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In this episode of This Week in Health Tech we welcome our very own and close friend Wayne Che to talk about Health System and Mobile Apps - Management, Resources, Build vs Buy, Testing, Infrastructure, Security, Privacy, and more!
This episode aligns well with the new digital product offering of Tido Inc. for the management of mobile and web apps for health systems. Wayne Che works in multiple roles, primarily as CTO of Sowingo Inc., and has tons of experience with the implementation of mobile apps.
We get right into mobile development by starting the discussion on build vs buy.
Vik comments that health systems main focus is improving patient outcomes and it does not make sense to assemble a development team in-house. Wayne agrees that you gain speed of execution and plus allows you to focus on the primary job of using IT for providing better care of patients.
Jimmy asks what to look for in the development shop and Wayne thinks that you need to have a partner that understands requirements and helps to define requirements. Also, the shop should not only have development skills but it is also more important to have management skills to keep the app updated and continuously test to provide the best user experience.
Vik comments that Tido Inc. launched a new digital package to help health systems manage apps and includes custom development of apps. It also includes test automation and maintenance. Wayne indicates that testing and maintenance is a key component otherwise with iOS or android updates app may stop working.
Vik and Jimmy then dive into test automation and the importance of testing on actual real devices. This is where real device testing comes into play. Both Vik and Wayne recommend the selenium framework with real device cloud providers like Sauce Labs or BrowserStack.
Testing helps provide the best user experience and it is so crucial for patients who may be already going through a lot and a frustrating app experience just adds to negative patient satisfaction.
The group then discusses infrastructure for apps. There are many cloud providers and what is the best approach for health systems.
Wayne comments that cloud providers do several things well including staying compliant with HIPAA and PHIPA. Vik comments that using the cloud has another benefit which is to reduce traffic from mobile devices directly into the health system network.
The group then talks about using APIs for data sharing for mobile apps. Also with ONC's Cures Act, it is required that there are no more data silos, but most health systems should go beyond Cures Act for bidirectional data flow securely.
Wayne comments that this is where health systems should look into hiring the expertise for API development and management and ensure security.
Jimmy asks the question of why this urgency of APIs and mobile development now? Wayne and Vik respond that not only Cures Act but from providing the best user experience, health systems have to provide APIs and app support.
Group then talks about the hybrid approach for mobile app development where you have some expertise in-house, maybe a product owner or architect but use an outside development company.
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On this episode of This Week in Health Tech, Vik and Jimmy welcome Mark Brookman, CIO, Commonwealth Healthcare Corporation in Bowling Green, Kentucky.
We jump right into tele-health and adoption with Mark. Mark indicated that even though they had started on tele-health path about 3-4 years ago, adoption was scarce. Providers were hesitant because there could be liability issues if they missed anything however things changed with COVID-19. Government changed their stance and they started reimbursing for telehealth visits.
At commonwealth telehealth was now used even in emergency health where patient information about a patient being transferred to the hospital emergency department was provided to a ER physician, and this help ER department to prepare equipment and room according to the incoming patient needs.
Jimmy poses question to Mark if provider mentality has changed and if they have adjusted to telehealth and if they will continue with telehealth post COVID-19.  Mark thinks it is still quite early to tell however they are proceeding with plans to expand telehealth services over next few years.
Mark then discusses remote monitoring and even in hospital monitoring for COVID patients where patients could be monitored without going inside the room.
The conversation then flows into cloud versus on-prem and hybrid infrastructure setup for healthcare organizations. Mark indicates that he has a very cautious slow approach to cloud adoption. He does not like giving up control by hosting everything in the cloud.
Industry is clearly moving in the direction of subscription or cloud hosted solutions. Vik indicates that it could be a hybrid approach, and gives an example for integration.  Hybrid approach would help separate external system connections to the cloud and not have them connected directly to the same on premise servers.
Vik, Jimmy, and Mark then discuss remote working and how healthcare staff has adopted to working remotely and if there has been a culture change.


