In its current state, the healthcare industry can be best described as a combination of valuable care, overuse of some costly interventions with little proven benefit, and underuse of some vitally important therapies. The care provided in a broad sense is fragmented and has a lot of scope for being better coordinated. An ideal healthcare setting should be removed from the extremes of either a single-payer system or an unfettered marketplace - with the former having failed already and the latter highly unlikely to go the long distance. Unless strongly regulated, the private insurers are bound to have an inclination towards shedding the enrollees which cost them dear in order to avoid making a dent on their profitability. Without social insurance of some shape the interests of patients are not likely to be protected by private insurance companies for the obvious reasons that they are business entities first. Besides the point mentioned above an optimal insurance structure also needs to be a deviant from a typical high-deductible plan. It has to be one which subsidizes high-value care while imposing a greater cost sharing on care of lower value. The later step would ensure that patients do not indulge in availing treatment which is not necessary or ones with limited benefits. Infact, providing people with the flexibility to decide from a host of variants seems be the best way to cater to their actual needs.
Moving forward, health reforms will have a need to focus on increasing the value that people can draw from health insurance and health care, instead of depending upon self-financing expansions of coverage. Thus, the concept of pay for performance is gaining steam as an emerging movement in health insurance. In this arrangement, Providers are rewarded for meeting pre-established targets for delivery of healthcare services. Hence physicians, hospitals, medical groups, and other healthcare providers are all required to meet certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care, which could be medical errors, or increased costs also get included as part of the deal.
A research done recently on profitability of hospitals in US came up with some very interesting data. Incidentally, the hospitals with high performance scores in patient care seemed to be the most profitable. This can serve as a very encouraging factor for providers who are skeptic about the new model. Effectively, the survey was a proof of the fact if patient experience (which has a direct link to the quality & and efficiency of care provided) is positive; there is a high possibility of financial profitability for the corresponding institutions. Thus the core of the model has to lay emphasis on providing the best of care to patients. In addition to it, there has to be strong focus on scoring high on publicly reported clinical measures. With these 2 factors taken care of, financial success becomes an automatic spin-off.
Agreeing to the fact that a value-based model shows a lot of promise and is worth investing in is one thing. But to assume that such a model would automatically ensure a higher quality of healthcare delivery would not be appropriate. Overall any new model to succeed, a couple of deliverables need to be ensured - extension of insurance protections to those who lack them and a constant improvement in the manner in which care is offered to those who are already insured. Thus, in order to successfully implement this new idea some major changes to certain otherwise archaic approaches and methods need to be made. For e.g. insurance coverage needs to be extended so as to allow more people to benefit from the protections that insurance affords and ensure that those protections are secure for those who fall ill. And, last but not the least, there is a need for people at the core of the establishments i.e. Physicians, nurses, hospitalists to bring in a few changes in the manner in which they go about performing their activities. They will need to ask the patients, which they presently do not do adequately, about their expectations. To attempt to serve them without being aware of their expectations would be utterly futile otherwise. Once this is done, then there would be the subsequent task of identifying vendors who provide healthcare IT services and then subsequent stages would involve developing the healthcare apps which is truly ‘pro-user’.
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Embracing mobile technology in their everyday working life seems to be second nature for the new generation of physicians – especially the ones who have graduated post 2000. It has provided them with the privilege of staying connected with their work outside the medical premises. It has given them the flexibility to access patient charts through their Electronic Health Records (EHRs), use clinical decision support systems, refer online drug information, take relevant notes, check references and do many more things on the move. The biggest benefit has been in terms of the improvement which has happened in terms of provider-patient communication.
With the healthcare norms incentivizing the push towards use of EHRs, mobiles have enabled the young generation of physicians to have a better work-life balance than their older peers. One cannot gainsay the obvious benefit this generation has over the older ones - for having been born in an era in which the use of technology in medicine has been the most pervasive. However, this does not mean that all young physicians are upbeat about their nature of work or life. It is common to hear about the medical school debt being quite a burden for the first few years of their lives. Seems like they have a few more points added to the list. Feedback received from surveys indicates a certain percentage wish they had not taken up this profession. Their concerns include:
- Unhappiness with third-party interference
- Lack of adequate insurance coverage for patients
- Lack of time to adequately educate patients on better health strategies
- Inability to provide quality care to patients amid the demands of a convoluted billing and coding system
Although the ease of adoption is higher, their overall analysis of the healthcare reforms and the push for EHR use also has had mixed feedback. The positives cited are as follows:
- Ability to remotely access patient information
- Improvements in quality of care
- Improvement in their ability to provide guideline-based care and track patients' markers of disease control over time.
