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eHealth in 2015 – what’s in store?

2015 is set to be a progressive year for eHealth. Following the momentum built up in 2014, I take a look at the top 4 predictions and eHealth “hot-spots” that deserve the attention of Healthcare strategists in 2015.

Personally Controlled Electronic Healthcare Record (PCEHR)

In 2015 expect to see substantial progress in the PCEHR and integration of clinical information. Some of the progress made in 2014 will flow on to impact providers and consumers of Healthcare in 2015. Healthcare providers in particular should already have plans in place to align with the work NEHTA is doing, and if not, get prepared now for change.

The National E-Health Transition Authority (NEHTA) will offer funding to private hospital groups to begin integrating their systems with the PCEHR. They have released the details of their Private Hospital PCEHR Rapid Implementation Program (RIP), which will contribute towards the technical requirements for uploading and viewing of clinical documents. Release five of the PCEHR will pave the way for NEHTA to work with pathology and diagnostic imaging services to enable provider information systems to send PDF pathology and diagnostic imaging report to the PCEHR.

In Aged Care, 2015 will (hopefully) see the formation of a single client record that aligns the Aged Care Gateway system and the central client record, to the PCEHR.

In Melbourne, Western Health is gearing up to enter phase two of a project to securely deliver notifications from its hospital systems directly into GP desktop practice management software through an SMD-compliant eMessaging Gateway. This initiative, and others like it, will become more common-place in 2015.

Expanding Consumer Choice

Consumer Directed Care (CDC) is set to be more widely integrated in 2015, with a broadening of services offered under this model. Whilst CDC within the home and community care setting will continue to develop strengthen, residential aged care looks to embrace the same model of handing control to consumers over their choice of providers.

The My Aged Care gateway website for example, could be the “virtual marketplace where consumers and providers – or demand and supply – meet”. The quote from a speech delivered by Senator Mitch Fifield goes on to say “Trip Advisor style capacities on the My Aged Care website will develop ratings for the quality of providers and their services, according to what matters to consumers, rather than what Departments and providers think they should be”.

CDC for Residential Aged Care is good for consumers, and is currently in the mindset of policy makers. Residential Aged Care providers would be wise to consider the impacts of this, and think about strategies to best position themselves for the years ahead.

A current challenge is how Healthcare Providers will manage the new CDC reporting requirements. From July 2015 all Home Care Packages will be delivered on a CDC basis, so there is some concern in the industry around the lack of IT capability to deliver on these reporting requirements as July 2015 approaches.

Digital Healthcare

In 2015 many facets of healthcare will increasingly be digitised. Healthcare digitisation offers many benefits around clinical workflow automation, storage savings, longevity of records, and transmission and communication of clinical information.

Fully digital hospitals promise connection, integration and digitisation of medical records, x-rays, pathology results, radiology imaging, medications, CT/MRI scans, vital signs and other health information. Digitisation also provides opportunities around big data analytics and business intelligence to gain a broader picture of patients to improve health outcomes.

Other examples of digital healthcare include: doctors using speech recognition software to translate voice instructions directly onto patient records; linking patient meal planning with allergies and conditions (eg diabetes); medication verification and stock supply; and fingerprint biometrics for clinical staff access to rooms and systems.

It is not just hospitals that will benefit from digital healthcare in 2015. In the home care space a clinically validated monitor has recently been released that allows home users to measure blood pressure and heart rate, and connect it wirelessly to a mobile app. QardioArm works with Apple’s HealthKit, which lets users access all their health and wellness information in one place. It also records irregular heart beat history to provide a reference for doctors. This is just one of many examples.

With digitisation of healthcare inevitably on the rise, appropriate management and governance within this new paradigm will be required. One example that helps pave the way is the release of the “Clinical Images and the Use of Personal Mobile Devices” guide, which was created to assist doctors and medical students in the proper use of personal devices such as smartphones, when taking and transmitting clinical images.

