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Bringing Zen To Healthcare:  Transformation Through The N of 1

Posted on July 21, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The following essay wasn’t easy to understand. I had trouble taking it in at first. But the beauty of these ideas began to shine through for me when I took time to absorb them. Maybe you will struggle with them a bit yourself.

In his essay, the author argues that if providers focus on “N of 1” it could change healthcare permanently. I think he might be right, or at least makes a good case.  It’s a complex argument but worth following to the end. Trust me, the journey is worth taking.

The mysterious @CancerGeek

Before I share his ideas, I’ll start with an introduction to @CancerGeek, the essay’s author. Other than providing a photo as part of his Twitter home page, he’s chosen to be invisible. Despite doing a bunch of skillful GoogleFu, I couldn’t track him down.

@CancerGeek posted a cloud of interests on the Twitter page, including a reference to being global product manager PET-CT; says he develops hospital and cancer centers in the US and China; and describes himself as an associate editor with DesignPatient-MD.

In the essay, he says that he did clinical rotations from 1998 to 1999 while at the University of Wisconsin-Madison Carbone Comprehensive Cancer Center, working with Dr. Minesh Mehta.

He wears a bow tie.

And that’s all I’ve got. He could be anybody or nobody. All we have is his voice. John assures me he’s a real person that works at a company that everyone knows. He’s just chosen to remain relatively anonymous in his social profiles to separate his social profiles from his day job.

The N of 1 concept

Though we don’t know who @CancerGeek is, or why he is hiding, his ideas matter. Let’s take a closer look at the mysterious author’s N of 1, and decide for ourselves what it means. (To play along, you might want to search Twitter for the #Nof1 hashtag.)

To set the stage, @CancerGeek describes a conversation with Dr. Mehta, a radiation oncologist who served as chair of the department where @CancerGeek got his training. During this encounter, he had an insight which helped to make him who he would be — perhaps a moment of satori.

As the story goes, someone called Dr. Mehta to help set up a patient in radiation oncology, needing help but worried about disturbing the important doctor.

Apparently, when Dr. Mehta arrived, he calmly helped the patient, cheerfully introducing himself to their family and addressing all of their questions despite the fact that others were waiting.

When Dr. Mehta asked @CancerGeek why everyone around him was tense, our author told him that they were worried because patients were waiting, they were behind schedule and they knew that he was busy. In response, Dr. Mehta shared the following words:

No matter what else is going on, the world stops once you enter a room and are face to face with a patient and their family. You can only care for one patient at a time. That patient, in that room, at that moment is the only patient that matters. That is the secret to healthcare.

Apparently, this advice changed @CancerGeek on the spot. From that moment on, he would work to focus exclusively on the patient and tune out all distractions.

His ideas crystallized further when he read an article in the New England Journal of Medicine that gave a name to his approach to medicine. The article introduced him to the concept of N of 1.  All of the pieces began to began to fit together.

The NEJM article was singing his song. It said that no matter what physicians do, nothing else counts when they’re with the patient. Without the patient, it said, little else matters.

Yes, the author conceded, big projects and big processes matter still matter. Creating care models, developing clinical pathways and clinical service lines, building cancer centers, running hospitals, and offering outpatient imaging, radiology and pathology services are still worthwhile. But to practice well, the author said, dedicate yourself to caring for patients at the N of 1. Our author’s fate was sealed.

Why is N of 1 important to healthcare?

Having told his story, @CancerGeek shifts to the present. He begins by noting that at present, the healthcare industry is focused on delivering care at the “we” level. He describes this concept this way:

“The “We” level means that when you go to see a physician today, that the medical care they recommend to you is based on people similar to you…care based on research of populations on the 100,000+ (foot) level.”

But this approach is going to be scrapped over the next 8 to 10 years, @CancerGeek argues. (Actually, he predicts that the process will take exactly eight years.)

