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Lights on network, software affiliated with Cerner obtains data for frequent alarms and evaluates users use of EHR. It uses analytics to find providers with alert fatigue to find areas that have room for improvement.

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Lights On Network can help with alert fatigue

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Lights on Software link for more information

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Lights on Software link for more information

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Light's on Software from Cerner, identifies areas where there is room for improvement.

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Transforming data into knowledge and action

Lights On Network ® provides enterprise-level data analytics to maximize the value of your EHR across your entire organization. This means a better experience for your providers, better results for your organization, and the most efficient system to support it all.

We provide this analytical cloud-based solution free of charge as part of an ongoing commitment to our clients and the improvement of health care in communities around the world. No other vendor in the marketplace provides this level of knowledge sharing across clients to facilitate long-lasting partnerships.

It's hard to achieve value-driven results without transparency to adoption, performance, security, system infrastructure, and solution usage. Lights On Network ® helps you achieve a better experience for your providers, maximize the impact of your Cerner solutions, and improve marketplace competitiveness with prescriptive recommendations.

Workforce Experience

Providers are the front line of patient care, and should have an EHR that meets their needs in an efficient manner. Lights On Network ® has the power to transform the EHR experience by pinpointing providers needing assistance, enabling them to spend more time with their patients.

Optimized Solutions and Systems

No health care organization is immune to system slowness or inadequate solution configuration. Lights On Network ® strengthens the foundation of your EHR experience by identifying system bottlenecks and deviations from recommended best practices.

Organizational Value

Your investment in an EHR should yield optimal financial, workforce, and value outcomes. Lights On Network ® provides key performance indicators that help you target the right value or opportunity at the right time.

Features and Capabilities

All data has a story to tell, but often lacks context. Local and national benchmarking allows you to baseline your analysis with other Cerner clients around the globe.

We live in a fast-paced environment and it's tough to keep tabs on everything. Leverage alerting and emailing capabilities to stay connected with your data while on the go.

Your organization is complex, but your data doesn't have to be. Several dimensions of data such as facility, venue of care, role, specialty, and time are available to provide the right information at the right level.

Make your data work for you. Customizable features like saving your favorite reports and setting automatic notifications help keep you in control.

When issues arise, you need answers at your fingertips. Near real-time views help you analyze, take action, and resolve problems before they become large-scale.

Some decisions can't wait for normal business hours. Securely connect to your data from any computer, tablet, or smart phone using a flexible web-based application.

"We used tools like Lights On Network ® data to be able to see what their current usage time was, what their current CPOE was, how much time they were spending documenting." Amanda Logue, CMIO Lafayette General Health

"The Lights On Network ® is very exciting because it gets us the data to see well, have we made a difference, so we can set goals, we can meet those goals and know that we really are impacting care." Cynthia Mensendick, RN; CNIO Genesis Health System

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Related Offerings

Lights On Network ® is an integral part of the comprehensive platform of Analytics solutions offered by Cerner to track your financial, workforce, and outcome-related value.

Population Health

Align Lights On Network ® EHR and Population data into your comprehensive data analytics strategy.

Integrate a full data-driven analytics approach to managing your Revenue Cycle program to make impactful revenue decisions each and every day.

FAQ

Organizations that use Lights On Network have faster response times, higher alignment to Model Experience, and better alignment to system best practices.

Lights On Network ® has information in multiple categories including: system and network performance, user interactions, best practice configurations, and more.

You fully control who in your organization can access the solution, with no limits on the number of people who have access.

A variety of free training opportunities are offered, including user guides, instructional videos, and a Web Based Training course to help you get the most from the solution.

Cerner also offers 2 day workshop courses for complete instructor-led training. Contact us for additional information and pricing.

Applicable Roles

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Lights On Network ® provides enterprise-level data analytics to maximize the value of your EHR across your entire organization. This means a better experience for your providers, better results for your organization, and the most efficient system to support it all.

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Model for change: Alarm Fatigue (BMC 2014)

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Model for change: Alarm Fatigue (BMC 2014)

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2014 - learned to adjust manufacturers defaults. Dropping from 87,823 alarms to 9,967.

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Boston hospital alarm fatigue technique held up as national model

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1. Accuracy and Precision

2. Legitimacy and Validity

3. Reliability and Consistency

4. Timeliness and Relevance

5. Completeness and Comprehensiveness

6. Availability and Accessibility

7. Granularity and Uniqueness

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While many organizations boast of having good data or improving the quality of their data, the real challenge is defining what those qualities represent. What some consider good quality others might view as poor. Judging the quality of data requires an examination of its characteristics and then weighing those characteristics according to what is most important to the organization and the application(s) for which they are being used.

The seven characteristics that define data quality are:

1. Accuracy and Precision

2. Legitimacy and Validity

3. Reliability and Consistency

4. Timeliness and Relevance

5. Completeness and Comprehensiveness

6. Availability and Accessibility

7. Granularity and Uniqueness

Accuracy and Precision: This characteristic refers to the exactness of the data. It cannot have any erroneous elements and must convey the correct message without being misleading. This accuracy and precision have a component that relates to its intended use. Without understanding how the data will be consumed, ensuring accuracy and precision could be off-target or more costly than necessary. For example, accuracy in healthcare might be more important than in another industry (which is to say, inaccurate data in healthcare could have more serious consequences) and, therefore, justifiably worth higher levels of investment.

Legitimacy and Validity: Requirements governing data set the boundaries of this characteristic. For example, on surveys, items such as gender, ethnicity, and nationality are typically limited to a set of options and open answers are not permitted. Any answers other than these would not be considered valid or legitimate based on the survey's requirement. This is the case for most data and must be carefully considered when determining its quality. The people in each department in an organization understand what data is valid or not to them, so the requirements must be leveraged when evaluating data quality.

Reliability and Consistency: Many systems in today's environments use and/or collect the same source data. Regardless of what source collected the data or where it resides, it cannot contradict a value residing in a different source or collected by a different system. There must be a stable and steady mechanism that collects and stores the data without contradiction or unwarranted variance.

Timeliness and Relevance: There must be a valid reason to collect the data to justify the effort required, which also means it has to be collected at the right moment in time. Data collected too soon or too late could misrepresent a situation and drive inaccurate decisions.

Completeness and Comprehensiveness: Incomplete data is as dangerous as inaccurate data. Gaps in data collection lead to a partial view of the overall picture to be displayed. Without a complete picture of how operations are running, uninformed actions will occur. It's important to understand the complete set of requirements that constitute a comprehensive set of data to determine whether or not the requirements are being fulfilled.

Availability and Accessibility: This characteristic can be tricky at times due to legal and regulatory constraints. Regardless of the challenge, though, individuals need the right level of access to the data in order to perform their jobs. This presumes that the data exists and is available for access to be granted.

Granularity and Uniqueness: The level of detail at which data is collected is important, because confusion and inaccurate decisions can otherwise occur. Aggregated, summarized and manipulated collections of data could offer a different meaning than the data implied at a lower level. An appropriate level of granularity must be defined to provide sufficient uniqueness and distinctive properties to become visible. This is a requirement for operations to function effectively.

There are many elements that determine data quality, and each can be prioritized differently by different organizations. The prioritization could change depending on the stage of growth of an organization or even its current business cycle. The key is to remember you must define what is most important for your organization when evaluating data. Then, use these characteristics to define the criteria for high-quality, accurate data. Once defined, you can be assured of a better understanding and are better positioned to achieve your goals.

Blazent's data quality tools provide a stable and steady mechanism that collects from multiple sources, fills gaps and intelligently reconciles conflicting values to improve IT management. You can learn more by downloading the white paper, "Data-powered IT Service Management," here.

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Dan Ortega, Vice President Marketing, Blazent Inc.

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Seven Characteristics That Define Quality Data

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While many organizations boast of having good data or improving the quality of their data, the real challenge is defining what those qualities represent. What some consider good quality others might view as poor. Judging the quality of data requires an examination of its characteristics and then weighing those characteristics according to what is most [...]

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EHR's can help with quality measurement reporting

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EHR's can help with quality measurement reporting

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How Can Certified EHR Technology Help with Quality Measurement Reporting?

Certified EHR technology supports your MIPS participation in two ways:

1. It may reduce your workload.

Instead of your having to manually extract information from your patient health records and then calculate information for your reports, your certified health information technology (health IT) software may be able to automate data capture and calculation to generate the reports you need.

2. It may help you earn an electronic reporting bonus.

Using a certified EHR technology to capture and report on your clinical data (whether you do so directly through your EHR or through an intermediary such as a clinical data registry), you may earn bonus points on top of your performance score. This may positively impact your overall MIPS payment.

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Under MIPS, you can earn a bonus in the Quality performance category for end-to-end electronic reporting of clinical quality measures. The goal is to incentivize the automated capture and reporting of quality data throughout the health care industry.

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Healthcare technology can have it's own problems

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Healthcare technology can have it's own problems

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This is an article focused on emergency departments and the number of HIT related errors that occur in it. One physician's solution to HIT errors is to establish a multidisciplinary performance improvement group to review the information system and problems that occur and find solutions

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Relias Media | Online Continuing Medical Education | Relias Media - Continuing Medical Education Publishing

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It's no secret that for all of the efficiencies that health information technology (HIT) brings to the table, there are also immense challenges that go along with safely using tools that, in many cases, alter workflow, documentation, and the way providers interact with patients. Of particular concern is the potential for patient harm that can result when systems are poorly designed or implemented, raising the possibility that information will be miscommunicated or entered incorrectly.

Indeed, in an analysis of 3,375 sentinel events that resulted in permanent patient harm or death between January 1, 2010, and June 20, 2013, The Joint Commission (TJC) found 120 events that included HIT-related contributing factors. For this reason, TJC has issued a Sentinel Event Alert, urging healthcare providers to take steps to improve their safety culture, approach to process improvement, and leadership in ways that will effectively address the risks posed by the rapid entry of new HIT tools into the healthcare setting.

While TJC has sounded the alarm about HIT before, this latest alert focuses particularly on the risks posed by sociotechnical factors. Experts agree that while these types of issues are complex, the need for new solutions is clear. "The technology is only as good as the processes and people that you have to implement it," notes Shaun Grannis, MD, MS, the associate director of the Regenstrief Center for Biomedical Informatics in Indianapolis. "I do think the sociotechnical factors are a substantial portion of the issues we need to face here."

The ED is hardly immune to these issues. In fact, the emergency environment is brimming with opportunities for HIT-related errors to occur, according to Drew Fuller, MD, MPH, FACEP, the director of safety innovation for Emergency Medicine Associates in Germantown, MD. "If we thought about the factors that contribute to errors in the environment in healthcare, they are exemplified at a higher level in emergency care on a daily basis," he says. "In the ED, we have to multi-task. I have 10 patients at one time, and I have to manage all of their care at the same time, and there is no other way to do it."

Fuller adds that production pressures are higher in the ED than in other settings, and there are competitive pressures as well. "Everybody wants to be the best ED group or the best ED, and there is more and more pressure to move patients [through] faster," he says.

Further, whereas most specialists take care of a very thin and selective slice of the healthcare burden, Fuller observes that the ED takes care of it all, "from the newborn who is struggling to breathe to the 90-year-old who is having sudden stroke symptoms to the 45-year-old with chest pain," he says. "[Emergency providers] take care of all patients no matter what age, no matter what conditions; they have to cover like 24 different specialties, and this in addition to the noise, chaos, and other factors that play a role."

For all of these reasons, Fuller notes that even some of the best-run EDs in the country are at highest risk for factors that can lead to lapses in communication, cognitive errors, oversights, and any lapses that can lead to harmful events.

Many of the problems cited by TJC in the Sentinel Event Alert relate to orders or medicines being prescribed for the wrong patients. These can result from toggling errors or pop-up screens where providers are asked to click on the appropriate patient or medicine, and they mistakenly click on the wrong selection.

Other problems can result from poor data displays - an issue that is probably as challenging as it has ever been, notes Fuller, who reported on this and other HIT-related problems in a 2013 article. ¹ "I used to be able to look at a paper chart and know in a very short period of time what was going on with a patient because everything was very succinct and clean and there wasn't a lot of text that got repeated," he explains. "What used to be a two- or three-page chart has become a 10- or 15-page or even a 20-page chart that we have to scroll and scroll and scroll through." The sheer volume of text makes it harder for abnormal findings to stand out, he adds.

However, Fuller acknowledges that EMRs do offer a lot of value in certain, select areas - especially retrospective value, when clinicians are trying to look back and see what was done on a patient hours, days, or weeks earlier. "They have a lot of value there, but in real time, [EMRs] sometimes make it harder for us to communicate between teams," he says.

To make such systems work better, it is important to acknowledge that EMRs are difficult to use and that they can increase communication barriers, says Fuller. "There need to be additional pathways formalized in which the physicians and the nurses can communicate," he says.

For example, in his own workplace at Calvert Memorial Hospital in Prince Frederick, MD, clinical leaders are starting to mandate that physicians seek out the nurse and share the plan of care with him or her after they see a patient, or share key information regarding transitions of care, explains Fuller. "The reason why it is ... important to make those policies within your department now is because the EMR is so consuming that it has put up a wall between the physicians and the nurses. If you go into an ED now you see a bunch of people with their faces stuck in a computer," he explains. "We think having a code of expectations where we can make communication more formalized is going to help with that."

Grannis notes that one of the challenges he has faced as an informatician is that he has to bridge multiple cultures. "I bridge the technical, I bridge the process, and I bridge the clinical, and often those are different skill sets within an organization," he says. "All of those people who don't talk or collaborate as much as they potentially need to now come together and realize, gosh, the IT folks aren't just doing scheduling and billing for us anymore. They're actually supporting systems that impact patient care and we need to understand that."

Similarly, the workflow people who are setting up processes for care and medication delivery need to be communicating with the IT people. "It has to be collaborative, and I think that is a fundamental point that I bring away from this," adds Grannis. "Often I think with health IT there is almost this mistaken assumption that it is all about the technology, when, in fact, I think it is all about the humans who implement, manage, and use that technology."

In the ED specifically, Fuller recommends the establishment of a multidisciplinary performance improvement group to continuously monitor the ED information system (EDIS), recognize problems, and work with the vendor to resolve them. "We have a core physician champion, nursing leadership, and IT people working together with the vendor to make modifications in the system to help make it work better with the workflow," he says.

There is also a mechanism in place by which IT problems can be quickly and easily reported. "My hospital has a phone line where you can actually leave a voice message to the nurse champion who actually does the modifications," notes Fuller. "It doesn't mean that every concern is easily addressed, but the point is it needs to be quick and it needs to be easy because we know physicians won't use formalized electronic reporting systems. There is just natural resistance to that."

Robert Wears, MD, MS, PhD, FACEP, a professor in the Department of Emergency Medicine at the University of Florida (UF) Health Science Center in Jacksonville, and a core faculty member for the fellowship in patient safety and quality at UF, recommends that hospitals and EDs arrange for usability assessments before making purchasing decisions about health IT. "This involves more than just showing a system to users and asking them if they like it. There is a formal engineering process that you can go through to look at the usability of systems," he explains. "The problem is that the people with the skills to do this are not real common."

Also, Wears advises ED directors to press their hospital administrations hard for a commitment to rapid cycle change. "When [new IT systems] go into place that haven't been well-designed, that is when all kinds of problems are going to pop up right off the bat," he explains. "The last thing you want is the organization saying that it is because you aren't trained very well. What [administrators] should be saying is they will fix that for you right away, so if they will commit to doing [rapid cycle change], then I think you can get rid of the worst [IT-related problems] right away."

Many of the IT-related issues that crop up are minor, but when they create obstacles for staff, the issues can turn into bigger problems, says Wears. "Fixing things like this very quickly without a lot of running around is a very important way of getting people to support the system," he says.

For instance, Wears notes that the IT system used by the Veterans Administration is old and clunky, but a lot of people like it because it is home-grown. "They actually have an office of software safety, so when an issue comes up, they don't get all this finger-pointing," he says.

In fact, Wears suggests that one of the biggest problems with the software systems now in place at most hospitals is that they are not required to have any sort of safety assessment. "That is astounding when you think about it," he says. "You can't write a program for flight management software and install it on airliners without having a safety assessment of the program that is approved by the FAA [Federal Aviation Administration], so that is one of the fundamental things that needs to be changed [in healthcare]."

An added challenge is that many software vendor contracts have clauses that spare them from any financial responsibility when design problems lead to adverse consequences, explains Fuller. Some contracts even prevent clinicians from publically pointing out or discussing software problems that have been identified in specific programs, he says. "The auto industry doesn't have these rights, so we have asked that those [provisions] not be part of clauses [in software contracts]," says Fuller.

While the convergence of so many different types of health IT has created a complex landscape, there are a number of tools that healthcare administrators can leverage to help them monitor the systems they have in place and identify opportunities for quality improvement. For example, TJC recommends that hospitals make use of the Safer Guides for EHRs, offered by the Office of the National Coordinator for Health Information Technology (www.healthit.gov/safer/safer-guides).

"I think [the Safer Guides] provide a great framework for thinking through a number of these issues, from technical things like system interfaces to system configuration, patient identification, and workflow-related issues like clinician communication and processes for monitoring and follow-up," notes Grannis. "[The Joint Commission's] Sentinel Event Alert evaluation form also provides some very clear areas to be addressed." (www.jointcommission.org/safe_health_it.aspx)

Grannis explains that while most of these documents provide strategic bullet points, they still need added details to be filled out underneath, and these will vary depending on the complex business practices and workflows of each individual organization. "This is an emerging space," he says. "I think we will get better at identifying the kinds of patterns that lead to both good and not so good, or suboptimal, outcomes, and we have to recognize those patterns quickly and address them but, again, we are talking about very complex interactions among multiple stakeholders. The frameworks that have been put out there will help us begin to do a better job of that, but I think we have an opportunity to improve."

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TJC: HCOs need to be on alert for HIT problems related to...

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It's no secret that for all of the efficiencies that health information technology (HIT) brings to the table, there are also immense challenges that go along with safely using tools that, in many cases, alter workflow, documentation, and the way providers interact with patients. Of particular...

