Navigating Healthcare – Patient Safety and Personal Healthcare Management

Making it Easier to do the Right Thing

Behavioral Health for Positive Impact

Behavior

This week I am talking to Matt Wallaert (@mattwallaert), Chief Behavioral Officer at Clover Health. I have listened to Matt on a few occasions, most recently at the FitBit Captivate event in Chicago so I was excited to get to talk to him one on one.

Matt plays an unusual and atypical role in Clover Health – he is their Chief Behavioral Officer, a title and role that is not commonly found. He is a Social Psychologist who focuses on Judgement and Decision Making and is most well known for applying behavioral science to practical problems.

We explore behavioral health influences and how we can create interventions that will have a positive impact. How do we create incremental steps and test these and then roll out of programs to have a positive impact on health? He wanted to have an impact and wanted to make things better for people and over the course of his career has managed to do so in many places but is now focused on healthcare and specifically personal health. There’s a recurring theme in many of my INcremental interviews and I heard it again from Matt:

Assume you are going to fail

As Matt puts it – “don’t set up a durable process – for example, if you are doing a mailing do that yourself vs getting your marketing department to create the mailing”. Then head out to the next step – a Test. It is not hard to find behavioral changes that work – but that’s not the only requirement as the change has to work well enough and are scalable enough that you really want to roll them out widely.

Incremental Step to Behavioral Health

It’s not just finding good behavioral changes but rather things that are worthwhile and scalable

“If behavior is your outcome and science is your method – then you are a behavioral scientist”

As Matt says we have to make it easier to do the right thing and not blame individual choices and health behaviors when we make poor health, decisions. Listen in to find out why there are significant cultural differences in flu vaccination take up rates and what incremental steps can be taken to improve on that and hear why it is important not to blame people for poor health behaviors. Learn how they are behaving like Netflix or Pandora that can can match you to the right videos or music we should be able to match you to the right doctor

 


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

Making it Easier to do the Right Thing was originally published on Dr Nick – The Incrementalist

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Improving Healthcare’s Security Posture

Blackhat

Healthcare’s Security Posture

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

Healthcare

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

Healthcare

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

 

Incremental Steps for Improving Healthcare’s Security Posture

 

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

Here’s the short list:

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

Encrypt

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

Unbreakable Encryption

Encryption Algorithms Under Siege

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

Unbreakable Encryption

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

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

 

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

Cryptography

Single Photon Based Encryption Keys

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

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

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

Here’s the Interview:

 

Unbreakable Encryption was originally published on Dr Nick – The Incrementalist

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

Memorable Healthcare from 2015

Posted in Innovation by drnic on December 31, 2015

The New York Times pulled together a list of memorable stories from 2015 (Medical and Health News that Stuck with us here)
– The discovery that Ebola is not cured nor over
– The ongoing war against epidemics and debilitating and now potential treatable diseases
– Anxiety and stress increasing (or is it increasingly diagnosed) and little progress in treatment
– The ongoing Drug Nuclear arms race of blockbuster (and unaffordable) prices for new drugs
– valuing time with the clinician for discussion of end of life care
– the sorry state of mental health in this country pales into insignificance with the chain therapy in Africa
– Despite real progress in treating Type 1 Diabetes unnecessary limitations are still being placed on children

Its been an interesting year and we have made much (rapid) progress. These stories are just the tip of iceberg and next year expect many more and heres hoping for some real change to a broken healthcare system

Memorable Healthcare from 2015 was originally published on Dr Nick van Terheyden, MD

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Science, Evidence and Clinical Practice

Posted in Health, Healthcare, HealthIT by drnic on September 4, 2013

A recent article on the The Difference between Science and Technology in Birth on the AMA site demonstrates the challenges we still face in getting clicnal practice influenced by science and data. Studies and data may show the path for best clinical practice but as the authors note there are multiple instances of the clinical community – in this case the OBGYN – either knowingly or unknowingly failing to follow the best practices

For deliveries in the US evidence tells us that fetal monitoring in low risk pregnancies has a deleterious effect – yet it remains standard practice in most settings to place external scalp electrodes and intrauterine pressure catheters

Although we still see external continuous fetal monitoring employed in many low-risk pregnancies, “as a routine practice [it] does not decrease neonatal morbidity or mortality compared with intermittent auscultation…. Despite an absence of clinical trial evidence, it is standard practice in most settings to place internal scalp electrodes and intrauterine pressure catheters when there is concern for fetal well-being demonstrated on external monitoring” [3].