Over time, he sees care moving gradually from the managing groups to delivering personalized care through one-to-one interactions. He believes the process will proceed as follows:

  • First, sciences like genomics, proteomics, radionomics, functional imaging and immunotherapies will push the industry into delivering care at a 10,000-foot population level.
  • Next, as ecosystems are built out that support seamless sharing of digital footprints, care will move down to the 1,000-foot level.
  • Eventually, the system will alight at patient level. On that day, the transition will be complete. Healthcare will no longer be driven by hospitals, healthcare systems or insurance companies. Its sole focus will be on people and communities — and what the patient will become over time.

When this era arrives, doctors will know patients far more deeply, he says.

He predicts that by leveraging all of the data available in the digital world, physicians will know the truth of their experiences, including the food they eat, the air they breathe, how much sleep they get, where they work, how they commute to and from work and whether they care for a family member or friend, doctors will finally be able to offer truly personalized care. They’ll focus on the N of 1, the single patient they’re encountering at that moment.

The death of what we know

But we’re still left with questions about the heart of this idea. What, truly, is the N of 1? Perhaps it is the sound of one hand clapping. Or maybe it springs from an often-cited Zen proverb: “When walking, walk. When eating, eat.” Do what you’re doing right now – focus and stay in the present moment. This is treating patients at the N of 1 level, it seems to me.

Like Zen, the N of 1 concept may sound mystical, but it’s entirely practical. As he points out, patients truly want to be treated at the N of 1 – they don’t care about the paint on the walls or Press Ganey scores, they care about being treated as individuals. And providers need to make this happen.

But to meet this challenge, healthcare as we know it must die, he says. I’ll leave you with his conclusion:

“Within the next eight years, healthcare as we know it will end. The new healthcare will begin. Healthcare delivered at the N of 1.”  And those who seek will find.

E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT, Second Stanza

Posted on July 7, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As some of you may recall, I recently wrote a positive review of Kaiser Permanente’s use of consumer-facing health IT. (Kaiser Permanente is both my health insurer and provider.) Their offerings have a number of strengths including:

  • Interfaces: The kp.org site is decent, and the KP app highly usable
  • Access to care: Booking medical appointments is easy, as is cancelling them
  • Responsiveness: Physicians are quick to replay to email via the Kaiser portal
  • Connectedness: Thanks to being on a shared Epic platform, every provider knows my history (at least for the time I’ve spent within the KP system, which is pretty useful)

At the time, I also noted that I had a few minor concerns about the portal features and whatnot, but I was still a fan of KP’s setup.

By and large, my perceptions of Kaiser’s consumer health IT strengths haven’t changed. However, after a couple of months in the system, I’ve gotten a good look at its weaknesses as well. And I thought you might be interested in the problems Kaiser faces in connecting consumers, particularly given its use of best practices in many cases.

All told, these weaknesses suggest that over more than ten years after its Epic rollout, KP leaders still haven’t put their entire consumer health IT strategy in place. Here are a couple of my concerns.

Specialist appointments aren’t integrated

The biggest gripe I have with Kaiser’s interactive tools is that while I can schedule PCP appointments myself, I haven’t been able to set specialist appointments without speaking to a real live person. (My primary care doctor seems to be able to access specialist schedules and set appointments with them on my behalf.)

This may work for someone with no significant health problems, but creates a significant burden for me. After all, as someone with multiple chronic illnesses, I schedule a lot of specialist consults. You don’t realize how much time it takes to set each appointment with a clerical person until you’ve done it for five times in a week.  Try it sometime.

You might assume that this is a rationing measure, as organizations like KP are pretty strict about limiting access to specialist care. The truth is, that doesn’t seem to be the case. At least when it comes to my primary care physician (a big shout out to my PCP, Dr. Jason Singh) it doesn’t seem to be unduly hard to get access to specialists when needed.

No, I have concluded that the reason I can’t schedule specialist appointments online is that KP still hasn’t gotten their act together on this front. My guess is that the specialist systems live in some kind of silo, one that KP hasn’t managed to break down yet.

Mobile and web tools clash

As noted above, I’m largely satisfied with both KP’s consumer portal and its mobile app. True, the website sprawls a bit when it comes to presenting static content — such as physician bios — but the portal itself works fine. The mobile app, meanwhile, is great to use, as it presents my choices clearly and uses screen real estate effectively.

