Kaiser Permanente is one of the largest healthcare organizations in the United States, serving just around 9 million patients. It has also been a leader in healthcare innovation through initiatives like the Kaiser Permanente Information Technology’s Innovation & Advanced Technology Group and Laboratory for Innovation.

Kaiser has now released a mobile portal for patients to access their medical records – medication lists, lab results, and more. Interestingly though, they have released a native Android app only. For iOS, Blackberry, and Windows users, there is instead a web-app.

Through either the web-app or Android native app, patients can now access their medical information from virtually anywhere. The app provides full access to patient information that currently resides on the KP health record system and certainly demonstrates the growing movement to empower patients. In addition though, the release of the Android app first may also reveal a surprising shift in the mobile development landscape.

Patients who want to access their medical information on their iPhone are instructed that they can download a shortcut from the kp.org website that will open up the mobile friendly version of the website. From there, they can access all their medical information.

With the new native and web app, KP patients will have 24/7 access to lab results, diagnostic information, direct and secure email access to their doctors, and will also be able to order prescription refills.  In fact, in 2011, more then 68 million lab results were made available through the website to patients.  All this can be accessed through the dedicated Android app and the mobile website.

“With the new offering, Kaiser Permanente patients have 24/7 access from their mobile devices to view their secure personal health record, email their doctors, schedule appointments, refill prescriptions and locate Kaiser Permanente medical facilities. Members who have the ability to act on behalf of a family member on kp.org now can accomplish the same tasks. Those caring for an elderly parent or someone with a chronic condition can now more easily check lab results, refill prescriptions and communicate with the doctor’s office on behalf of the patient.”

George Halvorson, chairman and CEO of Kaiser Permanente, explains the release of these new mobile offerings.

“This is the future of healthcare. Healthcare needs to be connected to be all that it can be. This new level of connectivity is happening real time, and it is happening on a larger scale than anything like it in the world. The fact that a Kaiser Permanente patient in an emergency room in Paris or Tokyo can simply pull out their mobile device and have immediate and current access to their own medical information is an evolutionary and revolutionary breakthrough for medical connectivity.”

Interestingly, this is one of the few times we have seen an Android release precede the iOS release. Developers, in the past, have often cited issues with cross-device compatibility, a smaller market, and security issues. In many ways, things have changed – there are now far more Android users than in the past for example. iOS challenges, such as the cumbersome approval process and constrained development parameters, haven’t changed much. With Kaiser releasing this app first on Android, we certainly wonder whether the development environment is changing.

Please share your thoughts in the comments below and in our Forum.

By Tim Bredrup

Kaiser Permanente, the largest managed care organization in the United States, has unveiled an Android app and mobile-optimized website through which its 9 million patients can access their own medical information anywhere in the world on their mobile devices for free.  Information and services provided include: lab results, diagnostic information, secure email access to doctors, ordering of prescription refills, scheduling appointments and locating of healthcare facilities. It is also possible for family members to get access on behalf of a patient and accomplish the same tasks.

press release | www.KaiserPermanente.com

Recording notes about a patient is standard practice among physicians and has often left patients curious about what is written down about them.

While federal law guarantees patients the right to examine and get copies of their medical records, it hasn’t always been an easy process to go through.

In fact, there has been some reluctance on doctors to reveal this information in a timely manner. Misunderstanding the notes is a concern for doctors. Many clinicians are troubled by the prospect that patients may get confusing news without a healthcare provider available to explain the context of the information.

Despite this, a recent survey published in the Annals of Internal Medicine suggests that the public has a desire to see them. In fact, most patients thought open visit notes were a good idea.

“The study surveyed 173 doctors and nearly 38,000 patients at three primary-care practices about sharing information with patients. After the survey, the practices joined a project called OpenNotes, in which patients were give electronic access to their files.”

The OpenNotes project demonstrates and evaluates the impact of sharing encounter notes between patients and their primary care physicians (PCPs) online.

“The project involves 3 diverse settings– Beth Israel Deaconess Medical Center (BIDMC) and its associated primary care practices in Boston, MA, Geisinger Health System (GHS) and its primary care practices in rural Pennsylvania, and Harborview Medical Center (HMC), a county hospital and safety net provider in Seattle, WA.”

The options for sharing information with patients doesn’t end there. In 2010 Quest Diagnostics released a free smartphone app called Gazelle that lets patients in 33 states including DC download their lab test results directly to their phone. Though, patients using Gazelle can’t get direct results on HIV, cancer or genetic diagnostic tests.  All other test results have a 48-hour delay on them in order to give physicians time to contact the patient first about the findings.

“No one wants to see their diagnosis of cancer on their own without a medical professional,” says Jonathan Darer, chief innovation officer for Geisinger Health System, which makes most patient information available online. “We try to manage that.”

Source: Washington Post

By Tim Bredrup

mHealth Capital Corp., a capital pool company, announces they have entered into a letter of intent to purchase Heltheo Inc., which provides a “patient centric” patient medical record (PMR). Heltheo disgtinguishes itself from other PMR products by offering  subscribing patients an “eNurse” available 24/7. The eNurse can be accessed via phone, email or via video conferencing. Heltheo offers patients access to their health records via QR codes on their Heltheo cards and via bracelets with built in USB flash drives, describing it as “wearable health”. The transaction is valued at 4,750,000 shares for a total value of Cdn . $950,000. 

press release | www.heltheo.com

Its no secret that the smartphone is becoming as much of a staple of the physician’s toolkit as, say, the stethoscope. Several studies and surveys have sought to quantify this trend among practicing physicians.

Recently, a group of researchers released the results of a survey of smartphone utilization among residents in ACGME (Accreditation Council for Graduate Medical Education) and the results provide interesting insights into what the future may hold.

We have previously looked at reports on the rate of adoption of smartphones for nurses and practicing physicians. While there is a fair amount of variability, such as between physicians of different specialties, this survey demonstrates that we can expect even higher rates of adoption in the future.

Approximately 8,353 surveys were sent out electronically to residency and fellowship program directors for further distribution among their faculty, fellows, and housestaff. Just over 3,000 responses were submitted. It’s worth noting though that the response rate could not be assessed because there is no way to know how many individuals actually received the survey in the end.

