Kevin Campbell, M.D.

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 to address health data privacy concerns. Through the bill, the senators hope to protect consumers’ personal health data by requiring a new privacy regulation that targets health data collected by health tracking applications, wearables and direct-to-consumer DNA testing kits.

However, with patients’ health data at constant risk, we as healthcare executives and physicians must do our part to make sure we are protecting our patients’ privacy.

Welcome to The Clinical Divide. I’m Dr. Kevin Campbell. I’m a Duke-trained cardiologist and the chief innovation officer of the health data startup PaceMate and its parent company, biocynetic. Every week, this 

 video series examines healthcare technology and medicine’s top news. I bring you the views that help physicians and healthcare executives bridge the clinical divide.

Last week, Sens. Amy Klobuchar and Lisa Murkowski introduced the Protecting Personal Health Data Act. The bill would require the secretary of HHS to implement regulations for new health tech like wearables, mHealth apps and direct-to-consumer genetic testing kits which are currently not covered by existing laws.

This proposed bill is a long time coming. Data breaches are happening all over our country — in small practices and in large, multi-hospital health systems. With all of the new technologies out there, these privacy and security issues will only continue to grow and likely affect more and more people.

While this legislation is a step in the right direction, more must be done. We need to take action as physicians and healthcare executives — and all healthcare workers &mdash; independent of a bill like this. We must ensure that when we handle our patients’ data, that they are always secure and encrypted. In addition, we must make sure our patients are educated on how their data can be used by wearable device companies, mHealth app developers or genetic testing companies &mdash; because knowledge is power.

Thank you for joining me for this episode of The Clinical Divide. Until next week, I’m Dr. Kevin Campbell, for 

Navigate the digital transformation with confidence. 

Leveraging AI Technologies to Improve Efficiency in Healthcare

Videos

Physicians and healthcare executives need to take action independent of a bill to protect patients' health data. 

The Clinical Divide: Protecting Patients' Health Data

virtual reality (VR) tool identified Alzheimer’s disease

 more accurately than existing cognitive tests.

While virtual and augmented reality technologies are still not widely accepted in healthcare, clinical trials have shown that these tools can have a 

So what can we as healthcare executives and physicians do to promote VR technology in the healthcare community and potentially implement these technologies into more health systems and practices?

In the Alzheimer’s study, researchers from the University of Cambridge found that a VR navigation task had a higher sensitivity and specificity for differentiating those who are biomarker positive with Alzheimer’s, compared to those who were negative.

This study is just the latest to show how the technology can be used in healthcare to improve accuracy and efficiency in diagnosis, which is important for our patients.

VR has also been proven to be helpful for non-opioid-related pain management and to relieve patients with 

Another startup, Arena Laboratories, is using VR to train students, residents and staff, helping them prove their performance in stressful operating room clinical situations and in other challenging scenarios in order to provide better care.

As the market for VR in medicine is heating up, we must continue to test the efficacy of these technologies. We must participate in and support trials. As physicians and healthcare executives, we need to be aware of these available tools that can enhance our ability to help patients better than traditional tried and true practices. VR has great potential to be used as a motion management system, for therapy, for surgical planning, navigation training and treatment.

This technology is no longer just for video games. It’s time to continue to evaluate these systems and, when appropriate, implement these systems to manage our patients in new and innovative ways.

Leveraging Tech to Influence Drug Pricing Policy Change

Virtual reality technology is no longer just for video games.

The Clinical Divide: Using VR for More Accurate Diagnoses

A Canadian software company has recently developed and deployed an application that uses artificial intelligence (AI) and cloud-based technologies to help clinicians make and confirm their clinical diagnosis when it comes to cardiac auscultation.  

Health technologies like this one have great potential to improve efficiency, accuracy and outcomes in medicine. So what can we as physicians and healthcare executives do to leverage these types of technologies to enhance our workflows and the patient experience, while at the same time providing high quality care?

Welcome to The Clinical Divide. I’m Dr. Kevin Campbell. I’m a Duke-trained cardiologist and chief innovation officer of the health data startup PaceMate and its parent company, biocynetic. Every week, this 

The eMurmur ID system is a technology that can analyze and classify human heart sounds and acoustic abnormalities such as heart murmurs. The technology relies on sounds that are recorded using a third-party electronic stethoscope.

