74 percent of physicians believe communication improves when patients set the agenda

What happens when patients set the agenda for their appointments by entering information in the EHR? Pretty much everybody’s happier.

Republicans are stuck on healthcare but they have no choice but to persevere

Republican health analysts said party officials had little choice but to keep trying to reach consensus — or at least enough consensus to pass a bill out of the House.

VA uses predictive analytics to prevent suicides, contemplates scrapping VistA EHR

While striving to decrease veteran suicide rates, the Department of Veterans Affairs is considering getting rid of its VistA EHR system.

U of Miami Health System, Syapse join forces for cancer care

Precision medicine.

The phrase doesn’t fall on unfamiliar ears in the healthcare world. But now it’s getting an extra bit of attention with the launch of a new partnership.

Sylvester Comprehensive Cancer Center, which is part of the University of Miami Health System, and Syapse, a Palo Alto, California-based software company, have teamed up to create a precision medicine initiative specifically focused on cancer care.

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Physicians at Sylvester will be able to use Syapse’s platform to give patients more personalized care based on their clinical and molecular information.

“We bring all the data together for the physicians so they can understand what’s going on with the patient,” Jonathan Hirsch, president and founder of Syapse, told MedCity in a phone interview. “We have a decision support framework and a quality improvement framework so we can track the patient’s outcomes.”

With all the buzz surrounding precision medicine, now seemed like a better time than ever to launch the partnership.

Dr. Jonathan Trent, associate director of clinical research at Sylvester and professor of medicine at the University of Miami Miller School of Medicine, expressed a similar sentiment. “Matching a cancer patient with a certain treatment based on the cancer’s molecular profile is among the most promising treatment options in this age of personalized medicine,” he said in a statement.

Hirsch also pointed to a number of trends that are impacting the growth of precision medicine. For one, today’s science and medicine and advanced enough to target treatment more specifically.

Additionally, although the physicians are recognizing the effectiveness of precision medicine technology, they don’t always have the correct training to use it.

Patients are also taking note of precision medicine. “Patients are becoming increasingly aware, especially in cancer, of the different options that are out there,” Hirsch said. “They’re becoming very educated and are going to shop for care.”

A final cause of the momentum stems from a value-based care perspective. “A lot of health systems are looking to gain control over the most complex specialty areas,” Hirsch said. “They’re getting more sophisticated about care that necessitates a precision medicine approach.”

Moving forward, Hirsch said the partnership success will be based on cost containment, patients living longer with a higher quality of life and ensuring all patients are receiving the same level of care regardless of their location.

In early 2016, Syapse raised $25 million in Series C funding. It has partnerships with other organizations such as Intermountain Healthcare and Cancer Treatment Centers of America.

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How are hospitals using mobile devices for care?

Smartphones and tablets are commonplace in society today. But how common are they in healthcare settings?

A new survey from HIMSS Analytics, called the “2017 Essentials Brief: Mobile Study,” highlights the use of mobile technology in hospitals across the United States.

Respondents participated in the online survey from February 9 to February 15, 2017. Approximately 129 C-suite leaders, clinicians, department heads and IT professionals participated. Forty-four percent of respondents came from standalone hospitals. Another 29 percent came from multi-hospital health systems and 25 percent were from integrated delivery networks.

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As far as organization size, 33 percent of respondents were from organizations that have less than 50 beds. Twenty percent were from organizations with between 101 and 250 beds. Only 17 percent were from organizations with 501 or more beds.

The results of the survey show 79.8 percent of respondents said they use tablets to coordinate and provide patient care, and 42.6 percent said they use smartphones to do so. Despite these findings, desktop computers still take the lead for the most commonly used devices. Approximately 94.6 percent of respondents said they use desktops, and 37.2 percent said they use laptops to support care.

HIMSS Analytics Director of Research Brendan FitzGerald said he wasn’t shocked by the survey results. “I wasn’t necessarily surprised, primarily because when you look at mobile technology, it’s not widely used in the hospital setting,” he told MedCity via phone.

Among respondents who use smartphones and tablets, 76.5 percent indicated they use them to access clinical information. Approximately 70.6 percent said mobile devices are used to access EHRs and 66.2 percent said they’re used to access nonclinical information such as educational resources. Nearly half — 48.5 percent — said they use mobile devices for systemwide communication.

While healthcare organizations appear to be putting mobile devices to use in a variety of ways, there are still a number of hurdles to widespread adoption. One such barrier is security.

“There’s been such a runup of adoption that advanced security was kind of an afterthought,” FitzGerald said. “People had the normal safeguards in place, but hacking has become more sophisticated, and healthcare hasn’t kept up as much as other industries.” And mobile devices are that much harder to oversee. It’s much easier for providers lose mobile devices, thereby more easily giving unauthorized access to someone.

