Healthcare software innovation: Why in-house accelerators are better

This post was originally published on Vector, Boston Children’s Hospital’s science & innovation blog.

Considering that Boston is home to some of the country’s best medical, scientific and technological minds, it is little surprise that the city has a vibrant startup ecosystem. That ecosystem lowers barriers to creating groundbreaking innovations, connecting innovators to funding, mentorship and human capital. Yet, it isn’t very well-suited to help health care software innovators, who face a unique set of challenges.

The unique and increasingly complex IT environment within health care institutions is one of the biggest barriers to the development of novel clinical software solutions. To start with, health care delivery IT environments boast complicated safeguards to keep medical information secure. In addition, as these environments grow in scope and complexity, keeping pace with advances in clinical technology, it becomes harder to incorporate new software. Breakthroughs that enable Boston Children’s Hospital to be a leader in robotic surgery, for example, also make it harder to design technologies that can easily integrate with a hospital’s IT system.

The clinical IT environment is further complicated by a myriad of regulatory requirements. Plotting a course through the IT complexity, while complying with stringent security and HIPAA requirements, can be daunting. Furthermore, the FDA may soon be regulating clinical mobile apps and novel software as it does medical devices and pharmaceuticals. With regulatory concerns and complexity, it’s not difficult to see why many potential health care software innovators can get stuck in the early stages of the innovation lifecycle.

And the IT environment is not the only challenge for innovators wanting to develop new clinical solutions. Innovators need not only time and resources, but also highly specialized technical skills. Typically, innovators will reach out to their institution’s IT developers for help—only to discover that those developers have limited bandwidth and are busy working on higher priority projects.

As a result, innovators may seek an external software development vendor to build the solution they have in mind. But finding the right vendor is not easy. And even when there is a good health care software developer with which to partner, there are hurdles to negotiating contracts—and that is assuming there is money available to pay for the work.

Looking inward for answers

At Boston Children’s Hospital, we have built a unique program to help free aspiring innovators from many of the traditional challenges in building new clinical IT software. Known as FastTrack Innovation in Technology (FIT), part of the hospital’s Innovation Acceleration Program, it offers annual software development awards in the form of time with a special team of Boston Children’s project managers, business analysts and software developers.

The FIT team can rapidly translate a clinician’s idea into functional software that can be piloted in the hospital setting—and generally does so more efficiently and at a lower cost than most traditional software development vendors. FIT solutions have ranged from clinical software to mobile apps, and from clinician to patient-oriented solutions. Here are three examples:

• A Twitter-inspired app, called BEAPPER, allows emergency department staff to easily share and update information about their patients in real time and to get lab results on their mobile device.

• Another mobile app, MyPassport, helps inpatients communicate with their clinicians, access their care plan and track their progress toward discharge.

• ALICE, a digital “smart board,” has replaced the white boards and hand notations Boston Children’s clinicians used to keep track of patients in each unit.

A harvest of solutions

Having an in-house incubator has allowed Boston Children’s to rapidly create and test novel software solutions. Because our FIT developers understand the hospital’s IT environment, their technologies integrate far more smoothly than most vendors’ solutions to the same problem.

Innovating around clinical software solutions has traditionally been difficult. Because we can provide dedicated healthcare software development resources, our staff’s ideas are bearing fruit and helping us to enhance the delivery of pediatric care. To see so many innovators embrace these resources is not only gratifying to all of us in the IAP, it is also tremendously beneficial to the people who matter most—our patients.

Read more: http://medcitynews.com/2014/01/healthcare-software-innovation-house-accelerators-better/#ixzz2rbV0pFKT

Humana bought Healthrageous to build out Vitality

Humana was the mystery buyer of Boston-based health engagement company Healthrageous, MobiHealthNews has learned. Healthrageous sold its assets to Humana and a number of Healthrageous employees who supported the platform will also be joining the insurance company. 

MobiHealthNews first reported last week that Healthrageous had shut down and had its assets acquired. The financial details of the deal remain undisclosed.

Healthrageous also had a handful of other customers and pilot deals that had been previously unannounced — including three of the regional Blue Cross Blue Shields and a large IDN in Indiana.

Humana’s acquisition of Healthrageous will likely mean considerable changes to Humana Vitality, a competitive offering to Healthrageous. Humana first launched Humana Vitality in mid-2011 as a program that used a points-based rewards system to encourage healthy behavior and wellness education among employee populations. HumanaVitality is a joint venture between Humana and the Vitality program parent company, South Africa-based Discovery Holdings.

When Humana first launched Vitality the platform offered members an initial health assessment to determine their “Vitality Age,” a “scientifically calculated” number that offered a representation of their risk-adjusted “true” age, and taught members how their current behaviors are impacting their health. Vitality users were then given “personal pathways, recommended goals to help improve their health based on their individual health needs.” They could choose from more than 30 activities, divided between four categories: Fitness, Healthy Living, Prevention, and Education. In addition, children could earn Vitality Points by receiving immunizations, flu shots and participating in team sports. Vitality was included as a part of Humana’s commercial members but not its Medicare members.

