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Remote Patient Monitoring (RPM) – a Projected $37.7 Billion Market – Requires Actionable EMR Connections to Create Value

The mobile health solutions market is projected to grow 33.4% per year through 2020 generating a market value of $59.15 billion. Of this market, subscription based home and ambulatory Remote Patient Monitoring (RPM) systems offered by home security and cable companies will likely be the leading the services segment with a projected 63.7% market share ($37.7 billion) annually. These systems will offer wireless glucometers, weight scales, BP Cuffs,spirometers, pulse oximetry, EKG, and infrared thermometry connected to the EMR via Bluetooth, WiFi and 3G/4G LTE/5G systems.

Market drivers include: (1) the rapid adoption of connected mobile healthcare devices and services; (2) new government reimbursement CPT codes for both chronic disease management (CPT 99490) and transitional care management (CPT 99495 and 99496), and; (3) advanced deployments of 3G, 4G LTE and new 5G networks for patient-focused care. When 5G is operational in the next few years for RPM, there will be “no perceivable latency, facilitating Cognitive and Perceptual Computing, Augmented Reality and Haptic Internet ” to address the Federal government’s new “Precision Medicine” in initiatives.

With this new technology, recent study by HIT Consultants predicts telehealth video visits will reach 158 million by 2020. Almost half of the large employers surveyed by the National Business Group on Health made telehealthoptions available in 2014, and that number is expected reach 74% in 2016. Towers Watson indicates telemedicinewill save U.S. companies more than $6 billion per year in healthcare costs and, Goldman Sachs research linkstelemedicine to an annual reduction of healthcare costs of about $104 billion.

EMR Connected RPM Technologies Can Reduce Heathcare Costs to $3-$5/Day

These new high speed RPM technologies will enable vast amounts of patient video, diagnostic data to come into RPM systems rapidly expanding telemedicine and telehealth capabilities. Connecting to the EMR can to shift the average cost of treatment from the inpatient acute setting of $5,000 – $10,000 per day to ambulatory subscription based/home monitored cost of less than $50-$100 per month or $3 -$5 per day amortized including equipment.

According to a recent survey, more than 2/3rds of hospitals and health systems are seeking to deploy RPM to: (1) reduce 30 day readmission penalties achieve operational efficiencies; (2) better manage capitated risk contracts; (3) improve risk management, and; (4) boost care quality and control costs. Of that group, 84% are planning to use mobile devices for post-hospital discharge support and 79% are seeking analytics and decision support tools to turn raw patient data into “actionable knowledge”

Focus on Chronic Disease Management to Achieve Greatest Cost Savings

The RPM market for “Population Health” is initially focused on chronic disease management for the 20% of U.S. patients with high risk, unstable chronic conditions who represent 86% of total Medicare costs.As of 2012, about half of all U.S. adults (117 million people) had one or more chronic health conditions and 25% had two or more chronic health conditions. CMS (The Centers for Medicare and Medicaid) estimates that 2/3rds (68.4%) of Medicare beneficiaries have 2 or more chronic conditions and about 1/3 had 4 or more chronic conditions.

The new (January 1, 2015) Medicare Chronic Condition Management Reimbursement code (CPT 99490) requires that patients have “(two or more) chronic conditions expected to last at least 12 months” to qualify for a roughly $41.90 capitated monthly reimbursement for “non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.” Therefore, more than 34 million Medicare recipients may be eligible. With the growing availability of RPM technologies, the addressable market for these new technologies for all insurers, Self-insured employers and ACOs includes:

(1) 26 million children and adults with diabetes and the additional 7 million underdiagnosed population;

(2) 78 million U.S. residents with obesity (defined as body mass index [BMI] 30 kg/m2) and nearly one of five youths aged 219 years are obese (BMI 95th percentile) as well as 5.1 million with Congestive Heart Failure for which the connected weight scale can be used;

(3) 114 million people (47% of U.S. adults) with uncontrolled high blood pressure.

(4) 15 million people have diagnosed Chronic Obstructive Pulmonary Disease (COPD), 25 million estimated including under-diagnosed cases as well as 18.9 million (8.2%) U.S. adults and 7.1 million (9.5%) U.S. children asthma for which the Peak Flow Spirometry units can be used, and;

(5) 26.5 million people in the with heart disease generating 12.4 million annual medical visits, 2 million annual hospital outpatient visits, and 135,700 (9.3%) home healthcare patients for which a combination of these devices can be utilized.

While “Well Management” is applicable to approximately 50% of the U.S. population (169 million people), it represents only 3% of the nearly $3 trillion per year cost of annual U.S. Healthcare expenditures. More than $1 Trillion is spent on patients with chronic conditions representing 45% of the U.S. Population (143 million). Another $1 Trillion spent on those patients who are acutely ill and “Aging Independently.”

Many patients who are “Aging Independently” also have chronic illnesses. In fact, the CDC states that 86% of the annual cost of healthcare is spent on caring for those with chronic illnesses. By CMS’s definition, Chronic Illnesses include, but are not limited to: Alzheimer’s disease and related dementia; Arthritis (osteoarthritis and rheumatoid); Asthma; Atrial fibrillation; Autism spectrum disorders; Cancer; Chronic Obstructive Pulmonary Disease; Depression; Diabetes; Heart failure; Hypertension; Ischemic heart disease; and Osteoporosis

With EMR connectivity CCM Reimbursement will drive RPM Adoption by Hospitals and Physicians

To qualify for the $41.92 per month CCM Medicare reimbursement, these chronic conditions must be: (1) expected to last at least 12 months, (or until the death of the patient), and; (2) require at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, for conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. The physician must establish, implement, revise and monitor the patient’s progress using a written, comprehensive care plan established, implemented, revised, and monitored.

