Philips to acquire BioTelemetry, Inc. for USD 72.00 per share; implied enterprise value of USD 2.8 billion (approx. EUR 2.3 billion)
Acquisition is a strong fit with Philips’ strategy to transform the delivery of healthcare: combination of Philips’ leading patient monitoring position in the hospital with BioTelemetry’s leading cardiac diagnostics and monitoring position outside the hospital
With 2019 sales of USD 439 million, BioTelemetry annually monitors over 1 million cardiac patients remotely; its portfolio includes wearable heart monitors, AI-based data analytics and services
Combination will result in significant synergies driven by cross-selling opportunities, geographical expansion, portfolio innovation synergies, and productivity gains
BioTelemetry business is expected to deliver double-digit growth and improve its Adjusted EBITA margin to over 20% by 2025; acquisition will besales growth and adjusted EBITA margin accretive for Philips in 2021
Amsterdam, the Netherlands – Royal Philips (NYSE: PHG, AEX: PHIA), a global leader in health technology, and BioTelemetry, Inc. (NASDAQ: BEAT), a leading U.S.-based provider of remote cardiac diagnostics and monitoring, today announced that they have entered into a definitive merger agreement. Pursuant to the agreement, Philips will commence a tender offer to acquire all of the issued and outstanding shares of BioTelemetry for USD 72.00 per share, to be paid in cash upon completion. This represents a 16.5 percent premium to BioTelemetry’s closing price on December 17, 2020. The implied enterprise value is USD 2.8 billion (approximately EUR 2.3 billion), inclusive of BioTelemetry’s cash and debt. The board of directors of BioTelemetry has approved the transaction and recommends the offer to its shareholders. The transaction is expected to be completed in the first quarter of 2021.
The acquisition of BioTelemetry is a strong fit with Philips’ cardiac care portfolio, and its strategy to transform the delivery of care along the health continuum with integrated solutions. The combination of Philips’ leading patient monitoring position in the hospital with BioTelemetry’s leading cardiac diagnostics and monitoring position outside the hospital, will result in a global leader in patient care management solutions for the hospital and the home for cardiac and other patients. Philips’ current portfolio includes real-time patient monitoring, therapeutic devices, telehealth and informatics. Moreover, Philips has an advanced and secure cloud-based Philips HealthSuite digital platform optimized for the delivery of healthcare across care settings. Every year, Philips’ integrated solutions monitor around 300 million patients in hospitals, as well as around 10 million sleep and respiratory care patients in their own homes.
Given the risk of chronic disease increases for all of us as we age, it’s not surprising that two out of three older Americans have multiple chronic conditions. These conditions often involve complex treatments, like juggling a handful of different medications. That’s why we put together this toolkit. This medication management guide will empower seniors, caregivers, and family members with helpful information about medication use, storage, organization, and more.
In this guide, you’ll learn how age changes our response to medication, and how to keep track of the medication you’re taking. You can also find out how you can reduce your medication error and drug interaction risks.
Throughout this guide, you’ll find tips for becoming a more active part of your own health care. We believe education empowers you. Of course, it’s important to always check with your doctor or pharmacist before you take any new medication or make changes to your medication regimen, so be sure to ask your healthcare provider how the information in this guidebook can apply to your individual health.
Effective medication management requires teamwork
You’re an important part of your own health care—which is why you should educate yourself and be an empowered consumer. To be successful, you’ll need to partner with your healthcare team to keep them informed and work together to make the right medication adjustments. Instead of prescribing medication once and refilling it for the rest of your life, your doctor needs to be aware of health status changes that may affect or even eliminate your need for certain medications altogether.
“I would also recommend asking if there are any medications which are no longer needed,” says Erin Pitkethly, pharmacist at Robinsong Health Low Carb Clinic. “It is very common for meds to be added on, but it is uncommon for them to be stopped even when they are no longer needed. ”
Adding to the potential confusion, many seniors have a mix of different medicines, some of which are prescription and some that are not. Even if it’s just a medicine you take for a temporary condition, it’s important to read labels and understand why you’re taking every drug.
Regardless of the type of medication, it should have a label with basic information that can serve as your guide and starting point.
Reading medication labels
As you review your new prescription, be sure to read the label carefully for information on dosage, timing, interactions, and other important medication management details.
Typically, a prescription label has eight parts and types of information. Keep in mind that your own prescription labels may look somewhat different, but they will generally have similar content listed for you to reference. Learn to recognize these parts on your own medications:
Pharmacy information: Name and address, phone number, and other key details about the pharmacy that filled your prescription.
Your information: Name and address of the person the drug is prescribed to.
Prescribing doctor’s information: Physician or healthcare provider’s name and contact information are also included.
Drug name and strength: Medicine’s brand, chemical, or generic name along with the strength of one unit of the prescription in a measurement such as milligrams (mg).
Instructions: Instructions might read “Take one tablet twice daily, morning and night, by mouth” and explain how and when to take the medication. Always read the instructions section carefully for any new medication, and ask your doctor or pharmacist if you have questions.
Prescription information: Date your medication was prescribed, the date your medication was filled by a pharmacist, the number of pills or doses provided, how many times your prescription may be refilled, when your medication expires, and the number your pharmacy assigned to your prescription.