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Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
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In this episode of Digital Transformation acceleration with APIs, Vik and Jimmy discuss the basics of API and its impact on digital transformation in health systems.
The biggest factor for talking about APIs in healthcare is digital transformation. COVID has accelerated digital transformation in healthcare, it started with telehealth, but it is way beyond just telehealth: increased use AI and machine learning, patient or provider facing mobile apps, analytics, and remote monitoring. As a CIO or CEO of a health system,  you need to be ready for digital transformation.
Healthcare has been working on digital transformation however COVID has expedited and pushed health systems to make changes, plus the government is also pushing digital transformation with CURES Act.
Vik and Jimmy use examples from other industries to show user experiences are way better compared to healthcare.
From a CIO standpoint, it starts with strategy, to enable digital transformation, you need to make it easier for data sharing for AI, Machine Learning, mobile apps, remote monitoring. And API is the way to go compared to the traditional way of integration. 
Vik and Jimmy then dive into specifics about strategy and use a practical example to explain how APIs need to be implemented.
APIs also help realize significant ROI (return of investment) over traditional integration because of reduced resource time for implementation.
Vik and Jimmy then dive into on-premise vs cloud for API implementations. Vik explains using FHIR specification for healthcare APIs.
Vik explains the competitive advantage of having APIs to enable better user experiences.

Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Music Provided by Soundstripe.com
Linkedin: Vik Patel
Linkedin: Jimmy Kim

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In this week of This Week in Health Tech, Vik and Jimmy tackle a very timely topic about COVID vaccine scheduling for health systems.
Vaccines are here, Pfizer, Moderna, Astra Zeneca. The phone is ringing off the hook at health systems, which is creating operations issues for health systems. Clogged up phone lines does not help with patient care because more critical issues might not get the attention they deserve.
Vaccine protocols are changing and currently, healthcare staff members, long term care facilities, and elderly people are prioritized over the general population.
Now the number of vaccine shots are limited and health systems need to figure out a way to provide vaccine to people in the community. Roll out of vaccines is definitely a logistics issue.
Jimmy and Vik dive into different ways to set up online scheduling for vaccines that could be useful for health systems. 

Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Music Provided by Soundstripe.com
Linkedin: Vik Patel
Linkedin: Jimmy Kim

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In this episode of This Week in Health Tech, Jimmy and Vik recap the 2020 episodes of This Week in Health Tech and chat about the best of 2020 topics, guests, and more.
Vik and Jimmy start out by reminiscing about 2020 and how it all started. It is also the one-year anniversary of the TWIHT podcast.
Vik concedes that it was not easy to start the podcast and staying on track. But over time it has definitely gotten easier, it no longer feels like work.
They start out talking about the very first 2 episodes and how they really dived into it with security in healthcare. Throughout 2020, we actually talked about security in pretty much every episode, especially with the growing number of healthcare apps and data.
Vik and Jimmy comment that on the surface it may seem that lots of apps like Gmail zoom etc may seem free however data they collect is priceless. Big tech influence in healthcare is continuing to grow and they talked about big tech in the episode with Unmesh.
AI and machine learning were also topics that came up in a lot of episodes in 2020. COVID has also accelerated AI and machine learning influence in healthcare. Vik and Jimmy comment on how digital strategy has become very crucial now more than ever.
They also talked about how COVID forced work from home in all industries including healthcare and the use of different technologies to work securely from home. Jimmy also comments on how he had to switch his corporate fitness programs to virtual programs to survive. Jimmy learned a lot from this and actually provided great tips for improving the telehealth experience in an episode in mid-2020.
They also talk about how all the guests of TWIHT were very positive and contributed in different ways using their experience and expertise in dealing with the tough situation of COVID personally and professionally.
Vik then reminds listeners of the human resources episode with Tony Welch which was emotional and raw. They also talk about the Alan Shoebridge episode where competing organizations came together to fight COVID.
Vik mentions the episode with Laura O'Toole and being future prepared with technology. How do you deploy more applications quickly but securely and making sure all apps provide the best user experience. Test automation is the way to go to ensure the best user experience. They also talk about the mobile development episode and geeking out on the episode with Wayne Che.
Vik then comments about the future 2021 trend. He suggests that because of the ONC Cures Act and the increased influence of AI, Machine Learning, and Big Tech, and based on the conversations that they are having with CIOs, managers are that there will be a spur in the healthcare app economy. Organizations will need to be ready with a hybrid architecture that will allow them to deploy apps, not just in-house but also external patient-provider facing apps.
Vik also thinks that test automation and digital app management will play a huge role especially with the increase in healthcare apps. 


Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Music Provided by Soundstripe.com
Linkedin: Vik Patel
Linkedin:

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In this episode of This Week in Health Tech we welcome our very own and close friend Wayne Che to talk about Health System and Mobile Apps - Management, Resources, Build vs Buy, Testing, Infrastructure, Security, Privacy, and more!
This episode aligns well with the new digital product offering of Tido Inc. for the management of mobile and web apps for health systems. Wayne Che works in multiple roles, primarily as CTO of Sowingo Inc., and has tons of experience with the implementation of mobile apps.
We get right into mobile development by starting the discussion on build vs buy.
Vik comments that health systems main focus is improving patient outcomes and it does not make sense to assemble a development team in-house. Wayne agrees that you gain speed of execution and plus allows you to focus on the primary job of using IT for providing better care of patients.
Jimmy asks what to look for in the development shop and Wayne thinks that you need to have a partner that understands requirements and helps to define requirements. Also, the shop should not only have development skills but it is also more important to have management skills to keep the app updated and continuously test to provide the best user experience.
Vik comments that Tido Inc. launched a new digital package to help health systems manage apps and includes custom development of apps. It also includes test automation and maintenance. Wayne indicates that testing and maintenance is a key component otherwise with iOS or android updates app may stop working.
Vik and Jimmy then dive into test automation and the importance of testing on actual real devices. This is where real device testing comes into play. Both Vik and Wayne recommend the selenium framework with real device cloud providers like Sauce Labs or BrowserStack.
Testing helps provide the best user experience and it is so crucial for patients who may be already going through a lot and a frustrating app experience just adds to negative patient satisfaction.
The group then discusses infrastructure for apps. There are many cloud providers and what is the best approach for health systems.
Wayne comments that cloud providers do several things well including staying compliant with HIPAA and PHIPA. Vik comments that using the cloud has another benefit which is to reduce traffic from mobile devices directly into the health system network.
The group then talks about using APIs for data sharing for mobile apps. Also with ONC's Cures Act, it is required that there are no more data silos, but most health systems should go beyond Cures Act for bidirectional data flow securely.
Wayne comments that this is where health systems should look into hiring the expertise for API development and management and ensure security.
Jimmy asks the question of why this urgency of APIs and mobile development now? Wayne and Vik respond that not only Cures Act but from providing the best user experience, health systems have to provide APIs and app support.
Group then talks about the hybrid approach for mobile app development where you have some expertise in-house, maybe a product owner or architect but use an outside development company.

