Machine learning – There are two main approaches – supervised and unsupervised – and each has specific applications in the context of healthcare.
And even though machine learning tools impact has not yet sent shockwaves through the industry, the potential of each is enormous, according to John Guttag, head of the Data Driven Inference Group at MIT’s Computer Science and Artificial Intelligence Laboratory.
At its basic level, machine learning involves looking at data, and from that data finding information that is not readily visible. Example: Applying machine learning to data about patients infected with Zika or another virus and using what we can learn about what happens to those people to inform care decisions regarding the best ways to treat people who get infected in the future.
“Typically we use machine learning to build inference tools, where we find patterns in existing data that allow us – when presented with new data – to infer something interesting about that data,” said Guttag. “Machine learning is driven entirely by the data, rather than by, say, human intuition.”
Here’s a look at the two main types of machine learning and why they matter to healthcare.
Supervised machine learning
“In supervised machine learning, we’re given the data and some outcome associated with the data,” Guttag explained. “We’re given all the people who have Zika infections and then we know which of the women have children with birth defects and which don’t. And maybe from that we could build a model saying that if the woman is pregnant and has Zika, what’s the probability that her baby has a birth defect. And it might be different for 30 year old women than for 40 year old women. Who knows what the factors would be. But there we have a label – all sorts of details about the woman, and was the baby healthy or not. So that would be supervised learning: We have a label about the outcome of interest.”
Unsupervised machine learning
Unsupervised learning, on the other hand “means we wouldn’t have a label,” he said. “We just get data, and from that data we try to infer some hidden structure in the data. So for example you get a bunch of healthcare data and you find patients who look ‘similar.’ Typically the nice thing about unsupervised learning is you find things you weren’t even looking for. It’s also useful for when, for one reason or another, the data is impossible to label.”
The case for using emerging tech today
Guttag added that machine learning is among the fastest growing parts of computer science right now in the world. As healthcare entities continually ramp up their analytics and big data efforts and gird for precision medicine and population health, machine learning as well as artificial intelligence and cognitive computing are poised to become even more valuable.
While vendors such as IBM Watson, Google, Microsoft, and other tech giants are bringing new technologies to market, most of the progress made in machine learning is happening in financial services, retail and other industries, and has been for about a decade.
Healthcare, true to its reputation for slowly embracing new technologies, is a bit late to the party.
One of the challenges unique to healthcare is the long gap between when new knowledge is obtained and when clinicians and doctors can put it to use treating patients, which is among the reasons Guttag urged major healthcare providers to more aggressively integrate today’s machine learning tools into their workflows now.
“People should be using today’s technology to do things today,” Guttag said. “Machine learning is a huge deal. And we’re going to see some pretty dramatic changes over the next few years.”
Harvard researchers predict that contact-free continuous monitoring platforms have the potential to save the healthcare industry as much as $15 billion. By Jeff Lagasse, August 04, 2016
Contact-free continuous monitoring, a platform that taps into sensors to measure patients vital signs and other metrics, hold the promise to save health systems $15 billion a year.
That’s according to a new peer-reviewed paper published in Critical Care Medicine.
CFCM is used to monitor heartbeat, respiratory rate, ulcers and patient motion. The technology’s components include sensors placed under a patient’s mattress or in a chair, bedside monitor, central display station and in handheld devices.
The sensors measure vibration and calculate motion, heartbeats per minute and breaths per minute, which detect any changes from regular patterns. If a patient’s status changes, the platform alerts nurses through large screens set up in conspicuous locations, as well as handheld devices.
Researchers from Harvard School of Medicine in a new Frost and Sullivan report entitled “Finding Top-Line Opportunities in a Bottom-Line Healthcare Market” claimed each hospital bed monitored with the EarlySense CFCM approach enables hospitals to achieve a cost savings nearing $20,000.
The cost savings are attributed to clinical outcome improvements published by hospitals implementing CFCM. Evidence suggests the technology can assist clinicians in earlier detection of patient deterioration, helping to reduce patient length of stay, minimize use of intensive care units, reduce falls and pressure ulcers and avoid cardiac and respiratory arrests.
The $15 billion figure was arrived at by extending the savings to all 750,000 relevant beds in the U.S. hospital system. The estimate does not take into account those patients in beds outside the hospital setting.
Clinical data also estimates that use of EarlySense has the annual potential to reduce patient falls by 301,809; reduce pressure ulcers by over 1 million; slash ICU days by about 1.7 million; eliminate more than 259,000 “Code Blue” events; and avoid close to 208,000 deaths.
