Hospital innovation, FHIR takes hold, AI chatbots, and more provider news from Q2 2018

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In the second quarter of 2018, hospitals and other healthcare providers continued to advance technology in a number of ways. Read on for a recap of trends in innovation, telemedicine, patient engagement, telemedicine and more in Q2 2018.

Hospitals build towards innovation 

Hospitals are evolving as more technology and innovations are integrating into the care system. Take New York’s newest inpatient pavilion the Helen L. And Martin Kimmel Pavilion, which will incorporate the Hassenfeld Children’s Hospital—34th Street. The new facility will incorporate digital in everything from how clinicians distribute pills to practical matters like ordering food and controlling the ambiance of the room. Providers will also see the changes—surgeons will be using new tech to help them visualize surgeries.
 
But this isn’t the only center looking to digital as a way of the future. In May the Beth Israel Deaconess Medical Center announced that it had launched an innovation research center, called the Health Technology Exploration Center.
 
According to the hospital, the research center is modeled after sandbox startup incubators, and is “poised to spark the technological and systemic transformations in health care delivery,” which it will do by exploring emerging technologies such as blockchain.

Meanwhile, some hospitals like the Brigham and Women and Massachusetts General Hospital, have already kicked off their innovation initiatives and are now bringing their experiences to the table. The hospitals stress making smart decisions about internal vs. external innovations, making the innovations simple and easy to use, getting the right buy-in from staff, guiding the projects through their journey and having a plan for how this innovation is going to succeed.
 
Big names in tech, like Alphabet subsidiary Verily, are cropping up with new innovations to help providers as.
 
Verily researchers have built prototype devices for painless blood collection that uses a system of “exploding” micro-needles, magnets, and potentially a blood storage chamber, . Information on the device was received from several anonymous sources, who CNBC said did not want to be named as the project is still unannounced.
 
But as innovation in the space continues to push forward with record speed, there are questions about what this means for patient care and providers.
 
For example, artificial intelligence has been one of the go-to topics this year. The technology has proved a valuable asset in many studies. But that doesn’t mean AI is at the point where it’s going to take over physicians jobs any time soon. In fact, according to a panel at Health 2.0’s Dev2Health conference in Cleveland Ohio, in order for the technology to work in healthcare providers and developers have to work together.
 
While the technology may not replace a doctor it could help relieve physicians paperwork duties.
 
“Deep learning and image recognition are perfect partners, I think ideally suited,” Dr. Anthony Chang, who serves as chief intelligence and innovation officer and medical director of the heart failure program at Children’s Hospital of Orange County, said. “I’m a cardiologist, so I would love it if machine learning can take away the mundane part of my job, which is looking at a lot of normal echocardiograms, [allowing] me to focus on the challenging part instead.”
 
The question of AI’s future in the space is even being taken up by the American Medical Association. In June the organization outlined a new set of recommendations on augmented intelligence, a type of technology that aims to extend, but not replace, a human medical expert’s insight and decision-making capabilities. The new recommendations encourage clinicians to look at the technology but also to recognize the limitations.
 
But it has been difficult for policy to keep up with new innovations like machine learning and AI. At HIMSS Precision Medicine Summit in Washington DC, speakers discussed the risks of the new technologies without more regulations.
 
"Our healthcare system is broken," Dr. Michael Dulin, director of the Academy for Population Health Innovation at the University of North Carolina Charlotte, said at the event. ”It's inefficient, and precision medicine is an amazing tool but if we layer it on top of a broken system we can actually make things worse. Health disparities can get worse, we need to be very proactive when we're thinking about how to integrate this into our delivery system."
 
Additionally, as data becomes more available in the healthcare space and technologies expand their capabilities, former US Chief Technology Officer Aneesh Chopra is calling on the industry to embrace its own ‘digital Hippocratic oath.’

