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Tag: Tech

EHRs Are Workarounds, Rerouting the Way Physicians Work

By HANS DUVEFELT

IT GUY: Hey, Doc, don’t make up workarounds, use the EHR the way it was designed.

DOCTOR: Listen, your whole EHR is a workaround itself – around the way medicine is practiced.

– Hans Duvefelt, MD

This was a tweet I posted a while ago. I expected it to either go viral among doctors or catch the ire of administrators and IT folks. Neither happened. So I’m back on my soap box:

Imagine creating a computer simulation or video game that people expected to prepare them for or refine their skills in any given sport. Then, assume that this game altered the rules of the game – using a volley ball instead of a hockey puck, scoring goal attempts rather than goals, rewarding slowness rather than speed and so on.

Then, imagine you, the programmers/code writers, went to the team owners and proposed athletes and coaches should abandon the time-honored rules of the game and instead play like it plays out on the pixelated imitation you just created. And just to be clear: You, the programmer, actually never played the game yourself.

You’d get shown the door and sent back to the digital drawing board.

But that’s not what is happening in medicine.

FIRST: Is finding the clinically relevant information easier than, or at least as easy as, the regulatory information? (The cumbersome ways we have to enter information is a big topic, better covered separately.)

Here’s a silly example: One of the EMRs I work with displays prominently that the smoking assessment requirement has been satisfied, but I’ll be darned if I can see whether the patient smokes or not. Whom does the Holy Grail serve here?

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The Backstory of a Photo That Went Viral

By MIKE MAGEE

“People might not treat you the right way or they may stare at you. But the way that you treat people is going to go way further than anything else.”

Carson Pickett, NWSL/Orlando Pride/NC Courage

In the summer of 2017, Colleen and Miles Tidd were told that their third child would be born without a left forearm. Colleen later reported that she cried at first, but not for long. They had two other children, girls age 2 and 12, to consider. In preparation for their son Joseph’s birth, they reached out to an advocacy organization, “Lucky Fin”, for information and support.

The name derives from the 2003 Disney classic, “Finding Nemo”, and its’ animated star clownfish, Nemo. He was born with one short fin, the result of a barracuda attack that killed his mother and sister, and cracked his egg while he was still in development. The little fish was left with an over-protective father who, out of fear, tried to limit his future. Nemo resisted and found his strength and purpose, in part, by redefining what other sea creatures saw in him. They saw an unfortunate fish with an abnormally shortened limb. He saw adventure ahead, powered by his “lucky fin.”

Carson Pickett, the soccer star, has her own story. She was born in 1994 near Jacksonville, Florida, with a missing left forearm, nearly identical to Joseph (nicknamed Joe-Joe). Her parents, Treasure and Mike were former college sports stars, committed to expanding rather than limiting their daughter’s horizons. Carson’s mantra became, “Control what you can control”, her own variation of Nemo’s famous, “Just keep swimming.”  At age five, her father introduced her to soccer and she never looked back. She was a standout at Florida State University, and was drafted by the National Women’s Soccer League team, Seattle Reign. In 2018, she was part of a three-person trade to the NWSL Orlando Pride.

Colleen and Mike Tidd immediately took notice. Joe-Joe and Carson were both born in Florida, loved soccer, were athletic, and had partially formed left arms. Their limb defects placed them among 2,250 U.S. babies born each year with the condition. By the time their photo was taken in April, 2019, Joe-Joe was 21 months old and had taken to wearing a purple Pride jersey with Carson’s #16 on the back.

The famous photo was taken by Joe-Joe’s mother at a home game when Carson jogged over to the family after hearing their cheers. As reported, “She repeatedly tapped her arm against his as he shrieked with glee.” After the game, the two spent time in the locker room playing their version of peekaboo – pulling up their shirt sleeve to expose their left arms. As Colleen recounted, “It took a minute for him to realize, ‘Wow, we’ve got the same arms,’ and then he just giggled. You could see it hit him, and then they were best friends after that…She’s like me.”

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Up, Please

By KIM BELLARD

When I think of elevator operators, I think of health care.

Now, it’s not likely that many people think about elevator operators very often, if ever.  Many have probably never seen an elevator operator.  The idea of a uniformed person standing all day in an elevator pushing buttons so that people can get to their floors seems unnecessary at best and ludicrous at worse. 

But once upon a time, they were essential, until they weren’t.  Healthcare, don’t say you haven’t been warned. 

Elevators have been around in some form for hundreds of years, and by the 19th century were using steam or electricity to give them more power, but it wasn’t until Elisha Otis debuted the safety elevator that they came into their own.  New engineering techniques such as steel frames made skyscrapers possible, but safe elevators made them feasible; no one wanted to climb stairs for 10+ stories. 

Those generations of elevators weren’t quite like the ones we’re used to.  The speed and direction had to be controlled manually, the elevator had to be carefully brought to a stop at a floor, and the doors had to be opened and closed.  Managing all this was not something that anyone wanted to entrust to passengers.  Thus the role of the elevator operator.