- Better provider communication as a result of having everyone on the same EHR system
The main concern however is that EHRs are more expensive than expected, threatening the financial sustainability of their practices. Other negatives shared are :
- Poor usability
- Time-consuming data entry process
- Less time availability for face-to-face patient care
- Degradation of clinical documentation by trying to force it into structured fields
- Information overload, as having more EHR functions--such as reminders, alerts, and messaging capabilities leads to lower professional satisfaction
Amidst all this, one area which has seen a lot of enthusiasm amongst the young generation of physicians in the use of smartphones and apps. Although the debate for how much real value apps bring to the table continues, its use has been on the rise. From using them to attend medical education training online to prescribing them to patients as an alternative to a face-to-face meeting, most of them do not seem to have any hesitation is trying out various available possibilities. Infact there is a strong belief that judicious use of smartphones and apps will result in saving millions of dollars otherwise spent in unnecessary hospital visits and surgery.
As Healthcare industry undergoes major changes, for the better, physicians are also required to develop new skills and acquire new competencies so as to not fall behind expectations. With the push of healthcare financing more towards value-based payments rather than volume based, clinicians will have 3 major objectives.
- Improve quality of care
- Promote greater efficiency in care delivery
- Improve Patient safety
In order to achieve the above, they will be required to better utilize evidence-based practices, work in inter-professional teams and coordinate care across settings which would also include other providers. Hence moving forward, the need of the hour is to have physicians who are excellent in interpersonal and communications skills and an penchant towards collaborating with others to provide cost effective care. On the part of the hospitals, it has become imperative now to invest in the training of their existing staff in order to address the gaps and avoid the risk of becoming redundant. To leverage maximum benefits of healthcare software development, it is highly essential to spend proportionate amount of budget and efforts in training.
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mHealth and broadly speaking e-health is proving to be a boon to low and middle-income countries because it offers a suitable solution to two of their most compelling issues in healthcare delivery – reach and cost. People in these countries for all these years have been deprived of access to valuable healthcare information because of where they live. It is upto the governments of these countries now to figure out ways and means to hasten the adoption and removal of all possible roadblocks - the chief among which is proving to be lack of adequate expertise in the area.
Inspite of all the concerns related to privacy and regulations, reports indicate that mHealth market is expected to reach around $9 billion by the end of 2014. For the subsequent 6 years, the market is expected to grow at a CAGR of 40 percent. The biggest thrust to this growth will come from the following factors:
- Increased penetration of 3G and 4G networks
- Better engagement and awareness of chronic diseases
- Push for cost efficiency
- Higher adoption of smartphones
Besides the above four factors, mobile network operators also see a lot of business opportunity in mHealth as the field allows them to offer a range of services over and above the basic ones which they provide.
mHealth software development projects for hospital setups create applications which are found to be highly effective in tracking valuable equipment, managing inventory, tracking patients and hospital staff, as well handling medical emergencies. A latest breakthrough has been in the area of handling combative patients - through devices which can be used by the hospital staff to alert their co-workers in the event of their confronting such a situation. New solutions are also finding ways to address temperature monitoring, hygiene compliance etc.
Many countries with an aging population find mHealth a commendable platform to reduce the cost of treatment and increase convenience and reach. However, in order to achieve this, the population has to be trained so as to enable them to manage their condition independently. Also, devices have to be more to sophisticated to handle a range of conditions effectively. Efforts towards developing capability to handle the second factor have already had its inception. Moving forward, the market for using wearable devices connected to smartphones is expected to grow. These devices are going to be expected to handle a host of functions in a stand-alone manner or in conjunction with third-party platforms. Since internationally the population of diabetic people is increasing rapidly, diabetes management devices market is expected to grow and so is the market for accompanying healthcare applications.
The applications market for Healthcare is shared between medical apps and health apps. The former includes segments medical reference, disease specific apps etc. whereas the later includes ones for weight loss, meditation exercise to name a few. The Healthcare apps market is currently dominated by exercise apps and moving forward the download volume in this category is expected to increase multifold. But the same cannot be said about the impact it will have on revenue. So the fitness app market is expected to reach maturity quicker than the rest and only those apps in this category which are significantly innovative might make a relatively better revenue contribution.