Looking ahead, FitzGerald noted that many people are worried that technology adoption in the healthcare world may slow down. But in his opinion, that’s not the case. “The horse is out of the barn,” he said. “Organizations aren’t going to go back and say they were better with a paper-based system. It’s here to stay.”

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Researchers created a menstrual cycle on a chip, paving the way for innovative cancer research

Researchers from Northwestern produced EVATAR, a modular system designed to replicate hormone signaling in the human menstrual cycle. Photo: Northwestern University Feinberg School of Medicine

Researchers have been looking for better ways to study human biology. Cells in a dish don’t capture the body’s complexity and generally don’t live that long. Recent advances in 3D organoids often fall short on their own. But now, researchers at Northwestern University Feinberg School of Medicine have developed a modular system that incorporates all the necessary organ types to replicate hormone signaling in the human menstrual cycle.

Called EVATAR (a combo of avatar and Eve), the system’s various modules contribute 3D models of human fallopian tube, uterus, cervix, liver and mouse ovary tissue. Microfluidics transfer a universal medium that acts like blood and carries hormonal and other signals between tissues. This communal approach produces a better model.

“They were sharing all this media and releasing factors that were propagating each other,” said Julie Kim, research professor and co-author on the team’s Nature Communications paper in a phone interview. “They survived better and responded to hormones better – more so than if they were alone in a static environment. These different cultures together in this microfluidic platform are able to survive for a whole menstrual cycle, 28 days, which is a long time for cells to grow in culture.”

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The effort pulled in experts on each tissue type – Kim’s lab focused on the uterus. Draper laboratory helped engineer the various connected boxes. Because we don’t take out healthy human ovaries, researchers used mouse ovaries, but even that was a win.

“The mouse estrus cycle is only four days long,” said Kim. “But by putting it in a dish and stimulating with hormones, like FSH and LH, we got 14 days of estrogen and 14 days of progesterone.”

The research led to a lot of firsts, such as new 3D models for uterus and cervix, but it’s the applications that are generating the team’s excitement. EVATAR could enhance their ability to study many conditions, such as fibroids, endometriosis and endometrial cancer.

“If we could study tumors long-term in a microfluidic system, then we could see how tumors respond to progestin and see if we can use these types of platforms as mini clinical trials for compounds that can affect these diseases,” said Kim.

The project was spawned by NIH efforts to create a “body-on-a-chip.” The agency solicited proposals for a variety of tissues – cardiovascular, kidney, bowel – though, according to Kim, reproductive tissue was notably absent. The Northwestern team took that as a source of motivation.

Teresa Woodruff (director of the Women’s Health Research Institute and senior author on the paper) said we need a reproductive tract,” said Kim.

Their work is part of a major push to find better models to study human biology, test drugs for safety and efficacy and ultimately personalize care. Companies like Hµrel, Ascendence Bio and Tissuse have developed organs on chips. Others, like Organovo and BioBots, are creating or enabling 3D tissue printing.

Still, there’s lots more to do. The Northwestern group will be working on a male counterpart to EVATAR and there are other tissues that could improve their female model.

“We have only a couple of cell types in the endometrium,” says Kim. “There are more types that play an important role. If we put in blood vessels, immune cells and other cell types, we could see the tissue differentiate and eventually bleed.”

How 16 insurance policies stack up for substance use disorder benefits

Unfortunately, a chasm has separated primary care and behavioral health for many years in the U.S. This division is being repaired as the healthcare field recognizes the importance of behavioral health.

Dr. Itai Danovitch, chairman and associate professor of Cedars-Sinai Medical Center’s department of psychiatry and behavioral neurosciences, agrees.

“It’s now broadly recognized that in order for people to have good health outcomes, it’s not sufficient to pay attention to medical health,” he told MedCity in a phone interview. “You have to also address their mental health, which includes substance abuse.”

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Indeed, substance abuse is a crucial part of healthcare coverage today. But depending on your health insurer’s offerings, your benefits may strongly differ.

A recently published study by Dr. Danovitch and Dr. David Kan, assistant clinical professor at the University of California at San Francisco’s department of psychiatry, analyzes these differences. Titled The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement, the study was published in the Journal of Psychoactive Drugs.

The study is based on a previous project headed up by Dr. Danovitch and Dr. Kan: the Consumer Guide and Scorecard. In 2014, the California Society of Addiction Medicine created an assessment framework (based on criteria from the American Society of Addiction Medicine) for rating the quality of substance use disorder treatment benefits offered by 10 insurers on California’s marketplace, Covered California. A panel of physicians then rated the 16 bronze-level plans across seven total categories, such as pharmacy benefits and outpatient benefits.

The result is the Consumer Scorecard, which clearly shows how the policies stacked up overall and in each category.

