The Federal Trade Commission is weighing options to respond to health data winding up in the wrong hands.
Companies receiving healthcare data through avenues like mHealth applications on mobile devices should be regulated further, according to a trade association of healthcare CIOs.
"A recent estimate by IQVIA Institute for Human Data Science pegged the number of health-related apps at 350,000," Russell P. Branzell, president and CEO of CHIME, said in the organization's letter to the FTC. "Given the explosion in mobile apps and data aggregation practices, it is entirely possible that the amount of health data held by entities who are not required to comply with HIPAA exceeds the data held by those who are HIPAA-covered entities, certainly a concerning development."
The FTC is seeking comments on whether it should implement new trade regulation rules or other regulatory alternatives concerning the ways in which companies collect, aggregate, protect, use, analyze, and retain consumer data, as well as how they transfer, share, sell, or otherwise monetize that data in ways that are unfair or deceptive.
CHIME said it supports these efforts, using existing authority under the Health Breach Notification Rule to hold non-HIPAA-covered third parties, such as vendors of personal health record (PHR) software and apps, responsible when they illegally disclose – intentionally or not – covered information.
"Actions from the FTC will make a consumer’s data more secure and help ensure that those entities who have a breach of this crucial private data are held accountable," Branzell said. "Not only does it hold bad and unsecure actors accountable, but it also creates a disincentive that urges all businesses with PHR and PHR-related entities to strengthen their data security practices."
UNC Health's system director of digital health and innovation wants to take complexity out of the healthcare journey and give patients a simple path to care.
For many health systems, consumer activation is defined by the digital front door, and that doorway enables the visitor to quickly identify and find the resources that he or she needs for that healthcare journey.
"It's a continuing, evolving platform," says Dan Dodson, system director of digital health and innovation for the Chapel Hill, North Carolina-based health system. "What we need to know is how do we get it into [patients'] hands so they can begin their journey."
To borrow an analogy familiar to North Carolina Tarheel fans, many health systems see the patient's healthcare journey like a basketball play, with players passing the ball around until someone sinks the basket. But in today's patient-centric healthcare world, that patient wants to get to the basket in as few moves as possible, without the annoyances and stress of passing through so many different players and hands.
That's why health systems like UNC are pulling together all the apps they've launched over the past few years and combining them into one platform.
Dan Dodson, system director of digital health and innovation, UNC Health. Photo courtesy UNC Health.
"This is the use-case call to action that's relevant," says Dodson (who, for anyone still following the analogy, went to both Kansas and Kansas State). "You need to go to where the people are to get their attention."
While there are many different ways that a visitor accesses a health system, the majority of visitors are looking to connect with someone for a healthcare concern, and they want to know who to connect with, where, and when. With that starting point, UNC health partnered with digital health companies Gozio and WELL to create a wayfinding platform that sends text reminders about upcoming appointments and directions to that appointment.
That's just part of the journey, Dodson says. That appointment reminder includes a smartlink to the app, which the patient downloads. That app is pre-populated with patient-specific information on locations and other resources, even parking tips, and then synched with a calendar, giving the patient all that he or she needs for that appointment.
"That's how we start to make it efficient," he says. "The experience has to be seamless [for the patient], or they might find something that is easier next time."
This focus on the digital journey was, in many ways, shaped by the pandemic. COVID-19 prompted many health systems to jump onto the virtual care bandwagon with both feet, fashioning online portals and apps so that patients could access needed healthcare services from the safety of their own homes. In the process, they created multiple online platforms, adding new apps to those that had been launched over the past few years—but not all of them play well together.
"Digital platforms fail to meet consumer expectations because of what I call 'Frankenstein' apps," Gozio Health CEO and founder Joshua Titus said earlier this year when the company released a survey on patient engagement platforms. "This is when an organization launches a mashup of mobile features that are not cohesive, resulting in a disjointed experience for the consumer. This problem is exacerbated when an organization has multiple mobile offerings—one app for labor and delivery, one app for ortho, one app for EMR access, etc.—each vying for the consumer's attention, essentially moving from a Frankenstein app to a Frankenstein strategy, which is unlikely to deliver strategic value to the organization as a whole."