Specifically, Chopra believes HIPAA needs to be augmented with a “voluntary but enforceable code of conduct” that applies to data even if it didn’t originate in the healthcare system.
 
Still, the government is looking at digital technologies and open data to solve some of the most pressing issues the country is looking at including the opioid epidemic and kidney diseases.
 
“In the department we’re in a renaissance of opening data,” Bruce Greenstein, who recently stepped down as US Chief Technology Officer, told Babyforyou.net.ua in April. “So the last administration started in a number of initiatives. … We love it, so we’re taking that baton and running as fast as we can forward innovating based on the work that they did. To me this is a non-partisan issue. It's about doing the right thing and doing it wisely, deliberately, and thoughtfully.”
 
In fact, in the last quarter HHS has hosted competitions for developers to show off their solutions for tackling the opioid epidemic and Kidney disease. As of April the department had already raised $25 million in prize money for the kidney disease competition.
 
Contests like these have become a popular place for emerging technologists to debut their work. But it isn’t all about the money. While contests typically come with a cash prize tacked on, a survey from consultancy group Luminary Labs shows that developers aren’t entering for the money. The group surveyed 60 prize recipients from 14 challenges run by Luminary Labs. While not all winners surveyed were in the healthcare space, many, including Osso VR, Wellframe and Ginger.io, were, and the sample included challenges sponsored by Janssen and Merck.
 
Although money might be only one factor for emerging technologists, it remains an important part of the business and can allow companies to grow. To support developers financially, The American Heart Association, the University of Pittsburgh Medical Center, and Royal Philips have teamed up to finance a new $30 million venture. The fund will be called Cardeation Capital and will target developers working on systems for cardiac diseases.
 
“Cardiovascular disease costs are projected to exceed $1 trillion by 2035,” Nancy Brown, CEO of the AHA, said in a statement. “New approaches are urgently needed to increase prevention and treatment strategies to reverse the trend for those already suffering from heart diseases, as well as prevent populations from ever getting heart disease. Through Cardeation Capital, we expect to deliver better outcomes and improve the quality of healthcare delivery for the people who are counting on us the most.”

Interoperability at last: FHIR, Apple innovate EHRS

When it comes to EHRs, Apple has been the name to watch in the industry this spring.
 
Early on in the quarter Apple officially launched its Apple Health Records feature—just two months after deploying the beta version. The feature aggregates existing patient-generated data in a user’s health app with data from their EHR—if the user is a patient at a participating hospital.
 
This launch opened up the feature to 39 health systems—including 12 from the original beta. Now any patients who has an iPhone and iOS version 11.3 will be able to download the patient-facing side of the feature by updating the health app in iOS.
 
Following this launch, in June Apple announced Health Records API, which will allow developers to create apps that can, with permission, use data from patients’ electronic health records to help people manage care, medications, nutrition, and more.
 
In other Apple-related EHR news, DrChrono, developer of electronic health records, practice management, revenue cycle and other ambulatory software for Apple devices, introduced leasing bundle plans to help medical practices replace their outdated computer hardware with new Apple machines.
 
This quarter players in the industry also discussed the possibilities of SMART and FHIR systems for the future.
 
For example, Beth Israel Deaconess Medical Center, Lahey Health, and three other medical centers are in the midst of a mega-merger. However, each of those facilities has a different EHR system. Merging those systems into one EHR system would be expensive and difficult.
 
“That might be [the way to go] if I had $2 or $3 billion,” or if I had the nerve to uproot the current EHR workflows, Dr. John Halamka, Beth Israel Deaconess CIO  said at HL7’s DevDays in June. “But I don’t want to do that. So instead, what we’ve said is FHIR. Why don’t we just create a suite of apps, device neutral, then enable providers to have the appropriate workflow and experience, regardless of the transaction in the EHR.”
 
Looking ahead, Dr. Joshua Mandel, who was at the time health IT lead at Verily and was on the team that created SMART, said there is still a lot of work to do in the space.
 
