How can technology enhance elderly adherence to self-managed treatment plan?

Patient non-compliance with treatment care is one of the leading causes of increasing healthcare costs and hospital readmissions. Elderly patients, those 65 years and older, are especially prone to losing motivation to adhere to treatment, particularly when self-management is required and they are infrequently checked by providers. This study investigates the effect of information systems on retaining motivation to adhere to self-management and satisfaction with treatment. Drawing upon goal-setting and control theories, we found that clearly defined and revisited goals are more likely to be followed by elderly patients if progress is monitored and regular and timely feedback is provided by their provider.

The full pdf can be downloaded below.  

What's Needed to Develop Strategic Purchasing in Healthcare?

In the context of serious concerns over the affordability of healthcare, various authors and international policy bodies advise that strategic purchasing is a key means of improving health system performance. Such advice is typically informed by theories from the economics of organization (EOO). This paper proposes that these theories are insufficient for a full understanding of strategic purchasing in healthcare, because they focus on safeguarding against poor performance and ignore the coordination and adaptation needed to improve performance. We suggest that insights from other, complementary theories are needed. A realist review method was adopted involving three steps: first, drawing upon complementary theories from the EOO and inter-organizational relationships (IOR) perspectives, a theoretical interpretation framework was developed to guide the review; second, a purposive search of scholarly databases to find relevant literature addressing healthcare purchasing; and third, qualitative analysis of the selected texts and thematic synthesis of the results focusing on lessons relevant to three key policy objectives taken from the international health policy literature. Texts were included if they provided relevant empirical data and met specified standards of rigour and robustness. A total of 58 texts were included in the final analysis. Lessons for patient empowerment included: the need for clearly defined rights for patients and responsibilities for purchasers, and for these to be enacted through regular patient-purchaser interaction. Lessons for government stewardship included: the need for health strategy to contain specific targets to incentivise purchasers to align with national policy objectives, and for national government actors to build close, trusting relationships with purchasers to facilitate access to local knowledge about needs and priorities. Lessons for provider performance included: provider decision autonomy may drive innovation and efficient resource use, but may also create scope for opportunism, and interdependence likely to be the best power structure to incentivise collaboration needed to drive performance improvement. Using complementary theories suggests a range of general policy lessons for strategic purchasing in healthcare, but further empirical work is needed to explore how far these lessons are a practically useful guide to policy in a variety of healthcare systems, country settings and purchasing process phases.

The full article can be downloaded below.  

Professional culture, information security and healthcare quality—an interview study of physicians’ and nurses’ perspectives on value conflicts in the use of electronic medical records

Digital healthcare information systems impose new demands on healthcare professionals, and information security rules may induce stressful value conflicts, which the professional culture may help professionals to handle. The aim of the study was to elucidate physicians’ and registered nurses’ shared professional assumptions and values, grounded in their professional cultures, and how these assumptions and values explain and guide healthcare professionals’ handling of value conflicts involving rules regulating the use of electronic medical records. Healthcare professionals in five organisations in two Swedish healthcare regions were interviewed. The study identified ensuring the patients’ physical health and well-being as the overarching value and a shared basic assumption among physicians and registered nurses. A range of essential professional and organisational values were identified to help attain this goal. In value conflicts, different values were weighted in relation to each other and to the electronic information security rules. The results can be used to guide effective design and implementation of electronic medical records and information security regulations in healthcare.

The full pdf can be downloaded below.  

How health insurance companies use AI to make consumers healthier

Health insurance companies today are using artificial intelligence and machine learning in ways not possible just five years ago to better pinpoint at-risk individuals and to reduce costs.

"The applicability and opportunity on the insurers side is fantastic," said Mark Morsch, vice president of Technology for Optum360. "AI has gotten hot in the last few years.

The biggest breakthroughs are in more sophisticated machine learning. Being able to take that data and leverage it to drive algorithms and move towards being more predictive."

The full Healthcare Finance article can be found at this link.  

AI Doesn't Ask Why -- But Physicians And Drug Developers Want To Know

Both physicians and drug developers draw much of their authority from their ability to leverage mechanistic understanding to move from observation to insight. This ability is likely both better and worse than we typically recognize. Our mechanistic understanding is often far less robust than we appreciate, but we bring a sense of intuition and a wealth of tacit knowledge to these domains, enabling us to notice that a patient just doesn’t seem himself, or that a cell culture or chemical reaction is behaving in a curious way. Humble physicians and drug developers will seek ways to embrace (as well as critically verify) the mechanistically unmoored insights offered by ever more sophisticated algorithms. At the same time, engineers seeking to disrupt medicine and pharma would do well to temper their messianic vigor with a healthy appreciation for the lived experience and hard-won-wisdom of many incumbent practitioners.

