Mobile App Medicine: It's here. Are patients and providers ready?

Is medicine via smart phone alive and well?

Earlier this month, Healthcare IT News' Michelle McKnickle posted an article regarding five new mobile medical apps that improve doctor patient communication. Her case is pretty solid in that these apps do improve the flow of information and streamline a lot of what goes into a normal patient visit to the physician's office.

Medical and many other related apps have the potential to revolutionize the way healthcare providers and patients interact, with one small caveat: Only if doctors are willing to embrace the technology and use it.  

While the technology is here and constantly evolving (which in itself could be part of the adoption problem), there are several factors that could stall implementation into the healthcare consumer marketplace; the first and foremost of which is physicians themselves.

Doctors, especially some of the more established professionals are often not only technology averse, but actively untrusting of it. If it's not on a chart or recorded on a microcassette, it is not real, tangible information. These are the same professionals who are already cynical toward the Internet due to the fact that it allows people to self-diagnose and come into an exam with what they've already decided they have, and demand a prescription for the medicine they want (or one that has been best advertised).

I am not saying these professionals are wrong for holding these attitudes. A patient comes in convinced that they have thyroid cancer and it turns out, they need to drastically change their diet to feel better. The patient is meanwhile thinking of ways to expose the doctor for fraud because obviously, they know better. After all, it is their body.

What's my point?

Communication is the key. Also, that one to two hours waiting for an appointment that was supposed to start two and a half hours prior, could be a thing of the past if all of that paperwork could be handled ahead of time in the days leading to an appointment or with a 'bump' of  smart phone.

On the surface and in practice, mobile technology is a perfect fit for healthcare.

There is however, a distinct problem with regulation and implementation of this technology. The government is slow to move on regulation, and, the legal aspects of such implementation are often overwhelming for HCO's and private practices. These are doctors we're talking about, not lawyers. Shouldn't a doctor be thinking more about how to make you better or keep you well than worrying about malpractice and privacy breaches?  What's best for the patient in a 'common sense' sense is not always what is right legally.

Here's are some other points to ponder.

Doctors only get paid when you have a billable appointment with them.  In our instant access culture, with smart phones in our pockets, and Google effectively negating the entire futuristic feel and wonder of the Hitchhiker's Guide to the Galaxy, will doctors really be open to this technology? 

If they can share results with patients, potentially do follow ups through a quick instant survey instead of billable in-person visits, and share records and results instantly; will they be willing to give up the associated revenue simply to make their patients happier?  Will they even believe that it will make their patients happier? With so much of a patient's attitude toward a doctor having to do with bedside manner, does this type of technology strip away any of that patient doctor relationship?

Mobile apps provide the healthcare industry with a multitude of benefits. However, implementation will likely have to be a patient-pushed initiative, in a situation where there is no real call to action. Nobody is dying because this doesn’t exist and not even a thousand small puppies can be shown in an onslaught of commercials to pull our heart strings enough to mobilize and demand progress.

As a healthcare IT staffing professional, I have to remain on top of industry news and trends. I don’t see adoption of medical apps as part of mainstream medicine until the 'younger' generation, who has and is growing up with this technology, makes it part of their daily life at work in the ER and everyday practice.

You can blame criminal elements, but counterfeit products enter markets through stupidity.

The principal of Occum’s Razor is used by most of us in our day to day lives, whether we know it or not. All things being equal, the simplest explanation is most likely to be true.

There’s been a lot of speculation about counterfeit produce in US markets recently, from fake Tiffany rings on e-bay to major influxes of counterfeit drugs into the US pharmaceutical market place.

This is not robbery, it’s not theft – it’s a lesson in false confidence. At some point, someone was taken for a fool in a circumstance where they should have known better. In almost all cases, they were motivated to ignore or downgrade the risk element because they had something to gain. When we ignore the tell-tale signs of fraudulence, it’s almost always because we want to believe.

There’s a reason they’re called confidence scams. The con man doesn’t need the real product; he doesn’t even need any product at all. All he needs is your confidence. This seems like a good deal to me.

As I read these stories, I’m constantly brought back to the same question: How are so many people in this country able to ignore the advice they have been given since childhood by mothers, fathers, teachers and bosses?

If a deal looks too good to be true, then it probably is.

Great deals come with simple explanations. The rent for this apartment seems very cheap, but the owner needs to leave town urgently for 6 months and doesn’t have time to wait around. This hotel seems cheap, but they’ve only been open two weeks and they are attracting customers away from established competitors. Sensible and simple explanations.

