Microsoft and Nuance team up on ‘exam room of the future’ to end doctor burnout | GeekWire

Microsoft and Nuance team up on ‘exam room of the future’ to end doctor burnout | GeekWire

As I am getting prepared to go see my doctor this afternoon (EDT) this blog post caught my attention. This is the type of story not necessarily expected from this publisher, but it does have a connection to their beat, being Microsoft. I have asked the Dr. about this and he admits that the paperwork part is the least favorite aspect of the job and not what he signed up for. The EHR system at his medical facility needs either serious work or a better buy-in.

Microsoft is teaming up with Nuance Communications to revamp hospital exam rooms with artificial intelligence and natural language processing, creating technology that will help clinicians spend less time documenting interactions with patients — a well-known source of burnout among health workers.

Studies have found that doctors spend more than half their day interacting with the electronic health record (EHR). And more than two-thirds of physicians say that medical record documentation contributes greatly to burnout.

Source: Microsoft and Nuance team up on ‘exam room of the future’ to end doctor burnout

UPDATE

This is near straight from the ultimate source, and published after the original post.

A new strategic partnership between Microsoft and Nuance Communications Inc. announced today will work to accelerate and deliver this level of ambient clinical intelligence to exam rooms, allowing ambient sensing and conversational AI to take care of some of the more burdensome administrative tasks and to provide clinical documentation that writes itself. That, in turn, will allow doctors to turn their attention fully to taking care of patients.

Of course, there are still immense technical challenges to getting to that ideal scenario of the future. But the companies say they believe that they already have a strong foundation in features from Nuance’s ambient clinical intelligence (ACI) technology unveiled earlier this year and Microsoft’s Project EmpowerMD Intelligent Scribe Service. Both are using AI technologies to learn how to convert doctor-patient conversations into useful clinical documentation, potentially reducing errors, saving doctors’ time and improving the overall physician experience.

https://blogs.microsoft.com/ai/nuance-exam-room-of-the-future/

Five Blockchain Use Cases for Healthcare Payers, Providers

Five Blockchain Use Cases for Healthcare Payers, Providers

This is a technology I am really excited about. The common wisdom and current case uses are an underpinning of cryptocurrencies, such as Bitcoin and Ethereum. While this is important, only secondary to the technology highlighted below and from the base article.

 

Blockchain may offer a solution to these issues by keeping all members of the community instantly updated on where a provider is allowed to practice, whether or not she is accepting new patients, and what new affiliations she has formed.

This is important, because of current mHealth initiatives, such as CMC Virtual Visit, requires you to physically be in North Carolina, though the system servers both Carolinas. That has to change.

Administrative tasks such as claims processing and underwriting may also benefit from a blockchain approach, since managed permissions make it easier for payers to assess the validity of a claim, manage pre-authorizations, and ensure that providers are meeting the criteria laid out in their value-based contracts.

“Smart contracts could automate these processes and decrease the time and resources needed to execute the terms and conditions [of value-based contracting],” the report says.  “And because smart contracts are decentralized and cannot be changed, all parties can be confident that terms will be consistently executed.”

Pages from CMC Mercy Wound Care 10062017_Redacted_Page_1I continue to get notice of bill payments, similar to an actual bill image to the left, despite my plan being straightforward, at least as I know about it. Possibility to save much headaches and time wasting.

Blockchain would nearly eliminate this as rules can be set; such as “only render services covered under Medicare” to a particular patient. This removes the doubts about all parties getting compensated.

 

Enhanced security and transparency may also drastically reduce the amount of fraud that slips through the defenses of public and private payers.  When entities must have current and authenticated identities before a transaction is approved, the ability to push suspect claims through the reimbursement process is diminished.

Payers with access to a patient’s complete medical record and all of the individual’s approved providers would be more able to identify suspect claims or payment requests that do not match the patient’s documented conditions or normal care habits, explains Deloitte.

Source: Five Blockchain Use Cases for Healthcare Payers, Providers

EHR & our healthcare system, match made somewhere?

EHR & our healthcare system, match made somewhere?

Electronic Health Records are a good thing, except when they are not. Being disabled, medical professionals are a major part of my life. Interactions with them, for the most part, can’t be avoided. I consider myself a geek and reasonably wise to electronic communication means. I even have a working knowledge of HIPAA and all that entails. Coming to grips with the utter lack of EHR implementation at the consumer level is difficult to deal with. One of the providers has a reasonably popular medical specific web portal. It’s not very functional, but it exists. Another group is part of the region’s largest system. My mind struggles with the concept of a total lack of confidence in modern medical communications and associated technology. Having a secure HIPAA compliant communication portal, app, or even Whatsapp, which is 100% encrypted, suitable for transferring files that can be imported into the record keeping that all facilities are mandated by law to control. As the nation nudges toward a single payer system, despite current politics, inefficiencies become sore wounds and costly. The lack of portable EHR with a common format for the secure interchange of data will come back and bite the clients who are in no position to weather the outcomes. Nobody, not even TPTB, wins in that environment.

Recently, I had a doctors appointment with my family physician. What is interesting about this event? He carried a tablet with a keyboard dock with him as he discusses with the patient. All of our conversations are transcribed and available for reference. The rest of the office only has the standard technologies; desktop computers, printers, faxes, that sort of thing. I printed out the most recent list of medications, and the staff either scanned or typed the information in their systems; couldn’t tell which, and it didn’t occur to me to ask.