The CCM service is extensive, including structured recording of patient health information, an electronic care plan addressing all health issues, access to care management services, managing care transitions, and coordinating and sharing patient information with practitioners and providers outside the practice. Some of the CCM Scope of Service elements require the use of a certified EHR or other electronic technology. Physicians and the following non-physician practitioners may provide the service and bill including Certified Nurse Midwives; Clinical Nurse Specialists; Nurse Practitioners; and Physician Assistants.

Structured Data Recording requirements in the EMR includes recording the patient’s demographics, problems, medications, and medication allergies and create structured clinical summary records using certified EHR technology. Therefore, integration with the Electronic Medical Record system is a key component.

Transitional Care Management Service Payments under Codes 99495, 99496

CMS spends an estimated $17 billion per year on hospital readmissions. Therefore, in addition to the Hospital Readmission Penalty CMS instituted in 2012, in January 2013, CMS created the Post Hospital Discharge Care Coordination codes 99495, 99496 for Transitional Care Management services furnished within 30 calendar days following the date of discharge from a hospital, nursing facility and specified outpatient services.

Transitional Care Management includes one face-to-face visit within specified time frames in combination with non-face-to-face virtual RPM services that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his or her direction. Code 99495 is for a moderate level of service and a provider stands to get paid $163.88 or $230.86 for a more intense level of services under code 99496, depending on the complexity of the medical decision making (E&M 3 or 4) and how quickly there is a face-to-face visit (less than 14 days or less than 7 days).

Combined with the CCM reimbursement codes, RPM linked EMR systems will likely have a dramatic effect on not only “bending the cost curve” as ACO’s are designed to under the ACA, but to actual lower real costs of care significantly.

To learn more about the latest growth in remote health and home monitoring, visit: www.stevenrgerst.com.

Steven R. Gerst is Dean Emeritus of the Masters of Science in Applied Health Informatics and Professor, Bryan University. He is currently at the University of Miami, Miller School of Medicine in the Office of the Chief Innovation Officer and Vice Provost as an “Entrepreneurin-Residence,” and has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine.

Dr. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives.

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Dr. Steven R. Gerst: The Future in Healthcare Is Here. Remote Patient Monitoring Achieves Great Success With Continually Advancing Technology.

For medical professionals, the ability to work with patients remotely in their homes is an extremely effective method of prevention. Remote Patient Monitoring (“RPM”) allows the immediate capture and notification of any medical issues that a patient with a chronic condition might experience. Over 71% of the U.S. Healthcare dollar is now spent on treating patients with chronic conditions; 86% of the Medicare dollar.  This is well over $1 trillion per year.

Leveraging new connected health technologies to manage the 19 or more Chronic Conditions that the Centers for Medicare and Medicaid have now identified will now be critical to shifting the cost curve as government reimbursement shifts from” volume based” reimbursement to “value based” reimbursement through the under MACRA  Quality Payment Program (“QPP”), MIPS and the APMs.

Better yet, the Centers for Medicare and Medicaid are now subsidizing the cost of Remote Patient Monitoring for the home and outpatient settings under CMS Code 99490 which pays providers $41.92 per patient per month for “non-face-to-face” virtual visits using a remote patient monitoring platform. This applies to any patient with 2 or more Chronic Diseases which are expected to last 12 months or more (71% of the cost to the nearly $3 trillion U.S.healthcare system).

In addition, CMS is also paying providers approximately $163.88 and $230.86 per patient for post discharge transitional care which also involves a “virtual visit” (CMD Codes 99495, 99496) that may be performed by the physician or other qualified health care professional and/or licensed clinical staff under his or her direction.  The payment amount is based on the complexity of the medical decision making (E&M 3 or 4) and how quickly there is a follow-up visit (less than 14 days or less than 7 days).

Steven R. Gerst: The success rate achieved with remote patient monitoring technology is what is moving thehealthcare industry into telemedicine today.

Several companies that are addressing this market only providing remote monitoring systems, but they are also integrating the systems and hardware into provider environments, helping them classify their patients, staffing their teams, and incorporating RPM analysis into their electronic health records. There are only a few that have the scale and infrastructure to support this as well as a large install base.  This primarily includes those companies already in the home security business with millions of homes already serviced 24/7, Personal Emergency Response systems in place and a 24/7 staffed service line to handle emergencies  with direct ties to 911.

The few companies that have this infrastructure are also developing direct connections from the home to both thetelemedicine companies for virtual visits and the spines of the larger Electronic Medical Record systems. This provides this provides “real-time” actionable data” for hospitals and providers to achieve the “Triple Aim” 1.significantly improve access to care; 2. Improve quality of care, and; 3. Dramatically reduce cost as the system moves to “Value Based Care and Outcomes Management.

Steven R. Gerst: Focus on the High Cost Conditions.

Remote Patient Monitoring technology is initially focusing on the high cost chronic conditions such as Congestive Heart Failure (“CHF”), Chronic  Obstructive Pulmonary Disease/Asthma (“COPD”), Diabetes, and Hypertension which can easily be remotely managed by exiting FDA cleared 510K connected devices.  These include 510K clearedBluetooth connected weight scales, glucometers, spirometers, thermometers, pulse oximeters and 2 lead EKG sensors.

These Bluetooth and WiFi dual band technologies can then be automatically paired to a 3G/4G hub for real-time data transmission to the physician’s EMR with alerts and alarms set based on pre-established parameters set by the physician for each patient. This customizes the remote care for each patient’s specific medical condition and needs.
This will dramatically reduce the incidence of medically unnecessary hospital 30 day readmissions for which over 2,600 were penalized by CMS last year up to 3% of the Medicare reimbursement totally over $428 million.