That being said, it annoys the heck out of me that there are minor but seemingly pointless, differences between how the portal and the mobile app function. It would be one thing the app was a shrunken down version of the website, offering a parallel but more limited version of available functions, but that isn’t how it works.

Instead, the services accessible through the portal and via the mobile app vary in small but irritating ways. For example, when emailing providers, you must choose a prewritten subject line from a drop-down menu. And I don’t know why, but the list of subjects available on the web portal version varies significantly from the list of subjects you can access via the mobile app.

There may be a rational reason for this. And mine may sound like a petty objection. But when you’re trying to address something as important as your healthcare, you want to know what’s going on with every detail.

I’d identify other ways in which the app and website portal vary, but I don’t have any other examples I can recall. And that’s the whole point. You don’t remember how the site and/or portal function until you stumble into another incompatibility. You roll your eyes and move on, but you see them again and waste one more spark of energy being annoyed.

It’s all about tradeoffs

So, you might ask if there’s any broad lesson to be taken from this. Honestly, probably not. I don’t like that KP’s tools pose these problems, but they don’t strike me as unusual.

And do my criticisms have any meaning for other healthcare organizations? Nothing more than a reminder that patients will take note of even small problems in your health IT execution, particularly when it comes to tools they rely upon to get things done.

In the end, of course, it’s all about trade-offs, as with any other industry. I don’t know whether KP chose to prioritize a potentially dangerous problem in provider-facing technologies over consumer quibbles, or just don’t know what’s going on. Perhaps they know and have added the fix to a long list of pending projects, or perhaps they don’t have their act together.

Still, lest it is lost in the discussion, remember I’m the customer, and I really don’t care about your IT problems. I just want to have tools that work every time and simplify my life.

So this is my official challenges to Kaiser leadership. For Pete’s sake, KP, would you please help me cut down on the specialist phone calls? Perhaps you could create a centralized specialist appointment call center, or use carrier pigeons, or let me suss out their schedules using my vast psychic powers — hey, they’re all options. Or maybe, just maybe, you can let me schedule the appointments online. Your call.

WorkFlow Wednesday: Patient Satisfaction and West’s Patient Experience Survey

Posted on July 5, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Providers can improve patient experiences and revenue. So much of what improves satisfaction is outside the clinical setting.  West’s Insights and Impact Study titled “Prioritizing the Patient Experience” examines the gaps in patient value perception in the current healthcare marketplace.

West recently conducted a survey of patients providers to get more insights into what patients and providers value.  With value based payment models and consumer focused health providers are increasingly motivated to provide high quality service. Today’s patient is more aware of choice in provider options and will shop around for a provider that matches their needs.

Patients and Value Based Care Provide More Awareness of Choice in the Healthcare Marketplace

Patient experience using current technology and workflows is the space West has been working in for 25 years, including patient reminders for large hospital systems. As a company that specializes in patient experience, they used an outside firm to get insight about how well provider and patient perceptions were aligned. It was impressive to see an engagement company practicing what they preach and being proactive about feedback and improvement.

The most interesting takeaway from all of the statistics and research and report is that we know what the drivers of a good experience are. If you ask patients and providers what their motivation are answers are not usually aligned. This gap in what providers and patients value in terms of healthcare experience can cost providers revenue and patients. Patients value a high level of communication and transparency about cost of care more than providers believe.

Looking at the study, 78% of patients with a Chronic condition are likely to say that their provider cares about them as a person. Personally I’ve experienced this with my son that has a Chronic condition. We researched providers to ensure that we had similar values about communication and follow-up. Social Media groups like mom groups on Facebook have a lot of feedback about provider value. I know his provider gives great care and cares about him.

Patients with a Chronic Condition are Likely to Receive Personalized Care.

