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Social Media Still Controversial in Healthcare?

Posted on October 6, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Thirteen years after the first Facebook post and eleven years after the first tweet, social media use by healthcare professionals continues to be a controversial topic.

In October last year, nurse Carolyn Strom was found guilty of “professional misconduct” by the Saskatchewan Registered Nurses’ Association (SRNA) for a post she made on Facebook. On February 25th 2015 Strom posted the following comment following her grandfather’s death at St Joseph’s Health Facility (Strom did not work at that facility):

“My grandfather spent a week in palliative care before he died and after hearing about his and my family’s experience there, it is evident that not everyone is ‘up to speed’ on how to approach end of life care or how to help maintain an aging senior’s dignity.”

“I challenge the people involved in decision making with that facility to please get all your staff a refresher on this topic and more. Don’t get me wrong, ‘some’ people have provided excellent care so I thank you so very much for your efforts, but to those who made Grandpa’s last years less than desirable, please do better next time.”

André Picard wrote an excellent post earlier this year about the Strom “professional misconduct” decision by the nurse association.

This case and a recent Canadian Medical Association session on the lack of civility between physicians on social media served as the kernel of a recent #hcldr chat led by guest hosts Pat Rich @pat_health and Trish Paton @TrishPaton.

A clear sentiment from the #hcldr community was that healthcare regulatory bodies and professional associations were woefully behind-the-times when it came to social media policy.

Matthew Katz MD had a keen observation and suggestion for regulators:

Fear of fines and sanctions from regulatory bodies/associations coupled with the very real danger of being ostracized by peers, have effectively made social media into a “no-go” zone for healthcare professionals.

Robert Mahoney @mahoneyr had a very interesting take on social media posts from healthcare professionals.

Thankfully there are some progressive healthcare organizations out there who actually encourage their healthcare professionals to get engaged online. To help their staff navigate social media, they have created clear policies and guidelines so that they do not run afoul of regulatory bodies. The Mayo Clinic shared theirs with the community:

What are your thoughts about healthcare professionals, governing associations and social media?

Digital Health is Dead! Long Live Digital Health!

Posted on October 2, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Rob Coppedge, CEO of Echo Health Ventures recently wrote a provocative post for CNBC proclaiming that digital health is dead.

As evidence, Coppedge cited the work of Rock Health that shows $16 Billion in VC funding has gone to approximately 800 digital health companies since 2014 (note: Rock Health tracks VC deals >$2M for US-based digital health companies). He argued that in order for these VCs to see their expected returns, the entire digital health market would have to triple in value by 2021 – well beyond current projections. Coppedge’s conclusion was that fewer and fewer VC deals in the digital health space will happen in the years ahead – effectively signaling the death of the market.

Although I don’t agree with Coppedge’s claim that that digital health overall is dead, I do concur with his observations and commentary on why VCs may exit the space. Here are some of his lessons learned after investing in digital health:

  1. Better mousetraps are not enough. Inadequate attention was paid to solving how to go to market.
  2. Ill-equipped for enterprise health care. Subject matter expertise, outcomes measurement and political savvy is needed in healthcare – which is rarely necessary in star-ups targeting other industries.
  3. Consumers and patients are not the same. Unlike consumers, patients may not be the ones paying for the service they receive. Plus, engaging individuals in their health is surprisingly difficult and low engagement is common.
  4. Healthcare sales cycles are slow and industry adoption is measured. Growth expectations need to be tempered.
  5. DC is not to blame for stalling digital health. There is no evidence that supports the theory that healthcare innovation has stalled because of the uncertainty surrounding funding and regulations.

For long-time readers of this publication, the list above states the obvious.

Technology alone has never been enough to guarantee success in healthcare. Not only do healthcare customers need evidence a company’s solution actually works, they also need to help through (and beyond) the implementation of the technology. For companies, this often means creating new workflows that incorporate the new technology and helping their client’s staff adjust to those changes. Digital health companies cannot simply activate an account then foist self-serve instructional videos onto clients and expect success.

