Readers Write 4/30/10

Setting Your Data Free

By the UI Guy

As its nomination for “Most Overrated Technology” at HIStalk’s 2010 HISsie Awards demonstrates, Service Oriented Architecture (SOA) is a term too often bandied about by healthcare IT vendors. It’s not the nomenclature itself that’s the problem, but rather its misuse and the unwillingness of many of these vendors to do anything more than pay it lip service.

This shortsighted approach is reflected in products that require too much local functionality, time-consuming client-side data management and restrictive allegiances to pre-defined operating systems and form factors. The latter limits the advance of healthcare mobility, as the form factor of choice remains desktop applications that tie clinicians down. When companies do create mobile apps, users often face similar limitations – they’re only for one device – such as the iPhone – and rely on functionality that does not make the best use of the device’s attributes.

Another challenge is that the data collected by many applications is housed in silos – it’s unusable across the 30, 40, 50 or more disparate systems that hospitals typically have. It seems like many vendors are developing in a vacuum and then slapping an SOA badge of honor on their technology, without meeting the key criteria of true SOA – collecting data from numerous device types, via any operating system and platform and making this data usable by other systems.

Developing high-impact products involves a commitment to SOA at the conceptual level. Part of this is versioning HIT applications to take advantage of certain form factors, rather than trying to cram features into the device, come what may. For example, a product versioned for the iPad would make the most of of the large screen, light bodyweight and long battery life, and also multi-touch. If a vendor can’t apply its products across multiple device types, getting the most from the merits of each, this should be a red flag that the product is not really embracing SOA.

The next step to developing SOA-focused software is to create a simple and intuitive UI that makes it easy to capture data. By embracing industry standard web services methodologies and universal exchange approaches like XML and HL7, this data can be made usable across multiple systems and databases.

Patient information should be accessible from mobile devices, so that it has maximum impact on clinical floors. This in turn extends data retrieval and management capabilities to a wide user group. For example, if patient data is captured at the point of admission by an enterprise forms management system, the application should be able to pre-populate clinical forms with this information on a tablet carried by a nurse. Such synchronization eliminates delays and redundant effort.

If captured data is stored or managed at a server level – rather than locally as is the problem with a lot of SOA impostors – users will have a more focused interaction experience and will be freed from unnecessarily top-heavy interfaces. By separating data from the UI once it has been captured, developers can free clinicians to perform tasks quickly and get back to focusing on what really counts – delivering timely and informed patient care. Without such a switch in design philosophy, SOA is just another ingredient in the revolting acronym soup that HIT vendors have been serving to hospitals in recent years.

Filed under Articles & Interviews on April 29, 2010 - No Comments -

News 4/26/10

I wanted to make a quick follow-up comment to my last post about the iPad. Someone who bought the iPad as soon as it came out told me they had some of the same concerns about handling the iPad – it’s sleak and slick, a little heavy if you were to carry it around in your hand, and just too precious to risk dropping. The person noted that those thoughts disappeared as soon as he put the iPad in the case that he purchased with it. In fact, he said he couldn’t possibly imagine having the device out of the carrying case. I was a little intrigued so went back to the Apple store to check it out. Interestingly enough, the store doesn’t show the carrying case at all. I had to get an associate to hunt down an iPad in the case being used by another employee. The tip-off was absolutely correct. The carrying case totally alters my view of handling the iPad. It’s a little odd that Apple doesn’t more prominently showcase the carrying case. I realize it’s a beautiful device, but my concerns are hardly unique. A simple carrying case can go a long way towards addressing them. The person who sent me the comment also noted that he thought the iPad was a perfect consumer device – streaming movies, reading ebooks, surfing the Net – but said he couldn’t see using the device for business purposes… Just another data point.

And if it’s love the iPad is looking for, it just found a little… Israel lifts ban on imports of the iPad. After banning the devices about two weeks ago for fear they would interfere with other wireless devices, Israel is now allowing people to bring the iPad into the country. Israel consulted with Apple, a recognized international lab, as well as European counterparts before concluding that the device could successfully locate Wi-Fi access points and adjust its settings automatically. Craig Mathias, writing for InformationWeek, speculates that the ban probably had more to do with political sentiments than genuine technological concerns… Either way, the bottleneck in Apple’s global distribution network has been removed and the 20 devices confiscated over the last two weeks are being returned to their owners.

