A crisis brewing for the healthcare system and a crisis already happening for our students

Working in medicine has always been a stressful job for a number of reasons. Long hours, dealing with life and death situations day and night, lack of time to build personal relationships and stressors related to work-life balance contribute to personal stress. This is compounded by putting oneself second to the needs of others combined with changes in practice of medicine, technical advances and changing patient expectations among other factors. Furthermore, organisational and institutional pressures and structures can add to the burden of practising medicine. Medical students (doctors-in-training) carry with them a number of stress-inducing factors. First and foremost, they are in that vulnerable age group where two thirds of psychiatric disorders begin. Secondly, stressors of all types can contribute to the development of mental ill-health. The history of medicine tells us that doctors would often work hard and in relative isolation, but enjoyed extremely high social status and other rewards. This social contract with medicine has shifted significantly over recent decades, with doctors almost ubiquitously working in teams with other doctors, nurses, social workers and others. Indeed, health care overall is becoming much more collaborative and patients themselves are increasingly seen as a crucial part of the overall team in their care. This is undoubtedly welcome. At the same time, societal and financial rewards for doctors have lessened in many places alongside marked changes in patient expectations and changes in laws with clear emphasis on health as a commodity which can be bought and sold and patients being consumers who have greater understanding and can communicate widely using social media and other methods.

The full article can be downloaded below.  

Data exchanges based on blockchain in m-Health applications

The most important aspect of handling data in the healthcare industry is its seamless and secure transition across intercepting nodes. Effective elimination of third-party entities and ensuring direct links between patient and healthcare provider can result in the transmission of error-free, unduplicated data. The use of blockchains can open up opportunities to counter the current requirements due to their ability to safely share information across nodes and networks from the access point and secure the safety of transactions. Currently, sharing medical data is observed to be slow, incomplete, insecure, and provider-centric. These shortcomings prevent data interoperability and are a consequence of lack of foundational, structural, and semantic inoperability. By applying the blockchain technologies with appropriate markers, the safety of patient data can be ensured during data transmission. This paper evaluates the potential use of blockchain technology in association with mobile-based healthcare applications.

The full article can be downloaded below.  

Impact of Pharmacist Involvement on Telehealth Transitional Care Management (TCM) for High Medication Risk Patients

This pilot study sought to evaluate the impact of pharmacist involvement in the preexisting telehealth transitional care management (TCM) program at Atrium Health on the quality and safety of the medication discharge process for high medication risk patients. Eligible participants were those 18 years of age or older with moderate-to-high risk for hospital readmission who were contacted by a TCM Nurse, identified as high medication risk patients, and referred to the TCM Pharmacist from September 2018 through February 2019. The TCM Pharmacist contacted patients by phone, completed a comprehensive medication review, identified medication list discrepancies (MLDs) and medication-related problems (MRPs), and made interventions or recommendations to primary care providers. Primary endpoints included the number and types of MLDs identified, number and types of MRPs identified, and the rate of unplanned 30-day hospital readmissions. Seventy-six patients were enrolled, and 78 MLDs and 108 MRPs were identified. Of the identified MRPs, 74.1% were resolved. A relative risk reduction of 36.8% was achieved for 30-day hospital readmissions for those with high medication risk contacted by the TCM Pharmacist compared to those only contacted by the TCM Nurse. Overall, TCM Pharmacists identified and resolved 80 medication-related problems, improved access to medication therapy, provided comprehensive medication counseling, and bridged gaps in care following hospital discharge.

The full article can be downloaded below.  

The Polypill Revisited: Why We Still Need Population-Based Approaches in the Precision Medicine Era

Nearly 2 decades ago, Wald and Law proposed “a strategy to reduce cardiovascular disease by more than 80%” by administering a polypill to everyone 55 years of age and older. Their bold proposal had its roots in the debate surrounding risk-based versus population-based approaches to prevention, as described by Rose. In risk-based approaches, preventive measures are targeted specifically at higher risk individuals, with medication therapy tailored to each patient’s risk factor profile. The identification of higher risk patients typically relies on clinical and laboratory-based prediction algorithms, the traditional approach endorsed in most practice guidelines. In contrast, population-based approaches aim to shift the entire risk distribution, even modestly, with measures implemented at the population level. The latter necessitates interventions that are low in cost and have a low incidence of side effects. These are among the proposed advantages of the polypill, a fixed-dose combination of cardiovascular medications, usually including a statin and several antihypertensive drugs.

One of the objections to the Wald and Law proposal was that large numbers of low-risk individuals would end up receiving unneeded and/or unindicated drug therapy. Thus, despite randomized trials supporting the tolerability of various polypill formulations and regulatory approval in multiple countries outside the United States, momentum in the field shifted toward viewing the polypill primarily as a strategy for high-risk individuals with established cardiovascular disease. The problem is that a one-size-fits-all approach to pharmacotherapy may not be optimal for patients with established disease, for whom aggressive cholesterol and blood pressure targets often require titration of multiple medications. Furthermore, secondary prevention patients often have comorbidities such as diabetes that influence the choice of therapy.