For me Coppedge’s post reaffirmed something I have long believed – Success in healthcare IT/digital health takes effort. Not only do you need a good product that actually solves a problem, you need a dedicated team of individuals who are healthcare-savvy that can help you navigate the complex health ecosystem. You need people on your team who are truly passionate about and dedicated to improving healthcare – those are the people with staying power and who will help you ride through the frustrating slow pace of change.

In my opinion, digital health is far from dead. It is evolving and changing. The influx of VC money has brought in smart, enthusiastic risk-takers from other industries who have now gotten a sobering dose of cold water dumped on them. Now that many companies are waking up to the reality that it takes years to become an overnight success in healthcare, we will see more consolidation and flame-outs in digital health. To me this potential turmoil represents an evolution of the market rather than a death spiral. The easy money and opportunists will soon be making an exit – leaving the market wide open for true believers and passionate hard workers.

Time for Healthcare to Look Out the Windshield Instead of at the Dashboard

Posted on September 29, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Society for Healthcare Strategy & Market Development (SHSMD) recently released the second edition of Bridging Worlds: The Future Role of the Healthcare Strategist. This update to the original 2014 report outlines five key imperatives that SHSMD believes are needed for healthcare success:

  1. Be nimble to exceed the rate of change
  2. Create consumer experiences, tell powerful stories
  3. Integrate and co-create
  4. Erase Boundaries of Business
  5. Generate Data-Driven Insights

“One of the biggest changes from the 2014 edition and one of the biggest opportunities that has come to the forefront is consumerism” says Holly Sullivan, Director of Strategic Partnerships at Spectrum Health and Vice Chair of SHSMD’s Bridging Worlds Committee, “It’s up to us as Strategists and Marketers to embrace this new reality and help our organizations adapt to this new level of expectation from patients. It’s definitely something that’s right in front of the windshield.”

Investing in technologies that improve and transform the patient experience will be key to meeting these heightened expectations including telemedicine, wearables, remote patient monitoring and artificial intelligence. However, technology alone will not lead to success, healthcare organizations will also need to break down their walls and collaborate in a more frictionless manner.

According to Sullivan: “Culture is the biggest challenge here. Historically healthcare organizations don’t like to share the sandbox and have believed they can do it all, own it all. We need to help our organizations lift their heads and see what’s coming at us down the road. We need to educate people that partnerships are an imperative.”

This need for collaboration and partnership is captured in the “Erase Boundaries of Business” section of the Bridging Worlds report. That portion of the report also encourages Strategists to think well beyond the walls of their organizations.

“We have to stop thinking of healthcare as a place where you go when you are sick,” adds Donna Teach, Chief Marketing and Communication Officer at Nationwide Children’s Hospital and Chair of SHSMD’s Bridging Worlds Committee. “Care is now anywhere the patient is and we need to engage patients through their entire healthcare journey rather than just points in time. Patients want to use new technologies like telemedicine and remote monitoring because it’s easy, convenient and fits nicely into their daily lives.”

Embracing HealthIT technologies permeates Bridging Worlds and Big Data in particular seems to hold the most potential in the eyes of the report authors: “Most importantly, data is only useful if it generates insights that enable better decision making. New tools, including predictive models and artificial intelligence, allow regular users to connect and visualize large volumes of data from multiple sources in ways that generate actionable insights.”

“EMRs + Big Data is just the tip of the iceberg”, echoes Teach. “It’s a technology will fundamentally change healthcare.”

Bridging Worlds is a useful guide. It clearly outlines the skills that Healthcare Strategists and Marketers will need to master in order to help their organizations transition from old models of care. Sprinkled throughout the report are useful instructions and examples of how to practice the skills and knowledge being outlined.

The key takeaway from report? “Marketing Strategists can be the agent of change no matter what level they are.” says Sullivan, “That’s the one key idea that I hope people will take from reading Bridging Worlds.”

SHSMD17 Opening Keynote, Ceci Connolly, Delivers Refreshing Dose of Perspective

Posted on September 25, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On a hot and muggy day in Orlando, Ceci Connolly, President and CEO at the Alliance of Community Health Plans, delivered an opening keynote that felt like a splash of refreshing cool water at the 2017 Society for Healthcare Strategy & Marketing Development Conference (SHSMD17).

