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Channel: hospitals – Mobile Health Matters

Data, Data Everywhere and Not a Drop to Drink

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Clinicians want two things from data. On an individual patient level, they need to be able to see the data whenever and wherever they want – in a clean at-a-glance format and with essentially zero lag time. And at a cohort (population) level, they want the data presented as meaningful information in a way that enables conclusions, decisions, and actions about a group of patients.

These statements may seem like self-evident  Data 101 to many of you, but in my decades of experience working clinically as an emergency physician and being responsible for operations of multiple emergency departments, it is clear that we have not delivered on this vision. In fact, the healthcare world lags other industries by 15-20 years in the availability, presentation, and use of information. Although our industry is catching up, there is still more effective use of information technology in banking, aviation, on-line retail, and a multitude of other industries. Even though many of the concepts of optimum presentation and use of data have been around for decades – the quest for electronic health records began in the 1980s – their breadth of execution and the realization of their value propositions have not been sufficient to become the norm. Healthcare has moved at a glacial speed of change, at least until recently.

In developing technology to improve healthcare, there are two things to consider: how it improves patient care and how it affects clinicians. One of our drivers at the MedStar Institute for Innovation, is the creation of information platforms that provide care teams with near-instantaneous access to all relevant data, regardless of source, that is relevant to a clinical care decision. Years ago (circa 1996), my colleague Craig Feied, MD and I developed Azyxxi, a clinical information system that was first used at the MedStar Washington Hospital Center emergency department. Its design was driven by our realization that clinicians spent 30-40 percent of their time just looking for information. If we could make any item of data concerning a patient available in less than 1/8 of a second (so its access would feel essentially instantaneous), we knew that the clinician experience would flow and that the time not spent in search or wait mode would be better spent using that data to make the appropriate care decisions.

By eliminating data silos, creating simple and sleek user interfaces, providing data in context, and using human factors design principles to bring the important data to the forefront of a clinician’s ken, we can improve care. We can make better clinical decisions faster, we can “miss” less important information, and we can make care safer by reducing the number of actions or inactions which can have serious consequences on a patient’s well being. In healthcare, it’s not good enough to get it right 99 percent of the time, i.e. miss things at a one percent rate. For every patient in whom a preventable adverse event occurs, that error in care happens 100 percent for that individual, who must live with the consequences forever.

To design and build information tools that support optimum care, it is important to consider what physicians and broader care teams really need – and only what they need. More is not necessarily better. Signal is easily overwhelmed by noise. The patient is ill-served by a drive for completeness if an item of data that represents critical information is buried in a welter of unimportant information. Clinicians understand what they really need to know and when they need to know it. They know what it is they have to go hunting for and what would make sense to bring to the forefront.

And while many of us may think we have a clear understanding of what needs to be done, based on our own needs and analysis, working within a liquid network of other like-minded clinicians and outside vendors who know how to develop and deploy technology effectively will give us the best chance of success. Partnerships with vendors can enable us to build on their previously existing platforms and to share and spread transformative tools and best practices among healthcare facilities. In this way, we can work together to bring healthcare up to a “use of data” standard enjoyed by other industries.

As the African proverb says, “If you want to go fast, go alone. If you want to go far, go together.” Let’s go together.

Mark S. Smith, MD, is director of the MedStar Institute for Innovation (MI2). In this role, Dr. Smith leads a system-wide initiative to foster and catalyze innovation at MedStar Health. In addition, Dr. Smith serves as professor and chairman of emergency medicine at the Georgetown University School of Medicine and is the former chair of MedStar Emergency Physicians.


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Harnessing the Power of Big Data with Digital Health Partnerships

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KWard_dataIn today’s digital world, electronic patient data is growing exponentially and moving faster than healthcare organizations can imagine.  At the same time, clinicians suffer from information overload, and high-volume and increasingly complex clinical patient loads, alongside dwindling time and resources.

Now more than ever, the pressure is building to harness the power of big data and digital technologies to help clinicians make faster, patient-centric decisions that increase quality of care and enhance health outcomes all while decreasing costs.

Sounds great, right? Especially to the critical care domain where data is extraordinarily dense, time is our greatest opponent, and fiscal concerns represent an annual cost to the U.S. economy in excess of $260 billion and approximately 40 percent of total inpatient costs.

