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Apple Watch and Hospitals Using It in the News

The new Apple Watch has been in the news this week, but so have several hospitals that are using it with patients. Apple’s HealthKit mobile app is available with its Watch.

Cedars-Sinai Medical Center has linked its electronic medical records system to Apple’s HealthKit software, giving patients the option for adding their data to their health records. Ochsner Health System will be using the Apple Watch to manage hypertension in patients initially, but may add other patients with chronic diseases.

Mayo Clinic, Stanford University Hospital, and Duke University Hospital are also among the first hospitals or health systems connected to HealthKit system. Reuters news service has reported that 14 of 23 major hospitals it contacted have pilot programs using Apple’s HealthKit mobile software. Competitive services from Google and Samsung have also begun reaching out to some hospitals and others in the medical field..


Stempniak M. New Orleans Health System harnesses Apple Watch to manage chronic disease. H&HN Daily, April 27, 2015. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/April/Oschsner-Health-Apple-Watch-chronic-disease-blog-stempniak

Bowman D. Cedars-Sinai goes all-in on Apple HealthKit. FierceHealthIT.com, April 27, 2015. http://www.fiercehealthit.com/story/cedars-sinai-goes-all-apple-healthkit/2015-04-27

Comstock J. Apple Watch already has 264 health apps, unused pulse ox functionality, and a hospital pilot. MobiHealthNews.com, April 27, 2015. http://mobihealthnews.com/42900/apple-watch-already-has-264-apps-unused-pulse-ox-functionality-and-a-hospital-pilot/

Higgins T. Apple’s HealthKit linked to patients at big Los Angeles hospital. BloombergBusiness, April 26, 2015. http://www.bloomberg.com/news/articles/2015-04-26/apple-s-healthkit-linked-to-patients-at-big-los-angeles-hospital

Diamond D. A hospital is already giving Apple Watch to its patients. Forbes.com, April 24, 2015. http://www.forbes.com/sites/dandiamond/2015/04/24/can-apple-watch-make-patients-healthier-how-one-hospital-is-trying-to-find-out/

Farr C. Exclusive: Apple’s health tech takes early lead among top hospitals. Reuters, Feb. 5, 2015. http://www.reuters.com/article/2015/02/05/us-apple-hospitals-exclusive-idUSKBN0L90G920150205

Dvorak K. mHealth Summit 2014: HealthKit, EHR pilot programs show great promise, execs say. FierceMobileHealthcare.com, Dec. 20, 2014. http://www.fiercemobilehealthcare.com/story/mhealth-summit-2014-healthkit-ehr-pilot-programs-show-great-promise-execs-s/2014-12-10

Goldstein P. Apple moves into mobile healthcare with HealthKit software. FierceWireless.com, June 2, 2014. http://www.fiercewireless.com/story/apple-moves-mobile-healthcare-healthkit-software/2014-06-02

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

The Value Proposition of Retail Clinics

A new report from the Robert Wood Johnson Foundation looks at retail clinics and their role in advancing health.

As a starting point, the report provides an overview of the current retail clinic landscape, including their history, growth, and the patients served. The first clinics opened in 2000 and had grown to about 1800 by 2014. By 2012 they were serving about 10.5 million patients, accounting for 2% of all primary care encounters in the U.S.

Almost all clinics now accept Medicare and commercial insurance, while 60% accept Medicaid. High income patients are double as likely to use a retail clinic than those with low incomes. Clinic location may be one reason why, since clinics are more often placed in urban/suburban higher income areas. Yet when compared to the general population, retail clinic patients are more likely to be uninsured or have no personal physician.

It’s no surprise that convenience, hours of operation, and the option of getting walk-in care without an appointment are key reasons patients give for using a retail clinic. Most patients visit for diagnosis and treatment of a new illness, followed by vaccinations and prescription renewals. However, retail clinics have been expanding into more comprehensive primary care and chronic care management.