It would have been easy for Connolly, a former Washington Post national health correspondent, to focus her keynote on the impact Capitol Hill has had on US Healthcare. Instead, Connolly used her 60 minute talk to provide the SHSMD17 audience with repeated doses of perspective. You could almost hear the gears turning in people’s heads as she dispelled common healthcare misconceptions and reframed daunting challenges.

Connolly started by highlighting the problem of the rising cost of healthcare. In 1960 US healthcare spending as a percentage of US Gross Domestic Product (GDP) was just above 5%. By 2010 it was almost 18%.

According to the Centers for Medicare & Medicaid Services (CMS), national health spending is projected to grow 1.2% FASTER than GDP per year until 2025. This means that by 2025, US healthcare spending as a percentage of GDP would reach a whopping 19.9%.

This in and of itself is not news, but what Connolly did was expertly re-frame these statistics:

The more that healthcare consumes our GDP, we will have less and less money for things like building national infrastructure, fueling economic growth and oh, helping people recover from devastating hurricanes. Those priorities will suffer because healthcare will dominate our GDP spending.

Connolly’s statement was especially poignant given SHSMD President Ruth Portacci’s early comments about the heroic efforts of healthcare workers in Florida, Texas, Louisiana, Puerto Rico and the Caribbean to help those areas recover from devastating hurricanes.

From there Connolly proceeded to cast a new light on the wave of healthcare provider consolidation, payer mega-mergers, patient consumerism, aging populations, millennial expectations and retail health. Particularly noteworthy was Connolly’s take on rising drug prices and high deductible health plans (HDHPs).

According to Connolly, drug prices go up when new drugs are introduced for specific conditions. These new drugs, often with fancy names, are brought to market at prices higher than existing alternatives. The companies that own those existing drugs then raise their prices to match the new entrant and justify the increase with a mountain of evidence that their drug is every bit as good as the new one.

Connolly also took aim at HDHPs. During the industrial boom, US employers offered to pay for employee healthcare as way to entice workers to join their ranks. In short order, employer-sponsored health became the standard. Fast forward to 2017 and employers can’t shed healthcare costs fast enough. Instead of offering more health coverage, employers are offering HDHPs and transferring the burden to employees. According to Connolly the era of employer-sponsored healthcare is ending and that will have enormous consequences for US Healthcare where almost 50% of Americans still receive their health coverage through their employer.

It certainly was not your typical rah-rah opening keynote, but in these challenging times, it was courageous and refreshing to have someone stand up in front of 1,500 healthcare insiders and get us to think differently.

Consumer-centered Approach to Innovation by Thomas Jefferson University’s DICE Group

Posted on August 30, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Sparking and sustaining Innovation is a much-sought-after goal for healthcare systems today. Some organizations have set up specialized innovation centers whose goal is to commercialize technologies developed internally by staff. Others are fostering innovation by becoming incubators and early-stage investors.

Thomas Jefferson University (TJU) in Philadelphia PA is taking multiple approaches to innovation. They created the Jefferson Accelerator Zone (JAZ) where they hold Health Hackathons, host in-person keynotes and have meeting space for local innovators. TJU also created an internal innovation team – the Digital Innovation and Consumer Experience (DICE) Group – a hidden gem.

I had the chance recently to sit down with Neil Gomes @neilgomes – Chief Digital Officer and Senior VP for Technology Innovation and Consumer Experience at TJU and Jefferson Health, who leads the DICE team – to talk about their unique approach to healthcare innovation.

How is DICE different than other healthcare innovation centers that we read about in articles?

We are not an innovation center as people have come to know them. The DICE Group isn’t focused only on commercializing technologies that have been developed by physicians or staff. DICE is an internal group that’s focused on designing and developing solutions to problems faced by the institution, from both a healthcare and educational perspective. Often our solutions incorporate a new technology innovation – but just as often we end up implementing an innovative process without replacing the existing technology. DICE is more like a team of internal catalysts. We enable the design and development of consumer-focused, value-driven, digital-ready solutions. Our goal is to build an efficient, agile, and future-focused organization that delivers value and quality to patients, students, employees, donors, and the community.