“The healthcare industry is constantly working to improve efficiency,” said Charlie Whelan, Frost and Sullivan’s Transformational Health North America consulting director, in a statement. “These studies show that continuous monitoring presents a unique opportunity to create both top and bottom line benefits, while simultaneously improving quality of care.”
CEO Spotlight: American Well’s Roy Schoenberg on the U.S. coming out of a 10-year telehealth war zone
By Bill Siwicki, August 05, 2016
As providers, payers and patients align in what Schoenberg calls a national play for delivering real-time care anywhere patients and providers can connect, telemedicine stands ready to revolutionize healthcare the way Amazon has rewritten retail.
After a long decade of struggle, the stars have aligned for telemedicine, according to Roy Schoenberg, MD, CEO and co-founder of telehealth technology and services vendor American Well. And the understanding and acceptance of providers, payers and patients have united to the point where the electronic delivery of healthcare is poised to become part of the norm.
“First, medical authorities, policymakers, and healthcare’s movers and shakers have acknowledged that delivering healthcare through technology can be valuable and safe; that has been the war zone for the last 10 years of telehealth,” Schoenberg said. “Medical boards and medical associations were hesitant about embracing telehealth; physicians were concerned about diminishing the relationship they have with patients. But the experiences with telehealth during the last couple of years have been reassuring, and telehealth increasingly has become one of the ways physicians interact with patients.”
Second, insurance companies that while label American Well technology including Anthem, United Health Group and several of the big Blues have finally begun to take the stance that, like in any other industry, digital mechanisms are here to stay and will be a major part of the industry’s future; as a result, payers are getting on top of telehealth and discovering how to conduct such care safely, Schoenberg said.
“Payers are understanding that the efficiencies and even the humanitarian value of allowing healthcare to be delivered in this manner are overwhelming,” he added. “If you can shift healthcare via the internet to more private home care settings, for example, you not only are saving costs of emergency room visits and inpatient stays, you are changing how and when appropriate healthcare can be rendered. Telehealth, for instance, can have a very deep impact on how chronic patients are managed.”
And third, enough time has passed that telemedicine technology vendors have gained the experience – and learned lessons from mistakes – so that the vendors are completely capable of providing safe and comprehensive care via technology, Schoenberg said.
“Vendors have made corrections to the patient experience and physician usability, for example, and have learned how to foster intimacy in these kinds of healthcare encounters,” he explained. “Between the adoption of electronic delivery as a valid way of doing medicine, the payment structure, and all of the factors that affect the physician-patient experience, the stars have aligned to cause what we see today, which is a booming market.”
What’s more, telemedicine tools and practices are becoming more embedded into the routine delivery of care among providers that also white label American Well services such as Cleveland Clinic, Community Health System, Intermountain, Miami Children’s Hospital, Providence Health System and others — even employers are getting into the act, such as clients Oracle and Honeywell.
So what are the next steps? Schoenberg points in two directions.
“From the patient standpoint, we will see very quickly the transition of telehealth from just the myopic quick urgent care example of finding a physician to prescribe antibiotics to something that envelops all of healthcare, especially patients who need serious longitudinal care and frequent interaction with physicians, which increasingly is tied into things like accountable care organizations,” Schoenberg said. “We will see telehealth serving as a part of the overall relationship with patients.”
Schoenberg said American Well today is seeing provider organization clients developing telehealth programs around things like heart disease and autism, and that this sort of care will become the prevailing way healthcare executives and providers think of telehealth.
“No longer just the mother with a child in a stormy night who needs to see a physician kind of stuff,” he added. “Telehealth for ongoing clinical relationships will become the avalanche of this technology.”
On the other end of the spectrum, at the national level, Schoenberg said another next step in the evolution of telemedicine will be the realization of benefits derived from the notion that healthcare can be extended through technology so that patients are no longer married to a facility.
“If we bring together organizations that represent demand for healthcare and allow them to electronically interact with care delivery organizations, then that will not be unlike what online retail has done to the retail industry – we will be able to expand on how healthcare is being rendered and where it is being made available,” Schoenberg concluded. “This is a national play for the delivery of real-time healthcare that is embraced by the provider and the payer brands that will be available wherever the internet goes. That is how Amazon has rewritten the retail industry.”
Digital health tools: a new study found that patients of all ages, with Baby Boomers leading the charge, are interested in accessing medical records online and tapping into portals to book appointment, pay bills, and refill prescriptions.
By Jack McCarthy
Nearly 75 percent of patients expressed a high level of interest in accessing their electronic medical records via digital tools, according to new research, and 33 percent indicated that EHRs have already changed their experience for the better.
