More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing.

In the past 35 years, hospitalizations have declined by more than 10% as more patients migrate to urgent-care centers, physicians’ offices, and at-home care—and the disappearance of hospitals is “inevitable and good,” Ezekiel Emanuel writes in a provocative op-ed for the New York Times.

Emanuel, a prominent physician and vice provost at the University of Pennsylvania, writes that U.S. hospitalizations reached their peak more than 35 years ago, in 1981. There are now fewer hospitalizations than in 1946.

Due to this decline, the number of hospitals has fallen as well, from 6,933 in 1981 to 5,534 this year.


Why hospitals are disappearing

One reason hospitals are disappearing, according to Emanuel, is that patients increasingly view hospitals as potentially dangerous places to be—”less therapeutic,” he writes, “and more life-threatening.”

In 2002, there were 1.7 million cases of hospital-acquired infections, resulting in nearly 100,000 deaths, according to CDC research. Plus, hospitalizations create risks of medical errors and falls—and constant interruptions in the middle of the night “are not conducive to recovery,” Emanuel writes.

Further, providers increasingly can provide complex care outside of the hospital, Emanuel writes. For example, anti-nausea medications and new forms of treatment mean that many cancer patients no longer have to receive their chemotherapy at hospitals. Similarly, hip and knee replacements are often performed at ambulatory surgical centers rather than at the hospital. Births frequently happen either at home or at birthing centers.

These trends will continue, Emanuel contends, and as they do, more hospitals will downsize, merge, close, or turn into doctors’ offices or outpatient clinics. The hospitals that remain, he writes, will focus on their ED, complex procedures like organ transplantation or brain surgery, and similarly urgent and high-complexity services.

Emanuel’s provocative argument about how hospitals will respond

Emanuel writes that, while he believes the shift away from hospitals will benefit patients, special interest groups within the hospital business may find it threatening. As such, he argues that hospitals are likely to lobby for higher payments from the government and insurers “to retain the ‘good’ jobs hospitals offer.”

But Emanuel argues that “the shift of medical services out of hospitals will create other good jobs—for home nurses, community health care workers and staff at outpatient centers.”

Further, revenue pressures will lead even more hospitals to consolidate and merge into massive health systems. Emanuel writes that the hospitals will claim that these mergers will create cost savings for the consumer, but he argues that these “mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds.” Federal antitrust regulators, he argues, should oppose these mergers.

“Instead of trying to forestall the inevitable, we should welcome the advances that are making hospitals less important,” Emanuel writes. “Any change in the healthcare system that saves money and makes patients healthier deserves to be celebrated” (Emanuel, New York Times, 2/25).

Source: More than 1,000 hospitals have closed in 35 years. Ezekiel Emanuel says that’s a good thing. | Advisory Board Daily Briefing


Flex Expands Digital Health Capabilities, Launches BrightInsight Connected Health Solution on Google Cloud Platform

Advanced medical-grade managed services solution analyzes connected medical device data and therapies, delivering real-time insights within a regulatory-compliant environment

SAN JOSE, Calif., March 1, 2018 /PRNewswire/ — Flex (FLEX), the Sketch-to-Scale™ solutions provider that designs and builds intelligent products for a connected world, has expanded its service offerings for the healthcare industry with a new digital health offering. BrightInsight is a secure, managed services solution built on Google Cloud Platform that can aggregate data and deliver real-time insights to optimize the value of connected drug, device or combination products. The company made the announcement ahead of the annual Healthcare Information and Management Systems Society (HIMSS) conference, taking place March 5-9 in Las Vegas, Nevada.

The  McKinsey Global Institute estimates that applying big-data strategies to better inform healthcare-related decision making could generate up to $100 billion in value annually across the U.S. healthcare system. Medical devices today collect massive amounts of data, which creates enormous potential for a rapid feedback loop that can help improve patient care and enhance drug therapy delivery and management. In order to make an impact, the data needs to be aggregated from a myriad of apps and stand-alone devices, as well as analyzed to provide actionable insights. BrightInsight solves these challenges and helps patients and health care professionals, from physicians to medical device and pharmaceutical manufacturers, to better understand medical device usage and medication adherence, and streamline the product development and certification process.

“We saw the need for a secure cloud platform designed to support highly-regulated connected drug delivery and medical devices, going beyond simple connectivity to deliver real-time intelligence and actionable insights,” said Kal Patel, MD, senior vice president of Digital Health for Flex. “With our 20 years of experience operating in global regulated medical environments, and having deployed more than 75 regulated hardware and software medical products, Flex can combine our cross-industry capabilities to simplify our customers’ digital transformation.”

