Is there an unspoken fear among caregivers that the subtext of all this digital disruption is a devaluation of the human element?
In countless industries, workers and analysts alike watch the slow march of technology and innovation and see as inevitable the takeover of human tasks by robots, AI, or other smart systems. We watched as the threat of outsourcing transformed into a reality of automation in industrial sectors, saw drones take on countless new roles in the military and in commerce, and now we hear about how driverless cars, self-checkout kiosks, and even robotic cashiers in restaurants are all waiting in the wings to dive in and displace even more formerly human occupations.
And looking at how EHRs — by virtue of their cumbersome workflows alone, not to mention all the documentation and growing emphasis on analytics and records-sharing–are taking flack for burnout and frustration in hospitals across the country, it hardly seems a reach to suggest that maybe America’s caregivers are feeling not just burdened by technology, but threatened.
Digital records are already changing what doctors and nurses do, how they work, and what is expected of them — it must surely be only a matter of time before their roles start getting handed over to the robots and supercomputers … right?
Wrong.
Change, Not Replacement
While some jobs or roles may face elimination through automation, the more common effect is transformation. In healthcare, that may mean that for many their title is the same — perhaps even the education and certification standards that go along with it–but their actual functions and roles in context will be different.
We see this already with respect to EHRs. The early, primitive documentation workflows and reporting obligations have drawn ire from clinicians who see their autonomy under attack by digital bureaucracy. But this is naturally destined for correction; medicine has advanced through trial and error for centuries, and the 21st century is no different.
The transition and disruption doesn’t manifest exclusively as growing pains. Consider the role of medical laboratory scientists and technologists: the Obama administration is pushing for a cure for cancer based on the advancement of personalized medicine; patient-centered care is becoming a priority among all caregivers as well as a quality metric in health centers across the country; genomic testing is seeing growing demand on the consumer side, as well as applications in a growing array of clinical settings.
All of these trends point to the medical lab as a newly central component of the modern care center, treatment plan, and information hub. The demands all these new technologies and applications put on laboratory professionals requires them to do more learning, adapting, and leading than ever before, especially to integrate the latest and greatest devices and tests available.
Simply put, machines are still fallible, and require assistance in providing critical context, to supplement their ability to accurately read, diagnose, and self-regulate to ensure accuracy and consistency, not to mention proper application in the clinical setting.
Guest post by Bryce Cannon, Vice President – Client Services, Modea.
Healthcare and Wearable Tech: How the Fitbit Can Improve the Patient Experience
As of 2015, 1 in 6 U.S. adults owns a smartwatch or fitness tracker. This means that there are 40MM people in this country counting steps, checking their heart rate, and tracking other data. The wearables market already represents a multi-billion dollar industry.
If this doesn’t seem like a big enough wakeup call to take wearable tech seriously, then what if I told you that soon we’re likely to be wearing smart clothing that measures breathing rate and muscle effort? Or that having small microchips embedded in your nail polish will allow you to track your movement and virtually type?
Fitness bands are just the beginning of human beings living a more measured life. And with the strong connection between wearable tech and healthcare, providers would be foolish to ignore this trend.
So how can you ensure that you don’t miss the wearable boat? In this article I’ll share two examples of hospitals that have already found a way to tap into the growing trend of wearables, as well as three benefits that you can realize for your own practice if you do the same.
Cedars-Sinai – Using Fitbit to Help Cancer Patients
Dr. Arvind Shinde, a faculty physician in the departments of Supportive Care Medicine and Hematology and Oncology at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, knows that activity level has a strong correlation to whether or not an oncology patient can physically make it through chemotherapy. To quote Dr. Shinde, “People who are spending more time in bed usually get harmed by the treatment we give, even if the cancer is responsive to the treatment.”
The problem is that the typical method for assessing patient activity level is simply to ask them and accept their word. But thanks to wearable tech, Dr. Shinde saw an opportunity to use empirical data.
So he rolled out a test in January of this year to enroll 30 adult cancer patients who have access to an internet-connected smartphone. Dr. Shinde provided each one with a Fitbit Charge HR device so that he can monitor stats like heart rate and miles walked. The goal is to assess patient activity levels over a fixed period of time, and then correlate that data with patients’ outcomes from cancer treatment.
