Friday, May 29, 2015
and patient engagement rank among the top priorities for CIOs. In fact, they rank above improving care coordination, streamlining operational efficiencies, and achieving Meaningful Use.
The tides are clearly changing. We’ve all been talking about what the shift to a value-based care model means for healthcare organizations. What we haven’t been talking about is how this shift is transforming our patients into “prosumers.”
There’s a saying, “To a worm in horseradish, the world is horseradish,”
meaning we are predominantly aware of that which we are surrounded by on a daily basis. Health IT, in all its intricacies and expansiveness, has become hyper focused on making sense of its nebulous infrastructures, working hard to prepare healthcare organizations for next new wave of regulations. Our world, while not horseradish, is composed of goals and milestones that are 100 percent contingent upon these systems.
But, as yet one more unintended consequence of this pursuit, we have become myopic. The business of healthcare is no longer simply confined to a hospital or an IDN site map.
Patients are reaching for their phones, not to call their doctors, but to research their symptoms. They’re educated buyers, looking up reviews before seeing a new specialist, just as they would before buying the latest gadget on Amazon. And, as we enter the era of the Internet of Everything (IoE), they want their wearable devices to meaningfully connect as simply as when they use their phones to play songs from the playlist on their laptop.
It becomes a challenge of sustaining the momentum of the moment. As the wearable trend continues to grow, it is not merely enough to count steps or measure the amount of UV rays absorbed. That won’t keep patients engaged. We need statistics and personal health trends that can be used to foster a richer, ongoing dialogue between patients and their physicians.
Consider the positive health implications for patient who receives a treatment plan from her doctor, which is entered into the EMR during the visit and connected to a three-question daily check-in for three months via a mobile device. The patient could provide a thumbs-up, thumbs-down, or neutral rating (think Pandora playlist) on how the treatment is working, with perhaps an option to enter free text should she choose to expound upon her responses. These daily reports could be aggregated into trends and reviewed by a clinician to make adjustments to the treatment plan as needed, extending patient care beyond confines of the four walls and the 12 minutes of an office visit.
Connectivity and personalization is the zeitgeist. CIOs know this. We are all unique snowflakes, and as more and more people submit their genes for analysis and mapping, we’re proving the increased drive for individuality. While the industry is pushing for population health (a laudable vision indeed), patients are looking not to be considered in aggregate, but to be treated with the same personalized attention they experience when they go to a favorite restaurant where the wait staff recalls their usual order or when they go to a website that remembers all their previous preferences. It’s about not starting from square one every time.
Patients aren’t going to tolerate the disconnect in healthcare forever. And as digital natives,some generations won’t tolerate it at all. The day is coming where a patient will ask her doctor, “Did you notice that that my headaches seemed to lessen on those days I go to the gym? I’m wondering if there’s a connection?” If her physician isn’t paying attention to her, she will find a physician, or perhaps even an intelligent medical assistant, who will.
This post originally featured on HISTalk
Saturday, May 23, 2015
This memorial day is a good time to reflect and give thanks - in fact this visual gives a great sense of the sacrifices of so many for our freedoms and life today
Original from Facebook
Here's one for the SHARE button. A truly powerful image that tells it like it is.
So while thinking about how lucky we are we should try hard to be happy as Bobby McFerrin suggested: “Don’t Worry, Be Happy” So in the spirit of focusing on happiness which is well proven to improve your life this piece in Time Magazine: Happy Thoughts: Here Are the Things Proven To Make You Happier choked full of great ideas and principles - starting with Gratitude which
Showing gratitude for the good things you have is the most powerful happiness boosting activity there is....which seemed a perfect match for today. But there are many other elements starting with
Doing what you are good at - no matter what that might be as often as possible - Starving Artists are happier with their jobs which goes a long way to explain the power of Regina Holliday and her amazing presence and power in medical advocacy (She’s just a published her first book “The Writing on the Wall” which should be required reading and would definitely be on Oprah's book list if that were still thing)
As for you time - spend it with the people you like - the happiest people are social with strong relationships and that describes much of the online community around Healthcare and Patient advocacy that i consider myself very lucky to be part of. There have been some studies that suggest a causation between happy social networks influencing others and helping them to be happier (I know could just as easily be correlation but either way Happiness is infectious)
Money can help but is not essential to happiness and it is not good to focus on money or the desire for it.
