Navigating Healthcare – Patient Safety and Personal Healthcare Management

May the Fourth be With You

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

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

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

 

But this year I follow Yoda’s advice:

“Pass on what you have learned”

Specialty Pharmacy

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

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

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

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

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

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

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

Patient Engagement and Access

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

Access to quality
Incentives
Long-Term Value
Competitive principles

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

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

GIYF

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

Patient Communities

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

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

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

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

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

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

 

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

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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

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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

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

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Social Media in Healthcare

Posted in #hcsm, #mHealth, Healthcare Technology, HealthIT, HIT, social media by drnic on April 21, 2014

Social Media is here to stay and its impact in Healthcare has been impressive and far reaching.

If you still need convincing – look no further than this piece 24 Outstanding Statistics & Figures on How Social Media has Impacted the Health Care Industrythat features a host of examples. As they put it

In a generation that is more likely to go online to answer general health questions then ask a doctor

And that’s the point our population and customers are changing and they are using the internet and social media as a major source and guide to their care. A few choice data points:

90% of respondents from 18 to 24 years of age said they would trust medical information shared by others on their social media networks

This may be the younger generation but in many instances they are becoming the healthcare support infrastructure for their parents and will use the same methodology to for their parents care as their own

31% of health care professionals use social media for professional networking

I am willing to be this is increasing and I only have to look at my own twitter feed and lists of doctorsI am connected with, follow and use as major source and guides

41% of people said social media would affect their choice of a specific doctor, hospital, or medical facility

Ignore this at your peril – 2 in 5 of your patients are looking at social media to guide their healthcare selection. And the opportunity and impact will increase as we see the penetration of mobile devices increasing

International Telecommunications Union estimates that global penetration of mobile devices has reached 87% as of 2011

So for those of you already online the impact and effect will increase. Those of you not….well that train has left the station. This graphic by Howard Luks (@hjluks) captures the extent of the opportunities

Comments Off on Social Media in Healthcare

Four Reasons Doctors Worry About Social Media – #GetOverIt

Posted in #hcsm, HealthIT, HITsm, social media by drnic on April 17, 2013

I’m fortunate enough to spend a lot of time interacting with physicians, entrepreneurs, and investors on the bleeding edge of digital health – and it’s a consistently thrilling experience.

At the same time, the continuous exposure to the imaginative and the extraordinary can also be a bit deceptive.  Self-associating groups, as Sunstein has discussed, tend to adopt relatively extreme views, and it’s easy to envision this happening in Silicon Valley in general, and to digital health innovators in particular.

Consequently, it was probably healthy, and certainly arresting, to attend a breakout session on social media at recent a medical conference; the audience members were mostly practicing physicians, seemed passionate about patient care, and were explicitly interested in learning about social media.  Yet, most of the clinicians were not prepared to embrace it, and many were poignantly struggling to come to terms with a phenomenon they recognized as important, yet which viscerally troubled them.

Their concerns seem to fall into four categories, two involving patients, and two involving physicians.

1. Patients Receiving “Bad” Information

Many physicians described the challenges of dealing with patients who had retrieved wrong or incomplete information from the internet.  This turns out to be a remarkably common problem; doctors reported spending a lot of time undoing bad information.

The challenge was highlighted by the observation that 25% of Google searches for headache reportedly discuss brain tumors, even though such a diagnosis would be exceptionally uncommon.  The thought was that while physicians have learned during their training to appropriately weigh pre-test probabilities, patients have not, and are likely to fixate on extreme diagnoses rather than those that are most likely.

It seemed to me that “Dr. Google” upset many doctors not only because it complicated office visits, but also because it fundamentally altered the traditional doctor/patient relationship; as one physician said – verbatim – “I’ve lost my authority.”  It’s hard not to see this as a profound shift in perspective many experienced physicians understandably struggle to manage.

2. Patients Transmitting “Bad” Information

Many doctors in the audience were also visibly troubled by the ease with which patients could share “misleading” information, whether about medicine or the doctors themselves.

Despite the clear repudiation of a link between vaccines and autism, for instance, many patients continue to worry, a concern reportedly spurred on by an active internet anti-vaccine community.

Doctors were also fretting about the ease with which disgruntled patients could use the internet to besmirch reputations — one physician complained that when he Googled himself, the first links that came up were bad reviews he said represented a small number of extremely vocal patients.

3. Physicians Receiving Information Badly

While some senior physicians worried that young doctors might start to rely on tweets rather than peer-reviewed articles, it seemed that the most significant concern raised was the impact that the “internet culture” was having on the practice of medicine.  “We need to teach students that traditional values are still important,” one audience member said (again, verbatim), suggesting that students have become progressively less reflective.

The use of mobile devices – what consultants call “phone hygiene” – emerged as a particular source of physician aggravation.  Rounding residents would routinely look at the cell phones rather than pay attention to either the patients or the senior doctors, leading at least one doctor to prohibit the use of mobile devices on rounds – except for a 5’ phone break he built into the schedule, to accommodate what he described as the young doctors’ obvious addiction.

Another senior doctor, in a complaint evocative of this recent, much-discussed NYT article, noted that residents would routinely update her by text, rather than by phone.  She suggested this reflected a more general trend of young physician disengagement, evidently preferring to interact with devices rather than with other people.

4. Physicians Transmitting Information Badly

The ability afforded by social media to share information rapidly and broadly was another source of concern.  Many senior physicians worried young doctors might use social media in unprofessional ways – sharing things they shouldn’t, saying things they shouldn’t – potentially placing themselves and their institutions at risk.

In some cases, even seemingly innocent activities might be deemed inappropriate.  One young physician offered as an example a (medically-related) internet survey research project he wanted to do.  He said that while he could do this very easily, nearly instantly, and essentially for nothing using Google, he learned from his department this would violate institutional policy, and to conduct the research with the required protections in place would cost at least $25,000; naturally, the research has not progressed.

Moving Forward

Great post by David on why clinicians should jump with both feet into the world of Social Media

June Show Highlights on VoiceoftheDoctor

Posted in #hcsm, #voiceofthedoctor, EHR, EMR, Scribes, social media by drnic on June 18, 2012

June 15

Speaking with Ruthann Lipman, DO from the Department of Otolaryngology, Millcreek Community Hospital and David Eibling, MD, FACS from the Department of Otolaryngology, University of Pittsburgh and VA Pittsburgh who are presenting a paper at Human Factors and Ergonomics Society (HFES) this October titled: 

“Re- engineering the Healthcare Team: Meeting the needs of Providers with Information Specialists”

June 22

Joel Selzer (@jbselz), the CEO Ozmosis will be joining me to discuss Social Media in Healthcare. Ozmosis has created a tool set that allows clincinas to engage in a secure environment allowing for easy collaboration and bringing Social media into the healthcare world

We have a list of doctors to follow on twitter and this list of docs and a listing of HIT folks who are influential in #hcsm in celebration of of Social Media Day. Certainly one of the leaders in this space – University of Maryland Medical Center has really shown what can be achieved. Even the US Army has gone created a guide for social media

Army Social Media Handbook 2012

View more documents from U.S. Army

June 29

Will round up the news from the past week including dicussion on these two papers that have created quite a stir

Escaping the EHR Trap from the NEJM (Jun 14), and

Method of EHR Documentation and Quality of Primary Care from JAMIA (May)

 

Join me on every Friday at 2:30 ET on VoiceoftheDoctor

There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.
• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#
• HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk.