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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 June 7, 2019

When a patient makes an office visit, the provider may send home information, prescribe medicine, and schedule a follow-up appointment. What patients lack are points of accountability and reminders to help stay on track in order to make health improvements. Patient care should not have to stop at the clinic door, and it does not have to add to provider workload. In fact, messaging can reduce it.

A recent review of studies on SMS health reminders showed a range of positive outcomes for patients. Automated messaging improves compliance through appointment reminders, immunizations, and prescription reminders. Behavioral reminders for smoking cessation and diet reminders for patients with diabetes or heart disease are also shown effective.

The study references articles showing "major financial savings" in the reduction of missed appointments, alone. Reminders can be automated for frequency, duration, and helpful custom information, such as addressing each person by their first name. Even two-way messaging can be automated using chatbot technology. This can be the first line of communication to answer patient questions, with a path to escalate to a provider, if needed. More sophisticated integration of messaging with EHR can measure the effectiveness of messages to hone the system.

SMS is not encrypted and not a secure method of communication. Although text messaging is an accepted daily risk for most people, reminders must be crafted to contain no PHI. Care should be taken to obtain permission to use this channel of communication. It is also important to inform each patient of the risks to their personal information and the types of messages you intend to send. Examples of the types of messages and the information they will contain will be helpful for patients to make an informed decision.

Automated messaging is a low-cost method of communication that has been shown to improve patient compliance. There are still more areas where this approach can be explored.

posted by adgrooms on June 6, 2019

Healthcare providers need great tools that facilitate their work and empower them. IT teams need to stay ahead of risk to their organizations; this includes all forms of system resilience, especially security risk. Leadership needs cost-effective solutions and reliable systems. To this end, healthcare IT departments have oversight of all software used in their institutions. They are charged with protecting patient data, efficient use of resources, and the overall security of computer systems; therefore, they review and approve every piece of software used. Sometimes employees find the approved software to be inadequate or prefer using solutions not provided by the institution. The use of unauthorized software without disclosure is known as "shadow IT". What are effective ways of addressing shadow IT?

Some healthcare employees may not know what a security risk shadow IT is or the HIPAA policies they are violating. For example, one common use of shadow IT is communication. Providers looking for a more efficient way to share patient health information amongst themselves could be using their personal device for messaging. It seems like a pragmatic and reasonable solution, but in reality, this is an insecure method and highly vulnerable to a data breach. How can these instances be addressed?

Many times it is the lack of a good clear process towards getting a better solution implemented. Any large organization has many rules and processes, and it is hard to be aware of the relevant steps. A solution-seeking provider may not know where to go to get the software approved. Is it an IT committee? The IT department itself? The CTO? Having a defined and published process with a clear entry point gives the progress-oriented people on the front lines a path to work within the institution's guidelines. A step beyond this is to develop an innovation committee. All approaches should show appreciation for the inclination toward improvement and steer creative souls into constructive, informed steps in partnership with IT.

Maybe you are an IT team member reading this thinking "We have a process. We still have this problem." This is an indication that a process audit would be helpful. Can you view the steps from the perspective of a healthcare provider in your organization? What are the steps to discovery? How do they become learn how to work with you? Is the process time-consuming or confusing? Can it be more clear or streamlined? Are innovators encouraged? Discouraged? Punished, even?

Shadow IT may not be any single department’s fault. Conflicting interests between leadership, IT, and the providers can cause the adoption process to be slow and painful, leading to more shadow IT. Creating and refining a collaborative and encouraging process will go a long way to reducing shadow IT, increasing security, and encouraging innovation.

posted by adgrooms on June 4, 2019

A recent report in the Annals of Medicine provided an estimate of the institutional cost of physician burnout. The researchers used mathematical data from other recent studies to come up with the conservatively estimated total annual cost of $4.6 billion or $7600 per physician. The study notes that it focused on the cost of replacing physicians and lost income from unfilled positions. When we consider other organizational costs of overburdening physicians, the amount is much higher.

Inefficient systems, which contribute to burn out, are a cost unto themselves. When Physicians are required to spend more than half of their (12 hour) workday in the EHR, their training is not put to best use. The amount of available time for patient care is unnecessarily limited. What would the impact be of reclaiming just one hour for each person? Spent on patient care or spent on self-care, either would lead to a greater benefit to the individual and the organization.

Beyond this, a 12-hour workday is wearing people out to the point of error. Mistakes due to decision fatigue are another hidden cost. At the end of a long day, of course, decisions are not going to be the same quality as those at the start. Minor mistakes lead to costs in unnecessary tests and prescriptions. Major mistakes, in the case of injury, add large costs of lawsuit settlements and legal bills.

Cost-effective solutions to this include:

  • Proper delegation of tasks. e.g. If another staff member can do the task, move it to their queue.
  • Streamlined interfaces.
  • Effective automation.
  • Communication triage.

This study and others have found that a moderate investment per physician can reduce burnout. Considering the extra costs not included in the study, the potential for a large return on investment is very high. Do you see a downside?