In an era of sophisticated information technology and rapid communication, the medical device community lags far behind other fields in its ability to alert patients about safety concerns.
For example, auto manufacturers and government regulators are able to quickly identify potential safety concerns by linking reports of crashes, malfunctions and defects with individual vehicle identification numbers (VINs).
They can then communicate recalls to affected customers by using their VIN. Manufacturers will issue notifications via mail or e-mail, or offer customers the ability to search the manufacturer’s website using their VIN.
In health care, drugs are tracked using a system established in the 1970s called National Drug Codes (NDCs). The 10-digit NDCs are assigned to all manufactured medications. The code tracks the vendor, product, and package code, which can then be captured in electronic health records and the FDA’s national database.
Unfortunately, we do not yet have a similar national system that can identify and communicate potential concerns for the tens of millions of patients with implantable devices such as pacemakers, glucose meters, artificial joints, and defibrillators.
Patients are bombarded by news stories about device recalls, but unless they have access to information about the exact make and model of their device, they have no way of knowing if they should be concerned. Since most medical device procedures take place in a hospital, a patient’s health care providers may also lack this critical, sometimes life-saving information.
The patient is then burdened with the task of tracking down their specialist or surgeon, in hopes that they documented the specific device information.
Clearly, the current health care information infrastructure does not yet support a robust surveillance system.
Continue reading “Medical Devices and Patient Safety: A Promising Path Forward”
Filed Under: Uncategorized
Tagged: Craig Daniel, Craig Streit, Design, Medical Devices, national drug code (NDC), Patient Safety, Siromi Gardina, unique device identifiers (UDIs)
May 4, 2014
At the first White House public workshop on Big Data, Latanya Sweeney, a leading privacy researcher at Carnegie Mellon and Harvard who is now the chief technologist for the Federal Trade Commission, was quoted as asking about privacy and big data, “computer science got us into this mess; can computer science get us out of it?”
There is a lot computer science and other technology can do to help consumers in this area. Some examples:
• The same predictive analytics and machine learning used to understand and manage preferences for products or content and improve user experience can be applied to privacy preferences. This would take some of the burden off individuals to manage their privacy preferences actively and enable providers to adjust disclosures and consent for differing contexts that raise different privacy sensitivities.
Computer science has done a lot to improve user interfaces and user experience by making them context-sensitive, and the same can be done to improve users’ privacy experience.
• Tagging and tracking privacy metadata would strengthen accountability by making it easier to ensure that use, retention, and sharing of data is consistent with expectations when the data was first provided.
• Developing features and platforms that enable consumers to see what data is collected about them, employ visualizations to increase interpretability of data, and make data about consumers more available to them in ways that will allow consumers to get more of the benefit of data that they themselves generate would provide much more dynamic and meaningful transparency than static privacy policies that few consumers read and only experts can interpret usefully.
In a recent speech to MIT’s industrial partners, I presented examples of research on privacy-protecting technologies.
Continue reading “Using Technology to Better Inform Consumers about Privacy Decisions”
Filed Under: Uncategorized
Tagged: Apps, Big Data, Brookings Institution, Cameron Kerry, Consumer Protection, Design, Privacy
Apr 30, 2014
By DAVID DO, MD
WILD PREDICTION: It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.
This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.
Here’s the bottom line: how can we improve technology when doctors seem so resistant? They are not happy with their EMRs, and rightly so, because they were built to do too much for too many.
Current system is inefficient
The EMR has become essential for documentation, billing, medical reasoning, and communication, among other things. Currently, documentation is built on a system of daily progress notes. If I consult a cardiologist about a case, he needs to go through each note, containing narratives, laboratory values, vital signs, and physical exams.
A patient with a seven-day hospital stay may have twenty notes that need synthesis to put together the story–this can take hours per patient!
In an age where more providers are involved in a patient’s care (whether due to duty hour restrictions, or the increasing presence of specialists for every problem), this inefficiency is not acceptable.
Continue reading “What an EMR Built on Twitter Would Look Like”
Filed Under: Tech, THCB
Tagged: David Do, Design, EHR, FutureMed, Social Media, Twitter
Apr 27, 2014
Je n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte. —Blaise Pascal
Translation: I have made this longer than usual because I have not had time to make it shorter.