Pharmaceutical manufacturer information: Name of the company that manufactured your medication and a physical description of the drug. If it’s a generic version of a brand-name drug, the name of the branded counterpart may also be listed here.
Federal caution statement: Prescription warnings such as “Caution: Federal law prohibits transfer of this drug to any person other than the patient for whom prescribed.” Remember, you should never take someone else’s medication even if you’ve taken it before. It’s dangerous to take medicine that’s not prescribed for you and doing so could put your health at serious risk.
An over-the-counter medication you can purchase without a prescription has a different label, called a drug facts label. Here’s what that usually includes according to U.S. Food and Drug Administration (FDA) regulations.
Active ingredient(s): The therapeutic ingredients within your medication and the amount in each dose.
Uses: Any symptoms or condition the medicine is designed to treat or prevent.
Warnings: This section tells you when you shouldn’t use this medicine, lists possible side effects and drug interactions, lists any conditions that may require a doctor’s advice before taking the medicine, tells you when you should stop taking the medicine and see a doctor, and provides other critically important information about taking the medication. Read this section carefully. If you’re concerned about anything you see, talk to a healthcare professional.
Inactive ingredients: Other substances added that don’t have a therapeutic effect, such as colors or flavors.
Purpose: The medicine’s category or action is included (for instance, antacid or pain reliever).
Directions: Dosage information may offer different doses for different ages or symptoms. It may also direct you to ask a doctor.
Other information: Anything else the manufacturer wants you to know about the medicine. It may include information about how to store the drug. It may also list how much of an ingredient (such as calcium) the medication contains.
When you get a new medication, take a look at the label and jot down any questions you have for your healthcare provider. If you’re using medication reminders, add this prescription so everything is ready for the first day of treatment. If you encounter anything unusual or confusing on your label, check with your pharmacist.
Do keep in mind that your prescription is tailored to your health. Even if a friend or family member is taking the same medicine, your medication may work differently for you. This is one reason why it’s absolutely essential to refer to your healthcare team for medical advice and information instead of other sources (like the internet) meant for a broad audience. Only your healthcare provider can give you relevant guidance for how to take medications safely.
Aging changes our responses to medication
As we age, our bodies change how they interact with medications. Even very healthy people might respond differently to medications than they did in earlier years. Getting the most from your medications is possible with close cooperation with your healthcare team.
How does aging change the body’s reaction to pharmaceuticals? Here are few possible changes.
Metabolism: Your body processes each medication at a different rate. Over time, your metabolism of a particular drug may speed up or slow down. This can increase the risk of side effects or decrease the effectiveness of the drug.
Brain and nervous system: Many drugs impact the central nervous system (CNS) directly and aging can change this process. For example, seniors are more susceptible to the CNS effects of drugs like benzodiazepines and antidepressants.These effects can include increased dizziness or drowsiness for some people.
Kidney and liver function: Since these organs are responsible for filtering and cleaning, any age-related changes to kidney and liver function can adjust how well your body is able to remove medicines and toxins.
Weight changes: Many people gain or lose weight as they experience appetite changes. Some drugs are processed and distributed differently throughout the body depending on your body weight.
“Elders have less tolerance for medications than younger adults,” says Elizabeth Landsverk, MD, a board-certified geriatric doctor and founder of ElderConsult Geriatric Medicine. Dr. Landsverk notes that these changes in how our bodies process medication can lead to different side effects. The timing of new side effects may provide clues to the root cause, however. “If a symptom starts after a new medication, it’s likely a side effect from the new meds,” she says. “Seek the advice of a doctor or pharmacist, they will likely change the prescription. Do not change dosages or try a different medication based on something you read on the internet.”
Aging may also change the dosage you need before your medications are effective. So your healthcare providers should regularly reevaluate the medicines you’re taking to see if new prescriptions are necessary. According to Dr. Landsverk, many seniors gradually lose their appetite and experience weight loss that impacts medication dosage.
If you notice anything different or unusual during treatment, it’s important to bring this up during your next conversation with your doctor or pharmacist.
Medication safety tips and dosage information
Knowing how to manage your medications can be the key to benefiting the most from your treatments. Medicines have the potential to make life-changing improvements to your health. At the same time, your medications are only helpful if you know how to use them correctly.
Ultimately, your doctor or personal healthcare provider and your pharmacist should be your guide on how to use and track your medications. When in doubt, be sure to check with a qualified health professional. Only your healthcare provider or pharmacist knows how your individual health profile, health status, and history impact your medication needs.
Medication safety also means knowing where many seniors go wrong with medication management and how you can avoid those mistakes to protect yourself.
Common medication mistakes and how to avoid them
“The two key challenges that seniors face are polypharmacy (taking lots of pills) and remembering to take them,” says Dr. Ceppie Merry, who holds a Ph.D. in pharmacology. “It can be really complex to remember what to take and when to take them.” Merry also adds that any cognitive decline or complex conditions seniors have can make it even easier to make mistakes when managing your own medications.
Medication errors can have serious consequences for your health. Many people accidentally take the wrong dose, miss doses, or take their medications incorrectly. Don’t panic if you use your medication incorrectly, but do call your doctor if you’re concerned. (If you are experiencing a life-threatening emergency, call 911.) The adage “better safe than sorry” applies here. This is why you should always keep important phone numbers like your doctor’s contact information nearby in case you need to call their office.