“The patient experience is dramatically transforming,” CareCloud CEO Ken Comee said in a statement. “Patients of all ages are actually embracing digital online patient engagement tools from scheduling appointments to accessing their medical records and making online payments.”
Contradicting stereotypes that millennials are the leading technology adopters, a CareCloud survey of 1,443 patients determined that Baby Boomers (51-65 years of age) are the group most likely to use healthcare tools.
Sixty-two percent of baby boomers, in fact, use technology to access their health records, while 50 percent engage with health IT tools to request prescription refills, and 43 percent to ask their providers care-related questions.
When asked what was the preferred platform of interaction with a medical group, 35 percent listed online patient portal; phone calls, 29 percent; emails, 21 percent; mobile application, 8 percent; and text messaging, 7 percent.
More than 25percent of patients have completed an online review of their doctor.
“This survey of the patient experience only reinforces the importance of technology in modern medicine,” Comee said.
The healthcare industry is at a unique crossroads in regards to innovation. Has the urge to innovate accompanied with the consumerism of care driven us down a path that could impact clinical quality? Perhaps. At least that is what American Medical Association’s (AMA) CEO James Madara, MD cautioned in his original and expanded comments regarding digital health technologies as the 21st century’s “digital snake oil.” These three little words generated strong reactions on both sides.
HIMSS, PCHA and many others agree that misleading technologies guised as clinically valuable applications have no place in healthcare. But we must be careful not to lump all digital health technologies under one umbrella as many have already had a positive impact on people’s lives and our healthcare system as a whole.
Let’s celebrate how far digital health has come
Digital technologies have already improved care delivery in a number of areas. Organizations such as the Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC) have implemented digital technologies that provide warning alerts for patient deterioration; in the program’s first year, UPMC clinicians prevented 132 intensive care unit visits for children and $5 million in savings. Missouri Health of the University of Missouri Hospital demonstrated the power of clinical decision support with catheter removal procedures as they reduced their Catheter-Associated Urinary Tract Infections by 25 percent (rates went from 6.0 to 4.5 in one year).
These are just two from hundreds of examples across the U.S., Canada, and around the world. And clinical studies havetime andtimeagaindemonstrated the value of remote monitoring technologies.
Mobile apps, sensors and remote monitoring devices and trackers are also demonstrating significant benefits in improving health, wellness and clinical outcomes. For example, congestive heart failure patients monitoring their vital signs and then transmitting personal health data to their provider, reduce their hospital readmissions by over 50 percent. Mobile apps and texting programs help to improve medication adherence and empower individuals to make important behavior changes to better self-manage their health and wellness.
Digital health: onward
Health and wellness tech have the highest Compound Annual Growth Rate (CAGR) in the mobile market (48.1 percent); and 78.5 million consumers will use home health technologies by 2020, this market represents a significant opportunity. As Christina Farr of Fast Company wrote, however, “not every app is created equal.”
Two things to keep in mind: first, as with any new market, there’s a flood of products – some good, some bad. This is healthy because an environment of innovation and creativity is in the best interests of the consumer. We need tools like data analytics, clinical testing, product evaluation, and design and needs assessment; all of which help ensure a more personalized and seamless experience for users.
Looking ahead, we must work to bridge the “app and research gaps” – i.e., aligning product development with consumer needs. Abody of evidencesubstantiating the tangible value of health IT is freely available online to help users understand how to extract value from adopted technologies and achieve long-term successful use of personal connected health devices.
As an industry, our focus is clear:
Person-centered design is a must. Personal health technologies and devices must be plug-and-play, easy-to-use and intuitive.
Reimbursement for connected health devices will be key to achieving widespread support and adoption from clinicians and engagement by consumers.
Interoperability, the seamless, standards-based, secure exchange of personal health information between individuals and their care team, is a must as well. PCHA’s Continua Design Guidelines, as well as cross-sector alliances such asIHE and the CommonWell Health Alliance are actively ensuring the right information is available to the right people at the right time.
Personalization is necessary in order to achieve long-term engagement. Data analytics allows us to finely tune the messaging and interactions, thereby creating a highly personalized experience to keep an individual engaged and motivated to achieve their health goals.
Consumer choice driving innovation
“Snake oil” and the degree to which it has captured headlines is indicative of the crossroads we have reached. We can innovate and move forward, but we must do so within the Hippocratic oath, to “first do no harm.”
The sector must ensure that there is a systematic way that consumer-facing mobile apps and other digital health technologies are being clinically validated.