Gozio's survey found that many health systems are struggling to develop a cohesive strategy. Of the 82% of health systems reporting that they do have a mobile presence now, only 38% rated that presence as an 8 or higher in terms of effectiveness.
"Given that a health system's digital strategy impacts so much of the organization, it needs to be thoughtful and cohesive," Titus said in the press release announcing the survey. "This is only becoming more important as health systems seek a competitive edge in their communities."
At UNC Health, Dodson says that strategy is constantly evolving. Integrating Gozio and WELL was a challenge, he says, because each have specific services that hadn't been connected in the past. And now they're working to synch some of the back-office tasks to the platform, including the Epic EHR, and looking out towards new functions, like scheduling.
"We want this journey to be more robust, but we need to make sure we don’t create any new silos that make things more difficult," he says.
Dodson notes that journey also has to be measured. And that's not easy.
"One of the challenges of digital health is that it's hard to quantify," he says. Some functions may find their ROI in patient engagement or satisfaction surveys, while others hew towards clinical outcomes, which may take longer to measure. For wayfinding, the health system is charting no-show rates for appointments; for messaging, they're looking at timely responses, such as changed or cancelled appointments, and looking at whether clinicians are filling in those open time slots.
"This is the other side of healthcare: logistics and administration," Dodson says. "All of this ties into making the healthcare experience better."
HealthLeaders Strategy editor, Melanie Blackman, is joined by Sandra Lindsay, RN, MBA, DHSc, who was the first American to be vaccinated against COVID-19 and a recipient of the Presidential Medal of Freedom. Dr. Lindsay also recently became VP of public health advocacy for Northwell Health. During the conversation, Dr. Lindsay discusses her pandemic experiences and shares insight into her personal and professional background.
HealthLeaders editor Jay Asser speaks with Samir Courdy, chief informatics officer and senior vice president of informatics for Duarte, California-based City of Hope, about creating and leveraging a...
An AHIMA white paper recommends more use of artificial intelligence and automation.
A white paper from a leading health IT education and advocacy group recommends more use of artificial intelligence and automation in healthcare to keep up with changing consumer demands.
"A Watershed Moment: Recommendations and Insights for the Health Information Profession to Meet the Emerging Needs of the Modern Healthcare Consumers," based on interviews with health system leaders, insurers, health technology companies, health information exchanges, academic institutions, patient advocacy groups, and trade associations, has been released by the American Health Information Management Association (AHIMA).
"Health information professionals must be prepared to leverage and embrace new technology to meet the demands of consumers," Keith Olenik, AHIMA's chief member relations and service officer said in a press release. "It is essential for the healthcare industry to harness the infinite amount of data being captured today. Health information professionals can turn this data into valuable information, empowering consumers to impact their health and wellbeing."
The report makes five core recommendations to support the healthcare field and other organizations in meeting consumer expectations:
Prepare the health information field for more analytical capabilities and roles.
Prepare the profession to be increasingly involved in governance and management of healthcare data.
Develop strategies and resources allowing health information professionals and clinicians to improve the user experience of consumers—and address the social determinants of health.
Increase health information personnel participation in external advocacy and policy efforts.
Prepare the health information field to be open to more direct future interactions with patients.
The report recommends that health information personnel coordinate closely with clinicians to improve the design and delivery of data capture. It also calls for increased advocacy to support improved processes and regulatory changes to ease the exchange of information between entities.
The white paper was prepared by Kaufman Hall, a healthcare consulting firm, at the request of AHIMA.
According to researchers at UCLA, patients using telehealth for follow-up care after ED discharge were more likely to return to the hospital and be admitted than those who followed up an ED visit with an in-person visit.
New research finds that telehealth isn't always better than in-person care, and it can sometimes lead to more healthcare visits and even hospitalization.
A study led by researchers at UCLA and published in the Journal of the American Medical Association (JAMA) compared follow-up care for patients who'd visited the Emergency Department at the California health system between April of 2020 and September 2021, and found that patients using telehealth were more apt to seek in-person care and be rehospitalized than those who'd had in-person care.