While 85% of respondents reported owning a smartphone, only 56% reported using it in clinical practice. One interesting feature however is breaking this down by training level. Nearly 70% of residents (N = 1,397) reported using their smartphone clinically, while only 39.2% of attendings in practice for more than 15 years (N = 665) reported the same. This is despite only marginally different smartphone ownership rates – 88% among residents and 78% among the attendings. In short, this confirms the intuitive prediction that younger physicians are using smartphones (and likely other mobile technology) at higher rates and are likely to carry this forward as they become practicing physicians.

Another interesting finding was the difference between specialties. Only 52% of surgeons reported using their smartphone clinically, despite an ownership rate of 98% – by far the lowest utilization rate among the specialties queried. Perhaps this is reflective of a deficit of resources targeted at surgeons, particularly those in training. However, it is somewhat surprising that usage of relatively universal resources is presumably then lower among surgeons as well – 75% of all respondents reported using Epocrates, a rate that is doubtlessly far lower among surgeons.

Finally, the survey also assessed what kind of apps respondents wanted. Leading the list were textbook/reference apps, exam review apps, classification/treatment algorithm apps, and general medical knowledge apps. Interestingly, these are mostly categories in which a wide range of apps are already available. One possibility is that this is reflective of the difficulty an individual physician has navigating the app store, where the useful apps that they want are drowned out by the noise of the thousands of other apps available.

To read the full Pubmed article from the source click here.

While electronic medical records have many benefits, they are often limited by the fact that different EMR’s do not communicate with each other. Even with the consolidation of healthcare in many areas within a few large systems, if a patient goes between an Epic-system and an Allscripts-system, they are still out of luck. That, however, is set to change thanks in part to provisions in HITECH and promotion of health information exchanges.

In the Cincinnati area, two hospitals that are testing this new functionality are The Christ Hospital and Mercy Health Anderson Hospital. They are using Healthbridge as their Health Information Exchange (HIE) to facilitate this process.

The aim is to facilitate access to and retrieval of clinical data to provide safe, efficient and effective patient care while decreasing healthcare spending. This data is securely accessible in real-time for physicians across multiple connected hospitals, in this case The Christ Hospital and Mercy Health.

Healthbridge is one of the largest nonprofit supporters of health information technology and HIE adoption, supported by a coalition of hospitals in the Cinicinnati area.

Trudi Matthews, spokeswoman for HealthBridge, explained why Cincinnati is primed for the implementation of a HIE.

“The Cincinnati region is a leader nationally in health information technology, with most all hospitals in the region having already implemented electronic medical records or in the process now, including hospitals serving Butler County. The adoption rate of electronic medical records by hospitals and other providers in the Cincinnati area is more than 60 percent, more than twice the national average.”

That was step one of the process.  Now that the Greater Cincinnati area uses electronic medical records, the next step was facilitate the HIE,

“Now all hospitals in town use electronic medical records, but communicate frequently with providers that aren’t. The secure direct email is a way for nonelectronic providers to get information in a quick, timely, easier-to-use way that’s better to use than a fax. Following step two in the process, hospitals will be able to transmit patient records back and forth to each other and to other health care providers, such as primary care doctors, nursing homes and home health agencies.”

In addition to communication between providers on different EMR’s, this HIE also seeks to bring our paper-based colleagues into the fold as well. As pointed out in the article, it doesn’t yet necessarily make sense financially for some providers to move to an EMR (though HITECH changed that calculus for many). Systems that encourage seameless communication between providers across the care continuum will be important, particularly in the short-term, to provide safe, cost-effective care.

Source: Middletown Journal 

Rock Health, the San Francisco based seed incubator for health start-ups, has curated a great list of digital health startups in various vertical markets as well as a database of digital health start-ups who have raised capital in 2011. It is but by no means a comprehensive list so I thought I would re-post it here on iMedicalApps to solicit suggestions from our readers on what app developers and device makers should be considered for inclusion in the list.

We encourage reader feedback on what app developers and device makers have overlooked and should be considered for inclusion in the list. Please add your suggestions in the comments and enjoy exploring the best of the best in digital health.

Digital Health Start-up List

Quantify yourself:

• Azumio develops mobile apps for testing stress and your heart rate. Raised $2.5M (7/27/11)
• CareLogger helps people with diabetes measure and track their glucose levels, blood pressure, meals and weight
• Genomera is enabling crowd-sourced open health studies
• HealthTap‘s advanced algorithms personalize your health experience, bringing you expert knowledge and community insights. Raised 2.35M (3/23/11)
• InsideTracker measures vitamins and nutrients in blood and provides recommendations to optimize health and athletic performance
• Massive Health aims to help people gain control of their weight. Raised $2.25M (2/3/11)
• Scanadu is creating a commercially-viable medical tricorder. Raised $2M (11/11)

The new EMR:

• CareCloud
• Cientis
• Drchrono
• elationEMR
• gloStream
• Practice Fusion. Raised $23M (4/4/11) and $6M (9/11)

Life is not complete without your PHR:

Diagnose or treat it:

• Cellscope created a medical microscpe from your cell phone to your doctor
• DoseSpot is an e-prescribing platform
• medivo offers fast and convenient access to lab testing
• Zipnosis allows you to get diagnosed and treated for minor health problems using a computer or smartphone.
• ScriptPad is a digital prescription pad for iPhone and iPad.

Mental Health:

• AbilTo helps individuals manage life transitions
• Breakthrough connects patients and counselors for private, online therapy
• BrainBot helps you monitor and learn from your brain activity with state-of-the-art EEG brain state detection technology
• Empower Interactive hosts online tools for managing depression and anxiety
• Lumosity helps you exercise your brain!