Recently, eMurmur has been granted FDA clearance for this application and as a medical device.

This is how it works: The physician or healthcare provider pairs a Bluetooth-capable stethoscope to a smartphone that is running the eMurmur ID application. They then perform an auscultation exam. The app takes the sound from the stethoscope and passes them to a series of algorithms that are applied on the cloud to the recording. The algorithms perform a signal analysis that results in a diagnosis that is provided quickly to the clinician.

As healthcare executives and physicians, we must continue to support the development of technology that can improve patient outcomes and improve our ability to expedite care. We must back clinical trials of these types of technologies and urge our health systems to implement them when proven safe and effective. Most importantly, we must educate ourselves and our colleagues on the potential of AI in medicine and how this technology can complement, but not replace, the role of the physician in healthcare.

It’s up to us to speak up about the way technologies like this can make our work easier and make our patients’ lives better. 

How can physicians leverage AI technologies to enhance their workflows and the patient experience?

The Clinical Divide: Leveraging AI Technologies to Improve Efficiency in Healthcare

Earlier this month, reports revealed that leading drug companies allegedly colluded to inflate generic drug prices by as much as 1,000%. A lawsuit filed by 43 states named 15 individual senior pharmaceutical executives responsible for sales. This behavior hurts everyone: hospitals, doctors and — most significantly &mdash; patients.

As you know, I’ve been a longtime advocate for leveraging technology for drug price transparency in order to provide consumers, or patients, with insight into how they are being charged with the hopes of ultimately getting them better deals on pharmaceutical purchases. Now, the Centers for Medicare and Medicaid Services (CMS) is proposing a new drug pricing transparency tool for Medicare Part D plans. So what is this rule and how can technology like this benefit our patients?

Welcome to The Clinical Divide. I’m Dr. Kevin Campbell. I’m a Duke-trained cardiologist and CEO of the health data startup PaceMate. Every week, this 

The new CMS rule we talked about would require Part D plans to adopt tools that provide clinicians with information they can use to discuss out-of-pocket costs for prescription drugs with patients. Part D plans would be required to provide access to a price transparency tool that is integrated into the electronic health record system. This is very ambitious, but the rule also requires that the Explanation of Benefits document that Part D enrollees receive each month includes information on drug price increases and on lower-cost therapeutic alternatives that work just as well.

The rule implements Part D legislation signed by President Trump to prohibit these “gag clauses” that you hear about. In the past, these shady backroom deals kept pharmacists from telling their patients and customers about lower-cost ways to obtain prescription drugs. This simply is not fair.

The hope is that patients and their physicians will better understand the cost of drugs and seek out high-value options to increase adherence and improve outcomes. When efficacy is equivalent, why should patients pay more just to fill the pockets of pharmaceutical executives?

As physicians and healthcare executives, we must push for more price transparency tools such as this one. We must urge our health systems to implement the technology to better our patients. It is essential that we give our patients all the tools they need so that they can make informed healthcare decisions. Those that abuse the system, such as those involved in this latest scandal, must be held accountable and prosecuted to the fullest extent of the law.

Driving Organizational Change to Create Better Patient Experiences

The tech gives patients more options when purchasing medications.

The Clinical Divide: Promoting Drug Price Transparency Tools

In February, pharma CEOs were summoned to appear before the U.S. Senate to testify about the steep rise in drug prices. Now, it’s the pharmacy benefit managers’ (PBMs) turn. Both big pharma and PBMs are a big reason for the rise of drug prices today, and it is simply unacceptable. Will forcing PBMs to testify on Capitol Hill help us find a solution to lowering drug prices? And how can we as healthcare executives and physicians leverage technology to influence policy change?

Last week, five of the nation’s largest PBMs — CVS Health, Cigna, Prime Therapeutics, Humana and Optum &mdash; all went to Capitol Hill and denied that the industry’s backdoor deals with drug makers were responsible for the increasing price of drugs. Instead, the companies blamed big pharma and its pursuit of profits. The companies blamed the drug industry for the rising costs of brand-name drugs. Yet when big pharma testified in February, executives there blamed the middlemen &mdash; the PBMs &mdash; for pocketing discounts instead of passing them on to patients. In actuality, I believe the PBMs are the Sopranos of the drug industry &mdash; making money on all sides of the deal and carefully driving up prices in order to line their own pockets.

