Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

“Doctor on Board” Experiences for Women Doctors and Over Reliance on Devices in Healthcare

Posted on November 30, 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.

My good friend, Wen Dombrowski, MD (better known as @HealthcareWen for those of us on social media), recently shared her experience on a KLM International flight where the announcement came over the loudspeaker, “Is there a doctor on board?”

Her story and experience provide a great message and reminder that we still have a ways to go when it comes to our biases around gender and race. Plus, in true Wen fashion, she also provides a great reminder about over-reliance on technology and the lost art of “laying hands on a patient” medicine.  Not to mention a usability and design lesson as well. So, I knew I had to share it with Healthcare Scene.

Here’s her story and lessons learned (shared with permission):

“IS THERE A DOCTOR ON BOARD? (Someone had fainted)
I get up and ask staff who needs help. They say they already have enough doctors, thanks.

I brief a sigh of relief and am grateful that other doctors offered to help, because it’s challenging to practice medicine on a plane. So I go use the restroom. But…

On my way back to my seat, I notice there is activity happening up the aisle around the scene. From the back of the plane it looks like the volunteers are trying to do a procedure so I’m guessing maybe they are putting in an IV? But it is so dark in the plane with the interior lights off in sleep mode.

So I go up to the scene to quietly shine the light from my phone onto the procedure…
I’m appalled to find 2 guys are fumbling to put on a blood pressure cuff. It is a simple cuff for well-known home BP machine, nothing fancy. I watch them try to figure out over and over and over again how to wrap the BP cuff around the passenger’s arm… inside out…upside down… they can’t figure out the direction and Velcro…can’t get the BP cuff onto the passenger. By the way, the patient was awake, cooperative, with normal habitus, so there were no barriers from that perspective.

After watching the 2 guys repeatedly struggle with this, I offer to help.
The airline flight attendant rebukes me, “Please sit down. Are you a nurse? because we already have 2 doctors”(while we watch these guys scrambling to figure out how to put on a BP cuff).
I tell her, “I’m a Doctor & a doctor certified in 3 Specialties.”

The 2 guys say they’ve got it under control (while still trying to put on the cuff backwards etc), they say they are an Internist and a Nephrologist.
(I think to myself what a sad state of Medicine to have Internal Medicine and Nephrology not know how to check a BP! It would be understandable if they were orthopedics or psychiatrists or ENT, but blood pressure management is the bread and butter of those 2 specialties.)

Meanwhile, while they struggle to get the BP cuff velcro’d around passenger’s arm, I ask if anyone has checked passenger’s pulse — Is it Fast or Slow? Regular or Irregular? Strong or Weak? Clammy or not? This would provide valuable triage info and could be been done in 5 seconds by one of the guys who wasn’t holding the BP cuff. I ask again if they or I could check the passenger’s pulse, but they ignored this (seemed like neither of them knew how or didn’t think it was important). I wanted to jump in to do it myself, but there wasn’t enough physical space.

After more than 10 minutes struggling, the “doctors” finally got the BP cuff around the passenger’s arm.

I’m sharing this story because:

1. I’m shocked at the sad state of Medicine that doesn’t know how to nor value laying hands on patients as part of assessing patients (flashback to the practical skills Housecalls and field medicine has taught me). The guys were waiting for “the machine” to tell them “the numbers.” I’m sad at the lost “art” of medicine – lack of common sense handson skills & not looking at the qualitative data, just waiting for the quantitative device data. A lot of valuable time was lost in caring for this passenger. (And while I love technology, sensor devices, and clinical decision support tools – I wonder/worry what will happen to future physician’s common sense and clinical reasoning skills?)

2. And sad about the lack of team mindset of these 2 guys, who insisted on doing it themselves, the blind leading the blind. Not accepting help from female colleague. Not acknowledging what they don’t know nor allowing for help.

I know they meant well and were just trying to help, but sometimes helping comes in the form of teamwork.

There’s a lot that I don’t know in medicine and I’m happy to delegate/consult that to others. But geesh, at least I know how to check a Pulse and Blood Pressure.

3. Not to mention the persistently gender biased attitudes of flight crews who decline help from female physicians, to the detriment of everyone’s safety. This problem has been documented many times by other Female & Minority Physicians, for example: http://www.idealmedicalcare.org/blog/female-physicians-told-to-sit-down-shut-up-and-get-out-of-the-way-during-emergencies-as-patients-nearly-die/

4. The BP cuff was basic and not at fault per se. But these crisis moments highlights opportunities to design it better, to improve its usability and accessibility for laypeople and those who aren’t familiar with it. Perhaps the BP machine company could print pictures on the cuff itself that show the up/down and in/out directions of how to apply the cuff.”