Well known that giving is better for happiness than receiving - notable during the holiday that the giving of gifts is more satisfying than receiving. Interestingly striving for ambitious goals has a positive effect and being optimistic (even bordering on delusional) has positive effects but it is this list of “big life regrets” that is worth highlighting
- I wish I’d had the courage to live a life true to myself, not the life others expected of me.
- I wish I didn’t work so hard.
- I wish I’d had the courage to express my feelings.
- I wish I had stayed in touch with my friends.
- I wish that I had let myself be happier.
and as someone pointed out - no one says as they near death - I wish I had worked much harder and spent more time at work.
Relish the time off, enjoy your life, family and friends, savor the positive experiences and do so frequently even in small doses.
Wednesday, April 15, 2015
Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.
I presented this topic at HIMSS15 on Wednesday Apr 15 - you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation
- 68 percent of patients bring a list of questions to each doctor's consult;
- 39 percent have checked WebMD or another online source in advance; and
- 20 percent bring personal health data from outside monitors.
- It’s a conversation, not a lecture
- It’s an extension of everyday interaction
- It’s group driven, not top-down
- It’s messy, disorganized & hard to control
- It’s a tool, not an end-point
- But most of all…
- What you have read that you want to share with others
- When and where you are speaking
- Something you post on your blog
- A link to a Web site that you find interesting
- Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
- Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
- Share information, valuable content with them
- Questions and Requests for information and help – crowdsourcing answers
- At a minimum – Lurk, Listen and Learn
What Not to Do
- Social Media for Physicians is a Game Changer
- Social media, when effective, will establish a physician’s brand and connect him/her with those in need of their services
- With increased deductibles, more consumers will “shop” using social media sites.
- Social Media will Expand the Physician’s Role with Patients
- Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
- Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.
Friday, April 10, 2015
First off - download the HIMSS Mobile APP that now comes with GPS intelligence which hopefully will start to provide keen insights into activities and opportunities that are nearby as you move around Chicago, the convention center and beyond
Download and print (I know not very environmentally friendly but there is a lot to absorb) the HIMSS Conference Guide (72 Pages) - or if you are feeling really clever send it to you iDevice, Pocket, Kindle or some other reading device
Or use the online version of the HIMSS of the guide - here
For the physician centric guide - head on over to this living breathing dynamic Google Document - put together by Wen Dombrowski (@HealthcareWen)
For the HIT Centric Guide from John Lynn (@TechGuy)
For the latest and greatest news be sure to follow the #HIMSS15 hashtag, and others linked to the conference including #DrHIT
And your best option for keeping up with the latest and greatest from Symplur tracking system on #HIMSS15 and that page features additional topics and tags worth following and tracking
And of course follow your Social Media (#SoMe) Ambassadors can all be found in this list on twitter
Tuesday, March 24, 2015
Health and fitness apps, smart devices and connected products are making us more aware of our own health—and more active participants in our efforts to stay healthy. At the same time, health providers are looking to technology for smarter ways to deliver quality care, whether we are in the hospital or at home.
- Wearable technology - 80% of consumers would benefit from the use of wearable technology
- Connected devices - Using remote monitoring to reduces readmissions
- EHRs - 71% of physicians now use EHRs and 85% meeting current meaningful standards
- Telehealth 70% patients comfortable communicating with their doctor using digital technology vs hauling themselves in to the officer
- Predictive analytics - More than 80% of standard tasks (BP, glucose etc) and even complex testing (e.g. genomics) will change the way we deliver care as described by Eric Topol in "The Patient Will See You Now"
- Population health management - 70% of providers reporting patient care benefits from population health initiatives
- mHealth apps - 71% of want providers to use mobile apps not least of because they do...going where everyone else is
- Data security - rightly ranked as a major issue among consumers given the ongoing debacle of healthcare related security breaches (Premera and Anthem Blue Cross, the HHS wall of shame)
- Partnerships - increasing healthcare companies entering new healthcare partnership - Tenet seem to be the latest
- Cloud-based technology - importantly seen in conjunction with "Data Security" expect this to grow at a staggering 20% rate and heading to $5.4 billion in annual revenue.
Saturday, March 14, 2015
Here’s to those who choose to defy reality and instead envision a future world – a world that ventures beyond even Mr. Spock’s wildest dreams.
