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PointClickCare Tackling Readmissions from Long-Term and Post-Acute Care Facilities Head-On

Posted on January 12, 2018 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.

Transitioning from an acute care to a long-term/post-acute care (LTPAC) facility can be dangerous.

According to one study, nearly 23% of patients discharged from a hospital to a LTPAC facility had at least 1 readmission. Research indicates that the leading cause of readmission is harm caused by medication (called an adverse drug event). Studies have shown that as much as 56% of all medication errors happen at a transitional point of care.

By the year 2050 more than 27 million Americans will be using LTPAC services. The majority of these LTPAC patients will transition from an acute care facility at least once each year. With this many transitions, the number of medication errors each year would balloon into the millions. The impact on patients and on the healthcare system itself would be astronomical.

Thankfully there is a solution: medication reconciliation

The Agency for Healthcare Research and Quality (AHRQ) states: “Patients frequently receive new medications or have medications changed during hospitalizations. Lack of medication reconciliation results in the potential for inadvertent medication discrepancies and adverse drug events—particularly for patients with low health literacy, or those prescribed high-risk medications or complex medication regimens.”

Medication reconciliation is a process where an accurate list of medications a patient is taking is maintained at all times. That list is compared to admission, transfer and/or discharge orders at all transitional points both within a facility and between facilities. By seeing orders vs existing medications, clinicians and caregivers are able to prevent drug-interactions and complications due to omissions or dosage discrepancies.

What is surprising is the lack of progress in this area.

We have been talking about interoperability for years in HealthIT. Hundreds of vendors make announcements at the annual HIMSS conference about their ability to share data. Significant investments have been made in Health Information Exchanges (HIEs). Yet despite all of this, there has been relatively little progress made or coverage given to this problem of data exchange between hospitals and LTPAC facilities.

One company in the LTPAC space is working to change that. PointClickCare, one of the largest EHR providers to skilled nursing facilities, home care providers and senior living centers in North America, is dedicating resources and energy to overcoming the challenge of data sharing – specifically for medication reconciliation.

“We are tackling the interoperability problem head-on,” says Dave Wessinger, co-founder and Chief Operating Officer at PointClickCare. “The way we see it, there is absolutely no reason why it can take up to three days for an updated list of medications to arrive at our customer’s facility from a hospital. In that time patients are unnecessarily exposed to potential harm. That’s unacceptable and we are working with our customers and partners to address it.”

Over the past 12 months, the PointClickCare team has made significant progress integrating their platform with other players in the healthcare ecosystem – hospitals, pharmacies, HIEs, ACOs, physician practices and labs. According to Wessinger, PointClickCare is now at a point where they have “FHIR-ready” APIs and web-services.

“We believe that medication reconciliation is the key to getting everyone in the ecosystem to unlock their data,” continues Wessinger. “There is such a tremendous opportunity for all of us in the healthcare vendor community to work together to solve one of the biggest causes of hospital readmissions.”

Amie Downs, Senior Director ISTS Info & App Services at Good Samaritan Society, an organization that operates 165 skilled nursing facilities in 24 states and a PointClickCare customer, agrees strongly with Wessinger: “We have the opportunity to make medication reconciliation our first big interoperability win as an industry. We need a use-case that shows benefit. I can’t think of a better one than reducing harm to patients while simultaneously preventing costly readmissions. I think this can be the first domino so to speak.”

Having the technology infrastructure in place is just part of the challenge. Getting organizations to agree to share data is a significant hurdle and once you get organizations to sit down with each other, the challenge is resisting the temptation just to dump data to each other. Downs summed it up this way:

“What is really needed is for local acute care facilities to partner with local long-term and post-acute care facilities. We need to sit down together and pick the data that we each want/need to provide the best care for patients. We need to stop just sending everything to each other through a direct connection, on some sort of encrypted media that travels with the patient, via fax or physically printed on a piece of paper and then expecting the other party to sort it out.”

Downs goes on to explain how narrowing the scope of data exchange is beneficial: “I definitely see a strong future for CCDA data exchange to help in medication reconciliation. Right now medication information is just appended to the file we receive from acute care facilities. We need to agree on what medication information we really need. Right now, we get the entire medication history of the patient. What we really need is just the active medications that the patient is on.”

