By MICHAEL PAINTER, MD

I am here in California at the Health 2.0 conference with 2,000 health care innovators. One of the most popular Health 2.0 sessions is called The Unmentionables—where speakers discuss those important things that affect our health but we’re often afraid to address. I participated in thisyear’s session where we talked stress—what it is and how it’s making us sick.

I’m an avid cyclist. That means I train a lot. Training on a bike means purposefully and intensely stressing your body—sometimes ridiculously hard—in order to make your body stronger, fitter and faster. In that sense stress can be really good. You can’t get stronger without it.

But here’s the key: as you ratchet up that stress—the miles, the hours on the bike, the intensity— you must work just as hard on the flipside, the buffering. The more you train, the more you have to focus on the rest, the sleep, your social supports, the yoga, the nutrition—whatever it takes.

If you don’t buffer you will burn out, get injured or sick, or all of the above. Without buffers, the stress will crush you.

The Robert Wood Johnson Foundation has been thinking about stress and its connection to health for quite some time. We’re finding that in many ways we have a culture of stress rather than a culture of health. We need to understand that and work together to fix it.

I’m a family doctor and used to practice at a community health center in Seattle. I recently came across a story that reminded me of many of my former patients. Jeanette is a young mother living in Connecticut experiencing major stress in her life: she just had baby, was suffering postpartum depression, lost her job, was facing eviction, and her relationship was in trouble. Not surprisingly, her stress also affected her baby, Shiloh—just weeks old. Shiloh wasn’t smiling, didn’t play, and didn’t communicate.

When we’re under stress, our bodies produce an increased amount of cortisol. A certain amount is healthy, but too much over a long period of time can have very negative effects—especially in a developing brain. That is likely what was happening to Shiloh. Stress can exacerbate or cause lifelong illness like diabetes, depression and heart disease.

At RWJF we wanted to understand how the public perceives and manages stress, so we conducted a public opinion survey on stress with NPR and Harvard’s School of Public Health.

Here’s some of what we found:

• Half of those we surveyed had a stressful experience in the past year.
• Most who reported high stress were already in poor health—including many who have chronic conditions or illness.
• The vast majority said that stress negatively affects their family and social lives, how they perform at work—as well as their health.
• Over half of those with a great deal of stress and a chronic illness or disability said stress made their symptoms worse and their condition harder to manage.
• Over 90% said they manage or buffer stress by spending time with family and friends, exercising, eating well, or doing outdoor activities,
• Unfortunately, only 50% said they do things to buffer their stress.

The numbers, of course, are important, but the stories are even more powerful. Jeanette and Shiloh did get help from an RWJF-funded initiative, Child First—a home visiting program that helps stabilize families with young children. But that’s just one story; there are many, many more. When NPR asked people to share stories about the stress in their lives, they received an overwhelming number—6,000 responses when they typically only get about 500.

Why? Americans are stressed; they know it, and they want to talk about it.

Health isn’t just a lack of illness. It’s so much more—it’s enjoying and embracing life—that includes successfully managing life’s stress.

The goal of our work is health and well-being for everyone. We can’t get there unless we address the stress in our lives. (See our infographic about how to move from a culture of stress to a culture of health.) That means we must try to reduce it where we can and learn to directly manage it where we can’t.

What we’re finding: stress is making us sick.

The good news: we don’t have to let it.

By THCBist

Local media reports that a Dallas police officer who accompanied health officials to the apartment of Ebola patient Thomas Eric Duncan has been . Hospital officials are not identifying the man, who was rushed by ambulance to Texas Health this afternoon after visiting a local walk-in clinic complaining of flulike symptoms. However, local TV news reports indicate that the individual appears to be  officer Michael Mannig.  Mannig does not appear to have been on the list of high risk contacts, meaning he has has probably remained on active duty, which if true, could spell serious trouble for health authorities tracing his contacts.

By NIRAV DESAI

When you realize that 40% of premature deaths are driven by poor behavior like smoking, alcohol abuse, poor diet and exercise, you have to start asking some hard questions about how to promote better care:

• How can we make sure people are listening to their doctor’s advice once they leave the office?
• How do we get people to take their life-saving medications after they’ve been discharged from the hospital?
• How do we get insight into whether patients’ conditions are deteriorating so that we can make adjustments before they have to make a trip to the ER?

