In this same vein, another area that may require some additional consideration is in terms of planning for upgrades to a hospital or health system’s interactive television system. Similar to how consumers, patients and clinicians continue to drive the adoption of smartphones in the arena, a similar trend may be on the horizon with interactive TV in the health care setting. Except, this time, the device in question is in a majority of living rooms across the nation.

Television has seen some drastic changes and great technological advancements over the past decade.Projection TV, plasma, LCD, and 3D TV have all been part of the evolution of television technology. But it does not stop there; TVs are now turning to mobile platforms to become smarter, more interactive units.

While traditionally you can connect a PC or gaming console to your TV to take advantage of the integrated, advanced capabilities, Apple and Google took different approaches. Sony and Logitech partnered with Google to implement Google TV in some of their devices. Sony was the first to embed the actual Android based platform in its televisions, with Android being the platform of choice for many smartphone users in the market. Google TV also provides the ability to develop and deploy apps (native, HTML5, or a mix) and make them available for use on any Google-capable TV.

The integration of mobile platforms and interactive programming with television technology seems to hold great potential for the health care industry. Personally I have been using Google TV for about a month now and the feedback I’ve gathered from both colleagues and family, as well as the many potential uses I’ve considered, support the incredible promise this technology has for health care and the future of pateints who will use and interact with programs and content at the bedside.

For hospitals who currently have interactive TVs in their patient rooms, there are many possibilities for Google TV:

• Interactive patient education
• Customized hospital content feeds (news, community based events)
• Online and interactive dining services
• Interactive patient charts or health records (integration with PHR or hospital EHR)
• Patient surveys
• Teleconferencing with family, friends and care givers (Medical home can contact patients and do conference calls regardless of TV hardware used)
• Social media services (Facebook, Twitter and other social sites accessibility).
• Access to commonly used apps
• Remote control from any smart phone device (iPhone, Android based remote control)
• Health & fitness tracking, interactive/reward based capabilities
• Interactive schedules
• Access to clinicians for hospital based and health apps used in the enterprise from anywhere in the network
• Interactive entertainment and on demand (watch your own movies from your own Netflix subscription
• Gain access to work related items without the need of a laptop on hand
• Cost effective
• Integration capability with IP-based TVs and other online TV providers

While not all TV stations are available via the internet, many are considering moving in this direction.Andd should this trend continue to take off, this would one day mean that all TV programming will be IP (internet protocol) based, significantly justifying the use of a smart TV. And with the use of Android and iOS platforms, this add more content availablity and other possible uses for the larger displays.

The Office 365 products and services go well beyond the simple creation of presentations, web pages and spreadsheets via web tools.  They contain a valuable set of features and functionalities that end users are dependent on for day-to-day work.  And as we look at health care and its own line of applications that enable better, more connected patient care, one must wonder if there will be a time where electronic health records (EHRs) will learn from the lessons that companies such as Microsoft and SalesForce have identified as critical for success in the software industry.

The following is a list of eight takeaways from cloud-based applications that EHR vendors should consider as part of their long term software development strategy:

Make it cloud or browser-based: Given the pace at which technology change is moving today, IT is more focused on aligning organizational objectives and ensuring compliance rather than managing physical servers and the downtime associated with them.  For that reason alone, many organizations are now looking to leverage cloud-based or browser-based products that require low up-front costs and offer higher up time, availability and redundancy.  Vendors such as Cerner, AthenaHealth and others provide a full hosted application model where there is very little need for a full infrastructure in-house to maintain the application.  In addition, with this model, a cloud-based application requires very little maintenance and experiences very little downtime that could be associated with upgrades, conversions or system updates.

Low up-front cost: In every EHR implementation, there are several items that contribute to the high costs.  From workflow redesign, training and hardware procurement, to software licensing, maintenance and product support, many see the future in solutions that are provided at a monthly fee per user or business unit.  This reduces the up-front costs and allows for the organizations to appropriately budget and justify the use of the new products and solutions.