How do you find problems to work on?

Our team spends a lot of time out in the field with front-line staff. Not only do we listen to their ideas but we also observe how things are working or not working as the case may be. Through this first-hand interaction with our stakeholders and consumers (aka end-users), we develop focused projects and strategic initiatives.

What are some of the projects you have worked on?

We work on varied projects, some extremely complex such as enabling the implementation of a new Electronic Health Record (EHR) along with other project teams and others that could be as simple as moving equipment to a more efficient location.

On one such simpler (but impactful) project, we enhanced patient experience while at the same time reduced stress on staff – all by moving a label printer from one side of the room to the other. This project started off as a request to reduce delays in the Emergency Room (ER). Through direct observation, we discovered several improvement opportunities. One of the delays we addressed was in the processing of urine samples from patients. Instead of jumping in with a new technology, we took the time to really dig into the problem and just by moving a label printer, we solved it.

On another project, we helped improve our US News & World Report (USNWR) survey scores by assisting our own and referring physicians with setting up their Doximity account. The USNWR annual ranking of Best Hospitals is based on a survey that is distributed online exclusively via Doximity. What we found, however, is that many of the physicians that refer their patients to Jefferson Health and our own physicians did not have their Doximity accounts set up. If a physician is making a referral then they must believe we are a good facility…but without an active Doximity account they wouldn’t be able to participate in the survey. So we created a process along with some technology to help them set up their account when they made a referral. We ended up capturing a lot of that positive sentiment on the USNWR survey and that helped us get to our current ranking of the 16th best hospital in the nation.

We have also done a lot of work with our EHRs (EPIC and several others) as well as designed and developed our own digital apps such as: myJeffHealth, myBaby@Jeff, JeffDocs and Strength Through Insight. While several of our apps are directed at patients and students, we also develop apps and applications for our employees to enable efficiency, data collection, reduce process latency, enhance business processes, and build future-focused competitive advantage. While developing these solutions, we work in partnership with internal and external stakeholders and even with industry partners such as Google, Apple, Adobe, IBM, ServiceNow, EPIC, Harman Kardon, AllScripts, etc. who co-innovate with us.

What is the DICE secret sauce?

If I had to pick one thing that makes us unique it’d be our approach to innovation. We don’t go into situations with a “we must build something” mindset. We remain open to the possibility that a workflow change or additional training may be the best solution to the problem. Our team really takes an ethnographic look at the situation. Nothing is assumed. We give ourselves the time to really dig deep into whether the proposed solution will really achieve the desired outcome and whether it is even aligned with the problem.

We’ve worked hard at building close working relationships with operational leaders and our consumers. We have taken the time to really understand their world and we don’t just come in and try to impose our ideas on them. We build things together with our employees, partners, and consumers. That’s our secret sauce.

Being consumer-centric isn’t ground-breaking. The retail, hospitality, travel, and banking industries have been doing this for years. We have just started to bring consumer-centric thinking into healthcare. For the DICE Group, focusing on the consumer is the most organic and natural way we approach problems and devise solutions.

Many organizations have tried to create internal innovation teams, why has DICE been so successful?

Being close to our end-users has been a cornerstone of our success, but there are few other key things that we do at DICE that we think contribute to our success. One of the core principles we live and breathe every day is human-centered design. This is something that is ignored or overlooked by many in healthcare today – and some HealthIT vendors are especially bad at this. When you subscribe to a human-centered design approach, you realize that building and implementing the technology is only part of the solution. You also have to help end-users incorporate that technology into their daily routines. You have to help them through the disruption and help them bridge the knowledge gap. You can’t just drop in the technology and move onto the next project. Without proper follow-up people will revert back to past patterns – which means the organization will not see any improvement.