As consumers, we all also have the responsibility to use the power of choice to our advantage. We have the ability, and duty, to make informed choices about what gadgets we put on our bodies or technologies we use to improve our health. Consumer demand and preferences for digital health technologies, accompanied by ongoing product innovations and highly-credible studies to evaluate effectiveness, will drive health improvements over time and leave accusations of “snake oil” in the dust.
Allegro Pediatrics has been able to support its mobile workforce by expanding its Citrix IT infrastructure. The expansion has increased the performance, speed, stability and scalability of the delivery of its EHR and apps to its clinicians. The 90 physicians who work for Allegro Pediatrics are a mobile group, moving to and from its eight clinics and local hospitals in the Bellevue, Washington, area. The need for physicians to be able to access patient data anywhere or any time was the driver for providing mobility solutions, according to CIO Brock Morris. And a mobile environment such as this one requires a robust IT infrastructure to support both physicians and an IT team.
In 2009, when Allegro Pediatrics first implemented its electronic health record (EHR) system, Morris’s team decided to expand its Citrix deployment, which is now comprised of Citrix NetScaler, XenApp and XenServer. The goal was to securely deliver the EHR and other applications to the end user with performance, speed, stability and scalability in mind. The IT team leverages Citrix NetScaler to manage its user load across all of its XenApp servers and its EHR application servers.
Allegro Pediatrics outfitted its physicians with laptops and tablets, rather than deploying workstations in the exam rooms. With physicians seeing 250,000 patients a year –1,400 patients on a busy day – performance and speed are critical. Physicians complete rounds at three of the local hospitals and also Seattle Children’s Hospital for newborns. “With their mobile devices, they are able to access EHRs remotely when they are on-call at home, and even when they are away on vacation,” he explained. “They can pull up a patient’s chart wherever they are.”
With eight clinics, physician shortages often occur. Armed with the devices that they’re comfortable with, physicians can easily move from one clinic to another without having to become familiar with specific devices in any particular clinic. This seamless experience and accessibility to patient data has led to higher physician satisfaction, according to Morris.
One of the most important benefits of having a Citrix-based infrastructure is the fact that no patient data resides on devices. Instead, data remains in the data center. “If the devices are lost, retired or stolen, we can remotely disable them to ensure the safety of protected health information,” says Morris.
Allegro Pediatrics has also garnered business benefits. Now physicians are able to fill out billing forms online when they visit newborns in the hospital – a task that previously was often completed after the fact. Bills are sent out in a timely manner and accounts receivable is collecting payments sooner than ever before.
In addition, the IT department is benefiting from the infrastructure. In one day, Morris and his team recently rolled out 110 tablets pre-loaded with Windows 10 to medical assistants across its landscape of clinics. The medical assistants were able to power-on the devices, and with little training, they were able to log onto the Citrix storefront, access applications and start their regular tasks that morning. “We had a seamless migration to Windows 10. Despite provisioning brand new devices and operating systems, the Citrix platform enabled all end users to have the same consistent experience,” he said. The IT department received few calls the day after deployment. Morris concluded, “It is the most successful migration that we have ever performed in our organization.”
Google, the world’s most used search engine, is partnering with two of the world’s leading health organizations to take the confusion out of symptom searching.
“We worked with a team of medical doctors to carefully review the individual symptom information, and experts at Harvard Medical School and Mayo Clinic evaluated related conditions for a representative sample of searches to help improve the lists we show,” Veronica Pinchin, a product manager on Google’s search team, writes in a blog post introducing Google’s new offering.
“Before symptom search, you really had to know the exact name of what you were looking for to find the best health information,” Pinchin adds. “It was difficult to stumble on the right condition. Health content on the web can be difficult to navigate, and tends to lead people from mild symptoms to scary and unlikely conditions, which can cause unnecessary anxiety and stress.”
About 1 percent of Google’s search queries worldwide are related to medical symptoms. That seems small, but it translates into millions of searches, she notes.
In consultation with Harvard Medical School and the Mayo Clinic, Google has built millions of digital cards for millions of searches.
“Because this is an algorithm, it isn’t perfect,” Pinchin writes. “But we’re going to expand and improve it over time.”
Symptom search is currently available only in the U.S. – and only in English – in Google iOS and Android apps, and in Google.com search results on mobile phones and tablets.
But Google plans to make searches available via desktop browsers and to international markets in more languages, but the company has not indicated when.
In her blog, Pinchin offers some cautionary words: “Symptom search (like all medical information on Google) is intended for informational purposes only, and you should always consult a doctor for medical advice.”
