An Overview of Mobile Cloud Computing for Pervasive Healthcare

Mobile devices, along with wearable sensors, allow patients to access healthcare services from anywhere at any time. The longstanding constraints of computational capability and storage space on mobile devices can be alleviated by outsourcing computation- or data-intensive tasks to remote cloud centers. Thus, mobile cloud computing (MCC) has been recognized as a promising approach to provide pervasive healthcare services to people in their daily life. As the development and adoption of MCC techniques in healthcare, new optimization strategies have been explored and studied to help mobile cloud healthcare services to be deployed in a more effective and efficient manner. In this survey, we demonstrate how MCC techniques have been extensively deployed in various healthcare applications and, specifically, describe the general architecture and design considerations one should take into account while designing an MCC for healthcare scenarios. Given a large number of factors that may affect the performance of the MCC and even result in catastrophic consequences in healthcare, this paper presents the state-of-the-art optimization methods on the MCC for meeting the diverse priorities and achieving the optimal tradeoff among multiple objectives. Finally, the security and privacy issues of the MCC in healthcare are also discussed.

The full article can be downloaded below.  

How Startups And Providers Can Drive Transformation In Health Care: Best Practices

All technology improvements are iterative. Even the ones that seem like breakthroughs have taken a long time to come to fruition. For startups and providers that want to capitalize on opportunities in the industry and help to drive it forward, here are three things you must do:

Best Practices

• Understand the landscape - Founders and CTOs should always design their systems in such a way that the data is portable or can be made portable with relative ease. It’s much harder to retrofit tech systems to match new standards than it is to design and build them from scratch in a way that ensures that they’re portable and adaptive to standardization.
• Align with the right partners - Especially given the interoperability issues within the industry, startups will generally be more successful if they align themselves with established players (think Google, GE and IBM Watson Health) to help them navigate a technically and politically divided industry landscape.
• Keep your promises - Health care providers and startups can’t forget their most important asset in pursuit of big data breakthroughs -- the trust of their patients. Moreover, now that the value of patient data has been clearly established, it is a target. No data is ever completely secure, and the more that health care data is aggregated into larger and larger pools, the greater the risk that bad actors will gain access to it, either through hacking or nefarious business practices. As such, providers should anonymize patient data whenever possible, obfuscating all but what is absolutely required to develop requisite insights.

The full Forbes article can be viewed at this link.  

2019 is a year of unprecedented regulatory releases and activity by federal healthcare agencies. eHealth Initiative (eHI) responded to two of the year's most significant proposed rules related to interoperability and information blocking on Thursday, May 30. Key issues highlighted in eHI’s CMS and ONC responses include:

Overarching ONC and CMS Issues

• Agency Coordination – Practical, thoughtful agency coordination between ONC and CMS on implementing programs related to these proposed rules is needed.
   
• Promoting Patient Access to and Control over Health Information – eHI expresses support for the ONC and CMS strategy to anchor their proposed rule around fostering innovation that promotes patient access to and control over their health information. eHI emphasizes that patient self-efficacy is critical in value-based payment and patient engagement/education is fundamental to that success.
   
• Patient Matching RFI – eHI supports the intent expressed in the proposed rules to identify additional opportunities in the patient matching space and explore ways that ONC and CMS can lead and contribute to coordination efforts with respect to patient matching. eHI also offers its perspectives and support on patient matching issues such as:
  • Matching solutions involving patients;
  • Adoption of well-tested demographic data standards to improve patient matching; and
  • Working with industry and experts to identify other regularly collected demographic data elements that could be incorporated into the US Core Data for Interoperability (USCDI) to support patient matching.

ONC Specific Issues

• Scope of Electronic Health Information - Given that the electronic health information definitions will form the basis for both action and penalty in our healthcare system, eHI urges ONC to further define and appropriately focus and specify the electronic health information definition for the final rule.  
   
• Conditions and Maintenance of Certification (APIs) - eHI commends ONC for selecting an innovative and flexible suite of standards and associated resources, including HL7® Fast Healthcare Interoperability Resources (FHIR®).

As with the proposed information blocking provisions, eHI urges caution given our concerns about complex and costly compliance, documentation, patient education and healthcare stakeholder risk issues related to the proposed API provisions. All parties will need to undertake significant steps to implement APIs and all stakeholders will need to work together to ensure a measured, secure, informed and realistic approach to this transition.

eHI also registers concern regarding the proposed rules’ API provisions and the associated app and attestation process, which could present risk to both providers and patients. Specifically, according to the ONC proposed rule:

APIs should require a “yes” attestation by the app that patients are provided meaningful notice and control over how their protected health information (PHI) is used to connect to the API.

eHI believes that this traditional "click yes to continue" model likely isn't enough to communicate to the patient the risk managing that data might have or to give confidence to providers concerned that patients understand the risks and benefits of this data use. Healthcare providers and others should be assured that patients comprehend the risk prior to using their data in apps and in choosing using the API.