As I was researching this post, there are few events in life that haven’t happened to someone else, this being no exception. As early as five years ago, this entered my view:

Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully (Tong, 2012)

If any of my interactions are any guide, these lessons were not learned nor executed. And that is a shame really. Anything close to a potential utopian solution must have the free and fair interchange of Electronic Health Records while automating as much of the nonclinical minutiae of the American Health Care system; even if it remains a continuation of the Affordable Care Act.

Continue reading

Stream 04/07

Healthcare EMRs [personal]

I had the misfortune to sprain my wrist recently that required a medical facility visit. After lengthy waits and treatment, discharge papers (handout with no digital option) disclosed the usual suspects such as purpose of visit and treatment, meds given and prescribed, and follow up procedures. Here is where the follow-up gets hairy approaching fubar. At the left is the first page of an actual discharge paper given out by the Emergency Department. It touts their secure access to your health records and provides a way to contact your doctors and allied professionals. Near the bottom are follow-up instructions, who to see, address info, phone number, and timeframe. The mistake I made was depending on the forms in the service to set up an appointment for today. Their system did not work and when a call was made late Thursday about it, the staff was unapologetic and less than helpful about. This is but one example of how Electronic Medical Records (EMR) failed in real world applications, the kind that drives costs up and reduces outcomes. A copy of the record that I was given was sent to the specialists’ office, which they acknowledged; made its way to the digital equivalent of the circular filing cabinet, the “ignore” bin. An education about how EMR’s are not really what is needed for healthcare reform and cost containment sheds light on the subject. There is the concept of Electronic Health Records (EHR). EMR is a digital version of paper charts in the Doctor’s office, scanned for archival and supposedly sharing purposes among vetted parties. Right answer, wrong question. A move to EHR takes these digitized documents and facilitates sharing throughout the whole system by design. “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual” (Peter Garrett & Joshua Seidman PhD, 2011, para. 6). This was five years ago little action taken on this. The facility certainly dropped the ball with the information passing with the patient suffering negative outcomes because someone did not think through a system promoted by “suits” who generally do not have a clue on what happens on the front lines of care. This leads us to the present. National Coordinator for Health IT Karen DeSalvo wants to move forward with public access of their own data with a measure of control that is anathema to the profitable business of “blocking” data. the Office of the National Coordinator (ONC) said its 2016 goals include continuing to “build the economic case for interoperability,” coordinate with industry stakeholders to increase enhance consumer access to data, and to discourage health information blocking (Hall, 2016, para. 8). There are many avenues to making dollars in the corporate world; I do not understand how blocking data allows happening beyond a potential lock-in similar to Windows lock in for personal computing back in the day.

BCBSNC Shakeup

A recent media report has the #2 person at Blue Cross Blue Shield of North Carolina (BCBSNC) has resigned leaving behind a mess of a computer system tied to mistaken billing of customers and other software issues.

name Alan Hughes
title Chief Operating Officer (COO)
compensation $1.77M (2014)

(John Murawski, 2016)

I was a customer of BCBSNC during my “interim” period prior to Medicare [long story] and based on most of my interactions with them on the phone and in person, no surprise of their flawed systems. Someone has to fall on their sword and there is usually a severance associated with this, which was not disclosed in the piece, but I do not think he will visit the poor side of Durham County anytime soon. When your background is the Chief Information Officer (CIO) and the information system does not work properly, it happens. The Department of Insurance has reported 11,162 customer calls as of April 1, including 2,346 complaints against the insurer. The agency’s investigation could result in fines against Blue Cross up to $1,000 per violation per day (John Murawski, 2016). That has to leave a mark, but it is election year in North Carolina, so “stay tuned”.

Ransomware

UPDATED: Symantec said, “The 2007 and 2010 fixes referenced in the article were not contributing factors in this event” (Ann C Nickels, 2016). Further comment will not emanate from MedStar concurrent to the advice of IT, cybersecurity and law enforcement experts.

This topic will not go away. The hackers that penetrated MedStar Health in the Maryland/DC region came in through a 9 year exploit named JBoss, an application server courtesy of Red Hat Inc. (Tami Abdollah, 2016). As night turns into day, the hospital chain denies this. It must be stated that part of the mission of hackers is to expose weak spots where found. This time, it is the Samas or “samsam” vector specifically for JBoss middleware and other Java based servers. More details can be found here and here. When an IT person in charge of security ignore application threats from the writers of such software and the government on at least 2 other occasions, that would fit the definition of maleficence. MedStar is in deep doo doo, but admitting it would bring more of the wrong kind of attention in a competitive marketplace. Never mind these breaches are not specific to this chain.

Bibliography

Ann C Nickels. (2016, April 6). MedStar Response to Incorrect Media Reports. MedStar Health. Retrieved from http://www.medstarhealth.org/mhs/2016/04/06/medstar-response-incorrect-media-reports/

Susan D Hall. (2016, April 7). Karen DeSalvo: Tech can improve patients’ access to health data. Retrieved April 7, 2016, from http://www.fiercehealthit.com/story/karen-desalvo-tech-can-improve-patients-acesss-health-data/2016-04-07

John Murawski. (2016, April 5). Blue Cross executive resigns amid technology fiasco | News & Observer. The News and Observer. Raleigh, NC. Retrieved from http://www.newsobserver.com/news/business/article70020192.html

Peter Garrett, & Joshua Seidman PhD. (2011, January 4). EMR vs EHR – What is the Difference? Retrieved from https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/

Tami Abdollah. (2016, April 5). Hackers broke into hospitals despite software flaw warnings. AP The Big Story. Washington DC. Retrieved from http://bigstory.ap.org/article/86401c5c2f7e43b79d7decb04a0022b4/hackers-broke-hospitals-despite-software-flaw-warnings