To stay on track with taking your medicines, it helps to have a medication strategy. Here’s what you can do to reduce your risk of a serious medication error.
Take medications consistently: Always take your medications at a consistent time. It also helps with consistency if you can associate taking the medication with a specific event like a meal. For instance, if you take a pill with breakfast at 8 a.m. one day, try to always take that medicine around 8 a.m. when you eat.
Use reminders: Forgetful about taking your medicine? Consider using a reminder app or setting an alarm for each dose.
Prevent interactions: Many medicines can’t be taken together or with specific foods or supplements. A lot of medications interact with citrus fruits, for example. Your pharmacist can help you identify any diet or medication list changes you need to make.
Get a medication review: With every new prescription, ask your pharmacist to review your medication and supplement list. Your healthcare provider may recommend ideas for how to take them together safely. Also, see if you’re eligible for your pharmacy’s medication therapy management (MTM) program. Your pharmacist will sit down with you for a comprehensive medication review at no additional cost to you.
Ask your doctor or pharmacist: If you’re prone to forgetting doses or taking an extra pill now and then, ask your healthcare professional what you should do if this happens. Sometimes, it’s not a big deal. Other medications might cause a serious interaction, side effect, or other serious damage to your health.
Read the literature and instructions: If your medication came with written information or your healthcare provider included instructions, be sure to read these carefully. If anything is unclear, don’t hesitate to make a note of it. Call your doctor and ask for clarification before you start taking your medication. It’s a good practice to read the instructions before you leave the pharmacy, so you can ask the pharmacist.
Have trouble remembering your medications? Here are a few ideas to try.
Use a dosage reminder or pill reminder app: Consider using a smartphone pill reminder app to remind you to take medication.
Set an alarm: Set an alarm for times during the day that you take your medicine. Be sure to keep track of what you’re supposed to take, too.
Make a list: Write down a list of your medicines and the time you take them so you can easily refer back to it later.
Ask for help remembering: If a family member, friend, or caregiver can help you remember, ask for their help.
Add it to your calendar or planner: Write down reminders in your calendar or planner.
Use sticky notes, send yourself emails, or post other reminders: Think about how you manage your time and how you use reminders. Choose a method that works best for you.
Use a pill organizer for medication storage: At most drugstores, you can buy an inexpensive pill organizer with compartments for different times and days. This works best if you take a small number of medications every day.
Keeping your medications organized may also prevent mistakes. Here’s how to get started with tracking and organizing medicines.
Organizing your medications and medication storage
Managing your medications is easier when you can fully account for everything you’re taking. With the help of a healthcare professional (if needed), gather all the medications and supplements you’re currently taking and start organizing them.
Consider these tips to help with medication management.
Create a medication list (if needed, use a medication list template): Write the name of each prescription you’re taking on the list. You can also add information about how often you take each dose and for what condition, but the important thing is to start with a complete list of drug names and doses so your healthcare provider knows where to look and what questions to ask.
Start with supplements: Since so many people don’t consider supplements to be medications, it’s not uncommon for some seniors to take supplements that interact with medications prescribed by their doctors (or contain unhealthy ingredients). Bottom line—your doctor needs to know. Make sure your personal medication list template covers supplements.
List all OTC (over-the-counter) medicines you take: Many seniors take drugstore medications that are sold over-the-counter without a prescription such as acetaminophen (the generic version of Tylenol) for pain relief or calcium carbonate antacids for managing heartburn.
Keep medication packaging: Hold onto the original boxes and containers for your medications so you can quickly refer to the package or label if needed. Package inserts or patient information leaflets are included with the medication so be sure to keep it with the original packaging. A shoebox-size plastic storage bin with a lid or a gallon-size plastic bag are great ways to store packaging and information for medicines you’re currently taking. Always store your medicinesand packaging away from where pets and children can reach them, even if your medicines have child-proof caps.
Pick one pharmacy: Ideally, you should only use one pharmacy so your pharmacist can easily review your other prescriptions and provide you with relevant information about contraindications. If you must use more than one pharmacy for any reason, be sure to provide complete information about the medications you’re currently taking, and make sure the pharmacist has access to this information.
As you organize your medications, don’t forget to check expiration dates and remove medicines you no longer take. Ask your doctor if it’s okay to discard old medication documentation.
Reviewing medicine with your pharmacist or doctor
Periodically, you should have a medication review appointment with your doctor. During these appointments, you’ll want to keep your doctor informed about how your treatment is going. This is also a good time to ask questions and express your concerns. Highlight any side effect you haven’t told your doctor about yet, and mention any frustrations or concerns you have with your medicines. Don’t forget to bring a list of questions with you. Since many doctor appointments are short, make the most of your time together by preparing a list of topics and questions beforehand.
By educating yourself and managing your medications properly, you may get better results from your treatment and you may avoid some of the common risks of using medicines. Your healthcare team is there to help you. Work closely with them and become your own healthcare advocate.
Your body goes through a number of gradual changes as it ages. Your sense of smell and taste are altered, the body loses some of its strength and flexibility, and memory and cognition may slowly diminish. Lifestyle changes and adaptations are often necessary during the later years, but your basic needs stay the same. You still need to exercise, eat nutritious food, find ways to keep your mind active, and pay close attention to your health.