My Takeaways From the West Report

  • Current Systems do not always create a seamless workflow. Smooth workflow and patient communications improve patient experience.
  • Patients really want to know about what to expect in appointments. Sending a notification about costs including copays and obligations improves patient satisfaction.
  • Wait times are a huge cause of concern for patients. Electronic messaging or text information about waits can improve patient satisfaction even in cases where delays cannot be avoided.
  • Making payment as easy for patient as possible improves patient healthcare experience. A reminder about a bill with information about how to pay will improve practice revenue and patient experience.
  • Simple workflow improvement and automation improves clinical outcomes and patient retention in an increasingly consumer aware healthcare world.
  • Providers can focus on using the technology to better measure that for further strategy for improvement.

Well developed workflow can ensure that physicians have fewer patient surprises. Rather than waiting for an HCAP you can proactively collect data and brief surveys on specific topics before you are doing emergency triage. Contact recently discharged patients via an automated phone message or email. Have the questions tie back to HCAP survey questions so they can see what they will get.

What can systems do? Select Key measures for patient satisfaction.

What can physicians do? Tell patients that what to expect.

West is following their own advice and getting feedback about the value of communications and technology The survey is a connector for patients and for technology companies in the HealthIT space. Great ideas about Workflow improvement and best practice for business from West.

The report can be accessed online here and these key takeaways and is a great read for providers.

Artificial Intelligence in Healthcare Series: Women in Technology

Posted on June 29, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Meeting with Lauren Hayes, the model behind Amelia, an AI cognitive agent.

What I Learned from Lauren Hayes: the Face of Artificial Intelligence.

This month I was invited to a workforce summit with companies interested in Artificial Intelligence (AI) cognitive agents in New York City. I had the opportunity to hear from great thinkers about AI, including research about workforce transformation from the McKinzie institute. I also met Lauren Hayes, the face behind Amelia, a cognitive agent for IPsoft specializing in customer experience.

Michael Chui – Partner at the McKinsey Global Institute.

One of the most impactful things for me personally was Lauren’s perspective about women in technology. Lauren has worked as a partner for a Jacaranda Ventures focusing on early stage startups, and served as an executive and communications expert, as well as being a model for Wilhelmina models. As a veteran of the technology space Lauren commented on male dominated events  “One of my past jobs as a Director of Communications & PR included hosting events that typically ended up being 90% male. The audience was comprised of our investors, partners, and C-level business development folks. It’s always sad when there’s no line for the women’s restroom.”  Her  grace in dealing with the dynamics taught me two valuable lessons: Be fiercely positive and seek out your people.

Today Lauren works in technology as a Founder at Ritual and the face of a cognitive agent that interfaces with customers for several industries, (patients for a healthcare system.) What does current customer experience look like? In my experience- not great. There is a definite need to improve the experience for patients online and many companies and healthcare systems have solutions that help improve outcomes and cost.  My personal strategy? Get on the phone and press as many buttons as I can, while hoping a real human comes on the line since I don’t remember my insurance ID number. Or my account number with the power company.

Lauren is part of the future of healthcare as AI automates repetitive tasks. A little background on the potentials and current benefits can start with the patient as a consumer. Many healthcare companies use an automated system when a patient calls with medical questions or personal patient information. They may want a copy of their records and need identity confirmation or need to know if they should make an appointment with a doctor or go to a local emergency room. These questions can be answered through digital tools and phones.

Systems can range in sophistication from a series of recordings to a chat bot to an artificial intelligence cognitive agent and a human with highly specialized training and clinical knowledge. Not to brag, but at one of my jobs the company asked me to be the voice for their system so I can relate to being the face of AI. A cognitive agent can use artificial intelligence technology and interact with a clinical framework to help patients get great care. This can be paired with the clinical bounds of a program like Health Navigator and use natural language processing to help patients get appropriate support quickly and in the context of their personal history and insurance or healthcare information. Adoption and development of these technologies will see huge positive impact on patient outcomes and security.

I interacted with Lauren on twitter before the conference to discuss working as a woman in tech. The thing that struck me meeting her was her grace. Some people have powerful positive energy and I wonder how we can teach that type of interaction to a machine learning system. We can teach a system to have an asymmetrical appearance like humans. Artificial intelligence engines are learning to identify customers by voice and appearance. The human experience in medicine is also about presence and connecting us digitally. I asked Lauren what she thought about working with Amelia, and about being a woman in Technology. Mainly I wanted to understand the way she has established expectations and boundaries.

