Memorial Day Thanks – 2014

Tomb of the Unknown Soldier

Memorial Day each year honors the ultimate sacrifice that service men and women of the Armed Forces of the United States of America have made in defending and preserving the freedoms we enjoy as the greatest democracy in the world.

We honor the memory these brave men and women on this day and thank them and their families for their service.

They died in service of our country to make our nation as a continued force for good around the world.

Thank you. We will continue our work to make your care better through healthcare providers and information technology.


mHealth: The Future of Provider-Patient Engagement

These days, I spend a lot of my time on my (so called) smartphone or ubiquitous tablet. I saw a video this past weekend about how we were not smart due to our dependence on (anti) social media while our phones were (I liked that a lot).

While I was in Los Angeles, on a project some years ago, managing the development of specialty clinical notes, the neurology physician I was with at the time, asked me why could we not have the notes on her tablet rather than on the laptop. The functionality that we wanted was not quite possible then, so we continued with our project with the laptop or desktop in mind then.

In today’s world and possibly in the future, this is even more relevant a question as both physicians and patients are more in tune with their mobile devices than they are with any other gadget around. We take pictures, we check our bank account, we send simple emails (sometimes with attachment) and I chat with someone eight thousand miles away in an instant.

I remember a HEMOC physician told me that he received pictures from his patients on his personal phone and also used his “AOL” account to email them, outside of his provider mandated email address. While this was “unusual”, (i’m being polite) it is definitely something that needs to be kept in mind as we move towards a more mobile and connected patient-provider interaction life. Since I already engage with my physician on a portal online, my next easy access would be my smartphone app. Like other individuals, I am also on the go and want to make sure that I am connected at all times (yes, most of us are unfortunately tied to our devices with an invisible umbilical cord).

We keep hearing about BYOD and by now, many provider organizations have developed a policy for BYOD, while the smaller organizations still lag behind. Last week, the American Telemedicine Association had a trade show in Baltimore, MD. For anyone interested in the Tele-Health, Telemedicine areas that is a fast growing initiative in several provider organizations, they should attend this show to get a perspective on the many different solutions for this type of patient engagement. One of the options was interaction directly from your “smartphone” app from your healthcare provider (I just updated the app I use and it had face to face call functionality with my provider, which I thought was very impressive indeed).

While I am a traditionalist at heart and know that what the HEMOC physician in Los Angeles who said that he felt it was insulting to his patients to have a PC in the room, the march of technology, possibly in ways that are less intrusive, will continue if there is a market, which I am sure there will be. As each new generation and iteration of healthcare specific devices becomes available in the market, you will see a much more symbiotic relationship between physician and their technology over the next few years. We are still only in it’s infancy and will look back on this time as we did mainframes and punch cards.


Thought Leadership – Empathy’s involvement in Patient Engagement


Earlier this year, I had introduced you to “lifestyle philosopher” and Oxford University Professor, Roman Krznaric and his work on empathy’s role in our world today. He has released a new animation which is an amazing video that is part of this post. Hopefully, it is as insightful for you as it was for me. I interviewed Roman on some of his thoughts about empathy and it’s role in healthcare as well as other areas that were relevant to our world today. Here, below is that interview.

