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Only 1.4% Of Physicians Are Ready To E-Prescribe Controlled Substances, Report Finds

Only 1.4% Of Physicians Are Ready To E-Prescribe Controlled Substances, Report Finds | Healthcare and Technology news | Scoop.it

As deaths involving prescription opioids increase, prescribers look toward other ways to curb patient overdoses. One fairly new solution in the medical community is to prescribe controlled substances electronically, but just how far along is this revolutionary approach, and will it help combat the ever-growing opioid epidemic in the country?

Health information network provider Surescripts on Tuesday released the results of research focusing on health data transactions in 2014. The report, titled the “2014 National Progress Report,” reviewed how prescribing controlled substances electronically could potentially diminish prescription fraud and abuse in the country.


The Centers for Disease Control (CDC) found that there were 16,235 deaths involving prescription opioids in 2013, an increase of 1% from 2012. In response, the CDC launched several initiatives. One of them included a campaign, titled “When the Prescription Becomes the Problem,” last month at the fourth annual National RX Drug Abuse Summit. The social media activity, designed to raise awareness of prescription painkiller abuse and overdose, ended on May 15 of this year. President Obama’s drug control priorities for the upcoming fiscal year included reducing prescription drug and heroin abuse by allocating additional funding to states with prescription drug monitoring programs (PDMPs), expanding and improving treatment for addicts, and spearheading efforts to make naloxone more readily available to first responders.


Dr. Sean Kelly, chief medical officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston,said in an interview that electronic prescribing of controlled substances (EPCS) has the potential to improve care, reduce fraud and identify potential evidences of abuse by “creating a secure, auditable electronic transmission directly from the prescriber to the pharmacy.”


“With EPCS, a paper prescription and a physician’s DEA number are never in the hands of the patient, which minimizes the risk of fraud or theft,” he said. “EPCS also improves care for patients with legitimate needs by reducing both wait times at pharmacies and the number of trips they need to make to the doctor’s office.”


He added: “EPCS also improves care by reducing prescription errors and inaccuracies.”


Prescribing controlled substances electronically can only effectively combat opioid abuse, misuse and overdose if both prescribers and pharmacies are willing to hold up their part of the deal — but that doesn’t seem to be the case. Nearly 75% of pharmacies across the country are ready to receive electronic prescriptions for controlled substances, the report found. Their counterparts are not: Only 1.4% of controlled substance prescribers are set up for EPCS.


EPCS for controlled substances is still in the early stages of development, and this is one of the main reasons why prescribers are slow to embrace this new kind of technology, Kelly said. This, however, shouldn’t worry early adopters.

“This is similar to the early days of e-prescribing for non-controlled substances,” he said. “Initially, it was a new technology that providers were unfamiliar with, but because it significantly improved efficiency and the delivery of care, it has gained rapid adoption.”


Even though physicians seem hesitant, the practice of prescribing controlled substances electronically is growing. The study reported a 400% increase in controlled substance e-prescriptions in 2014, totaling 1.67 million nationwide.


Every state in the country handles combatting the opioid epidemic in its own way. Despite only 53% of primary care physicians using prescription monitoring programs (PMPs), the majority of state governments have continued to support them. Structural differences hinder EPCS adoption. To rank states on their readiness to prescribe controlled substances electronically, Surescripts looked at several factors: the percent of enabled pharmacies, the percent of enabled prescribers and the percent of controlled substances prescribed electronically. The study found that Nebraska, California and Michigan are best equipped to handle e-prescribing of controlled substances.

“Total EPCS transaction volume is still so low across the board, so it’s difficult to say why some states are doing better or worse than others,” said Paul Uhrig, chief administrative and legal officer, and chief privacy officer at Surescripts. “But it seems to mostly hinge on whether or not a state government makes it a priority. The elimination of regulatory barriers and the implementation of legislative mandates have been the primary drivers of the adoption of EPCS.”


He added: “This means we need to work collectively, across the industry, to educate and inform all stakeholders in order to drive utilization of the technology.”


As investments in technology to improve delivery and patient care continue to grow, prescribers will become more selective. “This means that it must enable, not impede, the delivery of care,” Kelly said. “If the technology is developed and implemented in such a way that it fits easily into providers’ existing workflows, EPCS can gain widespread adoption as a formidable weapon in the fight against prescription drug abuse."


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Debating a Physician's Role in Assisting Patient Death

Debating a Physician's Role in Assisting Patient Death | Healthcare and Technology news | Scoop.it

Physician-assisted death, physician-assisted suicide, and physician aid in dying are all variations on the same theme: the use of our knowledge and craft as physicians to help a patient end his or her life.

Our choice to become physicians compels us, not only to heal but also to alleviate the suffering of those who entrust their lives to us. It is the latter aspect of our duty that is at issue here. As a surgeon, I know there are times when our attempts at healing can cause pain and suffering.


What we seldom reflect on is: What happens when we can no longer heal? What happens when our patient does not wish to be treated? What is our duty then? What is our moral and professional obligation when we can no longer heal? It is specifically at this time when our responsibility transfers from healer to caregiver, educator, mentor, counselor, and friend. What do we do at that time when death is known, and we're helpless to defeat it? Despite our narcissistic view of our invincibility, we must change our paradigm from fixing the disease to fixing the problem of pain and suffering. It is a complicated but necessary intellectual transformation. And it is a moral and right change.


This transformation brings forth the issue of how to alleviate pain and suffering at the end of life. How do we quantify the pain? And most importantly, is death the ultimate and only option for relief? Should we as physicians use our craft to cause or assist our patient to die to fulfill our obligation to alleviate suffering?

I will answer and illustrate two opposing positions. Then I will summarize and offer a personal conclusion.


Yes, we should assist patients in dying.


The proponents of physician-assisted death (PAD) establish the base of their position with the concept of "death with dignity." Dignity, grounded primarily on the principle of autonomy; that the dignity of a human being is violated when their natural right to free exercise of will is removed.


Respect for autonomy is a fundamental guideline for the moral physician. Autonomy in medicine is not just allowing patients to make decisions. Physicians have an obligation to create the conditions necessary for those decisions. At such a critical and final time as death, the ability to decide for ourselves, i.e., how and when to die, is implicit in our dignity as a person. It is the physician's obligation to respect and enable that request as part of our obligation to alleviate suffering. Assistance in dying is not inconsistent with the principle of beneficence, as recognizing and creating the environment of autonomy is beneficence.


The other grounding of PAD advocates is the idea that the pain of dying patients can only be removed with death. Compassionate physicians should recognize that suffering is not always physical but is also existential.  Death is at times the only treatment.

Finally, and probably the most contentious point, is that PAD already happens despite the laws against it. In the 2004 book, "Physician-Assisted Dying: The Case for Palliative Care & Patient Choice", the authors note that several studies of U.S. physicians indicate "a measurable, fairly consistent incidence of physician-assisted suicide whether legal or not."


The latter argument is assigned to the principle of non-maleficence, i.e., do no harm. Being dishonest with our patient's request to die using disingenuous legal or moral validations is doing harm.

No, we should not assist patients in dying.

The perception that pain and suffering at the end of life removes human dignity is not in question. The question is whether ending life is ever protective of human dignity?


Physician and medical ethicist Daniel P. Sulmasy defines human dignity in three ways: Intrinsic, inflorescent, and attributed. Intrinsic dignity is what dignity we have just for being a human person. Intrinsic dignity obliges us as members of the human kind to comport ourselves consistently and to foment the flourishing of this dignity in all members of the kind. Inflorescent dignity is more complex. Inflorescent dignity is used to refer to individuals who are flourishing as human beings, living lives that are consistent with and expressive of the intrinsic dignity of the human. Attributed dignity is more material; it is based on what is given by society or community.


As a result, dignity is sometimes used to refer to a state of virtue in which a human being acts in ways that expresses the intrinsic value of the human.  For example: "He faced the onslaught of cancer with dignity."


To reduce the concept of dignity, as the proponents of PAD do, to exclusively exercising one's autonomy is to ignore 1,000 years of theology and philosophy.


To actively participate in ending a life by acceding only to the patient's will is to deprive them of their intrinsic dignity by negating all other aspects of dignity.


Three arguments against PAD


Sanctity of life argument against:
Sanctity , according to the Old English Dictionary, is: What is secured by religious sentiment or the like against violation, infringement , or encroachment. Causing the end of life by any means is the prototypical encroachment, violation, and infringement of human "dignity."

Medical/ Psychological argument against:

A request for assisted suicide is a cry for help. The patient is depressed. Several studies dating back to the 70s conclude that at least 58 percent of terminally ill patients are clinically depressed by several assessment methods. When given viable alternatives to end their pain and suffering, most rational patients almost invariably choose them over death.  Wanting to die is a reflection of exasperation and depression. A perception clouded by pain, and they will it relieved regardless of the consequences.

Violation of professional principles argument:
Hippocratic Oath which states: "I will not administer poison to anyone where asked," and I will "be of benefit, or at least do no harm." Major professional groups such as the AMA oppose assisted death. PAD would undermine the fundamental principles by which physicians practice and further compromise the inherent trust of the doctor-patient relationship.


Conclusion


It is apparent that the proponents of PAD base their support on two points. First is preserving the principle of autonomy and its violation being perceived as an assault on dignity. Second is the perception that only death can relieve these patients' suffering.

The first is arguably rational. However, dignity is more than just autonomy. But, what is more important is that intrinsic dignity defines us as a human being. Immanuel Kant's concept of dignity is "intrinsic" and based on reason. It is not reasonable to wish death to the exclusion of all other means to relieve suffering. To end one's life even through choice violates that dignity.


The second is perceptive. The American Society of Anesthesiologists outlined in their syllabus on ethics : Pain and suffering can be relieved in the vast majority of cases without intentionally causing death. The latter is the conceptual validation for palliative sedation and pain relief that may sometimes hasten death.


In PAD, the death is not a consequence or a circumstance. It is an action of the will. An action incorrectly perceived as a zero option.

