Literature Review

Why recent outages are a wake-up call for healthcare and regulators Forbes; by Chris Bowen; 10/11/24 When the CrowdStrike outage first started to show itself in the early hours of that hazy July morning, it was hard to believe that this wasn’t a hack or cyberattack. I was driving in my car that morning and looked up to see a digital billboard glitch into the "blue screen of death" before my eyes. Flights were grounded, travel was delayed, and nearly every Windows machine in the world was unusable. It was total mayhem. Clearly, this was an outage of major proportions, as millions of Windows systems worldwide essentially cratered. Caused by a faulty misconfiguration, we saw firsthand how the very digital advancements that have helped transform and modernize our world also expose us to more vulnerabilities than ever. ... In healthcare, this event laid bare the vulnerabilities we cannot overlook—the gaps that directly threaten patient care and safety. It’s a clear reminder of our industry’s utmost responsibility to patient privacy and well-being. ...

Asian-American communities face ‘digital divide’ in health equity, hospice care Hospice News; by Holly Vossel; 10/1/24 Recent research has dug into the barriers limiting greater telehealth utilization among Asian American, Native Hawaiian and Pacific Islander (AANHPI) communities. The data come at a time when hospices are striving to better understand how to improve those groups’ end-of-life trajectories. Technology utilization has gained momentum in health care, including in hospice care delivery. Though increased virtual health care access can help hospice providers reach patients upstream, the trend may be worsening disparities and outcomes among Asian American populations, according to Victoria Tsze, an outpatient hospice social worker at Tucson Medical Center (TMC) Hospice. 

Research suggests AI could enhance patient safety, but raises questions The American Journal of Managed Care (AJMC); by Hayden E. Klein; 9/26/24 A new study from Boston University highlighted the potential of generative artificial intelligence (AI) to improve patient safety in health care. Published in The Joint Commission Journal on Quality and Patient Safety, the study tested the widely used AI model GPT-4 on the Certified Professional in Patient Safety (CPPS) exam, where it answered 88% of questions correctly. Researchers believe AI could help reduce medical errors, estimated to cause 400,000 deaths annually, by assisting clinicians in identifying and addressing safety risks in hospitals and clinics. ... The study authors suggested that AI has promise in helping doctors better recognize, address, and prevent mistakes or accidental harm in hospitals and clinics. ... However, the study also highlighted critical limitations of current AI technologies, including the risk of bias, fabricated data, and false confidence in responses. 

Visible, active leadership is vital to change management, says Epic emeritus CIO advisor Healthcare IT News; by Bill Siwicki; 9/26/24 [Part 1 of 2] Lost amidst talk of all the amazing technologies used in healthcare today is a subject very important to Robert Slepin: change management. ... Clinical workforce shortages and burnout, increasing costs and decreasing reimbursement, and capacity to care for patients with behavioral health/addiction issues – these are among the top issues confronting U.S. hospitals, according to the American College of Healthcare Executives. ... While there is no magic wand to accelerate progress, in my experience you can significantly improve the outcomes in a healthcare transformation initiative with an intentional focus and disciplined approach to change management. Conversely, not being thoughtful and effective in leading change could hinder your efforts or adversely impact the outcomes, and even possibly spell disaster. ... Visible, active leadership is vital. ... A hands-off approach of issuing orders from the corner office and asking others to "let me know when it's done" won't cut it. ... Besides being visible and hands-on, the best leaders I have worked with demonstrate a positive style; for example, they are authentic, coaching, transformational, engaging and compassionate. They remove fear and build trust, and inspire, educate, coach and support people in moving together toward a common, stretch goal. ...

77% of health system IT employees eyeing new jobs Becker's Health IT; Naomi Diaz; 9/25/24 Health system IT employees are keeping their options open, with 77% actively seeking new jobs or planning to do so within the next year, according to Bloomforce's "2024 EHR Salary Insights Report." The report, based on an online survey conducted between November and December 2023, gathered responses from 284 healthcare professionals across various roles, including application analysts, team leads, project managers and people managers. It explored areas such as salary, job satisfaction, work-life balance, talent retention and attitudes toward remote work. Here are some key findings from the report: [Click on the title's link to read more.]

AI 'early warning' system shows promise in preventing hospital deaths, study says Pique NewsMagazine, Toronto, Canada; by Nicole Ireland; 9/16/24 An AI early-warning system that predicts which patients are at risk of deteriorating while in hospital was associated with a decrease in unexpected deaths, a new study says. The study, published Monday in the Canadian Medical Association Journal, found a 26 per cent reduction in non-palliative deaths among patients in St. Michael's Hospital's general internal medicine unit when the AI tool was used. "We've seen that there is a lot of hype and excitement around artificial intelligence in medicine. We've also seen not as much actual deployment of these tools in real clinical environments," said lead author Dr. Amol Verma, a general internal medicine specialist and scientist at the hospital in Toronto. "This is an early example of a tool that's deployed that was rigorously tested and evaluated and where it's showing promise for actually helping improve patient care." ... The technology called CHARTwatch continuously analyzed more than 100 different pieces of information about each patient in the unit, Verma said. When the AI tool predicted that a patient was deteriorating, it sent an alert to physicians and nurses, prompting them to quickly intervene.