Get in shape:

• Blisslogik helps you create workout routines
• Fitbit’s Tracker automatically tracks data about fitness activities, such as calories burned, sleep quality, steps and distance
• Dailyburn provides  fitness plans, nutritional tracking,and social motivation to help you reach your fitness goals
• The Digifit™ Ecosystem helps you track your cardio exercising
• Everyday Better provides expert instructional exercise videos and short intense workouts with workout plans
• EveryMove helps you track your activities
• Fitnio uses GPS to track your walk, jog or run and supplies you useful fitness-related data about the workout.
• GAIN Fitness’s web and mobile applications generate personalized training plans
• Join Sessions is a platform for meeting new people and getting fitter through exercise
• getupp is a location-based commitment service
• Skimble provides a cross-platform ecosystem of fun, dynamic and social fitness/ coaching applications
• SportyPal helps you improve your running or cycling performance using your gps enabled mobile phone
• Striiv keychain-based body area network aiming to make personal fitness rewarding.Raised $6M (9/11)

Food & nutrition:

• Eatucate is a social and educational food community site that enables people to shop, cook, and eat healthy
• DesignMyMeals
• FoodSpotting lets you tag and track dishes
• Ideal Mealz is a subscription recipe service that enables you to prepare chef quality, healthy, home-made meals
• Zeer provides consumer grocery information

Got health questions? They have answers:

• FoundHealth
• GoodGuide.com
• Greatist
• GravityEight
• HealthcareMagic
• HealthCentral.com
• HealthCrowd
• The Health Guru Raised $6M (6/1/11)
• Healthism
• HealthiNation
• Healthtreatment
• Healthline Networks
• iMedix
• ipatient
• iRapid Consultant
• MedHelp
• myOptumHealth.com
• Orca MD
• Organized Wisdom
• ShareCare
• Wellsphere

Find a doctor, book a doctor, rate a doctor:

• AdvisorMed.com
• AppointmentCity.com
• BrightWhistle.com
• DocMatcher.com
• DocMeIn
• DocSpot lets users search medical professionals based on certification, ratings, and more
• FairCareMD is an Open Healthcare Network where patients can contract for care directly
• go2doc
• HealthGrades publishes reports and ratings of healthcare providers
• Health In Reach is a search and scheduling tool for out-of-pocket health services
• MyHealthDirect Raised $4M (4/6/11)
• ZocDoc is the open table for doctors. Raised $50M (8/1/11)

Paying the bills / cost transparency:

• Bloom Health helps employers control their health care spending & helps employees spend their benefit dollars wisely
• Cake Health is a central place for all your healthcare plans online
• Castlight Health enables employers  lower the costs & provides individuals with unbiased pricing and quality information
• Change:Healthcare helps you analyze claims data
• Kareo provides physicians a cloud-based online billing system Raised $10M (10/17/11)
• My Health and Money makes shopping for health care easier by centralizing financial information
• My Healthon offers coupons and discounts
• Simplee helps with tracking medical expenses & managing health care costs Raised $1.8M (4/11)
• Zepherella offers convenient electronic patient billing

Modernizing the clinical trial:

• GoBaltois creating easy to use web products for clinical research. Raised $5M (10/17/2011)
• TrialX enables patients to find and learn about clinical trials that match their health conditions
• TrialReach is a search engine for clinical trials

In the cloud:

• Cloud Prime provides secure application to application messaging for healthcare
• eHealthMe is a cloud computing service to study large-scale real world drug outcomes
• Explorys provides a cloud-computing platform specialized for the healthcare industry. Raised $11.5M (5/10/11)
• HealthHiway focuses on facilitating better interaction within the healthcare ecosystem
• Humedica provides SaaS-based clinical business intelligence solutions for connecting patient information. Raised $20M (4/12/11)

For children and their neurotic parents:

• alt12 apps‘s Baby Bump keeps soon-to-be parents informed about their pregnancy progress and enables tracking and sharing the experience with friends/family and an online community of moms
• Baby2.0 is a fun way to keep track of your baby-related activities
• Evoz allows for remote baby monitoring
• MotherKnows collects and securely displays important childhood health data including immunizations and growth charts. Raised $3.3M (7/1/11)
• WeSprout combines your child’s medical data with targeted Q&A and charts

For the older crowd:

• eCareDiary is designed to make coordination of care easy amongst family members and other caregivers
• getminders helps individuals manage and improve their day-to-day health
• Gilbert Guide is a comprehensive senior housing guide and homecare directory for aging parent

For the ladies:

• alt12 apps‘s pink pad is a health and lifestyle tracker with an  integrated online community to connect women
• ChickRx provides expert health information for women
• EmpowHER provides  women’s health and wellness content libraries and an online community for discussing health/wellness issues

Making health a game:

• Ginger.io helps you keep track of changes in your health. Raised $1.2M (11/1/11)
• HealthyWage implements health challenges to allow corporations to reward health and weight loss
• Health Month is a social game around improving health habits
• Keas helps employees stay healthy with their games
• LifeKraze is an online community where people encourage each other to be active offline
• Mindbloom is an online game and goal tracking system to improve quality of life
• Skinnyo.com is a weight loss community that pits members against, friends, family and colleagues in weight loss challenges

Making health social:

• Caring Bridge enables patients to create personalized sites to share their health experiences
• Crohnology is  patient-to-patient information sharing platform for crohn’s and colitis patients
• Cure Together offers treatment ratings and reviews for over 589 conditions and tools to help you track and manage your health
• PatientsLikeMe helps you find and connect with people who have similar conditions
• RealSelf is a network for sharing experiences About cosmetic surgery
• RNRounds is an online network for nurses
• SoberCircle is an online community for recovering alcoholics and addicts
• WeAre.Us is a social network dedicated to patients, family, friends, and caregivers of those coping with chronic illnesses
• WebTribes is a social networking for people facing addictions, obsessive compulsive disorder, depression, anxiety, & HIV
• What’s Going Around allows users to connect over location/symptoms to help each other identify and treat illnesses that are “Going Around”

Tools for med professionals:

