Navigating Healthcare – Patient Safety and Personal Healthcare Management

Change Behavior, Change the World

Change Behavior, Change the World

The Incrementalist Graphic Adam Pelligrini

This week I am talking to Adam Pelligrini,(@adampelligrini) the General Manager and SVP for Fitbit Health Solutions. Adam has had a long career in the Digital Health coming from the Digital Health group for Walgreens Boots Alliance where he built a range of digital and mHealth platforms. He recently ran and hosted the highly successful FitBit Captivate conference where over 300 employers, health systems and health organizations from around the country gathered in Chicago to hear about the latest innovation in wearable personalized health technology. You can read more about it here.

The new digital space and innovations in wearables are an exploding and Adam shares his insights into what it takes to be successful in the wearable space. FitBit’s focus is on an open platform and incorporating behavioral change into the DNA of the company and these solutions have been instrumental in getting 6.8 Million people participating in population health programs with their devices!

Connecting Data Wearables

They found Incremental steps to getting people engaged in the United Healthcare Motion Program which was founded on the principle of connecting people to their data and making it simple. Their program was focused on simple small steps of  “FIT – Frequency, Intensity and Tenacity” that were tied to rewards back to the individual

 

 

Listen in to find out how they managed to record 6.5 Billion nights of sleep and added 2.9 Million participants to a new female health tracking feature with just native word of mouth!


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Change Behavior, Change the World was originally published on Dr Nick – The Incrementalist

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Consumer Level Insights to Healthcare

Posted in bigdata, HealthIT, Incremental, Innovation, obesity, Population Health, SDoH by drnic on October 2, 2018

How Much you Travel Can Predict Your Health-Related Behavior

The Incrementalist Graphic Won Chung

This weeks interview was an opportunity to catch up with Dr Won Chung – an Emergency Room doctor and co-founder of Carrot Health – a company focusing on bringing consumer level insights, data and analysis to medicine

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His clinical career has been centered on the Emergency Room which as he describes is primarily focused on treating Accidents and Emergencies but as he has discovered where an awful lot of what happens in the Emergency room is not impacting the long term health of patients. We know that our personal behavior and the social determinants of health (SDoH) (such as gender, marriage and other consumer attributes) are not only important to health but actually are the major components of differential health outcomes and by most estimates contribute 60-80%. I make this point frequently in my presentations:

In a recurring theme on the show – the incremental insight that got him here happened when he was attending business school where he met his co-founder Kurt Waltenbaugh where they were discussing the data missing to manage patients better. As he puts it

if I knew details of what you were buying in the supermarket I could predict you HB1Ac before you even enter my clinical office

Once again – the adjacent possible discussion was the foundation for the company as they realized together that they could gather the missing data from other sources especially retail and help answer those questions.

Listen in to hear our discussion on their insights into Diabetes – a chronic disease affecting 10% of the population (that’s 30 Million people in the US) and a whole lot more that are are pre-diabetic. Hear about the two groups of patients and the correlation between the how much you travel and the success or failure of your diabetes management. Hear how pet ownership and your civic responsibility are also linked and find out which car you drive is linked to your success in managing diabetes. We talk about marriage and its effects on health offering some new and more granular insights into the benefits of marriage – the results will surprise you

You can read more about this insight here


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Consumer Level Insights to Healthcare was originally published on Dr Nick – The Incrementalist

Improving Healthcare’s Security Posture

Blackhat

Healthcare’s Security Posture

As part of my interview series from BlackHat I spoke with Mike Weber VP Coalfire Labs – they are a large Cybersecurity Systems provider focused on securing transactions in the cloud working with all if not most of the cloud providers. Coalfire just released their Penetration Risk Report that included a special section on Healthcare. Not surprisingly the news wasn’t good showing that healthcare had the worst “External Posture” with the least security for anything that can be seen by an attacker – external facing systems such as routers, firewalls etc.

Healthcare

The biggest issue was with legacy systems and many instances upgrades installed but the legacy and unsecured systems remain in use.

Healthcare

Listen in to the interview and hear Mike’s thoughts on Incremental Steps to combat the Security challenges faced in healthcare. As he and others have pointed out Medical records are high risk because they have such a long shelf life offering a rich vein to exploit for anyone able to steal these records.

