Navigating Healthcare – Patient Safety and Personal Healthcare Management

The blast radius of hacking attacks gets

Posted in Uncategorized by drnic on September 30, 2015

The blast radius of hacking attacks gets wider each time #security #HCIT http://ow.ly/SrJMU

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Patient engagement lessons from Africa

Posted in #mHealth, Africa, education, HealthIT, Patient Engagement, Technology, Telemedicine by drnic on September 29, 2015

I was raised in Gabon on the equatorial west coast of Africa

and though I’ve never practiced there, I consider myself African and continue to be interested in the delivery of healthcare on the continent. Though health resources are scarce, my colleagues there have made creative use of the tools available. In Gabon, and indeed across much of the rest of Africa, text messages are routinely used to provide timely health messages about medications, clinic appointments, health risks and general health information. They are way ahead of the U.S. in proactive use of mobile technology for health improvement.

Below are a few examples of the remarkable achievements they’ve made with cell phones and text messages. Most of the examples were compiled by IRIN, a news service that focuses on humanitarian news and analysis, plus a few others that I’ve added to the list:

Health check-up by text message

  • A recent study published in The Lancet noted that Kenyan patients who received weekly text message check-ups were 12 percent more likely than a control group to have an undetectable level of HIV virus a year after starting life-prolonging antiretroviral (ARV) treatment.
  • In the south-central Ghanaian village of Bonsaaso, using mobile phones to contact health workers has lowered the maternal death rate.
  • TxtAlert, a product of the Praekelt Foundation, is a mobile tool that sends unique, automated SMS reminders to patients on chronic medication. This reminds them to take their medication or perform other necessary tasks. A special tool, called “Please Call Me” allows patients to call their doctors even if they don’t have any airtime available by pinging their doctor who then calls back.
  • A pilot project in Cape Town, South Africa, used text messages to improve adherence to tuberculosis regimens.
  • Medic Mobile allows patients to get home-based care even if they can’t be physically visited by a caregiver. The organization launched a pilot program in Malawi, where more than 100 patients received treatment for TB after their symptoms were noticed by the community and reported by text message.

Health information

Health literacy is often low in Africa, and text messages have proven an effective way to increase knowledge

  • In Tanzania, text messages are sent to pregnant women based on their due dates, providing important information that is relevant to each stage of their pregnancy.
  • On Valentine’s Day 2008, a Dutch NGO started an eight-week campaign in Uganda’s southwestern district of Mbarara with the slogan, “Don’t guess the answers, learn the truth about HIV.” The campaign led to a 100 percent increase in visits to the voluntary counseling and testing center run by the NGO’s health partner. This year, the same NGO used a text message quiz to test malaria knowledge in a fishing village in eastern Uganda.
  • In Ethiopia, people can call a confidential hotline anonymously with HIV-related queries.
  • On a 24-hour toll-free medical hotline in the Republic of Congo, set up by the government, the UN Children’s Fund (UNICEF) and a mobile telephone network operator, health professionals respond to queries about pediatric emergencies.

I could go on, and on and on, listing successful use of cell phones and text messages. The bottom line is that African health workers are using this technology in useful and creative ways to provide communication with patients.

Many U.S. medical professionals have been reluctant to use text messages and other mobile technology, and lag far behind their African colleagues in this area.

So what’s behind this disparity? Two factors, both related to infrastructure, have boosted use in Africa and delayed use in the U.S. First, because there is no significant landline infrastructure in much of Africa, cell phones account for 90% of all phones on the continent. In the cities, adoption has been near universal. (Pre-paid cell minutes are now used as a form of currency, as an alternative to sometimes volatile official currencies.) In many remote locations, where even clean water and electricity are scarce, you can get a cell signal and power a cell phone with a small solar charger to gain access to voice calls, text messages and the Internet. Cell phones have become a vital link for the continent.

With scarce health infrastructure and near-universal adoption of cell phones, health care workers were quick to see the usefulness of text messages, which only cost about 2 cents each.

Conversely, in the U.S., we have highly advanced medical infrastructure that has been in place for decades. A large proportion of primary care physician practices were established long before cell phones became widely used, and they still depend largely on the landline infrastructure they’ve always used. Same for most hospitals and outpatient clinics. Changing protocols, workflows and thinking patterns for these organizations isn’t easy, particularly if there is no urgent incentive to do so.

