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Stanford Survey Generates Predictable Result: Doctors Want EHR Changes

Posted on June 11, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I know you’re going to have trouble believing this, but many PCPs think EHRs need substantial changes.

Such is the unsurprising conclusion drawn by a survey conducted by The Harris Poll on behalf of Stanford Medicine. The poll, which took place between March 2 and March 27 of this year, surveyed 521 PCPs licensed to practice in the U.S. who have been using their current EHR system for at least one month.

The physicians were recruited via snail mail from the American Medical Association Masterfile. Figures for years in practice by gender, region and primary medical specialty were weighted where necessary to bring them into line with their actual proportions in the population of PCPs in the U.S.

According to the survey, about two-thirds of PCPs think EHRs have generally improved care (63%). Two-thirds said they were at least somewhat satisfied with their current systems, though only 18% were very satisfied.

Meanwhile, a total of 34% were somewhat or very dissatisfied with their system, and 40% of PCPs said that EHRs create more challenges than benefits. Also, 49% of office-based PCPs reported that using an EHR detracts from their clinical effectiveness.  Forty-four percent of PCPs said that primary value of EHRs is data storage, while just 8% said that the biggest benefits were clinically-related.

To improve EHRs’ clinical value, it will take a lot of effort, with 51% saying they think EHRs need a complete overhaul.  Seventy-two percent of PCPs said that improving user interfaces could best address their needs in the immediate future.

Meanwhile, 67% of respondents said that solving interoperability problems should be the top priority for EHR development over the next decade, and 43% reported wanting improved predictive analytics capabilities.

Nearly all (99%) of PCPs said that EHR capabilities should include maintaining a high-quality record of patient data over time, followed closely by providing an intuitive user experience. Also, 88% said that providing clinical decision support at the moment of care was important, followed by identifying high-risk patients in their patient panel (86%).

When asked what EHR features they found most satisfying, they cited maintaining a high-quality patient record (73%), offering patients access to medical records (71%), sharing information with providers across the care continuum (65%) and supporting practice/revenue cycle management needs (60%).

However, EHRs still have a long way to go in offering other preferred capabilities, including changing and adapting in response to user feedback, improving patient-provider interaction, coordinating care for patients with complex conditions and engaging patients in prescribed care plans through mobile technologies. Vendors, you have been warned.

“Shadow” Devices Expose Networks To New Threats

Posted on June 4, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new report by security vendor Infoblox suggests that threats posed by “shadow” personal devices connected to healthcare networks are getting worse.

The study, which looks at healthcare organizations in the US, UK, Germany, and UAE, notes that the average organization has thousands of personal devices connected to their enterprise network. Including personal laptops, Kindles and mobile phones.

Employees from the US and the UK report using personal devices connected to their enterprise network for multiple activities, including social media use (39%), downloading apps (24%), games (13%) and films (7%), the report says.

It would be bad enough if these pastimes only consumed network resources and time, but the problem goes far beyond that. Use of these shadow devices can open up healthcare networks to nasty attacks. For example, social media is increasingly a vector of malware infection, where bad actors launch attacks successfully urging them to download unfamiliar files.

Health IT directors responding to the study also said there were a significant number of non-business IoT devices connected to their network including fitness trackers (49%), digital assistants like Amazon Alexa (47%), smart TVs (46%), smart kitchen devices such as connected kettles of microwaves (33%) and game consoles such as the Xbox or PlayStation (30%).

In many cases, exploits can take total control of these devices, with serious potential consequences. For example, one can turn a Samsung Smart TV into a live microphone and other smart TVs could be used to steal data and install unwanted apps.

Of course. IT directors aren’t standing around and ignoring these threats and have developed policies for dealing with them. But the report argues that their security policies for connected devices aren’t as effective as they think. For example, while 88% of the IT leaders surveyed said their security policy was either effective or very effective, employees didn’t even know it was in effect in many cases.

In addition, 85% of healthcare organizations have also increased their cybersecurity spending over the past year, and 12% of organizations have increased it by over 50%. Most HIT leaders appear to be focused on traditional solutions, including antivirus software (60%) and cybersecurity investments (57%). In addition, more than half of US healthcare IT professionals said their company invests in encryption software.

