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Is the EHR in Terminal Decline?

We ask the question that nobody wants to admit..

When the slides failed during Mahad Huniche’s erudite address on the personalisation of healthcare at the recent HIMSS eHealth Europe Conference – he did what every speaker should do. He ad-libbed, and carried on. And in doing so – he said two things that were seismic in their importance.

The first – that we are entering an era of disruptive clinical IT – everybody “got”. The second – that healthcare will now be driven by you and I as “consumers”, and as such, will be governed by eCommerce technology, rather than clinical technology – nobody got.

Whether we like it or not, the wearable technology that is ever more prevalent, will be the source of our own health data – and it will be transmitted, in real time, to wherever we want to send it – i.e., to places where they can monitor this and do something about it. In short what this means is a reversal of the current necessity of a/having to travel to a place called a hospital; and b/ having to use monolithic IT called “EHR Solutions” – to manage said information. It also means that the driver of future health improvements will be you and I, as we will insist that our healthcare givers can monitor us remotely; and that the hospital importance of people like CIOs etc, will fade into one of support. We just don’t need it any more.

This will do two things; first, at a General Doctor level, fewer people will need to see their local GP – he will already know their info; this means that the GP (according to one that was discussing this with me on the plane recently) – can now spend as much time as they wish, sorting out the patients who are truly sick, as opposed to those who just “think” they are. It means less people coming into the A&E areas of hospitals (for the above same reason). And more important – less people requiring on demand beds in hospitals. Our doctors will be able to tell us straightaway, remotely, if we need to be admitted as such.

The interesting point about all this – is that it;’s not like this technology is not available already, Even places such as Turkey have their own regional connected patient record App, that will be the platform for the sort of enhanced personalisation we describe above – and this explains why Steve Leiber, CEO of HIMSS was already on a plane to Turkey even before the applause had died down from his opening Conference keynote speech.

The other interesting point, is that this consumer driven change – flies in the face of existing Hospital wisdom, who are continuing to invest in ever larger and all embracing “big patient record systems” – that will both be too cumbersome to give any actual clinical benefit, and too inflexible to cope with the personalisation that is not just required by the mobile wearable world we are all embracing, but by even now, some of the key modules that need to be stand alone in their own right – Theatre Management is a good example – if they are to cope with how individual communities want their healthcare.

What is worse – is that very few “communities” are geared up at a bureaucratic level – to handle this. When we talked to several Kommuns in Scandinavia recently, their assessment was that it will be at least twelve months before they could look at a “Procurement” to put in place relevant services.

The result – is that not only will you and I start to define our own healthcare needs – but that we will go to places called Supermarkets, to obtain this. The ICA supermarket in Scandinavia is deep in expansion of its Apotek chain of walk in healthcare shops. It can only be a matter of time before those services expand.

How so?

Because retail and supermarkets are the bedrock of eCommerce. And the very technology that drives the analysis of every purchase that you and I make in a store, is already being used to calculate the personalisation of Genomes and Genomics, as well as manage the health data wirelessly sent, all the time from yours and my Apple Watch.

Which brings me back to Mahad and his unfortunate slides. Sometimes you need to get to the horses mouth, the deeper vision. Who needs powerpoint anyway?

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New Advances in Personalised Remote Monitoring

Spry Health — a leader in health management technologies and remote patient monitoring announced today “Loop” — a first-of-its-kind combination of clinical-grade wearable and disease management platform. Loop enhances timely care to chronically ill patients, with individualized analytics to improve patient outcomes, reduce hospitalization; and decrease spending by healthcare organizations.

Following in the footsteps of similar but complementary devices from Sahlgrenska Science Park, Sweden, the heart of Spry Health’s mission is empowering better care – the right care at the right time – for patients who are coping with chronic conditions. Spry Health, incubated at the highly-selective Stanford-affiliated accelerator StartX, began in 2013 in the minds of founders Pierre-Jean “PJ” Cobut and Elad Ferber while Stanford business school students. In 2013, Business Insider named them among 17 Stanford business school graduates who will change the world.

