Navigating Healthcare – Patient Safety and Personal Healthcare Management

Happy Birthday to my Best Friend

Posted in Inspiration, Kenya, life by drnic on April 19, 2017

 

I married my best friend and today is her birthday. This post: If You Want To Be Successful, Marry Your Best Friend detailed exactly why.

In this world of individualized culture that focuses on independence and self-reliance I am happy to say I am not. We are one and success and failure is our success and failure. We are programmed to have relationships and to belong — for those of you skeptical or feeling like you need independence you might just be suffering from the “dependency paradox”. I give up nothing and gain everything.

people who are more dependent on their partners for support actually experience more independence and autonomy, not less

This is what I would term “Healthy Dependency” and something that contrary to some viewpoints that see this as a negative quality in a relationship it is not but rather makes me a better person, stronger and more independent, successful and happier. I depend on her — we share the ups and downs of life and travel this journey called life together

Happiness is an experience best shared and I am lucky to be sharing this with my best friend and wife

Palazzo Vecchio with Uffizi in the Background

“The need for someone to share our lives with is part of our genetic makeup and has nothing to do with how much we love ourselves or how fulfilled we feel on our own. Once we choose someone special, powerful and often uncontrollable forces come into play. New patterns of behavior kick in regardless of how independent we are and despite our conscious wills.”

I love traveling this road with you and wish you a very Happy Birthday — We are One

Or the African version from this African boy

Happy Birthday to my Best Friend was originally published on Dr Nick – The Incrementalist

The Best Exotic Marigold Hotel

Posted in DigitalHealth, Healthcare Technology, Innovation, Inspiration, Technology by drnic on February 9, 2017

HIMSS is rapidly approaching and I am excited to be presenting:

The Best Exotic Marigold Hospital: Learning digital lessons from the hospitality industry to personalize the healthcare experience on Monday February 20, 2017 — 01:30 PM EST – 02:30 PM EST in the Chapin Theatre (W320) – Session ID:
43

The Friction of Travel

As part of my role I travel a lot and I have watched the travel experience change over the last several years. Remember the time when you actually visited the check-in desk before proceeding to the gate to get your boarding pass?

 

I remember that in the early days I still wanted to go to the check in desk but quickly discovered that the ability to check in at home the night before made my life easier and reduced the friction of travel. The same is happening in the hospitality industry and I am excited to be presenting with Nathalie Corredor, SVP Startegy for Hilton Worldwide

 

The Hilton group have invested a huge amount of effort in refining their Digital Experience you can do everything from make a reservation, choose her room, get your digital key access once again decreasing the friction of travel. This increases the customer satisfaction and improves the hotel staff productivity so instead of spending time checking in guests and creating key cards, the staff can spend their time making sure guests feel welcome and taking care of their individual requests and needs. By removing people from the administrative process, the hotel was able to make the guest experience more welcoming and friendly.

Healthcare environments can learn some important lessons from the hospitality industry, as well as retail and travel websites. By taking service staff out of tasks that are more efficiently done by computers, these industries are able to personalize the customer experience, improve accuracy of data entry and cut their costs.

For companies in the hospitality, retail and travel industries, efficiency, accuracy and cost control is directly related to their ability to compete successfully for customers. But just as important is the customer experience. These industries have learned that a customer irritated by the friction in the buying/checking in process is a customer who will seek out other options in the future. While some customers will put up with a poor experience to cut costs if they must, as soon as those customers find an affordable option that is less irritating, they are gone. And, importantly, companies are no longer being compared just to the competition in their own market — now their competition is any optimal experience from any industry. If our online interaction with Amazon is friction-free, then we want and expect the same experience from everyone else.

You can read more here on the Beckers Health IT and CIO Site (Beckers – The Best Exotic Marigold Hospital – Nick van Terheyden)

 

 

The Best Exotic Marigold Hotel was originally published on DrNic1

Healthcare in the Year 2030

The Year 2030

by Dr Nick van Terheyden (@DrNic1)

How will the world of medicine change in the next 15 years? Well 15 years ago AOL had just bought Time Warner, the human genome had just been deciphered and published and the first inhabitants of the International Space Station had arrived.