Also, about one-third of healthcare IT professionals said the company is investing in employee education (35%), email security solutions and threat intelligence (30%). One in five were investing in biometric solutions.

Ultimately, what this report makes clear is that health IT organizations need to reduce the number of unauthorized personal devices connected to their network. Nearly any other strategy just puts a band-aid on a gaping wound.

How Technology Helped My Family Receive a Better Healthcare Experience

Posted on May 10, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - Stericycle

When was the last time you had a truly outstanding patient experience? For my family, two healthcare facilities located hours apart recently teamed up to make our lives significantly more convenient. Without modern technology, however, our new reality may never have been possible. Let’s start from the beginning.

A few years ago, my family member suffered a heart attack that caused a traumatic brain injury. He was treated at a major facility about two hours away from his home for speech therapy, occupational therapy, neurological care, cardiologist support, and more. After a year of hard work, he was discharged from the hospital and was able to move back to his home town.

Unfortunately, his community hospital was not equipped to provide the specific care he required. So for the next two years, he and his wife, who is now his primary care giver, commuted to the city multiple times a week to ensure he received the care he needed.

Eventually, we all wondered the same thing: Isn’t there a better way?

After many meetings with the facility that treated my relative and our local hospital, we started discussing how digital health experiences and virtual care could augment my family’s patient and caregiver experience. We were determined to find a solution that provided care options and choice, and allowed them to continue receiving the necessary care without the exhaustion of “living on the road.”

A recent study by Accenture said it best: “Finding the best combination of traditional in-person services and making those same services available virtually can offer consumers the choice they want in deciding when and how they receive care and support.”

Fortunately, we learned that our local hospital was equipped to provide virtual care. However, many patients had not yet taken advantage of these technologies. After some coordinating between facilities, we were able to set up ongoing virtual appointments. These appointments enabled my family member to receive care in a much more convenient setting.

With virtual appointments, they can even:

  • Easily schedule virtual appointments
  • Participate in the appointments from the comfort of a boardroom at the hospital
  • Consult with the first hospital’s specialist and also an in-person care facilitator
  • Receive follow-up health reminders and education directly after the appointment

Now, almost half of his appointments have transitioned to virtual appointments. And my family is not the only one taking advantage of this care capability. Recent research explores the many reasons why healthcare consumers are making this virtual shift:

  • One of the top three reasons why consumers tried virtual health was convenience. 37% said it was more convenient than traditional, in-person health services
  • 76% of people would have a follow-up appointment (after seeing a doctor or healthcare professional)
  • 74% would get virtual follow-up care services in their home after being hospitalized
  • 73% would discuss a specific health concern virtually with a doctor or other healthcare people and
  • 72% would be open to getting virtual daily support to manage an ongoing health issue

Consumer willingness to demand choice and becoming more involved in their health is rising. Like my family, more patients are ready to collaborate with clinicians, embrace new technologies, and explore digital health experiences that can help manage our health and create more convenient and engaging patient experiences.

Learn more about how Stericycle Communication Solutions is helping create the optimal patient experience through a combination of human and tech-enabled communication services. Check out our service overview here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality live agent services, scheduling solutions, and automated messaging solutions.  Stericycle Communication Solutions provides unified human & tech-enabled communication solutions for optimized patient experiences.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Why You Shouldn’t Take Calculated Risks with Security

Posted on May 9, 2018 I Written By

The following is a guest blog post by Erin Gilmer (@GilmerHealthLaw).

Calculated risks are often lauded in innovation.  However, with increasing security breaches in the tech industry, it is time to reassess the calculated risks companies take in healthcare.

Time and again, I have advised technology companies and medical practices to invest in security and yet I am often met with resistance, a culture of calculated risk prevails.  To these companies and practices, this risk may make sense to them in the short term. Resources are often limited and so they often believe that they needn’t spend the time and money in security.  However, the notion that a company or a practice can take this chance is ill advised.

As a recent study conducted by HIMSS (and reviewed by Ann Zieger here) warns, “significant security incidents are projected to continue to grow in number, complexity and impact.” Thus in taking the calculated risk not to invest in security, companies and practices are creating greater risk for in the long run, one that comes with severe consequences.

