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Archive for October, 2019

The Known Citizen: A History of Privacy in Modern America

Although the “P” in HIPAA stands for portability, the question of privacy and data protection is a big topic in healthcare. While at the same time we need to protect all personal health information for patients, individual patients have the right to share that data how they wish. New legislation on data interoperability seeks to break down silos and data blocking to enable patients and providers to have access to data to improve care. With this as the current situation in 2019, those interested in privacy should not miss Sarah Igo’s excellent history of privacy and policy “The Known Citizen.” We recommend this book to all data and privacy nerds. While not focused on healthcare, it provides a great primer on the evolution of privacy and technology’s ability to outpace our understanding and desires both to be known and to be forgotten.

The book kicks off with the advent of photography and the debate at the time about whether people own their likeness. (At the time they didn’t, and people found their pictures on boxes in the grocery store.) It details the evolution of thought, law, and popular sentiment in privacy, including the first ideas that patients have a right to privacy, championed by nurse Dorothy Smith in 1969, and institutionalized in the Patient Bill of Rights in 1973. The premise is that while the loss of privacy is required in the doctor/patient relationship and to deliver care, this doesn’t mean that all aspects of privacy should be ignored. “Arranging for privacy”: curtains, confidentiality, (robes that close at the back?), can created a zone of privacy around the patient and help preserve the individual’s dignity. Smith felt that this was the duty of the nurse, although now we see it as the responsibility of everyone in healthcare from the receptionist to IT.

Healthcare privacy is also touched on in the social determinants of health, and whether people receiving public aid should have their entire lives under the microscope, and again, in the introduction of internal review boards and ethics committees for medical research to protect patient/subjects from harm, but also from disclosure of private information without their full cooperation or understanding of its use.

While you may know Betty Ford for her disclosure of addiction and subsequent support of treatment, she is also responsible for destigmatizing breast cancer and showing that open discussion, and especially by prominent figures can drive public health agendas. After Ford disclosed her breast cancer and mastectomy in the media, there was a noticeable uptick in mammograms, and over 5,000 calls of support to the White House.

While healthcare is a small part of this book, the learnings from society at large, and the race between technology, sentiment, and legislation have great lessons to apply in healthcare. And interestingly much of the discussion we are having today about being known, has been going on for over hundred years, and the
“big data” discussions for at least 50 years. Finally, this book has the added bonus of a really interesting bon mot for your next cocktail or mocktail party: the first reality TV show was broadcast in 1973, on PBS of all broadcasters!

Posted in: Behavior Change, big data, Clinical Research, Data Protection, Health Regulations, Healthcare Legislation, Healthcare Policy, Healthcare Research, Healthcare Technology

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HIMSS WA Innovation Summit

I had the opportunity to attend the Washington HIMSS Innovation Summit, where leaders from Virginia Mason, Providence, Overlake, Seattle Children’s, UW Medicine, Vera Whole Health and Confluence spoke about innovation in their organizations. A lot of great themes and takeaways. These are the ones that stood out most to me.

Technology Adoption

Several panelists mentioned they have problems with their health systems adopting new technologies. Executives tend to bring in new technologies, get pilots kicked off, but struggle in the system-wide adoption. A lot of times new technologies are implemented and expected to work immediately. The reality is that no matter what Health Systems are implementing, they need to invest resources. Physicians and end users need to be engaged early on to really take ownership of the new technology. A well-defined change management process is also key to ensuring a successful adoption. Lastly, even though organizations are piloting the new technology, call it Phase 1 vs Pilot. Pilots imply a short-term project with and end date. Phase 1 makes the technology more real and gets people thinking about what Phase 2 and 3 look like.

Return on Investment

One of the panelists challenged any technology vendor to show him a technology that has ROI. He said his organization does over $200M in uncompensated care per year so he must evaluate new technologies against cost of patient care, which is a valid point. This brought up an interesting discussion about what health systems consider to be a ROI. Not all technologies will give Health Systems dollar-for-dollar return. Some technologies will. ROI can be a blend of hard and soft cost, so it’s important to spend time thoroughly defining a business case and make sure that success metrics align with the overall mission of the Health System.

Patients

I was surprised at how much of the discussion was focused around clinician-facing vs patient-facing technologies. I agree better tools and algorithms for clinicians will directly influence the quality of care that patients receive. Virginia Mason panelists did a great job bringing everything back to the patients. Patients should be the center and they should have access to all their data, regardless of where it comes from, in one place. They should have one seamless app and experience for all their healthcare needs. We at Wellpepper could not agree more!

Key Takeaways

When evaluating and implementing new technologies:

  • Define a realistic business case and what financial and non-financial ROI looks like
  • Ensure alignment to Health System’s mission and goals
  • Don’t assume that new technologies can just be plugged in and solve all problems
  • Allocate resources and engage providers and end users from the beginning
  • Treat it as a multi-year, phased journey; call it Phase 1 instead of a Pilot
  • Have a solid change management process
  • Keep patients’ experience and needs at the top of mind

Posted in: Adherence, Behavior Change, Healthcare costs, Healthcare Disruption, Healthcare Technology, Healthcare transformation, HIMSS, patient engagement, Patient Satisfaction, patient-generated data, Return on Investment, Uncategorized, Using Wellpepper

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