In addition to working on FHIR and APIs, BJ Boyle, Director of Product Management at PointClickCare, is also leading a data sharing initiative for those instances when there is no fellow EHR platform to connect to. “We are working towards something that is best described as a ‘Post-Acute Care Cloud’ or ‘PAC Cloud’,” explains Boyle. “We’re designing it so that hospital case managers can go to a single place and get all the information they need from the various SNFs they refer patients to. Today, when HL7 integration isn’t possible, case managers have to be given authorized access to the SNF’s system. That’s not ideal.”

PointClickCare has already taken an initial step towards this vision with an offering called eINTERACT. According to the company’s website eINTERACT allows for the “early identification of changes in condition…and the sooner a change in condition is identified, the quicker interventions can be implemented to prevent decline and avoid potential transfers” which is key to managing patient/resident health.

It’s worth noting that John Lynn blogged about LTPAC readmissions in 2014. Unfortunately at the macro/industry level, not much has changed. Dealing with readmissions from LTPAC facilities is not particularly exciting. Much of the attention remains with consumer-monitoring devices, apps and gadgets around the home.

Having said that, I do find it encouraging to see real progress being made by companies like PointClickCare and Good Samaritan Society. I hope to find more examples of practical interoperability that impacts patient care while touring the HIMSS18 exhibit floor in early March. In the meantime, I will be keeping my eye on PointClickCare and the LTPAC space to see how these interoperability initiatives progress.

Using Geography to Combat the Opioid Crisis

Posted on January 10, 2018 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 it comes to the opioid crisis, the numbers aren’t good. According to the latest CDC numbers, over 66,000 Americans died from drug overdoses between May 2016 and May 2017. Unfortunately this continues the rapid upward trend over the past five years.

Credit: New York Times, The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years, 2 Sept 2017, https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html

One of the biggest drivers for this increase is the prevalence of opioids – a class of drugs that includes pain medications, heroin and fentanyl (a synthetic opioid). The opioid crisis is not the stereotypical street-drug problem. It is not confined to inner cities or to any socio-economic boundaries. It affects all neighborhoods…and therein lies one of the greatest challenges of dealing with the crisis, knowing where to deploy precious resources.

As governments and public health authorities begin to take more aggressive action, some are wisely turning to geographic information systems (GIS) in order to determine where the need is greatest. GIS (also called geospatial mapping) are designed specifically to capture, store, manage and analyze geographical data. It has been a mainstay in mining, engineering and environmental sciences since the early 1990’s. For more information about GIS, please see this excellent PBS documentary. In recent years, GIS has been applied to a number of new areas including healthcare.

Esri is one of the companies doing pioneering GIS work in healthcare and recently they have focused on applying their ArcGIS technology to help tackle the opioid crisis. “One of the basic challenges that public health authorities face is clearly defining the scope of the opioid problem in their local area.” says Estella Geraghty MD, Chief Medical Officer & Health Solutions Director at Esri. “The good news is that the information to map the extent of the problem is available, it’s just stored in disparate systems and in incompatible formats. We help bring it all together.”

Geraghty points to their work with the Tri-County Health Department (TCHD) as an example of how effective GIS can be. TCHD is one of the largest public health agencies in the US, serving 1.5 million residents in three of Denver’s metropolitan counties: Adams, Arapahoe and Douglas. Using Esri’s ArcGIS solution, TCHD created an open data site that allows internal teams and external partners to pool and share their opioid health information using a visual map of the region as a common base of reference.

According to Esri: “Since the creation of the Open Data site, there has been a dramatic increase in both the information available to the public and the community’s understanding of the opioid crisis.” You can see the Open Data site here and if you scroll down you will see six different maps available to the public. Particularly sobering is the Opioid Overdose Deaths from 2011-2016, which allows you to zoom in down to specific streets/blocks. Another interesting map is the Household Medication Take-Back Locations which seems to indicate there is a lack of coverage for the city of Denver.

Esri itself has created its own site to bring attention to the opioid crisis at a national level. Two maps in particular stand out to me. The first is the map of Opioid Prescriptions per Provider. The red zones on that map represent areas where a high number of opioid prescriptions are being made by relatively few providers. This points to potential areas where opioid abuse may be occurring.

By mapping the data in this way, some interesting insights emerge. Take Taliaferro County in Georgia for example where 2,069 claims out of a total of 29,016 were for opioids, yet the county only has 2 providers. Or Clinch County in Georgia where a whopping 10% of all claims were for opioids.

The second interesting map is Lost Loved Ones (located at the bottom of the Esri site). This is a completely open map where anyone can pay tribute to a loved one who has been lost to the opioid crisis. Each dot is a person – a stark reminder that behind each statistic is a son, daughter, mother, or father who has died from opioids. Anyone can add to the map by clicking the button at the top of the map.