But what if health care analytics and clinical decision support (CDS) could combine to deliver rapid bedside diagnostics or upstream health detection capabilities?  That is to say, a tool that provides first responders, clinicians, hospital staff, home care providers, and patients with clinically relevant, patient-centric information, intelligently filtered and presented at appropriate times to transform care delivery.

Historically, CDS applications have operated as components of comprehensive electronic health record (EHR) systems—in other words, retrospective data repositories or order entry systems with limited data streams that are, at best, semi-real time.

However, the next generation of CDS tools seeks to incorporate advanced data processing systems capable of discovering and harnessing actionable insights from all varieties of medical data, and leveraging these insights for diagnostic, predictive and prescriptive capabilities.

In a nutshell, this next gen CDS tool will aggregate disparate patient health information—static and real-time—across care delivery touchpoints for analysis and optimization, enabling clinicians to make faster decisions and implement personalized, patient-centric treatment options at the point of care, whether that is the home, ambulance, hospital or battlefield.

Bear in mind, this description simplifies what is a highly sophisticated and complex health IT tool to a functional concept. Key challenges for implementation include the ability to:

  • Collect and aggregate health data, including that from monitors, throughout the patient care continuum into a single portfolio
  • Normalize, pre-process and de-identify data for analysis—not all data is created equal and not all data is useful in its raw form
  • Capture data at the point of care, stream for real-time computational analysis and combine with retrospective data
  • Present actionable insights in a format that end-users can easily consume for enhanced decision-making in the clinical workflow or home life-flow

Ultimately, such a solution could have the power to save a life, elevate care delivery, reduce length of stay, improve quality of life or predict and avoid a critical health event altogether.

To many, this sounds almost like science fiction, but probable with the help of a small village—or in our case, a team of digital health partners comprised of world-class researchers like those at the University of Michigan, advanced analytic technology products, wearable and anti-wearable sensors, and mobile and connected health solutions.

Healthcare has lagged behind the retail and financial sectors in the use of big data and digital technologies but the gap is closing and closing fast. The risks are high, but manageable through the teaming of digital health partners, and worthy of such a high-impact payoff.  Data is king and the more hard evidence we have the better decisions we can make as clinicians, patients, families, providers, payers and industry alike.

Kevin R. Ward, MD is the Executive Director, University of Michigan Center for Integrative Research in Critical Care and Professor of Emergency Medicine, University of Michigan Medical School.


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Transformation in 2015: Focusing Technology on the Patient

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We are currently experiencing the biggest transformation in healthcare ever. Technology plays a significant role as an enabler of this transformation, but will not drive it alone. Improving patient care and driving toward patient engagement are crucial goals in this next phase of the healthcare industry. To make adoption ubiquitous and implementation effective, there are several things we should focus on as we dive into 2015:

  • Real-time clinical decision support will transform care: As even more patients in need of care move into the system because of the Affordable Care Act (ACA), the amount of data needed by healthcare professionals to improve care will increase by an order of magnitude. The impact of adding more data to a limited number of caregivers means that the top technologies to enable clinical transformation will be data aggregation, big data analytics tools, and real-time processing engines. The ability to collect and analyze clinically relevant data on a near real-time basis and visualize via mobile devices will empower clinicians to make faster, more confident care decisions.
  • Wearables can take on a new life: mHealth applications have become accepted – and almost expected – in the hospital environment. The same level of secure, diagnostic-quality medical device connectivity should also make its way into the home to support remote monitoring and population management. There are some impressive technologies from the research community that will revolutionize the way we monitor patients and manage diseases beyond the four walls of the hospital. This includes disease-specific body sensors and implantable devices that can collect and transmit a wide variety of clinically relevant data on a near real-time basis to the caregivers. At the same time, while activity monitors like the FitBit and Nike Fuel have thus far been geared toward healthy (and competitive!) people – not sick patients – there is a home for them in chronic disease management. By connecting this kind of data to a real-time analytics engine and a patient’s EMR, the care coordination team is armed with a list of priority patients who are not following their prescribed activity protocol that the team can follow-up with and work to remedy.
  • Patient data should be protected like financial data: When dealing with mobility, it is crucial to consider the way data is protected. Patient data is highly valuable, and should be treated as such, and protected the same way mobile access to a bank account is secured. When a person accesses a bank account on a mobile device, there are layers of encryption, including a token that dictates that every 30 seconds both the device and the bank change the password and sync again – a high-level of security beyond normal standards. Patient data should be protected with similar standards that offer layers of security at all levels: server, client, transmission and authentication. HIPAA rules for mobile technology were written in 2003, and we should consider that anything that was written before the release of the first iPhone to be obsolete.
  • Hospitals and health systems will guide innovation: Whether we are caregivers, payers or vendors, we are also consumers of mHealth. Therefore, we share the responsibility to transform healthcare. The first step toward that goal is to unlock clinical data from legacy systems. Without interoperability, there is very little chance for success. This seems to be a hot topic in the industry. Many are talking about it, but unfortunately very few legacy vendors are actually advancing the cause of interoperability. This is a mission-critical task.