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First FDA approved video game to treat ADHD. The target age group is 8-12 years old. It was developed by neuroscientists and game specialists. "Kids are challenged to multitask and ignore distractions by navigating courses, collecting targets, and avoiding obstacles". The treatment length: 25minutes a day, 5 days a week, for at least 4 weeks. The site does specifically state that the app is not a substitute for medication.

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1623772151

EndeavorRx®: The first-and-only FDA-cleared treatment delivered through a video game experience
EndeavorRx is available in 3-month treatment periods, during which your child will use the treatment as prescribed by a healthcare professional.

The EndeavorRx app is a digital treatment indicated to improve attention function as measured by computer-based testing in children ages 8-12 years old with primarily inattentive or combined-type ADHD who have a demonstrated attention issue and should be considered for use as part of a therapeutic program.

EndeavorRx is an FDA-cleared medical device and must be prescribed by a healthcare professional. It is not intended as a stand-alone therapeutic, nor is it a substitute for your child's medication.

Watch: EndeavorRx Gameplay Trailer

Getting Started with EndeavorRx

01: Consult

Contact your child's healthcare professional to discuss EndeavorRx. EndeavorRx is a new prescription video game treatment, and your child's healthcare professional may not be familiar with it. To help start the conversation, download, review, and take the discussion guide to your next appointment.

02: Confirm

EndeavorRx is available through our pharmacy partner, Phil. If your child's healthcare professional decides EndeavorRx is appropriate, they can send the prescription to Phil pharmacy.
Less than $100/month for a 3-month prescription.
EndeavorRx may be covered by your health insurance and we're actively working to improve coverage. If your health insurance doesn't cover EndeavorRx, a discount will be automatically applied to all prescriptions through our online pharmacy partner, reducing the regular price of $450 to less than $300 for a 3-month prescription. A Patient Assistance Program is available for those that qualify for free access to treatment.

Contact Phil pharmacy for more coverage and pricing details. Call 855-977-0975 or visit phil.us/contact.

Once the prescription is submitted, look out for a text message from Phil pharmacy with a confirmation link to start your order. Phil can't fill your Rx without this step!

Once enrolled, you'll get a text with a link to confirm payment.

03: Activate

Let the games begin! After payment receipt, you'll receive a pharmacy-issued activation code via text and email. You can download the EndeavorRx app from the Apple App Store and apply the activation code to begin treatment. Be sure to check out Treatment Tips for additional information on getting started.

Interested in a refill? Subsequent refills will be billed and dispensed by Phil pharmacy, on schedule and automatically.
To stay up to date with EndeavorRx, join our email list Please see our Privacy Notice for EndeavorRx for details on how we safeguard, process, and use your information.

Stay up to date with EndeavorRx

Curious about EndeavorRx and wondering if it's right for your child? Just complete this form to get more information & receive our latest updates. Please note that all fields are required in order to submit your form.

Daily Treatment

Experienced through an immersive and challenging digital therapy on an Apple iOS mobile device

Personalized Experience

Proprietary and patented technology adapts real-time and between treatment sessions to your child's level, continuously challenging and encouraging them to improve their performance

Entirely New Option

Prescribed by your child's healthcare professional and used alongside your current treatment plan

At Akili, we understand the impact of inattention on children and families. To help address this problem, our team of world-class neuroscientists and video game designers collaborated to strive to improve attention in a truly unique way.

How does EndeavorRx work?

Evaluated in over 600 children with ADHD across 5 clinical studies ¹, the EndeavorRx treatment uses sensory stimuli and simultaneous motor challenges designed to target areas of the brain that play a key role in attention function.

When using EndeavorRx, the goal is for your child to successfully navigate their character through a course while collecting targets and avoiding bumping into obstacles. These actions require focus and flexibility to manage multiple tasks at the same time.

In a controlled clinical trial, EndeavorRx demonstrated a significant improvement in a computer-based measure of attention (TOVA® API) compared to a digital control word game.

In our randomized, controlled clinical study, EndeavorRx improved objective attention in children with ADHD ages 8-12. In addition, 48% of parents indicated that EndeavorRx improved ADHD-related day-to-day impairment and 56% of parents indicated the treatment improved their child's attention. ²

In an open-label study, 68% of parents reported improvement in ADHD-related impairments after a second month of EndeavorRx. In addition, up to one third of children had a clinically meaningful change in ADHD symptoms after one month of treatment with EndeavorRx; this increased to 45% after a second month of treatment. These effects were similar whether children were on or off ADHD medication. ³

There were no serious adverse events seen in any clinical trials of EndeavorRx. Of 538 participants using EndeavorRx in clinical trials, 50 participants (9.3%) experienced treatment-related adverse events. EndeavorRx associated adverse events included frustration (6.1%), headache (1.3%), dizziness (0.6%), emotional reaction (0.4%), nausea (0.4%), and aggression (0.2%).

Watch: How EndeavorRx Works

¹ STARS-ADHD Pivotal Study: Kollins et al, Lancet Digital Health, 2020. Kollins et al, npj digital medicine, 2021. Proof of concept study: Davis et al, PLOS One, 2018. Pilot studies: Anguera et al., PLOS One, 2017. Yerys et al., J Autism Dev Disord, 2019

² STARS-ADHD Pivotal Study: Kollins et al, npj digital medicine 2021.

³ Kollins et al, npj digital medicine, 2021.

What's treatment like?

It's important to know that EndeavorRx might feel repetitive and challenging for some children at times, and it takes commitment from you and your child to see results. Although there are exciting rewards and motivational elements designed into the treatment, you should expect tough moments on the path to improving your child's attention. But, making this part of your family's routine can help. Remember: you and your child can do this, and we're here to help.

Here are some treatment tips to help guide you and your child through the EndeavorRx experience.

How and when should EndeavorRx be considered for use

EndeavorRx should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of ADHD. EndeavorRx is not intended to be used as a stand-alone therapeutic and is not a substitute for your child's ADHD medication.

You should contact your child's healthcare professional and review the important indications, safety and cautions information in the Instructions for Use before using the EndeavorRx treatment.

What patients and caregivers have to say about EndeavorRx...

The views and opinions expressed in these videos are unique to the parents featured and not necessarily representative of Akili's views.

Adam & Ash's Story

Emily & Brittany's Story

Kate, Kara & Trey's Story

Interested in trying a demo of EndeavorRx before obtaining a prescription?

In the 5-minute demo, you can expect your character to navigate through 'Planet Frigidus,' and tap and steer in order to progress and earn rewards. This demo should provide you with a better understanding of the EndeavorRx gameplay mechanics and overall experience. The demo is for look and feel only, and does not contain any therapeutic benefit. It should not be used as a substitute for the actual EndeavorRx treatment.

Use this guide to start a conversation with your child's healthcare professional about EndeavorRx

Tracking and monitoring your child's ADHD is now at your fingertips.

Designed with you and your child at the forefront, we created the ADHD Insight™ app to empower you to better understand your child's ADHD. In just a few minutes a day, you can keep track of the ups and downs and celebrate the little wins.

Getting Started with EndeavorRx

01: Consult

Contact your child's healthcare professional to discuss EndeavorRx. EndeavorRx is a new prescription video game treatment, and your child's healthcare professional may not be familiar with it. To help start the conversation, download, review, and take the discussion guide to your next appointment.

02: Confirm

EndeavorRx is available through our pharmacy partner, Phil. If your child's healthcare professional decides EndeavorRx is appropriate, they can send the prescription to Phil pharmacy.
Less than $100/month for a 3-month prescription.
EndeavorRx may be covered by your health insurance and we're actively working to improve coverage. If your health insurance doesn't cover EndeavorRx, a discount will be automatically applied to all prescriptions through our online pharmacy partner, reducing the regular price of $450 to less than $300 for a 3-month prescription. A Patient Assistance Program is available for those that qualify for free access to treatment.

Contact Phil pharmacy for more coverage and pricing details. Call 855-977-0975 or visit phil.us/contact.

Once the prescription is submitted, look out for a text message from Phil pharmacy with a confirmation link to start your order. Phil can't fill your Rx without this step!

Once enrolled, you'll get a text with a link to confirm payment.

03: Activate

Let the games begin! After payment receipt, you'll receive a pharmacy-issued activation code via text and email. You can download the EndeavorRx app from the Apple App Store and apply the activation code to begin treatment. Be sure to check out Treatment Tips for additional information on getting started.

Interested in a refill? Subsequent refills will be billed and dispensed by Phil pharmacy, on schedule and automatically.
To stay up to date with EndeavorRx, join our email list Please see our Privacy Notice for EndeavorRx for details on how we safeguard, process, and use your information.

EndeavorRx: Indications, Safety and Cautions

Indications for Use:
EndeavorRx is a digital therapeutic indicated to improve attention function as measured by computer-based testing in children ages 8-12 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue. Patients who engage with EndeavorRx demonstrate improvements in a digitally assessed measure, Test of Variables of Attention (TOVA®), of sustained and selective attention and may not display benefits in typical behavioral symptoms, such as hyperactivity. EndeavorRx should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder.

Cautions:
Rx only: Federal law restricts this device to sale by or on the order of a physician. EndeavorRx should only be used by the patient for whom the prescription was written. For medical questions, please contact your child's healthcare provider. If you are experiencing a medical emergency, please dial 911. EndeavorRx is not intended to be used as a stand-alone therapeutic and is not a substitution for your child's medication.

If your child experiences frustration, emotional reaction, dizziness, nausea, headache, eye-strain, or joint pain while playing EndeavorRx pause the treatment. If the problem persists contact your child's healthcare provider. If your child experiences a seizure stop the treatment and contact your child's healthcare provider.

EndeavorRx may not be appropriate for patients with photo-sensitive epilepsy, color blindness, or physical limitations that restrict use of a mobile device; parents should consult with their child's healthcare provider.

Please follow all of your mobile device manufacturer's instructions for the safe operation of your mobile device. For example, this may include appropriate volume settings, proper battery charging, not operating the device if damaged, and proper device disposal. Contact your mobile device manufacturer for any questions or concerns that pertain to your device.

Safety:
Of 538 participants using EndeavorRx, 50 participants (9.3%) experienced treatment-related adverse events (probable, likely), and three participants experienced treatment-related adverse events with the digital control, in studies where a control was used. EndeavorRx associated adverse events included frustration (6.1%), headache (1.3%), dizziness (0.6%), emotional reaction (0.4%), nausea (0.4%), and aggression (0.2%). There were no serious adverse events. All adverse events were generally transient. Only 3 events led to device discontinuation, and no subject reported lasting or irreversible effects after discontinuation.

BY

®

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EndeavorRx® - FDA-approved Video Game Treatment for ADHD.

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1623772151 EndeavorRx®: The first-and-only FDA-cleared treatment delivered through a video game experience EndeavorRx is available in 3-month treatment periods, during which your child will use the treatment as prescribed by a healthcare professional.

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Gamification is enhancing systems, experiences and increasing engagement by utilizing aspects of games

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The are a large variety of wearables for adults and children. Many people are now using smart watches. My children all have the Garmin vivo-fit jr that comes with inter-changeable bands. They will watch their steps for the day and compete with each other. The watch syncs with their tablets and they can monitor their progress and win badges.

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I believe when used in the correct situation telehealth can be incredible helpful and useful. Don't forget, a virtual appointment is never the same as an in-person appointment. Seeing and touching patients brings a connection that cannot be met with a virtual session. Virtual sessions with providers you have never met brings a sort of disconnect. It is like going to an urgent care or an emergency department, you will likely see a different provider every time depending on what time of day, or day of the week or facility you are going to. Then again what can be dialing in to a provider to get an immediate appointment right from home when your kids are sick or you have a headache and you don't want to get into the care and drive 15 minutes across town. I think telehealth can be a great thing, but when used properly and when programs are aware of their limits and know when to refer patients for in person visits.

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An editoral article regarding pros and cons of telehealth

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An editoral article regarding pros and cons of telehealth

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A series of columns addressing the challenges consumers face in California's health care landscape.

Send questions to bwolfson@kff.org.

As COVID-19 took hold in March, U.S. doctors limited in-person appointments - and many patients avoided them - for fear of infection. The result was a huge increase in the volume of remote medical and behavioral health visits.

Doctors, hospitals and mental health providers across the country reported a 50- to 175-fold rise in the number of virtual visits, according to a report released in May by the consulting firm McKinsey & Co.

The COVID-fueled surge has tapered off as patients venture back to doctors' offices. But medical professionals and health experts predict that when the pandemic is over, telehealth will still play a much larger role than before.

Studies show patient satisfaction with telehealth is high. And for physicians who previously were skeptical of remote care, necessity has been the mother of invention.

"There are still a few doubting Thomases, but now that we've run our practices this way for three months, people have learned that it's pretty useful," says Dr. Joseph Kvedar, president of the American Telemedicine Association and a practicing dermatologist who teaches at Harvard Medical School in Boston.

For patients, the advantages of telemedicine are clear: You typically can get an appointment sooner, in the safety of your own home or workplace, saving time and money on gas and parking - in some cases, even avoiding a loss in wages for missing work.

James Wolfrom, a 69-year-old retired postal executive in San Francisco, has had mostly virtual health care appointments since the pandemic started. He particularly appreciates the video visits.

"It's just like I'm in the room with the doctor, with all of the benefits and none of the disadvantages of having to haul my body over to the facility," says Wolfrom, who has Type 2 diabetes. "Even after the pandemic, I'm going to prefer doing the video conferencing over having to go there."

Telemedicine also provides care for people in rural areas who live far from medical facilities.

The growth of virtual care has been facilitated by Medicare rule changes for the COVID-19 emergency, including one that reimburses doctors for telemedicine at the same rate as in-person care for an expanded list of services. State regulators and commercial health plans also loosened their telehealth policies.

In California, the Department of Managed Health Care, which regulates health plans covering the vast majority of the state's insured residents, requires commercial plans and most Medi-Cal managed care plans during the pandemic to pay providers for telehealth at parity with regular appointments and limit cost sharing by patients to no more than what they would pay for in-person visits. Starting Jan. 1, a state law - AB-744 - will make that permanent for commercial plans.

Five other states - Delaware, Georgia, Hawaii, Minnesota and New Mexico - have pay-parity laws already in effect, according to Mei Wa Kwong, executive director of the Center for Connected Health Policy. Washington state has one that also will begin Jan. 1.

If you are planning a telehealth appointment, be sure to ask your health plan if it is covered and how much the copay or coinsurance will be. The appointment may be through your in-network provider or a telehealth company your insurer contracts with, such as Teladoc, Doctor On Demand or MD Live.

You can also contact one of those companies directly for a medical consultation if you don't have insurance, and pay between $75 and $82 for a regular doctor visit.

If you are one of the 13 million Californians enrolled in Medi-Cal, the state's Medicaid program, you can get telehealth services at little to no cost.

Large medical offices and health systems usually have their own telemedicine platforms. In other cases, your provider may use a publicly available platform such as FaceTime, Skype or Zoom. Either way, you will need access to a laptop, tablet or smartphone - though, for a phone conversation, a landline or simple cellphone will suffice.

Smartphones with good cameras can be particularly useful in telemedicine because high-resolution photos can help doctors see certain medical problems more clearly. For example, a photo from a good smartphone camera usually provides enough detail for a dermatologist to determine whether a mole requires further attention, Kvedar said.

Relatively inexpensive apps and at-home tools enable you to measure your own blood pressure, pulse rate, oxygen saturation level and blood sugar. It's a good idea to monitor your vitals and have the numbers ready before you start a virtual visit.

Be aware that a remote visit is not right for every situation. In the case of serious injury, severe chest pain or a drug overdose, for example, you should call 911 or get to the ER as quickly as possible.

Virtual visits also are not recommended in other cases for which the doctor needs to lay hands on you.

Wolfrom has had only a few in-person health visits this year, one of them with a podiatrist who checks his feet every six to 12 months for diabetes-related neuropathy. "That can only be done when you are in the room and the podiatrist is touching and feeling your feet," Wolfrom says.

Face-to-face visits are generally better for young children. Kids often require vaccinations, and it's easier for doctors to monitor their growth and development in person, says Dr. Dan Vostrejs, a pediatrician at Santa Clara Valley Medical Center in San Jose.

In general, telemedicine is effective in cases that would typically send you to an urgent care clinic, such as minor injuries or flu-like symptoms, including fever, cough and sore throat.

It is also increasingly used for post-surgical follow-ups. Telemedicine can be a godsend for geriatric or disabled patients with reduced mobility. And it's a no-brainer for mental health care, which is mostly talking anyway.

Among the top telehealth adopters are medical specialists who treat chronic illnesses such as diabetes, hypertension, cardiovascular disease and asthma, says Dr. Peter Alperin, a San Francisco internist and vice president of product at Doximity, a kind of LinkedIn for medical professionals.

Providers can monitor patients' vitals remotely and discuss lab results, diet, medications and any symptoms in a video chat or a phone conversation. "If you happen to see something that's awry, you can bring them into your office," Alperin says, adding it's "a better form of triage."

But telemedicine has some serious disadvantages. For one thing, the less formal setting can allow some routine medical practices to slip through the cracks.

In the second quarter of this year, blood pressure was recorded in 70% of doctor office visits compared with about 10% of telemedicine visits, according to a study published early this month.

Elsa Pearson, a resident of Dedham, Massachusetts, had a medical appointment scheduled in March, which was switched to a telephone call because of the pandemic-induced lockdown.

"It was honestly the most efficient appointment I've had in my life," says Pearson, 30. But, "I must admit, without the push of having the labs right there when you leave the appointment, I've yet to get them done."

Perhaps the biggest pitfall in telehealth is the loss of a more intimate and valuable doctor-patient relationship.

In a recent essay, Dr. Paul Hyman, a Maine physician, reflected on the times when an unexpected discovery during an in-person examination had possibly saved a patient's life: "A discovery of an irregular mole, a soft tissue mass, or a new murmur - I do not forget these cases, and I do not think the patients do either."

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Telemedicine or In-Person Visit? Pros and Cons

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A series of columns addressing the challenges consumers face in California's health care landscape. Send questions to bwolfson@kff.org. As COVID-19 took hold in March, U.S. doctors limited in-person appointments - and many patients avoided them - for fear of infection. The result was a huge increase in the volume of remote medical and behavioral health visits.

