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Radiology beyond the machine

Artificial intelligence (AI) is increasingly permeating medical imaging, but its integration into clinical practice will depend on the capacity of AI technology to facilitate workflow.
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Health system moves from text-only to AI-powered interactive multimedia radiology reports

Health system moves from text-only to AI-powered interactive multimedia radiology reports | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
The University of Virginia Health System wanted to create interactive multimedia reports, believing that radiologists could communicate better through the use of enriched and interactive content
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Using EHR Voice Recognition to Improve Clinical Documentation, Usability

Using EHR Voice Recognition to Improve Clinical Documentation, Usability | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
EHR voice recognition tools at Concord Hospital advance clinical efficiency and boost the quality of clinical documentation.



October 22, 2018 - EHR tools with voice recognition capabilities can help to reduce data entry duties for healthcare providers and free up time for face-to-face interaction with patients.


Hospitals and health systems are increasingly integrating voice recognition tools powered by artificial intelligence (AI) into EHR technology to improve EHR usability, boost clinical efficiency, and reduce administrative burden on providers.


However, questions surround the accuracy of EHR clinical documentation generated through voice recognition software. Some clinicians hesitate to utilize the technology in day-to-day operations. A July 2018 JAMA study found a 7.4 percent error rate for clinical documentation generated through voice recognition tools. Maintaining a high level of accuracy in clinical documentation when using voice recognition EHR tools is imperative for promoting clinician buy-in during health IT adoption.


Optimizing accuracy and clinician engagement was top-of-mind when New Hampshire-based Concord Hospital expanded its use of Nuance’s Dragon Medical One. The hospital went live with Dragon Medical One shortly after launching a new system-wide Cerner EHR implementation. Concord replaced its GE Centricity and McKesson Horizon Clinicals EHR systems with a single, integrated Cerner system in 2017.


“It was a huge project with the full replacement of our enterprise system, including revenue cycle,” Concord Hospital CMIO Paul Clark, MD, told EHRIntelligence.com.


READ MORE: How Providers Use Clinical Documentation Improvement Tools


While many clinicians in the hospital were new to voice recognition software, the hospital’s outpatient providers were already accustomed to the technology before going live with Cerner.


“On the outpatient side, we had a baseline of about 30 to 40 percent of our Centricity users already using Dragon,” said Clark. “We had a pretty high use of Dragon in Centricity. But when we converted to Cerner with Dragon Medical One, the use of voice recognition in all clinical areas became extremely high.”


“The place where it totally changed the experience was on the inpatient units,” said Clark. “Those docs were not using voice recognition. So that was a big conversion for them.”


This high rate of clinician engagement cut the hospital’s transcription costs by nearly 90 percent. Buy-in was especially high among clinicians working in surgery.


“Especially for post-op notes,” said Clark. “In the previous world, clinicians had to write an immediate post-op note. Then they’d come back later and dictate a note. Now, they use templates that allow them to dictate their immediate post-op note, and it also functions as their operative note, so they’re not doing it twice.”


READ MORE: What Are the Benefits of Clinical Documentation Improvement (CDI)?


Cutting data entry completely from clinical documentation has been a significant time saver for clinicians in surgical care settings.


Voice recognition EHR tools have also helped to boost provider satisfaction among nurses.


“Instead of the nurses now typing a narrative from a patient call, they dictate it,” explained Clark. “And at least in one practice, we saw the triage time drop from 17 minutes down to 5 minutes.”


In addition to boosting clinical efficiency, hospital leadership also received feedback from nurses that the software generates high quality notes.


“They preferred it to typing,” said Clark. “A similar situation exists in our preoperative service area, where nurses had to do a lot of work to get people ready who were coming in for surgery. Deploying voice recognition in that space was huge for some nurses.”


READ MORE: AHIMA Fuels Clinical Documentation Improvement with New Toolkits


While clinicians readily embraced the new technology, staff still needed to address the potential for error. 


“There is some error rate, which is frustrating,” said Clark. “People have a hard time in my opinion with proof-reading something they dictated in Dragon.”


Researchers in the recent JAMA study came to a similar conclusion. Zhou, MD et al. found the high error rate of notes generated by voice recognition software was partially attributable to inadequate provider review of clinical documentation.

Ensuring medical transcriptionists or clinicians thoroughly proofread notes before signing off on clinical documentation can significantly improve note accuracy. In the study, error rates plummeted to 0.3 percent after clinician review.


Clark has his own method of proofreading notes in a way that also helps to foster a stronger relationship with patients.


“My clinical work is in geriatrics and I use Dragon for all of my work,” said Clark. “One of the things that I've done — which I'm trying to get other people to do — is dictate my end-of-visit summary in the room, in the patient’s presence.”


“They hear what my instructions are,” continued Clark. “I get to clarify anything they didn't understand. And then when they leave, they get a copy of the exact same instructions. That’s pretty powerful. It also saves me time.”


Reviewing summary notes in the presence of patients may help providers to cut down on administrative burden and time spent after work hours completing clinical documentation review.


By thoroughly proofreading notes, Clark stated the accuracy of clinical documentation generated through voice recognition software is significantly higher than that of handwritten progress notes. 


“We went from illegibility — where virtually no one could read a progress note — to having immediate access to a legible document now,” he said. “This has been a very big win for nursing, with the ability to understand the provider’s plan for the patient.”


Looking ahead, hospital leadership plans to further expand the use of voice recognition software to streamline non-clinical tasks for staff members.


“We’ve now had more and more requests from administration to use Dragon,” said Clark. “We’re looking for other opportunities to leverage voice recognition.”

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EMR v. EHR: Electronic Medical, Health Record Differences

EMR v. EHR: Electronic Medical, Health Record Differences | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
The differences between EMR and EHR have largely eroded but speak to the maturation of health IT use among providers.


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How Text Message Communication Improves Patient Outreach

How Text Message Communication Improves Patient Outreach | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
Text messaging tools made patient outreach more efficient by meeting patients where they prefer.



October 15, 2018 - For Bill Hambsh, CEO of North Florida Women’s Care, patient outreach and communication looked a lot more like a game of phone tag. The process, which ideally would be marked with efficiency and high patient engagement levels, too often left patients and providers stuck in a back and forth of phone calls.


For years, Hambsh and his colleagues called patients to manage appointments. Phone lines would get tied up with schedulers making up to 500 calls a day trying to get patients into the clinic, or patients trying to cancel or reschedule their appointments.


“Trying to get through the volume of calls and the voicemails that were left was just out of control,” Habmsh told PatientEngagementHIT.com in a previous interview. “Previously, filling the slot would require my staff to manage those waiting lists and call the patients.”


The process was convoluted and lengthy, leaving some patients waiting up to 20 minutes to connect with a call center represenative. Eventually, Hambsh and practice administrators found that patients would give up on trying to contact the clinic, leaving the clinic liable for patient no-shows.


And in a specialty marked by high patient loyalty – patients often wait three to five months trying to see their OB-GYN, Hambsh said – that simply wouldn’t do. Call center staffers needed to know when patients were canceling their appointments so they could fill that time slot with another available patient.


READ MORE: Using Text Messages to Boost Patient Outreach in Specialty Care


All of that was too much to handle over the telephone, Hambsh explained.


So North Florida Women’s Care tapped text messaging technology from Luma Health. These tools reach out to patients when it is time to schedule an appointment, allow patients to confirm or cancel or reschedule appointments, and even connect with new patients recently referred by their primary care.


The decision to implement text message outreach was an easy one, Hambsh said. The technology was automated, meaning there was little room for human error and could bring a level of efficiency that was unprecedented at North Florida Women’s Care.


“Within 15 minutes, I could pretty much tell this was something worthwhile,” Hambsh recalled. “The main reason for that was because of the abilities to take some manual processes that we had in the office and convert them into a fully automated system.”


The tool was also cost efficient, Hambsh said, which for better or for worse is always an essential question for any organization adopting a new technology.


READ MORE: Healthcare Orgs Tap Text Messages for Patient Appointment Reminders


Additionally, implementing the tool proved relatively simple – or at least a simple as these digital overhauls can be. Armed with the knowledge that organizations get bogged down during the technology implementation process, Hambsh was sure to select a vendor that would work alongside him and practice administrators to iron out the details of implementation.


Hambsh and his team also decided to do an incremental implementation that made it easier for call center staffers to become accustomed to the text message technology.


The results have been positive, he added. For one, patient no-show rates have gone down.


“Keeping my docs busy actually has reduced my no-show rate by half,” Hambsh reported. “This is partly due to the fact that, previously, patients calling to cancel or reschedule their appointment would sit on the phone holding for 10 to 20 minutes, due to the volume of calls that a call center department was managing.”


Now, he continued, patients can send a text through the secure messaging tool saying that they cannot make the appointment. And as a result, it is easier for Hambsh and his team to get other patients in the door.


READ MORE: Using Automated Patient Outreach to Improve Patient Communications


The text messaging tool has also increased the clinic’s referral conversion rate by 25 percent. As noted above, it was difficult for call center staffers to get in contact with new patient referrals because the phone was not always a convenient method of communicating.


Using the text message outreach, North Florida Women’s Care was able to identify itself to referral patients and reach those patients where they are.


The text messaging platform has also opened the door for overall practice improvement, Hambsh explained. Analytics gleaned from the messages have proven helpful, as have tools aimed at addressing online reviews.


Previously, the clinic’s online review presence has been less than stellar as mostly outlier patients have published negative online reviews to different websites. A patient with a good experience usually is not moved to leave a review unless prompted, Hambsh explained. This is because patients expect their care to be good.


The text messages provide that opportunity to prompt patient reviews.


“We ask through text messaging for the patient to rate their encounter from one to ten,” Hambsh stated. “If they score between eight and ten, it links them to whatever review cite we want online, from Google, or Facebook. We can use that to build up our scores on different sites. If it's less than an 8, we do an internal survey, and it allows us to manage the feedback internally, and keep that from being publicly reported.”


Text message communication proved effective because of the patient panel the clinic serves, Hambsh acknowledged. By nature of the specialty, most of the patients visiting North Florida Women’s Care are younger and more tech savvy, meaning they are poised to adopt text message outreach into their healthcare experiences.


Of course, North Florida Women’s Care leverages other patient engagement technology, primarily the patient portal.


“We have a patient portal and I feel it's pretty robust,” he said. “But our utilization of the portal was not near as high as I wanted it to be. And, I think it's just a challenge of people remembering their logins, and passwords and, how many different things they have to track.”


Text message outreach is a more accessible and more streamlined approach to patient engagement, Hambsh added.


However, technology is not a panacea, Hambsh acknowledged. While the text message communication has improved patient relationships with the practice, there are some things that cannot be resolved with a digital message. Delivering bad news, for example, will still require a telephone call or in-person visit, Hambsh explained.


“There are times when technology is inappropriate and you do need to talk to the patient traditionally over the phone,” Hambsh concluded. “With abnormal test results, it's not something you want to be told by text message, that you've got breast cancer.”


But that is in cases where the provider needs to have a deeper, more detailed conversation about patient care, he said. As more organizations look for more efficiency with patient outreach, technology can help fill in gaps.


Paramount to those efforts will be utilizing technologies that are most salient to the patient population at hand.

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Health and fitness app usage “grew 330% in just 3 years” #esante #hcsmeufr #digitalhealth

Health and fitness app usage “grew 330% in just 3 years” #esante #hcsmeufr #digitalhealth | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it

"The data, from Flurry Analytics, also shows that engagement is high, with three quarters of active users opening their health and fitness app at least two times a week, and more than 25% of users access their fitness apps more than 10 times a week.

Key findings:


• Many fitness and health app users are loyal to their favorite apps, with 96% using only one health and fitness app. Over 75% of active users open their health and fitness app at least two times a week, and more than 25% of users access their fitness apps more than 10 times a week.


• Over the past year, mobile health & fitness apps have grown 9%, with the highest growth coming from studio and fitness content apps (49%). Comparably, nutrition apps have declined in usage by 26%.


• Workout and weight loss apps are hugely popular, accounting for nearly three-fourths of all health and fitness app sessions. This trend can be attributed to wearables like fitness bands, which encourage users to track their weight or exercises daily.


• Fitness app usage correlates with seasonal workout habits! The holiday season marks the lowest activity, followed by a peak in January (after people have made their New Year’s resolutions). Naturally, summer is also a popular time when people are accessing health and fitness apps — app usage is about 24% higher than the yearly average.


Flurry data shows that of active health & fitness app users, 96% are using only one health & fitness app. As seen in the app loyalty matrix, health & fitness apps show the highest retention rates across all categories. This indicates that users are dedicated to their fitness apps once they start using them.


Over 75% of active users open their health & fitness app at least two times a week. Also, there is a remarkably high percentage of Fitness App Addicts: more than 25% of users access their fitness apps more than 10 times a week.


As a result, this frequency of usage drives up overall category engagement. For app developers, this presents an attractive opportunity to capitalize on users’ frequent engagement and boost monetization.


Year-Over-Year Growth is Slowing Down


Since 2014, we have seen massive growth in the health & fitness app category. In just three years, usage grew by over 330%. However, since 2016, growth has slowed down: while we saw a year-over-year growth of 178% from 2014 to 2015, the health & fitness app category only grew by 9% from 2016 to 2017. This correlates with the trends of the overall app industry.
To understand this slowdown in more detail, Flurry segmented the health & fitness market into four sub-categories: Workout & Weight Loss, General Health, Nutrition, and Studios & Fitness Content.


The largest subcategory, workout & weight loss, shows a significantly slower growth than in the previous year: year-over-year growth is down from 67% in 2015 to 11% in 2016. The other major subcategory, general health, revealed stagnation in the last two years. While nutrition apps declined in the last year, we still see a 49% growth for studio & fitness content apps. The negative trend of nutrition apps is likely influenced by studio & fitness content apps that are offering nutrition content in addition to their core focus.
Track, Set, Go: Workout & Weight Loss Apps Gain Market Share


Workout & weight loss apps account for 73% of all health & fitness app sessions. This represents a substantial gain from a 55% share in 2014. Working out and tracking weight loss are key use cases for health & fitness app users. While general health apps still held a usage share of 41% in 2014, workout & weight loss apps have eaten away large portions of it within the last three years. Wearables, such as fitness bands and smartwatches, have been key growth drivers for that development. According to Kantar Worldpanel ComTech, 15.6% of consumers owned a smartwatch or fitness band in December 2016.