• Ability Network is a secure web-based healthcare network for connecting providers and hospitals to improve patient care. Raised $27M (5/1/11)
• Assure Rx helps clinicians find the right drugs for their patients. Raised $19M (3/1/11)
• Axial Exchange‘s communication platform and clinical dashboard helps synthesize and deliver data where and when you need it. Raised $1.5M (2/11/11)
• CipherHealth helps doctors follow up with their patients
• Corepoint Healthspecializes in healthcare systems integration and optimizing healthcare operations through software, consulting and HL7 training courses
• CoverMyMeds helps physicians and pharmacists complete prior authorization and insurance coverage determination forms
• Digital Assent simplifies the gathering of patient information with the PatientPad. Raised $7.5M (6/24/11)
• Doximity is a communication platform and professional network for physicians. Raised $10.8M (3/10/11)
• Duet Health enables engaged doctor/patient communication
• Epocrates enables healthcare professionals to find answers more quickly and confidently
• Kyruus’s p3 platform enables information exchange. Raised $5.5M (5/31/11)
• MobileMD offers four dimensional health information exchange – care, service, economics, and technology – providing physicians with real-time clinical/administrative information
• Nephosity is building MobileCT, an app for doctors and patients to view and share their medical images on their iPad.
• NudgeRx focuses on post-discharge follow-up care and improving patient adherence to discharge plans
• Personalized Medicine enables docs to add a service line strategy of house calls to their existing office practice
• QuantiaMD is an online physician-to-physician learning collaborative
• RefillWizard allows prescribers to manage prescription refill requests for their practice
• Sermo is a social network for physicians. Raised $3.5M (2/11/11)
• Voalte combines voice, alarms, and text for facilitation communication between care providers

Gadgets & Sensors:

• Affectiva uses wearable sensors to monitor patient emotion. Raised $5.3M (7/11)
• AgaMatrix created the first Apple-approved blood glucose meter that connects to the iPhone in real time
• AliveCor is building a clinical-quality electrocardiogram (ECG) recorder. Raised $3M (8/11)
• BAM Labs created the Biometric Sensor for detecting heart rate, breathing rate, etc. while you’re asleep. Raised $2.4M (3/1/11)
• Basis created the Basis Band, a wearable wrist health and heart rate monitor that collects data calories burned and sleep patterns. Raised $9M (3/1/11)
• BodyMedia’s arm band collects real-time info on calorie burn & workout data
• Cognionics has developed a  non-contact sensor that enables the acquisition of clinical quality cardiac (ECG) and brain (EEG)
• ConnectedHealth develops health monitoring devices for remote health management
• Coreventis‘ adhesive skin sensor+mobile transmitter diagnose and treat cardiac arrhythmias
• Echo Therapeutics is creating a non-invasive, wireless glucose monitoring  system
• Exergen is creating Temporal Artery Thermometers
• GreenGoose uses tiny sensors and accelerometers to track everyday behavior and record it online. Raised $500K (3/11)
• HealthPal uses bluetooth and M2M cellular technology to collect and transmit health readings from medical monitors to a user’s EHR
• Huneo develops a series small wireless sensor units which collect and transmit biophysical data
• Jan Medical has developed the world’s first mobile acute stroke analysis system. Raised $3.15M (6/17/11)
• JawBone developed a motion-recording wristband
• Lark is a silent un-alarm clock and sleep sensor for your iPhone/iPad
• LENA is a digital language processor
• MC10 developed wearable, temporary tattoos that detect vitals. Raised $12.5M (6/11) and $2.5M (8/11)
• MyTrek is a wireless pulse monitor
• Proteus Biomedical developed an ingestible event marker that helps track and monitor medication adherence
• Sensimed Triggerfish‘s contact lens is a simple solution to continuously monitor fluctuations of intraocular pressure
• Sotera Wireless develops ambulatory body area network technology for comprehensive physiological monitoring. Raised $7M (7/11)
• Vitality’s GlowCaps improve medication adherence through reminders, social feedback
• Withings creates connected devices that improve health, fitness and well-being.
• Zeo developed a headband + bedside analytic tool for improving quality of sleep
• Zamzee is a movement based incentive program powered by your real world activity

Medical Imaging

• MIM Cloud allows users to connect directly to their medical images via iPhone or iPad

Please make suggestions for who is missing in the comments.

According to a Jackson and Coker report, four out of five practicing physicians use smartphones, computer tablets, and other mobile devices during the course of their workday.

These doctors are accessing a variety of medically related apps such as those that allow access to a patient’s EHR. This equates to about 80% of all doctors.

The report, Apps, Doctors, and Digital Devices, relied on research from several studies that investigated the use of smartphones, mobile computing devices such as the iPhone and iPad, and a wide variety of software apps by physicians in different specialties.

“The common thread is that physicians in all specialties–especially more recent graduates–are relying more and more on modern technology to advance their concern to provide medical care more efficiently, cost effectively, and ‘creatively’ through digital instruments that are readily available,” Edward McEachern, Jackson & Coker’s VP of marketing, told InformationWeek Healthcare. “What this indicates in terms of future trends is that mobile device manufacturers and companies that supply app solutions are well aware of the growing market in the healthcare field for their products and services.”

The various breakdowns by specialties are as follows:

• Emergency department physicians: 40%
• Cardiologists: 33%
• Urologists: 31%
• Nephrologists: 31%
• Dermatologists: 30%
• Gastroenterologists: 30%
• Psychiatrists: 28%
• Radiologists: 24%
• Rheumatologists: 22%
• Endocrinologists: 21%
• Oncologists: 20%
• Clinical pathologists: 16%

The Apps, Doctors, and Digital Devices report also noted that there are separate medical categories in both the Apple App Store as well as the Android Market. However, the imedicalapps team has previously commented on the drawbacks and limitations of both medical sections. These separate categories have been created due to the rising popularity of this niche app segment.

Furthermore, the report also discussed the increasing security concerns with accessing sensitive medical information on mobile devices. As more information becomes available via mobile devices, the report claims that the burden will be placed on physicians and healthcare providers to make sure that the manner in which they protect, access and share information is in compliance with HIPPA law.

Not only do the devices have to be secure from hackers trying to gain sensitive data, but also from computer viruses.

“With physicians and healthcare professionals eager to integrate these digital tools into their workflows, hospital administrators and information technology professionals are scrambling to make sure that the devices can integrate in a manner consistent with the security protocols to which the hospitals and practices are beholden.”

The report also mentions that in the future, mobile devices will become more pervasive in medical settings, not only as a tool to access medical information, but also as a device that will be integrated with other clinical systems to help the physician perform their tasks.

“Over the course of the examination, networked medical tools automatically record the patient’s vital signs; and at the end of the examination, the physician schedules a follow-up, schedules lab tests, enters billing codes, and prescribes medication for the patient … all within minutes from the same tablet. Most of these things are already possible, but the future of medical apps and mobile devices will integrate all of these tasks seamlessly.”