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One application not covered in lecture includes amazon's new business venture, amazon health. A telehealth site that not only allows for video appointments, but allows for chats via text post appointments for additional follow up questions, they can schedule an in-person visit and have their own health portal to access

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About - Convenient Healthcare | Amazon Care

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Amazon Care will connect you and your family with a team of medical experts dedicated to providing Connected Care to meet your unique needs.

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-primary care and specialist referral services
-remote patient monitoring
-consumer medical and health information
-medical education

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Benefits of Health information exchange video

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Benefits of Health information exchange video

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Office of the National Coordinator for Health IT

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Health Information Exchange: Making a Difference

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This is a great description of what is health information exchange, coming directly from the Office of the National Coordinator for Health Information Technology.

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If you ever used your health care systems MAR to open a soon to administered medication to check the link to your facilities drug administration guidelines to ensure correct dosing and administration, or also used that tool to confirm two medications can be administered at the same time? That is a clinical decision tool. Have you ever used your system to screen for a patient feeling safe at home and they answered no? Did a pop up come on your screen to flag you and request to order a social work consult as a result of an electronic algorithm instituted by your facility? That is also a clinical decision support tool that your facility set up to improve quality of care and ensure patient safety

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The goal of clinical decision support is to enhance decision making processes with important clinical knowledge matched with patient information in an organized manner to improve healthcare

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Here is an interesting article outlining 7 common EHR challenges

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At their best, electronic health records (EHRs) give physicians data and tools to care for their patients more efficiently and thoroughly than ever before. But sometimes, EHR design, customization or configuration can contribute to patient harm.

A report from the AMA, Pew Charitable Trusts and Medstar Health, Ways to Improve Electronic Health Record Safety, identifies shortfalls with EHR usability, implementation and testing and outlines how to improve usability and safety across the continuum-from development to the post-implementation of EHRs.

The three organizations reviewed the medical literature and convened an expert panel of physicians, nurses, pharmacists, EHR vendors, patients and health IT experts. As a result of the panel's work, leaders from the three organizations are calling on developers and health care organizations to voluntarily adopt the criteria and asking oversight organizations such as the Joint Commission to drive providers and vendors to incorporate the recommendations and adhere to the best practices throughout an EHR's life cycle.

The criteria include several factors such as safety culture, product design and development, acquisition, customization and configuration, implementation and system upgrades, and training and provides EHR developers and health care providers with specific areas of opportunities for improvement within each EHR life cycle stage. For example, health care providers should "develop clear justification and use cases for why customizations should be made" and "allow clinicians and subject-matter experts to shape usability and safety design and testing."

They also said the Office of the National Coordinator for Health Information Technology can recognize elements of the voluntary certification as alternatives to its current approach.

"Adherence to these recommendations by EHR developers and health care providers can reduce the likelihood of unintended patient harm from clinician use of this technology," the report said.

After analyzing 557 reports that clinicians submitted, researchers identified seven safety and usability challenges physicians should be on the lookout for when they use EHRs in their practice.

Data entry. A clinician's work process may make it hard or impossible to appropriately enter the desired EHR data. One case researchers analyzed showed that a clinician chose the wrong frequency for a drug to be administered because the clinician didn't realize that the order in which the options were populated into the EHR had changed.

Alerting. EHR alerts or other feedback from the system are sometimes inadequate because they are absent, incorrect or ambiguous. For example, a report showed that even though a patient's gelatin allergy was listed in the EHR, a clinician wasn't alerted to the allergy while prescribing a medicine.

Interoperability. Communication of information in an EHR may be hindered because interoperability is inadequate within components of the same EHR or from the EHR to other systems. In one case, clinicians couldn't access labs for a hospital patient from records held in a different part of the hospital.

Visual display. Clinicians may find it hard to interpret information because EHR displays are confusing, cluttered or inaccurate. For example, a clinician tried to order 3.125 mg of a medication, but the EHR listed only a 6.25 mg prescription, with a 3.125 mg dose listed in small print, confusing the clinician.

Availability of information. Clinically relevant information is hindered because it is entered or stored in the wrong location or is otherwise inaccessible in the EHR. For example, a hospital lab staffer couldn't access a section of a patient's health record where the clinician ordered diagnostic tests; consequently, the tests weren't performed.

System automation and defaults. The EHR automates or defaults to information that is unexpected, unpredictable or not transparent to the clinician. For example, a clinician ordering an anticoagulant tried to start the dosing at a set time, but the date automatically defaulted to the following day.

Workflow support. The EHR workflow is not supported due to a mismatch between the EHR and the end user's intent. In one case, a physician ordered diagnostic tests and included instructions for the lab in a special instructions field, not knowing that the lab staff couldn't see that information. Consequently, the tests weren't conducted.

The report recommends that health care providers and EHR developers use safety-based, rigorous test case scenarios that are outlined in the report to detect and correct problems and help avoid patient safety issues similar to those reported above.

An appendix to the report includes 14 cases that tackle the seven usability issues. Each usability issue has a basic scenario that evaluates one aspect of the clinical workflow and an advanced scenario that tests a more detailed aspect of the clinician's workflow, including activities like teamwork and communication with other clinicians.

Physicians and others also can create their own rigorous test cases based on their individual needs. The report says a rigorous test case needs to be representative; contain concrete goals and measures, test areas of risk or inefficiency and define the audience.

For more details on this analysis by researchers at MedStar Health's National Center for Human Factors in Healthcare, read their JAMA study, " Electronic Health Record Usability Issues and Potential Contribution to Patient Harm."

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7 EHR usability, safety challenges-and how to overcome them

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At their best, electronic health records (EHRs) give physicians data and tools to care for their patients more efficiently and thoroughly than ever before. But sometimes, EHR design, customization or configuration can contribute to patient harm.

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Identify key components of electronic health records.

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Identify key components of electronic health records.

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Electronic health records are a specific patient's life-long health record.
It will contain:
-Computerized provider order entry
-electronic medication administration
record
-barcode medication administration
-clinical documentation
They can and may also include specialty services and or ancillary systems such as radiology systems, laboratory systems, pharmacy systems or other systems

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Can you make money or lose money with meaningful use

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Can you make money or lose money with meaningful use

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This video highlights meaningful use and how a provider can be re-imbursed, how much money their practice can make but also how they potentially could lose money in medicaid reimbursements if they do not fulfill all 20 objective requirements of meaningful use

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The HITECH Act: Electronic Health Records and Meaningful Use

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How can providers benefit from meaningful use?

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How can providers benefit from meaningful use?

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Providers can quality for incentive payments through CMS but they must demonstrate meaningful use with their electronic health records

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Meaningful Use

To qualify for incentive payments through the Centers for Medicare & Medicaid Services EHR Incentive Programs, eligible providers and hospitals must demonstrate meaningful use of an electronic health record (EHR). In other words, "meaningful use" sets the specific objectives that eligible professionals and hospitals must achieve to participate in the EHR Incentive Programs.

Stages of Meaningful Use

The meaningful use objectives will evolve in three stages:

Stage 1 (2011-2012): Data capture and sharing

Stage 2 (2014): Advanced clinical processes

Stage 3 (2016): Improved outcomes

For More Information

For more information on meaningful use and how achieving meaningful use can help you improve health care quality and patient outcomes, see the following resources.

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To qualify for incentive payments through the Centers for Medicare & Medicaid Services EHR Incentive Programs, eligible providers and hospitals must demonstrate meaningful use of an electronic health record (EHR).

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To put it simply, meaningful use is uses health informatics in a meaningful way. According to the CDC there are "5 pillars" that support meaningful use.
-ensuring privacy for personal health information
-improve public health
-improve care co-ordination
-engage patients a family
-improve quality, safety, and efficiency, while reducing health disparities

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Big Data In 5 Minutes | What Is Big Data?| Big Data Analytics | Big Data Tutorial | Simplilearn

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Why do we need standard terminology in healthcare informatics?

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Why do we need standard terminology in healthcare informatics?

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These standards address a fundamental requirement for effective communication - the ability to represent concepts in an unambiguous manner between a sender and receiver of information. Most communication between health information systems relies on structured vocabularies, terminologies, code sets and classification systems to represent health concepts.

Why Do We Need Standard Terminology in Health Informatics?

Standard terminology provides a foundation for interoperability by improving the effectiveness of information exchange. Using standard terminology should be a simple and logical step in health IT. However, with the complexities of many diagnoses systems, clinical narrative transferred via PDF format, various coding systems, and the cost of digitizing volumes of reference material/dictionaries, it isn't as easy as you would think.

Structured terms provide a means for organizing information and serve to define the semantics of information using consistent and computable mechanisms. Therefore, health information specialists need the tools to focus on delivering terminology through a common delivery system to the software vendors and institutions in a consistent, high quality and verifiable fashion. Vendors and institutions need to be able to write applications that access terminology content, be it SNOMED, immunization data, demographics, LOINC, or a coding system local to the institution in exactly the same way.

See below for some of the common terminology standards used in health information and technology.

LOINC

Logical Observation Identifiers Names and Codes (LOINC®) is a universal code system for identifying health measurements, observations, and documents. These codes represent the "question" for a test or measurement. LOINC codes can be grouped into Laboratory and Clinical tests, measurements and observations. Visit LOINC's database to explore these data standards.

UCUM

The Unified Code for Units of Measure (UCUM) is a code system intended to include all units of measures used in international science, engineering and business to facilitate unambiguous electronic communication of quantities together with their units.

SNOMED CT

Systematized Nomenclature of Medicine--Clinical Terms (SNOMED CT) is a comprehensive clinical health terminology product, owned and distributed by SNOMED International. It enables the consistent, processable representation of clinical content in electronic health records. These codes often represent the "answer" for a test or measurement to the LOINC "question" code. Explore these standards.

RxNorm

RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary. RxNorm now includes the National Drug File - Reference Terminology (NDF-RT) from the Veterans Health Administration. NDF-RT is a terminology used to code clinical drug properties, including mechanism of action, physiologic effect, and therapeutic category. Explore the RxNorm standards database.

RadLex

RadLex is a unified language of radiology terms for standardized indexing and retrieval of radiology information resources. It unifies and supplements other lexicons and standards, such as SNOMED-CT and DICOM. It is managed by the Radiological Society of North America.

MEDCIN

MEDCIN is a medical terminology, maintained by Medicomp Systems, that encompasses symptoms, history, physical examination, tests, diagnoses and therapies.

ICD-10

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems(ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

CPT®

Current Procedural Terminology (CPT®) is a code set, maintained by the American Medical Association (AMA) used to bill outpatient and office procedures.

HCPCS

The Healthcare Common Procedure Coding System (HCPCS) is a set of healthcare procedure codes based on CPT that is leveraged for Medicare reimbursement.

CDC CVX and MVX

The Centers for Disease Control and Prevention (CDC) provide a number of code sets for vaccines (Vaccines Administered ( CVX)) and manufacturers (Manufacturers of Vaccines ( MVX)). These codes can be used in immunization messages. Explore the CVX database.

NDC

The National Drug Code (NDC) is maintained by the Food and Drug Administration (FDA) and provides a list of all drugs manufactured, prepared, propagated, compounded or processed for commercial distribution. Search the NDC database.

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These standards address a fundamental requirement for effective communication - the ability to represent concepts in an unambiguous manner between a sender and receiver of information. Most communication between health information systems relies on structured vocabularies, terminologies, code sets and classification systems to represent health concepts.

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Who has helped develop informatics competencies: QSEN

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Who has helped develop informatics competencies: QSEN

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The EHR implementation process can be a difficult time particularly due to the risks involved with getting the process wrong. As such, organizations, rightly, have many questions about the process particularly what it entails and how to go about it in a manner that positions them best for success.

What is EHR implementation?

Implementation is a term that is not specific to EHR systems, it refers to integrating a software-based service or component into the workflow of an organizational structure or an individual end-user. Therefore, an EHR implementation would refer to the process of planning and carrying out the integration of EHR software and components in a healthcare organization.

How long does EHR implementation take?

How long an EHR implementation will take depends on the context. Given the number of variables that can either increase or decrease the time needed for an EHR implementation the typical time needed for implementation vary according to setting and product. As such, one cannot easily find a standard timeline for EHR implementation. However, when creating an EHR implementation plan a certain amount of the uncertainty regarding timing can be eliminated as experts involved in the process can provide solid estimates regarding the amount of time needed to complete the implementation.

What are EHR implementation steps?

Moving beyond the general roadmap or checklist provided here, it's important to look at the steps involved in the EHR implementation process in a more detailed fashion. The EHR implementation process generally follows the following steps.

1. Selection team building: selecting and organizing the individuals who will be involved in selecting the EHR.

2. Requirements gathering: requirements gathering refers to the process of determining what features and functionality your practice requires in an EHR.

3. RFI and RFP: once the requirements list has been created the selection team will research potential vendors and then submit Requests for Information (RFI) and Request for Proposals (RFP) to prospective vendors.

4. Evaluate RFI and RFP responses: once RFIs and RFPs have been returned the selection team will evaluate these responses based on how well they adhere to the requirements list.

5. Ranking of vendors to create a shortlist: the top vendor/candidates will be narrowed down to a shortlist of 3 or 4 finalists who will then be asked to provide a vendor demonstration.

6. Vendor demonstrations: shortlisted vendors will conduct demonstrations of their products using presentations and simulations of their product for the selection team. The selection team will then have the opportunity to ask questions.

7. Selection: a vendor is selected, contracts are negotiated and the process moves forward to actually implementing the EHR product.

8. Planning and go-live preparation: with the help of the vendor the selection team and representatives from the vendor will plan out how the software and hardware will be deployed. Also, plans will be made for staff to be trained on the new system.

At this time a go-live date will be selected along with other milestones related to the deployment.

Your practice may not be ready to achieve success in these areas right now, but you and your implementation plan are going to change that using this 8-step checklist with all the stages of EHR implementation.

1. Build your EHR implementation roadmap

Roadmap. Checklist. Matrix. Template. Call it what you want.

The first stage in any EHR implementation plan is to outline all the tasks and processes which need to be executed by your team of physicians, practice managers, IT staff (and even patients). Key tasks include:

Recruit your implementation committee from stakeholder groups

Outline your expected implementation costs and define the total budget

Schedule your implementation (best done after your roadmap is complete)

Migration of patient and practice data

Create a user training program

EHR testing (unleashing it in a "live" practice environment at some point)

Clearly define go-live activities

Define critical success factors and evaluation strategies

Whether you choose to map these tasks in a checklist, roadmap or GANNT chart will depend on your practice's project management protocols but commonly used tools include:

Google Sheets - great for collaborating on roadmaps

Trello or Wrike - great for flexible project management (GANNT, calendar, checklists)

Asana - great for advanced "to-do" lists

2. Recruit your EHR implementation committee

With your implementation tasks defined you need people to execute each process on schedule and budget. The following committee members can be sourced from key stakeholder groups or external consultancy:

Project Manager - if you're reading this, you may have volunteered already

Application Analyst - responsible for data migration and cleansing

Application Developer - responsible for system customization

QA Test Engineer - responsible for system testing and performance

Physician Advocate - represent physicians and advise on training, data and testing

Nurse Advocate - represent nurses and advise on training, data and testing

Billing Advocate - represent billing department and advise on training, data and testing

Meaningful-Use Manager - required if MU attestation is required

Super-Users - early adopters for training programs

The makeup of your implementation team will depend on the scope of your practice, budget... and project manager's patience. A key decision to make at this stage is whether to bring in external EHR implementation specialists or consultants...

What does an EHR implementation specialist do?

"Things senior practice management will ask when presented with the bill."

The answer is everything. And, potentially, nothing. It's not the abilities of an EHR consultant that matter, it's how you use them to assist with any combination of...

Project scheduling and roadmapping

Data migration and cleansing

User training and change management

Testing and go-live activities

Security assessment

...just don't put them solely in charge of the budget (their paycheck).

3. Forecast your EHR implementation costs and define a budget

Now you have a team and a to-do list, you are in a position to ask...

What is the cost of EHR implementation?

The only answer one can give with some certainty at this stage is...

... approximately $6,000 more than you expected.

Having said that, a well-defined budget featuring the following elements should ensure no unexpected costs come out of the woodwork:

Hardware and network upgrades

Practice staff overtime and temporary staff

Productivity loss (some estimate as high as 50% reductions in patient throughput)

Customization consultancy from the EHR vendor

Vendor training fees

Consultancy costs

Data backups and storage (often bundled with cloud EHR costs)

A recent EHR report found that most practices can expect to spend around $6,200 per user of their software, so bear this figure in mind, in hand with the elements above, when considering your projected budget.

If you're looking for information on the upfront cost of purchasing EHR software, you can download our EHR software pricing guide here.

4. Schedule your EHR implementation

This is often the first thing practices work on. The problem with that approach is clear when you consider what impacts a schedule:

Luckily for you, you have now defined all three and can begin to add timescales to your roadmap outlined in step one. So the question is:

How long does an EHR implementation take?

611 hours is the simple answer.

The complicated answer is an analysis of our holy trinity of project attributes outlined above.

5. Migration of patient data and practice data

This is the point where the everyone has to keep their nose to the grindstone. Or their cleansed patient data to the well-formatted EHR database if you want to be literal.

Key stages in EHR data migration include:

Conversion of paper records to electronic records

Data cleansing and verification

EHR database setup

Mapping legacy data to new database fields

Data transfer to the new system

Testing and verification of legacy data

Testing and verification of new data inputs

Get this process right and the rewards are great... a 10% reduction in data errors to be precise.
To clarify this process, it is useful to produce a map of your practice data as shown above (source: Advance Healthcare Network)
6. Create a use training program

With $70,000 in annual savings and a 10% increase in productivity at stake, your EHR training program has a huge impact on the final ROI for your system.

Successful training programs include:

Super-users as system and program advocates

Clear communication channels with vendor support teams

Role-based training to ensure relevancy

Feedback loops to keep users in dialogue with project management

These steps should not be seen as silver bullets as one of the primary causes of EHR implementation failure is poor user adoption of the system.

