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It’s Hard To Be Neutral About Network Neutrality For Health


August 18th, 2014

Network Neutrality (NN) has been in the news because the FCC is considering two options related to a neutral Internet: Either regulation forcing NN, or an approach that creates a “fast lane” on the Internet for those content providers that are willing to pay extra for it.

Network Neutrality reflects a vision of a network in which users are able to exchange and consume data, as they choose, without the interference of the organization providing the network basic data transport services. The second option, preferential service, entertains the possibility that the Internet could become what the National Journal describes as “a dystopia run by the world’s biggest, richest companies.”

However, the problem of network neutrality is more complex. Full network neutrality could also lead to a tragedy of the commons in which application developers compete for the use of “free” bandwidth for services to win customers while clogging networks and lowering performance for all. Key stakeholders providing basic transport Internet service such as Comcast, Verizon, or AT&T, and large Internet savvy content providers like Google have a clear understanding of the debate and what they stand to gain or lose from network neutrality.

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Health Affairs Web Firsts: Two Studies Find Mixed Results On EHR Adoption


August 11th, 2014

Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009, Health Affairs has published many articles about the promise of health information technology and the challenges of promoting broad adoption and “meaningful use.”

Last week, on August 7, the journal released two new Web First studies, “More Than Half Of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most” and “Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings.” These studies focus on the latest trends in health information technology adoption among U.S. physicians and hospitals. Both studies, which will also appear in the September issue of Health Affairs, show that while basic electronic health record (EHR) adoption plans have moved forward, more significant implementation remains a daunting challenge for many providers and institutions

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Health Policy Brief Updates


July 22nd, 2014

In the first half of 2014 Health Affairs has released seven new Health Policy Briefs and also has provided updates of five previously released briefs, in order to reflect continuously changing and evolving health policy issues and perspectives.

The following Health Policy Briefs were updated in 2014:

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Lessons Learned: Bringing Big Data Analytics To Health Care


July 14th, 2014

Big data offers breakthrough possibilities for new research and discoveries, better patient care, and greater efficiency in health and health care, as detailed in the July issue of Health Affairs. As with any new tool or technique, there is a learning curve.

Over the last few years, we, along with our colleagues at Booz Allen, have worked on over 30 big data projects with federal health agencies and other departments, including the National Institutes of Health (NIH), Centers for Disease Control (CDC), Federal Drug Administration (FDA), and the Veterans Administration (VA), along with private sector health organizations such as hospitals and delivery systems and pharmaceutical manufacturers.

While many of the lessons learned from these projects may be obvious, such as the need for disciplined project management, we also have seen organizations struggle with pitfalls and roadblocks that were unexpected in taking full advantage of big data’s potential.

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The Era Of Big Data And Its Implications For Big Pharma


July 10th, 2014

Editor’s note: For more on the topic of big data, check out the July issue of Health Affairs In addition to Marc Berger, Kirsten Axelsen and Prasun Subedi also coauthored this post. 

Health care research is on the cusp of an era of “Big Data” — one that promises to transform the way in which we understand and practice medicine.

The Big Data paradigm has developed from two different points of origin. First, significant efforts to digitize and synthesize existing data sources (e.g., electronic health records) have been driven by policy and practice economics. Second, a wide range of novel ways to capture both clinical and biological data points (e.g., wearable health devices, genomics) have emerged.

The era of Big Data holds great possibility to improve our ability to predict which health care interventions are most effective, for which patients, and at what cost.

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ACAView: New Findings On The Effect Of Coverage Expansion Since January 2014


July 9th, 2014

Editor’s note: In addition to Josh Gray, Iyue Sung also coauthored this post. 

Together, athenahealth and the Robert Wood Johnson Foundation (RWJF) have undertaken a new joint venture called ACAView, as part of the foundation’s Reform by the Numbers project, a source for timely and unique data on the impact of health reform.

The goal of ACAView is to provide current, non-partisan measurement and analysis on how coverage expansion under the Affordable Care Act (ACA) is affecting the day-to-day practice of medicine. athenahealth provides a single-instance, cloud-based software platform to a national provider base.

Any information that our clients enter using our software is immediately aggregated into centrally hosted databases, providing us with timely visibility into patient characteristics, clinical activities, and practice economics at medical groups around the country.

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New Health Affairs July Issue: The Impact Of Big Data On Health Care


July 8th, 2014

Health Affairs explores the promise of big data in improving health care effectiveness and efficiency in its July issue. Many articles examine the potential of approaches such as predictive analytics and address the unavoidable privacy implications of collecting, storing, and interpreting massive amounts of health information.

Big data can yield big savings, if they are used in the right ways.

