Navigating Healthcare – Patient Safety and Personal Healthcare Management

Patient Centered Systems

What will it take to move our healthcare system to a truly patient-centered system? We know based on multiple data points that engaged patients have a big impact on the successful outcome of treatment. Leonard Kish cited the phrase back in 2012

Patient Engagement is the Blockbuster Drug of the Century

Referencing a 2009 Kaiser study of coordinated cardiac care and comparing to those not enrolled in the study

“patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program.”

“clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent.”

And this study in Telemedicine and e-Health. Dec 2008; Vol.14 (10): 1118-1126 that showed impressive results for chronic disease management:

  • 19.74% reduction in hospital admissions
  • 25.31% reduction in bed days of care
  • 86% patient satisfaction
  • $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
  • 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression

 

Patient Data Ownership

I believe as do many others that the patient is at the center of everything we do and deliver in healthcare. By placing the patient and their information at the center of care and allowing them access and control we empower them and enable a model that moves away from the historical paternalistic delivery of healthcare to patient-centered and enabled care. It does come with challenges since many people contribute to that care and the current administrative and financial configuration focus the management and ownership of data with providers, healthcare systems and payors. While many patients want access to their data and some even want to own and manage it, many do not and are ill equipped to be responsible for this data. Perhaps what we need are some independent services and providers who aggregate, manage, secure and maintain patient data on behalf of patients – much as banks do with our money. There was some hope when Google and Microsoft jumped into healthcare offering Google Health and Microsoft Health Vault respectively. Microsoft’s version continues to this day – google withdrew theirs and Sergey Brin was widely quoted when he said

“Generally, health is just so heavily regulated. It’s just a painful business to be in, I think the regulatory burden in the US is so high that think it would dissuade a lot of entrepreneurs.”

But while complex, not insurmountable and as he rightly points out

“I am really excited about the possibility of data also, to improve health”

I am too and while there remain many challenges associated with securing and sharing that data the “entrance” of these alternative participants into the healthcare space – some perhaps looking at this from a simple employee perspective, is an opportunity for new ideas, insights, and people applying the collective brain power to one of our most pressing problems. I continue to hear from colleagues and friends of companies that are exploring and looking at healthcare. UPS highlighted their healthcare focus and the potential for 3-D printing in a recent tweet:

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And I heard from a friend that Dyson even has a healthcare “focus”.

Protecting Patients

There are some major concerns as these data-focused companies offer access but do so with agreements that contain so much legalese as to be unintelligible and opaque to the consumer who may well be giving up much more than his own personal data but potentially giving up his future health. The GINA act offers some protection to individuals who in sharing personal genomic data that tag them with a “pre-existing’ condition could have found themselves unable to access care. But the act did not go far enough failing to address the issue of other insurance and employers who can use this data to deny access or coverage and perhaps even employment?

We need the combined power of this patient data to create the insights into diseases but not at that personal expense. There are many technologies on the horizon that offer a potential path to help achieve this and blockchain represents an interesting innovation of decentralized secured data that offers individualized control and dynamic revocation options for access. If you are interested in learning more about Blockchain this article in HealthcareIt News is a good primer for its potential in Healthcare: How does blockchain actually work for healthcare?. It is not a panacea and the fundamental rights and ownership still need to be addressed without giving away the farm to corporations and businesses.

Interoperability

The existing healthcare system incentivizes behavior that is in opposition to a scalable nationwide vendor neutral interoperable patient-centered data. Our model has multiple groups who have a vested interest in the control and ownership of data (for example Payers, Providers, Patients and even employers). Each has their own economic and commercial drivers and in many instances, these do not coincide with open sharing of data. In a system that is driven by activity and delivering care (Fee for Service) sharing data could mean a reduction in work and income. Until our reimbursement system moves to a more holistic care model that focuses on wellness and outcomes and incentivizes behavior that delivers better health and outcomes for patients through cooperative and coordinated care and ultimately equitably rewards all the contributors to these outcomes we will remain stuck in the quagmire of limited interoperability.

The key to a patient-centered interconnected care model is the free flow of data between all the areas responsible for delivering care. We moved away from the single index card medical record held by your personal physician who was the focal point of care and care coordination to a distributed team-based model of care that encompasses multiple areas and people. In some instances, thatcher coordination may be carried out, at least in part by the patient or their family members, and they need to be included and ultimately in control of the data and its flow. The only way this team can deliver excellent care is through the frictionless flow of enhanced data and knowledge. This information flow must include the patient and all their family members that are authorized, interested and engaged in their care. Data should be shared with the patient’s consent with everyone concerned and available for as long as it is needed to deliver care but this access should be flexible enough to allow it to be revoked or removed when it is no longer needed or necessary

Welcome to the Fray

I am a big fan of learning from other industries and perspectives and spoke about this at HIMSS Conference in Orlando

The Best Exotic Marigold Hotel and I am excited to see the rush of companies and people into the healthcare space but for those stepping in and thinking about data and the ownership and control of this data, I would suggest this requires a new way of thinking. Much like security – patient access and control needs to be baked in from the start. Taking ownership and rights away from patients will stall progress and anger your constituents and community. As ePatient Dave would say or better yet sing:

Give me My Damn Data

Here’s hoping that these new players see the value of the engaged patient and include some of these principles in their march towards our common goal of better more cost effective healthcare. For the large organizations thinking about the data, remember you and your family members are patients too. The following thoughts are offered as some basic guiding principles on data stewardship:

  • Patients want control of their own data,
  • Patients want to be able to share safely and securely share their data with all their care providers and participants (this will include family members and friends)
  • Patients want granular control of some elements of the data limiting individual access to certain elements and areas
  • Patients requires a full audit capability tracking who has access and has accessed their data
  • Patients want to be able to easily and dynamically revoke access
  • Patients will share their data for research and benefit of others but their contributions need to be recognized and accounted for
  • Data cannot be used against Patients to deny coverage or increase their costs

 

What have I missed – what controls or limits would you place on your data that would make you more willing to share your data. What would stop you from sharing your data and why?