7. Clearly define go-live activities

If there is ever a day to have a plan it is go-live day. Day one. The start of the rest of your life.

With that in mind, it is prudent to create a zoomed in version of your roadmap specifically for the days (or weeks) around your go-live date. This roadmap can include:

System testing processes (pre- and post-go-live)

Patient communication guidelines (including expected downtime)

Staff scheduling including required overtime or temporary staff

Modification of appointments and scheduling

Reporting processes for system and project evaluation (see step 8)

In-practice communications (signs on noticeboards etc.)

Network speed and reliability checks

Data backup processes

8. Define critical success factors and evaluation strategies

Congratulations, you made it through go-live. Or at the very least the planning process.

Now you should ask...

How can you evaluate your EHR implementation?

Evaluation of EHR implementation can take many forms and the best one for your practice will depend on your project goals:

Perform ROI calculations to assess profitability

Record patient throughput to assess efficiency

Survey patient satisfaction to assess quality of care

Survey physician satisfaction to assess user adoption and training

Analyse data error rates to assess data input and quality

A final thought...

Following these steps will produce a plan which gives your project a foundation. It is up to you and your team to execute this plan in the face of practice nuances, disgruntled users and missing data (even the best implementations experience these).

Kathryn Beeson

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EHR Implementation Plan: Your 8-Step Checklist

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The EHR implementation process can be a difficult time particularly due to the risks involved with getting the process wrong. As such, organizations, rightly, have many questions about the process particularly what it entails and how to go about it in a manner that positions them best for success.

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Changing information system can be costly.....

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Changing information system can be costly.....

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Brigham and Women's hospital EHR changed to EPIC

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When evaluating an information systems model, a swot analysis is completed

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When evaluating an information systems model, a swot analysis is completed

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The relationship between data, information, knowledge and wisdom

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The relationship between data, information, knowledge and wisdom

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ICD 10 is data that helps with tracking and efficiency

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ICD 10 is data that helps with tracking and efficiency

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Components to transform data into wisdom

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Components to transform data into wisdom

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Context is added to data to form information, rules are applied to information to transform into knowledge

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Developing Understanding using the DIKW Pyramid

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Healthcare Information and Management Systems Society

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Healthcare Information and Management Systems Society

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Aligning Core Health Informatics Competencies
By Marisa L. Wilson, DNSc, MHSc, RN-BC, CPHIMS, FAMIA, FAAN, Associate Professor/ Interim Chair, University of Alabama at Birmingham; a HIMSS TIGER International Task Force Member
Our lives are spent interacting with technology and the data and information produced. The flow of our lives, both personal and professional, have been, and will continue to be, impacted by technology implementation. The changes that occur from the interactions of people, processes, technology and data can be supportive or destructive. Much of that divergence stems from how the technology and data are used. The move toward a supportive process requires users who are competent and ethical in the use of devices, information systems, data management and technology mediated interaction.

Banking, retail, communications, entertainment, education, and now healthcare, have all been transformed by technology implementations. What has not necessarily happened with the transformations, particularly in healthcare, is the positive optimization of those implementations. The healthcare organizational and operational changes needed to ensure technologies and data improve the interactions with patients and consumers has been diminished by often the lack of fully competent users. Full beneficial use requires proficient and competent point of care professionals. Moreover, healthcare systems are particularly risk adverse and the clinicians who interact with the patients and consumers require knowledgeable engagement in implementations to ensure minimal negative outcomes.

In addition, there is internal and external pressure for healthcare systems to improve and learn in order to make care more efficient, effective and satisfying all within the context of a technology rich environment. In order to accomplish these tasks and create that learning health system with the tools and processes available, healthcare students and current providers must be educated to utilize the tools to form data, information and knowledge to fuel the learning cycle within the system.

However, there is an issue. Healthcare providers often receive poor or nonexistent education in informatics and the use of information technology to advance care during their professional formation.

Competencies Needed

Nearly two decades ago, the Institute of Medicine produced five core competencies that all health professionals should possess regardless of discipline to meet the needs of the 21st century healthcare systems. They are:

1. Apply quality improvement

2. Employ evidence-based practice

3. Provide patient centered care

4. Utilize informatics

5. Work in interdisciplinary teams

Each individual profession's overseeing association has taken on the task of trying to lay out its professions expected informatics and IT competency set, to a more or less successful outcome. We will explore just three, starting with nursing which has the most defined list.

Nursing

The American Association of College of Nursing (AACN) took these competency expectations and incorporated them into the Essentials. In nursing education, expectations of nurse graduates at the bachelors, masters and doctoral levels delineate informatics and IT competent use as essentials. This set of essentials, however, date back to 2006 and are being re-envisioned to meet the needs of the industry today. Therefore, detailed specifics related to the measurable sub competencies will not be presented here.

However, what remains of these re-envisioned essentials will include informatics and IT as a key domain and a set of core competencies. Domain 8, Informatics and Healthcare Technologies, will contain actionable and measurable competency expectations for many graduates of U.S. nursing schools for which the school will be responsible to provide to the students. At this writing, the categories of competencies in Domain 8 fall into the following:

1. Demonstrating the use of information and communication technologies and informatics processes to deliver safe nursing care to diverse populations in a variety of settings

2. Understanding how the various information and communication technology tools used in the care of patients, communities, and populations

3. Use information and communication technologies in accordance with ethical, legal, professional and regulatory standards, and workplace policies in the delivery of care

4. Use information and communication technology to support chronicling of care and communication among providers, patients, and all system levels

Medicine

Physicians, like there nurse team members, will also need to interact competently with IT and informatics processes. Although no unified documentation on expected informatics competency for general medical education is available through the American Association of Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME) does lay out the program requirements for fellowship in clinical informatics for graduates of ACGME accredited programs as also outlined through the American Medical Informatics Association (AMIA). For all medical education, a group from Oregon Health & Science University did document specific learning objectives and milestones to support developing informatics competent medical practitioners. These competencies were developed through a consensus agreement between the group of six faculty.

The team offered multiple competencies across the continuum of medical education. Among them are:

1. Apply personalized/precision medicine

2. Engage in quality measurement selection and improvement

3. Engage patients to improve their health and care delivery through the use of personal health records and patient portals

4. Find, search and apply knowledge-based information to patient care

5. Maintain professionalism through the use of information and technology tools

6. Participate in practice-based research

7. Protect patient privacy and security

8. Provide clinical care via telemedicine

9. Use and guide implementation of clinical decision support

10. Use health information exchange (HIE) to identify and access patient information across settings

11. Use information technology to improve patient safety

Pharmacy

As with other interprofessional team members, pharmacists are also expected to demonstrate competency using IT and informatics processes to impact better outcomes. However, going back nearly a decade, it was noted that the education provided for the student to achieve competence, despite inclusion in Accreditation Council for Pharmacy Education Standards and Guidelines, as a requirement was found to be inconsistent. More recently, it appears that there is work to refine and revise those competencies.

The pharmacist informatics task force of the American Academy of Colleges of Pharmacy (AACP) used 11 sources and faculty feedback to create a revision. This revision lists the following domains with detailed, aligned competencies:

1. Emerging Technologies

2. Health Care and Clinical Biomedical Informatics

3. Interoperability and Standardization

4. Legal and Regulatory

5. Patient Outcomes

6. Practitioner Development and Education

A Gap

Those responsible for educating or training the students or current providers, despite mandates to do so, are themselves often lacking in knowledge, skills and attitudes so that there is not a transference of knowledge and skill that results in a demonstrable competency. As an example, the AACN reports that the average age of nursing faculty with a doctoral degree for positions of professor, associate professor and assistant professor were 62.4, 57.2, and 51.2 years.

These faculty members were most likely not educated about informatics during their own time in school and perhaps not even during clinical practices. This results in an informatics skill and competency gap among graduates. For nursing, this significant gap has been identified by the HIMSS TIGER (Technology Informatics Guiding Education Reform) initiative, the European Commission's EU*US eHealth Work Project, and the Nursing Knowledge Big Data Science Education Work Group.

Substantiating the Gap

To substantiate and justify the size of the gap, the EU*US Work Project Consortium, funded by the European Commission's Horizon 2020 innovation grant program, issued a survey to over 1,000 targeted respondents to measure the need, supply and trends that support necessary workforce skills and competencies. Over 1,000 responses were returned from 51 countries around the world. Respondents represented all of the healthcare professions involved in health IT and represented the full spectrum of the healthcare workforce.

A synthesis of results pointed to several major gaps related to training and skills, the top four address:

1. Availability of courses and programs

2. Lack of knowledge and skills of faculty and educators

3. Lack of knowledge and skills of providers and caregivers

4. Quality and quantity of training materials. Moreover, research identified the pressure placed on universities to deliver eHealth education in a curriculum wide approach for which the universities are struggling to meet the needs for applicable and novel learning opportunities.

Ursula Hübner with the University of Applied Sciences Osnabrück and Beth Elias with University of Scranton with TIGER share the strategic approaches to seamlessly delivering health informatics education HIMSS TV.
A Solution and Resources

Given the serious need to have health professionals and graduating health professional students competent in the provision of quality and safe care using IT and informatics processes, faculty and educators providing the knowledge, skills and attitudes on the topics must themselves be competent. Moreover, given that there are not enough health professionals with formal informatics education and training to take on this challenge, support must be provided to those who currently interact with the profession and the students.

TIGER International Competency Synthesis Project

The TIGER International Competency Synthesis Project 's Global Health Informatics Competency Recommendation Frameworks provide a comprehensive and compiled core set of international and interprofessional informatics competencies for nursing and other healthcare professionals.

Framework 1.0 is nursing centric and lays out two sets of core competency tables. In the first grouping, there are expected nursing informatics competencies that align with direct patient care, quality management, coordination, management and IT roles a nurse may hold. These competencies align with the AACN Essentials including the re-envisioned version. The second, more expanded set, align with all health professions across multiple levels. This expanded set contains four domains under which multiple competencies align:

1. Biostatistics and technology

2. Data, information and knowledge

3. Information exchange and information sharing

4. Management in informatics

Resources

As stated previously, despite all of this competency work and the expectations across various health professions, there is a significant gap. The gap is exacerbated by the knowledge, skills and attitudes of those currently teaching and educating. So, rigorous support and guidance has to be provided to those educators and faculty. There are tools to help, including the following.

Global Health Informatics Competency Recommendation Framework 1.0 (nursing) + 2.0 (interprofessional): This describes the framework with all the domains and competencies. A review of this document will demonstrate an alignment with the core informatics expectations of the AACN, AAMC, ACGME and AAPC.

Health IT Competencies Tool & Repository (HITComp): This web-based tool that lets you explore specific competencies, sub competencies across roles and education. It is aligned with the Global Health Informatics Competency Frameworks and serves as a detailed companion guide.

Interactive Education Demonstrator Modules: These modules provide instructional videos on the foundational curriculum, HITComp and cybersecurity focused on targeted malware attacks.

Skills Knowledge and Assessment Development Framework (SKAD) is a questionnaire focused on self-assessment to better understand personal digital literacy skills.

Today, more than ever, there is a major need to improve the informatics competency and skills of not only of the healthcare workforce but of those who teach and guide them. These tools offer an opportunity to address the gap in both areas.

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Discover key insights about global health informatics, the related competencies and how these can be applied in the workforce.

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Take a poll: Would you rather have a telemedicine visit or see a provider in person?

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Take a poll: Would you rather have a telemedicine visit or see a provider in person?

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Manage existing quizzes, Custom Templates, Better Security, Data Exports and much more

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Have your say: Would you rather have a telemedicine visit with a medical provider or an in person visit

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Voice your opinion on the poll: Would you rather have a telemedicine visit with a medical provider or an in person visit

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An Initiative for Technology and Health Informatics Education

The Technology Informatics Guiding Education Reform (TIGER) initiative from HIMSS provides the global health workforce with innovative informatics/eHealth tools and resources to transform health for all.

The global TIGER network collaborates to integrate informatics/eHealth into healthcare education, certification, practice and research through an inclusive, interdisciplinary, intergenerational approach.

Education Reform

We create an environment that maximizes the possibilities of technology toward knowledge development and dissemination, driving rapid implementation of best practices as well as competency and curriculum development.

Interprofessional Community Development and Growth

We actively engage and collaborate with the global healthcare workforce, students and adult learners to encourage standardized, person-centered and technology-enabled processes to facilitate teamwork and relationships across the continuum of care worldwide.

Global Workforce Development

We foster a respectful learning community of diverse stakeholders that embrace shared values to drive innovation and technology around the world.

Global Recommendations

While informatics recommendations on competencies and education support the design of curricula and courses, they are unable to inform educators on how to customize content for local needs and requirements. That's why the TIGER International Competency Synthesis Project (ICSP) and the EU*US eHealth Work Project came together to describe and validate the TIGER initiative's framework of global informatics core competencies for health professionals.

Together, these projects compiled a recommendation framework of health informatics competencies (v2.0) to measure, inform, educate and advance development of a skilled workforce throughout the EU and U.S. and around the world. Although the EU*US eHealth Work Project has ended, we are compiling global case studies to continue bringing our findings to life, with a focus on all states within the EU.
Hear TIGER International Task Force Former Co-Chairs Ursula Hübner, PhD, professor, University of Applied Sciences Osnabrück, Germany, and Beth L. Elias, PhD, MS, FHIMSS, adjunct faculty, Panuska College of Professional Studies, University of Scranton, present these important project findings at the HIMSS19 Global Health Conference.
TIGER International Task Force

The TIGER International Task Force, seated under the HIMSS Professional Development Committee, provides our global community of 34 countries with knowledge, leadership and guidance in its efforts to reform technology and informatics education. It provides domain expertise through activities, projects and collaborations within the interprofessional community to support faculty, students, adult learners and providers.

TIGER Resources

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The Technology Informatics Guiding Education Reform (TIGER) initiative offers tools and resources for learners to advance their technology and health informatics skills and for educators to develop valuable curricula.

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Telemedicine, how are health informatics involved?

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Telemedicine, how are health informatics involved?

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In February - the month before COVID-19 hit Boston - Partners Healthcare, the huge health system that includes Massachusetts General Hospital, treated 1,600 patients via video visits.

By April, the number of patients seeking care through Partners' video service had swelled to 242,000.

"We're not the only ones," said Joe Kvedar, a dermatology professor at Harvard Medical School and a telemedicine advocate at Partners for three decades, in a May webinar. The same thing was happening across the country as the COVID-19 pandemic made in-person visits at doctors' offices dangerous for patients and clinicians alike.

Regardless of when the COVID-19 threat dissipates, video visits have crossed a tipping point to become a mainstream way to obtain care, says cardiologist Joe Smith, coauthor of an overview of telemedicine in the Annual Review of Biomedical Engineering. "I don't think we go back," he says. "For a long time, hospitals have been the cathedrals of health care where patients have to come. But people are now seeing that they can get their health care in the safety and comfort of their own home."

Video visits are a form of telemedicine, a term used for technology-enabled ways to deliver virtual medical care (some also use the term telehealth in this context). Telemedicine includes phone calls and secure email, of course, but a lot more as well. Heart-failure patients can be "remote-monitored" in their homes, for example; a smartphone app can alert digestive-disease patients about problems before they occur; and knee-replacement patients can receive physical therapy at home from a virtual assistant named VERA.

Video visits, primarily offered by commercial companies like Teladoc and AmWell, have become more frequent over the years. But they have never become common. Smith, who now runs two telemedicine companies, says that disincentives such as lower payments than for in-office visits and required changes to office processes have discouraged physicians and health systems from embracing them. Thus, many patients are simply unfamiliar with video-delivered care.

"We adopt technology probably slower than any other industry in the U.S.," Smith adds. "A rubric inside of health care is that change is bad even if it's change for the better. So it's been a real challenge."

Telemedicine has been bedeviled by myths, wrote Judd Hollander, an emergency physician with Jefferson Health in Philadelphia, in the New England Journal of Medicine Catalyst. It's "too hard," "virtual visits are not effective," "there is not a payment model" and more.

All were swept away this spring when, in a matter of days, the pandemic forced physicians, insurers, regulators and patients to figure out how to make live-video health care work.

That's one positive thing to come out of COVID-19, says neurologist Michael Okun, national medical director for the Parkinson's Foundation. "We accomplished in 10 days what we have been trying to do for 10 years - fighting and advocating and trying to get telemedicine up and going," he says.

Leap forward, step back?

When medical clinics started closing their doors to stymie the spread of COVID-19, physicians went home and regulators went to work. Within weeks, hundreds of federal and state telemedicine rules were changed - in most cases, temporarily - to allow doctors to quickly pivot the way they practiced medicine.

The rules have long been a morass. Telemedicine is regulated at the state level, and no two states are alike. Georgia, for example, requires that private insurers pay the same for telemedicine visits as they do for in-person care, according to the nonprofit Center for Connected Health Policy. But cross the state line to South Carolina and no such "payment parity" exists. For patients insured by Medicaid in New Jersey, video visits are limited to mental-health services. Next door in Delaware, Medicaid will pay physicians, nurse midwives, audiologists and other health-care professionals licensed by the state for care delivered via live video. All states allow video visits for some types of care to Medicaid-insured citizens, but many do not allow care via telephone.

The federal Medicare program, which covers more Americans than any other payer, has its own set of rules. Until now, patients enrolled in Medicare generally could not receive telemedicine services in their homes. In fact, Medicare paid for routine video visits only if a patient lived in a rural area and, even then, the patient had to travel to a local hospital or clinic for a video hook-up with a physician in a different location.

COVID-19 upended everything. All states relaxed their telemedicine rules and, by early March, Medicare was paying for care delivered by telephone, email or video for any diagnostic or treatment purpose in patients' homes, rural or otherwise. What's more, Medicare gave a thumbs-up to Skype, FaceTime, Zoom and other platforms. Pre-COVID, those would have been strictly prohibited under the Health Insurance Portability and Accountability Act of 1996, which regulates the privacy and security of health information.