David W. Bates of the Brigham and Women’s Hospital and coauthors analyze six use cases with strong opportunities for cost savings: high-cost patients; readmissions; triage; decompensation (when a patient’s condition worsens); adverse events; and treatment optimization when a disease affects multiple organ systems.

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Health Affairs Event Reminder: Using Big Data To Transform Care


July 7th, 2014

The application of big data to transform health care delivery, health research, and health policy is underway, and its potential is limitless.  The July 2014 issue of Health Affairs, “Using Big Data To Transform Care,” examines this new era for research and patient care from every angle.

You are invited to join Health Affairs Editor-in-Chief Alan Weil on Wednesday, July 9, for an event at the National Press Club, when the issue will be unveiled and authors will present their work.

WHEN:
Wednesday, July 9, 2014
9:00 a.m. – 12:30 p.m.

WHERE:
National Press Club
529 14th Street NW
Washington, DC, 13th Floor

REGISTER NOW

Twitter: Follow Live Tweets from the briefing @HA_Events, and join the conversation with #HA_BigData.

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Request For Abstracts: Health Affairs Health Care And Medical Innovation Theme Issue


June 5th, 2014

Health Affairs is planning a theme issue on health care and medical innovation in early-2015. The issue will span the fields of medical technology and also cover public policy and private sector innovations that promote improvements in the delivery of care, lower costs, increase efficiency, etc. We plan to publish 15-20 peer-reviewed articles including research, analyses, and commentaries from leading researchers and scholars, analysts, industry experts, and health and health care stakeholders.

We invite interested authors to submit abstracts for consideration for this issue. To be considered, abstracts must be submitted by June 25, 2014. We regret that we will not be able to consider any abstracts submitted after that date. Editors will review the abstracts and, for those that best fit our vision and goals, invite authors to submit papers for consideration for the issue. Invited papers will be due at the journal by September 2, 2014.

More information on topics and themes for this issue, as well as process guidelines and timetables, is available below and on the Health Affairs website.

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Connected Health Opportunities For Medicaid’s Most Vulnerable Patients


April 22nd, 2014

The February issue of Health Affairs features a series of articles on connected health and highlights the potential for telehealth and telemedicine to reshape how health care is delivered, consumed, tracked, and even paid for.

With funding support from Kaiser Permanente Community Benefit, the Center for Health Care Strategies (CHCS) recently conducted a series of focus groups that showed how one key Medicaid population — medically and socially complex, low-income individuals — stands to gain from these advances.

The four focus groups were designed to better understand the issues driving these individuals’ health care utilization, their current level of comfort with technology, and how technology might be able to help them better manage their challenges. Participants were actively receiving services from of one of four case management/care coordination programs in New York City, Long Island, the Hudson Valley, and Philadelphia, and all were Medicaid beneficiaries with multiple medical and/or behavioral health conditions.

According to a recent Health Affairs article by John Billings and Maria Raven, these individuals frequent emergency departments and have a high incidence of chronic disease. They typically have chaotic, unstable, and socially isolated lives, and many lack permanent housing, live on the street, or in homeless shelters.

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Recent Health Policy Briefs: Mental Health Parity And ICD-10 Update


April 3rd, 2014

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the issue of mental health parity. The push to make coverage for mental health treatment equal to that of physical health has been on legislative to-do lists for some time, both in Congress and in state houses. This brief looks […]

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New Health Policy Brief: Transitioning To ICD-10


March 20th, 2014

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation looks at an important change expected in the American health system later this year: the transition to the ICD-10 coding system by all health providers for diagnoses and inpatient procedures. ICD stands for the International Classification of Diseases, which is maintained by the World Health Organization. The ICD system, which began in the nineteenth century, is periodically revised to incorporate changes in the practice of medicine.

While the most current version, ICD-10, has been used in most countries since its initial adoption in 1990, the United States has until now limited its use to the coding and classification of mortality data from death certificates. This brief examines the debates that have accompanied the broad conversion in this country to ICD-10, set to take place on October 1, 2014.

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Exhibit Of The Month: Virtual Visits On The Rise


February 27th, 2014

At Health Affairs Blog, we’re excited to introduce a new regular feature. Each month, Health Affairs editors will review all the tables, charts, graphs and maps that have run in the latest print edition of the journal. After deliberating in a dark, but smoke-free, backroom, we’ll emerge to crown the most compelling, creative or surprising exhibit as our Exhibit of the Month!  Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

This exhibit shows how, within the Kaiser Permanente Northern California system, the number of virtual physician visits grew from 4.1 million in 2008 to 10.5 million in 2013.

