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Penn Medicine’s Innovator Awards Story: A Standard Clinical iPhone Enhancing Patient Care

March 15, 2018
by Rajiv Leventhal
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Officials from Penn Medicine, a 2018 Healthcare Informatics Innovator Award Winner, share their story of innovation

Several years ago, providers at Penn Medicine, based in Philadelphia, began using mobile apps for a variety of reasons, including: to support better interaction among care teams, conveniently manage and monitor multiple patients, prioritize needs, and make treatment decisions.

As officials from Penn Medicine noted in their project submission for the 2018 Healthcare Informatics Innovator Awards Program, “Having standardized mobile devices to convey real-time, medically relevant key information about patients promoted rapid clinical adoption and demand escalated to more consistently support ‘care on-the-go.’” Then, in January 2016, Penn Medicine met with Apple engineers to develop a full configuration standard clinical iPhone (SCiP) to work with the healthcare organization’s mobile device management tool, while leveraging Apple’s Device Enrollment Program (DEP) and Volume Purchasing Program (VPP)—two deployment programs for device setup and app provisioning.

The Penn Medicine project, “Standard Clinical iPhone Effectively Enhances Patient Care,” was recognized with semifinalist status in this year’s Innovator Awards Program. In a recent interview with Healthcare Informatics, Sean Sarles, director of clinical engineering at Penn Medicine, says that the initial beginnings of this initiative were centered on the medicine team at the hospital wanting a communication tool. So, an initial plan brought in 55 iPhones, and at first, pilots were developed around secure texting. Sarles says the idea was “to provide a means for the multi-disciplinary team to communicate about patients in real-time to promote patient progression—to get discharges completed on time, to understand when patients were coming into the unit, and when patients were coming from the ED and through the hospital.”

Sean Sarles

Providers and nurses were thrilled with the iPhones’ effectiveness early on, and it was at that point when a project was created to distribute a shared iPhone device to all the nursing units at the hospital, and then eventually throughout all Penn Medicine hospitals.

Vasee Sivasegaran, corporate director of information systems (IS) infrastructure at Penn Medicine, notes that Apple’s VPP program was in its infancy about three to four years ago, at which a point a strong request was made by several large enterprises to turn the consumer-focused iPhone device into one that would be enterprise ready—specifically for adopting workflows in which there is a lot of shared device usage. As Apple was working to automate the device enrollment program and make it consumer-focused, it was realized that there was no practical way to expand that to the scale that Penn Medicine was thinking of. But then, the phone carrier entered the picture, Sivasegaran explains.

The way it works, Sivasegaran says, is that a carrier that is part of the procurement process is able to tie in Penn Medicine’s organization ID with Apple’s VPP program, allowing an end user to take a device that was procured for them out of the box and turn it on, while also allowing for the carrier to detect the cellular signal and tell Apple that it belongs to the using organization, and that it’s time to evoke this organization’s VPP ID as part of the program.

Then Apple will contact the mobile device management vendor and can confirm which organization the device ID and VPP ID belongs to. “I can now send the image for that mobile device, and then a user can turn on that device and provision for them within just a few clicks,” explains Sivasegaran. “This is where our teams worked together—my architecture team with Sean’s team—to get the three vendors aligned with us. And then the clinician gets a free image device with all of the key clinical applications that fill into that form factor and that deployment mode right at the fingertips. And now we have over 1,600 devices across three hospitals,” he says.

Vasee Sivasegaran

There are several benefits gained from the result of all this technical work, Penn Medicine officials say. Sarles points to the newfound flexibility and being able to manage the device, and very quickly things, if necessary. “So if we decide to bring into a new app, something for medication administration, for instance, and if those were consumer devices, you would have to go to each individual phone and set them up accordingly. But with the device enrollment program you send out those required settings and applications, and it appears on 1,600 devices,” explains Sarles.

And Sivasegaran notes some of the clinical benefits as well. With Penn Medicine being scattered around more than 170 physical locations in two states, “providers are challenged to navigate that much territory, geographically, only to find out that the patient is not ready or something isn’t done for him or her. Now you are giving clinicians the information they need right at their fingertips to navigate the giant footprint we have,” Sivasegaran says.  “The amount of time saved as well as the optimization of patient care are the real [clinical] benefits.”

Indeed, Penn Medicine officials have estimated that using this method has saved them 975 man hours in the organization’s initial deployment using DEP streamlined setup (15 minutes versus 1-hour for each iPhone). “Pushing additional apps to devices without needing an Apple ID and password for download or manual touch also made the implementation efficient. By implementing this project, it placed a vital tool into caregivers’ hands,” officials said.

What’s more, taking it a step further, Sarles says that this approach has allowed the organization to create a community of nurses, doctors, nurse practitioners, respiratory therapists, social workers, and others, bringing everyone into one virtual location to talk about patient’s discharge, treatment plan or repository status.

One specific example of this, officials offered, involved the cardiac surgery team on a thread with the patient’s current caregivers. The nurse took a picture of the surgical site and sent it securely—every device is encrypted—with a description, concerned about swelling around the surgical site. The surgical team was able to provide immediate feedback and resolve the issue remotely.

“That’s unique—it’s really tough, almost impossible, to get everyone together physically,” says Sarles. “So this allows them to not only talk about the patient securely over text messaging, but you are also all looking at the same information. That’s invaluable.”

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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”


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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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