Both founders have watched family members struggle with navigating the healthcare system with chronic illnesses: they came together with a mission to bring proactive care to chronically ill patients. “The body is a system in constant change — but nobody is monitoring the micro-changes in patients with chronic conditions”, says Cobut, “We are building a solution to bridge gaps in traditional chronic care management.”

By design Spry Health developed Loop to be a catalyst for both better care and lower costs.

“In a given year, over 28 million hospitalizations are attributed to chronically ill patients, resulting in an average bill of $37,300 per stay with some patients winding up in the hospital three or more times per year,” says Ferber. Empowering chronically ill patients is what drives the company’s dedicated team of experts in advanced health informatics, biological signals analysis, and medical research.

The Loop wearable continuously and noninvasively collects vital signs to assess the patient’s baseline, and monitor how their condition evolves. Loop’s analytics platform pinpoints subtle physiological changes and delivers relevant, actionable insights to healthcare organizations before new symptoms are noticeable to the patient.

Healthcare organizations can then guide their most vulnerable members to the right care at the right time. The combination of an easy-to-use wearable with individualized analytics increases peace of mind and compliance for patients, improves their outcomes, and prevents costly hospitalizations.

Spry Health conducted “one of the more comprehensive pre-market evaluations of a digital medical device ever published”, said Steve Steinhubl, MD, at Scripps Translational Science Institute. The evaluation had over 250 participants to prove the clinical equivalence of Loop against standards of care for blood pressure, heart rate, oxygen saturation, respiration, and CO2 monitoring.

Spry Health has submitted with the FDA and is seeking clearance for Loop by early 2018.

How Advanced is UK Healthcare?

We take a look at the upcoming eHealth Europe HIMSS Conference in Malta, and ask; where does the UK figure?

According to the Independent Newspaper recently, UK Healthcare provision, is on a par with some of the “lesser” countries in Europe. It is now no better than places such as; Poland, Turkey, etc.

This is both a kick in the teeth to the good people of Poland and Turkey, and it is also misleading. It is not the case that the UK is falling downwards. It’s just that other places are doing better. Turkey in particular, ever since Mehmet Atasever, former VP Health Ministry in Ankara, met me at a HIMSS Conference in Brussels, and handed me his 5 year Plan – has been progressive and focussed on new solutions, custom built, but (despite recent politics) – open to European links. Key areas of advance are the provision of Insurance based treatments, to help finance the general population access to five-star hospital Treatment, etc.

And it is not the case that the NHS is completely underfunded. We have shown in earlier Posts, that Hospitals can usually find the money when needed. The question may be that surprising answer, which is; maybe Hospitals don’t actually “want” to find the answer?

To get to that conclusion, you need to compare UK Health provision, with that in Scandinavia. Because of the growth of Medical Science Parks, in Sahlgrenska Gothenburg; and Pharma, in Lund and Gothenburg – there is a stimulated market in acceptance of new technologies, to help drive better care, which is now regarded as the top area in Europe (including the UK). This explains why some 20% of Visitors to eHealth Europe in a few weeks, are from Scandinavia – but only 5% are from the UK.

The UK has its own Health Conference, the week before, in London. Our question is therefore – why so? It surely has to make more sense to bring everyone together under one common roof? As we have seen above, going our own way is not helping us in terms of keeping up with better services.

Nevertheless, things might be changing. Although we ourselves will be Moderating the Nordics session of eHealth Europe, on “bridging data and genomics” – the Genomics England organisation has just appointed a new Commercial Director.

There are key and specific areas of clinical provision, where the UK is expert. What is now needed is to bring this acceptance of new processes – into other areas, particularly IT.

How Safe is the IoT?

We look at the recent situation at Abbott, and get a comment from new kids on the block, Tridentify AB (www.tridentify.se) – Sweden.