News 4/20/10

I finally had the chance to stop by the local Apple retail store to check out the iPad. I have to say…not quite what I expected. As always, and really this goes without saying, Apple has created a gorgeous device that resembles art more than science. And the dozens of people groping to get their hands on one of the many devices being displayed like artwork would back me up on this. Once I got past the shock and awe, however, my innate craving for the newest, coolest gadget (from Apple no less) was quenched. Why? I just couldn’t see using it… Let me take that back. I think this is a perfect device for plane trips. I could absolutely see myself – snugly packed into a seat – watching a movie. I could let the device sit on the tray, put it in my lap… maybe even hold it for a few minutes. Best of all, I could effortlessly slide my hand into my bag and pull it out 10 minutes after lift-off. Don’t have to worry about opening a laptop. Don’t have to worry that I can’t get my laptop to open once the person in front of me crushes me with their seat back. Yes, the perfect flight companion. Anywhere else, I’m not so sure. When I first saw the specifications, I couldn’t believe it only weighed 1.5 pounds. When I held it in my hands, I couldn’t believe how heavy 1.5 pounds is. With its sleek and smooth lines, there’s not much to grab onto with the fingers. My hands are starting to sweat just thinking about it. I guarantee you a lot of devices are going to be hitting the ground. I haven’t seen any dropped iPads, but I’ve seen plenty of dropped iPhones. Not a pretty sight. Now that I’ve had the chance to play with the iPad, I’m thinking a tablet needs to be in the 5 to 7 inch range, somewhat ruggedized, and half the weight. For healthcare, needs to be heavily ruggedized, anti-microbial, etc…

No sooner said… Dell Streak tablet lineup leaked. According to Engadget, which first obtained images of the devices, Dell will be adding 7-inch and 10-inch versions to the Dell Streak 5 (previously named Mini 5). All 3 tablets will run on the Android OS. The Streak 5 is expected out this summer, with the Streak 7 to follow towards the end of the year, and the Streak 10 at the beginning of 2011. Not much is known about the 7-inch and 10-inch models as Dell has not officially announced. However, prototype models of the Streak 5 have been floating around for a couple of months. The device is not just an internet-enabled mobile device. It also serves as a 3G phone. No sooner will the HTC Evo arrive with its 4.3-inch screen this summer only to be trumped by the Streak 5 where screen size is concerned.

Mediquations Medical Calculator now available for iPad. Originally developed for the iPhone, the Mediquations Medical Calculator, with 214 clinical scores and formulas, has been redesigned specifically for the iPad.

Came across an article in MedCity News by Brandon Glenn discussing the Personal Caregiver app by Medic8 Manager, LLC which was launched in January. The application joins a handful of others that are trying to tackle the medication compliance problem. I believe it is the first medication reminder software that has an integrated drug database – though I’m not sure who is providing the drug data.

Unbound Medicine releases new 3rd Edition of RNotes. RNotes is a quick-reference application that provides nurses with the latest clinically-focused content. The new edition includes: nursing-focused topics, full color images, tables and charts, and personalized favorites.

The folks over at Healthagen continue their tidal wave. They partner with Asklepios to deliver a German version of iTriage called Meine Klinik… Austin Immediate Care announces partnership with Healthagen to include medical and facility information in the iTriage application, and promotes their story with the local Fox News channel… Healthagen collaborates with leading marketing firm to take their message global… And what do they have to show for the tireless effort? According to the company, their user-base is growing by the thousands and last week they made it into the top 5 of iPhone healthcare apps… Congrats!

Finalists for the TripleTree I Award for the Wireless-Life Sciences Alliance announced. The finalists are competing in three categories- Best Operational Effectiveness Solution, Best Clinical Application, and Best Consumer Experience Solution. The twelve finalists are: AirStrip Technologies, Calgary Scientific, CellTrak Technologies, Corticare, Great Connection, Hopskipconnect, InnerWireless, Ocutronics, PerfectServe, PharmaSecure, Zeo, Inc., and ZMQ Software Systems.

Vodafone Americas Foundation and mHealth Alliance announce winners of wireless innovation competitions. Winners of the Second Annual Wireless Innovation Project were: First Place – 100 Million Stoves, Second – FrontlineSMS: Credit, Third – Sana (previously MocaMobile). Sana also won the first mHealth Alliance Award for innovation in mobile health.