At the recent American Telemedicine Association meetings in Minneapolis, one company reported drastically reduced physician office visits and ER readmissions through the use of connected pulse oximeters, scales, and blood pressure cuffs on a group of 400 pulmonary obstructive disease patients.

Also being showcased at the ATA 2016 were monitoring devices and cutting edge technology that had been developed specifically to be user friendly “plug ‘n play” RPM platforms for both patients and caregivers. New monitoring technology is opening up opportunities for health IT and tech vendors which will dramatically improve lives and reduce the cost of care.  These solutions are perfect for the Accountable Care Organizations, MSOs, hospitals and insurers with at-risk populations in Medicare Advantage plans, Commercial and capitated Medicaid plans.

Steven R. Gerst: Behavioral healthcare also benefitting from advancements in telemedicine.

While remote patient monitoring, telephonic chronic care management and telehealth medical consultations benefit those with chronic physical conditions, mental health consults and treatment services are also quickly being added to the list of healthcare services that providers can offer their patients remotely, according to Forbes.com.

Telehealth firms are expanding their reach to provide access to psychiatrists, psychologists and therapists via asmartphone, tablet, or computer as part of a national effort to reduce the rates of suicides, addiction, and various mental health conditions.

The introduction of “telepsychiatry” services to mental health patients will help match patients with doctors in a sector of healthcare where there is a national shortage of psychologists and psychiatrists. Telemedicine will help bridge a gap where, at present, very few dealing with mental health disorders actually receive treatment.

To learn more about the latest growth in remote health and home monitoring, visit: www.stevenrgerst.com.

Dr. Steven R. Gerst is a Managing Partner of Telemetrix Systems, LLC (steve@telemetrixsystems.com) and is an Entrepreneur-in-Residence at the University of Miami, Miller School of Medicine, U Innovation, Office of the Vice Provost.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He is also Dean Emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) where he serves on the Board of Advisors and has taught on the faculty. Dr.Gerst also has recently been invited to join the faculty of the University of Miami, School of Nursing and Health Sciences and has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine.

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Dr. Steven Gerst: Remote Patient Monitoring Is the Driving Force Behind Telemedicine’s Impact on Healthcare Today.

Remote patient monitoring is transforming healthcare and expanding its reach to a growing population of patients with diverse medical conditions. Integrating telecommunication with information technologies in a medical setting has been successful in advancing the way healthcare is delivered to patients. The continued application and innovation of these technologies in this capacity are projected to skyrocket.

RPM has already achieved great success in reducing per patient costs and improving patient outcomes. By eliminating distance barriers, access to medical services is improving dramatically, furthering the ability to reach more and more patients on a global scale.

Utilizing cutting edge, yet user-friendly remote patient monitoring devices and tools, patients are now empowered with the ability to take part in the management of their own health. Remote patient monitoring devices and othertelehealth tools work to provide more ways for healthcare professionals to interact, treat, and monitor patients, by offering:

·      Remote communication via the Internet to assist providers in reaching diagnoses, managing health issues, and providing follow up care.

·      Improved supervision and management of chronic diseases, such as diabetes, asthma, cardiac, chronic obstructive lung diseases, obesity and even mental health conditions that require vigilant monitoring.

·      Convenience, ease of access and affordability with medical assistance at the patient’s disposal 24/7 – with zero travel to a healthcare facility. This helps chronically ill patients avoid exposure to other illnesses, as well as saving money by not having to alternatively visit an emergency room or urgent care clinic.

In 2011, a study conducted by the Center for Disease Control revealed that 80% of adults who visited the emergency room for noncritical treatment did so because they didn’t have access to the services of their primary care physician. The difference in out of pocket expenditures in these cases is astounding: an average visit to the ER is between $1,500 and $3,000, in comparison to $130 to $150 for a regular doctor visit. The cost of a typical telehealth visit? Only $40 on average.

Steven R. Gerst: Telehealth technologies and RPM offer patients faster response times and treatment, which can mean the difference between life and death.  It also means greater control over your own health.

The results of a recent yearlong patient monitoring study indicated that when patients used their own at-home remote patient monitoring program creating “Active Living” situations as a powerful extension of the patient’s care delivery team, it yielded an average annual savings of $8,375 per monitored patient.

The program combined predictive analytics, cutting edge technology, and in home personalized care planning. It compared its active program participants to a control group of non-monitored members with statistically similar conditions. Both participants and members of the control group had:

·      A diagnosis of heart failure

·      Similar risk scores measured by recent claims and demographics

·      12 months of pre program claims data and up to 12 months of post program claims data

·      At least one inpatient hospital admission or two ER visits in the last 12 months prior to being asked to participate in the program study.

The program evaluated clinical, utilization and cost outcomes, as well as patient experience.  It yielded nearly 45% reduction in hospitalizations, with a net 34% reduction of acute heart failure admissions. It delivered improved patient satisfaction, with participants reporting an overall satisfaction rate of 94%.

The study successfully showed largely positive clinical, cost, experience and utilization outcomes. When applied in conjunction with a quality case management and clinical support teams, along with a state of the art technology platform that has the capability to collect and interpret critical device data, there is no question that it could save the typical health plan million per year, significantly dropping their Medical Loss Ratios to exciting new levels.

These remote patient monitoring programs show great potential to influence the cost of healthcare and to improve patient health outcomes for those who live with chronic medical conditions and disease. These programs can benefit many seniors who suffer from chronic illness. By integrating technology together with patient providers and a hospital based case management team, a better comprehension and management of each patient’s condition can be achieved so that they may live full and independent lives in their homes.