If the simple explanation is either missing – or you have cause to doubt its veracity – it’s time to back away.

Most of us have seen it on the streets of major cities. There’s a guy selling designer goods out of a suitcase; the boxes are all top end brands – Calvin Klein, Ray-bans, Gucci. $10 for the 50ml bottle that sells for $70 in Macy’s. Hungry tourists crowd round to get themselves a bargain.

Now and again a furious buyer returns shouting at the vendor. They’ve opened the box and the product is a cheap imitation.

But what are they complaining about? Of course the product is fake. They’re produced for $2.00 and sold for $10.00. No other plausible explanation existed from the beginning. You can hope that they’re stolen if your conscience allows it, but even then – what are the chances?

Some research for this blog threw up some incredible message boards where people complained at length that the Tiffany ring they had bought on e-bay was not the real thing. The price was $6.00. Come on. Seriously?

The perfume is fake. The handbag is not really from Gucci. The sunglasses are not really Ray-bans and yes – the $6.00 ring is not really from Tiffany. If you paid $6.00 and expected a Tiffany ring, then you are an idiot by anyone’s definition.

So when it comes to the healthcare industry’s issue, who is really to blame for the influx of counterfeit drugs into the huge US market? (40% of the world’s prescription drugs are sold in the US.) The answer is simple. At some point the supply chain moves from illegal to legal. It moves from the criminally devious to the honestly stupid. Breaking this link in the chain is the answer to combating counterfeit produce.

At a corporate level, every bit as much as at a personal level, we are responsible for making sensible decisions. We must assess risk, identify things that need explanation and follow a sensible, logical course of action.

In every occurrence of a fake product entering a market, someone is failing to do these things. Someone is chasing a bargain or a glut – and an opportunity to benefit personally – that is blinding them to their obvious responsibility to see things for what they are.

If you don’t 100% trust the source you’re buying from, you have to be 100% sure you have the means to assess the product before you either use it or pass it on.

Buyers across the pharmaceutical supply chain would do well to keep Occum’s Razor close at hand.

ICD-10 is Big – Inefficiency Through Absurdity – When Bureaucracy Gets Out of Hand

It appears that as is true with most things that grow beyond usefulness (i.e. - our 72,000 page tax code in the U.S.) ICD-10 has gone into the realm of regulating ridiculousness.  When you need billing codes that include the following items, you know that we are spending more tax dollars on coming up with these categories than we receive in efficiency of having them in the first place:

W5612XA: Struck by a sea lion, initial encounter

Now, I’ve been around the world. I’ve seen a lot of things. I have yet to encounter anyone that’s had an initial encounter of this nature with a sea lion. They’re big. They’re bad. I imagine if you egg them on enough they could do some damage, or, if you’re scuba diving they could mistake a flipper for a fish but, in all honesty, why not just “Attacked by marine animal (non-venomous), initial encounter”  and why “initial encounter”? Are there repeat offender sea lions? How about a “You’re not going to believe this one, explanation pending” billing code?

or

W5609XA: Other contact with dolphin, initial encounter

Hmmm. I am trying to figure out what exactly justifies “other contact with a dolphin” and how it could be “other” if it is the “initial encounter.” That aside, this one scares me a little. Granted dolphins aren’t prone to the same history of striking people like the evil sea lions but, I have always envisioned dolphins as the loveable, sea park kind. You know the aquatic entertainers that ride on their tails, running through a series of commands with their trainer for entertainment purposes. I have also heard of dolphins being used for medical and mental therapy purposes (although it’s a highly controversial practice and oddly enough, not covered by a lot of insurance carriers so – no billing code). However, I have heard that dolphins have come to the aid of humans and other creatures being attacked by sharks, punching them off the intended prey with their sturdy snouts.  Does Flicka have a secret Jekyl and Hyde complex? It all depends on the intent, if any, behind the wording of this code.

These highly obscure and extremely specific codes, except in the case of “other contact,” abound in ICD-10. That’s a problem for me and likely a problem for the billing coordinator that’s inputting the code as well.

This next one is almost beyond belief:

T7501XD: Shock due to being struck by lightning, subsequent encounter

Lottery ticket anyone? Come on! I know it has happened. I have read about a forest ranger that was struck seven times in his lifetime. A freak of nature?  Certainly.  Does that mean we need to add five more billing codes in case it happens again? Subsequent encounters with lighting seem like a statistical anomaly that likely should not warrant their own code. If you survive the first strike and make it through the second, I think they should throw out the bill. You’ve been through enough and it’s less absurd a thought than having two codes for lightning encounters.