As we have seen outside of healthcare, even “simple” breaches of user names and passwords as happened to Under Armour’s MyFitnessPal app, become relatively important use cases as examples of the impact a security breach can have. While healthcare companies typically think of this in terms of HIPAA compliance and oversight by the Office for Civil Rights (OCR), the consequences reach far wider.  Beyond the fines or even jail time that the OCR can impose, what these current breaches show us is how easy it is for the public to lose trust in an entity.  For a technology company, this means losing valuation which could signal a death knell for a startup. For a practice, this may mean losing patients.  For any entity, it will likely result in substantial legal fees.

Why take the risk not to invest in security? A company may think they are saving time and money up front and the likelihood of a breach or security incident is low. But in the long run, the risk is too great – no company wants to end up with their name splashed across the headlines, spending more money on legal fees, scrambling to notify those whose information has been breached, and rebuilding lost trust.  The short term gain of saving resources is not worth this risk.

The best thing a company or practice can do to get started is to run a detailed risk assessment. This is already required under HIPAA but is not always made a priority.  As the HIMSS report also discussed, there is no one standard for risk assessment and often the OCR is flexible knowing entities may be different sizes and have different resource. While encryption standards and network security should remain a high priority with constant monitoring, there are a few standard aspects of risk assessment including:

  • Identifying information (in either physical or electronic format) that may be at risk including where it is and whether the entity created, received, and/or is storing it;
  • Categorizing the risk of each type of information in terms of high, medium, or low risk and the impact a breach would have on this information;
  • Identifying who has access to the information;
  • Developing backup systems in case information is lost, unavailable, or stolen; and
  • Assessing incidence response plans.

Additionally, it is important to ensure proper training of all staff members on HIPAA policies and procedures including roles and responsibilities, which should be detailed and kept up to date in the office.

This is merely a start and should not be the end of the security measures companies and practices take to ensure they do not become the next use case. When discussing a recent $3.5 million settlement, OCR Director Roger Severino recently emphasized that, “there is no substitute for an enterprise-wide risk analysis for a covered entity.” Further, he stressed that “Covered entities must take a thorough look at their internal policies and procedures to ensure they are protecting their patients’ health information in accordance with the law.”

Though this may seem rudimentary, healthcare companies and medical practices are still not following simple steps to address security and are taking the calculated risk not to – which will likely be at their own peril.

About Erin Gilmer
Erin Gilmer is a health law and policy attorney and patient advocate. She writes about a range of issues on different forums including technology, disability, social justice, law, and social determinants of health. She can be found on twitter @GilmerHealthLaw or on her blog at www.healthasahumanright.wordpress.com.

Privacy Fears May Be Holding Back Digital Therapeutics Adoption

Posted on May 3, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Consumers were already afraid that their providers might not be able to protect the privacy of their health data. Given the daily news coverage of large data breaches and since the Facebook data scandal blew up, consumers may be even less likely try out new digital health approaches.

For example, a new study by innovation consultancy Enspektos has concluded that patients may be afraid to adopt digital therapeutics options. Many fear that the data might be compromised or the technology may subject them to unwanted personal surveillance.

Without a doubt, digital therapeutics could have a great future. Possibilities include technologies such as prescription drugs with embedded sensors tracking medication compliance, as well as mobile apps that could potentially replace drugs. However, consumers’ appetite for such innovations may be diminishing as consumer fears over data privacy grow.

The research, which was done in collaboration with Savvy Cooperative, found that one-third of respondents fear that such devices will be used to track their behavior in invasive ways or that the data might be sold to a third party without the permission. As the research authors note, it’s hard to argue that the Facebook affair has ratcheted up these concerns.

Other research by Enspektos includes some related points:

  • Machine-aided diagnosis is growing as AI, wearables and data analytics are combined to predict and treat diseases
  • The deployment of end-to-end digital services is increasing as healthcare organizations work to create comprehensive platforms that embrace a wide range of conditions

It’s worth noting that It’s not just consumers who are worried about new forms of hacker intrusions. Industry CIOs have been fretting as it’s become more common for cybercriminals to attack healthcare organizations specifically. In fact, just last month Symantec identified a group known as Orangeworm that is breaking into x-ray, MRI and other medical equipment.