 

 

Patient Centered Systems was originally published on Dr Nick – The Incrementalist

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Secure Your Accounts Today

Secure Your Accounts Today

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

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

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

Original tweet from #HCLDR chat

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

Fast forward to this morning and a widespread hack is revealed

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

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

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

Enable Two Factor Authentication

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

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

For Twitter

Link a mobile phone to your Twitter Account and then:

Settings/Privacy — Enable Login Verification

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

For Google Accounts

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

You can find the details for this here

Google Authenticator

Google Authenticator for Android and for Apple iOS

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

Your Digital World is being Watched and Needs Securing

Which Accounts

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

This post originally appeared on Medium and LinkedIn

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

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What 2016 will Bring for Healthcare Technology

Posted in Africa, Disruptive, Innovation, Patient Engagement, Technology by drnic on March 25, 2016

2015 was an incredible year in technology and healthcare; from new consumer technology and personalized devices coming to market to the introduction of new supercomputers that reduce the time and cost of healthcare data analysis. It’s been great to see how innovation continues to penetrate the medical profession, improving patient services and care. As we look to 2016, there are some areas that we can expect technology to further impact.

Dance like no one watching Encrypt - Security

Growing patient concern over security

Security is a major concern for consumers and the healthcare industry, and the threat of it is only rising. While technology and data provides patients with the precise, personalized medicine that they want, individuals have not forgotten the security breaches that occurred this past year, which had heightened their concern, particularly with the type of personal information in medical records. Implementing stronger, more reliable and transparent security practices will be a critical objective for medical practitioners, but equally important will be reestablishing trust with their patients and consumers.

The consumerization of healthcare

Consumers have grown to expect personal and custom experiences from technology.  The consumerization of healthcare will gather greater momentum and the healthcare industry will see the first effects of this trend on individual behavior in 2016. By treating patients and individuals seeking healthier lifestyles as consumers, the healthcare and related technology developed becomes more and more applicable to serving their needs and meeting them where they are. This is a great thing. As an example, imagine telehealth kiosks now allow patients to engage in a face-to-face video consult with their doctor, or have their vitals taken and receive a diagnosis – without setting foot in their doctor office.  Pilot programs for these “pods” are being tested in Rite Aid and the Cleveland Clinic.

The latest innovations will further fuel the moment around treating patients as consumers and developing relevant technology that make it easier for them to monitor their health and seek treatment, driving more adoption and healthier populations.

IoT - We have to go out for Dinner - Fridge not Talking to Stove

Embracing the Internet of Things toward patient engagement

The Internet of Things (IoT) connects billions of objects around the world, and in 2016, the healthcare industry will take the first steps in tapping IoT’s full potential through passive monitoring. Leveraging wearables and connected devices, healthcare organizations, with the consent of patients will be able to passively monitor the wellness of patients and personalize their experience. For example, for those with chronic diseases, such as diabetes or heart disease, these devices can monitor all aspects of the patient’s  daily life to provide insight to the patient and the healthcare providers, into how different activities, such as eating, sleeping or watching TV, affects his or her body. Connected devices equipped with real-time feedback can provide subtle alerts that prompt, caution or encourage patients to stick with or avoid certain behaviors.  These devices can also help them to comply with a treatment or regimen. In 2016, we’ll see the industry understand that subtle patient engagement through passive monitoring can have positive, long-term effects on behavioral change.

 

The potential of ICD-10

While the rollout of ICD-10 was reluctantly undertaken by some in 2015, the healthcare industry will begin to realize its actual potential in 2016. As a result of ICD-10, healthcare organizations will receive a higher level of granularity in the clinical data that has been collected including patient information and clinical data.  Utilizing this data will enable new insights and deeper analysis.  This will be the first step in turning descriptive healthcare analytics to predictive and prescriptive insights enabling results like reducing readmission and improving population health management. However, as we see potential benefits being realized, discussions will center on the interoperability of systems that is limiting analysis and holding back potential insights.

Africa-Kids-iPad

More democratized, globalized healthcare

While diseases such as AIDS and malaria are now considered chronic or curable with the proper treatment, there are still geographical, technological and societal barriers that pose great challenges when trying to treat the demographics that are most commonly affected. In the third world and emerging countries, healthcare organizations are leveraging technology, including simple mobile devices, to provide patients with faster, more effective care. In 2016, we will see more companies create technology that democratizes healthcare with innovations that help to lower the cost of healthcare, enhance patient engagement and improve overall worldwide population health.

Not only is it exciting to imagine how we’ll see technology continue to evolve and change everyday life, but also fascinating to see the impact and opportunities for enabling healthcare providers. These trends will manifest in some exciting and innovative changes in 2016 that will have a tremendous impact and further improvements in patient care.

 

This post originally appeared in HealthIT Outcomes

 

Original

 

 

What 2016 will Bring for Healthcare Technology was originally published on Dr Nick van Terheyden, MD

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