Scalability: For products that are offered through SalesForce, Google, or Microsoft office 365, it takes the same effort to sign up 5 users as it does to sign up 5000 users; the system is designed to easily scale out.  This is all done behind the scenes, where the client is ready to start using the application right away.  This capability would benefit EHR vendors greatly as their products continuously need to have the ability to scale out, especially when there are clear indicators of health systems mergers, acquisitions and growth.

Easy to use UI: One of the critical success factors for any user-facing product in the market, including EHR packages, is an easy to use, functional and feature rich user interface (UI).  Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI.  These products must be  easy to use and allow health professionals to attend to their patients without feeling lost in the software.

Integration: As we move toward a health care model that rewards for outcome measures, complete patient care and care team collaboration, many applications are starting to look for ways to allow for protected health information (PHI) to be exchanged, safely and securely.  For Google docs and Office 365, having the ability to connect to other systems, as well as the collaboration platforms, was a useful function in the products.  This would also be a significant feature for EHR packages.  While some do provide the ability to receive and submit health information across a given HIE, there is still a significant lack of adoption from physicians.

Collaboration: Microsoft and Google chose their own collaboration platform as part of their products.  Within Office 365 and Google Docs, there are capabilities for end users to use video conferencing and chatting capabilities.  This provides a useful method for users to communicate beyond the simple email messages.  As accountable care organizations (ACOs) begin to implement their collaboration platforms, there will be a clear demand for chat, audio and video conferencing capability.

Platform agnostic: For software vendors in today’s market, the big question from the majority of prospects and potential buyers is: “Do you have an app for that?”.  That said, for many of these products, having the mobility capability as part of their offerings is now a must-have for clinicians.  Whether it is a hospital system or a small independent physician practice with two physicians, a medical application should have some sort of mobile application that will allow its user access to the information from smartphones, tablets and many other mobile devices.

Power is in the numbers: There are clearly some very powerful players in the EHR marketplace.  These are the groups of vendors that are well established and have had incredible success with high number of users.  However, this does not always mean that there would not be a place for a disruptor.  And in the world of technology, especially the world of software products, it is all about the new, functional differentiators that a product brings to the table and the perceived the value that the software has from users in the market.  Similar to SaleForce, AthenaHealth, Facebook, Chatter, LinkedIn and the other very successful sites, there will continue to be room for new innovators that can disrupt the marketplace and continue to push the technology buck forward, especially in health care.

Fortunately, we did not have to wait too long. On Oct. 19, 2011, VMWare announced that it has partnered with Verizon Wireless to develop smartphones with dual personalities, basically developing a product suite with an Android platform that will enable a user to use their personal smartphone as their work phone. These devices will enable enterprises to efficiently manage the content of work phone “profiles” without mandate on user’s personal phone specific corporate requirements.

This simple yet powerful functionality will allow IT departments across enterprises, including health care, to securely provision and deactivate some of the application and configurations that are unique to the enterprise over the air.

This also provides a great security advantage for enterprises. The work profile or work phone is completely hosted in a central data repository, and therefore nothing is stored directly on the device itself. For health care providers and hospital CIOs, this is a significant improvement on securing and controlling access to health related apps and data. By centralizing the data and securing it, lost devices would not pose a data breach, as they do not contain actual data on them.

This is a very significant technology for the health care industry, recognizing that many physicians and HIT professionals are using iPhone or iOS based devices. We still need to see what are VMWare’s plans are for the iPhones and iPads, as Android based smartphones and tablets will be the first to receive a significant boost from this technology.

And as this is VMWare’s first product to have a major role in the mobile area, there is no doubt that there may be additional innovations coming down the road, ones which will allow for apps to run on devices across multiple platforms. Similar to the existing product called ThinApp, where you can run any application on any platform without its installation (the application runs on a central server or data center), this is another possibility that we may end up seeing in the mobile world from VMWare. Mobile ThinApp!