Thanks Wen Dombrowski, MD for sharing this story and your insights.

Selecting the Right AI Partner in Healthcare Requires a Human Network

Posted on March 1, 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

Artificial Intelligence, or AI for short, does not always equate to high intelligence and this can have a high cost for healthcare systems. Navigating the intersection of AI and healthcare requires more than clinical operations expertise; it requires advanced knowledge in business motivation, partnerships, legal considerations, and ethics.

Learning to Dance at HIMSS17

This year I had the pleasure of attending a meetup for people interested in and working with AI for healthcare at the Healthcare Information and Management Systems Society (HIMSS) annual meeting in Orlando, Florida. At the beginning of the meetup Wen Dombrowski, MD, asked everyone to stand up and participate in a partner led movement activity. Not your average trust fall, this was designed to teach about AI and machine leaning while pushing most of us out of our comfort zones and to spark participants to realize AI-related lessons. One partner led and the other partner followed their actions.

Dedicated computer scientists, business professionals, and proud data geeks tested their dancing skills. My partner quit when it was my turn to lead the movement. About half of the participants avoided eye contact and reluctantly shuffled their feet while they half nursed their coffee. But however awkward, half the participants felt the activity was a creative way to get us thinking about what it takes for machines to ‘learn’. Notably Daniel Rothman of MyMee had some great dance moves.

I found both the varying feedback and equally varying willingness to participate interesting. One of the participants said the activity was a “waste of time.” They must have come from the half of the room that didn’t follow mirroring instructions. I wonder if I could gather data about what code languages were the specialty of those most resistant. Were the Python coders bad at dancing? I hope not. My professional training is actually as a licensed foreign language teacher so I immediately corroborated the instructional design effectiveness of starting with a movement activity.

There is evidence that participating in physical activity preceding learning makes learners more receptive and allows them to retain the experience longer. “Physical activity breaks throughout the day can improve both student behavior and learning (Trost 2007)” (Reilly, Buskist, and Gross, 2012). I assumed that knowledge of movement and learning capacity was common knowledge. Many of the instructional design comments Dr. Dombrowski received while helpful, revealed participants’ lack of knowledge about teaching and cognitive learning theory.

I could have used some help at the onset in choosing a dance partner that would have matched and anticipated my every move. The same goes for healthcare organizations and their AI solutions.  While they may be a highly respected institution employing some of the most brilliant medical minds, they need to also become or find a skilled matchmaker to bring the right AI partner (our mix of partners) to the dance floor.

AI’s Slow Rise from Publicity to Potential

Artificial Intelligence has experienced a difficult and flashy transition into the medical field. For example, AI computing has been used to establish consensus with imaging for radiologists. While these tools have helped reduce false positives for breast cancer patients, errors remain and not every company entering AI has equal computing abilities. The battle cry that suggested physicians be replaced with robots seems to have slowed robots. While AI is gaining steam, the potential is still catching up with the publicity.

Even if an AI company has stellar computing ability, buyers should question if they also have the same design for outcome. Are they dedicated to protecting your patients and providing better outcomes, or simply making as much profit as possible? Human FTE budgets have been replaced by computing AI costs, and in some instances at the expense of patient and data security.  When I was asking CIOs and smaller companies about their experiences, many were reluctant to criticize a company they had a non-disclosure agreement with.

Learning From the IBM Watson and MD Anderson Breakup

During HIMSS week, the announcement that the MD Anderson and IBM Watson dance party was put on hold was called a setback for AI in medicine by Forbes columnist Matthew Herper. In addition, a scathing report detailing the procurement process written by the University of Texas System Administration Audit System reads more like a contest for the highest consulting fees. This suggests to me that perhaps one of the biggest threats to patient data security when it comes to AI is a corporation’s need to profit from the data.

Moving on, reports of the MD Anderson breakup also mention mismanagement including failing to integrate data from the hospital’s Epic migration. Epic is interoperable with Watson but in this case integration of new data was included in Price Waterhouse Cooper’s scope of work. If poor implementation stopped the project, should a technology partner be punished? Here is an excerpt from the IBM statement on the failed partnership:

 “The recent report regarding this relationship, published by the University of Texas System Administration (“Special Review of Procurement Procedures Related to the M.D. Anderson Cancer Center Oncology Expert Advisor Project”), assessed procurement practices. The report did not assess the value or functionality of the OEA system. As stated in the report’s executive summary, “results stated herein are based on documented procurement activities and recollections by staff, and should not be interpreted as an opinion on the scientific basis or functional capabilities of the system in its current state.”