The testimonies before Congress have yielded little more than a, “he said, she said” controversy. Ultimately, Congress is allowing both groups to play a dangerous blame game that negatively impacts our patients.

Every part of the pharmaceutical industry has a role to play in driving down drug prices, and it is time that lawmakers hold all of them accountable.

In order to do this, we must leverage technology. This will improve transparency for consumers, physicians and lawmakers. To be honest, in the digital era, technology should eliminate the role of PBMs in the first place. What need do we have for “middlemen” in the age of instant communication and transparency of pricing?

As CEOs and physicians, we must also utilize social media platforms and put big pharma

 PBMs on notice. The price hikes and putting profits ahead of patients is no longer going to be tolerated. We must get the attention of policymakers and government officials. We must use our voices and not back down. We must be heard — we have the power to influence regulators.

Our patients deserve better, and now it is on us to use our voices and our positions to influence positive change for all patients.

Implementing eConsults into Health Systems

Leveraging technology could improve pricing transparency for consumers, physicians and lawmakers.
 

Patients with diabetes who have prescription coverage provided by Express Scripts might finally see some additional benefits coming from their insurer very soon. Last week, it was announced that a new plan could limit out-of-pocket costs for insulin to only $25 a month.

With the price of insulin skyrocketing — for really unclear reasons other than profit &mdash; and now out-of-pocket costs reaching more than $450 a month for some patients, how can we as CEOs and physicians facilitate and promote this type of fair pricing &mdash; and compassionate pricing &mdash; for patients with diabetes and other chronic diseases?

Welcome to The Clinical Divide. I’m Dr. Kevin Campbell, a Duke-trained cardiologist and CEO of the health data startup PaceMate. Every week, this 

™ video series examines healthcare technology and medicine’s top news. I bring the views that help physicians and healthcare executives bridge the clinical divide.

Patients with Type 1 diabetes must have daily insulin in order to live. But with the prices of the drug continuing to surge every year, some patients are unable to buy it and resort to rationing their insulin — with sometimes deadly consequences.

Under pressure from both lawmakers and consumers alike, both Cigna and Express Scripts have finally begun to recognize that this is in an alarming and potentially life-threatening problem. It appears — thus far &mdash; that these insurers may actually &mdash; at long last &mdash; be doing something about it. Under a new plan, reported in the New York Times last week, employers who cover their workers through the insurer can opt into the program and the average monthly savings would be almost $16.

The extra costs will be picked up by the three drug makers that sell insulin, Eli Lilly, Novo Nordisk and Sanofi. Many of us — particularly me &mdash; remain skeptical as these are the same drug makers who have sued other companies to prevent the development of generic insulin competition. It’s hard to wrap my head around this one.

But people deserve to feel secure about their ability to afford the medication that they need to live. No longer is it acceptable for drug developers and insurance companies to overcharge for these — just because they can. We as CEOs and physicians must continue to speak up about the outrageous drug pricing and advocate for our patients. We have got to have more stringent regulations and our government must hold these drug makers accountable. We must support the companies and developers who do things like this &mdash; who are working hard to improve access and reduce costs, like this potential drug savings program may provide.

Speaking Out Against EHR Contract Gag Clauses

We as CEOs and physicians must continue to speak up about the outrageous drug pricing and advocate for our patients.

Advocating for Fair Drug Pricing 

Health systems have been increasingly focused on enhancing the patient experience. The patient experience is more than just a satisfaction survey—it’s really about providing safe, high-quality, patient-centered care. And in order for our patients to be provided with better experiences, there are some things that we really need to know about in order to drive meaningful change within our organizations. So, what can we as healthcare executives and physicians do to transform our organizations and place the focus back on the patient where it belongs?

Enhancing the patient experience is not a new trend or buzzword of the moment. However, as a whole, healthcare has really failed to make much headway in this arena. But as much as physician leaders and CEOs talk about how important it really is, what’s actually being done to achieve better patient experiences today? This year, the Strategic Insights report from Press Ganey gives leaders suggestions on how to make big changes to do just that. Whether the changes are created as a way to embrace the newly proposed value-based care models or to address consumerism among patients, as physicians and CEOs, it is really our responsibility to continue to innovate and find ways to improve our organizations.

