UK study: Telehealth not cost effective

dondennison Healthcare IT , , ,

UK study: Telehealth not cost effective …I have two thoughts on this.

One, telehealth is not only about cost reduction—it is also providing patients access to scarce resources, such as a cardiac specialist. Patients with chronic disease in rural or otherwise under served areas can use telehealth to get services where they otherwise would go without. In this case, telehealth costs equal to, or even a premium above, standard costs may be warranted (or, at least, a comparison to average costs is unfair considering the inflated costs to provide equal services in an area where resources would need to travel to the patient).

Two, costs will come down. And, an 80% reduction in costs (as cited in the article) is not that difficult to achieve if one compares dedicated enterprise solutions to consumer solutions (e.g. smartphone apps). The cost of a widely shared set of web services in the cloud accessed by off-the-shelf, multipurpose consumer devices, like smartphones and tablets, is much lower than deploying and maintaining dedicated vendor-proprietary solutions.

Article – Creating a Clearer Picture of Patient Flow

dondennison Radiology , , , ,

This is cool.

It would be interesting to see the convergence of the output of SIIM‘s SWIM initiative and this application to understand real-time metrics of a Radiology department. The dashboard could show the actual location of patients, their spot in the prescribed workflow, and the comparison to statistical norms and/or KPIs.

Layered on top of a BI (business intelligence) platform for historic data analysis, and you would have something special.

Open mHealth vs. HL7 FHIR

dondennison Healthcare IT , , ,

OK, so check this out. I signed up to the mailing list for Open mHealth, an initiative that promotes the use of designs and technologies that I believe in, like REST APIs and JSON. They have started to post some documentation and specs, and have even have published some early implementation code. They have some discussion going on in a Google Group.

But what I am trying to figure out is how this relates to HL7’s FHIR. They seem to be using the same tools with similar missions.

It will be interesting to see which one gets traction:

  • the open initiative (seemingly) driven by the user community (doctors and people working in hospitals), or;
  • the standard from the well-established and accepted healthcare standards body

It reminds me of MINT (open community) and DICOM Working Group 27‘s (standards body) output (but in this case it was many of the same people involved in both).

In general, the open community moves faster, drives rapid innovation, and gets lots of attention, but the established healthcare IT vendor community often waits for the responsible standards body committee to provide a formal, consensus-driven specification (with design controls and governance around it to prevent unexpected changes), before implementing the API. Also, initiatives like IHE will typically only reference final standards in their integration profiles.

Get Moving – New Kinect SDK from Microsoft

dondennison Technology , ,

Using a Microsoft Kinect (motion, voice) as a healthcare application interface input (e.g. navigating images without touching a computer in the operating room) made a lot of press, but those folks that actually developed for it found the initial device release lacking an a mature API for PC application developers. Microsoft has since released a software developer kit (SDK), but it still required extra coding to have the device recognize desirable gestures. An update to the SDK was recently released and it adds several new gestures that can be recognized and made available to application developers through the SDK.

Check it out.

So, for those many Rads that played the clip from Minority Report (where Tom Cruise interacts with images and video by moving his hands around) during their talks at SIIM and elsewhere, we are one step closer to realizing your dream. 🙂 Though, do try and wave your arms around for a 4 to 8 hour workday and let me know how it goes—eye fatigue will be the least of your worries, my friends.

Designing for the ‘Public’ and the ‘Pros’

dondennison Product Management

I read Seth Godin frequently. I like his style of thinking about and explaining things. Here, he discusses designing interfaces for the public and for pros.

How does this relate to healthcare IT? An example is when designing an image viewer interface. The needs of most clinicians (and certainly patients) are different from those of a Radiologist (though some ‘power users’ outside Radiology would disagree, if for no other reason than they feel they should get access to the same tools as Rads, so as not to be thought of as second-class citizens).

While enterprise IT staff want a single image management and viewing system to buy and manage, the needs of the users do vary and need to be considered. Select one optimized for Radiology and more basic imaging consumers are frustrated with the complexity. Provide a viewer that is simple to use, and power users complain about the lack of features.

Managing all images generated in the different departments in a VNA at least gives enterprise IT one of its wishes. As enterprise viewers evolve to provide more capability, more of the power users will shift from using the PACS to the enterprise viewer. The design challenge, of course, is to maintain the ease of use of the enterprise viewer as these more advanced features are added.

