CardioLync

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The proliferation of smartphones in the pockets of most patients and clinicians may offer a common link between for true patient engagement

The ubiquitous smartphone has found its way into the pockets of nearly every clinician and patient in recent years and offers new opportunities to greatly redefine healthcare in the coming years. Smartphones and apps for healthcare — referred to as mobile health or mHealth — offer a key technology to help reduce healthcare costs, improve the efficiency of care delivery and enable greater access to high-quality care via telemedicine. mHealth can serve as a bridge between providers, healthcare IT and patients to enable true patient engagement. These tools also can help empower patients to take more responsibility for their own health and offer the ability to interface and collaborate more with their providers.

There are now about 165,000 published mHealth apps available,[1] and the U.S. Food and Drug Administration (FDA) recently developed guidelines for regulating the small fraction of these clinical-grade apps. Today, these apps enable patients to use their phones to track their fitness, record calorie and diet information, heart rate and single lead ECGs, enter medication reminder alarms, manage diabetes, and even access their lab results, reports and imaging from their electronic medical records (EMR). Proponents of mHealth say this is just the tip of the iceberg for the potential of apps and mobile devices to impact the future of healthcare.

Read the full article here: http://www.dicardiology.com/article/how-smartphones-and-apps-may-change-face-healthcare

New healthcare cybersecurity report exposes risk of attacks through social engineering, highlights vulnerability of industry

SecurityScorecard, a security rating and continuous risk monitoring platform, released its 2016 Healthcare Industry Cybersecurity Report in October. The report is a comprehensive analysis exposing alarming cybersecurity vulnerabilities across 700 healthcare organizations including medical treatment facilities, health insurance agencies and healthcare manufacturing companies. Security breaches in this industry pose devastating consequences, according to the company, because they can render an entire system or network inoperable, creating a life or death situation that needs immediate attention.

Among the report's key findings are:

• Over 75 percent of the entire healthcare industry has been infected with malware over the last year;
• Ninety-six percent of all ransomware targeted medical treatment centers;
• Healthcare manufacturing nearly reaches a 90 percent malware infection rate;

Ransomware and breaches are affecting the healthcare industry at an increasingly alarming rate, according to the report, with 22 major public breaches occurring since August 2015. Earlier this year, Hollywood Presbyterian Medical Center paid $17,000 as a result of ransomware after losing access to patient records for 10 days. In March 2016, 21st Century Oncology struggling with DNS Health, Network Security and Patching Cadence suffered a data breach that led to a loss of 2.2M patient records and a $57M class-action lawsuit. Overall, breached healthcare companies still struggle with security post-breach, according to the report.

For more information: www.securityscorecard.com

Read the full article here: http://www.dicardiology.com/content/healthcare-industry-lacking-basic-cybersecurity-awareness-among-staff

Healthcare reforms requiring wider sharing of patient images and records make Web-based systems an attractive solution

Healthcare reform requiring wider access and enterprise sharing of patient images and records are making Web-based cardiology picture archiving and communication systems (PACS) a more attractive solution over traditional thick-client, server-based systems. In just the past few years there has been a departure from thick-client cardiology and radiology PACS to Web-based platforms. There are several reasons for this, including better interoperability, anywhere-anytime access, remote access to data and images, and reduction of IT burdens. Web-based systems also enable easier delivery of many healthcare reform Stage 2 meaningful use (MU) requirements.

The biggest clinical benefit of a Web-based cardiology PACS (also referred to as cardiovascular information systems — CVIS) is the ability for cardiologists and supporting staff to conduct their daily duties from one system instead of several disparate systems, each requiring a separate workstation. The single point-of-entry allows access to all cardiac imaging modalities and related reports, echocardiograms (ECG), procedural reports and prior exams from any computer with Web access.

This consolidation of data allows data mining, which can quickly identify the exact numbers and types of cases seen at a facility, numbers and types of tests ordered, patient demographics, how patients are being triaged and treated, and trends in room or equipment usage.

Web-based, single platform cardiac PACS provide the freedom of mobility for cardiologists and referring physicians, regardless of their physical location. This allows new workflows, such as conducting rounds using a tablet device like an iPad rather than a clipboard. The systems allow immediate access to the most up-to-date patient information. Some Web-based systems allow two-way data transfer so physicians can add notes, complete reports, change drug therapy or order additional tests through computerized physician order entry (CPOE) right at the patient’s bedside. Immediate remote access to images, test results and ECGs also has utility in better addressing emergency situations. Just like the cultural revolution Web-based smartphones have created with people’s personal access to the world via the Internet, social media and e-mail, Web-based PACS untether physicians from their desktop computers and allow them to do their job just as well from a remote clinic or at home.

