imagineSmart people have noted that the current healthcare analytics market is “hyped beyond imagination” and “filled with the Hot Air.” To a certain extent, I agree. Sky-high pitches are rampant these days, but no one person or company or even the federal government has a firm handle on what analytics can or should or will ultimately do. There are many unknowns.

But that is as it should—or rather, as it must—be.

Data analysis is, to begin with anyway, inherently wily. You can’t know in advance what you’re going to find. Trends must be unearthed, or revealed. Until then, they are unknowns. Now, you can create hypotheses. You can imagine. You can test. My point is that the front end of data analysis actually requires speculation, and healthcare is definitely at the front end.

What is big data actually going to do for hospitals? What is going to improve and how? We can’t know yet. Big data in healthcare is in its infancy; it needs nurturing before it will pay off. Still, I believe hospitals should be collecting data now so they can use it in the future. How they’ll use it remains to be seen.

Big data should not be oversold, but it should not be underestimated either. What begins as hot air can turn into innovation. What seems unimaginable one day can happen the next. Even though the big-data-in-healthcare honeymoon is over, I am still hopeful.

Special thanks to Jonathan Hasson for permission to use the image above.

 

 

 

 

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“Good nursing cannot be achieved by devotion alone.” 
– Florence Nightingale

This week, iSirona joins the nation in honoring the nearly 3 million registered nurses who make up America’s largest healthcare profession. National Nurses Week is celebrated every year, beginning on May 6th and ending May 12th – the birthday of Florence Nightingale.

Clearly, the nursing profession has transformed dramatically since Miss Nightingale’s time, and the most recent changes are due in large part to advances in technology. It seems fitting, then, that this year’s theme for National Nurses Week is “Delivering Quality and Innovation in Patient Care.” We think Miss Nightingale would be pleased.

Many of the new developments in patient care technology are aimed at reducing the risk of hospital errors. This, in turn, helps nurses provide better, safer care for their patients. In addition to reducing the risk of errors, such technological advances have the added benefit of alleviating some of the stress inherent in the nursing profession. The electronic medical record (EMR) is a prime example.

EMRs can help make nurses’ (and physicians’) jobs easier by providing quick and easy access to patient information. When the EMR is further strengthened by implementing medical device integration, the benefit to nurses is greater still. By transferring patient data directly to the EMR, device integration solutions can relieve nurses of time-consuming documentation, transcription, and data entry tasks.

Technology-driven developments, such as advanced medical devices, innovative software solutions, and sophisticated nursing tools, are improving the quality of patient care. But what’s equally important, and often ignored, is the great benefit these developments offer to nurses themselves. Advances in technology can help ease workloads, boost efficiency, and reduce stress – thereby empowering nurses to spend more time at the bedside, saving lives and providing high quality care to their patients.

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Joseph Smith’s testimony addressed the need for interoperability and then went on to look at how we might get there. He drew from examples of interoperability in other industries:

Standards-based interoperability allows e-mail to work seamlessly across different servers, cars to fill-up their gas tanks at different filling stations, phone calls to be completed between different head-sets, and yet, when it comes to our health care, information is stuck in multiple non-communicating silos as lifesaving devices are forced to work independently.

Those examples show that standards can be a promising, long-term solution. A number of organizations are working on this approach. However, Smith pointed out that “no single effort has reached critical levels of adoption.” One such project is Integrating the Healthcare Enterprise (IHE), which creates profiles based on existing standards. Another is the Medical Device “Plug-and-Play” (MDPnP) Interoperability Program, focused on “providing interoperability building blocks (use cases, standards, a neutral lab environment and open research tools) and changing clinical and market expectations of what can be achieved.” Recently, AAMI (the Association for the Advancement of Medical Instrumentation) launched a partnership with Underwriters Laboratories (UL): the partnership aims to work with existing standards and “map them into a framework and address further safety issues where applicable.”

Some or all of the above approaches may prove successful in future years, though it’s difficult to tell now which ones they might be. If you don’t need to address interoperability for some years yet, then your best strategy may be to wait and see. It’s more likely, though, that you’ll need to address interoperability sooner than later—to reach Meaningful Use targets, to free up clinician time, or to eliminate errors from hand transcription.

