Navigating Healthcare – Patient Safety and Personal Healthcare Management

May the Fourth be With You

It’s the artificial holiday that celebrates the play on words from Star Wars movies – a rallying cry

The list of suggested actions from the Starwars site may not be to everyone’s taste and includes everything from

  • Holding movie marathons
  • Dress up as a Star Wars Character
  • Star wars food including blue milk!
  • Getting a Star Wars Tattoo

 

But this year I follow Yoda’s advice:

“Pass on what you have learned”

Specialty Pharmacy

This year I attended the Asembia Specialty Pharmacy Summit held this time each year in Vegas at the Wynn/Encore resort. This is the largest conference for specialty pharmacy but as Alex Fine noted and I agreed –

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All pharmacy is moving rapidly in the direction of specialty as we head into a world filled with precision medicine customized to the individual. On the one hand, this is an exciting proposition – at least to me. I am always reminded of the great scene in Monty Python’s Life of Brian

You are all individuals…..we are but medicine has not treated us that way. Historically the path to understanding disease was based on grouping patients, diseases, signs, and symptoms into logical groups that helped decode underlying cases of a disease.Just think of the seminal work of Louis Pasteur and Robert Koch who established the germ theory of disease and the resulting incredible advance in outcomes that derived from that block of work when Joseph Lister published in 1867 his Antiseptic Principle of the Practice of Surgery (met by substantial skepticism and took years to be widely accepted and adopted). This was just the start as we came to understand causative agents behind diseases that had vexed the profession. Treating someone with an infection with Penicillin thanks to Alexander Fleming’s work in 1928 was just one of many advances that grouped patients based on similarities of their disease. This methodology has served us well but the sequencing of the human genome- completed in Jun 2000 would have a big impact on this thinking.

Just think of the seminal work of Louis Pasteur and Robert Koch who established the germ theory of disease and the resulting incredible advance in outcomes that derived from that block of work when Joseph Lister published in 1867 his Antiseptic Principle of the Practice of Surgery (met by substantial skepticism and took years to be widely accepted and adopted).

This was just the start as we came to understand causative agents behind diseases that had vexed the profession. Treating someone with an infection with Penicillin thanks to Alexander Fleming’s work in 1928 was just one of many advances that grouped patients based on similarities of their disease. This methodology has served us well but the sequencing of the human genome- completed in Jun 2000 would have a big impact on this thinking.

From: http://sandwalk.blogspot.com/2016/02/happy-birthday-human-genome-sequence.html

Over the course of the last few years, we have seen a clear move towards the individualized understanding of patients and disease accompanied by the inclusion of patients (Patient Engagement).

Patient Engagement and Access

There was a clear theme in the messages from various presenters that offered a clear vision of the push towards the consumer and patient engagement and a clear desire to find a path to delivering access to everyone that was captured by Liz Barrett from Pfizer in her keynote presentation and summarized with her slide – The 4 Tenets for Healthcare:

Access to quality
Incentives
Long-Term Value
Competitive principles

Providing access that overcomes the current challenges but builds in incentives for everyone in the system – not just the providers and hospitals but also patients and everyone involved in healthcare. This is the principle of competition without which systems tend to decline and ultimately stop working. There are people who perceive competition and capital principles as contraindicated in healthcare that we want to provide to everyone. I think these ideals can and should co-exist – without competition motivation disappears and efficiency will decline.

To achieve this we should take a book out of Yoda’s wisdom to pass on this wisdom and my key message for this day. Benefiting from the extended community. Our ability to connect and access people and resources has never been better. The need to remember data is much reduced:

GIYF

This access goes far beyond the data and to people and resources. Can you imagine making a purchase without looking at ratings and reviews on sites – I can’t. Yet the reviews are from people I don’t know and have not met – yet I trust them. This works because of the human desire to help others (this, by the way, is the reason that social engineering as carried out by hackers is so successful – this will be the subject of a post coming up in the future). But this creates an incredible set of resources and talent available to you.