There is something to be said about seeing data overlaid onto an interactive map. It takes data from abstract lines, bars or numbers on a page and transforms it into something more tangible, more “real”. I suspect that for many on the front lines of this crisis, having the opioid data visualized in this manner helps to drive home the need for additional resources.

“Esri is helping public health officials all over the country make better decisions,” continued Geraghty. “We are helping them determine if they have enough coverage for places where people can drop off expired drugs, places where Naloxone is available and mental health program coverage. We can visually present the types of drugs being dropped off by region. We can track where first responders have had to use Naloxone. We plan on continuing to collaborate closely with customers, especially with public health authorities. This opioid crisis is impacting so many neighborhoods. We can make a difference.”

Given the continued upward trend in opioid-related deaths, healthcare can use all the difference makers it can get.

Excitement Mixed with Realism at Top Of Mind 2018

Posted on December 18, 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 recent #TopOfMind2018 conference hosted by the Center of Connected Medicine was one of the best events of 2017. A stellar lineup of speakers was matched by an equally outstanding group of attendees. Together this combination created an atmosphere of realistic excitement – a unique mixture of exuberant enthusiasm for the latest healthcare technology (Artificial Intelligence, Machine Learning, Cybersecurity, Home Monitoring) tempered by sobering doses of reality (lack of patient access and poor usability).

One of the most engaging presentations was delivered by Jini Kim, Founder and CEO at Nuna. She opened by recounting her hilarious first-ever conversation with President Obama. Very early one morning (around 3am PT), Kim got a call on her cell phone from an unknown Washington number. When she answered the person on the other end introduced himself as President Obama. Kim reacted as I’m sure many of us would – with disbelief – and said as much to the caller. Obama laughed and said “I get that a lot, but seriously this is the President of the United States and I’m calling because your country needs you”. Kim compared that moment to feeling like a superhero being invited to join the Avengers.

Kim was one of six people handpicked by the President and his advisors to fix the failed Healthcare.gov website. For the incredible behind-the-scenes look at how this team was recruited and how they fixed the site, check out this amazing Time article.

In front of a slide that showed her company’s mantra, “Every row of data is a life whose story should be told with dignity”, Kim told story after story about how healthcare organizations would bring her in to help solve difficult healthcare problems. What Kim realized through that work was how badly health data is stored, protected and used.

In project after project, her team was tasked with bringing order to data chaos. One of the biggest challenges they encountered over and over again was bringing together massive amounts of data that was stored in different formats and used different terminologies.

Kim’s presentation was an effective counterbalance to the presenters just before her who had spoken excitedly about the future of Artificial Intelligence (AI). She cautioned the #TopOfMind2018 audience not to get too distracted by the shiny new AI object.

So much work needs to be done on the basics first before we can effectively apply AI. We need to get back to basics: data integrity and data cleansing. It’s not sexy, but if we don’t fix that then the more advanced technologies that layer on top will simply not work.

The session presented by Erin Moore, patient advocate and healthcare innovation consultant, made the biggest impact on the audience. For 45 minutes, she shared her deeply personal healthcare story, which started when her son Drew was diagnosed with cystic fibrosis seven years ago. Moore took the audience on an emotional roller coaster ride that mirrored her own family’s journey – from small wins (finding a doctor who would listen) to draining setbacks (medications changed without explanation) and from serendipitous windfalls (a researcher sent her an app that encouraged Drew to take his medication) to scratch-your-head moments (having to manually build Drew’s medical record by going to each provider and filling out forms in order for the information to be released).

There were two memorable takeaways from Moore’s presentation. First, was her story of how eye-opening it was for Susanna Fox, then Chief Technology Officer of the US Department of Health and Human Services, to spend the day shadowing Drew (virtually). Whenever Drew had to take his medication, Fox would pop a Tic-Tac. 500 Tic-Tacs and multiple hours waiting for appointments later, Fox had a new appreciation for how all-consuming it was to be the caregiver to someone who has cystic fibrosis. You can read more about Fox’s experience in her revealing blog post.

Second, was Moore’s double challenge to the audience:

  • To truly walk a mile in your end-users world when creating/designing the next generation products.
  • To make products truly interoperable.

The best unscripted moment of #TopOfMind2018 came from Amy Edgar, a #pinksocks #hcldr #TheWalkingGallery member. In one of the early Q&A sessions, she asked the speaker “How do we prevent digital health from becoming the next snake oil”. For a moment there was stunned silence as the room absorbed the full weight of Edgar’s comment.