“The plans themselves had a fair amount of heterogeneity,” Dr. Danovitch said. A few specific plans tended to perform well across all seven categories, while another set of plans tended to perform poorly across all the categories, he noted.

However, Dr. Danovitch also pointed out a few caveats. “One is that the question of what’s in insurance plans is a moving target because it changes every year,” he said. “It’s certainly changed by now.”

Another is evaluating the difference between “what insurers said they offered and what they actually offered,” Dr. Danovitch said. “We did contact insurers to help sort out areas where there was a lack of clarity, but we didn’t get much of a response.”

In 2015, 20.8 million Americans met the criteria for a substance use disorder. But less than 11 percent of them receive treatment, according to the Substance Abuse and Mental Health Services Administration. “[Substance use disorders] are treatable, yet most people don’t get treatment or don’t get treatment that’s adequate,” Dr. Danovitch said.

Substance use disorders are clearly a problem. But then why don’t insurers cover everything they should? Dr. Danovitch says it’s because the population isn’t speaking up about it. “Insurers need to cover this, but they won’t until everybody expects it,” he said. “The population has to develop expectations about what their entitlements are in order to hold insurers accountable.”

Photo: ANDRZEJ WOJCICKI, Getty Images

Anti-aging tech trends you need to know about

As technology continues to evolve, humans have more and more tools at their disposal to hold off the hands of time. Anyone wanting to look — or feel — more youthful has any number of resources available to explore.

But anti-aging isn’t just about looking younger and more attractive: It’s about returning a higher quality of life to people who suffer from age-related chronic health conditions.

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Unsurprisingly, the costs of treating these conditions continue to skyrocket. For instance, private nursing homes can cost close to $100,000 every year. And because Medicare doesn’t cover long-term visits, so many people across the nation have to spend down their assets to qualify for Medicaid.

With that in mind, the most important aspect of anti-aging research is helping to lower exorbitant healthcare costs for age-related health issues. As it stands, technology may be the best way to achieve that goal.

Factors contributing to the anti-aging revolution

To nobody’s shock, technological advances play a prominent role in the ever-evolving capabilities possessed by anti-aging. But where is the bulk of that support being seen?

Scientific innovation has the potential to provide two key components for advancing anti-aging research. The first is the simulation model system, which allows you to precast and adjust different scenarios to save time. It also enables you to input different factors in your research to forecast for different outcomes.

The second key is the cloud system and how we computerize all the data that we collect. The system’s design is currently insufficient for data collection for the aging population.

But once we standardize the system more, the technology could provide large, reliable data sources to help us make the best choices in anti-aging research and treatment options. Reliable data and prognostications can establish more widely accepted treatments that benefit a wider net of patients.

Technological advances have already changed much of the world, and anti-aging research is no exception. As the science’s capabilities continue to grow, medical professionals are finding more chances to drill down to specific symptoms, ailments, and concerns not traditionally addressed by anti-aging.

Here is a pair of important technological trends that can specifically boost anti-aging research:

Rejuvenation of organ capacity

Organs like the heart, lungs, and kidneys carry a reserve of energy that allows them to function beyond their typical demands. As we age, however, our organs lose their vitality and must work harder. For instance, a 20-year-old’s heart moves 10 times the amount of blood a body needs, though 1 percent of that amount is lost each year after a person turns 30. Many chronic illnesses are influenced by this dysfunctional or decreasing organ capacity, and one of the biggest trends relates to the physical rejuvenation of aging-related organ degeneration.

By focusing on rejuvenation, the anti-aging industry can provide more solutions to eliminate these chronic illnesses, rather than just reducing symptoms. It will truly revolutionize the way we look at chronic illnesses, as well as alleviate the economic burden placed on the government and the healthcare industry.

Pathology of neurodegeneration

Every year, the National Institutes of Health spend nearly $480 million researching Alzheimer’s disease. The most significant challenge to comprehending such aging-related neurodegenerative diseases is their causes, so a pathological map would be valuable in understanding those causes and designing solutions.

Technology related to this area could open a new field of market focus, appeasing society and allowing it to live without concerns about dementia. It would also conclude the work of thousands of scientists and researchers who have been studying neurodegenerative disorders for decades.

Rejuvenating organ tissues and gaining a better understanding of neurodegeneration are only two of the upcoming trends poised to change healthcare in 2017 and beyond. But they’re among the most important trends to monitor, especially for patients dealing with age-related conditions.

Those cases — along with their families and the healthcare system — are increasingly feeling the burden of chronic aging-related diseases. Let technology lighten that load.

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65 percent of healthcare organizations have documented mobile strategy

The rise of technology in healthcare is causing many organizations to implement a mobile strategy.

