Healthcare Technology need to include Patients

A survey conducted at HIMSS15 found that patient satisfaction

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

The intersection of Science Fiction, super-pi, and technology innovation

Celebrating Pi (3.141592653) 3/14/15 at 9:26:53

Today is super-pi day, a day that comes but once a century and extends to a specific time at 9:26:53 seconds (although when that occurs will depends on your time zone. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation and see how far they can plot the number. As Spock put it:

"Pi as we know the value of Pi is a transcendental figure without resolution"

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.

The sad news of Leonard Nimoy’s passing has spurred tributes to not only to his life and craft, but to Star Trek, and what it has meant to so many over the years. In talking with my friends and colleagues, it seems that regardless of age, most Trekkies are also techies.

One of the neatest things about working in technology is that you inhabit two worlds. The first is our everyday reality—with all of its joys, frustrations, celebrations, and inconveniences. This world has soft tender moments tempered by harsh truths; it is simultaneously disappointing and inspiring.

But from this disappointment is born opportunity and a vision for the future world. Here is where Star Trek is a reality, where innovators take those every day frustrations and disappointments as ask themselves how things can be done better.

I’m lucky to work alongside some incredibly innovative, talented minds and whether in R&D or client services, at the core, we all share an inquisitiveness that pulls us from one orbit to another.

“I grew up watching Captain Kirk, Spock, and the Enterprise crew boldly go where no man has gone before. In the 1980s, Star Trek was big in India and it ignited our collective sparks of creativity and imagination. In fact, as school children, we learned to make “communicators” with matchboxes and rubber bands. When I grew up, I realized this type of voice-activated technology could be a reality, and I have dedicated my career to making that vision something that is accessible to everyone. I still wonder how close our technology today is to what Gene Roddenberry had imagined when he created Star Trek.”

- Vivek Kaluskar, Nuance Natural Language Processing Researcher

“Star Trek introduced me to the idea of being able to talk to a computer, and have it understand and respond. That’s actually what got me into speech-recognition technology: it was that sense of wonder about making technology collaborative—where you could ask a device a question and it could parse through vast amounts of data to help you do something faster.

The show also got me interested in science fiction, which has proven to be an enduring affection. It’s amazing to step back and see many ideas that seemed outlandish, like tractor beams, talking computers, matter transmission, and warp drives, are either becoming a reality, or are being researched and developed. Science fiction, in many ways, has created a technological roadmap for the future. It reminds us to keep dreaming and keep asking ‘why can’t we do that?’”

- Ignace Van Caneghem, Nuance Customer Support Specialist

Finding solutions to seemingly impossible situations is what innovators do. It’s why we wake up in the morning. I’m constantly looking for ways to make health IT more connected, accessible, and more intuitive so physicians can focus on treating their patients.

Working in tech isn’t easy, but some of the most worthwhile pursuits are also the most challenging. Thinking outside the box is the key to solving complex problems. There’s an episode of Star Trek (“Wolf in the Fold,” 1967) where Spock forces an alien entity out of the ship’s computer by asking it to calculate pi to the last digit, an impossible feat. At that time, using speech recognition to control a computer was also impossible.

We are a lot closer to the Hollywood vision that’s been in our minds since 1967, creating innovative technology that continues to amaze us at an incredible pace. It was this sense of amazement, instilled by the creative mind of Gene Rodenberry, which helped open my eyes to the potential for healthcare technology to touch not just hundreds, but millions of patients through innovation.

This Saturday is Super Pi Day, a day that comes but once a century. While pi is an infinite non-repeating decimal, there are still mathematicians and scientists seeking to build computers that can run the computation, see how far they can plot the number. Here’s to those who chase the impossible. To those who know there is a better way to do things and dare to keep asking “how?” They choose to live between two worlds and they are building the future. Super-pi day is for you.

This post originally appeared in Whats Next

Honor Spock's Logic - Follow the Science

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…”
Kirk: “The needs of the few…”
Spock: “Or the one.”

He spoke out on smoking - something that in the end killed him before his time in this tweet from January 2014:

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!! LLAP
— Leonard Nimoy (@TheRealNimoy) January 30, 2014

30% 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

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!