Interoperability

Interoperability is essentially an expansion of the PCEHR.

In the medication management space, 2015 may be the year to directly import medication information out of the PCEHR or GP systems straight into Healthcare Providers medication management (or clinical) system. From a hospital perspective, work needs to be done to address the challenges faced by interoperability between different clinical systems, as well as the challenges in mapping the Australian Medicines Terminology (AMT) to SNOMED CT-AU.

2015 will also see the continued proliferation of wearable devices. A recent survey from Kronos indicates that 30 per cent of Australians use wearable devices in their personal lives. This adoption rate could result in a smooth transition to wearables for health and fitness use. Health and fitness data can be useful in doctor consultations to aid diagnostics, and in the future could be designed as medical devices and for monitoring general health and well-being. There will be a time where the patient will upload the data and it will end up on the health professional’s screen. It may not happen in 2015, but it will happen.

Some wearable devices that already exist include glucose meters that allow clinic alerts and remote monitoring; devices that monitor vital signs; devices and apps that allow patients to monitor their diets; and apps to help with medication compliance. Check out my blog “The Mobile eHealth Revolution” for more information.

The Mobile eHealth Revolution

21 Aug

The mobile e-health landscape is about to be transformed. We are now embarking on an era where consumerisation will drive the proliferation of integrated mobile medical health.

There are already a staggering number of healthcare apps available to consumers, but the piece of the puzzle that will take consumerised healthcare to another level is the integration and usability of applications, systems and devices across the full spectrum of care.

Research suggests that smartphone and tablet shipments are still on the rise. Another metric on the rise relates to the number of seniors going online. In a recent article from Senior Housing News, 71% of seniors go on-line every day. In addition, tablet ownership among seniors has risen from 2% in 2010 to 25% in 2014. According to the study, the number of seniors going online from their phone has quadrupled from 7% in 2009 to 29% in 2014.

Not only do the families of seniors want to be connected and involved in care, it’s the seniors themselves who are becoming engaged in mobile and internet connectivity.

Further to this, data published on the Intel Healthcare Innovation Barometer demonstrates that we are more ready than ever to embrace technology in monitoring and maintaining our health. The Intel study showed that:

People are more willing to anonymously share their health records or genetic information than their banking information or phone records.
Seventy-two percent are receptive to communication technologies that allow them to remotely connect to their doctor.
Almost half of respondents (43 percent) globally would trust themselves to monitor their own blood pressure and other basic vitals.
Fifty-three percent of people say they would trust a test they personally administered as much or more than if performed by a doctor.

It’s been no secret that Samsung, WebMD, Apple and Google are all investing heavily into health. Their aim is to help consumers see all their health and wellness data in one place, and provide both platform and integration capabilities into the consumer space. The term “ubiquitous connectivity” is often used in this situation; where mobile platforms are used to integrate health data from disparate sources to provide people with a complete integrated view of their health.

The two dominant players in the mobile space are Apple (iOS) and Samsung (Android). They are both ramping up investment from a device and application perspective. Looking first at the devices, both companies are making use of an increased number of device sensors. The iPhone had 3 sensors in 2007 – accelerometer, proximity, ambient light. In 2013 the iPhone 5s had 5 sensors, adding a 3-axis gyro and fingerprint sensor. The Samsung Galaxy S in 2010 had 3 sensors – accelerometer, proximity and compass, whereas the 2014 Galaxy S5 has 10 sensors adding gyro, fingerprint, barometer, hall, gesture, heart rate, ambient light.

Secondly, Apple and Google are in a race to have the health and fitness platform of choice. The Apple Health platform (HealthKit) allows apps that provide health and fitness services to share their data with the new Health app and with each other. A user’s health information is stored in a centralized and secure location and the user decides which data should be shared with your app. Independent programmers can develop additional apps to integrate with Apple Health.