Considerations for Web-Based Systems

• Zero-Footprint Access — These systems allow images and data to be accessed anywhere using a Web browser. Some vendors require the download of special software to access the data, while others do not.
• Mobile Devices — There is a growing expectation among physicians to access images and data using their tablet and smart phone devices. By far the largest class of these devices deployed in medicine includes the iPad and iPhone, which use the iOS operating system. Most vendors design access specifically for these devices, but often offer interfaces for other operating systems, such as Android.
• Thick vs. Web-Client — Some systems offer a Web-based and thick-client system, which may differ in functionality.
• Eliminating CDs — A big headache at some facilities is the transfer of files, especially of image datasets on CD between facilities or referring physicians. Burning CDs can be time consuming, and the CDs sometimes cannot be opened or are not compatible with the receiving center’s computers. Web-based systems can help eliminate the need for CDs by allowing direct transfer of the files electronically.
• Creating telecardiology programs may be easier

Read the full article here: http://www.dicardiology.com/article/evolution-cardiac-web-based-pacs

Healthcare reforms requiring wider sharing of patient images and records make Web-based systems an attractive solution

Healthcare reform requiring wider access and enterprise sharing of patient images and records are making Web-based cardiology picture archiving and communication systems (PACS) a more attractive solution over traditional thick-client, server-based systems. In just the past few years there has been a departure from thick-client cardiology and radiology PACS to Web-based platforms. There are several reasons for this, including better interoperability, anywhere-anytime access, remote access to data and images, and reduction of IT burdens. Web-based systems also enable easier delivery of many healthcare reform Stage 2 meaningful use (MU) requirements.

The biggest clinical benefit of a Web-based cardiology PACS (also referred to as cardiovascular information systems — CVIS) is the ability for cardiologists and supporting staff to conduct their daily duties from one system instead of several disparate systems, each requiring a separate workstation. The single point-of-entry allows access to all cardiac imaging modalities and related reports, echocardiograms (ECG), procedural reports and prior exams from any computer with Web access.

This consolidation of data allows data mining, which can quickly identify the exact numbers and types of cases seen at a facility, numbers and types of tests ordered, patient demographics, how patients are being triaged and treated, and trends in room or equipment usage.

Web-based, single platform cardiac PACS provide the freedom of mobility for cardiologists and referring physicians, regardless of their physical location. This allows new workflows, such as conducting rounds using a tablet device like an iPad rather than a clipboard. The systems allow immediate access to the most up-to-date patient information. Some Web-based systems allow two-way data transfer so physicians can add notes, complete reports, change drug therapy or order additional tests through computerized physician order entry (CPOE) right at the patient’s bedside. Immediate remote access to images, test results and ECGs also has utility in better addressing emergency situations. Just like the cultural revolution Web-based smartphones have created with people’s personal access to the world via the Internet, social media and e-mail, Web-based PACS untether physicians from their desktop computers and allow them to do their job just as well from a remote clinic or at home.

Considerations for Web-Based Systems

• Zero-Footprint Access — These systems allow images and data to be accessed anywhere using a Web browser. Some vendors require the download of special software to access the data, while others do not.
• Mobile Devices — There is a growing expectation among physicians to access images and data using their tablet and smart phone devices. By far the largest class of these devices deployed in medicine includes the iPad and iPhone, which use the iOS operating system. Most vendors design access specifically for these devices, but often offer interfaces for other operating systems, such as Android.
• Thick vs. Web-Client — Some systems offer a Web-based and thick-client system, which may differ in functionality.
• Eliminating CDs — A big headache at some facilities is the transfer of files, especially of image datasets on CD between facilities or referring physicians. Burning CDs can be time consuming, and the CDs sometimes cannot be opened or are not compatible with the receiving center’s computers. Web-based systems can help eliminate the need for CDs by allowing direct transfer of the files electronically.
• Creating telecardiology programs may be easier

Read the full article here: http://www.dicardiology.com/article/evolution-cardiac-web-based-pacs

In a bid to promote access to healthcare data, officials from the FDA’s Center for Devices and Radiological Health (CDRH), reiterated Tuesday during a webinar covering the final guidance on medical device data systems (MDDS), that technologies that receive, store or display data from medical devices are of such low risk that they no longer need to be strictly regulated by the agency.