At a time when Abbott Laboratories have been the subject of a stinging criticism from the US FDA, for failing to properly investigate and resolve risks related to its implanted heart devices, including cybersecurity threats and a battery malfunction linked to two patient deaths – it’s important to take a measured view, and ask; are all devices that contain a battery, and can send info – likely to run into these same problems.

Not according to new Tracer developers, Tridentify. Based in Stockholm and Gothenburg, their CIO Leif Sandvik. It all depends on whether you have actual patient data. Simple tracking of info and pure functionality, should not be an issue. This is what he says and how Tridentify solve these aspects:

“It is correct that we use AES-128 for all communication in QTA Tracer System, but the most important is that we do not use any patient data in the system for the moment. This mean that we actually do “not have any” data to protect even if we do it.😬

If a battery should fail, the tracer will reset and the red LED will flash. If the battery is drained no LED will flash and according to the manual the product should be handled as expired.”

But Johan Snis, former Abbott Marketing Manager and new Commercial Director at Tridentify – goes further:he says there will always be some element of risk – but this is manageable;

“I would say that secure data is an important topic when entering IoT or IoMT as med tech has their own abbrevation.
Hospitals was one of the last “industries” to internetify themselfes and still they are a bit behind in knowledge and technology, including security. But patientdata is now, in most countries, in digital format on databases accesible from interhospital networks. So if healthcare already has accepted that evolution they cannot void themselfs against IoT. And they shouldn’t, since this is the most prominent way to personalize healthcare and keeping patient at home or specialist clinichans on remote locations.

However, data security is important. All data transfered to and from QTA is done using AES-128, Advanced Encryption Standard. The encryption uses a 128 bit key and it gives 3,4×10^18 possible key combinations.
If we would use the fastest supercomputer in the world it would take it approx 1 billion billion years to crack the encryption. The universe is 13.75 billion years old as we speak.
If we assumes that every person on the earth has 10 computer each and all of them would be used to crack the encryption it would take 77,000,000,000,000,000,000,000,000 years.

So data transfer can be secure. The above argument doesn’t say that it cannot be broken but that it will be tough. On the other hand it is possible to break into a hospital, it is possible to disguise as a doctor and give poison to a patient. Paper journals are possible to steal and forge…and so on.

For me the discussion has to be open minded. Yes it is very important to have secure future system! On the otherhand, the system used today are not foolproof or “pentagon” secure.”

Bridging Data and Genomics, for Personal Health.

We look at how healthcare provision is moving from a one size fits all approach – to a personalised and more insight driven delivery

We are delighted to say that we will be moderating the above session at the prestigious eHealth Conference, in Malta later this May. The specific time and date is 12.15 – 13.15 on the 10th May, the first day of the Conference.

Hosted in the Nordic Community, the session brings together key speakers from Pharma and Government, to look at how we deliver a personalised healthcare to each one of us.

We will publish deeper details as soon as these are made public. But in meantime – do make a point of meeting us at the Session. Please register your Comments below, so we can include as many of these as possible in our time together.

Better Care Management thru Population Control

We look at how new data analytics solutions can focus on better care across a large population