In my view, 2015 will be the year where providers will have the opportunity and power to lead the industry and force legacy vendors to open up and truly collaborate, instead of just talking about it.

Provider consolidation and collaboration is creating much larger healthcare organizations with a strong need to integrate in order to better manage population health by both clinical condition and market. This trend is further exposing the lack of interoperability, but at the same time is creating an ecosystem of providers that is gaining a degree of power never experienced before. These providers have the power to drive healthcare costs down, improve the quality of care, guide the federal government on introducing and enforcing standards, force vendors to comply with those standards and, eventually, transform healthcare.

That shift of power that we are seeing today will shift yet again if providers do not take advantage of their ability to drive transformation. As data consumers, the patients could take control by refusing to engage with those healthcare organizations that fail to bring transparency to their data. The ultimate goal for healthcare providers is to maximize patient population, and only those providers that drive and innovate will achieve that goal.

The healthcare industry seems to be forever changing, but with the right approach and some forward thinking, 2015 could be the year of transformation and transition – when the patient really and truly becomes the focus of care.


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Future of Health Care: Keeping the Patients in Mind

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imagesThe key to successful health care technology is making sure it improves both the patient experience and the quality of care. While technology is sometimes seen as a barrier to human connection and interaction, the right tools can transform the health care experience for the patient. At Dignity Health, our focus for 2015 is centered on making population health a reality by looking toward the ambulatory side of care. The mobility strategy we put in place in 2014 is enabling us to empower our providers and care teams with telehealth solutions so they can have alternate ways to connect with and care for their patients.

As we take on more risk and value-based contracts, we need to manage our patients’ care differently than in the past. We need to provide cheaper and more convenient care to a bigger population. Today, the typical doctor’s visit requires a trip to the brick-and-mortar office location. However, there is a significant opportunity to better engage patients and encourage them to seek medical attention by conducting virtual visits. We should work to reach them where they are, providing more choice, options, and transparency – all without sacrificing quality. Meeting this final criterion requires providing the care team with easy access to integrated data that offers a full picture view of the patient’s health.

As we move into 2015, we are working on a number of projects to improve the quality and convenience of care at Dignity Health including:

  • Increasing access by creating virtual urgent care centers or clinics where patients can reach a Dignity Health doctor on demand;
  • Providing patients with video visits as an alternative to traditional visits, given the interest of patients in meeting and interacting with their primary care doctors or specialists;
  • Monitoring patients via video so physicians and care managers can see their patients in their home environment. Physicians can also arm patients with home monitoring equipment once they are discharged from the hospital so they can track vitals, weight, oxygen levels, etc. without the patient ever having to step outside their front door.

Marrying virtual solutions with patient data helps create an environment that makes patients feel comfortable in their own space and reduces wait times and missing work, while still ensuring they feel their caregiver understands their environment and is making confident and personally relevant care decisions.  While some say technology creates a barrier, when implemented strategically, technology can actually make patients feel more connected, engaged, and satisfied with their care.

Davin Lundquist, MD is VP/CMIO of Dignity Health of San Francisco, CA. Lundquist graduated from the University of Southern California Keck School of Medicine in 1999. He specializes in Family Medicine and is affiliated with Saint Johns Regional Medical Center and Saint Johns Pleasant Valley Hospital. He speaks English and Spanish.


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The Healthcare Dinner Party

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WineIt may not be obvious, but the healthcare industry has been preparing for an enormous dinner party. Over the last several years, innovation vendors like AirStrip have been adding ingredients to our fridges and pantries based on numerous requests from customers. Metaphorically, this would be just about anything you can imagine that will transform clinical collaboration. At this point, companies can support a wide variety of different use cases across the continuum of care. However, the next phase is for healthcare industry to sit down at the table since it has been set up already for the big dinner party. The table and the settings are the EMRs, EHRs, medical device companies, among others. If we keep replacing them we will starve to death. Now, we need to spend more time figuring out what exactly the healthcare providers are trying to cook – getting to know their specific use cases by clinical service lines and working backwards with the ingredients that already exist, rather than waiting for food to appear magically at the table.