Within the 696 page document, there are sections that outline the measures on which reporting will be required. Currently the number of measures has been decreased from the original count of 65 down to 33.

In addition, HHS has also announced that it has reduced its requirements for the number of physicians required to use a certified EHR system. Now, only 50% of participating members will need to be meaningful users for ACO participation, welcome news by many groups still in the laggard adoption phase. There was also the announcement for a new program that will provide funding for care providers to hire staff and upgrade IT infrastructure with EHRs in order to support their participation in an ACO.

Several health care associations welcomed the news and noted that HHS seems to have taken into consideration much of the feedback from providers and health care professionals as they’ve taken steps toward the meaningful use journey but have yet to reach the pot of incentives gold.

Recommendation 1: Facilitating Health Text Messaging Development. The Task Force recommends that HHS develop and host evidenced-informed health text message libraries to leverage HHS’ rich and scientifically based information.

Recommendation 2: Research and Evaluation. The Task Force recommends that HHS develop further evidence on the effectiveness of health text messaging programs.

Recommendation 3: Partnerships among Federal Government Agencies and Non-Federal Organizations. The Task Force recommends HHS explore and develop partnerships to create, implement and disseminate health text messaging and mobile health (mHealth) programs.  It is further recommended that in FY2012, specific HHS staff persons (e.g., HHS mHealth lead) serve as main points of contacts to represent HHS in discussions of collaborations or partnerships with other stakeholders in the mHealth ecosystem

Recommendation 4: Coordination across HHS. The Task Force recommends that HHS form a mobile health (mHealth) community of practice, initially led by HHS staff in the Office of the Secretary, that meets regularly (e.g., monthly or quarterly) to discuss and coordinate mHealth activities, including health text messaging, across the Department.

Recommendation 5: Integration of Health Text Messaging/mHealth with other HHS Health Information Technology Priorities (e.g., Electronic Health Records, Cloud Computing, Health Games, etc.).  The Task Force recommends that HHS align health text messaging/mHealth activities with other HHS Health IT priorities.

Recommendation 6: Delineating Privacy/Security Issues. The Task Force recommends that HHS conduct further research into the privacy and security risks associated with text messaging of health information and establish guidelines for managing such privacy/security issues. Furthermore, mHealth issues should be discussed within the HHS Inter-Division Health IT Policy and Security Task Force.

Recommendation 7: Regulatory Issues. The Task Force recommends that relevant HHS agencies (FDA, NIH, AHRQ, ONC, etc.) conduct research on future trends of text messaging technologies and establish regulatory guidelines for these interactive systems that can be used in treating, curing, mitigating or preventing diseases or conditions.

As one quick read will tell you, these recommendations are significant. They will enable HHS to establish regulatory guidelines for interactive systems, and with the emerging ACOs and Medical Homes, where personal physicians and care givers will need to have effective ways to communicate with their patients, SMS will allow them to interact and inform patients adequately and efficiently. Privacy and security concerns will still need to be addressed, but this is a first step toward in the right direction.

Top 5 reason why tablets are a favorable option for your next trip out of town:

1. Battery life: For many iPad users, the advertised battery life is about 10 hours. But many tests have shown that 6 is about what you can get out of it, and of course a lot less if you are watching videos or using wi-fi. Regardless, considering the lengthy battery life in comparison to a regular laptop, the tablets are an attractive choice for users looking not to be connected to a power source for too long.

2. Quick boot: As we’ve all experienced at some point, when you pull your laptop out of sleep mode or doing a fresh boot up, the system takes it a while to be fully loaded. This means that if you have an urgent email to write, you are most likely going to have to wait for the Windows / Linux splash screen to go away. But many of today’s tablets are just as quick as a smartphone, providing instand access to email and whatever applications you need in order complete urgent work.

3. Quick install: Selecting the right installer for your workstation operation system version requires some knowledge of your PC. It also means that some applications may not even be available for your version. But with many of the tablets and the existence of App Store/Marketplace and a single click installer, the simplicity and ease of application deployment on many of the tablets available today make them an increasingly attractive option.