The optimal solutions for these kinds of healthcare challenges encourage patient engagement and incorporate insights. The ultimate tool for this is mobile technology. Why is that?

First, people have already voted with their wallets on which technologies they will welcome into their daily lives – smartphones and tablets.

Second, people are voting for these technologies with their time. A recent study indicated that people check their smartphones 150 times a day on average. Even if you’re on the low end of that average, you’re likely to admit that it is the one tool you use most frequently and find indispensable to your lifestyle.

That’s because you can select the apps you want and customize your smart device to your lifestyle needs, whether it’s for entertainment, news, maps, weather, finance, increasing productivity, etc. You have what you need whenever and wherever you need it. No wonder you’re engaged. So, why should healthcare try to create its own separate engagement tools when people have voted for mobile with their time and money? It shouldn’t. More importantly, it doesn’t have to.

Nowadays, our smart devices have integrated and finely tuned so many technologies that can be applied to healthcare. Some examples include:

1) Phone/Video – to connect to a clinical expert
2) Camera – to take high-resolution images of a wound or skin lesion
3) GPS – to identify a patient’s location on a hospital floor, in their house, or in their community
4) Accelerometer – to track how a patient is moving or not moving
5) Messaging – to send text messages that remind patients how to follow their care plan (i.e. when to take their medicine)
6) Connectivity – to pull information from sensors and wearables to collect biometric data

As importantly, companies like Apple and Google who build the operating systems for most of today’s mobile devices or Samsung, Nokia and LG who actually build many of those devices, are continuously going through the hard part of integrating all the latest great technologies into their products. Apple, for example, will be building biometrics and personal health records into its next generation of operating systems and devices.

The bottom line – people are highly engaged with mobile devices and the innovation opportunities for healthcare are only getting better. The time to leverage mobile for healthcare to engage patients and gain insights is now. Before your competition does.

By MICHELLE RONAN NOTEBOOM

“We the people want easy, electronic access to our health information.”

That’s the seemingly simple objective for supporters of Get My Health Data, a new initiative organized by former National Coordinator for Health IT Farzad Mostashari, MD.

Folks like ePatientDave, Regina Holliday, and other patient advocates have spent years fighting for better patient access to health data, but support for the movement has reached new heights, thanks to recently proposed changes to the meaningful use program.

In April, CMS stirred up the patient data access hornets’ nest by proposing a modification to the Stage 2 meaningful use requirement that 5 percent of a provider’s patient population views, downloads, or transmits their online health information.

Many providers thought the bar was too high because few patients were interested in accessing their health information online. CMS responded to provider concerns by reducing the threshold from 5 percent to one single patient.

The proposal caused a bit of an uproar as patient advocates decried that one patient was not enough. Mostashari quickly called for a “day of action” to show opposition to the proposed changes.

Earlier this month Mostashari expanded on the plans for the renamed “Data Independence Day,” scheduled for the fourth of July. Organizers are hoping that the one day event will actually spur a larger movement with consumers demanding access to their health data. The intent is to demonstrate to lawmakers, providers, and other decision makers that people do care about electronic access to their health information.

The Get My Health Data movement is asking consumers to sign a petition demanding convenient, secure online access to their health data. In addition, the organization is looking for patients to serve as “tracers” by requesting access to their records and reporting on the response.

I was curious how my family’s doctors would comply with such a request, so I reached out to four of them. Here’s how it went:

Primary care physician. My family practice is part of a large group that utilizes Epic’s MyChart patient portal. I accessed the portal and was able to easily view and download my health summary in a format that was very user-friendly. This is how it the process should work.
Specialist #1. My gastroenterologist uses gMed EHR and its gPortal. I accessed the portal and easily pulled up my health summary. While it included basic details on my health history, it lacked a few critical elements, such as diagnostic test results. I had the option to email a copy of my medical summary to anyone I chose, as long as they used a secure email with a Direct protocol address. I was also able to download the summary but it came over as a .XML file that was nearly impossible to decipher. I messaged the practice about getting a more user-friendly version of my records and received a quick reply that they could either mail me a hard copy or I could pick up a copy in person. Unfortunately there was no option for a more complete electronic version. All and all this practice came close to delivering what I needed and they get bonus points for being so responsive.
Specialist #2. My daughter’s endocrinologist uses the Medfusion portal. Actually, it’s probably more accurate to say they have the portal installed but it’s obviously underutilized. There is no option for accessing medical histories, though you could request lab results or medication refills, as well as pay bills online. You can send a message, so I sent a note asking for an electronic copy of my daughter’s records. I wasn’t optimistic I would get a response since I have sent them five messages over the last year, none of which appear to have been opened, much less replied to (I ended up calling.) It’s been four days since I requested the records and so far no response. I’m calling this a failure.
Specialist #3. Basically ditto to Specialist #2. Nothing is available online and no one responds to my messages.

My takeaways:

The technology exists to provide patients with easy online access to their medical data.
Some providers are a little behind on the technology curve but making good progress.

Shame on providers that implement technology to engage patients and then abandon the project. Patients like me use the online messaging option either because the office is not opened at an hour convenient to me, or because I am avoiding a confusing phone system – which never connects me to a live person.


Everyone should take 30 seconds and sign the Get My Health Data petition. We all deserve easier and less frustrating access to our health information.

Michelle Ronan Noteboom specializes in healthcare IT communications, marketing, and strategy. She spent seven years as an independent contributor for HIStalk and HIStalk Practice writing under the name “Inga” and as a freelance writer for various publications and health IT vendors.

This post originally appeared on Healthcare IT News.

By PAUL LEVY

Perhaps you don’t want discouraging news about electronic health records. If that’s the case, browse on to another site.  However, the authors of this new paper have some important things to say.  And they have the expertise to be credible, being part of the National Center for Human Factors in Healthcare.

First, some background on the topic:

The usability of any device or system can be broken down into two major categories: basic interface design (human factors [HF] 1.0) and cognitive support of the user (HF 2.0). The basic interface design should follow well-established principles that ensure information is clear and readable, such as font size and color, while also providing adequate contrast between text and the background. Focused on the cognitive support of the user, HF 2.0 entails much greater detail and a deep understanding of the workflow and cognitive needs of the user. Designers focusing on HF 2.0 principles seek to understand how users accomplish their work in the context of their actual work environment (e.g., observations, task analysis, and other ethnographic techniques) and engage in iterative user testing of the interface throughout the development process.

Next, an assessment of the “state of the art:”

We are . . . concerned about the lack of progress in addressing HF 2.0 challenges. Nearly all EHR vendors, both large and small, struggle with the challenge of designing for numerous permutations of workflows, clinical specialties, and physical environments in which their EHRs are deployed.( Yet these systems must be designed with the cognitive needs of the frontline users in mind for each specialty and each user role (physician, nurse, tech, clerk, etc.). For example, an HF 1.0 patient discharge tool may have the necessary textbox fields that allow the provider to enter all of the important discharge instructions. But an interface incorporating HF 2.0 design principles would ensure easy access and display of relevant nursing notes, changes in patient status and vital signs, automatically highlight abnormal test results, and suggest follow-up information based on those results. In current systems, abnormal findings and change in a patient’s status are easily missed during the discharge process, despite the fact that the information is contained somewhere in the EHR, just not presented in a meaningful way to the user.

Recommendatons:

To do this well, EHR vendors, health care systems, and frontline health care workers need to partner so that all can deeply appreciate the intersection between the technology and the users and design the system accordingly. These efforts must leave adequate time for testing the systems during the development process, and should not be rushed after the system is built and ready to be implemented. 

From our experience in studying EHRs and their implementations, we believe that health care systems and vendors would be well served by a library of lessons learned and use cases that they can draw upon to design and install their systems. Too often, health care systems undertaking a new EHR installation find themselves reinventing the wheel and repeating the same mistakes and missteps that another institution made previously. This is neither sustainable, nor desirable when it comes to implementing safe and efficient health IT systems

Paul Levy is the former President and CEO of Beth Israel Deaconess Medical Center in Boston.