Navigating Healthcare – Patient Safety and Personal Healthcare Management

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

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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

What Healthcare Design Can Learn from the Oscars

Posted in DigitalHealth, EHR, Healthcare Technology, HealthIT, HIT, Patient Safety, Technology by drnic on March 1, 2017

The snafu at the Oscars with another movie being announced as a winner before being corrected has created quite a stir!

Picture from Wikipedia
https://en.wikipedia.org/wiki/Academy_Awards

You can watch the fateful sequence here and the audience reaction captured by the LA Time photographer Al Seib

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User Design Thinking

The design of the User Interface is so important – as this article rightly points out: This Simple Design Change Would Have Saved The Oscars

Credit Reddit
https://www.reddit.com/r/Design/comments/5wfs74/another_award_show_cringe_brought_upon_by_bad/

As they point out – the largest thing on the card is the Academy’s logo – not useful information in this context. Simple changes would have made all the difference for the hosts reading the card including large print for the key pieces of data

Electronic Medical Records Design

The same is true for Electronic Medical Records (EMR’s). This has been an ongoing topic of discussion and challenge with the interaction – for example:

2009 Usability of Electronic Medical Records (pdf) – as they describe is a difficult task as crafting a system for the highly tangled tasks in medicine that includes that involves skilled users, complex functionality, and critical tasks is difficult in any form – and even more so from a digital user interface

Obvious problems with EMRs, such as loss of productivity and long training times, have deeper causes. These stem from the complex interaction of highly skilled physicians trying to complete complex tasks in a challenging work environment with a complex and not always usable medical information system. Yet, by applying user-centered design in this complex environment, usability professionals can contribute significantly to improving EMR usability. Greater productivity and lower costs with better health care may yet be our destiny.

Bearing in mind this was written 8 years ago we are still struggling to navigate to the greater productivity and lower costs that were the pot of gold at the end of this particular rainbow.

More recently

2013: Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications

We see the same challenges associated with the EMR design that contribute to suboptimal care and continue to frustrate the clinical team who’s task lists have increased in both volume and elements reducing the available time

Usability errors occur as a result of system complexity, lack of user-friendly functionality (e.g., confusing user interfaces), workflow incompatibility, or limitations of the user. Faulty functionality could mislead clinicians where there is a confusing screen display or when incorrect values result from a programming error that incorrectly converts from one measurement system to another (e.g., pounds to kilograms or Celsius to Fahrenheit). A new kind of error occurring in EHRs that is not an issue with paper-based records is an “adjacency error,” in which a provider selects an item next to the intended one in a drop-down menu, such as the wrong patient or medication.

 

And as recently as 2016 in Journal of Biomedical Informatics: Navigation in the electronic health record: A review of the safety and usability literature (behind a paywall)

A methodical review of the literature focused on the inefficient navigation of EMR’s that increases user’s cognitive load

Courtesy Pixabay

which may increase potential for errors, reduce efficiency, and increase fatigue.

As they noted, “usability researchers are frequently capturing navigation-related issues even in articles that did not explicitly state navigation as a focus. Capturing and synthesizing the literature on navigation is challenging because of the lack of uniform vocabulary. Navigation is a potential target for normative recommendations for improved interaction design for safer systems.

For anyone involved in user interface design or dealing with Electronic Medical Records and complex densely populated screens this challenge is clear. The path for healthcare is not as clear as it is for the Oscars

Using a simple San Serif Font – large print for the award category and the name of the winner followed by the people involved with the Oscars logo at the bottom.

User Design Thinking in Healthcare

Healthcare is not that simple – but that should not and does not stop us from learning from other industries to apply user design thinking to everything we do:

  • Designing with simplicity and ease of use in mind
  • Reducing not increasing cognitive load for clinicians
  • Removing or at least suppressing non-essential information from the immediate clinical dashboard
  • Capitalizing on existing intuitive multi-input interfaces that are prevalent everywhere else

The user interface remains challenging and requires a new level of focus and attention as we continue to increase the data load and resulting cognitive load on our busy time challenged clinical staff. Let’s not have an Oscar moment in healthcare

