Assessing the Unintended Consequences of Health Policy on Rural Populations and Places 

Because of the complexity of the U.S. health care system, thoughtfully designed health policies carry a risk of having unintended consequences, particularly for health systems in rural places that have place-based fundamentals that deviate substantially from urban and suburban areas. Policies developed without consideration of rural contexts are likely to create unanticipated and negative consequences for rural residents, providers, and communities.

When health policies are being developed, a number of themes that emerge are useful to keep in mind. Specifically, how will this policy impact the ability of a rural health system to offer essential, affordable, and high-quality services to rural populations? How might this policy result in disparate outcomes and widen health inequities, such as threatening access, slowing quality improvement, or creating financial barriers to obtaining health insurance or buying health care services?

The rural-proofing framework presented in this paper is a policy analysis tool for thinking about what the unintended consequences of a policy may be on rural populations and places vis-à-vis the objectives of a high-performance rural health system. Policy analysis must be applied to all sources of authoritative actions given that policies are produced not just in the legislative context, but also through judicial, administrative, and rulemaking actions.

The full report can be downloaded below.  

Success At Cleveland Clinic And The Future Of Healthcare

Healthcare is being transformed with new alignments of medical personnel, digitalization and personalization, focus on prevention and internationalization, according to Cleveland Clinic CEO Tom Mihaljevic. Cleveland Clinic is leading the way in a number of these areas. I interviewed Tom on The CEO Show, and he outlined some of the key features that have earned top-ratings for Cleveland Clinic and his vision of the future of healthcare. 

Cleveland Clinic is an international healthcare provider employing 60,000 caregivers. The majority of its hospitals are around the City of Cleveland, Ohio, and they have hospitals in southeast Florida, Las Vegas, Toronto and Abu Dhabi in the United Arab Emirates. They are now building a hospital in London.

I asked Tom what sets Cleveland Cleveland apart as it earns its top ratings in clinical care and outcomes year after year.

“The most important differentiator for Cleveland Clinic, in our belief, is in our model of care. Cleveland Clinic is organized in such a way that we work as teams,” Mihaljevic said.

The full Forbes article can be viewed at this link.  

The Use Of Telemedicine By Physicians: Still The Exception Rather Than The Rule

Using data from the American Medical Association’s 2016 Physician Practice Benchmark Survey, we provide the first nationally representative estimates of physicians’ use of telemedicine. In 2016, 15.4 percent of physicians worked in practices that used telemedicine for a wide spectrum of patient interactions, including e-visits as well as diagnoses made by radiologists who used telemedicine to store and forward data. In the same year, 11.2 percent of physicians worked in practices that used telemedicine for interactions between physicians and health care professionals. We found that in addition to specialty, larger practice size was an important correlate of telemedicine use. This suggests that despite regulatory and legislative changes to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier for small practices.

The full article can be downloaded below.

Wireless healthcare

The work of Professor Eisuke Hanada and Professor Takato Kudou has been a driving force of innovation in medical technology. Here, they discuss their focus on manipulating wireless communication systems to assist medical efforts

At Saga University, the Hanada Laboratory and its collaborators have plunged into the world of wireless communication in medical devices, developing novel systems for real-world application in hospital environments.

The full Impact article can be downloaded below.  

Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review

While the current telemedicine approaches show promise, limited studied conditions and small sample sizes affect generalizability, therefore, warranting further research. The information presented can inform health care providers of the most widely implemented, studied, and effective forms of telemedicine for patients and their families and the telemedicine initiatives that are most cost efficient for health systems. While the focus of this review is to summarize some telehealth applications in pediatrics, we have also presented research studies that can inform providers about the importance of data sharing of remote monitoring data between hospitals. Further reports will be developed to inform health systems as the systematic literature review continues.

The full article can be downloaded below.  

Digital Healthcare Growth Drivers In 2019

The digital transformation of healthcare will see significant growth in the next 12 months fueled by institutional interest in driving down costs and improving patient engagement. Expect increased pharma investment, improving regulatory status, payer engagement with digital tools and better telemedicine connectivity through consolidation.

Digital health will build on the major events of the past year. Amazon made headlines at the beginning of 2018 with its announcement of collaborating with Berkshire Hathaway and JP Morgan to create a new entity to improve care options for their employees. Towards the end of the year Amazon got attention again with its expansion into software to digitize and mine patient medical records to improve treatment and cut costs. It joins the ranks of IBM and UnitedHealthcare’s Optum, as well as Apple and Google’s efforts to mobilize, organize and analyze health records. The anticipated buyer for all these services are health systems that have historically lagged in fully embracing the potential of electronic record analytics.

The full Forbes article can be viewed at this link.  

Amulet: an open-source wrist-worn platform for mHealth research and education

The advent of mobile and wearable computing technology has opened up tremendous opportunities for health and wellness applications. It is increasingly possible for individuals to wear devices that can sense their physiology or health-related behaviors, collecting valuable data in support of diagnosis, treatment, public health, or other applications. From a researcher’s point of view, the commercial availability of these “mHealth” devices has made it feasible to conduct scientific studies of health conditions and to explore health-related interventions. It remains difficult, however, to conduct systems work or other experimental research involving the hardware, software, security, and networking aspects of mobile and wearable technology. In this paper we describe the Amulet platform, an open-hardware, open-software wrist-worn computing device designed specifically for mHealth applications. Our position is that the Amulet is an inexpensive platform for research and education, and we encourage the mHealth community to explore its potential.

The full article can be downloaded below.  

Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value

Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings.

We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013.

During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases.

The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.

The full article can be downloaded below.  

Consumerism Will Spark Change Across the Industry: My Top Seven Health IT Predictions for 2019

As we prepare to take on the challenges and opportunities of a new year, let’s lay out some of the industry’s macro trends and what they might mean to us in 2019.

This year, there is a theme. As patients, we have an increasingly consumer-oriented mindset—and rightfully so. We’re paying closer attention to the quality and value we’re getting for the money we’re spending. This “consumerization” of healthcare, along with constant technology innovation, is driving a tectonic shift across the industry, and it’s easy to be excited about what the future holds. 

After nearly 40 years in this business, I’d better be getting good at reading between the lines to understand what’s coming next. So without further ado, here are my top seven health IT predictions for 2019.

1. Consumerization of healthcare reaches tipping point
2. Telehealth, mobility and millennials will upend the who and where of care delivery
3. Consumers will demand healthcare price transparency
4. People will insist on the ability to easily share their health data -- forcing the industry to accelerate interoperability solutions
5. Increased interoperability will propel value-based care
6. Initially driven by government regulations, the health IT industry will take the lead on battling the opioid epidemic
7. The healthcare market will demand easier, more appropriate access to high cost specialty drugs

The full Surescripts article can be viewed at this link.  

5 Ways Artificial Intelligence May Affect Health Care in the Near Future and What That Means for You

Technology is changing fast, and the world is changing with it. Concepts that were mere science fiction only a couple of decades ago -- like artificial intelligence (AI) -- are quickly becoming commonplace. Computers have become powerful enough to handle complex AI computations; machine learning algorithms are more accurate and faster than ever; and the cloud and the internet of things have made it possible for even small devices to access artificial intelligence's enormous capabilities.

That's why responsible use of AI solutions in health care could improve, and even save people's lives. On the other hand, health care is an area where recklessness can occur; that's why new developments are regulated and implemented slowly and cautiously.

Here are five ways that AI and machine learning will likely be affecting your health care in the very near future:

• Digital Consultations
• Radiology and Images
• Personalized Medicine: Faster, More Accurate Diagnoses
• Robot Surgeons
• Cybersecurity

The full Entrepreneur article can be viewed at this link.