healthcare technology

Incorporating persuasive design concepts into primary care electronic health records (EHRs) increased same-day data entry by 10 percent per physician, demonstrating the potential for persuasive design to change data entry behavior, a study published in JMIR Human Factors revealed.

Persuasive design is a way of developing technology to influence behavior by leveraging social processes. Healthcare stakeholders have primarily focused on using persuasive design in consumer-facing mobile apps to improve outcomes, but there are few examples of using persuasive design to influence clinician behavior.

In primary care settings, providers often face barriers to entering data into EHRs in a timely manner.  Data entry tasks often take a long time, and users may feel as if completing documentation is a lower priority than seeing patients or finishing other tasks.

“Persuasive design is a viable approach for designing and encouraging behavior change and could support effective data capture in the field of medical informatics. There may be opportunities to continue improving this approach, and further work is required to perfect and test additional designs,” the team concluded.

read the original unedited article at https://healthitanalytics.com/news/persuasive-ehr-workflow-design-increased-same-day-data-entry-by-10

In its State of the Market 2018 report, HIMSS Analytics outlined nationwide adoption of major health IT trends.

The report detailed market insights related to blockchain, cloud computing, EHRs, precision medicine and telehealth, among other health IT segments.

Here are 5 highlights from the report:

1. Blockchain. The plurality of hospitals (45.3 percent) are still learning about blockchain and have not deployed any related programs. However, 55 percent said it is "somewhat likely" they complete a blockchain proof-of-concept or pilot in the next 24 months, followed by 17 percent of whom said it was "very likely."

2. Cloud. The majority of hospitals (65 percent) said they currently use the cloud or cloud services. Reasons for adopting cloud services included concerns with disaster recovery (37 percent), lack of internal IT expertise on site (25 percent) and IT maintenance costs (25 percent).

3. EHRs. EHRs have achieved almost universal hospital adoption; however, interoperability continues to present a core challenge. Only 2 percent of hospitals are on a single vendor at all affiliated practices, and nearly three-quarters of hospitals said they deal with more than 10 disparate outpatient vendors.

4. Precision medicine. Hospitals tended to cite lack of funding, technological or clinical expertise as barriers to adopting precision medicine, although nearly half of hospitals (45 percent) said they plan to expand their existing programs.

5. Telehealth. Telehealth adoption has reached 50 percent at U.S. hospitals. Moving forward, 55 percent of hospitals said they are "unsure" if they have plans to invest in telehealth services in the next 24 months, followed by 27 percent that said they do.

more at https://www.beckershospitalreview.com/healthcare-information-technology/himss-analytics-the-state-of-blockchain-cloud-ehr-adoption-more.html

The objective of this study was to investigate how users experience the implementation of self-regulation techniques
in a Web-based intervention targeting physical activity and sedentary behavior in the general population.

Background: eHealth interventions show stronger effects when informed by solid behavioral change theories; for example,
self-regulation models supporting people in translating vague intentions to specific actions have shown to be effective in altering
health behaviors. Although these theories inform developers about which behavioral change techniques should be included, they
provide limited information about how these techniques can be engagingly implemented in Web-based interventions. Considering
the high levels of attrition in eHealth, investigating users’ experience about the implementation of behavior change techniques might be a fruitful avenue.

Results:

The techniques “providing feedback on performance,” “action planning,” and “prompting review of behavioral goals”
were appreciated by users.

However, the implementation of “barrier identification/problem solving” appeared to frustrate users; this was also reflected by the users’ website data—many coping plans were of poor quality.

Most users were well aware of the benefits of adopting a more active way of living and stated not to have learned novel information. However, they appreciated the provided information because it reminded them about the importance of having an active lifestyle. Furthermore, prompting users to self-monitor their behavioral change was not sufficiently stimulating to make users actually monitor their behavior.

Conclusions: Iteratively involving potential end users offers guidance to optimally adapt the implementation of various

Those suffering from mental health problems have more options than ever before. And along with the tireless efforts of advocates and mental health professionals, technological advancements have also played a large role in combating mental illness.

From diagnosing mental health issues, to finding local treatment options and support groups, the internet allows us to deal with mental health in a way that previous generations would never have thought possible. And thanks to advances in smartphone technology, new methods such as online therapy are becoming more and more common.