In the report, Press Ganey suggests that one way to improve is for organizations to undertake a critical self-assessment process by developing an enterprise-wide survey that includes audits across multiple performance domains, leadership surveys and stakeholder interviews. These activities will really help us find opportunities to improve and identify obstacles that we must overcome to get better.

The report also recommended that organizations develop an analysis of performance interdependencies, which really help us to better understand the relationships and interdependencies across safety, quality, patient experience and workforce engagement.

Most importantly, by identifying measurable targets, we can create actionable goals that are carefully prioritized in order of importance and urgency, so that we can get better fast.

As CEOs and physician leaders, one of the things that we can do to make us more effective is for us to develop an integrated dashboard to maintain a comprehensive view of the organization. This type of 50,000 ft. view is really absolutely crucial for driving change.

CEOs and physicians must drive change together and must work diligently to put our organizations in a better position that will allow us to be successful. We must engage employees at all levels and lead by example. The only way to create meaningful change and truly improve the patient experience is from the top down. We must inspire our employees and staff and share our vision—if we do not, change does not happen.

What can we as healthcare executives and physicians do to transform our organizations and place the focus back on the patient where it belongs?

Electronic consultations, or eConsults, are growing in popularity and are becoming a very effective way for primary care doctors and specialists to securely communicate with each other in order to discuss complex patient cases. These consults are incredibly efficient and can help patients avoid extra visits to specialists — ultimately freeing up space in crowded health systems, which can reduce patient waiting times and improve patient care.

So, how can we as physicians and healthcare executives leverage eConsults to save time and money for patients 

eConsults have the potential to be a game changer for both doctors and patients, especially for those on Medicaid or without health insurance. Studies have found that more than 40 percent of referrals to specialists are not even needed. If a patient can get the proper medical advice without having to go and visit a specialist, it could be extremely beneficial — for both patients 

physicians. More efficient and appropriate use of specialty consultations will also free up clinic time and allow the patients who truly need specialty consultation to be seen in a much more expedient fashion. 

These eConsults can also be helpful for patients in rural areas who have a lot of trouble traveling long distances to be seen by specialists. By facilitating specialty consultation via digital means, physicians in more remote areas will have the benefit of getting the help that they need to treat complex cases without delay.

The way the eConsults work, if a primary care doctor feels that a specialty consult is necessary for the treatment of a patient, the requesting doctor simply emails a specialist reviewer for help. This email initiates a HIPAA-compliant dialogue — email or video &mdash; between the reviewer and doctor and an exchange of clinical information and expertise begins immediately. In many cases, this dialogue may result in the disposition of a particular case without a face-to-face patient specialty consultation. Also, these discussions can better identify those patients who must be seen by a specialist urgently and in person. This type of conversation really facilitates care and allows patients to get the care they need much faster.

This system does not mean that patients do not have access for face-to-face consults with specialists, nor does it mean that specialists are going out of business because they don’t have any consults. In fact, in one health system that has implemented eConsults, waiting times for specialists have fallen by an average of 17 percent and the proportion of appointments scheduled actually rose from 24 percent to 30 percent — everybody wins.

As physicians and healthcare executives, it is really incumbent upon each of us to evaluate new technologies as they emerge, such as eConsults and then implement them into our health systems when and where appropriate. We can no longer simply accept the status quo of a workflow in a healthcare system as, “Oh, that’s the way it has always been done”. Let’s continue to innovate and embrace new ways of doing business. And in the case of eConsults, it appears that they certainly have the potential to save time, cut costs and reduce headaches for both doctors and patients.

Replacing Drug Injections with High-Tech Pills

eConsults have the potential to be a game changer for both doctors and patients.

Implementing eConsults into Health Systems 

The promise of electronic health records (EHRs) has been stifled by many broken promises. Tedious hours of manual data entry and separation of doctor and patient during an encounter with a computer screen prevent the physician from spending quality time with their patients. EHR technology was — in theory &mdash; created to improve efficiency, quality and safety, yet many would say that EHRs are the leading cause of physician burnout today.

We often hear about high level complaints about EHRs from physicians, but a gag clause in most EHR contracts prevents users from talking publicly about specific issues.

If physicians and health systems cannot share and discuss the shortcomings of a new technology, how can we get better? What can we as CEOs and physicians do to solve this problem and make it more workable?

