Navigating Healthcare – Patient Safety and Personal Healthcare Management

“13 Ways Successful People Deal With To

Posted in Uncategorized by drnic on July 8, 2015

“13 Ways Successful People Deal With Toxic Persons”
1. They set limits
2. They don’t expect or request change
3. They don’t get embroiled in fights
4. They don’t allow anyone to restrict their happiness
5. They don’t forget
6. They forge a support system
7. They get some rest
8. They focus on solutions rather than problems
9. They set barriers
10. They are self aware
11. They rise above negativity
12. They never play the victim
13. They never judge

#Digitalhealthcare is coming – and its b

Posted in Uncategorized by drnic on July 1, 2015

#Digitalhealthcare is coming – and its bigger than u think http://ow.ly/P2Dm1

Memorial Weekend – Be Happy

Posted in Inspiration, Personal Health by drnic on May 23, 2015

This memorial day is a good time to reflect and give thanks – in fact this visual gives a great sense of the sacrifices of so many for our freedoms and life today

BloodofourVeterans

Original from Facebook

Here’s one for the SHARE button. A truly powerful image that tells it like it is.

Posted by Madison Rising on Thursday, October 30, 2014  

So while thinking about how lucky we are we should try hard to be happy as Bobby McFerrin suggested: “Don’t Worry, Be Happy” So in the spirit of focusing on happiness which is well proven to improve your life this piece in Time Magazine: Happy Thoughts: Here Are the Things Proven To Make You Happier choked full of great ideas and principles – starting with Gratitude which

Showing gratitude for the good things you have is the most powerful happiness boosting activity there is….which seemed a perfect match for today. But there are many other elements starting with

Doing what you are good at – no matter what that might be as often as possible – Starving Artists are happier with their jobs which goes a long way to explain the power of Regina Holliday and her amazing presence and power in medical advocacy (She’s just a published her first book “The Writing on the Wall” which should be required reading and would definitely be on Oprah’s book list if that were still thing)

As for you time – spend it with the people you like – the happiest people are social with strong relationships and that describes much of the online community around Healthcare and Patient advocacy that i consider myself very lucky to be part of. There have been some studies that suggest a causation between happy social networks influencing others and helping them to be happier (I know could just as easily be correlation but either way Happiness is infectious)

Money can help but is not essential to happiness and it is not good to focus on money or the desire for it.

Well known that giving is better for happiness than receiving – notable during the holiday that the giving of gifts is more satisfying than receiving. Interestingly striving for ambitious goals has a positive effect and being optimistic (even bordering on delusional) has positive effects but it is this list of “big life regrets” that is worth highlighting

  • I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  • I wish I didn’t work so hard.
  • I wish I’d had the courage to express my feelings.
  • I wish I had stayed in touch with my friends.
  • I wish that I had let myself be happier.

and as someone pointed out – no one says as they near death – I wish I had worked much harder and spent more time at work.

 

Relish the time off, enjoy your life, family and friends, savor the positive experiences and do so frequently even in small doses.

 

 

 

 

 

 

 

 

 

 

 

 

 

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HIMSS15 The Year of DigitalHealth, Interoperability and Security

Posted in Uncategorized by drnic on April 10, 2015

HIMSS is finally upon us and like the 20,000+ people heading Chicago there is a lot to take in, many options and far too much for any one person to see or catch up with. So what do you do?

First off – download the HIMSS Mobile APP that now comes with GPS intelligence which hopefully will start to provide keen insights into activities and opportunities that are nearby as you move around Chicago, the convention center and beyond

Download and print (I know not very environmentally friendly but there is a lot to absorb) the HIMSS Conference Guide (72 Pages) – or if you are feeling really clever send it to you iDevice, Pocket, Kindle or some other reading device

Or use the online version of the HIMSS of the guide – here

For the physician centric guide – head on over to this living breathing dynamic Google Document – put together by Wen Dombrowski (@HealthcareWen)

For the HIT Centric Guide from John Lynn (@TechGuy)

For the latest and greatest news be sure to follow the #HIMSS15 hashtag, and others linked to the conference including #DrHIT

And your best option for keeping up with the latest and greatest from Symplur tracking system on #HIMSS15 and that page features additional topics and tags worth following and tracking

And of course follow your Social Media (#SoMe) Ambassadors can all be found in this list on twitter

 

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

Posted in Uncategorized by drnic on March 14, 2015

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

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

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

Here’s to those who choose to defy reality and instead envision a future world – a world that ventures beyond even Mr. Spock’s wildest dreams.