Patient Communities

Some of it is formalized like the early website entry in this area: Patients Like Me. But extends to informal interactions on social media channels like facebook and one of my favorite: Paying till it Hurts. Then there is your extended family and friends who all want to help. You will find people who have been through similar experiences, will have tips and ideas on how to deal with problems that others have faced and have conquered

I was lucky to hear Arnold Schwarzenegger present as the keynote at this recent conference – his recurring theme was that he was not a self-made man but his success was the result of all the help and support he received from others

So use the power of the Force – it is your network, your friends, family and those around you.

Derive strength from them, have them provide tips on what small changes you can make to improve your health and then help keep you on track – nothing like knowing that you are being watched to help keep you on track.

One of my most successful personal health drives was base don a weekly self-reported weigh in for myself and two colleagues. Anytime I felt I was going to make a poor choice on food or exercise I just thought of the weekly chart and where my line would be relative to my colleagues and I did not want to be the outlier.

Have you had success helping friends and family? What works and what doesn’t. Is there a special trick or insight you could share that might help someone else – share it now and help the community.

 

May the Fourth be With You was originally published on Dr Nick – The Incrementalist

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World Malaria Day 2017

Posted in Africa, DigitalHealth, Healthcare Technology, Innovation by drnic on April 25, 2017

Malaria

 

World Malaria day is today – Tuesday, April 25, 2017. Recognizing global efforts to control and perhaps one day eradicate this major killer that disproportionately affects my home country of Africa.

The WHO African Region continues to shoulder the heaviest malaria burden, accounting for an estimated 90% of malaria cases and 92% of malaria deaths in 2015. The WHO South-East Asia Region accounted for 7% of global malaria cases and 6% of malaria deaths. Three quarters of these cases and deaths are estimated to have occurred in fewer than 15 countries, with Nigeria and Democratic Republic of the Congo accounting for more than a third

 

Status of Malaria Today

Based on the WHO 2016 Malaria report there were 212 Million cases globally of Malaria. While we have seen some great progress with a decrease in Malaria infection rate between 2010 and 2015 of 21% and a decrease in the mortality rate of 29% we have a long way to go. Almost Half the population of the world is at risk from Malaria, and in 2015 an estimated 429,000 people died from Malaria. That’s the whole population of Miami dining every year.

Source: Marc Averette

More than 2/3 of the deaths that occur in children under the age of 5 and pregnant women are really susceptible – that’s a double hit on vulnerable populations.

The lifecycle encompasses the mosquito as carriers and transmission to humans. This is a great graphic summarizing the

 

 

Prevention and Treatment

The basis of prevention and treatment is tied to 3 basic methods

  • Insecticides and Mosquito Nets
  • Indoor spraying of insecticides
  • Preventative Therapies for pregnant women, children and infants in Africa

 

The good news is that advances in Digital Health and mobile technologies that are bringing testing capabilities to many remote and underserved areas. Testing rates of suspected malaria cases have increased from 40% in 2010 to 76% in 2015 much of it due to rapid testing capabilities that economical and are increasingly available.

Sadly despite the progress, some of the mainstays of prevention and treatment are being impacted by the emergence of insecticide and drug resistance that has seen 60 countries reporting resistance to at least one of the 4 classes of insecticides and even more troubling 5 countries have reported drug resistance to the core compound used in antimalarials artemisinin

 

 

The report card by country is a mixed bag with some progress and success but increases in incidence in other areas

Many organizations have been working hard in this area and that includes the work by the Bill and Melinda Gates foundation has been focusing for many years on a World free of Malaria. They have invested over $2 Billion in grants spread across multiple areas prevention, mitigation and treatment.

Current Problems

Its a tricky virus that uses all sorts of clever subterfuge to fooling our bodies and the other carriers into ignoring the infection. There is even a clever “bending” of the red cell wall to allow the virus to enter more easily as demonstrated at Imperial College – Malaria parasites soften our cells’ defenses in order to invade:

However, now researchers led by a team at Imperial College London have found that the parasites also change the properties of red cells in a way that helps them achieve cell entry. The results are published in Proceedings of the National Academy of Sciences.

There are many fronts open and Papua New Guinea are one of the countries that dare to hope with encouraging progress that may bring about the end to the disease

In PNG, control measures – in particular the rollout of long-lasting, insecticide-treated bed nets – have resulted in the prevalence of malaria declining by more than 80% across the country since 2009. Cases reported at four sentinel sites have dropped from 205 to 48 per 1,000, surpassing all expectations.