Mobility Aids & Transportation Equipment Market is Anticipated to reach 7.8 Billion USD by 2021
Increasing ageing population and new betterment in the Healthcare Industry is driving the Mobility Aids and Transportation Equipment Market to $7.8 Billion by 2021.
Report Market Analysis: By Type (Wheelchairs, Walking Aids, Mobility Scooters, Stair Lifts); By Age Group (Children, Elderly); By User (Hospital, Clinics, Patients)- Forecast (2016-2021)”, published by IndustryARC, estimates the market to reach $7.8 Billion by 2021.
Mobility Aids and Transportation Equipment are used by individuals with any kind of physical disability to assist them in mobility. They are also used in hospitals and clinics for shifting patents from one room to another. Intensive R&D in the field of medical devices and equipment has led to the invention of products that have enhanced the quality of life of the disabled people. These aids and equipment comprise of wheelchairs, walking aids, mobility scooters and stairlifts among many others.
According a recent study of IndustryARC the global market value for Mobility Aids and Transportation Equipment Market is estimated to reach $7.8 Billion by 2021. The manual wheelchairs segment will be the highest revenue generating segment in this market. The fastest growing segment will be motorized wheelchairs. The combined revenue for these two segments accounted for approximately 68% of the total revenue in 2015. Walking aids such as canes, crutches and walkers among many others also contributed a significant share to the total revenue.
Mobility Equipment for elderly disabled people and seniors comprises of a large number of assistive, rehabilitative and adaptive devices as well as disability products. The increasing number of bone and knee disorders as well as the disabilities and diseases such as Stroke and osteoarthritis lead to the rising demand of the mobility equipment across the elderly people and the seniors. These assistive tools such as wheelchairs and power chairs help in performing activities and tasks with greater ease and freedom in case of a difficulty or an injury.
Americas region was the market leader in 2015 with nearly 55% of the total market and is estimated to grow at a CAGR of 3.2% through 2016 to 2021. However APAC region will have the highest growth rate in the forecast period. Americas will continue to be the market leader in 2021 also.
The Major Players in this Market Include:
Sunrise Medicals GMBH & Co. (Germany)
Invacare Corporation (U.S.)
Stryker Corporation (U.S.)
Medline Industries Inc. (U.S.)
Drive Medicals (U.S.)
The major manufacturers in this market have utilized product launches, product developments and acquisitions to expand entry into interconnected markets and enhance core competencies through additions to product portfolio as well as improving the existing product line. The acquisitions help them to reduce competition and enter into new markets.
The report mobility aids and transportation equipment provides detailed analysis of different types of mobility aids and their end users. The various mobility aids and transportation equipment products incorporated in the study include-
The overall market is also presented from the perspective of different geographic regions and the key countries for this industry. Competitive landscape for each of the product types is highlighted and market players are profiled.
Related Reports of Your Interest:
• Healthcare Transportation Services Market – Healthcare Transportation Services Market Analysis: By Medical Transportation Type (Incubator, Pharmaceuticals, Mobile Treatment, Patient Transport); By Non-Medical (Repatriation Services, Courier, Mailroom Services) – Forecast (2015 – 2020)
IndustryARC is a Research and consulting firm that publishes more than 500 Reports Annually in various industries, such as Agriculture, Automotive, Automation & Instrumentation, Chemicals and Materials, Energy and Power, Electronics, Food & Beverages, Information Technology, Life sciences & Healthcare.
IndustryARC primarily focuses on Cutting Edge Technologies and Newer Applications of the Market. Our Custom Research Services are designed to provide insights on the constant flux in the global demand-supply gap of markets. Our strong analyst team enables us to meet the client research needs at a very quick speed with a variety of options for your business.
Africa market – eMEDICS.org (YFORM Ltd) has come up with an innovating way of allowing users to convert their paper forms to mobile and start collecting data from anywhere instantly.
YFORM Ltd builds forms that are suitable for worldwide market and especially Africa. We share these forms with our clients through a form catalog. Using the app, team members can log in and start collecting data on mobile devices.
The aim of the technology is to collect data better including pictures, GPS locations, sketches, audio and video, with the platform working both online and offline.Africa is an economy that relies heavily on paper forms for 60 per cent of its processes. Another 20 per cent collect data in silos, are not integrated and face a huge challenge collecting data from remote areas with little or no internet connectivity,”
Moreover, paper-based data collection moves slowly, taking hours or days to get from the point of capture to the point of entry, and is also prone to damage and loss. YFORM Ltd aims to tackle all that.
The possibilities for YFORM Ltd, are unlimited.
“We can replace paper forms completely and be the gold standard for data collection in Africa,”
“It’s a huge market, and we have not even scratched the surface in Africa yet. We have a few contacts who have expressed interest in our product from other African countries, and also India.”Initially, YFORM Ltd struggled to understand how to implement its technology, and how to handle the extremely poor connections in remote areas. We eventually got the hang of it.
“Now all we struggle with is meeting the ever-increasing demands of our clients, always a good sign,”
“In five years we expect to be the data collection tool of choice for all NGO projects in Africa and endorsed by major NGO funders like USAID, the WHO, and the World Bank.”
ChinaBio® Partnering Forum is the premier life science partnering event in China. Held on May 18–19, 2016, in Suzhou, the event will attract biotech and pharma leaders from around the world along with hundreds of China-based developers of novel technologies for two days of productive partnering.
ChinaBio® Partnering Forum 2015 had more than 858 delegates from 435 companies and 22 countries, making it the largest partnering conference in China. The 2016 edition promises to be even better with top notch attendance from pharma and biotech companies as well as leading researchers from China’s top universities and institutes.
The conference also features partneringONE®, enabling delegates to efficiently identify, meet and network with companies from across the life science value chain.
Who will you meet?
Senior executives of leading China-based pharma and biotech companies
Senior management and business development executives from global biotech and pharma companies
Venture capitalists and other investors active in life science
With over one-third of the attendees being C-level decision makers, ChinaBio® Partnering Forum is the event to get partnerships started in China.
Profile of participants at ChinaBio® Partnering Forum 2015
Innovative companies, organizations or researchers interested in partnering their technologies or products, initiating strategic alliances, or tapping into the financing network are welcome to apply to present at the ChinaBio® Partnering Forum 2016.
A panel of industry experts will select the presenting companies. The panel will make each decision based on the company profile submitted in the partnering system, on the interests of the biotech industry, and the licensability of products or technology.
Presenting companies will be selected based on the corporate profile they have submitted.
Delegates of a presenting company other than the presenter will need to register separately and will be invoiced for the registration fee.
Your registration fee covers
Submission of up to 150 requests per company for one-to-one meetings during the conference
Access to all workshops, presentations, panel discussions and the exhibition area
Publication of your company and personal profiles on partneringONE®
Breakfast, lunch, snacks, coffee and other non-alcoholic beverages in the conference center
Evening networking events
Multiple attendee discount
Companies with three full-paying delegates will receive one complimentary ticket for the fourth attendee from that company.
Your company profile will be published in the password-protected Partnering section of the ChinaBio® Partnering Forum website.
Companies selected for a presentation will receive an invoice shortly after they have been notified of their assigned presentation slot. Payment must be made in advance of the event.
Please email Philipp Dormeier at firstname.lastname@example.org if you are registered and will not be able to attend the conference so that your partnering account can be deactivated.
We are sorry, but we do not allow refunds of paid registration/presentation fees for this conference. However, a paid registration is transferable to a replacement from your company.
Please note that no-shows will be billed for the full registration fee and, if applicable, the full presentation fee.
Primary care doctors now lose more than an hour a day to sorting through approximately 77 electronic health record (EHR) notifications, researchers at Baylor University found.
“Information overload is of concern because new types of notifications and ‘FYI’ (for your information) messages can be easily created in the EHR (vs in a paper-based system),” the researchers wrote in the Journal of the American Medical Association Internal Medicine.
Making the workload harder to endure, reading and processing these messages is uncompensated in an environment of reduced reimbursements for office-based care, according to the study.
Physicians are receiving these increasing amounts of notifications in EHR-based inboxes such as Epic’s In-Basket and General Electric Centricity’s Documents. The messages include test results, responses to referrals, requests for medication refills, and messages from physicians and other healthcare professionals.
The system is crying out for change the researchers wrote. “Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed.”
What’s more, optimistic predictions that EHRs would improve patient care through better doctor-patient communications have not ubiquitously materialized.
“Unfortunately, we are far from this promise and now also grapple with the unintended consequences of EHRs,” Joseph Ross, MD wrote in an editorial accompanying the research.
In fact, electronic “paperwork” has burdened doctors and reduced the time for patient care.
Ross advocated that inbox notification capabilities be periodically reviewed to be sure EHRs are working in the best interests of patient care and not creating an unnecessary burden on physicians.
In addition, doctors should be reimbursed for time spent reviewing EHR notifications.