To do this, medical technology vendors must know their role in the process: to serve as a canvas for customer innovation. The goal is to use the strength of technology platforms that are created and have them run seamlessly in a way that provides clinicians the right data to address their patients’ needs. Each hospital and health system knows what they like and need better than anyone else – and working with them to design these systems accordingly will inspire innovation that can help other organizations. The vendor’s role is to take the technology that seems simple to the creators, and make it user-friendly and accessible in time-sensitive scenarios. This innovation could be things like bringing in contextual images, video, secure messaging, and other third-party components that are brought to customer’s APIs on top of a mobile platform all in context. Thus, physicians are able to work more efficiently, improve workflow and ultimately lead to better patient outcomes.

In the coming years, mobility adoption will be the fastest growing technology trend in healthcare, functioning primarily as a delivery mechanism for clinical decision support for healthcare providers. Physicians are clearly mobile professionals, and clinically relevant data needs to be provided to them wherever they are in order to improve the quality of care. Clinical decision support delivered via mobile devices will rely on a number of underlying technologies that are essential for clinical transformation. They include: big data analytics, real-time processing engines, tools focused on interoperability, care coordination, patient engagement and cloud computing.

Thus, medical technology companies need to assess what the hospitals are trying to ‘cook’ and create the technology to meet the needs of their use cases. Once these needs have been discovered, medical technology companies can whip up the perfect personalized recipe for each hospital or health system – one batch at a time.


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Creating a Friendly Environment for Adoption of Clinical Decision Support

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In recent years, our ability to stream large amounts of data in real-time has improved dramatically. This enhancement can transform how clinicians offer care by sourcing unprecedented opportunities for clinical decision support. However, the capability to process, store, and display data in and of itself does not transform care. Rather, it is how the clinicians adopt and apply decision support that will make all the difference to patients. However, the current environment must be altered to create a clinical decision support-friendly climate.

From a patient perspective, we must migrate away from automation of population-based models and toward a model that supports the individualization of care. From the clinician’s perspective, there is a thin line between enabling and burdening them with data. We need to find the right balance: empowering physicians to prescribe care using their training, experience, humanity, intelligence, and reason while giving them the technological support to catch and analyze what isn’t always obvious. If we are to make clinical decision support a reality, we must ensure that it is personalized, valuable, and adoptable.

There are a few things the industry needs to do to make this happen:

  1. Customize care: Each patient’s data, circumstances, responses, and care path will be unique. Clinical decision support is based on advanced analytics and calculated trends, but we must provide the patient-centered context to improve the accuracy of the final call. In the past, the industry has pushed for uniformity to the detriment of care and at the expense of patient individuality and physician autonomy. For example, clinical practice guidelines that do not allow for important patient-specific customizations are less than helpful. Guidelines tend to focus on populations and not people. We must not genericize the process of care. Our goal in providing more data and better care support should be to enable a patient-centric, unique plan upon which physicians can act immediately. This will require a convergence of clinical decision support, ready access to data, which has been transformed into actionable information, and alignment of customized medicine.
  1. Make it easy and put it in one place: As we move away from a one-size-fits-all approach, we also need to perfect interoperability and appropriate graphical user interfaces to improve ease of use, while getting the right information to the right person at the right time. In parallel, let’s also move away from the recent habit of “apping” our physicians to death. It isn’t efficient, and doctors aren’t learning to invest their effort into any particular application – they’re instead distracted and half-heartedly using a handful of various mobile tools. If physicians enjoyed true interoperability, data would be streaming through multiple processors to do digital background work for them and, in turn, providing patient-specific choices A, B and C. The key is giving clinicians options, rather than an answer, and in saving steps to make clinical workflow more efficient.
  1. Push for real reform: We must better align incentives for key stakeholders around innovation. Reform must move beyond its current focus on payment and access. We need fundamental changes in 1) physician training, behavior, and adoption; 2) incentives for the commercial life science industry; and 3) regulatory agency policies and practices.[i] Today we can leverage voluminous data, transform it into actionable information, and get it to a physician via a mobile device – essentially in near real-time. Getting physicians to embrace clinical decision support will require aligning incentives, embracing innovation, providing interoperability, and earning their trust.

