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Hacking Health in Hamilton Ontario - Let's hear that pitch!

What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it. A pubmed search on Health Hack...

Showing posts with label Project Management. Show all posts
Showing posts with label Project Management. Show all posts

Sunday, April 23, 2017

Hacking Health in Hamilton Ontario - Let's hear that pitch!

What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it.

A pubmed search on Health Hackathons...https://www.ncbi.nlm.nih.gov/pubmed/28250965 came up with a research article that shows that Hacking Health does have very useful benefits. I am intrigue and would even like to do my own research on this.

I attended a pitch workshop and learned that intellectual property on ideas is not what it appears to be. From that perspective, and in the interests of ehealth promotion:

1. Medical School ePortfolio - So you want be a Doctor eh? [app, educational]
Problem:
Getting into medical school is like a lottery. Or is it? How can students best prepare so they don't become disappointed or feel like they are gambling getting in, or getting in and realizing it is not their ideal career choice?

Solution:
This app will be for students who want to be physicians. Maybe it could even be aimed at three levels; elementary, high school, and university. It would allow students to track their interest in a career in medicine from early days. Students are also getting into medical school after high school these days at Queens University. It could have tests and quizzes, links to schools, CV prep, volunteer opportunity suggestions, how to apply, what's involved in the actual application process at very schools. The book "So you want to be Doctor eh?" by Anne Berdl is an excellent resource to model this on. Also, many universities have learning portfolios and that is also a model. Possible mentor relationships or chats or talks with professionals in the field. By tests and quizzes, it could also have an educational role to survey student empathy, compassion training, aptitude, in addition to preparation for MCAT and other formal tests.

2.Smart Forms Builder for Healthcare [ app, software]
Problem:
Hospitals were faced with a crisis in screening patients and visitors for SARS at Ontario hospitals in 2003. The paper system they had was bogging down entry to the hospital. A LAMP (Linux, Apache, MySQL, PHP) online screening system was eventually created to streamline the process. Healthcare administrators and even IT need to develop online forms quickly without programming skills as well as have access to useful data.

Solution:
There are smartform software systems like Google docs and commercial ones like Jotform, but they are not private and secure for personal health information. As well, smart forms need to be smart enough so people without programming experience can quickly develop an application. These kind of systems are evolving, but they just need something more akin to artificial intelligence to make them really smart and inexpensive to setup. API, mobile and REST applications would also be good integration components.

3. eHealth enabled browser [ browser, app, big data]
Problem:
Personal Health Records come in many different types, tethered, stand alone, and integrated. The  people who benefit most are those who need to monitor and access a lot of medical records and visits. However, tracking health, IOT, and fitness device data can be integrated into Personal Health Records to create an overall digital health snapshot. Not everyone likes to login to a portal and track their health data.

Solution:
The idea here is to integrate Watson IBM analytics, or google alpha Go search engine analytics built into a dedicated open source browser built on chrome (or chromium). While this might sound just like an app running on a smartphone, the idea is to build a Firefox, Chrome or Safari browser that is actually a dedicated health analytics and digital health single sign on personal health record browser. What you search and read in every day life is all fodder for personal health anlaytics. This is digital "google flu" writ larger for an individual. In a way, think of it is a browser add on or extension that is a personal health record data collector, storage, and dashboard, but it is actually the browser itself.

4. Universal Healthcare Observatory [Big Data app]
Problem:

The problem is that not everyone has access to free healthcare. Statistically, millions of people are rising out of poverty every year, according to the late Global Health researcher Hans Rosling. Access to free or affordable healthcare should be a basic human right.

Solution:
The purpose of the project is based on the scientific based belief of evidence based medicine that "for profit healthcare is hazardous to your health". The United Nations and even the WHO have many observatories, and this one would be similar to the European Observatory of Health Systems and Policies. It will be a big data app that pulls data and statistics from disparate sources to monitor the global healthcare systems in the world and promote any trends towards universal healthcare. It might be able to use the Trendalyzer software. The bold target would be to achieve universal access to free or affordable healthcare for everyone on the planet by 2050.

5. eHealth Garage [ infrastructure, service]
Problem:
In my neighbourhood there are two former automobile/gas stations that are now a Vietnamese restaurant and a Holistic Health Clinic. Gas stations used be found on almost every block in every neighbourhood in every city and town. Cars no longer break down because the technology is better and gas monopolies are pushing gas stations out of neighbourhoods. Needless to say, electric cars are moving in soon. Also in my neighbourhood is a legal Medical Marijuana Clinic. Why not an eHealth Garage?