Monday, March 2, 2015
It’s always comical to watch movies from the 1980s, not only for the distinct style choices that typified that decade, but to see the type of technology most of us can still recall using. It’s nearly impossible to believe we used to happily lug around three pound mobile phones with antennas and back-up battery packs, but they offered a convenience the likes of which we had never seen before. While heading to the 2015 Mobile World Congress (MWC)
one of the most prominent tradeshows in the tech industry, I couldn’t help but think about the pace of change and get excited about the digital health innovations that will be showcased.
We tend to take for granted the conveniences and time-saving effects such innovation has on our lives. Prior to the pervasiveness of mobile technology, if you were walking down the street and you saw someone collapse, you would need to find the nearest store or phone booth to call for help. In fact, most of us probably knew which corners on our daily commute had pay phones. Now, even if you’ve left your phone in the car (an unthinkable these days) you can comfortably rely on the fact that someone nearby will have theirs in the case of an emergency.
Is your heart in it?
From a healthcare perspective, the interconnectivity of devices is fascinating and holds a lot of potential for engaging patients and improving health outcomes. Innovations such as smart watches, which are being outfitted with fitness trackers and heart rate monitoring sensors, can alert the wearer he has achieved 10,000 steps that day or that a runner has reached her target heart rate
While innovations such as these are always exciting, the bigger picture is about creating a healthier population. According to the World Health Organization, cardiovascular disease is the number one cause of death in the world today. Factors such as poor diet and lack of physical activity are some of the main contributors to the disease— and they are also elements most of us struggle to balance. In other words Lifestyle is the biggest contributor to your health as you can see in this video
Wearable devices designed with intuitive interfaces hold the possibility of helping us maintain that balance, remind us of our inactivity, track our daily caloric intake, remind us of how many hours, minutes, and days it has been since our last cigarette (even Spock spoke out against smoking)
When smart watches and fitness bands are tethered to mobile devices, we can layer on more practical applications for personal health management. What if you were walking down the street and your wearable could sense you were having a minor heart arrhythmia, send a signal to your phone, and have it call for help or advice? Or, perhaps, much like our phones can now alert us to poor traffic for our daily commute, what if your wearable, knowing you are diabetic, could sense low blood sugar, sync this data with your phone and tell you some appropriate restaurants and grocery stores nearby? They will be able to translate personal health data into steps and actions we, as patients, can take to better manage our care and keep ourselves healthier.
Engagement ROIThe benefits of an engaged patient population are numerous. Not only will people be healthier, but consider the above World Health Organization cardiovascular disease statistics and the associated costs of care, medication, and lost productivity, not to mention the personal impact on each of us. For coronary heart disease alone, the U.S. spends $108.9 billion. If people were more dialed in to their health— tracking, monitoring, and being rewarded by insurance companies for adherence to healthy lifestyle activities— imagine the savings both in lives and dollars. And with the pervasiveness of health IT innovation, we are seeing more consumer-facing health apps, such as Sharecare’s AskMD, becoming standard features on mobile devices. People can now use these apps to walk them through their symptoms, offer guidance on managing chronic conditions, and remind them to check in with their doctors.
We’ve come a long way from the shoe-box sized mobile phones of the ‘80s and it will be interesting to see a glimpse of our future technologies, widgets and devices on display at CES 2015. One thing is certain: whether you’re a physician or a patient, we’re all still consumers and our expectations for efficiency and conveniences on mobile devices will play a large role in the next phase our health evolution. In fact, I imagine the current wearable will be considered clunky and dated in as little as 10 years. We might find our lives equipped with even more svelte tools integrated with all of our healthcare data and real-time advisors, apps or avatars that coach, coerce or cheer us on through daily choices to keep our lives and health on the ideal track.
The original article appeared in WhatsNext
Saturday, February 28, 2015
Like many I was saddened to hear the loss of one of my heroes growing up - Leonard Nimoy was Spock to me as he was to many others. He epitomized the value of science and logic in the resolution of problems
As my good Friend Jane Sarasohn-Kahn highlighted in her tribute on Healthpopuli: Learning from Mr. Spock and Leonard Nimoy about living long and prospering. Her selection of this iconic moment with Spock were right on target - from one of the great movies from the franchise - Wrath of Khan
Spock: “Do not grieve, Admiral. It is logical: the needs of the many outweigh…”He spoke out on smoking - something that in the end killed him before his time in this tweet from January 2014:
Kirk: “The needs of the few…”
Spock: “Or the one.”