Healthcare must be centered on the unique needs of individual patients. Providers need technology that powers customized, patient-centric clinical decision support. Expanding the scope of health care reform will foster an environment of innovation. Inside this new realm of creativity, physicians will actually be empowered and incentivized to actively leverage emerging technology to help transform care.

[i] Topol, E. 2012. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Basic Books. New York, NY. ISBN-13: 9780465025503.


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Healthcare in South Africa – Two Systems, Common Challenges

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When it comes to mHealth, most industrialised nations such as the U.S. and Europe have a head start. Money for healthcare technology investments is available, the infrastructure is in place, and most of the population is already engaged in the healthcare system.

As a country of about 52 million people, South Africa shares many characteristics with its larger brethren. There is a mix of public and private healthcare providers and health insurance plans, physician shortages in key areas, and South Africa is beset by many of the same chronic diseases that industrialised countries face (cardiovascular and obesity-related diseases, diabetes, etc.).

But, the country also faces unique challenges.  HIV/AIDS and tuberculosis rates are high. Maternity and infant health issues affect large segments of the population.  The system is highly fragmented. These and other factors contribute to a life expectancy of only 58.5 years, twenty years shorter than in the US.

The South African healthcare system is really a tale of two systems. Basic primary care is provided free by the state, and the public health system serves about 80% of the population. The public sector is woefully underfunded, and care is less accessible and/or inadequate for that 80% of the population.

The South African government has embarked on major reforms to the system, including a universal National Health Insurance (NHI) programme. From its implementation beginning in 2012, however, the system will take 14 years to roll out.

For the remaining 20% of the South African population, healthcare is more accessible, better-funded and more effective. Middle- and upper-class citizens purchase supplemental care through various medical schemes (insurance plans), giving them access to better clinicians and advanced medical practices.

Public or private, there are a number of challenges the two systems share:

  • An over-reliance on paper records – When patients present at a medical facility, runners are dispatched to gather up paper records and bring them to the clinicians. Even when records have been digitized, there are few online systems for viewing and reviewing them.
  • Silos and lack of interoperability – Primary care are the gateways to the system, both public and private. Even more so than in the US, there are few common systems across primary care practices, so even where automation has taken place, these silos of information do not interoperate.
  • Lack of detailed clinical information – Although South Africa implemented ICD-10 beginning in 2005 (yes, 2005), the fragmentation of the systems has led to only simple, lowest-common-denominator information being available; sometimes only patient ID and diagnosis code are available to other clinicians. This blunts efforts at any sort of analytics that could improve quality or core measures. Real-time analytics, dashboards accessible through mobile devices, or remote notifications are all impossible without tools to cut across disparate systems.
  • Healthcare for mothers and babies – Maternal, infant and childhood mortality present a major health crisis throughout Africa. Prenatal care and monitoring in particular are inadequate, resulting in combinations of high maternal mortality, infant mortality, and post-natal complications. With many expectant mothers in far-flung areas of the country, this is a health crisis begging for innovative remote technology.
  • The need for secure health records and communication – Although not as stringent at HIPAA regulations in the US, and driven more by the medical schemes, security and privacy are essential to overcoming patients’ inherent distrust of technology, especially if data are to be shared through a variety of systems.

The South African healthcare system needs to undergo major change. “Business as usual” is unlikely to yield progress quickly enough. Innovative healthcare technology can provide an accelerator to improving conditions more quickly, with interoperable mHealth and telehealth playing a major role in that transformation.

Christopher Whitfield, CEO, founded Batswadi Pharmaceuticals in October 2005 as a specialist healthcare company focusing on four core business areas: pharmaceuticals, diagnostics, research and development, and consumer health. After jump-starting the company by leading a management buy-out of Eli Lilly’s insulin portfolio in South Africa, Christopher has quickly built Batswadi into a diversified company with significant potential. As the only black-empowered (majority-owned by historically disadvantaged South Africans) pharmaceutical company in South Africa, Batswadi is a rising star.


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Why 2015 is the Worst Time to be a Physician

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With the ONC’s recent release of their 10-year interoperability vision, it might seem like the industry is starting to make things easier for clinicians. In reality, 2015 is starting off to be one of the worst times ever to be a physician. Interoperability is a critical issue to support a transition from fee-for-service to value-based care. Physicians will eventually be reimbursed around their ability to impact clinical outcomes, so the need for clinically relevant information at their fingertips is mission critical.

