Changes in approach needed for mHealth implementation

In order to truly become a disruptor in the healthcare industry, mHealth needs to break out of the shackles restricting its widespread use. Although the area shows a lot of promise to bring about major changes in healthcare delivery, the slow pace of its adoption has resulted in many industry leaders quoting the benefits to be speculative. They are generally the elderly lots who have throughout their careers seen various such disruptions start, show a lot of promise and then frizzle away. They are waiting for this one to stand the test of time and meet the changing requirements of the industry. There are enough indications already to suggest that mHealth has the elements to change the healthcare delivery on its head and transform it completely. Infact mHealth is the result of unsustainability of current healthcare spending, rapid growth of wireless connectivity, and the need for more precise and individualized medicine.

So the pertinent question which comes to mind is that if certain obstacles have resulted in the emergence of a solution, what has stopped its widespread use? In order to achieve the purpose, some roadblocks have been identified. They are as follows:

• Complexities which exist in the healthcare system related to current drivers of reimbursement
• Apprehensions of the part of clinicians as they expect the patient-physician relationship to weaken further; with a likelihood of an increase in their workload
• Challenges to the appropriate use and validation of mHealth technologies
• Possibility of downloading apps which are not very useful and can possibly even have a detrimental effect if used

mHealth intends to transform healthcare by addressing inefficient practices and various challenges faced by clinicians and consumers. The real beginning of the mHealth surge will start the day Physicians stop being wary of recommending apps. And for that to happen, there needs to be more availability of evidence. It is only by doing a systematic research on the impact of mobile technologies on health outcomes and showing positive results, on a continuous basis, that reliable evidence can be gathered. Also, for its widespread usage and subsequent acceptance, partnerships with governments become a critical factor. The key here is to identify and engage very early, by identifying the right people within the setups to provide support and handing them over to scale up after reaching a certain level of success. Achieving scale without such an approach i.e. involvement on the part of the government, is next to impossible.

Before beginning any mHealth project, it is very important to take into account 4 dimensions - People, places, payment and purpose. Importance of considering these factors is highly critical in determining the outcome. The following needs to be taken into account while addressing the dimensions

• People: Technological platforms to be used have to be chosen keeping in mind the demographics and preferences of the consumers and health professionals who are likely to use them. A platform with exceptional features and lacking on usability is of no use.
• Places: There is a need to have a strong backbone of network with good accessibility and reliability. This has a major bearing on how and when mHealth is used. If the functionalities available are complex, then in order to leverage those, the required download speed and bandwidth capacity needs has to be available as well.
• Payment: Evidence-based standards should be used to link payment with quality outcomes. Additionally, organizations dealing with patient data should adhere to the required policies to address privacy and security.
• Purpose: In order to be effective the strategy should be such as to align with complexities involved in case management and various clinical objectives.

You can hire developers from top medical software development company in India who can help you build your applications within allocated budgets and time schedules.

We provide healthcare IT services. If you would like to know more about the expertise of our certified healthcare software developers, please get in touch with us at Mindfire Solutions.

Ethical considerations for Physicians?

The desire and need to have a better healthcare delivery system has necessitated implementation of a number of regulatory mandates and adoption of healthcare IT. This requires physicians to make considerable amount of investment in their clinical setups to obtain the required level operational efficiency and subsequently to avoid the risk of punitive actions by the government in the event of failure in compliance. All this has resulted in making the existence of independent medical setups very tough. The jobs of physicians now go beyond just patient care and involve understanding the implications of regulatory norms and changing their working styles so as to abide by them. In order to avoid the pain of dealing with so many factors, which are generally looked upon as nothing by hindrance to their core work of providing care, and risk profitability, physicians are actively getting into agreements with larger provider setups and picking up a payment method with suits their deal. It helps them avoid to a large extent the headache of keeping their clinical setups updated with evolving regulatory norms and making sizable investment in healthcare IT. All this is automatically taken care of by the larger organization they enter into a contract with. Physicians thus have all their energies to focus on their primary area of work and draw financial benefits based on the agreement they hold. This is where there is a need for them to be proactive and take into account ethical concerns around those financials incentives, offered as a part of financial arrangements, which influence their clinical decision making.

Capitation is a popular payment arrangement model, comes in different variants and can potentially result in offering cost effective and efficient care. However, there is a lot of scope for conflict in such systems too. The onus lies on physicians to guard against those. It starts right from the time they are about to get into one such agreement. Two factors which they should never compromise on are the quality of care and the range of services they offer. While arriving at a rate-of-capitation the existing conditions of enrolled patients should also be taken into account. While evaluating plans, they should look at the size of the plan and the duration; both of which should be large to bring in more predictability. Physicians generally get concerned when treatment expenses go beyond predictable limits. It has a possibility of influencing their behavior since outcome generally results in a financial loss for them. Stop-loss provides a good option to handle such situations. Finally, the sanctity of a physician-patient relationship needs to be kept intact. Although it is an obligation on the part of the physicians to consider and meet the broader needs of a patient population, in order to achieve it, they have to focus their energies into every one-to-one relationship that they share with their patients. Any financial reimbursement system which acts as an impediment to this has to be avoided or worked around at any cost.

Health plans generally tend to set expectations for physicians which are not always easy to meet. For e.g. it could be in the form of a steep utilization rate which is difficult to achieve or making physician payment dependent on so many factors that it is next to impossible to get a good deal without affecting clinical behavior. All health plans have financial incentives. Physicians should keep a few things in mind before entering into a contract with any plan:

• large incentives generally make it difficult for physicians to turn down but more often than not require them to make commensurate compromises on clinical standards
• show more preference towards those types of incentives which are applied across broad physician groups
• advocate increase in the time-duration over which incentives get determined. It helps in negating the impact of fluctuations in utilization
• prefer those plans which have a large pool of patients
• avoid agreeing to a tiered system of incentive/penalty payout
• advocate for a stop-loss provision as a solution to handle outliers
• ensure that patients are informed about financial incentives which could affect the level-of-care that they receive.

Physicians should always urge for incentive programs which do not just primarily focus on utilization, efficiency and cost reduction. On the contrary, they should emphasize on those which lay importance to quality-of-care and patient satisfaction as well. Physicians ought to be given flexibility to accommodate the varying needs of patients. No incentive plans should tempt them towards selectively treating healthier people and avoiding the high-risk ones in order to improve their own and their groups’ chances of gaining financially. Creating custom solutions for your healthcare practice can help you immensely. Healthcare software development companies can assist you in this.

We provide healthcare software maintenance services for physicians and clinics. If you would like to hire healthcare software developers from us, we would be glad to assist you at Mindfire Solutions.

What is stifling innovation at Health Information Exchanges?

Innovation is not what Health Information exchanges are focusing on right. The reason is that there is enough work pending to be done on improving deployment rates performance and usability. The Stages 2 and 3 implementation of the Meaningful Use program have HIEs as a major component. Its adoption although in higher single digits now has been steady. In the process there have been multiple instances of vendors exiting from the market and more expected to follow suit. Overall, their impact on better care co-ordination and interoperability has started becoming evident. A governance framework has been setup by the Office of the National Coordinator for Health IT to provide a guiding model for HIE governance. According to the framework, there are four principles of paramount importance which should pervade all governance models. These principles in reality are not binding in any form and are expected to act as guidance. The four tenets include:

• Trust: on matter involving patient privacy, meaningful choice and data management
• Business: Transparency in operations and finances
• Technical: Use standards to implement principles and further interoperability
• Organizational: Identify the best approaches to achieve the means

Reports done by surveys have indicated that HIEs have achieved commendable progress in areas like portal access, orders and results, and clinician messaging. The aim is to try and achieve a state where information related to a patient can flow electronically across organizations, vendors and geographic boundaries. A national information exchange governance forum has been also created to make it possible for the best practices followed across regional HIEs to be shared. This is not only going to help the members but also a go a long way is assuring privacy and security of electronic exchange.

Some of the areas in where HIEs are falling short of expectations include notifications and alerts, queries across networks and clinical alignment. Other issues of concern include the variability of technical standards and policies related to who should have access to patient information. All these are acting as major hurdles which need to be overcome. The stakeholders are looking up to ONC to find solutions to these issues. One of the suggestions put forth is to define the baseline standards and modify them when the market by and large moves to it. But all future standards and related certifications have to be such so has to enable complete interoperability. For e.g. an EHR which receives data should be able to use right away. This will also require a synergized effort directed towards making key stakeholders IT literate with in quick time. They will need to be aware of all the relevant technical standards and protocols related to data exchange. ONC on its part has acknowledged the concerns of the stakeholders and is constantly taking feedback from vendors, providers and others involved enabling them to suggest solutions. That matters are in a state of flux and that solutions will have to evolve with time is understood by all.

Given how things stand today, HIEs are more or less to be looked upon as startup businesses. People who currently are and will be part of the workforce will need to have a set of diverse skills. They will be expected to learn and deliver as various models start taking shape. From governance to policies to technical infrastructure, everything is expected to evolve into something tangible and reliable in the future so as to ensure long-term sustainability. All the neo care concepts which are being promoted like patient-centered medical home and population health management depend heavily on information exchange. Also, with the widespread use of electronic health records, HIE will end up a “necessary tool“ for providing affordable and high quality care. In fact many leaders in the Health IT have recommended that the best way to further HIE adoption could be by showing its value to healthcare reforms rather than pushing it as a regulatory step.

Healthcare software testing can be an eye-opener in this case as well. The feedback collated from user acceptance testing can also help provide insights into the needs of the patients and users of the systems. If there is a regular mechanism to test and record the feedback, that would also help HIEs.

We provide healthcare software development services. If you would like to hire top healthcare software developers from our team, please get in touch with us at Mindfire Solutions.

Concierge Medical Care System

Some of the Health policy makers in the US feel that the current system is highly expensive and is not producing the desired effect in terms of outcomes. Their belief is based on a trend which is seeing a lot of physicians opting out of insurance-driven traditional model and shifting to a concierge medical care model. This is primarily the result of high administrative costs and below expectation payout by insurance companies. In fact some are struggling to stay afloat because of this. This has resulted in quite a number of Physicians moving to a Concierge Medical Service model. Also, Patients assigned to Primary Care Physicians have to wait for hours and days before being able to get an appointment, that too for short time durations, with them. Concierge system of providing medical care is one in which a patient pays an annual fee or retainer to a primary care physician. Depending upon the agreement there may or may not be some additional amount charged.

This can come as a relief for people who have had to wait for weeks to see the doctor. For some additional fees, patients get the opportunity to enjoy same-day appointments with 24-hour access, get more time with the doctor and invest in extra preventative care. Although the broad factors remain the same, variants exist in terms of payment requirements, operation and structure. In this, the insurance companies are completely taken out of the loop and patients pay for the service that is rendered. Currently, the most common type of Concierge model in practice has physicians holding on to their traditional practice but charging an additional fees from a small group of patients who are then entitled to special treatment and services which are not otherwise covered by traditional insurance. The variant at the other extreme has the physicians cancelling relationships with Medicare, Medicaid and insurance carriers. They build their practices aimed exclusively for patients willing to pay a retainer fees. The amount paid as retainer depends entirely on the range of services a particular patient wants to cover. Generally these patients carry insurance cover for all those types of services which are unavailable with their concierge physicians.

It enables physicians to focus more on their patients, spend more time on them rather than having to deal with the payment issues which generally arise out of handling insurance companies. Also, the physicians are absolved of being influenced by the insurance companies changing their ways of practice or suggesting what drugs to suggest, etc. They now have to decide on the number of patients they would like to attend to and do everything they possibly can to provide them with the best of care. The patients on their part however are responsible for prescription drugs and other ancillary medical devices and testing. Patients are required to use their insurance to pay for visits to specialists and hospitals. Many feel that this approach is going to lead to a two-tiered health-care system - one in which the rich will get preference for care over the ones who are not financially at par. There is also another problem likely to arise. Because of the inherent nature of the model, physicians will be required to reduce the number of patients they can handle which over a period of time, if the system gets widely accepted, will lead to a dearth of primary care physicians.