 

Incremental Steps for Improving Healthcare’s Security Posture

 

  • Upgrade Old Systems and Importantly plan retirement for old systems as part of the upgrade
  • Consolidated Your audit program to Decrease Audit Fatigue
  • Prioritize Your “Crown Jewel’s” of the data and Systems you are protecting

Here’s the short list:

  1. Personal data is the top target (highest value) – medical identity information has a smaller market
  2. Platform Access – and the ability to install ransomware
  3. Encrypt everything

Encrypt

Improving Healthcare’s Security Posture was originally published on Dr Nick – The Incrementalist

Incremental Steps to Health

Incremental Steps to Health

The Incrementalist Graphic Khan Siddiqui

This week I am talking to Dr Khan Siddiqui (@DrKhan ) radiologist, programmer, serial entrepreneur, and Founder, CTO, and CMO of HIGI – the company that is taking the concepts of consumer engagement and tracking to the next level and creating actionable insights that patients and their care team can use

Much of Khan’s journeys mirrors my journey into the space of Digital Health – starting as a programmer in school where he was building applications on a PDB-11 using punch cards and continuing on through his early work on the Electronic Health Record mining data and applying machine learning and deep learning as far back as 2005 to healthcare data.

Microsoft Kinect

Listen to his story of a turnabout of shared innovation at Microsoft where the work the healthcare team had done on image analytics was applied to the Kinect bar and gaming solving one of the challenging problems of “missing body parts”

He was involved in the early work of Microsoft Health Vault and like others believed in the mission of sharing clinical data with patients and getting them engaged was a key requirement to solving health challenges – many of which are tied up with personal behavior. Frustrated by the lack of uptake compared to the Xbox gaming system he took this experience with him to found Higi and replicate the gaming user engagement and bring this to healthcare

Listen in to gain a different perspective to Xbox gaming and how healthcare has contributed and learned from this world.


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Incremental Steps to Health was originally published on Dr Nick – The Incrementalist

Unbreakable Encryption

Encryption Algorithms Under Siege

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Over the course of history, the development and subsequent breaking of encryption standards have been a constant cycle. As new keys were developed so they were broken and the speed of with which new keys were broken has increased. Modern day encryption “Data Encryption Standard” or DES was launched int he 70’s with a 56-bit key (64 bits but with 8 parity bits). This encryption was cracked in 1999 and with the likelihood, looming NIST launched a new search for encryption standards giving rise to Advanced Encryption Standard (AES) (aka Rijndael) with 256-bit keys and is under attack both cryptographically and by brute force of faster computers including as and when they arrive. As a result, NIST is seeking new proposals for cryptographic standards to replace AES when it is broken – but with the advent of Quantum computing this will be broken too

Unbreakable Encryption

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I spoke with John Prisco, President & CEO for QuantumXchange who in his words are pioneering unbreakable encryption. I know what you’re thinking – the idea of something being unbreakable/unhackable seems impossible and I was dubious as well.

But here’s what’s interesting – the foundation of the technology is the Heisenberg (no not that Heisenberg) uncertainty principle

 

You have to go deep into theoretical quantum physics to understand the background to this and while no expert I’m fascinated by the quantum world. This explanation in the Encyclopedia Brittanica is helpful comparing the concept to measuring the pressure of air in your tires TL;dr you can’t because as soon as you attach the pressure gauge you change the pressure. Essentially you can never know with perfect accuracy both of the position and velocity of a particle. It is impossible to determine accurately both the position and the direction and speed of a particle at the same instant.  You could learn more from the always brilliant Richard Feynman video Lecture: Probability and Uncertainty in Quantum Mechanics

Cryptography

Single Photon Based Encryption Keys

That uncertainty is a physical property, not a mathematical derivation (the foundation of encryption). QuantumXchange uses the quantum properties of single photons (light) to exchange data between two locations, with keys derived from the exchanged quantum information. The keys are Tamper Evident: Any attempt to intercept (look at or break) the key will change the state thanks to Heisenberg Uncertainty Principle causing a change in quantum state thereby corrupting the key – in which case those keys are rejected and a new pair created.