Palliative sedation has the advantage of relieving pain and suffering without the intent of causing death. The grounding philosophy of this position is found in the principle of double effect. The principle of double effect states: Accordingly, the bad effects of an action that would be morally wrong if caused intentionally are permitted if these effects are foreseen but unintended. As a result, if the intent is to alleviate suffering even with death as a consequence, the action is morally permissible.


In conclusion, wisdom compels me to do all within my power to alleviate suffering even if the action hastens death; however, my intention will always remain to preserve that intrinsic dignity of the human being. The latter opinion grounds my ethical stance. As physicians, we have an obligation to act in the best interest of our patients. If I can be virtually certain death is the only option, then so be it.


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ToKTutor's curator insight, April 1, 2015 9:04 AM

Title 1: The problem of assisted-death: a medic's exploration of how knowledge helps or hinders the solution.

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Patients, doctors see benefits of sharing medical records

Patients, doctors see benefits of sharing medical records | Healthcare and Technology news | Scoop.it

When Stacey Whiteman was diagnosed with multiple sclerosis two years ago, she didn’t realize the toughest challenge would be its impact on her brain. The 53-year-old from Massachusetts was forced to quit work as an executive assistant after becoming easily confused and prone to forget, even about priorities like doctor appointments.

When her physician suggested OpenNotes, an electronic portal allowing patients full access to their medical records, including doctors’ notes, Whiteman was eager to log on.

“For somebody like me who has a hard time processing things, I need this convenience,” she said. Whiteman now refers to OpenNotes daily, to review what happened during appointments, be reminded of future ones and check lab results.

Patient access to physician notes, historically rare, has led to more collaborative doctor-patient relationships and more engaged health care consumers, according to a new paper online February 10 in the British Medical Journal.

“Regardless of one’s competence, health information is often quite opaque,” said coauthor Michael Meltsner, a professor at Northeastern University School of Law in Boston.

Meltsner and his two coauthors, Dr. Tom Delbanco and Jan Walker, both at Beth Israel Deaconess Medical Center in Boston, evaluated data on 19,000 patients and 105 primary care physicians using OpenNotes at three U.S. hospitals.

After one year, 99% of patients wanted to continue accessing notes. Despite initial concerns among physicians about additional work, none decided to discontinue use.

“It’s like oysters. Once you like oysters, you hang in there with them,” Delbanco said. “But it’s an acquired taste.”

According to the paper, patients described “a new understanding of the importance of medications and more motivation to adhere to treatment.” They shared notes with caregivers and “reminded harried doctors about follow-up that had not been completed.”

The participating institutions, Beth Israel Deaconess, Geisinger Health System in rural Pennsylvania, and Seattle’s Harborview Medical Center, have since expanded OpenNotes use throughout specialty and primary care. Overall, five million Americans now have access to notes, up from 20,000 two years ago.

Delbanco predicts access will soon be common nationwide. Electronic medical record software suppliers, such as Epic, are building note access into products. Health institutions may opt for or against activation.

The most surprising finding, Delbanco said, is that elderly patients and those with little education were as interested in reading notes as the young and well educated.

“We thought this would be a yuppie internet,” he said. However, at Harborview, a safety-net institution, patients read online notes by logging on to computers at public libraries and hospital kiosks.

“Patients have a right to information about themselves and the right to be told the truth,” said bioethicist Nancy Berlinger of The Hastings Center.

Note sharing can be particularly beneficial for patients with serious conditions like cancer, Berlinger said, as emotions are often high during appointments in which multiple issues are addressed and treatment plans formulated.

“A lot of these patients’ lives are happening outside of the clinic,” Berlinger said. “People can take in information in the privacy of their own homes.”

Berlinger said she questions how usable OpenNotes would be for non-English speaking patients and for those with dementia.

According to Delbanco, OpenNotes is like a new medicine, good for some and contraindicated in others. “Every medicine is designed to help some people, and OpenNotes is no exception,” he said.

Rita Charon, an internist and director of the program in narrative medicine at Columbia University in New York City, said any program opening the flow of information between clinicians and patients is beneficial.

“It’s easy to do, and something many of us do routinely,” Charon said. “It lets the patient know what I think, and it reminds me to write in English and not in abbreviations. It reminds me to faithfully repeat what happened in that twenty minutes.”

Measuring outcomes, she said, would help note-sharing practices to spread.

“This work has helped us see the important feasibility parts, that patients will put time into reading what we write, and that it does something,” Charon said. “Now we have to ask what does it do?”

Delbanco acknowledges that health outcomes are still unknown and difficult to evaluate.

However, he said, “We know that engaged patients have better outcomes.”


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Doing More for Patients Often Does No Good

Doing More for Patients Often Does No Good | Healthcare and Technology news | Scoop.it

Given the remarkable advances that have been made in the last 50 or so years in pharmaceuticals, medical devices and surgical procedures, it’s not a surprise that people want more, and more invasive, care than they have had in the past. Just as it’s hard to do nothing when you’re ill, it’s sometimes hard to do less than the maximum when there are different treatments to choose from.

Unfortunately, doing more often does no good. Sometimes, it even leads to harm.

In the United States, when it appears that someone might be in trouble, emergency medical services are dispatched. Many patients die from an out-of-hospital cardiac arrest, but steps taken out in the field can make a difference. Basic life support, the kind you might be taught in a CPR class — involving the use of bag valve masks, cardiopulmonary resuscitation and automated external defibrillators — can absolutely save a life.

Advanced life support, usually requiring a trained paramedic, involves much more. Trained providers may put in endotracheal breathing tubes; start intravenous lines; deliver sophisticated cardiac drugs; and defibrillate patients manually.

We’ve assumed, for the most part, that advanced life support is better than basic life support — so much so that in most areas where both options are available, advanced life support is almost always used. But a recent study in JAMA Internal Medicine brings this assumption into question. Researchers examined Medicare patients who were billed for either advanced life support or basic life support before admission to the hospital from 2009 through most of 2011. They looked at how often patients survived to hospital discharge, and then months later.

What they found was that about 13 percent of patients who received basic life support survived and were discharged versus 9 percent of patients who received advanced life support. More patients who received basic life support lived for 90 days after discharge, too (8 percent versus 5 percent). Basic life support patients also had better neurological outcomes.

Now, of course, this is not a randomized controlled trial. It’s possible that sicker patients received advanced life support and that people who didn’t appear as sick received basic life support. But the authors called all of the state agencies, and they reported that this can’t really happen. After all, a 911 dispatcher can’t tell if it’s a “mild” or “severe” heart attack from a third party on the phone with no medical training. Dispatchers send out advanced life support if it’s available, and basic life support if it’s not.

It’s also possible that there could be differences in bystander CPR administration until help arrives. But the authors attempted to control for that, too. They conducted a number of sensitivity analyses, and in none of them did advanced life support outperform basic life support.

It would also be easier to dismiss this finding if it weren’t corroborated in many other studies. In 2004, results from the Ontario Prehospital Advanced Life Support Study were published in the New England Journal of Medicine. This was a multicenter controlled trial in 17 cities in Canada comparing advanced life support with basic life support. They found that if an instance of cardiac arrest were witnessed by a bystander, the chance of survival significantly improved. They also found that CPR administered by bystanders improved survival, and so did rapid defibrillation. These are all components of basic life support. The addition of advanced life support, however, made no difference in survival.


A 2007 study conducted in Taipei also found that advanced life support did not improve survival to discharge. Even the main components of advanced life support have failed to show results in studies. A 2008 systematic review showed no efficacy for emergency intubation. A 2010 cohort study found advanced airway methods — basically, putting in an airway tube rather than using a bag mask — to be associated with decreased survival compared with basic life support methods, as did a 2013 study in Japan.

A 2012 JAMA study found that the use of epinephrine was associated with worse outcomes, and a 2008 New England Journal of Medicine study found that adding vasopressin (another drug that, like epinephrine, constricts blood vessels to raise blood pressure) didn’t improve things. A randomized controlled trial of these drugs, published in 2009 in JAMA, found that their use didn’t improve survival either.

The evidence is compelling. Advanced life support does not seem to provide any benefits in the randomized controlled trials, and it’s often associated with worse outcomes in the cohort studies. How can this be so? Some theorize that the things that work have already been incorporated into basic life support. All that the advanced life support may be doing is slowing things down in the field, distracting people from the useful basic life support measures, and delaying the time until a patient can get to the hospital.

It’s hard not to do more if we can, though. We see this in all sorts of areas of care. A few months ago, a study was published in JAMA that examined the outcomes of women with stage 0-III unilateral breast cancer who underwent breast conserving surgery with radiation compared with those who had a unilateral mastectomy and those who had a bilateral prophylactic mastectomy. The 10-year survival differences between the groups were negligible. Breast conservation therapy is more tolerable, is much less invasive and costs less.




In fact, breast conservation therapy has become a “standard of excellence” in breast cancer care. But a study published even more recently showed that from 1998 through 2011, the odds of a woman eligible for breast conservation therapy receiving a mastectomy increased. Rates of bilateral mastectomy went up over this time period as well, from 2 percent in 1998 to 11 percent in 2011.

And based on the data from many randomized controlled trials, we know that women who have radiation therapy for early breast cancer do well with less of it. The use of “hypofractionated” whole breast irradiation, which consists of fewer treatments with higher levels of radiation, has been shown to be equally effective for women without any excess side effects. It’s cheaper, easier and just as good. Hypofractionated whole breast radiation has been endorsed by the American Society for Radiation Oncology for women who satisfy certain criteria since 2011.

But a study published a month ago that looked at the use of radiation in women with early stage breast cancer found that in 2013, only about a third of women who qualified for hypofractionated radiation therapy were getting it. The rest got more, but not better, care.

The reasons for this are varied. With respect to the radiation therapy, it’s hard not to lay some of the blame on economics. After all, in a fee-for-service system, more visits and more treatments mean more money. Research shows that twice as many women want hypofractionated radiation therapy as want conventional therapy, but only half of radiation oncologists offer it.

But it’s not all money. It’s also probably fear. Many radiation oncologists are concerned that doing fewer treatments will lead to worse outcomes. That’s most likely the concern of women who choose much more invasive surgery than necessary as well.

It’s certainly the rationale for why advanced life support is so prevalent. The Ontario Prehospital Advanced Life Support Trial was supposed to be a randomized controlled trial, but the paramedics evidently refused to do it because they felt that holding back advanced life support was unethical. This was in spite of the lack of evidence that it was effective.

More is expensive. More sometimes does no good. Sometimes, more is even harmful. When our policies and care ignore these facts, we all suffer.


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8 Ways to Improve Patient Satisfaction, Patient Experience And (By The Way) HCAHPS Scores

8 Ways to Improve Patient Satisfaction, Patient Experience And (By The Way) HCAHPS Scores | Healthcare and Technology news | Scoop.it

In light of Medicaid’s announcement that it may expand the use of Child HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) results, let’s do a roundup of what actually increases patient satisfaction and improves the patient experience, for hospital systems, primary care providers, and ambulatory care centers alic.

Although I feel that these CAHPS assessments are a largely positive development, it’s also true that patient satisfaction and the patient experience can suffer if your institution takes the wrongheaded approach of trying to “game” the assessment process, of aiming too narrowly for success on the specific questions asked in the assessment.

The power of the halo effect

A better approach is to look at the survey questions only as they fit within your broader attempt to create an overall experience of caring that will in turn translate into better responses on the individual assessment questions due to a positive “halo effect.”  The halo effect I’m referring to is the tendency of humans–including patients and their loved ones–to cut you slack when they have a generally positive impression of you, how a positive experience with you will spread in their minds (and in their survey responses) to areas where, literally speaking, your institution may not have been entirely up to snuff.

“Always” is impossible–but if patients love you, they’ll cut you some slack

Consider an assessment question where your goal is to have an answer of “always” (for example: “During this hospital stay, how often were your room and bathroom kept clean?”). Always kept clean” is, strictly speaking, an impossibility. Not even a five star hotel can achieve that level of housekeeping; they may tidy your room three times a day, but that’s plenty of time to trash it in between. Yet it is possible to get an “always” response from a patient. Because the way patients remember is more holistic than you think it is.  An overall extraordinary experience with your facility and organization will subliminally inspire a patient to cut you slack while a generally poorly treated patient is going to grade you literally on your survey. And a literal reading of/response to the HCAHPS survey questions isn’t going to turn out all that well for anyone.

Here, therefore, is a roundup of my suggestions for how to improve patient satisfaction and the patient experience–and, as an aside, improve your HCAHPS scores. 

1. If you want to stem patient dissatisfaction, stop giving off cues of indifference and uncaring.   Such as: Healthcare professionals avoiding eye contact with “civilians.” Med students hurrying self-importantly down the halls, nearly running down the slow-moving patients who won’t get with the program.  Patients ignored by nurses who haven’t yet clocked in and therefore don’t realize they are already (poorly) representing their institution. Doctors in the hallway loudly carrying on about the relative benefits of different Canyon Ranch vacations they’ve taken. Two radios playing at once from two administrative areas (with the waiting area for patients and their families located equidistant to both). Vending machines that are left out of service indefinitely. Vending machines that require exact change, but there’s no change machine.

2.  Strive actively to experience your care the way that your patients do.  Park where the patients do.  See how easy it is/isn’t to get to the front door on crutches.   Take a tour of your hospital with someone who hasn’t been there before, and let them show you whether they can really find where they’re going.  You’ll be amazed how many mis-aligned, out of date, confusing signs you have. It all makes intuitive sense to you, of course, because you have been in your building enough times that you know your way around in your sleep (Literally, I suspect.)  And, once a year, do a “full bladder exercise”: Everyone who works with patients should drink two or three liters of water–it is incredible how your perception of a “reasonable delay” between call button and response changes when you have a full bladder.

3.  Get every employee thinking about purpose, not just functions. A particularly crucial aspect of great patient service is ensuring that every employee—from orientation onward –understands her particular underlying purpose in your organization and appreciates its importance. An employee has both a function—his day-to-day job responsibilities—and a purpose—the reason why the job exists. (For example, ‘‘To create successful medical outcomes and hospitable human experiences for our patients” is a purpose.   “To change linens” is a function. A properly trained and managed employee will know to—and will be empowered to—stop changing linens if creating successful medical outcomes or being hospitable require a different action at the moment. And afterward, she will be celebrated for doing so, not scolded for being a few short in the number of linens changed.

4. “Sorry” may be the hardest word, but it’s a word that everyone on your team needs to learn.  Resolving patient issues means knowing how to apologize for service lapses pointed out by a patient. It means getting rid of the defensiveness (or, at best: apathy) that tends to mar the healthcare industry when confronted by a patient upset with what she perceives to be a service gaffe. Instead, take your patient’s side in these situations, immediately and with empathy, regardless of what you think the “rational” allocation of “blame” should be. And spread this approach throughout your staff through role-playing and other training devices, so it will serve you fully every time a patient hits the fan.

5. Teach your employees – every single one – how to handle a patient or family member’s complaint or concern.   Even if handling the concern means “I’m finding you someone right now who can address this” it’s far better than “I can’t help you, I’m the wrong person.”

6. If you want to improve, strive to create a blame-free environment. As the founder of the Ritz-Carlton is fond of saying, “If a mistake happens once it may be fault of employee. If it happens twice, it is most likely the fault of the system.”  So, they get to work fixing the system. This blame-free system has worked to help The Ritz-Carlton build a great culture, and it can do the same for your hospital.

7. Understand that improving patient satisfaction is about systems just as much as it is about smiles.  When we discuss improving patient satisfaction and the patient experience, physicians often think we are going to focus on making them “smile harder.” While genuine warmth and smiles are of value here, so are systems. For example, when Mayo Clinic overhauled their scheduling system they employed (according to the great Leonard L Berry) industrial engineers using stopwatches to time wheelchairs between appointment locations in order to ensure that correct scheduling algorithms were created.

8. Benchmark outside healthcare. One of the biggest obstacles to improving the patient experience in healthcare is the industry’s insular nature and the way this makes its problems self-reinforcing. In other words, healthcare providers and institutions compare themselves to each other – to the hospital in the next town, the surgeon in the next O.R. – and benchmark their customer service accordingly. And to do so is to set the bar too low.  It’s not as if patients stop being consumers – customers – when they put on a hospital gown. And it’s not as if their loved ones surrender their identities as businesspeople, twitterers, Facebook users, either, when they enter your institution. So, it’s time to benchmark healthcare customer service against the best in service-intensive industries, because that’s what your patients and their loved ones will do. Every patient’s interaction with healthcare is judged based on expectations set by the best players in hospitality industry, the financial services industry, and other areas where expert players have made a science of customer service.


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How Community Hospital Used Health IT to Conquer MERS

How Community Hospital Used Health IT to Conquer MERS | Healthcare and Technology news | Scoop.it

A little more than a month ago, Community Hospital was not in the most enviable of positions for a hospital.

The 450-bed, regional tertiary care facility in Munster, Ind. became home to the first patient in the U.S. with a confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in late April. The potentially deadly viral respiratory illness, which has no known recommended vaccine or treatment, can spread like wildfire to anyone in close contact with the patient. In Saudi Arabia, where it likely originated, the Centers for Disease Control (CDC) say there have been 450 lab-confirmed cases and 112 deaths (as of May 2014).


It’s fair to surmise that things could have gone very badly for Community Hospital. Look no farther than Abu Dhabi, where experts from the World Health Organization (WHO) say that failure to control the virus by hospitals and healthcare settings in the city have exacerbated the problem. If MERS had spread in the U.S., Community Hospital, which is located very close to one of the busiest interstate highways in the nation, very well could have been targeted for blame.

Instead, MERS cases in the U.S. have been few and far between, and not one person has contracted the virus from the patient who stepped into the Community Hospital’s ER the night of April 28th. Much of this has to do with Community Hospital’s fast acting approach in treating the patient from the minute he arrived.

“We have protocols and procedures in place that we like to use. When someone has respiratory symptoms, we like to isolate them every time because there are some diseases that we’re not aware of that could be contagious,” says Alan Kumar, M.D., Chief Medical Information Officer at Community Hospital. “You don’t want to take chances. We had a room that was negative airflow [when the air from the room doesn’t mix the rest of the hospital]. We put him in that room in the possibility that it was something bad.”

It ended up being something bad.

Thanks to the infectious disease specialist finding out the patient had recently visited Saudi Arabia, she and other members of Community’s medical staff were able to deduce that he likely had MERS. The isolation was amped up with Community using gloves, masks, gowns, and all kinds of protection. Two days later, a test confirmed that the patient was positive for MERS. The hospital began working with the CDC and Indiana Department of Health to ensure the disease didn’t spread and that the Community Hospital workers and public were being educated.

One important task was to determine who had come into contact with the patient and was possibly at risk for MERS. To do this, Community relied on video footage, patient interaction notes in the electronic medical record (EMR), and radio-frequency identification (RFID)-based technology.

The RFID system (from the Traverse City, Mich.-based Versus Technology) was installed by Community in 2009 to decrease overhead noise in hospital units. It automatically logs when healthcare providers have entered the room, how long they’ve been in a room, and how long it takes from them to go from one room to the next. Thus, when nurses and doctors are needed, the hospital knows where they are located. In this case, it allowed them to track who was in the room with the MERS patient and for how long.

“The CDC found this data absolutely amazing because it’s something they never had access to in any prior investigation, to know down to the minute and down to the second, how long a healthcare worker was in contact with the patient,” says Kumar. He adds that for those healthcare workers who don’t wear the RFID tags, such as ambulatory workers, imaging specialists, and social workers, the EMR was a useful tool in tracking interactions.