Besides this, Affordable Care Act will compel approximately 30 more million people to be insured. This again will lead to a demand for PCPs. So there is a high possibility of the overall healthcare system taking a hit because it widespread use of concierge practice will mean that more and more people, esp. with lower income levels, will be left without any access to primary care. Presently, the number of physicians who have chosen to adopt this new model is very low. For the model to succeed it has to be gain acceptance from a bigger and wider audience. There are some physicians who are moving to a model with the intent of directing their focus is entirely towards wealthy patients. Besides visiting them at their homes they also accompany them to the specialists.

In all such situations, online applications which impart healthcare services or at least assist the physicians in servicing patients are picking up steam. Needless to say, healthcare software testing also has to be done to ensure the effectiveness of the systems are maintained.

We provide healthcare software development services. If you would like to know more about our expertise in healthcare software maintenance, please visit us at Mindfire Solutions.

How Often Are Doctors Switching From One EHR System To Another?

Similar to other professionals, doctors and medical practitioners also have to store, manage and process a huge amount of information and data. The medical information also needs to be organized based on certain grades and specific structuring. So many doctors, nowadays, use specially designed electronic database systems to access and process a variety of medical information smoothly. The electronic health records (EHRs) are used by large number of doctors to manage the electronic health information about a specific patient or certain groups.

As per the ISO/TR 20514 definition, EHR can be defined as, “Collection of computerized information referring to the health state of a certain subject stored and transmitted in complete safety, accessible to any authorized user. It has a logic pattern for information organization implemented, universally accepted and independent from the system. Its main aim is to assure continuous, efficiently and quality integrated health services along with retrospective and prospective information.”

So EHRs can be used to store, access and share a variety of medical data including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. The complex nature and constantly increasing volume of medical data encourage many companies to upgrade EHR by incorporating more advanced features and customized functionality. These features make it easier for a doctor to share a patient’s digital medical information across different healthcare settings.

At the annual conference of the Healthcare Information and Management Systems Society held at New Orleans in March 2013, the results of a survey conducted by American EHR was presented, which highlighted that doctors frequently switch from one EHR to another to achieve certain objectives. According to AmedNews, “A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that user satisfaction declined from 39% in 2010 to 27% in 2012. The rate of those “very dissatisfied” increased from 11% to 21% during the same period.”

What Makes a Doctor Switch from One EHR to Another

Easy-to-Use Features: The medical information of a patient is accessed by several professionals. Along with the physician, the digital media data is also accessed by the dietitian, nurse and other staff. As the technical knowledge and skills vary from one professional to another, most doctors look for EHRs that can be easily used by their staff. So many doctors choose EHRs that comes with a set of simple and easy-to-use features. These features further allow them to train the new staff without putting any extra effort.

Option to Access Information Anytime: Similar to other users, a doctor also looks for option to access the medical information of a patient anytime, anywhere. Many doctors even look for fast and convenient options to share the medical data. So many doctors replace their conventional EHRs with the advanced systems that allow them to access and share the information over internet. Many companies have launched Cloud based EHRs to enable doctors to store all medical data in a centralized location, and access these at their own pace and convenience.

Integrating Data from Various Sources: Each doctor wants to provide the best healthcare service to his patients. So, doctors often consult with external physicians and specialists to choose the most effective treatment for his client. As the choice of EHRs varies from one doctor to another, many professionals look for systems that can collect medical information from several data sources. Also, the EHR must be compatible with multiple devices, so that the doctor can easily access and evaluate a specific patient’s medical report.

Installation and Operational Expenses: As the doctors are not sure about using an EHR for a longer period of time, they often avoid the expensive systems. Along with buying and installing the healthcare system, a doctor also has to put some amount of time and efforts in training other physicians, dietitians and nurses. So many doctors prefer investing in inexpensive EHRs to make it reduce their operational expenses. Also, the inexpensive EHRs make it easier for them to switch to avail additional benefits by switching to a more advanced system.

Some companies upgrade their EHRs frequently to overcome the common problems faced by users. The recent reports will compel many companies to standardize medical data processing, so that a doctor can change his existing EHR in a smooth and hassle-free way. And that is when need for healthcare software development services is felt.

We provide clinical software development services. To know more about the expertise of our EMR EHR Software development team, please visit Mindfire Solutions.