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.

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!

As medical information becomes readily available to clinicians, regardless of their location and via health information exchanges that connect provider networks, certain groups will lead by providing services that will both benefit the patient and organization through outsourcing care delivery.

As patients, we are already seeing some of these services in action today. For many of the small to mid size primary care providers, the use of outsourced radiologists to read x-rays is a common practice. This basically means that the reading of x-rays taken at the primary care physician’s office is being outsourced to an outside service provider. What is interesting here is that we will actually see a slightly more advanced flavor of outsourced care that brings value to both patients and provider.

Kaiser Permanente, for one, has long been using telemedicine to get patients to see a specialists without their even needing to leave their primary care provider’s office. So if you need to be seen by a dermatologist or orthopedic specialist, you can simply connect with them via video conferencing immediately after your visit with your PCP. So long, waiting for the referral!

This expansion of the care continuum opens the door for a new model of delivery and structure. It means that physician groups can now compete for patients across state lines (keeping in mind the different state accreditation requirements and such). This means that a patient can request to be referred to a specialist of their choice  — or the one that has to most persuasive TV ads – which may create more competition for the local private groups. Right now, most large private specialists groups tend to have a significant percentage of the patients in their community. But if care providers from out of state provide the same professional care, same day appointments, reduced fees, and virtual visits, then patients may just simply opt for the virtual office visit instead.

Several years back, this would have been an impossible scenario, but with today’s connected health environment and increasing adoption of electronic health records and standards for interoperability, physicians are able to do more remotely. Teleconferencing technology has also enabled users to do this quickly and easily. This does not mean that virtual office visits would eliminate the need for one on one with care providers, but for follow-ups and simple “minute clinic” types of illnesses, it only makes sense to seek alternatives that reduce cost, increase efficiently for everyone.

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.

For some time now, there have been many pilots in place for ACOs and medical homes. Some have been able to offset the costs associated with the initial capital investment through CMS grants that have been available; others have established a community base ACO and leverage collective funding, which has allowed several private physician practices to create the infrastructure needed to collaborate on patient care.

As ACOs and medical homes grow in numbers, some of the larger, privately owned physician groups would need to define and prepare their infrastructure and ensure that their business model can adapt to the changing landscape.

Following are some of the changes that will affect the larger private health organizations:

The need for a community based HIE or Registry:

HIE is one of the core components that will be required in order to have a successful ACO or medical homes.This is the engine that will facilitate the exchange of patient health information. So for many organizations, having connectivity and the ability to exchange information is a must have. Unfortunately not all states will be able to provide an operational HIE when some practices will look to engage in ACO’s. This would leave many of the privately owned physician’s group looking to their local health system for similar infrastructure or create their own community based HIE. In Charlotte N.C. for example since there are two large health systems, one of which has taken the initial steps to implement an enterprise wide HIE and maybe on its way to enable future ambulatory practices to connect and exchange health records.

The need to create and fill more health IT (HIT) positions:

For sometime now, many of the mid to large physician owned groups have not required extensive health informatics knowledge as a perquisite for internal IT positions. As some begin to implement EHR and participate in ACOs and become medical homes, they are requiring additional staff with more healthcare specific training. Some of the skills needed in the candidate pool will be: healthcare data analysis, interface and integration experience, EHR experience, EDI, HL7, and an understanding of clinical and administrative workflow.

Establishing community-based collaboration that goes beyond care:

Since some of the reforms call for bundled payments for services and care, many of the physicians will need to work collectively at all different levels. When we discuss ACOs, we focus mostly on the collaborative efforts that physicians will be able to participate in when providing care for their patients. But there will also be additional collective work that will need to happen behind the scene to ensure payments are received, processed and distributed accordingly. CFO, coders, administrators and scheduling staff will need to work together to ensure that the practices are working toward the same goal and ensuring that they are collectively identifying process bottlenecks to better streamline the workflows.