Flex is partnering with Google Cloud to deliver insights through customizable analytics dashboards fueled by Google Cloud’s advanced machine learning and artificial intelligence (AI) capabilities. Google Cloud Platform enables BrightInsight to securely store, analyze and gain insights from health information, without pharmaceutical and medical technology customers having to manage the underlying infrastructure. Advanced use cases for BrightInsight may include controlling connected devices, drug dosing, decision support, personalized patient interventions, trend analysis and AI-driven insights.

“Google Cloud is committed to leveraging our deep engineering expertise to accelerate innovation in digital healthcare,” said Gregory Moore, MD, PhD, vice president, Healthcare, Google Cloud. “With a partner like Flex, we will enable our customers to develop innovative solutions and leverage machine learning-based analytics that can turn new data sets from wearables, medical devices, therapies and apps into actionable information for patients and providers.”

BrightInsight is designed to support CE-marked and FDA-regulated Class I, II and III medical devices, combination products and Software as a Medical Device requirements, enabling automated interventions. Deployed as a managed service, the BrightInsight platform allows pharmaceutical and medical technology companies to accelerate their time to market, reduce the cost of implementation and maintenance across multiple products, and scale for global markets.

BrightInsight features foundational capabilities for rapid development and a modular platform architecture to support customization and worldwide implementation. It is built from the ground up to securely manage highly regulated medical device data and personal health information, and Flex has put the people, technology and processes in place to monitor security and threat prevention to meet global compliance standards.

BrightInsight eliminates regulatory bottlenecks that can lead to costly delays by offering turnkey regulatory design control and file management of master files with the FDA. This service enables pharmaceutical and medical technology companies to focus on their drug, device or combination product submissions without the burden of documenting the software platform.

Source: Flex Expands Digital Health Capabilities, Launches BrightInsight Connected Health Solution on Google Cloud Platform

Apple launching medical clinics for employees

Apple is launching a group of health clinics called AC Wellness for its employees and their families this spring.
— Read on


House balks at $10 billion price tag for VA-Cerner EHR project | Healthcare IT News

VA Secretary David Shulkin, MD, testifies at the House VA Committee meeting on Thursday. Credit: YouTube

VA Committee Chair Phil Roe was also concerned that the amount doesn’t cover maintenance or the cost to update the infrastructure necessary to accommodate the new platform.

As the time draws near for the U.S. Department of Veterans Affairs to sign its EHR contract with Cerner, Congressional members are growing increasingly concerned over not only the $10 billion price tag, but that the agency will need to keep the legacy system in place, perhaps indefinitely.

“While the EHR modernization effort is necessary, it is very expensive,” House VA Committee Chairman Phil Roe, MD, R-Tennessee, said during the Thursday hearing on the VA’s 2019 budget requests.

“The contract with Cerner alone has a price tag of about $10 billion and that doesn’t even include the costs of updating infrastructure to accommodate the new EHR, implementation support or sustaining VistA up until the day it can be turned off,” he continued.

In fact, Roe is concerned that the VA’s legacy EHR may never be completely gone.

“After visiting Fairchild Air Force Base in Spokane, Washington, recently, I’m not even sure you can ever turn VistA off,” Roe said.

President Donald Trump released his proposed FY19 budget this week, which earmarked $1.2 billion to get the project with Cerner off the ground. VA Secretary David Shulkin, MD put the potential Cerner contract on hold in January, pending an independent review of Cerner’s interoperability capabilities.

While Roe applauded Shulkin’s move to ensure interoperability, he’s still not certain the project can be successful.

“It’s unthinkable that VA could potentially spend billions of dollars on a project that doesn’t substantially increase the department’s ability to share information with the Department of Defense or community providers,” Roe said. “But that’s exactly what could happen if VA fails to proceed in a careful deliberate manner.”

In response, Shulkin stressed that the agency is taking the modernization very seriously.

“We have to make sure that we can be interoperable with dozens of different health systems out there,” said Shulkin. “And that’s a challenge that frankly the American healthcare system hasn’t figured out yet… We think VA can help lead this for the whole country by making this interoperable.”

Shulkin recognized the agency’s track record of failed IT projects – the Government Accountability Office recently reported that the VA likely wasted at least $1.1 billion on multiple EHR modernization attempts – and understands that this EHR replacement must work.

Given the size and scope of the project – there are more than 130 versions of VistA operating right now – Shulkin said the legacy system will need to be maintained over a 10-year implementation period.