As Appley as it gets.
A while ago I was challenged to write about what an Apple-like approach to healthcare might look like.
That challenge has been weighing on me.
For starters, we’re all over Appled aren’t we? Maligned anecdotes about Steve Jobs and the iPhone make their way into almost every presentation remotely related to innovation or technology. Triteness aside, I’ve been stalled because Apple is really a philosophy, not a series of steps or lessons learned. (Although, they are nonetheless methodical.)
Instead, what I’ve been kicking around in the ole noggin are three notional predictions, which I’ll assert are inevitabilities which will fundamentally disrupt healthcare delivery as we know it today.
What follows is about as Appley as I’m likely to get. Despite big-bang product launches, Apple actually plays the long game. They introduce small features into products to affect user behavior years before a flagship product takes advantage of those reprogramed behaviors.
That’s how they disrupt.
I believe there are three meaningful, unstoppable trends, in our current world which will significantly alter healthcare. The steps taken towards these inevitabilities, along the way, are what will define the innovators and leaders. They are the ones who see this future and know how to drive towards it.
The three trends are:
- Tools and culture which favor individual empowerment
- The commoditization and automation of diagnosis
- Accelerated globalization of treatment options
But wait, there’s Moore.
Don’t worry, I’m not going to leave you hanging. I’ll attempt to rationalize each of these points and explain why, particularly when considered as a bundle, they are a powerful force for disruption. And to prime that pump, we have to talk about Gordon Moore.
Continue reading “Moore’s Law in Healthcare – Three Predictions”
Filed Under: Tech, THCB
Tagged: Apple, consumer driven health, Design, diagnosis automation, digital health, DIY medicine, FutureMed, Gordon Moore, health care delivery, Innovation, Intel, Moore's Law, Nick Dawson, Patient Portals, specialized treatment options
Apr 23, 2014
Our friends at Kaiser Permanente asked us reach out THCB readers for help with a cool crowdsourcing project. The Kaiser innovation team is working on developing new content for The Kaiser Permanente Center For Total Health , KP’s shiny new 16,000 square foot exhibition and meeting space in downtown Washington D.C.
If you’re close enough to make the trip, we highly recommend that you stop by and take an hour or so to poke around a bit before submitting your suggestions. Failing that, you can take the online interactive tour here.
If you’re a doctor, a med student, a designer, an entrepreneur, a patient – or if you just have a good idea – we’d like to hear from you. KP’s innovation team asked us to ask you four questions. You can answer one or you can answer them all.
1. What is Total Health? In other words, what is health? What’s important to you?
2. What should total health look like when implemented? What innovations can be used to drive change in the healthcare system? What will healthcare look like in the future?
3.How should total health be supported? What can be done to make healthcare better? Smarter? Both within the healthcare system? And in our own lives?
4. If you were designing an interactive wall to demonstrate total health to visitors what would you focus on. In other words, if you were designing an exhibition what would it look like? What would your message be? What would help educate the public? How would you get that message across? Yes, you can send us an picture.
Answers can be left in the comment thread below. If you prefer to submit a video response via YouTube send the link to email@example.com. or paste in the comments below. Blog posts should be submitted to THCB editors at firstname.lastname@example.org
For the interactive design question, we asked THCB’s editors what they’d like to see. Here’s what we came up with on the back of our paper napkin:
Continue reading “Crowdsourcing the Kaiser Permanente Center For Total Health”
Filed Under: THCB
Tagged: Center For Total Health, Crowdsourcing, Design, Education, Kaiser Permanente
Mar 14, 2014
I’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation.
As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design advisor, I see them as an encumbrance for both providers and patients.
And, as a patient I see them largely as an opaque blob of data about me with a placating window in the form of a portal.
Which makes me wonder, am I obsessed with EMRs lately?
One of the reasons is certainly my personal interest in technology. And, while I don’t work in health IT, it’s natural to draw some connections. For instance,Wikipedia is consistently in among the top 10 most visited internet sites ( it is currently number 6 ).
And, say what you will about citing Wikipedia, but a 2010 study found it as accurate as Britanica.