All this takes place on “Dark Fiber” from Boston to Washington DC and offering this up to customers in the healthcare and financial services markets and have examples already in play of oil rigs using their Quantum Keys to secure the huge numbers of IoT devices that are used in critical infrastructure and control for oil drilling and production

This concept is especially important for Healthcare data which has the longest shelf life of any data in the industry so protecting it over extended periods of time is essential if we are to maintain patients privacy and confidentiality

Here’s the Interview:

 

Unbreakable Encryption was originally published on Dr Nick – The Incrementalist

Artificial Intelligence in Medicine

Artificial Intelligence in Medicine – Better More Rewarding Medicine

The Incrementalist Graphic Anthony Chang

Incrementalist Chang

It was great to catch up with colleague and friend Dr. Anthony Chang (@AIMed_MD) Pediatric Cardiologist, Founder of Artificial Intelligence in Medicine (AIMed) and Director of Medical Intelligence and Innovation Institute (MI3) .

How did a pediatric cardiologist find his way into the field of Artificial Intelligence, Machine and Deep Learning?

Those of you that saw the original Watson Jeopardy Challenge

Anthony like me had the same reaction to this incredible achievement by the IBM Watson team that beat out the top 2 Jeopardy champions with an Artificial Intelligence Computer system that consumed the contents of the internet library and tested out the correct answers more frequently than the two human champions.

With a background teaching statistics augmented with an MS in Biomedical Data Science/Artificial Intelligence, he has blazed a path to attract colleagues and data geeks from around the world to participate in the future of healthcare augmented by data

For those of you challenged understanding the terminology of the space this Venn diagram is helpful in putting the various disciplines in perspective

AI Deep Learning and Big Data Venn Diagram

Along the way, he like many of my other guests has discovered the value of the adjacent possible – in his case adjacent to data scientist and technologists with clinicians deeply invested in day to day clinical care – both learning from each other

We cover everything from machine learning and data science through the requirements for clinicians (or not) to gain qualifications in data science. Hear his eloquently answers the age-old question of

Will I still have a job once AI has replaced me

TL;dryes and it will be more rewarding

Join me as you hear how and why you should change the way you think of medicine and data. The good news is – you can participate in the next AI Med event which mixes specialist, clinicians, data geeks and patients from around the world in a unique experience that offers a great learning and mind opening experience.


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

Artificial Intelligence in Medicine was originally published on Dr Nick – The Incrementalist

Are Your Pagers Leaking PHI Data

Hospital Paging Systems Security

Blackhat
Mark Nunnikhoven Trend Micro

I spoke with Mark Nunnikhoven, VP of Cloud Research at Trend Micro talking about their recently published paper: Leaking Beeps: Unencrypted Pager Messages in the Healthcare Industry which were designed and built in an era when it took a lot of resources and technology to access the system but now all it takes a couple hundred dollars and a pc add-in and you are in.

“When pagers first came out the effort to interact with the system was high”

TL;dr Pagers in the Clinical setting are unencrypted and represent a security risk for breach of Personal Health Information

Mark’s Incremental step – don’t include PHI in any pager traffic, then get rid of pagers and replace with mobile devices that have end to end encryption

In their study they found that the transmissions are not encrypted and contain multiple elements of PHI – they saw lots of examples – (you can download the report here) but the summary of the exposure of PHI information in the unencrypted messages being sent analyzed by TrendMicro offers a peek into the potential breaches taking place on a daily basis

Mark also mentioned another report on Securing Connected Hospitals that looked at connected devices highlighting the huge increase in attacks on healthcare information systems in particular with Ransomware

 

 

Incremental Steps for Securing Your Pager System

  1. Don’t Include Personal Health Information in Pages but rather ask for a Call Back
  2. Replace the Old Style Pagers with New Technology and Devices, and
  3. When Building Devices you must build security into the product

 

Are Your Pagers Leaking PHI Data was originally published on Dr Nick – The Incrementalist

Telehealth is Here – Getting There Quicker with Incremental Steps

Telehealth is Here – Getting There Quicker with Incremental Steps

The Incrementalist Graphic Til Jolly

This week I am talking to Dr. Til Jolly, CMO for Specialists on Call (SOC) Telemed who are delivering enterprise-wide telemedicine to over 450 hospitals

Dr Jolly is an Emergency Room physician with a fascinating background that includes working for the NFL Super Bowl “Emergency Preparedness Team” planning super bowls around the country over multiple locations. He shares some of his experiences in that role and some of the things he learned along the way – learning from previous events, clear role assignment and division and above all practice (he’s talking about the medical teams but I’m sure that’s true for the NFL teams :-))

We talk about the small incremental improvements that have been adding up in Telehealth delivery – as he puts it the barriers are not technology anymore and there has been some good progress around reimbursement. In an interesting twist and different perspective, he looks back with fondness at the introduction of the Fax machine and the positive impact it had on care with the ability to fax EKG’s direct to clinicians.