But, of course, technology evolved, allowing for more automation.  According to elevator engineering expert Stephen R. Nichols:

Elevator buttons were introduced in 1892, electronic signal control in 1924, automatic doors in 1948, and in 1950 the first operatorless elevator was installed at the Atlantic Refining Building in Dallas. Full automatic control and autotronic supervision and operation followed in 1962, and elevator efficiency has steadily increased in other ways.

Elevator operators gradually transitioned from being mechanical operators to concierges, helping passengers find the right floors and making them more comfortable.  A 1945 elevator operators strike in New York City had a crippling effect.  As Henry L. Greenidge, Esq. wrote on Linkedin, “The public refused to go near the controls despite having watched the operators work the levers numerous times. The thought that a layperson could operate an elevator was simply an outrageous thought.” 

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Holograms to the Rescue

By KIM BELLARD

Google is getting much (deserved) publicity for its Project Starline, announced at last week’s I/O conference.  Project Starline is a new 3D video chat capability that promises to make your Zoom experience seem even more tedious.  That’s great, but I’m expecting much more from holograms – or even better technologies.  Fortunately, there are several such candidates.

For anyone who has been excited about advances in telehealth, you haven’t seen anything yet.

If you missed Google’s announcement, Project Starline was described thusly:

Imagine looking through a sort of magic window, and through that window, you see another person, life-size and in three dimensions. You can talk naturally, gesture and make eye contact.

Google says: “We believe this is where person-to-person communication technology can and should go,” because: “The effect is the feeling of a person sitting just across from you, like they are right there.” 

Sounds pretty cool.  The thing, though, is that you’re still looking at the images through a screen.  Google can call it a “magic window” if it wants, but there’s still a screen between you and what you’re seeing.

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An Epic Fight for the Metaverse

By KIM BELLARD

 You might have missed it amongst all the headlines about the U.S.P.S., the 2020 elections, and, of course, that little thing we call the pandemic, but Fortnite got kicked off Apple’s App Store (and subsequently Google Play).

I’m not a gamer, but I am fascinated by gaming, because, as Steven Johnson put it, “The Future is where people are having the most fun.” Tim Sweeney, the founder and CEO of Epic Games, Inc., which makes Fortnite, seems to be having a lot of fun. And he thinks the future is the Metaverse.

Healthcare, take note.

The tech giants were reacting to Epic allowing “permanent discounts” on developer fees for in-game purchases made directly, rather than going through Apple or Google. Developers thus avoid the 30% commission charged in those Stores. Mr. Sweeney has been railing about the commission level for some time, leading to the recent decision.

Apple tried to justify its action:

Today, Epic Games took the unfortunate step of violating the App Store guidelines that are applied equally to every developer and designed to keep the store safe for our users. As a result their Fortnite app has been removed from the store. Epic enabled a feature in its app which was not reviewed or approved by Apple, and they did so with the express intent of violating the App Store guidelines regarding in-app payments that apply to every developer who sells digital goods or services.

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Home, Sweet Work

By KIM BELLARD

If you’re lucky, you’ve been working from home these past couple months.  That is, you’re lucky you’re not one of the 30+ million people who have lost their jobs due to the pandemic.  That is, you’re lucky you’re not an essential worker whose job has required you to risk exposure to COVID-19 by continuing to go into your workplace.  

What’s interesting is that many of the stay-at-home workers, and the companies they work for, are finding it a surprisingly suitable arrangement.  And that has potentially major implications for our society, and, not coincidentally, for our healthcare system.

Twitter was one of the first to announce that it wouldn’t care if workers continued to work from home.  “Opening offices will be our decision, when and if our employees come back, will be theirs,” a company spokesperson wrote in a blog post.  “So if our employees are in a role and situation that enables them to work from home and they want to continue to do so forever, we will make that happen.”

Other tech companies are also letting the work-from-home experiment continue.  According to The Washington Post, Amazon and Microsoft have told such workers they can keep working from home until at least October, while Facebook and Google say at least until 2021.   Microsoft president Brad Smith observed: “We found that we can sustain productivity to a very high degree with people working from home.”  

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9 Things Every Healthcare Startup Should Know About Business Development

By ANDY MYCHKOVSKY

In this post, I write down all my strategy and business development knowledge in healthcare and organize it into the top 9 commandments for selling as a healthcare startup. I think everyone from the founder to the most junior person on the team should know these pillars because all startups must grow. I should also note these tenets are most applicable for selling into large enterprise healthcare incumbents (e.g., payers, providers, medical device, drug companies). Although I appreciate the direct-to-consumer game, these slices are less applicable for that domain. If your startup needs help developing or implementing your business development strategy, shoot me an email and we can discuss a potential partnership. Enjoy!

1. Understand Everything About the Product and Market

You must also understand the competitive landscape, who else is in the marketplace and how they appear differentiated? What has been their preferred go-to-market approach and is your startup capable of replicating a similar strategy with your current team members? Also, do you understand the federal and state policy that most affects your vertical, whether that be pharmaceutical or medical device (e.g., FDA), health plans (e.g., state insurance commissioners), or providers (e.g., CMS)? For example, if your company is focused on “value-based care” and shifting payment structures of physicians to downside risk, do you intimately understand The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the requisite CMS Demonstration Models from the Innovation Center (e.g., MSSP, BPCI-A, etc.)? Make sure you do or at least hire someone to explain what is important now and in the future.

