Posts Tagged with AR

posted by adgrooms on June 12, 2019

Ransomware is in the news again for a weeks-long ordeal for the city of Baltimore. Healthcare is another favorite target. In cities and health systems the need to access data is vital to operation. Attacks are growing in number and becoming more sophisticated. The FBI reported that healthcare lost $4.5 million over 337 victims in 2018. The cost could be even higher if patient data was also stolen for exploitation. What is ransomware, how can an attack be avoided, and how can it be dealt with effectively?

Ransomware is a type of malware that prevents users from accessing data, usually by encrypting the data. The hacker demands a fee to restore access. However, there is no guarantee that the attacker can or will restore access once payment is made. Bad actors apply this technique wherever they can, to any industry and even personal systems. Unfortunately, these bad actors have realized that data lockouts create dangerous and life-threatening conditions when applied to critical systems in healthcare. This urgency can motivate an unprepared health system to comply in order to protect patients.

Ransomware spreads like a virus. It requires a person to run malicious code that locks the system. Phishing and drive-by downloads are two common ways to spread ransomware. Phishing is a trick that deceives a person into running a malicious program with a legitimate-looking email. Drive-by downloads either trick a person into running a malicious program off of a website or secretly download and run a program while the person visits a site. All healthcare employees should be extensively trained on how to spot malicious emails and suspicious links. Regular security meetings should be held to remind and update employees on the latest tricks and traps.

The best overall tactic in security is to make yourself a difficult and undesirable target. You want to become not worth the effort. Either the value is too low or the cost is too high. The best defense against ransomware is a disaster recovery plan. With a solid disaster recovery plan in place, ransomware is neutralized. They can go to the trouble of getting in and locking your data up, but you'll sidestep the attack and resume operations. It may cost some time to restore data and systems, but showing yourself as able to recover and unwilling to negotiate will deter future efforts. A good disaster recovery plan should be in place for any medical institution.

The only perfect security is zero access at all. If authorized individuals can access a system then motivated, unauthorized individuals can find a way in. Vigilance from all employees is the first line of defense, and quick recovery is dependant on good planning.

posted by adgrooms on June 11, 2019

Is organizational transparency possible in healthcare? The very nature of healthcare includes private, personal information. Does this prevent healthcare organizations from having a culture of transparency? What are the benefits of being transparent and why don't more institutions strive for transparency?

Medicine is based on trust. Patients trust that a doctor is going to take care of them. Doctors trust that their organization will support them. In a healthy institution, you see trust reflected in every interaction. But no person or place is perfect. People make mistakes, and when that happens, trust is reduced and needs to be restored. Fostering trust is one of the major benefits of transparency. It is impossible to learn from a mistake without first acknowledging it. When there is an event, there is a choice to be made. The organization that acknowledges and addresses a mistake retains the community’s trust. Versus the organization that denies the problem and withholds, hides, or misrepresents information. On the inside, a culture of blame and shame breeds a toxic environment. On the outside, this behavior erodes the community's trust. Transparency is a conversation that banishes blame and cultivates constructive thought.

Transparency improves safety. In line with learning from mistakes, maintaining awareness of performance is the only way to learn and improve. As Peter Drucker said, "If you can't measure it, you can't improve it". This extends further in a healthcare organization. If you track outcomes and measure results but keep the numbers hidden from team members, they can not contribute to improvement. You are relying on the few that know to provide the solutions and they may not be the right people with the right knowledge. It is a substandard use of the team's abilities. When tracking is implemented and all team members are brought to bear, the best achievements can be reached.

Culture change is not easy. Moving from no or low transparency to full visibility requires a plan and time for adaptation. It requires buy-in from everyone in the organization and a leap of faith in each other. Increasing internal visibility in low-risk areas will give team members time to adjust and become advocates. A good place to start is increasing internal access to measures of performance and outcomes. When the organization has reached a good level of comfort with internal transparency, it will be ready to work on external visibility, eventually becoming a resilient culture that constructively incorporates all feedback.

Clearly, there is a benefit to healthcare in transparency, even though enacting and maintaining transparency is difficult. Egos must be checked at the door; none of us want to reveal our faults. But, intentionally acknowledging our faults leads to positive change. Ultimately it is conversation through all levels that will lead to long term success.

posted by adgrooms on June 10, 2019

Augmented reality (AR) is a developing field in medical education that is showing promise in enhancing medical training. Uses for AR are being developed across many disciplines to assist in learning procedures that require interaction with patients that range from conversation to surgery. So how do you determine if AR is right for your program?