According to the American Psychological Association, some studies indicate that “telemental health” and “asynchronous messaging therapy” can, in some cases, “be as effective as in-person therapy.”

Other studies have shown that online therapy often proves useful as a first step for those who are reluctant to get help, and can lead to patients to seeking out more intensive treatment methods.

For those who are interested in exploring the world of online therapy, we list here 4 websites which are a great place to start on your journey toward optimal mental health.

You can receive online therapy, counseling, and psychiatry with these sites that optimize your mental health.

1. ICOUNSELING.COM

2. MYTHERAPIST.COM

3. PRIDECOUNSELING.COM

4. REGAIN.US

read the original story at http://wordpress.futurism.com/telemental-sites-that-will-optimize-mental-health/

Using electronic health records (EHRs) to create a learning healthcare system, say the authors, can enable researchers to generate new knowledge that will accrue benefits to future generations of patients.

Real-world data are increasingly viewed as a crucial factor in the eventual acceptance of biosimilar drugs, and indeed, current real-world evidence points to the safety and efficacy of these products in the marketplace.

In a recent paper, officials from the European Medicines Agency, the Organisation for Economic Cooperation, and other European government entities explained that such data can help make decisions about pharmaceuticals—from development to reimbursement—more efficient.

The authors called for international cooperation on a learning healthcare system that will better harness these data. 

The authors note that the expense of prospective data generation in a research setting is high, limiting the number of research questions that can be answered in a randomized controlled trial (RCT).

RCTs are rarely large enough to detect infrequent outcomes, nor are they long enough to determine long-term outcomes. 

Using electronic health records (EHRs) to create a learning healthcare system, say the authors, can enable researchers to generate new knowledge that will accrue benefits to future generations of patients.

However, current inadequacies of EHRs present a “technical bottleneck” to the objective of gathering real-world data.  

The paper’s authors propose that governments establish and implement national health data governance frameworks to encourage the use of personal health data to serve the public interest.

The collection of data must translate into the production of useful evidence.

A coordinated and international effort will be key to speed the implementation of a true learning healthcare system for global benefit. 

read the news article at https://www.centerforbiosimilars.com/news/european-officials-promote-use-of-ehrs-to-gather-real-world-data-on-pharmaceuticals--

mHealth platforms are helping healthcare providers with Quick Access to Decision Support Resources

insight by Nrip Nihalani

Well how surprising! Collective human intelligence still works :)

As I been posting in my articles, speaking at my talks and offering my $0.02 in my insights, for all the talk of AI and Deep Learning, I feel technology’s best use in healthcare is in automation of processes and improving communication and collaboration between care teams. And such studies show that we have lots to gain by building better tools to help clinicians communicate and collaborate better. Someday , AI “may” replace human intelligence, but not today and not anytime soon.

Proposing a Transactional Model of eHealth Literacy: Concept Analysis

insight by Nrip Nihalani

eHealth literacy is the ability of internet users to locate, evaluate, and act upon web-based health information. The result of this study identifies that the role of “communication” in eHealth literacy remains underdeveloped.

Current frameworks and technologies do not account for physical and cognitive processing abilities necessary for multiway transactions.

A study of the Consumption(access by patients) patterns of a majority of patient education resources will be interesting. It may shed light on this underdevelopment being required or not.

more at https://medium.com/@plus91/healthcare-technology-insights-for-oct-1st-oct-14th-2018-8505bbd81fd9

AI-powered smartphone app can reduce physician burnout, enhance patient experience

Virtual assistants are a fast-growing phenomenon, not only with the use of consumer products such as Amazon's Alexa, Google Assistant, and Apple's Siri, but as part of automated communications with many industries, such as airlines and banking. Market intelligence firm Research and Markets released a report earlier this year forecasting:

The healthcare market has lagged behind, but in September, Nuance and Epic released the first version of a conversational virtual assistant. It operates on Nuance's Dragon Medical cloud-based platform and is available through Epic Haiku, a mobile app for physicians that interfaces with the Epic EHR. The assistant is an upgrade to the app, used by physicians, which provides secure access to clinic schedules, hospital patient lists, health summaries, test results, and notes, while supporting dictation.