According to Dr. Shinde: “The next step will be to do a larger study across multiple tumor types and follow people longitudinally for a much longer period of time. We can see how they do as they progress through their treatments, follow their ups and downs. We’ll be able to get changes over baseline and create a better algorithm for this assessment.” (To read more about Dr. Shinde’s trial, read this article.)
Through Dr Shinde’s work, Cedars-Sinai has found a way to leverage wearable tech to improve quality of life and provide better patient outcomes.
Dartmouth-Hitchcock Rolls Out ImagineCare to Improve Sustainable Health
Built on 2 years of research surveying best practices across areas from hospitality to high tech, Dartmouth-Hithcock has rolled out a new platform (ImagineCare) allowing patients the ability to tap into a full network of health alerts and personalized support, as well as to voluntarily supply connected health data to their care providers. It’s particularly focused on those managing chronic diseases. The platform incorporates use of the Microsoft Band activity tracker to measure and collect personal health data. In their own words:
“Patient health data is captured, monitored and analyzed in a sophisticated command center using powerful applications developed in partnership with Microsoft. ImagineCare combines patient health data with other relevant data sets, for example from national health organizations like the Centers for Disease Control and Prevention (CDC), and applies care pathways, which have been developed using the latest clinical evidence and best practices…”
This video helps bring it to life:
By bringing together wearable tech, personalized support, and a new ImagineCare app, Dartmouth-Hitchcock is providing a holistic care platform that helps patients to manage chronic health issues and better provide self care.
Integrating with Connected Health Data
As a healthcare provider there are many ways to get started integrating with wearable data. As a first step, I’d recommend exploring Apple HealthKit. In 2014 Apple released the “Health” app for iOS. Now over 75MM iPhone users in the U.S. can track statistics like activity and heart rate, just by carrying their phone around in their pocket.
Later that year, Apple released “HealthKit”, an accompanying developer platform that allows software developers to hook their own apps into collected data on Health via API.
HealthKit allows other applications to access data collected by Health (with the user's permission of course). For example, a nutrition application can inform a fitness application how many calories a user consumes in a given day.
Building into HealthKit would allow your practice to integrate personally connected data from ~100MM adults in the U.S. market.
In addition, you can also consider tapping into data from other devices with developer platforms, such as the Fitbit or the Microsoft Band.
If terms like “integrate” or “API” freak you out, then consider working with a digital partner to help you navigate the wearable device trend and build out a strategy.
Regardless of how you decide to get started, here are three benefits that you can realize as a provider by tapping into data from wearables.
1 – Achieve Better Patient Outcomes
Can healthcare practices that encourage the use of wearables or (better yet) integrate with wearable tech to provide more holistic care actually provide a better patient experience? The answer lies within how using wearable tech can change patient engagement. Here’s a quote from a recent HiMSS study:
“Even without universal agreement on ‘one’ definition of patient engagement, two truths are emerging: a patient’s greater engagement in healthcare contributes to improved health outcomes, and information technologies can support engagement.”
Healthcare is being consumerized, with people taking an increasingly active role in their own care experience. By providing patients with the option to easily share personal health data, providers are not only helping doctors to be more informed, they’re increasing the value of connected data for the patient. And doing so increases patient engagement and empowerment.
Getting doctors more informed and patients more engaged will lead to better patient outcomes.
2 – Become More Efficient
Hospitals are under constant pressure to scale back and do more with less. Coupling mobile technology with wearable tech, physicians can connect live with a patient via video conference and scan data from activity trackers like the Apple Watch or Fitbit. They can even source data from “smart” household items like a scale or thermometer. All of this can be done without the patient or doctor having to leave their homes.
Sound like the future? It is, but it’s also the present. Companies like AmWell already provide in-home, fully digital care via web and mobile apps. The service also integrates with wearable data to ensure that doctors are making the best possible diagnosis. With a typical price point of $49 per “visit”, AmWell has created a more efficient model for delivering urgent and therapeutic care.
3 – Brand Perception
We may not always think of brand when it comes to providing healthcare. But as patients become increasingly empowered to make their own care choices, their perception of your brand could become a deciding factor in whether they choose you as a provider (or not). Paul H. Keckley, PhD, Executive Director of the Deloitte Center for Health Solutions said the following:
“Consumers have more skin in the game now than ever before. They’re able to compare prices and outcomes for simple medical treatments. And they can access their own medical records to compare their signs, symptoms, risk factors, and comorbidities to clinical algorithms and better understand where to get the appropriate care, and how much that care will cost.”