As of May 2013, Humana Vitality integrated with a number of activity and biometric tracking devices including all Fitbit devices, some Garmin heart rate monitors, Polar heart rate monitors, and Timex heart rate monitors, as well as apps like Nike+ and Humana’s own Fit apps for iPhone, Android and BlackBerry. Humana also offers two white-labeled devices called HumanaGear Pedometers — one requires a USB connection and the other is wireless-enabled.

While it may not be related to the Healthrageous buy, Humana’s CEO was slated to serve as a keynote at Health 2.0 in Santa Clara last week but cancelled shortly before the event.

http://mobihealthnews.com/26099/humana-bought-healthrageous-to-build-out-vitality/?utm_source=feedly

17 Senators Ask HHS to Extend Stage 2 Meaningful Use

Seventeen Republican U.S. Senators have sent a letter to Health and Human Services Secretary Kathleen Sebelieus making a compelling argument for implementing a one-year extension to Stage 2 of the electronic health records meaningful use program. Here is text of the letter, dated September 24:

“Dear Madam Secretary:

“The Electronic Health Records Meaningful Use Incentive Program has played a significant role in advancing the adoption of health information technology across the country. However, given the feedback from stakeholders on the timing of Stage 2 of the program, we respectfully request an extension of Stage 2 by one year for providers who need extra time to meet the new requirements. Providers who are ready to attest to Stage 2 in 2014 should be able to do so consistent with current policy.

“Starting in 2014, eligible hospitals and eligible professionals participating in the EHR incentive program for Medicare will have to progress to new Stage 2 regulatory standards in order to demonstrate growth in the use of EHR technology. All eligible hospitals and professionals will have to demonstrate achievement of Stage 2 meaningful use objectives for any quarter-based 90-day period of either Fiscal Year 2014 for hospitals or Calendar Year 2014 for physicians in order to avoid penalties in 2016. This requirement applies to those who began Stage 1 in 2012 or earlier. However, even providers that began Stage 1 in 2013 or will attest for the first time in 2014 will have to use 2014 Edition Certified EHRs to satisfy the revised set of Stage 1 objectives.

“Therefore, based on a wide range of feedback from providers, vendors and other stakeholders, we identity three key problems with the current timeline for Stage 2.

“First, we are concerned that the regulatory structure of the program has created significant time pressure in 2014, and progressing to Stage 2 may not be feasible for all participants. In one year, over 500,000 hospitals and physicians are required to upgrade their existing technology to demonstrate new standards of ‘meaningful use’ by the end of 2014 in order to be eligible for the corresponding incentive payments. Further, the vendors are under tremendous time pressures to ensure their products are certified for the 2014 Edition criteria and have sufficient time to upgrade their products for each hospital or physician client. This time pressure has raised questions about whether such a short period for Stage 2 is in the best long-term interest of the program.

“Second, we are concerned that the onset of Stage 2 may further widen the digital divide for small and rural providers who lack the resources of large practices and may not be vendors’ top priorities. Even if certified products are available to them, simply receiving the software update does not satisfy meaningful use requirements for a hospital or eligible provider. They also need assistance learning how to use the new technology and time to address how they will achieve the new standards of meaningful use.

“Third, an artificially aggressive Stage 2 timeline may have serious unintended consequences such as stifling innovation and increasing medical errors. Innovation in health information technology could be hampered, since vendors do not have the time to introduce administrative flexibility into their EHRs to best serve diverse practices. Medical errors could be increased inadvertently, because rushing through upgrades could introduce new risks in the technology that could cause errors or patient safety problems.

“If the goal is to improve care by achieving broad and meaningful utilization of EHRs, providing sufficient time to ensure a safe, orderly transition through Stage 2 is critical to having stakeholder buy-in, a necessary component of long-term success.

“We are not suggesting a delay of Stage 2 and the progress we have seen to date. Providers who are ready to transition to Stage 2 should do so and should receive incentive payments in 2014 and 2015 consistent with current policy. However, providers that are not yet ready to transition to Stage 2 should have a one-year extension before they must demonstrate Stage 2 meaningful use, consequently mitigating the threat of penalties while still abiding by the statutory deadlines.

“In future efforts, continued focus on achieving interoperability is critical. We believe that for this program to ultimately be successful, heeding stakeholder feedback on the current progress to achieving interoperability is imperative. It is critical to continue holding vendors accountable for providing products that advance the ability for unaffiliated providers to share information.

“We appreciate your attention to this request and urge you to move quickly with a decision so stakeholders have the clarity and certainty they need to plan. We look forward to your response by October 8, 2013.”