One of the benefits of AR is that can help trainees learn hands-on procedures without putting anyone at risk. For instance, laparoscopic surgery is a popular AR training use. A simulated surgery can give realistic feedback and allow for repeated practice. Visual overlays can be added to guide the physician to optimal approaches to the procedure. Other complex procedures in disciplines such as neurosurgery or echocardiography can also benefit from AR training simulation giving a feel for spatial orientation encountered in a real clinical setting.

Another interesting application is patient interaction. It is rare that a learning physician already knows how to interact with the wide variety of personalities and socioeconomic backgrounds that one encounters in a clinical setting. This is knowledge that comes from experience, but similar to surgery, learning and practicing on real people in need of real help can lead to less than optimal outcomes. A physician can interact with a virtual patient to learn how to react to vocal and visual cues through different role-playing situations. This can reduce miscommunication and improve listening and interpretation skills in order to create a better patient experience and make communication less stressful for the physician.

AR is a fertile area for physicians to partner with startups and smaller companies that can develop ideas useful in medical learning. There are training systems on the market, but there is potential as technology improves for an even greater variety of learning experiences and even deeper immersive training applications. The cost of developing learning tools can pay off in better patient outcomes, more efficient procedures, and increased speed to proficiency.

AR will be growing in medical education in the foreseeable future. This growth should bring many benefits to all stakeholders in the medical community. What applications would you like to see? Who do you want to see benefit?

posted by adgrooms on May 29, 2019

Physician-led team-based care is widely used as a coordinated effort to provide higher quality care to patients. Team members of different specialties are included to provide different strengths in a coordinated effort to create better outcomes. A team effort in a clinical setting has its challenges, and technology can help.

To accomplish effective team care, exceptional communication and information sharing between team members is needed. A tool that pulls data from an EHR and distributes to individual team members while seamlessly incorporating communication would be beneficial. Providing individual team members the ability to select and view relevant information would help them both focus attention and reduce preparation time before a conversation with the patient or other care team members. Dictation and voice recognition could be used to record and share notes and observations from patient visits. In addition, an integrated secure messaging system could ensure the team can coordinate care more efficiently.

Effective communication to and from the patient is essential to provide a sense of trust in the team. If different team members relay contradictory messages, trust is eroded. Trust could be supported by consolidating and making treatment and planning information accessible to the patient and family. The patient-facing interface could provide an easy to understand summary of procedures, prescriptions, and visits from care providers. Bi-directional notes from both patient to provider and provider to patient could further aid communication and improve trust. These notes could be written at any time, providing a way, for example, for a patient to log how they are feeling at a particular time, drug interactions, or a question for a particular care team member.

The physician, as a leader, should have an interface that provides an overview of patients and team members that is easy to read and manage. They should be able to dictate a plan of action for the patient that automatically coordinates and notifies team members what is required of them. Visualizations could be implemented, such as a patient timeline, to quickly understand and assess a patient’s progress.

Team-based care could benefit from a comprehensive, easy-to-use coordination system that integrates seamlessly with the EHR and encourages patient participation.

posted by adgrooms on May 24, 2019

A trip to the hospital can be a stressful and overwhelming experience. While the patient is already unwell and concerned, they are also receiving information and guidance about their current and future care from physicians and therapists. Upon discharge, the patient or caretakers must take this information and continue self-treatment at home. But how is the patient to keep track and apply all of the advice and instructions - some spoken, some printed?

Patient portals may contain notes about the visit, but often don’t have detailed information that a patient was given in person. Many patients lose printed discharge information and reasonably resort to looking for the information online. However, this is lacking the specific input from the various specialists and therapists that all provided direction.

An ideal solution would be an after-visit summary that consolidates information from all points of care and a patient could access at any time in their portal. Of course, producing these notes for every patient in language that they could understand would be extremely time-consuming for a physician. This is another area that could be helped by dictation systems. Capturing the instructions as each care provider speaks them to the patient and providing both the audio and transcribed text would help a patient remember what was conveyed.

Additional information could be automatically supplied with libraries of information tied to medical coding. Instead of asking patients to remember to ask for key information and keep track of the answers, these formats could become electronic templates and filled with specific details. This could be further enhanced with the ability for physicians to include additional instructions as needed. The information library could be made take into account the specifics of a patient such as prescription information, health numbers to monitor and aim for, and dietary instructions/goals.

Outcomes can be improved with better patient discharge information. Providing the information in an understandable and accessible way can benefit communication and help a patient take an active role in their recovery.