Apps are no longer optional for Fitness Studios and Health Clubs


Studio & fitness content apps registered the largest percentage increase in the category: Since 2014, studio & fitness content apps grew by over 830%. In 2014, studio & fitness content apps were accountable for 2% of all health & fitness sessions. By 2017, the share increased to 5%. Users continuously declared that they want to arrange their studio visits through a mobile application. This trend makes it crucial for gyms and studios to offer an app that lets their users conveniently schedule their workouts and classes.


Fitness App Usage Correlates with Seasonal Workout Habits


Fitness app usage can be described as highly seasonal: in the last months of a year, fitness app usage declines and hits rock bottom when the holidays approach. December 25th marks the lowest activity with 57% less usage than the most active day of the year, which is August 8. Usage picks up again in January after users have made their New Year’s resolutions and set their fitness goals for the coming year, and it builds up toward the summer, peaking in August. In the last three years, August has always been the most active month by an average of 23% higher usage than the yearly average. From September on, usage decreases again toward the holiday season.


Fitness app activity throughout a week strongly aligns with user workout habits. Users are most motivated to work out from Monday through Wednesday. Once the weekend nears, app usage declines; Saturday marks the lowest activity by 10% fewer sessions than the weekly average.


Flurry data shows that health & fitness app usage peaks in the morning and evening. People work out before or after heading to work. According to Fitbit, the busiest gym workout times are between 9-11 am and 5-8 pm. Surprisingly, the highest app usage period occurs at around 10 pm. While some people are doing a late-night workout, others might be reviewing their daily activity or planning their next day. For developers, this represents a unique opportunity, as this is a rather unusual peak time for engagement. App developers can leverage the higher engagement for specific marketing and re-engagement tactics.


The future of health & fitness apps and tips for app developers


Health & fitness app users are the most loyal users in the app industry, with high retention rates, engagement, and frequency of usage. A significant share of heavy users with more than ten sessions per week drives constant engagement. That makes this market segment very attractive for app developers. On the other hand, it can also be hard to acquire active users given people typically stick to one fitness application. Fluctuating engagement levels make it crucial for developers to focus on peak times during weekdays in the morning and evening.
Gartner forecasted that there would be over 310 million wearables sold in 2017, which would be an increase of 16.7% to 2016. A study from PwC shows that the number one reason for people purchasing a wearable device is health. This indicates a substantial growth opportunity for health & fitness app developers in the next year.


Read the full report here


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Use your words! Sorting through the confusing terminology of artificial intelligence


"Use your words! Sorting through the confusing terminology of artificial intelligence
AI, machine learning, cognitive computing, neural networks? Supervised, unsupervised, semi-supervised? Object recognition, natural language processing? What does it all mean?"

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Learn Why Doctors Look To Data To Increase Patient Engagement

Learn Why Doctors Look To Data To Increase Patient Engagement | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it

As doctors aim to increase patient engagement in their practice, many are starting to turn to data to better understand patient needs.

For many reasons, several of which we’ll discuss here, a patient’s full understanding of, and engagement with,their health care experiences are vital for a positive outcome. And today, we have more options than ever for achieving higher levels of interest, patient engagement, and “buy-in” from health care customers. These include data-rich wearables, telemedicine for housebound patients and electronic health records that follow us around as we switch providers or seek treatment from specialists.


We’re positively swimming in data. But all that noise stands a good chance of confusing or distracting patients from their ultimate goal of ongoing good health if doctors and patients don’t come to the table together with a plan and a common understanding of which data points are meaningful in context and which are not. 


There’s no doubt anymore: Big data is going to revolutionize the way we administer health care throughout the world and help us achieve financial savings. But as doctors look to leverage modern tools for interacting with and sharing patient health data, there are several factors to remember and several key advantages worth checking out. Here’s a rundown.

Data in Long-Term Treatment for Chronic Diseases

Regrettably, we still lack a cure for many chronic diseases. Therefore, doctors and their patients must instead “manage” these conditions. It’s possible to live a full and active life while undergoing treatment for severe diseases and conditions, but only with the right levels of vigilance and engagement. Patients with chronic illnesses must maintain their motivation, their attention to treatment and medication schedules and their general knowledgeability about their condition.


Chronic diseases are particularly well-suited to data-driven treatment because they come with unique challenges:


  • Maintaining a working knowledge of how the condition and treatments are progressing is vital for patients to keep good morale.
  • Lapses in treatment can add to the overall costs of treatment, which is why vigilant adherence to treatment plans, as laid out by doctors and specialists, is so important.
  • Not every chronic condition requires constant trips to the doctor’s office. In many cases, self-management of these cases is possible, and patients can independently administer medicine and engage with their health outcomes without regular trips to a doctor’s office or exam room.

Working together, doctors and patients can use real-time and historical health data to better understand the individual’s holistic health and draw up bespoke treatment plans for their unique circumstances. One part of the equation involves applying predictive models to anticipate future changes or unexpected turns their health condition might take.


For instance, gathering and organizing data from a large number of insured people lets data-driven health care systems and insurers more accurately take into account social and geographical “determinants” for future patient health.


This process can help break down a health care system’s roster of patients by risk type — such as proximity to environmental conditions with known connections to patient health.


Plus, not everybody has a history of responding the same way to known pharmaceutical treatments. And not every patient is equally likely to make the lifestyle changes recommended by their doctors. We’ve entered an era in health care where insurers and doctors will eventually begin requiring patients to wear health and fitness monitors as a matter of course. Doing so ensures everybody remains on the same page and that doctors can draw the most personalized conclusions possible from the reams of data such devices collectively produce.

Natural Language Processing, or “Once More in Plain English”

Health care is a product, like it or not. And whether we’re purchasing that product on some convoluted health care exchange, or we live someplace where health care is an understood right of being a citizen, we all buy into this product one way or another.


But even in countries where a single-payer system spreads out the liabilities and costs among patients and consumers and helps drive down prices for everybody, health “literacy” is still a real problem almost across the board.


We all know the jokes about doctors’ handwriting. But that’s not the kind of literacy we’re talking about. Often, the valued customers of the world’s health care systems lack even basic knowledge about human health or turn to poor sources of information, such as doctors who skate by on name recognition alone.


The situation only becomes worse when you consider the chorus of medical jargon patients must digest as they visit physicians and specialists for what ails them. Here’s why poor health literacy is detrimental to health outcomes:


  • Patients who don’t understand their situations in full are less likely to adhere to medication and treatment schedules consistently.
  • Lab results tend to include medical terms patients don’t necessarily readily understand. And the generally poor doctor-to-patient ratio in the U.S. and elsewhere means doctors don’t always have the time to make sure patients leave their practices feeling confident and informed. Misinterpreted lab results are common as a result.
Natural language processing has had a long road to relevance as the technology has slowly come of age. But in 2017, researchers from Yale, the University of Massachusetts and the Veterans Administration applied natural language processing algorithms to the task of demystifying electronic health records, or EHRs, to make them more easily digestible for laypeople. They wanted to see whether a computer algorithm could promote better communication about health.

It did. Indeed, it worked so well it outperformed the researchers’ expectations, even with unsorted and unlabeled data from patient evaluations. Another 2018 study, now made public by e-health publisher JMIR, confirmed the original findings: When patients and health care providers use natural language algorithms, themselves powered by big data and machine learning, patients have a far and away more complete understanding of their health.


After a few tweaks to the systems, researchers even found patients’ ability to recall complex medical definitions later had improved further.

Lower Costs Are Just the Beginning

It’s true we frequently measure the quality of health care in dollars and cents. It’s also true that when deployed sensibly, emerging technologies can help bring down costs for everybody. But that’s just the start. Here are some of the other advantages of applying data to solving lackluster patient engagement:

  • Health care systems can pivot from reactionary to proactive treatment as health databases become richer with relevant patient data.
  • Algorithms are already making it much easier to match patients with relevant clinical trials that might deliver results. Using data encourages hesitant patients and ensures the most compatible matches.
  • Hospital readmissions might drop as a result of doctors and patients having more tools for anticipating setbacks in the recovery process.


When we empower people with knowledge about the condition of their bodies, they make better lifestyle choices. And when that happens, we enjoy a healthier population overall. It shouldn’t come as a surprise, but the effectiveness of our communication and the quality of our information are two of the keys we need in hand to build a health care system that works the way it’s supposed to.

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How to build a lifetime of patient value

How to build a lifetime of patient value | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


In an era of value-based care that places an increased emphasis on health outcomes, engaging with patients throughout their journey is critical and these are now possible using telehealth and mobile technologies.


Today, it’s all too common for healthcare providers to treat patients on a one-off, situational basis based on information provided at the moment. A patient’s healthcare journey doesn’t begin or end with a single appointment or medical procedure. On the contrary, it is a continuous cycle that requires consistent, personalized attention and communication throughout a patient’s lifetime to ensure optimal health outcomes.


Providers and health systems need to keep this at the forefront, and focus on delivering value and care throughout the patient’s healthcare journey. This is no small task, but a new breed of patient relationship management technologies are providing critical support for value-based clinics and physicians to maintain regular interaction with patients, support improved health outcomes and enhance the patient-provider relationship.


Value-Based Care and the Patient Journey


Under the new tenets of value-based medicine, providers are compensated based on patient outcomes and experiences, rather than on completed appointments and procedures. Consequently, healthcare providers are incentivized to deploy solutions that help them more quickly and effectively deliver care to their patients that drive maximal outcomes.


Rather than focusing on individual appointments or hospital visits, value-based care drives a more holistic approach to the patient journey. The patient journey starts before a patient’s first office visit and continues all the way through end-of-life care. It includes medical appointments and procedures, but also the care and wellness in between visits. Appointment reminders and confirmations, education about specific ailments or procedures and guidelines on how to prepare for a procedure are among the types of regular communication patients require throughout their journey to keep them informed and engaged.


To comply with the new goals under value-based care, providers are modernizing their infrastructure and processes to sustain the relationship management required to provide adequate patient guidance to maximize health outcomes.


Telehealth: Providing Patient Value Across Distances


The patient-to-primary care physician ratio in rural areas is 13.5 fewer physicians per 100,000 people than in urban locations. Similarly, there are only 30 specialists per 100,000 people in rural communities, versus 263 specialists per 100,000 patients in urban areas. In an effort to better reach and serve patients in rural areas, providers are increasingly adopting telehealth technologies.


The federal Health Resources and Services Administration (HRSA) defines telehealth as the “use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.”


Earlier this year for example, the Centers for Medicare & Medicaid Services (CMS) unveiled its first Rural Health Strategy to improve patient access to high quality and affordable healthcare in rural areas of the U.S. Objectives within the strategy include the adoption of health IT to enhance patient access to health information and removing barriers to implement telemedicine. For example, Alabama, which ranks 46th for both overall health and diabetes, uses telehealth technology to educate diabetes patients and provide them with the tools they need for more effective self-care and self-management for optimal well-being.


Telehealth technologies support the

patient journey by removing barriers such as distance and access, making it easier for patients to not only get to care, but also to maintain control of their own health with the tools they need to sustain the level of self-care required in between doctor appointments and follow-ups. Though not yet widespread, a recent MGMA poll among practices found that 26 percent of organizations offer telehealth services, compared to 23 percent the previous year, and that another 15 percent plan to offer them in the future. Efforts such as that of CMS are likely to help telehealth continue to grow even further in the future.


The power of mobile


There is also an ongoing cultural shift within the industry that recognizes the role of the patient as a consumer. Consumers use mobile phones to manage almost all aspects of their lives, such as banking, making dinner reservations, shopping for groceries and scheduling babysitters. It is logical for the healthcare industry to follow this path to the mobile device to drive patient-provider communications and engagement.


Modern patient relationship technologies leverage the power of mobile to help patients manage their healthcare journey and to allow clinics to become more effective delivering care. Based on data from thousands of providers, results show that clinics that deploy mobile-first text messaging, for instance, (and automatically feed that data into the EHR system for smart waitlists etc.) communicate more effectively with patients. This includes:  


  • 45-50 percent patient response rates, compared to the current industry average of 10 percent


  • 15 percent increase in patient capacity utilization


  • 25 percent lower patient cancellation rates


  • Monthly referral schedule rate of 65 percent, compared to the 54 percent industry average


New advances in mobile technology also power clinical feedback and advice to ensure consistent guidance throughout the patient journey. Bot-powered text messaging can be customized based on medical specialty or the type of procedure in order to address the specific requirements of each patient. For example, if a patient has a scheduled colonoscopy, a few days before the procedure they will  receive customized text reminders from their physician to ensure they are following the correct procedures, such as avoiding high-fiber foods in the days before, or taking a certain medication. Communication can continue after the procedure as well, reminding patients to get plenty of rest and fluids and to make sure their recovery is on track.


In this age of advanced technology, provider-patient communication too often occurs in the form of pre-appointment emails or voicemail reminders. As providers continue to adjust and adapt to the ubiquitous use of mobile, so will the patient frustration decrease and clinic capacity increase. The metrics of success depend on delivering the right care to more patients effectively and at scale


What can we expect for the future?


In an era of value-based care that places an increased emphasis on health outcomes, engaging with patients throughout their journey is critical. Telehealth and mobile technologies enable providers to connect and engage with patients before and after appointments, as well as in-between to provide pre-emptive guidance and self-management instructions. These efforts and technologies provide patients with control of their patient journey and they will only become more important. We’re only now seeing the beginning of how modern technology can improve the healthcare system as a whole. Ongoing advancements to extend physicians’ ability to easily view and track patients’ medical history and treatments will further power the patient journey and build a lifetime of value for patients through constant education and improved access to care.

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Le dossier médical électronique européen verra-t-il le jour ?