The study analyzed almost 17,000 ED encounters from roughly 13,000 patients at two hospitals, and found that 16% of those who'd had in-person post-discharge follow-up visits returned to the ED and 4% were rehospitalized within 30 days, while 18% of those using telehealth for a follow-up visit returned to the ED and 5% were rehospitalized.
The study isn't necessarily earth-shattering, in that telehealth advocates have stressed that virtual care doesn't replace in-person care and isn't appropriate for all services. But it does highlight the need to compare the two treatment modes and study when and where telehealth is appropriate.
"While telemedicine has been heralded for its potential to improve health care access and convenience, the findings of the study … highlight the need to better understand the limitations of this care modality," Charlie Wray, DO, MS, of the University of California, San Francisco and San Francisco VA Medical Center, said in an accompanying editorial. "Like any other medical intervention, telemedicine can have unintended consequences that eclipse its benefits. Some of these limitations include diminished patient-clinician relationships, decreased efficiency of health care delivery, and lower quality of care."
The study was led by Vivek Shah, MD, of Harbor-UCLA Medical Center, and colleagues from UCLA's David Geffen School of Medicine and Fielding School of Public Health, and the University of Pennsylvania's Perelman School of Medicine and Leonard Davis School for Health Economics.
Shah and his colleagues noted that telehealth studies have seen good results in the treatment of people living with chronic conditions, while the results are mixed in the use of virtual care in acute care settings.
"A potential mechanism to explain increased healthcare utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms," the study noted. "It is also possible that independent of the lack of a physical examination, telehealth clinicians may not be able to communicate as well with patients, leading to an inability to fully evaluate or intervene on evolving illness and leading to deterioration in patient condition and subsequent need for hospitalization."
It's also worth noting that ED visits that require follow-up care tend to involve more acute concerns, such as chest pain, abdominal pain, and shortness of breath—all of which could be serious and would need an in-person exam.
This doesn't mean the use of telehealth in the ED is a complete waste of time or money, either. Health systems have seen success using the platform to screen and even treat patients with less-acute health concerns, thus enabling ED staff to more quickly treat those who need in-person care.
The conclusion here is that health systems have to understand the benefits and limitations of telehealth in different departments and for different patient populations, so as to know when it will work and when in-person care is required.
The health system is contributing $250,000 to quadruple the size of an community health clinic in Denver, part of a project that includes 150 affordable living units and space for fresh food providers.
Health systems are investing in innovative partnerships that not only improve access to care but address some of the social determinants that affect access and outcomes.
The latest example is taking place in Denver, where Intermountain Healthcare is funding the expansion of a community health clinic serving the Hispanic/Latinx community, which accounts for almost 30% of the city's population. The $250,000 grant will quadruple the size of the Tepeyac Community Health Center, which sits in the middle of an even bigger project that will include 150 affordable housing units and 5,000 square feet of space for fresh food providers.
“Intermountain has a reputable legacy of standing in the gap to serve our communities that are most in need," Tiffany Capeles, Intermountain's recently appointed chief equity officer, said in a press release. "This is fulfilled through offering health care options that are both high quality and affordable.”
The expansion will quadruple the clinic's size to 24,500 square feet, add imaging and pharmacy services, and expand annual patient visit capacity from 20,000 to 37,000.
The clinic has operated in East Denver for roughly 25 years, offering primary, behavioral and dental care services in an area that has seen an 88% increase in growth over the past 20 years.
Tepeyac Community Health Center is the first line of care for the fast-growing community, and sends patients in need of more services to nearby Intermountain St. Joseph's Hospital, which is coordinating the grant.
“For the past 28 years, Saint Joseph’s Hospital has been a steadfast partner of Tepeyac Community Health Center and has stood with Tepeyac at every stage of our growth," Jim Garcia, the health center's founder and chief executive officer, said in the press release. "As we prepare to open our new clinical facility, Saint Joseph’s has once again demonstrated their unwavering support, as we continue our mission of serving (or 'of providing high quality, affordable healthcare') to the most vulnerable members of our community."