A few weeks after he first stepped into the hospital, the patient was cleared of the virus and deemed not a risk to the public. Every single person who came in contact with him was tested. Even though none of them came back positive, they were taken offline until the longest window of incubation (14 days) had passed. They were repeat tested after that window and again, none tested positive.

From beginning to end, Community Hospital was able to escape this incident unscathed. Everything went smoothly when it absolutely had to go smoothly. When it comes to the role RFID and other health IT played in this success, Kumar says there is a lesson to be learned for other hospital executives.

“It’s not meant to watch employees. It’s meant for something more admirable. If you approach IT spending with the goal of ‘Does this improve quality of care to patients?’ and the answer is yes, that’s why you invest. Everything else is secondary to that goal,” Kumar concludes. 


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5 ways to improve patient engagement in hospitals

5 ways to improve patient engagement in hospitals | Healthcare and Technology news | Scoop.it

Improving patient engagement is a subject that’s being talked about in hospital boardrooms across the country. It’s become the in-fashion political buzz phrase. Certainly sounds very well and good, but what exactly does it mean?

Likely different things to different people depending on what angle they approach it — all the way from a care assistant up to the hospital CEO. In a nutshell, it’s all about allowing the patient to take center stage in their health care, and being fully informed and understanding each step of the way. It’s about education, encouraging healthy behaviors, improving health outcomes, and lowering health care costs. The ideal state is to allow the patient to feel that they are in the driving seat and full participants in their own care.


As things currently stand, most health care systems across the world are way off from this place. It’s not just the health care that’s to blame either — because the biggest part of patient engagement involves the patient stepping up to the plate themselves. And there are some very real barriers to this including education, demographics and motivation. There’s also the reality that most 90-year-old chronically unwell patients in hospital will have difficulty taking care of themselves. The issue is thus a complex one.

No one has a better understanding of where the opportunities for improvement lie than the doctors and nurses working at the coalface. We get to see all the problems up close and personal on a daily basis. I’m going to talk about how this pertains to my own specialty of hospital medicine, and where we have enormous room to engage patients better while they are in hospital. Here are 5 areas to focus on:

1. Encouraging patients to ask questions when they see their doctor every day. As simple as it sounds, this is not done nearly enough, and is a big missed opportunity to make a difference to patients’ understanding of their illness. There are a number of reasons why this doesn’t happen, ranging from a “rushed” hospital environment, to patients sometimes feeling embarrassed to ask certain questions. I’m actually surprised by some of the questions I hear when I ask my patients if they have anything they want to ask me, and there’s no way I would have guessed what they were unsure about unless I encouraged them to speak up.

2. Giving patients all the knowledge they need about their medical condition. Writing details such as blood count numbers on the whiteboard at the end of their bed is one way to do this. In the future, patients will likely be able to pull up some of their own data on computers. The more that patients know, the more empowered they will be to make important health care decisions.

3. Involvement of families. Just as important as the patient, is the family. This is true for any patient who is too unwell to speak for themselves, and particularly applies to the elderly. Doctors and nurses have to ensure that family is completely on board with the plan of care and what their role is in the recovery process. I’ve always said that if you want to make sure that something is done after discharge, tell the patient’s daughter. It’s been my observation everywhere.

4. Involving the patient fully in the discharge process. The discharge process by its’ very nature is a risky endeavor. Typically there are medications that have been changed, tests pending, or even an uncertain diagnosis. All this at a time when the patient is still very frail. It is a crucial transition point, more important than almost any other to get right.

5. Follow-up care. All hospitalized patients must follow-up in a timely manner after being discharged. Nipping a potential problem in the bud can help reduce readmissions and potentially serious complications. Reminders should be sent to the primary care physician and a post-discharge follow-up call from a nurse or administrator would not go amiss — and also shows that we care.

There is no one magic formula for solving the issue of patient engagement in hospital medicine. It will require a multifaceted and multidisciplinary approach. Whichever arena we are in, it is vital for a number of reasons. Whether we are talking about raising the quality of health care, improving outcomes, or lowering health care costs — there’s a great deal to play for. The more knowledge and opportunities to participate in their own health care, the better it is for both patients and doctors.


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When the doctor’s away, the patient is more likely to survive

When the doctor’s away, the patient is more likely to survive | Healthcare and Technology news | Scoop.it

"Don't get sick on a weekend." That advice is also part of a title of a research paper that evaluates the fates of patients who go through the emergency room on a weekend. These patients are more likely to die. It's just one of a number of studies that suggests patients who enter the hospital while the staffing is lower or the staff more relaxed end up with worse results.

But the precise cause of this enhanced weekend mortality has been hard to determine; is it the reduced staff, a more leisurely approach to care, or some other factor? To try to get at the cause, some researchers obtained records of heart patients who had a critical event during a time when hospitals were at full staff, but heart specialists were likely to be out of town. Unexpectedly, they found that the patients did significantly better when the relevant specialists were unavailable.

The study relied on medicare records to track patients that were admitted to a hospital with a serious heart condition: acute myocardial infarction, heart failure, or cardiac arrest. The key measure was simply whether the patient was still alive 30 days later.

That may sound simple, but the rest of the analysis was remarkably sophisticated. To figure out when heart specialists were most likely to be present at hospitals, they selected two large cardiology meetings: the American Heart Association and the American College of Cardiology, both of which attract over 10,000 participants. Patients admitted during the meetings were compared with groups admitted three weeks before and after. Reasoning that researchers are more likely to attend these meetings, they analyzed teaching hospitals separately from regular ones.

As additional controls, they checked a number of additional meetings for oncology, gastroenterology, and orthopedics specialists. They also looked at the impacts of additional critical injuries, like gastrointestinal bleeding and hip fractures, as well as non-critical cardiac problems.

In total, there were tens of thousands of patients involved. And the trends were clear. At teaching hospitals, the rate of death after heart failure was 24.8 percent on non-meeting days. While the cardiologists were out of town, it dropped to 17 percent. A similar trend was apparent with cardiac arrests, where death rates fell from 68.6 percent to 59 percent while cardiology meetings were happening. There was no significant difference with acute myocardial infarction patients.

So, having specialists in town appeared to make matters worse for patients—the exact opposite of the hypothesis the researchers set out to examine. The various controls suggested the effect was robust, and it persisted after adjusting for other potential influences, like age and sex.

In a press release accompanying the report, one of its authors, Anupam Jena, said "That's a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions." What could possibly be causing it? The authors consider three possibilities. First, there's something involved with the changes in cardiology staffing that occur when specialists go out of town that actually increases care. The second is that there are fewer people having outpatient or same-day procedures, given that doctors wouldn't schedule these when they knew they'd be absent. This would allow the remaining physicians to better focus care on the serious cases.

The final possibility that they consider is that the doctors that remain behind are more cautious about the care they give, avoiding aggressive procedures such as the use of angioplasty or stents to re-open clogged heart vessels. This would be consistent with the lack of effect in acute myocardial infarction patients, where this procedure is used less often.

Although their analysis can't distinguish among these possibilities, it's clear that this effect warrants further attention. Both because it's possible that the long-term survival evens out thanks to more aggressive treatment, and because we might find out that we've been acting a bit too aggressively.


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When the patient’s touch alters the doctor

When the patient’s touch alters the doctor | Healthcare and Technology news | Scoop.it

I do not know about you, but I get confused about the Heisenberg uncertainty principle.  Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement.  However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits.  If you measure one thing, such as the speed of a car, you cannot at the same time, accurately, determine the location of the car, simply because it is moving.


When we say that measuring an object or event changes it, we are talking about the “observer effect.”   I cannot taste a cake, without removing a few crumbs.  Cannot measure the temperature of an oven, without stealing a bit of heat.  Cannot measure the pressure in a tire, without venting a sample of air.  Must lift a stone to weigh it.

In health care, examples of the observer effect are ubiquitous; they define the practice of medicine.  We take blood to measure anemia.  Cut tissue to render a biopsy.  Radiate to do a CT scan.  Raise blood pressure by squeezing the upper arm, as we take a reading.  Demand psychiatric introspection as we try to understand emotional crisis.  Use toxic drugs to make possible curative therapy.

Patients expect to be altered, even as they are observed.  It is part of the sick role, to consent to be changed, damaged, as we yearn to be repaired.  We call these changes “side effects,” “complications” or just the cost of treatment.  We allow our hearts to be broken, so we may heal.  The frailty, interconnectivity and sensitivity of our body’s means that care is intrusive, disruptive and altering.   If we do not allow such invasion, which becomes more destructive as the illness becomes more threatening, then testing, diagnosis and treatment would be impossible.

It occurs to me that in the practice of medicine, it is not just the patient being observed, measured, and tested and, therefore, it is not only the patient being changed.  Just as the doctor’s touch alters the patient, so the patient’s touch alters the doctor.   While this may not be the stated goal of the interaction, it is definitely its effect.  With each patient, each day, and throughout a career, a physician is molded.  His or her heart is figuratively broken, and as they heal, they are never the same.

Last Wednesday was a “bad” day in the office.  Carmen was devastated to learn that her PET/CT scan showed new cancer growth.  Long-time patient Allen changed doctors, because he did not think I understood his needs.  Nick had an anaphylactic reaction to a new chemo drug.  Ester was found to be getting narcotic prescriptions from other doctors, and probably selling them.  A physician friend of mine was sued. Tom died.

Last Thursday was a “good” day in the office.  Chris started multidrug therapy and, despite the six-hour infusion, had no side effects.  Lung cancer survivor Joan and I laughed for 10 minutes, looking at video of her grandson.  Steve’s biopsy was benign.  Paula’s out-of-control liver test, turned out to be a lab error.  Stella celebrated 10 years cancer free.  An exciting breast cancer study was published.  Nina’s first restaging CT scan shows a complete remission.

Doctors change with days like these.  When you hold a patient in your arms after telling them they will soon die, or hug close the infant child of a cured leukemia patient, you are altered, corrupted, modified, as if you inhaled the air of a frozen winter day or watched sunrise burst on an azure sea.