Nutrient-Dense Foods As your sense of taste changes, your food preferences may shift. Foods you once ate with gusto may have lost their luster., but the need for a diet rich in nutritional food remains. Your diet still needs to include vegetables and fruit (the more colorful the better); beans, seeds, and nuts; low- fat dairy, including milk, cheese, and yogurt; protein-rich meats, including seafood, poultry, and eggs; and whole grains, such as whole-wheat bread, brown rice, and oatmeal. Mindful Chef and Hello Fresh, two of Britain’s leading meal delivery services, offer delicious foods made from healthy ingredients, a valuable resource if cooking every day has become too difficult. If you’re looking for some easy and healthful recipes, why not enjoy a breakfast of scrambled eggs over red potatoes and a salmon wrap for dinner (salmon in a whole grain wrap with tomatoes and avocado)? Or, if you’re into really simple recipes, just whip up a can of pinto or black beans and serve with brown rice, oats, or barley. Technology Smart home technology is making it easier for older adults to age in place and live safely in their homes. For those with hearing impairments, smart doorbells allow you to see who’s at the front door, whereas external security cameras help keep your home secure from intruders. These high-tech advantages also let you check on your house from wherever you happen to be, and indoor cameras make it easy for family members to keep an eye on you.
Senior-Friendly Exercise Exercise is an important factor in one’s health no matter what age you happen to be. Even if mobility limitations make it difficult to engage in physical activity, there are many senior- friendly exercises that can be done easily in the comfort of your own home. Just raising your arms and legs slowly can help strengthen weakened limbs, and all you need to do toe raises is a straight-backed chair to lean on. If walking is your favorite form of exercise, start a walking group with friends so you can enjoy some social interaction as you exercise. However you like to exercise, bear in mind the National Health Service’s recommendation that seniors need to do two types of physical activity every week, involving both aerobic and strength exercises.
The NHS and Seniors The National Health Service works to help seniors remain as healthy and independent as possible, for as long as possible. That includes using early identification and self-management assistance to help reduce the period of time an older adult spends in ill health. Check out this online resource on healthy aging. The NHS emphasizes personalized care planning and provides information on maintaining a safe home environment. Older adults who suffer from Alzheimer’s disease or dementia can find support through Britain’s Alzheimer’s Society. Growing older doesn’t have to mean giving up on an active and enriching life. Your body may have changed, but you don’t have to settle for a sedentary lifestyle. The secret to good health remains much the same for seniors as it always has: exercise, eat a nutritious and well-rounded diet, and pay careful attention to one’s health and in-home safety. It’s a time to try new things, to see new places, and make (or renew) friendships.
Seriously Simple, and Smart, Ways to Plan Ahead for Long-Term Care
Why do you need to plan ahead for long-term care? If you have no clue how to answer this and you are planning for retirement, you could be in for a major financial surprise. Long-term care is expensive and most everyone needs it at some point, so it’s important to take these long-term care planning tips to heart before you finalize your retirement plans.
Be Aware of Medicare Limitations
If you’re looking forward to retirement, you may think you don’t need to plan for long-term care because Medicare will cover it. This is a huge mistake, however, because Medicare offers basically no coverage when it comes to paying for a nursing home, an assisted living home, or in-home care. That’s because this kind of care is considered custodial, rather than medical, and therefore is not included in the coverage that most seniors receive from Medicare. With long-term care, you are more likely to need help with daily tasks such as bathing or dressing, and this is why more involved care is necessary. Medicaid might cover some costs if you’re eligible, or you may be entitled to assistance from the VA if you have served in the military or are an eligible dependent. If neither of these is an option, you will need to come up with other ways to plan for care. However, try not to stress yet. If you are planning well ahead of time, you have some ways to prepare yourself for long-term care.
Make Healthier Changes to Your Life
There’s really no surefire way to prevent the need for long-term care. According to statistics, you may need long-term care at some point in your adult lifetime. You can, however, try to beat the odds by making some simple changes to your life and home. Falls can be a source of debilitating injuries as you get older. Those tricky stairs could lead to a serious fall in the future, so take steps to help yourself age in place at your own home. If you do have steps or stairs, have some secure railings installed on either side to provide support and reduce your risk of falling. You’ll also want to think about fall-proofing your bathroom as time goes on, by installing grab bars in slippery areas. Another simple change you can make is to add better lighting throughout your home. You can swap out to brighter bulbs or add fixtures to ensure areas are lit evenly. Finally, don’t underestimate the impact lifestyle choices can have on your long-term health. Regular exercise and diet can reduce your risk for serious conditions such as dementia and Alzheimer’s disease and give you a chance for a more independent life.
Research All Your Options for Paying for Care
Paying for long-term care can be a real financial burden, especially if the need comes up unexpectedly. Most American seriously underestimate long-term care expenses, which can run upwards of $100,000 per year if you need to stay in a nursing home. However, you have a decided advantage by choosing to plan ahead. For one, you can research just how much care could cost you, as well as how exactly you can pay for it. If you are in your 50s, for example, you may be able to snag long-term care insurance for much lower monthly payments than someone who is only a few years older than you. When long-term care insurance is not feasible, there are other financial avenues you can include in your long-term care plans. You could pre-pay, plan to receive care from a loved one, or you can get roommates to offset housing costs and allow you to tuck away more funds for care.