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

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

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

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

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

– Vivek Kaluskar, Nuance Natural Language Processing Researcher

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

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

– Ignace Van Caneghem, Nuance Customer Support Specialist

Finding solutions to seemingly impossible situations is what innovators do. It’s why we wake up in the morning. I’m constantly looking for ways to make health IT more connected, accessible, and more intuitive so physicians can focus on treating their patients.
Working in tech isn’t easy, but some of the most worthwhile pursuits are also the most challenging. Thinking outside the box is the key to solving complex problems. There’s an episode of Star Trek (“Wolf in the Fold,” 1967) where Spock forces an alien entity out of the ship’s computer by asking it to calculate pi to the last digit, an impossible feat. At that time, using speech recognition to control a computer was also impossible.

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

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

This post originally appeared in Whats Next

Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

I spent some time at Medicine 2.0 and participated on the panel Bridging the Digital Divide and will presented: Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology. With ubiquitous technology comes ubiquitous complexity – adn this is especially true for doctors who face challenging User Interfaces – captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine

Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.

Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.

Here’s a video showing off Florence

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Dunkirk Spirit: How physicians support patients overcoming adversity

One in eight U.S. women will develop invasive breast cancer over the course of her lifetime.  In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed.  That’s approximately 808 cases per day.

That’s ~640 cases per day or a little over 1 case per hour (26 per day)1

But these statistics don’t matter.  Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers.  It immediately becomes a reality to you.  We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”

As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before.  We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news.  We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.

What never ceases to amaze me, however, is the strength of the human spirit.  Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.

Dunkirk Spirit

It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.

Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives.  As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care.  We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.

Technology can help in healthcare, but it is not the goal nor should it ever be the focus.  Yet, in some cases, it has detracted from our ability to provide care and compassion.  To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.

To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions

 

This article originally appeared on WhatsNext: Healthcare

Tracking #Ebola Effectively hindered thanks to #ICD10 (double) delay

Posted in Africa, bigdata, CDI, coding, icd10 by drnic on January 19, 2015

This graphic

Offers a timely reminder that the US Government delayed a second time the implementation of ICD10 coding system that is used in the rest of the world

There is no code for Ebola in ICD9 – just a non-specific 078.89: Other specified diseases due to viruses which covers:

Disease Synonyms Acute infectious lymphocytosis Cervical myalgia, epidemic Disease due to Alpharetrovirus Disease due to Alphavirus Disease due to Arenavirus Disease due to Betaherpesvirinae Disease due to Birnavirus Disease due to Coronaviridae Disease due to Filoviridae Disease due to Lentivirus Disease due to Lone star virus Disease due to Nairovirus Disease due to Orthobunyavirus Disease due to Parvoviridae Disease due to Pestivirus Disease due to Polyomaviridae Disease due to Respirovirus Disease due to Rotavirus Disease due to Spumavirus Disease due to Togaviridae Duvenhage virus disease Ebola virus disease Epidemic cervical myalgia Infectious lymphocytosis Lassa fever Le Dantec virus disease Marburg virus disease Mokola virus disease Non-arthropod-borne viral disease associated with AIDS Parainfluenza Pichinde virus disease Tacaribe virus disease Vesicular stomatitis Alagoas virus disease Viral encephalomyelocarditis Applies To Epidemic cervical myalgia Marburg disease

ICD-10 has one specific code for Ebola: A98.4 – Ebola Virus Disease Clinical Information A highly fatal, acute hemorrhagic fever, clinically very similar to marburg virus disease, caused by ebolavirus, first occurring in the sudan and adjacent northwestern (what was then) zaire.

Accurate tracking and reporting stop at the border of the United States

This is one of many examples of codes “missing” in ICD9 for conditions and care we are already delivering and dealing with

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Connected Health and Accelerating the Adoption of #mHealth

Posted in #hcsm, #mHealth, bigdata, EMR, Health Reform, HealthIT, HITsm, Medical Devices by drnic on November 7, 2014

I attended the Connected Healthcare Conference in San Diego yesterday Accelerate mHealth Adoption: Deliver Results through Data Driven Business Models for End-User Engagement

Never has there been so much to play for in the mobile health landscape, a revolution is just round the corner with key players from the health care and consumer markets coming together to develop the mHealth industry. This Connected Health Summit will create a bridge bringing together hospitals, clinicians, providers, payers, software and hardware innovators, consumer groups and the wireless industry.

You can find the agenda here and the organizers will be publishing the presentations – there were many interesting insights

Andrew Litt, MD (@DrAndyLitt) (Principal at Cornice Health Ventures, LLC) opened the conference with a great overview of the industry and a slew of challenges and opportunities.