FDA, in the meanwhile, has released its latest guidance which it expects to provide clarity and predictability to manufacturers of mobile medical apps. Quite a lot of these companies/developers were holding on to their development work which were risky. These apps are termed so as they can pose a risk to the patient’s safety if they do not work as they are expected to. The delay in releasing the guidelines was acting as a deterrent since they weren’t sure how the final draft would affect the outcome. Although industry stalwarts have expressed their personal opinions to the outcome, there is a consensus on the fact that apps involved in direct patient care need regulation and having a set published guidelines is a step in the right direction.
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In an ideal scenario, caregivers would like to be able to share health information with one another. Driven by a need, if a patient were to shift to a new caregiver, the later would at once like to have access to the medication, lab reports, discharge summaries etc. This would only be possible if electronic health records could communicate with each other through an information exchange infrastructure. This is not only going to improve the quality of care but also increase the efficiency levels besides saving healthcare costs. The current scenario is far from ideal because of lack of interoperability of EHRs and exchange infrastructure.
For the Healthcare industry to take the giant leap and reach the state its leaders envisage, a break-through on interoperability is a must. Unless handled on a priority basis, this a stumbling block which every big IT initiative in this industry will hit at some stage. It is only by bringing in fluidity in the information flow that the industry stands to draw the biggest benefit. Otherwise, the healthcare software development services industry cannot expect to bring about a transformation by just working in an efficient manner in silos. Real benefits will be harvested only with seamless data exchange. Collaboration is imperative and so is safety and security of data that is shared across the industry. It will not only enable providers to manage their workflows better in their clinics but also make it possible to send and receive healthcare related data across disparate EHRs used by various other healthcare setups.
To make interoperability a reality, massive amount of work needs to be done in a synchronized manner. Public-private coalition holds the cue here and the pace of adoption depends on strict adherence to the agreed upon national standards with no allowance made to variations. It is only when disparate EHR products and HIEs agree to strictly follow the same standards that the capability can be achieved. States being awarded grants to setup Health information exchanges is definitely a step taken in the right direction since it will provide the backbone for interoperability. There are concerns however shared from some of the stakeholders who feel that too much of emphasis on regulations while setting up or running HIEs will only jeopardize things more. The key areas to be handled here include Patient matching and finding solutions to the variances of safety and privacy rules followed across states. It thus calls for innovative approaches to work around these issues rather than strict adherence to policies which might eventually result in deadlocks.
On the EHR front, realizing the need of the hour, a group of otherwise competing vendors has decided to get their act together to promote their data exchange standards to facilitate information transfer. The new alliance is expected to result in:
- Cross entity Patient linking and matching
- Patient consent and data access matching
- Patient record locator and query Services
This is an initiative which moving forward is expected to draw in more vendors, especially the ones which intend to be in the business for the long haul, since there is no future without interoperability. The most important outcome of such an initiative is that it will expedite the process of drawing a map to reach the destination in an efficient manner. This also will bring about a change in the landscape for vendors whose products will now have to compete in terms of their adaptability towards cross-vendor exchange and interoperability.
The impetus provided by the Federal grant might have got the adoption of HIEs rolling but moving forwards these organizations will have to figure out ways of being financial afloat beyond the grant money. On the other hand the adoption of HIEs will pick pace only if the standards and certifications are concrete and get defined such that interoperability is completely achieved. It would result in any EHR product receiving data to be able to work on it straightaway.
We provide Healthcare application development and Healthcare software testing services. If you would like to talk to one of our software testers or one of our certified healthcare software programmers, please get in touch with us at Mindfire Solutions.
The universal adoption of Electronic Health Records in a Meaningful way is the backbone on which all Healthcare reforms are hinged. Based on figures shared by HHS, incentive payments under the Medicare and Medicaid Meaningful Use programs have reached more than half of all eligible professionals, and 80 percent of eligible hospitals. Expected to be responsible for better healthcare outcomes, it is the implementation which has been the cause of a lot of bane. Apart from the operational changes that are required to be brought in, the whole process takes a lot of financial toll on healthcare setups. There is infact a strong belief which is gaining ground that the net cost outweighs the benefits of using an EHR. The independent physicians rather than the employed physicians are more likely to hold this view. Another complaint held by the physicians’ fraternity is that the EHRs have been built without keeping their requirements in mind. Some physicians have actually gone to the extent to build EHR products to exactly suit their clinical requirements and also to handle the common issues they otherwise face in using the standard products available.