4. Remote processing: As is the case many health care organizations, virtualizing environments, moving  desktops to data centers and going the way of the cloud is a new trend they’re exploring. This of course is in line with many of the capabilities of the tablets, which have apps that allow them direct access to a virtual desktop. Whether it is Citrix or VMware View, a user can have all the functionality that a standard business desktop with Windows has to offer directly from their device with full audio and video support.

5.Lightweight: For many of today’s leading laptop manufacturers, they recognized that users want lighter, more portable computers for ease of travel and use during a commute or on the go. But no matter how light or thin, it is very hard to compete with weight of iPads and tablets alike. They have been the ideal device for note taking, messaging, video conferencing, rich content viewing and even gaming.

From a financial standponit, for some of the smaller size practices, this can also mean more purchasing and negotiation power when engaging in relationships with the large systems. However, these value add propositions are still not convincing enough for private practices just yet. Some have continued to stay independent and maintained their profitability despite the bigger competition.

But the reality is that there is no simple answer to whether joining a large health care system will boost profitability and improve care for the patient or not. From one perspective, you have the hospital who can convince practices to use its system and can provide a value add to both practices and consumers (patients) by having one central location for all their health data. On the other hand, many of the private practices continue to face high costs from implementing these new technologies and infrastructure upgrades, and must continually look for ways to reduce their up front costs as they move toward becoming paperless.

This cost/benefit analysis is not anything new, though, and as we continue to see different reform initiatives and new mandates, health care systems and private physician practices will continue to cross paths and evaluate and redefine their relationships. And in just these recent years, ACOs have been one subject of discussion, as everyone is wondering what it will all mean to them from not only from a technology perspective, but also distribution of savings or payments. Only time will tell.

Fortunately there were several mobile apps that allow me to maintain all my devices in sync with my Outlook tasks, with one of my favorites being toodledo. The toodledo app allows me to apply some of the principles of proper time management outlined in Steven Covey’s “The four discipline of execution,” and allows all of my “toys” to maintain the same list.

But one challenge that some face lies in deciding when to separate and manage multiple to-do lists. For example, for those physicians who are still practicing and also participating in leadership roles, managing their calendar requires a tremendous amount of discipline and time management skills. In a perfect world, a physician’s EHR messages should be able to easily integrate and populate with their Outlook tasks and calendar (securely and without any patient info). Unfortunately, not all systems integrate or sync with Outlook tasks, which means that many times users need to manage multiple lists or else rely on manual synchronization between different systems.

The good news is that many can still successfully and efficiently manage their time even when having to work with multiple lists. Best practice should always be to review your to-do list(s) daily and stick to deadlines, as this will ensure that you are continually monitoring progress are are aware of changing priorities.

The goal of an ACO, or a set of health care organizations that work together and collaborate on and coordinate care for a set of patients, is to not only reduce costs and increase efficiencies in the system, but also improve patient outcomes and the overall coordination of care. But while ACOs are still evolving and taking shape, it is important to dive into some of the core infrastructure components that will be required to ensure success and long-term sustainability.

In order for an ACO to succeed, it must operate a provider network that will enable the electronic exchange of information, provide a platform for care management and offer a payment distribution system. Underlying all of these attributes, of course, are the technology implications, some of which are the following:

Health Information Exchange (HIE): This is a standards based exchange for electronic health records. The current standard being used is the HL7 CDA or CCR (Continuity Care record), which is the format in which health information is stored and exchanged across systems. The HIE is the facilitator that will enable systems to identify patients as well as locate their chart and route it to the requestor. This does not necessarily mean that an ACO will need to operate its own HIE, however. In fact, most ACO will likely connect, or have the option to connect, to one or more HIEs, especially when working across state lines.

Certified Electronic Health Records (EHRs): For participating caregivers, having EHRs to view and document care during a visit is a must. An ACO might offer a hosted EHR or patient tracking system to help boost participation, though it is not required to have one common EHR system for all the members simply due to the fact that most certified products do have the capability to exchange medical information in a standardized format.