AI scribes show promising results in helping family doctors and nurse practitioners spend more time with patients and less time on paperwork LaGrange Daily News, Toronto, Canada; by PR Newswire / Canada Newswire; 9/11/24 Family doctors report spending 70% to 90% less time on paperwork in a study evaluating the use of artificial intelligence (AI) scribe technology. OntarioMD (OMD), a subsidiary of the Ontario Medical Association (OMA), announced this week the findings of the study that examined the use of AI scribes by more than 150 family doctors and nurse practitioners (NPs) over a three-month period. AI scribes capture conversations between family doctors or nurse practitioners (NPs) and their patients and summarizes them into detailed electronic medical notes. The family doctors and NPs assessed AI scribes' effectiveness in reducing their time spent on administrative tasks and the results are very promising. ... The results also support the Ministry of Health and Ontario Health's Patients Before Paperwork (Pb4P) initiative aimed at helping doctors spend more time caring for patients instead of doing unnecessary paperwork.

Seven pillars to put healthcare consumers at the heart of the digital transformation Forbes; by Hélène Musikas, Géraldine Maouchi, Lorenzo Mandelli, Daniel Brown; 9/6/24 The digital age has seen many industries undergo a profound transformation, evolving into agile "Hybrid Organizations" that blend traditional and digital business models. ... The healthcare sector, however, faces a unique set of challenges on its journey toward this transformation. ... One of the most significant shifts in healthcare is the rising concept of "Self-Care". Seven Ways To Harmonize The Digital Landscape In Healthcare ...

How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunitiesPublic Library of Science (PLOS) Digital Health; Amy Bucher, Beenish M Chaudhry, Jean W Davis, Katharine Lawrence, Emily Panza, Manal Baqer, Rebecca T Feinstein, Sherecce A Fields, Jennifer Huberty, Deanna M Kaplan, Isabelle S Kusters, Frank T Materia, Susanna Y Park, Maura Kepper; 8/24With a renewed focus on health equity in the United States ... there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors.

Doctors saved her life. She didn’t want them to. DNYUZ; by Kate Raphael;  8/26/24 Marie Cooper led her life according to her Christian faith. ... [And, she] always said that at the end of her life, she did not want to be resuscitated. ... Last winter, doctors found cancer cells in her stomach. She’d had “do not resuscitate” and “do not intubate” orders on file for decades and had just filled out new copies, instructing medical staff to withhold measures to restart her heart if it stopped, and to never give her a breathing tube. In February, Ms. Cooper walked into the hospital for a routine stomach scope to determine the severity of the cancer. After the procedure, [Ms. Cooper's daughter] visited her mother in the recovery room and saw her in a panic. ... [The daughter] called for help and was ushered to a waiting room while the medical team called an emergency code. Ms. Cooper grew even more distressed and “uncooperative,” according to medical records. Doctors restrained her and inserted a breathing tube down her throat, violating the wishes outlined in her medical chart. Ms. Uphold, livid, confronted the doctors, who could not explain why Ms. Cooper had been intubated. ... 

Connected to the cloud at time of death: a case reportJournal of Medical Case Reports; by Isabel Straw, Claire Kirkby, Preethi Gopinath; 8/24Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the 'Internet of Things', examining how existing guidelines capture data related to death which is no longer confined to the patient's body... Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). Publisher's note: An interesting article posing interesting questions about the impact technology has on death and the potential use / misuse of health information gathered by devices.

Helpful, harmful, or illegal: Can your patients really record you? — The pros and cons of recording doctorsMedPage Today; by Max Feinstein; 8/9/24My name is Max Feinstein and I'm an anesthesiologist in New York City. I'm not a lawyer, but as a physician and a content creator, I think it's really important for both patients and healthcare providers to have a good understanding of when it's okay to record audio or video in the hospital. The term "wiretap laws" refers to statutes that govern audio and video recordings made of face-to-face conversations, telephone calls, or video calls. These laws vary from state to state. Where states that have one-party consent laws means that only one person who is in the area that's being recorded has to provide consent... Thirty-seven states in the United States have one-party consent laws. This contrasts with all-party consent, meaning, as the name implies, that everyone who is involved with the recording has to provide their consent. Violation of these laws may result in fines up to $100,000 and possibly jail time as well. Wiretap laws are not the same thing as HIPAA, which you might have heard about before... In addition to wiretap laws, many hospitals also have policies in place specifically describing what is and is not allowed as far as recording is concerned...Publisher's note: Nearly everyone has a recording device (i.e., a smartphone). Does your organization have recording policies?