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.

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.

But as we continue to see EHR flyers and marketing brochures outline the benefits of not using paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR. There are several reasons that can put a medical organization who still relies on paper chart at risk. Especially when we are seeing the transformation that is currently happening the US healthcare system.

Following is a list of 6 items that can put the paper based practice at risk in the near future if they don’t adopt an EHR?

More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHR and see how a healthcare providers who uses EHR can communicate as well as share medical information with them electronically (such as: X-Rays Lab results, treatment plans, e-prescriptions, and PHR), many of these health service consumers will begin to ask and look for physicians who are using these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.

Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialists consults over video conferencing and for a reduce rate. Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many of these physicians that will provide telehealth services will be in need for an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.

Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.

Using remote health monitoring to manage chronic conditions: With the increase in patients with Chronic disease and the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. These would be ways to capture health information and monitor patient’s vitals real time. These technologies would require physicians to have some sort of EHR in place to be able to transmit the information to.

Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.

Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts.These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

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.