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HIMSS 2012


Medical Device Daily Contributing Writer

LAS VEGAS — It may have started with electronic health records (EHR), also known as electronic medical records (EMR), but now it is about the personal health record (PHR), or how to get the patient involved in managing their own healthcare. From gaining patient involvement up front as they register for a doctor's appointment, to following their health afterwards—whether from their home, nursing care center, or any other distant place, the big move here at the 23rd annual Health Information Management Systems Society (HIMSS; Chicago) meeting is to get the patient involved in investing in their own healthcare.

This meeting set record attendance topping over 35,000 attendees: a population larger than many American cities. Vendors and education sessions demonstrated how health information can flow in a secure HIPAA accredited manner from patient to doctors' offices, hospitals, pharmacies, labs, and insurance carriers; all the while accumulating lab results, diagnostic imaging files, ICD coding, billing, and archiving.

Much of the focus was on interoperability, or the way to get these diverse individual systems to talk to each other, cleverly described by Nextgen Healthcare (Horsham, Pennsylvania) in their ad campaign as "Connectitis: A community-acquired condition caused by a loose patchwork of interfaced databases resulting in isolation and uncoordinated care." Nextgen has integrated their flagship EHR with their ambulatory EHR and their practice management system to automate contact with patients. Physicians can enhance care by ensuring patients are in compliance with treatment plans. Nextgen's system has demonstrated that there is revenue associated with proactive patient communication and care when it is tracked, captured, and processed through an integrated administrative workflow.

To this end, capturing patient engagement drew much attention, with the intent to get Americans involved in managing their own health. Two companies stuck out as frontrunners in patient engagement, although many vendors offered something geared toward patient involvement. Tonic Health (Menlo Park, California) has developed, and is just this week rolling out their first products that revolutionize medical data collection from the patient by making it more like a game than like a chore. Tonic employs contextually relevant graphics that are engineered toward patient engagement. This appealing cartoon-like patient interface achieves greater patient data collection, more accurate data, improved patient management and tracking that results in lower costs for everyone. The Tonic software allows clinicians to fully customize the content of their patient intake forms, questionnaires, surveys, etc. which result in those questions being asked in a fun, colorful, game-like format. These cuter versions of the questionnaires are then deployed to all of their iPads. Patients enjoy, engage with and complete the questionnaire (even if longer than most other questionnaires). Interestingly, Tonic has found that only 5 iPads are needed to manage 30,000 patients annually being seen in one office. They do recommend holding the patient's drivers license until the iPad is returned in order to avoid any temptation on the patient's behalf to take the iPad home with them. The data is then sent securely to an existing electronic health record or back end database. No other installation or integration is required. No data can be stored on the iPad — it is all sent to the cloud — rendering it 100% HIPAA-secured. All data collected using Tonic's platform can be mined, rendering it a huge clinical research tool as well. As Sterling Lanier, CEO of Tonic sarcastically said, "We are a patient engagement company that just happens to collect data."

On the other end of the patient-management-through-ease-of-engagement spectrum is iMPak Health's (Neptune, New Jersey) system that is also just being rolled out beyond their pilot program at this meeting. NoMoreClipBoard (Fort Wayne, Indiana) joined iMpak to develop and market a patient-friendly system that manages patients' compliance following their visit to the doctor or hospital. Upon discharge, the patient is given a small cardboard record-keeper about the size of a greeting card. In it are a series of questions with multiple-choice answers specific to that patient's treatment plan that they respond to daily by pressing a small built-in button to answer each question. These cards are ideal for the millions of patients who are uncomfortable with computers or who cannot afford expensive technology. After about a month of this type of journaling, the patient uploads the information stored on the card by holding the card over virtually any smart phone. (Well, except iPhones for now. It is anticipated that the iPhone 5 will also have the Near Field Communication (NFC) capability required to do this that all other phones currently have.)

Once the data is uploaded, the card's data is cleared and ready to begin a new month. The initial application for these cards was to reduce readmission rates, one of the more costly events for a hospital and one that will cost the hospital even more once the new regulations are in place. By monitoring the patient's daily health journal, the treating physician can be alerted to the potential for an upcoming event and intervene prior to re-admitting the patient. The other great market for these devices will be for wellness, with cards designed for monitoring diet and exercise, medication compliance, cholesterol management, and a host of others. The first smart cards being designed for the more acute patient being discharged will be for chronic obstructive pulmonary disease (COPD), asthma monitoring, and heart failure.

These patient-centric data collection devices will reduce ER visits, hospital re-admission rates, and promote improved wellness, all of which will reduce our burgeoning healthcare costs.

Published  February 24, 2012

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