If groups like Orangeworm have begun to attack medical devices — something cybersecurity experts have predicted for years — we’re looking at a new phase in the battle to protect hospital devices and data. If one cybercriminal decides to focus on healthcare specifically, it’s likely that others will as well.

It’s bad enough that people are worried about the downsides of digital therapeutics. If they really knew how insecure their overall medical data could be going forward, they might be afraid to even sign in to their portal again.

More Ways AI Can Transform Healthcare

Posted on April 25, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

You’ve probably already heard a lot about how AI will change healthcare. Me too. Still, given its potential, I’m always interested in hearing more, and the following article struck me as offering some worthwhile ideas.

The article, which was written by Humberto Alexander Lee of Tesser Health, looks at ways in which AI tools can reduce data complexity and detect patterns which would be difficult or even impossible for humans to detect.

His list of AI’s transformative powers includes the following:

  • Identifying diseases and providing diagnoses

AI algorithms can predict when people are likely to develop heart disease far more accurately than humans. For example, at Google healthcare technology subsidiary Verily, scientists created an algorithm that can predict heart disease by looking at the back of a person’s eyes and pinpoint early signs of specific heart conditions.

  • Crowdsourcing treatment options and monitoring drug response

As wearable devices and mobile applications mature, and data interoperability improves thanks to standards such as FHIR, data scientists and clinicians are beginning to generate new insights using machine learning. This is leading to customizable treatments that can provide better results than existing approaches.

  • Monitoring health epidemics

While performing such a task would be virtually impossible for humans, AI and AI-related technologies can sift through staggering pools of data, including government intelligence and millions of social media posts, and combine them with ecological, biogeographical and public health information, to track epidemics. In some cases, this process will predict health threats before they blossom.

  • Virtual assistance helping patients and physicians communicate clearly

AI technology can improve communication between patients and physicians, including by creating software that simplifies patient communication, in part by transforming complex medical terminology into digestible information. This helps patients and physicians engage in a meaningful two-way conversation using mobile devices and portals.

  • Developing better care management by improving clinical documentation

Machine learning technology can improve documentation, including user-written patient notes, by analyzing millions of rows of data and letting doctors know if any data is missing or clarification is needed on any procedures. Also, Deep Neural Network algorithms can sift through information in written clinical documentation. These processes can improve outcomes by identifying patterns almost invisible to human eyes.

Lee is so bullish on AI that he believes we can do even more than he has described in his piece. And generally speaking, it’s hard to disagree with him that there’s a great deal of untapped potential here.

That being said, Lee cautions that there are pitfalls we should be aware of when we implement AI. What risks do you see in widespread AI implementation in healthcare?

London Doctors Stage Protest Over Rollout Of App

Posted on April 18, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

We all know that doctors don’t take kindly to being forced to use health IT tools. Apparently, that’s particularly the case in London, where a group of general practitioners recently held a protest to highlight their problems with a telemedicine app rolled out by the National Health Service.

The doctors behind the protest are unhappy with the way the NHS structured its rollout of the smartphone app GP at Hand, which they say has created extra work and confusion among the patients.

The service, which is run by UK-based technology company Babylon Health, launched in November of last year. Using the app, patients can either have a telemedicine visit or schedule an in-person appointment with a GP’s office. Telemedicine services are available 24/7, and patients can be seen in minutes in some cases.

GP at Hand seems to be popular with British consumers. Since its launch, over 26,000 patients have registered for the service, according to the NHS.

However, to participate in the service, patients are automatically de-registered from their existing GP office when they register for GP at Hand. Many patients don’t seem to have known this. According to the doctors at the protest, they’ve been getting calls from angry former patients demanding that they be re-registered with their existing doctor’s office.

The doctors also suggest that the service gets to cherry-pick healthier, more profitable patients, which weighs down their practice. “They don’t want patients with complex mental health problems, drug problems, dementia, a learning disability or other challenging conditions,” said protest organizer Dr. Jackie Applebee. “We think that’s because these patients are expensive.” (Presumably, Babylon is paid out of a separate NHS fund than the GPs.)