A digital health company has unveiled an app and platform that can help consumers identify flu-like symptoms at home and access resources for treatment.
With experts predicting an extremely hectic flu season, a digital health company is marketing a direct-to-consumer platform designed to help consumers identify flu symptoms at home and access resources for recovery.
California-based Evidation, which has developed digital health tools in the past to support organizations like Merck, Sanofi, the US Department of Veterans Affairs, and the Michael J. Fox Foundation, says its FluSmart technology analyzes data from wearables to identify flu-like symptoms and offer personalized insights and links to resources.
The platform is the latest in a surge of digital health products designed to help consumers—and their care providers—identify health concerns like infectious viruses at home, before they go to work, school, or a public location like the mall, and help manage their care instead of going to the doctor's office or hospital.
These products can help health systems in reducing waiting room and ED traffic and speeding up time to treatment, while businesses, schools and government offices can monitor employee health.
HealthLeaders spoke virtually with Christine Lemke, co-founder and co-CEO of the company, about the new offering.
Q. How is FluSmart used by the consumer? What technology is used?
Lemke: To get started with FluSmart, individuals download the Evidation app for iOS or Android and sign up for FluSmart via the app or an online link. FluSmart participants have the option to connect a wearable—the program is device-agnostic—but it is not required. Participants answer questions about how they’re feeling on a weekly basis, in addition to being prompted when an Evidation algorithm notices changes in their wearable device data that suggests they may have influenza-like-illness symptoms.
More broadly, the FluSmart program relies on models Evidation has built over many years engaging directly with hundreds of thousands of individuals over the course of their experiences with flu, COVID, and other influenza-like illnesses.
Q. How are you marketing this, i.e. getting the word out that it’s available?
Lemke: Evidation is recruiting participants for the program from its network of almost 5 million members from all over the country using the Evidation app. The Evidation network is one of the largest, most diverse virtual pools of research participants, and there are already 90,000 individuals enrolled in FluSmart this year.
Q. How might healthcare providers (health systems, hospitals, clinics, etc.) or payers take advantage of this service? In other words, can this be integrated into a primary care practice, health plan or some other provider-based strategy or program?
Lemke: This program can help identify individuals with meaningful changes in wearable data or survey data that are correlated with flu—in a key window of early symptom onset. This could be used to do things like identify individuals and prompt them to consider getting screened for flu or COVID, generate awareness for available interventions in an especially relevant moment, precisely recruit people for a clinical trial, or send targeted messages around self-care and when to contact or see a healthcare provider.
Evidation is able to collaborate with health systems, providers, and other partners to use FluSmart with their population. As with every partner, Evidation utilizes industry-leading privacy and regulatory practices, and requires every individual participant to consent for any use of their data.
One day, our hope is that providers could integrate this to help guide their patients into preventive or proactive care journeys to ensure care is delivered at the right time. This technology has the potential to reduce emergency room visits and find patients who need extra support at the right moment.
Q. How do you check or ensure that a consumer knows how to use this technology properly?
Lemke: If someone is able to use an app and answer basic questions about themself, they can use FluSmart. Participants only need to enroll in the program via the app, connect any wearables or other devices they want to contribute data, and respond to prompts for self-reported information as desired. The app walks them through the enrollment process and how to contribute, and there is no special equipment required.
If a participant has a connected activity tracker, FluSmart will alert them when it detects a change in activity data that suggests they might be feeling under the weather – no special setup is needed beyond enrollment. Engaging with this alert will route the participant to the next best action for them.
Q. How might this product or program evolve? How might it be used to address other health concerns or populations?
Lemke: FluSmart is emblematic of the work Evidation does. The core principle underlying Evidation is to help guide individuals toward healthy actions or information when it is most useful to them—and their care teams and broader community. In addition to flu and other infectious diseases, Evidation has explored the utility of data collected from smartphones and wearables to more effectively identify, track the development of, and return insights regarding Alzheimer’s Disease and cognitive impairment, Parkinson’s, and heart health, among other health conditions. There’s great potential for this sort of data to provide better understanding about health in everyday life across a range of therapeutic areas.