Accenture releases a mobile report entitled “The Dawn of a New Age in Healthcare: An early look at the market for networked devices in mHealth”. It’s any easy to read slide presentation in PDF, so worth perusing.

Finally, in addition to checking out the iPad at the Apple store, I had a chance to take a good look at the iPhone bar code scanner that the reps are carrying around. I’ve heard some grumbling in the past that the iPhone didn’t have a true bar code scanner, which limits its medication administration and specimen collection roles. The accessory is manufactured by a company called Infinite Peripherals. The casing includes its own battery source, bar code scanner, and magnetic card reader.

Filed under News on April 20, 2010 - 1 Comment -

News 4/15/10

Apple previews iPhone OS 4.0. Apple is touting the iPhone OS 4.0 as the biggest and most exciting iPhone software update yet. The new OS includes more than 100 features, including: multi-tasking for third-party apps; unified email inbox; enhanced enterprise support with improved security, management, wireless app distribution, and more; Apple’s new iAd mobile advertising platform; and iBooks, the company’s new ebook reader and online bookstore recently debuted on the iPad. In addition to the preview, Apple released a beta version of the new OS, which includes an updated SDK.

Simbionix introduces their first mobile app for surgical education. The company, which provides medical education and minimally invasive surgery (MIS) simulator products, created an interactive mobile application for training medical professionals. The first application, developed for Johnson & Johnson, is a course about umbilical hernia repair using a partially absorbable mesh patch. Simbionix will be releasing a library of mobile apps to address a variety of medical topics and procedures.

UBM Medica announces SearchMedica app for iPhone. The application allows users to easily navigate the company’s search engine for medical professionals. Specific features include: access most current and relevant information from any of eleven specialty channels; target searches to journal articles, evidence-based content, guidelines, trials, or patient information; locate frequently searched topics; and more.

I don’t typically refer to other blogs, but Dr. Larry Nathanson – who heads up Beth Israel Deaconess Medical Center’s(BIDMC) Emergency Medicine Informatics – submitted a guest article to John Halamka’s blog about his experiences with the iPad. It’s a great perspective from an actual clinical user, so worth checking out… especially if you are considering. The folks at Forerun, Inc. asked that I mention that Dr. Nathanson was running the Forerun EDIS on the iPad.

The California Telehealth Network selects AT&T to build network. The telehealth consortium, led by the University of California and the UC Davis Health System, has chosen AT&T to build a secure, medical-grade telecommunications system. The nearly $30 million project will increase bandwidth capacity for telecommunications so that clinics, hospitals or other provider sites will have direct, peer-to-peer connectivity to all network members, plus connections to a wide range of external networks and services. AT&T will be responsible for establishing new, or upgrading existing, telemedicine connections, especially in rural communities throughout the state.

Verizon Wireless and BL Healthcare trial remote healthcare solutions. The two companies, along with an extensive list of third-party providers, aim to deliver “best of breed” applications and healthcare-related services to patients remotely using BL Healthcare’s remote health management platform and Verizon Wireless’ network.

Mission Hospital selects VIXIA to provide Equipment Distribution services. As part of the service, VIXIA will deploy a Real Time Location System (RTLS) and their VixPort information portal which was co-developed by Patient Care Technology Systems (PCTS) and VIXIA to more effectively manage movable medical equipment assets. Mission Hospital is a 345-bed facility located in Misison Viejo, California.

In case you were looking for a number to add to your mHealth business plan… Revenues from mobile health monitoring to reach $1.9 billion globally by 2014 says Juniper Research.

Good article in the Economist – “When your carpet calls your doctor.” It’s pretty short but includes a number of pertinent trends and companies.

There’s an interesting article in Scientific American that poses the question – Should medical apps face government oversight? The article, by Jessica Wapner, focuses mostly on the smartphone and whether the FDA should be regulating smartphone apps. While it’s not clear where the FDA stands, it seems fairly likely that they’re going to have to take a position before too long…

A couple of reports from the California Health Care Foundation (CHCF)…

CHCF has released a report entitled “How Smartphones Are Changing Health Care for Consumers and Providers,” by Jane Sarasohn-Kahn, M.A., M.H.S.A. It provides a good, high-level overview/survey of the sector and includes a plethora of survey statistics.

CHCF has also released the results of a survey conducted by Lake Research Partners on consumers and health information technology, with special attention on PHRs. According to the survey, the national adoption rate of PHRs has grown from 2.7 to 7 percent over the last year.

