HIMSS 2015 Day 3

Day 3 at HIMSS15 opens with a minor issue, my laptop did not charge at all last night! I’m now forced to do my note taking the new-fashioned way, on a touch-sensitive keypad…yikes.

Session 1: Healthy Living, Connected Devices, & Wearables Roundtable Discussion

The opening discussion was about how the entertainment industry knows how to produce shows people like and we should aim for the same goals in designing health-monitoring/enhancing systems. Access, cost, and quality are the new standards for efforts. In the consumer’s mind quality means engagement, or their willingness to want to come back again and again. Quality of care will be measured by consumer engagement.

We are moving away from an episodic model to a preventative model through technology. A typical person will spend a few hours with their doctor during a given year, but spend countless hours engaged in health decisions on a daily basis. The care model is moving from reactive to proactive with the provider as facilitator of care.

Today there is a bit of a disconnect in what consumers are trying to accomplish and the effectiveness of current programs like weight loss or smoking cessation. You will see a number of users who download an app, use it for a week, and then disappear. Adoption is one thing, utilization is another. It’s not about how many devices are purchased it’s how they are used.

The call to free the data from devices and proprietary platforms was echoed again. Data freedom will empower consumers to be their own best advocate.

Roundtable Discussion

  • Challenges, rewards, penalties, all help. How do we tap into human nature and reach pervasive change?
  • The simplicity of the interface is crucial ease of use and integration.
  • The biggest behavior changes happen when these tools become social, that seems to be the most powerful way to make change.

This topic has been echoed at many sessions this week and It’s very apparent that we know what we want to do, but just don’t yet know how to do it, how do we make a Facebook for healthcare? Can we?

Session 2: ONC Consumer eHealth Action Plan & Advancing the Blue Button

Lanna Moriarty, Director, Office of Consumer eHealth, ONC

ONC is definitely on the path of encouraging a culture of change that supports person-centered care. They are but one of the MANY voices I heard throughout this conference and it stands in stark contrast to the message from 10 years ago when efficiency meant seeing more patients. I fairness, the focus was on removing the non value-added processes such as redundant data forms to allow the clinician to really focus on the person in the room.

The Blue Button initiative began in 2011. “It is a symbol and a movement that you can get your health information here.” The goal is to “free the data” and make it easy for you to get access to health information. I have to admit, I have not heard of this effort and would have liked a bit more background would have been helpful, but I found their website during the talk: http://healthit.gov/patients-families/your-health-data

The Blue Button lets you go online and download your health records so you can use them to improve your health, have more control over your personal health information and your family’s healthcare.

Session 2 Second Topic: Overview: Engaging Consumers Through HealthIT

Jodi Daniel, JD Director of Policy ONC,

When we started, the discussion was all about the doctors and not about the patients. Getting information from the patients was designed to help the doctor make better decisions.

Now the focus is on the patient, or rather the person at the center of their care. I do like the notion of a person versus the connotations associated with the word patient. ONC has been working on policies to promote personal engagement, interoperability, and a common clinical data set for data exchange.

2017 goal is the ability to share data over a “Common Clinical Data Set” and that products can respond to API requests for data. This approach is taking a page directly out of the IT developer’s playbook, give me access and I’ll make some magic! 

Random Thought: They say batteries are to us what fire was to the caveman. 5 minutes at HIMSS15 proves it.

Session 3: Improving Clinical Communications and Workflow via Smartphones

Ed Fisher and Dr. Allen Hsiano from Yale New Haven Health system walked us through an outstanding program they implemented bringing smartphones into both their adult and pediatric emergency departments. The talk included the why, the how, and that results including lessons learned. Very impressive.

The need for better communication was established early-on with examples like bad overhead paging, ineffective group communication channels, HIPAA concerns, etc. They stared with a wish list and wanted to consolidate all communication to a single device. It is insane to be caring a pager, cell phone, possibly a tablet, or any number of other devices all at the same time.

The wish list stared with texting, VOIP, a staff directory, and access to patient data. Further user discussions illustrated the need for real-time staff presence (who’s here), alerts, EMR integration, directed alerting, and EMR updates. Other considerations include security, both physical and logical, network connectivity (Wi-Fi and cellular), charging, assigning, MDM, etc.

The solution was not a BYOD effort, but rather a purchase of devices that stay in the EDs. They also made sure no PHI is ever stored on the devices themselves.