“Although many of these notifications are in the service of patients,” Ross wrote, “we need to be sure that physicians’ reimbursement, particularly for primary care physicians, is taking into account the full time needed to manage patients’ care.”
HIMSS16 – Experts say healthcare providers need to turn up the pressure on tech vendors to create more intuitive products.
By Mike Miliard, March 10, 2016
HIMSS16 – Electronic health record usability might not have been the hottest topic at HIMSS16 this past week – our polling shows big data and interoperability tied for that honor, with privacy/security just nudging population health for the second spot – but it was certainly top of mind for many.
The multi-day User Experience HIMSS16 Forum, for instance, explored the human factor and design choices that can directly impact the use and efficacy of health information technology, examining UX from the perspective of physicians, nurses, patients, vendors and more. Sessions gave voice to end-user frustrations, looked to tear down the barriers to innovation and tracked the clinical and financial return that can be gained from improved software interfaces.
In a provocative prime-time speech, meanwhile, Acting CMS Administrator Andy Slavitt threw down the gauntlet: “I’m certainly not bashful about what we need to do better, and I’m not going to be bashful here, even in the face of some very good reasons for optimism, about ways we need to take our game up across the board.”
The health IT industry has done very well in the years since the HITECH Act, said Slavitt. “But we’re still at the stage where technology often hurts rather than helps physicians providing better care.”
To bolster his case, he rattled off a series of actual quotes from frustrated clinicians. One complained that in his EHR, “to order aspirin takes eight clicks; to order full-strength aspirin takes 16.”
Slavitt said at HIMSS16, CMS is newly committed to taking a “user-centered approach to designing policy.” He asked vendors to do the same, with a similar spirit of empathy: “Step back and look at what you don’t think is working, and make it better.”
In recognizing that health IT still “often hurts rather than helps physicians,” Acting CMS Administrator Andy Slavitt said at HIMSS16 that the agency is newly committed to taking a “user-centered approach to designing policy.” He asked vendors to do the same, with a similar spirit of empathy: “Step back and look at what you don’t think is working, and make it better.”
‘Dissatisfaction with EHRs has been immense’
The rigors of federal policy requirements, combined with the suboptimal UX of many EHR products has left doctors and nurses feeling less like clinicians and more like clerks, said one chief medical information officer at HIMSS16. Ceaseless data entry is bad enough. But even worse when done through a clunky or dated user interface.
“Dissatisfaction with EHRs has been immense,” said George Gellert, MD, associate system CMIO at CHRISTUS Health. “Understandably, physicians are looking for release.”
Increasingly, many of them are finding it by using unlicensed medical scribes, who often have minimal training, as data-entry workarounds. If that poses obvious patient safety risks, it also hinders the progress of EHR product improvement, he argued.
“If you insert a scribe permanently between the physician and the EHR, and the physician totally disengages from using the EHR, you are going to have a significant deceleration of technological advancement because there’s no market pressure,” said Gellert at HIMSS16.
As problematic as UX often still is, many IT vendors have made big design and usability improvements in recent years, as a direct result of pointed and specific clinical feedback – including at CHRISTUS, where docs and nurses now enjoy an updated EHR made better thanks to the health system’s commitment to capture “every single physician complaint” and relay them to its vendor.
Market pressure works, said Gellert, and a rising sub-industry of scribes could be counterproductive as doctors’ dissatisfaction comes to a boil.
At least scribes still engage with technology, in contrast with one New York Times item that garnered a bit of attention in health IT circles this past December. “In Age of Digital Records, Paper Still Carries Weight,” was the headline.
The good news? We’ve come a long way in a short time: “In 2009, fewer than 10 percent of hospitals had any kind of electronic medical records,” wrote Abigail Zuger, MD. “By 2014, 75 percent had at least a basic system.”
The bad news? That “rushing” has led to some severely problematic products that often have care providers gnashing their teeth in frustration. Or, sometimes, making use of workarounds that defeat the purpose of well-meaning federal policies such as the Affordable Care Act and meaningful use.
“Paper has become our lingua franca, our fallback and standby,” wrote Zuger. “In our new digital universe, we have peculiarly seen a retro explosion of paper. We may no longer write paper prescriptions, but we fax or hand-deliver paper versions of our electronic dealings routinely now. When you don’t know what electronic language the receiver speaks (and you never do) you go with paper.”
While her primary complaint was about systems’ lack of interoperability, it’s a safe bet that she and many of her colleagues would add poor usability to their list of EHR gripes.
That dissatisfaction is getting worse, not better. A study published this summer by the American Medical Association and the American College of Physicians found that physicians are more frustrated with EHRs than they were five years ago.