Process reengineering:

For many practices that have continuously reevaluated their processes and improved on them, they will be challenged again to make further modifications. As with the shift toward preventative care, outcome based fee, bundled payment model, organizations will need to quickly adapt to the changes and rework their processes and workflows to ensure sustainability.

mhealth will play a bigger role:

As it stands today, smartphones and mobile devices are as far as IT is concerned are in the hands of very few clinicians. But as telehealth becomes more popular, health organizations will begin to use it to engage patients in their care as well as communicated with them. There are very few services that are covered under telehealth. But with the new ACO model and Medical home, providers now can be reimbursed for both virtual or home visits. In addition, many providers will need to monitor patients outside the practice settings and coach them. Mobile devices will then play a much greater role as they can provide the vehicle to transfer information regarding the patient to their health provider.

It is fair to assume that the only constant in health care is change. Whether it is through new mandates or simply moving toward a more sustainable health care system, many of the upcoming changes will require the organizations to reinvent themselves to navigate through the tough economy and ensure its success.

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.

This is where a hosted model, or infrastructure as a service (IaaS), becomes a more attractive alternative for hospital and health systems currently taking the steps toward EHR implementation. However, this framework will change the role of the IT department in-house, and this is an important distinction to make. With this model, the IT department will no longer be in the business of IT, but will instead be tasked with supporting the organization’s enterprise IT goals and objectives and ensuring that technology is there to improve efficiency within the IaaS model.

Top 7 reasons why hospitals why would consider IaaS for EHR implementation:

Faster resolution and support:

For many of the larger hospitals and health care systems, when implementing an EHR system across the different departments, the IT team spends a tremendous amount of time upgrading, troubleshooting and communicating with the EHR vendor to support the product and resolve technical issues. This creates a tremendous amount of additional work for the IT department. With a hosted or IaaS model, the vendor is fully responsible for maintaining the system, supporting it and ensuring uptime. This means that the hospital IT team spends less time troubleshooting and more time with end-users.

Less upfront capital:

Imagine you are a 500 bed hospital getting ready to implement a system like EPIC or Cerner. There are significant amount of capital investments that need to be made up-front, not only during the upgrade of the infrastructure that will support the system, but also with the additional resources needed to support it. Essentially, when a hospital decides to implement the IaaS model, they are changing the cost from a capital expense to an operational expense, where they are paying the vendors a monthly fee for the services and access to the system and support, which becomes a much more attractive option for many institutions.

Redundancy:

As the natural disasters that we have experienced in the recent months help to illustrate (i.e. tornados, hurricanes, earthquakes), it is critical to have system redundancy and continuous availability in case of system failure. This would mean that a hospital system will have to invest in a data center located in a different geographic area, which will allow them to switch systems quickly in the event they need to protect the hospital records and electronic patient data.

Focus on healthcare informatics:

Getting away from the business of learning and troubleshooting issues with a new EHR system and moving to providing business value through technology is what healthcare IT should be all about. With the quick availability of IaaS services, infrastructure delivered as a service, it enables IT to leverage and focus their time and resources in bringing innovations, solutions and improvements to the healthcare system.

Scalability:

IaaS providers offer a service model where you pay as you go, or as you grow. You can easily scale out the system as needed without any hardware upgrades, which can sometimes be as simple as submitting a request online for additional computing power or storage. And voila! The system can now accommodate additional users from a new hospital acquisition or outpatient practice.

Security:

Security is in the mind of every cloud computing adopter. Whether it is protecting sensitive intellectual property or patient medical information, many IaaS providers have implemented strong security practices and have been granted certifications such as ISO/..IEC 27001 and PCI. These have helped their customers meet the different regulatory and compliance requirements from HIPAA.

Less downtime during major upgrades:

Major upgrades have caused of a lot of headaches for IT folks. Requiring downtime during back-ups, coordinating with the vendors, scheduling onsite visits from vendors — these are all things that can easily be handled, more efficiently, by an EHR vendor in an offsite data center. The hosted model eliminates many of the challenges experienced during a local upgrade and shifts the responsibility and work from the organization and back to the EHR vendor.

Many health care executives and decision makers are beginning to see the benefits of the IaaS model and are starting to carefully evaluate what their IT departments could look like in the future. Employing the technologies and solutions that can help improve efficiency and cut operational costs, while transitioning IT from reactive support to a more proactive business/vendor partnership model.

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.