The resistance is no longer coming from patients and in some instances is clinicians and health systems who want to find “traditional” methods of care delivery but the writing on the wall is clear: Telehealth is here to stay and will be a major part of helping support our aging population even mitigating some of the loneliness these individuals have


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


 

Listen along on HealthcareNowRadio or on SoundCloud

Telehealth is Here – Getting There Quicker with Incremental Steps was originally published on Dr Nick – The Incrementalist

Digital Health Summit

This is Australia’s premier health innovation convention on the technologies that are revolutionizing healthcare and the implementation of ehealth initiatives and I was honored to be asked to give a keynote presentation at the Digital Health Summit taking place in Melbourne 29-30 March 2017. The bonus was listening to so many great presentations throughout the day from some great speakers.

The Perfect Storm for Healthcare

The opening session that set the tone for the future came from Alfred Poor, Editor for Health Tech Insider who eloquently described the perfect storm of The Internet, wireless communications and the pervasive smartphones that last year shipped 1.5 Billion – enough to provide one for every 5 people on the planet. Innovation that can take off the shelf technology and create accessible telehealth programs that reduce readmissions from 20% to 6%.

Everything from wearables devices to non-invasive sensors and monitoring to allow the capture of data on patients, improve care and treatment options and allow the elderly to safely stay in their home. Innovations that address the major challenges around the world in the society that needs to adapt and focus on wellness:

2009 Continua Health Alliance Brigitte Piniewski, MD

 

Stuart Smith took us through the potential for Gamification: exploring the magic of video games in health and rehabilitation providing repeated examples where implementing Gamification to engage with patients was seen as some kind of Voodoo by his colleagues who were amazed at the incredible success and high utilization by patients

He showed examples of rehabilitation patients using Sony Play Station with Microsoft Kinect that made the rehab program a positive experience and even had the audience dancing along with Dance Dance Revolution explaining how they had adapted this to elderly patients and using Glenn Miller and Big band music

With the explosion of data comes increasing risks to the security and privacy of data and Nathan Steiner Veeam Software detailed the expanding risk and the staggering incidence of data breaches that extend well beyond healthcare which remains the top target for hackers. No surprise and notably the FBI highlighted the hacking community that is targeting vulnerable FTP servers.

Julian Bright and Adrian Medhurst from Amelie AI took the audience on an interactive journey with an Artificial Agent focused on mental health issues and braved the Live Demo gremlins as captured on this Periscope:

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Personalized Medicine

 

Dr Robert McLeay, Founder, DoseMe highlighted the changing nature of medicine that improves on the old style model of guess work on drug choice and dosage and builds individual models to reduce the side effects and maximize the selection of the right drug for patients first time round – practical personalized medicine available for your patients today

Professor Phil Robinson, Head, Cell Signalling Unit, Children’s Medical Research Institute (CMRI), co-lead of The Australian Cancer Research Foundation International Centre for the Proteome of Cancer (ProCan) shared the exciting international progress being made in fighting cancer with industrial scale proteomic system that they have set up in the Children’s Medical Research Unit that was Announced by Vice-President Joe Biden on 17 July 2016 in Melbourne as part of the Cancer Moon shot that has rapidly grown to include 10 Nations, 18 Institutions. They are now producing huge amounts of proteomic data and creating Digital Proteme Maps that has been committed to the public domain indefinitely to facilitate ou sharing and learning and will be providing new options for targeting cancer. You can see more about their project here.