To account for that, Shulkin is requesting Congress provide the VA a separate account to fund the project. The account would provide the VA with the necessary funds for maintaining VistA and implementing the Cerner EHR, and would provide transparency to where those funds are going.

The VA is expected to sign the Cerner contract in the next few weeks, after the vendor reportedly passed its independent assessment.

Source: House balks at $10 billion price tag for VA-Cerner EHR project | Healthcare IT News


Top 5 free apps to keep you healthy in 2018

The most-downloaded health apps on iPhone and Android app stores reveal where Americans are turning to take control of health issues.

A new year means it’s time to comply with new resolutions for many people. Most often, that means targeting health and wellness. A Google search analysis conducted last January showed that getting healthy was the most popular resolution, with more than 62 million searches, almost double the second-most-searched New Year’s resolution: getting organized.

The ubiquity of smartphones in daily life makes it easier than ever to make a resolution related to health — sticking to it is something else. App tracker App Annie provided CNBC with data on the most popular free versions of health and wellness apps from 2017 based on both the Apple and Android app-store downloads. The data was through Dec. 28, 2017.

As technology giants such as Apple, Amazon and Google get serious about remaking the health-care sector, these results show how Americans are using their phones to take more control of their health, and the specific health issues that are proving to be most app-friendly.

Source: Top 5 free apps to keep you healthy in 2018


The AI 100: Artificial Intelligence Startups That You Better Know

The 100 startups on our list have raised $11.7B in aggregate funding across 347 deals.

Source: The AI 100: Artificial Intelligence Startups That You Better Know


Canada Digital Health Innovation Seminar

Pleased to be keynote, looking forward to seeing you all at The Innovation Seminar at More information here:

Learn about cutting-edge trends from leading international experts & get a look ahead at innovative thinking that will shape the future of digital health. At this seminar, you will learn why Canada is on the forefront of the Health IT industry and how you and your business can benefit from exciting new developments in this rapidly changing field.

Source: Canada Digital Health Innovation Seminar


EHR interoperability: A global conundrum | For the latest in interoperability, health information exchange (HIE) and connected care.

Black Book Research survey reveals “an enduring confusion on the definition of a highly interoperable EHR system outside the United States.”

Maybe it’s no wonder that interoperability appears to be an elusive goal in healthcare, since the vast majority of healthcare professionals around the world struggle to even define interoperability.

A new global survey by Black Book Research shows that 90 percent of the nearly 12,000 responding healthcare professionals across 23 countries say they are unsure about what constitutes a highly interoperable electronic health record (EHR) system.

“There is an enduring confusion on the definition of a highly interoperable EHR system outside the United States,” Black Book said. “Seventy-two percent stated in 2017 that their regional preferable strategy for electronic health records is to link disparate systems through messaging, APIs, web services and clinical portals. Only seven percent of all international EHR survey respondents described their regional HIT system as having ‘meaningfully connectivity’ with other providers.”

The seven-month poll, which closed in January, surveyed 11,838 doctors, clinical leaders, healthcare administrators, and technology managers.

Fortunately, many of these non-U.S. provider organizations are moving toward interoperability. Poll results reflect a pending shift away from siloed EHR systems in Europe, the Middle East, and South Asia, where nearly 57 percent of respondents foresee a move to comprehensive healthcare IT systems with data exchange and care coordination capabilities.

Countries with the highest potential for progressing EHR interoperability and expanded health IT functionalities beyond their local regions are (in order) New Zealand, Denmark, Israel, Singapore, Netherlands, Germany, Hong Kong, Norway, Australia, Canada, Sweden, Finland, United Kingdom, Switzerland, and France.

“A number of countries have launched national initiatives to develop ICT-based health solutions including EHR systems and have progressed well, despite several hurdles,” Black Book managing partner Doug Brown said in a statement. “As the obstacles are clearing with technological and non-technological interventions, approved standards and regulatory frameworks, funding and health-tech guidelines, the growth opportunities for U.S.-based global EHR vendors magnify as well.”


Source: EHR interoperability: A global conundrum | For the latest in interoperability, health information exchange (HIE) and connected care.


HIMSS urges ONC to modify draft Trusted Exchange Framework | For the latest in interoperability, health information exchange (HIE) and connected care.

Organization proposes changes around what is required of Qualified Health Information Networks (QHINs) as well as the eligibility requirements for QHINs.

HIMSS is calling on the Office of the National Coordinator for Health Information Technology (ONC) to change requirements for Qualified Health Information Networks (QHINs) under the federal agency’s draft Trusted Exchange Framework and Common Agreement (TEFCA).