With non-disclosure agreements and ongoing lawsuits in place, it’s unclear whether this recent example will and should impact future decisions about AI healthcare partners. With multiple companies and interests represented no one wants to be the fall guy when a project fails or has ethical breaches of trust. The consulting firm of Price Waterhouse Coopers owned many of the portions of the project that failed as well as many of the questionable procurement portions.

I spoke with Christine Douglas part of IBM Watson’s communications team and her comments about the early adoption of AI were interesting. She said “you have to train the system. There’s a very big difference between the Watson that’s available commercially today and what was available with MD Anderson in 2012.”  Of course that goes for any machine learning solution large or small as the longer the models have to ‘learn’ the better or more accurate the outcome should be.

Large project success and potential project failure have shown that not all AI is created equally, and not every business aspect of a partnership is dedicated to publicly shared goals. I’ve seen similar proposals from big data computing companies inviting research centers to pay for use of AI computing that also allowed the computing partner to lease the patient data used to other parties for things like clinical trials. How’s that for patient privacy! For the same cost, that research center could put an entire team of developers through graduate school at Stanford or MIT. By the way, I’m completely available for that team! I would love to study coding more than I do now.

Finding a Trusted Partner

So what can healthcare organizations and AI partners learn from this experience? They should ask themselves what their data is being used for. Look at the complaint in the MD Anderson report stating that procurement was questionable. While competitive bidding or outside consulting can help, in this case it appears that it crippled the project. The layers of business fees and how they were paid kept the project from moving forward.

Profiting from patient data is the part of AI no one seems willing to discuss. Maybe an AI system is being used to determine how high fees need to be to obtain board approval for hospital networks.

Healthcare organizations need to ask the tough questions before selecting any AI solution. Building a human network of trusted experts with no financial stake and speaking to competitors about AI proposals as well as personal learning is important for CMIOs, CIOs and healthcare security professionals. Competitive analysis of industry partners and coding classes has become a necessary part of healthcare professionals. Trust is imperative and will have a direct impact on patient outcomes and healthcare organization costs. Meetups like the networking event at HIMSS allow professionals to expand their community and add more data points, gathered through real human interaction, to their evaluation of and AI solutions for healthcare. Nardo Manaloto discussed the meetup and how the group could move forward on Linkedin you can join the conversation.

Not everyone in artificial intelligence and healthcare is able to evaluate the relative intelligence and effectiveness of machine learning. If your organization is struggling, find someone who can help, but be cognizant of the value of the consulting fees they’ll charge along the way.

Back to the dancing. Artificial does not equal high intelligence. Not everyone involved in our movement activity realized it was actually increasing our cognitive ability. Even those who quit, like my partner did, may have learned to dance just a little bit better.

 

Resources

California Department of Education. 2002. Physical fitness testing and SAT9 Retrieved May 20, 2003, from www.cde.ca.gov/statetests/pe/pe.html

Carter, A. 1998. Mapping the mind, Berkeley: University of California Press.

Czerner, T. B. 2001. What makes you tick: The brain in plain English, New York: John Wiley.

Dennison, P. E. and Dennison, G. E. 1998. Brain gym, Ventura, CA: Edu-Kinesthetics.

Dienstbier, R. 1989. Periodic adrenalin arousal boosts health, coping. New Sense Bulletin, : 14.9A

Dwyer, T., Sallis, J. F., Blizzard, L., Lazarus, R. and Dean, K. 2001. Relation of academic performance to physical activity and fitness in children. Pediatric Exercise Science, 13: 225–237. [CrossRef], [Web of Science ®]

Gavin, J. 1992. The exercise habit, Champaign, IL: Human Kinetics.

Hannaford, C. 1995. Smart moves: Why learning is not all in your head, Arlington, VA: Great Ocean.

Howard, P. J. 2000. The owner’s manual for the brain, Austin, TX: Bard.

Jarvik, E. 1998. Young and sleepless. Deseret News, July 27: C1

Jensen, E. 1998. Teaching with the brain in mind, Alexandria, VA: Association for Supervision and Curriculum Development.

Jensen, E. 2000a. Brain-based learning, San Diego: The Brain Store.

Reilly, E., Buskist, C., & Gross, M. K. (2012). Movement in the Classroom: Boosting Brain Power, Fighting Obesity. Kappa Delta Pi Record, 48(2), 62-66. doi:10.1080/00228958.2012.680365.

Amazing Transforming Healthcare Conference Logo

Posted on September 23, 2013 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.

Props to @healthcarewen for pointing out this awesome healthcare conference logo for the 2013 Oklahoma Association for Home Care and Hospice Annual Conference & Trade Show:
Transforming Healthcare - Transformers Conference Logo

If you love that logo, you’ll love the conference brochure even more.