I quit smoking 30 yrs ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP
I quit smoking 30 yrs ago. Not soon enough. I have COPD. Grandpa says, quit now!! LLAP30% of people will suffer serious Chronic Obstructive Airways Disease (COPD) as a result of smoking - and that's just one of a slew of diseases inextricable linked to smoking. Smoking while in decline in some countries is on the rise in others and this major health risk remains one a negative impact on personal health
— Leonard Nimoy (@TheRealNimoy) January 30, 2014
You can explore WHO data in this interactive chart from who here
But don't limit the application of science to health and smoking - you can put Vaccines in the same category of Science and Logic. Jimmy Kimmel captured the sentiments aptly in this segment featuring real doctors
So much of your health boils down to Lifestyle choices that was so elegantly captured by Brigitte Piniewski, MD in this chart
Where would you rather be - fun or no fun
Spock the Hero with Super Powers
We may wish for the seriously cool vulcan Nerve Pinch
But we don’t need the vulcan nerve pinch. He and his character have taught us that science while not infallible has been working for us for millennium. We have started to tap into the power of science and the opportunity offered to our health and well being.
When it comes to science and healthcare Doctors are your trusted advisor - the relationship may be changing from the paternalistic role to a collaborative role as Eric Topol so eloquently describes in his latest book - The Patient will See you Now. But as captured in this piece by this Trauma Surgeon (@DocBastard) on the Daily Beast: Why You Trust the Internet More Than Your Doctor
...for god’s sake don’t think that you know as much as a doctor because you Googled something. Medical training takes up to a decade or longer (depending on the specialty), so a 0.452 second Google search does not substitute for consulting with an actual physician whose only interest is your health.We are only at the beginning - what comes next and in our future is unimaginable. Our innovation, inventiveness and abilities continue to expand our universe and our understanding. Science wins- every time. Be logical with that splash of human emotion and honor his legacy - open your mind, analyze the facts and apply the science. As Jesse: Yeah, Mr. White! Yeah, science!
On a side note - if you are interested in the history of the Spock Vulcan Salute - Live Long and Prosper you can watch his explanation of his Jewish Origins here (derived from the Hebrew letter shin and the first letter of several hebrew words Shaddai (god), Shalom (hello/goodbye/peace) and Shekhinah (feminine word for god) - How Fascinating!
Monday, January 26, 2015
There is no known medical condition that enables an individual to predict the future. While such an ability would be extremely useful for myriad reasons, we have, instead, learned to hone and leverage our analytic skills to deduce what might occur, relying on the data we cull and parse to help forecast the future. So, when it comes to predicting the year ahead, we should consider the one we just had.
Consumer technology is often a good indicator of what type of capabilities and functionalities might be in store for health IT. This past year, we saw major players in the tech space announce their forays into healthcare. While this will not be without its challenges, it does not diminish the underlying fact that there is a need and want for better technology in healthcare— regardless of whether you are a patient looking to effectively manage your weight or a physician struggling to juggle patient care and administrative duties.
In the last year, we saw a wave of next-generation wearable devices flood the market, and as a result, we, as patient consumers, now have streamlined access to information such as our daily step count and average heart-rate on our watches. We know that ease-of-use, understandability, and some level of gameification:
are vital to maintaining engagement.
I believe this is the beginning of something much larger, a groundswell movement that will result in patients wanting more information about their health data, and, more importantly, craving a better understanding of what all these numbers actually mean and how to positively impact them. Achieving this level of engagement demands a simpler intelligent interface that doesn’t require a learning curve, but is one that consumers can just use. Clever user interface designs can only go so far, particularly given the small visual real estate available on wearable devices, and the addition of capabilities such as intelligent voice assistants will be an integral part of this explosion of personal health management.
Having a heart-to-heart about your heartTechnology holds the potential to create clinical synergy, bringing patient consumers (who have become professional health IT consumers, or health prosumers) better intelligence about their personal health data and outlining the proactive measures they can take to become better partners in their own health. The average patient consumer may not have a reaction to the phrase
“Your Protime this week is 3.3,” but for someone with a heart condition, this number is very important and indicates how fast her blood is clotting. The data, while extremely useful to a clinician, is only helpful to the patient if she understands what it means and how she can take the right actions as a result.
The future is about patients managing their own care and working alongside clinicians to drive better outcomes. To the woman who has a Protime of 3.3, access to these results supplemented with clinical guidelines would mean that she wouldn’t need to wait for her physician to call with diet recommendations, she would know her blood is clotting too slowly and that she might have an inadequate protein consumption or might need to increase her vitamin K intake. If the number required that her Coumadin dosage be adjusted, this would be the point where her physician would reach out to her to discuss.