That’s another key to our success. We are no longer on the see-problem-solve-problem hamster wheel. In the first few years we “followed the problems” and we racked up early wins. These quick wins helped us build trust, credibility, and most importantly, internal momentum. However, you can’t succeed in healthcare by just solving one problem after another. Healthcare will not be fixed if everyone is just focused on organic point solutions. We need to look above the day-to-day and build solutions that push us in a particular direction. Basically we need to focus on larger, bold, and strategic goals and then creatively innovate towards them.

For example, rather than just looking at streamlining the ER at our Jefferson-Abington hospital, we set ourselves a goal that we would optimally utilize our ER to the extent that we could triage a patient to a room and team in the ER even while they were on the ambulance to the ER. It seemed impossible when we started, but as we worked with our stakeholders and end-users we eventually achieved this goal through a combination of technology and process improvements.

What’s next for DICE?

Now that we are deeply integrated in the organization, we see ourselves getting even more closely involved with the organization’s strategy. With the support of our President and CEO, Dr. Steve Klasko, our staff, board, and co-innovating industry partners, we continue to move from just solving the problems of today to helping TJU solve the problems of tomorrow, develop competitive advantage and value, and deliver closed-loop consumer experiences digitally and in the physical world that engage, enchant, and improve lives.

For more insight into DICE and to see what projects they are working on, follow them on Twitter @DICEGRP


Healthcare Robots for Elderly – Triumph or Tragedy?

Posted on August 21, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

When most people talk about robots in healthcare they often are referring to the self-guided machines that help deliver medications, food and other items to patient rooms.

Robots of this type can be very helpful and alleviate some of the mechanical tasks on overburdened staff. There is, however, another type of robot that is making in-roads in healthcare – companion robots like Softbank’s Pepper and Intelligent Systems Research’s PARO.

Instead of performing a physical action, the aim of these robots is to serve as patient companions. PARO, for example, has been used extensively in Japan with patients suffering from Alzheimer’s and Dementia – where it has helped reduce wandering, agitation, depression and loneliness. Below is a short video from Alzheimer’s Australia about PARO.

From a technology standpoint this is an amazing triumph. A machine providing emotional support to a patient was the stuff of Science Fiction a decade ago. At the same time, however, do these robots represent a failure of society? Does the fact that these robots exist demonstrate that we would rather delegate human contact with elderly patients to machines rather than go ourselves?

The #hcldr community debated this topic on a recent tweetchat.

A manual analysis of the tweets shows that approximately 80% of the community saw robot companions as a positive development. Most people, like Grace Cordova, pointed to the fact that our aging population already outstrips the existing infrastructure so why shouldn’t we invest in robots to help us manage (as a society).

Some responded with tempered positivity. Jon McBride saw the potential in robots but cautioned against relying on them solely for human companionship.

Many echoed Jon’s sentiment.

Personally I see robots as an innovative solution to addressing a problem that already exists – the lack of human interaction with elderly patients. I believe we have to admit to ourselves that staff are stretched thin in elder-care facilities and there are long stretches where patients are on their own. If those hours can be filled by interacting with a robot companion that responds in a human or animal-like way…I’m all for it.

What are your thoughts?

Doctor Who? Reaction to Female Casting an Opportunity to Revisit Gender Equality in Healthcare

Posted on July 24, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On Sunday, immediately after Roger Federer defeated Marin Čilić for his eighth Wimbeldon title, BBC One announced to the world that the next actor to play Doctor Who would be…wait for it…a woman! It is the first time in 13 iterations of Doctor Who (fans call it regenerations) that a woman will play the titular character.

Jodie Whittaker of Broadchurch and Attack the Block fame, will become The Doctor following the annual Christmas special later this year when current actor Peter Capaldi ends his run on the show.

The announcement of Whittaker set off a firestorm of tweets and online comments. Although many were supportive of the move, there were some who felt betrayed by the show’s producers in casting a woman to be The Doctor. Although many tweets came from women-hating trolls (I’m choosing not to give them more air time by highlighting them in this blog), there seem to be an equal number of comments about how this breaks too far from the tradition of the show.