The FDA in 2011 had already issued a final rule reclassifying MDDS from class III (high risk) to Class I (low risk) devices. Tuesday, Bakul Patel, CDHR’s associate director for digital health, said that in “taking a harder look” at medical device data system and medical image storage and communication device rules, the FDA concluded:

• These types of products included in the regulations are really considered low-risk, and are already classified as Class I.
• Systems that record, share, and use medical device data have become a significant portion of a connected healthcare system.
• Inter-communication functionality is foundational in an interoperable digital health ecosystem.

The final MDDS guidance was issued February 9. In it the FDA pointed out that since it has determined that these devices pose a low risk to the public, it “does not intend to enforce compliance with the regulatory controls that apply to MDDS devices, medical image story devices and medical image communications devices.”

“FDA is certainly sticking to its word, working to down-classify or altogether exempt low-risk software-based technologies,” said Bradley Merrill Thompson, an attorney with the firm Epstein, Becker & Green in Washington D.C, who counsels medical device, drug and combination product companies on FDA regulatory, reimbursement, and clinical trial issues. “The implications are profound, both for MDDS type software, but also for what it suggests about the future for health information technology generally.

Read the full article here: http://www.radiologybusiness.com/topics/policy/fda-will-no-longer-enforce-regs-medical-device-data-systems

One aspect of religious dogma that has entered the medical world is that fee-for-service pricing of medical services is bad and should be replaced by a capitated, or global, arrangement that establishes an annual budget for care for different risk groups of patients.

Like other religious beliefs, this is often offered without rigorous analytic support. Some insurance companies are particularly pleased with this approach because it shifts risk from insurers to providers and makes it easier for the insurers to create budgets and price their products.

Now, though, let me let you in on a little secret with regard to capitated care. Underneath the global budget, there is still a fee-for-service arrangement establishing the transfer prices among the providers in a network. That GI specialist will still get paid for each colonoscopy. The big thing to work out in this system is the allocation of any surplus or deficit in the annual budget among the various specialists.

Unless that allocation is skewed heavily towards primary care doctors, decisions about the level of care given will not change. But, if the allocation is skewed too heavily towards the PCPs, there is no real income signal for the specialists, leading to a danger that they will not feel invested in the end result. Unless the system is accompanied by intensive, real-time reporting, along with clear penalties for excessive care, it will not work.

I predict that the biggest issue facing physician groups in the coming years is the perceived interference by the global payment risk unit in the clinical decisions made by specialists.

Paul Levy is the former President and CEO of Beth Israel Deaconess Medical Center in Boston and blogs at Not Running a Hospital. He is the author of Goal Play!: Leadership Lessons from the Soccer Field and How a Blog Held Off the Most Powerful Union in America.

Read the full article here: http://www.kevinmd.com/blog/2011/05/problem-global-capitated-payments-doctors-hospitals.html

The federal government’s readmission penalties on hospitals will reach a new high as Medicare withholds more than half a billion dollars in payments over the next year, records released Tuesday show.

The government will punish more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected return within a month. While that is about the same number penalized last year, the average penalty will increase by a fifth, according to a Kaiser Health News analysis.

The new penalties, which take effect in October, are based on the rehospitalization rate for patients with six common conditions. Since the Hospital Readmissions Reduction Program began in October 2012, national readmission rates have dropped as many hospitals pay more attention to how patients fare after their release.

Medicare said the penalties are expected to total $528 million, about $108 million more than last year, because of changes in how readmissions are measured.

Medicare examined these conditions: heart attacks, heart failure, pneumonia, chronic lung disease, hip and knee replacements and — for the first time this year — coronary artery bypass graft surgery.

The fines are based on Medicare patients who left the hospital from July 2012 through June 2015. For each hospital, the government calculated how many readmissions it expected, given national rates and the health of each hospital’s patients. Hospitals with more unplanned readmissions than expected will receive a reduction in each Medicare case reimbursement for the upcoming fiscal year that runs from Oct. 1 through September 2017.

Kaiser Health News staff writer Sydney Lupkin contributed to this report.

Read the full article here: http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/

Telemedicine is expected to reduce hospital readmission rates

Wireless remote monitoring devices will be used by more than 1.8 million people worldwide in four years, representing a six-fold increase in adoption of telehealth technology, according to a new study by InMedica, part of research firm IHS.

Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic illnesses such as diabetes, heart disease, asthma and Alzheimer's Disease, according to Dadong Wan, who leads the health innovation program at Accenture Technology Labs.

The majority of those using remote monitors were post-acute patients who had been hospitalized and discharged and suffered long-term conditions such as congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes, hypertension and mental health issues.

According to InMedica, congestive heart failure currently accounts for the majority of telehealth patients, and it is one of the costliest for hospitalization. COPD is second in terms of telehealth patients. However, by 2017, diabetes is forecast to supplant COPD with the second largest share of telehealth patients. Although home monitoring of the glucose levels of diabetes patients is more often done now with personal glucose monitors, there is a push to integrate these monitors with telehealth systems, allowing caregivers access to patient glucose data.

Telehealth is seen as a significant tool among healthcare providers for reducing hospital readmission rates and to track disease progression.

Over the next five years, InMedica sees four main drivers of telehealth demand:

• Federal policies: Readmission penalties introduced by the U.S. Center for Medicare and Medicaid Services (CMS) are driving providers to adopt telehealth.
• Provider-driven demand: Healthcare providers want to use telehealth to increase ties to patients and improve quality of care. In many cases, this is being done despite no clear financial return on investment.
• Payer-driven demand: Telehealth is also being increasingly used by insurance providers to increase their competitiveness and reduce in-patient pay-outs by working directly with telehealth suppliers to monitor their patient base.
• Patient-driven demand: There is currently very little demand from patients actively requesting telehealth services from their payer or provider. As fitness awareness increases and consumers adopt personal devices to track their fitness, they will also increasingly seek professional devices to remotely track disease state.

Read the full article here: http://www.computerworld.com/article/2494451/healthcare-it/in-home-health-monitoring-to-leap-six-fold-by-2017.html

The revolution is finally here—raising a host of questions for regulators, providers, insurers and patients

Doctors are linking up with patients by phone, email and webcam. But some critics question whether the quality of care is keeping up with the rapid expansion of telemedicine.

After years of big promises, telemedicine is finally living up to its potential. Driven by faster internet connections, ubiquitous smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs—and it’s upending the delivery of health care.

Doctors are linking up with patients by phone, email and webcam. They’re also consulting with each other electronically—sometimes to make split-second decisions on heart attacks and strokes. Patients, meanwhile, are using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions at home.

Telemedicine also allows for better care in places where medical expertise is hard to come by.

Experts say more hospitals are likely to invest in telemedicine systems as they move away from fee-for-service payments and into managed-care-type contracts that give them a set fee to provide care for patients and allow them to keep any savings they achieve.

To date, 17 states have joined a compact that will allow a doctor licensed in one member state to quickly obtain a license in another. While welcoming the move, some telemedicine proponents would prefer states to automatically honor one another’s licenses, as they do with drivers’ licenses. “You don’t have to stop a get a new license every time to drive through a new state,” says Jonathan Linkous, the American Telemedicine Association’s CEO.

Read the full article here: http://www.wsj.com/articles/how-telemedicine-is-transforming-health-care-1466993402

While 87% of Americans now have health insurance, overwhelming co-pays, high deductibles and a lack of primary care doctors still stand in the way of healthcare for many.

An average GOLD level plan—one of the more expensive, “better” insurance plans—still has a deductible of $2,000 for an individual, which approximately 40% of Americans cannot afford. Thirty-five percent of Americans already struggle with medical debt despite that 70% of those struggling have insurance. And by 2025, the United States faces a potential physician shortage of as many as 52,000.

For many, new health insurance is not providing access to affordable care, and the ACA will not address the physician shortage. To bridge that gap, we must find innovative ways facilitate hassle free access to a provider that is more cost-effective. Telemedicine is a growing model that is a part of the answer.

Telemedicine, or “telehealth,” is the provision of remote access to a physician via phone or videoconference to address a health care issue. It’s not a new concept. It’s well-established in rural areas for specialty consultations, and has been widely used in many primary care practices like pediatrics as a practical matter (although most pediatricians do not bill for phone consultations).

More broadly, telehealth is gaining ground as an alternative to urgent care or the emergency department for more minor concerns like ear infections and colds. This week, Blue Cross Blue Shield of Massachusetts announced that it is offering video visits to patients within two physician groups. BCBSMA Director of Network Innovation Greg LeGrow told MobiHealthNews that video visits have the potential to improve cost, access, quality, efficiency, as well as patient and physician satisfaction.