Forty-two percent of respondents said their EHR system’s ability to improve efficiency was “difficult or very difficult.” Some 72 percent said the same about its ability to decrease workload.
We saw similar feedback in HIMSS16 Healthcare IT News’ first-ever EHR Satisfaction Survey this past fall. In addition to numerical scores, we also asked for anecdotal feedback from more than 400 people who took the poll. Opinions such as “not very intuitive,” “cumbersome” and “too many clicks” cropped up over and over again.
‘Limited in their understanding of people’In his landmark book, The Design of Everyday Things, Don Norman, director of The Design Lab at University of California San Diego wrote:
“The reasons for the deficiencies in human-machine interaction are numerous. Some come from the limitations of today’s technology. Some come from self-imposed restrictions by the designers, often to hold down cost. But most of the problems come from a complete lack of understanding of the design principles necessary for effective human-machine interaction, Why this deficiency? Because much of the design is done by engineers who are experts in technology but limited in their understanding of people.”
Of course, in healthcare IT there are other challenges. EHR vendors would probably love to have all their products look as sleek and intuitive as the latest iOS release. But they also have to ensure they check all the boxes to comply with certification criteria from the Office of the National Coordinator – all 560 detailed pages of the 2015 Edition.
“I know some people inside big EMR companies who want to do excellent design, but in an organization that’s owned by IT, it’s difficult for even a design advocate to have their voice heard and affect the process,” Amy Cueva, co-founder of the design-centric Health Experience Refactored conference, told Healthcare IT News in 2013.
Meaningful use spurred uptake, of course, but that doesn’t necessarily mean the end-users are looking at EHRs with joy in their hearts.
“You don’t have to pay people to use Facebook or Google or their iPhone,” Cueva said. “They use it because it’s valuable and meaningful and it gives them something they can’t get anywhere else.” In many cases there was too much of a rush to get hospitals online – to the point where many were “just sort of throwing software out there,” she said.
That’s changing, thankfully, as more and more efforts are being made industry-wide to make EHRs easier to use and perhaps a bit better-looking. One of those ONC certification criteria, after all, is that vendors employ a user-centered design process when developing their tools, and report the results of usability testing.
A recent study published in the Journal of the American Medical Informatics Association took a look at UCD processes at 11 unnamed vendors, seeking to understand the challenges and opportunities for better design practices.
“Our analysis demonstrates a diverse range of vendors’ UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD,” wrote AMIA officials – noting that the latter category might refer, say, to the mistaken belief that responding to end-users’ requests and complaints qualifies as user-centered design.
“Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization,” according to AMIA.
Dishearteningly, the researchers found some respondents still didn’t see the business case for investing in UCD processes. It even found that some smaller EHR vendors didn’t even have any usability experts on their staff.
But there’s evidence that many are moving in the right direction. In December, for instance, the EHR Association and American College of Physicians joined forces for a workshop to discuss ways to improve EHR usability – enlisting clinicians, developers and usability experts to explore ways to improve the experience.
“The workshop also included a ‘design-a-whirl’ where the group rotated through examples of different techniques for obtaining and validating clinician feedback during the development process, which was an important opportunity for the attending clinicians to learn more about the software development life cycle,” according to a brief in Politico.
Meanwhile, a recent report looking at EHR usability and clinical decision support called upon AHRQ research to explore ways improved health IT interfaces – websites, apps, dashboards – can lead to better patient care.
It’s “promising that electronic health records and clinical decision support tools are rapidly being implemented in hospitals and clinics nationwide,” wrote Thomas McGinn, MD, chair of medicine at Hofstra North Shore-LIJ School of Medicine, in the study’s introduction.
But implementing EHR and CDS into clinical workflow “continues to be challenging,” he added. Poor integration runs the risk of “substantially reducing adoption and use.”
Lately, there has been some movement toward thinking a bit more closely about the clinical users of these technologies. ”It is believed that thoughtful systems engineering approaches, including consideration of user experience and improvements in user interface, can greatly improve the ability of CDS tools to reach their potential to improve quality of care and patient outcomes,” wrote McGinn.
Exploring topics such as UX and system redesign, EHR-based visualization tools and integration patient-reported data, the multi-part study aims to spur some rethinking about the ways EHR decision support is presented to clinicians.
“We are at the very early stages of the science of usability,” wrote McGinn. “Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice.”
“The reasons for the deficiencies in human-machine interaction are numerous,” writes design guru Don Norman. One of the biggest, he says, is that “much of the design is done by engineers who are experts in technology but limited in their understanding of people.”