To learn more about the growth in remote health and home monitoring, visit: www.stevenrgerst.com.

Dr. Steven R. Gerst is a Managing Partner of Telemetrix Systems, LLC (steve@telemetrixsystems.com) and is an Entrepreneur-in-Residence at the University of Miami, Miller School of Medicine, U Innovation, Office of the Vice Provost and is on the faculty of the School of Nursing and Health Sciences where he lectures on Management Information Systems in Healthcare.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He is also Dean Emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) where he serves on the Board of Advisors and has taught on the faculty.

Dr. Gerst also has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine and is a Principal  in the Asclepius Life Sciences Fund, LP, a Cayman Islands activist Hedge Fund which invests  private equity and venture capital in biotech and biopharmaceutical ventures.

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Dr. Steven Gerst: Exploring How Connected and Digital Medicine is Changing the Landscape of Healthcare as We Know It.

Digital Healthcare/Remote Patient Monitoring (“RPM”) is making its revolutionary debut. Even in its early developmental stages, Digital Healthcare/RPM provides medical providers with the ability to monitor patients virtually (24/7), make diagnoses, offer treatment, and conduct follow-up monitoring at a fraction of the current cost of traditional healthcare practices and delivery methods.

Even better, the Federal Government is paying for this virtual, “non-face-to-face” monitoring for Medicare patients for 19 Chronic Conditions under CMS’ Chronic Care Management Code 99490 (1) and post hospital discharge under Transitional Care Management Codes 99495 and 99496.(2)

For Medicaid patients, Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs which allows hospitals to apply for waivers to implement these programs in some states. (3)

Preventative medicine has, therefore, never been more widely accessible as through these new connected digital health and Remote Patient Monitoring platforms. Expansion of Digital Medicine/RPM allows significantly more efficient access to more patient populations instantly.

Nearly half of all adults in the U.S. (117 million people) suffer from Chronic Conditions with nearly 58 million suffering from 2 or more. (4)

86% of the total cost of total U.S. healthcare goes to pay for these chronic diseases. (5)

With Digital Medicine and Remote Patient Monitoring, these patients can now be directly monitored in their homes to either prevent exacerbation of their chronic conditions or prevent medically unnecessary and costly 30–day readmissions.

Steven R. Gerst: Connecting through the EMR is critical to Real-Time, Actionable Data Transfer and Provider Reimbursement generating $305 Billion in Savings (est.)

Provider reimbursement for the new service can be billed directly through the EMR. Wirelessly connected blood pressure cuffs, EKG sensors, electronic weight scales, glucometers, spirometers and other devices are changing the dynamic of virtual care feeding real-time, actionable patient data directly to the providers with system alerts specific to each patient based on their condition and medications.

Hospitals are developing case management nursing teams to telephonically respond immediately to changes in patient vital signs and weight taken in the home or workplace, avoiding costly medically unnecessary 30 day readmissions and millions of dollars in penalties while improving patient care. One hospital system in Minnesota has demonstrated reductions in hospital readmissions for Congestive Heart Failure from the national average of 24.8%6 to less than 2% by simply connecting an electronic weight scale remotely into the hospital’s EMR system (7).

These advancements will dramatically impact the movement under the new MACRA, MIPS and APM legislation from “Volume Based” care reimbursement to “Value Based” and Outcomes Management reimbursement. (8)

According to a report by Goldman Sachs in its Internet of Things (IoT)9 series, joining the physical and digital worlds: changing physician and patient interaction through digital health “offers the most commercially viable potential to change the US healthcare economy.” Goldman Sachs estimates $305 billion in savings generated by 3 new innovations:

  • $200 Billion from Remote Patient Monitoring
  • $100 Billion from Telehealth, and
  • “An infinitely large savings” from Behavior Modification regarding obesity management, smoking cessation and overall lifestyle improvements.

The report estimates commercially available opportunities to provide these services and technologies at approximately $36 billion per year.

Dr. Steven Gerst: Efficacy Needed to Overcome Hurdles for Digital Medicine/RPM Adoption.

Chronic disease accounts for 1/3rd of total US healthcare expenditures – over $1 Trillion annually10. Heart conditions, COPD, asthma, and diabetes constitute the largest cost component. These conditions also have the greatest potential using Digital Medicine/RPM to improve patient outcomes, lower adverse events, and reduced costs when shifting to a Value Based- Outcomes driven approach to treatment and reimbursement.

Digital Medicine/RPM is a powerful enabler. These systems will serve as the information portal to data management, giving managed care the potential to lower its chronic care burden. Efficacy remains the standard by which to judge any digital health offering.

With respect to digital health, “efficacy” is further defined as a user-friendly platform that collects accurate and actionable data promotes behavioral change (by both the patient and the provider in his treatment), demonstrates results, and also protects sensitive information.

The Goldman Sachs’ IoT report charts the hurdles in which must be overcome and how far we have progressed in the adoption of digital health including:

  • FDA Regulation: With over 100 digital health applications approved to date, the FDA has laid out   guidelines for regulation and approval for digital health.
  • Patient Adoption: Developers are creating seamless interfaces for users of all levels of tech competency.
  • Physician Acceptance: While most healthcare organizations have attempted to integrate mobile into
    their healthcare offerings in some way, there are many who are still not recognizing its viability, and are waiting for better technologies.
  • Reimbursement: Securing reimbursement is essential to the viability of digital health business models; while some argue that it is counter to the objective of connected health.
  • Privacy: Making mobile therapies HIPAA compliant represents a tremendous challenge in wireless healthcare.