HOW VIRTUAL ASSISTANTS WILL CHANGE HEALTHCARE SHORT TERM 

According to Sean Bina, vice president of access applications for Epic, the assistant can answer questions such as:

• What are the patient's A1c test results?
• What medication is the patient taking?
• What's my schedule for today?
• Has the patient had a colonoscopy?

The immediate impact has the potential to reduce provider burnout, diminish difficulty locating information in the EHR, and change the physician-patient dynamic.

WHAT THE FUTURE HOLDS

VUMC is taking the virtual assistant another step further and developing contextually useful summaries to provide an overview of relevant patient information for the physician to listen to before entering the exam room.

Among the other capabilities in development:

• Medication and test ordering. While Dragon Medical currently has these capabilities built into its system, Epic has not yet activated this feature. During testing with Vanderbilt, the mean time for ordering medications via the virtual assistant was 17 seconds, compared to 50 seconds using the mobile app without voice assistance.
   
• Decision support tools that could issue alerts, for example, if a patient has adverse reactions or allergies to medications the doctor orders.
   
• A desktop version of the virtual assistant is planned by Nuance and Epic.

read the entire article at https://www.healthleadersmedia.com/innovation/virtual-assistant-eases-ehr-distractions-physicians

Estonia and Finland will start exchanging digital prescriptions at the end of the year, in a groundbreaking move that Estonian Health Minister Riina Sikkut said she hoped other EU countries will follow.

Speaking to EURACTIV.com on the sidelines of the European Health Forum in Gastein, Austria, Sikkut said that in Estonia, it is common practice for healthcare professionals to use the e-health system to exchange patient medical records.

“But it is also important for people who have a need for healthcare services abroad to have his or her health data available to a doctor, nurse or a pharmacist so that they could also provide quality healthcare services and continuity of care,” she said.

The cross-border flow of data has taken centre stage in the discussion in Brussels. Right now, when citizens move to another EU member state, their healthcare data is in fact simply “lost”.

Advocates of the digitisation of healthcare say data mobility, or the “5th freedom”, in the EU could unlock the potential of innovation in the sector and make EU patients’ lives easier.

Estonia is known for its digitisation push in all sectors, and during its EU Presidency (July-December 2017), it took significant steps to create a “coalition of the willing” of EU member states to speed up healthcare data mobility in Europe.

Adaptiiv Medical Technologies said that the U.S. military will use its 3D bolus software to treat American veterans with cancer at Walter Reed National Military Medical Center.

Adaptiiv designed its software to convert patient CT scan data into a digital model that can be used to print a bolus that conforms to patient anatomy, according to the company. The structure is then exported as an STL file that can be printed in a matter of hours on a healthcare facility’s existing 3D printer or on a printer provided by the company.

Using Adaptiiv software, practitioners can 3D print patient-specific, uniform thickness boluses, modulated boluses for modulated electron radiation therapy (MERT), high-dose-rate (HDR) surface brachytherapy and other potential ancillary devices. The boluses are printed using durable, tissue-equivalent materials that hold their shape and do not degrade during treatments. Patients typically use the same 3D printed bolus for the duration of their treatment, reducing the risk of infection. Patients are more comfortable throughout the treatment period, while set-up and production times are reduced, the company said

A new project launched by Penn Medicine last week will take on the monumental task of EHR usability.

Impatient with the current progress of electronic health records (EHRs), one of the nation’s foremost academic medical centers is taking matters into its own hands.

Last week, Penn Medicine—which operates as the health system under the University of Pennsylvania—launched a new initiative aimed at transforming EHRs into “more streamlined, interactive, smarter tools.”

That effort will focus primarily on what David Asch, M.D., the executive director of the Penn Medicine Center for Health Care Innovation, calls “the middle space” between EHRs and clinical productivity.

“It’s about the creation of some middleware that takes the EHR products created by large companies and creates interfaces that are better,” he told FierceHealthcare. “It might ultimately be absorbed by those [EHR] companies, but I don’t think we can wait. I don’t think we should force clinicians to move to the EHR when we can be a part of the solution to help bring the EHR to them.”