Le dossier médical électronique européen verra-t-il le jour ? | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it



Le transfert de données de santé entre différents pays de l’UE qui est déjà encadré par le RGPD pourrait bien s’élargir avec la création d’un dossier médical électronique européen pour chaque patient. Comme le signale cette publication de presse européenne, deux pays membres de l’UE préparent déjà la mise en place d’un système d’échange de dossiers médicaux électroniques.


L’Estonie et la Finlande ont travaillé pour que les premiers échanges aient lieu dès la fin de l’année 2018. L’ambition affichée est d’étendre cette pratique à l’ensemble des pays membres de l’UE, comme l’a annoncé la ministre de la santé estonienne Riina Sikkut lors du forum européen de la santé de Gastein. Il semblerait d’ailleurs que des pays tels que la République tchèque, le Luxembourg et Malte travaillent également à la mise en place d’échanges transfrontaliers de dossiers médicaux électroniques. Côté français, cette question d’un dossier médical électronique européen ne semble pas encore avoir été franchement posée mais suivra probablement la mise en oeuvre du dossier médical partagé (DMP).

Pourquoi créer un dossier médical électronique européen ?

La raison du transfert des dossiers médicaux électroniques entre pays membres de l’UE tient dans la facilitation de la mobilité des citoyens au sein de l’Union. Actuellement, le passage d’un patient entre deux pays membres conduit régulièrement à ce que son dossier médical demeure dans le pays initial : toutes les informations sont « bloquées ».


L’objectif est donc de mettre en oeuvre un dossier médical électronique uniformisé dans tous les pays de l’UE qui permette à toute équipe médicale en charge du patient de disposer des antécédents médicaux et de toute information utile sur sa santé. Cela signifie d’abord qu’un format de données unique, commun à tous les dossiers médicaux électroniques, devra être discuté et implémanté dans tous les pays membres de l’UE. Mais cela implique aussi que des discussions aient lieu au sujet du contenu précis des données de santé amenées à être proposées dans le cadre de ce dossier médical électronique européen. 


A l’heure actuelle plusieurs initiatives interétatiques ont été lancées pour vérifier le bon fonctionnement des échanges de dossiers médicaux électroniques mais nous sommes encore loin d’un mécanisme commun à tous les pays de l’UE. 


S’agissant de la situation française dans ce dossier, on peut se demander si le dossier médical partagé français (lancé uniquement dans quelques départements de France après des années de travail, souvenons-nous que le DMP est prévu depuis une loi datée du 13 août 2004) serait adapté à un tel transfert vers un autre pays membre de l’UE. Il faut espérer qu’après tant d’années de développement, ce DMP pourra être adapté aux éventuelles exigences du future dossier médical électronique européen. 

Jean-Christophe Lévêque's curator insight, October 18, 3:35 AM

Que peut-on attendre du Dossier Médical européen? Certains pays comme la Finlande ou l'Estonie s'y sont préparés. En France, il faudra déjà disposer du DMP sur tout le territoire et voir comment l'adapter pour l'UE. #MBAMCI #hcsmeufr

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How are doctors using tech for patient engagement?

How are doctors using tech for patient engagement? | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


In a survey of more than 200 physicians, respondents said they're currently using various types of technology — including digital waiting room screens, mobile apps and exam room tablets — to engage or educate patients.



The healthcare industry relies on technology for numerous purposes — billing, scheduling, and documentation, to name a few. And a new survey found providers are increasingly relying on tech to engage patients.


The poll from patient engagement business PatientPoint and nonprofit think tank Digital Health Coalition included responses from more than 200 doctors. The survey was powered by physician social network SERMO.


Ninety-five percent of physician respondents said they sometimes or nearly always use technology to better educate or engage with patients.


“I think a big reason why we’re seeing such high utilization of patient engagement tools is because physicians truly believe in the power of technology to provide better care,” PatientPoint founder and CEO Mike Collette said via email.


Indeed, 77 percent of surveyed doctors agreed technology helps improve patients’ overall experience.


Digging deeper, the survey asked what types of tech physicians are currently using to engage or educate patients. The top answers included digital waiting room screens (58 percent), mobile apps (46 percent) and exam room tablets (44 percent).


Collette noted these tools all allow providers to have more meaningful conversations with patients. He explained:


"The waiting room screens empower patients to ask about treatment options, enroll in patient portals and adhere to preventive screenings and immunizations. In the exam room, patients can take a deep dive into their condition alongside their doctor via rich media like anatomical models and videos. Then patients can continue their education and conversation with their doctor on mobile apps before and after their visit, bringing things full circle."


Other solutions currently in use by doctors included check-in tablets (34 percent), digital screens in the back office (33 percent) and interactive touchscreens in the exam room (28 percent).


When asked about which types of technology they’re interested in utilizing in the future, 52 percent of doctors pointed to check-in tablets. Additionally, two key locations stood out as important touchpoints: the waiting room and the exam room. Thirty-six percent of physicians are interested in digital waiting room screens, while 45 percent want exam room tablets and 44 percent want interactive touchscreens in the exam room.


Collette said these two spaces — the exam room and the waiting room — are pivotal, and that doctors see the benefits of engaging individuals there.


But patient engagement doesn’t only happen in the office. That’s perhaps why 54 percent of physicians said they want help connecting to patients before and after their visits. Those surveyed said they’re interested in using a variety of technologies to connect with patients outside the office, including email (59 percent), mobile apps (48 percent) and SMS texting (39 percent).

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Docs Say Patient Engagement Technology Drives Education, Experience


Ninety-five percent of physicians employ patient engagement and education technologies, which in turn improve patient communications and experience.


By Sara Heath | October 09, 2018 - 


Physicians overwhelmingly support the use of patient engagement technology as a means to improving patient education and patient-provider communication, according to a recent survey conducted by SERMO on behalf of PatientPoint and think tank Digital Health Coalition.


The survey of 200 respondents revealed that three-quarters of physicians link patient education and engagement tools with an improved patient experience.

Because of this promise of better patient experiences, most providers are integrating patient-facing tools into their practices. Ninety-five percent of respondents said they were using some type of patient engagement tool, whether it be a waiting room education screen, handheld exam room tablets, or mHealth tools that connect patients to care outside of the clinic.

Dig Deeper


As a result, patients are becoming more informed of their care, physician respondents said. With better patient education comes more meaningful patient interactions, showing that these technology investments are paying off.


Physicians also say that patient engagement technology has been instrumental in bringing healthcare into the 21st Century. While exam rooms were previously filled with posters and models of different health and body systems, they are now being filled with digital engagement tools.


About half of respondents said they were planning on installing digital patient engagement tools in their exam rooms.


What’s more, providers have no qualms with having these tools be sponsored by pharmaceutical company advertisements. About three-quarters of respondents said they would approve of ads from pharmaceutical companies appearing on their patient-facing technology so long as the tool bear little financial investment and include detailed and contextualized patient education.


Going forward, healthcare professionals are looking for technology that creates administrative simplification. With easier healthcare processes, providers should be able to dedicate more time to patient interactions.


Two-thirds of physician respondents said they are interested in voice-controlled technology, such as Google Home or Amazon Alexa. These tools could be useful for documentation, answering patient questions, and communicating with practice staff.


These technologies could also reduce physician burnout and open the door for more meaningful patient interactions.


These survey results demonstrate that healthcare providers are leaning toward a more patient-centered and technology-driven future, said PatientPoint founder and CEO Mike Collette. As organizations begin to create a more futuristic view of healthcare and the healthcare facility, health IT vendors will see greater opportunities.


“The results from our survey are clear: physicians are embracing patient engagement technology and are looking to integrate it across important touchpoints to better educate patients and optimize the patient experience,” Collette said in a statement. “This positive view of technology—and knowing that pharmaceutical brands can play a role—represents significant opportunities for brands to better connect with patients and physicians during the office visit as well as before and after.”


Additionally, these findings underscore the promise health technology holds for improving patient-provider interactions, said Christine Franklin, the executive director for Digital Health Coalition. While many industry stakeholders have been wary of the burden technology could place on patient-provider interactions, physicians are beginning to realize that technology can also enable patient relationships.


“Our data confirm that physicians see technology as a valuable part of their practice of medicine,” said Digital Health Coalition Executive Director Christine Franklin. “They see, understand and most importantly are excited about how future innovations in the space are poised to transform how they interact with and educate patients.”


Over the past decade, value-based care models have pushed the healthcare industry toward more patient-centered care. Health IT has emerged as a key tool in that pursuit. Patient portals have been instrumental in connecting patients to their care, while in-office engagement tools have worked to boost patient education and digitize the patient experience.


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MGMA18: What every doctor needs to know about social media, according to ‘KevinMD’ | FierceHealthcare

MGMA18: What every doctor needs to know about social media, according to ‘KevinMD’ | FierceHealthcare | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


BOSTON—Kevin Pho, M.D., is an internal medicine physician. But he’s probably best known as “KevinMD,” the doctor who is the founder and editor of the website that bills itself as “social media’s leading physician voice.”


His website, KevinMD.com, provides a forum for thousands of physicians to write about topics that range from how to achieve financial success, to the lessons learned from dying patients to surviving a medical liability lawsuit.


“One reason why I became a doctor was to give patients a voice—a voice when they are at their most vulnerable. Clinicians also needed a voice and that’s one of the reasons why I started KevinMD. I wanted to be their voice," said Pho, who advised doctors and practice managers on how to harness social media to help transform healthcare at the Medical Group Management Association annual conference in Boston last week. 


Social media provides doctors with a way to connect with patients and to be heard, said Pho, who practices in Nashua, New Hampshire, and has over 140,000 people subscribed to his email alerts that direct them to the site’s latest content.

RELATED: For physicians, social media can be tricky to navigate


His social media journey began in 2004 when his brother-in-law commented that he had lots of opinions and told him he should start a blog. “I had no idea what a blog was,” Pho said. “Honestly, I wasn’t sure where this was going to go or how long this was going to share.”


It was when he wrote about the recall of the drug Vioxx over safety concerns and reassured patients there were other options that he said he realized the tremendous potential of social media to connect with patients. Yet lots of doctors are reluctant to jump into the social media pool, he said.


They are skeptical, say they don’t have the time and don’t see how it will make a difference. But today, not having an online presence isn’t an option, he said, citing three ways social media can benefit practices.


Among them:

Social media can strengthen the clinician-patient relationship. Seven out of 10 internet users use the web to look for healthcare information, Pho said. With 72% of people looking online for health information, the problem is “fake news” or unreliable information.


“Fake news is not only a problem in politics; misinformation online is a problem in healthcare,” he says. For instance, parents who look for information about infant sleep will find that fewer than half of the websites are accurate.


RELATED: More surgeons rely on social media to learn about new techniques, practices


Doctors can be a filter for all that information for their patients and use social media to educate them, he said. For instance, California pediatrician Robert Hamilton, M.D., has a YouTube video on how to calm a crying baby that’s been viewed over 1.8 million times. An orthopedic surgeon in New York City, Howard Luks, M.D., answers patients’ common questions on his website.


Social media can define an online reputation. Social media is also a powerful way to define your online reputation, Pho said. 


More than 40% of people look online for information about physicians. Clinicians should Google themselves once a week and see what comes up because that is what patients are doing, he said.


RELATED: 5 influential ER docs on Twitter—A scientific approach


On third-party review sites, patients are rating doctors just as they rate books, movies, hotels and restaurants. By creating content online, through social media sites such as LinkedIn and Twitter, doctors can help control what patients will see. One-third of patients will click on the first result in a search, and fewer than 10% of people will read the second page of results.


Whenever he coaches clinicians, Pho said he advises them to be aware of their privacy settings on social media accounts and use the maximum settings.


Clinicians should create a bio and post a high-resolution photo that will come up in a search. Create a professional presence on a site such as LinkedIn or Doximity, the social media site for physicians. Take a few hours to do that and then stop. You can take an incremental and cautious approach as you start to use social media.

There is a return on investment with social media, he said. “Finding and connecting with new patients is by far the most powerful and direct one.”


RELATED: Hospital Impact—To improve patient engagement, leverage the power of digital content


Social media can make doctors’ voices heard. There are stories doctors and other clinicians need to share, Pho said. Those stories can make people realize that doctors are human, too. For instance, a doctor may write about the challenges of being a physician and raising a family. Clinicians may write about burnout and depression and let other healthcare professionals know they are not alone.

Humanizing healthcare professionals and making their voices heard “has emerged as my primary social media goal. KevinMD is now a prominent, public platform,” he said. “I’ve shared hundreds of these stories.”


“The biggest risk of social media is not using it all in healthcare,” he said. “It’s an opportunity we cannot miss.”

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HIMSS Analytics delivers a state of the health IT industry report

HIMSS Analytics delivers a state of the health IT industry report | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
The research firm examines where EHRs, cloud, blockchain, telehealth, security and other technologies are today – and where they might be headed.


By Tom Sullivan  | October 09, 2018


For National Health IT Week 2018, HIMSS Analytics delivered new research exploring some key trends, looking closely at established software infrastructure and emerging technologies alike.


"What we're seeing as far as a state of the market is acceleration beyond the EMR," said Blain Newton, executive vice president of HIMSS Analytics. "We're seeing it manifest in a few different ways."


Those post-EHR technologies and trends include blockchain, cloud computing, security, precision medicine, supply chain, telehealth and, of course, network infrastructure. 


Electronic health records. EHRs are a key piece of the health IT infrastructure and the market segment is very mature with near universal adoption, according to HIMSS Analytics data – but only 2 percent of hospitals have a single vendor enterprise EHR.


Instead, the average system has 15 vendors across its affiliates — making the next issue a complex mess. "We're seeing migration past the EMR as a foundation as well as retrofitting how we create scale and secure infrastructure," Newton said.


Interoperability. With mega-mergers such as Dignity and CHI and CVS Health and Aetna – as well as Amazon's partnership with JPMorgan Chase and Berkshire Hathaway – significant challenges are arising amid the hodgepodge of EHR vendors.


"Creating a secure environment where interoperability can happen is not a challenge of desire," said Newton. "It's very technical."


