Not all sensors are created equal: a framework for evaluating human performance measurement technologies

Recent years have witnessed an explosion in the number of wearable sensing devices and associated apps that target a wide range of biomedical metrics, from actigraphy to glucose monitoring to lung function. This offers big opportunities for achieving scale in the use of such devices in application contexts such as telehealth, human performance and behaviour research and digitally enabled clinical trials. However, this increased availability and choice of sensors also brings with it a great challenge in optimising the match between the sensor and a specific application context. There is a need for a structured approach to first refining the requirements for a specific application, and then evaluating the available devices against those requirements. In this paper we will outline the main features of such an evaluation framework that has been developed with input from stakeholders in academic, clinical and industry settings.

The full article can be downloaded below.  

Stigma in health facilities: why it matters and how we can change it

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

The full article can be downloaded below.  

Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016

As the opioid epidemic evolves, it is vital to identify changes in the geographical distribution of opioid-related deaths, and the specific opioids to which those deaths are attributed, to ensure that federal and state public health interventions remain appropriately targeted.

From 1999 to 2016, a total of 231 264 men and 120 366 women died from opioid-related causes across the whole United States. Sixty-six observations were removed owing to missing data on age; therefore, 351 564 US residents were included in this study. The mean (SD) age at death was 39.8 (12.5) years for men and was 43.5 (12.9) years from women. Opioid-related mortality rates, especially from synthetic opioids, rapidly increased in all of the eastern United States. In most states, mortality associated with natural and semisynthetic opioids (ie, prescription painkillers) remained stable. In contrast, 28 states had mortality rates from synthetic opioids that more than doubled every 2 years (ie, annual percent change, 41%), including 12 with high mortality rates from synthetic opioids (>10 per 100 000 people). Among these 28 states, the mortality rate from natural and semisynthetic opioids ranged from 2.0 to 18.7 per 100 000 people (with a mean mortality rate of 6.0 per 100 000 people). The District of Columbia had the fastest rate of increase in mortality from opioids, more than tripling every year since 2013 (annual percent change, 228.3%; 95% CI, 169.7%- 299.6%; P < .001), and a high mortality rate from synthetic opioids in 2016 (18.8 per 100 000 people); the mortality rate from natural and semisynthetic opioids was 6.9 per 100 000 people. Nationally, overall opioid-related mortality resulted in 0.36 years of life expectancy lost in 2016, which was 14% higher than deaths due to firearms and 18% higher than deaths due to motor vehiclecrashes; 0.17 years of the life expectancy lost was due specifically to synthetic opioids. In 2016, New Hampshire and West Virginia lost more than 1 year of life expectancy due to opioid-related mortality.

Opioid-related mortality, particularly mortality associated with synthetic opioids, has increased in the eastern United States. These findings indicate that policies focused on reducing opioid-related deaths may need to prioritize synthetic opioids and rapidly expanding epidemics in northeastern states and consider the potential for synthetic opioid epidemics outside of the heroin supply.

The full article can be downloaded below.  

HIT Think: Why precision medicine will buck typical consolidation trends

It is important is to focus on the expectations, questions and concerns that are common across the precision medicine field today. One of these is the general consensus across the industry that provider organizations won’t be able to lean on one vendor to meet all of their precision medicine needs.

Precision medicine is a multidisciplinary priority for a health system. In other words, doing work in precision medicine and operationalizing a precision medicine program takes multidisciplinary collaboration across several key areas of expertise within a health system.

The full Health Data Management article can be viewed at this link.  

How Conversational AI Can Help Cure Physician Burnout

Physician burnout is one of the most serious conditions in today’s medical profession. The Agency for Healthcare Research and Quality defines the condition as “a long-term stress reaction caused by emotional exhaustion [and] depersonalization,” among other factors. According to the American Medical Association, physicians suffer from considerable stress caused by facets of their job that have little to do with actually providing personalized patient care. The AMA reports that physicians spend up to six hours daily working with electronic health records (EHRs) to adhere to government and hospital documentation requirements. That’s six hours not spent seeing patients, and thus not having the time to listen carefully and diagnose, empathize, hold a hand, speak with family members, or explain conditions and next steps. Physicians are not to blame.

All of this belies the fact that good patient care is the primary source of job satisfaction for 79% of physicians, according to The Physician Foundation. Healing patients is why doctors choose to practice medicine. Dissatisfaction is sounding alarms as physicians leave the field at alarming rates.

At the most recent Health Information and Management Systems Society’s (HIMSS) annual conference, technology was front and center of industry efforts to improve health care. Nuance Communications’ focus on how Conversational AI and Ambient Clinical Intelligence (defined below) are particularly promising. I had the opportunity to speak at length with Nuance CEO Mark Benjamin about how technology may help cure physician burnout. 

The full Forbes article can be viewed at this link.  