Technology is now available to provide the efficacy needed to enable digital medicine through Remote patient monitoring and reimburse providers for their services. To learn more news about connected and digital healthcare, visit: www.stevenrgerst.com.

Dr. Steven R. Gerst is a Managing Partner of Telemetrix Systems, LLC (steve@telemetrixsystems.com), an Entrepreneur-in-Residence at the University of Miami, Miller School of Medicine, U Innovation, Office of the Vice Provost and is on the faculty of the School of Nursing and Health Sciences where he lectures on Management Information Systems in Healthcare.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He is also Dean Emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) where he serves on the Board of Advisors and has taught on the faculty.

Dr. Gerst also has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine and is a Principal in the Asclepius Life Sciences Fund, LP, a Cayman Islands activist Hedge Fund which invests private equity and venture capital in biotech and biopharmaceutical ventures (http://asclepiuslifesciences.com/).

1 Department of Health and Human Services, Centers for Medicare and Medicaid, Medicare Learning Network, “Chronic Care Management Services,” ICN 909188 May 2015. As found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

2 Department of Health and Human Services, Centers for Medicare and Medicaid, Medicare Learning Network, “Transitional Care Management Services,” ICN 908628 March 2016. As found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf

3 Medicaid.gov. Section 1115 Demonstrations. As found at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html

4 Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. DOI: http://dx.doi.org/10.5888/pcd11.130389.

5 Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

6 20 Statistics on Hospital Readmissions. As found at: http://www.beckershospitalreview.com/quality/20-statistics-on-hospital-readmissions.html

7 Siwiki, B. (2016). Essentia Health slashes readmissions with population health initiative, telehealth. Healthcare IT News (March 15). As found at: http://www.healthcareitnews.com/news/essentia-health-slashes-readmissions-population-health-initiative-telehealth

8 CMS.gov. Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Merit Based Incentive Program (MIPS), and Alternative Payment Models (APMs). As found at: Medicare https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

9 Roman, DH and Conlee, KD, (2015), The Digital Revolution Comes to U.S. Healthcare, Technology, incentives align to shake up the status quo. Goldman Sachs Global Investment Research, Internet of Things, Vol. 5. (June 29, 2015.) p 4.

10 CDC, Johns Hopkins, and Robert Wood Johnson Foundation

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Digital Medicine/Remote Patient Monitoring is Expected to Save $305 Billion

Digital Healthcare/Remote Patient Monitoring (“RPM”) is making its revolutionary debut. Even in its early developmental stages, Digital Healthcare/RPM provides medical providers with the ability to monitor patients virtually (24/7), make diagnoses, offer treatment, and conduct follow-up monitoring at a fraction of the current cost of traditional healthcare practices and delivery methods.

Even better, the Federal Government is paying for this virtual, “non-face-to-face” monitoring for Medicare patients for 19 Chronic Conditions under CMS’ Chronic Care Management Code 99490 (1) and post hospital discharge under Transitional Care Management Codes 99495 and 99496.(2)

For Medicaid patients, Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs which allows hospitals to apply for waivers to implement these programs in some states. (3)

Preventative medicine has, therefore, never been more widely accessible as through these new connected digital health and Remote Patient Monitoring platforms. Expansion of Digital Medicine/RPM allows significantly more efficient access to more patient populations instantly.

Nearly half of all adults in the U.S. (117 million people) suffer from Chronic Conditions with nearly 58 million suffering from 2 or more. (4)

86% of the total cost of total U.S. healthcare goes to pay for these chronic diseases. (5)

With Digital Medicine and Remote Patient Monitoring, these patients can now be directly monitored in their homes to either prevent exacerbation of their chronic conditions or prevent medically unnecessary and costly 30–day readmissions.

Steven R. Gerst: Connecting through the EMR is critical to Real-Time, Actionable Data Transfer and Provider Reimbursement generating $305 Billion in Savings (est.)

Provider reimbursement for the new service can be billed directly through the EMR. Wirelessly connected blood pressure cuffs, EKG sensors, electronic weight scales, glucometers, spirometers and other devices are changing the dynamic of virtual care feeding real-time, actionable patient data directly to the providers with system alerts specific to each patient based on their condition and medications.

Hospitals are developing case management nursing teams to telephonically respond immediately to changes in patient vital signs and weight taken in the home or workplace, avoiding costly medically unnecessary 30 day readmissions and millions of dollars in penalties while improving patient care. One hospital system in Minnesota has demonstrated reductions in hospital readmissions for Congestive Heart Failure from the national average of 24.8%6 to less than 2% by simply connecting an electronic weight scale remotely into the hospital’s EMR system (7).

These advancements will dramatically impact the movement under the new MACRA, MIPS and APM legislation from “Volume Based” care reimbursement to “Value Based” and Outcomes Management reimbursement. (8)

According to a report by Goldman Sachs in its Internet of Things (IoT)9 series, joining the physical and digital worlds: changing physician and patient interaction through digital health “offers the most commercially viable potential to change the US healthcare economy.” Goldman Sachs estimates $305 billion in savings generated by 3 new innovations:

  • $200 Billion from Remote Patient Monitoring
  • $100 Billion from Telehealth, and
  • “An infinitely large savings” from Behavior Modification regarding obesity management, smoking cessation and overall lifestyle improvements.

The report estimates commercially available opportunities to provide these services and technologies at approximately $36 billion per year.

Dr. Steven Gerst: Efficacy Needed to Overcome Hurdles for Digital Medicine/RPM Adoption.

Chronic disease accounts for 1/3rd of total US healthcare expenditures – over $1 Trillion annually10. Heart conditions, COPD, asthma, and diabetes constitute the largest cost component. These conditions also have the greatest potential using Digital Medicine/RPM to improve patient outcomes, lower adverse events, and reduced costs when shifting to a Value Based- Outcomes driven approach to treatment and reimbursement.