Planning for long-term care doesn’t have to be a headache. If you start planning early and going over all your options now, you will have more options to choose from and end up with less stress in the future if you do need some form of long-term care. So, don’t forget to add long-term care to your list of essential retirement planning steps.
Micro2media.com has just completed its homecaremarketplace platform YMKT and invites medical professionals such as RAI evaluators or specialized nurses to register on Micro2media.com to offer their services at home.
Several organizations have showed interests using this platform if the number of registered resources is sufficient.
Housekeepers can also register for housekeeping and meal services. Registration is completely free. Service providers can indicate their availability and their hourly rate in order to receive the right requests.
The Micro2media.com social network, YHSN (e-Health Social Network) is being finalized. The marketplace platform should be able to integrate with eHSN but also with coreERP, software used by medical organizations, to bring these organizations closer to the medical professionals and patients.
eMEDICS.org coreERP v1.7 turnkey solution has been successfully completed for the Swiss market. The EMR (Electronic Medical Record / Medical requests) and RAI evaluation processes (RAI MDS and Household assessments) are now fully functional. When the medical staff assess RAI MDS evaluations, performance scales (ADL, IADL, CPS and DRS) as well as the GAD alarms, are automatically generated (on the fly). This helps streamline the decision making. Mental Health PHQ-9 / GAD-07 is being implemented and shall be available in the coming weeks.
We invite Swiss home-care organizations to contact us at firstname.lastname@example.org or +41 75 416 4140 to participate to our pilot projects. Your organization would take advantage of a substantial gain of productivity in your day to day business (ex: use of Electronic Patient record, fill-in RAI evaluations online, document generation on the fly, such as OPAS…). In exchange, free licenses and support will be provided by eMEDICS.org team in order to meet your expectations and business needs.
coreERP solution is now responsive using the same code for mobile and web, reducing by half any development cost. The solution could also be used in the field while we’re still adjusting the offline capabilities. It has been optimized to run on any type of IT infrastructure. Our framework is open-source which makes our first class solution available to large but also small to medium home-care organizations. Our solution combines quality and competitive pricing over time with a drastic cut in maintenance and operations.
1) Pilots and projects updates:
We’re already in discussion with a couple of home-care organizations to start pilot projects.
We’re also meeting AVASAD this month, to discuss a potential collaboration.
At this stage, we only invite Swiss home-care organizations that are interested by such a solution to contact us for free demos and licenses.
The generic international InterRAI solution is scheduled to be supported by Q4 2018. European and North American home-care organizations could still contact us to book a demo and reserve free coreERP licenses.
2) Infrastructure update:
coreERP has been tested on shared hosted environments such as InfoManiak and the solution works perfectly fine. This is a huge achievement, allowing small/medium/large home-care associations to significantly reduce their infrastructure expenses and operational costs.
InfoManiak infrastructure platform provides a state-of-the-art back-up solution: your data is backed-up daily on a second data center and previous versions could be restored in one click. This is crucial especially when dealing with high sensitive patient data information.
It is now GDPR compliant (European General Data Protection Regulation) which makes it the best choice to host our Health oriented software for European organizations.
coreERP is also being tested in other countries (OVH and HostGator) and on-premise (LAMPP and WAMPP servers).
3) eMEDICS.org Process automation update:
OPAS computations are fully functional providing the LiMA and OPAS estimates on the fly.
Approbation workflows are ongoing and should be ready in the coming weeks.
The advanced business process automation based on RAI assessments, has been refined and is functional. An updated version including end-to-end automation (from the assessment or the medical request to invoicing) shall be available by Q2, 2018.
4) Other updates:
Multilingual module is now available and any language could be supported by filling-in a single source file. coreERP could handle any new language in a week.
Activity reports and time sheets are 50% completed.
As planning of the visits may require extensive computation, we’ve decided to incorporate coreERP with existing solutions instead of implementing the whole solution ourselves. Several partnerships are currently being discussed.
eMEDICS.org Health Care Network (EHC Network): our EHC Network implementation is progressing and will be opened to all physicians, clinics, pharmacies, Home care organizations, hospitals and insurance companies (with the preservation of medical data of patients), and patients themselves, facilitating the exchange of medical information by Q4 2019. A catalog of forms will be available to medical organizations, which will allow them to set better diagnosis and share data with the patients (patients could also provide health measurements over time).
The considerable hype around blockchain is starting to be tempered by enterprises earning practical experience and identifying worthwhile use cases for the technology.
Most of the buzz around blockchain in healthcare has focused on EHRs, interoperability and security, but a new potential for value-based care, precision medicine and a patient-driven healthcare system are emerging as more clear and present opportunities for the distributed digital ledger technology.
While we don’t expect the hope for data interoperability and security to fade away, hospital executives who want to stay abreast of what’s really happening with blockchain will also need to understand these new considerations.
Blockchain and the move to value-based care
A variety of possible use-cases for blockchain are coming into focus for healthcare, ranging from clinical to financial to administrative.
“Traditional healthcare fee-for-service payment systems are overly complex and expensive from an administrative perspective. On average, payment administration accounts for about 14 percent of healthcare spending. Blockchain applications can definitely reduce the waste,” said Corey Todaro, chief product officer at Hashed Health, which leads a consortium of healthcare companies focused on accelerating innovation using blockchain.
Beyond fee-for-service, blockchain as a technical architecture can enable value-based payments to take off and thrive, some experts said.