Janae: What is it like working in technology as a woman?

Lauren: This is not specific to one of the roles I’ve held particularly, whether at IPSoft or any of my other jobs, however, I think in some of the male dominated industries, there’s a feeling as though you have to prove yourself and get over the “female hump” before a conversation with someone who expects to be talking to another man. I’ve had past jobs that bred a bit of a “bro” culture, where there are no women in high-level positions and I think that really trickles down and impacts the rest of the culture. It goes without saying that I’ve also overheard and been part of situations where sexist comments were made, or where visitors of the company assumed the first girl they saw was an assistant/office manager, etc.

Janae: What do you wish men understood about being a woman in tech?

Lauren: “That the same way racism is still rampant in the US, the same goes for sexism. Even when there’s not overt instances or actions that are clearly offensive, there are small, every day micro instances of things that are said under the breath or actions that are hard to prove clear wrongdoing that still add up and take a toll over a period of time.”

Janae: What do you love about working with Amelia?

Lauren:  “I think Amelia can potentially have such a positive impact on the workforce and ultimately world. After all, to date, she’s the most sophisticated AI in history. Throughout history we’ve changed our jobs to leverage technology. AI is going to do that too. I heard a lot of the execs presenting at the conference talking about how they are changing the structure of their teams in order to have Amelia take on a lot of the high volume repetitive queries and let their staff evolve to take on more exception cases that help them have more interesting conversations with customers. I think most of us would prefer to spend our time on tasks we find challenging and rewarding and less on repetitive chores. That idea of freeing up our day to spend more time doing things we love really appeals to me.”

Overcoming general fatigue from interactions that question credibility based on gender can be hard to grasp. Repetitive music and actions that themselves are harmless have been weaponized into torture. Constant references about appearance can be difficult. Talking to Lauren about women in technology was positive. For women, the sum is greater than it’s parts. The result for providers can be burnout or a lack of empathy for patient requests.

Artificial intelligence will restructure workforce roles and take some of the stress of repetitive tasks and recording. Building positive interactions while filtering through repetitive actions that lead to burnout can provide better support. Physician time can be used for helping and connecting on a personal level. I was grateful for the time I had discussing women in technology and the future. Establishing boundaries in workforce interactions can be like structuring the bounds of a healthcare customer service system. Creating purposeful positive interactions improves the system. Be fiercely positive to other women in technology.

The EMR Vendor’s Dilemma

Posted on June 6, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Yesterday, I had a great conversation with an executive at one of the leading EMR vendors. During our conversation, she stressed that her company was focused on the future – not on shoring up its existing infrastructure, but rather, rebuilding its code into something “transformational.”

In describing her company’s next steps, she touched on many familiar bases, including population health, patient registries and mobile- first deployment to support clinicians. She told me that after several years of development, she felt her company was truly ready to take on operational challenges like delivering value-based care and conducting disease surveillance.

All that being said – with all due respect to the gracious exec with whom I spoke – I wouldn’t want to be a vendor trying to be transformed at the moment. As I see it, vendors who want to keep up with current EMR trends are stuck between a rock and a hard place.

On the one hand, such vendors need to support providers’ evolving health IT needs, which are changing rapidly as new models of care delivery are emerging. Not only do they need to provide the powerhouse infrastructure necessary to handle and route massive floods of data, they also need to help their customers reach and engage consumers in new ways.

To do so, however, they need to shoot at moving targets, or they won’t meet provider demand. Providers may not be sure what shape certain processes will take, but they still expect EMR vendors to keep up with their needs nonetheless. And that can certainly be tricky these days.

For example, while everybody is talking about population health management, as far as I know we still haven’t adopted a widely-accepted model for adopting it. Sure, people are arriving at many of the same conclusions about pop health, but their approach to rolling it out varies widely.  And that makes things very tough for vendors to create pop health technology.

And what about patient engagement solutions? At present, the tools providers use to engage patients with their care are all over the map, from portals to mobile apps to back-end systems using predictive analytics. Synchronizing and storing the data generated by these solutions is challenging enough. Figuring out what configuration of options actually produces results is even harder, and nobody, including the savviest EMR vendors, can be sure what the consensus model will be in the future.

Look, I’m aware that virtually all software vendors face this problem. It’s difficult as heck to decide when to lead the industry you serve and when to let the industry lead you. Straddling these two approaches successfully is what separates the men from the boys — or the girls from the women — and dictates who the winners and losers are in any technology market.

But arguably, health IT vendors face a particularly difficult challenge when it comes to keeping up with the times. There’s certainly few industries are in a greater state of flux, and that’s not likely to change anytime soon.

It will take some very fancy footwork to dance gracefully with providers. Within a few years, we’ll look back and know vendors adapted just enough.

Christina Farr’s TEDx Talk Asks “What If the Patient Knows Best?”

Posted on June 1, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my favorite healthcare IT journalists is Christina Farr. She’s skipped around a few publications over the years, but she’s currently writing for CNBC about large tech companies like (Apple, Alphabet(Google), etc) that are getting into the healthcare and biotech world. Plus, she covers a lot of healthcare IT startup companies.

Christina Farr recently gave a TEDx talk at TEDx Oslo where she shared her perspective on the move from a doctor-dominated healthcare model to an empowered patient model where patient and doctor work together to find the best care solution together.

If you care about patients, take 12 minutes to listen to Christina’s TEDx talk embedded below and think about what her message means for you. It’s a good one.

Clinical Insights from Social Media Data: Amplifying Patient Voice with Symplur

Posted on May 31, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

What data from social media can help healthcare organizations?

One of the biggest challenges of online and social data is the sheer volume of unstructured data. Can your physician read all your tweets and postings? Hopefully not. Physicians have data and work overload, a daily report of steps taken from activity trackers or online social media use hurts their ability to treat patients. HealthIT solutions can help process this data and find patterns and changes.

I had a conversation with Audun Utengen about actionable insights into healthcare from his company, Symplur. At Datapalooza he participated in a panel and mentioned the rich amount of patient data that can be found on twitter (shocked gasp followed by a furrowed brow). Symplur signals tracks online engagement.  You can find healthcare insights from conversations really quickly. They provide tools that help healthcare providers get patient insights where they are naturally interacting. There is value in meeting patients where they are, and patients are discussing their healthcare online.

Originally, the assumption was that patients would not say things online. Sensitive topics do not naturally show up in social media use- fewer people are discussing gonorrhea online than receive treatment for gonorrhea. Providers assumed that things which are protected patient information would not show up on twitter. They were wrong. As most social media users know- it’s shocking what people will post online. Not every aspect of health is on twitter but patients want to engage online.  They go to twitter because they want their voices to be heard. They want things to change. They can’t be ignored on twitter. They want their voices to be heard by people in decision-making positions.

Patient’s online discussion have positive impacts on organizations. The key is to be proactive about patient engagement online. Stanford did a study looking about patients’ engagement at conferences. Typically, you will find 1 patient in the top 1 percent of influencers. While this number is low, conferences which have a higher percentage of patients active as top influencers have a greater reach. Want to increase your Healthcare voice and conference audience? Engage patient advocates online. Engaging patients is commercially valuable in amplification. Future patients get more insight as well.  Audun Utengen and I looked at the data from Datapalooza and found that 11 of the top 100 influencers were patients.  That is way ahead of the median number for all healthcare conferences- in 2016 the average number of top influencers that were patients at a conference was one.

“They did a great job giving patients a voice at the conference. I am impressed.”

-Audun Utengen, Co-Founder of Symplur

Healthcare Stakeholder breakdown of the top 100 influencers ranked by the Healthcare Social Graph Score.

Datapalooza had a higher than average reach and a unique blend of participants. Audun Utengen described some of the unique features of the conference:

“The social conversation from the conference was very dynamic. From the 9,366 tweets, 80% included at least one mention. Lot’s of connections were made and we witnessed the typical “flattening of healthcare” that social media is known for by breaking down the barriers between the stakeholder groups. Below is a network analysis graph showing the flattening and the conversational patterns between Twitter account and their healthcare stakeholder groupings.”