Most of the changes were enacted as temporary measures just to get through the COVID-19 crisis. But Mei Wa Kwong, the Center for Connected Health Policy's executive director, expects that some of them will become permanent. "I don't think all of these relaxations will stick around, but I don't think we will revert back to what we had before COVID-19," she says.

Medicare's vast expansion of services that can be delivered by telemedicine is likely to hold, for example. Allowing physicians to examine patients over FaceTime and other non-secure platforms? That will probably go away.

As they consider telemedicine restrictions going forward, regulators are going to be hearing from patients who, until now, have not been vocal telemedicine advocates. "Now that ordinary people are getting a crash course in telehealth, that this how you can receive health-care services, they will be become an important voice post-COVID-19 that will make it a little harder for policymakers to ignore," Kwong says.

How good is video care?

Can video visits be trusted to offer the same quality of care as traditional in-person visits when those become safe again? "That's a horrible question," Hollander says.

Telemedicine, in his view, offers additional ways - not better or worse ways - to receive care from your doctor. You might, for example, see your cardiologist in person in January, check in via video in February, exchange text messages in March and return to the clinic for a face-to-face in April. If bad weather makes travel difficult in April, jumping on a video visit is better than missing care entirely even if an in-person visit would have been preferred that month.

Nonetheless, as telemedicine goes mainstream, the question of quality deserves attention. There are few published studies so far, and they give conflicting signals. A 2016 review of insurance claims, for example, compared care delivered by Teladoc, a popular direct-to-consumer care company, with that delivered at physicians' offices. Teladoc performed worse on two measures - appropriate ordering of strep tests and antibiotics for bronchitis - than physicians' offices, and about the same for appropriate ordering of images for back pain.

And a 2016 report tells how researchers at the University of California, San Francisco, had actors and medical students pose as patients with common conditions - sore throats, urinary tract infections and so forth - and seek care from one of eight companies via telephone, webchat or video. Overall, just 77 percent of the "patients" received a correct diagnosis, and providers followed care guidelines in only 54 percent of the visits. Researchers noted that some video-visit providers did better than others, and they also pointed out that adherence to guidelines and the quality of care also vary widely in face-to-face visits. "If you're a bad doctor in person, you're probably a bad doctor via telemedicine," Hollander says.

In another study, Hollander and three colleagues at Thomas Jefferson University compared the care delivered by Jefferson Health emergency physicians in the emergency department, in an urgent care clinic and via a video visit. The rate of appropriate antibiotic prescribing was at least as good in video-visit care as in the other two settings.

For patients who have trouble traveling to medical appointments, the quality of care is just one factor worth considering. A 2017 randomized controlled trial found that patients with Parkinson's disease, a degenerative neurologic condition, who had "virtual house calls" with a neurologist had clinical outcomes - such as the number of emergency room visits and number of hospitalizations over 12 months - comparable to those who had regular outpatient visits. But patients who were seen via video in their own homes reported that they felt better than those who received care at a clinic; and each video visit, on average, saved a patient from traveling 38 miles.

Another study showed that care via telemedicine care can save a lot of money. Reflexion Health - Smith is its CEO - provides virtual physical therapy, using an avatar coach and imaging that gives patients real-time feedback on whether they are doing exercises correctly. In a randomized controlled trial published this year, virtual therapy was found to be as effective as traditional in-person therapy for patients rehabilitating after total knee replacement surgery . On average, the avatar-led therapy cost $2,745 less per patient over three months.

Kvedar, who is the current president of the American Telemedicine Association, wants federal and state regulators to adopt permanent policies that make it easy - and financially viable - for health systems to offer video visits. Before COVID-19, his own system's video-visit program was limited to a virtual urgent-care service where patients could get simple problems - skin rash, sinusitis, urinary tract infection symptoms - checked out. The average wait time for patients was six to seven minutes; in about 80 percent of the cases, clinicians could address the problems via video; and patient-satisfaction scores were high.

When we reach that wonderful nirvana of access, quality and convenience, everyone knows it," Kvedar says. "And nobody wants to go back."

Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

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Is COVID-19 the Tipping Point for Telemedicine?

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In February - the month before COVID-19 hit Boston - Partners Healthcare, the huge health system that includes Massachusetts General Hospital, treated 1,600 patients via video visits. By April, the number of patients seeking care through Partners' video service had swelled to 242,000.

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If you are interested in pursuing a career that merges healthcare and technology, health informatics could be an excellent choice. Not only do health informatics careers allow you to put your technical skills to work to improve others' lives, but they also offer competitive pay and job security due to the rising demand for skilled workers in the industry.

What is health informatics?

Health Informatics (HI) is a relatively new, interdisciplinary field in the healthcare industry that uses information technology to organize and analyze health records to improve healthcare outcomes. It is also called Health Information Systems.

A rapidly growing field across the healthcare sector, health informatics deals with the resources, devices, and methods required to acquire, store, retrieve, and use health and medical data. Healthcare informatics work provides electronic access to medical records for patients, doctors, nurses, hospital administrators, insurance companies, and health information technicians.

Learn more about earning an MS in Health Informatics

Prepare to successfully address the combined clinical, technical, and business needs of health-related professions.

The Future of Health Informatics

As , we are now expanding the way we address patients' and healthcare vendors' needs. In addition to managing the more traditional health informatics elements, there are evolving industry trends that are currently defining the field. Below, Jay Spitulnik, associate teaching professor and director of Northeastern's healthcare changes MS in Health Informatics, shares his expertise on emerging industry trends and how professionals can stay prepared.

Health Informatics Trends

Health Informatics Trend #1: Interoperability

The Northeastern MS in Health Informatics program addresses interoperability in two ways. First, many courses that cover the management of health information also address interoperability at some level. Secondly, Northeastern's curriculum includes a course that specifically addresses how to build and maintain interoperable systems. The faculty instructor for Key Standards in Health Informatics is a member of , the group that is responsible for international interoperability standards. As is the case with faculty across Northeastern, this faculty member's industry experience provides real-world knowledge that supports students in their networking and job searches.

Health Informatics Trend #2: Consumerization

Younger generations were raised in an online world-from streaming their favorite TV shows to submitting college applications to grocery shopping. But today, many of them still can't go online to make an appointment with their primary care physician (PCP) for a physical or a sick visit or see the average wait time for the ER. When today's consumer-centric options, such as a local pharmacy or urgent care center, allow for this level of visibility and ease, people who grew up digitally will question the value of maintaining a relationship with a PCP who does not provide this level of visibility.

With this in mind, Northeastern's health informatics curriculum addresses how providers and others can use existing and developing technologies to support open, proactive, two-way communication between hospitals, clinicians, patients, vendors, and other healthcare stakeholders.

Health Informatics Trend #3: Health Data Analytics

Health Informatics at Northeastern

The Northeastern University Health Informatics program is a fully interdisciplinary program that addresses the combined clinical, technical, and business needs of health-related professionals. Students gain knowledge of how technology, people, health, and the healthcare system interrelate. In addition, they develop the ability to use technology and information management to improve healthcare delivery and outcomes. Finally, students can develop the skills to communicate effectively among healthcare practitioners, administrators, and information technology professionals.

Northeastern's health informatics program accepted its first students in 2007, making it one of the country's oldest health informatics graduate programs. The program belongs to both Northeastern's Bouvé College of Health Sciences and Khoury College of Computer Sciences . to help students develop well-rounded proficiency in health science, management science, and information science. Given the increasing demand for professionals with this intersection of skills, almost 100 percent of Northeastern's graduates find job placement within three months of graduation.

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What is Health Informatics? 3 Key Trends to Know

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If you are interested in pursuing a career that merges healthcare and technology, health informatics could be an excellent choice. Not only do health informatics careers allow you to put your technical skills to work to improve others' lives, but they also offer competitive pay and job security due to the rising demand for skilled workers in the industry.

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An area of healthcare that obtains, organizes health information and records to improve healthcare and patient outcomes

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An area of healthcare that obtains, organizes health information and records to improve healthcare and patient outcomes

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Major Functions

Develops and implements health initiatives, including data harmonization and data exchange standards, data science and analytics, open data, knowledge management, research and development, as well as big data initiatives and activities.

Captures, develops, coordinates, and promotes effective uses of informatics-based organizational knowledge.

Ensures a next-generation open source informatics platform that enables collaboration, fosters information-sharing, and provides analytic tools as regards the Precision Medicine Initiative.

Leads, researches, and implements enterprise informatics solutions in support of FDA's regulatory mission.

Ensures, coordinates, and sponsors standards-based electronic data submission, brokering, storage, retrieval, analysis, and knowledge dissemination.

Defines, advocates, and implements data exchange standards that are consistent with health information technology and the industry.

Implements harmonized controlled vocabularies and data.

Identifies and reviews electronic data sources (e.g. electronic medical records, data standards, and novel data sources) for FDA in collaboration with the Office of the National Coordinator (ONC), Centers for Medicare & Medicaid Services (CMS), and industry, among others.

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Mission

The mission of the Office of Health Informatics is to provide health informatics tools, solutions, and expertise that enhance, transform, and sustain FDA's ability to protect and promote the public health.

Major Functions

Develops and implements health initiatives, including data harmonization and data exchange standards, data science and analytics, open data, knowledge management, research and development, as well as big data initiatives and activities.

Captures, develops, coordinates, and promotes effective uses of informatics-based organizational knowledge.

Ensures a next-generation open source informatics platform that enables collaboration, fosters information-sharing, and provides analytic tools as regards the Precision Medicine Initiative.

Leads, researches, and implements enterprise informatics solutions in support of FDA's regulatory mission.

Ensures, coordinates, and sponsors standards-based electronic data submission, brokering, storage, retrieval, analysis, and knowledge dissemination.

Defines, advocates, and implements data exchange standards that are consistent with health information technology and the industry.

Implements harmonized controlled vocabularies and data.

Identifies and reviews electronic data sources (e.g. electronic medical records, data standards, and novel data sources) for FDA in collaboration with the Office of the National Coordinator (ONC), Centers for Medicare & Medicaid Services (CMS), and industry, among others.

Key Initiatives

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Mission The mission of the Office of Health Informatics is to provide health informatics tools, solutions, and expertise that enhance, transform, and sustain FDA's ability to protect and promote the public health. Major Functions Develops and implements health initiatives, including data harmonization and data exchange standards, data science and analytics, open data, knowledge management, research and development, as well as big data initiatives and activities.

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A blog post explaining the difference between exploratory versus explanatory analysis
key point: Explanatory analysis is the step beyond exploratory. Instead of explaining what happened, you're more focused on how and why it happened and what should happen next and, in most cases, communicating that to the necessary decision-makers and stakeholders.

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Pretty much every marketer wants to be (or thinks they already are) a data-driven marketer. But a lot of us aren't.

Sure, we spend time - maybe a lot of time - building monthly reports on campaign performance, but we never quite have the bandwidth to analyze those results to find useful insights and recommendations, the kind that our stakeholders really want.

To understand why this happens and, more importantly, how to fix it, we have to understand the difference between exploratory analysis and explanatory analysis and the role they play in marketing analytics.

What Is Exploratory Analysis?

Exploratory analysis is just what it sounds like. You're exploring the data to identify trends and outliers.

You might have a specific question you're trying to answer, like which products were your top sellers last quarter. But a big part of exploratory analysis is ... well, just exploring, looking to see what happened and what seems noteworthy.

A lot of marketing reporting falls under the heading of exploratory analysis. If you give a monthly update on your Google Analytics numbers, with a status check of your website's sessions, goal completions and other KPIs, along with a list of your best-performing pages, that's exploratory analysis.

What Is Explanatory Analysis?

Explanatory analysis is the step beyond exploratory. Instead of explaining what happened, you're more focused on how and why it happened and what should happen next and, in most cases, communicating that to the necessary decision-makers and stakeholders.

An explanatory analysis of your Google Analytics data, for example, might include a closer look at why your top-performing pages attract so much traffic and recommendations for how they could be used to increase goal completions.

Cole Nussbaumer Knaflic, the author of "Storytelling with Data," has a good analogy for the difference between exploratory and explanatory analysis: Exploratory is turning over 100 rocks to find one or two gems. Explanatory is showing those one or two gems to someone else.

Exploratory Analysis vs. Explanatory Analysis - Which Is Better?

A lot of marketers (and their CEOs) view explanatory analysis as being more valuable because it provides specific, actionable advice, the kind that can lead businesses to make smarter decisions about their business strategy.

While explanatory insights are valuable, you still need both types of analysis. Exploratory analysis often serves as the "Check Engine" light of marketing. All those monthly reports might feel boring and unnecessary, until they warn you that something is on fire and about to explode and, hey, are you going to do something about that?

The problem for many organizations is that exploratory analysis eats up a great deal of time. Explanatory analysis takes a backseat.

The good news is that you can fix this dynamic.

How to Find More Time for Marketing Analysis and Insight

Automated Data Aggregation

The first step is to automate your marketing data. Use a platform to automatically collect campaign data from each source system (like Google Ads or Facebook Ads) and put everything into analysis-ready datasets. We've seen marketers save hundreds of hours per month by doing this.

That's because marketing data tends to be ... unruly. A typical campaign might include Google Ads, Facebook Ads, your email platform, some display ads, maybe even some direct mail or traditional media.

Each of those sources has their own way of handling the same metrics, assuming they even use the same metrics. Putting all that data together in a common view, so you can compare apples to apples, is extremely time-consuming if you're manually downloading campaign data and cutting-and-pasting it into a single spreadsheet.

(And that's not even getting into the issue of APIs and data access, which, ugh, is a whole other problem.)

Automating your data with a dedicated platform takes that work off your desk.

Automated Reporting Dashboards

The next step is to automate your reporting. Instead of creating a spreadsheet or PDF every month, you set up a marketing dashboard.

All the data that you've been automatically collecting? You're going to pipe it into the dashboard that features the standard KPIs that would normally be featured in a monthly report.

Because this process is automated, with data refreshed every day in many cases, your monthly report now becomes a "whenever my stakeholder has a question" dashboard.

You can still present a roundup of the latest numbers at the end of the month if you like (or if your boss insists) but reporting can mostly become a self-service activity.

The Benefits of Automating Data and Reporting

If you're a marketing analyst - or someone else who's responsible for campaign reporting - your world now looks a lot different.

You suddenly have more free time that you can use for explanatory analysis. And that analysis should become easier, too. All the data you need is available whenever you require it and updated without any effort on your part.

You can produce more useful insights and recommendations more frequently. Those recommendations make your organization more successful and efficient. Your stakeholders notice. Your team gets a larger voice in decisions (and maybe even a larger budget).
You Can Produce the Insights Your Audience Needs
Exploratory analysis is a necessary (if boring) fact of life for marketers, but automating your data and your reporting can streamline this task, giving you the time and data required to produce more valuable (and more interesting) explanatory analysis.

By shifting your approach, you can give your decision-makers the kind of insights that really do move the needle.

Automatically Collect Marketing and Sales Data from ANY Source
Alight's end-to-end analytics solutions offer seamless data aggregation from any marketing, media and sales platform, potentially saving your team hundreds of hours. Schedule a free solution consultation with our team!

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The Difference Between Exploratory and Explanatory Analysis

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Pretty much every marketer wants to be (or thinks they already are) a data-driven marketer. But a lot of us aren't. Sure, we spend time - maybe a lot of time - building monthly reports on campaign performance, but we never quite have the bandwidth to analyze those results to find useful insights and recommendations, the kind that our stakeholders really want.

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A site to assist with the different steps in health data storytelling

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Acknowledgments
This resource is for health organizations that want to publish reports, data or insights to harness the power of storytelling and bring data to life. Drawing from journalism techniques and research on psychology, sociology and science communication, From Numbers to Narrative walks you step by step through the process of crafting high-impact, data-driven health reports and insights.

With a data storytelling approach, your readers will be able to easily understand, absorb, and act on the data you're reporting.

Why are health reports often dense and boring? While they might be factually correct and contain nuggets of compelling data, they tend to have one glaring missing element: a storyline. Without a narrative, readers will quickly lose interest and won't be able to gain insights from the data, nor will they be compelled to act on it.

We no longer live in a world restricted to printed reports. Digital journalism has shown what's possible with online storytelling. There's an opportunity for health organizations to do the same.

A powerful example of data journalism and visual storytelling: Extensive Data Shows Punishing Reach of Racism for Black Boys, The New York Times' The Upshot

What is this guide and who is it for?

For data to be meaningful, they need to tell a story.

The guide shows you how to find the sweet spot at the intersection of big data, visualization and storytelling, to bring health data to life and drive policy and behaviour change. It's a practical resource for people who work in health care or health organizations to banish the boredom from their data-driven reports. With a data storytelling approach, readers will be able to easily understand, absorb, and act on the data you're reporting.

It can be challenging to shift to a new style and format of health reports. But good news - you don't need to change everything. This guide leaves plenty of leeway for your own decisions and creativity. It also covers a range of options. You can start by making a few valuable tweaks to your current reporting format, or push your reports forward with interactive data and advanced storytelling techniques. Where possible, we base our recommendations on the best evidence available, which will help you support the changes you make to your own products.

You can use this guide to:

Improve existing reporting

Start a new report

Present data that was historically just a regular report in story format

Tackle a complex health data topic you need to communicate

What is storytelling with data?

"Storytelling" has many meanings. In this guide, storytelling means telling a story through the way you select, organize, describe and visualize the health data in your overall report. At the most basic level, a story has a beginning, middle and end, in which "one thing happens in consequence of another."[2] You can use storytelling to tell stories within the broader report storyline, by including stories from patients, family caregivers, doctors, nurses and other health care providers, and even researchers.

Health data storytelling will only be effective if you can share your narrative through writing, data visualization, and design.

The 7-Step Process for Telling a Story with Health Data

1. Defining your report strategy and goals
2. Selecting data and generating insights
3. Conducting user research
4. Building a storyline
5. Writing a lived-experience story
6. Designing your report
7. Publishing and socializing your report

1. Defining your report strategy and goals

From the outset, you and your team should articulate why you're producing this report. A thoughtful strategy will guide your focus as you develop the report.

Why are you creating this report now? Consider these questions:

1. Have you identified an important or trending topic in health?

2. Are you shedding light on a new treatment or therapy?

3. Is the report looking at a specific disease or condition?

4. Will you be highlighting time trends, inequity issues for different populations, or geographic variations? How will this report help improve people's lives?