Digital Health Innovations from the Front Line

 

We heard from 2 clinicians from the US Aenor J Sawyer, MD, MS Director, UCSF Skeletal Health Health Innovation &Tech in Ortho University California, San Francisco and Dr Megan Ranney, Associate Professor of Emergency Medicine; Director, Emergency Digital Health Innovation program, Brown University. They shared the experiences from UCSF and Brown University of applying digital technology in the clinical setting offering insights into the use of sensors, Virtual reality and how to evaluate the technology in the context of a busy hospital and Emergency room.

 

After lunch, the panel session on the future of aging was hosted by The Hon Bronwyn Pike, former Victorian Minister for Housing, Aged Care, Community Services, Health, Education, Skills and Workforce Participation focusing on the innovations in place and how the sector can benefit from the data and analytics increasingly available from the digital transformation taking place. and then a detailed review of the great Victorian Stroke Telemedicine Program that has been rolled out with great success by Prof. Christopher Bladin, Program Lead – Victorian Stroke Telemedicine Project, The Florey Institute of Neuroscience & Mental Health with a proven protocol that is statewide and heading nationwide

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Social Media in Healthcare

 

Professor Enrico Coiera, Director, Centre for Health Informatics, Australian Institute of Health Innovation offered some tantalizing insights into the way that social media is changing the way we think about health. Not only does Social Media offer a means of reaching and engaging with patients it is also a potential avenue for treatment. The social propagation of obesity as detailed in this New England Journal of Medicine article: Network Medicine — From Obesity to the “Diseasome” and these complex networks are of direct relevance

He left us wondering of social media can treat social disease (his BMJ article Social networks, social media, and social diseases talked about this concept)

Modeling of Data

 

James McCaw, Associate Professor in Mathematical Biology, The University of Melbourne shared insights into the modeling for influenza forecasting and pointed out that despite how much progress we have made in medicine the influenza pandemic of 1918/9 (Spanish Flu) would have a similar effect on the population today

The models for prediction have improved but he likened them to weather forecasting capabilities from the 1970’s

 

It was a great day filled with insights from a wide selection of experts covering a huge range of areas. All the talks were engaging with practical tips and wisdom that the attendees could take back and use.

Digital Health Summit was originally published on Dr Nick – The Incrementalist

Secure Your Accounts Today

Secure Your Accounts Today

No better example of simple security preventing what would have been at best a major disruption of my account or at worse a loss of control and embarrassment than last night

I was joining the #HCLDR tweetup when I received notification on my phone

Someone was trying to login to my account from a new and unrecognized device. I joined the chat and made the comment

Original tweet from #HCLDR chat

But secure in the knowledge whoever was trying to get in was unable to because they did not have the code that twitter was asking for that had just been sent to my phone

Fast forward to this morning and a widespread hack is revealed

In a large-scale Twitter hack, thousands of Twitter accounts from media outlets to celebrities, including the European Parliament, Forbes, BlockChain, Amnesty International, UNICEF, Nike Spain and numerous other individuals and organizations, were compromised early Wednesday.

http://thehackernews.com/2017/03/twitter-account-hack.html

(I am wondering what the criteria was by the hackers for selecting accounts given my account targeted but no one else on the chat noted any irregularities)

Enable Two Factor Authentication

A simple change in your account settings can have prevented this — at a minimum making it much harder to steal your account and credentials.

There are many choices but 2 simple options — Use Your Mobile phone and Text Messaging — or use Google Authenticator

For Twitter

Link a mobile phone to your Twitter Account and then:

Settings/Privacy — Enable Login Verification

and while you are there — Enable requirements for personal information to reset your password

For Google Accounts

Enable Two Factor Authentication using your mobile phone and text messaging — this is available for you google accounts including GMail

You can find the details for this here

Google Authenticator

Google Authenticator for Android and for Apple iOS

The impact is minimal and there will be occasions when you might be logged out and have to re-log back in but these are minor challenges compared regaining access to your accounts and the potential embarrassment of content posted under your name that is offensive

Your Digital World is being Watched and Needs Securing

Which Accounts

All of them! But if you can’t or don’t want to do that the obvious ones are anything dealing with your financials and then important to add your email accounts — if these are left unsecured then it can be trivial to reset your passwords and gain access to all the other accounts linked to your email address

This post originally appeared on Medium and LinkedIn

Secure Your Accounts Today was originally published on Dr Nick – The Incrementalist

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