By now, you’ve all either heard about or experienced many of the problems associated with an EHR. When the use of an EHR system was mandated by the Hitech Act of 2009, it galvanized the industry and generated hundreds of millions of dollars in revenue for EHR companies. In order for an EHR to comply with the act, it must be used for the collection, display and storage of very specific diagnosis and treatment data. Much of the required data from this act are irrelevant to patient care or individual patients, but helpful to insurance companies, payors, government agencies and others that manage healthcare systems as a whole — basically it’s a billing system.

Most EHRs do not function as promised, and there are even examples of errors in data entry or data display and processing that have led to physicians unknowingly performing medically unnecessary procedures, or ordering expensive, unnecessary tests.  However, gag clauses in EHR hospital contracts prevent users from talking publicly about their specific problems and shortcomings. So, how can we learn from our mistakes and get better if we can’t even talk about the problems we are facing?

We as CEOs and physicians MUST advocate for patients. We have to call out EHRs for what they are — billing machines. There has never been one study that has shown an improvement in patient care or patient outcomes with EHR utilization. That’s what the technology was initially designed for. It was designed for capturing billing. We must apply pressure on EHR companies and must demand that our government officials and agencies hold these companies accountable.  We must negotiate better contracts with EHR providers, and no healthcare system or healthcare professional should ever be required to remain silent about issues that can negatively impact a patient when it comes to technology.  It is never acceptable for the users of a healthcare technology to not be allowed to discuss shortcomings or failures associated with things such as EHRs &mdash; we do this among ourselves at our national meetings. If we remain silent, our patients suffer and innovation stalls.

Gag clauses in electronic health record (EHR) contracts are preventing physicians from speaking out about specific issues associated with the health tech. 

The wearable device market is booming and competition has continued to heat up over the last year. Most recently, AT&T announced its LTE-M certified medical wearable, designed to monitor chronically ill and elderly patients who wish to remain at home and age in place. Not to be outdone, Samsung announced that users can download a blood pressure application directly to the Galaxy Watch Active to monitor blood pressure in real-time. With all of these new wearables hitting the market, how can we as healthcare executives and physicians work together to make sure that all of these items are used properly, No. 1, and are used in a way that can enhance and improve care for our patients?

February was a busy month in the world of wearable technology. Apple, which launched its ECG app for the Apple Watch 4 at the end of last year, rolled out a digital health plan that features the ECG reader in an effort to get users to focus on their own heart health. Likewise, AT&T’s smartwatch, OneLife, monitors users 24/7, gives medication reminders and auto prescription refills. It also has a fall detector. It provides data for heart rate, location, movement and sleep. Samsung’s Galaxy wearable line has exercise, sleep and health tracking features to help those seeking a healthier body and mind.  Alive Cor, which remains on the cutting edge of innovation in the wearables space, really continues to lead the way with artificial intelligence algorithms for atrial fibrillation and its U.S. Food and Drug Administration-cleared Kardia Band.  Alive Cor now has the largest library of wearable ECG tracings in the world.

As the market will only continue to grow, it is really incumbent and essential that as CEOs and physicians, we continue to evaluate and incorporate these devices into our practice when and where appropriate — that’s the rub. It is clear to me that these wearables can improve patient outcomes and certainly can decrease healthcare costs by improving patient engagement and alerting users and their physicians when abnormalities in biometric data are detected. However, it is vital that we continue to support the development of these wearables, and as more and more options enter the marketplace, we have a duty as physicians and CEOs to make sure that patients are well-educated about the benefits and limitations of these new and exciting technologies.

Wearable devices can improve patient outcomes and keep patients in the loop about their health data. 

Kevin Campbell, M.D.

Articles

The Clinical Divide: Protecting Patients' Health Data

The Clinical Divide: Using VR for More Accurate Diagnoses

The Clinical Divide: Leveraging AI Technologies to Improve Efficiency in Healthcare

The Clinical Divide: Promoting Drug Price Transparency Tools

Leveraging Tech to Influence Drug Pricing Policy Change

Advocating for Fair Drug Pricing

Driving Organizational Change to Create Better Patient Experiences

Implementing eConsults into Health Systems

Speaking Out Against EHR Contract Gag Clauses

The Rapid Rise of Wearable Technology