If you have ideas on how we can improve and accelerate the user centric design thinking in healthcare – share your thoughts below or reach out to me on any of my channels

 

 

What Healthcare Design Can Learn from the Oscars was originally published on DrNic1

Joining the MedicAlert Board

MedicAlert

I am excited to be elected to the MedicAlert Board joining Jessica Federer, head of digital development at Bayer. As Barton Tretheway, CAE, chair of the MedicAlert Foundation Board pointed out

Their collective experience aligns with our priorities and will be immeasurable to us as we look to leverage the power of new technology to expand the mission of MedicAlert Foundation, which is designed to help save lives

Which succinctly captures my feelings around this additional role. I personally experienced the value of the MedicAlert solution, brand and promise when I practiced as an Emergency Room physician in the United Kingdom. It was part of the standard procedure for any patient who arrived unconscious or confused to look for the signature bracelet

Traditional Medical Alert Bracelet

 

With its iconic Caduceus (similar but different to the Rod of Asclepius) which was the traditional sign of the God Hermes and became established as the symbol of medicine in the United States in the late  19th Century.

History of MedicAlert

The Original MedicalAlert User – Linda Collins

The history of MedicAlert dates back to the Early 1950’s developed by parents of Linda Collins who had an who had an anaphylactic reaction to tetanus anti toxin (which in her instance she only received a small scratch test as was the practice in 1953) and had a severe reaction. She survive but her parents Dr Marion Collins and his wife Chrissie realized that she was at risk and made a paper bracelet and note that was attached to her coat detailing her severe allergy.

 

 

 

 

 

In fact the original MedicAlert Bracelet is now in the permanent collection of the Smithsonian Institution in Washington, D.C. Today

The Original Bracelet stored in the Smithsonian in Washington DC
The Original Bracelet stored in the Smithsonian in Washington DC

From these modest beginnings things have developed with early recognition by “Peace Officers”. The California Peace Officers magazine even ran an article back in January 1957 highlighting the MedicAlert bracelet to their members. In the era before mobile phones and always on communication it was a reliable way of identifying individuals and providing immediate access to a 24- hour phone line linked to critical and life saving information for that individual. This function continues today with a live 24/7 Emergency Response Service

I worked on one of these switchboards as a Medical Student many years ago

 

 

with full health and personal information including your personal health record and emergency contacts information and available in other countries including Australia, the UK, Canada and South Africa to mention a few through affiliates and partnered with many groups including AAFP, Alzheimer’s Association, ACEP, Autism Association, Philips LifeLine, National Alliance of Mental Illness, Food Allergy Initiative – to mention but a few

The age of computing brought new innovations and the ability to more readily store and retrieve more information for members and track and follow membership and presidential recognition dating back as far as April 9-16, 1978 when then President Jimmy Carter commemorated the occasion of MedicAlert and their contribution to Medic Alert week in April. Even Hollywood got in on the act with appearances of the MedicAlert in everything from the Today Show and Good Morning America to CHiPs

and Columbo

Peter Falk in Columbo

 

Moving into the Digital Age

The organization is moving into the digital age with solutions around stored medical records, moving to digital mobile formats and storage solutions and even exploring the potential for RFID enabled solutions and in partnership with the American Medical Association has a joint venture on advanced directives.

Back in 1956 Dr Marion Collins commented that

“I think I can save more lives with MedicAlert that I’ll ever save with my scalpel”

Which is much like my own perception of medicine and the opportunity of Digital Health that I saw 30 years ago and continues to be the case. It’s this combination of a storied brand and concept from MedicAlert as a foundation and the opportunity to update for the new Digital world we live in that presents such an exciting opportunity. We are facing a Silver Tsunami of people who struggle to age in their homes and technology and solutions that help them do so, safely and with the support of their relatives and the health system will be in high demand.

I’m looking forward to working with my fellow board members and the MedicAlert team to continue the tradition and build on the brand with a Digital update and twist

 

 

 

 

 

 

Joining the MedicAlert Board was originally published on Dr Nick van Terheyden, MD

Tagged with:

The Dell World DoMoreHIT Panel

Posted in #DoMoreHIT, Dell, Healthcare Technology, HealthIT, HIT, Innovation, social media, Technology by drnic on April 1, 2016

On Tuesday March 15th, 2016 a the Dell Lounge at South by Southwest (SXSW) we hosted the #DoMoreHIT Thinktank event.