Many PACS interfaces were based on existing modality workstation design (in part to appeal to modality technologists and PACS admins, who were often former technologists), which was never a design priority or strength of modality manufacturers. Hopefully, enterprise image viewer developers use the opportunity to define some new interface designs, and not just copy the old, ineffective ones.

Article – Mostashari, policy committee take critical look at CommonWell

dondennison Policy , ,

Mostashari, policy committee take critical look at CommonWell

Something to watch as it evolves in the coming months and years, but here is an excerpt of the alliance’s goals…

  • Enabling providers to unambiguously identify patients – but not with a national patient identifier;
  • Providing a way to match patients with their healthcare records as they transition through care facilities;
  • Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
  • Enabling patients to manage consent and authorization;
  • Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
  • Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
  • Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

Article – Imaging centers hit with surprise 30% cut for MRI codes

dondennison Radiology ,

Full article is here, but requires (free) registration. A short summary (no registration required) is also available here.

The full article is worth a read as it goes into several reimbursement changes happening and pending.

An excerpt…

Because of adjustments made by the Centers for Medicare and Medicaid Services (CMS) in its assumptions about room use time for 2013, reimbursements for CPT code 73721 (lower extremity joint MRI) and 73221 (upper extremity joint MRI) have been cut dramatically, according to Mike Mabry, executive director of the Radiology Business Management Association (RBMA).

“To calculate [relative value units (RVUs)], Medicare estimates labor, medical supply, and equipment costs associated with every procedure,” Mabry told AuntMinnie.com. “For these two codes, CMS decreased its estimate of the amount of time the room would be used, from 63 minutes to 33 minutes. They cut the room time in half for those two codes, which results in lower equipment and direct costs and a lower technical component. That’s why freestanding centers are seeing cuts in the range of 30% for these two MRI codes.”

Rick Davis, vice president of Palm Coast Imaging, a freestanding center in Palm Coast, FL, was shocked when he saw his center’s Medicare explanation-of-benefits report.

“In 2012, reimbursement for CPT code 73721 was $427.21,” Davis told AuntMinnie.com. “This year, the Centers for Medicare and Medicaid Services reduced the reimbursement to $297.58. If managed care companies follow suit, freestanding centers will find it difficult to remain open.”

Articles on Mobile Health Applications and FDA Regulation

dondennison Healthcare IT , ,

Check these out…

Dear FDA: Qualcomm’s Robert Jarrin lists his wishes for FDA regulatory action

Where is the ‘fine line’ between safety and free rein for mobile development?

Some thoughts…

  • At risk of ending up on some government list of subversives, I question how often FDA (or equivalent agency in other countries) regulations actually result in protecting patients when they are applied to health IT products. Yes, good design, development, and validation practices are necessary for quality products. And, yes, health IT products are managing very important, not to mention legally protected, information that—when misused or when a defect affects its operation—can result in improper actions being taken …sometimes with adverse effects. But, for those that have worked for a registered medical device manufacturer, we spend more time with our eyes on paperwork than we should be. Time we could be spending on better design, or additional testing before launch. Too much of the paperwork is about evidence creation, and not about actual quality. Many process and method innovations developed in general IT product development are often difficult to adapt to the expected models in the FDA’s so called good manufacturing practices (GMP), and therefore do not achieve the same benefits/results.
  • If the U.S. government is generating revenue from the new medical device excise tax, is it possible that the FDA may be motivated to determine that more, not fewer, mobile apps are medical devices, and therefore subject to taxation? OK, I may have crossed the line into full-fledged conspiracy theory there. Sorry about that.

 

Blog – March Madness in Radiology: the Push for ACOs

dondennison Radiology ,

March Madness in Radiology: the Push for ACOs

This excerpt…

Prompt, consistent report delivery must be available and employ current technologic standards that streamline this, including tablet and smartphone delivery to providers. Rigorous quality reviews, peer evaluation and communication between radiologist and technical centers must be used to improve quality. Electronic methods of tracing and evaluating incidents should be employed.

…is on the money, but this technology platform should be part of the EMR (probably sourced as an add-on) and managed by the same group that manages the EMR, not Radiology. Radiology should indeed provide the guidance to configure the platform to meet Radiology’s needs, but they aren’t the only specialty that needs these tools, so a shared service is the best approach.