Filed under News on April 15, 2010 - No Comments -

HIStalk Mobile Interviews Peter Hudson, MD

Peter Hudson, MD is Co-Founder and CEO of Healthagen

When did you decide that you wanted to start this company? Can you just walk us a little bit through what’s happened over the last couple of years from inception to where you are today?

Wayne Guerra and I are both ER docs, so we’ve seen 50,000 patients around the point-of-care. Over the last three or four years we just realized that patients weren’t sure where they should go. They often ask us questions: “Is this the right place? What should I be worrying about? Was this the best place for me to come for the condition that I have?”

The genesis was a Saturday morning, trying to get the kids off to soccer and I got three calls from different neighbors who not only weren’t sure what they had – they had a symptom, or their kid had a symptom or had an accident – and they weren’t sure what to worry about, and how to think about it.

Then, when they sort of settled on what they were most worried about, where should they go? What kind of facility, and then where. Exactly where – the latitude and longitude, address, and phone number. I was really surprised by that because these people had lived in our community for years and they’d probably driven near hospitals and urgent cares and things like that and they just weren’t aware of it.

We realized that there’s a real need for answering those two simple questions [what could be wrong, and where should I go], which aren’t really that simple when you realize how much content is required for the first one – which is kind of a clinical question; and how much data and location specific data is required for the second one. As mobile technology became available and the landscape for distributing software became more open, we felt that was a perfect opportunity.

At what point did your vision of an opportunity to create this valuable tool go from ‘let’s build an iPhone app’ to ‘let’s build a company that we can build a platform for providing consumer-based health information’?

We’ve been thinking about this for awhile because there’s just so little that’s known about the details of healthcare – how much does this cost; what’s the best treatment for this; who’s the specialist to take care of this condition? We felt like there was this huge information gap and inefficiency. We started thinking about that even before we realized that this product could be a good entry point for some of that.

But as we thought about our initial product, it was never about just being an iPhone app; it was about being a decision platform for people. We modeled this entire thing out with a comprehensive flow chart from start to all sorts of different finish points with every data set that we needed completed. Our product does what we modeled. I guess having provided medical care, having been patients, and having talked to so many patients, we just had a really clear view of what we saw to be some of the problems. Natural places where different data sets could really provide information to patients within a context of the decision they needed to make.

See, from my perspective, the application is a very nice application. It looks like you guys have done a great job, but there’s a lot more here than I think most people would expect. I say that because for one, the founders are a couple of long-practicing physicians. It’s not like you just started residency and then decided to start a software development business. But then, you start to uncover a little bit more, and it’s quite impressive that you guys have a fairly serious group of people behind your company and you look pretty serious about it.

We’re extremely serious about it. We think that patients deserve, really, a very robust, very connected resource at their side and it’s possible, so why not have it? We went out to a lot of the largest companies that could help us for the data needs and we shared our vision, and they partnered with us. We went to large health systems and we talked about what we were doing and they became our clients.

We rolled our software out and then asked people for stories about how they used it, and they used it in every way we designed it for and got benefit from it. In fact, we’ve had very few comments saying anything other than ‘can you add this disease or that one because I didn’t see it on there?’ Most of it has been ‘I had a problem. I now have a way to think through it because I want to be empowered. I want the information when I need it and I made a decision. I was really happy with my decision.’

It’s been extremely rewarding. As much as taking care of patients one-on-one in the hospital; now we can take care of and help people in a sort of one-to-many, or a much larger focus.

When did you first launch the first version of your application?

March 10^th of last year – about a year ago.

I’m very impressed because you guys are covering a lot of ground very quickly. Where do you see yourselves, as a company, in a year?

I think we’ve tackled one of the harder parts of a consumer-facing technology for healthcare, and that’s real-time decision support with real-time access to over a million data points around the country. We will be expanding into helping people manage their health; helping people learn more about their health, and promoting different capabilities of improving their lives. You know, getting healthier.

With the knowledge that they have the value-add of thinking through an acute problem. It’s always there. Thinking through how to access the system is always there. I think that’s more of our vision of where we’ll be in a year.

Our current technology, which we call symptom-to-provider technology, we see it as a flow chart or a flow of information that goes down many different pathways, but the same kinds of pathways, the same categories of pathways. We envision it becoming more engaging on the front-end with more specificity for the patient, and better connections to our clients on the back end. So, as you access the system, we’ll become more and more integrated and valuable to both the hospital and the patient in facilitating their entry point to the healthcare system.