“Almost any deep question you dig into requires data from across the healthcare continuum,” Mandel said. “Some of that is structured and some of it is unstructured and today almost everyone is focused on the structured part. … On the other hand there is a tremendous value to the unstructured clinical notes and reports and all of the light information that just exists as text in the EHR. … All these things are stored in an EHR as text. You could drive tremendous value from deriving information from free text. And I think that’s going to be important.”

Symptom-checkers and chatbots: Healthcare’s new first line of defense? 

Companies in the health tech space are taking steps to make healthcare start in the home, even before a telemedicine visit. Whether it’s an upgraded symptom-checker or an AI-fueled chatbot, this quarter saw plenty of examples of the consumerization of healthcare, starting with triage.
 
WebMD, long the go-to for patients turning to the internet for an answer to mysterious symptoms, launched a redesigned, rebuilt version of its symptom checker, originally launched in 2005. From a user interface perspective, the biggest change is that the iconic human figure, which used to invite users to click on the body part where their symptoms were localized, has been dropped in favor of a predictive text search bar. But the changes are just as substantive on the back-end, where the new symptom checker is based on a clinical decision support tool built for physicians, by physicians, but with the inputs modified to be easier to use by laypeople.
 
Another example: Buoy Health, which offers an AI-powered tool that serves to help people understand potential health problems, announced a partnership with CVS MinuteClinic. When users go through Buoy Health’s online or app-based chatbot interface, if the suggested possible diagnoses lend themselves to treatment at one of the 1,100 MinuteClinics around the United States, the app will do two things. First, it will use GPS to locate the nearest MinuteClinic, and second, it will offer to hold a place in line for the user.
 
Later in the quarter, Buoy teamed up with Circulation, a technology startup that helps connect patients in need of medical transport with rides from Lyft, Uber, and other specialized options like wheelchair vans and non-emergency ambulances.
 
Another company in the same space, NHS darling Babylon Health, made a big press push this quarter toting the performance of its AI-powered chatbot, saying that the program can pass England’s GP exam and go head-to-head with top doctors in a simulated diagnostic environment. However, the announcement was met with skepticism and pushback from many, including the Royal College of General Practitioners, whose exam was used in the test.

Telemedicine: More evidence and new specialties 

The quarter was peppered with news about telemedicine. As studies, surveys, and a new federal rule bolstered and illustrated the technology’s growing adoption, several pieces of news demonstrated how telemedicine is moving into new and novel fields.
 
In May, the US Department of Veterans Affairs finalized its federal rule to allow providers to deliver patient care across state lines and outside of a VA facility using telemedicine. This final rule gives the VA the needed authority to override state restrictions that would inhibit providers from treating patients outside of the agency or their region.
 
Younger people are valuing telemedicine more than their parents did, new research suggests. In April an EBRI survey showed that millennials and Gen Xers are more likely than baby boomers to report that a telemedicine option is "extremely or very important," with 40 percent of millennials reporting that telemedicine is an extremely or very important option, compared with 27 percent among Gen Xers and 19 percent among baby boomers.
 
In May, a study of hypertension patients showed that follow-up visits conducted virtually were just as effective in maintaining blood pressure control as those conducted in person. Conducted by researchers at the Massachusetts General Hospital (MGH) and Brigham and Women’s (B&W) Hospital, the investigation also found no differences in non-primary care visits between the two patient groups.
 
Telemedicine got another vote of confidence when the American Academy of Family Physicians and virtual care technology vendor Zipnosis embarked on a partnership that will offer a virtual healthcare platform to AAFP's 129,000 members. The telemedicine tech provides an online diagnosis and treatment system that would enable AAFP members to offer their patients easy access to care by connecting them virtually with their family physician.
 