These tweets got me thinking about what it was like for Elizabeth Blackwell, the first female physician in the US and Jennie Kidd Trout, the first woman to be a practicing physician in Canada. If we were to transport ourselves back in time (see what I did there?) I can easily imagine hearing the same “but the doctor has always been a man and always should be” refrain from the medical establishment.

Traditions have their place – like Thanksgiving dinners and ice-cream after baseball games – but traditions based on gender (or race for that matter) deserve to be torn down. Healthcare is steeped in tradition and it wasn’t that long ago when the idea of a female clinician was deemed ludicrous. It took courageous people like Dr. Blackwell and Dr. Trout to tear down the walls of medicine’s male-only traditions and blaze the trail for the many women that would come after them. Over the years women have had to fight become physicians, nurses, surgeons, administrators and CEOs. It has been and continues to be a difficult road when compared to their male counterparts.

The same is true for women in HealthIT. You would think that in 2017 gender bias would have gone the way of COBOL, but it lingers. Although it is no longer strange to see women in IT roles, they still have to put up with being bullied, belittled and objectified online and at industry events. There really is no place for this type of behavior. I applaud the efforts of people like Mandi Bishop, Jennifer Dennard, Linda StotskyMel Smith Jones and Regina Holliday who stand up for gender equality in healthcare, yet at the same time I’m sad that their efforts are needed.

If the reaction to the Jodie Whittaker as Doctor Who is any indication, we collectively still have a lot of gender equality work to do. We should take Whittaker’s announcement as an opportunity to revisit the issue of inequality in healthcare.



Smart Bottles, Incentives & Social Support Not Enough for Adherence

Posted on July 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Journal of the American Medical Association recently released the results of a study that looked at the effect of technology and behavioral interventions on patient outcomes following a heart attack.

The researchers found no significant difference between the medication adherence or clinical outcomes of those in the control group vs those that were given a combination of technologies and incentives.

According to one of the study’s authors, Dr. David Asch, executive director of Penn Medicine’s Center for Health Care Innovation, “It was a surprise. We went into this study thinking that it would be effective and it wasn’t”. Fellow author, Dr. Kevin Volpp echoed that same sentiment: “What we found was a little bit surprising and a little bit disappointing”.

The study was conducted at the University of Pennsylvania Health System (UPHS) over a span of 12 months. There were 1,509 patients involved in the study; all hospital inpatients who had experienced a heart attack and had been hospitalized between 1 and 180 days. The average age of the study group was 61 and they were all insured with five carriers who had Medicare fee-for-service arrangements with UPHS. All of the patients had been prescribed at least two daily medications (statin, aspirin, beta-blocker or antiplatelet).

The control group of 506 patients was given the standard post-discharge medication instructions and treatment. The remaining 1,003 patients were given additional tools to help them post-discharge:

  • A smart pill bottle that tracked whether or not it had been opened at the prescribed intervals
  • Participation in a daily lottery with a 1 in 5 chance of winning $5 and a 1 in 100 chance of winning $50 each day medications were taken as prescribed
  • An option to enlist a friend or family member to receive notifications if the participant failed to use the smart pill bottle twice in any 3-day span
  • Access to social work resources
  • A hospital-based advisor to answer questions and reinforce medication adherence over the phone

On the surface, the failure of this level of support and intervention is disheartening for anyone developing medication adherence technology or involved with helping a loved one recover from being hospitalized. However, if you listen to the post-study podcast or spend time looking at how the incentives/technology was administered to the study group, important clues emerge as to why this failure may not mean abandoning hope for technology-based interventions.

First, only 878 of the 1,003 patients activated their smart pill-bottles and only 70% of that same group fully participated in the incentives and technology. This indicates that the lack of adherence may not have anything to do with technology when its working, but rather that there is a challenge to get patients using that technology in the first place.

Second, the fear of another heart attack may have been enough of an incentive to keep patients on their medication regimens. Put another way, perhaps the control group already had sufficient incentive to follow their prescriptions and thus technology would have little impact.