In that case, waiting for industry-wide standards to emerge is not a viable option. And when (or if) such standards do emerge, there will be the question of what to do with the population of devices that are now in use. If future standards are not backwards-compatible then today’s devices would be orphaned: in our current economic climate, that would be impractical.

These are exactly the problems that medical device integration (MDI) was created to solve. MDI can provide interoperability today, working with today’s varied population of devices and broad landscape of vendors. If you’re evaluating MDI solutions, be sure to look for one that is vendor-neutral and can easily accommodate new devices as they appear on the market. That will give you the flexibility for achieving interoperability and maintaining it—whether or not the future brings new standards into play.

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Interoperability went to Congress recently. Or, to be more precise, interoperability was the topic of a March 20 hearing in front of the Subcommittee on Health, which is part of the House’s Committee on Energy and Commerce.

Joseph Smith, from the West Health Institute (WHI), testified about the need for interoperability; his full testimony is available here.

  • The problem: “While all of our Internet-enabled devices freely and instantaneously share e-mail and information, the medical devices that surround our most acutely ill patients most often function completely blinded of the critically important information being collected by other such devices only inches away.”
  • The solution: “We view interoperability as the ability of medical devices and health care systems to seamlessly communicate and exchange information to improve the delivery of care.”

At the hearing, WHI also released their new white paper on The Value Of Medical Device Interoperability (available for download here). The paper gives a detailed analysis of the potential cost savings from interoperability, amounting to some $36 billion a year. The biggest share of those savings would come from two sources.

  • Shortening the length of hospital stays: $17.8 billion. “Delays in receiving test results hinder decision making, unnecessarily extending the length of ED visits and inpatient hospital stays. Medical device interoperability, by pushing test results to the clinician, would accelerate decision making, reducing length of stay.”
  • Eliminating hand-entry of data: $12.3 billion. “Significant cost results from clinician time spent manually entering information. Widespread interoperability could save nurses’ time valued at nearly $12.3 billion, or 7 percent of total nurse salaries…. These efficiency gains would likely translate into the ability to serve an increasing volume of patients with the current number of nurses and increase the amount of nurse time devoted to direct patient care.”

Smith’s statement of the problem, and the potential cost savings, highlights the value of interoperability. In the next post, we’ll look at how to achieve it.

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brain-460x307The emergence of our knowledge-based economy is as profound a change as the switch to a machine-driven economy was all those years ago, and perhaps an even greater one — Peter Drucker

We are living through a revolution, as deep and wide today as the industrial revolution was in its day. The digital revolution has remade one area of our lives after another. Commerce and finance have been radically changed. The media — movies, magazines, radio, TV — now operate in deeply different ways. Libraries are shedding their brick-and-mortar forms [if you haven’t seen it, take at look at the newly launched Digital Public Library of America! You can find it at here]. Photography, printing, telephones, music and more: one after another, whole industries have been transformed.

Except medicine. Medicine has been largely untouched until now, but that’s about to change. Actually, the changes have already begun. In some ways, they began with medical device integration (MDI), which eliminates hand transcription and replaces it with fast, direct data-capture technology.

In so doing, MDI lays a necessary foundation for systems that depend on current, accurate data. Those systems are coming, and they’re coming soon. For a great overview of some of the coming changes, see Intel’s short new video The Doctors Weigh In: Mobility, Security, and Cloud Lead to Patient-Centered Healthcare [link here]. In the video, three doctors talk about some of the changes that are coming over just the next three to five years.

  • A flood of data. Personal genomics + Big Data + patient data from inexpensive mobile devices = more data than any individual doctor can process. Clinical decision support systems (CDSS) will bridge help the gap.
  • Open, transparent systems. Patients are becoming more involved in their own care. Combine that with greater patient access to data and a growing focus on outpatient treatment. The result will be more open systems and the development of patient-centered charts and records.
  • New roles. Doctors will have CDSS to help them cope with the flood of data. Patients will need help too, and that will change some existing medical roles and introduce new ones.

For a full-length video of the panel discussion, click here.