Lessons Learned

  • The Big Bang approach (rolling it out widely from the start) worked well, the tool was less effective when not used by everyone
  • Strong nursing a physician leadership was needed to make the work
  • Triple check Wi-Fi coverage – we had to learn how the Apple iPhone worked on Wi-Fi. You don’t what a physician in the middle of a call have it dropped.
  • Having signs or cases on the devices help to show the patients you are not on your personal device.
  • Centralized storage and accountability for devices are key – They use badge scanners to open the cabinet and us video surveillance
  • Quickly adding functionalities helps adoption – We you ask for something and it is delivered quickly, you become very committed to the process.

New Functionality

  • Eye chart on every device – When assessing an eye injury, they no longer have to take the patient to the chart for an assessment.
  • Common Peripheral Vessels chart has helped with IVs and blood draws – patients like the nurse checking things like this
  • Durable Medical Equipment (DME) Billing and Scanning – using the built-in camera for scanning – helps with supply management
  • Medical photos – with the images being integrated with the EMR and not stored on local device. Before this, our two main options were to take images with a regular camera and use cards that could be easily lost or stolen or to take images with your own personal phone.

Results Survey – How did we impact care in the EDs? The survey results show significant improvement in communication, reduction of noise, and the improvement of patient care.

In the future, they are looking a dynamic alarms, dynamic assignments: sending message to a role like attending on call versus an individual name, which changes every day. Next steps include a full enterprise rollout and continued functionality expansion.

Community-based physicians need to communicate with the EDs and that is vital going forward. We are looking to spilt the phone with two different numbers so you can have both personal and professional function on the same device.

This is a very interesting project and drastically illustrates how technology can improve process. Ironically, but using a technology solution they have actually drastically reduced their potential for PHI breeches.

Session 4: Innovation in Health Care Delivery: Accelerating with New High Impact Practices

Roy Rosin, Chief Innovation Officer, Penn Medicine

First, having an innovation officer is clearly a sign of a forward-thinking organization.

Before you can start with innovation, you must first build a foundation, getting the appropriate approvals and establishing a sand-box for innovation and rapid development.

To achieve innovation, you have to go into the environment and see what your customers see and do what your customers do. Actual behavior and stated behavior are not the same, you have to see it. There are contextual reasons why people do the things they do.

There is real power in story telling, tell me the story of what you need, then design solutions that answer the actual need. We almost always solve the wrong problem.

An innovation technique is not to ask why, but rather ask 5 “so whats”.

The dialog would be: Ok, tell me the story. What would be good about that? So, why is that better?

Innovation can leverage techniques like fake front ends, putting something out there that does not exist to see if there is any demand. If so, build it. You can see this in online retail at times when an item is “out-of-stock.” The retailers may be doing research to see if a product will actually be purchased before investing.

There are also fake back ends. When IBM was working on speech to text, instead of building a massive system, they tested the process by bringing in users and having a person in the back room fake the process by typing what the tester was saying. This illustrated the utility of the tool before spending the money in development.

We should flip the process from design, build, sell to sell first, making sure people want it before building.

This was an outstanding session that has me thinking in different ways and considering how I can facilitate more innovation on my team.

Keynote: President George W. Bush

Before President Bush took the stage, the announcement came out, “No recordings, no photography, and no note-taking during the presentation.” That caused quite a stir in a room filled with IT people.

After the opening drama, President George W. Bush took the stage and participated in an hour-long discussion on a range of topics from his presidency.

Highlights Included

  • His opening joke: One day you are president and the next you’re not. It’s a bit of a shock.
  • A recount of the events and his thoughts during the 9/11 crisis
  • A discussion about his brother Jeb and his “likely” candidacy for the Presidency: Do you want Bush/Clinton/Bush/Obama/Bush or Bush/Clinton/Bush/Obama/Clinton?
  • An incredible story about President Putin dissing his dog Barney and the lessons one can learn about a man’s character.
  • A similar story about Tony Blair that stood in stark contrast to Putin
  • The work he has been doing to combat AIDS and Cervical Cancer in Africa and how protecting life is essential to our interests.
  • And a consistent theme of what his family means to him and how his father continues to inspire him.

During 9/11, the Japanese Prime Minister called and pledged to stand shoulder-to-shoulder with us to promote freedom in the world. President Bush could not help but to think about his father who enlisted early to fight the Japanese after Pearl Harbor and how that enemy has become a close ally because they chose freedom and democracy.

President Bush was humble, appropriately self-deprecating, funny, and incredibly inspiring. I consider myself fortunate to have had the opportunity to hear him speak today. Thank you HIMSS!

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