Data show that telemedicine can deliver quality outcomes comparable to in person office visits. A 2011 Center for Disease Control study showed eighty percent of adults discharged from the emergency room-meaning patients who could be treated and sent home-said they sought care at the ER due to lack of access to a primary care provider (PCP). However, the ER is also the most expensive and least efficient way to provide non-emergent care, costing from $1,500 to $3,000 on average compared to $130 to $190 for a PCP visit. A telemedicine visit can cost as little as $40.

Read the full article here: http://www.forbes.com/sites/billfrist/2015/03/12/telemedicine-is-a-game-changer-for-patients-the-system/#13ad0ea5e301

Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians’ ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers.

Author Affiliations

1. Robin A. Leahy is Director of Electrophysiology Services, Sanger Heart & Vascular Institute–Carolinas HealthCare System, 1001 Blythe Blvd, Ste 300, Charlotte, NC 28203 (robin. leahy@carolinashealthcare.org). Elizabeth E. Davenport is Nurse Manager, Cardiac Rhythm Device Clinics, Sanger Heart & Vascular Institute–Carolinas HealthCare System, Charlotte, North Carolina.

Read the full article here: http://acc.aacnjournals.org/content/26/4/343?trendmd-shared=1

CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems are moving to outcome and value measures, the revenue for most primary care practices continues to be fee-for-serviced based, and alternate payment models (APM) are built on top of fee-for-service.

Thumbs up to transitional care management (TCM)

Primary care practices are already managing the transition for hospitalized patients to home, and getting paid only for the office visit. TCM allows the group to be paid for the work the physician, NPP, and staff are already doing. It requires a phone call to the patient in two business days, a visit in 7 or 14 days (depending on the code), reviewing the discharge summary and medication reconciliation. It is not for every discharge. It is for patients who need additional non-face-to-face support by the medical and clinical staff in the transition to home. It has high work RVUs and reimbursement. CMS changed the rules January 1, 2016, allowing the visit to be billed on the day of the E/M office visit, rather than waiting 30 days from the date of discharge. This is a definite yes: get paid for the work the practice is now doing for free.

Read the full article here: http://www.kevinmd.com/blog/2016/04/how-to-perform-services-that-increase-primary-care-revenue.html

Mobile Imaging Services Market (Service: X-ray, CT, Ultrasound, MRI, PET/CT, Bone Densitometry, Mammography; End-users: Hospitals & Private Clinics, Home Healthcare Service Providers, Rehabilitation Centers, Geriatric Care and Hospice Agencies, Sports Organizations, Military Institutions and Prisons) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2014 - 2020

The mobile imaging services market has been around for over two decades, but is still restricted to the U.S. and the European markets. Over the past few years, the market has however gained pace due to an increase in the number of procedures performed using mobile imaging services. This surge in the number of mobile imaging services is attributed to the aging population and rise in the prevalence of diseases such as cardiovascular diseases, renal disorders, neurological disorders, and cancer. Furthermore, as the life of fixed imaging equipment nears obsolescence, hospitals seek cost-effective alternatives such as mobile imaging services. The global mobile imaging services market was valued at USD 10,698.0 million in 2013 and is expected to reach USD 13,356.5 million by 2020, growing at a CAGR of 3.2% during the forecast period 2014 to 2020.

The global mobile imaging services market is broadly categorized into service type, end-users and geography. X-ray, ultrasound, CT scan, MRI, PET/CT, bone densitometry and mammography altogether comprised the services segment. The MRI segment constituted the largest share in the global mobile imaging services market and is expected to witness fastest growth amongst all the segments at CAGR of 3.5% during the forecast period 2014 to 2020. The freedom to stay at home and eliminate the long waiting time at the hospitals, clinics or in case of emergency are the prime reasons which explain the emergence of mobile imaging services market in the overall diagnostic imaging market. End-users for this market include hospitals and private clinics, home healthcare service providers, rehabilitation centers, geriatric care and hospice agencies, sports organizations and others such as military institutions and prisons.

Currently, small hospitals account for a large share of the overall mobile imaging services market. Although these hospitals are in need of scanning machines, the volume of patients does not justify investment cost. Hence, these healthcare providers prefer outsourcing the mobile imaging services and this scenario is observed to be consistent in North America and Europe. The mobile imaging services market is in its growth phase in North America and in the late introductory phase in Europe. In developing countries of Asia, and rest of the world, majority of mobile imaging services are performed by non-profit organization.

Access the full report here: http://www.transparencymarketresearch.com/mobile-imaging-services.html