5. And importantly, do you have quality data available to support the right level of insight generation?

Once you've established the reasons for producing the report, you're ready to set some specific goals and outcomes for the project. These should align with the strategy and mandate of your organization. Your goals should also consider the main audience for the report.

Think about who you are trying to influence or educate with this report:

You can have multiple audiences, but narrowing it down to one or two main audience targets will help you achieve your goals and outcomes.

2. Selecting data and generating insights

Once you have a story strategy, the next step is to identify data sets that are needed for analysis. This means collecting, acquiring or accessing the data to begin analysis. Data can include health care indicators, or qualitative data such as patient interviews.

There are many ways to select data and generate insights for a report, but it tends to be an iterative process. First, make sure you have the right data at the start, otherwise you may look at the data that's readily available and realize you can't get the rich, meaningful insights that you need from it.

The question-based method is one of the best ways to organize and structure insights:

1. Frame a series of specific, key questions in a hierarchy that you want to answer with your analysis. For example:

What is the overall trend of this disease?

Does the trend vary by geography, such as by region, city, or hospital?

Do you see different growth rates by demographics or social determinants?

What is driving the trend? What are the related or causal metrics or indicators that impact this trend?

2. Identify which questions are answerable by the data (some data may not be available or reliable enough to answer the question).

3. Consider titling your data visualization with the key question. For example: How do the annual rates of hospitalizations for chronic fatigue vary across regions?

4. With the remaining questions you can answer, use a variety of data analysis techniques to generate the insights.

5. Understand that most of the insights produced won't make it into the final report.

The insights you generate can take on many forms, including simple statistics, percentages, regression analysis and even predictive models. In the "Designing Your Report" section of the guide we talk about how to visually present your insights. Regardless of the data's visual form, we recommend refining the insight until it's simple, specific and factual. For example:

"People in the north have a much shorter life expectancy than those in Ontario overall - 2.9 years lower than Ontario in the North West LHIN region and 2.5 years lower in the North East LHIN region."

(Health Quality Ontario, Health in the North report, 2017)

With some insights, the reader (especially an analytical one) might wonder, "What's the reason for that statistic or insight? Why was this included in the report? What's the underlying driver?" It's helpful to bring the answers to these questions forward as you continue to understand your audience and build your report.

Here are a few key considerations for generating insights:

Refine: If you haven't published a report before, you may need to refine your process and adjust how you do the analysis.

Align: Begin the analysis with the goal of finding insights that line up based on the focus of your report.

Ask questions: Generate a lot of insights. We've listed one method of structuring your analysis below. Finding the story in the data tends to be as much a science as it is an art.

Focus: Distill down to the most impactful and meaningful insights based on the criteria you establish. What should you include in this report and what can be saved for later or used elsewhere?

Fit the story: Evaluate the insights to decide whether they'll help drive your narrative.

3. Conducting user research

While you're getting the data you need and producing a good crop of insights, it's useful to learn more about your audience. Since user research is a broad topic, we're not going to delve into it in detail in this guide. A good understanding of your audience is one of the most important things you can do to produce a great story within your report, as it will help you frame the report to their interests. So if possible, get a user researcher to work on the project team. Here are a few key aspects of user research:

Define your audience: Drawing from your report strategy and goals, clearly define your audience and prepare a user research plan to engage with and understand your audience, their information needs and interests. Identify what value your report will have for each audience.

Define your objectives: Do the research with clearly defined objectives: who do you need to understand and what is most important to understand? Based on the objectives, select the appropriate research methods, such as interviews, surveys and focus groups.

Gather user perspectives: Even if it's not your current practice, take steps to incorporate user perspectives and feedback into the report creation process as it unfolds.

Develop personas: Personas can be a good way to illustrate the types of people that make up your primary audiences and inform important decisions as you work to create your report.

Scan the landscape: Consider doing a landscape scan up front to learn more about the types of reports already available, position your report and generate ideas.

Perform user testing: As you progress through the project, we recommend coming back to your understanding of the user on an ongoing basis and actively testing what you create with users. For example, engaging clinicians and patients will help to ensure the insights are clear, understandable and impactful.

As you move to the next steps, continue to advocate for the needs of your audience, in particular patients, so that the report is tailored to speak to them and tell them a meaningful story that resonates.

4. Building a storyline

If you've done research into your audience, you'll now have a good idea how to organize the data to build a storyline that meets their needs. There are a few things that would be good to know about your audience: their health literacy, their personal perspective on the topic, and their level of current knowledge and awareness of the topic.

Here are some tips to help craft your storyline as you assemble the report:

Make your headline a key finding

The simple technique of writing your key finding into a headline is commonplace in news and magazine features, because it works.

Journalists figured out ages ago that if you want people to read your content, you need to draw them in with an enticing headline. You can also add more context with a teaser - a bit of text under the headline that makes the reader want to read more. This will also force you to figure out exactly what you're trying to say in each of your chapters or sections. Alternatively, you can write a longer headline that summarizes the entire key finding and complement it with a secondary finding as a teaser:

There were nearly 1.3 million new starts of opioid prescriptions in Ontario in 2016

New starts of opioids decreased slightly in 2016 from 2013, by about 25,000, or 2%.
(Health Quality Ontario, Starting on Opioids, 2018)

Think about how the text flows

Graceful transitions between paragraphs will help keep the reader's attention. "Prose is architecture, not interior decoration," Ernest Hemingway said. Build your narrative with a logical flow between sentences and paragraphs.

You can take the easy route as we've done here and stick a series of titles atop each paragraph. Other transition techniques include:

The building block: Reinforce the idea set up in the previous paragraph, and then introduce a new concept.

The comparison: Introduce a new paragraph by comparing the data points you've described in the previous paragraph.

Cause and effect: Show how the data points in the previous paragraph influence the data described in the next paragraph.

Ninja level: Paragraphs just flow naturally and logically, without transition sentences.[3]

Whenever possible, make the data about people

People-izing your data will make it much more relatable than reporting abstract percentages. If you have a data point that 15.1% of Canadians are current smokers, you can say "more than 1 in 7 Canadians are current smokers." Even better, include the actual total number of people, as in this report from the University of Waterloo's Propel Centre for Population Health Impact:

"In 2017, the overall prevalence of smoking in Canada
was 15.1%, equivalent to approximately 4.6 million
Canadians."

Your health data will be much more impactful if you can show how many people are involved in a statistic. For example, a report that showed an increase in the percentage of family or friend caregivers who were experiencing additional distress included the number of additional distressed caregivers:

"More than 4 in 10 long-stay clients with caregivers (43.5%) had caregivers who experienced distress, anger or depression in relation to their caregiving role, or were unable to continue caregiving, in 2017/18. That was up from 33.8% in 2014/15, and represented more than 26,000 additional distressed caregivers." (Ontario Health (Quality), Measuring Up 2019)

Introduce a plot twist to make your reader care

Your story outline should include an element of surprise. Data storytelling consultant Jay Golden says a story "is not the shortest distance between two points. A story is a journey with a twist, a problem approached in an interesting way, that makes us care." Another way of thinking about the twist in your report's narrative is to find the data points that are surprising. If you have subject matter experts reviewing the data, ask them what they find most surprising. You'd be surprised how often this simple technique works to identify twists in your narrative.
For a report on palliative care, the doctor reviewing the data said he was shocked to see that more than two-thirds of patients receiving palliative care had an emergency department visit in their last month of life. This became the plot twist. Most people said they wanted to die at home, but about two-thirds of those receiving palliative care ended up in the ER near the end of their life, and most died in hospital. The report's narrative highlighted the tension between what people wanted, and the reality of what was happening in the health system.
Chunk your text

In 1956, cognitive psychologist George Miller discovered that people could only retain about seven chunks of information in their short-term memory. To make your narrative more effective, group your information into easily digestible chunks of related material.[4]
Key resource: How Chunking Helps Content Processing, Nielsen Norman Group
Use pull quotes and callouts

Pull quotes and callouts are invaluable devices to captivate readers skimming your reports. Take a few of the most interesting nuggets of text or data points, blow them up into a large font, and intersperse them throughout the report. These callouts can even tell a mini story of their own for a reader who does a quick scan of the report.

"THE WAY WE RESPOND TO MISTAKES AS HOSPITALS IS AS TRAGIC AS THE MISTAKES THAT HAPPENED" ( Vox.com article on hospital harm, by Sarah Kliff)

5. Writing a lived-experience story

Behind all health data, there are stories about people. In health care, those stories are often extremely powerful. So powerful that they can completely alter someone's viewpoint on a topic.

You don't need to have a professional writer on staff to include lived-experience stories in your reports. By following a few simple techniques, you can create great stories that capture the essence of what it was like for someone at the heart of your report topic.

"Patient stories offer valuable insights that go way beyond the statistics and the outcomes: they have the power to inspire, humanize, compel action, and challenge assumptions," says Jennifer Schipper, Interim Communications Lead at Ontario Health. "Our colleagues tell us that hearing patients and their experiences, and being able to ask thoughtful questions, really gives them insights that they wouldn't have by just looking at published literature or data."

While generally referred to as patient stories, these lived-experience stories can include perspectives from family or friend caregivers, health care providers, and researchers.

Anatomy of a patient story

Conflict: "There is no story without conflict," says patient storytelling consultant Franklin Street. Even good-news patient stories have an element of conflict if you ask questions about fears, which can help with empathy and memorability.[5]

Empathy: "Find elements of a story that are just uncommon enough to be unique but no so far out of space that it is difficult to create empathy," Street says.

Setting: Describe the scene, and don't overcomplicate the story with too many settings.

Plot: Take a page from Shakespeare, says Street, and tell your story in three acts: establish the characters, explore a problem they face, and then solve that problem.

3 keys to story selection

1. Diverse voices: "There's no one universal patient voice, so you want to make sure you have a process wrapped around having ethnic, age, socioeconomic and gender diversity," says medical communicator Dr. Seema Marwaha. "While difficult, that's worth the effort."[6]

2. Do a pre-interview by phone or email: A brief pre-interview will give you a sense of whether the patient's story is a good fit for your report. It will also let you gauge the patient's comfort level in re-living potentially traumatic experiences.

3. Let the patient tell their own story: Give the patient leeway to tell the parts of their story that are important to them, rather than checking off boxes related to specific data points. The most impactful patient stories go beyond medical details.

7 Best Practices for Patient Stories

1. Identify your goals - What's your purpose in telling these patient stories?

2. Write an invitation letter - Explain to the patient the context of the report, what kind of stories you're looking for, and how the stories will be incorporated into the report.

3. Consider emotions - Coach the patient through the possibility that recounting their story could make them angry, regret, grief or trauma.

4. Give options for story-gathering methods - Let the patient choose how they would like to tell their story, such as by phone interview, in-person interview, or email.

5. Ditch the jargon - Communicate with the patient in clear language, and avoid health care jargon and acronyms.

6. Obtain written consent - Get a standard release form written up for your organization, with check boxes for different types of publication and consent, such as print, audio, video, communications documents.

7. Assess risks - Ask the patient if publishing their story will create of any challenges or risks, and ask them to get publication approval from anyone else in the story who might be affected.

6. Designing your report

Design plays a critical role in creating a report that tells a compelling story. When it's done really well, the narrative, insights, data visualization, and patient stories all intertwine seamlessly. High-quality design and visual appeal is not an easy feat. Getting design resources involved early on and throughout the process will have a substantial impact on the success of the project from concept to launch.

Focus the design process on the audience and user research.

Presenting insights and data visualization

So much of telling a story with data involves presenting the insights you have in a simple, accessible and intuitive way. By its nature, data is often complex to analyze and communicate. Data visualization is both an art and a science: it's just as important to get the graph axes and units of measure right as it is to make the graph visually appealing.

Tip: to help your audience interpret the data, consider using a question as a chart title? For instance, "How are patient infection rates trending provincially?"

We suggest always using less complex visualization types, steering clear of trendy styles such as 3D graphs and bullet charts.

Infographic-style visualizations and report formats can be effective, but typically work best in narrower applications.

The visualizations you create should also match and be from the same family. Think of it as curating a number of art pieces as part of an art gallery exhibit.

Data visualization design is a topic in itself. Instead of covering it in this guide, here are some excellent resources:

For online reports, you can use static images of data visualizations, though they have constraints, including a loss of quality when zoomed, and potentially sluggish download speeds if large.

There are free and relatively simple embedded chart tools such as Google Charts that present data visualizations effectively.

Report design

For the report design itself, take an iterative approach by producing mock-ups, prototypes and then testing these with users before publication, and ideally at key points along the way as the report takes shape.

Depending on the report audience, you may need one or more formats: print, downloadable PDF (Portable Document Format), online digital or mobile format. Historically, reports have largely been designed to be printed. Though static formats such as PDF files have the benefit of being printable and available online, we recommend designing your report as digital-first rather than print and digital.

PDF-based reports don't work well on mobile devices and are not as easy to navigate and read. When you design for digital, you're creating a digital product that can be viewed in a web browser on a laptop, tablet or mobile phone. If you design your report for the small screen size of mobile devices (smart phones and tablets) it can act as a helpful constraint, keeping your content focused and succinct.

Across all formats think about the colour, theme and style that best suits the type of data and the audience. For instance, for a patient-oriented report on chronic disease, you may prefer to have a more informal theme versus a standard, corporate-looking layout.

Photography is a critical component of the report, especially if you're including patient stories. Choosing a photo that fits with your story can be a challenging and time-consuming process. Whenever possible, use real photographs of the people in your stories, instead of stock photography. When in doubt, take it out: don't include photos that could detract from the tone and message of your story.

Video, much like photography, can dramatically enhance the story you're telling if done well. Planning, cost and time to produce a high-quality custom video should be clearly understood up front. One trend is to use informal, phone-camera style videos that are more real and much more inexpensive.

Animation for data visualizations and insights should be used in select instances where you really want to draw attention to data. Too much animation can draw attention away from the actual power and impact of the data and story itself.

All of the design choices you make should line up with the original vision and balance readability, content and length. If you plan to issue multiple reports over time, think about coming up with a design language. Design language is the overall style that guides the design of a set of associated products, such as a series of reports on different cancer therapies.

7. Publishing and socializing your report

Publishing and then socializing your report is the last step and should be part of your overall plan.

Earlier in your design process you'll ideally have considered how your report audiences are going to receive and access the report. Here are three common ways that many organizations publish their reports, and their pros and cons:

1. Printing: A printed report is great to pick up and read, but is often costly and reduces the potential reach of the report. Some types of reports will continue to benefit from being printed - it comes back to your overall strategy and audience.

2. PDF: If you're printing copies you'll likely also have a PDF version available that can be posted on a website or distributed by email. Cost is much lower per reader than printing. That said, PDFs have a number of limitations that make your report less accessible and usable than designed-for-digital formats. For instance, viewing a PDF report on a mobile device can be cumbersome and frustrating, in particular having to zoom in to read text and charts. Also, PDFs are typically not created in a way that makes them accessible for people with disabilities.

3. Digital: If you're looking to maximize the reach and use of your report it's worthwhile to invest in producing a digital version. Converting your report to a digital format such as web page or mobile app means that it's designed to be viewed on a variety of devices, from laptops to mobile phones. The primary downside is that digital-first reports can require more resources and specialized expertise to produce than other formats. That said, for a large distribution report (e.g., over 100,000 readers) the cost per impression can be less than print, and you can ensure the report is easy to view across devices and accessible by all audiences.

Socializing and promoting your report to your audiences effectively will ensure that the right people read it and share it with others.

There are a variety of ways you can share and promote your report. For broad-scale reports and large audiences you'll typically want to use a multi-channel approach, combining a mix of communications across social media, internet, email, and potentially events and conferences. For more niche reports, if you have the specific audience in mind, how can you best contact them and get the report in their hands?

From an audience perspective, think about how readers of your report will find it. People who haven't received direct promotion via email will most likely discover it through an internet search.

Prepare to make your report more easily discoverable in search on Google, and optimize your report content and keywords to rank higher in search results.

One of the best ways to reach a broad audience is to pitch it to the news media. If your report tells a story, you're much more likely to attract media coverage, and elevate your report findings, leading to widespread promotion and increased interest.

Lastly, we strongly recommend setting up some form of report and audience analytics. With minimal effort, you can at least approximate the reach and use of your report and estimate its value and impact. At a minimum it's good to know how many views or downloads your report has amassed over time. You can also launch surveys at the time of the report launch to get direct feedback from readers on their experience to inform your work in future.

In his book, Houston, We Have a Narrative: Why Science Needs Story,[7] Randy Olson argues that "narrative deficiency is the biggest problem facing science," and advocates for creating a narrative culture within organizations. This is a noble goal, but it doesn't mean you need to follow every step of this guide. By the simple act of considering the story in the development of your health reports and insights, you're already on your way toward building that narrative culture. One small step toward a narrative approach is a giant leap for health data impact.

The authors thank the team at Ontario Health (Quality) who helped inform the work on health data storytelling that inspired this guide, with special thanks to everyone in the Public Reports, Digital, and Patient Partnering branches. Thanks to Susan Brien, PhD, Interim VP of Health System Performance at Ontario Health, and Julia Zarb, PhD, Program Director of the Master of Health Informatics program at the University of Toronto's Institute for Health Policy, Management and Administration, for their wisdom, guidance and support on this project.
Go back to the start of the guide

1. Lohr, S (2013). The Origins of "Big Data": An Etymological Detective Story. Retrieved from The New York Times: https://bits.blogs.nytimes.com/2013/02/01/the-origins-of-big-data-an-etymological-detective-story/

2. Frank, AW (2010). Letting Stories Breathe: A Socio-Narratology. University of Chicago Press: Chicago

3. Mascarelli, A (2018). Good Transitions: A Guide to Cementing Stories Together. Retrieved from The Open Notebook: https://www.theopennotebook.com/2018/09/25/good-transitions-a-guide-to-cementing-stories-together/

4. Moran, K (2016). How Chunking Helps Content Processing. Retrieved from Nielsen Norman Group: https://www.nngroup.com/articles/chunking/

5. Street, F (2018, August 23). The Anatomy of a Patient Story. Retrieved from Franklin Street: https://www.franklinstreet.com/insights/2018/08/the-anatomy-of-a-patient-story/

6. Milne V., Buchanan F, Tepper J, Petch J. (2017) How patient stories are re-shaping health care. Retrieved from Healthy Debate: https://healthydebate.ca/2017/09/topic/patient-centered-care-stories

7. Olson, R. (2015). Houston, we have a narrative: Why science needs story. The University of Chicago Press.

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From Numbers to Narrative A practical guide to bringing health data to life through storytelling By Christian Otte and Michal Kapral Acknowledgments This resource is for health organizations that want to publish reports, data or insights to harness the power of storytelling and bring data to life.