He sees our industry in Phase 1 – the Capture and Digitization of records and we have yet to really move and explore Phase 2:

Move and Exchnage Data AND Analyze and Manage Data that is linked to Information Driven decision Making

And Phase 3:

Managing Patient Health

In our need to move from data to analysis and information he cited a statistic from a white paper: Analytics: The Nervous System of IT-Enabled Healthcare that sadly puts 80% of data in the EMR unstructured. This is a fixable problem today with Clinical Language Understandingand we are seeing some results and a change in the industry to stop looking to doctors to be data entry clerks He also cited Hospitals:

Technology offers tremendous scope to not only fix these problems but get ahead of the problem (as is done in other industries like the Airline industry that has rebooked your flights before you even land and miss your connection). As he suggested could we use data to understand who is likely to develop a heart attack in the next 2 hours and try and change this outcome

But integrating mHealth into our workflow requires an mHealth Ecosystem:

mHealth needs an ecosystem that improves workflow and integrates data to reduce clinicians workload. This is why doctors and clinicians are resisting mHealth – they don’t like the change to the workflow that has little if any positive effect (for the doctor – they may have a positive effect for the individuals health) of reducing clinicians workload

Interesting comment on wearables and the perspective of doctors on these devices:

What bothers the doctor – mostly the people who are buying and using wearable fitness/activity trackers are the people that are young healthy fit and want to prove to (themselves/others) that they are young fit and healthy?

His graphic on Security and privacy was on the money:

Essential to balance Privacy of Health with interoperability but trust is the imperative The stats he presented were troubling (at best)

  • 96% – Percentage of all healthcare providers that had at least one data breach in the past two years
  • 18 Million – Number of patients whose protected health information was breached between 2009 and 2011
  • 60% – Proportion of healthcare providers that have had 2 or more breaches in the past 2 years
  • 65% – Proportion of breaches reported involving mobile devices
  • $50 – Black market value of a health record

The healthcare industry is under attack and is the most attacked industry today:

You might find these figures of the value of Healthcare data as it is valued on the black-market

Another interesting data point:

HIMSS records a total of 11,000 Healthcare Technology companies – less than 100 are large size and the balance of 10,900 are small business that are essentially capturing and scattering your data across many systems and data repositories…

Multiple other presentations and panelists that were all insightful. As always Jack Young (@youngjhmb) from Qualcomm Life Venture fund had some great insights – impossible to capture all of them but here are some:

Healthcare is moving out of the hospital into the home for many reasons but cost is a big driver:

and he suggested there was at least $1.5 Trillion in economic value as the industry shifts (shifting vs replacement?)

 
 

Many were surprised by his stat that users check their smart phone at least 150 times per day (just looking around my world this seems low) – in fact a quick check online suggests this is no longer valid and it is probably 221 times per day. Given this device is the one thing we will not leave home without and it now contains a range of sensors including:

  • Accelerometer
  • Gyroscope
  • Magnetometers
  • GPS
  • Cameras
  • Infrared
  • Touchscreen
  • Finger print
  • Force
  • NFC
  • WiFi/Bluetooth/Cellular

We have the potential for more passive compliance with our patients (and as many stated in their presentations likely more accurate as self reported data is notoriously inaccurate) He predicted a a 10x growth in wearables from 2014 – 2018 with 26% of this growth attributable to smart watches (I know hard to believe at this point but I think if you looked back 4 years ago the iPad had nothing like the level of penetration it does today) iPad Growth Rate

I liked his assessment of the werable market place by researching the eBay Discount against the price of the new device:

and even worse for Smart Watches

I also presented “mHealth Reimbursement – Who Will Pay: You can see it here at Slideshare or below:

mHealth Reimbursement : Who Will Pay? from Nick van Terheyden

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What can we learn from Robin Williams in life and in Healthcare

Posted in Depression, Health Reform by drnic on October 23, 2014

Like many people the death of Robin Williams

was sad on so many levels and while my connection with him was limited to the exposure I had through his canvas of work, I like others felt I knew him.

He was not only prolific in his work with a list of films, interviews and shows (and if you have NetFlix – here’s all the movies available there), but could often be found adding color and charisma in the most unusual places – in this story related by Christopher Reeve talkingabout his friendship as they walked past a lobster tank in a restaurant

One evening we went out to a local seafood restaurant, and as we passed by the lobster tank I casually wondered what they were all thinking in there. Whereupon Robin launched into a fifteen-minute routine: one lobster had escaped and was seen on the highway with his claw out holding a sign that said, ‘Maine.’ Another lobster from Brooklyn was saying, ‘C’mon, just take da rubber bands off,’ gearing up for a fight. A gay lobster wanted to redecorate the tank. People at nearby tables soon gave up any pretense of trying not to listen, and I had to massage my cheeks because my face hurt so much from laughing.”