Google trusts Wikipedia enough to use it as the primary source for its knowledge graph cards; and we’ve all settled a bar bet by finding some fact where a Wikipedia article is the canonical answer.
The secret sauce for Wikipedia is in it’s roots. Literally, the root of its name, wiki, describes the underlying structure. Wikis were the internet’s a solution to knowledge bases – large repositories of information about a process or thing. Companies had been using knowledge base software for years. Traditionally, a central maintainer, often a sort of corporate librarian, curated information, such as common answers to customer questions, so customer service reps could find it quickly.
Wikis democratize the knowledge base by allowing anyone to edit an entry. If you work for a company which sells widgets and you discover a new way to service the widget, you simply amend or append to the record in the corporate wiki. But what about the corporate librarian, they all cried. Except, no body cried.
It turns out, the network effect and the wisdom of crowds produce richer, more accurate databases of knowledge when the literal barrier to entity is removed. Make it easy for anyone to input knowledge, and the database and its accuracy grow.
And so it came to be, since anyone can edit almost any entry in the largest encyclopedia the world has ever known, Wikipedia is remarkably current and accurate.
So I wonder…what if medical records worked like Wikipedia?
What if, my record lived on some commonly accessible platform; not open to anyone, but accessible by my providers and I? Maybe we have to do some kind of online handshake to mutually access it.
What if we could both edit the record, at the same time? My doctors could put in their notes and I could add my own. Or I could edit theirs. And they could edit mine. Continue reading “What If EMRs Worked Like Wikipedia?”
Filed Under: Tech
Tagged: Design, EMRs, Nick Dawson, Privacy, Wikipedia, Wisdom of the Crowds
Feb 5, 2014
I’ve recently returned from the 7th ID Ecosystem Steering Group Plenary in Atlanta. This is an international public-private project focused on the anything-but-trivial issue of issuing people authoritative cyber-credentials: digital passports you can use to access government services, healthcare, banks and everything else online.
Cyber ID is more than a single-sign-on convenience, or a money-saver when businesses can stop asking you for the names of your pets, it’s rapidly becoming a critical foundation for cyber-security because it impacts the resiliency of our critical infrastructure.
Healthcare, it turns out, is becoming a design center for IDESG because healthcare represents the most diverse collection of human interactions of any large market sector. If we can solve cyber-identity for healthcare, we will have solved most of the other application domains.
The cyber-identity landscape includes:
proving who you are without showing a physical driver’s license
opening a new account without having to release private information
eliminating the risk of identity theft
civil or criminal accountability for your actions based on a digital ID
reducing your privacy risks through anonymous or pseudonymous ID
enabling delegation to family members or professional colleagues without impersonation
reducing hidden surveillance by state or private institutions
when appropriate, shifting control of our digital tools to us and away from corporations
The IDESG process is deliberate and comprehensive. It impacts many hot issues in health care including patient matching, information sharing for accountable care and population health, health information exchanges, prescription drug monitoring programs, accounting for disclosures, patient engagement and meaningful use, the physician’s ability to communicate and refer without institutional censorship, the patient’s ability to control information from our increasingly connected devices and implants, and more.
Hospitals and health industry incumbents that seek to solve the hot issues raised by health reform are not eager to wait for a deliberate and comprehensive process. For them, privacy and cyber-security is a nice-to-have. Who will pay for this digital enlightenment?
Continue reading “IDESG Is a Glimpse of Our Digital Future”
Filed Under: Uncategorized
Tagged: Adrian Gropper, Cyber ID, Design, FutureMed, IDESG, Privacy
Jan 26, 2014
Now that consumers can generally make an efficient health insurance purchase at HealthCare.gov and most of the state-run exchanges, we can finally get to the real question.
Are the healthy uninsured going to buy it?
The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.
To be clear, no one I know of wants to go back to the prior health insurance market that excluded people from being covered because of pre-existing conditions.
But what if most of the uninsured literally don’t buy Obamacare?
Then people will question whether or not all of this change was worth it: Why did those who were in the old individual and small group market have to accept all of the expensive changes, narrower networks, higher deductibles, and fewer choices if the uninsured largely don’t want it?
Are we moving away from a system where only the healthy could buy health insurance to a system where only the sick want to buy it?