The Year 2030 – my bed has been tracking my vital signs throughout the night and notices I was restless and managed fewer REM cycles during sleep than usual. Prometheus (my personalized artificial automated agent) checks my calendar and traffic and elects to wake me an hour later. Appointments for the morning are rescheduled and my drone pick up is postponed. Prometheus sends an update to “Hestia” (my kitchen AI) with instructions to increase the energy component of my meals for the day to adapt for the lack of sleep and deliver a boost of energy with almond snacks through the day. Prometheus sends my updated sleep and vitals data to my personal health record. While I rest peacefully the rest of the household is awakened and sets about their day.

 

Time to Get Up

When it’s time to awaken, the bed starts warming to ease the process, the lights slowly turn on and the GPR (Galactic Public Radio) custom news cycle is playing gently in the background. My calendar has been reorganized, and there’s an additional appointment with Asclepius (My health AI) before I leave in the morning. My food is ready and waiting and contains a boost in energy, helping me wake up and acclimate after the poor night’s sleep. I hear the inbound calling for Asclepius and take the call. We review the reasons for my poor night’s sleep and agree I should track this more closely for the next few days to ward off any potential problems. In this instance Asclepius suggests no further investigation is warranted, but if I am worried a drone will be dispatched with some auto investigator tools to apply and track additional parameters if necessary.

Personal Drone
Personal Drone

As we finish my personal drone arrives and I step outside, catching my foot on a fallen replicator brick discarded by one of the children. As I fall my head strikes the corner of a table and carves into my cheek. Prometheus is immediately on top of the situation checking on my vitals, and while no major damage to my body, the cut will need review and probably some stitches. Checking with local urgent care facilities, the optimal treatment for me today is a quick trip to the urgent care clinic and my drone is reprogrammed to take me there immediately.

Urgent Care in the Future

As I arrive my MedicAlert Digital Bracelet transmits my allergy to lignocaine and identifies me based on the bracelet

and my retinal scan taken as I walk through the door, which authenticates my presence and consent initiates transfer of my medical data and records to the clinic.

Robot Nurse
Robot Nurse

 

 

I’m guided to a room where a robot nurse cleans my wound and positions me on the bed and brings in the Panacea (the medical repair robot). My medical record shows I have had a recent Tetanus shot, and a comparison of my previous vitals shows there are no serious changes that would warrant additional investigation. Repair completed, my records are updated with the new details and a drone appears to take me to work.

 

 

 

Medical Offices and Care in the Future

As I step into my office my team are all walking in (virtually) and the central console and screens around the room light up with data on our first patient. We process through the details provided by the various Artificial Intelligence agents and data gathering tools. “Jane” (name changed to preserve her privacy) has been having some frequent dizzy spells and falls – her mother had Meniere’s disease and a degenerative disease linked to the A2ML1-AS1 / ADAM20P1 / MTor Complex 2 / WDFY3-AS2 – we think there may be a link. Even though Jane does not have these gene expressions there may be a new epigenetic influencer she received that is affecting her stable sequence. We need to get to the bottom of this. Jane is here too (virtually) – with her mother and father – and they are looking at the same data, shown with basic annotations to help them understand the details.

South Korean Researchers unveil first CRISPR nanobot editor
South Korean Researchers unveil first CRISPR nanobot editor

We think we have an answer, but want to share the details and show Jane and her family the model of the CRISPR editor nanobot and its effects before we decide on the next course of action. Do we create a more realistic model of her body functions with the cell printer and test on that? Or is the confidence in our simulation high enough to warrant immediate therapy? Whatever we decide we will get real time approval from the GMAA (Galactic Medical Agent Agency that replaced the FDA in 2021). Jane and her family have seen a new therapy advertised and they want to understand how that might work for them. We pull up the details and all the data on patients and do an immediate comparison. The data’s questionable but, more importantly, it’s contraindicated in anyone with GRAMS domain, Heat Shock 70kDa protein expression and several others that disqualify Jane.

We elect a wait and see approach – so much easier these days with the real time monitoring and detailed data we have on patients that allows us the scope to wait and watch while reassuring patients. Directives are sent to their family “agents” and a drone dispatched to their location with some additional monitors for Jane to wear to give more detailed data on her for the next few days.

Amazon Prime Air Drone Delivery
Amazon Prime Air Drone Delivery

 

As we complete the consultation a drone arrives with my almond snacks and some water – perfect timing.