This was Dell’s 5th’s annual healthcare Think Tank. Together with my good friend and colleague Mandi Bishop – Healthcare Analytics Innovations & Consulting Practice Lead, Dell, #HIT100 influencer, @MandiBPro we were joined by a veritable who’s who of thought leaders from healthcare and related industries for an outstanding set of panelists:

  • Claudia Williams, Sr. Advisor, Health Innovation and Technology at White House Office of Science and Technology Policy

2016DoMoreHITPanelists

 

 

We divided the session up into three segments –  Data explosion in Healthcare, Embracing New Technology and How to be Future Ready

 

The Data Explosion in Healthcare

  • Physicians, patients and health systems are over whelmed with data – is there too much noise to discern the signal of relevance?
  • Is there any focus area for gathering or managing data that healthcare should target over others (wearables vs genomics vs population health vs clinical data vs lab values vs imaging for example)? And are there data sources outside those traditionally considered “health” that you’d consider particularly relevant?
  • What can patients – and clinicians – do to get ready for the deluge of data and information that they will be receiving and become increasingly responsible for managing?
  • How can we, as an industry, and our individual organizations help make the vast quantities of diverse data into meaningful information that can be readily understood?
  • How much do you trust the quality of the data sources your organization is using for BI and analytics? And how do you address it if/when you don’t trust the data quality?
  • If your organization is collecting data about your patients/consumers, do you offer that data – and any health insights derived from it – back to those patients/consumers? If so, how? And if not, why not?

 

 

Embracing New Technology

  • How do we embrace technology while keeping the focus on patient and compassion?
  • Is there any new technology that stands out as delivering value that patients, clinicians and health systems can jump on, now?
  • Do you think there’s a fear amongst healthcare providers that digital health technology, in conjunction with advanced analytics, will change – perhaps reduce – the role of the clinician in healthcare delivery?
  • What do you see as ripe opportunities for emerging technology to disrupt healthcare? What’s already been done that’s working, and what do you think is on the horizon that’s about to break?
  • How do we make wearable technology and remote monitoring accessible to the underserved populations who may best benefit?
  • What do you think are the biggest obstacles to tech adoption (for consumers and for providers/industry)?

 

 

Future Ready Healthcare

  • What does being “future-ready” mean to you and your organization? How can you be future ready in the age of constant and increasingly rapid change?
  • What one thing do you think will change the future of healthcare this year, in 3 years and in 10 years?
  • Increasingly people want personalized health and wellness care – how do we deliver that with the current system that does not readily enable personalization (both from a technology perspective and from an incentives perspective)?
  • Do you believe precision medicine principles – genomics informing personalized clinical pathways – are sustainable across vast numbers of people? Or are they perhaps best narrowly applied to complex disease states with limited number of affected persons? And how will incentives have to change to align?
  • When was the last time your doctor asked you how you’d like to be engaged? And if they’ve asked you, have they done what you suggested?
  • Do you have a formal patient/member advisory board/council? If so, how does it work? And if not, why not?

 

The event was a great success and despite the global LiveStream issues at the time we managed to trend #2 on Twitter just behind #IndianaJones

TwitterTrend

 

As of writing there have been over 20M #DoMoreHIT impressions and the material continues to provide additional utility and is in use in other forums. The venue itself was packed and there have to date been 2,500+ Livestream views and ongoing On-Demand promotion and use. In house attendees and online described it as the “best panel yet!”