If a physician is lucky, if they have good supports, if they are blessed with a holistic view of the world, then the experience, the lessons, will make them better at the practice of medicine and happier in life.  Allowing, in fact yearning for change, which is the complement of the sick role, will build in the doctor the skill to be a true artist who can sense the physical and emotional needs of patients.  They are molded into healers more than any text or professional mentor could offer.

If a physician is unlucky, has weak supports, and has invasive and destructive experiences, which come at the wrong times, they may become bitter, burned out, angry and isolated.  Good days will be brutal.  The side effects of the practice of medicine will injure them, so that they cannot go on.

Heisenberg, of course, was talking about quantum mechanics, the movement of sub-microscopic particles through space, randomly slamming in to one another and changing with time.  Perhaps, that is all we truly are.  Tiny beings in an infinite universe, randomly running in to each other and, with each bump, each moment, the wonder of each experience, changing over time.  Where ever we meet, whenever we touch, even if it is just a few minutes in an emergency room, a hospital ward or a clinic, we are both altered, forever.



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Patients want more from their EHRs | Healthcare IT News

Patients want more from their EHRs | Healthcare IT News | Healthcare and Technology news | Scoop.it

Having established a level of trust and familiarity with electronic health records over the past few years, increasing numbers of U.S. patients are looking for more advanced features from their EHRs, according to a new survey from the National Partnership for Women & Families.


The study, "Engaging Patients and Families: How Consumers Value and Use Health IT," follows up on a similar 2011 report that assessed consumer views toward EHRs. A lot has changed since then, with more and more patients comfortable with the idea of digitized records, and easier online access to health information spurring more patient engagement in their care.

In the past year, more than four in five patients with online access to their health records (86 percent) used their online records at least once, according to NPWF; more than half (55 percent) used them three or more times a year.


"To date, the public discourse on health IT has largely focused on the views of doctors, hospitals and vendors," said NPWF President Debra L. Ness in a press statement. "It is crucial to hear what patients have to say about how they experience EHRs and health IT as they receive care and manage their health."

By repeating questions from 2011, the new survey – which lays out seven strategies to help engage patients and families more effectively in their care – identifies trends in patient attitudes since meaningful use has helped fuel EHR adoption. Its new questions yield data on new topics in discussion for health IT policies and programs, such as patient-generated health data, patient care plans and mobile access.


"Engaging Patients and Families" is not the only new report being updated for the first time since 2011: It comes close on the heels of the Office of the National Coordinator for Health Information Technology's new 2015 Strategic Plan, which was published on Monday for the first time in four years.

"As the National Partnership's new data show, more consumers are accessing, sharing and using their health information, underlining the importance of interoperability of health data and systems," said National Coordinator for Health IT Karen DeSalvo, MD, in a statement. "We are focusing our efforts in these areas to empower individuals to address not only gaps in information exchange and interoperability, but also enable them to take steps to improve their health and better manage their health needs,"

Among other key points from NPWF's report, which polled more than 2,000 patients: Patients' online access to their health records has nearly doubled – from 26 percent in 2011 to 50 percent in 2014.

Still, they want even more functionality, including the ability to email providers (56 percent), review treatment plans (56 percent), see doctors' notes (58 percent) and test results (75 percent), schedule appointments (64 percent); and submit medication refill requests (59 percent).

Patients' trust in the privacy and security of EHRs has increased since 2011, and patients with online access to their health information have a much higher level of trust in their doctor and medical staff (77 percent) than those with EHRs that don't include online access (67 percent).

Different populations prefer and use different health IT functionalities. Hispanic adults were significantly more likely than non-Hispanic Whites (78 percent vs. 55 percent) to say having online access to their EHRs increases their desire to do something about their health. African American adults were among the most likely to say EHRs are helpful in finding and correcting medical errors and keeping up with medications.

NPWF suggests that "specialized strategies" may be necessary to improve health outcomes and reduce disparities in underserved populations.

"The views of patients must be front and center as we take the next steps in implementing health IT," said Sandra R. Hernández, president and CEO of the California HealthCare Foundation, which funded the poll. "As we as a nation become more diverse, the imperative to address disparities grows. We need the kind of robust information EHRs provide and the genuine patient engagement they can facilitate."

"We have made progress in leaps and bounds in just a few short years," said Mark Savage, NPWF's director of health information technology policy and programs, in a statement. "But clearly there are barriers still to overcome, and this report breaks down policy implications for the meaningful use program as well as broader delivery system initiatives that must be carried out. And it's an important reminder that meeting the needs of patients and families must always be at the core of health IT design and implementation."



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Are we moving beyond Meaningful Use to something that means something useful?

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The fallacy of patient engagement

The fallacy of patient engagement | Healthcare and Technology news | Scoop.it

You may have noticed the absence of my usual posts to HealthBlog. Here’s why. I was preparing for an out of town business trip on Monday of last week when I learned that my adult daughter needed an emergency appendectomy. As coincidence would have it, my business trip just happened to be to a city very close to where my daughter lives. I was able to keep my business meeting in the morning and still arrive at my daughter’s apartment soon after she was discharged from the hospital. I spent the rest of the week helping her get in and out of bed, doing some cooking, walking her dog, and making sure that she was well enough to be on her own before I headed home.


It’s at times like this that one is very grateful for access to good healthcare. After all, there was a time before modern surgery and the availability of antibiotics that appendicitis was often a death sentence. Today, that rarely happens if the patient receives timely care.


There’s no question that when we are in pain, injured or very sick that we are “engaged” patients. Not only is the patient engaged, but often his or her entire family. The problem is that when we are well again, we tend to disengage and fall back into our usual routines. The fact of the matter is that most people really don’t spend all that much time with doctors and hospitals. Most care happens in the home, and most of the contributors to good health are determined more by our genetic makeup, diet, socioeconomic status, education, exercise and other environmental factors than by the things that doctors and hospitals do in our lives. For most people, encounters with doctors and hospitals are  episodic and infrequent. So, when hospitals and health systems speak of the need for greater “patient engagement”, what does that really mean and how can it be accomplished?


As a physician I know from the get-go that patient engagement is hard to achieve. First of all, we need to understand that healthcare is something most people view as a kind of “grudge buy”. Just as I dread going to see my dentist, I also don’t particularly enjoy anything about visits with my doctor. While both my dentist and doctor are very nice human beings, the reasons I go so see them aren’t on my list of fun things to do. I imagine most people feel the same way. Likewise, I suspect most people hate paying medical bills. Who wants to pay for something they don’t enjoy? One person I recently met likened buying healthcare services to purchasing tires for her car—necessary but definitely not satisfying.


Engagement is made even worse by the fact that medical billing is such a nightmare and paying for, and dealing with, health insurance companies is absolutely no fun at all. The insurance industry long ago trained most of us to expect someone else (government or insurance) to pay for a lot of the healthcare services we received. Now the tables have turned. More and more of our healthcare costs are not covered by insurance until we reach a yearly high deductible. This has consumers feeling even more disgruntled about doctors and hospitals and high healthcare costs. Is it any wonder that people are not “engaged”!


I think the way to engage patients or consumers is to really help them understand the things they can do to avoid any more “engagements” with doctors and hospitals than are absolutely necessary. Show them the connection between the unhealthy choices they make and the chronic diseases and health encounters they would much rather avoid. Create financial incentives to help people stay healthy. Develop technologies that ease the pain of engaging and interacting with the health system when one must do so, and help consumers avoid as many unnecessary medical visits and costs as possible. I’d like to see doctors and hospitals acknowledge that they totally understand they are not on our list of the people we like to see and places we like to go, and that they are doing everything possible to help us take better care of ourselves so we can avoid doing business with them as much as possible. Now that is a cause that just might get me “engaged”.


How about you?


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Health IT Security: What Can the Association for Computing Machinery Contribute?

A dazed awareness of security risks in health IT has bubbled up from the shop floor administrators and conformance directors (who have always worried about them) to C-suite offices and the general public, thanks to a series of oversized data breaches that recentlh peaked in the Anthem Health Insurance break-in. Now the US Senate Health Committee is taking up security, explicitly referring to Anthem. The inquiry is extremely broad, though, promising to address “electronic health records, hospital networks, insurance records, and network-connected medical devices.”

The challenge of defining a strategy has now been picked up by the US branch of the Association for Computing Machinery, the world’s largest organization focused on computing. (Also probably it’s oldest, having been founded in 1947 when computers used vacuum tubes.) We’re an interesting bunch, having people who have helped health care sites secure data as well as researchers whose role is to consume data–often hard to get.

So over the next few weeks, half a dozen volunteers on the ACM US Public Policy Council will discuss what to suggest to the Senate. Some of us hope the task of producing a position statement will lead the ACM to form a more long-range commmittee to apply the considerable expertise of the ACM to health IT.

Some of the areas I have asked the USACM to look at include:

Cyber-espionage and identity theft
This issue has all the publicity at the moment–and that’s appropriate given how many people get hurt by all the data breaches, which are going way up. We haven’t even seen instances yet of malicious alteration or destruction of data, but we probably will.

Members of our committee believe there is nothing special about the security needs of the health care field or the technologies available to secure it. Like all fields, it needs fine-grained access controls, logs and audit trails, encryption, multi-factor authentication, and so forth. The field has also got to stop doing stupid stuff like using Social Security numbers as identifiers. But certain aspects of health care make it particularly hard to secure:

  • The data is a platinum mine (far more valuable than your credit card information) for data thieves.
  • The data is also intensely sensitive. You can get a new credit card but you can’t change your MS diagnosis. The data can easily feed into discrimination by employees and ensurers, or other attacks on the individual victims.
  • Too many people need the data, from clinicians and patients all the way through to public health and medical researchers. The variety of people who get access to the data also makes security more difficult. (See also anonymization below.)
  • Ease of use and timely access are urgent. When your vital signs drop and your life is at stake, you don’t want the nurse on duty to have to page somebody for access.
  • Institutions are still stuck on outmoded security systems. Internally, passwords are important, as are firewalls externally, but many breaches can bypass both.
  • The stewards/owners of health care data keep it forever, because the data is always relevant to treatment. Unlike other industries, clinicians don’t eventually aggregate and discard facts on individuals.
Anonymization
Numerous breaches of public data, such as in Washington State, raise questions about the security of data that is supposedly anonymized. The HIPAA Safe Harbor, which health care providers and their business associates can use to avoid legal liability, is far too simplistic, being too strict for some situations and too lax for others.