As long as we’re exploring the edges of absurdity, I’d like to suggest a few more codes that we could incorporate into the code:

14THE8GES: “Other contact with an alien being, close tertiary encounter”

M1FAVR8:  “Shock due to being struck in hand by joy buzzer via hack comedian, subsequent annoyance”

Or the highly specific:

MY2CENTS:  “Struck by chair on pinky toe while walking barefoot through a dark room rendering it pretty much useless for the next two weeks and may require amputation, yearly encounter”    

Certainly there is a place for efficiencies and consistency in medical billing- but seriously, should there be a difference in medical BILLING between being struck by a sea lion vs. a dolphin? The astronomical and egregious rise in healthcare costs seemed to be caused by similar "inefficient efficiencies" throughout the system.

Although, even though highly specific, I know for a fact that most of us can relate to the proposed pinky toe billing code.

Candidate has great skills, ideal experience and strong references? Well done, you’re half way there.

If you made a new hire today, there is a 46% chance that they will be gone in 18 months. This statistic, which is alarming enough in itself, is compounded by the fact that 89% of these failures will be attributed to attitudinal factors. Put simply, half the people you hire will not survive in the job you gave them, mostly because they have bad attitudes.

Now a bad attitude may conjure up images of laziness or insubordination, but there are other more common faults that fit into this area, including a lack of coachability, emotional intelligence or motivation.

Turnover in the modern workplace is a major problem for productivity and where failure occurs, it is only occasionally due to a lack of hard skill.

Ask anybody with hiring experience, in any sector, anywhere in the world and they will tell you that the best way to lower turnover and increase tenure is to hire the right people in the first place.

What this recent study (the basis of Hiring for Attitude - a new book from business coach Mark Murphy) suggests is that far too many employers are basing their hiring practices on simple check lists of hard skills, at the expense of a genuine assessment of a person’s suitability. The result? A short term success that spells long term disaster.

Talascend hires thousands of people every year, for our own staff and for our customers. What everyone here will tell you first and foremost is this…

The interview is the most important part of the entire hiring process.

Here are our five tips for getting it right.

1.       Don’t duplicate the role of the resume and references.

Let the resume and references establish the candidate’s skills and credibility. If they claim to be academically qualified, capable of a specific role technically and that they have worked in the role for five years at these two companies, then – If it all checks out via transcripts and references – it’s a safe assumption that they can do the job, so you don’t need to focus too much time on their hard skills.

2.       Move quickly to the important part

You’ll want to spend a short time satisfying yourself that their track record is deserved, but once you have, move quickly on to the soft skills that are going to determine whether they succeed or fail with you. How will they behave within a team? (and most importantly your team.) What motivates them? (and are their needs consistent with what you can offer?) How are they likely to respond to pressure?

3.       Don’t be awkward asking personal questions

 It’s easy to understand why interviews tend to focus heavily on hard skills; it’s much safer territory for the interviewer and interviewee. Tell me about your experience using the new ABC software. How much time have you spent conducting site reviews?  These are a lot less awkward to ask than questions that drive at emotional intelligence and very few hiring managers have had the training they need to conduct a rounded interview. 

4.       Get Help

There are a number of great resources available to navigate this terrain. There are templates available online, your HR department is likely to be very helpful. There are also external devices like psychometric profiles, which some employers swear by. Staffing agencies that you work with will be happy to help you; it's in their interest for your interviews to go well – ask them what they can offer.

5.       Act now, before the next 46% doomed hire joins you

Whatever you do to address this issue, do it sooner rather than later. We all understand what 46% turnover means for our teams, projects and businesses. 

We can all do better than this; we simply have to do better if our operations are to thrive and grow. Your next coin-toss hire could be sitting in your building right now. 

Education, not legislation, is the key to lower healthcare spending.

In 2005, the British chef and media personality Jamie Oliver launched a highly successful campaign to raise awareness of the poor quality of food being served in British schools. The result was to transform the way Britain thinks about school food, delivering healthier, balanced meals and most importantly, educating children early about the benefits of eating properly. Oliver himself was awarded an MBE by the Queen (a civilian medal of honor for service to the country.) His approach has been used with great success across Europe.

Then he came to America.