 

 

 

 

 

 

This post appeared in abbreviated form on SHIFT communication site – and is included in their downloadable ebook

 

Healthcare in the Year 2030 was originally published on DrNic1

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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

Memorial Weekend – Be Happy

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

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

BloodofourVeterans

Original from Facebook

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

Posted by Madison Rising on Thursday, October 30, 2014  

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

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

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

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

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

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

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

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

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

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We Must All be Engaged in the Design, Delivery, and Re-imagination of Healthcare

Previously posted on HITConsultant

On a recent flight, I had my headphones on and the Rolling Stones’ “Satisfaction”

began to play.

It’s a song I have heard hundreds of times over the years, but I was struck by the difference listening to it with headphones made. With no distractions, I noticed the bass line, in time with the percussion, provides the perfect offset to Mick Jagger’s distinctively strained voice. It was a completely different experience than hearing the track play in the background of a movie or while at a restaurant. Being fully-immersed and listening only to that song allowed me to pick out and appreciate subtle details I had never noticed previously. It’s no surprise that things sound differently when you’re able to concentrate your full attention on what is being said, but as I was sitting there, I became acutely aware of the function headphones serve—they enable the wearer to listen, blocking out distractions.

That is exactly what we are seeking in healthcare and it has proven to be difficult to achieve – in part because of pace, complexity of care, and technology. For centuries, physicians have listened to their patients and relied on their senses— their powers of observation— and matched these insights with clinical experience to heal. Clinicians need to be able to listen and concentrate on what their patient is telling them and noticing those distinctive symptoms he or she may be exhibiting. As Sir William Osler

famously advised:

“Listen to your patient, he is telling you the diagnosis.”

Being able to dedicate your undivided attention to anything these days is a rarity, but in healthcare, it is a crucial but frequently missing element. The last thing you want to feel when you are at your most vulnerable is that your physician is multi-tasking. Patient satisfaction scores will suffer, but more concerning are the clinical risks and missed opportunities of distracted physicians.

Distracted clinicians are the result of what Dr. Steven Stack of the American Medical Association refers to as an “over-designed” health IT system.” In a recent discussion with industry leaders, he explained that we seem to have become victims of our own ambition. We have devised structures that don’t work for everyone and policies that create very real, very expensive consequences for those who don’t abide. And this has left physicians stretched too thin, trying to do more in less time without any direct impact on improving their ability to care for their patients.

So, maybe it’s time we scale back. Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and co-chair of the nation HIT Standards Committee, noted that while we are in this period of transition and growth, we need to focus on parsimony, or determining the smallest number of moving parts that need to be adjusted in order to create seamlessness in HIT. Quite simply put, while the cart has been upset, there is no reason to trample all over the apples.

The MIT Technology Review recently interviewed Sarah Lewis, a doctoral candidate at Yale, about her recent book that explores how different unlikely circumstances or paths, like failure, have often spurred innovation. Citing creative geniuses such as Cezanne and Beethoven to Nobel laureates, she defines failure as the gap between where one is and where one would like to be. Confronting this gap, she asserts, is important because it “lets people go deep with their failure while letting it be an entrepreneurial endeavor if they like, or an innovative discovery.” We, in health IT, are currently at that gap where there is a disparity between where we are and where we would like to be.

The recent ICD-10 delay has provided the perfect opportunity for us to find Halamka’s parsimony, leveraging solutions that work for physicians and creating consistency and impact wherever possible. Like medicine itself, there will be no one perfect solution for every physician or organization, but we need to begin finding things that work – from re-skinning EHRs with easy to use tools like single sign-on or mobility to systems that respond to voice, touch or swipe to improve the experience for clinicians and patients. We need to start thinking of health IT more like headphones, coming in different styles to suit preferences, but providing the same function of reducing distraction and enabling the clinician to focus on the inflections in their patients’ voices, and truly hearing what is being said.

As Mick Jagger poignantly remarked, “The past is a great place and I don’t want to erase it … but I don’t want to be its prisoner, either.” We have accomplished a lot, but it is time to learn from the past and break free from what isn’t working. I think we can get health IT satisfaction (despite what the song says), but to do so we must all be engaged in the design, delivery, and re-imagination of healthcare and its intersection with technology. This truly is the art of medicine and we are all virtuosos contributing to the next masterpiece of healthcare.

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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)