Although a basic example, it is one that has endless permutations when it comes to building a more engaged patient population. There is no one more invested in your health than you, and the person who cares the next most about keeping you well, is your physician. I believe that clinical synergy will be driven by both patients, who want to actively manage their chronic conditions and take meaningful preventative care measures, and physicians who want to empower their patients to better understand how the choices they make have significant health implications. Technology is the connective fiber that can enable the transmission of this important data, and help translate it into wisdom. And that truly is the crux—the data flowing between patient and physician must be relevant and meaningful. That ability for technology to determine the relevancy of health data information is just around the corner and soon our wearables will be able to notify our health information data that deviates from our personal “normal” results.
Approximately 75 percent of U.S. healthcare expenditure is related to chronic care management, imagine the impact this level of clinical synergy will have on driving a healthier population while reducing cost. I’m ready, are you?
This post originally appeared on WhatsNext
Tuesday, January 20, 2015
While it was interesting to see all the fitness and consumer health apps, I found myself spending extra time looking at non-healthcare related technologies, drawn in one direction or the other based on the “oohs” and “ahhs” of crowds marveling at incredible and unfettered innovation. I made countless stops along the way, and spoke to many different creators about the potential healthcare implications of their products, and I quickly realized that the future of health IT innovation will be a combination of various consumer technologies that are carefully sutured together.
Internet of Healthcare Things (IoHCT)The interconnectivity of devices has been a growing trend in the consumer world, but it is one that has not really made its foray into healthcare. When it does, the potential will be astounding. I spoke with La Crosse Technology,
They collect data from weather systems, such as temperature, humidity, etc. They have developed the ability to leverage this data to adjust home heating and cooling systems according to the current weather conditions. Practical and money-saving for sure, but it is easy to extrapolate the benefits of such technology to patient consumers.
Imagine the impact this could have for someone suffering from chronic respiratory issues or severe asthma: they could receive guidance on what is going on outside and perhaps take extra medication to cope with poor air quality.
Additionally, such data could be used to send important reminders to help patients better cope with their medical issues, for instance, a virtual assistant that says “Heavy snow is on the way for the next three days, and I noticed your drug supply was down to two days, you should refill today so you don’t run out while the weather is bad and traveling is difficult.”
I also met with Butterfleye
a company that develops in-home monitoring systems.
Although there were many players in the home-monitoring space, I found this one compelling as it was easy to install and designed to learn, adapting to daily occurrences and routines as opposed to being programed. Imagine the value of setting this device up in the home of an elderly patient or loved one and using it not for security purposes, but for peace-of-mind, to make sure there is activity and movement and to learn of a fall or worsening condition more quickly.
Because the system is able to learn, it can discern the difference between a dog or cat roaming about the house and a person, so if there was an incident, a pet won’t “trick” the system into thinking the individual is actually walking about the room. While personal alerts are helpful if the individual is conscious and is wearing a medical alert device, a system such as this could help identify more severe life-threatening health conditions, and, with an intelligent virtual assistant, could ask residents if they are okay and call for help, if they get a negative or no response.
A Modern-day Techie OdysseusThose familiar with the story of Odysseus know that he spent seven years sailing the seas trying to return to his homeland, Ithaca. What started out as a point A to point B trip, became a journey that forced him to see things differently. He was drawn in by all sorts of alluring (and not so alluring) options along the way, and when he finally returned home, he did so a wiser man. Meandering through the labyrinth-like CES showroom floor, I saw everything from robots that attach to windows
Solving that challenging problem of dirty windows on the outside
And clean the outside, to alluring bionic sensor
Technology that allows users to control devices via subtle muscle movement from behind their ears.
A Nod to 3-D Printing3D printing is taking off and I saw multiple exciting innovations of the technology on the show floor that included developments around materials and the ability to print metals and food. As you can see from this Geek Beat clip we are heading for a reality of the Star Trek Replicator
Healthcare is just scratching the surface and you can get a sense of some of the excitement in this piece by Dave deBronkart (ePatientdave): The Future Is Leaking In: "The Patient Will See You Now" Is 3D Printed Reality
Health and Fitness Apps Get a MakeOverAs my colleague Rebecca Paquette pointed out in her post on CES we are getting people to talk to things more naturally.