Digital Medicine/RPM is a powerful enabler. These systems will serve as the information portal to data management, giving managed care the potential to lower its chronic care burden. Efficacy remains the standard by which to judge any digital health offering.

With respect to digital health, “efficacy” is further defined as a user-friendly platform that collects accurate and actionable data promotes behavioral change (by both the patient and the provider in his treatment), demonstrates results, and also protects sensitive information.

The Goldman Sachs’ IoT report charts the hurdles in which must be overcome and how far we have progressed in the adoption of digital health including:

  • FDA Regulation: With over 100 digital health applications approved to date, the FDA has laid out   guidelines for regulation and approval for digital health.
  • Patient Adoption: Developers are creating seamless interfaces for users of all levels of tech competency.
  • Physician Acceptance: While most healthcare organizations have attempted to integrate mobile into
    their healthcare offerings in some way, there are many who are still not recognizing its viability, and are waiting for better technologies.
  • Reimbursement: Securing reimbursement is essential to the viability of digital health business models; while some argue that it is counter to the objective of connected health.
  • Privacy: Making mobile therapies HIPAA compliant represents a tremendous challenge in wireless healthcare.

Technology is now available to provide the efficacy needed to enable digital medicine through Remote patient monitoring and reimburse providers for their services. To learn more news about connected and digital healthcare, visit: www.stevenrgerst.com.

Dr. Steven R. Gerst is a Managing Partner of Telemetrix Systems, LLC (steve@telemetrixsystems.com), an Entrepreneur-in-Residence at the University of Miami, Miller School of Medicine, U Innovation, Office of the Vice Provost and is on the faculty of the School of Nursing and Health Sciences where he lectures on Management Information Systems in Healthcare.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He is also Dean Emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) where he serves on the Board of Advisors and has taught on the faculty.

Dr. Gerst also has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine and is a Principal in the Asclepius Life Sciences Fund, LP, a Cayman Islands activist Hedge Fund which invests private equity and venture capital in biotech and biopharmaceutical ventures (http://asclepiuslifesciences.com/).

1 Department of Health and Human Services, Centers for Medicare and Medicaid, Medicare Learning Network, “Chronic Care Management Services,” ICN 909188 May 2015. As found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

2 Department of Health and Human Services, Centers for Medicare and Medicaid, Medicare Learning Network, “Transitional Care Management Services,” ICN 908628 March 2016. As found at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf

3 Medicaid.gov. Section 1115 Demonstrations. As found at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html

4 Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. DOI: http://dx.doi.org/10.5888/pcd11.130389.

5 Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

6 20 Statistics on Hospital Readmissions. As found at: http://www.beckershospitalreview.com/quality/20-statistics-on-hospital-readmissions.html

7 Siwiki, B. (2016). Essentia Health slashes readmissions with population health initiative, telehealth. Healthcare IT News (March 15). As found at: http://www.healthcareitnews.com/news/essentia-health-slashes-readmissions-population-health-initiative-telehealth

8 CMS.gov. Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Merit Based Incentive Program (MIPS), and Alternative Payment Models (APMs). As found at: Medicare https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

9 Roman, DH and Conlee, KD, (2015), The Digital Revolution Comes to U.S. Healthcare, Technology, incentives align to shake up the status quo. Goldman Sachs Global Investment Research, Internet of Things, Vol. 5. (June 29, 2015.) p 4.

10 CDC, Johns Hopkins, and Robert Wood Johnson Foundation

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Dr. Steven R. Gerst: With 5G, Narrow-Band Connected Medical Devices, Home Security Companies May Become the Dominant Providers of Secure, HIPAA Compliant Digital Medicine and Remote Patient Monitoring Under MACRA, MIPS and APM Legislative Initiatives

The Internet of Things(IOT), or as it is now known in healthcare, the Internet of Healthcare Things(IOHT) is comprised of the very latest, modern advancements that include web enabled medical devices connecting people to healthcare providers electronically in real-time through home monitoring systems, implantable devices, ingestible sensors, smart phone apps, and wearables. These devices all work to gather patient generated health data(PGHD). These data are evaluated and shared with patient providers through a complex system that has begun to transform healthcare and how it is delivered to the patient.

The Internet of Healthcare Things allows constant monitoring of patients’ conditions while systematizing communication with medical professionals to prevent abrupt or serious health events from occurring. Constant monitoring enables prompt action before a condition worsens or becomes unmanageable. These innovations have proven to reduce ER visits. It is predicted they will provide immeasurable savings by lowering costs. In just chronic disease management alone, the savings is expected to be more than $300 billion.

New technology will engage the patient while gaining knowledge about their personal care plan. Coupled with early detection and the analysis of patient data, health outcomes may be improved to meet the requirements of the new Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

Digital Medical technology has become more affordable, making Remote Patient Monitoring (RPM) devices more accessible to almost all patient populations. This has established a higher demand for telemedicine and RPM than ever before.

Not long ago, many could not afford a home computer or internet connectivity. The smartphone and its various applications dramatically increased internet accessibility.  With over 7 billion cell phones on the planet and 92% of adult U.S. residents owning a mobile device, digitally reaching remote patient populations for vital sign monitoring is now possible and will likely become a standard in rural health.

With the rapid growth in affordability for medical devices, sensors, processing power and bandwidth, the Triple Aim of the Affordable Care Act can likely be achieved- “Improved access, better quality healthcare at a more affordable cost.”

Dr. Steven R. Gerst:  With 5G Narrowband connectivity, great promise is predicted for the IOHT. Home security companies could become the dominant force in Remote Patient Monitoring.    