Rural Hospital Sustainability: New Analysis Shows Worsening Situation for Rural Hospitals, Residents

While the potential for a rural hospital crisis has been known for years, this predictive data sheds light on just how dire the situation could become. Now, by being able to accurately assess the economic health of all rural hospitals in America, there is no choice but to pay attention. Local, state, and federal political leaders, as well as hospital administrators, must act to protect the well-being of rural hospitals nationwide and the communities they serve.

The full analysis can be downloaded below.  

Burnout and Health Care Workforce Turnover 

Levels of burnout among primary care clinicians and staff are alarmingly high, and there is widespread belief that burnout and lack of employee engagement contribute to high turnover of the workforce. Scant research evidence exists to support this assertion, however.

We conducted a longitudinal cohort study using survey data on burnout and employee engagement collected in 2013 and 2014 from 740 primary care clinicians and staff in 2 San Francisco health systems, matched to employment roster data from 2016.

Prevalence of burnout, low engagement, and turnover were high, with 53% of both clinicians and staff reporting burnout, only 32% of clinicians and 35% of staff reporting high engagement, and 30% of clinicians and 41% of staff no longer working in primary care in the same system 2 to 3 years later. Burnout predicted clinician turnover (adjusted odds ratio=1.57; 95% CI, 1.02-2.40); there was also a strong trend whereby low engagement predicted clinician turnover (adjusted odds ratio with high engagement=0.58; 95% CI, 0.33-1.04). Neither measure significantly predicted turnover for staff.

High rates of burnout and turnover in primary care are compelling problems. Our findings provide evidence that burnout contributes to turnover among primary care clinicians, but not among staff. Although reducing clinician burnout may help to decrease rates of turnover, health care organizations and policymakers concerned about employee turnover in primary care need to understand the multifactorial causes of turnover to develop effective retention strategies for clinicians and staff.

The full article can be downloaded below.  

Smartwatches Are Changing the Purpose of the EKG

Think of the stereotypical representations of medicine, as they might appear on a television show: the crisp white coat, of course, and the stethoscope dangling at the ready. Syringes and intravenous lines, maybe. An X-ray or CT scan slammed theatrically into a light box.

But any medical scene is incomplete without an electrocardiogram (EKG) machine running in the background, its jagged line tracing across the screen reassuringly, or alarming to cue a dramatic threat. The EKG is the backbeat of many hospital scenes on television. Important medical things are happening here, it says.

To tap into that potent association, many private medical practices, urgent care clinics, community hospitals, technology companies, and health-care product designers use EKG imagery in their advertising. Most of those images bear little resemblance to actual EKG tracings. The spikes and bumps generated for signs or emblems (like the logo of the daytime talk show The Doctors, for example) mostly amount to arbitrary peaks and valleys. They do not reflect the output of a human heart, healthy or diseased.

But accuracy might be less important than allegory. Like the white coat or the caduceus, the EKG has become talismanic, more valuable for the symbolism it provides than any diagnostic information it can convey. Now that EKGs are making their way into smartwatches, their symbolic purpose could risk overtaking their medical one.

The full Atlantic article can be viewed at this link.  

Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning.

The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners’ knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs.

A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (standardized mean difference [SMD]=0.43, 95% CI 0.05-0.80, N=11 studies, low-quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD=0.20, 95% CI –0.47 to 0.86, N=6 studies, low-quality evidence). A total of 14 studies assessed skills (n=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD=1.12, 95% CI 0.56-1.69, N=5 studies, moderate quality evidence) and blended learning (SMD=1.06, 95% CI 0.09-2.03, N=7 studies, low-quality evidence) over traditional learning for skills. A total of 5 and 4 studies assessed attitudes (n=440) and satisfaction (n=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as high in 16 studies.

The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Although acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professions education using mobile devices in order to help tackle the global shortage of health professionals.

The full article can be downloaded below.  

Implementing Blockchains for Efficient Health Care: Systematic Review

The storage and sharing of medical data (developing interoperability) are vital for improved health outcomes. Respecting privacy of sensitive information while doing this remains a big challenge in health care. The literature shows that with the appropriate regulatory guidelines and use standards, blockchain can act as a vehicle to manage consented access to EHRs. This will increase interoperability without compromising security, while also protecting patient privacy. These issues would most effectively be tackled by the use of a private or consortium-led blockchain; however, this would need to be regulated to ensure appropriate use of data. The improved interoperability and reduced long-term administrative costs would lead to improved health outcomes.

Blockchain represents a new form of technology in which the current literature is lacking in this application context, and no usage feedback or statistical comparisons with traditional systems exist. There are costs associated with transferring to a new system, and in educating health professionals and patients on how best to take advantage of it for improved health. Blockchain involves concepts unfamiliar to the vast majority of the population, such as cryptographic signature and key management. Investments into new systems would, however, be outweighed through returns. In the primary stages of implementation, the practical usefulness of the proposed system will likely depend on the end-user experience—the complexities underlying the blockchain will need to be hidden behind a sufficiently user-friendly interface such as an online or mobile app to be adopted successfully. Short-term trials will outline the most effective ways to implement such a user-friendly experience, which may be expanded thereafter.

The full article can be downloaded below.