Part of Penn Medicine’s effort is a focus on using EHRs not just as an administrative or documentation tool, but also pushing it into the care delivery arena. That involves shaking up the traditional health system approach that says clinicians simply need more education to unlock the unused functionality of EHRs. The notion that clinicians need help becoming the “master of the EHR” often rubs them the wrong way, Asch says.

more at https://www.fiercehealthcare.com/tech/penn-medicine-s-new-transformation-project-middle-space-ehrs-and-clinicians

Patients with mental health conditions had positive perceptions about electronic medical records (EMRs) and physician clinical notes after being given full access to their records, according to a study published in the Annals of Family Medicine.

Nutrition evaluation and intervention in hospitalized pediatric patients is critical, because undernutrition negatively impacts physical and cognitive development, wound healing, immune function, mortality, and quality of life.

Multiple, validated pediatric nutrition screening tools are available, yet no consensus on the ideal tool exists.

Generally, the aims of the nutrition screening process are identification of current nutrition status and determination of a need for further nutrition assessment and intervention.

Children’s Hospital of Philadelphia has developed what it says is the first automated pediatric malnutrition screening tool using EHR data.

In this study the tool was used to analyze anthropometric measurements in the hospital’s Epic EHR—including body mass index, height, length and weight—for inpatients in the pediatric oncology unit at CHOP for a little more than a year, representing about 2,100 hospitalizations.

Researchers used software to take note of changes in the anthropometric measurements to assess each hospitalized patient’s risk of malnutrition. For those pediatric cancer patients determined to be at risk, the automated program categorized their risk as either mild, moderate or severe.

In the study, 47 percent were classified as at mild risk, 24 percent as moderate risk and 29 percent as severe—consistent with clinical experience and other research. In addition, the overall prevalence of malnutrition was determined to be 42 percent for the study period, which was also consistent with previous studies.

“This test study demonstrates the feasibility of using EHR data to create an automated screening tool for malnutrition in pediatric inpatients, Further research is needed to formally assess this screening tool, but it has the potential to identify at-risk patients in the early stages of malnutrition, so we can intervene quickly. In addition, this tool could be implemented to screen all pediatric patients for malnutrition, because it uses data common to all electronic medical records.”

ref: https://www.healthdatamanagement.com/news/chop-uses-ehr-data-to-identify-cancer-patients-for-malnutrition

study: https://jandonline.org/article/S2212-2672(18)30974-2/abstract

Use of eHealth technologies is common in the multiple sclerosis (MS) population and facilitates the exchange of health care information with providers, according to a recent study.

However, use of eHealth and mHealth technologies varies substantially with sociodemographic factors, and health care providers need to be aware of these disparities as these technologies are increasingly leveraged in health care settings.

Researchers surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry in 2017 about their use of eHealth technologies using questions adapted from the Health Information National Trends (HINTS) 4 Cycle 4 survey. They found:

• Of 6,423 participants included in the analysis, most participants were female, and white, with a mean (SD) age of 59.7 (10.1) years.
• Overall, 5,408 (84.2%) had exchanged medical information with a health professional most often using a secure online portal (1,839, 28.6%), followed by email (1,327, 20.7%).
• Of the 5,529 smartphone and tablet users, 2,556 (46.2%) used an mHealth app.

read original at https://www.mdedge.com/clinicalneurologynews/clinical-edge/summary/multiple-sclerosis/use-ehealth-technologies-common-ms

Researchers used people's Facebook data and their medical records to detect early symptoms of a mental health problem.

In research described the Proceedings of the National Academy of Sciences, scientists analyzed language from study participants' Facebook status updates to predict future diagnoses of depression. The researchers say their technique could lead to a screening tool that identifies people in need of mental health support and formal diagnosis, while raising serious questions about health privacy.

If this line of inquiry sounds familiar, you're not imagining things: Scientists have been studying the association between Facebook and the mental state of its users for years—often without the consent of the people being examined study subjects.

Earlier this decade, scientists at Facebook and Cornell conducted an infamous emotional contagion study, which targeted the moods and relationships of more than half a million Facebook users without their knowledge. 

But many scientists continue to use above-board research methods to access Facebook's data.

For instance: By asking study participants to provide their consent, log into their accounts, and share their data—all in person—to provide one-time access to said data. The overhead is tremendous; it can take years to amass a large enough sample population using in-person study recruitment.