Conversations blend between different stakeholders in the healthcare conversation at Datapalooza

The ability for many stakeholders to access information and interact with each other in one place is one of the advantages of twitter. Using hashtags can help stakeholders learn about content about a specific topic quickly. One of the things Symplur is allows is the visualization of keywords surrounding conversations on twitter. When looking at the conversations from Datapalooza the topic of “patients” was very high. Unsurprisingly, “data” is the topic of focus. Patient, Health and Patients rounded out the top conversation topics.

Keyword Frequency Analysis Graph

Symplur Signals have been used for over 200 healthcare studies. They partner with academic research centers seeking more information from online conversations. Companies can also look at competitors in their area and see how they compare. Does a nearby provider have more positive mentions on social media?

Data from online interactions can also give insights into patient health. Social usage has unique implications for mental health. Frequently, online behavior change can predict mental health change. Pediatricians and Providers are in a position to see online behavior in their area and help families understand the implications. If bullying is a problem in your area providers can know their patients will have higher stress levels and provide resources and support. Certain behaviors and even emojis indicate a higher risk of depression. A suicide that will predictably happen based on social data will not show up in clinical records. Listening to what patients want us to hear will help provide greater support.

The sheer volume of social data can mask its usefulness. Online activity and data can be difficult to process for many clinicians. In a world of ever-increasing data and patients reporting everything from steps taken a day to now online behavior many providers have data overload. Data insight tools such as Symplur filter data into a format that allows physicians and systems to use it to improve patient outcomes.

Patient Engagement and Patient Experience

Posted on May 24, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I got tied up on some big projects today and so for today’s post I’m going to point you to some really great resources being shared around patient engagement and patient experience from the Patient Engagement Summit hosted by the Cleveland Clinic.

Here are two images that were shared from the summit which give you a flavor for the types of conversations and knowledge that was being shared at the Patient Engagement Summit.


Note: Adrienne Boissy, MD, MA, noted that the chart above comes from this article.

You can find more great content like this by checking out the hashtag #PESummit on Twitter.

Collaborating With Patients On Visit Agendas Improves Communication

Posted on April 26, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Maybe it’s because I spent many years as a reporter, but when I meet with a doctor I get all of my questions out, even if I don’t plan things out in advance. I realize that this barrage may be unnerving for some doctors, but if I need to fire off a bunch of questions to understand my care, I’m going to do it.

That being said, I realize most people are more like my family members. Both my husband and my mother feel overwhelmed at medical visits, and often fail to ask the questions they want answered. I don’t know if they feel pressured by the rapid pace of your typical medical visit, afraid to offend their doctor or have trouble figuring out what information will help them most effectively, but clearly, they don’t feel in control of the situation.

Given their concerns, I wasn’t surprised to learn that letting patients create and share an agenda for their medical visit – before they see their provider – seems to improve physician-patient communication substantially. New research suggests that when patients set the agenda for their visit, both the patient and their doctor like the results.

Study details

The paper, which appeared in the Annals of Family Medicine, said that researchers conducted their study at Harborview Medical Center, a safety-net county hospital in Seattle. The researchers recruited patients and clinicians for the study between June 9 and July 22, 2015 at the HMC Adult Medicine Clinic. The 67-clinician primary care clinic serves about 5,000 patients per year.

When participating patients came in for a visit, a researcher assistant met them in the waiting room and gave them a laptop computer with the EMR interface displayed. The participating patients then typed their agenda for the visit in the progress notes section of their medical record. Clinicians then reviewed that agenda, either before entering the exam room or upon entering.

After the visit, patients were given a survey asking them for demographic information, self-reported health status and perceptions of the agenda-driven visit. Meanwhile, clinicians filled out a separate survey asking them for their gender, age, role in the clinic and their own perceptions of the patient agenda.

After reviewing the survey data, researchers concluded that using a collaborative visit agenda is probably a good idea. Seventy nine percent of patients and 74 percent of clinicians felt the agendas improved patient-clinician communication, and both types of participants wanted to use visit agendas agenda (73 percent of patients and 82 percent of clinicians).