Live Long and Prosper (LLAP)

or perhaps

Live Long, Logically and Prosper (L3AP)

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!

CES 2015 - The Year of Digital Health and Wearables

This year I have the privilege of attending CES2015 in Las Vegas - for those of you who have not been before its big..even by Las Vegas standards.

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
• Wearables

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?

We Must All be Engaged in the Design, Delivery, and Re-imagination of Healthcare

Previously posted on HITConsultant

On a recent flight, I had my headphones on and the Rolling Stones’ “Satisfaction”

began to play.

It’s a song I have heard hundreds of times over the years, but I was struck by the difference listening to it with headphones made. With no distractions, I noticed the bass line, in time with the percussion, provides the perfect offset to Mick Jagger’s distinctively strained voice. It was a completely different experience than hearing the track play in the background of a movie or while at a restaurant. Being fully-immersed and listening only to that song allowed me to pick out and appreciate subtle details I had never noticed previously. It’s no surprise that things sound differently when you’re able to concentrate your full attention on what is being said, but as I was sitting there, I became acutely aware of the function headphones serve—they enable the wearer to listen, blocking out distractions.

That is exactly what we are seeking in healthcare and it has proven to be difficult to achieve – in part because of pace, complexity of care, and technology. For centuries, physicians have listened to their patients and relied on their senses— their powers of observation— and matched these insights with clinical experience to heal. Clinicians need to be able to listen and concentrate on what their patient is telling them and noticing those distinctive symptoms he or she may be exhibiting. As Sir William Osler

famously advised:

“Listen to your patient, he is telling you the diagnosis.”

Being able to dedicate your undivided attention to anything these days is a rarity, but in healthcare, it is a crucial but frequently missing element. The last thing you want to feel when you are at your most vulnerable is that your physician is multi-tasking. Patient satisfaction scores will suffer, but more concerning are the clinical risks and missed opportunities of distracted physicians.

Distracted clinicians are the result of what Dr. Steven Stack of the American Medical Association refers to as an “over-designed” health IT system.” In a recent discussion with industry leaders, he explained that we seem to have become victims of our own ambition. We have devised structures that don’t work for everyone and policies that create very real, very expensive consequences for those who don’t abide. And this has left physicians stretched too thin, trying to do more in less time without any direct impact on improving their ability to care for their patients.

So, maybe it’s time we scale back. Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and co-chair of the nation HIT Standards Committee, noted that while we are in this period of transition and growth, we need to focus on parsimony, or determining the smallest number of moving parts that need to be adjusted in order to create seamlessness in HIT. Quite simply put, while the cart has been upset, there is no reason to trample all over the apples.

The MIT Technology Review recently interviewed Sarah Lewis, a doctoral candidate at Yale, about her recent book that explores how different unlikely circumstances or paths, like failure, have often spurred innovation. Citing creative geniuses such as Cezanne and Beethoven to Nobel laureates, she defines failure as the gap between where one is and where one would like to be. Confronting this gap, she asserts, is important because it “lets people go deep with their failure while letting it be an entrepreneurial endeavor if they like, or an innovative discovery.” We, in health IT, are currently at that gap where there is a disparity between where we are and where we would like to be.

The recent ICD-10 delay has provided the perfect opportunity for us to find Halamka’s parsimony, leveraging solutions that work for physicians and creating consistency and impact wherever possible. Like medicine itself, there will be no one perfect solution for every physician or organization, but we need to begin finding things that work – from re-skinning EHRs with easy to use tools like single sign-on or mobility to systems that respond to voice, touch or swipe to improve the experience for clinicians and patients. We need to start thinking of health IT more like headphones, coming in different styles to suit preferences, but providing the same function of reducing distraction and enabling the clinician to focus on the inflections in their patients’ voices, and truly hearing what is being said.

As Mick Jagger poignantly remarked, “The past is a great place and I don’t want to erase it … but I don’t want to be its prisoner, either.” We have accomplished a lot, but it is time to learn from the past and break free from what isn’t working. I think we can get health IT satisfaction (despite what the song says), but to do so we must all be engaged in the design, delivery, and re-imagination of healthcare and its intersection with technology. This truly is the art of medicine and we are all virtuosos contributing to the next masterpiece of healthcare.