The full Forbes article can be found at this link.  

THE FOOD AND DRUG ADMINISTRATION’S POLICIES AND PROCEDURES SHOULD BETTER ADDRESS POSTMARKET CYBERSECURITY RISK TO MEDICAL DEVICES 

FDA had plans and processes for addressing certain medical device problems in the postmarket phase, but its plans and processes were deficient for addressing medical device cybersecurity compromises. Specifically, FDA's policies and procedures were insufficient for handling postmarket medical device cybersecurity events; FDA had not adequately tested its ability to respond to emergencies resulting from cybersecurity events in medical devices; and, in 2 of 19 district offices, FDA had not established written standard operating procedures to address recalls of medical devices vulnerable to cyber threats. These weaknesses existed because, at the time of our fieldwork, FDA had not sufficiently assessed medical device cybersecurity, an emerging risk to public health and to FDA's mission, as part of an enterprise risk management process. We shared our preliminary findings with FDA in advance of issuing our draft report. Before we issued our draft report, FDA implemented some of our recommendations. Accordingly, we kept our original findings in the report, but, in some instances, removed our recommendations.

We recommend that FDA do the following: (1) continually assess the cybersecurity risks to medical devices and update, as appropriate, its plans and strategies; (2) establish written procedures and practices for securely sharing sensitive information about cybersecurity events with key stakeholders who have a “need to know”; (3) enter into a formal agreement with Federal agency partners, namely the Department of Homeland Security's Industrial Control Systems Cyber Emergency Response Team, establishing roles and responsibilities as well as the support those agencies will provide to further FDA's mission related to medical device cybersecurity; and (4) ensure the establishment and maintenance of procedures for handling recalls of medical devices vulnerable to cybersecurity threats. FDA agreed with our recommendations and said it had already implemented many of them during the audit and would continue working to implement the recommendations in the report. However, FDA disagreed with our conclusions that it had not assessed medical device cybersecurity at an enterprise or component level and that its preexisting policies and procedures were insufficient. We appreciate the efforts FDA has taken and plans to take in response to our findings and recommendations, but we maintain that our findings and recommendations are valid.

The full Office of Inspector General report can be downloaded below.  

America's Obesity Crisis: The Health and Economic Costs of Excess Weight

This study calculates the prevalence and economic effects of diseases related to obesity and overweight in the United States. These costs are paid by individuals and their households, employers, government, and society. The study uses a range of data sources to comprehensively establish the prevalence of conditions related to obesity, as well as the costs. To capture all costs, this study evaluated the direct costs of health care services to treat these diseases—costs paid by individuals, families, insurance companies, and employers—as well as indirect costs that relate to work absences, lost wages, and reduced economic productivity for the individuals suffering from the conditions and their family caregivers.  For each condition, the direct health care costs and the indirect costs are calculated and presented separately.

The full pdf from the Milken Institute can be downloaded below.  

Can AI Address Health Care’s Red-Tape Problem?

Productivity in the United States’ health care industry is declining — and has been ever since World War II. As the cost of treating patients continues to rise, life expectancy in America is beginning to fall. But there is mounting evidence that artificial intelligence (AI) can reverse the downward spiral in productivity by automating the system’s labyrinth of labor-intensive, inefficient administrative tasks, many of which have little to do with treating patients.

Administrative and operational inefficiencies account for nearly one third of the U.S. health care system’s $3 trillion in annual costs. Labor is the industry’s single largest operating expense, with six out of every 10 people who work in health care never interacting with patients. Even those who do can spend as little as 27% of their time working directly with patients. The rest is spent in front of computers, performing administrative tasks.

Using AI-powered tools capable of processing vast amounts of data and making real-time recommendations, some hospitals and insurers are discovering that they can reduce administrative hours, especially in the areas of regulatory documentation and fraudulent claims. This allows health care employees to devote more of their time to patients and focus on meeting their needs more efficiently.

The full Harvard Business Review article can be viewed at this link.  

Why Doctors Hate Their Computers

Digitization promises to make medical care easier and more efficient. But are screens coming between doctors and patients?  This in-depth article provides doctors perspectives on how technology has changed their workplace.

The full article from the New Yorker can be viewed at this link.