 

New Strategies in Treatment of Malaria

There has been a lot of work on Vaccines for Malaria and it would appear some successful studies including this one from Germany

University of Tübingen researchers in collaboration with the biotech company Sanaria Inc. have demonstrated in a clinical trial that a new vaccine for malaria called Sanaria® PfSPZ-CVac has been up to 100 percent effective when assessed at 10 weeks after the last dose of vaccine.

So perhaps like Dengue – it may be “The Beginning of the End”. Let’s not let up – this is a major killer. Even with prevention and mitigation therapy as expatriates living overseas in Malaria ridden areas my mother still contracted the disease. We have had a global eradication program in action since the 1950’s – with advancement in science and understanding perhaps we are finally on the cusp of eradication?

You can find out more here and download the Infographic: Malaria Can Be Defeated

 

World Malaria Day 2017 was originally published on Dr Nick – The Incrementalist

Population Health is a Team Sport

Designing an Effective Population Health Program

Population health is the topic du jour for the health care industry, and I’m glad to see us all focusing on this important issue. But there is a lot of confusion as to what, exactly, constitutes population health. Or more correctly, an effective population health system.

A good population health program consists of four major components:

  1. Identification and stratification of risk within a discrete population
  2. Dissemination of information to physicians, care coordinators or others designated to contact patients and arrange follow up.
  3. Appropriate follow up to further understand the risks for individual patients, identify gaps in care and design a care plan to help the patient improve his/her health status.
  4. Ongoing care individualized to each patient’s need. That might be coaching, medication reminders, telehealth visits, remote monitoring or other strategies customized to each person’s condition and socio-economic environment.

The key to making a population health program effective is ensuring that all four components are in place and working well. If there is a break anywhere in the chain, you lose the opportunity to improve patients’ health. The best analytics in the world are useless if the results do not quickly and easily pass into the hands of the people who can take action. And very good follow up and care planning can be ineffective if the ongoing support is lacking.

Friction

One of the biggest barriers to effective population health improvement is friction in the flow of information between health plans, hospitals/health systems and physicians. This has been a constant source of difficulty for the entire healthcare ecosystem for years, but with the new focus on population health and improving outcomes, it has reached a new level of urgency.

African heart disease is much lower
African heart disease is much lower

In traditional African societies coronary artery disease is virtually nonexistent, but in the migrant population to Western societies the rates are similar to those of the local population indicating that the primary determinants of these diseases are lifestyle and diet and not genetic. These indicators are a key asset in changing our healthcare system and addressing the current 75% of our healthcare spending that is focused on patients with chronic conditions which have their roots in lifestyle choices and behaviors. To address these challenges we need a way to better target our limited healthcare resources more cost effectively for maximum effect and identification and targeting with a robust population health system is no longer a nice to have – it’s a must.

To help patients improve their health, not just react to a situation that has already developed, requires information and insights. But in a survey of primary care physicians by The Commonwealth Fund, only 31% of U.S. physicians said they are notified when a patient is discharged from the hospital or seen in an emergency department. This is important information for primary care physicians, and is not that difficult to fix. All you need is standard protocol in place and a mechanism for notification. It could be a standard action that happens at every discharge. It could even be automated. If the retail industry can automatically send an email to confirm an order, hospitals and health systems should be able to send an automatic email to a physician with discharge information. But hospitals and health system executives haven’t made it a priority, so it doesn’t get fixed.

Get to know your team mates

This is just one example of the inward-looking approach that still permeates much of healthcare. Hospitals, nursing homes, skilled nursing facilities and other care providers pay attention to what happens within their organizations, but they neglect to look beyond. Organizations act as though the care they give is the only care patients receive. They forget that there are a multitude of other professionals who are also responsible for care and need to know what’s going on. We don’t just have data silos in healthcare, we have attitudinal silos that make data transfer and exchange an afterthought at best.

It’s like each care provider is a golfer alone on the course and the patient is the ball. As long as that lone golfer moves the ball forward, it’s all good.

The reality is that healthcare is a team sport, more like football (or soccer as it is called in the US) than golf. If you can’t make an accurate, effective pass to your team mates, you lose the ball.