Patient portals: In order to improve patient engagement, an ACO will need to provide a patient portal to facilitate secure electronic communication. This will provide the patients with web based and interactive personal healthcare records. The ACO should also offer integration with all major PHR providers.

Data warehousing and business intelligence (BI): There are over 65 measures in the proposed ruling for ACOs. All these quality measures must be reported on in order to be eligible for shared savings. The measures cover everything from care coordination and preventative health to patient experience. Much of the information will be submitted via GPRO tools. In addition, each measure has a minimum attainment threshold and performance benchmark, which requires the ACO to continuously monitor its performance over time.

IT support: In order to ensure system uptime and reduce disruptions to data flow, an ACO will need to provide IT support not only to support the connectivity amongst the members, but will also need a team of HIT specialists to maintain the internal ACO platform.

Unified communications: In a recent article, I discussed the need for sites or platforms that will facility coordination of care similar to Facebook , except more business oriented (similar to Chatter). These solutions will not only allow caregivers to communicate with each other regardless of distance, but it can provide them cost effective ways to have video conferencing, including telehealth services, and a platform for discussing patient cases.

ACO management technology: Since an ACO is the result of the collaboration of cross-disciplinary services and multi organizations collectivity accountable for the total patient care, it is critical to have a system that will support governance and management of the ACO care-delivery model.

Document management: While this may not be obvious at first, the reality is that there are still patients that bring their medical information in paper format. This may require the ACO to provide tools to digitize that information and make it available to everyone. The ACO may be forced to identify alternatives such as cloud-based document management system to be able to provide easy to use and widely accessible system to retrieve and review paper based documents.

Preventative health: In order for an ACO to have a proactive role in the population’s health, the organization must ensure that it is continuously working with patient through reminders and alerts for preventative care. This is especially important for patients with chronic disease.

Clearly an ACO will require a lot of technology as part of its foundation. This means significant capital upfront as well as resources and a strong strategic plan to ensure sustainability. Some hospital led ACOs may have some of the infrastructure components already available to them, while other ACOs may integrate with a payer system which has most of the components. Either way, the ACO and medical home models are not going away, and health IT leaders will continue to be faced with a unique set of challenges as the industry leaders continue to pave the way toward true coordination of care through health IT collaboration.

And many patients have begun to see the benefits and payoff themselves, utilizing mHealth apps for better care coordination and increased engagement. Whether it’s through apps that offer health coaching for the management and promotion of a healthier lifestyle, or those that allow for better treatment of chronic illnesses, we’re seeing new, patient-driven options truly start to make an impact.

For diabetes care, for example, the assistance can be found in many forms, such as the bant app that was unveiled at the ATA 2011 conference earlier this year, which focuses on increasing patient engagement in teens via the interaction of social media and an iTunes reward system. And at the University of Maryland School of Medicine, researchers have concluded that the use of mobile technology helped patients manage their type 2 diabetes, with results to back it up. Patients who used the app had their A1c levels drop significantly over the course of a year, results of which have helped increase consumer confidence in the app and help illustrate the efficacy of their usage in various patient populations.

There are several other solutions that have helped patients manage their chronic conditions. Asthma patients now have the ability to use a mobile app called Asthma Tracker, which can provide information on common medications, treatments, asthma triggers to avoid and additional resources and tools. Patients with high blood pressure or hypertension can also get assistance in tracking and measuring their BP over time, which allows for the constant monitoring of their levels and enables them to submit their data to their physicians electronically and in real time.

As we continue to monitor the mHealth arena and the many advancements to come, it is just as important for vendors to continue to strive for innovation and develop mobile devices with the patients in mind. Applications and devices that increase patient interaction and engagement are not only a win for the patients themselves, but are also a win for the market and industry as a whole, as they will continue to help drive the shift toward accountable care and frameworks that support and reward for qulity through care coordination.