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Since infographics exploded onto the graphic design scene about 15 years ago, they've become a staple for communication in classrooms, in the workplace, and across the web.

But if you're new to the world of design, the term "infographic" might still be foreign to you.

You might wonder: what are infographics?

Today, I'll give you a crash course on infographics and infographic design to answer all of your questions and more. Don't worry if you're no designer - I'll also show you how you can easily customize designs with Venngage's Infographic Maker and easy-to-edit infographic templates.

Click to jump ahead:

What is an infographic? Infographics defined:

According to the Oxford English Dictionary, an infographic (or information graphic) is "a visual representation of information or data".

But the meaning of an infographic is something much more specific.
An infographic is a collection of imagery, data visualizations like pie charts and bar graphs, and minimal text that gives an easy-to-understand overview of a topic.
As in the example below, infographics use striking, engaging visuals to communicate information quickly and clearly.

Infographics are a valuable tool for visual communication. The most visually unique, creative infographics are often the most effective because they grab our attention and don't let go.

But it's crucial to remember that the visuals in an infographic must do more than excite and engage.

They must help us understand and remember the content of the infographic, as seen in this infographic about employee resignation announcements:
Ready to dive right in and create your first infographic? Check out our Alternatively, join our webinar for a crash course on how to summarize information for your infographic: ultimate infographic design guide for everything you need to get started. When you need to give someone a really quick rundown on something that can be hard to explain in words alone, an infographic is a good way to go.
Why should you use infographics?

Infographics are great for making complex information easy to digest. They can be helpful anytime you want to:

This means that infographics can be useful in pretty much any industry. Here are just some of its use cases (click to jump ahead):

Marketing infographics

What are infographics used for in marketing?

Marketers use infographics to build brand awareness and boost engagement about topics important to the company, such as this infographic on diversity and inclusion:

Marketers can use infographics to:

Informational infographic examples, like this one about the effect of excess sodium, are great tools for educating a variety of audiences.

Consulting and freelancer infographics

Consultants use timeline infographics to visualize project timelines and to simplify new or industry-specific topics to their clients:

Consultants use infographics to:

Small business and entrepreneurship infographic examples

Small businesses and entrepreneurs use infographics to reach new audiences and increase brand awareness:

This brand style guide cheat sheet is a great infographic example for small businesses. It's visual and compact, which helps readers absorb the information faster.

Lists are a common type of document that all businesses have. But long lists can get tedious to read. It's unlikely that readers will even remember the items on the list.

Businesses can use infographics to visualize lists for better learning retention, like this colorful infographic example below.

Or this list infographic which discusses three different change styles:

A business may also want to visualize processes and activities. This infographic example on supply chain analysis could easily have been a boring document. Instead, the topic is covered more thoroughly and succinctly in an infographic:

Small businesses and entrepreneurs can use infographics to:

Government infographics

What are infographics used for in the governmental sector? Governments use infographics to share statistics and census data, like in this visual from the Government of Canada:

Government can also use infographics to spread useful healthcare information, such as vaccine infographics which promote accurate vaccine information and increase vaccination rates. Here's an example:

Nonprofit infographics

Nonprofits use infographics to promote events and raise awareness for their causes or to showcase their successful fundraising efforts:

Nonprofits use infographics to:

Make data and information about a given cause easy to understand. This can be applied to a newsletter, social media campaign, donation page, poster, and more.

Plan a campaign strategy

Show the impact of a fundraiser that can be sent to donors in an email

Highlight results in an annual report

Showcase successes in an impact report or case study

Visualize information in crisis communications

Education infographics

Educators and trainers use infographics to make content more memorable for students and employees:

Need to explain a complex process? Our process infographics can help communicate cumbersome processes in a visual way.

Infographics can be useful whenever you need to communicate information quickly, or any time you want to make an impact with your data or your message.

How do I create an infographic?

If I've convinced you that infographics are a tool you should be using, you're probably wondering how you can create your own infographic.

Our step-by-step guide on how to create an infographic is a great resource to design an infographic.

No matter how excited you are to get started making your very first infographic, you shouldn't jump into the design process without a game plan.

Instead, start by creating an infographic outline.

1. Organize your information with an infographic outline

2. Pick an infographic template

3. Customize your infographic

Create an infographic outline from existing content using these 4 steps:
1. Organize your information with an infographic outline

The process of creating an outline will help you organize your thoughts and ensure that your content will work in an infographic.

Determine the key takeaways of your content

Determine the title, headers, subheaders, and facts

Consider the length of paragraphs and points

Include notes for the designer

Starting with an outline in this format will ensure that the rest of the design process goes smoothly.

2. Pick an infographic template

Once you've got an outline, you're ready to pick an infographic template.
But most importantly, you need to pick the right type of infographic template for your content.
Pre-made infographic templates (like the one below) can give you the design inspiration you need to get your infographic rolling. Even just using them as a jumping-off point can be helpful.

There's a lot to consider when picking an infographic template, including the colors, fonts, length, size, and style of each template, and how well each of those factors aligns with your content.

3. Customize your infographic

Once you've chosen an infographic template, you can start customizing it to your needs. This infographic can be adapted for other types of lists with the Venngage editor.
Want more information about creating infographics? This video guide will show you how you can make an infographic in just 5 steps:
Here are a few ways to adapt the infographic examples in this post:

Change the background and text colors

Adjust the text to suit your message

Add or swap out icons that are relevant to your story

Add your brand logo in the footer

Increase or decrease the size of the list

What is the importance of using visual elements in an infographic?

The use of visual elements in an infographic can help enhance the overall effectiveness of the communication. Here are some key points highlighting the importance of using visual elements in an infographic:

1. Enhanced comprehension: Visual elements, such as graphs, charts and illustrations can simplify complex information, making it easier for the audience to understand the data presented.

2. Improved retention: Human beings tend to remember visual information more effectively than text alone. By incorporating visual elements, infographics can improve the retention of information, ensuring that the key points are more likely to be remembered by the audience.

3. Increased engagement: Visual elements in infographics make the content more engaging and appealing. People are naturally drawn to visuals, and the use of color, images and graphics can capture the audience's attention, encouraging them to spend more time interacting with the information.

4. Facilitated comparison: Infographics often involve the presentation of data sets, comparisons or contrasts. Visual elements can effectively facilitate such comparisons, enabling the audience to discern patterns, trends and differences more easily.

5. Universal understanding: Visual elements can transcend language barriers, making infographics a powerful tool for communicating with diverse audiences across different cultural and linguistic backgrounds.

6. Aesthetic appeal: Infographics that are well-designed and visually appealing are more likely to be shared and distributed widely, especially in the context of social media and online platforms. Aesthetically pleasing visual elements can attract more attention and help the infographic reach a broader audience.

7. Storytelling: Visual elements can contribute to the storytelling aspect of an infographic, allowing for the creation of a narrative that flows logically and is visually engaging. By combining text and visuals, infographics can effectively communicate a compelling story or message.

In summary, the use of visual elements in infographics is critical for conveying complex information in a more accessible and engaging manner, enhancing comprehension, improving retention, and increasing overall audience engagement and appeal.

What are the different types of infographics?
This video summarizes these 9 types of infographics and when to use them:
At Venngage, our library of infographic templates is sorted into 9 different categories:

1. Statistical infographics

2. Informational infographics

3. Timeline infographics

4. Process infographics

5. Geographic infographics

6. Comparison infographics

7. Hierarchical infographics

8. List infographics

9. Resume infographics

Each type of infographic is tailored to visualize a different type of content.

Informational infographics, for example, are typically more text-heavy than the other types of infographics.

Like this example from Course Hero below, they work best as summative, standalone pieces that provide a high-level explanation of a topic.

There are also informational infographics that explain something niche, but very simply. These are handy to have as visual references for topics that are new and unfamiliar.

TalentLyft's infographic on recruitment metrics is a great example - a short and sweet summary of the six key recruitment metrics hiring managers should understand and track.

Statistical infographics, on the other hand, are more focused on numbers and data visualizations, charts, and data, for example:

They tend to contain much less text than informational infographics and have less of a narrative flow.

Instead, they make a statement with big numbers and standalone facts, like this infographic from the Internet of Things.

Similarly, this sample infographic from Podia on the " State of the Side Hustle " uses numbers and stylization to make its most important points prominent with sparse supporting text.

Choosing the right type of template for your content is one of the keys to a successful infographic.

What makes an infographic design effective?

When it comes to designing an effective infographic, it's important to recognize that our brain seeks patterns in visual information to help us make sense of the world.

We can use this idea to structure our information visually and create patterns that will enhance the message that we're trying to communicate.

Let's run through some infographic design best practices to help you create infographics that are as effective as they are beautiful.

Also, check out our post on 7 ways to customize your infographic template for more easy hacks on how to make your design pop.

Use lines, borders, and shapes to group related information

Even something as simple as the position and grouping of elements on a page can influence the way our readers understand our graphics.

If we use basic design elements like borders, lines, circles, and squares to visually organize our content, our readers will find it easier to interpret that content.

For example, we can enclose related elements within an outline or a shape. Most infographics, like the sample below, use this tactic to break up the design into multiple sections, making the graphic easier to scan.

Alternatively, when the structure of the information is the main focus of the infographic (like in an organizational chart or a flow chart) it can be helpful to explicitly connect related elements with lines. Like in this marketing flow chart infographic:

Click the template above to make an organizational chart. Edit the template to your liking - no design experience needed.

Use contrasting colors to guide your readers' attention

Another major design element to think about is color. We're naturally inclined to use color to make infographics look pretty, but color can also be used as a powerful communication tool.
Pick one color that contrasts with all of the other colors in the graphic, and use it to make the most important information stand out.
Just like lines and borders, colors can be used to indicate information groupings, as seen in the business strategy infographic example below:

But more importantly, we can use color to draw attention to particular pieces of information and push supporting information into the background.

Take the infographic below, for example. The bright teal icons contrast with the plain white background to make the icons (the most important visual aspect of the graphic) stand out.

This strategy also happens to be highly trendy. Pops of color are one of the biggest graphic design trends of 2022.

Create a text hierarchy with three different font styles

Fonts are one of the first things people notice when they first look at an infographic. If chosen poorly, fonts can ruin an otherwise great infographic.

Our roundup of popular font types will steer you on the right path.

The key to using fonts correctly in infographics is to create a clear text hierarchy with three different font styles-one for the main heading, one for the section headings, and one for the body text.

The main header font should be the biggest and can be the most stylized. Think of it as the way to set the mood of your infographic.

The font for the section headers should be a bit smaller and less stylized, but it should still stand out on the page.

Finally, the font for the body text should be the smallest, and not stylized at all. It needs to be as easy to read as possible.

Not sure what a readable font looks like? Here's a quick reference guide to fonts that are great for body text:

Use images, icons, and illustrations to make key takeaways memorable

Last but certainly not least, make sure that the focus of your infographic is on visuals like images, symbols, icons, illustrations, and data visualizations like charts and graphs.

Visuals are crucial for making your information engaging and memorable. The best infographics have an equal balance of text and visuals.

The easiest way to make sure you have enough visuals in your graphic is to add an icon to represent each header, as seen in the example below:

Or even better, create visual examples of each main point in the infographic, as seen in this sample infographic from Elle & Company:
Making a data-heavy infographic and need help visualizing your data? Check out our guides on designing effective charts and choosing the best charts for your infographic.
It's important to have fun with your design, too. It doesn't need to be strictly business-y and serious.

Infographics are supposed to be engaging and memorable, and illustrations are great story-telling devices.

FAQs about creating infographics

What does infographic mean?

The word "infographic" is a combination of two words (you guessed it!): "information" and "graphic".

Simply put, an infographic is a graphic that presents information and/or data - most importantly, in an easy-to-understand way.

What is an infographic example?

An infographic example is a visual representation of information. Infographics examples include a variety of elements, such as images, icons, text, charts, and diagrams to convey messages at a glance.

What are infographics used for?

An infographic has numerous uses in different industries. Infographics can be used to convey complicated data in a simple visual format. They are also visual tools to tell stories.

Visual information graphics help people understand information quickly and more accurately.

Infographics can also be used to show changes or comparisons in data, time, and place, as well as statistics, maps, and hierarchies.

What are the five types of infographics?

We've mentioned the nine major infographic categories, among which these are the most common types of infographics are:

Different types of infographics require specific elements. Timeline infographics need to include the date and time stamps. A comparison infographic usually includes columns and rows.

The infographic examples in this post will help you understand what type you need to use for your message so you can make the right choice.

Do you need quantitative data to make an infographic?

Simple answer: No! You don't need quantitative data (numbers) to create an infographic. Infographics are meant to convey information in an easy-to-understand way, and that applies whether the information you have on hand is purely qualitative:

Or quantitative:

Or a combination of both, like in this infographic example:

Conclusion: Create an infographic to make the most out of your knowledge and data

The best infographics use a combination of text, images, and data to inform and engage.

If you're ready to create infographics that strike the perfect balance between fun and educational, make sure you follow these infographic design best practices:

Use lines, borders, and shapes to group related information.

Use one contrasting color to draw attention to key information.

Create a text hierarchy with three different font styles.

Use images, icons, and illustrations to make key takeaways memorable.

Not a designer? No problem. Create an infographic today using our easy-to-edit templates and simple online editor.

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What is an Infographic? Examples, Templates, Design Tips

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If you're new to the world of design, the term infographic might be foreign to you. You might wonder: What is an infographic? Why use infographics?

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An article reviewing the ethics of health informatics

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Summary

Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate uses and users of machine learning software, the balancing of privacy rights against the needs of public health and clinical practice in a time of Big Data analytics, whether and how to use this technology, and the role of ethics and standards in health policy. Historical antecedents in statistics and evidence-based practice foreshadow some of the difficulties now faced, but the scope and scale of these challenges requires that ethics, too, be brought to scale in parallel, especially given the size of contemporary data sets and the processing power of new computers. Fortunately, applied ethics affords a variety of tools to help identify and rank applicable values, support best practices, and contribute to standards. The bioethics community can in partnership with the informatics community arrive at policies that promote the health sciences while reaffirming the many and varied rights that patients expect will be honored.

Keywords: Artificial Intelligence, Big Data, Bioethics, Clinical Decision Support Systems, Public Policy

Introduction

Ethics is a kind of lens we use to identify issues and a lever used to formulate and motivate best practices. Applied ethics is a tool to employ widely shared if not universal values to contemporary questions and challenges in science and the professions. Bioethics is the branch of applied ethics that addresses issues in the health professions; it is often linked to other kinds of applied ethics, including business ethics, computer ethics, government ethics, and so on.

It has become commonplace to observe or argue that science usually or even always outpaces, or advances, more swiftly than applied ethics. In the case ofhealth informatics, this is a mistake. For some four decades, albeit with some exceptions, advances in biomedical informatics have been matched step for step by scholars who have identified and addressed the ethical, legal, and social issues (ELSI) raised by the expansion of a new science. This acronym, borrowed from the Human Genome Project, has ably served the informatics community as a label or guidepost for research and pedagogy.

Though bioethics has moved forward, the same cannot be said for the law which continues to lag as a source of official governance and oversight in health informatics and other domains. It might be that the relationship between ethics and public policy represents the greatest challenge faced by health informatics and the society health informaticians seek to serve.

What follows from these two observations is this: we have an extraordinary opportunity at a crucial time to try to ensure that the insights and analyses provided by ethics continue to mature and, as important, that they are taken up and incorporated by academic and health care institutions, businesses, professional organizations, and governments.

In what follows, I expand on these points by filtering them through a number of contemporary challenges. These include artificial intelligence and machine learning; Big Data, data sharing and privacy; duties to use and manage new technology; and ethics and public policy.

1 Artificial Intelligence, Machine Learning, and Ethics

The ancient fantasy of an intelligent machine or a smart homunculus became a research project in the 17 th century when Gottfried Leibniz, the philosopher and logician who, with Newton, discovered the infinitesimal calculus, suggested that human reason could be rendered in a universal language such that argumentation could be reduced to calculation. He built a primitive calculator 1 , arguably the first machine to replicate an aspect of human thinking. Leibniz thought that intelligent machines would formalize reason and end disagreements. They did not. During the greatest disagreement in the history of civilization - World War II - code-breaking machines represented nontrivial instantiations of Leibniz' aspiration: "The first digital, electronic and programmable computer was developed as an instrument of warcraft. The Colossus was a room-sized collection of racks, pulleys, wires and some 2,400 bottle-sized vacuum tubes built at Britain's Bletchley Park to decipher encrypted German messages.... It became operational in 1944 and was used to prepare the D-Day invasion of Normandy. One could argue that it eventually saved more lives than most medical inventions" 2 .

However, we want health informatics to save and improve lives, to reduce suffering, to help to achieve the larger goals of the healthcare professions. If an intelligent machine can help do that, why is there a problem or any controversy?

Indeed, there are several problems, and their identification has contributed to both greater understanding and to a period of overheated handwringing.

Key and core ethical issues in the development and use of machine learning programs have already been identified repeatedly and elsewhere. They can be framed as lessons learned or as recommendations. Some are lessons for developers, some for users. Though the context here is health and health care, the lessons may be useful in many other domains.