Third, and perhaps most significantly, an average of 41 days elapsed between the time the patients were discharged from the hospital and the time they were activated on the incentive/intervention program. This delay was attributed to the delay in the insurance process. According to Dr. Volpp:

If we had been able to engage these patients earlier, for example. If this had been a hospital-based intervention and this could have started at the time of discharge [rather than weeks later], then we would have had a greater opportunity to influence these patients and change the course of their care

I personally found this last point by Dr. Volpp fascinating. This study may have inadvertently shown that the timeliness of implementing post-discharge behavior and technology incentives matters as much as the types being implemented. 41 days after discharge is a long time – almost a month and a half.

Consider this example. Say you get caught for speeding and as part of the ticket-writing process the police officer activated a reminder system in your car that (a) warned you when you were 5 miles over the limit and (b) sent a message to your significant other whenever you receive two such warnings in the same day. From personal experience I can tell you that the week after I got a speeding ticket, I followed every posted speed limit. Why? Because the trauma of getting caught was still fresh in my mind.

Now imagine the same scenario but instead of immediately activating the warning system it took until 41 days after getting your ticket. By the time the system was in place you would have already fallen back into old habits and assured yourself that you were “fine” driving the way you were.

It would be interesting to see if analysis of this study’s data revealed a correlation between the length of time before incentive implementation and adherence. Even if it doesn’t, this study holds a cautionary tale for anyone in HealthIT – timeliness of implementation may matter as much as your solution itself.

Educational EHRs – A Void that Needs to Be Filled?

Posted on June 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had my eyes opened to the issue of EHRs in medical education at the #eHealth2017 conference in Toronto. Prior to last week, I had assumed medical schools in North America had incorporated EHRs into their curriculums a long time ago. I learned my lesson (excuse the pun) after attending a breakout session on the use of #HealthIT in medical education.

Lynn Nagel RN, PhD, assistant professor at the University of Toronto in nursing, gave me my first shock when she told the story of how no one raised their hands when she asked her final-year nursing class who had used an actual EHR before. My jaw hit the floor. This would be akin to a class of accountants who had never used a spreadsheet before or computer science majors who had never used a tablet before.

Nagel was not surprised to learn that there simply wasn’t any room for EHR training in the nursing school’s curriculum. Plus, there was a belief by the professors that the healthcare institutions would train these newly minted nurses how to use their EHR.

Later in the session Gurprit Randhawa, Manager of EHR Adoption, Use, Research & Development at Island Health in Victoria BC, told the story of recently graduated physicians who had been given minimal exposure to EHRs (less than 5hrs total).

Randhawa spoke about how she watched these new graduates struggle with actual patient encounters – not knowing whether to face the screen or the patient or both. The new physicians also did not know what to enter in the various fields and were confused over what to record in their clinical notes. Randhawa elicited a round of laughter when she talked about one physician who complained that he thought EHRs all came with a Siri-like interface so that doctors could just dictate their notes to the system.

Later in her presentation Randhawa spoke about how the institution eventually adopted an EHR to help acclimate medical students to the “real world”. They chose an EHR based on the US Vista system and it was well received by medical students.

Randhawa made specific mention of how lucky the medical school was in their choice of EHR. Not only did the vendor provide reliable technical support to the school’s IT department, they also took support calls from students free of charge (and often in the middle of the night before an assignment was due).

Cost, maintenance and support for the EHR are significant considerations for educational institutions, especially given their limited IT resources. Implementing a fully functional EHR is simply not an option.

In the Q&A scrum at the end of the breakout session, I listened to a former medical professor (now consultant) talk about the early days of EHRs and how they used the production system from their institution’s medical center to teach students. Although this provided the advantage of being “real-world”, it was difficult to find actual patient use-cases that matched the clinical criteria they were attempting to teach – partly because EHRs at the time lacked adequate search tools. This professor also mentioned how some of the health records used in class were a bit “too real” as the notes were rife with spelling mistakes, dosages in the notes that didn’t match actual prescribed medications and sometimes personal comments from the attending physicians.

Using actual patient data in an educational setting also raised privacy concerns. I can imagine that in some cases, patients were not made aware that their data could be used in this fashion.