Additionally, connecting with a geographically, racially, and ethnically diverse group of people in their everyday life, continuously and longitudinally, offers a profound opportunity to a) generate high impact real world data and evidence and b) offer personalized health programs by being able to identify which individuals a study or program may be most useful for.
Aetna Better Health of Florida aims to bend the cost curve for Medicaid patients living with chronic and complex conditions.
Aetna Better Health of Florida is bringing a different cost-saving approach to its Medicaid members through a combination of in-home care with telemedicine and remote monitoring.
Earlier this month, the insurer announced it is collaborating with Emcara Health, the value-based medical group of PopHealthCare, to deliver this approach to members.
Starting in the Tampa Bay, Orlando, and Miami-Dade areas, Emcara Health will deploy physician-led multidisciplinary teams to ramp up integrated, person-centered primary care for members in their homes, or wherever they call home, the two companies announced.
Chief Executive Officer Jennifer Sweet is leading this initiative at Aetna Better Health of Florida. After a decade in the Florida Medicaid industry, including a stint at PopHealthCare, she joined the company in February 2020.
Jennifer Sweet, chief executive officer of Aetna Better Health of Florida. Photo courtesy Aetna Better Health of Florida.
As a CVS Health company, Aetna Medicaid operates Aetna Better Health Medicaid plans in 16 states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia, and West Virginia.
During the pandemic, which began weeks after Sweet's arrival in February 2020, Aetna Better Health of Florida employees quickly pivoted to working from home. But even so, Sweet says, the business was changing rapidly.
"The state eventually changed a lot of the policies required in our Medicaid contract, so we were reorganizing our operations tremendously," she says. "Things are largely back to normal, but we're in a new normal. As utilization went down, telemedicine went up, and it has stayed up in the behavioral space."
What the pandemic didn't change was the health plan's aggressive pursuit of value-based care, Sweet says.
"We've continued to have more and more of our members getting care under providers who are in value-based contracts with us," she says.
The partnership with Emcara Health represents "a big step forward for us," Sweet says. "It combines much more hands-on direct care, that we are comanaging with them in many ways, than under a standard value-based agreement."
A huge component of that co-management is the sharing of data between Emcara Health and Aetna Better Health of Florida, Sweet says.
"We start with the medical conditions that our members have," she says. "That would qualify them as good candidates for the Emcara program."
There were some false starts, due to stringent security protocols that protect each entity's data. Sweet says that challenge was overcome by building appropriate data-sharing infrastructure and staffing to manage it.
"It can be a slow process, a very resource-rich proposition," she says.
Part of that process was automating data transfers.
"It was tactical," she says. "The setup can be complex--not to the IT people who do it, but to those of us asking for something to happen, making sure we have the right resources to actually deliver on building those processes."
After building a set of baseline data, the partners began moving toward sharing data in near real time, Sweet says. Governance also consists of leaders from both organizations meeting quarterly.
"The evidence is there," she says. "Nobody is saying, I saw 10 of your members. It's all right there. We can pull it up, slice and dice, and see what services are administered. On our end, we are adding the care [members] are receiving from non-Emcara providers, to paint the full picture for us both to discuss. The real time exchange of status is very important to this program."
Although the Medicaid plan does have numerous children under its care, the cohort selected by the health plan for the Emcara Health program consists of only adults, all of whom have chronic or complex conditions that improve with close management of their medical conditions.
"We believe that with the kind of activities the Emcara team delivers to members, all of that can be used to create better outcomes for the members, to give them a better quality of life, and a more positive experience of being in the healthcare world," Sweet says. "Probably because of their conditions, many of them are likely to have a lifetime ahead of being in the healthcare world. Teaching them at the same time how to lead their own healthcare journey, it's pretty well-proven from studies everywhere that this is an effective way to reduce the total cost of care. That's the approach we're taking with the Emcara program."
The initiative will also address social determinants of health.
"We have a social team, feet on the street, out there meeting with community-based organizations and other resources, maintaining and updating the database that CVS has established of community resources," Sweet says.
The partnership announcement followed by days the arrival of Hurricane Ian in southwest Florida, but this program has not been impacted by Ian, Sweet says.