Are Physicians the Cure to Healthcare’s Bugs?

This post originally appeared on HIT Consultant

During a recent and troubling discussion with a physician friend, he described to me a new ailment he’s been experiencing: waking up in the morning, and not looking forward to going to work.  The reality is that he is not alone.  It’s no secret that physicians across the country, regardless of their specialty or location, are reaching their limit for juggling new requirements, technology upgrades,  and policy changes, all while trying to deliver personalized, quality care to their patients.  As a result, busy physicians are, quite understandably feeling pressured and pulled away from direct patient care and critical clinical-decision making, and, at the end of the day, that is what matters most to patients and physicians alike.  
It is easy to imagine the impact overloaded and dissatisfied physicians could have on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and how these regulatory pressures and so many new healthcare technologies could be linked to the decline of the “art of medicine.”  But are we, in fact, misdiagnosing the problem?

A recent study from Johns Hopkins University found that internal medicine interns are lacking proper bedside etiquette, which is not only essential to providing quality care, it directly impacts medical outcomes and patient satisfaction scores.  Focusing on five key elements of proper patient-physician decorum, researchers tracked whether or not hospital interns:

1. Introduced themselves, 
2. Explained their role in the patient’s care,
3. Touched the patient,
4. Asked open-ended questions, or
5. Sat down with the patient during the visit.  

Results revealed that interns touched their patients (either during a physical exam, handshake or gentle, supportive touch) 65 percent of the time and asked open-ended questions 75 percent of the time, but introduced themselves only 40 percent of the time, explained their role merely 37 percent of the time, and actually sat down during only nine percent of the visits.  Such results are disconcerting, at best, and reveal a more pressing truth: These basic and critical communication deficiencies that are essential to providing holistic patient care are not being taught.

The study exposes the reality that the shift away from patient focus and the “art of medicine” isn’t just stemming from increased physician workloads caused by new policies and changing technologies.  It is infiltrating our profession through a change in training, as well.  While we have reduced junior doctors’ work hours for safety reasons, we have not adjusted the overall length of training they receive.  Medical students, our future physicians, are not receiving the holistic education that helps them balance keen scientific skills with compassionate delivery.

But, as they say, “knowledge is power,” and now that we are starting to pinpoint conditions that are tearing at our profession, we can start to heal them.  We can’t expect our medical interns to know how to handle difficult and emotional situations unless we show them.  We need to teach them how to engage with patients, earn their trust, really listen and understand them.  They need to be able to view what their patients say through both a  lens of science and medicine, as well as  a  lens of compassion and caring, in order to help them get and stay well.

And what of the technology challenges that are driving wedges between patients and physicians?  While there is no denying that much of health information technology is putting pressure on physicians and forcing them to adapt to new methodologies, these challenges are a necessary to revolutionizing patient care.  They are, in essence, the basis of growth and the very nature of science.  If it weren’t for boldly trying new approaches, we might still be relying on leeches and blood-letting to cure melancholia.   Just as we can’t expect a patient with heart disease to know intrinsically to maintain a low-sodium diet, we can’t expect the healthcare industry to know how to fix everything unless we speak up and advocate for change (especially with the other loud voices of insurers and politicians speaking on “our behalf”).

We must be mindful that as physicians, it is our sworn duty to defend the practice of delivering the best care to our patients from anything that threatens to impinge on that quality.  We need to stay engaged and be responsive; and that also means we need to assist with diagnosing major technology pain points and identify when something isn’t working.  We have the rare opportunity to shape the future of healthcare infused with technology and I, for one, want to be part of developing a solution that helps the next generation of physicians offer that comforting touch as they deliver an even greater level of care to their patients.

23 and Me and

The FDA issued a warning letter to 23andMe on Nov 22, 2013. There followed a slew of articles, posts, tweets and commentary - amongst the many

there's also more reason for concern .... Class Action Law Suit Filed Against @23andMe http://t.co/4pYhZGaaE0 via @forbes @danmunro
— Gregg Masters (@2healthguru) December 3, 2013

And this piece on Forbes on the class action suit and this older piece that talked about the service before this news hit and then followed up with this piece "23andMe Saga Doesn’t Bode Well for EMR Genetics Integration" and David Katz: Return to Sender, Genome Unknown: Seven Reasons I Will Return My Personal Genome Kit

Declaration: I am a 23andMe customer - I liked the concept and was excited by the price point that made the service accessible and cost effective...so maybe that explains my quick reaction (per the Kübler-Ross model of grief of Denial, Anger, Bargaining, Depression, Acceptance) to many of the posts and negative feedback pushing back.