Population Health a Team Sport
Team Sport

But patients aren’t balls, they’re human beings. When one member of the healthcare team fails to inform the rest of the team, a human being gets lost in the confusion with poor outcomes and frustrated patients.

In population health improvement, you have to play on a team, because it takes a wide variety of skills to make this all happen. And you have to be aware of all the other players on the team. The successful population programs include everyone who is part of the community – not just the healthcare system and resources but all aspects of the community. Dell Medical School held an inaugural event to crowd-source their population health strategy, coming up with areas of focus and metrics for success that included input from a wide range of stake holders. This is the kind of team based approach to population health that will help the whole community win – getting people healthy and staying healthy.

 

It starts with leadership

Most healthcare organizations are at least partly aware of the problem and are making efforts to solve it. But it is a complex problem, involving, as I noted above, attitudes as well as technology. To make data flow freely to those who need it, you have to have effective technology to integrate, manage and analyze the multitude of data streams in healthcare, and you also need leadership who prioritize data sharing over the competitive interests of conflicting health delivery systems. With free flowing information routed to all the interested parties including the oft forgotten but all important patient, in understandable and actionable form that includes the insights and management options we can successfully identify those at risk and develop appropriate interventions. By including the patient and personal care team that typically includes multiple family members we capitalize on underutilized resources that are both essential and highly effective at improving the trajectory for the patient’s outcome.

 

Custom Communication and Targeting

Traditional systems and methods have targeted the existing clinical systems and communications which, while suited to some, fail to adapt to the changing world of technology and the fact that people no longer go online – they live online. This doesn’t just apply to patients and their families; it’s increasingly true for clinicians. It can be as simple as a text based reminder for medication, timed to coincide with the patients personal schedule and preferences or as complex as an automated avatar with augmented intelligence that engages with the patient to assess their status and determine the need for additional intervention or personal follow up by the care team.

 

Each year HealthIT week raises awareness of technology in healthcare, bringing together innovators and key healthcare leaders who are diligently working together to make the best use of information technology to improve the healthcare systems and ultimately our each and everyone’s individual health. This past year we lost one of the titans whose personal journey of uncoordinated care she shared in her attempt to correct the system – Jess Jacobs (#UnicornJess). It might be too late for Jess but let this be the year we move past the individual approach in healthcare driven by underlying economics and focus on the team sport of population health and democratize access to the best possible care and outcomes to the widest swathe of people…worldwide.

 

This post originally appeared here

Population Health is a Team Sport was originally published on DrNic1

What 2016 will Bring for Healthcare Technology

Posted in Africa, Disruptive, Innovation, Patient Engagement, Technology by drnic on March 25, 2016

2015 was an incredible year in technology and healthcare; from new consumer technology and personalized devices coming to market to the introduction of new supercomputers that reduce the time and cost of healthcare data analysis. It’s been great to see how innovation continues to penetrate the medical profession, improving patient services and care. As we look to 2016, there are some areas that we can expect technology to further impact.

Dance like no one watching Encrypt - Security

Growing patient concern over security

Security is a major concern for consumers and the healthcare industry, and the threat of it is only rising. While technology and data provides patients with the precise, personalized medicine that they want, individuals have not forgotten the security breaches that occurred this past year, which had heightened their concern, particularly with the type of personal information in medical records. Implementing stronger, more reliable and transparent security practices will be a critical objective for medical practitioners, but equally important will be reestablishing trust with their patients and consumers.

The consumerization of healthcare

Consumers have grown to expect personal and custom experiences from technology.  The consumerization of healthcare will gather greater momentum and the healthcare industry will see the first effects of this trend on individual behavior in 2016. By treating patients and individuals seeking healthier lifestyles as consumers, the healthcare and related technology developed becomes more and more applicable to serving their needs and meeting them where they are. This is a great thing. As an example, imagine telehealth kiosks now allow patients to engage in a face-to-face video consult with their doctor, or have their vitals taken and receive a diagnosis – without setting foot in their doctor office.  Pilot programs for these “pods” are being tested in Rite Aid and the Cleveland Clinic.

The latest innovations will further fuel the moment around treating patients as consumers and developing relevant technology that make it easier for them to monitor their health and seek treatment, driving more adoption and healthier populations.