According to Pearl, “In 2008 KPNC implemented an impatient  and ambulatory care electronic health record system for its 3.4 million members and developed a suite of patient-friendly Internet, mobile, and video tools.”  Among these tools is a system that allows patients to send secure e-mail messages to their primary care physician.  KPNC physicians are now expected to respond within 24 hours of receiving the message.  This system builds on the 10-15 minute physician telephone visits that KPNC has offered patients for more than a decade.

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Doctors Without State Borders: Practicing Across State Lines


February 18th, 2014

Note: In addition to Robert Kocher (photo and bio above), this post is authored, by Topher Spiro, Vice President, Health Policy, Center for American Progress ; Emily Oshima Lee, Policy Analyst, Center for American Progress; Gabriel Scheffler, Yale Law School student and former Ford Foundation Law Fellow at the Center for American Progress with the Health Policy Team; Stephen Shortell, Blue Cross of California Distinguished Professor of Health Policy and Management and Professor of Organization Behavior at the School of Public Health and Haas School of Business at the University of California-Berkeley; David Cutler, Otto Eckstein Professor of Applied Economics in the Faculty of Arts and Sciences at Harvard University; and Ezekiel Emanuel, senior fellow at the Center for American Progress and Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

In the United States, a tangled web of federal and state regulations controls physician licensing. Although federal standards govern medical training and testing, each state has its own licensing board, and doctors must procure a license for every state in which they practice medicine (with some limited exceptions for physicians from bordering states, for consultations, and during emergencies).

This bifurcated system makes it difficult for physicians to care for patients in other states, and in particular impedes the practice of telemedicine. The status quo creates excessive administrative burdens and like contributes to worse health outcomes, higher costs, and reduced access to health care.

We believe that, short of the federal government implementing a single national licensing scheme, states should adopt mutual recognition agreements in which they honor each other’s physician licenses. To encourage states to adopt such a system, we suggest that the federal Center for Medicare and Medicaid Innovation (CMMI) create an Innovation Model to pilot the use of telemedicine to provide access to underserved communities by offering funding to states that sign mutual recognition agreements.

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Low ACA Knowledge And Health Literacy Hinder Young Adult Marketplace Enrollment


February 12th, 2014

Since October, the focus within the media and the health policy community has been on the troubled roll-out of Healthcare.gov and some of the state websites set up to enroll people in coverage under the Affordable Care Act (ACA).  But most Americans have paid little attention to how the changes taking place can affect their health insurance coverage.

Despite the media frenzy, findings from the Health Reform Monitoring Survey show that only about a third of adults have heard some or a lot about the Marketplaces, and only a quarter have heard about the Medicaid expansion to low-income adults.  Even for the more well-known ACA provisions, such as the expansion of dependent coverage to 26 year olds, the elimination of pre-existing condition exclusions, and the individual mandate, only about 50 percent report having heard much about those changes.

This gap in awareness of the ACA’s coverage provisions may be as much to blame as the widely publicized IT problems in driving the low levels of Marketplace enrollment. As shown in the figure below, only 24.3 percent of young adults (age 18 to 30) in the target population for the Marketplaces—defined as adults with incomes above 138 percent of the federal poverty level who are either uninsured or who have private non-group coverage—were aware of the availability of subsidies for coverage purchased through the Marketplace, compared to 43.6 percent of adults age 50 to 64.

Further, only 25.4 percent of young adults in the target population were aware of the availability of the Marketplaces themselves. Only 40.9 percent were aware of the individual mandate.

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The Changing Health Care World: Trends To Watch In 2014


February 10th, 2014

While today’s news is bombarding us with headlines about Healthcare.gov, the Affordable Care Act isn’t just about insurance coverage. The legislation is also about transforming the way health care is provided. Consequently, it has ushered in new competitors, services and business practices, which are in turn generating substantial industry shifts that affect all players along healthcare’s value chain. Following are some of the top trends that our alliance is preparing for in 2014:

Chronic Care, Everywhere. It’s no secret that providers are moving quickly to implement accountable care organizations (ACOs). Recently, the Premier healthcare alliance released a survey of hospital executives projecting that ACO participation will nearly double in 2014. As providers work to improve their way to shared savings payments, look for a more intensive focus on the biggest health care consumers: those with multiple chronic conditions.

Since each chronic condition increases costs by a factor of three, managing this population is the sweet spot for the ACO, and the deepest pool from which to pull savings. To do it, an increasing number of providers will deploy Ambulatory Intensive Care Units (A-ICUs) or patient centered medical homes as part of their ACO, which will be charged with better managing chronic conditions exclusively within a clinically integrated, financially accountable primary care practice. As part of the approach, providers will develop care pathways for better managing chronic conditions and behavioral health needs, with an eye toward lowering hospital utilization, including inpatient bed days, length of stay, admissions, readmissions, and ED visits.