The 3 sessions from LiveStream can be viewed here

http://livestream.com/Dell/2016DoMoreHIT

The Highlight Reel from the Dell Lounge Week Long Activities

Dell lounge Photos here

The Dell World DoMoreHIT Panel was originally published on Dr Nick van Terheyden, MD

National Doctors Day

Posted in Compassion, HealthIT, HIT by drnic on March 30, 2016

8Ton Orca jumping out of Ocean

On February 21, 1991 President George Bush declared in Proclamation 6253 March 30 would be National Doctors Day:

There is no greater reward in our profession than the knowledge that God has entrusted us with the physical care of His people. The Almighty has reserved for Himself the power to create life, but He has assigned to a few of us the responsibility of keeping in good repair the bodies in which this life is sustained

In honor of my colleagues and the countless others who make up the healthcare service and who struggle daily with the delivery of healthcare and the challenges of a system that is broken but still delivers outstanding care:

Always Believe in Yourself

For me:

Every Smart Person is Working in Healthcare small

Its an exciting and challenging time and the healthcare service is dependent on the clinical skills and dedication of Doctors to deliver excellent healthcare – take a moment to thank your clinical professional for all they do on a daily basis. The glass is full – 1/2 full of water and 1/2 full of air and I’m excited about the future and what’s coming and hope my friends and colleagues are too:

Excited - Winnie-the-Pooh

National Doctors Day was originally published on Dr Nick van Terheyden, MD

7 Tips for the Best HIMSS16 Experience

Posted in #hcsm, education, HealthIT, HIMSS, HIT, social media by drnic on February 5, 2016

 

This year will be my 19th year at HIMSS – things have grown significantly since 1997 when HIMSS was held in San Diego with a record number of attendees – 15,800 and 408 exhibitors (you can read more of the history going back as far as 1961 here). At the time I remember being overwhelmed adn that was before things had grown to the most recent statistics for 2015 now at over 43,000 attendees

 

HIMSS16 SMA BadgeThis year I am part of the HIMSS Social Media Ambassador program joining my 19 colleagues to help provide a guide that was not available back in 1997 to help guide you through the landscape of the HIMSS conference and get the best experience possible

If you do nothing else – follow my friends and colleagues on the list at the bottom. Their feed and content will keep you up to speed on the latest news, events and any last minute gems to keep you getting the most from the events and activities

 

 

 

As part of this opportunity I also the present the following 7 rules/suggestions things to help you get the best from HIMSS 16 in Las Vegas

 

Rule 1: Have Fun

HaveFun

Rules 2: Hack your Conference Badge to Include your Social Media Handle

This used to require some clever editing of the name in the system but it has gotten easier – all you need to do is put you Twitter handle in Nickname field

HIMSSHackBadge
Rule 3: Look up

SocialMedaiEverywhere
Don’t bury your nose in your phone and technology the whole time – part fo the value is the exchange with real people and real activities. When you get in the inevitable line for a taxi or shuttle at Las Vegas airport talk to your fellow travelers – you never know who you might meet and what they might share about their business, news or the conference. You might even be able to shorten the wait and share a ride.

Rule 4: Prepare and Plan and then Adapt

Your plans will change but if you come with no plan you will end up missing more. Depending on your organizational preferences either fill your gmail calendar with your plan or download the Apple or Android HIMSS16 App and use it to checkout the daily sessions and listing of keynote speakers, exhibitor listing, maps and the social media activity feed which will have the latest news from the show floor

Look for the sessions you really want to attend and grab the details and add to your schedule now – you may not make it but you stand a better chance of making it if its on your plan.

Rule 5: Enjoy the Parties but Don’t Stay Late

How you manage this may depend on what time zone you came from but be warned the days are long and can be physically and mentally exhausting

Celebrate but my advice is enjoy the parties and social activities but don’t burn the candle completely – get to bed especially so you can get up early to exercise before hitting the show floor. You may get your steps just walking the floor but even if you do 30 minutes in the gym will energize you to cope with the busy days on the show floor

Rule 6: Leave the Laptop in the Hotel Room

I know a full sized keyboard is great to have but the additional weight of a laptop will weigh heavily on your shoulder. If you can use your phone as your main device and carry a spare battery or a Portable Battery Charging device like this one and/or charging cable and plug

Like this 10ft cable

An extra long one would be helpful when accessing difficult and hard to reach ports)

If you really need the larger device – go with the tablet format but bear in mind the bigger the device the more weight you are carrying around every day

Rule 7: Stay Connected Socially

Use social media to stay connected and find out the latest adn greatest things going on at the conference. You can use Social media just as a lurker and to access information but this is a great opportunity to ascend the social media ladder of engagement

 

SociaMediaLadder

Use your phone to take pictures – post your experiences and things you see and tag everything with the official #HIMSS16 hashtag. But its not just twitter – there are other channels and some can help you share to a wider audience. If you set up your instagram account to link to twitter and facebook you can post from here and populate both your twitter and Facebook feed.