Signers of the letter were Sens. John Thune, Lamar Alexander, Tom Coburn, Mike Enzi, Richard Burr, Pat Roberts, Johnny Isakson, Patrick Toomey, Rob Portman, Mark Kirk, Saxby Chambliss, Jerry Moran, James Risch, John Barrasso, Lisa Murkowski, Daniel Coats and Roger Wicker.

http://www.healthdatamanagement.com/news/senators-ask-hhs-extend-ehr-meaningful-use-46649-1.html

High-tech monitors will help patients and their caregivers

TVs in your hospital room are so yesterday.

In the near future, flat-screen terminals mounted on the wall or near your bedside might offer a lot more than entertainment. Patients will be able to surf the Internet, order their meals, communicate with nurses and view their latest X-rays — all through interactive patient-care systems.

Educational videos on managing medical conditions, prescription orders and medical records can be flashed on the same screen where patients view dozens of television channels and just-released movies.

“The nice thing is it really puts the patient in the driver’s seat,” said Gary Harper, a registered nurse specializing in information management and communication at the West Palm Beach (Fla.) VA Medical Center in Riviera Beach, Fla., where 259 high-tech terminals should arrive by year’s end. “And it will help the nurses give even better care.”

West Palm Beach VA is one of six veterans hospitals in Florida scheduled to have systems installed in the next year, according to GetWellNetwork Inc., the Maryland technology company handling the project.

Hospital technology experts predict interactive systems, which have been around for more than a decade, will start taking off for one simple reason: They make patients happier. And that could make a big difference to a hospital’s bottom line.

Medicare now collects patient satisfaction data and cuts reimbursements for facilities performing poorly, said Nathan Larmore, a principle-and-practice leader at Sparling, a Seattle-based technology consulting firm advising the health care industry.

And using interactive tools to get patients more involved in their care should reduce hospital readmissions, Larmore said, which is another factor affecting reimbursements.

“In the past, hospitals looked at bedside technologies that improved a patient’s experiences as luxuries. But once they were mandated to focus on patient satisfaction, there was renewed interest,” Larmore said. “Hospitals being built in the last eight years are starting to look more like hotels, which is the industry where some of this technology has come from.”

Larmore estimates that about 10 to 15 percent of acute-care hospitals nationwide have interactive patient terminals. Costs have held many of them back, he said, as systems can run “several hundred dollars to a couple thousand dollars” per room.

“Project managers are used to spending millions of dollars on a fancy lobby, but not several hundred dollars on a television system,” Larmore said.

Children leading the way

Many of the early adopters have been children’s hospitals, he said, “because kids focus on their environment and adapt to the technology.”

Joe DiMaggio Children’s Hospital in Hollywood, Fla., has replaced televisions with interactive monitors. The GetWell Town system, a pediatric product from GetWellNetwork, was part of the new Joe DiMaggio building construction in 2011, then was expanded into the original hospital.

“When we were doing the new building, we talked to the kids about what they wanted, and they said a computer in their room,” said Michelle Barone, director of patient and family centered care for Joe DiMaggio and Memorial Regional Hospital, also in south Florida. “They wanted to be able to get on the Internet and watch movies without waiting for a volunteer to bring them a DVD.”

GetWell Town does all that — plus medical education videos, a hospital-wide game show, and an interface that lets young patients bring in their own Xbox or Wii games.

Barone said Memorial has discussed bringing interactive systems to the adult hospitals, “but right now, it’s all about the numbers,” she said. “When kids are in the hospital, we go above and beyond to cheer them up. We forget that when you’re an adult, you want to be coddled a little, too.”

Officials with the VA, which has its own federal health care funding, say the monitoring systems will greatly improve life for veterans residing in their Community Living Centers, which will be the among the first units to get the terminals.

The Miami VA, the first Florida veterans’ hospital to receive its systems, started the $2.4 million project in June, installing 230 units in the living center and some inpatient rooms.

Chuck Rivenburgh III, 43, is one of four paralyzed vets in Miami’s living center who got a “sip and puff” adapter, allowing him to flip through 48 television channels and pick from among 30 recently released movies by blowing through what looks like a double-pronged straw. The monitor is mounted on a flexible arm attached to the wall, allowing it to be pulled close to Rivenburgh’s bedside.

Rivenburgh, who served in the Army during Desert Storm but was injured after returning home, has lived at the VA hospital for 14 years. Before the GetWell system, he said he was limited to 14 TV channels, none of which included NFL games.

He is thinking of adding a keyboard to his tray table so he can access the Internet through his bedside monitor rather than at the computer on the other side of his crowded room.

“My TV is on pretty much all day long, so all these functions are a huge improvement,” he said.

Louis Marcus, GetWell’s interactive patient care manager for the South Florida VA installations, said the system will be upgraded so that doctors and nurses can leave notes, check pain levels and allow patients to order meals. Such terminals will become even more valuable as medical records go electronic, Marcus said.

As for the veterans, “The feedback has been great,” Marcus said. “I had one family who was visiting sit down with me for half an hour and tell me how grateful they were.”

http://www.startribune.com/lifestyle/health/221410951.html