Many healthcare organizations also are concerned about HIPAA compliance and security in mobile patient communications; while those are valid considerations, there is a host of information that can be exchanged through mobile devices that wouldn’t violate the patient privacy regulations. And with a secure patient portal that can be accessed via smartphone, physicians can use mobile technology to share even protected information.

So why should physicians and hospitals change the way they work? Three reasons: meaningful use attestation, better outcomes and market competition.

While texting is not a part meaningful use attestation, it is a tool that could help you meet the criteria for getting patients to log in and view their health records. A text message with a link to your portal could prompt many to take a look just out of curiosity. And chances are, they’ll use their smartphone, not a PC to access your portal. Just this year, the number of users who access the internet with a mobile device exceeded the number who use a PC to gain access. So you’d better be sure your portal is mobile-friendly.

Perhaps the most immediate value of texting and other patient engagement strategies is improved care and better outcomes. Currently, we are not doing a good job of patient communication and education, despite putting time, energy and staff resources on the task.

Often, physicians, nurses and health educators are talking to patients who are too scared, too stunned by a new diagnosis, or just too intimidated by the healthcare system to be mentally and emotionally available to learn. Much of what we tell them is forgotten by the time they are out the door. And even those who don’t completely forget instructions often miss medication doses and appointments due to the forgetfulness that plagues all of us. And they often have trouble taking the advice we give and putting it to use in the real world.

Text message reminders could be used to remedy many of these problems. If the texts are scheduled to automatically send at the time that is most useful to a patient, the immediacy of the information would help patients follow through on treatment and be more engaged in their care.

The third reason that we should start using text messages is that the population under 40, and especially those under 30, use text messages as a primary communication tool. I have kids in that under 30 group, and they never answer the phone when I call or reply to emails (I doubt they even open emails). But a text message gets their attention. In fact, the average teenager sends 3,339 text messages each month. That’s more than 100 texts per day.

Granted, adults don’t text nearly that much, but those age 25-44 send texts more often than they call. And email is declining for many users, because they hate sorting through all the ads. Instead of emails and phone calls, they text and use Facebook and other social media to communicate with friends. Even business use of texts are on the increase, because it offers immediacy without the intrusion of a voice call.

So if you want to remind a patient about an appointment, odds are that a text message is a more reliable vehicle than either a phone call (which usually ends up as a voice mail that is never heard) or an email (which is likely to be missed among all the ads, if the person even bothers to check the inbox). If you send a text reminder at the time that a patient should be taking medication, chances go way up that the dose won’t be missed.

If you have a robust, mobile-friendly patient portal, you can use text messages to alert your patients to information they need on the portal – like their health records, useful research information and links to lifestyle advice like healthy recipes and exercise tips. With a secure portal, you can exchange even the most sensitive data with patients, even from a mobile device.

As this under-30 cohort becomes an increasingly larger portion of your patient population, they will expect your organization to communicate with them in ways that make sense to them, not you. Call only during office hours and wait on hold? I don’t think so. They will expect to use their smartphones to schedule appointments through your portal and receive information and ask questions through your portal, with text alerts to let them know when to check back for answers.

And if your organization can’t do that, they will find another one that will. Because the more future-ready, forward-thinking organizations have already made a move in that direction.

This piece originally appeared in MedCity News

Patient engagement lessons from Africa was originally published on DrNic1

Personal Healthcare Management

This piece by Aaron Carroll detailing his personal experiences with the healthcare system for what should be an easy and simple activity represents the frustration and challenges everyone faces on a daily basis including myself

I have the exactly the same challenges with renewal of what is a long standing formulation

I know this is not good for anyone and as pointed out it is not good for personal health – in my case as my wife and family will attest it definitely raises my blood pressure as I spend countless hours on the phone fighting with systems.

Everyone’s story will be different and in my case I don’t love the drug company who have taken long standing medication mixed them in a standard way and patented this to make it extraordinarily expensive for a formulation that contains one over the counter medication (OTC) and one generic prescription medication. And because of the artificial limits placed on supplies (90 days supplies with a maximum 1 year) behavior is modified attempting to reduce unnecessary costs. Ultimately everyone is behaving in the way the system incents.

Imagine that experience in the store – CostCo refusing to allow you to buy your supplies in bulk limiting your purchase to 3 months supply of toilet paper

and having to keep going back to an external party to require approval for purchasing when CostCo offers a special deal to purchase 12 units that might cover you for a year. Costco want you to purchase more and if you have the space and storage and will use it you want to buy in volume because it saves you money and the manufacturer wants purchasing their product. Costco is focused on making the process and cost as efficient as possible.