But do physicians actually have the know-how to design EHR Systems? The answer to this question is not a simple one. At the end of the day, EHR systems are used by physicians and so, they are in a position to share the real-time issues which crop up during usage. But because they face issues in say handling certain features or are in the business of providing care it does not automatically qualify them to build new healthcare IT systems for many reasons. For e.g.
- Some of the features which they otherwise find troublesome or, even worse, as stumbling blocks to their normal flow of work might actually be highly essential ones; identified and implemented in the system based on industry based practices.
- It might also so happen that the features have been included to ensure interoperability with other systems for data exchange
- There is a high possibility of the complaints having arisen because of the inconvenience of physicians in adapting to a new workflow more than anything else.
As a solution, some of the physicians have been recommended to go the open source way in which they get in touch with Health IT experts and take their help them to make changes in standard EHR systems to meet their requirements keeping in mind adherence to the Meaningful Use criteria all-throughout.
The market for EHR adoption was $20 billion in 2012 and is expected to grow in the coming 2 years. However, the market of EHRs is likely to undergo some major change this year. Federal push for Meaningful Use led to a race among HealthCare software development vendors to create standard EHR products. They did not initially bother to customize their systems to meet the requirements of individual setups. Over a period of time this approach led to various complaints to the vendors. However, with the focus of the vendors more towards selling their products and reaching out to more clients, severe issues pertaining to implementation, support and specialty features, to name a few, started talking a toll on the performance of healthcare setups . This tolerance has reached a boiling point in 2013 with healthcare setups actively looking to switch over to EHR systems offered by vendors who were willing to address their concerns on an ongoing basis.
For the vendors, the short-term revenue growth was triggered mainly by the Federal stimulus. For a sustained long-term market they will be required to focus their energies on usability and interoperability. A survey done across industry experts reflected that eventually most of the EHR vendors are likely to acquired, merged or thrown out of business ; simply because most of them were targeted at the retail mass. As high cost of implementation independent practices are expected to merge with larger setups i.e. hospitals. This is bound to have an impact on the number of vendors in business. Pressed by deadlines hospitals will be compelled to quickly look out for vendors which provide an integrated platform with stable functionalities to ensure ease of use and interoperability across affiliated physicians. Thus the times ahead auger well for those EHR vendors which provide holistic and easily customizable systems and are quick to resolve issues which their clients face.
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MHealth which is essentially delivery of healthcare services using mobile devices. Given the pace at which smartphones, tablets etc. have pervaded are day-to-day lives, it is normal to see the traction building around the mHealth industry. Use of mobility is expected to increase the time spent by Physicians to address their patients besides allowing them to take real time decisions. Their energies, a lot of which was earlier spent going through a large amount of paperwork, can now be entirely channelized towards providing care. But there seems to be something very essential which is missing in the manner in which the industry is shaping up. Currently, the number of companies investing in developing effective apps and gadgets is growing by the days. But what is missing unfortunately is the focus towards interoperability. Unfortunately, this is likely to lead to people to a state where they have to deal with multiple stakeholders to meet their needs – a state not very different from what it has been all throughout except that a lot of paper work/manual processes are going to be replaced by electronic processes.
The use of Mobile health for delivering customized healthcare services seems to have significantly gone up. A case in point is that of apps being used for treatment adherence. It has been noticed that an individual’s belief system related to the illness and the prescribed medication determines the degree of adherence that a patient shows. Changing the belief system requires application of numerous psychological techniques. Mobile apps have been found to provide an effective channel for executing those initiatives. It has been noticed that information gathered during enrollment – which includes personal data and disposition towards treatment, and collected subsequently, provide matter that help in finalizing and implementing the correct interventions. Given the nature and seriousness of a disease there are also specialized apps available to track vitals aspects of patients with some allowing patients and physicians to hold video conferences.
Recent developments in the healthcare industry have set very high standards for the providers. Not only are they expected to operate at higher levels of efficiency, but also achieve capabilities of superior care in an environment which is highly regulated. All these factors put together have catalyzed the adoption of mobility in healthcare. Providers have started looking at mHealth as a means to achieve the required levels of effectiveness in the setups. The push for mobility is also because of the following factors:
- Desire among patients to get more involved in their care
- High number of cases of chronic illness among the ageing population
- Shortage of resources in healthcare in general
- Issues related to communication
Healthcare providers have always had to jostle with issues related to communication. Paper work made it the most difficult. Advent of electronic systems reduced the problems to a considerable extent as the stakeholders were not anymore expected to physically carry or reach out to artifacts to get the required information. However, mHealth took things to a different level altogether. Since Physicians and other hospitalists are required to be mobile, usage of devices which could enable them to access information on the move increased their productivity tremendously. Given the volume and the dynamic nature of healthcare data that gets generated and needs to be transmitted, mHealth makes it possible for anywhere access to relevant data with high reduction in the chances of error.