As consumers continue to be more empowered and many healthcare services continue to commoditize, being seen as a progressive brand and an early adopter of using connected health data from sources like Apple HealthKit can position your practice as the go-to place for the best, most progressive care.
Conclusion
More and more U.S. adults are measuring personal health statistics. This trend is not going away. Rather, it’s accelerating the consumerization of healthcare. Tapping into wearable data to improve the patient experience will help position your practice for the future.
Got thoughts or questions about how to take your practice into the future? Send me an email I’d love to hear from you.
Since 2011, more than $870 million have been invested in more than 65 healthcare artificial intelligence (AI) startups. These startups concentrate on various areas, from nursing to drug discoveries, where AI’s potential can be put to best use. This is where the world’s heading towards and the future of healthcare lies.
The roots of AI may have been from some science fiction storytellers, but now, the reality is that AI plays a major role in our everyday life. Beginning with the IBM Watson supercomputer defeating the longtime Jeopardy champion, Ken Jennings, the world started taking notice about what artificial intelligence can do.
With Google and IBM making tremendous progress with their AI initiatives and the other tech giants (Like Apple, Dell, Facebook) trying to catch up, it makes us wonder what will happen when one day we have robots running around doing our everyday chores.
But, the main question should be what will happen when AI does fully breach our day to day lives: Will we embrace this reality and let robots take us over? And do we really need or is it desirable to have self-driving cars and artificial intelligence? Should computers acquire enough data and knowledge to replace our existing doctors?
Maybe we do or maybe we don’t, but let’s stop before we get ahead of ourselves.
AI should not be perceived as “artificial intelligence” but rather as “augmented intelligence.” It has the potential to process data and make cognitive decisions, which an average human can take many months to process. AI has truly opened numerous opportunities in the field of healthcare, which was humanly impossible just a few years ago.
Getting into the facts, the main advantage AI has over a normal human being is the ability to process a gazillion data points within seconds.
So let’s imagine a patient walks in with a flu – even to diagnose and treat this common illness with the right medication can take a while. There are some cases where the patients don’t even react to the medication. These are common scenarios, as each body reacts differently to different medicines leading to an increased treatment time. Whereas, if the diagnosis is powered with an AI backed system to help, doctor’s will be armed with all the right data and can diagnose and prescribe the right medication within minutes.
How’s that for a game changer?
Yes, AI is the perfect medical assistant to healthcare professionals.Through an iPad based electronic medical record, even the patient genome studies could be integrated into their electronic medical reports. Armed with this data, AI has enough information to make a better analysis and provide accurate treatment plans based on the patient’s medical history, genetic conditions and other medications they are taking for other illnesses.
Guest post by Ben Oster, product manager, AvePoint.
Ben Oster
Balancing the strategic needs of a business with the user-friendliness of its systems is a daily struggle for IT pros in every industry. But for healthcare organizations, safeguarding the data living in these systems can be especially daunting. According to a study by the Ponemon Institute, healthcare is a minefield for various security hazards. Within the last two years, 89 percent of healthcare organizations experienced at least one data breach that resulted in the loss of patient data. As healthcare businesses and the patients they serve adopt a mobile-first approach, providers must strike a balance between innovation and risk to prevent patient data (and internal information) from falling into the wrong hands.
The use of mobile devices and apps certainly enhance patient-provider relationships, but these complex information systems present new concerns surrounding compliance, security, and privacy. As employees and patients increasingly adopt smartphones, tablets, and cloud-based software into their daily lives, healthcare leaders must prioritize users’ needs while mitigating security risks. Mastering this dynamic requires healthcare companies to balance mobility trends like BYOD and cloud computing with regulatory requirements like HIPAA.
To lower the risk of data breaches, healthcare organizations need to defend their systems by identifying, reporting on, and safeguarding sensitive data. Here are a few steps the healthcare industry can take to join the mobile revolution without compromising security:
Start with discovery – Traditionally, healthcare organizations have taken a “security through obscurity” approach to protecting data. In other words, relying on the ambiguity of the data in their systems to ward off malicious attacks and breaches. But as technology emerges that personalizes patients’ end-user experience – such as online patient portals and electronic medical records – the less obscure healthcare organizations’ data becomes. With patients and medical staff accessing this data through a range of devices and workflows, knowing precisely what content exists in a healthcare organization’s infrastructure is essential to security. That’s why discovery is the first step to safeguarding content. Healthcare IT teams should also roll out internal classification schemas to determine which user groups need access to this data. By categorizing content based on these factors, healthcare companies can lay the framework for a truly secure system.