IoT - We have to go out for Dinner - Fridge not Talking to Stove

Embracing the Internet of Things toward patient engagement

The Internet of Things (IoT) connects billions of objects around the world, and in 2016, the healthcare industry will take the first steps in tapping IoT’s full potential through passive monitoring. Leveraging wearables and connected devices, healthcare organizations, with the consent of patients will be able to passively monitor the wellness of patients and personalize their experience. For example, for those with chronic diseases, such as diabetes or heart disease, these devices can monitor all aspects of the patient’s  daily life to provide insight to the patient and the healthcare providers, into how different activities, such as eating, sleeping or watching TV, affects his or her body. Connected devices equipped with real-time feedback can provide subtle alerts that prompt, caution or encourage patients to stick with or avoid certain behaviors.  These devices can also help them to comply with a treatment or regimen. In 2016, we’ll see the industry understand that subtle patient engagement through passive monitoring can have positive, long-term effects on behavioral change.

 

The potential of ICD-10

While the rollout of ICD-10 was reluctantly undertaken by some in 2015, the healthcare industry will begin to realize its actual potential in 2016. As a result of ICD-10, healthcare organizations will receive a higher level of granularity in the clinical data that has been collected including patient information and clinical data.  Utilizing this data will enable new insights and deeper analysis.  This will be the first step in turning descriptive healthcare analytics to predictive and prescriptive insights enabling results like reducing readmission and improving population health management. However, as we see potential benefits being realized, discussions will center on the interoperability of systems that is limiting analysis and holding back potential insights.

Africa-Kids-iPad

More democratized, globalized healthcare

While diseases such as AIDS and malaria are now considered chronic or curable with the proper treatment, there are still geographical, technological and societal barriers that pose great challenges when trying to treat the demographics that are most commonly affected. In the third world and emerging countries, healthcare organizations are leveraging technology, including simple mobile devices, to provide patients with faster, more effective care. In 2016, we will see more companies create technology that democratizes healthcare with innovations that help to lower the cost of healthcare, enhance patient engagement and improve overall worldwide population health.

Not only is it exciting to imagine how we’ll see technology continue to evolve and change everyday life, but also fascinating to see the impact and opportunities for enabling healthcare providers. These trends will manifest in some exciting and innovative changes in 2016 that will have a tremendous impact and further improvements in patient care.

 

This post originally appeared in HealthIT Outcomes

 

Original

 

 

What 2016 will Bring for Healthcare Technology was originally published on Dr Nick van Terheyden, MD

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Digital Health for the Undeserved

A recent report published by Jane Sarsohn-Kahn for the California Health Foundation: Digitizing the Safety Net Health Tech Opportunities for the Undeserved offers some deep insights into reaching the population most in need of help but often left out in the discussions of the latest and greatest technology to break into the news cycle.

As pointed out low-income households have access to mobile technology with 8 out of 10 sending and receiving text messages – in fact mobile phone usage and ownership mirrors the experience in Africa where many of the communities have little choice given the paucity of existing infrastructure and have bypassed the traditional communications systems in favor of mobile networks
Adults who own a cell phone, Africa

and gave rise to a whole innovation of mobile banking that originated that pre-dated, is more flexible and is more widely used than anything developed in the west (The M-Pesa system) – servicing the unbanked people of Africa without requirements to have a smart phone nor to use an app. I’ve written about the opportunity we have of learning from our African friends in the past)
In the case of the undeserved here in the US many of these people mirror these experiences and providing easy access using simple tools is effective not just from a cost standpoint (as Healthcrowd showed $1 for mobile messaging vs $34 for paper mailing) – and that’s even before you consider the engagement/response rate we find with mobile applications and interactions…think about it, when you want to reach your children do you send them an email or text them

Textpectation

 

Take the time to read about the multiple projects that are reaping big benefits and doing so cost effectively. These are real working projects with a range of technology that has demonstrable impacts and could be applied to many more groups and environments. The extensive piece takes you on a journey from everything as simple as text messaging from Healthcrowd to the medication adherence and tracking concepts of Proteus Digital Health of digestible sensors that track your pill from manufacture to ingestion.