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Reference Manuals May Be Facing Obsolescence

We must ensure their relevance to contemporary patient care

By LONNY REISMAN, MD

It’s 1992 and disruptive technologies of the day are making headlines: AT&T releases the first color videophone; scientists start accessing the World Wide Web; Apple launches the PowerBook Duo.

In healthcare, with less fanfare, a Harvard physician named Dr. Burton “Bud” Rose converts his entire nephrology textbook onto a floppy disk, launching the clinical tool that would ultimately become UpToDate. Instead of flipping through voluminous medical reference texts, such as the Washington Manual, doctors could for the first time input keywords to find the clinical guidance they needed to make better treatment decisions.

The medical community embraced UpToDate’s unique ability to put knowledge at their fingertips. Today more than 1.7 million clinicians around the world use UpToDate to provide evidence-based patient care with confidence. For many, it along with other reference sources has become foundational to providing high quality medical care.

More than just an easy-to-use reference, UpToDate has gone on to improve patient outcomes, according to the Journal of Hospital Medicine.

In the new era of 21st century digital medicine, however, there are opportunities to go further in support of clinicians and patients. Reference tools must be powered by predictive and prescriptive analytics, be personalized to individual patient circumstances, and be integrated into clinician workflow. In some cases, clinicians may be unaware of which questions to ask of a computerized reference manual, or how to incorporate the nuances of an individual patient’s case into the general insights of a reference. Searching for heart failure treatment, for example, may be too broad a query and the resulting recommendations therefore may not provide optimal care for a specific patient’s unique medical circumstances. New digital health solutions that consider patients’ co-illnesses, contraindications, symptomatology, current treatment regimens, and hereditary risks are essential.

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Thinking ‘oat’ of the box: Technology to resolve the ‘Goldilocks Data Dilemma’

Marielle Gross
Robert Miller

By ROBERT C. MILLER, JR. and MARIELLE S. GROSS, MD, MBE

This piece is part of the series “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” which explores whether it’s possible to advance interoperability while maintaining privacy. Check out other pieces in the series here.

The problem with porridge

Today, we regularly hear stories of research teams using artificial intelligence to detect and diagnose diseases earlier with more accuracy and speed than a human would have ever dreamed of. Increasingly, we are called to contribute to these efforts by sharing our data with the teams crafting these algorithms, sometimes by healthcare organizations relying on altruistic motivations. A crop of startups have even appeared to let you monetize your data to that end. But given the sensitivity of your health data, you might be skeptical of this—doubly so when you take into account tech’s privacy track record. We have begun to recognize the flaws in our current privacy-protecting paradigm which relies on thin notions of “notice and consent” that inappropriately places the responsibility data stewardship on individuals who remain extremely limited in their ability to exercise meaningful control over their own data.

Emblematic of a broader trend, the “Health Data Goldilocks Dilemma” series calls attention to the tension and necessary tradeoffs between privacy and the goals of our modern healthcare technology systems. Not sharing our data at all would be “too cold,” but sharing freely would be “too hot.” We have been looking for policies “just right” to strike the balance between protecting individuals’ rights and interests while making it easier to learn from data to advance the rights and interests of society at large. 

What if there was a way for you to allow others to learn from your data without compromising your privacy?

To date, a major strategy for striking this balance has involved the practice of sharing and learning from deidentified data—by virtue of the belief that individuals’ only risks from sharing their data are a direct consequence of that data’s ability to identify them. However, artificial intelligence is rendering genuine deidentification obsolete, and we are increasingly recognizing a problematic lack of accountability to individuals whose deidentified data is being used for learning across various academic and commercial settings. In its present form, deidentification is little more than a sleight of hand to make us feel more comfortable about the unrestricted use of our data without truly protecting our interests. More of a wolf in sheep’s clothing, deidentification is not solving the Goldilocks dilemma.

Tech to the rescue!

Fortunately, there are a handful of exciting new technologies that may let us escape the Goldilocks Dilemma entirely by enabling us to gain the benefits of our collective data without giving up our privacy. This sounds too good to be true, so let me explain the three most revolutionary ones: zero knowledge proofs, federated learning, and blockchain technology.

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Changing the Way You Care: The Coming 5G Revolution

SPONSORED POST

By VERIZON WIRELESS TEAM

You might not know it yet, but there’s a revolution coming to healthcare.

While digitization has driven innovation across the healthcare sector, the advent of 5G is set to spark a fourth industrial revolution.

3G and 4G networks enabled large-scale change and rapid modernization. However, 5G delivers what these networks could not: blazing speeds and ultra-low latencies that permit enormous data transfers between devices in near-real time. That means that technologies like artificial intelligence, machine learning and augmented reality will be capable of transforming the industry as we know it.

Whether it’s strengthening telemedicine connections, implementing new teaching methods at medical school, or connecting large hospitals and clinics, see how 5G-powered technologies will open the door for innovation in healthcare.

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