: Free
Not available for the Android platform
Using the app, patients send in pictures of their acne and receive a
diagnosis from a licensed dermatologist. Prescriptions come through the
mail. Patients pay a monthly subscription fee of $19.95, for which they may
receive unlimited consultations. Prescriptions for topical medications
- which can cost hundreds of dollars if bought at pharmacies - are
included in the price. Patients have direct access to one of two dermatologists. Together the dermatologists are licensed in a total of 36 states. The topical prescriptions
include commonly used agents such as tretinoin, clindamycin, and
azelaic acid. Some oral medications can also be prescribed through the
Many patients with high blood pressure (BP) do not have
anti-hypertensive medications appropriately intensified at clinician
visits. In our randomized trial of primary care clinicians in the
northeastern Veterans Affairs hospital system, we found that this online
spaced-education (SE) game improved clinicians’ knowledge of
evidence-based treatment of hypertension and generated a modest but
significant improvement in time to BP target among their hypertensive
Structure of the Game
consists of 32 validated multiple-choice questions with explanations on
hypertension management. Participants are e-mailed one question every 3
days. Adaptive game mechanics re-sent questions in 12 or 24 days if
answered incorrectly or correctly, respectively. Clinicians retire
questions by answering each correctly twice consecutively. The goal of
the SE game is to retire all 32 questions.
Azoi has launched a smartphone case that can measure key vital signs. The
health tracker is called Wello. It consists of a number of sensors that are
embedded into a case that fits onto a smartphone. When held up with both hands,
the sensors can measure a series of vital signs, including blood pressure,
heart rate, temperature and blood oxygen. It also comes with an add-on device
that can measure lung function. The data is then sent to a Wello app that can
be downloaded onto the smartphone. This allows users to have quick access to
their health information and even track trends that may indicate they are
becoming ill. Wello can also connect with other health and fitness devices,
such as pedometers and sleep monitors. Furthermore, it has remote access,
meaning it can monitor and track the vital signs of family members.
Hamish Patel, CEO and founder of Azoi, says that Wello can help
individuals regularly monitor their vital signs, allowing earlier
detection of heart disease and other health problems.
"All too often health problems go undetected until they are too late to address.
We believe that through improved self-awareness of key vitals,
technology could very easily reduce the incidence and impact of a wide
range of illnesses and diseases."
In addition, Patel says the device could help ease the growing burden on health care services.
Wello is currently available for preorder in the US, UK, Canada, China,
India, Hong Kong, Singapore and across the European Union. The device is
priced at $199 (£120) and - dependent on approval from the US Food and
Drug Administration (FDA) - will be shipped later this year.
It is compatible with all iOS and Android KitKat phones with BLE (Bluetooth Low Energy).
Wello is currently available as a case for the iPhone and as an
individual insert for use with all other smartphones, but Azoi plans to
offer the device in the form of an Android phone case in the future.
iOS / Android
Digital library of handbooks and point-of-care reference cards like Lin's popular Paucis Verbis series.
Medical specific app for translating terms and helps phrase questions for simple yes/no responses.
Micromedex Drug Information
iOS / Android
Personalized Medical and Scientific Journal
iOS (requires internet connection)
Allows users to browse abstracts from a personalized list of journals.
After registration, members of 100 universities can view full text of
studies inside the app.
There are apps that turn your smartphone into a metal detector, a
musical instrument and a GPS system, and now there's an app that may
help doctors save your life if you're having a heart attack.
The app, which was designed by engineers and critical care
physicians, helps doctors rapidly diagnose certain kinds of severe heart
attacks, called STEMIs, before patients get to the hospital.