Bet you wish you had been there to listen in!

 

The outpouring of grief, sadness and accolades was no surprise and while he may not be everyone’s favorite actor or character it is hard to imagine people feeling dislike for him.

He was a serious actor who’s work included playing characters with flaws Good Will Hunting

Insomnia

And a personal Favorite (for the teacher we all wanted to have – Captain, My Captain) The Dead Poet’s Society

But is best known for his comedic genius and unstoppable energy that could light up any room or interaction and turn even the most somber of moods into smiles and laughter

And his comedic view of what Lobsters were thinking in a tank as he demonstrated when he visitedhis longtime friend Christopher Reeve and making him smile for the first time after his accident

“As the day of the operation drew closer, it became more and more painful and frightening to contemplate,” wrote Reeve. “In spite of efforts to protect me from the truth, I already knew that I had only a fifty-fifty chance of surviving the surgery. I lay on my back, frozen, unable to avoid thinking the darkest thoughts. Then, at an especially bleak moment, the door flew open and in hurried a squat fellow with a blue scrub hat and a yellow surgical gown and glasses, speaking in a Russian accent. He announced that he was my proctologist, and that he had to examine me immediately. My first reaction was that either I was on way too many drugs or I was in fact brain damaged. But it was Robin Williams. He and his wife, Marsha, had materialized from who knows where. And for the first time since the accident, I laughed. My old friend had helped me know that somehow I was going to be okay.”

The friend we all want to have…?

With that in mind it can be hard to reconcile that character with someone who would take his own life:

  • How is it possible that someone with what appeared to be so much joy and happiness who was surrounded by friends and family find themselves in such a state of despair to take an irreversible path and commit suicide?
  • How is it possible that someone who outwardly seemed to have such a sharp insight into people and laughter who could make us all laugh at the most unlikely of issues or discussions could take his own life?
  • How is it possible that someone with such a storied and successful career could drop into a state of depression with so much to live for and so many people who loved him and end his own life?
  • How is it possible that a smart, intelligent and gifted individual with so many positive aspects to his life could see no alternative to ending his life and commit suicide?
We can be surrounded by people but be all alone

In what seems eerily insightful he talked about this in his “report to Orson” in the show Mork and Mindy in 1981 where Mork meets a famous celebrity (in this case it the famous celebrity is Robin Williams): “Mork Meets Robin Williams”. You can watch part of it here Mork learns about the nature of fame on Earth and the toll it takes on those who get swept up in it, or try this link

There has been some mention of Parkinson’s Disease and this may have had a contributing role. But the underlying challenge was his battle with depression. On many occasions he had shared his struggle with depression and substance abuse and the ongoing challenge he personally faced dealing with his disease.

The word depression is used frequently by people to describe their feelings and emotions but it has a very specific meaning in medicine and is used to describe a mood disorder:

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.

Not to be confused with sadness which is a temporary feeling that is normally associated with some negative aspect of our lives or surroundings and passes

Our understanding of depression is still limited – our treatment of this disease is still in its infancy and mostly limited to broad-brush therapies that impact neurotransmitters that are implicated but not exclusively associated with depression. We have (mostly) moved past separating and isolating people from the general population (although some would argue that our prison system is the new version of the sanatorium). But our ability to treat or cure depression remains stubbornly missing.

Our understanding of the brain is limited and despite laudable attempts to jumpstart the process The NIH BRAIN Initiative progress however remains frustratingly slow and leaves our society with a subset of the population suffering from varying degrees of debilitating diseases of our brain including depression, mania and schizophrenia and many others.

So what did Robin Williams teach us in Life

Laughter is the best medicine

It is hard to pick a single moment from his incredible repertoire, so I picked 3: Mrs Doubtfire Explaining Golf  Or this medley tour of cultures and accents all done in less than 2 minutes Laugh and laugh loudly

Being different is not just OK its what makes life worth living

Endless compassion

and the real Patch Adams

What did Robin Williams Teach us in Death

We need empathy, compassion and tolerance in our society Empathy: The Human Connection to Patient Care Social Media can help link people but even with these digital connections humans may still feel disconnected and alone despite outward appearances to the contrary and connecting, engaging and reaching out is even more important today in our “connected” world

Suicide is painful – not only for the unnecessary loss of life but for the trail of despair it leaves behind for all the people wondering what if…. should have…. could have done….

I’ve experienced it with friends and still think about them. In fact I was reminded when I read about two more suicides in New York: Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths of two promising lives brought to a final and sad end.

Don’t let that be your legacy and reach out to someone today and remind them and yourself why life is great for both of you

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