For the rest of the day #TopOfMind2018 master of ceremonies Rasu Shrestha and other presenters made reference to snake oil. Edgar’s comment was even the inspiration for a recent HCLDR tweetchat that followed on the heels of the conference.

Overall #TopOfMind2018 was one of my most memorable conference experiences of 2018. The presentations were interesting. The venue was fantastic. Everything ran smoothly. Above all the people at the event were amazing.

Special Note: Thank you to Larry Gioia for organizing an amazing meetup during #TopOfMind2018 that was inclusive of #HITsm #HITMC #HCLDR #pinksocks and #TheWalkingGallery

What are you #HITThankful for?

Posted on November 23, 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.

It’s Thanksgiving in the US and for many this means spending time with family and friends over insane amounts of cooked poultry (or tofu for our vegetarian friends). It is also the time to stop and think about all the things we are thankful for.

This year, Brian Mack @BFMack, Marketing & Communications manager at Great Lakes Health Connect and member of the #HITsm #HITMC and #hcldr communities, started the #HITThankful hashtag as way for people to share what they are thankful for in HealthIT.

From the tweets that have been shared it’s clear that being thankful for family is at the top of the list, but there have also been many who have been thankful for supportive coworkers and online friends.

This year I am tremendously thankful for the support of all my friends and colleagues in healthcare and HealthIT. I seriously would not have made it through the year had it not been for the encouragement and thoughtfulness of friends like John Lynn, Rasu Shrestha, Joe Babaian, Robert Blount, Nick Adkins, Regina Holliday, Nick van Terheyden, Sarah Bennight, Amy Hamilton, Brittany Quemby, Erin Wold, Cristina Dafonte, Janae Sharp, Tim Kinner, Dennis Nasto, Steve Nickerson, Daniel Kube and Colleen Young.

I got a wake-up call in the spring this year and it forced me to give serious thought to where I was heading professionally. Over the summer I must have spoken with at least 100 friends and family who all told me the same thing – it’s time that I get back to doing something I love doing. For me that’s helping small HealthIT companies grow into big ones. I’m thankful to have the opportunity now to pursue my passion.

I do have to give a special shout-out to John Lynn who has allowed me to contribute blogs to HealthcareScene.com and for believing in me. You are a true friend John and I’m so happy that we are now getting the chance to work together more closely.

I also have to thank everyone in the #hcldr #HITMC #HITsm #pinksocks #HTReads #HealthITChicks #HealthXPh #irishmed and #hcsmsa communities. All of you inspire me to keep the flame burning.

Happy Thanksgiving everyone!

 

AMIA17 – There’s Gold in Them EHRs!

Posted on November 13, 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.

If even 10% of the research presented at the 2017 American Medical Informatics Association conference (AMIA17) is adopted by mainstream healthcare, the impact on costs, quality and patient outcomes will be astounding. Real-time analysis of EHR data to determine the unique risk profile of each patient, customized remote monitoring based on patient + disease profiles, electronic progress notes using voice recognition and secondary uses of patient electronic records were all discussed at AMIA17.

Attending AMIA17 was an experience like no other. I understood less than half of the information being presented and I loved it. It felt like I was back in university – which is the only other time I have been around so many people with advanced degrees. By the time I left AMIA17, I found myself wishing I had paid more attention during my STATS302 classes.

It was especially interesting to be at AMIA17 right after attending the 3-day CHIME17 event for Hospital CIOs. CHIME17 was all about optimizing investments made in HealthIT over the past several years, especially EHRs (see this post for more details). AMIA17 was very much an expansion on the CHIME17 theme. AMIA17 was all about leveraging and getting value from the data collected by HealthIT systems over the past several years.

A prime example of this was the work presented by Michael Rothman, Ph.D of Pera Health. Rothman created a way to analyze key vital signs RELATIVE to a patient’s unique starting condition to determine whether they are in danger. Dubbed the Rothman Index, this algorithm presents clinicians and caregivers with more accurate alarms and notifications. With all the devices and systems in hospitals today, alarm fatigue is a very real and potentially deadly situation.

Missed ventilator alarms was #3 on ECRI Institute’s 2017 Top 10 Health Technology Hazards. It was #2 on the 2016 Top 10 list. According to ECRI: “Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death”. The challenge is not the response but rather how to determine which alarms are informational and which are truly an indicator of a clinical condition that needs attention.