Cost of care at a retail clinic is lower. One 2009 study cited in the report found a retail clinic visit priced at $110 compared to $166 at a physician office, $156 at an urgent care center, and $570 at an emergency department. It’s also possible that a retail clinic visit might add to overall costs if it complements rather than replaces a physician office visit.

Most retail clinics are owned by pharmacies or big box stores. These retailers may staff and control the clinic on their own or affiliate with a health system. The affiliation arrangements may involve co-branding, and division of operational responsibilities between the retailer and system vary. In some cases, the health system [or hospital or physician group] may lease the retail space and assume full responsibility for the clinic’s operation.

A significant part of the report highlights examples of how retail clinics can play a larger role in promoting the public health. For instance, a ShopRite grocery store plans to open in an underserved area of Baltimore. It will introduce fresh food choices, participate in food assistance programs, and feature a health clinic and pharmacy. In another case, Geisinger Health System launched Careworks Convenient Healthcare inside the supermarket chain Weis Markets. Geisinger and Careworks share an electronic health record system and coordinate care. It has resulted in fewer emergency departments visits and gained 3000 new patients that previously had no primary care physician.

The report makes these retail clinic optimization recommendations for advancing the nation’s culture of health:

  • Integrate into the health delivery system
  • Measure and report quality of care
  • Improve access in underserved areas
  • Provide services to young children
  • Standardize scope of practice rules for nurse practitioners and physician assistants
  • Require Medicare and other insurers to reimburse clinics for appropriate telehealth services
  • Examine more expansive roles retail clinics can play in supporting public health and emergency response
  • Make the business case to payers to broaden and bundle services
  • Research the business case to expand the range of clinic services, such as assistance with insurance enrollment and program access to nutrition, housing and other services

Source: Bachrach D and others. Building a culture of health: the value proposition of retail clinics. Robert Wood Johnson Foundation; Manatt, April 2015. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf419415

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Update: EHR Adoption by U.S. Community Hospitals, 2008-2014

How have hospitals progressed in adopting electronic health records? New data from a survey conducted by the American Hospital Association for the Office of the National Coordinator of Health Information Technology points to significant progress:

  • Three-quarters of hospitals had adopted at least a basis EHR system in 2014, up 27% from 2013.
  • Almost all hospitals [97%] had a certified EHR technology, up 35% over the previous year.
  • Over a third of hospitals had adopted a comprehensive EHR system by 2014.

Hospitals have made significant inroads towards interoperable exchange of health information.


Source: Dustin C. and others. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2014. ONC Data Brief [Office of the National Coordinator for Health Information Technology], no. 23, April 2015. http://www.healthit.gov/sites/default/files/data-brief/2014HospitalAdoptionDataBrief.pdf 

Related: AHA Annual Survey IT Database is available for purchase, and the 2015 release with 2014 data should be available soon. For further background on the survey, see http://www.ahadataviewer.com/about/it-database/  Call (866) 375-3633 or email ahadatainfo@healthforum.com for more information.

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIAN VISITS: How often should you see your doctor?

Little is known about how often you should see your doctor, or the best interval between follow-up visits to physicians, according to the authors, who are all affiliated with Harvard Medical School.  It’s a question of interest in this era of accountable care organizations (ACOs), in which new care models are being fashioned.  The authors do not end up making any recommendations as to the optimal frequency for physician visits, but they do present some suggestions as to how to begin to think about making the health care system more efficient.  For example, ACOs could re-engineer the referral process to specialists to avoid unnecessary first visits.  Also, technology could be used more effectively to replace face-to-face encounters in the office or clinic.