Telehealth. Whereas the U.S. has surpassed a 50 percent adoption rate for telehealth capabilities, the average hospital has upwards of five different products installed, meaning it has yet to widely reach enterprise-level deployments. The surprise HIMSS Analytics found in its data is that the highest adoption levels for telemedicine tools are among non-profit hospitals with 100 beds or fewer.


"For a technology that the ROI is not yet entirely clear, you're seeing nonprofits with a very significant lead in adoption, presumably to reach out to rural populations," said Newton. "Either way, it's an unexpected view, we thought it would be large hospitals." When asked whether they plan to invest in telehealth in the next two years, 27 percent said yes, 18 percent said no and 55 percent said they weren't sure.


Precision medicine. In contrast to EHRs' near-ubiquity and telehealth on the rise, precision medicine adoption today is limited. The top three reasons are a lack of funds, technologies, and the clinical expertise necessary to undertake such programs. That said, 45 percent of respondents to HIMSS Analytics research said they plan to expand precision medicine work, while 23 percent do not and 32 percent are unsure.


Security. This should come as no surprise, but Newton said that "healthcare is absolutely a target," for nefarious attacks as 29 percent of breaches last year hit healthcare, a higher rate than any other industry.


"Twelve percent of hospitals do not have basic IT security systems," Newton said. "That's a bit frightening because whether you're the Mayo Clinic or a rural provider in south Dakota, you're a target." Protecting health data is one of the reasons more hospitals are looking to the cloud. But it's not the only one.


Cloud computing. Sixty-five percent of hospitals currently use cloud services in some capacity, and Newton said that it's expected the majority of EMRs will be cloud-based by 2020. Among the reasons healthcare organizations move to the cloud: 37 percent said it's for disaster recovery, while 25 percent said the cloud lowers current IT maintenance costs, another 25 percent answered that it'd sue to a lack of on-site IT staff or expertise and 13 percent do so to meet the need for a scalable always-on app or service.


"There's a significant component just looking at baseline IT costs, regardless of the motivator, the cloud is coming, on-premise is a thing of the past," he said. "It has really shifted wholesale here because of efficiencies and levels of service. I would expect this to continue increasing." 


Blockchain. Blockchain is still in the hype stage, to be certain, though it also appears that some early days type of activities are happening with 50 percent of health org's either investigating or building a business case around Blockchain, and doing so with plans to run a proof of concept in the next 24 months.


But payers, pharma and tech vendors are moving more quickly than healthcare providers, which may be hanging back to let the others figure it out first. Non-providers, in fact, are twice as likely as providers to conduct a proof of concept or pilot in the next two years.


Patient-generated health data. This was another surprising finding. "Organization said they are at least moderately prepared for consumer-generated data," said Newton. While more than 80 percent of patients are already expecting to see data in their record, in fact, 67 percent of hospitals are looking to invest. Just don't expect it to happen quickly.


"When we talk to CIOs, they flat out said this is an issue of data governance," he explained. "We don't believe we have adequate governance in place to manage consumer generated data."


Supply chain. Acknowledging that a better name for supply chain in this context might be utilization management and resource stewardship, Newton described it as "one of the biggest things we see happening."


Four of the top 10 predictive technologies are supply chain management related and hospitals should proactively invest in clinical infrastructure for tools that alert clinicians to risk or enable traceability that helps determine which products or people are safest and most cost-effective, as well as technology to enable learning systems.


"I see this as becoming something significant over the next 18 months or so and becoming much more enterprise focused as folks look to drive down costs and improve care," he added. "We see this as a powerful new capability that organizations are looking to go after."

What it all means

Broadly speaking, the state of HIT today is a digitized system now in place and a renewed investment in infrastructure to harness that and drive emerging trends such as predictive analytics, patient engagement and population health on the road to value-based care.
Some of it is being done on the EHR foundation while other work is more about retrofitting older technologies to create secure infrastructure scale that accordingly.
"People are looking up and saying the infrastructure we put in place 10 years ago isn't robust enough today," Newton said. "It's a mix of true innovation and securing things built to support a tech stack from a few years ago."


Twitter: @SullyHIT
Email the writer: tom.sullivan@himssmedia.com

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Designing for consumers means leaving no one behind

Designing for consumers means leaving no one behind | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it
Connected Health Conference panelists will cover digital literacy, health equity and patient-centric design.


Both in the consumer and clinical worlds, it’s important not only to design for the user and involve them in the process, but also to realize the full scope of your user base, and make sure no one gets left behind.


Considering the user is a vital step in teasing out the human element of connected health, and a number of speakers at this month’s Connected Health Conference will be tackling that issue, including Senior Director of Connected Health Innovation at Partners HealthCare Kamal Jethwani, and Tufts University School of Medicine Associate Professor and Recycle Health founder Lisa Gualtieri.

“This isn’t designed for me”

“Who are our personas? Who are our patients? What are their lives like?” Jethwani said to MobiHealthNews. “What happens in their life that we need to fit in with — versus designing a system that they have to modify their entire life to be able to use. That’s something that in the early stages is really important to understand because if you don’t consider that, you’re not going to develop something that works for them.”


This is easy to say, but can be hard to implement when even the simplest UI aspects could have unconsidered implications for particular subsets of patients. Gualtieri gave a particularly striking example.


“One of the apps that we were using, you had to put in your date of birth and it was dials — so the default is 2018 and then you start spinning it,” she said. “And it was a few people who were spinning this to get to — you know these were older adults and as they were spinning it, they were like ‘I really have to spin this a long time’. And you know, they were kind of joking, but I thought, why make somebody feel bad? Why make someone feel old? It’s not increasing their excitement about using this. It’s making them think it’s not really designed for them.”


In testing out an automated text message system for people with diabetes, Jethwani also got a reminder to challenge his assumptions about patients, although in this case smart technology was able to correct for the oversight.


“We saw someone was getting messages at three in the morning and we thought ‘This poor person is getting messages in the middle of the night’ So we called to make sure we weren’t completely off base,” Jethwani said. “One of the first things he told us was he loved the program because it sent him messages right as he was getting out of work. And the machine learning algorithm figured it out on its own through trial and error. And nowhere in the medical record did we have any data about him being a night shift worker or any of that. We were giving him insulin and treatment on a regular schedule.”


This need to consider all kinds of patients extends to the consumer world as well. As the founder of Recycle Health, a nonprofit that collects used fitness trackers, refurbishes them, and provides them to people in need, Gualtieri’s focus is often on those kinds of connected activity trackers. She said when Recycle Health provides trackers to older people, they often express that they had previously avoided the devices because they thought they weren’t for them.


“If you look at how Fitbit advertises, it’s very much kind of the young healthy people,” Gualtieri said. “I’ve only seen one Fitbit ad that had someone with grey hair, and it was this guy whose daughter gave him the Fitbit because she was engaged and she wanted him to look good and fit into his suit for her wedding. And while I totally get that as a marketing ploy, it really bothered me because it’s not about feeling good, it’s not about prevention of chronic disease. It’s about one day."

Other barriers to access

Of course, in addition to feeling excluded by design or marketing choices, there are many other barriers that keep people from using, appreciating or benefitting from digital health tools. Cost is a major one, and Recycle Health was founded in an effort to start to address the fact that there were populations that could benefit from health tech but didn’t have access to it. Recycle Health has used its supply of donated trackers to help a wide variety of groups including homeless populations, low-income schoolchildren and older adults. For example, Gualtieri described one project with a homeless shelter in New Jersey.


“These people’s primary concern in life is that they don’t have a home, they don’t have a job. So what they’re trying to do is help people to turn their lives around. And while they’re in residence there they’re also trying to teach them about nutrition, fitness etc. For a lot of people what they found was that it’s not that they didn’t care, it’s just that they cared about a lot of other things more,” she said. “With the trackers, what they were able to do was [make the experience] fun instead of one more thing that you have to learn to take better care of yourself.”


Designers also need to consider what kind of technology — up to and including smartphones — their patients, users or members might not have access to or the digital literacy to use.


“One thing we didn’t really expect but were surprised by is the extent to which people have smartphones but don’t really know how to use them, have pay-as-you-go phones or early version phones that they really can’t download apps to, or people who have a phone but they’ve never downloaded an app themselves,” Gualtieri said, discussing some research she has been involved with on digital literacy in older adults. “And that becomes a huge barrier, not just for using a tracker and the associated fitness app, but also for the wealth of digital health innovations that are taking place.”


Finally, designers need to understand not just who their users are, but where they are in their life, which can change their motivation — and their need for intervention — drastically.


“if you’re pregnant and there’s a limited amount of time to change your behaviors because that’s going to affect your baby, we find that those patients are very motivated to do something, they’re very ready to change, and in a lot of those cases our programs work really well and we don’t have to work hard for engagement,” Jethwani said. “Versus patients who have had diabetes for 15 or 20 years, and they’ve lived with it, and they don’t face symptoms on a day-to-day basis have lower motivation to change. In that case we try more things like gamification and other motivational patterns so you can get them to a point where they’re taking care of these sorts of things.”


Gualtieri said that many physicians don’t realize how major of a life change retirement is for older adults, and how it can affect motivation to work out or take care of oneself.


“A lot of people have this really dramatic change in their lifestyle and one of the things that we’re really interested in is how can trackers help with that and also how can data reflect these changes so that their physician can work with them,” she said.


The Connected Health Conference starts Oct. 17 at the Seaport World Trade Center in Boston.


Jethwani will be presenting on two sessions: “From Hype to Reality: How to Make AI Work for You” on Thursday the 18th at 10:40 a.m. and “What it Really Takes to Build a Connected Health Solution: Separating Myth from Reality” at 12:40 p.m. Oct. 19.


Gualtieri will be moderating the session “Designing for Equity” at 1:40 p.m. Oct. 19.

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Study: Free online consultation tool sees frequent, worldwide use by physicians

Over a roughly two-year period, Medscape Consult saw more than 310,000 physician users hailing from 171 different countries across the world.


Many physicians of various ages and geographic locations are turning to online medical consultation tools as an additional resource when providing care, according to a recent investigation published in npj Digital Medicine.


Conducted jointly by the Scripps Research Institute and WebMD, the study found that 310,563 unique physicians had used WebMD’s Medscape Consult — an online, free-to-use platform for physicians seeking second opinions — between November 2015 and October 2017.


Among these, 37,706 were “active users” who generated a total of 117,346 unique posts (7,834 original queries, 109,512 responses) during this time. The majority of these posts received at least one reply, with a median time to first response of roughly 90 minutes.


While users most often hailed from the US and Europe, the full user pool represented 171 separate countries on every continent. The mean age of all Medscape Consult users was 54.5 years, while those who created original queries skewed younger at 44.7 years. The most common primary specialties among active users were internal medicine, pediatrics, cardiology, obstetrics and gynecology, and dermatology.


Why it matters


Expert consultations can reduce medical diagnostic errors, but a number of factors including access and affordability can limit cross-specialty collaboration, the researchers wrote. Further, they noted that little data has been published on electronic consultations within closed systems, little was available involving open, crowdsourced, peer-to-peer networks — of which Medscape Consult is the largest.


The results, they wrote, suggest “extraordinary” global reach and use across age and specialty.


“Artificial intelligence has been advocated as the definitive pathway for reducing misdiagnosis. But our findings suggest the potential for collective human intelligence, which is algorithm-free and performed rapidly on a voluntary basis, to emerge as a competitive or complementary strategy,” the researchers wrote. “While there are certainly more refinements and study of this platform required, we have demonstrated an extraordinary reach and potential for a multispecialty, crowdsourced, global virtual consultation platform at scale for physicians in search of diagnostic input.”


What’s the trend


WebMD’s Medscape Consult launched in late 2015 as a physician-focused complement to its better known consumer health education services. But WebMD’s open platform isn’t the only approach — others, such as RubiconMD, offer a more focused ecosystem for providers to request specialist consultations through an app, and guarantee a response to queries within 24 hours.

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Striking a balance between patient-centred care, tech solutions and accessibility to increase drug adherence


According to a report published by the World Health Organisation, only about 50 per cent of people take their daily medications correctly. Drug non-adherence is costing people their lives and over US$700 billion each year in avoidable medical expenses. As healthcare providers and governments try to find new ways to ensure their patients follow prescriptions properly, the dignity and respect for patients must be at the forefront of any solution.


Healthcare providers are exploring different approaches to increase drug adherence. The age-old method of asking patients is tedious and inaccurate, resulting in patients lying due to guilt or embarrassment. Other proposed methods include bio-monitoring devices and urine tests, which are inconvenient, demeaning and costly. No one wants to handle bodily fluids or feel like they are being monitored because they cannot be trusted. Some providers have tried paying patients to adhere; however, studies have showed this method to only be effective in the short term and only with unsustainably high pay outs, while also calling into question ethics.


The common problem with these solutions is that they further disrupt patients’ lives and take agency away from patients. Managing chronic illness is already a life altering task and it is imperative that any solution to adherence does not cause further disruption.


Patient-centred care has shown the most promise for increasing drug adherence, shifting the focus from the patient’s disease to the patient themselves, identifying their individual needs and concerns, while empowering them to collaborate with providers on their treatment. If a patient feels that they can make an impact on their health, they are more likely to do so. In addition, engaging families as part of a patient’s care has been shown to be one of the most effective tools in long-term disease management.


While multifaceted, at its core patient-centred care is all about fostering relationships between patients and providers. Developing these relationships takes time and requires human-to-human interaction. However, the busy schedules of healthcare professionals can make implementing these plans difficult.

Searching for technological solutions to non-adherence must walk the tightrope of making patient-centred care less time consuming while keeping care individualised and human. Tech solutions are often promising on paper but end up being isolating and cumbersome user experiences. New tech can also clutter up users’ lives, adding yet another gadget they have to keep up with. But the answer to increasing drug adherence may already be in our pockets.


Cell phones are the perfect tool to solve non-adherence, offering an unobtrusive way to connect providers and patients on a platform that is already a staple of daily life.