Clearly, many institutions sharing data don’t understand the risks and how to mitigate against them. An enduring split has emerged between the experts, each bringing considerable authority to the debate. Researchers in health care point to well-researched techniques for deidentifying data (see Anonymizing Health Data, a book I edited).

In the other corner stand many computer security experts–some of them within the ACM–who doubt that any kind of useful anonymization will stand up over the years against the increase in computer speeds and in the sophistication of data mining algorithms. That side of the debate leads nowhere, however. If the cynics were correct, even the US Census could not ethically release data.

Patient consent
Strong rules to protect patients were put in place decades ago after shocking abuses (see The Immortal Life of Henrietta Lacks). Now researchers are complaining that data on patients is too hard to get. In particular, combining data from different sites to get a decent-sized patient population is a nightmare both legally and technically.
Device security
No surprise–like every shiny new fad, the Internet of Things is highly insecure. And this extends to implanted devices, at least in theory. We need to evaluate the risks of medical devices, in the hospital or in the body, and decide what steps are reasonable to secure them.
Trusted identities in cyberspace
This federal initiative would create a system of certificates and verification so that individuals could verify who they are while participating in online activities. Health care is a key sector that could benefit from this.

Expertise exists in all these areas, and it’s time for the health care industry to take better advantage of it. I’ll be reporting progress as we go along. The Patient Privacy Rights summit next June will also cover these issues.


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Is it OK for doctors to 'google' patients?

Is it OK for doctors to 'google' patients? | Healthcare and Technology news | Scoop.it

It's something we do to job applicants, first dates, former lovers and the quiet co-worker in the next cubicle. The practice of “googling” others for professional reasons or out of personal curiosity is so ubiquitous that the name of the popular Internet search engine has turned into a verb. In healthcare, patients often head online for diagnoses, drug information and details about their doctors. But do professional standards prevent physicians from doing the same to patients?

The authors of a new paper in the Journal of General Internal Medicine write that sometimes, the practice is acceptable. Most other times, in their opinion, it isn’t. They hope their paper sparks conversation among colleagues and the American Medical Association about the possibility of guidelines for providers in the digital age, one in which most medical students can't remember a world without search engines.

“The motivation is to protect patients and prevent harm,” said Maria Baker, a Penn State Hershey Cancer Institute genetics counselor.

Her paper lists 10 situations when physicians are justified in “googling” patients – for example, when they have a duty to warn of possible harm, if patient’s story seem improbable, if information from other professionals calls a patient’s story into question, if there are suspicions of abuse or concerns of suicide risk.

“There is something worth protecting in the physician-patient relationship,” said co-author Daniel George, an assistant professor in Medical Humanities at Penn State University College of Medicine. While the AMA has issued guidelines regarding physician professionalism and social media, George calls patient-targeted web searches a “blind spot” among providers.

The authors detail actual situations at Penn State when they felt “googling” was warranted. In one case, a 26-year-old requested that both of her breasts be removed to prevent breast cancer, although she hadn’t undergone genetic testing to see if she was at risk for the disease, and didn’t want to. She reported an “almost unbelievable” family history of breast, ovarian and esophageal cancer and had sought the same surgery at other hospitals.

The genetic counselor “googled” her and found that this patient “was presenting her cancer story at lay conferences, giving newspaper interviews, and blogging about her experience as a cancer survivor. Additionally, the patient was raising funds, perhaps fraudulently, to attend a national cancer conference.”

“Armed with this information,” the authors write, “the genetic counselor informed the surgeon, who subsequently told the patient he felt uncomfortable performing the surgery in the absence of formal genetic and psychological testing.”

Conversely, the authors argue, web searches can undermine trust among patients and providers. “You have a patient wanting to adopt healthy lifestyles, and the doctor helps him on a course of exercise and non-smoking,” Baker explained. “But the doctor ‘googles’ him and sees pictures he posted on Facebook smoking a cigar.”

Mildred Solomon, president of the Garrison, New York-based bioethics institute The Hastings Center, said she applauds the authors for raising such questions, but their “acceptable” reasons for “googling” patients are far too broad.

One scenario, “incongruent statements by the patient, or between a patient and family members,” occurs too frequently in clinical settings to justify Internet searches, Solomon said. “There’s too much wiggle room,” she explained, noting that “intention” is what should matter.

“Why is the physician motivated to do this? Is it going to bring benefit to the patient, or is it something self-serving or out of personal curiosity?” Solomon asked.

A spokesperson for the AMA declined to comment to Reuters Health, citing the issue as “unresolved” by the organization.

However, a 2013 policy statement from The Federation of State Medical Boards notes that physician use of digital tools must evolve as do technology and societal trends. It acknowledges the use of “patient-targeted googling” in medical crises, such as attempts to identify unconscious patients in emergency departments. But, according to the policy: “it instead can be linked to curiosity, voyeurism and habit. Although anecdotal reports highlight some benefit (for example, intervening when a patient is blogging about suicide), real potential exists for blurring professional and personal boundaries.”

Authors say they wish only for more dialogue about this digital practice.

“I think this is just a starting point,” George said. “Every conversation has to start with something. This is the raw clay that we hope the field sculpts into set guidelines.”

The paper, which first came online in September, appears in the journal’s January print issue.


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The key to medicine is to love our patients

The key to medicine is to love our patients | Healthcare and Technology news | Scoop.it

I have issues with the customer satisfaction paradigm, but it’s not generally hard to make patients happy. Sometimes, though, it can be nearly impossible. It all depends on our own inner life as physicians and human beings. The key to medicine, to being a beloved physician, is to love our patients.


This can be a tall order. Human beings are remarkably difficult to love. They are often angry, uncommunicative, cruel, manipulative, and dishonest. (And that’s just the doctors!) Humans resist love almost as fiercely as they desire it. They push one another away with profanity. They anger each other with attitude. They pick until someone lashes out. They remind us of our own human frailty.

So how do we do it? How do we love these people, especially when they come to us in the chaos of our work in the ED? How do we love them when we are weary and they have strange complaints at 2 a.m.? How do we love them when, despite our suggestions on all of their previous visits, they continue to ignore our advice, not take their prescriptions, and not change their lifestyles? Can we love them at all?

It depends. Do you think that loving them means having warm emotions for them? Do you think it means feeling good about them? Or is it having a satisfying relationship with them? If so, loving will be difficult. Because we in the modern West have excised and biopsied, reconstructed and deconstructed the word love until it is nearly unrecognizable.

We want love to be a feeling we have, when in fact, love must be an action we show. When our children are loud and disobedient, when they scream and throw tantrums, it’s often difficult to feel good about them. But we still feed them, bathe them, sing to them, and put them to bed with kisses in hope of a better day or after the terrible twos or threatening threes or whichever phase has passed. (Lately it’s the sarcastic seventeens, but I digress.)

Whatever we feel about the angry drunk, the manipulative attorney, the entitled college student, the addicted gang-banger, when we behave with competence, when we do what is right, and seek their best, we show love for them. A love borne of action, not emotion. A love that is in some ways more steady and true.

I’ve learned that a cycle is born. When I act toward them with competence, I show them love. And when I do that, I learn in time to see them less as numbers (or annoyances) and more as people. A crazy thing then happens; they love me back. And then the magic happens.

I talk to them, and they talk to me. And we come together. I ask about their family, and they ask about mine. I inquire about why they are sad, and they tell me things that shake me to the core and remind me of how I have nothing to complain about when held up to their life story of abuse and addiction, neglect and loss. And because I listen (and sometimes hug them or pray for them), they know I’m human, too. And they come to love me.

In time, you’ll find new, wonderful ways to love. Over the years, I’ve learned that everyone wants to hear how beautiful her baby is. I tell her. Because every baby is, if only to her own parents. And they say thank you, and I tell them how blessed they are. And we joke about children. The children then look at me, smile, and reach for me to hold them, and I am the recipient of the blessing.

I’m less and less bothered by little things. I like to get warm blankets, and I like to get cups of water. Yes, I still get annoyed when I’m busy, but I’m a work in progress, you see. If I can order a snack for them, I will. We have a wonderful time when it’s slow and I can sit and hear a life story or tell a joke. And the love grows. By acting in love, love increases.

Love isn’t taught in the classroom, and the boards certainly don’t measure it. It is nigh impossible to apply evidence-based evaluations to love. But once you allow it to start and carry you forward, your heart will thaw like the Winter Warlock and grow like the Grinch.

And your satisfaction scores will probably go up, too.



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HIM, Patient Monitoring, Health IT Markets to Grow Quickly | EHRintelligence.com

HIM, Patient Monitoring, Health IT Markets to Grow Quickly | EHRintelligence.com | Healthcare and Technology news | Scoop.it
Health IT markets will continue to expand as providers invest in new technologies to meet health information management and patient monitoring needs, a number of reports predict.

The purchasing markets for health information management, patient monitoring, and healthcare analytics technologies are slated to see significant growth as provider organizations continue to invest in new health IT infrastructure to meet upcoming clinical and reimbursement challenges.  As meaningful use, the Affordable Care Act, and the expansion of accountable care principles continue to demand utilization of sophisticated health IT systems, healthcare organizations will drive market growth in pursuit of high quality patient care.