When it comes to building consumer-oriented solutions, like PHRs, the prevailing attitude seems to be ‘let’s build it and they will come.’ I think that’s far from true. Your application is one of the first that I’ve seen that, as a patient, as a potential consumer of this application, you’ve actually given me a compelling reason to use it. I think that’s extraordinarily unique.

The challenge is then, how do you make people like me aware that you guys exist?

That’s why we have partners. That’s why, in every market, we have clients and they promote us, but you’re absolutely right. As to the first part of your question, I think there’s something that other vendors in the chronic disease space and the personal health records space should think about:

When and how do you engage somebody? People say that if you have this cool graphing technology for your glucose on your phone, that it’s engaging. That if your glucometer connects to the rest of the world and shares your data with your doctors and they can give you feedback, it’s engaging. I think those are connecting and those are efficient. Those are good ways to collect data and connect with data, but they’re not engaging.

I think that the moment of engagement comes when somebody has something wrong. I know this personally because people come into the ER with all sorts of chronic problems, for example, perhaps they’re an alcoholic and are drinking themselves to death. Every now and then if I’m around on a shift when they sober up I’ll say, “Listen, you’ve got to stop drinking. You’re going to kill yourself.” I’m never afraid to tell people exactly what I believe to be the truth – if you keep drinking you’re going to be dead. Every now and then somebody comes back and says, “You know what? I stopped drinking, Doc, cause you told me that I needed to stop drinking; that I was going to die.” Information combined with an event that helps someone take notice. That’s engagement.

Ultimately, if you have a technology that will help people track their weight or what they eat, or their nutrition, or what their glucose is – all that is great if they want to do it, but I think they probably need some event to promote their interest in doing it and what a better chance to engage somebody than to help connect them right at the point-of-care, right at the point of need, with the right solution.

Then guess what? Some of our partners are pretty interested in the fact that we have real-time surveillance of where people are going. And, can they engage with people and help them because they see that ER visit, or they see the urgent care visit or their interest in certain conditions being a sign of worsening or a sign of exacerbation of their condition.

I guess it’s something you’re probably used to dealing with, really. But to me, the frustrating part would be that how many people will go through a crisis and not really know how to respond, or don’t adequately respond because they don’t have the tool available. It won’t be until after the fact, and maybe never, for them to know that there is such a tool available and at their disposal.

You’re right, it becomes compelling and it becomes engaging when you need it. I suspect that’s the challenge for you guys is to get out there and get people’s attention before they need it, so when the need does arise, that you’re at hand.

I think that’s one of the reasons why we love talking to you and other people who have an audience. There’s huge businesses built on moving the needle for a population one-percent. It doesn’t take a huge amount of engagement to actually make a big difference, and then it becomes something that continues to snowball when people hear about it.

What is your exit strategy? You’re an entrepreneur, you’ve built a business. You guys are tracking nicely. What’s the end game?

Our exit strategy is really to keep our head down and to continue to add more and more data, add more and more hospitals, and provide some benefit to some populations that we’re talking with. Cost and quality information, personal health record access, etc. To some degree, it could look like we’re trying to do a lot of different things, but in my mind it’s so connected and so structured that it all fits together. I think we just want to keep building the best solution and see what happens.

Ultimately, somebody will realize that 130-million patients a year go to the ER; another 60-million go to urgent cares, and something like 800-million see the doctor. In all these decisions there is inefficiency and waste, in the hundreds of billions of dollars. If all of a sudden there’s a mobile solution that really facilitates that access and helps people think about it in the right way, it’s going to be compelling for somebody. We’re quietly building it.

Is there anything that I haven’t asked, or anything specific that you would like people to know either about the application or about your company that you feel we didn’t cover?

From a CIO’s perspective, or somebody in information technology, we offer a platform to communicate certain really key hospital system variables to patients in a very simple format, and offer many pathways to further enhance the patient experience through integration. Initially, this can even be marketing data, but the other integration opportunities are very defined, simple to execute on, and can provide meaningful revenue opportunities for your organization. I think that, especially with your audience, is a key message to get across.

Thanks, David, for taking the time to talk with me.

Filed under Articles & Interviews on April 13, 2010 - No Comments -

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