When patients confirmed a pill had been taken via a text, they showed a 30-37 per cent increase in adherence. Allowing patients to confirm their dosage gives them the agency to feel they are taking control of their care and it is also convenient, not requiring a significant or complicated change to their daily routine. Deploying cellular devices to tackle non-adherence allows some tasks to be automated, such as reminders and step-by-step medication regimen, while simultaneously providing a direct line for personal communication and feedback between caregivers, patients, and friends and family in the care network.


The systems we design must keep patient experience at the forefront and, because phones are so commonplace, we must also jump at the opportunity to harness their unprecedented power to collect data on patient outcomes.


By harnessing the power of blockchain-based applications, immutable data collection can be automatically pooled with existing health service databases to help create new benchmarks for drug performance. Mobile phones can offer insights on treatments by drug, demographics, and doctor on a scale that has never been seen before. Utilising these data sets, providers can improve decision making, tailor care strategies for better outcomes and decrease medication errors.  


Curating these real time, widespread data sets will also be paramount in the implementation of AI technology for the healthcare networks of tomorrow. Mobile phones hold the power to help facilitate this transition, optimising the tech of the future while helping treat the patients of today. By simply engaging patients on unified networks now, we can minimise back logging and pedantic data collection in the long run.


We must introduce unified, highly sophisticated solutions that aid in providing the highest quality patient centred care. However, almost paradoxically, the more tech solutions we introduce, the more they must blend into the background, focusing care on person-to-person interaction and integrating into the tech that is already part of our everyday lives.


So much of what we do is based around our mobile phones. They are the ultimate multi-tool for navigating the modern world. Deploying them to tackle drug non-adherence is a no-brainer and provides a simple, unobtrusive way to save millions of lives and billions of dollars in avoidable healthcare costs.


Nicholas Rumble is the founder and CEO of Curaizon.

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Moving Beyond the Portal with Patient Engagement Technologies

Moving Beyond the Portal with Patient Engagement Technologies | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


Patient portals have created positive connections with consumers, but additional patient engagement technologies can help move the provider-patient relationship beyond basic transactions.


As value-based payments push healthcare towards a culture of patient-centered care, organizations are looking for patient engagement technologies that offer more meaningful relationships than what are typically available through a basic patient portal.  


Patient portals have played a valuable role in introducing consumers to new methods of engagement with their providers.


In pursuit of meaningful use requirements earlier in the decade, organizations invested heavily in their patient portals. By 2015, nearly 90 percent of both eligible providers and hospitals offered patients access to the portal, and most patients followed up with portal registration.


But a 2017 analysis from the Government Accountability Office (GAO) found that despite those high numbers, patient activation on the portal left a lot to be desired. Only 15 percent of eligible providers and 30 percent of hospitals saw any patients view, download, or transmit their patient portal data.


This is likely because the patient portal does not always intuitively serve the needs of patients, especially those requiring more complex care.


Portals are geared towards enabling patients to access their health records, and perhaps conduct some administrative interactions, but they have not always offered a comprehensive hub for engaging in their own care.


“When it came down to trying to help patients manage chronic illness or the post-hospitalization time period, the portal was really manual,” Cynthia Burghard, a research director at IDC Health Insights, explained in an interview with PatientEngagementHIT.com. “The portal required the patient to go and do something. But the paradigm is starting to shift and there's starting to be an understanding that it's not about adding one more burden to the patient.”

Instead, organizations are exploring how to leverage additional patient engagement technologies and features to supplement the capabilities of patient portals and create seamless, holistic experiences for users.


What are the best patient engagement technologies to supplement patient portal use? What are the benefits of these tools? And how do healthcare organizations select and implement these technologies?


Patient portals may be ubiquitous, but they are not entirely living up to their potential.  


The 2017 GAO report on portal utilization found especially low levels of use among rural populations, senior citizens, and patients of smaller physician groups.


In addition, patients who believed themselves to be generally healthy rarely accessed the portal, stating that they saw little need to continually look at their health records, since they were not expecting to see any significant changes to their medical histories.


Patients have also expressed frustration with the design and user experience of portal tools, with 41 percent of participants in a 2016 Software Advice poll stating that they have given up on using their portals after getting overwhelmed with an inability to navigate options.


Providers have also shown tepid attitudes towards a technology that was required for eligibility for the EHR Incentive Programs, but didn’t necessarily bring an immediate return on the investment.  When providers are unenthused about the prospect of using portals, adoption rates in their practices suffer, found a study from the Journal of Medical Internet Research.


Patient portal developers have tried to encourage more adoption by adding new features to complement the basic view-and-download functionality, with varying degrees of success.


Between patient data access and secure messaging systems, these tools allow patients to connect with their providers in a way that was difficult before health IT came onto the scene.


Many patient portals have also begun to integrate online self-scheduling, bill payment, and chronic disease management tools.


However, negative perceptions of what patient portals can offer, coupled with the challenges of integrating new tools into provider workflows, have left many patients and providers feeling just as frustrated as before.


More than a third of participants in the Software Advice poll pointed out that even when they sent messages to their providers, administrative staff rarely responded in a timely manner, if at all.


And a 2017 report from the Medical Group Management Association (MGMA) found that providers are often unsure of how to adopt and best utilize innovative functionalities like appointment scheduling.


MGMA noted that while 80 percent of patients have accessed a portal, only 38 percent have managed to schedule appointments using the technology.  Just 58 percent of providers have made efforts to alter their scheduling practices to adapt to new patient preferences.


Patient portals also fall flat for paying bills online.

Nearly 65 percent of patients would prefer to pay their bills online, according to a 2018 surveyfrom InstaMed. However, separate data shows that few organizations offer these tools, or even have the ability to offer them.


A 2017 Black Book survey revealed that only 20 percent of healthcare organizations are poised to offer digital bill pay to patients, meaning organizations have either not leveraged patient portal bill pay functions or that those functions are insufficient.


Whether healthcare providers want to create more comprehensive experiences within their existing portal technologies or adopt separate, add-on tools that achieve similar goals, they must be aware of what their patients are asking for - and must focus sufficient attention on crafting new interactions that best meet their needs.


Patient engagement technology makes it easier for patients to interact with the healthcare industry, can create a better experience, and ultimately support better care outcomes.


About half of all patients prefer booking appointments online, and 42 percent of patients said they choose a provider based on their digital appointment scheduling offerings, according to a Doctor.com survey.


Ultimately, offering patients access to online scheduling is an essential part of shifting to more consumer-centric healthcare models, according to Banner Health’s chief marketing officer, Alexandra Morehouse.


Just as restaurants realized they needed online reservations to remain competitive, healthcare organizations will need digital appointment scheduling to stay on top of consumer healthcare trends, she said.


But when considering a switch to a new self-scheduling system, organizations may wish to maintain their telephone systems. Some patient populations may still be more welcoming of traditional appointment scheduling procedures.


“Anybody over the age of 40 is probably going to be calling to make an appointment because they've been trained to do so,” Morehouse noted. “That's all they know, and they like the personal connection. They're much more likely to have a personal relationship with the doctor and with the doctor's receptionist.”


Organizations should also consider the usability of the tool as a way to create patient buy-in, Morehouse added.


“The trick is the tool really does have to be faster and easier,” she explained. “If the interface is clunky or if it makes patients wait for a long time to get an appointment, they won't use it.”


Following implementation of an online appointment scheduling system, organizations see numerous benefits, according to a 2017 study from the Informatics Institute at the University of Missouri. Benefits include reduced wait times, increased patient-centeredness, and reduced no-show rates.


However, there are some challenges to adoption. For one, adopting an online appointment scheduling system, especially if it is used in tandem with phone call scheduling, can be a significant workflow change. Call center administrators must now integrate a new technology into their daily processes and determine how to operate a system which the patient controls.


Additionally, the tools could limit appointment flexibility. A system’s predetermined appointment slots may not allow for a patient who needs an extended appointment for a complex case. Triaging patients may also be difficult with web-based solutions.


However, most real-time solutions still require a human presence for monitoring, the study authors explained. These workers are in charge of ensuring patients do not book non-urgent appointments in urgent time slots, or overriding requests for longer appointments about complex cases.


Online appointment scheduling systems ultimately benefit the patient because they help connect patients to care in a way that is most convenient for them, according to Dave Kriesand, the vice president of the Consumer Experience Center at Banner Health.


“As healthcare continues to evolve, we want to be present in the channels where our consumers want to interact with us,” Kriesand said. “Previously, our main channel was the telephone for scheduling an appointment with a provider. Now, we will have both phone and digital, making it very easy for our consumers. By having a presence in both digital and phone channels, we are available to our consumers at times and in avenues that are most convenient to them.”


Before selecting and implementing a new appointment scheduling system, organizations may consider the following:


  • Does this platform overcome the barriers posed by my patient portal’s self-scheduling systems?


  • Is the platform easy to navigate? Does it clearly display days and times that are available?


  • Does the platform help patients identify different providers and their specialties?


  • Is the technology usable for professionals in the call center?


The healthcare billing process is a significant source of frustration for healthcare consumers, with 70 percent of patients saying that convoluted bills and payment systems increase dissatisfaction with the healthcare industry, according to a 2018 survey from InstaMed.


In fact, complex billing is so problematic that 65 percent of patients said they would switch practices if the new one promised easier payment processes, the survey showed. Digital bill payment tools could simplify that process.


Regardless of whether online bill pay lives in a third-party application or on the patient portal, healthcare organizations may wish to consider the digital tools to better serve their patients.


For Max Tselevich, CEO of the Doctor, a Medical Services Management Company, using a text messaging platform helped his patients manage their financial responsibility. Following a doctor’s appointment, Tselevich’s administrative team sends patients an introductory text message reviewing the online bill pay technology and alerting patients that they will receive their bills within a few days.


The administrative team then follows up that message with another text, this time containing a link to an online bill pay portal. Patients can view their bill, see a charge list, and enter their payment information.


“Sending a paper statement to a millennial or leaving a voicemail is about as useless as a hamburger driving a vehicle,” he stated in an interview with RevCycleIntelligence.com.

The text messages resonated with his young patient panel, and digital bill pay made it easier for patients to make payments.


In an era where three-quarters of millennial patients are likely to skip out on at least some of their financial responsibility, creating a bill pay process that is convenient - and reaches patients directly on their mobile devices - could improve revenue collection.


But other organizations looking to install online bill payment systems will need to bear in mind the habits and preferences of their own patients. Those treating older patient populations may consider using email bill notifications because those modes of communication may be more comfortable for that population.


Ultimately, it is about reaching patients where they want to be reached. Providers implementing digital bill pay may wish to maintain their more traditional bill payment options, such as cash, check, or credit card, because these may be more preferable to some patients.


Patient-facing healthcare tools and mHealth apps are key to improving chronic disease management. These technologies personalize healthcare, make it easier and more convenient for patients to take care of themselves, and engage patients outside the four walls of the hospital or clinic.


In turn, healthcare becomes more proactive and patients become in charge of their own care, according to Michael Adcock, who works on telehealth and remote patient monitoring for the University of Mississippi Medical Center.


“We’ve got to teach people how to take care of themselves instead of trying to take care of them, especially with patients with chronic diseases,” Adcock stated.


Remote patient monitoring tools offer opportunities for real-time health interventions. If a patient takes her blood sugar and it’s 200 points higher than it was the day prior, those results push to the top of a nurse’s triage dashboard and prompt a call to the patient.


Eventually, patients learn to avoid those calls by making better health choices and engaging in wellness behaviors, Adcock explained.


Providers can use mHealth apps and chronic disease management technology to deliver the patient education necessary for making healthy decisions. As technology advances, these tools are becoming more sophisticated and are delivering more personalized health, according to Burghard, the data scientist from IDC.


“Currently, medicine is not personalized,” she said. “How do I get information that's about me, not just a generic, ‘call your doctor in the morning, take two Advil?’ Those are some of the issues that consumers have and we're starting to see technology respond to that.”


Wearable devices and remote monitoring tools are enabling continuous interactions with providers and apps that offer personalized advice and insights.


The key to making these patient-facing apps successful is ensuring patients actually use the tools. In addition to providers promoting these tools, app developers need to create technology that meets patient needs.


According to a 2017 study from the University of Pittsburgh School of Health and Rehabilitation Sciences, the traits that yield patient activation and prolonged self-management include:


  • Ease of use and the app registration process


  • Aesthetic appeal and engagement


  • Level of user education


  • Inclusion of a social support system


  • Use of personal health information (as opposed to a generic education app)


“Tracking health trends and receiving information based on those trends was a common topic of discussion,” the researchers said. “The ability to receive basic guidance or advice for self-management based on the information being collected through the mHealth app seemed to increase a sense of independence for the participants.”


Integrating these options into a portal or other communication tool can help keep providers up to date on a patient’s health changes while fostering a two-way relationship that could improve adherence to treatment programs.


Selecting and implementing new patient engagement technology poses a challenge for healthcare organizations, just as any technology installation could. Organizational leaders are faced with difficult decisions about which vendors to select, how to implement new tools, and how to assess success.


To begin the process, organizational leaders should first determine their patient needs. Do patients need a self-scheduling option that makes it easier for them to contact someone at the organization? Are patients asking for a bill pay option that’s delivered right to their inbox? Determining patient and organizational goals will inform ultimate decisions regarding vendor selection.


Once leaders understand their own priorities, they must assess their many options. Organizations may ask themselves which vendors will work with them and accept feedback, or which have features that address organization goals.

Organizations may wish to consider vendors that offer a mobile-optimized tool, Burghard said, because these tools are more dynamic and can serve many different populations.


“Regardless of what one's age is, no one goes anywhere without a mobile phone,” she pointed out. “We do so much of our business with a mobile phone or a tablet.”

Mobile-optimized tools are easy to transport and can be easily accessed at any time, Burghard added.


After selecting a vendor tool, leaders can begin the implementation process. How long will this process take? Who are the key stakeholders? How will this new tool impact office workflow?


Leaders should tap nursing leaders, technology developers, administrative leaders, and physician officers to help support the transition based on which departments and processes will be impacted by the new technology.


Electing champions to endorse the technology and connect with more resistant staff members will also help ease the transition, according to the University of South Florida Health.


“It’s vital to understand the possible frustrations of those who will be impacted by the implementation,” the organization wrote on its website. “Without this empathy, there will be no way to effectively address those frustrations.