 

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For all their promise, EMRs are not winning any friends on the hospital floor. They may indeed be the future of medicine, and they stand at the nexus where health technology, doctors and patients come together. Confidence in their value is high enough for the U.S. government to back their adoption, with $19 billion in incentive funds for hospitals that demonstrate meaningful use.

In spite of all that, the EMR has been perceived as a burden on the hospital floor. As Jared Sinclair asked, “Other than billing or records, what problems does an EMR really solve? In their current state, EMRs add nothing of value to our work as nurses. They are tedious chores at best, outright obstacles at worst. They are database portals where we type some numbers and check some boxes, and nothing more.” [See How EMRs are failing nurses, KevinMD.com, November 9, 2010. Emphasis added; link here.]

To be fair, the above statement is three years old. Back then, EMR systems were new and might be forgiven for having some rough edges. But what’s worrisome is that they’re still perceived as a burden today. Shirie Leng puts it this way: “Every time a new rule or documentation requirement pops up, which in my institution is daily, it is always laid on the nurses to add that to their computer records. Nurses used to be nurses. Now they are data-entry specialists.” [See 10 ways to make EMRs more doctor-friendly, KevinMD.com, March 13, 2013. Emphasis added; link here.]

Perhaps the value of the EMR is so great that some amount of frustration on the hospital floor is an acceptable price to pay. The problem is, though, that user frustration and user resistance are not just irritations; they can actually be fatal to new technologies. One survey, taken of 375 organizations around the world, found user resistance to be the number one challenge for the implementation of large-scale IT systems.

If the people on the hospital floor find EMRs burdensome, it will be harder to achieve the EMR promise. Fortunately, a huge part of that burden—the tedious work of data entry—can be substantially reduced or eliminated through medical device integration (MDI). MDI will get patient data to the EMR quickly, effortlessly, and error-free. At the same time, it will lighten workloads and win friends. That’s a win for everyone.

 

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Medicine has built on a long history of innovation… Doctors have embraced each new technology, but nothing has changed clinical practice more fundamentally than the Internet —New England Journal of Medicine, quoted by Eric Topol

The coming explosion of data, and patient access to it, will change the landscape for patients and doctors alike. The Internet puts medical information at everyone’s fingertips, but it puts disinformation there as well. As Topol puts it, “problems confront anyone trying to navigate all the available medical procedures, medications, vitamins, herbs, alternative treatments, over-the-counter products, and home devices…. If a consumer can’t make the best, most intelligent use of it, all sorts of trouble can unfold.”

How will people make medical decisions in this emerging new information-rich landscape? There is a wide range of ideas. At one extreme is Vinod Khosla, a Silicon Valley venture capital investor. He thinks that computers will supplant the doctor’s diagnostic role: “They will progress from providing ‘bionic assistance’ to second opinions to assisting doctors to providing first opinions.”

Arnold Relman, Professor Emeritus at Harvard Medical School and former editor in chief of The New England Journal of Medicine, takes a more tempered view. He believes that few people will be able to “analyze or fully comprehend the avalanche of information, even if recorded and interpreted by a computer. And this would be particularly true when they are very sick, seriously injured, or simply terrified by the possibility that they might be dangerously ill…Good medical care is an art as well as a science. At best, computers can only deal with the science.” If Relman is right, we will still need doctors. Or, as David Duncan puts it in The Atlantic, “we will need partnerships, physicians working with and guiding individuals.”

This is what Topol, too, sees for the future. “Doctors will evolve, not to just survive but to thrive in the world of digital medicine. Physicians will leverage their remarkable assets and create new opportunities.” It will be an exciting time for medicine, and Topol gives us a great view of the possibilities.

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American health care is one of the last great industries to remain largely undisrupted by the information technology revolution of the past few decades—The Economist, quoted by Eric Topol

Eric Topol, a cardiologist at the Scripps Clinic in California, is also a professor of genomics at the Scripps Research Institute and one of the 10 most cited researchers in medicine. His recent book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, has been positively reviewed in The Wall Street Journal, the New York Times, The Economist, The Atlantic and over 40 other places.

Topol opens with a simple observation: “Digital information has turned our world upside down…But the most precious part of our existence, our health, has thus far been largely unaffected.” From this starting point, he surveys four remarkable developments and how they will impact medicine.