Yet the effort can be worth it to social science researchers, many of whom regard Facebook's trove of user information as the most significant data repository in the history of their field.

read more at https://www.wired.com/story/your-facebook-posts-can-reveal-if-youre-depressed/

also check out the opinion piece referencing this post at http://wordpress.futurism.com/ai-depressed-facebook-posts/

Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families.

Objective: The aims of this study were

(1) to explore the Pokémon GO user experience from a family perspective and

(2) to investigate Pokémon GO within the context of family health.

Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO.

Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach.

read the study at https://pediatrics.jmir.org/2018/2/e10679/

Amid all the talk that surrounds artificial intelligence — how it will simultaneously take jobs and improve lives — perhaps no form of AI could save more lives than the kind made to combat heart cardiac arrest, which is the biggest killer on Earth.

Detection of heart attacks is easily one of the most obvious ways AI should be used today. Cardiac arrest currently claims hundreds of thousands of lives a year around the globe.

With cardiac arrest events that occur outside of hospitals, every minute counts.

In initial trials, assistance  by Corti was found to identify cardiac arrest events more quickly than human operators.

Analysis of emergency calls involving cardiac arrest in Copenhagen in 2014 (published in a research paper in April), show Corti’s analysis of thousands of calls was 30 seconds faster than that of human operators, with an accuracy rate of 93 percent compared to 73 percent for human operators.

To serve a variety of needs and make it easier to get Corti up and running in more emergency call centers, the company created a hardware device to deploy its heart attack detecting AI on the edge. Enter: The Orb.

Work is underway to deploy Corti, an AI system that detects heart attacks during emergency phone calls, and it could be coming to some of the biggest cities in Europe.

Following plans announced earlier this year to roll Corti out in more cities, this summer the European Emergency Number Association (EENA), whose members include cities like London, Paris, Milan, and Munich, will deliver AI-powered assistance to emergency 112 operators.

Emergency call centers from Seattle to Singapore also want to make Corti part of their operations, but there’s no global standard for organizations working to save lives. Some are fine with the idea of deploying the AI through the cloud, while others with privacy concerns require the AI system to operate from on-premise servers.

read more at https://venturebeat.com/2018/10/14/cortis-heart-attack-detection-ai-can-now-deploy-on-the-edge-with-scandinavian-design/

A study to correlate EHR Communication with patient outcomes for diabetes patients reported that "EHR team communication flow patterns may be an important avenue to explore in raising quality of care and lowering costs for patients with diabetes in primary care." The study found that Primary care teams whose EHR communication reached more team members indirectly (ie, via message forwarding) had worse outcomes and higher medical costs for their patients with diabetes.

The study was carried out to determine how changes in electronic health record (EHR) communication patterns in primary care teams relate to quality of care and costs for patients with diabetes.

The Study Design: EHR-extracted longitudinal observational study.

A total of 83 health professionals in 19 care teams at 4 primary care clinics associated with a large Midwestern university participated in the study.

Counts of messages routed between any 2 team members in the EHR in the past 18 months were extracted. Flow-betweenness, defined as the proportion of information passed indirectly within the team, was calculated.

The analysis related changes in team flow-betweenness to changes in emergency department visits, hospital stays, and associated medical costs for the teams’ patients with diabetes, while adjusting for team face-to-face communication, patient-level covariates, comorbidities, team size, and clinic fixed effects.

Results: Patient hospital visits increased by 13% (standard error [SE] = 6%) for every increase of 1 percentage point in team EHR message forwarding (ie, higher team flow-betweenness). Medical costs increased by $223 (SE = $105) per patient with diabetes in the past 6 months for every increase of 1 percentage point in team flow-betweenness.

Conclusions: Primary care teams whose EHR communication reached more team members indirectly (ie, via message forwarding) had worse outcomes and higher medical costs for their patients with diabetes.

EHR team communication flow patterns may be an important avenue to explore in raising quality of care and lowering costs for patients with diabetes in primary care.

read the whole study details at  https://www.ajmc.com/journals/issue/2018/2018-vol24-n10/putting-the-pieces-together-ehr-communication-and-diabetes-patient-outcomes