Innovaccer Inc., a Silicon Valley-based healthcare analytics company, announced that the Mercy Accountable Care Organization, one of the largest ACOs in the state of Iowa, has chosen Innovaccer’s proprietary platform ‘Datashop’ to drive end-to-end value-based care initiatives in their organisation.
Mercy ACO uses Datashop as an integrated data warehouse for all clinical, financial, lab, pharmacy, and immunization data and port data with help of Datashop pipelines from over 65 service locations including Hospitals, CAH, Ambulatory sites, payer data, and more.
Datashop on top of its Data Lake powers applications like Contract Performance Reporting and Analytics, Care Coordination, and Clinical Documentation Improvement. This will enable Mercy ACO to manage all of their shared savings contracts both on cost of care and quality of care. Risk stratification and predictive quality scoring modules will intelligently queue up patients for care coordinators to look after coupled with intuitive care plan management system to increase their efficiency in coordinating care.
“InnovAccer has demonstrated a unique ability to aggregate and normalize data from multiple billing and clinical sources into an accessible data warehouse. They worked with us to develop the user interfaces and analytics to fit our specific needs to report actionable information from the statewide level to the individual physician level. Mercy ACO now has the data we need to clinically integrate and manage over 300,000 patients in value based contracts.” Dr. David Swieskowski, President of Mercy ACO.
“We are excited to collaborate with Mercy ACO in providing them with a holistic value based care technology suite – Datashop. It will enable them to cover whole spectrum of value based care initiatives and reduce number of IT systems in their network to only two: the EMRs and Datashop” said Kanav Hasija, Co-Founder and President at Innovaccer.
Innovaccer’s population health management suite will help the ACO create impact at population scale by inculcating advanced analytics supporting contract performance tracking and quality reporting. Furthermore, through automated work queues and risk stratification, Innovaccer will be automating the care coordination process for the ACO staff to streamline the care management process and take care of a lot of the patient identification and stratification work that has to be done manually.
“Using its pre-built connectivity with the majority of the EMRs deployed, Datashop provides Hadoop-based data lake infrastructure for near real-time exchange of information. It’s a modular approach, with flexibility to scale at its core” said Abhinav Shashank, CEO at Innovaccer. “This is an exciting, strategic relationship that leverages our deep experience in innovating big data applications in Healthcare. An interoperable population health management suite at Mercy ACO paves the way for a future-proof infrastructure with most advanced technologies being used to help manage patients without the hassles of last decade technology.”
Mercy ACO with these new capabilities will focus on expanding quality measures, value-based services, and advanced analytics to track and capitalize on care opportunities to treating complex chronic care patients. Innovaccer is also performing advanced analytics to improve Clinical Documentation Improvement processes with Mercy. The automated and centralized collection of data and intuitive dashboards ACO staff would be able to spend their time on analyzing the data and meeting the needs of the members, leading to better care management, and developing multiple use cases to improve outcomes, and drive shared savings for the entire ecosystem.

Focus on the Internet of Things

How IoT may be the worst of all options.

The idea that we can boil our kettle at home while flooring it down the motorway prior to arrival – has long been the stuff of geek dreams. It’s beauty is in its simple and home craft image, how nice and unthreatening is this. If IoT is all about kettles and making cups of tea, well, what’s wrong with that.
And it goes on, at a much deeper level, into how whole “cities” are now becoming Smart Cities. This is an energy conserved Utopia, at a corporate level, if you will, as opposed to a personal level. Whole new divisions are being created at some of the world’s leading IT Consulting houses, as to how they can deliver, using our love and total dependence on mobile and internet connectivity, a world where we are In Control – from anywhere.
In the UK and other parts of Europe, we can moderate our central heating using our mobile phone, and thus goes the argument, we can modify, ie, reduce, our heating bills, to cope with sudden sunny days and so forth.
My friend has a new car where, in the frozen climes she inhabits, – she can switch on the heated seats in her car some twenty minutes before she gets in. And whilst i am jealous and actually impressed, the question is however – do we actually want all this? Or just how useful and time and money saving, will all these facilities give us, or much as extra competences will be gained?
I ask this because for a start, I rarely change my central heating settings from one year to the next, let alone day by day. And judging from the number of times I receive rogue emails in one day, do I really want some central wifi being involved in my domestic life, however useful this might appear for the greater good? Because, if current life is anything to go by, if the Internet is involved, then our lives can be hacked.
We are not alone in voicing these shortcomings. Oren Dvoskin at Sasa Software says it like this:
“The IoT is definitely creating a buzz as a perceived weakness when relating to cyber security. Attackers constantly look for the easiest way into organizations, and unprotected devices are a potential point of entry. The most common scenario is scanning the internet for devices with default (or no) security credentials.

This was the case with the massive DDoS attack on Dyn’s servers in October – millions of devices were hijacked, then controlled remotely.