Chances are if you’re into staying fit, you’re into tracking all of the data that goes into keeping you happy and healthy. But tracking that data shouldn’t be a workout unto itself. The amount of time we spend logging meals, activity and sleep could be much better used burning more calories, or, if you’re like me, getting more shut eye (I forget to log it, then scramble to get it in before I fall asleep).This consumer health prototype app on the Samsung Gear S from Nuance turns the process of interacting with these devices on its head as featured in this interview at CESLive
But the best thing about wandering the show is that it makes you see things differently, helps you think about things in a new way. It’s about pushing the limits, finding new use cases, new possible technology partnerships to create an even more robust, more powerful solution to address what people need.
Healthcare impacts many different types of people, from patients and clinicians, to administrators, coders and compliance officers— just to name a few. The common denominator, regardless of who you are, is that we all seek the best possible health outcomes. Having the opportunity to not only see, but experience, all different types of technology with untapped healthcare potential was incredible. It wasn’t about finding the health-specific applications and devices that would magically solve any one challenge, but about seeing the copious options available to consumers en masse, and talking with innovators about the potential cross-over and blending of technologies to advance healthcare today and in the future
This post originally appeared on WhatsNext
Tuesday, January 6, 2015
CES attracts 150,000 visitors (all looking for the same cabs so I’m willing to bet that Uber is not going to work as well), occupies 2,000,000 sq ft of space (35 football fields - American or the rest of the world soccer) and includes 3,500 companies
This year the DigitalHealthCES meeting runs concurrently and I believe is in its 4th year. Further evidence of the merger of health, consumer and the engaged patient equipped with mobile technology and wearables.
As my friend John Lynn said in his post Initial CES 2015 Observations. He sees the top trends as
- 3D Printers
- Drones, and
The first two not closely linked to healthcare (except perhaps this recent recent student suggestion of an Ambulance drone to deliver help to heart attack victims).
Wearables are front and center and John cites the Amstrip company with a band aid style monitoring concept. I expect clothing and in particular sports to lead this charge with the initial interest in optimizing training and athletic performance as we saw from the World Cup last year and the miCoach system from Adidas that was in use by the winners Germany.
Needless to say others are joining the fray with clothing brands such as Asics, Under Armour and Ralph Lauren now offering clothes to monitor all sorts of parameters
This year may see the emergence of more from the Internet of Things (IoT) - or the new term the Internet of Everything (IoE).
Everything connected and controlled through a consumer friendly hub which will include the wearable and monitoring concepts.
This is as simple as ceiling fans and cooling systems and thermostats but with healthcare making this even more interesting and the learning potential of these intelligent systems and their Artificial Intelligence offering insights into our lives to help turn unhealthy behaviors and activities into healthy choices.
So much of our healthcare expenditure is related to chronic care management, imagine the impact this level of synergy and motivation will have on driving a healthier population while reducing cost.
I’m ready, are you?
Wednesday, November 12, 2014
This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology.
With ubiquitous technology comes ubiquitous complexity - adn this is especially true for doctors who face challenging User Interfaces - captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine
Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.
Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.
Here’s a video showing off Florence
Tuesday, November 11, 2014
Melody Smith Jones
The session was put together by Melody to take on the oft talked about but perhaps poorly understood “Digital Divide”. Patients spend less than 1% of their time with doctors - the balance of our time represents (lost) opportunity to interact with people helping them live fulfilling healthy lives and making the best possible choices.
On average, patients only spend 1% of their time in the clinical care setting. Traditional medicine has focused upon patient engagement during that eight minute doctor visit. Yet, it is the other 99% of the time, when patients are at home, at work, at school, and in their communities that matters most. It is outreach to patients while they are living, working, and playing that determines how their overall wellness is managed.We have seen a plethora of technologies that attempt to address this area with everything from diet and fitness apps to specific applications designed to address long term health issues.
But there is variability with access in the community to information technology preventing access and knowledge and skills necessary to derive the value from these tools. Melody has addressed this divide specifically focusing on apps doe Low-Income Mothers in her recent post: 3 High Health Apps for Low-Income Moms. Check out Melody’s top 3 picks for low income mothers - some great apps focusing on the Food stamps including clever use of Bar code scanning technology to check eligibility of food and the nutritional value and a novel use of simple text messaging to improve maternal and newborn health <----- approach="" font="" love="" of="" simplicity="" the="" this="">----->
As she points out many of us make assumptions about accessibility to technology in lower social economic groups- as she puts it
Many make an assumption that those with low income or low education levels would not have mobile technology to use in the first placeBut despite the budgetary restrictions we see a very high level of adoption of mobile technology - this is true worldwide as demonstrated by the statistics of mobile phone in the world: More People Have Cell Phones Than Toilets, U.N. Study Shows.