Source: InformationWeek

Recently, HealthSaaS, a champion of the Health 2.0 movement, and Happtique, Inc., a developer of mobile app stores for hospitals and other healthcare organizations, announced they were forming an alliance.

These two companies are coming together to create a custom app catalog of mobile health applications that will be used in hospital and physican practice settings.

These apps will facilitate a secure connection for patients through their mobile phones and tablet devices.  The technology will link patients to their respective healthcare organizations and even to their personal physicians via a secure network and infrastructure.

HealthSaas is a company that provides cloud based solutions for the healthcare industry.  They have been developing patient and clinician integrated solutions for over fifteen years.

HealthSaaS is currently building web-based disease and condition specific Personal Health Application (PHA) solutions including PainPHA, DiabetesPHA, and SportsmedPHA. Each PHA has its own unique attributes as every condition or disease has specific elements that need to be tracked and managed.

Happtique develops mobile app stores that are created by medical professionals for healthcare professionals. The company uses a healthcare app (hApp) indexing method designed to be intuitive to industry professionals. Happtique also offers hospitals, continuing care facilities, and physician practices the ability to create individually branded and secure substores that support employee and patient mobile technology use.

The new connected health app catalog will offer a suite of mobile apps for both patients and physicians. It will allow patients to perform remote (mobile) self-monitoring of their health.

“The HealthSaaS Connected Outcomes Framework will capture physician-requested data collected by patients on their mobile devices onto a secured, white-labeled provider portal and optionally into backend Electronic Health Record systems (EHRs). This platform-agnostic solution will bring patient data into the heart of clinical practice information flow where it can have a profound and positive impact on outcomes. HealthSaaS will provide the custom connected apps while Happtique will provide the means for healthcare providers to manage and control the deployment of the apps to their patients.”

Because healthcare organizations are trying to provide higher standards of care, the companies believe that a new paradigm can be established that is based on the sharing of information in a technology-enabling framework. In this case, it will manifest itself through the creation of the app catalog that patients and providers will both interact with.

According to the HealthSaaS website, interoperable information systems are the best way to improve patient outcomes and lowers costs.

“The HealthSaaS Connected Outcomes Framework is a portal solution which offers interoperability with many kinds of products. This framework can aggregate disparate data from many sources including mHealth applications, cloud based services, Telehealth solutions and connected medical devices. The framework removes silo barriers and makes data available to clinician practices, provider networks, payors, self funded employers and EHRs. We also offer a graphical reporting engine which will soon be linked to a robust business intelligence service which can assist in tracking outcomes and help providers meet the challenges that are ahead with performance based reimbursement models.”

Frank Ille, CEO, of HealthSaaS commented on the alliance.

“We are excited to announce this innovative alliance with Happtique because of the impact that it can make on our healthcare system. By using our HealthSaaS Connected Outcomes Framework, it is easy to pass patient collected data to any EHR system. Its use enables clinicians to be more proactive in the monitoring of treatment regimens while improving patient outcomes and lowering costs.”

Corey Ackerman, President of Happtique, also expressed his excitement.

“We are thrilled to be working with HealthSaaS to offer custom, connected mobile applications to our healthcare enterprise customers. Solutions like these represent the holy grail of health apps, and Happtique is excited to help providers manage their deployment.”

Source: Press Release

Manhatten Research, a pharmaceutical and healthcare market research and services company, recently released a detailed report stating that 56 million people in the US  have accessed their personal medical information through an  electronic health record (EHR) system maintained by their physician.

An additional 41 million people are interested in doing so.

The information was generated from Manhatten Research’s Cybercitizen Health 2011 report. This report is an annual market research study that tries to understand how U.S. consumers use the Internet, digital media, mobile devices and other technologies for health. The study is conducted every Q3.

The current study surveyed more than 8,600 U.S. adults online and on the phone.

“Growth in access of electronic health records by patients has been remarkable in the last year,” said Meredith Ressi, Manhattan Research President. “There’s been strong pent up demand from consumers over the years, but only now has the supply side caught up as a result of the government mandate. This is the beginning of a real shift in care delivery and patient engagement.”

Despite these promising results, there are still numerous Americans who do not currently access their health record online.

“Despite strong growth in EHR adoption and awareness, 140 million consumers report that they have not used and are not interested in accessing medical records from an EHR system maintained by their physician. Compared to consumers who do access their medical data on an EHR, the audience not interested in doing so is older, less educated, and significantly less likely to use the Internet or own sophisticated electronic devices such as smartphones and tablets.”

According to the website, some additional topics covered in the Cybercitizen Health 2011 report include:

• How is the health web evolving and how can marketers leverage emerging online health audiences?
• How does search and website behavior differ across the disease and treatment pathway?
• What role is digital health playing at the point of care for doctors?
• Do consumers want additional support and services from pharmacists and nurses?
• Is social media adoption for health maturing?
• To what degree are mobile devices transforming health seeking behavior?
• How advanced are consumers in terms of recording and sharing their health measurements?
• Which pain points related to digital on-going care represent the strongest opportunity for health stakeholders?

A related study from the company discovered that EHR adoption rates are increasing among physicians, and will likely accelerate as iPads and Android tablets facilitate EHR access for busy doctors on the move throughout the workday.

The Taking the Pulse Report studies how U.S. physicians use the Internet, digital media, mobile devices and other technologies for work-related purposes as well as patient interaction. The study is conducted annually in Q1, surveying more than 2,000 physicians.

Source: Press Release

In July, Epocrates released Epocrates EHR, an electronic health record system designed for smaller clinic-based practices. It goes without saying that Epocrates is an industry leader in mobile medical apps, and their successful IPO speaks to the potential their market position holds.

With Epocrates EHR, the company enters a highly competitive industry with a focus on a niche that has already proven itself interested in alternatives to the standard industry behemoths. With over a million physicians using their products, they certainly have a lot of potential.

Epocrates recently gave iMedicalApps a glimpse into their EHR and provided insight into future innovations that will soon be added. Here, we review what we saw and what we learned. Does Epocrates EHR have what it takes to extend their market dominance into the all-important industry of electronic medical records?