Another concern is attacking equipment with outdated security measures, or legacy operating systems. Sophisticated equipment, such as medical devices, often cannot be properly secured, due to manufacturer warranties. It could potentially be a nightmare, with hackers demanding ransom when they’ve sabotaged a hospital’s ventilation system (or a patient’s pacemaker).

What can be done?

As always, it’s the basics. Ensure that devices have updated security credentials, and when possible, that they receive ongoing updates. Sensitive equipment, and equipment in sensitive organizations should never have unrestricted access to the internet. ”

And this includes you and I at home. The kettle controlled wifi to make our cup of tea, will also let intruders in by the front door. And that, is what I would call a nightmare.

New Ways to Share Sensitive Data

We look at the launch of the 360ofme Platform and the appointment of its new Key Execs

If you would take your clothes off, – for less people than the number of fingers you have on one hand – then your Doctor would certainly be one of them. It goes without saying that – you would not expect him to share that info, with the rest of world.

And you could say the same about Financial Data too. Sensitive info, is, well, sensitive info. And that’s the problem. Because, in the modern world, our personal data is digital, and insights into our digital data routinely need to be shared and accessible to chosen people, for our own wellbeing. The question is – how do we do it?

The answer could be the new 360ofme platform. 360ofme is a new platform that provides consumers with portability, ubiquity and insights from their digital life. From healthcare to financial and insurance to automotive and home, 360ofme provides a simple means of securely sharing critical data with family members, doctors and others that consumers choose. Utilizing cognitive computing from IBM, new insights about people’s lives will be surfaced and consumers will gain control of their digital footprint.

The key point is that they attribute their future success to the appointment of seasoned industry experts, rather than the typical “start-up” routine of inexperienced founders, which rarely work. And they go on…

“360ofme, the world’s first personal data exchange platform, today announced that four new executives-in-residence will help to guide the further development of its groundbreaking solutions. Scott Dueweke, President of Zebryx Consulting; Becky Wanta, CEO & President of RSW1C; blockchain expert Evelyn DeSouza; and Steve Schlabs, VP of Sales Strategy at BMC Software, will serve as 360ofme’s Board of Technical Advisors. The new executives will serve alongside some of the brightest minds in consumer focused software development. Other members of the 360ofme Board of Advisors include Derek Collison, CEO, Apcera; Jan Plutzer, COO, Apcera; and Carole Bellis, Partner, Kilpatrick, Townsend, LLP.

360ofme offers an online solution that enables consumers to regain control of their digital assets, allowing them to manage, share and act on their digital data. From healthcare to financial and insurance to automotive and home.

The current Board of Advisors guided 360ofme to its recent beta launch in just 10 months and will be instrumental in onboarding its first cohort of consumers. 360ofme recruits advisors in areas of critical strategic importance and relies on their guidance to ensure that significant company disciplines and processes develop and operate according to industry best practices.

“We feel so fortunate to have the advisement and counsel of these recognized senior executives. As we complete the beta release of our platform, these executives are ensuring that we can scale, delight our customers, and maintain the trust that is expected and required,” said Cindy L. Warner, CEO and Founder of 360ofme. “Becky, Evelyn and Steve will be invaluable in our journey to becoming the market leader in consumer data privacy, and Scott will be instrumental in our next phase of security architecture, as we create the most secure personal data exchange in the world.”

How To Survive Brexit

Richard Bloss explains the tragedy of Brexit.