Unfortunately, the ONC’s attempts at outlining an interoperable future make it clear that this vision is influenced by the same vendors that benefited from billions of dollars flowing to them from great federal programs like ONC’s Meaningful Use and will continue to benefit from a roadmap that delays the path to data and streamlined clinical workflows. Preventing caregivers from being overwhelmed by data is understandable, but it is certain that physicians need more data than the ONC is seeking. How can physicians be efficient and effective if they don’t get the information they so desperately need? How can we move them into a value-based care model without freeing the data needed to improve clinical outcomes? My colleague, AirStrip President Matt Patterson M.D., recently wrote a blog post around this, emphasizing how low the bar has been set in terms of standards.

The directive generating the most attention calls for “a common set of electronic clinical information…at the nationwide level by the end of 2017.” According to ONC, the common data set would consist of about 25 basic elements, such as patient demographics, immunization records and lab test results. It seems this vision was created to help ease the strains physicians face with the overwhelming amounts of data. However, the basic elements ONC is suggesting is a subset of the relevant data that is trapped in the source systems; it is not nearly enough information for physicians to make informed decisions effectively.

These limited requirements are also preventing the enforcement of standards and the creation of new ones that would encourage the healthcare industry to partner with vendors to improve the inner workings of their health systems. In order to understand clinically relevant data in near-real time, hospitals need about five to six times the amount of data ONC is proposing as a common data set for the initial phases. This additional contextual data is crucial in order to decide next steps and make patient decisions proactively and effectively. Some vendors today have the ability to expose this data but, for some reason, healthcare providers continue their acquisitions without strong interoperability requirements – as if they are obeying ONC’s roadmap and those that influenced it. In an era of consolidation and collaboration, this approach will lead to patient leakage for closed organizations.

The blocking of clinically relevant data from some legacy vendors and ONC’s relaxed requirements also stifle innovation, impeding new vendors that provide data analytics and visualization tools that are agnostic to the data source and result in a better user experience. This impediment forces providers to use their archaic visualization tools. This trend started with desktops and is quickly propagating to mobile devices. We are, in essence, mobilizing the mess and making physician’s lives more difficult. Not only are we limiting their access to data on a real-time basis, but we are now forcing them to open multiple mobile applications to view a patient record throughout the continuum of care. And to top it off, we will force them to improve population health management and care coordination, while aligning incentives around those goals.

Healthcare cannot mobilize or leverage innovations such as telemedicine without first being interoperable. Interoperability is the core of successful mobile healthcare, we cannot place all the blame on the ONC’s interoperability roadmap. It is time for healthcare providers, payers, pharma and technology vendors to join forces with the Federal Government and transform healthcare. As we gear up for another HIMSS, it appears interoperability will once again be a topic of discussion for the future. Maybe next year, it’ll finally be accepted as a standard and the topic will be centered around the patient who in the end should own their data.


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Telehealth Brings Non-Stress Tests to the Home

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Non-stress tests (NSTs) are the current standard of care for monitoring high-risk pregnancies. Intended to reduce the risk of stillbirths, these tests are for those who have one or more risk factors, whether they be maternal, fetal or obstetric complications.

Currently, these tests can be very time-consuming for patients. NSTs involve attaching the mother to fetal and contraction monitors to watch the fetal heart rate tracing and uterine activity. However, many rural and remote areas don’t have ready access to NSTs. Consequently, mothers sometimes travel up to several hours each way to get to our facility for their NST appointments once or twice a week. Once they arrive, there’s the usual wait time, the 30-60 minute testing process, plus an additional wait time for the test to be interpreted by a staff member and a clinician. These appointments, on top of any additional prenatal visits the mothers have scheduled, can therefore add up to a considerable amount of time, even for patients who live nearby.

Telehealth and at-home NSTs may be able to transform this process for our patients. We are now conducting a pilot study that provides patients the technology to conduct at-home NSTs. Mothers in their third trimester of pregnancy who are on a schedule of twice-weekly NSTs will have one test on-site and one test at home every week. These patients will be thoroughly trained on how to use the at-home NST device, and will conduct a practice NST in the presence of an advanced practice clinician before sending them home to do the testing. After that, patients will conduct the home NSTs themselves as part of a ‘virtual’ appointment, with an advanced practice clinician carefully monitoring the test results.