In addition, Apple Health:

Displays personal biometric data (heart rate, calories, blood sugar, and cholesterol) from other fitness devices (eg JawBone, Glocose Meter).
Provides a single app that collates all the data in an easy to read dashboard.
Allows users to share information with doctors and other healthcare professionals.
Enables health providers to take advantage of the sensors in iPhone 6 and the iWatch (coming soon).
Will soon allow apps to sync with providers electronic health care records, with the aim of seamless integration.

There is no doubt that Apple aims to be the “hub” for health care data. The Apple alliance with IBM will also lead to a significant influx of healthcare mobile apps for the iPhone and iPad.

Google has announced “Google Fit”, which is a health platform similar to Apple Health Kit that allows various apps to share health data for individual users to create a complete picture of their fitness. Whilst the open platform is soon to be released, it looks set to provide developers a single set of API’s to access and store fitness data from apps and sensors. Like Apple, this will eliminate the complexity of accessing multiple sources of information to provide a unified view of fitness activity & overall health.

With the increasing number of seniors going on line and their growing acceptance of technology to help manage and enhance health outcomes, combined with the development of platforms that bring all health data together by integrating apps, hardware and systems, we are positioned for a transformation in electronic healthcare opportunities and management.

So where does this leave us as Healthcare and IT leaders?

It’s time for a strategy refresh!!! People of all ages (including the older folk) are ready to embrace technology to improve and maintain their health. Ignore these trends at your own peril, and instead look to develop strategies that leverage mobile health app platforms. Depending on your situation, you may need to weigh up the benefits of building your own independent app versus building an app on an existing health platform.
Consider the opportunities for integrated medical records. Look at opportunities to use these mobile platforms to provide a more integrated solution that, at the end of the day, will ultimately assist the end user to view all their medical data in one place.
A greater number of sensors and integration points results in more data. As vast amounts of this user-generated data is collected there will be opportunities to monetize that data.
Telehealth, remote monitoring, telecare – Patient care will become less complex and more affordable with an increased number of devices and software able to connect and integrate seamlessly.
Issues around security, privacy, consent and ethics still need to be considered.

For more information, please feel free to contact me.

1 Comment

Posted by CIO/COO on August 21, 2014 in e-health, mobility, strategy

Tags: app development, apple, apps, bigdata, consumerisation, e-health, ehealth, google, google fit, health, health kit, internet of things, iphone, mobile, mobile apps, mobile strategy, mobility, sensors, strategy, technology

Developing an e-health strategy – top considerations

14 Dec

E-health is considered by many to be one of the most important revolutions in health care. E-health uses technology and telecommunications to deliver health information and services more effectively and efficiently than ever before. E-health has enormous potential to improve service delivery, reduce costs in caring for the ageing population, and address the inequity in providing care to remote communities.

Despite this potential, the uptake of e-health is varied. Slow adoption of e-health can be put down to:

– Funding challenges, and governance of healthcare services

– Resistance to changes in existing models of care

– Lack of credible research evidence on the benefits of e-health

– Costs and complexities associated with e-health implementation

– The unknown impacts on practitioners and consumers

– Concerns over privacy

These challenges can, and are, being addressed. The Australian government has heavily invested in the National e-Health Transition Authority (NEHTA) to address integration and interoperability of health information, and are also focusing on care provision via a consumer directed care model.

For e-health managers, developing an e-health strategy in a period of significant change is an exciting but perplexing activity. Taking into account the barriers and challenges above, some of the key considerations in developing an e-health strategy are:

– Knowing the key objectives you wish to achieve with e-health. Your e-health strategy needs to align with your organisational strategic plan, have an approved business case, and have clear purpose, goals and KPI’s. Know exactly why you are doing it, the benefits you hope to gain from it, and the key risks involved.

– Ensuring the foundations are in place. Your e-health strategy needs to account for interoperability and integration with systems internal and external to your organisation. Ensure you take a standards approach to data and information exchange. Interoperability with referrers, service providers, hospitals, GPs, etc is critical.