“Blockchain can enable a smart payment system to match the distributed care teams that will take responsibility for episode- and disease-centered payment models,” Todaro added.
Claims adjudication and billing management is ripe for a blockchain-based system that can provide realistic solutions for minimizing medical billing-related fraud; this is a highly relevant use-case given the amount of fraudulent activities around improper medical billing and reimbursements across the payer industry, said Tapan Mehta, market development executive in the healthcare practice at DMI, a mobile technology and services company.
“For example, in a situation where a health plan and patient are dealing with a contract, the blockchain could automatically verify and authorize information, as well as the contractual processes, eliminating the back-and-forth between multiple parties,” Mehta said. “This would increase transparency and efficiency, leading to lower administration costs, faster claims processing and less money lost.”
Precision medicine and a patient-driven healthcare system
Blockchain-based systems could help drive unprecedented collaboration between participants and researchers around innovation within medical research, particularly in the fields of precision or personalized medicine.
Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, said that blockchain can enable the patient-driven healthcare system.
“The lack of interoperability among data systems in a personal health network is a detriment on patient care,” she said. “Informed patients know that data is critical to enhancing their care and safety. This is beyond safety from data hacks, this is the ability for their healthcare providers to have access to information that will help them better treat the patient.”
There has been a trend in educating patients to manage their health to embrace wellness and prevention, and that may also include the data that is generated out of this practice, she added.
The best type of patient is an informed patient. If blockchain can deliver a patient-managed EHR system, the business of healthcare will be about delivering service and treatment to better health and not owning the patient’s health, Palombini said.
Precision medicine in clinical trials presents another big opportunity for blockchain innovation, Mehta said.
“According to IgeaHub, it is estimated that about 40 percent of clinical trials go unreported,” he said. “In fact, a majority of pharmaceutical research related to clinical trials is completed in silos, thereby making collaboration across an organization’s internal team impossible. This creates crucial safety issues for patients and knowledge gaps for healthcare stakeholders and policymakers.”
The contribution of wearables
Wearables and internet of things devices can also be integrated into the health IT ecosystem via blockchain.
“Health wearables are currently hoarding critical information for clinical research, outcomes of treatments, and disease prevention and management,” Palombini said. “However, in its current state, the information often sits in a repository where raw data may be inaccessible and never has the ability to be shared for other uses.”
If validated, this health data could be secured, shared and verified on a blockchain and the function of the health wearable takes on a whole new role, with, for example, clinical trial patient recruitment, clinical research and treatment of disease.
Indeed, patient-mediated health data exchange holds a big opportunity for blockchain innovation in healthcare. Blockchain can empower patients and data owners to control access to their healthcare data by using the blockchain as a system of record for patient consent and health data transfer activity.
“Today, patients have little access to their health data and cannot easily share with researchers or providers,” said Shahram Ebadollahi, chief science officer at IBM Watson Health. “Giving patients the opportunity to share their data securely, for research purposes or across their healthcare providers, creates opportunities for major advancements in healthcare. Blockchain technology is designed to make this a reality.”
As more and more patients gain that kind of control over their own data it will flow more efficiently across the system to create something a lot closer to a longitudinal view than what exists now and that, in turn, can enable more accurate data, better access to new treatment options and ultimately improved outcomes, Ebadollahi said.
Yes, this is where electronic health records come back into the blockchain picture.
Blockchain and EHRs
One big question is how might blockchain affect the evolution of the electronic health record? Blockchain can enhance EHRs in many ways, presuming healthcare CIOs and other executives want to move in that direction.
“Blockchain will help connect electronic health records across providers, to enable the full view of a patient’s health data, if patients provide the consent to do so,” Ebadollahi said. “This would be through a patient-mediated health data exchange.”
Currently, EHRs focus on clinical data. The fastest growing type of information is exogenous data, from mobile devices and medical devices and including genomics, Ebadollahi added, and blockchain can help connect these disparate sources to the more traditional clinical data.
The electronic health record, in fact, is generated from many different sources – hospitals, doctors offices, labs and more – each acting as the owner of the data. The fragmented network tying things together can be viewed as more about maintaining the business of patient care.
“If we look at the truly disruptive and emerging trend in blockchain and healthcare, the EHR will be created, maintained and distributed by the patient,” said IEEE’s Palombini. “Therefore, no longer multiple health records owned and operated by Healthcare Inc. Instead, it will be one record with multiple compartments containing data that was extracted as a service by one of these entities and given back to the person to add to their health record.”
These entities will no longer own a patient’s health record; they will merely contribute to the data in it as a rendered service, she added. Blockchain could flip the ownership and maintenance of the EHR completely upside down. It could empower patients to choose with whom, how much, and when they want to share their information, and not be beholden to any health system, she said.
Dave Watson Chief Operating Officer of SSI Group said that EHRs and blockchain working together have a long way to go.
“First, EHR vendors have so many pressing enhancements to deliver, and second, without clear and compelling use-cases, why would EHR vendors move blockchain up in the development queue?” Watson pressed. “They may entertain some proofs of concept or simply make positioning statements so they don’t appear to not be on the bandwagon, but that’s not a viable deployment of the technology.”
Blockchain and security
Another area in healthcare where blockchain could have a profound impact, like with EHRs, is cybersecurity. Blockchain can fundamentally change the way healthcare CISOs and infosec teams think about securing data.