Whether you are trying to convince your employer to implement new tech, or you are the employer who is championing the implementation, it will be beneficial to talk with people who will be affected by the change. It’s also necessary to understand that no one technology can solve every problem.”


Throughout the entire selection and implementation process, organizations should consider the voice of the patient. A 2018 report from the Health Care Transformation Task Force recommended organizations use patient advisory councils, quality improvement committees, patient advocate offices, consumer insight surveys, and focus groups to determine patient input.


A better understanding of patient values could yield more effective patient activation with different tools. When patients have a say in the design of an online bill pay tool, for example, it could lead to higher patient adoption rates.

While patient advisory councils should not get caught up in the less pressing details of technology design—the colors of the interface, for example—they can be helpful in determining whether that interface is navigable.


Organizations may also wish to implement new tools and new workflows incrementally. This will give both staff stakeholders and patients the time necessary to adjust.


Ultimately, the selection and implementation process will require a careful knowledge of organizational and patient needs. Adopting a new technology is typically a costly endeavor, so it will be essential for organizations to identify their gaps in care and access. From there, organizations can select the most effective patient engagement technologies for their population needs.

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Where do patients share physician reviews online? 5 survey insights

Where do patients share physician reviews online? 5 survey insights | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


Written by Jessica Kim Cohen | September 26, 2018 


"Facebook is one of the most common places patients share physician experiences online, but users don't use the social network to assess their next provider, according to a survey from Binary Fountain, an online reputation management company.


Binary Fountain commissioned market research firm OnePoll to conduct its survey on digital engagement among healthcare consumers. From July 11-13, OnePoll polled more than 1,000 American adults who reported having a physician.


Here are five survey insights into how patients share their healthcare experiences online:


1. Roughly half of Americans (51 percent) indicated they share their healthcare experiences using either social media or online review sites, a 65 percent increase from Binary Fountain's 2017 survey results.


2. Millennials are most likely to share their healthcare experiences online, with 70 percent of those between the ages of 18 and 34 reporting they have done so.


3. Facebook is the most used channel to share healthcare experiences online for older millennials and Gen Xers (ages 25 to 54). Among younger millennials aged 18 to 24, Google is the most common online platform to share healthcare experiences.


4. The majority of Americans (70 percent) indicated online ratings and review sites have influenced their decision when selecting a physician. Forty-one percent of patients said they checked online ratings and reviews of their physician, even when referred by another provider.


5. A few of the common websites patients use to select a physician are the hospital or clinic's website (34 percent), Google (29 percent), WebMD (18 percent), Healthgrades (15 percent) and Facebook (12 percent)."


To view Binary Fountain's survey, click here.

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Why Cellphones Might Be the Next Great Public Health Tool | Healthcare Analytics News

Why Cellphones Might Be the Next Great Public Health Tool | Healthcare Analytics News | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it

"In spring 2015, Liberia was suffering a deadly Ebola outbreak. It wasn’t the first time the virus had gripped the African nation, and it was unlikely to be the last. But there was something different about this particular outbreak.

The distinction, however, was not found in the particular strain of Ebola or even its toll on Liberia’s population. Instead, it was a change in how public health researchers used technology to contact — and learn from — patients and people on the ground.

>> READ: mHealth Is Powered by Potential but Dogged by Dubious Studies

Researchers from New York University’s College of Global Public Health and Tandon School of Engineering issued a poll and received responses from 6,694 individuals — via text messages sent to their cellphones. The 10-question survey focused on how Liberians were using maternal health services during the outbreak. The effort revealed a decline in hospital-based births, which returned to typical levels once the Ebola outbreak was quashed, suggesting that people were afraid to visit the hospital, according to a new study describing the campaign.

But these findings supported a much larger implication: The study demonstrated how cellphones and text messages can be useful public health tools, especially in times of crisis.

“While text messages will not replace national surveys, they can capture changes in health behavior more nimbly,” noted lead author Rumi Chunara, Ph.D., M.S., an NYU assistant professor of computer science and engineering and global public health. “With appropriate methodological approaches, they can be a valuable tool for population health intelligence that allows us to quickly target the affected regions with public health messaging or deploy appropriate interventions.”

Typically, public health researchers and government responders survey affected populations by household or healthcare facility. This process can take months, and emergencies such as a viral outbreak can cause delays or even sink such efforts.

Chunara’s finding — that the number of in-hospital births “significantly decreased” during the Ebola outbreak — further illustrated this problem. If public health officials hoped to reach people through health institutions, they would have been out of luck.

“If you want to deploy treatment or interventions, you need to know if people are coming to hospitals or staying in their communities,” she added.

Cellphones solve that problem.

In Liberia, 81 percent of the population had a cellphone plan in 2015. To incentivize participants, researchers promised them 50 cents in phone credit, a tactic that has proved successful in other cases.

Still, the study was limited in that younger, more affluent and educated nature of cellphone users, posing an obstacle to gathering data that are representative of the population at large. But researchers used propensity score matching to balance population factors, according to the study.

Finally, they concluded that drops in the number of births occurred in both public and private hospitals.

In the future, this sort of digital campaign can be used to provide insights into flu epidemics, as individuals who come down with the illness don’t always seek medical treatment.

“As mobile phone ownership, and even smartphone use, is growing even among poorer segments of the population, and given its low cost, with appropriate methodological approaches, it can be a valuable tool for population health intelligence,” the researchers included.

And such an arrangement could even evolve to help governments and experts push forth digital health interventions."

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Art Jones's curator insight, October 5, 2:12 PM

Excerpt: “As mobile phone ownership, and even smartphone use, is growing even among poorer segments of the population, and given its low cost, with appropriate methodological approaches, it can be a valuable tool for population health intelligence,” the researchers included.

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Medical documentation AI system Sopris Health raises $3.4M


The Denver-based startup designed an AI system that lets doctors capture their conversations with patients and transfer those notes to EHRs.


By Laura Lovett

October 02, 2018

Yesterday Sopris Health, an artificial intelligence company designed to help with medical documentation, scored $3.4 million in a recent funding round. This time the Denver-based startup was funded by Access Venture Partners, Cue Capital, Tallwave Capital, Cedars-Sinai Accelerator, Techstars and Rockies Venture Fund. The financing comes in the form of new cash and conversion of promissory notes. 


The Sopris system includes a smartphone platform and smart watch app. It alsoworks as an artificial intelligence medical scribe app. When prompted the system has the ability to capture the physician’s conversation with a patient, according to the company, and can then automatically generate structured SOAP notes for the physician to review.


The Impact


The technology helps clinicians with EHR documentation and other paperwork required in their practices. Clinical documentation and EHRs has been a long-standing complaint among physicians.


A recent finding from the University of California's Riverside School of Medicine, for instance, listed EHRs as one of the biggest contributors to physician burnout. The report cited other EHR-related hurdles including HIPAA-restricted access to outside records, time at home finishing EHR records and unreadable cloned patient notes as additional factors. 


What's the trend 


Perhaps due to the increase in physician burnout, more and more companies are kicking off their own voice-powered doctors assistants. In early September Notable, a voice-powered artificial intelligence wearable for doctors, picked up $13.5 million. Similar to Sopris, the technology can capture information from a doctors visit and then recommend appropriate actions and integrate with EHRS. 


In May Robin Healthcare, another voice-enabled AI device designed to help doctors and clinicians write clinical notes, emerged from stealth mode. Additionally, voice-enabled doctor assistant Suki raised $20 million in the spring. 


On the record


“The additional investment bolsters Sopris Health’s growth trajectory and maintains its momentum as they scale across practice segments, EHRs, geographies and practice titles,” Kirk Holland, managing director at Access Venture Partners, said in a statement. “This funding round also helps Sopris Health continue building the smartest AI assistant platform, ensuring its promise to give physicians back time is fulfilled.”

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Understanding the Patient’s Role in Addressing Patient Matching

Understanding the Patient’s Role in Addressing Patient Matching | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


"Patients are well-positioned to vet health information and help address patient matching challenges.



October 02, 2018 - Patients may have a key role to play in the healthcare industry’s pursuit of addressing patient matching and health data exchange challenges, according to a new reportfrom the Pew Charitable Trusts.


With the industry well on its way to completing a transition to digitized patient records, providers and health data managers are encountering an issue with patient matching. Known as the practice of determining whether health records refer to the correct specific individual, patient matching is essential to ensuring quality healthcare, the Pew report authors explained.


“Yet in order for patients, doctors, nurses, and other clinicians to have this information, EHRs must be able to share data among the many different hospitals, offices, and other facilities where individuals seek care—especially when health care providers are seeing new patients and need to obtain information from previous care providers,” the report authors said.


“Effective data exchange also helps clinicians get information to treat individuals with chronic conditions— approximately a third of Americans—and older adults, who often see more than 10 different physicians at dozens of office visits per year.”


Patient matching has presented as a considerable problem throughout the country. Lacking data standards, typos, missing patient information, default or null values, similar information, information changes, and identity fraud can all lead to duplicative or mismatched medical records.


READ MORE: Can Patient Verification, mHealth Apps Improve Patient Matching?


Within a singular organization, patient matching can be as low as 80 percent, the report revealed, meaning one in five patients cannot be matched to their medical records. Match rates between organizations can be as low as 50 percent.


And when patient matching remains inadequate, patients are exposed to numerous safety problems. If a mismatched record does not contain a major allergy to a medication, the patient becomes liable to an adverse reaction, for example. Lacking patient matching can also result in costly repeated tests or delays in care.


This most recent Pew report highlighted various strategies to improving patient matching, including a strategy for enlisting patient expertise in medical records matching.


“Efforts to improve matching may be able to leverage patients’ ability to engage in their health care by giving them a more active role,” the report authors wrote. “Such an approach would represent a paradigm shift in matching, but it may face challenges in ensuring widespread adoption and utility for different patient populations—such as elderly, disabled, and low-income individuals.”


Pew developed the strategy in partnership with the RAND Corporation. Using different health technologies, Pew and RAND researchers say patients can help verify medical records information.


READ MORE: New Tool to Simplify Patient Data Access, Medical Records Request


For example, using a patient’s unique smartphone number on file, the patient can verify whether the medical record belongs to her.


During patient intake, the administrative worker would send an automated text message to the patient’s cell phone. The text will generate a confirmation code. If the message and code align with the patient’s cell phone number, the clinic or hospital will know they are accessing the correct patient chart.

The report authors also proposed using smartphone apps that contain unique patient demographic and health-related information. When connecting the smartphone to the provider’s EHR, healthcare professionals will be able to determine whether the patient information and the EHR data match.


“This information, in aggregate, would improve matching by ensuring that health care organizations can match records based on accurate, up-to-date data, including identifiers unique to an individual,” the report authors explained.

“These applications could serve as virtual clipboards to replace the patient manually filling out demographic data on paper forms when arriving at facilities. Instead, a patient would enter this information only once, which would then be reused and sent electronically in lieu of at least some data needed on paper forms.”


READ MORE: Arguing for Patient Data Access Amidst Provider Pushback


Of course, there are some challenges, the report acknowledged. For one, these strategies are not ideal in an emergency situation, or a situation in which the patient is unable to participate in the verification process. Additionally, pediatric patients may not have their own smartphones, negating the tool as a unique identifier.


Provider focus group also told Pew they had concerns about patients entering their own medical information, stating that this could still generate errors or typos. Additionally, infrastructure concerns about building new APIs could prove burdensome.

However, focus groups and researchers agree that creating patient-empowered strategies for patient matching holds some merit.


Experts looking to develop this strategy may look into the feasibility of adding a phone number as a form of patient identification, convene to iron out the technology details, and work to build a prototype, the Pew researchers recommended.


The report also addressed other solutions to the patient matching challenge, including developing and using other unique patient identifiers such as a national patient identifier, using demographic standards, and using referential matching.


Regardless of approach, there are essential themes for expert consideration, the report stated.


“First, regardless of the approach taken, a nationwide strategy will require coordination to identify the needed best practices; commitments from health care organizations and technology developers to implement agreed-upon standards; and patient involvement,” the report authors concluded.


“Second, no solution currently exists that could achieve perfect—or even near-perfect—match rates for all patients, but actions can be taken to better link records. Third, although some opportunities exist to make meaningful, incremental progress in the near term, more robust change will require the use of new approaches and technologies.”

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Seven Outcomes of Successful Patient Engagement Strategies

Seven Outcomes of Successful Patient Engagement Strategies | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


There are numerous patient engagement strategies aimed at improving care. What are the outcomes that show these solutions are working?



October 01, 2018 - This is the last article of a three-part series centered on the steps required to make a patient engagement initiative successful. The first article, Three Steps to Jumpstart Effective Patient Engagement Initiatives, focused on getting started. The second article, Three Keys to Implementing Successful Patient Engagement Strategies, focused on implementation.


Patient engagement affects every patient interaction across the care continuum. Accordingly, the outcomes that you can expect will come from every area of the organization. When refining targeted outcomes, let metrics be your guide. Measurement shows us what’s working and what’s not.


Patient engagement requires constant monitoring to enable continuous fine-tuning. An effective system can provide data on the clinicians, clinics, and hospitals that are getting the best results. This data and good reporting tools will help you answer the all-important question: Why are some teams getting great traction and others aren’t? Data also reveals the messages and delivery mechanisms that work, and highlights patients who need greater attention.


Here are some of the outcomes that you can realize:


1. Boosting engagement: An effective patient engagement solution delivers information that is developed with an understanding of human behavior, including what motivates action, how people process information, and what builds trust. Engagement is not a one-way relationship. While the goal for those in health care is to deliver meaningful information and drive patient action, we must also focus on building trust with patients. Without trust, patients will not engage. It is imperative for patients to feel that their voice is being heard through empathetic conversations. Those conversations should be driven by a solid patient engagement message that has been studied and refined, based on continuing evaluation of patient responses and staff feedback.