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New Health Affairs Issue: Successes And Missing Links In Connected Health


February 3rd, 2014

Health Affairs’ February issue focuses on the current evidence and future potential of connected health — encompassing telemedicine, telehealth, and mHealth. The importance of connected health is sure to grow as more Americans gain access to health care and new, team-based models seek to provide better quality care in more efficient ways. The issue offers a variety of articles that explore what can entice hospitals, health systems, and individual providers to embrace telehealth, as well as the policy solutions that can better facilitate adoption across the health care system:

Want to increase telehealth adoption among U.S. hospitals? Look to state legislatures. Julia Adler-Milstein of the University of Michigan School of Information and co-authors emphasize that state policies are influential. According to their findings, states that wish to encourage the use of telehealth should promote private payer reimbursement and relax licensure requirements.

Overall, Adler-Milstein and coauthors found that 42 percent of US hospitals had adopted telehealth by late 2012, with significant variation across the country: Alaska was the highest with 75 percent, and Rhode Island had minimal adoption.


Market forces and individual hospital features also influence telehealth adoption rates. Factors that positively influence adoption rates include serving as a teaching hospital, being part of a larger system, having greater technological capacity, and higher rurality. Factors negatively affecting adoption include high population density, being for-profit, and operating in a less competitive market.

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Health Affairs Connected Health Briefing: Reminder And Webcast Information


February 3rd, 2014

An explosion of knowledge that is increasingly available through mobile devices and an array of telehealth and telemedicine technologies are linking the marvels of medicine to more patients and providers separated by geography. The February 2014 thematic issue of Health Affairs examines these disruptive technologies and innovative services and their promise for improving health and access to care; potential for cost savings; rates of adoption and impact; and challenges of privacy, liability and regulatory policy.

Please join Health Affairs Founding Editor John Iglehart on Wednesday, February 5, at the Kaiser Family Foundation in Washington, DC, for a Health Affairs briefing at which we unveil the issue.

WHEN:
Wednesday, February 5, 2014
8:30 a.m. – 12:15 p.m.

WHERE:
Barbara Jordan Conference Center
Kaiser Family Foundation
1330 G Street NW, Washington, DC (Metro Center)

REGISTER ONLINE

If you can’t join us in person, you can watch the event via live Webcast. Follow live Tweets from the briefing @HA_Events, and join in the conversation with the hashtag #HA_ConnectedHealth.

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The Need For A Smart Approach To Big Health Care Data


January 27th, 2014

Today, academic medicine and health policy research resemble the automobile industry of the early 20th century — a large number of small shops developing unique products at high cost with no one achieving significant economies of scale or scope. Academics, medical centers, and innovators often work independently or in small groups, with unconnected health datasets that provide incomplete pictures of the health statuses and health care practices of Americans.

Health care data needs a “Henry Ford” moment to move from a realm of unconnected and unwieldy data to a world of connected and matched data with a common support for licensing, legal, and computing infrastructure. Physicians, researchers, and policymakers should be able to access linked databases of medical records, claims, vital statistics, surveys, and other demographic data. To do this, the health care community must bring disparate health data together, maintaining the highest standards of security to protect confidential and sensitive data, and deal with the myriad legal issues associated with data acquisition, licensing, record matching, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Just as the Model-T revolutionized car production and, by extension, transit, the creation of smart health data enclaves will revolutionize care delivery, health policy, and health care research. We propose to facilitate these enclaves through a governance structure know as a digital rights manager (DRM). The concept of a DRM is common in the entertainment (The American Society of Composers, Authors and Publishers or ASCAP would be an example) and legal industries.  If successful, DRMs would be a vital component of a data-enhanced health care industry.

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Health Affairs Issue Briefing: The Rise of Connected Health


January 17th, 2014

An explosion of knowledge that is increasingly available through mobile devices and an array of telehealth and telemedicine technologies are linking the marvels of medicine to more patients and providers separated by geography. The February 2014 thematic issue of Health Affairs, “The Rise Of Connected Health,” examines these disruptive technologies and innovative services and their promise for improving health and access to care; potential for cost savings; rates of adoption and impact; and challenges of privacy, liability and regulatory policy.

Please join Health Affairs Founding Editor John Iglehart on Wednesday, February 5, at the Kaiser Family Foundation in Washington, DC, for a Health Affairs briefing at which we unveil the issue.

WHEN:
Wednesday, February 5, 2014
8:30 a.m. – 12:15 p.m.

WHERE:
Barbara Jordan Conference Center
Kaiser Family Foundation
1330 G Street NW, Washington, DC (Metro Center)

REGISTER ONLINE

Follow live Tweets from the briefing @HA_Events, and join in the conversation with the hashtag #HA_ConnectedHealth.

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