"I'm in Tampa, and the devastation south of me was enormous," she says. "We're still out on the street, delivering supplies, doing everything we can with our community partners. We had always intended to expand the program over time, but we will cross that bridge when we get to it in those areas."
The health system's vice president of innovation and IT applications says innovation strategy has to be very flexible.
To Michelle Stansbury, innovation is a necessity at Houston Methodist. It certainly involves thinking outside the box, and now it also means thinking outside of the hospital.
"We're either going to disrupt ourselves or somebody's going to do it for us," says the hospital's vice president of innovation and information technology applications, noting the large number of healthcare organizations in the Houston area and the growing threat of competition from telehealth companies, payers, and retail giants like Amazon.
And that means expanding the playing field.
Houston Methodist already has a Center for Innovation Technology based in its flagship hospital, Texas Medical Center. Now the health system is partnering with The Ion, a 16-acre innovation district hosted by Rice University that's home to a wide range of industries.
"We are advancing the evolution of the hospital's role in healthcare through digital transformation," Stansbury said in an August press release announcing the partnership. "Having a footprint at the Ion will not only provide the Ion's network and Houston community with a window into what we are doing for patients, consumers and providers, but also gives the Ion community and rising innovators an opportunity to bring its own ingenuity and ideas to life with ours."
Stansbury says this new endeavor expands the healthcare innovation sandbox to include people, ideas, and industries that may not have been considered in the past. She points out the Center for Innovation Technology, which opened in 2018, is an ideal location for new ideas within the healthcare setting, while the space in The Ion will pull in concepts that might be new to healthcare.
"We need to tap into the talent that's out there," she says. "There's a lot of hope in what we want to have happen in that space. Some of it will be new to us."
Michelle Stansbury, vice president of innovation and IT applications, Houston Methodist. Photo courtesy Houston Methodist.
Stansbury joined Houston Methodist almost 30 years ago, after holding leadership roles at Compaq Computers and Amoco Oil. Among the many projects she shepherded through the years was the move in 2016 to the Epic electronic health record platform, followed by the opening of the Center for Innovation in 2018.
To Stansbury, integration is a linchpin to fostering innovation. The Center for Innovation, she says, was created with an eye toward breaking down the barriers between innovation, operations, and clinical, and involved executives from each department who took on multiple roles across the board. The goal was to get each department actively involved in discussing new ideas.
The center is designed as an innovation lab within the hospital environment, and it became a hotspot for critical thinking during the pandemic, with digital health and telehealth platforms and tools taking center stage. A lot of the thinking focused on the smart hospital and telemedicine processes that could be applied to inpatient services.
"You're still going to need the physical space," she points out. "You're never going to get rid of it. You're seeing a combination of the physical and digital – the 'phygital' space."
At the same time, she notes, the pandemic showed the industry that healthcare could be moved out of the hospital and into the home. But for that to work, healthcare needed to start looking at other industries that had already perfected online and home-based services.
Hence, the partnership with The Ion.
"We're talking about not only the hospital of the future, but the hospital room of the future, the clinic of the future, and the home of the future," she says. "There's a lot of ideas out there that we need to look into when we plan this."
At The Ion, Stansbury expects to see a wide range of ideas tested out, including wearables and biosensors, machine learning and AI, voice-enabled technology, and healthcare applications in smart home technology like TVs. She also sees a lot of interest in technologies and strategies that improve and reduce workflows for clinicians, especially nurses.
"In many cases they're the champions now" of new ideas and technology, she says of the nurses, one of many groups affected not only by staffing shortages, but high levels of stress and burnout. "They're coming up with some nice ideas in care redesign."
These projects and partnerships have positioned Houston Methodist as a leader in healthcare innovation, and Stansbury says other health systems have taken notice and sought advice. And while the health system is certainly open to advising and collaborating, she notes that innovation is often specific to the challenges, cultures, populations, and workflows of each hospital.
"They have to be very careful doing just what Houston Methodist is doing," she says.
In other words, there might not be a right way and a wrong way to do things, she says, just a different way. That's what thinking outside the box—or the hospital—is all about.