Comments from RNs in adverse-event reports shared in a 2016 presentation to the Association for the Advancement of Medical Instrumentation (AAMI) sums up this challenge nicely:

“Alarm fatigue is leading to significant incidents because there are so many nuisance alarms and no one even looks up when a high-priority alarm sounds. Failure to rescue should be a never event but it isn’t.”

“Too many nuisance alarms, too many patients inappropriately monitored. Continuous pulse oximetry is way overused and accounts for most of the alarms. Having everyone’s phone ring to one patient’s alarm makes you not respond to them most of the time.”

This is exactly what Rothman is trying to address with his work. Instead of using a traditional absolute-value approach to setting alarms – which are based on the mythical “average patient” – Rothman’s method uses the patient’s actual data to determine their unique baseline and sets alarms relative to that. According to Rothman, this could eliminate as much as 80% of the unnecessary alarms in hospitals.

Other notable presentations at AMIA17 included:

  • MedStartr Pitch IT winner, FHIR HIEDrant, on how to mine and aggregate clinically relevant data from HIEs and present it to clinicians within their EHRs
  • FHIR guru Joshua C Mandel’s presentation on the latest news regarding CDS Hooks and the amazing Sync-for-Science EHR data sharing for research initiative
  • Tianxi Cai of Harvard School of Public Health sharing her research on how EHR data can be used to determine the efficacy of treatments on an individual patient
  • Eric Dishman’s keynote about the open and collaborative approach to research he is championing within the NIH
  • Carol Friedman’s pioneering work in Natural Language Processing (NLP). Not only did she overcome being a woman scientist but also applying NLP to healthcare something her contemporaries viewed as a complete waste of time

The most impressive thing about AMIA17? The number of students attending the event – from high schoolers to undergraduates to PhD candidates. There were hundreds of them at the event. It was very encouraging to see so many young bright minds using their big brains to improve healthcare.

I left AMIA17 excited about the future of HealthIT.

Five Key Takeaways from CHIME17

Posted on November 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.

I recently had the chance to attend the 2017 CHIME Fall CIO Forum (CHIME17) for the first time. It was a fantastic experience.

What struck me most about the event was the close-knit feeling. In the hallways and in the sessions, it felt more like a class reunion than a healthcare IT conference. It was common to see groups of attendees engaged in deep conversations and there were frequent shouts of “hello” from across the hall. I can honestly say that I spoke with more CIOs at CHIME17 than the all the other 2017 conferences I have attended combined.

I learned at lot from my CIO conversations. Below are my top five takeaways:

Hospital CIOs are real people

At every other conference, you have to search pretty hard to find a hospital CIO. They tend to hide and run quickly from one pre-arranged meeting to another. They also do not spend a lot of time visiting the exhibit hall except with companies they are doing business with. At CHIME17 CIOs roamed the halls freely and were very approachable, especially at lunch. It was easy to strike up conversations at CHIME17 and it didn’t take long before funny stories of technology gone awry were being told. I came away from CHIME17 with a much stronger appreciation for CIOs – they are funny, caring people under a lot of pressure.

Optimization is the new black

Many of the conversations at CHIME17 were around the best ways to optimize existing IT systems – particularly EHRs. This optimization had two flavors. First, CIOs spoke about optimizing the user interfaces to reduce clinician frustration and to streamline workflows. This form of optimization was seen as a “quick win”. Second, CIOs spoke about optimizing/leveraging the data collected by their various systems. Many were investing in analytics tools and talent in order to unlock the value in the health data within their EHR, imaging and other applications. Optimization was the dominant topic at CHIME. For more details, check out my blog on this topic.

Attracting and retaining talent is a challenge

Another hot topic of discussion, or more accurately, a heated point of frustration at CHIME17 was the difficulty in attracting and retaining IT talent. CIOs at large urban hospital were frustrated at losing talented staff to HealthIT vendors and to “cooler” tech companies in their cities (like Google and Amazon). CIOs at smaller rural hospitals were frustrated at losing talented staff to their urban counterparts and to those same tech companies. With healthcare budgets frozen, CIOs were having to find more creative ways to attract and retain staff – like allowing work-from-home, hiring out-of-state resources and providing time for employees to pursue their own healthcare research projects. This war for HealthIT talent threatens to stymie healthcare innovation and is a challenge worth keeping an eye on.