– Define the scope of e-health. E-health can mean many things to many people. Make sure you define exactly what e-health is and is not. The definition and scope of e-health will vary from organisation to organisation, depending on capability, resources and what you are trying to achieve.

– Getting buy-in. Implementing e-health initiatives will have a much greater chance of success if you have buy-in from management, field staff and consumers/patients. Buy-in is achieved by getting all stakeholders to be part of the e-health story, eliciting input/feedback, education and training, communicating regularly, and remaining focussed.

Whilst there are many other considerations, the above points highlight areas that are critical to e-health strategic success. Developing and architecting the strategy to suit your organisations individual circumstances is the next step. More about that in a future post.

e-Health and Mobility – Strategy in a Nutshell

30 Nov

There are some staggering statistics recently released by Forbes regarding smartphones and apps. According to Forbes (www.forbes.com) there will be 1 billion smartphones sold in 2013, which is twice the number of PC’s predicted to be sold that year. By 2016 there will be 10 billion mobile internet devices used globally, which is 50 times the size it is today. Between 2010 and 2011 the time spent on mobile apps began to outpace the time spent on the desktop or mobile Web. In the same time period there was a 91% increase in the time users spent on mobile applications. By 2015, mobile application development projects targeting smartphones and tablets will out-number native PC projects by a ratio of 4-1. Between 2009 and 2014 the market for cloud-based mobile apps is projected to increase by nearly 90%.

So what does all this mean ???

The mobile revolution is well and truly here. Organisations of all sizes need to have developed a solid and robust mobile strategy, or face being left behind by clients and competitors. Whilst there is still some contention over the best strategic approach to mobile application development, there is no doubt that mobile applications are front and centre in leveraging market opportunities, client engagement, process efficiencies, and strategic innovation.

In a recent blog post I proposed the inclusion of a Mobile Enterprise Application Platform (or MEAP) as an integral part of any mobile strategy. Of course, this particular strategy depends on the nature of the organisation and its key mobility objectives; however MEAP should not be overlooked when considering a long term view to deployment of multiple different mobile applications, using multiple back-end systems, across any device.

For medium to large sized healthcare organisations, a MEAP based mobile strategy has several advantages over a natively developed application, which is often built with a pre-defined range of objectives, or based on one back-end system. In this scenario, a mobile platform approach is superior because it:

– Enables the organisation to customise a solution into fit exact requirements, tailored to the business needs and processes

– Can provide a competitive advantage, as no one else has that particular mobile application

– Ensures that changes to the mobile solution are immediate, flexible and more cost effective

– Is not restricted by the type of mobile device. Mobile platform applications built using HTML5 ensure availability on any mobile device

– Aligns to organisational “bring your own device” policies (if applicable)

– Ensures that any development code (apps or API’s) can be re-used to help build other apps

– Fits into the organisations long term strategies and e-health vision to provide mobile solutions for other uses, for example

Bedside medication management
Bedside electronic progress notes and electronic care planning
Capturing of client and staff incidents, risks, compliance and improvement initiatives
Mobile business intelligence and analytics
Mobile clinical assessments
Information management (eg, mobile access to policies or corporate documents)
Others ???

The above examples are likely to need data integrated from multiple in-house systems, which plays into the hands of a mobile platform. While organisations may not require mobility solutions for all the above examples right now, establishing a mobile platform caters for immediate AND long-term organisational use of mobility, even if the future state is not known. The mobility platform approach has already harnessed recognition across all the major ICT industry research groups including Gartner and Forrester, and is a key component of the ICT Strategy toolkit.

4 Comments

Posted by CIO/COO on November 30, 2012 in e-health, mobility

Tags: app development, apps, cloud-computing, e-health, ehealth, health, MEAP, mobile apps, mobile business applications, mobile strategy, mobile web, mobility, native app, strategy

Time to introduce Videoconferencing into Community Health ?