Thus, several decades since Wald and Law’s original proposal, there remains little clarity regarding the role of the polypill in cardiovascular care. This has coincided with the rising interest in precision medicine, a contemporary embodiment of the risk-based approach in the Rose framework. A natural question, then, is whether there is any place for a population-based strategy using the polypill in the present era with so much focus on precision medicine.

The full perspective article can be downloaded below.  

Development of the mHealth App Trustworthiness checklist

Mobile health applications (mHealth apps) currently lack a consensus on substantial quality and safety standards. As such, the number of individuals engaging with untrustworthy mHealth apps continues to grow at a steady pace.

The purpose of this study was to investigate end-users’ opinions on the features or actions necessary for trustworthy mHealth apps; and to convey this information to app developers via a succinct but informative checklist: the mHealth app trustworthiness checklist.

The checklist was formulated in three stages: (a) a literature review of studies identified the desirable features of the most prolific mHealth apps (health and fitness apps); (b) four focus group sessions with past or current users of these apps (n ¼ 20); and (c) expert feedback on whether the checklist items are conceivable in a real-life setting (n ¼ 6).

Five major themes emerged from the focus group discussions: informational content, organizational attributes, societal influence, technology-related features, and user control factors. The mHealth app trustworthiness checklist was developed to incorporate these five themes and subsequently modified following expert consultation. In addition to the trustworthiness themes, we identified features that lie between trust and mistrust (limited digital literacy and indifference) as well as 10 features and actions that cause end-users to mistrust mHealth apps.

This study contributes to the evidence base on the attributes of trustworthy mHealth apps. The mHealth app trustworthiness checklist is a useful tool in advancing continued efforts to ensure that health technologies are trustworthy.

The full article can be downloaded below.  

AMIA encourages NIH to fund FHIR for interoperability and clinical research

The National Institutes of Health issued a request for information earlier this fall, seeking to learn more about how HL7's Fast Healthcare Interoperability Resources specification can be better used for clinical research. The American Medical Informatics Association has responded with some suggestions for how NIH can help develop and promote the FHIR standard.

AMIA notes that the data exchange standard – as well as the larger issue of interoperability across the healthcare world – is in need of funding and research. And the informatics group has asked NIH to directly support FHIR research in three different ways: through investment, education and product support.

The full Healthcare IT News article can be viewed at this link.  

How AI Is Helping Diagnose Rare Genetic Diseases

400 million people globally suffer from a rare disease. This is greater than the population of the United States, yet the ominous figures don't end there. According to the Global Genes organization, eight out of ten rare diseases are caused by a faulty gene, yet it takes an average of 4.8 years to arrive at an accurate diagnosis. This is part of the reason why 30% of children with a rare disease won't live to see their fifth birthday.

Neither is this situation helped by the fact that 95% of rare diseases lack an FDA-approved treatment. However, while the rarity of rare diseases means they're often neglected by the medical establishment, artificial intelligence and machine learning have been emerging in recent years as new, promising tools in the fight against uncommon pathology. Several companies are developing platforms that harness AI as a means to identify genetic variants at the roots of rare diseases, while medical researchers and practitioners are using these platforms or developing their own.

The full Forbes article can be viewed at this link.  

On-Demand Telemedicine as a Disruptive Health Technology: Qualitative Study Exploring Emerging Business Models and Strategies Among Early Adopter Organizations in the United States

On-demand telemedicine is a potentially disruptive innovation currently in the early adopter stage of technology adoption and diffusion. On-demand telemedicine must cross into the early majority stage to truly be a positive disruption that will increase accessibility and affordability for health care consumers. Our findings provide guidance for adopter organizations as they seek to deploy viable business models and successful strategies to smooth the transition to early majority status. We present important insights for both early adopters and potential early majority organizations to better harness the disruptive potential of on-demand telemedicine.

The full article can be viewed at this link.   

 Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR). 

The full Forbes article can be viewed at this link.  

Can Synthetic Biology Inspire The Next Wave Of AI?

In building the world’s first airplane at the dawn of the 20th century, the Wright Brothers took inspiration from the “insightful” movements of birds. They observed and reverse-engineered aspects of the wing in nature, which in turn helped them make important discoveries about aerodynamics and propulsion. 

Similarly, to build machines that think, why not seek inspiration from the three pounds of matter that operates between our ears? Geoffrey Hinton, a pioneer of artificial intelligence and winner of the Turing Award, seemed to agree: “I have always been convinced that the only way to get artificial intelligence to work is to do the computation in a way similar to the human brain.” 

So what’s next for artificial intelligence (AI)? Could the next wave of AI be inspired by rapid advances in biology? Can the tools for understanding brain circuits at the molecular level lead us to a higher, systems-level understanding of how the human mind works? 

The answer is likely yes, and the flow of ideas between learning about biological systems and developing artificial ones has actually been going on for decades. 

The full Forbes article can be viewed at this link.