Among devices, Tablets, owing to the larger screen size are favored by physicians. It offers them with outmost convenience to view and analyze reports and images. The important thing to keep in mind while providing mobility solutions in the healthcare industry is that, there is a high level of intersection between the needs at the end user level and at enterprise . The benefits accrued at the enterprise level have a rub off effect on the end users. For e.g. improvements made in efficiency and quality of care through the right mHealth interventions at healthcare setups result in better safety and care outcome for the patients. You can hire developers from top Healthcare software development companies in india who can help you build mobile apps within allocated budgets and time schedules.
We provide Medical software development services. If you would like to discuss with a certified healthcare software developer from our team, please get in touch with us at Mindfire Solutions.
It is not just by actively using electronic health record systems or patient portals for example can the true value of IT be harnessed in a healthcare setup. Healthcare testing services India can equally help in this regard. In order to bring about a marked improvement in healthcare outcomes, IT systems have to contribute significantly in the following three areas:
- Clinical decision support
- Clinical workflow support
- Care coordination
From managing medication, improving documentation, enhancing communication - both among providers and between providers and patients, health IT can equip physicians to provide evidence-based preventive and chronic care. Multiple surveys done across medical setups to understand the usage of such tools have shown positive outcomes. For example one of the researches indicated that using clinical decision support predictive tools along with electronic health records can bring about a considerable decrease in the use of antibiotics for infections related to the respiratory track. This results in reducing the cost of treatment and also chances of over treatment. The facility to using alerts in workflows has been found to result in highly valuable outcomes. EHR alerts have made it possible for physicians to facilitate end-of-life discussions with patients who are terminally ill. It makes it possible for them to understand the preferences of such patients before they are admitted or in crisis mode. CDS alerts have also shown wonderful results in reducing the need of conducting repeated tests in cases of heart failure. The norm otherwise is to generally perform multiple tests in order to measure the severity of heart failure.
The cost incurred in implementing an EHR system is quiet high. The system offers multiple functionalities to its users. However, what is being seriously debated is the possibility of EHRs to achieve both - reduction in care costs and in parallel improve care for patients. Research done in this area has again shown that providers can expect the best return on investment if they are using the clinical decision support provisions in EHRs. The solutions provided by Clinical Decision Support systems are used across multiple areas. Some examples include diagnosis decision support, drug databases, care plans, disease/drug reference tools, surveillance software etc. All these tools need to be aligned both with the EHR and the clinical workflow to be completely active. Given its relevance, it is not a surprise that the emerging healthcare models like ACOs (Accountable Healthcare Organizations) have high demand for Clinical decision support systems. In order to draw the maximum possible benefit out of the systems, ACOs are gearing up by developing capabilities in terms of trained workforce who know the art of optimally using them to their benefit. For physicians, using CDS brings about a whole lot difference in their daily activities. Rather than having to refer to notebooks and keep in mind information related to drugs and health conditions, using the support tools helps them save a lot of time and make better decisions during encounters. CDS systems are broadly divided into two categories- Standalone & Accessory. The standalone software runs on a computing platform and provides diagnostic or treatment recommendations. Accessory software on the other hand supports the functionality of a particular medical device.
One of the challenges on adapting CDS to clinical workflows has been that of adjusting to its sensitivity. The alert fatigue surely seems to be an area of major concern. Having to deal with large number of alerts, at any given point in time, makes it very difficult to respond to the most urgent ones. This has resulted in some serious consequences leading to loss of life in many cases. Today’s healthcare environment is undergoing a lot of change. To expect physicians to cope up with the demands without using efficient CDS systems seems highly impossible. However relevant changes need to be made to reduce the obvious loopholes which exist. Infact all healthcare IT systems generally offer multiple functionalities. Barring the ones which have to be mandatorily used, the trick for a provider is always to identify and use those functionalities which have a higher likelihood of improving healthcare outcomes with least negative fallouts.
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