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In this episode of This Week in Health Tech, Vik and Jimmy invite Jeff Fallon with eVideon to talk about the hospital inpatient experience. It is the first time we are talking about changing inpatient experience with digital transformation in healthcare.
We start out with the traditional/existing setup in most hospital rooms. Jeff explains that patient rooms have not changed a whole lot since 1970s. There is still the nurse call button in the room maybe with a hardwired phone and a tube tv which is controlled by up and down buttons on the bedside remote control.
Vik mentions that the good thing is that digital transformation is in the works at most of the health systems. It starts with an infrastructure upgrade to support digital transformation.
Jeff agrees that infrastructure is the backbone for digital changes but it is easier to do in newer buildings than in really old hospital buildings. It becomes inherently expensive to upgrade wiring for example in buildings with concrete walls and increases barriers for entry.
Vik indicates that maybe we could get around the issue of physical wiring with advancements in wireless technology, especially with wifi 6.
Jimmy stated that there must be a reason for the change now with the inpatient experience and Jeff comments that value-based care is a big driver for this. Patient satisfaction scores are used for value-based compliance and providing a better inpatient hospital experience will help drive up patient satisfaction scores and hence patient outcomes.
Jeff also commented that pandemic also accelerated the transformation and the drive to use technology to provide a better experience but more importantly reduce contagious viruses.
Vik comments that in COVID times, when caregivers are wearing masks it is difficult to make that connection with patients. But maybe a smart room will display the caregiver's photo on the screen and badge information so you can make a better connection even through a mask.
Jeff also mentions that it is critical to give patients control of their experience and using technology we will be able to provide that experience. Vik thinks using a smart speaker could also be useful in the hospital room which can announce the schedule for the day or announce the person entering the room etc. Vik thinks in future patient could be given a tablet with all hospital approved apps to give the patient control on what apps / information they would like to make use of. Jeff thinks it needs to be balanced because some users could get overwhelmed and may need more hand holding.
Either way, we all agree that digital transformation will drive inpatient experience and improve all patient satisfaction. 


Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Jeff Fallon: Jeff Fallon
eVideon Healthcare:  https://www.evideon.com/
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Linkedin: Vik Patel
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We have our first physician on This Week in Health Tech. Dr. Michael Farmer, Cardiologist and founder of Corverix to talk about wearables.
Michael got into wearables because he found current healthcare very reactive and not enough on prevention. It became frustrating and Michael found that patients had access to smartwatches and all the indicators captured on these devices going wasted. Patients used to fax ECG from apple watch to his clinic.
Vik agrees that it is absolutely after the fact medicine but we should be getting to more active caring of patients. Value-based care will incentivize prevention and wearables and value-based care align quite well.
Michael indicated that there is a huge return on investment for organizations that recommend wearables for employees. For example, 50% of the US population suffers from high blood pressure and if even lowered blood pressure for 10% of the population using wearables would be a huge benefit.
Vik brings up the point that there are massive amounts of data collected by wearables so how do you go about deciphering so much data and presenting it to the provider where it is actually useful.
Michael indicated in a perfect world, it would very useful to have a link in the EMR that would present him with all the data points from wearables. For example sleep time, exercise time, etc. Because a lot of times the information you get from patients is not accurate so from a provider perspective it just helps to see actual data points collected in the last few months to make informed decisions.
Michael, Vik, and Jimmy then dig into more details about wearable data points like heart rate variability and how they help a physician.
Next, they talk about the limitations of EHR and how the data presented in a standard EHR is not easy to use and there is usually way too much going on instead of presenting crucial data points in a visual manner.
The other huge advantage of wearables is provided personalized care for patients.
Vik then mentions the strategy they use for digital apps integration. Instead of traditional pushing data and duplicating data, it will be on-demand. Also, because of the Cures Act, it will open up data using APIs. Having FHIR APIs in the cloud, it will allow apps to access EHR data in real-time.


Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Guest Linkedin: Dr. Michael Farmer
Coverix Website: https://corverix.com/pages/wearables
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Linkedin: Vik Patel
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In this episode of This Week in Health Tech, we welcome Ryan Neaves, VP, Care Applications from Novant Health, and Laura O'Tool, President, Santa Rosa Consulting. We focus on test automation for Electronic Health Record systems and also for digital testing of mobile and web applications.
As some wise person noted, there is never enough testing to provide the best user experience and satisfaction. Tido Inc. has test automation packages which help end to end testing of all workflows for EHR and also for the growing number of mobile and web applications with digital transformation in healthcare.
Laura comments that we are always scrambling to do testing or cover all the workflows. Testing is required for multiple reasons including whenever we are upgrading EHR or health systems. And we need to do enough rigorous testing because we care about patients and providing the best healthcare. So it is important all the scenario testing, integrated testing are covered in an automated fashion. This also frees up resources to actually focus on patient care. Especially in these difficult pandemic times, it is crucial to allow key resources to have confidence in health systems and not be bogged down by testing or incorrect workflows.
Ryan comments that it has been a great journey for Novant health and implementing test automation. There were also some unintended consequences of the test automation strategy. He also indicates that test automation has been used in other industries forever. While in healthcare we do testing with getting people in a room and running through workflows once.
Laura indicates that we have increased innovation in healthcare and Ryan agrees that we search for opportunities, and as the industry changes, there are a lot of tools available.
Vik agrees with Ryan that he has been part of those testing calls that Ryan mentioned where resources get together in a room. But a lot of times, there was no documentation of scenarios, it was mainly just relying on clinical personnel remembering workflows.
Ryan comments that traditionally you are relying on the key 3 or 4 personnel, and even when you do the testing manually once, it is still only done once! Laura provides an example of how many different data elements or workflows that have to be considered so testing once is definitely not enough.
 The other issue Ryan highlights are that key resources don't enjoy testing as it takes away from more important tasks at hand. Vik asks Ryan what were some of the challenges with test automation implementation.
Ryan indicated that culture shift or change of mentality was one of the main challenges. It was wrestling that control and providing confidence to staff that test automation will test applications thoroughly and intended as it needs to be tested.
Vik comments that with the COVID situation, digital transformation is happening rapidly, so from a digital strategy, there will be an increasing number of mobile and web apps. Ryan indicates that Novant is looking at everything including machine learning and AI. Ryan provides the example of telehealth and how they went from a few hundred users to 30000 users and it highlighted issues that were not known below. Laura comments that because of COVID through health systems into the frying pan and really highlighted the skills of healthcare staff and forced us to be more innovative and utilize automation.


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In this episode of TWIHT we focus on the ONC's Cures Act Final act which is all about "Empowering Patients with Their Health Record in a Modern Health IT Economy".
The ONC Cures Act Final Rule implements interoperability requirements outlined in the Cures Act. 

Vik and Jimmy jump into the details about how this Act helps Patients. Putting the patient first in health technology enables the health care system to deliver:

• Transparency into the cost and outcomes of their care
• Competitive options in getting medical care
• Modern smartphone apps to provide them convenient access to their records
• An app economy that provides patients, physicians, hospitals, payers, and employers with innovation and choice

Vik mentions about the API access that has already been enabled by EHRs and how it is allowing patients to access their health information on iPhone and Android devices.
Vik indicates that this ruling will spur up an App Economy, starting from purchasing a health service by comparing services and pricing provided by healthcare providers.
Another example would be the way information would be available to patients instead of the standard patient portal, where understanding the health / medical record is not very easy for most patients.
This is going to promote better health and better outcomes since it puts patients first.
Jimmy comments that this does sound amazing for patients but could be bad for bad performing clinics and hospitals. Vik said it will definitely increase patient quality because now the data available will show patient outcomes for every provider.
Vik and Jimmy also discuss privacy and security concerns. Vik discusses that you still need to follow the security protocols, OAuth2 to access patient information. There is also governance and authorization and it's not just open data. Vik compares it to banking budgeting apps that have to be authorized by the user and also need a valid back-end connection with the bank. The same idea will be used with the FHIR API access in healthcare and privacy and security concerns will be addressed.
Jimmy asks if everyone is for this ruling and Vik indicates that not everyone is. Big Tech (Microsoft, Apple, Google, Amazon), even more EHRs (Cerner, AllScripts, Meditech, etc). are for the ruling. Epic EHR did oppose this ruling based on patient privacy concerns.
Vik comments that innovation is also going to benefit clinicians as the app economy will lead to the development of many apps for every service provided by healthcare.
Jimmy and Vik also comment on few other examples including sharing medical record between clinicians and hospitals.

Website: http://www.thisweekinhealthtech.com
Twitter: @TWIHT1
Tido Inc.: https://www.tidoinc.com/
Music Provided by Soundstripe.com
Linkedin: Vik Patel
Linkedin: Jimmy Kim

Support the show (http://www.thisweekinhealthtech.com/)

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Vik Patel - LinkedIn
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