Before the deluge of complaints that buying drugs is not the same as buying toilet paper – true but take many maintenance drugs with excellent efficacy and safety. Even if it does require regular blood tests forcing the workflow to link the two in an sequence that tortures everyone in the process makes no sense. Engaged patients want an efficient process, will follow sensible and safe treatment guidelines and don’t need to be squeezed into a sequential process that includes steps that are linked for clinical reasons but remain disconnected in real life and difficult and expensive to follow for everyone concerned

As the costs shift to the individual the frustrations rise with the process and the necessary costs and waste – expect a rising voice of complaints and frustrations that might hopefully start to effect change

Personal Healthcare Management was originally published on DrNic1

Bad Medicine and the lack of Time – grea

Posted in Uncategorized by drnic on September 24, 2015

Bad Medicine and the lack of Time – great vision by @ZGJR #DigitalHealth http://ow.ly/SwFR0

Harvard Medical School revamps curriculu

Posted in Uncategorized by drnic on September 23, 2015

Harvard Medical School revamps curriculum #MedEd cc @ClayDellMed http://ow.ly/SwEsN

Process matters as much as technology

Posted in CMIO, EMR, Healthcare Technology, HealthIT, HIT, Innovation, Technology by drnic on September 22, 2015

Hope you can join me and my fellow Medical Informatics friends:

R. Dirk Stanley, MD, MPH @dirkstanley
Luis Saldana, MD @lSaldanaMD
Luke Webster, MD @LukeWebsterATL
Rasu Shrestha, MD, MBA @RasuShrestha
John Mattison, MD @JohnEMattison

 

for our inaugural #CMIOChat on Thursday September 24 at 4pm ET (Regular Chat 3rd Thursday of every month) 

Here’s the post for the topic we will be covering Emerging Technologies and questions around the technology that might be critical for success, what factors are helpful to consider when prioritization technology adoption and how to keep your IT department prepared for the future

 

It’s an exciting time to be a chief medical information officer (CMIO), especially at a hospital or health system with forward-thinking leadership. New technologies are emerging that will help us make huge strides toward truly effective, precise and personalized medicine.

That said, it’s also a very complex time. New technology comes with a host of challenges, and the biggest lie not so much with the technology but with the people involved. New clinical technology inevitably disrupts established workflows, and while it can be a big improvement, it has to be handled carefully if you want the project to succeed.

Over the past five years, as EHR adoption has soared, we’ve seen spectacular successes and spectacular failures in technology adoption. The difference between the two often lies in the process, training and the implementation services used.

So what makes for a good process? Discipline, for a start. You want to move forward with all deliberate haste, but you don’t let yourself be pushed into taking shortcuts or unjustified leaps of faith. Too many projects have gone down in flames because a good process was circumvented in the haste to meet an arbitrary deadline or at the behest of an impatient leader. As the strategic technology leader for your organization, you set the standard for how projects are planned, implemented and measured. If you are disciplined, others will follow your lead.

No matter what the technology, there are a few key factors to focus on to increase your chances of success. Below are the ones that I think make a big impact. Some are obvious, but there are organizations that have ignored the obvious and lived to regret it. Take heed.

Know where you are

Before you launch a project (before your even plan a project), know your organization and its capabilities. Don’t assume you know what’s happening on the nursing units just because you meet regularly with the nursing leadership. They may not know what’s happening and impacting day to day work on the nursing units. People get very creative with workflows when time is short and they feel the pressure to do too much. If you are introducing technology that will affect a particular area, take the time to talk to front-line staff, with a particular eye to understanding the process variations that exist.

Same thing for the technology. Don’t base all your knowledge on what the CIO reports. Talk to the data center manager and the front line IT staff to learn the variations that occur to the set protocols. They will also be aware of how well their end users are following security protocols, which is knowledge you should have before you introduce new technology.

Think carefully about all the stakeholders, and take the time to understand how those stakeholders currently do their jobs.

Know where you are going

Make both a clinical and business case for any technology you want to adopt. Have clear and realistic goals. Avoid the temptation to oversell the merits of the new tools, because if the results fall below the expectations, things will get very uncomfortable for you and anyone else who has championed a project. Don’t undersell, but be sure to set achievable goals.