 

They list several other standard practices including

  • routing episitomy
  • Use of Doula’s
  • Challenges with Epidurals

Reasons for these behaviors are varied but as the authors state:

Many well-intentioned obstetricians still employ technological interventions that are scientifically unsupported or that run counter to the evidence of what is safest for mother and child. They do so not because a well-informed pregnant woman has indicated that her values contradict what is scientifically supported, a situation that might justify a failure to follow the evidence. They do so out of tradition, fear, and the (false) assumption that doing something is usually better than doing nothing

Until we fix these basic issues there seems limited opportunity to implement intelligent medicine and real evidence or science based practices.

 

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http://drvoice.blogspot.com/2013/09/science-evidence-and-clinical-practice.html

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Introverts and Extroverts and How to Deal with them

Posted in Health, Healthcare, HealthIT by drnic on August 22, 2013

In a great piece on FastCompany titled: Are you an Introvert or an Extrovert? What it Means for your Career, Beth Belle Cooper explores what she considered a binary position or bucket to put people in but discovers this is really a continuum and one that we as individuals don’t sit at one spot all of the time

As she describes – it is an Ambivert Personality Scale Continuum
An important aspect to healthcare in our interaction with the ever expanding teams that contain wide variations of individuals

But in thinking about work, health acre and interactions the 12 tips for dealing with the different groups seemed like great advice all round
12 Tips for Dealign with Introvert
  • Respect their need for privacy
  • Never embarrass them in public
  • Let them observe first in new situations
  • Give them time to think don’t demand instant answers
  • Give them advanced notice of expected changes in their lives
  • Give them 15 minute warning to finish what they are doing
  • Reprimand them privately
  • Teach them new skills privately
  • Enable them to find one best friend who has similar interests and abilities
  • Don’t push them to make lots of friends
  • Respect their introversion and don’t try and make them into extroverts
10 Tips for Dealing with Extrovert
  • Respect their independance
  • Compliment them in hte company of others
  • Accept or encourage their enthusiasm
  • Allow them to explore and talk things out
  • Thoughtfully surprise them
  • Understand when they are Busy
  • Let them Dive Right in
  • Offer them Options
  • Make physical and verbal gestures of Affection
  • Let them Shine
I think what’s interesting is most of us are in both camps at different times – the two lists seem like great advice all round

https://navigatinghealthcare.files.wordpress.com/2013/08/038d6-3016031-inline-scale-750647.png?w=300

http://drvoice.blogspot.com/2013/08/introverts-and-extroverts-and-how-to.html

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Technology as an Aid vs Hinderance to Doctors

Posted in Health, Healthcare, HealthIT by drnic on August 12, 2013

A recent article in Becker Hospital Review:  Technology Should Aid Human Interaction: Q&A with Dr. Nick Terheyden, CMIO of Nuance featured some important points to make


Health IT needs to fade into the background. It needs to become part of the fabric of the office rather than the focal point, and then the interaction will change

  • Using the tools to allow the clinician to focus on the patient not the technology
  • Human beings deal in narrative and stories, patients want to tell their story and clinicians need the richness of the narrative to help guide medical decision making
  • Remove the Physical Barriers to the clinicians patient interaction
  • Healthcare is not the focus – the patient is

The key to our future and to the successful use of health IT will be turning the focus back on patient and the physician.

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http://drvoice.blogspot.com/2013/08/technology-as-aid-vs-hinderance-to.html

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Interview with HealthTech Vision

Posted in Health, Healthcare, HealthIT by drnic on August 8, 2013

I had the pleasure of speaking with Alex Welz of Health Tech Vision last week and he posted the interview here – or you can listen to it below

The importance of bringing intelligent voice interactions to Health IT especially as medical technology moves to into the Mobile world. It is an exciting time with technology offering real hope

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http://drvoice.blogspot.com/2013/08/interview-with-healthtech-vision.html

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Presenting at Health2.0

Posted in Health, Healthcare, HealthIT by drnic on July 31, 2013

See me at Health 2.0” src=Excited to be presenting at Health2.0

There have been exciting innovations in Cloud based Intelligent Speech Understanding and our new development tool set is offering a way to help healthcare providers transform patient stories into high-value clinically actionable medical information. No more burdening clinicians with data entry tasks.

See me at Health 2.0” src=Florence

You can see it here integrated by by Sense.ly

We have a mobile development platform with more than 750 developers signed up already

The mobile health platform is good at delivering information but the interface can be challenging and capturing the medical decision making difficult using on screen keyboards and point and click methodology.

Mobile speech enablement offers tools that facilitate the navigation and human device interaction and includes capture and clinical understanding services that turn narrative into discreet actionable data to capture the clinical decision making

You can see a brief demo here:

Hope to see you at Health 2.0

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http://drvoice.blogspot.com/2013/07/presenting-at-health20.html

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