You can watch the details of Oliver’s treatment at the hands of US school employees he met and the US media in general on YouTube (‘We don’t want to eat lettuce all day, who made you king?’) sufficed to say he was shot down in flames from minute one, and he returned home having failed completely.

Recent discussion about the growing cost of healthcare delivery remains focused on the level of investment necessary to keep the nation healthy, but to endlessly debate legislation and government investment misses the long term issue entirely.

The spiraling cost of healthcare in the US may be the direct result of defensive medicine, malpractice and government mandated programs like EHR, but there is no question where the real answer to reduced health care spending lays – healthier people.

It is education and not legislation that is the real answer.

The British chef and campaigner for healthy food 

in schools suffered a series of media beatings.

When Jamie Oliver was sent packing so emphatically by a firmly united front of American education workers, local media and national TV personalities, this country missed a major opportunity to start the move toward lower healthcare costs. 

Regular exercise, healthy eating and the limitation of obviously dangerous practices like smoking and heavy drinking are the keys to lower spending. This begins and ends with personal choices. The earlier we begin to encourage these choices the better.

One of the many reasons David Letterman gave Jamie Oliver (a long time friend of his incidentally) for why he would fail was the power of fast food chains. They’re not going anywhere, he says.

A typical McDonalds in London

McDonalds is not going away, but it can be forced to evolve. In the UK, it has. Gone are the gaudy red signs and plastic furniture, in favor of subtle dark green and high-spec leather chairs. Salads are not an after thought, they are a key part of the menu, as are many other healthy choices. You can still get a Big Mac if you want one, but McDonalds knows its future success depends on delivering more healthy options because they are simply what the consumer wants.

We the people are in charge of what fast food chains serve. We have the power in the long term to reduce the cost of healthcare in this country through the way we live. It’s happening in other countries, we could make it happen here.  

This would dramatically shift the debate about healthcare spending. 

Get a Cipher. It’s as easy as a walk in the qbsl4.

by Josh Kaplan

At Bletchley Park in England, the centre of allied code-breaking in the 1940’s, British and American personnel decrypted the enigma machine, Germany’s  main means of encrypted communication. Winston Churchill himself described Bletchley as the secret weapon that won the war. 

Bletchley Park, home to WWII allied code breakers

But despite the considerable intellectual and technological resources committed to the unit, the largest contribution made to the cracking of Enigma was made by German clerks.  

Bad code words were guessed by staff at Bletchley, using intelligence provided by spies and intercepted communications that were often as simple as the name of a clerk’s dog or girlfriend. These educated guesses, when correct, created the framework for breaking the overall code.  

60 years later, more advanced technology is available to our teenage children than was ever known at the park, but the Achilles heel remains the same. Bad passwords. Lazy, obvious codes that invite chaos in our homes and businesses. Here’s some simple statistics from Javelin Strategy and Research:

• 11.1 million adults were victims of identity theft last year
• The total fraud amount was $54 billion
• The average victim spent 21 hours and $373 out of pocket resolving the crime
• 4.8% of the population was a victim of identity fraud in the last year

The problem in so many cases, was bad passwords. A list of the 25 worst passwords, recently published by Forbes (http://www.forbes.com) carries only the occasional surprise. You could guess the top 5 with little effort - Password, 123456 and so on – but then that’s why they’re bad passwords.

The problem is that the idea of a password carries a central disconnection. It must be easy to remember but difficult to guess. This is not easy, especially with the number of passwords most of us must carry in our heads. Using the same word for everything is obviously a bad idea, as is committing any of your secure passwords to paper, or to the word document on your desktop entitled ‘passwords’.

So what’s the answer?  A cipher that adds an extra layer of security. For example kptvlbqmbo10 is a good password.  Great, you say – but how am I supposed to remember that in a cab to the airport trying to check in online? It’s easy enough. It’s my name. joshkaplan. I’ve used a simple transposition cipher (bumping each letter one up in the alphabet), then I’ve counted all the letters and put the number on the end (10). The result is a 12 letter combination of letters and numbers that is far more secure yet easy to remember.

If you’re one of the people who are using your children’s names (Ashley and Bailey are in the top 20), or words like Dragon, Baseball or Monkey – you should switch things up. Using my cipher, Baseball becomes Cbtfcbmm8. Invent your own cipher and try it out. Whatever you do, don’t use this one.

This kind of cipher won’t get past the guys at Bletchley, but it should be enough to keep your Facebook account safe, and your kids away from Cinemax.