The app currently is in the experimental stage, but it has undergone field testing. Dr. David Burt, an associate professor of emergency medicine at the
University of Virginia, challenged a class of systems engineering
students to develop an app that could shrink images to make them faster
to send, but still maintain the clarity needed for diagnoses. "It's very easy to use," Burt said. "You hold it over the EKG tracing,
you snap a picture." Hitting a button sends the image. When it's
finished, the app shakes and makes noise to alert senders to the
ReachMD MedicalRadio delivers world class medical content directly from
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professionals. All of the programming is broadcast on their exclusive
Sirius-XM satellite radio channel XM 167. ReachMD MedicalRadio provides
quality peer-to-peer content available in 15-minute programs that cover a
broad range of topics for both general practitioners and specialists.
Listen to a live stream of ReachMD's exclusive satellite radio channel,
by medical professionals, for medical professionals, on XM 167
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Browse content from our award-winning list of programming series, including latest updates from the FDA and CDC
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New content added every weekReachMD
works with the best medical strategic partners in the nation.
partners include the American Medical Association, the American College
of Cardiology, the American Gastroenterological Association, the
American Academy of Neurology, the National Lipid Association, the
American College of Allergy, Asthma & Immunology, and Penn Medicine,
to name just a few. These partners help provide ReachMD with access to
some of the world's top medical thought leaders.
Get ready to make your smartphone a partner in your health care.
Independent Health announced Wednesday the launching of a mobile
application that will allow its 375,000 members to search for doctors
and health centers, and get information about their health insurance
Health insurers nationwide have begun to turn to mobile apps as a new way to interact with customers.
Independent Health’s MyIH app is available as a free download for Android, iPhone and Blackberry devices.
Members can use it to securely view their benefits, carry an
electronic version of their health plan ID card and locate medical
services, including doctors, hospitals, pharmacies and urgent care
“When we thought about how to do this, we pulled back and asked
ourselves how we can help people whenever or wherever people need it.
Mom and dad are at the soccer field and want to local a doctor — that
sort of experience,” said Tom Kingsley, vice president of digital
experience and member operations for Independent Health.
The virtual ID card will be convenient for members who are out of
town on business or vacation and college students who are away from
home, according to the insurer. The benefit information will include
such items as co-payments and coinsurance, benefit limits and coverage.
Smartphone use is growing, with about 48 percent of Americans using the devices as of January, a Nielsen survey says.
As smartphones become a part of more people’s everyday lives, health
insurers see an increasing role for using the devices to provide
information to members and receive information from them. The health
care sector may be the most promising new growth channel for mobile
apps, according to a recent report by consultant Deloitte LLP.
Health plans elsewhere that have announced mobile apps in the last
year or so include Humana, United Healthcare and Kaiser Permanente.
Kingsley said the current mobile app constitutes a “small first step.”
He anticipates other services, including reports on the status of
claims, wait times and balances on health-related flexible spending
accounts. In addition, the technology exists to have members monitor
weight, blood glucose and other measurements, and transmit the data to
“We’re still trying to figure out which apps will be the most
effective,” Kingsley said. “First, though, we want to be brilliant at
Despite the best intentions of health plans, experts say mobile phone users should consider privacy and security issues.
“The further away we get from face-to-face interaction, whether on
the computer or through a smartphone, we tend to let our guard down
about security and privacy,” said Jeffrey J. McConnell, a Canisius
College computer science professor. “Mobile technology is opening up
easy access to information we’re going to want. But we shouldn’t be lax
about sharing that information.”
Initiate Systems Inc. has successfully integrated its software with the Federal Health Architecture's CONNECT Gateway. According to the company, Initiate's patient registry, part of the Initiate Interoperable Health solution, is among the first products to demonstrate interoperability with the Gateway. Its patient registry technology integrates with the open-source architecture, using Web service technology and HL7 standards. Initiate successfully completed tests with the CONNECT Gateway's Subject Discovery Service, which locates patients based on demographic information, and completed interactions needed to locate and return patient information requested by a peer from the NHIN network. According to the Department of Health and Human Services, the CONNECT Gateway is designed to enable public and private health information technology systems to communicate with each other through health information exchanges using Nationwide Health Information Network specifications and conventions.
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