The healthcare analytics outsourcing market is slated to see almost 9% compound annual growth over the next four years, predicts research from Reportstack, as healthcare organizations seek to implement the benefits of clinical, financial, and administrative analytics without bearing the entirety of the costs themselves.  The 8.60% CAGR will be driven by large, recognizable vendors as providers turn to trusted names for their most sensitive data needs.

Meanwhile, on the payer side, the global healthcare administrative systems market will see a 5.7% CAGR over the same time period, MicroMarket Monitor reports, as payers attempt to leverage health IT to meet the challenges of accountable care.  The market for payer administrative systems was valued at more than $2.2 billion in 2013, with billing systems accounting for greater than 40% of the segment.  North American markets will be responsible for the majority of the sector’s continued expansion.

Behavioral health software purchasing will explode at a 14.7% CAGR from now until 2019, says a prognostication by RnR Market Research as ongoing reforms in the healthcare industry pressure behavioral healthcare providers to implement electronic health records and administrative systems alongside their primary care peers.  The $752 million market may reach nearly $1.5 billion globally over the next four years, the report says, as healthcare providers focus on integrating behavioral health with other aspects of patient care.

The market for wireless portable medical devices may reach $2.83 billion by the end of the decade, MarketsandMarkets says, as wearable devices gain in popularity and home monitoring equipment becomes an essential tool for chronic disease management and elder care.  Continued innovation in therapeutic devices and patient monitoring technology, coupled with strong commitment to population health management from federal agencies will be key drivers of growth for these technologies.

Vendors of inpatient pharmacy information systems will also enjoy significant interest in their wares as the North American market grows as a CAGR of 7.5% over the next three years.  Led by familiar EHR developers such as athenahealth, Cerner Corporation, Allscripts, Practice Fusion, and NextGen, the global pharmacy health information management market may reach $2.5 billion by 2018.  As EHR vendors seek to expand their portfolios of product options to offset slowing growth in the EHR purchasing markets, providers may choose to select offerings that compliment their existing health IT infrastructure to ensure interoperability and health information exchange.


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Could Plug-And-Play Be The Future Of Healthcare Diagnostics?

Could Plug-And-Play Be The Future Of Healthcare Diagnostics? | Healthcare and Technology news | Scoop.it

As healthcare is moving toward greater consumerization, devices used for diagnostics are keeping pace and becoming leaner, meaner and even cheaper. Radiology, the “darkroom” of the healthcare world, is now coming into the light and directly into patients’ hands… so as to speak.

New-age diagnostic devices are changing the way we have conventionally diagnosed and understood diseases, and are no longer restrained to “just diagnosis.” Traditional radiology diagnosis involving CT, MRI, ultrasound, etc., included bulky, room-size equipment costing millions of dollars. However, in the past decade or so, new technology has unleashed a wave of creativity and innovation for both software and hardware, and is reshaping these products significantly.

The latest innovations at this year’s Radiological Society of North America (RSNA) Annual Meeting in Chicago were primarily focused on smarter and safer diagnosis using smaller equipment. For example, the ultrasound that used to be as bulky and heavy as a refrigerator is now the size of a handheld “phablet” (Philips’s VISIQ), and yet it does the same job it did before, if not more. How simple is that? As simple as plugging an iPod into a speaker.

The future of the ultrasound will be plug-and-play devices that capture exceptional quality images. In fact, ultrasound technology is becoming smarter with software enhancement tools (e.g., Toshiba’s premium ultrasound called Platinum).With such tools, an ultrasound scan can be used as an initial diagnostic tool for identifying cancer and other diseases, which was not the case before. As ultrasound doesn’t require surgery to obtain the cancer tissue (biopsy) or using radioactive contrast media in CT/MR (which is hazardous and unsafe), it will significantly reduce the pain and cost of treatment for cancer patients.

Clinicians, and in some cases patients, can now seamlessly upload any patient-related data, such as medical imaging files or picture, video and audio files, from any device (tablet, phone and personal computer) to digital patient records and view them on any device (tablet, phone and desktops/laptops). Such innovation will also reduce diagnosis errors and speed up the communication process between various departments in the hospital and outside. This is one more step toward digital health. These latest radiology innovations help improve efficiency, accuracy and workflow, thereby enhancing the lives of millions of patients.


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Reactive vs. Proactive Health Care: The Intersection of Payment Reform & Consumer Data Powering Clinical Insight | The Health Care Blog

Reactive vs. Proactive Health Care: The Intersection of Payment Reform & Consumer Data Powering Clinical Insight | The Health Care Blog | Healthcare and Technology news | Scoop.it

One of the greatest opportunities that exists in moving from “turnstile medicine” (or fee-for-service) to value-based payment models is the shift from reactive to proactive health care. The focus on accountability for population health forces providers to adopt a completely different mindset: Instead of waiting for sick patients to come knocking on your door, you need to figure out what they need, when they need it, and how to get it for them.

At the upcoming conference, Health 2.0 WinterTech: The New Consumer Health Landscape (January 15, San Francisco), I will moderate a panel on “Consumer Data Powering Clinical Insight.” The panel  features several different perspectives on how consumer-facing technologies can translate discrete consumer-generated data into useful information that providers and others can use to deliver more personalized and proactive support and care management.

The dramatic proliferation of electronic health records (EHRs) in the last five years means that much more clinical patient data exists in electronic form than ever before. True meaningful use of that data involves organizing it into meaningful and useful information by building algorithms, leveraging machine learning principles and delivering the right information to the right person at the right time. In addition, de-identified data in the cloud provides a scale for that kind of data analytics. Practice Fusion, a cloud-based EHR company uses patient-derived data—everything from booking an appointment to patient intake questionnaires—to drive proactive health management. CEO Ryan Howard will discuss how, in early 2015, they’ll begin incorporating qualitative and quantitative data from the patient and machine learning based on how physicians react to it to better target diagnosis, treatment and other support.

Taking machine learning even further, MIT engineers decided to apply that approach to better support people with mental health issues. Although validated survey instruments like the PHQ-9 can play an important role in diagnosing and managing depression, they’re not designed to be continuous assessment tools. In contrast, Ginger.io leverages passively collected data from people’s daily lives via smart phones to identify patients at risk and building proactive care management processes based on these naturally occurring data. Co-Founder Karan Singh will talk about the invaluable information that can be derived from seemingly mundane human behavior such as GPS data on a person’s mobility throughout the day or patterns of missed phone calls. Ginger.io is currently testing in multiple academic medical centers how these data can flow into algorithms to generate alerts in a web-based dashboard that care managers use.

The prevalence of incorporating data from activities of daily living into providers’ clinical information systems remains low, despite the fact that people spend a miniscule fraction of their annual 525,600 minutes within the confines of clinical settings. Meanwhile, although the tech industry seems to be buzzing about wearables that focus on wellness and fitness, many of these devices remain completely outside consumers’ interactions with their providers. Qualcomm Life has developed platform solutions around remote care monitoring with the goal of integrating daily-life data seamlessly into the care delivery process to drive consumer engagement. SVP & General Manager Rick Valencia is eager to share Qualcomm’s plans to integrate these data to tailor chronic care management and improve care transitions.

When we think about tailoring care management, it is sometimes hard to fathom the possibilities that genomic innovation has for personalizing treatment approaches. The growing efficiency of human genome sequencing – and its associated diminishing cost – raises the potential for more practical applications in the normal course of care delivery. The Illumina Accelerator hopes to drive personalized health care down to the genomic level by providing mentorship, financial support and access to scientific resources to start-up companies. Amanda Cashin, who heads the Accelerator program, will discuss how start-ups will leverage sequencing technology in diagnostics and therapeutics applications to support better care management in oncology, reproductive health and other clinical areas.

Meanwhile, FDA must figure out when these new tools cross a line that separates a care management support application from a new medical device. FDA’s Bakul Patel is right in the middle of these discussions and has to think through how broad or narrow to define “devices.” Patel will talk about what FDA has clarified thus far and how companies should think about these issues going forward.

This panel is sure to bring innovative, yet differing, views on the progression of consumer-based data sources. As moderator, I will particularly press them on how their solutions help consumers, clinicians and other stakeholders succeed under the demands of new payment models and the expectations of proactive care delivery models.



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Study: Nearly half of patients would withhold data from providers

Study: Nearly half of patients would withhold data from providers | Healthcare and Technology news | Scoop.it

Nearly half of patients participating in a trial looking at patient control of the medical records withheld clinically sensitive information from some or all of their care team.

The Regenstrief Institute, Indiana University School of Medicine and Eskenazi Health (formerly Wishard Health Services) conducted the six-month trial involving 105 patients at a primary care clinic. Patients were allowed to designate who could see their records, including information on sexually transmitted diseases, substance abuse or mental health.

Patients were able to hide some or all of their data from some or all providers--and 49 percent of them did. However, healthcare providers were able to view the hidden data, if they felt the patient's healthcare required it, by hitting a "break the glass" button on their computer screens, according to an announcement.

While patients strongly favored control over their records, providers had mixed reactions. In the trial, 54 percent of providers said patients should be able to control who can see their electronic health record data; 58 percent said restricting providers' access could be harmful to the patient-physician relationship; and 71 percent said withholding data in the EHR would have a negative impact on the quality of care.

The five research papers from the trial, including a point-counterpoint, make up the January 2015 supplement to the Journal of General Internal Medicine.

The growing ability to collect different data sets on patients has been both a curse and a blessing for the industry.

Since recommending that social and behavioral data be included in EHRs, the Institute of Medicine has a committee working out exactly which pieces of information it considers most relevant to health. It has winnowed its recommendations down to 11, including educational attainment, financial resource strain, stress, depression, physical activity, social isolation, and intimate partner violence.

However, a provider's use of an electronic health record can cause a patient to clam up for fear that the data won't be secure, according to a study in the Journal of the American Medical Informatics Association (JAMIA).

In addition, data segmentation poses a problem in EHRs, with teen privacy a particular challenge. Providers, however, worry that without segmentation capabilities, patients will be reluctant to divulge facts about themselves that could have a vital bearing on their care.