In 2014 a study was published in the American Journal of Medicine that tracked 3rd year medical students and their use of EHRs. The study concluded that there was no correlation between EHR usage and academic performance, however, the early exposure to EHRs was deemed to influence attitudes and habits related to the technology as the students became physicians.

Despite the potential impact of the EHR on educational outcomes, no correlation could be identified between EHR use and clerkship performance. These findings suggest that EHR use habits may be learned early in medical training and certain specialties are more prone to increased screen time. More attention should be directed towards the interface between medical students and the EHR. Their experiences with the EHR during these earlier stages of training are likely to influence attitudes and habits later on as physicians.

One interesting solution to the educational EHR challenge is the Regenstrief EHR Clinical Learning Platform which features more than 11,000 clinically accurate but misidentified medical records. This EHR is the result of a collaboration between the Regenstrief Institute (associated with the Inidana University School of Medicine) and the American Medical Association. This EHR is designed specifically for the education of students.

As with everything in healthcare, the use of EHRs in medical education is a multi-faceted challenge. Although the answer seems obvious (teaching EHRs help prepare students for the reality of healthcare), the implementation of the solution is not straight-forward. Will the vendor support educational institutions and the students themselves? Will the cost to install and maintain the education EHR be within the means of the institution? Will the EHR itself be easy enough for students to use?

That last question was the most memorable moment of the #eHealth2017 breakout session. At the end of Randhawa’s presentation she flashed up a slide with student reactions to using an EHR as part of their course. Take a look at the comment on the right.

Since the goal of education is to prepare students for the real world, a sub-optimal EHR experience is about as real-world as it gets.

Vendor Involvement in Online Communities – Caution but Proceed Forward

Posted on May 22, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the Healthcare Marketing and Physician Strategies Summit #HMPS17 (May 8-10 in Austin TX), I presented alongside Dan Dunlop @dandunlop President of Jennings and Cindy Price Gavin @cindypricegavin, Founding Executive Director of Let’s Win! Sharing Science Solutions for Pancreatic Cancer. The three of us will discuss Online Communities

The same week on the #hcldr tweetchat we asked the community for opinions on vendor involvement in online healthcare communities:

  • Should healthcare vendors join online communities or stay clear?
  • Should online communities like #hcldr #lcsm #LupusChat or #bcsm be accepting of sponsorships or would they lose too much credibility?

These questions generated a lot of discussion and a variety of viewpoints were shared.

In general, most people were favorable to vendors participating in online communities – as long as they didn’t try to push their products/services while interacting with community members.

One particularly interesting viewpoint was shared by Ken Gordon @quickmuse:

Ken’s point is well made: people want to connect with people, not faceless company avatars. In an online community, members want to interact with other members and get useful information. So if a company wants to participate, one easy path to success is to allow individuals from the company be the participant not the company account itself. The company “wins” twofold with this approach. First, employees will feel valued and trusted since the company is allowing them to express themselves online. Second, the company will gain goodwill be seen by the association to active members who are contributing to the conversation.

There are plenty of great examples from both the #hcldr and #HITsm communities. Just look at @TextraHealth, @OchoTex, @burtrosen, @MandiBPro, @drnic1 and @techguy – each represents the company they work for/at AND contributes to the community as unique individuals. They are all trusted individuals and by extension we look upon the organizations they represent more favorably.

One of the most important factors to vendor involvement in an online healthcare community is disclosure. This was brought up several times when #hcldr discussed the second question:

Many recommended that community leaders establish clear guidelines for how sponsorship money would to be used and to publish what vendors could expect/not expect in return for their $$$.

Other practical advice for community administrators and hosts included:

Personally, I believe vendors SHOULD get involved in online healthcare communities – even if just to listen to what their target audiences are saying. They could learn so much just by seeing what topics are being discussed and the frustrations people are experiencing. Product marketers and developers would have a field day with all the information being shared online.

One word of caution though – when vendors do decide to participate, they need to realize that many in the community will be very skeptical at the start. Online communities are typically outgrowths of individual passions and interests. As such, corporations can be viewed by many as “invaders” into a private space. So caution…but please proceed forward.