It is a truth universally acknowledged, that the persistent vilification of its allies by another country, will itself destroy its reputation among its friends.
The tragedy of Brexit, is not on a business level. There will be no obvious difference in business, good or bad, and no obvious difference of investment. BMW will still want to sell us their motor cars.
The sadness will be in a human and personal level. The thousands of Poles, Lithuanians, Africans, Syrians, even Russians – who have come to the Uk – have not done so in search of a better life sitting on their sofa and getting our free healthcare. They already have better healthcare at home.
They came because the Uk is the beacon of tolerance, support in adversity, democracy that looks after the little guy, honesty in a world of corruption. They came because they want to contribute to our economy, to support the vision that drove them here in the first place.
We have created in its place, a feeling of disappointment at the heart of our soul, how could they have been so wrong? It is a feeling of confusion mirrored in my discussions every single day in my meetings throughout Scandinavia and Europe;
‘Richard, why did you do it? Couldn’t we have worked it out”
There is an argument that says, without the negative Brexit vote, the rest of Europe would not have taken this seriously. And I get that. But that does not mean we have to accept this folly in perpetuity.
Lets not forget that nearly half of the country – did NOT want to believe the myriad of bigotry and frankly lies that were espoused by the Leavers. And until somebody somewhere puts up a coherent and practical plan that can deliver a better version of what we have already – please tell me where is the benefit in screwing our friends?
So what is there to do?
First – lets publicly confirm that we value the greater European residents. It will send a marker in the send that our values are still intact – but equally important, it will show up those minority of European countries that want to “give us a hard time”.
Lets open discussions, before any binding decisions – but in a spirit of amicality. People do not like being threatened, and so it goes for nations and governments.
Lets apologise for our mistakes, – nobody can counter someone who “apologises” – but encourage others to do likewise.
Lets engage on a country by country basis. Our view in the UK is that every country has its own identities, to be accepted – not shoehorned into some one size fits all. Eww are right to stand up for our views too.
We need to do this quickly. Reputations take 20 years to create – but can be lost in 20 seconds. Business leaders I know, who are shocked by the lack of welcome at Heathrow- are already having second thoughts, and over time this will destroy the one thing that people come here in the first place.

As the Beatles once said; we can work it out.

Time to take healthcare security seriously.

We look at the rapid rise of Sasa Software, and ask; has their time come?

The image of Oren Dvoskin, Commercial Manager at Sasa Software, sitting in his nondescript office, black t-shirt and headphones, looks Californian, as he spells out the pessimism of his profession.

“There are two types of hospital” – he says; “those that have been hacked and know it; and those that have been hacked, but don’t know it.”

Oren’s office is nowhere near Orange County. It is on the border of Israel and Lebanon. If anyone knows about pessimism, it is he. As Sasa Software prepare to face its growing and exponential market at HIMSS 2017 – it surely does not get any more black than this.

Cyber hacking and ransomware, is growing to the point where it cannot be ignored and assumed it is for someone else. But its growth is not the most alarming feature. It is that, for hospitals, any cyber attack would have to be pre-meditated and unique and specifically tailored to find the weak spot, the easiest point of entry, into that particular hospital.

What is worse is – because health records (which are the prime target) are deeply personal and full of personal ID info – any attack is inevitably immediately visible. Unlike say a Bank etc, a Hospital cannot pretend it has not happened and just pay the money.

This is no simple phishing attack.

What that means is, and why Sasa Software believe that this 2017 will be our most “challenging”, i.e. most concerted and worrying – is that Hospitals are still not waking up to this important threat, despite the evidence that 75% have suffered some sort of breach – and that is just those that are publicly noted.

The answer, according to Oren – is to have a mix of baseline protection, the sort that all of us have on our PCs and office servers and Cloud access. This stops the initial and simplest access. But to combat the precise and targeted attack mentioned above, Sasa take the view that every incoming email, data request, every file transfer – is a threat of some sort. Their range of solutions is designed to neutralise any incoming malware or suspicious entry, at source.

But it is also a realisation that files we take for granted – the DICOM image, the voice recording – that we regularly append to our EHR records, are the new source of threat. Viewing images online across the globe, that holy grail of Clinical Consultant interoperability – may be the one area that is the chiles heel for the modern Hospital.

If there is a light at the end of the tunnel, it is not in the fingers crossed hope that that things can get better,. It is the realisation that you can do something about it. Oren is a philosopher with a positive view of human nature, despite the nature of his profession and the market he develops.

The cost of your sorting out a cyber attack ranges from $230.00 – $400.00 per patient record. Sasa Software will be addressing both the Pharma and Clinical markets at HIMSS. Worth having a serious chat.