What We Got to See:

One of the largest selling points of the Epocrates EHR is that it was designed from the ground up by physicians, for physicians. Dr. Tom Giannulli, a small practice internist who has an impressive resume in medical technology (including being the CEO of the Caretools, who designed the first iPhone-based EMR), led the development team and personally demonstrated the functionality behind Epocrates EHR.

As the demo took place over conference call and screencast, it’s important to mention that we were not able to actually do a hands-on review of the product. However, the Epocrates team graciously allowed us to ask questions at any time and assured us that the real-life use of the product would resemble what we were shown. After the demonstration, we felt we were able to get a solid grasp of the functionality and flow of their product.

The Basics:

The rollout strategy for Epocrates EHR includes a multi-phase release schedule, with new and significant features being rolled out over the coming months. The current product is intended for smaller clinic-based practices, generally consisting of up to ten doctors.

Even in its current phase of release, the Epocrates EHR does not skimp on features. Taken from their product website, here are the current features that were demonstrated for us:

• Well-structured Patient Encounter Notes
• At-A-Glance Face Sheets for Patients
• Electronic Lab Orders
• Electronic Lab Viewing
• ePrescribing with Full Interaction Checking
• Interruption Handling with Task Manager
• Epocrates Essentials Ð Premium Version
• Epocrates Online

Pricing:

The Epocrates EHR is priced very competitively, at an Early Adopter price of $179/month per clinician (Physician, PA, or NP’s). After March 31, 2012, the pricing will increase to standard rates at $359/month/clinician. It’s worth noting that this pricing does NOT include Epocrates PM, powered by Nuesoft, which is the accompanying software that addresses practice management, including patient registration/scheduling, medical billing, etc. Epocrates PM will cost $200/month/clinician.

Web-Based Client: Pros and Cons

At its core, the Epocrates EHR is a web-based, SaaS (Software as a Service) system. In this sense, it resembles other Web 2.0 services like Gmail that run inside a web browser. This brings many notable advantages, including the fact that having expensive hardware becomes less of an issue. The service should run effectively on any Mac or PC running a recent web browser like Safari, Internet Explorer, Chrome, or Firefox. This also makes initial setup much easier as there is no hardware or software that needs to be installed or configured in the office.

Also, another advantage of being web-based is that data is heavily encrypted and backed up in the cloud. Since patient data will not be stored directly on site in your office, leaving patient files unencrypted won’t be a concern. Also, the data will be backed up in multiple Epocrates-maintained data centers throughout the country, so patient records will not be susceptible to disasters, like flooding, theft, or fires. Lastly, as a result of being based in the cloud, the Epocrates EHR is accessible from any computer, including computers at home, or laptops brought from home. This allows for the easy addition of new workstations to the office or the reviewing of files from home.

Being web-based does not come without disadvantages, however. Most concerning is the fact that the Epocrates EHR requires a steady internet connection to run. While I have full confidence in the stability of the internet service on the end of Epocrates with a full-time staff of internet technicians, I am less confident in a 100% steady uptime of a local clinic’s internet connection. If the internet connection service is not completely reliable, then the Epocrates EHR could be frustrating. An iPad app is currently in development that will not require a seamless internet connection, but it is still a work in progress.

The User Interface: Clean, Simple, and Effective

At iMedicalApps, the importance of User Interface (UI) design cannot be stressed enough. User Interface is key to the overall experience and workflow of any medical software, and this is where many products really frustrate and alienate clinicians and staff. Thankfully, the approach taken by the Epocrates development team hits the sweet spot combining simplicity, intuitiveness, and complex functionality. Functioning as a web app already provides a healthy dose of simplicity, and it avoids the archaic interfaces of older, legacy Windows-based software. I also appreciated the inclusion of a simple horizontal navigation bar at the top of the screen, and the omission of a persistent left column vertical navigation bar, which is found in some competitors. For one, this simplifies navigation and prevents the need for complex sequences of clicks to access certain menus. This also allows the primary screen area to span the entire horizontal width of the screen, which is especially helpful for smaller monitors and lower-resolution screens often found in clinics.

Particularly helpful is the initial home screen (pictured above), which intuitively lays out the clinic schedule on the left and the list of to-do’s (such as med refill requests and lab reviews) on the right. The development team went out of their way to streamline the workflow and prevent “alert fatigue,” which often occurs with competing products when users have so many warnings and dialog boxes to click through that they begin to ignore their contents. Such attention to detail goes a long way in improving the overall user experience.

Creating Patient Encounter Notes: Straightforward and Effective

Along with User Interface, the creation and viewing of patient encounter notes holds special significance to medial staff as it directly effects the bulk of their practice. Along with free text input, there are 3 tools provided to assist in automating note creation, two of which are in development and not yet available.

The current automation method utilizes the use of customized templates that focus around problems highlighted in the problem list (pictured above). For example, if the patient presents with a cough, navigating a series of pop-up menus and checkboxes directly relevant to cough are easily accessible and will highlight pertinent positives and negatives in the patient note. We were particularly fond of the final versions of the notes that were generated with these templates. In my experience, using templates often creates wordy sentences that are difficult to quickly navigate at a glance. Epocrates EHR avoids this by simplifying the final note with short phrases such as: “(+) fever, (-) chills.”

Future updates to the program plan on integrating voice-to-text transcription using the Nuance Speech Recognition engine. We were not able to see these features, and look forward to their release.

Electronic Labs and ePrescribing: The Epocrates Advantage

The Epocrates Mobile App is most widely used for its medication prescribing database and guidelines, and this database is seamlessly integrated into the ePrescribe workflow. When the physician enters the electronic medication prescriptions, the corresponding Epocrates drug information is displayed on a small window pane along the right edge of the screen. Wielding this trusted database in this manner is a major advantage to this service.
Likewise, the Epocrates EHR allows for the simple entry and retrieval of patient labs. Arrangements have already been made with major medical diagnostic laboratories, including Quest Diagnostics and LabCorp, allowing for automatic viewing of patient lab results.