Is there lessons here for US-based healthcare providers? Perhaps so.

Of course, the National Health Service model is substantially different from the way care is delivered in this country, so the administrative challenges involved in rolling out a similar service could be much different. But this news does offer some lessons to consider nonetheless.

For one thing, it reminds us that even in a system much different than ours, financing and organizing telemedicine services can be fraught with conflict. Reimbursement would be an even bigger issue than it seems to have been in the UK.

Also, it’s also of note that the NHS and Babylon Health faced a storm of patient complaints about the way the service was set up. It’s entirely possible that any US-based efforts would generate their own string of unintended consequences, the magnitude which would be multiplied by the fact that there’s no national entity coordinating such a rollout.

Of course, individual health systems are figuring out how to offer telemedicine and blend it with access to in-person care. But it’s telling that insurers with a national presence such as CIGNA or Humana aren’t plunging into telemedicine with both feet. At least none of them have seen substantial success in their efforts. Bottom line, offering telehealth is much harder than it looks.

Should Apps with Personal Health Information Be Subject to HIPAA?

Posted on April 10, 2018 I Written By

The following is a guest blog post by Erin Gilmer (@GilmerHealthLaw).

With news of Grindr’s sharing of user’s HIV status and location data, many wonder how such sensitive information could be so easily disclosed and the answer is quite simply a lack of strong privacy and security standards for apps.  The question then becomes whether apps that store personal health information should be subject to HIPAA? Should apps like Grindr have to comply with the Privacy and Security Rules as doctors, insurance companies, and other covered entities already do?

A lot of people already think this information is protected by HIPAA as they do not realize that HIPAA only applies to “covered entities” (health care providers, health plans, and health care clearininghouses) and “business associates” (companies that contract with covered entities).  Grindr is neither of these. Nor are most apps that address health issues – everything from apps with mental health tools to diet and exercise trackers. These apps can store all manner of information ranging simply from a name and birthdate to sensitive information including diagnoses and treatments.

Grindr is particularly striking because under HIPAA, there are extra protections for information including AIDS/HIV status, mental health diagnoses, genetics, and substance abuse history.  Normally, this information is highly protected and rightly so given the potential for discrimination. The privacy laws surrounding this information were hard fought by patients and advocates who often experienced discrimination themselves.

However, there is another reason this is particularly important in Grindr’s case and that’s the issue of public health.  Just a few days before it was revealed that the HIV status of users had been exposed, Grindr announced that it would push notifications through the app to remind users to get tested.  This was lauded as a positive move and added to the culture created on this app of openness. Already users disclose their HIV status, which is a benefit for public health and reducing the spread of the disease. However, if users think that this information will be shared without explicit consent, they may be less likely to disclose their status. Thus, not having privacy and security standards for apps with sensitive personal health information, means these companies can easily share this information and break the users’ trust, at the expense of public health.

Trust is one of the same reasons HIPAA itself exists.  When implemented correctly, the Privacy and Security Rules lend themselves to creating an environment of safety where individuals can disclose information that they may not want others to know.  This then allows for discussion of mental health issues, sexually transmitted diseases, substance use issues, and other difficult topics. The consequences of which both impact the treatment plan for the individual and greater population health.

It would be sensible to apply a framework like HIPAA to apps to ensure the privacy and security of user data, but certainly some would challenge the idea.  Some may make the excuse that is often already used in healthcare, that HIPAA stifles innovation undue burden on their industry and technology in general.  While untrue, this rhetoric holds sway with government entities who may oversee these companies.

To that end, there is a question of who would regulate such a framework? Would it fall to the Office for Civil Rights (OCR) where HIPAA regulation is already overseen? The OCR itself is overburdened, taking months to assess even the smallest of HIPAA complaints.  Would the FDA regulate compliance as they look to regulate more mobile apps that are tied to medical devices?  Would the FCC have a roll?  The question of who would regulate apps would be a fight in itself.

And finally, would this really increase privacy and security? HIPAA has been in effect for over two decades and yet still many covered entities fail to implement proper privacy and security protocols.  This does not necessarily mean there shouldn’t be attempts to address these serious issues, but some might question whether the HIPAA framework would be the best model.  Perhaps a new model, with new standards and consequences for noncompliance should be considered.