READ MORE: Raising Patient Satisfaction Scores as a Component of Quality Care


Since your organization’s portal is likely the gateway you’ll use to automate aspects of engagement, portal use is key. Patient engagement programs can track which techniques result in higher adoption rates, for example:


  • Offering faster test results
  • Streamlining prescription renewals
  • Access to 24/7 appointment
  • scheduling


These programs can also help reveal which tactics result in patient activation. We need patients to act on the guidance provided, whether it be scheduling an annual physical or diagnostic test, following their rehab regimen, or improving their diet. Without patient activation, organizations will not attain the outcomes they have targeted.


2. Managing care transitions and reducing readmissions:  Engaging patients beyond a health crisis and throughout their recovery is critical to reducing complications, avoiding readmissions, and monitoring the recovery process. A patient engagement system can support an array of transitions, including hospital-to-home transitions after a procedure or chronic condition episode, or rehabilitation-to-home transitions after a period of therapy.


Two of the most effective means of reducing readmissions are quality interactive education tools and follow-up phone calls to the patient. The hospital experience is stressful for patients. Being alone or suddenly having family around at the bedside can make it even more complicated. Stress can increase when patients are sent home. They receive a lot of information, from discharge paperwork to care and follow-up instructions. All this occurs while most still feel unwell.


Patient education: Every clinician is an educator. However, it is impossible for each clinician to deliver the same quality education to every patient at every encounter. It simply cannot be replicated and measured, even using a script. Clinicians have a different amount of time with each patient and each patient has a unique way of learning. That’s why it is best to enable them with quality, interactive education materials using appropriate technology. This way, patients can watch and interact with the materials on their own time and as many times as they want. The content should be developed for different learning styles, tested, and improved over time. Of course, educational content must be easy to access. Delivering consistent education using technology helps patients take greater ownership of their care.


READ MORE: Patient Engagement Technology, EHRs Influence Patient Satisfaction


For example, a Cleveland Clinic study showed that unsatisfactory bowel preparation has been reported in up to 33 percent of screening colonoscopies. Patients who viewed an educational, interactive video prior to their colonoscopy procedure had higher rates of satisfactory preparation – 92.3 percent compared to 87.4 percent for the group that did not watch it.


Follow-up phone calls: In addition, a good patient engagement system should facilitate follow-up phone calls to make sure patients have filled their medications and that they are taking them as prescribed. After a hospital visit, a post-discharge call can verify that patients have scheduled a follow-up appointment with their primary care physician, and that they have transportation. Follow-up calls can help identify and address changes in a patient’s status, possibly preventing another hospital visit. These calls also are a way to touch base without requiring a visit. They can help detect signs of depression, loneliness, poor eating habits, etc. Implementing technology that automates the process of patient outreach means that staff is not wasting time simply trying to get patients on the phone when they are available. As a result, clinicians can work at the top of their license and provide counsel specific to the patient’s condition.


3. Improving patient safety: A patient engagement system provides consistent and easy-to-understand content that patients can consume on their own time, via the devices that work best for them. Step-by-step tips for maintaining wellness, easy to understand instructions for taking medications, and programs for effectively managing chronic conditions are central to self-care. Better-informed patients translate to fewer adverse events and better outcomes.


4. Increasing HCAHPS scores: Receiving effective and quality health care is not something that just happens. It is requires partnership between the patient and the care team. When patients understand what is happening around them, they feel more in control and have less fear and anxiety. They feel more satisfied with their care. A good patient engagement system will help you manage expectations during encounters. This can be automated to occur before the hospitalization, which frees up clinicians to have more personalized conversations with patients.


5. Enhancing clinicians’ workflows and satisfaction: Prepared patients save clinicians time, and patients who know what to expect are less likely to cancel an office visit or procedure. Patients’ most common questions should be answered by engagement programs, thus reducing calls to the office. For example, nurses can alert a patient with a scheduled surgical procedure to watch an educational video via the portal. The patient can watch at his or her convenience. Nurses can then respond to individual questions, helping optimize clinicians’ time and potentially improving job satisfaction.


READ MORE: Patient Engagement Tools, PGHD Present New Engagement Opportunities


6. Empowering patients: Wellness is highly dependent on attitude. When patients receive clear and timely communication in a way that makes them feel heard and appreciated, they better understand and participate in their own care as a true partner. They have more meaningful interactions with their care team. For example, exploring treatment options when a range of choices exist helps patients weigh the risks and benefits of different approaches. They feel empowered by understanding their options and being allowed to express their preferences. In addition, technology can enable family and the care network to be supportive, regardless of their location. Patients and families who have a good experience with an organization and its staff form a stronger connection to their team and are more confident about the care received.


7. Promoting positive results: Highlighting good results helps motivate clinicians when they see that their efforts are making a difference. Be sure to report on positive results, even when you achieve outcomes that you weren’t expecting, such as the following:


Example 1: A large, multi-hospital organization standardized the education for a common disease process and then sent patients more information about their care via a tailored video program. Nurse care managers would do a follow-up call with the patients who watched the video, after being informed by a reporting system. This approach saved nurses tedious administrative time tracking down patients and delivering lengthy over-the-phone education about their disease. Patients were better able to digest the information and formulate questions and thoughts around the topic. As a result, follow-up calls were shorter and allowed the nurse to deliver teach-back and motivational interviewing. Nurses doubled the number of patients they could follow up within a week. This simple process improvement resulted in thousands of dollars saved.


Example 2: Most organizations believe they’ll achieve the most cost savings in addressing patients with chronic conditions. This is often the case. However, by tracking patient queries, one healthcare system learned its greatest consumers of services were worried mothers with children under 12. These moms and their children were one of the highest utilizers of the emergency department for the self-insured organization. Implementing an education program geared for moms and explaining care options after hours (such as the proximity of urgent care clinics or 24-hour outpatient clinics near their homes) helped reduce unnecessary emergency visits.


When done right, patient engagement programs can provide more effective ways to manage care by building trust and delivering important patient education that motivate people to take greater ownership of their care. Equally important, digital systems with robust reporting mechanisms can help uncover outcome data that can support organizations’ business objectives, while cultivating a happier, healthier patient community.



Pam Holt, RN, BSN, MOL, is operational consultant for patient engagement with Clinical Effectiveness at Wolters Kluwer, Health. In her role, Pam helps deliver measurable business outcomes through patient engagement strategies. Prior to joining Wolters Kluwer, Pam served as the System Director for Patient Education at Mercy Health System, based in Chesterfield, Missouri.


Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, students and the next generation of healthcare providers. With a focus on clinical effectiveness, research and learning, safety and surveillance, and interoperability and data intelligence, our proven solutions drive effective decision-making and consistent outcomes across the continuum of care. To reduce the variability that prevents effective care, healthcare professionals around the world use our trusted solutions, such as UpToDate®, Lexicomp®, Medi-Span®, and Emmi® patient engagement programs.

Learn more at: http://healthclarity.wolterskluwer.com/


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How AI, Blockchain Combine to Fuel Healthcare Big Data Analytics

How AI, Blockchain Combine to Fuel Healthcare Big Data Analytics | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


Artificial intelligence and blockchain are powerful individually, but combining the two may be the key to truly impactful big data analytics.


Every healthcare organization across the care continuum is currently racing to gain an edge over their peers by using big data analytics to provide the best solution to the puzzle of the Triple Aim.


There are countless impactful strategies to help organizations reduce costs and improve outcomes by leveraging data, but the past few months have seen two intriguing concepts rise above the rest.


Artificial intelligence and blockchain have quickly become the tools of choice for developers, providers, and payers looking to bulk up their health IT infrastructure with innovative, effective data management capabilities.


Both purport to offer speedy and substantial returns on investment, and both have been lauded as game-changing for providers and payers looking to get ahead.


However, both are admittedly near to the peak of their respective hype curves, leaving some providers and payers wary of diving in too deep and too soon.  


Concerns over security, utility, and return on investment are common, leading many organizations to put one or the other on the back burner until someone more adventurous has taken the time to work out all the kinks.


There may be some merit to this approach, especially for organizations that find themselves close to foundering in the midst regulatory uncertainty, value-based care initiatives, and the challenges of the modern cybersecurity landscape.


But those who take a bold approach to machine learning and blockchain are likely to discover that combining these two emerging technologies can help them overcome some of the fundamental challenges of securely exchanging the big data sets that support innovative analytics.


“Machine learning is very data-hungry, and some of the limitations of deploying machine learning into the healthcare environment revolve around the problems with accessing and drawing data from one silo to another,” explained David Houlding, MSc, CISSP, CIPP, Principal Healthcare Program Manager at Microsoft Corporation.


“With limited data, you can only produce limited models that tend to have higher error rates.  That is simply not acceptable in healthcare, especially if you are trying to make a diagnosis or predict a clinical event.”


While federal, academic, and research organizations arebeginning to open up the doors to their big data treasure houses and allow broader access to curated data sets, the vast majority of data resources remain behind lock and key in individual institutions.


There are plenty of good reasons for this, Houlding said, many of which revolve around the fundamental requirement for healthcare organizations to keep patient data private and secure.


“HIPAA says to protect the confidentiality, integrity, and availability of data, which leads a lot of organizations to err on the side of caution and say that they aren’t going to share what they have with the community, just in case,” he said.


“There is certainly some logic to that – no one wants to be the subject of the next data breach headline.  But that’s where blockchain can come in.  It has the potential solve a large number of the issues that are stunting the deployment of artificial intelligence for healthcare purposes.”


Blockchain is a shared digital ledger that creates an immutable record of transactions taking place between participating members of the community.  Each member of the community holds his or her own copy of the ledger, which allows the community to come to a consensus regarding the validity of any new transaction. 


If enough of the members cryptographically agree that the transaction is valid, it will be recorded on the blockchain and turned into an unchangeable “fact” with a timestamp that cannot be altered or erased.  


Blockchain is viewed as an inherently secure technology due to the infeasibility of a bad actor altering every single copy of the shared ledger across all members of the community to change or erase the record of a transaction. 


Healthcare stakeholders have identified a number of attractive use cases for this highly trustworthy data management structure, including governing claims transactions, monitoring pharmaceutical supply chains, and tracking professional credentials or certifications.


Houlding believes that blockchain is also ideally suited to becoming the fabric of trust that binds together disparate organizations and creating a secure environment for meaningful, collaborative health information exchange for developing artificial intelligence.


“The idea is to use blockchain as a mechanism to produce metadata about the datasets available at multiple organizations,” he said.  “The metadata of the shared blockchain facilitates the discovery of information and the subsequent secure, peer-to-peer exchange of that data.”


This strategy allows blockchain to fill a role similar to that of a DICOM header: the blockchain creates a “pointer” to where the full data set is stored, allowing for discoverability, without requiring the entire data set to move each time someone wants to conduct a transaction.


As a result, organizations will be able to keep sensitive data, such as protected health information (PHI) and other personally identifiable information (PII) off the blockchain, reducing the risks of a breach or other improper usage.


“Our general guidance about what data to put on the blockchain is ‘minimal but sufficient,’” said Houlding.


“Keep the PII and PHI off the blockchain.  That data should be stored in secure access, controlled enterprise systems.  The blockchain is more for metadata: audit trails, cryptocurrency information, provenance information, and maybe some transactional data.”


A lightweight blockchain that only records metadata still has enormous value for artificial intelligence researchers, Houlding stressed, especially when it comes to tackling one of AI’s biggest pain points: unintentional bias in the data that can skew the results of a clinical decision support model or other algorithm.


“The point of machine learning is that models change and adapt over time, so using an immutable tool like blockchain to monitor those changes can create an audit trail that allows developers to track that evolution and make adjustments accordingly,” he explained.


“Metadata stored on the blockchain allows us to track the provenance of data that goes into training an artificial intelligence model. If bias creeps into the model at some point, you can look back through the blockchain to see what data is causing the biasing and alter the model accordingly.” 

In addition to preventing biasing during development and training, blockchain can help healthcare organizations validate the results of AI models as they mature. 


Currently, validation is a relatively slow and laborious process.  Clinical algorithms, for example, must typically be validated against data annotated by experts, which can in itself be fallible or hard to collect at scale.


Tools that purport to offer decision support must be thoroughly vetted for accuracy and safety before they can be integrated into the clinical environment, creating an incentive for researchers and developers to speed up the validation process.


“If the validation process is shared between organizations using blockchain, then participants could share those tasks and learn to trust a shared model faster,” said Houlding.  “And blockchain offers the additional benefit of allowing for tokens or cryptocurrency to incent collaboration and sharing or the development of some new capability.”


Developing a financial ecosystem around model validation could be an important motivator for researchers, and may create a positive competitive atmosphere that accelerates artificial intelligence innovation even further.


5 Steps for Planning a Healthcare Artificial Intelligence Project


Can Health IT Platforms Support Success as Artificial Intelligence Looms?


Blockchain comes in two main flavors: public chains that are open to any participant from anywhere, and private or permissioned blockchains which limit participation to pre-approved entities.


The major cryptocurrency platforms, such as Bitcoin and Ethereum, are fully public exchanges.  There is no prerequisite for being allowed to engage in trading – just like any traditional monetary system, being in possession of currency automatically qualifies the individual to use it, and anyone is allowed to acquire currency.  


Similar public blockchains have value for healthcare, says Dr. Jack Neil, a practicing anesthesiologist and Chief Technology Officer at MedStream and CEO of Zather, Inc, but a fully open community also brings challenges.


“Every participant needs to be able to see the entire ledger for most healthcare applications, which means a public blockchain is probably ideal from an architecture standpoint,” he told HealthITAnalytics.com


“You don’t have to take someone’s word for it that they have modified or deleted something, because the entire chain and all its transactions are visible to members of the community.  That is a significant change from the way we do transactions right now, and it’s a step in the right direction.”


“But a fully public blockchain is fully decentralized,” he continued.  “If you are working with health data, you are going to need some sort of administrative function to govern the involvement of very sensitive data and make sure there is adherence to privacy rules.  Any form of centralization is a hard pill for real blockchain evangelists to swallow, but it will likely be unavoidable for healthcare.”


Truly decentralized public blockchains also make it impossible to change or update code, Neil added.