Coming Soon: iPhone/iPad Apps, Speech Recognition, etc

As mentioned earlier in the app, the Epocrates team is committed to upgrading and enhancing their EHR service. Soonest to arrive is a mobile app for the iPhone that is planned for release over the next several weeks. This app would be a simplified interface for the EHR service that is more focused on the basic tasks for the physician, such as viewing schedules, viewing patient charts, writing prescriptions. For more thorough chart dissection or encounter note modification, clinicians should be able to access their EHR from any web-connected computer, as the data is stored on Epocrates’ own remote servers.

Another significant feature is planned with the arrival of the iPad app, which would allow the clinician to access all of the complex features of the service right from their iPad. This would allow for clinicians to carry out the encounter simply from their iPad, and holds a lot of promise for drastically simplifying the work flow and allowing for more face-to-face interaction with the patient. Also, the development team told us that the iPad app would allow for some off-line syncing of data, and would be able to accommodate small interruptions in internet connectivity.
The last important feature in development that the Epocrates team was able to share with us was the inclusion of Nuance’s Speech Recognition software when creating patient notes. Although we were not able to test out the real-life practicality of this service, the Nuance-powered experience should resemble the industry-leading products that Nuance provides.

Room for Improvement:

Without being able to use the demo first-hand, we cannot speak to any specific bugs or troublesome issues that might arise with regular use. However, as mentioned earlier, Epocrates EHR is a web-based service and the fact that local interruptions in internet connectivity could significantly disrupt the service is troublesome. Thankfully, the iPad client that is currently in development should solve this issue, as it will allow for off-line access and saving of data.
Also, as a resident physician, I have a soft spot for medical education and I think the current pricing scheme makes it difficult for adoption by medical residencies. My current medicine residency program’s outpatient clinic is a fairly small practice staffed by about 7 attending physicians, but there are approximately 35 residents who would be considered as “paid users” or “clinicians.” While I understand that Epocrates is taking a gradual, deliberate approach into the market, educational discount pricing would be helpful.

Conclusion: A Worthy Competitor

Epocrates wisely selected their target audience for their first entry into the competitive arena of EMR/EHR’s by focusing on smaller outpatient clinics based around less than 10 physicians. For a small owner of a group practice, there is an dizzying number of competing products advertising similar features and few distinctions. Epocrates, via their prominence in the medical app field, provides a welcome and trusted name, especially to the more tech-savvy physicians. With Epocrates EHR, physicians have a solid and rapidly developing groundwork that utilizes the strengths of Epocrates (eg. including drug prescribing information on the prescription entry screen). And with their successful funding and market-leading mobile app, Epocrates has the financial support and resources to continue innovating and upgrading their services.

There is reasonable cause for concern with the fact that Epocrates EHR is a newcomer with some features still in development, and is a web-based app relying on a steady connection to the Internet. However, it is this same focus on new and upcoming technology that makes Epocrates EHR a promising service and differentiates it from its more “old-fashioned” competitors. If I were choosing a new EHR to start a practice with, I would highly consider the Epocrates EHR.

Verizon’s Universal Indentify Service (UIS) for healthcare recently received an upgrade, allowing for secure access to electronic health records and health information exchanges on smartphones running Apple OS, Android, Windows Mobile and Blackberry.

A health information exchange (HIE) securely automates the transfer of health-related information stored in multiple organizations, while maintaining the integrity of the data. An HIE also provides access to and retrieval of patient information to authorized users.  In fact, in some states, organizations have been created that provide technology, governance and support for HIE initiatives.

This news is great for providers who want to be able to securely access patient information from their smartphones.  Since security is of such high importance, access to the information is only provided with correct medical credentials.

“What the managed service does at the highest level is ID proofing, proofing that you are who you say you are, Tracy Hulver, director of products and marketing for Verizon’s Identity Solutions group, told eWEEK. Doctors can use Verizon’s security credentials to access e-prescribing applications and authenticate their identity using Apple iOS, Android, BlackBerry and Windows Mobile devices.”

Verizon didn’t stop there, adding new features in the UIS such as digital signatures for treatment plans, discharge orders, and electronic laboratory reports.

“In addition, Verizon has added an ID Message Center to allow physician practices to sign documents digitally and log in securely to EHRs and HIEs using a mobile application or Web portal. Through Message Center, doctors can see which user actions are pending, accepted, rejected or expired.”

These enhancements provide a compelling service to organizations looking for a cloud-based authenication service.

Cloud-based authentication systems can save costs for a health care practice, compared with housing authentication hardware, according to Hulver. Health care practices can also reduce the costs of identity theft by using the service, according to Verizon.

For further reading please check out eWeek.

Practice Fusion is a free, web-based electronic health record that has seen a rapid rate of adoption over the last two years and, as we reported recently, is currently the largest commercial EHR installation after Kaiser and the Veterans Affairs.

But like all “overnight successes”, the rise of Practice Fusion is not accidental and not without laborious engineering. In fact, important design decisions at its inception have been instrumental in its growth, allowing for rapid iteration of features without incurring heavy development and deployment costs. Matthew Douglass, currently the VP of Product Development, has been through almost the entire history of the company. He was the second person to join the company and continues to lead the engineering process.

In this interview we learn some of the fascinating story of Practice Fusion’s rise, its plans to expand its API (application programming interface) and launch an app store.

We envision that doctors could prescribe an app much like they prescribe a medicine now. – Matthew Douglass

How did you get involved in Practice Fusion?

At the time I was approached by [now CEO] Ryan Howard in 2007, I was working in energy and finance. But, even then, I wanted to do something besides, as I said, “turning millionaires into billionaires”. Ryan had started in 2005 and had just bought a one site EHR that was developed by a family practitioner. I was charged with making it multi-tenant and web-based. Multi-tenant means having all the data stored in a single database, instead of separate for each user. Back then, we worked in coffee shops, communicating electronically. I worked hard for six weeks, including one non-stop 72 hour stretch just before we launched, which has become urban legend around here. Three months later, we went on to the web. That was the beginning of 2008.

How did Practice Fusion initially grow?