Roman, thanks for your time to answer some of my questions. How did you get involved with the concept of empathy?
I used to be an academic teaching and researching political science. But about a dozen years ago I had an intellectual awakening when I came to realize that societies and politics didn’t simply change through new laws, institutions and policies but through changes in the way people treated each other at the individual level, especially through empathy. I define empathy as the art of stepping imaginatively into the shoes of another person, understanding the feelings and perspectives, and using that understanding to guide your actions. It’s a fundamental skill that almost all of us have, but we rarely fulfill our empathic potential, or work hard enough to harness the power of empathy to create social transformation. 
How do you think that empathy can help healthcare, both there in Britain and here in the US, where healthcare is a very politically charged topic?
It’s interesting to me that the origins of public healthcare in Britain can be traced back to an important empathic shift during the Second World War. Over a million children were evacuated from big cities to rural foster homes to escape the German bombs. And one of the unintended results was that relatively well-off rural folk suddenly had relatively poor city children thrust into their homes, and they could see the extremes of urban poverty with their own eyes: it was a moment of empathic understanding and awakening. There was huge public outcry and the government took immediate action, improving public health care for children, giving free meals in schools, vitamin supplements and other health care. This mass meeting of strangers was, in effect, the beginnings of the British welfare state – and it happened right in the middle of the war when resources were extremely scarce. There is a lesson here: that empathy sensitizes us to health care inequalities, and can spur social and political action to alleviate it.
Of course, healthcare reform is a very politically charged topic in the US, since it is so closely associated with the Obama administration. It was also Obama who started talking about America’s ’empathy deficit’ in the lead up to the 2008 Presidential Election. The American right then started critiquing the concept of empathy because of its links to Obama. Despite all this political complexity, I think empathy remains essential to the issue of healthcare. Why? The historical evidence points to the fact that empathy opens the door of our moral concern for neglected or marginalized social groups, and laws, rights and public policy wedge that door open, helping to universalize that moral concern. Healthcare, like other key areas of public policy, is one where we should be shining the light of empathy, trying to understand how different parts of society experience the public health system (or lack of it), and equally how they are impacted by the structure of private health care. It is only through empathising that we gather enough evidence, from enough points of views of different citizens, to design truly effective and socially just health care systems. Otherwise good healthcare becomes the privilege of a few, rather than the right of the many. 
The US is undergoing a sort of renaissance in healthcare information and technology. What do you see as the role of empathy in this area (more usage of smartphones, tablets and laptops vs. human interaction)?
One way to think about this issue is to look at the new wave of ’empathy skills training’ for doctors that has become popular in the last few years. Doctors are often criticized for being too clinical and emotionally detached from their patients. In 2010, doctors at a Boston hospital took part in an empathy skills program in which they were advised to pay greater attention to the changing expressions on their patients’ faces (for instance whether they showed anger, contempt, fear or sadness), to take note of voice modulations, and to make simple changes such as facing the patient rather than their computer screens during a consultation. After just three one-hour training sessions, doctors who went through the program showed vastly improved empathy levels. Their patients said these doctors made them feel more at ease, showed greater care and compassion towards them, and had a better understanding of their concerns. The doctors too could see the benefits. After spending a day putting the program’s methods into practice, one hospital doctor reported that while it was initially difficult to empathize with the patient while simultaneously making her diagnosis, eventually it ‘became fun’ and embodied the kind of personal interaction that had initially drawn her into medicine.
Now, what does this tell us? It would seem to suggest that it is person-to-person interaction that patients are after more than anything, and that this is the key to bringing more empathy into the sphere of healthcare. All the technology in the world doesn’t substitute for having a real human being treat you, look you in the eye, and hear your personal story.
That might make me sound pessimistic about the possible role that technology might play in empathic healthcare. Yet I also believe that if we get smart about using technology, it can help bring about an empathy revolution in healthcare. OK, almost everyone would rather have the doctor look at them rather than at their computer screen during a consultation. Yet just imagine if basic video technologies like Skype became a standard way for your doctor to visit you in your home to give post-treatment or post-operation check ups and advice. We need to learn to bring a little more intimacy into the way we use technology, especially social networks.
Do you foresee any upcoming empathy deficits?
The evidence is pretty clear that the US in a period of long-term empathy decline. A well-known study (Scientific American, December 23rd, 2010) revealed that US empathy levels are down nearly 50% in the last 40 years, with the steepest decline occurring in the past decade. So the empathy deficit is growing. At the same time we see rising levels of narcissism – around 1 in 10 Americans now exhibit narcissistic personality traits. There is also growing evidence that social networking technologies are exacerbating narcissism and contributing to empathy decline. There is a question about whether these trends are going to continue. I’m glad to say that there is a growing movement trying to address these problems by teaching empathy in schools. The most effective program, called Roots of Empathy, began in Canada and has now reached over half a million children worldwide.
Will we see more of these animations in the future? I think it is a great tool to get your message  across in a simple, entertaining and informative way.
My animation about empathy, The Power of Outrospection (produced by the Royal Society of the Arts in London) makes the case that empathy can be a powerful tool for social change. It’s fascinating how popular the animation form has become – this particular one has had over half a million views – and is evidence of the shift towards visual learning. I think we need to tap into our multiple intelligences when communicating ideas. For some people books are the most powerful, for others it will be animations, blogs or going to talk with a real live human being! Personally I plan to pursue all these communication routes in the future, including the animations – luckily for the world someone else does the drawing, since my drawing skills are in need of serious work!
Thanks for your time on this interview. Hopefully we see a much more empathetic world as we move forward in the 21st Century.
RomanKrznaricRoman Krznaric, PhD, is a writer on empathy and social change based in the UK. His latest book is Empathy: A Handbook for Revolution (to be published in the US by Penguin in November 2014). He advizes organizations including Oxfam and the United Nations on using empathy as a tool for social transformation and public policy. He is a founding faculty member of The School of Life, and founder of the world’s first digital Empathy Library. Website: Twitter: @romankrznaric

Is DEFCON 1 the new normal for Healthcare?

I remember when I first heard the phrase DEFCON 1 (in the 80s movie, WarGames). These days, I think attributing that to healthcare seems relevant with all of the issues surrounding Privacy and Security. Continuing with my post from last week, it brought to mind that providers may be getting increasingly frustrated about how much they have to deal with over the last few years and how much more they need to focus on security than they did in the past after their clinical applications implementation and the new HIPAA Omnibus regulations. Recognizing that healthcare IT leaders these days have somewhat limited authority, but an enormous amount of accountability, it’s difficult to see why many would want to take that position.

A Healthcare IT leader has to think about so many situations such as how to encyrpt every device, and how to manage and secure data integrity & try to develop multi-layered defense mechanisms for the clinical and operational applications that a provider now has to manage. What about protecting their data center from internal and external attacks?

Will we ever be perfect? With the new issues around Internet Explorer (I’m updating the blog using Chrome by the way), the issue of security, continues to dominate the healthcare headlines. This along with the continued use by many provider organizations of XP after Microsoft said that they will discontinue support for the operating system after April 2014.

What do we do? Is this the new normal? Dr. John Halamka of Harvard Medical & Beth Israel in an interview recently at HIMSS 14 with Healthcare IT News  discussed this (while mentioning that that he had 14 different work streams in his privacy and security efforts) the need for access based on what you do rather than who you are and said that there will always now be some vendor who will announce that there is a new vulnerability that everyone needs to watch out for.

Information Security Officers will need generals defending their provider fortress. With more devices accessible by technologies like blue tooth, a rogue employee walking through a facility possibly wrecking havoc and changing information of patients, there has never been a need for solid fortress-like defenses than ever before. All this as well as providers try to have better, more meaningful engagement with their patient population!

But then again folks, we’re just getting started…