In a February 20 letter to ONC head Donald Rucker, HIMSS Chair Denise W. Hines and CEO Harold F. Wolf III praised the TEFCA draft guidance for taking the right approach in attempting to “minimize the point-to-point interface agreements required in the long-term and the flexibility for providers to find the right exchange network that supports their care delivery model needs.”

“The overall concept underlying TEFCA is pushing our nation in the appropriate direction of enabling providers and communities to deliver smarter, safer, and more efficient care; promoting innovation at all levels; and, achieving a system where individuals are at the center of their care and where providers have the ability to securely access and use health information from different sources,” the HIMSS leaders wrote.

The HIMSS letter proposes maintaining the role of the Recognized Coordinating Entity (RCE), which, according to the ONC, will be responsible for ensuring the Trusted Exchange Framework is operational and which will be selected through a competitive process.

But HIMSS also said it “would like to see changes around what is required of QHINs as well as the eligibility requirements for Qualified Health Information Networks (QHINs).”

“HIMSS looks to find a path forward that allows existing interoperability exchanges, networks, approaches, and frameworks to largely continue to function under their existing business models, qualify as QHINs, and have them report to the RCE as the primary oversight mechanism of TEFCA,” the letter said.

“Today, there is significant momentum being built across the community to support broader nationwide exchange. All of the major interoperability approaches ONC identified as part of the process to implement 21st Century Cures have made considerable progress in building the reach of their networks, increasing collaborations/partnerships with other approaches, and enhancing the services that they offer to providers and other interoperability participants,” Hines and Wolf wrote. “However, HIMSS is concerned that the community will not be able to maintain the current upward trajectory of nationwide interoperability if these entities have to make significant adjustments to their workplans to become QHINs under TEFCA.”


Source: HIMSS urges ONC to modify draft Trusted Exchange Framework | For the latest in interoperability, health information exchange (HIE) and connected care.


Many hospitals lack strategy for leveraging smartphone technology | Healthcare Dive

Dive Brief:

  • Smartphones are ubiquitous in today’s culture, but many healthcare organizations are still figuring out how to leverage them to support providers and patient outcomes, a new KLAS Research report concludes.
  • Shared-use smartphones that are under an organization’s control can build out the clinician tool kit and increase efficiencies by enabling mobile access to patient data. Other options include personal use phones, usually reserved for physicians and management, and “bring your own device” (BYOD) programs that allow employees to access and share personal health information.
  • Meanwhile, nearly 76% of practices use mobile health on a weekly basis, but half of those use it five hours or less, according to the Physicians Practice 2018 Mobile Health Survey. More than 22% of practices use mHealth six to 10 hours a week, while just 27% use it more than 10 hours.

Dive Insight:

The Apple iPhone’s ease of use and broad application library have made it the go-to choice for shared-use phones, but weaknesses could cause other companies to gain ground, according to the KLAS report. Drawbacks include cost, poor Wi-Fi connectivity, no built-in barcode scanner and inability to switch batteries between different iOS models. The iPhone also lacks ruggedization — a feature required for it to be considered healthcare grade.

By contrast, Zebra (previously Motorola) offers a healthcare grade smartphone, is more durable and has an integrated scanner, the report notes. “Two EHR and secure communications vendors now favor Zebra over Apple due to Apple’s inadequacies.”

Organizations issuing personal-use devices almost exclusively use Apple, while half also offer Samsung primarily as a secondary device. The primary use of these phones is communicating with the care team and accessing EHRs. But again, some of the same limitations — like poor WiFi connectivity — apply. While Apple is seen as more secure, Samsung wins on flexibility.

Unless organizations ban personal smartphones, KLAS recommends having a corporate BYOD program to keep the phones HIPAA-compliant when employees access patient data. Successful programs should include stipends to support usage of approved personal phones, an approved secure messaging app, remote device security and lockdown and means to access EHRs.

Asked their motivation for purchasing smartphones, 87% of organizations said securing messaging, while 60% cited EHR mobility.

The Physicians Practice survey shows practices using mHealth for a variety of purposes, with the chief one being communicating with staff (70%). The next most common usage is mobile EHR application (51%), followed by communication with providers (50%) and education on clinical issues (47%).

The National Institute for Standards and Technology developed a practice guide on mobile device security that describes enterprise mobility management, in which a profile is installed on a device to enable monitoring and control. The problem, according to critics, is that staff in organizations that permit BYOD don’t want their personal devices monitored.


Source: Many hospitals lack strategy for leveraging smartphone technology | Healthcare Dive