This finding comes from part one of a two-part Spok report. Titled “The Evolution of Mobile Strategies in Healthcare,” part one highlights a number of key points in Spok’s annual survey. The survey results include responses from more than 300 U.S. healthcare professionals, which were gathered in February 2017. Thirty-five percent of respondents held various hospital roles such as quality directors, risk managers, infection prevention specialists and mobility engineers. Another 22 percent of respondents were physicians, 13 percent were nurses, 10 percent were IT staff members and 7 percent were executive leaders.

All the respondents answered questions about their organization’s mobile strategy — though their responses regarding the definition of “mobile strategy” varied across the board. For simplicity’s sake, Spok defined a mobile strategy as something that “brings together elements of security, technology and communications in a collective plan to improve staff productivity and enhance patient care.”

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The survey results show 65 percent of the organizations have a documented mobile strategy in place. This number has been steadily increasing through the years. In Spok’s similar 2014 survey, only 44 percent of organizations had a mobile strategy. In its 2012 survey, even fewer organizations (34 percent) had a mobile strategy.

Of the 65 percent that currently possess a mobile strategy, 21 percent have had it for less than one year. Forty percent have had a documented mobile strategy for between one and three years, and 14 percent have had it for between three and five years. The remaining 25 percent of respondents said their organization has had a mobile strategy for more than five years.

Among the organizations that have had a mobile strategy in place for more than a year, many have updated their strategy since its initial creation. According to respondents, the update stemmed from reasons such as the changing needs of end users, the availability of new mobile devices, new capabilities from their EHR vendor and alterations to strategy goals. Twenty-three percent of respondents said they were unsure of any updates to the strategy, and 7 percent said their organization has not updated its strategy.

But the implementation of a mobile strategy isn’t the only important factor.

Are the implemented strategies being reviewed and assessed? Not really. Only 32 percent of respondents said their organization has a formal review process for evaluating the success of projects such as mobile enablement. The remaining 68 percent said their organization does not have a formal review process.

While the number of organizations with a documented mobile strategy has been increasing since 2012, organizations should take a closer look at how to evaluate and improve their mobile strategies after implementation.

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UHC, Henry Ford, HonorHealth deploy Xenex robots to reduce HAIs

Clostridium difficile bacteria, TEM

Healthcare-associated infections are an undeniable risk to patient safety. According to the CDC, approximately one in every 25 hospital patients has an HAI on any given day. In 2011, approximately 75,000 patients with HAIs died while hospitalized.

The prevalence of HAIs caused by pathogens like Clostridium difficile (or C. diff) and Staphylococcus aureus (or MRSA) is only growing. To combat such risk, hospitals and health systems are taking active steps to improve disinfection and thereby reduce infection rates.

United Hospital Center in Bridgeport, West Virginia, is one such system. It took its first step in 2010, when, upon building a new replacement hospital, it deployed a mercury UV technology disinfectant system. “I wanted to deploy this UV technology and try to keep the bioburden as low as possible,” Mark Povroznik, UHC’s vice president of quality and chief quality officer, said in a phone interview with MedCity. “We started with mercury devices.” UHC was among the first hospitals on the East Coast to use such technology, Povroznik said.

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But this past February, UHC changed its tune. “It was a good time to change from old technology to state of the art technology,” Povroznik said. “Xenex had some significant attributes, which made us change out all our systems.”

Numerous factors influenced UHC’s decision. For one, the Xenex LightStrike Germ-Zapping Robots are faster and higher-intensity than the mercury devices. Povroznik noted UHC also finds the Xenex robots easier to move from room to room. Additionally, the Xenex robots don’t need to heat up, while the mercury devices did.

The heated mercury also caused a certain odor to permeate rooms after disinfection. “While you’re doing something nice for patients, you find yourself explaining what the smell is,” Povroznik said. “You had to let the room air out before you brought a patient in.” But with the Xenex robots, that isn’t the case. There’s no odor to be detected, and as Povroznik said, the rooms smell like “an ocean breeze.”

UHC isn’t the only hospital to use Xenex LightStrike Germ-Zapping Robots. Detroit, Michigan-based Henry Ford Health System and Scottsdale, Arizona-based HonorHealth recently became the first hospitals in the country to implement Xenex’s robots in all their hospitals.

Data backs up the effectiveness of UV technology for hospital disinfection. A 2015 study in the American Journal of Infection Control found using pulsed xenon UV light for disinfection caused a 70 percent decrease in ICU C. diff infection rates.

In 2010, Povroznik said, using UV for disinfection was novel. But now, things have changed. “It’s no longer a pioneer step for hospitals to deploy UV technology,” he said.

Is UV technology the future of hospital disinfection? Perhaps. If so, it’ll be key to reducing the one in 25 hospital patients that have an HAI.

Photo: DR KARI LOUNATMAA, Getty Images