We initially charged $50 per month per doctor. Then we decreased it to just $50 for support and training. By the time we went to the web, we were free. This led to rapid growth. We started rapidly signing up physicians. Our very first web user, by chance, was also in San Francisco. With the passage of HITECH act in Feb 2009 [which provided financial incentives for physicians adopting EHRs], we started to get interest from investors. The first were a large Bay Area angel group called the Band of Angels. Later Mark Benioff [CEO of Salesforce] invested. We recently completed a series A round from a venture capital firm [7.2m, 11/24/09, Morgenthaler Ventures]. We don’t do direct sales, meaning door-to-door. Most of our customers find us online. The majority of our users are in California, New York, Florida and Texas.

How did you settle on free as the price?

We found that primary care practices were quite price sensitive, as their real income had stagnated for more than 20 years. We decreased our price until we got to free. We are committed to keeping it free. We feel there are enough other participants in the health care IT ecosystem who can subsidize the EHR, such as device makers, labs, billers, pharmacies, etc. Doctors should not have to pay.

How about advertising revenue?

Ads are a large part of our revenue.

Talk about your implementation

The original EHR was written by a physician, Robert Rowley, who is now the Chief Medical Officer. Our multi-tenant database, where all patients around the country are stored in a single database, has allowed us to scale smoothly by allowing us to release new versions of the software while keeping everybody on the same version. Our architecture also allowed us to easily add a patient portal [Patient Fusion]. Initially we were adding 5-6/day users a week, now we are adding as much as 350 users or about 40-50 practices per day. We have surpassed 60,000 registered users. Just two months ago we were adding 250/users a day, so the rate of growth is accelerating quickly, and we feel that with HITECH incentives in 2011, this may push it higher. We are planning for even greater acceleration.

How many engineers do you have at Practice Fusion ?

We have a total of 53 employees, 17 are engineers and we are hiring 6 more, thanks to the stimulus.

What are your continuing challenges?

A lot of what we do is integration, tying together other systems and suppliers. This does not always show up as an explicit feature. For example, seeing a Labcorp result requires getting a file, parsing it, displaying and storing it. And every single lab is different. e-Prescription integration, such as with Surescripts, and determining formulary eligibility can be very complicated behind the scenes. But because our system is multi-tenant and web-based, we just have to do it one time and all our customers get the update simultaneously.

Tell us about the Practice Fusion Developer Challenge

Last spring, Matthew Holt and Indu [Subaiya, of the Health 2.0 Conference] approached us about posting a Developer Challenge at the Health 2.0 meeting in July. We decided within a week, and launched within 3 weeks. [The Health 2.0 Developer Challenge is supported by HHS but run by Health 2.0]

For our Developer Challenge, we discussed it and decided to go with a limited API emphasizing ways to get real time data into Practice Fusion. We felt that getting the physician real-time measurements [e.g. blood pressure, etc] could be really valuable – instead of requiring the physician or practice to enter all the clinical information. We were very surprised when 35 developers submitted projects, more than any other challenge.

Of the 35 submissions, 25 had to do with medical devices and data transfer. This tells us that there is a market for this connectivity. The winner [Team Critical Systems] was a great example of hacking – a simple bathroom scale was hacked to read the LCD display and the result is transferred directly into Practice Fusion.

Any surprises among the submissions ?

I was surprised that 10 of the submissions did not even submit their own data, but rather co-opted the API to present unstructured data, for example turning a patient intake form into a rudimentary data entry API, e.g. patient submitted “mood” data. This [type of observation] will drive our API strategy. Other types of structured data we had not anticipated such as reporting diagnoses or clinical workflow.

How did you decide on your Challenge ?

There are a lot of medical device manufacturers which already transfer measurements to their own servers. However, this data is isolated. It does not take too much work for them to use an API to transfer this data to patients’ records and allow clinical decisions to be made from this information. This is what could be revolutionary. We already have a dozen companies lined up to work on our API

What future directions are you anticipating for your API ?

We are planning on extending the API enough to allow a limited interface. The first will be scheduling, problem list and medication manager. As with everything else, we will listen to the market. Extending the API has to be carefully done not to disturb published APIs. Developing an API does take away resources from other efforts, but we feel it is important.

What are your mobile plans ?

We will shortly have a Practice Fusion interface which will work on smartphones. It will have limited functionality, giving you the ability to view patients and the schedule. The extension of the API will probably have the same capabilities. We will be bringing our mobile interface, including iOS, Android, and RIM, hopefully in first half of 2011. This will work across all mobile devices with web enabled browsers. We are planning on native apps, depending on marketplace.

The Practice Fusion app store

The biggest enhancement will be a Practice Fusion app store. This is not yet announced although I have a rough date. The idea is that the doctor will have access to all the application within the Practice Fuson network . The app store concept is a way to unify the apps, downloading may occur elsewhere. We put the application as something the doctor can prescribe. The instructions to download the application may be sent to the patient via email.

This is a way for making applications work for you. The buyer could be the doctor, patient, payor, etc. It will be a place where developers can showcase their apps. The apps will be attached to a user’s account but could also be used on other devices, such as a communicating smartphone app.

We envision that doctors could prescribe an app much like they prescribe a medicine now. Right now all a doctor can do is write an order [CPOE] or hand out a pamphlet. But, there are a lot of things in between appointments where a patient can report back to the doctor – maybe compliance with a medication or nutrition plan. A weight monitoring app for a patient trying to lose weight can directly enter weights into their record. Simple alerts can signal patient compliance, or can even provide feedback to the patient herself.

Yesterday, the folks at Practice Fusion announced they had passed an impressive milestone. There are now 5 million patients, or 2% of the US population, that are being served by physicians using this rapidly expanding EHR.

Just three years after our free, web-based EMR’s official launch, we now serve 50,000 medical professionals and 5 million patients. Practice Fusion’s growth has accelerated so that we add more than half a million patients to the system each month. We now serve almost 2 percent of the US population, making us the third largest EHR community behind the VA and Kaiser.

We had previously reported on an alliance between Dell and Practice Fusion to offer hardware bundles to physicians adopting Practice Fusion. While this milestone does not immediately impact mobile medical apps, the growing Practice Fusion community will surely be looking for ways to access their patients’ records on the go. In October, Practice Fusion launched their “API Challenge”, to open up the data in Practice Fusion to other devices and software applications. The publishing of this API will launch a new phase in the company’s explosive growth and undoubtedly mobile solutions will be among the first crop to be launched. We are excited to see what comes next.