Solution:
With an aging population living longer and a coming generations that might may well live easily way over 100 years of age because of advances in exponential medicine, preventive medicine and holistic health services need to be accessible with digital health services in the community. This is also a way to deconstruct medicine.The eHealth Garage could be a component of a Family Health Team but they might call it an eHealth clinic. I see the Garage being full of healthcare technology: x-ray machines, ultrasound, MRI, fitbits, resistance training gym machines, Transcranial Magnetic Stimluation (TMS) - almost any health technology that can be coupled with a digital health technology or record. DIY healthcare, though with options for professional healthcare oversight.



Wednesday, May 22, 2013

10 mistakes made implementing IT systems in Healthcare

IT systems tend to fail at high rates. Studying EHR systems that users in hospitals hate using is one of the classics in Health Informatics. I found this piece on the Kevin Pho newsletter and thought it was a very good precautionary guide. We should all know better, right?

10 mistakes practices make in implementing information technology

What is the measure of successful technology adoption? Is it never having to hunt for a missing chart? Is it a reduction in specific operating cost line items? Is it about access to clinical information when you need it and where you need it?
Technology implementation has a significant effect on profitability. The Medical Group Management Association Cost Survey Report beginning with 2010 data shows that total medical revenue after operating and nonphysician provider costs per FTE physician actually increased as total IT expense per FTE physician increased. For multispecialty groups, for instance, among groups that invested less than $10,000 per FTE physician in IT revenue was $230,968; it was $313,900 in groups that spent between $10,000 and 20,000.
But simply acquiring technology is not enough; it is essential to implement the technology effectively to achieve those types of results.
Here, then, are the top 10 mistakes practices make in implementing information technology — and how to avoid making them.
10. Selecting a system based primarily on a demonstration session. Better to be thorough than fast in the practice management/EHR selection process.
  • Apply structure to the process.
  • Incorporate your workflow into the vendor’s application by defining a sample patient case in advance.
  • Don’t sign a contract without a reference site visit — no matter how busy the physician claims to be in order to avoid the visit!
9. Going live with your EHR without a lab interface. Viewing lab results via PDF is cumbersome for providers and trending a patient’s labs without a lab interface requires staff to enter test result values as discrete data, which is problematic and too labor intensive to be cost effective.
Identify the lab that provides the most results to your practice and test the interface with that lab prior to a go-live implementation.
8. Waiting to implement the patient portal. Implement the patient portal first, even before you convert your practice management system or go live with your EHR.
  • Save staff data entry time and effort by encouraging patients to self-register.
  • The patient’s past medical, social, and family history can be captured in the portal and “accepted” or imported into the PM/EHR system.
Getting information into the system will also save the patient time by reducing time in the waiting room. Patients are also usually more accurate and comprehensive when using the portal than they are with paper and pen.
7. Accepting the vendor’s “train the trainer” plan. Your trainer must understand the application of the system, not just which screens to go to to perform which function. Your own standards and processes are critical to how to use the new technology in your practice workflow.
6. Allowing physicians access without training. Don’t issue any physician a login/password without completing the required training. Provide test-out options to the physicians that demonstrate adequate system knowledge to prevent the dissatisfaction that will ultimately arise from not having sufficient training.
  • Provide one-on-two sessions specific to nurse/physician workflow.
  • Include procedural training along with the system know-how training. Answer the question “How does this apply to what we do?”
5. Assigning the project to the wrong person. Do not assign responsibilities for implementation based on seniority or loyalty or because you have no other position available for a long-term employee. The clinical application project manager must have some clinical background or understanding. He or she must understand what a provider sees (and grasps) when they open a chart.
Characteristics necessary for successful project management:
  • Commands authority and respect
  • Able to delegate tasks and lead others
  • Creative problem-solver and analytical thinker
  • Has high level of energy and self-direction.
4. Not including nursing in the selection process. Nurses touch the chart more than physicians do. Messaging and nurse workflow are critical to the successful use by physicians (nurses must do more of it so that physicians do less of it).
Nurses can facilitate the implementation or create barriers to the implementation; get them involved to get the best result.
3. Not elevating the EHR project in the organization. The EHR Project Manager/Director should report directly to the CEO/COO and work in conjunction with the physician champion(s). The manager should participate in the EHR governing body to establish standards and policies and procedures.
2. Making the EHR implementation an IT project. The implementation is about clinical operations and workflow changes. It is about improving operations with the use of a new tool. The EHR is no more IT than the front desk reception is. IT supports the infrastructure, just like the telephone infrastructure.
1. Not investing in ongoing optimization. Technology implementation is not a once-and-done project; it is an evolutionary process. Technology changes what is feasible. Technology adoption is iterative. Static templates will not satisfy changing needs of the end-users.
Implement a formal rounding plan to observe users and to prioritize ongoing development, training, and required modifications.
The initial goal of an implementation should be to acquire enough knowledge to get through the day. Users don’t know what they don’t know and need support as their use of the technology becomes routine.
Remember: Optimize your technology adoption and improve your profitability.
Rosemarie Nelson is principal, MGMA Health Care Consulting Group and blogs at Practice Pointers.