Regardless, it is time to start really addressing privacy and security of personal health information in apps. Last year, both Aetna and CVS Caremark violated patient privacy sending mail to patients where their HIV status could be seen through the envelope window. At present it seems these cases are under review with the OCR. But the OCR has been tough on these disclosures. In fact, in May 2017, St. Luke’s Roosevelt Hospital Center Inc. paid the OCR $387,200 in a settlement for a breach of privacy information including the HIV status of a patient. So the question is, if as a society, we recognize the serious nature of such disclosures, should we not look to prevent them in all settings – whether the information comes from a healthcare entity or an app?

With intense scrutiny of privacy and security in the media for all aspects of technology, increased regulation may be around the corner and the framework HIPAA creates may be worth applying to apps that contain personal health information.

About Erin Gilmer
Erin Gilmer is a health law and policy attorney and patient advocate. She writes about a range of issues on different forums including technology, disability, social justice, law, and social determinants of health. She can be found on twitter @GilmerHealthLaw or on her blog at www.healthasahumanright.wordpress.com.

The Human Side of Healthcare Interactions

Posted on March 19, 2018 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

The week after HIMSS is certainly a rest and reflect (and catch up) time period. So much information is crammed into five short days that hopefully fuel innovation and change in our industry for the next year. We hear a lot of buzzwords during HIMSS, and as marketers in general. This year my biggest area of post-HIMSS reflection is on the human side of healthcare. Often, as health IT professionals, we can be so enamored with the techie side of things that we lose sight of what adding more automation does to our daily interactions.

The digital revolution has certainly made life easier. We can connect online, schedule an appointment, Uber to our destination, order groceries online, and pick them up on our way home with limited interactions with any real human. While the convenience for many far outweighs any downside, the digital world is causing its own health concern: loneliness.

Research by Holt-Lunstad found that “weak social connections carry a health risk that is more harmful than not exercising, twice as harmful as obesity, and is comparable to smoking 15 cigarettes a day or being an alcoholic.” But the digitization of our lives is reducing the amount of human interaction and our reasons to connect in real life. I keep hearing the phrase “we are more connected than ever, but we are feeling more alone”.  How do we avoid feeding another health issue, such as depression, while making healthcare more accessible, cost-effective, and convenient?

In healthcare communications, I want both technological convenience and warm, caring human interaction depending on what my need is at a given moment. If I need to schedule an appointment, I’d better have the option to schedule online. But in the middle of the night, when my child has a 104F fever and I call my doctor, I want a real person to talk and ask questions to, who will listen to the state my child is in and make the best recommendation for their health.

I had the privilege of discussing this balance of human and tech in a meet up at HIMSS last week. We learned that my colleague and friend learned the gender of her baby via a portal while waiting patiently for the doctor’s office to call. This is pushing the line of being ok in my opinion. But what if it was something worse, such as a cancer diagnosis or something equally scary? Is that ok for you? Wouldn’t you prefer and need someone to guide you through the result and talk about next steps?

As we add even more channels to communicate between health facility and patient, we need to take a look at the patient interaction lifecycle and personalize it to their needs. We should address the areas where automation might move faster than the human connections we initiate to ensure we are always in step with our tools and technology. Healthcare relationships rely on confidence and loyalty, and these things aren’t so easily built into an app. Online interactions will never replace the human, day-to-day banter and touch we all need. But I believe that technology can create efficiency that allows my doctor to spend more quality time with me during my visits and better engage me in my health.

So the question stands: how do you think the healthcare industry can find the right tech and human balance?

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

A Whole New Way of Being Old: Book Review of The New Mobile Age

Posted on March 15, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The recently released overview of health care for the aging by Dr. Joseph Kvedar and his collaborators, The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan, is aimed at a wide audience of people who can potentially benefit: health care professionals and those who manage their clinics and hospitals, technologists interested in succeeding in this field, and policy makers. Your reaction to this book may depend on how well you have asserted the impact of your prefrontal cortex over your amygdala before reading the text–if your mood is calm you can see numerous possibilities and bright spots, whereas if you’re agitated you will latch onto the hefty barriers in the way.