12 Sep

One of the most effective ways for healthcare providers to improve service delivery is by enhancing the level of collaboration between different stakeholders using videoconferencing, according to a recent report by independent analyst firm Ovum.

Putting dedicated telehealth and telemonitoring solutions to one side for the moment, both home grade and enterprise videoconferencing solutions can be used to improve service delivery outcomes, enhance collaboration and communication between patients and practitioners, and provide more equitable healthcare – particularly to those in rural and remote areas.

Clinicians’ and care workers who provide care for patients in their homes can use videoconferencing tools on tablet or laptop devices:

for Occupational Therapy reviews, particularly to review and monitor client equipment usage or risks in the home
to link with a physiotherapist to review a patients home exercise program
to link with wound assessment or diabetes management experts
to liaise with the palliative care team for communication and triage
for patient social isolation prevention

Whilst there are many more usage senarios, the main point is that we have the technology available today (eg laptop/tablet & skype) to deliver improved outcomes by using this readily available technology. Unfortunately many (dare I say “most”) community healthcare providers are not using it in this manner.

So, why are some/many community healthcare organisations not using videoconferencing ?

Culture and process change – using videoconferencing in the clients home requires change in process, documentation and culture. It needs to be driven proactively by organisational leaders, and requires consultation and buy-in from field staff (and patients).
Perceived cost – the purchase of laptops/tablets, monthly data plans and systems (corporate systems give the best experience but come at a price). There is also the cost of change and training. A business case is essential in justifying the return on investment and benefits to patients/staff.
Lack of connectivity in remote areas – unfortunately many rural pockets of Australia do not have broadband connectivity, and many areas struggle with cellular 3G connectivity.

To have the best chance of success, the above issues need to be addressed, or mitigated as much as possible. Also, video-conferencing solutions must be tailored to various usage scenarios, so having a clear picture of how the technology will be used is very important. Health related video conferencing initiatives must align with, and be included within an over arching e-health strategy.

With the continual improvements in fixed and mobile broadband connectivity, improvements in equipment interoperability, and relatively low cost entry, video-conferencing in healthcare has a lot of potential now and in the future.

1 Comment

Posted by CIO/COO on September 12, 2012 in e-health, videoconferencing

Tags: conferencing, e-health, ehealth, mobile business applications, skype, strategy, telehealth, video, videoconferencing

Consumerisation of Telehealth

02 Aug

According to a 2010 study by Access Economics, Telehealth is a subset of e-health that includes the application of IT and telecommunications for diagnostic and treatment services, educational and support services and the organisation and management of health services.

Looking at this wide definition, it is interesting to examine the consumerisation of telehealth, and the role being played within the mobile applications space for every-day users. According to MobiHealthNews latest report, there are more than 10,000 “medical” apps available for iPhones, Android, Blackberry, Nokia, Palm, etc. Whilst the largest group of consumer health apps are cardio fitness apps, there are also thousands more apps that fit into the “health & fitness” category that are not actually health, medical or fitness related. Despite this, the quantity of health apps for consumers is growing at a steady rate.

Popular health apps are used for counting calories, gauging nutrition, tracking workouts, calculating body mass index and quitting smoking. Our humble smartphone device offers a relatively low-cost and real-time method to assess disease, movement, images, behaviour, social interactions, and a host of other health related information. Much like the consumerisation of smartphones into businesses, there is also a gradual consumerisation of telehealth via smartphones.

There is significant further potential in using smartphones to improve the health and wellbeing of clients. Remote monitoring, at home triage services, teleconsultations, medication management, outpatient services – could all contribute to improving health related outcomes.

Unfortunately there are still many obstacles in the way that is preventing higher penetration and enhanced mobile application services to clients. Cost, usability, security, privacy all play a role, however the role of mobile apps in healthcare isn’t set to disappear any time soon, so it may pay to embrace this technology and plan it’s place in your strategy, rather than hoping for a fast exit.

Ben Ward