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Patient Portals: The Good, The Bad and The Ugly -

Patient Portals: The Good, The Bad and The Ugly - | Healthcare and Technology news | Scoop.it

I experienced the “pain” of accessing and managing multiple provider portal sites firsthand following an injury and subsequent surgery earlier this year. In the months following my hospitalization, I walked away with paperwork and access codes to five different patient portal sites, including my PCP, surgeon, the initial hospital where I received emergency treatment, the hospital where I had surgery, and in addition (not related to my injury) my OB/Gyn, and recently, my dentist! Despite my healthcare IT background, it was a daunting task to sign up for each site and as you can imagine the lack of linkage leads to a very fragmented view of my patient data.

But, the fragmented view is only the beginning of the problem with multiple portals. There are multiple log-ins and each portal has different requirements for my user ID and password. One site advertises that they are a “Healthkey” member, and if your providers are all members then you can link user IDs and passwords, resulting in one user ID and password for all sites. In my case, only one out of the five portals offered this feature. Another portal offered the use of Facebook, Google, LiveID, and Yahoo as a log-in, with the disclaimer that the only advertised “secure” site was the vendors’ login.

Another difficulty is that each portal looks and feels different. Each portal offers its own navigation, verbiage and menus. A “roadmap” for each would be helpful or maybe it would add to the confusion. Perhaps most alarming is that each portal contained different “pictures” of my healthcare information, including conflicting medication lists. None of the current medication lists were accurate. Some had missing active medications, some listed medications that I no longer take, some contained the wrong dosage, while others listed no medications at all.

Only one portal (my PCP’s portal) was close to containing an accurate medical history, and even that was incomplete. Only three out of five portals contained lab test results, just one had a complete list, and two contained imaging results.

How do we make the patient portal experience better? A few thoughts:

  • Offer additional ways to consolidate and standardize patient user IDs and passwords
  • Create and follow a standard model for menus and navigation
  • Develop a single repository for access to all data or optimize sharing of patient healthcare data between systems
  • Standardize accuracy requirements for entry of healthcare data to provide a consistent, accurate view for all patients

Some organizations are moving toward standardization. One vendor has developed a “shared” patient portal and while the concept is on track, there is still the option to customize the look and feel based on organizational build decisions. The result is a fragmented record that almost looks the same. Both of the hospitals I was treated at use the “same” EHR, but each EHR utilizes their organization’s version. In order for healthcare organizations and providers to meet Meaningful Use (MU) requirements for patient access to their electronic healthcare records, and communication with their patients, they will need to simplify the process overall. Personally, I was ready to pitch all of the information on these portals when I realized how much of my time would be involved, measured in hours, not minutes. And that’s not counting the time I could spend logging into each portal to update (and correct) my personal healthcare information. The typical patient will not have the patience, and quite possibly the ability to handle management of multiple sites and all that goes with them. And while we have come a long way, there’s still much work to do in simplifying patient portals.



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Three Ways Doctors Can Use Patient Data to Get Better Results | The Health Care Blog

Three Ways Doctors Can Use Patient Data to Get Better Results | The Health Care Blog | Healthcare and Technology news | Scoop.it

Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.


The future will mandate that healthcare systems have sophisticated analytical infrastructures in place to collect, analyze, and display these vast streams of data in ways that assist physicians and other care providers in delivering optimal care. Healthcare has always been dependent on managing information and knowledge to achieve the best possible outcomes, but this will become increasingly truer over the next decade.

Three Aspects of the Data-Driven Healthcare Transformation

This data-driven transformation will likely play out in at least three important ways.

1. Efficient and Effective Operations: Reduce Wasteful Spending

First, health systems will have to use data to run their operations more efficiently and effectively. Data can help healthcare providers better understand their operations. It can spotlight where they are wasting time, energy, and money. If an organization effectively uses information, it can optimize the use of resources, run more efficiently, and maximize reimbursement—all prerequisites for survival in the years ahead. While it sounds simple, this process alone promises to yield major efficiency gains and cost savings for organizations and for the nation. Experts have estimated that between 30 and 50 percent of healthcare expenditures in the United States are waste. Thus, this step alone represents a potential trillion-dollar opportunity to free precious resources for more productive use.

2. Manage Population Health
Second, data can help healthcare providers optimally manage population health. Data can be used to design more effective clinical processes that improve the diagnosis and treatment of the ill and injured. It can help physicians and other care providers understand how to standardize on evidence-based care processes. Standardization on a best practice represents significant additional opportunities to save costs and improve the quality and safety of care. Coupled with a physician’s knowledge and experience, data can augment a clinician’s ability to provide the best possible care.

3. New Technology-enabled Care and Personalized Medicine

Finally, new technology-enabled care delivery models will help healthcare providers deliver care that is more continuous, proactive, and geographically dispersed. Facilitated by the revolution in sensors, these care models will provide vast streams of data and turn society into an enormous learning laboratory. These sensors will provide information about what we do, how we eat, and when we exercise. They will provide information concerning our behaviors and our environments. In short, these new technologies will provide information regarding how we live in the real world and how our activities and environment impact health, disease, and treatments.

With the support of modern digital sensors, former trickles of information will turn into torrents creating vast pools of information that can provide new knowledge. In combination with genomic medicine, this new information will allow care providers to determine the right diet, medications, and therapies for each individual based on their specific situation, thereby delivering care that is far more personalized. And this type of personalized care will be empowering for patients and families, enabling them to participate in their healthmanagement in far more meaningful ways. The opportunities to improve population health are massive. Yes, there are significant issues regarding data security and privacy that must be addressed, but in time, they will be solved.

The Impact of New Data on Healthcare Costs

The impact of these trends on healthcare will be immense, to the point that it becomes hard to predict the ultimate impact on national healthcare expenditures. For years, healthcare policymakers and economists have been projecting massive increases in healthcare spending with each passing year. They correctly point out that this inexorable rise in healthcare costs poses an unacceptable risk to our economy.

While this is certainly of concern, the ultimate impact of aggressive waste elimination, process standardization, and new, more efficient, outpatient-centric care models is hard to quantify, yet it will likely be substantial. These powerful forces promise to drive healthcare expenditures down. As healthcare experiences the exponential impact of technological change, it is likely we will face a far different healthcare world a few years from now. Recall that not long ago we all relied on the thick Yellow Pages left on our doorsteps. Little did we know what impact a small company called Google would have on our lives.

Sooner or later, the same forces that have transformed other industries will fundamentally change healthcare. This will result in entirely new care environments and dynamics. This new world will most definitely revolve around data.Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.


The future will mandate that healthcare systems have sophisticated analytical infrastructures in place to collect, analyze, and display these vast streams of data in ways that assist physicians and other care providers in delivering optimal care. Healthcare has always been dependent on managing information and knowledge to achieve the best possible outcomes, but this will become increasingly truer over the next decade.

Three Aspects of the Data-Driven Healthcare Transformation

This data-driven transformation will likely play out in at least three important ways.

1. Efficient and Effective Operations: Reduce Wasteful Spending

First, health systems will have to use data to run their operations more efficiently and effectively. Data can help healthcare providers better understand their operations. It can spotlight where they are wasting time, energy, and money. If an organization effectively uses information, it can optimize the use of resources, run more efficiently, and maximize reimbursement—all prerequisites for survival in the years ahead. While it sounds simple, this process alone promises to yield major efficiency gains and cost savings for organizations and for the nation. Experts have estimated that between 30 and 50 percent of healthcare expenditures in the United States are waste. Thus, this step alone represents a potential trillion-dollar opportunity to free precious resources for more productive use.

2. Manage Population Health
Second, data can help healthcare providers optimally manage population health. Data can be used to design more effective clinical processes that improve the diagnosis and treatment of the ill and injured. It can help physicians and other care providers understand how to standardize on evidence-based care processes. Standardization on a best practice represents significant additional opportunities to save costs and improve the quality and safety of care. Coupled with a physician’s knowledge and experience, data can augment a clinician’s ability to provide the best possible care.

3. New Technology-enabled Care and Personalized Medicine

Finally, new technology-enabled care delivery models will help healthcare providers deliver care that is more continuous, proactive, and geographically dispersed. Facilitated by the revolution in sensors, these care models will provide vast streams of data and turn society into an enormous learning laboratory. These sensors will provide information about what we do, how we eat, and when we exercise. They will provide information concerning our behaviors and our environments. In short, these new technologies will provide information regarding how we live in the real world and how our activities and environment impact health, disease, and treatments.

With the support of modern digital sensors, former trickles of information will turn into torrents creating vast pools of information that can provide new knowledge. In combination with genomic medicine, this new information will allow care providers to determine the right diet, medications, and therapies for each individual based on their specific situation, thereby delivering care that is far more personalized. And this type of personalized care will be empowering for patients and families, enabling them to participate in their healthmanagement in far more meaningful ways. The opportunities to improve population health are massive. Yes, there are significant issues regarding data security and privacy that must be addressed, but in time, they will be solved.

The Impact of New Data on Healthcare Costs

The impact of these trends on healthcare will be immense, to the point that it becomes hard to predict the ultimate impact on national healthcare expenditures. For years, healthcare policymakers and economists have been projecting massive increases in healthcare spending with each passing year. They correctly point out that this inexorable rise in healthcare costs poses an unacceptable risk to our economy.

While this is certainly of concern, the ultimate impact of aggressive waste elimination, process standardization, and new, more efficient, outpatient-centric care models is hard to quantify, yet it will likely be substantial. These powerful forces promise to drive healthcare expenditures down. As healthcare experiences the exponential impact of technological change, it is likely we will face a far different healthcare world a few years from now. Recall that not long ago we all relied on the thick Yellow Pages left on our doorsteps. Little did we know what impact a small company called Google would have on our lives.

Sooner or later, the same forces that have transformed other industries will fundamentally change healthcare. This will result in entirely new care environments and dynamics. This new world will most definitely revolve around data.



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