Source: Ganguli, I., Wasfy, J.H., and Ferris, T.G. (2015, Apr. 6). What is the right number of clinic appointments? Visit frequency and the accountable care organization. JAMA, E1-E2. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2241120&resultClick=3  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT FALL RATE: 3.44 falls per 1,000 patient days (2011)

The National Database of Nursing Quality Indicators (NDNQI) is a rich source of data from over 1,900 participating U.S. acute care hospitals.  This study reports data on patient falls occurring in 2011.  Here are some of the findings:

  • 166,883 falls were reported by 1,464 general hospitals in 2011
  • The overall fall rate was 3.44 falls per 1,000 patient days
  • 5.5 percent of falls were repeat falls
  • 12.4 percent of falls were assisted (a staff member was present to break the fall)
  • 85.5 percent of falls were unassisted

Source: Staggs, V.S., Mion, L.C., and Shorr, R.I. (2014, Aug.). Assisted and unassisted falls: different events, different outcomes, different implications for quality of hospital care. The Joint Commission Journal on Quality and Patient Safety, 40(8), 358-364, retrieved from https://www.readbyqxmd.com/read/25208441/assisted-and-unassisted-falls-different-events-different-outcomes-different-implications-for-quality-of-hospital-care 

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

THE FOLLOWING IS AN EARLIER POST from this blog with similar data:

This research, based on the National Database of Nursing Quality Indicators, presents data on over 300,000 falls in hospitals during a two-year period just prior to implementation of the new rules from the Centers for Medicare and Medicaid Services banning payment for costs associated with patient falls during hospitalization.  Comparative patient fall rates are given for medical versus surgical units, for hospitals of different sizes, magnet versus non-magnet, teaching versus non-teaching.  Here are some overall findings (quoted from the article abstract):

  • 3.56 falls / 1000 patient days (overall)
  • 0.93 injurious falls / 1000 patient days (overall)
  • Injurious falls represent 26.1 percent of all falls

Why I like this article: Data based on large number of hospitals; authoritative researchers; topical data; numbers numbers numbers!

Source: Bouldin, E.L.D., and others.  Falls among adult patients hospitalized in the United States: prevalence and trends.  Journal of Patient Safety;9(1):13-17, Mar. 2013.  Click here for the publisher’s website:http://journals.lww.com/journalpatientsafety/Abstract/2013/03000/Falls_Among_Adult_Patients_Hospitalized_in_the.3.aspx  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

TRENDS: National health expenditures $2.9 trillion in 2013

The Centers for Medicare and Medicaid Services, Office of the Actuary, produces statistics each year on national health expenditures with comparisons to previous years.

National Health Expenditures: US Total

  • $2.3 trillion 2007
  • $2.4 trillion 2008
  • $2.5 trillion 2009
  • $2.6 trillion 2010
  • $2.7 trillion 2011
  • $2.8 trillion 2012
  • $2.9 trillion 2013

National Health Expenditures as a Percent of Gross Domestic Product: U.S.

  • This has been exactly the same — 17.4 percent from 2009 through and including 2013
  • It was a little lower before that — 15.9 percent in 2007 and 16.4 percent in 2008

Source: Hartman, M., Martin, A.B., and others. (2015, Jan.). National health spending in 2013: growth slows, remains in step with the overall economy. Health Affairs, 34(1), 150-160. Retrieved from http://content.healthaffairs.org/content/early/2014/11/25/hlthaff.2014.1107 

NOTE: Another good place to research these statistics is on the CMS website here: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TRENDS: Retail clinics, e-visits, urgent care compared

Geisinger Health System (Danville, Pa.), a leading health system, decided to enter the retail clinic market using a franchise model which would put Geisinger Careworks clinics within retail stores.  The problems encountered with this approach are detailed in this lengthy, candid article.  It was found to be more desirable to create a different model of walk-in care, Careworks After-Hours, located at existing Geisinger primary care centers.  However, there are challenges with this approach – also described in this article.    Trends towards e-visits are discussed and an exhibit compares e-visits, retail clinics, and urgent care centers as far as appropriateness for different patient conditions.

Here are some interesting thoughts from this article:

  1. Successful clinics break even within a year and a half
  2. Acuity of emergency department patients increases after a walk-in clinic opens
  3. There is significant overlap between retail clinics and e-visit services

Source: Prince, D.B., and Graf, T. (2015, Spring). Geisinger’s retail innovation journey. Frontiers of Health Services Management, 31(3), 16-30. Retrieved from http://www.ache.org/pubs/Frontiers/frontiers_index.cfm


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