Proper management of patient generated health data is essential. A primary medical provider should be designated to provide overall case management of each patient record with computer assisted, targeted predictive analytics to better manage a patient’s treatment plan.  Under CMS Code 99490 for Chronic Care Management and Transitional Care Management Codes 99495 and 99496, the Federal Government is reimbursing providers for this virtual, non-face-to-face care.

Establishing interoperability of devices with mobile, HIPPA Compliant Bluetooth hubs and narrow band 5G connections is the future of virtual, “non-face-to-face” remote patient monitoring.  In what could be a dramatic shift in healthcare delivery systems, the home security companies may become the largest providers of digital healthcare services feeding real-time, actionable HIPPA secured patient data to hospital and provider electronic medical record systems.

With hundreds of millions of sensors already in homes and complete emergency response system infrastructures already in place, home security companies can do what hospitals, providers, insurers and gateway providers cannot do on a nationwide scale.

This involves protecting patient data and security, something home security companies are proven to be able to do where hospitals and insurers have not. Patient Authentication technologies to verify patient and provider identities may still require additional advancements and web enabled communication channels must be proven secure in order to maintain the protection and integrity of the data flowing through them.

Dr. Steven Gerst: The Department of Veterans Affairs finds effective solutions in treating patients and expands the telehealth services it offers. 

In 2015 alone, the VA provided over two million telehealth visits. VA Telehealth programs reached over 677,000 veterans, or 12 percent of the entire veteran population, through home telehealth care, and store-and-forward medicine. The VA reported that they reduced hospital bed days of care by 58 percent, and psych bed stays of care by 32 percent. Under the  new outcomes based MACRA legislation, other hospital systems and insurers are likely to follow.

Today, the goal of the VA is to develop and leverage this technology even further, reaching veterans particularly in rural or hard to reach areas, and providing them with quality healthcare. Telehealth services allow healthcare treatment and services to be provided in a variety of environments outside of the traditional doctor’s office setting, such as in the patient’s home, or nearby in their local community.

The VA now provides healthcare services to veterans in 50 clinical specialties through three main initiatives:

·      Clinical video telehealth – Also known as VVCVA Video Connect, this visit takes place through real time interactive video conferencing between the provider and patient remotely. It enables the ability to provide fast, easy, real time and encrypted access to health care through a personal mobile device, smartphone, tablet or computer. It is used for video healthcare visits as well as telemental health visits. Clinical video telehealthprovides comfort, convenience, and ease of access for the patient. Telemental health has proven to be equally as effective as face-to-face visits, maybe even more so, as it offers an increased comfort level for the patient.

·      Home Telehealth Technologies: This allows the provider to monitor the veteran’s health, provide clinical advisement and treatment, while also engaging the patient by teaching them self-care management. The goal of this program is to assist the VA in improving clinical outcomes and providing access to more veterans while reducing complications, hospitalizations, and costs. Home telehealth technologies also help veterans to live independently.

·       The VA offers national store-and-forward telehealth programs that deliver screening services in specialties such as dermatology and retinal screening. Through the use of a special camera to take photos of the retina, for example, an eye care specialist can detect possible risks such as diabetes. They may then forward findings in a report to the patient’s primary care physician for treatment and follow up care.

While the VA has achieved success in utilizing telehealth technologies, improvements are always being sought and lessons are being learned, as is the same for most all healthcare providers who are the very beginning of this healthcare revolution that is known as Digital Telemedicine/Remote Patient Monitoring.

To learn more about the latest growth in Digital Medicine, Remote health and home monitoring, visit:www.stevenrgerst.com.

Dr. Steven R. Gerst is a Managing Partner of Telemetrix Systems, LLC (steve@telemetrixsystems.com), an Entrepreneur-in-Residence at the University of Miami, Miller School of Medicine, U Innovation, Office of the Vice Provost and is on the faculty of the School of Nursing and Health Sciences where he lectures on Management Information Systems in Healthcare.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He is also Dean Emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) where he serves on the Board of Advisors and has taught on the faculty.

Dr. Gerst also has served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine and is a Principal in the Asclepius Life Sciences Fund, LP, a Cayman Islands activist Hedge Fund which invests private equity and venture capital in biotech and biopharmaceutical ventures (http://asclepiuslifesciences.com/).

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Dr. Steven R. Gerst: Telemedicine Takes Hold in Health Care, Providing Valuable Alternatives to the Traditional Model of Delivery

Steven R. Gerst is excited about new changes in the healthcare industry and points to recent developments such as with healthcare leader, United Healthcare.

United Healthcare has just announced that it has broadened telehealth coverage options for enrollees in self-funded employer health plans. This represents great progress in the delivery of healthcare to the consumer. Choices for those eligible will include around the clock, online access to a physician’s services via mobile phone, tablet, or computer. United Healthcare also announced that it will be working with three telemedicine companies: Doctor On Demand, Optum’s Now Clinic, and American Well to cover doctor/patient visits via video technology in the same way it would cover in person visits.

Enrollees can access virtual visit care providers through United Healthcare’s Health4Me mobile app, which includes pricing information for each provider listing available within the subscriber’s network, and subscribers can compare costs between all three contracted provider groups.

A shortage of 45,000 primary care physicians has underscored the critical need for an alternative in healthcare delivery to the consumer, especially for those located in rural areas, or for those in an area where the shortage of providers has made it a challenge to find care. This growing need has made accessibility to virtual services a definite necessity, and demand is growing. Last year alone, it has been reported by the American Telemedicine Association that more than 10 million consumers took advantage of using telemedicine services directly.