1.1 Quality and Standards Are Ethical Issues

Good software conforms to certain standards for quality which can be assessed in terms of trustworthiness and reproducibility. The mark or measure of good software will include accuracy of documentation and transparency about the provenance or source of any code components. This is no mere courtesy to code-writing colleagues - it is an auditable track record of what code is intended to do and how it was modified along the way. This facilitates understanding, corrections, and improvements. It follows that if one is developing or modifying machine learning software, the automated learning process itself must also be monitored and documented. Relatedly, careful software version control is an essential part ofhigh-quali-ty programming. The values of transparency, veracity, and accountability reinforce the connection among quality, standards, and ethics 3 . This has long been true across the health professions.

1.2 Prevent and Eliminate Bias

A sure way to erode confidence in artificial intelligence is to identify ways in which a deep learning algorithm embeds racial, ethnic, gender, or other biases which shape or corrupt its results. The very nature of machine learning algorithms makes plain that one might unintentionally develop a biased system or accept biased results. Though intent matters in ethics - many actions are praiseworthy or blameworthy precisely because of someone's intent - this problem makes equally clear that failure to attend to and correct or mitigate a problem can also be blameworthy; that failure to do so is a kind of negligence (no surgeon ever intends to cut off the wrong arm or operate on the wrong patient). If datasets used for training machine learning algorithms include or entail bias or foster biased interpretations, then careful scrutiny of such sets is a difficult and labor-intensive approach to take. Another is careful screening of output to identify and filter bias, and perhaps to identify ways to modify the algorithm to suppress it. It is now even possible to incorporate anti-bias features into the code itself 4 . This is an extraordinarily promising approach, and something like it might very well be the best way to ensure that public health surveillance and prediction, disease diagnosis and treatment, and health policy are not infected or corrupted by illicit bias.

1.3 Use Machine Learning Software for Good and not Evil

Current relativist trends and fashions notwithstanding, some actions are good and others are bad and there is little credible dispute about their moral status. Reducing suffering, eliminating disparities, and improving health are good; depriving people of rights, using people for political or economic purposes without permission given voluntarily, and harming people for profit are bad. If we start there, great progress can be made. It is the hard cases, or cases on which reasonable people disagree, that pose the most significant challenges. Is there a chance that a clinical decision support system will improve diagnosis, treatment, and prognosis and simultaneously erode confidence in the clinician-patient relationship? May a nurse with a good computer system undertake duties traditionally reserved for physicians? Will the use of intelligent machines in health care cause the erosion of healthcare practitioner clinical skills? Addressing these and other challenges successfully will require sustained research, education, and debate. At the least, we will make great progress by acknowledging and grappling with such challenges.

1.4 Insist on and Provide Robust Education and Evaluation

No technology will ever fulfill its promise or be used in an ethically optimized manner unless we insist on and provide robust education and evaluation. Scientists and clinicians must not only be taught empirical methods and clinical skills, but also the appropriate uses of these methods and skills. Given our concern for appropriate uses of intelligent machines in healthcare, it follows we must also identify appropriate users, and a core criterion for demonstrating such appropriateness will be a user's fitness to use the tool. Making and acting on this assessment has long been recognized as a key ethical challenge when computers are used in healthcare 5 . We are, moreover, in urgent need of a comprehensive ethical curriculum in and for health informatics. We must also not lose sight of the importance of system (algorithm, device) evaluation in the context of its actual use; this, too, is an obligation long recognized 6 . Much more recently, system validation in real-world settings has been identified as a duty for anyone who would use an intelligent system in healthcare 7 . This may be especially true and important given the rapid progress in precision medicine.

2 Big Data, Data Sharing, and Privacy

Empirical sciences have evolved and grown by using data and information to support inferences which, if correct, come to constitute knowledge. In biology and medicine, we use that knowledge to prevent, predict, mitigate, and cure maladies that sicken, disable, or kill us.

A favorite example from the history of medicine of "calculating" to improve health care is that of bloodletting, used for millennia to treat and often unintentionally kill people who, under the humoural theory of disease, had too much blood. For instance, George Washington one day in 1799 awoke with a sore throat, asked to be bled, lost some five pints of blood, and was dead four days later, probably because of the bloodletting. The work of Pierre Charles Alexandre Louis (1787-1872) was likely unknown to him. Louis, a French physician, analyzed cases from several hospitals using his "numerical method" and determined that bloodletting was not a cure but, rather, usually harmful. He wrote: "As to different methods of treatment, it is possible for us to assure ourselves of the superiority of one or other.. .by enquiring if the greater number of individuals have been cured by one means than another. Here it is necessary to count. And it is, in great part at least, because hitherto this method has not at all, or rarely been employed, that the science of therapeutics is so uncertain" 8 .

Necessary to count? Numerical method? Is it - can it really be - that simple?

Yes, sometimes. Observational science and basic arithmetic were, at first, the best tools we had to support efforts to learn how the world worked. Observe and count (or measure), find the mean, note changes over time, and then make inferences about physical reality. An early form of statistics, frequency analysis, originated in the Middle Ages with the Arab philosopher Al-Kindi as a code-breaking tool more than a millennium before Colossus. His method also required counting - of letters. With an adequate "plaintext...long enough to ill one sheet or so," one could determine the frequency of letters and combinations of letters as a baseline and use it to determine the values of letters in a coded document 9 . It was a very early anticipation or foreshadowing of the data sets used to train artificial intelligence programs.

What became clear in the 17 th and 18 th centuries was the utility of using data about observations to make predictions. In the 1660s, John Graunt of London's "Natural and Political Observations Made upon the Bills of Mortality" constituted the first actuarial tables and spurred efforts to predict and control the causes of death. It is also the basis for modern insurance, including the business of using statistics to sell health "coverage" to people in need of health care in countries with dysfunctional health care systems.

The preceding part of this section embeds several important ethical issues. Chief among them are these:

Are data reliable and who is responsible for ensuring reliability?

How exactly does the calculation work?

How should it be determined who should use these calculators, and for what purposes?

These, of course, parallel the "lessons learned" we earlier identified for appropriate use of machine learning or any other medical software.

The datasets created by Al-Kindi, Louis, and Graunt were actually tiny; we might even call this "small data." Yet their work suggests the first grains or nuclei of a vastly larger project. Framed very broadly, one might argue that the work of these three data collector-analyzers raised ethical issues that parallel those we find when collecting and analyzing some of the more than 2,000 exabytes of medical data in the world today (an exabyte, recall, is 1,000 petabytes, with one petabyte being 1,000 terabytes, and one terabyte being 1,000 gigabytes, etc.). But their work did not cause any ethical consternation at the time; it was just science advancing.

Though we ought to regard privacy and confidentiality as universal rights, they are neither absolute nor have they ever been regarded as absolute. There are tradeoffs to be made: public health surveillance gives us better public health, hospital patient monitoring gives us better hospital care, the sharing of research results and other data gives us better medical treatments. Put differently: if a physician learns something about effective practice from Patient Epsilon's response to a treatment, does the physician violate Epsilon's privacy or confidentiality six months later by using what she learned to help Patient Omega 10 ? Indeed, such a reductio ad absurdum argument makes clear that not only does the physician not violate confidentiality but also that she would be irresponsible not to use the information from one patient to help another.

With very large datasets, however, our challenge is magnified. Until recently, the ability to reconnect a datum with a person, or "re-identify" the datum, was either impossible or difficult. Now it is comparatively easy, and this entails that the tools of applied ethics must in a world of Big Data rise to the occasion. One way to put this, according to my colleague Richard Bookman in a personal communication, is that "Ethical boundaries move with scale. As little data goes to Big Data, onetime practices at small scale may be rendered offensive and unacceptable at broader scale."

The same could be said for data sharing. Few would argue that science progresses when investigators communicate openly and generously with each other. It also progresses when scientists are motivated by curiosity and service instead of profit and priority - at least historically. When the financial stakes were low, history shows discovery science was fertile and productive. That slowed when fame attached to empirical success and reputations were made by being the first to make a discovery. We then commodified science so that not only would a good scientist learn something, he could also make a lot of money. In 1955, Jonas Salk famously disdained patenting his polio vaccine ("Could you patent the sun?"); it was the same year the Dartmouth Workshop, at which Artificial Intelligence as a field was fledged, was proposed. In 2020, one would be regarded as a fool for not leveraging a discovery or method for profit. Big Data means big profit, and the ethical boundaries have correspondingly shifted.

It would perhaps not be so difficult if the accumulation of wealth from others' information could rely on their concurrence and support. Worse, the erosive use of Big Data for profit in business and industry has polluted public perceptions of all uses of Big Data. We learned earlier that applied ethics can contribute to the identification of appropriate uses of information technology. Here we have an opportunity to protect fundamental privacy rights by making a distinction between using social media, for instance, to track people's behavior to target them for political purposes, and using electronic health records to analyze their data to improve clinical outcomes. There is indeed evidence that ordinary people are prepared to accept this distinction, at least if the user is trustworthy 3 .

We have several ways to meet the privacy challenges posed by Big Data for health care. All of them should be seen as trust-enhancing.

The ffirst is security backed up by law. Make it difficult for unauthorized - inappropriate - parties to access or use the data, and punish them severely if they do. Constant and evolving research improves privacy-protecting software. The 2018 IMIA Yearbook of Medical Informatics, for instance, included a special section ("Between Access and Privacy: Challenges in Sharing Health Data") that featured a suite of articles describing research devoted to improving digital privacy protection 11 . It is clear that the good guys write better software than the bad guys. Use it.

Next, insist on accountable oversight. From bioinformatics laboratories to hospitals, those who collect, store, and analyze health information are stewards of a precious resource. They must, absolutely must, be held to trust-enhancing standards. The "trusted broker" model of scrutiny and oversight can ensure both innovative research and the protections that are demanded by the sources of health data and information, i.e., usually, patients 3 . Institutions and governments need to require and help implement mechanisms to review, scrutinize, and approve collections and analyses of health data. This builds trust and makes clear that those who use health data are motivated by values different than those who scrape online clickstreams to beguile shoppers, those who vacuum social media postings to monetize the intimate behavior of strangers, and those who weaponize the Web to undermine democracies. They wanted, rather, to heal the sick.

Finally, educate lay people to improve digital health literacy, and teach scientists and clinicians to learn to appreciate that the opportunity to study others' information is a privilege. If the former are willing to share data for better health and the latter are motivated by higher values than those that govern the marketplace, then we reinforce the foundation of a collective, international edifice that both protects legitimate privacy interests while simultaneously ensuring enjoyment of the right to benefit from science 12 .

It might be that the greatest utility of applied ethics is in the balancing of rights, in part by the identification of responsibilities.

3 Duties to Use New Technology

Information technology has transformed daily life, business, entertainment, and health care. The list could, of course, go on, and on. The proper criterion to use in determining if any new tool should be used is, generally, whether its advantages outweigh its disadvantages and, if so, whether any antecedent rights are being violated. We learned more than three decades ago that if health information technology could improve health, then, ceteris paribus, this entailed a duty to use it for that purpose 5 .

Such an insight does not of itself begin to answer the many questions that follow - that is the job of scholars and analysts who scrutinize appropriate uses, privacy implications, and governance. It nevertheless signals a powerful moral commitment to reject basic Luddism, the movement that began in the 19 th century with British workers smashing mechanical looms because the machines imperiled their jobs. The best approach is to control machines, not destroy them.

One of the most promising and systematic approaches to achieve that control at scale is the Learning Health System (LHS) paradigm 13 , an evidence-building, safety-promoting system "capable of continuous self-study and improvement" 14 . Such a system is a data-driven creature; it learns from every patient encounter, every lab result, every outcome tracked and measured; it learns from public health prevention and intervention. It captures Louis' fabulous and simple understanding that counting can count for a lot 8 . Moreover, LHS embodies core values of evidence-based practice, most especially that it is neglectful and blameworthy to lose information that could have been used to improve the wellbeing of individuals and the health of populations.

The LHS also provides an excellent example of and justifies what has been called the "secondary use" of health information. In many respects, the term "secondary use" is a misnomer: it implies that health information collected in a clinic, for instance, is and ought to be collected for a primary purpose, and that any other purpose enjoys lesser warrant. Similarly, it would be peculiar to collect public health information and then regard that information's use in a clinic as secondary and requiring additional permission. Rather, it would be irresponsible to acquire information in a clinic, research study or public health surveillance effort and not use it to support one of the others 15 16 17 . Widespread views and focused regulations regarding how best to protect these three kinds of data and information are largely historical artifacts. Clinic data is protected by privacy laws that evolved to protect, well, clinical data. Research data use is governed by rules aimed at protecting human subjects, including their privacy. Public health findings are, and always have been, acquired with the presumed or tacit consent of those who benefit from - and trust - competent public health authorities.

Developers of Learning Health Systems (or "the" system if there is one and it is global) are wise and quick to identify the values that reinforce it: person-focused, privacy, inclusiveness, transparency, accessibility, adaptability, governance, cooperative and participatory leadership, scientific integrity and value 14 . Indeed, one would be forgiven for suggesting that those values should underlie any health system.

How such values are embraced will continue to challenge our best inclinations. The effort to make the most of health data and information, however, is a collective recognition of the overarching duty to use tools that improve health. Perhaps the most difficult challenge is shaped by the values of inclusiveness and accessibility; that is, inclusiveness and accessibility for whom?

Any duty to use a tool is cheapened or diluted if the tool benefits only those in some jurisdictions or some socio-economic classes. If we intend a health system to serve all, and if we know that social determinants are key etiologic sources of illness, then perhaps a Learning Health System can be used to reduce disparities. Universalizing access to health care, which has so far eluded most countries, would require far more than data analysis - but such analysis in conjunction with tailored social commitment might at the least effect some improvement. To be sure, such a course would require the inclusion of social determinants, including poverty, in electronic health records or other repositories of patient information. This in turn could cause or magnify stigma, and it might be the case that some people would disdain being thus identiied. 1

A robust attention to ethics and informatics cannot provide a script or formula for righting wrongs. It can however usefully identify issues to be addressed, scrutinize approaches to confronting those issues, and help point the way to the best possible solutions. There is, as well, an element of professionalism in this regard, and major informatics organizations have developed codes of ethics to guide those working in the field to follow such precepts as help to secure the integrity of the profession 18 19 .

4 Ethics, Standards, and Public Policy

Once we figure out how to get something right, it can be irrational to insist it should be ignored. The evolution of standards in health care has improved quality, increased safety, and conserved resources. This is especially true for health informatics. What follows should be obvious: if continuously reined and improved standards can achieve so much, and if those achievements improve human health and welfare, then there is an ethical imperative to develop and improve them.

Any laws in the discovery and communication process - there are a lot of standards, some conflict, and others are not very good - are remediable. As was once suggested, "What is wanted here, in informatics, is in an important if vague respect what is wanted everywhere in the world of standards: we want to be as good as we can be, along with our efforts and tools, and to improve. That part of 'standard' that implies regularity or consistency captures the intuitions that order is more successful than chaos, and that clarity and order produce goods and services that are easier to explain and share. We have something very important to accomplish in health information technology, and good standards are necessary for the process" 3 .

Standards are also an important component of public policy and one of the ways by which applied ethics informs and shapes public governance.

From the foundations of software engineering to the design of electronic health records to embedded privacy protections to evaluation and interoperability, ethical principles and standards serve as both guiderails and signposts. Is there a problem with biased algorithms? Adopt standards for better software and testing. Do members of communities distrust those who collect and analyze personal information? Follow standards for trust enhancement. Confused about whether to adopt a new technology? Then turn to ethical standards for harm reduction and rights protection.

As elsewhere in life, we sometimes in health informatics are over-eager to make problems seem intractable or lose sight of the fact that we have available many tried-and-true conceptual devices and publicly accountable processes for solving these problems. To say, as some are wont, for instance, "privacy is dead; get over it," is a sad surrender to an ancient challenge tricked out with very large data bases and powerful computing tools. Such surrender is neither necessary nor apt.

If we care enough about these issues, and we should, then applied ethics emerges as the silent partner or loyal opposition to speak truth to a power whose benefits we deserve and whose harms we must protest. When appropriate, in civil society, the law itself can be a partner in ensuring that standards capture best practices. Ethics should always come ffirst, both to guide us and to reduce the likelihood of health-system laws that permit or even encourage unethical conduct.

Conclusion

Ordinary language loves the locution "ethical dilemma." But to be on the horns of an ethical or moral dilemma is to be in a position such that no matter what one does, one does something wrong. Most ethical problems or challenges are not dilemmas, and even the dilemmas, if they be such, can, as in logic, be escaped. The project here has been to argue and so to make clear that the tools of applied ethics are adequate to the task of guiding developers, users, and institutions as they adopt and try to make the most of health information technology. This has been framed as statements of issues and problems (machine learning, privacy, and duty to use the new tools) and as suggestions for addressing them. As elsewhere in the health professions, the ethical issues raised by a new technology are sources of interesting and significant challenges. These challenges are difficult, but not intractable. Finding their solutions presents opportunities to use critical thinking in the service of shared values. Chief among these values is that of health itself. Producing better and ethically optimized tools for healers is a contribution requiring the collaboration of the informatics and ethics communities. Such collaboration affords a rare and unparalleled opportunity.

Footnotes

¹ I am here again indebted to my colleague Richard Bookman for thoughts about the intersection of social determinants and health information technology.

References

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8. Louis P CA. Philadelphia: American College of Physicians; 2006. Essay on Clinical Instruction. [ Google Scholar]

9. Cozzens M, Miller S J. Providence, Rhode Island: American Mathematical Society; 2013. The Mathematics of Encryption: An Elementary Introduction. [ Google Scholar]

13. Institute of Medicine.The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine) Washington, DC: The National Academies Press; 2007 [ Google Scholar]

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Articles from Yearbook of Medical Informatics are provided here courtesy of Thieme Medical Publishers

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Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate ...

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Pink and Blue Collage Scrapbook Data Infographic

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Two step authentication utilizes two different factors to verify identity or authentication. The first step is often the password used to access information, the first step then triggers a second step often an email, text message or even a security site/app to the authorized receiver.

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Health Insurance Portability and Accountability Act was enacted in 1996. It provides privacy and security measures in health care and mandates to de-identify data by removing 18 identifiers. It was also followed by the American Recovery and Reinvestment Act, as well as the High Tech Act which strengthened security.