Out of the world’s estimated 7 billion people, 6 billion have access to mobile phones. Only 4.5 billion have access to working toilets.
In one of my personal areas of passion - Africa that is replete with examples of successful use of technology to impact the health of the population at levels that we can only dream of here in “the West". Here in this study: Text message reminders improve healthcare practice in rural Africa
and this piece in the Atlantic: Medicine by Text Message: Learning From the Developing World
It might seem counter intuitive to spend money on what some might consider a luxury or discretionary spend - but for some this is the only means of communication replacing the plain old telephone line (POTS) and these devices come with capabilities and a reach that was pervasively unavailable to many in our society. The statics suggest as many as 80% of low income consumers own a mobile device.
But despite this opportunity the technology and apps are often times targeted at the higher income who already have fitter healthier lifestyles. Some of this is because of the existing developer community (higher social economic group) who develop for the problems they perceive and the harsh economics - this is where the money is (or at least we think it is). Despite Malaria being such a big killer there is limited investment in prevention and treatment of the disease as it affects the poor nations with limited capacity to buy any solutions that are developed despite significant progress and the impact of World Malaria Day
This was covered eloquently by J.C. Herz at wired in this piece: Wearables Are Totally Failing the People Who Need Them Most. We are awash with wearables, new devices and new apps and buckling under a Tsunami of data but:
...developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk. It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies.There are some economic reasons for these current trends, some social aspects of the development community but these may be based on false belief of the economics when you consider the opportunity exists to shake up the $2 trillion annual cost of chronic disease….!
I’m with Kabir Kasagood, director of business development for Qualcomm Life who said
Go from the children’s table to the grown-up table...If you’re serious about this, embrace the FDA. Learn how HIPAA works... move away from fitness and go hardcore into health. That’s where the money isAround 45% of US adults are dealing with at least on chronic condition and picking on one Diabetes and look at the market opportunity of $6.3 Billion spent on blood glucose strips gives you a sense of the economics of this market. These are motivated people for whom the quantified self can mean the difference between an (expensive) admission to hospital or managing and improving at home.
At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office?We plan to address these issues in our panel - if you can’t join us maybe you can join the conversation using the hash tag from the conference #Med2 here at Symplur
Monday, November 10, 2014
One in eight U.S. women will develop invasive breast cancer over the course of her lifetime. In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed. That’s approximately 808 cases per day.
But these statistics don’t matter. Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers. It immediately becomes a reality to you. We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”
As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before. We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news. We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.
What never ceases to amaze me, however, is the strength of the human spirit. Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.
It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.
Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives. As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care. We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.
Technology can help in healthcare, but it is not the goal nor should it ever be the focus. Yet, in some cases, it has detracted from our ability to provide care and compassion. To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.
To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions"
Monday, October 27, 2014
A thoughtful piece that drilled in to the detail of events surrounding the arrival and subsequent consultations, admission and treatment of Thomas Eric Duncan
who sadly died on October 8 succumbing to the ravages of the Ebola virus
As the authors state
The mishandling of US Patient Zero is receiving widespread media attention highlighting failures in disaster management, infectious disease control, national security, and emergency department (ED) care.....also brought decision-making vulnerabilities in the era of the Electronic Health Record (EHR) into the public eyeMuch of the commentary generated "fear, uncertainty, and doubt about the competence of our health care delivery system" and while there were problems I agree with the authors that this is a “teachable moment” and a chance to identify the missed opportunities and key issues that we can learn from
The authors used the publicly available documents and testimony in their quest and it is important to note that they did not have access to the full record, the EMR used or indeed all the pieces of the puzzle and made up for this in some areas with educated guesses.