Kvedar highlights, as foremost among the culture changes needed to handle aging well, is a view of aging as a positive and productive stage of life. Second to that comes design challenges: technologists must make devices and computer interfaces that handle affect, adapt smoothly to different individuals and their attitudes, and ultimately know both when to intervene and how to present healthy options. As an example, Chapter 8 presents two types of robots, one of which was accepted more by patients when it was “serious” and the other when it was “playful.” The nuances of interface design are bewildering.

The logical argument in The New Mobile Age proceeds somewhat like this:

  1. Wholesome and satisfying aging is possible, but particularly where chronic conditions are involved, it involves maintaining a healthful and balanced lifestyle, not just fixing disease.

  2. Support for health, particularly in old age, thus involves public health and socio-economic issues such as food, exercise, and especially social contacts.

  3. Each person requires tailored interventions, because his or her needs and desires are unique.

  4. Connected technology can help, but must adapt to the conditions and needs of the individual.

The challenges of health care technology emerged in my mind, during the reading of this book, as a whole new stage of design. Suppose we broadly and crudely characterize the first 35 years of computer design as number-crunching, and the next 35 years–after the spread of the personal computer–as one of augmenting human intellect (a phrase popularized by pioneer Douglas Engelbart).

We have recently entered a new era where computers use artificial intelligence for decision-making and predictions, going beyond what humans can anticipate or understand. (For instance, when I pulled up The New Mobile Age on Amazon.com, why did it suggest I check out a book about business and technology that I have already read, Machine, Platform, Crowd? There is probably no human at Amazon.com or elsewhere who could explain the algorithm that made the connection.)

So I am suggesting that an equally momentous shift will be required to fulfill Kvedar’s mandate. In addition to the previous tasks of number-crunching, augmenting human intellect, and predictive analytics, computers will need to integrate with human life in incredibly supple, subtle ways.

The task reminds me of self-driving cars, which business and tech observers assure us will replace human drivers in a foreseeable time span. As I write this paragraph, snow from a nor’easter is furiously swirling through the air. It is hard to imagine that any intelligence, whether human, AI, or alien, can safely navigate a car in that mess. Self-driving cars won’t catch on until computers can instantly handle real-world conditions perfectly–and that applies to technology for the aging too.

This challenge applies to physical services as well as emotional ones. For instance, Kvedar suggests in Chapter 8 that a robot could lift a person from a bed to a wheelchair. That’s obviously riskier and more nuanced than carting goods around a warehouse. And that robot is supposed to provide encouragement, bolster the spirits of the patient, and guide the patient toward healthful behavior as well.

Although I have no illusions about the difficulty of the tasks set before computers in health care, I believe the technologies offer enormous potential and cheer on the examples provided by Kvedar in his book. It’s important to note that the authors, while delineating the different aspects of conveying care to the aging, always start with a problem and a context, taking the interests of the individual into account, and then move to the technical parts of the solution.

Therefore, Kvedar brings us face to face with issues we cannot shut our eyes to, such as the widening gap between the increasing number of elderly people in the world and the decreasing number of young people who can care for them or pay for such care. A number of other themes appear that will be familiar to people following the health care field: the dominance of lifestyle-related chronic conditions among our diseases, the clunkiness and unfriendliness of most health-related systems (most notoriously the electronic health record systems used by doctors), the importance of understanding the impact of behavior and phenotypical data on health, but also the promise of genetic sequencing, and the importance of respecting the dignity and privacy of the people whose behavior we want to change.

And that last point applies to many aspects of accommodating diverse populations. Although this book is about the elderly, it’s not only they who are easily infantilized, dismissed, ignored, or treated inappropriately in the health care system: the same goes for the mentally ill, the disabled, LGBTQ people, youth, and many other types of patients.

The New Mobile Age highlights exemplary efforts by companies and agencies to use technology to meet the human needs of the aging. Kvedar’s own funder, Partners Healthcare, can afford to push innovation in this area because it is the dominant health care provider in the Boston area (where I live) and is flush with cash. When will every institution do these same things? The New Mobile Age helps to explain what we need in order to get to that point.