“Blockchain offers a new combat strategy because it is not simply a security system, it is a technology that compels every enterprise professional to rethink their business operations in a digital universe,” Palombini said. “Blockchain is not a patch. It’s a whole new approach to distributing, managing and verifying information in a tamper-proof, decentralized system.”
All transactions are time-stamped and replicated in every block visible to permissioned users but can never be altered, only appended. The decentralized nature of the blockchain provides the ability to distribute anonymized, encrypted data that can be verified by credentialed users.
“This can provide traceability for all health data access, with transparency to auditors,” said IBM’s Ebadollahi. “Blockchain can provide integrity of data by maintaining indelible hashes of the data, so that any alterations of the data are detected.”
The distributed digital ledger technology can also can maintain keys for access to data, adding another level of security by working in concert with other systems to produce immutable audit logs, thereby making illegitimate access more difficult, Hashed Health’s Todaro said.
The largest opportunity is rethinking the movement of data in the healthcare ecosystem. Todaro explained that blockchain enables the development of light-data transactional models in which partners can get expanded utility without having to do large-scale data transfers or availability, both of which are sources of cybersecurity risk.
“One might argue that it may not be blockchain the technology that is oversold, but the amount of work to fix existing taxonomies, protocols and policies to fully maximize blockchain may be undersold.”
Maria Palombini, IEEE Standards Association
Hype outpacing reality?
In the end, one might wonder whether blockchain is all it’s cracked up to be. Evangelists sure make blockchain sound like a panacea for all of healthcare’s woes. But is it? Or is there more hype than promise?
Today, the challenge in truly driving innovation in the healthcare system is the inability to obtain and share clean patient health data while maintaining data privacy. The current crop of data management systems are not designed to evenly negotiate the ability to share data while retaining privacy, so the default has been to safe-harbor the data and let data-sharing fall to the wayside.
“The lack of data-sharing has become a true impediment to advancing innovation in drug development and healthcare,” Palombini said. “The true value healthcare providers offer is not the service or product but the data they provide. The data is the key to innovation in finding treatments, disease prevention and more.”
The very nature of blockchain – to distribute information with anonymity in an encrypted and tamper-proof environment – provides the platform to overcome this critical barrier of data-sharing and privacy, Palombini said.
As history has shown time and again, however, technology for technology’s sake cannot fix all problems.
“One might argue that it may not be blockchain the technology that is oversold, but the amount of work to fix existing taxonomies, protocols and policies to fully maximize blockchain may be undersold,” Palombini said.
“It’s important to remember we are just at the beginning of blockchain’s potential in health, so it will take some time before its benefits are fully realized.”
Shahram Ebadollahi, IBM Watson Health
An evolutionary journey
Palombini said that there are already more than 100 blockchains in existence across multiple vertical industry sectors.
“It’s important to remember we are just at the beginning of blockchain’s potential in health, so it will take some time before its benefits are fully realized,” IBM’s Ebadollahi said. “But it’s potential should not be underestimated.”
In the next five to 10 years, patient consent and data exchange backed by blockchain could fundamentally change the way healthcare services are provided by making patient longitudinal data readily available and opening the door to new treatments, new care delivery models and better coordination of care, IBM’s Ebadollahi explained. He pointed to blockchain underlying precision medicine and wellness programs outside the health systems as potentially having a large impact on outcomes.
And the matters of blockchain’s inherent limitations with respect to scalability, confidentiality and governance still need to be ironed out, SSI Group’s Watson said.
Working through those thorny issues will be an evolutionary journey for blockchain-based healthcare applications. Trust and governance are key as the interval between proof-of-concept production-quality technologies gets shorter. And building blockchain networks will require a lot of heavy lifting by software vendors and hospitals alike.
A visit to the hospital typically ends in a doctor prescribing a particular set of medications, the details of which are printed on a physical form and handed to the patient. The patient must then take the form and submit it to a pharmacist.
Looking to overturn this traditional model, South Korea has set out to start digitizing prescription forms and make them accessible via mobile devices.
The Korea Internet & Security Agency said Tuesday that it has signed a Memorandum of Understanding with Seoul National University Hospital and Samsung Medical Center to create and implement a new service that digitizes prescription forms.
Under the agreement, the two hospitals will deploy a new system that lets patients receive and access prescriptions via their mobile devices, offering them convenience and an organized digital database of their prescription records that can be used for future personalized medicine services, KISA said.
The system will be adopted by the two hospitals within the first half of 2018, according to the Seoul-based internet technology agency.
In addition, implementing mobile-based prescriptions will save 2 million pieces of paper per year and allow pharmacies to retain their prescription records in an organized way without physical hurdles, it added.
KISA did not state whether it would expand its prescription digitization project to additional hospitals.
Digital platforms – As Australia’s healthcare system creaks under the strain of ageing baby boomers and a looming chronic disease crisis, digital solutions like telehealth, big data and the internet of things (IoT) are joining to drive more effective and affordable care, while helping to identify solutions to problems that are yet to even arise.
Australia’s healthcare digital system faces some daunting challenges over the coming years and decades.
With an ageing population and rising incidences of chronic disease, current healthcare resources and funding models are already buckling under the strain, demanding that policy makers and health professionals develop new ways of thinking and problem-solving.
According to Philips Australia and New Zealand managing director, Kevin Barrow the immediate challenge facing healthcare systems is how to develop proactive, rather than reactive, approaches to patient care.
Typically, the older people get the greater the chances they will require hospitalization when they are ill. This is one of the biggest cost burdens on Australia’s healthcare system, while the rising incidences of chronic diseases like diabetes and heart disease across the board, put further pressure on the system.
Data from the US Department of Health and Human Services, and other sources, reveals that in developed countries, as little as three per cent of patients are deemed sufferers of chronic disease. Yet this group uses up to half the available healthcare resources.
This should come as a wake-up call for Australia’s healthcare industry, which has so far been slow to adapt, Barrow says. “Most of our healthcare digital systems haven’t changed in 100 years in terms of how healthcare is delivered.”
Many health facilities and organizations are still bogged down in proprietary legacy systems that can’t talk to each other.
For instance, there are several different imaging and health record systems in Australia, meaning that hospitals and clinicians waste time trying to access patients’ medical histories.
This helps to explain why the fax machine remains an essential – yet extremely wasteful – tool for hospitals and health professionals. Delegates to the recent Royal Australian College of General Practitioners (RACGP) eHealth Forum in Melbourne, were told that some 1 billion pieces of paper are generated by Australia’s healthcare system each year.
Barrow says that often when patients are admitted to hospital, or visit a doctor, the issue is something that could have been dealt with without a physical consultation, if the right systems were in place.
Strong telehealth – or digital telemedicine platforms – allow patients and doctors to interact and engage remotely. Combined with robust, secure digital systems supporting easy access and sharing of patients’ health records, a picture begins to emerge of a more efficient, cost-effective system able to support true continuity of care.
In mid-2016, Philips published the Future Health Index (FHI), a comparative international study analyzing the readiness of healthcare operators around the world to meet the challenges of the future. Some 200 healthcare professionals, and 2,000 patients were surveyed in Australia.
All respondents revealed a strong desire for systems supporting better interaction and data sharing between doctors and patients. However, the survey also showed there’s quite a long way to go.
Most notably, almost three-quarters (70 per cent) of patients said they were having to repeat information about their health each time they visited a different health professional. Other data revealed frustrations around accessing health records, both for patients themselves and people trying to provide homecare to sick relatives.
As one of the world’s leading providers of healthcare innovation, Philips has been involved in a number of important initiatives helping chronic disease sufferers better manage themselves.
Mid-2016, Philips published the results of a three-year ‘self-supported care’ program involving almost 2,000 patients in UK city Liverpool living with chronic, or long-term conditions (LTCs) including diabetes, heart failure and chronic obstructive pulmonary disease (COPD).
The trial sought to improve patient awareness and emotional well-being by combining innovative telemonitoring equipment with a ‘clinical hub’ and a program of case management, monitoring, education and coaching for patients with varying levels of long-term disease. The results included reductions in emergency admissions and secondary care costs ranging from 22 to 32 per cent.
In late 2014, Philips and US-provider Banner Health, commenced a six-month ‘at-home’ telehealth trial for patients with multiple chronic conditions, which saw a 45 per cent drop in hospitalizations, 32 per cent drop in acute and long-term care costs, and a 27 per cent reduction in the total cost of care.
“One of the key themes we see emerging in the sector is the needs of patients becoming increasingly linked with those of the clinician,” Barrow explains, adding that connected digital tools coupled with improved clinical capabilities are driving better collaboration and improved ways to manage health.
How big data will disrupt the future of digital healthcare
Healthcare is an extremely data-intensive industry, with no one expecting the deluge to abate anytime soon.
Added to the huge volumes of conventional patient information, such as x-rays, CT scans, pathology reports and the like, personal health records will increasingly contain genetic, proteomic, 3D and other complex data sets, in turn bringing the promise of personalized medicine closer to reality.
Massive shared, or ‘cloud’ computing grids are increasingly able to process and correlate these sorts of data sets with those charting family histories, as well as data on drug compounds, allowing clinicians to finely calibrate treatments in ways undreamt of five or 10 years ago.
As one of the leading innovators in the personalized health space, Philips is working with New York cancer specialists, WMC Health, to build a large-scale informatics platform designed to create individually-targeted oncology treatments based on each patients’ specific genome. The solution features Philips’ IntelliSpace Genomics Solution which will integrate large-scale genome analysis with large patient clinical data sets.
As big data technologies continue to improve, the possibilities for developing even deeper insights into the factors influencing human health and our environment appear vast.
For instance, healthcare organizations are now realizing the potential to correlate data on chronic or communicable disease with factors such as geography, climate and pollution, socio economic background, age, ethnicity and family history to develop more targeted, cost-effective and measurable healthcare solutions.
The huge amounts of data already being generated within digital healthcare are set to increase by orders of magnitude over the coming years as the expansion of the Internet of things (IoT) gathers pace, potentially linking billions and billions of electronic devices and sensors.
These digital devices and sensors will generate and share still more data, and with them will come more opportunities for discovery. New and emerging systems will add further impetus, morphing and adapting environments as they evolve.
As one of the world’s leading makers of high-end medical devices and solutions, Philips sees IoT as a critically important driver of healthcare innovation moving forward, with implications at the individual level as well as the macro level helping us develop a better understanding and better strategies to prepare for the healthcare challenges that lie ahead.