I am still processing the news and not sure exactly where I sit - personally I am glad I got in before the health information was blocked. Maybe this is a purely personal position coming from the privilege of being a physician. In fact this piece on Forbes/Quora: What Do Doctors Think About 23andme?
probably captures the viewpoint I have different from others. In fact the images summarize how many people might approach this

Hmmm - you can see the logic and while the point made that not all information is relevant or important my view is firmly on the side of the patient being allowed to make that decision themselves.  It is always worrying to me that someone else is filtering information and making decisions as to what they consider to be important to me - how can they know?

The example cited is one of a fit healthy individual making a decision based on genetic testing that suggests they might be at increased risk of cardiac disease that needs to be put int he context of them being fit and healthy

In fact they state

This is why every ethical healthcare provider follows this mantra: do not order a test or perform a procedure if it will not change your management of the patient, because doing so may cause needless harm/risk to the patient and will cause needless damage to the patient’s finances.

A reasonable position and one perhaps we might expect the FDA to support.....yet the FDA allows for direct to consumer advertising in the US.....? That seems at odds with the stance taken on genetic testing. There is no doubting that extra testing can cause additional stress and concern - putting everyone into an MRI is a bad idea since we identify around 20% "findings" many (may even be most) of which are incidental. I personally am delighted with my 23andMe results that include genetic details and insights that help me make my own personal health decisions.

I gave up personal genetic information to 23andMe who like any other cooperation could misuse it, may not protect it sufficiently or may share it with insufficient privacy protections to shield me from being identified. But that was my choice and in this instance I felt the risks outweighed the benefits.

But the cynic in me can't help but think that this may all be money related especially given the recent spat over the BRCA gene testing that was recently struck down but remains the tip of the patent iceberg.

This piece on KevinMD: 23andMe and the FDA: Did the government overreach? probably captures my basic views on the subject. As Dr Marroquin states

One worry is that people might undergo unnecessary tests and procedures based on the information 23andMe provides.  For example, critics worry that a woman who is found to have a false-positive BRCA mutation might have a prophylactic mastectomy inappropriately.  This seems to me to be an impractical concern.  It is difficult imagine a surgeon operating in such a situation without first verifying the genetic testing through another lab and extensively discussing the benefits and risks of such an approach with the patient.

Quite - it might create a worthwhile discussion between a patient and their healthcare provider. In another example the risk of Alzheimer's which a customer might feel powerless to prevent but I would suggest that this may not be true in the future and as one friend and colleague told me when he shared his results that showed an increase risk of Alzheimer's:

It just means I am going to play more sudoku as I get older

That seemed like a good strategy and attitude. It is also important to note:

It turns out, however, that people seem to be less psychologically devastated by adverse genetic test results than many of the experts anticipated.  For instance, a study published in the New England Journal of Medicine found that “in sample of subjects who completed follow-up after undergoing consumer genomewide testing, such testing did not result in any measurable short-term changes in psychological health, diet or exercise behavior, or use of screening tests.

On balance I'd rather have the choice than have the government make decisions about what data I can access. I say this with all due respect to my clinical colleagues who may disagree and the many that had exchanges with me in other social media forums.

I would also explicitly state that this is a personal view and does not represent that of my employer nor does it represent clinical guidance.

Nuance joins a who's who in 50 Most Disruptive Companies for 2013

via www2.technologyreview.com

This is really cool - Nuance made the list for top 50 disruptive companies in technology. We join other great and innovative leaders like
SpaceX
Google
IBM
Square
Toyota
Apple
Amazon
Corning
Facebook
....to name a few

But also some neat Healthcare focused companies like
Diagnostics for all
Foundation Medicine
Illumina
UniQure

Congratulations to all the others but should out to Nuance - proud to be a part of this team

Posted via email from drnic's posterous