The role of the Hospital CIO is evolving rapidly

Several sessions at CHIME17 were dedicated to the rapidly changing role of technology in healthcare organizations and to the role of the CIO itself. There was a lot of talk about the new emerging roles of:

  • CSO – Chief Security Officer
  • CMIO – Chief Medical Information Officer
  • CNIO – Chief Nursing Information Officer
  • CDO – Chief Data Officer
  • CHIO – Chief Health Information Officer

As information technology permeates everyday hospital operations, the CIO role will fracture into hybrid operational+technology roles like the ones listed above. There was heated debate as to whether all these roles should report into the CIO or whether they should be kept separate from. John Lynn wrote a great blog on this topic.

Size doesn’t matter

The challenges being discussed by the CIOs at CHIME were independent of the size of their organizations. Whether it was attracting talent, finding good vendor/partners or dealing with slashed budgets – CIOs from small rural hospitals to large urban systems, were struggling with the same challenges. On one hand it was comforting to know the problems were universal but on the other, it was worrying to see how pervasive these challenges were.

BONUS: Marketing tchotchkes are an invasive species

CHIME is one of the few healthcare conferences that does not have an exhibit hall. Despite this, there was still a lot of tchotchke available to attendees – proving that Marketing Tchotchke should really be labeled as an invasive species at healthcare conferences.

Shout-out to CHIME organizers for putting on such a fantastic event.

New York Presbyterian brings ER to patients via Mobile Stroke Treatment Unit

Posted on November 3, 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.

After a year in operation, New York Presbyterian’s (NYP) Mobile Stroke Treatment Unit (MSTU) continues to be a shining example of how healthcare technology can be used to facilitate true patient-centered care.

“The MSTU program was started with the singular goal of reducing the disability resulting from stroke,” explains Dr Michael Lerario, Medical Director of NYP’s MSTU Program and Assistant Professor of Clinical Neurology at Weill Cornell Medicine. “There is a term we use when we talk about stroke: Time is Brain. Every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die from the lack of oxygen. This loss can lead to severe cognitive and physical disability for patients.”

Two feet longer than a regular New York City ambulance, the MSTU houses a Samsung portable computer tomography (CT) scanner, a point-of-care laboratory, a complete mobile EHR station (with super-fast WiFi) and a Cisco tele-presence system. The MSTU is staffed by four team members who are specially trained:

  • 1 CT Technician
  • 1 Registered Nurse (RN)
  • 2 Paramedics

With this sophisticated equipment, the MSTU team is able to bring stroke treatment directly to patients where they are instead of waiting for the patient to be transported to the hospital’s ER. Those precious minutes can be the difference between a full recovery and months of rehabilitation (or permanent disability).

When a 911 call comes in, the operator quickly determines if it is a potential stoke situation using a predetermined set of criteria (Plerior referrs to them as “triggers”). This specific protocol was jointly developed by NYP and the New York Fire Department which handles all 911 calls. If the criteria are met, the MSTU is dispatched to the patient’s location.

Upon arrival, the MSTU team stabilizes the patient and quickly conducts a number of diagnostic tests using the equipment onboard: PT/INR test, hemoglobin test and a CT scan. The CT images are sent wirelessly in real-time to NYP’s PACS system where the on-call neurologist reviews the results with the MSTU’s RN via a tele-conference. Based on the scans and the onsite lab work, the neurologist and the onsite team can decide the best course of treatment.

If the scans show that the patient is suffering an ischemic stroke (an obstruction within a blood vessel supplying blood to the brain) and is not already taking anticoagulant medication, then tPA (tissue plasminogen activator – a clot dissolving medication) can immediately be administered. Often referred to as the “gold standard” of Ischemic Stroke Treatment, if tPA is administered quickly it significantly improves the chances for a full recovery.

“Right from the beginning we had complete buy-in and support from within our organization,” says Lerario. “The Neurology and Emergency Medical Services departments in particular were very excited about the MSTU program. They had seen the positive impact MSTU’s were having in Europe and the team wanted to bring that treatment to the people of New York City.”

In just one year of operation, the MSTU has been dispatched on 400+ calls and the response from patients has been universally positive. In fact, a number of cases have been highlighted as good news stories in the press including one about a famous Brazilian singer.

“It won’t be long before mobile stroke treatment will become the standard of care,” Lerario continues. “The benefits are now well documented and more and more people are becoming aware of the impact an MSTU can have on your quality of life following a stroke. People are starting to demand this type of care from their care providers.”

MSTUs are also fantastic for healthcare as a whole. It costs far less to operate an MSTU than it does to treat and rehabilitate patients who suffer disabilities because tPA was not administered quickly enough.

From a patient, provider and public perspective, New York Presbyterian’s MSTU is a winning combination of healthcare technology and patient-centered thinking.

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.”