Obviously, the health care providers in your facility do great work every day. You might even argue that miracles are a common occurrence. But when we talk about halos in health care, we aren’t talking about health care in a spiritual sense. When we refer to a halo, we’re talking about the overall impression that patients and their families have of your hospital, and how it can influence your patient satisfaction scores. Because as it turns out, your HCAHPS scores aren’t always based entirely on the actual patient experience.
Understanding the Halo Effect
In 1920, psychologist Edward Thorndike coined the term halo effect to refer to the cognitive bias that influences our impressions of others. According to Thorndike, the overall impression that we have of someone influences the assessment of their character. When someone rates another person highly in one trait, for example, leadership, they are more likely to carry those positive impressions over to other traits, and consider that person more intelligent and dependable as well. We see the halo effect often in our ratings of celebrities: Because celebrities are often attractive and successful, we are more likely to evaluate them with other positive associations as well, such as being kind or intelligent, despite not having any evidence to support that impression.
The halo effect does not only apply to individuals, though. When asked to rate businesses or services — including healthcare — people who have a positive experience in one or more areas are more likely to rate the entire experience as being a good one. What constitutes a positive experience depends on the individual; for example, someone who values tidiness might be upset that their room is not cleaned and straightened up often enough, and thus rate the entire experience more negatively because their experience in one area clouded the entire stay.
The Halo Effect and Satisfaction Surveys
Often, hospital administrators approach patient satisfaction surveys and scores literally. That is, they look at the areas where they are perhaps not up to snuff and focus on improving those specific aspects of the patient experience. While that’s undoubtedly important, by improving the overall experience that patients have with your hospital you can also see an uptick in your overall satisfaction scores. In other words, patients who have a generally extraordinary experience with you are going to rate you higher on the HCAHPS even if every aspect of the experience wasn’t perfect, then a patient who had a less than ideal experience. If the room wasn’t cleaned enough and the food was subpar then those experiences will influence their responses on questions relating to other areas, which may have been excellent.
So how do you “polish your halo,” so to speak? By focusing on the entire patient experience, and identifying the factors that most strongly influence how patients respond to patient satisfaction survey questions, and developing plans to improve in those specific areas. Healthcare administrators are well served to follow the lead of facilities like the Cleveland Clinic, which went so far as to develop an entire department devoted to patient experience and operates under the notion that patients view service as synonymous with quality in healthcare.
Guest post by Stu Sjouwerman, founder and CEO, KnowBe4.
A story about hospital ransomware or a compromised computer seems to emerge weekly. It is no surprise that healthcare breaches have been on a steady increase for the past five years. Loss of personal health information (PHI) poses a financial risk for health care institutions, expected to cost the industry in the neighborhood of 6.2 billion dollars.
By the numbers
Despite the prevalence of cybersecurity incidents, a study by Ponemon Institute in May 2016 showed that the majority of healthcare organizations and business associates were most concerned with negligent or careless employees causing healthcare data breaches.
Sixty-nine percent of healthcare organizations believe they are more vulnerable to a data breach than other industries.
When asked what the greatest threat was to healthcare data security, the majority of healthcare organizations stated employee inaction or error (69 percent). Rounding out the top three concerns were cybercriminals at 45 percent and the use of insecure mobile devices at 36 percent.
Employee error was also the top concern for business associates (53 percent), followed by use of cloud services (46 percent) and cyberattacks (36 percent).
Ransomware is currently one of the most prevalent threats to Healthcare. A June survey done by KnowBe4 of Healthcare IT professionals shows 44 percent of healthcare organizations have been hit with ransomware, 6 percent above the national average of 38 percent. 65 percent of these IT professionals know someone personally who has been hit and another 47 percent would pay the ransom if faced with a scenario of failed backups. With some healthcare ransomware demanding five figures, this can get pretty expensive.