“There’s no ability to perform customer service,” he said.  “Once you write the code and send it out into the world, that’s it – it’s final.  If you haven’t foreseen every single possibility that could come up before you hit ‘send,’ you’re stuck with what you’ve got.” 


“There may be some situations where that’s acceptable, but it seems unlikely that anyone in healthcare would be comfortable without the ability to make adjustments if necessary.”


Houlding agrees that the Platonic ideal of a completely decentralized blockchain may not be appropriate for the majority of healthcare use cases in the present landscape.


“The need for governance doesn’t go away just because you start using blockchain,” he said.  “Code doesn’t write itself.  It gets written by people, and those people need to consult with the entire consortium to make sure the code meets the requirements and parameters for the situation at hand.”


“Blockchain may turn the role of the intermediary into a governance role, which is good for democratizing data access and reducing bottlenecks, but it doesn’t eliminate the need for someone to create consensus across disparate groups.”


Consensus is the key to how blockchain operates, and it is exceedingly difficult to generate efficiently on a truly open, public blockchain, says Emily Vaughn, Director of Blockchain Product Development at Change Healthcare.


In a public model where anyone can join, all participants remain anonymous to one another to preserve their privacy, which sounds as if it should be highly valuable to healthcare organizations.  But anonymity can swing both ways.


In such an environment, “it is very difficult to understand the intent of the person who is going against what everyone else is saying or acting in a way that raises suspicions,” Vaughn said earlier in 2018.  “That means that the consensus model has to be designed to account for anonymous individuals who may be malicious.” 


“Bitcoin and Ethereum have to deal with that by creating much more complex consensus mechanisms for making sure everyone is in agreement.  That requires a lot more processing power, which can slow down the network and limit the volume that can move through the system.”


In private or permissioned communities, on the other hand, all of the participants know each other and understand that they all share a common purpose within the community, creating a backdrop of trust.

“That is why the vast majority of healthcare organizations piloting blockchain right now are using private or permissioned blockchains,” pointed out Houlding. 


“With a private, permissioned blockchain, healthcare organizations can be certain that they are only inviting highly trusted participants that are already known to them.”


Healthcare organizations may be particularly inclined to embrace private communities due to the fact that blockchains acting as “pointers” to artificial intelligence training data are, in fact, connected to the systems where those full datasets are stored, he added.


“Blockchain is not a stand-alone thing,” said Houlding.  “It can augment enterprise systems, such as the electronic health record or a payer platform.  The blockchain component may be acting in a decentralized way, but it will still be connected to those enterprise systems.” 


“The EHR or the claims management application acts as the user interface for blockchain.  Blockchain is simply the behind-the-scenes engine that will make the systems we’re used to seeing more secure and interoperable.”


“In a private community, providers don’t have to worry about some random person in a random country accessing the public community and getting their hands on something they shouldn’t.”


Instead, if a member of a permissioned community acts in a way contrary to the best interests of the consortium, they can be easily identified and removed from the group – a threat which could have larger financial implications for any organization that gains a bad reputation for managing privacy and security.


“Not even blockchain is zero risk in terms of security,” Houlding cautioned.  “There is no such thing, especially when there are humans involved.  But blockchain does help to mitigate the chance of a negative event, and gives more visibility into what happened when a negative event occurs.  I believe the benefits will significantly outweigh the risks when using this technology.”


Vaughn believes that permissioned communities are the natural place for healthcare organizations to start, but she envisions a shift to more open and public blockchains as the technology matures.


“In order to get healthcare stakeholders comfortable with the idea of blockchain, especially more open blockchains, we have to prove that it’s viable and prove that the value will be greater than what we have at present,” she said.


“I do believe that we will have permissioned blockchain networks that will create enterprise value within the next few years, and we will certainly keep the goal of more open blockchains in mind as we build on the technology and really start to find out what it can do.”


Why Blockchain Technology Matters for Healthcare Security


Blockchain Will “Change the Physics” of Health Data Sharing


Healthcare organizations are, understandably, reticent to embrace any new technology that might have an impact on the way they protect and manage their data, observed Neil, which may slow the adoption of blockchain across the industry.


“Healthcare isn’t known as being an early adopter of pretty much anything,” he said. 


“We’re just now adopting cloud – we probably won’t get to blockchain for a while.  A lot of chief information officers are very wary of anything that has the word ‘blockchain’ in it, because they know it’s still early in its evolution and they are not willing to be the first to experiment and potentially expose their organizations to a problem.”


“That’s completely understandable – it’s very similar to where we are with some artificial intelligence applications, too,” Neil continued.  “It’s an uphill battle to get some organizations to develop confidence either of those things. Providers are very results-oriented and they want to see proof that they – and their patients – can benefit from that kind of investment.”


The proof is not yet sufficiently forthcoming for a large number of CIOs, a Gartner survey from May of 2018 revealed. 


Across multiple industries, only one percent of CIOs said that they have adopted any kind of blockchain technology, and just 8 percent had any near-term plans to do so. 


Participants identified the lack of available development talent as a major contributor to their reluctance to dive into the world of blockchain.  Changing the culture of the IT department was another significant challenge.


Adoption was highest in the financial services and insurance industries, which doesn’t surprise Houlding.


“Blockchain has found a home in the financial services, because blockchain is really good at transaction-based use cases,” he said.  “There are a number of very similar opportunities in the healthcare industry where B2B networks already exist – and that is where blockchain is slowly but steadily gaining traction.”


At Change Healthcare, blockchain is performing that supplementary role by operating in parallel with the company’s existing claims management technology, said Vaughn. 


“It provides an additional window into the status of a claim based on data captured on the blockchain, which can be very helpful for providers waiting for reimbursements to clear,” she explained.


With $2 trillion moving through Change Healthcare’s claims processing tools each year, the added visibility creates value by helping providers plan their revenue cycles more effectively.


Blockchain also has the potential to streamline existing networks that are simply too nebulous and complex to be effective in their current state, said Houlding. 


“In the case of provider identity management, for example, there is a lot of waste that is easy to identify but harder to eliminate using the traditional tools we have at our disposal,” he said.


Multiple industry efforts are underway that aim to use provider identity management as a high-value prove point for blockchain. 


Currently, obtaining proof of licensure or certification typically requires multiple phone calls, faxes, and paper-based verifications, all of which have to be repeated for each site of care where an individual is seeking authorization to practice.


Delays in credentialing due can cost a hospital up to $7500 a day in missed revenue, says Hashed Health, an industry blockchain consortium that includes Change Healthcare.


In March of 2018, the group released a provider identity tool that uses blockchain to securely exchange data related to a practitioner’s credentials to practice at certain levels or locations.


The system doesn’t replace the need to produce the set of documents required by each state medical board or other associations, says Hashed Health CEO John Bass, nor does it constitute a new or separate credentialing process.


Instead, “an individual can put a certificate of attestation of licensure on the blockchain and other states are able to see that on the network,”

Bass explained to HealthITAnalytics.com in October of 2017.  “That offers a faster, better, cheaper way to ensure that everyone remains up-to-date without all the back-and-forth of traditional communication.”


“It’s a good starting place because the information involved isn’t overly sensitive.  It isn’t a politically charged issue, and there aren’t a lot of existing competitive interests. Everyone is searching for a better solution to a shared problem, which makes it a perfect place to innovate with low barriers to entry for those who want to try new strategies.”


Hashed Health isn’t the only group that shares the opinion.  In April of 2018, five heavyweight stakeholders - Humana, MultiPlan, Optum, Quest Diagnostics and UnitedHealthcare – announced a plan to tackle changes to provider demographic data in a similar effort to drive waste out of the industry.


“Health is hard, but great breakthroughs may come from industry players collaborating around emerging, innovative technologies to make life easier for doctors and patients,” said Busy Burr, Vice President and Head of Healthcare Innovation and Trend at Humana.


“We think industry leaders can work together to eliminate technology barriers in the health care system and promote better health outcomes.”


Houlding believes that these early projects addressing transaction-based use cases will provide the substrata of trust necessary to bring blockchain and artificial intelligence closer together.


“These prove points are a little bit easier to get our hands around, and they will act as a necessary stepping stone along the evolutionary curve to discovering the intersection of innovation and value,” he said. 


“The blockchain use cases that achieve satisfactory ROI will spread, and then we’ll start to see rapid growth in terms of layering on additional functionalities in more areas of the industry.  I firmly believe that data sharing to fuel artificial intelligence will be one of the functionalities that we will see sooner rather than later.”


“As the industry becomes more familiar and comfortable with blockchain, it will support the flow of data across disparate systems, and we will be able to use blockchain as a foundation for AI, machine learning, and big data analytics.  We will see a very rapid acceleration of innovation, and blockchain will be at the core of those breakthroughs.”

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Patient advocates: We can help innovators build digital health tools

Patient advocates: We can help innovators build digital health tools | "Patient empowerment through digital health - ehealth - connected health - patient portals - EHR - Health IT - digital hospitals - artificial intelligence (AI) & healthcare | medicine" by VAB Traductions | Scoop.it


From design to validation to deployment, any novel health tech innovation comes with a number of challenges and considerations that requires a coordinated effort from every stakeholder.


Despite the best efforts of the tech sector, changes in medical practice don’t occur overnight. From design to validation to deployment, any novel health tech innovation comes with a number of challenges and considerations that requires a coordinated effort from every stakeholder.


But while care providers, payers, and device makers all have a role to play in the process, it’s the patient who has the most to gain, and lose, from new treatment technologies. With more resources than ever now available to help the average patient take control of their care, some advocates are urging the industry to incorporate more patient voices into daily care and the development of new digital health tools.


That’s because patients can help innovators build the right tools and, in turn, patient can also be critical in aiding doctors trying to get others to adopt digital health apps and devices to take charge of their own care.

Patients can help remove barriers to engagement

“Whatever it is that the new innovative tech is for, you need to try to at least involve a few patients at the beginning,” said Dominique Goodson, a patient advocate with firsthand experience in sickle cell disease.
Goodson’s is a familiar call -- and common sense.


Getting user feedback early in software and other product development cycles is a proven tactic for success and it should be happening more when innovators build digital health tools. At the very least, it can help hospitals avoid spending money on apps that patients and clinicians ultimately refuse to use because they don’t like the way it works.


One benefit to involving patients is that many are generally receptive to new tools that could minimize numerous complications that come with managing a disease, Goodson said.

This is especially true for those whose conditions come with substantial, long-term burdens to quality of life, explained Steve Van, another patient advocate who has lived with diabetes and a resulting heart condition for several years.


“Imagine having the worst flu of your life, and walking around with that every single day. Wouldn’t you want a solution?” Van said. “I walk around with the chronic condition every day of my life, there’s no pill or shot that I can get to eliminate it, so the best I can do is manage it. What I want are better tools to be able to manage it.”

With that being said, there are a number of roadblocks keeping patients from fully embracing the novel. Chief among these are practicality and cost, Goodson said, with the latter especially likely to halt engagement with a new tool before it has a chance to prove its worth.


“Even if it’s an innovation that’s going to change everything for them, patients aren’t going to use it strictly for the cost,” Goodson said. “I know when I tell other sickle cell patients about the voice app, the first thing they ask is how much does it cost.”

A more deeply seated fear for many patients is how the growing emphasis on data collection and sharing might possibly work against them, Van said.


“From a patient point of view, what I was most worried about was someone doing something with my data that might hurt me; that it might lead to someone not caring for me because of the data that they get,” Van said. “There’s also the darker side: you have my data, you’re going to use it against me. That’s a real concern, and I think it needs to be on the table.”

How patients can help doctors get other patients to try digital health tools

Both Van and Goodson said patients will always have some concern over whether or not they are being used as a “guinea pig” for an ill-fated experiment.

Still, so long as the innovation is relevant to the condition —  for instance, telemedicine being used only for conditions that do not require in-person care — and the risks are well communicated, they didn’t see this point as a major holdup for patients in search of effective treatment.


“If they knew this wasn’t 100 percent going in, and it didn’t hurt them or create some kind of really bad medical situation, they would still try out the next solution. I know I would,” Van said. “I didn’t get to this point myself trying just this first thing, and that thing worked 100 percent. I think we’ve been making these kind of choices for a long time."


In fact, strong communication and relationships between patients and their care providers was cited by the advocates as a key factor in how well a new treatment or innovation is received.


“If it’s me, I’m questioning a number of things, like how this is actually going to make things better for me, what exactly is it supposed to do, if you were in my situation, would you use it. And then if all of the questions that I have are answered to the point I like, then I’m willing to try it,” Van explained. “I might compromise though — you might say six months, I’ll say three months and reevaluate — but a lot of times it comes down to the relationship the patient and doctor have. If it’s not a good relationship, the patient is going to be iffy about doing it.”


This kind of relationship may not always be the case between doctors and patients, but new tools and resources are allowing more patients to become active participants in their care, Van said. Specifically, he cited his own experience of accessing and sharing blood sugar data collected through a monitor, and how that information has now become a point of reference between both parties.


“I think it’s moving from a monologue, where a doctor tells you what to do, to a dialogue, a back and forth. It becomes having an understanding of what is available in terms of new technology,” Van said. “I often think of the way that my doctor and I used to talk. He would talk doctor, I would talk patient. He would talk in these technical terms … we weren’t able to communicate with these different languages. The data gave us a common language, but in order to get my understanding of what new technology is, it takes a dialogue.”


Patient-doctor relationships aren’t always a given, though, and ultimately the decision to try new technologies should always be up to the patient, Goodson stressed.


With this in mind, providers who aren’t having luck persuading a patient through direct communication should not be afraid to bring their other charges into the conversation.


“Get another patient who has been using the innovation, and has positive reviews,” she advised. “Have the doctor talk to that patient and say ‘Look, I know this has helped you a lot. I have a patient who is iffy on it — if she says it’s okay to come in and talk with you, would you mind coming in to speak to the person and explain how it helped you?’ Because a lot of times patients are willing to listen to another patient rather than the doctor that they don’t trust.”

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Curated by VAB Traductions
ENG to FR freelance translator specialised in patient empowerment through global health literacy - health education - patient education - ehealth - digital health - health IT - AI & medicine/healthcare - www.linkedin.com/in/VABtraductions