Saturday, September 15, 2012

eHealth Ontario Diabetes Registry is no more

A variation of this article in whatever edition of the Toronto Star I saw, was headline news.  The story line in the current online edition says"Diabetes Registry obsolete, ehealth tells liberals". The headline I saw on the shelves in the grocery store at around 10:00am this morning was something like "eHealth Ontario Axes Diabetes Registry". The twists and turns in this story are many and varied.  I remember the eHealth Ontario procurement and spending scandal in 2009 mostly because I had just starting working towards a graduate degree in eHealth (or Health Informatics) at the time and I was beginning to feel a lot of regret about the name of my degree. The real concern here should be about people who have diabetes and the epidemic this is now becoming globally - not some provincial political hot potato, or football, or whatever metaphor pleases you.

I was studying the clinical efficacy of using personal health records to manage diabetes, looking for systematic reviews of the literature in the Cochrane Collaboration.  They were not many because they are not many clinical trials involving diabetes and electronic medical records (let alone personal health records).  Yes I looked on the clinical trials registry site as well - clinicaltrials.gov   and found a rare few clinical trials, mostly involving large hospital systems that had electronic health records in the United States. I had learned in my courses that clinical trials present the highest form of medical evidence, exept for meta-analysis or systematic reviews, which is a composite study of all the best clinical trials.

It was when I was studying the project management issues in a mobile application for managing type II diabetes, that I came upon the understanding that clinical efficacy should precede business opportunity. See the COMPETE studies at McMaster. In healthcare, the return on investment is improvement in quality of life, but why spend millions on a system because it is believe to be clinically helpful, when the evidence for the actual efficacy is not in yet.  There were experiments and studies that did show promise for this, and maybe they showed promise because they were all small studies and easy to manage.

We were aware that a smartphone or mobile solution for persons with diabetes tracking and managing their condition always seemed to involve a triage person or nurse practitioner who monitored the data flows from the patients.  York University's Department of Health is now started a course of training for Health Coach Professionals, which was part of the subject of my last blog post on a consortium of academics, business and health organizations to develop the open source OSCAR EMR and it's companion PHR call MyOSCAR.  It is this kind of triage person who I think could really help fill the gap between the patient with diabetes using the smartphone or the computer, and the personal health record or electronic medical record where data measurements and journaling provide the tools necessary to self-manage the condition.  A coach is really needed to get people to exercise, eat well, adhere to regimes of all sorts, etc.

Later in 2011 when I was researching the system architecture of personal health records systems in Ontario and their relationship to the national blueprint architecture of the Canada Health Infoway, that main benefit for using them would evolve in the prescription model that physicians currently have with their patients.  A personal health record system could be prescribed to a patient, because of the clinically proven benefits of using them to manage the condition. Again, this involves the evidence based medicine preceding the business model or expediency.  As well, the prescription model maintains the traditional trust between physician and patient, and as far as I know, diabetes is not something you want to try and handle on your own, without professional guidance and help.

When in 2010 we learned eHealth Ontario was going to create a Diabetes Registry for all Ontarians, I for one thought they really did not know what they were getting themselves into.  It is not that I am proved right, it is just that technology projects are often started for the wrong reasons, and pulling the plug on them, before trying to fix the short comings, is the right thing to do.  Wished it could have turned out better for the eHealth Ontario people, CGI, and I suppose the Liberal government, who I know have the patients in Ontario and their health in mind first.