It is interesting to note that in the first visit to the ED the patient's temperature spiked to 103 degrees accompanied by pain described by the patient as 8/10 in severity.
|This from a Malaria Study but typical of the Spike in Temperature found with this disease|
He was diagnosed on initial discharge included sinusitis but "but that CT scans of “head and abdomen” ordered during the ED visit showed no evidence of sinusitis" and perhaps with more attention and importantly time made available to the clinical staff would offer them the opportunity to focus on the history and examination and less on high tech investigation. In many cases clinicians are forced into their use not by clinical practice but rather to meet the production pressures - as the authors put it
A host of system-related factors detract from optimal conditions for critical thinking in the ED, leading clinicians to lose situational awareness. These include production pressures, distractions, and inefficient processesThe upshot was a discharge and subsequent return days later at and even then:
even after the second ED visit which led to hospitalization, strict Ebola isolation precautions were not followed for 2 days, until the diagnosis was confirmed by the CDCOffering a window into the events that is made so much easier with the benefit of 20/20 hindsight
The authors offer some learning opportunities that are worth highlightingTop of the list in would be working with software developers to improve EHR usability
As this case illustrates, EHR-based clinical workflows often fail to optimize information sharing amongst various team members, leading to lapses in recognizing specific clinical findings that could aid in rapid and accurate diagnosisAs an interesting addition none of the systems (or incentives) have any form of feedback loop built in to allow clinicians to learn from their actions.
As for the process of information capture - we have lost site of the information that is relevant in the fog of billing and regulatory driven template driven charting.
Condition-specific charting templates, drop-down selection lists, and checkboxes developed in response to billing or quality reporting requirements potentially distort history-taking, examination, and their accurate and comprehensive recording.. Clinicians also tend to ignore template-generated notes in their review process; often the signal-to-noise ratio in these notes is low. EHRs can lead to less verbal exchange, which is all the more needed and more effective when dealing with complex tasks and communicating critical informationRight on except to say this does not "potentially distort history-taking" - it does distort history-taking and
not "EHRs can lead to less verbal exchange" - EHRs do lead to less verbal exchanges
The data entry requirements place an enormous burden on our clinical professionals
who are tasked and measured not on clinical practice and the delivery of great care but on specific content of documentation that is mandated to capture clinical information in specific ways determined by the reimbursement, coding and regulatory system.
Other factors, such as heavy data entry requirements and frequent copy-and-paste from previous notes, detract from critical thinking during the diagnostic decision-making process... For EHRs to be most effective, they need to be able to automatically sort through patient data, identify the pertinent findings, and present them in an easy to understand manner. Computer algorithms could combine patient-specific information with the latest evidence-based clinical knowledge to help clinicians reach the correct diagnosisThis is the next frontier of Healthcare technology and in particular clinical documentation - we know we can sort through patient data, identify the pertinent findings - focused in these examples on quality of care and evidence based guidelines and we know computer algorithms can use patient specific information combined with evidence based knowledge to help
Technology can help but there are some fundamental flaws in the design and management of healthcare that are fed by the current incentives. Many initiatives attempting to improve patient safety and value-based purchasing but don't focus on accuracy and timeliness of diagnosis and in particular Outpatient reimbursement policies do not reward diagnostic decision-making, teamwork, or quality time spent with the patient in making a diagnosis.
What you incent is what you get and this needs to be changed as well.
Wednesday, October 22, 2014
There is no code for Ebola in ICD9 - just a non-specific 078.89: Other specified diseases due to viruses which covers:
Acute infectious lymphocytosis
Cervical myalgia, epidemic
Disease due to Alpharetrovirus
Disease due to Alphavirus
Disease due to Arenavirus
Disease due to Betaherpesvirinae
Disease due to Birnavirus
Disease due to Coronaviridae
Disease due to Filoviridae
Disease due to Lentivirus
Disease due to Lone star virus
Disease due to Nairovirus
Disease due to Orthobunyavirus
Disease due to Parvoviridae
Disease due to Pestivirus
Disease due to Polyomaviridae
Disease due to Respirovirus
Disease due to Rotavirus
Disease due to Spumavirus
Disease due to Togaviridae
Duvenhage virus disease
Ebola virus disease
Epidemic cervical myalgia
Le Dantec virus disease
Marburg virus disease
Mokola virus disease
Non-arthropod-borne viral disease associated with AIDS
Pichinde virus disease
Tacaribe virus disease
Vesicular stomatitis Alagoas virus disease
Epidemic cervical myalgia
ICD-10 has one specific code for Ebola: A98.4 - Ebola Virus Disease
A highly fatal, acute hemorrhagic fever, clinically very similar to marburg virus disease, caused by ebolavirus, first occurring in the sudan and adjacent northwestern (what was then) zaire.
Accurate tracking and reporting stop at the border of the United States
This is one of many examples of codes "missing" in ICD9 for conditions and care we are already delivering and dealing with