Also, get the metrics for a full year of operations prior to the adoption of the new technology, to have a reliable baseline for monitoring performance. Why a year? Because that will show any seasonal variations as part of a continuum. If you use a shorter window, you might inadvertently have data that is either on the top end or the bottom end of a variation, which could skew your view of results.

Gain from lessons learned

If others have blazed the trail before you, talk to them – use social media or join a TweetChat like #CMIOChat for example. Find out what mistakes they made, what challenges they saw and what factors were most important in making things work. Were there unintended consequences or unanticipated benefits?

Plan carefully

As you start the process, get all the key stakeholders at the table. Make sure you have input from the people who will use the technology most. That means frontline staff as well as leaders. Make your timeline reasonable, and do a pilot launch of the technology in parallel with your usual operations. That will allow you to test and refine before you go live. Even seemingly small changes can have big impact, and testing will uncover all those unintended consequences that could trip you up.

Don’t forget the business operations in your planning. One large system saw a huge drop in revenue when they implemented a new EHR in 2013, because it changed where and how charge capture occurred. Millions of dollars were lost over several months while they tracked down the problem and retrained staff. So if your new technology changes charge capture in anyway, you’ll need to plan for that. Your colleagues in the business operations arena must be involved.

Get the right resources

Don’t assume that you have all the expertise in-house to plan and implement a new technology. You can often save money in the long run by investing in consulting services and short-term staff augmentation to assist your people with the planning and implementation. Your staff have to keep the business running, while these contracted experts can focus solely on the project. If you choose your vendor wisely, you will have access to knowledge gained from hundreds of other engagements. And they will bring a disciplined process to the project, one that has been refined over many iterations and in widely varying environments.

But don’t just hire folks and walk away. Stay involved. Treat the consultant as a partner, and work together. Take advantage of the experts’ knowledge, and offer your own knowledge of the organization to improve the planning and implementation.

Choose your champions carefully

Physician and nursing leadership are often critical to successful technology adoption. The right champions can make or break a project. Choose these people based on their influence with their peers; their ability to be enthusiastic without being unrealistic; and their ability to take a disciplined approach to a project. An enthusiastic champion with no follow-through abilities can create cynicism and distrust. Conversely, don’t choose people who are so nit-picky that they slow things down over unimportant details. Common sense and an optimistic frame of mind are the key attributes you want. Plus a thorough-going knowledge of the clinical issues involved.

Start small and be both willing to fail and persistent

New technology inevitably requires trial and error. Failure is okay, if it happens small and early and is well documented. Do pilot projects before you take on a big one with new technology. Test, learn and test again. Don’t abandon a project without knowing exactly what went wrong and why. That process of examination can often identify a new approach that will lead to success.

In a TED talk on the subject of trial and error, Tim Harford (@TimHarford) notes that all really good complex systems are the result of trial and error. But it has to be disciplined trial and error, with results carefully documented and each failure examined for lessons that guide the next attempt.

Don’t be on the tail end of technology

In 2005, Blockbuster dominated video rentals. By 2010, the company filed for bankruptcy, its business model disrupted by Netflix’s streaming video and Redbox’s rental kiosks. Other brick and mortar businesses also declined, their profits eroded by Amazon, e-Bay and other virtual markets that offered responsive service and convenience.

Healthcare faces a similar turning point, in which the delivery of healthcare is radically changing. With the emergence of disruptive technologies like telehealth and retail express clinics, consumers want a different healthcare experience, one in which they have greater control, engagement and convenience.

So don’t be Blockbuster. You don’t have to be Netflix, but you don’t want to stick your head in the sand and wait to see what happens. If you are disciplined in your research, planning and expectations, and you have a well-thought-out business and clinical case for a new technology, move forward. The alternative is to fall behind and become irrelevant. And our patients can’t afford for us to give them half-measures.

 

This post originally appeared on CMIOChat: Process matters as much as technology, especially when treading new ground

Process matters as much as technology was originally published on DrNic1

7 Surprising Facts About Women and Ambit

Posted in Uncategorized by drnic on September 22, 2015

7 Surprising Facts About Women and Ambition http://ow.ly/SwbcU

If Air #Travel worked like #healthcare –

Posted in Uncategorized by drnic on September 21, 2015

If Air #Travel worked like #healthcare – ‘What Century is this”! http://ow.ly/SrMAm