  • Physiology. Small, unobtrusive wireless sensors can now capture detailed, high-quality data that would have been unimaginable just a few years ago.
  • Biology. Genome sequencing is rapidly falling in price, to where each person’s medical record can include their full genetic code.
  • Anatomy. We have technologies that give us better imaging of tissue and organs. At the same time, we now have the technology to build customized replacements—tissue and organs to order—through 3D printing.
  • Data Systems. To use all that data efficiently, we will need a robust infrastructure for data storage, sharing and processing. That is exactly what Electronic Medical Record (EMR) systems and Health Information Technology (HIT) are putting in place.

Topol shows how the convergence of these four developments will make them, together, far more powerful than they are alone. They will amount to “perhaps the greatest convergence in history: the one that finally coalesces the rapidly maturing digital, nonmedical world of mobile devices, cloud computing, and social networking with the emerging digital medical world of genomics, biosensors, and advancing imaging.”

Whether you agree with everything he forecasts or not, Topol’s assessment of today’s technology and its promise makes for eye-opening and inspiring reading.

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Personalized health care is one of the most promising applications for the coming era of “big data” in healthcare. The falling cost of genome sequencing offers the possibility that health care could be personalized to the genetics of each individual.

Information Week recently surveyed the landscape for data-intensive innovations in health care and found that personalized health care is not yet a reality—but the foundations are actively being put in place. [To read more, see “Is Healthcare Big Data Ready For Prime Time?” by clicking here.]

·     Kaiser Permanente has a $25 million grant from the National Institutes of Health for linking patients’ genetic data with their electronic health records to explore the causes of diseases.

·     Over the next five years, the University of Pittsburgh Medical Center will spend $100 million to build a new data warehouse. It plans to combine genomic and clinical data to pave the way for personalized care.

·     The Department of Veterans Affairs is preparing to launch a data warehouse combining genomic and clinical data.

Of course, sequencing the patient’s genome is only one side of the personalized health care equation. The other side is the patient record. For personalized health care to become a reality tomorrow, hospitals and others will have to work today to ensure that their electronic health records (EHRs) are sound and that the data is accurate. And indeed, that’s exactly what they are focusing on. When Information Week surveyed business technology professionals in healthcare about their 2013 priorities, “managing digital patient health records” was #1 (survey as of January, 2013). Personalized health care isn’t here yet, but it’s clearly coming.

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Information is the lifeblood of modern medicine, and health information is destined to be its circulatory system—New England Journal of Medicine, quoted by Eric Topol

In The Creative Destruction of Medicine, Eric Topol raises an interesting question. If information is indeed the lifeblood of modern medicine, how much of it do we have, and how does that compare to how much we need? As Topol sees it, the amount of information we have today is impressive, but it’s small compared to how much we really need and will soon have.

The data we have today is generally obtained at the doctor’s office, the clinic or the hospital. That represents only a small slice of a person’s life, making it hard to see trends, identify anomalies or correlate data with lifestyle. In addition, the data is only taken at times of illness or injury, or in settings where the patient is likely to be stressed. Topol’s summary is: “We have limited insight into the physiology of each and every individual—a nonrepresentative, fleeting, pinhole view, taken through the prism of an artificial environment.”

In an ideal world, we would have a constant stream of data, not just occasional samples. To get there, “we just need biosensors to capture the data,” Topol says. And it turns out that we already have the platform for doing so, in the form of mobile phones and other mobile devices combined with small, reliable biosensors. “We can use them to monitor virtually any physiologic metric from any place, any time, or even all of the time,” adds Topol.

The result is an expanding gold mine of data for understanding the whole patient, both in times of health and in times of injury or illness. This will lead to vast growth in the patient record, solutions that make the data actionable, and an expanded role for medical device integration (MDI) solutions. Today, MDI solutions are the conduits for bringing data generated in traditional patient care settings into the EMR; tomorrow, they will likely become the conduit for all patient data across the continuum of care to all stakeholders of patient care.

In a future post, we’ll look at how this explosion of data will affect the doctor-patient relationship.

 

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