Flawed but still valuable

In closing, the authors admitted that the study had its technical limits, including the use of a small convenient sample at a single clinic with no comparison group, It’s also worth noting that the study drew from a vulnerable population which might not be representative of most healthcare consumers.

Nonetheless, researchers feel these data points to a broader trend, in which patients have become increasingly comfortable with electronic health data. “The patient cogeneration of visit notes, facilitated by new EMR functionality, reflects a shift in the authorship and “ownership” of [their data],” the study points out. (I can’t help but agree that this is the case, and moreover, that patients’ response to programs  like Open Notes support their conclusion.)

I’m not sure if my mom or hubby would buy into this approach, but I imagine that if they did, they might find it helpful. Let’s hope the idea catches fire, and helps ordinary consumers take more control of their clinical relationships.

Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 25, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

AI-driven chatbots are becoming increasingly popular for a number of reasons, including improving technology and a need to automate some routine processes. (I’d also argue that these models are emerging because millennials and Gen Z-ers have spent their lives immersed in online-based social environments, and are far less likely to be afraid of or uncomfortable with such things.)

Given the maturation of the technology, I’m not surprised to see a number of AI-driven chatbots for healthcare emerging.  Some of these merely capture symptoms, such as the diabetes, CHF and mental health monitoring options by Sense.ly.

But other AI-based chatbots attempt to go much further. One emerging company, X2ai, is rolling out a psychology-oriented chatbot offering mental health counseling, Another, UK-based startup Babylon Health, offers a text-only mobile apps which provides medical evaluations and screenings. The app is being pilot-tested with the National Health Service, where early reports say that it’s diagnosing and triaging patients successfully.

One area I haven’t seen explored, though, is using a chatbot to help doctors handle routine communications with patients. Such an app could not only triage patients, as with the NHS example, but also respond to routine email messages.

Scheduling and administration

The reality is that while doctors and nurses are used to screening patients via telephone, they’re afraid of being swamped by tons of electronic patient messages. Many feel that if they agree to respond to patient email messages via a patient portal, they’ll spend too much time doing so. With most already time-starved, it’s not surprising that they’re worried about this.

But a combination of AI and healthcare chatbot technology could reduce their time required to engage patients. In fact, the right solution could address a few medical practice workflow issues at one time.

First, it could triage and route patient concerns to doctors and advanced practice nurses, something that’s done now by unqualified clerks or extremely busy nurses. For example, the patient would be able to tell the chatbot why they wanted to schedule a visit, with the chatbot teasing out some nuances in their situation. Then, the chatbot could kick the information over to the patient’s provider, who could, with a few clicks, forward a request to schedule either an urgent or standard consult.

Perhaps just as important, the AI technology could sit atop messages sent between provider and patient. If the patient message asked a routine question – such as when their test results would be ready – the system could bounce back a templated message stating, for instance, that test results typically take five business days to post on the patient portal. It could also send templated responses to requests for medical records, questions about doctor availability or types of insurance accepted and so on.

Diagnosis and triage

Meanwhile, if the AI concludes that the patient has a health concern to address, it could send back a link to the chatbot, which would ask pertinent questions and send the responses to the treating clinician. At that point, if things look questionable, the doctor might choose to intervene with their own email message or phone call.

Of course, providers will probably be worried about relying on a chatbot for patient triage, especially the legal consequences if the bot misses something important. But over time, if health chatbot pilots like the UK example offer good results, they may eventually be ready to give this approach a shot.

Also, patients may be uncertain about working with a chatbot at first. But if physicians stress that they’re not trying put them off, but rather, to save time so they can take their time when patients need them, I think they’ll be satisfied.

I admit that under ideal circumstances, clinicians would have more time to communicate with patients directly. But the truth is, they simply don’t, and pressuring them to take phone calls or respond to every online message from patients won’t work.

Besides, as providers work to prepare for value-based care, they’ll need not only physician extenders, but physician extender-extenders like chatbots to engage patients and keep track of their needs. So let’s give them a shot.