Tuesday, June 03, 2014

#HDPalooza Common Challenges, Tough Nuts and Other Next-to-impossible tasks

Chris Gibbons from Johns Hopkins

People are turning to Dr. Google.

The Digital Divide is real.

Giving Internet access doesn’t solve the problem.

Who are the digital disadvantaged:

  • Over 65
  • Below Poverty Line
  • Non English Speaker

40M over 65 on 2+ Medications
65.7M Caregivers

30M people don’t speak english well. It is not just spanish speaking. There are many dialects in play including slang and vernaculars of the urban landscape.
40% or 115M US people can’t understand health information.

145M with communication challenges.

Lessons Learned:

  • Minorities stress value of being able to tell their story.
  • Information Sharing precedes shared decision making
  • A belief in an acceptable role for non-adherence as a mechanism to express control.

Low Income Seniors:

  • Health happens in a social context
  • Many use tech, few are totally disconnected
  • The Doctor is not the most important person assisting them with their health.
  • More than half use technology regularly
  • Almost 60% optimistic about health technology.

Dr. Farris Tamimi – Mayo Clinic

Making Quality Metrics Actionable

A personal story: in 24 hours of hospitalization he had over 50 people care team members involved in his care.

Dabo Health and Mayo Clinic for Social Media – Applying Teamwork and data transparency to effect better care and better health.

Providers and Competitive and Engagement can encourage that.

Transparency means something becomes actionable.

Metrics plus conversations (behind the firewall)
Visualizations leading to comprehension

Personalized view of performance.

Dabo Health – Enterprise Quality Score Card was beaten by Dabo Health 4x over in access.

“You can’t change what you don’t measure and you can’t change what you don’t discuss.”

Dr Paul Bleicher – Optum Labs

Making Technology work for Clinicians

What is the difference between competitively working and dominating your sector?

How do you cross the chasm to dominating your industry?

Health Tech for Clinicians:
- Easy to view and understand
- No data/tech manipulation by clinician
- Limited analytic aptitude/training by clinician
-Consistent with standard clinical knowledge and practice
- ACTIONABLE (Drill down to specifics. Clear corrective steps)
- Address a problem of major significance (Improve patient outcomes/ improves clinician quality scores / reduces cost)

Working Clinicians need data Pertinent to themselves and the patients they are dealing with.
Immediacy and Actionable is essential.

Lessons Learned:
- Don’t add to workflow to collect information
- Technology adoption requires close attention to people, process and technology.
- Engineers shouldn’t develop requirements
- Actionable: If I know X I can do Y
- Clinicians want a clear answer. They don’t want to explore.
- HIT enables transformation
- Some clinical IT is amazing but few are useful and practical.

Q & A:

How did you get adoption?

  • No adoption until providers saw ACTIONABLE information.

What about Mental Health as a difficult to reach category?

  • Mental Health/substance abuse patients are another higher level category of population to reach
  • Don’t underestimate the value of mHealth technology to reach them
    -TV is more ubiquitous than phones. Don’t forget that as a channel.
  • Third parties can bring the technology with them (eg. Health Navigators and Social Workers)

Does clinician data in DAb Health go to the EMR?

  • The data is sourced from the EMR
  • Social Media policies are in place and there has been education in the use of social tools.

How does usability play in to the development and deployment of solutions?

  • 1 in 7 minutes of US Viewing population is spent in social media (1 in 4 minutes on Facebook)
  • How do we make solutions as simple as Facebook/Twitter/Google

Recommendations on getting users involved?

  • Start by engaging in an Agile way. State what they are trying to do
  • Get away from the design and focus on the functions ie. pure requirements.
  • Important to create a usability lab and see how prototypes are ACTUALLY used.
  • Physicians and Clinicians only get involved when it meets an immediate Operational need.

Nurses have only 20% of their shift time available for patient interaction.

Start with the problem or need or requirement. Get the right use cases.

The federal shift to quality is something that Physicians and Clinicians cant keep track of. If you can relate that to how it will impact their day and then provide a tool to help ease the pain. Then you have a call to action.

An operations director of a Medical Center

30% of patients are cognitively impaired.
Providers have less time to focus on diagnosis and relating to the patient.

Two fold increase in time spent doing mandatory paperwork.

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