For short videos (less than 6 seconds) – Vine is great for capturing and sharing across multiple channels

Facebook has been rolling out a live streaming feature and if it is available in your newsfeed you could try this for any exciting presentations or interactions

And expect some addition of live streaming from Twitter’s Persicope and the more recent interactive streaming from Blab

Enjoy the conference – it presents a host of opportunities to learn, meet new people and renew old friendships. You are in Las Vegas – you never know you might win some great new friends – to start you off here is a list of my colleagues and friends who are also Social Media Ambassadors

 

 

7 Tips for the Best HIMSS16 Experience was originally published on Dr Nick van Terheyden, MD

Tagged with:

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

The Problem with Celebrity Medical Advice

Posted in #hcsm, #HITMC, HIT, Pharma, science by drnic on August 26, 2015

The challenge with taking advice from celebrities is you never know what the underlying drivers are. FDA Responds to Kardashian Post

In this case the FDA has to respond to social media posts from Kardashian who has 35 Million followers and 45 Million on Instagram and offers up Diclegis for pregnancy associated nausea. Pharma advice from celebrities and other non-scientific sources is an increasing problem especially given the increasing influence of these individuals with large followings of people who might not see the counter points of science and the FDA post (The FDA Twitter handle (@FDA_US) has not even broken 110,000 followers – that’s less than 0.4% of the direct influence.
Aside from the fact this is based on a data set of on, it transpires Kardashian is a paid spokesperson for Duchesnay. This is not independent advice.

The Problem with Celebrity Medical Advice was originally published on DrNic1

New Horizons for me at Dell

Posted in #hcsm, Dell, Healthcare Technology, HealthIT, HIT, HITsm, Innovation, Technology by drnic on July 20, 2015

I am excited to announce I am joining Dell Healthcare and Life Sciences 

as their Chief Medical Officer. Dell has been ranked number one in Healthcare Provider Services for six consecutive years by Gartner and continue to expand their presence in healthcare space with an incredible range of solutions and services that are combined with extensive experience offerings of hardware and infrastructure.

This was such an exciting opportunity with a dynamic company with a focus on healthcare that is driven by a guiding principle from Michael Dell:

Technology has always been about enabling human potential

The opportunity to apply this principle with the assembled first class talented team that have a wide range of skills and deep industry knowledge is empowering and exciting. Healthcare is personal and struggling to deal with technology that has in many cases hindered the personal realtionship between the doctor and the patient. Clinicians want to focus on the patient and not the technology and while patients like technology to be used to improve the quality and safety of care while helping to reduce the costs they also want to doctor to pay attention to them not the device(s) as I have said on many occasions – here in this AMDIS presentation on documentation:

and Healthcare Technology need to include Patients

When I looked at the breadth of what Dell already offers its customers, the range of amazing talent, and some of their innovation projects that included

  • An impressive healthcare cloud and a focus on Interoperability
  • Patient engagement, predictive analytics, population health management
  • Social Media and mobile solutions
  • Working on Genomics Cloud Storage and analysis that included the recent announcement of the Dell and Translational Genomics Research Institute that is supporting the fight against Pediatric Cancer and helping clinical researchers and doctors globally expand the reach and impact of the world’s first Food and Drug Administration (FDA)-approved personalized medicine trial for pediatric cancer.
  • This all felt like a perfect match and one that offered me personally an incredible opportunity to have a positive impact on healthcare delivery system here in the US but also around the world.

Amongst the many bonuses of this opportunity was my friend becoming a new work colleague – I am excited to be joining Mandi Bishop (@MandBPro) – social media guru, #HealthITChick and innovator in data management and analysis.

The big draw for me was that Dell already has a vast amount of products, solutions and data along with insights that they are already integrating across multiple platforms, facilities and technologies. I can’t wait to share more on some of the projects the Dell team are working on soon.

 

 

New Horizons for me at Dell was originally published on Dr Nick – The Incrementalist