Continue reading “To Buy Or Not to Buy”
Filed Under: THCB
Tagged: Design, Exchanges, Healthcare Marketplace, Robert Laszewski, The ACA, uninsured
Jan 13, 2014
When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.)
I have — yet again — met a family with reams of paper health records. On one hand, they’ve done very well: at our first visit they were able to show me labs, MRI results, and even some specialty consultations from last summer. They even had a hospital discharge summary, although unfortunately not the one from the most recent hospitalization.
And they’d taken steps to digitally organize, having scanned several key items, as well as created an online space providing shared access to their parent’s information.
So this is better than the situation I often encounter, which is that an elderly person has seen multiple outpatient doctors, has been hospitalized in a few different facilities, and no one has a copy of anything handy. (See why new elderly patients are a killer in primary care? If there is no data you fly blind, if there IS data it can take hours to review it.)
Still, there are clearly many ways a little well-designed technology could improve things for this family – and for the doctors trying to help them.
Here are the problems we have right now:
- Hard to search the whole pile, whether on paper or via the family’s online repository of PDFs. These were not OCRed and searchable until I manually converted them with my own PDF editor, after which I had to upload them to the patient’s chart in my EMR. Now each file is text searchable (for me), but the pile still is not.
- Cannot trend the labs. Figuring out what has happened to this patient’s key lab values over the past year has been very labor-intensive. This remains a problem once the lab data is uploaded to my EMR, because it’s still in PDFs which have to be looked at one at a time. Being the nerdy doc that I am, I’ve spent a fair bit of time creating a note that summarizes the key lab data over time. Ugh. Better than nothing but a far cry from being able to graph and trend the patient’s labs as needed.
- Takes ongoing time and effort to get records from the hospitals and other involved doctors. Kudos to this family for being diligent and persistent in asking for copies of everything they can. But wow, it’s a lot of effort for them, and I can tell you that in my practice so far, I’ve generally had to expend a fair amount of energy repeatedly asking for information from other providers. (And then I’ve had to try to organize all this info which comes in as scanned images via fax. Oy!)
Continue reading “In Search of a Really Usable PHR”
Filed Under: Tech, THCB
Tagged: caregivers, Design, FutureMed, Geriatrics, health records, Leslie Kernisan, PHRs
Jan 11, 2014
Besides the importance of physician happiness when using an EHR, using design principles that maximize user intuition and presentation of relevant information, there is one aspect of health care information systems that should never be overlooked…patient safety.
Scot Silverstein, MD, blogging at Health Care Renewal as InformaticsMD, frequently brings to light issues surrounding health care IT implementations that compromise patient safety. Reading his posts should be sobering and concerning to both medical professionals and the public alike. Like I’ve said, health care IT, in my opinion, is still in its infancy despite the number of years computers have been around and the existence of Meaningful Use legislation.
As a practicing physician as well as a software coder, I’ve used a number of EHR’s (and still currently using a well known EHR by my employer of my part time job) to know how some of these appalling user interfaces affect not just workflow and user happiness, but patient safety.
An example of one design element that most physicians may not be able to identify, ironically, is the one that is most harmful when it comes to patient safety. In this well known EHR, you are presented a medication list for a patient. As a physician, you assume that this list is a current medication list and is up to date. However, the reality is that this EHR system automatically removes a medication from the list when it is determined to be expired even if it should be appearing on the current medication list.
When a physician prescribes a medication from this system, it calculates the duration of usage of the medication based on the instructions, quantity of medication prescribed, and the number of refills. Once the duration exceeds the number of days that has elapsed since the prescription was made, the medication is taken off the current list automatically by the EHR. Now, taken at face value, this sounds like the logical approach to manage a medication list and utilizes the computing power that an EHR will gladly show off as a benefit to physicians.
Unfortunately, the EHR programmers failed to understand that medications are not taken regularly by all patients all the time. In fact, no physician assumes that at all. So why should an EHR make that assumption? Furthermore, there are plenty of treatments that are to be taken only as needed so how can an EHR account for that? Absolutely, impossible.
Continue reading “Why EHR Design Matters”
Filed Under: Tech, THCB
Tagged: Design, EHR, Michael Chen, Patient Safety, Physicians
Dec 18, 2013