Dr. Steven R. Gerst: Telemedicine represents a thriving field of opportunity that lies at the forefront of the modernization of healthcare.

The National Business Group on Health predicts that 48% of employers will provide telehealth options to employees this year. Telehealth options not only provide great benefits to employees on the healthcare delivery side, but they also serve as a money saving option as well. As United Healthcare has noted, the cost of a video based virtual visit is less than $50, compared to costs of comparable medical services received at a doctor’s office, which run at about $80. Savings increase even more when comparing virtual visit costs to those incurred at an urgent care center, where the patient fee commonly charged is at around $160, or to costs incurred in an emergency room, where the financial burden is the greatest, often at $650 or more per visit.

“UHC is developing innovative telemedicine solutions that enable consumers, especially people who live in rural areas of the country, to access quality, cost-effective health care, whether at home or on the go,” said Jeff Alter, CEO of UHC’s Commercial Group business. “Consumers can save time and money choosing among quality physician groups from the convenience of their smartphone, tablet or home computer at any time of the day.”

Also newsworthy, it has been reported that an unprecedented number of Telemedicine bills are awaiting congressional action. There is a backlog of legislation being introduced in both the House and Senate, and momentum appears to be growing in Congress to expand federal support for telemedicine, according to the American Telemedicine Association.

Steven R. Gerst: Technology is allowing patients to utilize alternative options that are helping them take control of their health.

Steven R. Gerst is Dean Emeritus, the Masters of Science in Applied Health Informatics Program, Board Member and Professor at Bryan University (Los Angeles, Sacramento, Toronto and Phoenix) and is currently at the University of Miami, Miller School of Medicine in the Office of the Chief Innovation Officer and Vice Provost in the “Entrepreneur–in-Residence” program where he is working in the area of medical information systems, telemedicine, medical devices, pharmaceutical product development and commercialization.

Steven R. Gerst is a graduate of the Columbia University College of Physicians and Surgeons (M.D.), Columbia College (B.A.), Columbia School of Public Health – Health Administration (M.P.H.) and the Goizuetta School of Business at Emory University (M.B.A.). He is a Diplomat in the American College of Healthcare Executives. He has also served as an Adjunct Professor of Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine.

Dr. Gerst will be speaking at the IHC Forum and Expo, taking place in Atlanta, Georgia at the Cobb Galleria Center, June 23rd – 25th, 2015. He will be speaking on healthcare consumerism, and the solutions for health reform.

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The Affordable Care Act Has Created a Remarkable Transformation in Healthcare that Continues to Adapt and Grow – Even Amid Political Threats to Change It.

The Affordable Care Act has led to a new era in healthcare. With constant political threats looming to bring forth change or to dismantle it, the healthcare industry continues to gain strength while changing shape and moving forward. It shows few signs of slowing. Fortune.com points out that this is an important time to be following the rapid transformation of healthcare.  As the largest single industry in the world ($2.9 Trillion spent annually and growing), U.S. Healthcare continues to incorporate fresh innovation while providing a shining example of how the public sector and private sector can join forces to launch healthcare into a new dimension: cross-over digital health and wellness medical device products leveraging clinical technology into the home to improve triage efficiency through the retail industry.

Steven R. Gerst: The brightest outcome of America’s ‘new healthcare’ will benefit the patient above all.

Fortune.com mentions three factors that presently stand out that provide foreshadowing for the future:

  1. The combination of public and private exchanges creating 9.1 million new customers fostering a competitive market focused on better quality and lower prices. The ACA is finally creating an industry responsive to consumer demands.
  2. Employer provided health insurance, the nation’s main source for coverage, is driving innovation, helping hospitals and providers create new consumer portals to access data, coordinate care amongst providers and leverage technologies into the home. This forces focused change from volume driven incentives to value and outcomes metrics.
  3. Insurers are also retooling protocols toward improved health outcomes By combining efforts with medical device manufacturers and pharmaceutical giants technology driven solutions will allow digital monitoring of vital signs and other health indicators into the home through wireless technologies directly into physician portals with e-prescribing and other digital solutions leveraging efficiencies and reducing the need for Emergency Room Visits and primary care office visits creating immeasurable new consumer and employer benefits.

Steven R. Gerst: Government and private sector partnerships are establishing a significant part of healthcare today.

Competitive public exchanges, new grants and incentives worth hundreds of millions of dollars are being offered to the private sector to drive innovation and experimentation with new care delivery, the development of new technology, research, and other areas. Digital technology is a primary focus. Consumers are taking more control over their own health, creating demand for wearables, mobile apps, and new FDA approved medical device technologies. Fortune.com reports that the FDA cleared 24 new devices in the first 10 months of 2014. While an emphasis on digital technology is nothing new for the healthcare industry, it is still considered to be of critical importance for research and analytics, consumer engagement, and offers great value to operational efficiency to the future of healthcare.

Simultaneous with the proliferation of wireless devices for the home and portal transmissions is the growing importance of securing personal consumer data. Ensuring their privacy is of utmost importance to all parties involved will be paramount to the success of healthcare providers and companies. Many consumers report a willingness to share more personal information of value with providers electronically to improve care coordination and real time decision-making. Yet privacy and security must be maintained. As these issues are addressed, technology will provide more convenient access to imaging and test results, computerized clinical decision support, doctors’ notes, chart information, diagnoses and prescriptions.

Dr. Steven Gerst lectures on the new reforms in the Affordable Care Act. He shares his foresight and understanding about what is needed to improve healthcare overall. Dr. Gerst is a respected expert in the field among his peers. To learn more about changes happening with the Affordable Care Act, and in the field of health informatics, visit: http://stevenrgerst.com.

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