By conducting NST tests at home, we hope the following might be achieved:

  • Improved Patient Satisfaction: A telehealth strategy for NSTs will reduce the number of required on-site appointments. This strategy also means more flexibility, comfort and convenience for our patients.
  • Enhanced Efficiency and Capacity: Facilities have a limited amount of space and personnel to conduct NSTs. For example, the University of Utah Health Care has four chairs dedicated to these tests, so appointments need to be scheduled accordingly. By conducting NSTs at home, we can engage with more patients, increasing our flexibility to accommodate those who need NSTs. While there still needs to be careful supervision by trained clinicians, this process may greatly improve our efficiency and capacity for NST testing.
  • Cost Effectiveness: Performing an NST can cost several hundred dollars, and part of that fee is for the use of the facility. The clinician interpretation portion of the billing is always going to be the same – someone always has to look at the results and render an opinion – but by conducting a number of these tests off-site, there is an opportunity for significant cost savings for payors. Home NSTs may also mean cost savings for the hospital, since efficiency and capacity are expected to improve.  Patients will also likely save money related to travel, missed work and childcare expenses.

Healthcare systems are becoming increasingly interested in implementing innovative care strategies in order to improve the quality of health care, reduce cost and improve patient satisfaction – in other words, create value. Within obstetrics, home NSTs show promise for helping to achieve these aims.  Our research will consider whether this technology could develop into a viable NST option for health care systems across the nation.

 

Erin Clark, MD has been an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center since she completed her Maternal-Fetal Medicine Fellowship at the University of Utah in 2009. She is board certified in Obstetrics and Gynecology, as well as the subspecialty of Maternal-Fetal Medicine. She initiated the Preterm Birth Prevention Clinic for the Utah Department of Health in 2010. Dr. Clark’s current research includes a grant from the NICHD to look at markers of developmental delay and cerebral palsy. Other interests include pelvic floor dysfunction related to childbirth and preterm labor.


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Finding Balance in Chaos

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hospital-1822460_1920The role of a nurse is a complex one. Not only is this individual responsible for the physical bedside care of multiple patients, but may also be called upon to offer emotional support for patients and their families. While this is an absolute honor and a privilege, it can also be emotionally draining and lead to burnout syndrome or compassion fatigue. In order to ensure that patients receive the highest quality care, we must make sure that nurses have support for their own emotional well-being.

Seek Closure

One of the most difficult situations a nurse can experience is losing a patient. No matter the situation or how long the patient was under a nurse’s care, it is hard to ignore the fear that something more could have been done. With the introduction of technology and a digital record of a patient’s stay, care teams now have objective data that can be reviewed and assessed after an incident. Simply knowing what exactly happened can relieve an element of stress, because the unknown is often more terrifying.

By reviewing these records as a team, nurses also benefit from an objective, clinical process that removes the emotional chaos. Instead of wondering whether it was an isolated event that caused the patient to deteriorate or a symptom that had been trending for days, nurses can find emotional support from leadership and peers. By using these sessions as learning experiences and refusing to point blame at any one individual, these reviews can foster positive physician-nurse collaboration, building a foundation of trust for an environment where both parties can confidently work side by side.

Lean on Resources

While nurses must remain focused on caring for their patients, the families and loved ones of these patients often need support and information as well. This is particularly important for high-stress wards like the ICU and pediatrics. By identifying and leveraging resources within the hospital – whether a social worker, chaplain, or the resident psychologist – a nurse can ensure that the family has the resources they need and are treated with the respect they deserve.

Ask for Help

Nurses can’t be afraid to ask for help. One of the most beneficial things a nurse can do is identify a mentor that can offer both emotional and clinical support. Having someone to turn to in times of duress or confusion can make a significant difference in a nurse’s experience – as well as a patient’s. As this mentor is usually someone who can recognize emotional fatigue, avoiding burnout before it happens helps ensure everyone’s health and care remains the top priority.

Another resource: other nurses! Forming a peer group within the hospital that meets on a regular basis creates a forum to share experiences and stressors. Open conversation can ease the burden of feeling alone and provides a safe space within the context of a group who would understand.

With the right resources and approach, finding and maintaining a balance between investing in patients’ well-being and preserving a nurse’s own health can be much less daunting. Remembering that a hospital is a community – and everyone is working toward the same goal – can make a significant difference in a nurse’s life.





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