Telemedicine is being used in more and more specialty areas:

  • The Salford Royal NHS Foundation Trust has tapped healthy.io for a new program that will allow kidney patients to take home urine tests, using their smartphone cameras and digital testing kits. The test results will then be automatically electronically delivered to physicians. Tel Aviv, Israel-based Healthy.io uses computer vision and machine learning to turn the smartphone camera into a medical device. Their app is CE-certified, but still awaiting FDA clearance.
     
  • Online refractive eye exam company Opternative launched  called EZRx. Working with providers will allow Opternative to operate in some states where online eye exams are not otherwise allowed, because those states allow online exams if they're used as a complement to a comprehensive eye exam.
     
  • Telemedicine company American Well and health technology company Royal Philips launched a telemedicine feature built into the Philips Avent uGrow application for parents of young children. With the new feature, app users in the US will be able to access video visits with medical professionals including pediatricians, lactation consultants, and mental health professionals 24-7 through an American Well feature within the app. The telemedicine visits aren't free, but can be paid through insurance in many cases, and out of pocket in others. 

Remote patient monitoring also saw some interesting partnerships:

  • Garmin and the University of Kansas Medical Center are taking a closer look at the role wearables can play in detecting and managing medical conditions, the groups announced in May. Initially focused on sleep apnea and atrial fibrillation, the collaboration is a clear step beyond the fitness and wellness realm to which Garmin’s wearables have so far been limited.
     
  • Harrogate, UK-based remote patient monitoring company Inhealthcare has partnered with Sussex, UK-based MSKnote to target obesity, physical inactivity, and aging within the UK. Inhealthcare will be using its platform to connect the MSKassist app’s doctor and physiotherapist users with the National Health Service, specifically within the Coastal West Sussex NHS CCG region where the service will go live this summer. 

Digital health studies 

When it comes to health apps and chronic condition management, there was good news and bad news this quarter.
 
On the bad news side, a survey showed a first-ever decrease in hospital mobile strategy prevalence. When healthcare communications firm Spok first began investigating the prevalence of mobile strategies in 2012, only a third of survey respondents reported that their organization had a formalized strategy in place. While this number has generally increased over time, the company’s most recent annual survey of US healthcare professionals found, for the first time, a decrease in the year-to-year reported prevalence of a documented mobile strategy in health systems.
 
Additionally, an overview of systematic reviews of published randomized control trials of mobile health apps found just 23 RCTs of currently-available apps have been conducted, and less than half of those showed a positive health effect from the app in question. A group of researchers from the Centre for Research in Evidence-Based Practice at Bond University in Queensland, Australia conducted the review, which was published in Nature's new Digital Medicine journal.
 
Other studies were more positive. One, published in the New England Journal of Medicine, shows that 24-hour ambulatory blood pressure monitoring is a better predictor of cardiovascular and all-cause mortality than just monitoring blood pressure in the clinic. A team of researchers from the University of Madrid in Spain analyzed 10 years of data from 63,910 adults who had signed up for a blood pressure registry. All of the patients had both a 24-hour ambulatory blood pressure measurement and a two-visit clinical blood pressure measurement in their records.
 
Digital health was a major topic of discussion at the Heart Rhythm Society Scientific Sessions in Boston in May, as researchers and clinicians from around the world presented their most recent study results. The focus of these studies included wearables, AI, and web-based platforms. One study presented at the event found that popular consumer wearables can accurately measure induced paroxysmal supraventricular tachycardia (PSVT), which means a rapid heart rate above 100 beats per minute. Participants in the study wore either an Apple Watch, Samsung Galaxy Gear, or Fitbit Charge 2. In another study, the Mayo Clinic teamed up with AliveCor to focus on how artificial intelligence and deep neural networks can help identify patients with congenital Long QT syndrome despite normal QTs on their electrocardiogram.
 
Similarly, the American Diabetes Association’s annual conference saw a host of digital health studies presented. The meeting included presentation on studies covering a range of technologies, such as continuous glucose monitors, insulin pumps, apps, and other digital-backed management strategies.
 

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