There are a few guiding principles to help steer you to success

  • Meet people where they are – widely varied and none are typical
  • Build Trust – under promise, over deliver; everything is fragile for this community and failure can be far more catastrophic for them than “average” users
  • Address social determinants of health – just providing a ride to get to the clinic could mean the difference between success and failure and an Uber Ride is a lot more cost effective than an ambulance required for the crisis that could have been averted
  • Consider the cost of data service – data is expensive on many plans treat it like memory used to be in the days of 640K
  • Recognize the many layers of health literacy – not just comprehension but basic literacy and even language
  • Speak in the Vernacular – and make it culturally sensitive too

As Aman Bhandari said

“The new sexy is scaling what can work”

Proven solutions that have been effective provide great opportunities for those looking to make that impact on their own area.

 

 

 

Digital Health for the Undeserved was originally published on Dr Nick van Terheyden, MD

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

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

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

Peace #Inspiration Love – Nelson #Mandela – I’m a Rainbow Too #tribute

Posted in Africa, Inspiration, Mandela, Mandiba by drnic on December 6, 2013

Nelson (Rolihlahla) Mandela or Mandiba as he was know to many

was an inspiration for many with his incredible strength and especially his compassion and moral courage despite his 25 year incarceration. His strength contributed to the Rainbow Nation. In the words of another early lost talent Bob Marley:

I Want you to know I’m a rainbow too


You can take the boy out fo Africa, but you can’t take Africa out of the boy. Today I am proud to call myself an African and stand tall with the people of Africa at this time of sorrow

He managed to bring light into any situation and there are so many tributes across the web – you can read his biography here – hard to pick on any but I liked Richard Branson’s here
and included this great version of the classic song by “Biko” that was performed by
Peter Gabriel performed Biko a cappella at the unveiling of Steve Biko’s statue and the whole crowd sang every word. He said: “I have been living with the words (of the song) for a long time. It is a sense of completion to be here.” You could see tears in Madiba’s eyes – it was one of the most emotive moments of all of our lives.

and Time’s 10 songs to remember Manndiba by

The Nelson Mandela Foundation posted its own message. But it was his words that summed it up for me and I have quoted many times:

What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.” — Nelson Mandela

My deepest sympathies and condolences to the Mandela Family, the Nation of South Africa, the Continent of Africa and his friends around the world

Hamba kahle Madiba
(Go well/stay well)

Want to See #Mobile #Health Success – Look to #Africa #mHealth

Posted in #mHealth, Africa, Disruptive, HealthIT, Kenya by drnic on October 25, 2013

I’ve said it before – Africa like many of the under developed countries is exploding with great use cases for mHealth. This piece: Kenya Has Mobile Health App Fever tracks the explosion of #mHealth.
Promoted and supported by the Kenyan Medical Association and Shimba Technologies the latest release MedAfrica offer ready access to medical information and verifying clinicians in the field and even a tool to verify the authenticity of drugs.

With over 50% of banking done by mobile phone in Kenya they are clearly adopting the platform in large numbers (Kenya is rich in mobile phones, with 25 million subscribers; Africa has more than 600 million of them). Applying #mHealth to the slew of health problems is exciting and rewarding. The size of and range of health challenges is daunting:

Many Kenyans have serious health problems; for example, according to the World Health Organization, more than 30 percent of children under age five show stunted growth. At present, only 7,000 doctors serve a nation of 40 million people. 

All this out of a company that was founded by Stephen Kyalo and Keziah Mumo, with $100,000 in seed money from a European VC

Seen here Steve Mutinda Kyalo

And its not just Kenya:

Mobile health platforms are making a strong showing in other parts of Africa, too. In South Africa, efforts include platforms that give HIV-infected patients automated ways to receive health information and reminders about upcoming doctor visits. In Johannesburg, 10,000 people infected with HIV have taken on these SMS-based alerts, resulting in big declines in missed appointments.
In Ghana and Liberia, a group called Africa Aid is experiencing strong success with MDNet, a system that allows users to call or text doctors for free. Since its founding in 2008, 1,900 physicians in Ghana have logged more than a million calls to patients, the group says.

Having real impact with that funding – awesome

Nkosi Sikelel’ iAfrika

You can take the boy out of Africa, but you can’t take Africa out of the boy