Why hospitals are the perfect targets
I was interviewed by WIRED magazine’s Kim Zetter. She’s written a great article that analyzes why hospitals are perfect targets for ransomware. She started out with: “Ransomware has been an internet scourge for more than a decade, but only recently has it made mainstream media headlines. That’s primarily due to a new trend in ransomware attacks: the targeting of hospitals and other healthcare facilities.”
Now, Who Else Should Be Scared?
Hospitals have shown themselves to be soft targets and are under full attack by several cybercrime gangs using different attack vectors. The SamSam ransom gang attacks server vulnerabilities in JBoss apps using an open source pentesting tool called JexBoss, so these are targeted attacks are based on scans the bad guys did. Cisco technical background:http://blog.talosintel.com/2016/03/samsam-ransomware.html
That is an exception though; the vast majority of ransomware infections are caused by phishing emails. Next are malicious links and ads leading to compromised websites with Exploit Kits causing drive-by-infections.
Guest post by Cheri Bankston, RN, MSN, director of clinical advisory services, Curaspan.
Cheri Bankston
When determining a discharge plan, hospitals must provide a list of home health agencies (HHAs) or skilled nursing facilities (SNFs) that are available to care for the patient; this comes as part of the Conditions of Participation (CoPs) for Discharge Planning. In the case of a HHA, the provider must be able to serve the patient in the area where the patient resides, or in the case of a SNF, the area requested by the patient.
Acute care providers have been struggling on how to set up a high-quality provider network to support patient choice as we move from volume to value. Provider networks aim to gather more information to assist beneficiaries with selecting a high-quality post-acute provider. CMS has not outlined any specific criterion that deems a provider “high quality,” but the end goal is to provide the patient more information on quality performance and resource use at the time they are making a decision Through the Center for Medicaid and Medicare Services’ (CMS) Star Rating program, discharge planners or case managers working for hospitals are able to highlight those provider networks that will best fit the needs of the patient. The networks are able to counsel patients about their available choices, while more importantly upholding the patient’s right to choose.
Under the Affordable Care Act’s value-based purchasing initiative, hospitals are at financial risk for the outcomes of care its patients receive from post-acute care providers, leading hospitals to work towards establishing high-quality provider networks. For many, upholding the standard of Medicare policy – patient freedom of choice – is challenged by potential financial incentives and penalties for the bottom line – the quality of care provided to the patient after discharge impacts the reimbursement levels for hospitals and ACOs. Although provider networks may appear to narrow patient choice, they actually create a set of higher quality post-acute providers that improve patient outcomes without impeding access to care.
Payers have been using “provider networks” for years, but being applied to hospitals is a brand new concept. An ACO’s success depends on using a provider network that has a demonstrated history of high quality of care outcomes. For example, SNFs that have a high rate of patients going to emergency rooms and not being admitted must be evaluated to determine the variance from other providers with the same level of care and fewer emergency room visits. Quality outcomes and patient satisfaction are going to drive the definition of provider networks.
A question that many businesses dither about is whether outsourcing their billing will be profitable to them or not. Third-party services can help make billing smoother as compared to the in-house process that involves using billing software. While some practices think outsourcing to be the right decision because that allows them to make use of the experts, their resources, and the timely manner in which the job is finished. However, others think doing it all in-house will help them maintain control over their practice. Caught in the same conundrum? Don’t worry! We can help! Here are a few reasons why outsourcing is a good idea:
In-house billing is costly
If you have been thinking that outsourcing is expensive then just try adding the expenses of in-house billing and you are in for a surprise. The expenses will include:
What you will be paying the billers
How much employee benefits will cost you
How much the technology systems will cost you
Outsourced billing is less expensive
Outsourcing seems like a good idea for startups, especially small ones, and transitioning businesses dealing with an employee who has resigned.
In-house billing comes with liabilities
A billing department is chock full of liabilities. Here are two of the sources from which said liabilities may originate:
Embezzlement
Employee neglect
Thus, they require constant and strict supervision from the manager all the time.
Obviously, the health care providers in your facility do great work every day. You might even argue that miracles are a common occurrence. But when we talk about halos in health care, we aren’t talking about health care in a spiritual sense. When we refer to a halo, we’re talking about the overall impression that patients and their families have of your hospital, and how it can influence your patient satisfaction scores. Because as it turns out, your HCAHPS scores aren’t always based entirely on the actual patient experience.