We urge ONC to evaluate for future certification criteria, ways in which certified health IT can gather and store information specific to a patients’ understanding of the use of the data, drawing as appropriate on elements of the Model Privacy Notice created by ONC.

• Information Blocking - eHI urges a review of the very broad definitions of health care actors related to information blocking, particularly health information networks and health information exchanges. We also register caution and concern about complex and costly compliance and documentation related to the proposed information blocking provisions.  eHI expresses its willingness as a leading, multi-stakeholder national HIE resource to work with ONC on HIE issues as they evolve and grow within ONC program purview.

CMS Specific Issues

• Patient Access Through APIs (Open API Proposal for MA, Medicaid, CHIP, and QHP Issuers in FFEs) - eHI registers caution and concern about complex and costly compliance, documentation, patient education and healthcare stakeholder risk and liability issues related to the proposed API provisions. Significant steps to implement APIs will be required and all parties will need to work together to ensure a measured, secure, informed and realistic approach to this transition.

Cited as particularly aggressive are the API implementation and data availability timeframes - January 1, 2020 for MA plans and QHP issuers in FFEs, July 1, 2020 for Medicaid FFS, Medicaid managed care plans and CHIP managed care entities.

For more information, please see eHI’s detailed ONC and CMS comments attached below.

Why It Matters: Prescribers Can Now Access Accurate Medication History Data for Virtually Every American

Surescripts processed 17.7 billion secure health data transactions last year. More than 2.5 billion of those were requests for patient medication history data to be delivered from pharmacies and pharmacy benefit managers (PBMs) directly into care providers’ EHR software.

Continued network expansion and rapid provider adoption of powerful technologies like electronic medication history are a good thing. But what real benefit does high quality medication history data offer? How is this technology helping doctors, nurses and other clinicians deliver safe, efficient and cost-effective healthcare?

I met with Stacy Ward-Charlerie, Manager of Product Innovation, to gain a deeper understanding of the critical role that accurate and complete medication history plays for patients and providers at the point of care.

The full Surescripts article can be read at this link.  

Flexible collaboration infrastructures and healthcare information exchange in hospitals: an empirical resource-based perspective

Exchanging health information and data will enhance the efficiency, quality, cost-effectiveness, and even safety of healthcare practices. However, views and strategies differ on how hospitals can facilitate or enable this exchange process. This study explores a relationship between two constructs, i.e., a flexible collaboration infrastructure—an integrated set of IT assets and networking functionalities that support applications and enable business collaboration—and health information exchange. Second, we argue that the strength of this relationship is influenced by the degree to which hospitals deploy security measures. Findings—based on an SEM-PLS analysis on a sample of 983 European hospitals—show a positive relationship between the two constructs. We additionally find that hospitals’ security measures to protect the confidentiality, integrity, and availability of the data condition this particular relationship. Our findings contribute to the literature and provide valuable insights for hospitals.

The full article can be downloaded below. 

Personal Health Record Interoperability

Personal Health Records (PHRs) is a software application that allows patients to review their medical information remotely through a secure domain. There are four forms of PHRs which are; 1) self-contained Electronic Health Record (EHR), 2) self-contained EHR, 3) PHRs integrated care EHR controlled by health provider and partially by the patient/consumer, 4) PHRs integrated care EHR controlled by the patient/consumer. The methodology for this study was a literature review and semi-structure interview with a specialist in health information technology. Electronic databases used included PubMed, Academic Search Premier, EBSCOhost, LexisNexis and Google Scholar. A total of 38 sources were referenced. Currently, most PHRs are not integrated with other systems. Interoperability exists and has continued to grow steadily, but few individuals perceive the potential benefits of a PHR system including cost and quality of care. Regardless, the review has shown increased PHR use as well as MU adoption. Based on previous literature PHRs, although there has been imported accesses for patient portal as well as major saving for health care providers, the success rate of adoption is still low. The information gathered through semi-structure interview identified PHRs lack of interoperability in the nation and interoperability will not be achieved until the implementation of MU stage 3 by 2019. PHR interoperability has been presented to have significant ability to transform the way individuals have been able to access their PHRs and allowed for increased patient autonomy in the US.

The full article can be downloaded below.  

The Big Word Holding Health Care Back: Interoperability

While interoperability has become routine in so many industries, it is one of the biggest challenges the health care industry faces right now. The lack of interoperable infrastructure prevents patients from being engaged, prevents providers from efficiently delivering care, and prevents health systems from operating more effectively as an organization. It’s the underlying problem that makes it difficult for the industry to adopt novel technologies.

How did we end up here? It's easy to blame technology vendors who gain market position by data blocking. It's also easy to throw the government under the bus and say they didn't do enough or, conversely, that the regulatory environment itself caused our current problems. The reality, in my view, is that there was, and still are, a lot of moving parts that contribute to the ongoing challenges. I'd like to dive into these factors to understand how a holistic approach should guide the way industry players, from patients to providers and payors to health systems, can solve the problem together in the years to come.

The full Forbes article can be viewed at this link.